1/ "Federal antitrust oversight has proved inadequate at preventing anticompetitive effects across the health care sector" per @commonwealthfnd

What else can the federal government do, given the difficulty of passing healthcare legislation?

Plenty.
commonwealthfund.org/blog/2021/fede…
2/ in this article, Joseph Kannarkat and I break down all the tools that the Biden administration and @SecBecerra have to address competition beyond antitrust reviews

jamanetwork.com/journals/jama-…
3/ first of all, if the Biden administration chooses to elevate health care competition as a priority, it may garner rare bipartisan support.

This is an issue that has support from left (@ZekeEmanuel) and right (@Avik) thought leaders and legislators.
4/ removing perverse incentives to consolidate in payment policies can arrest or reverse hospital-physician consolidation.

The appeals court upheld @CMSGov ability to enact site-neutral payments.

they need to be expanded beyond office visits to other services, like ultrasounds
5/ fight against state-level anticompetitive ploys

"Certificate of Need" is often abused to grant local monopolies that then drive up prices

CMS has set the precedent of saying "if there's a CON, we will provide additional flexibilities on network adequacy"- they can go further
6/ Enforce against holding data hostage.

I joined 5 other former national coordinators for Health IT in an unprecedented letter that supported using CMS Conditions of Participation as a tool for ensuring data sharing of hospital events.

We have a final rule, but no enforcement
7/ the FTC and DOJ should review physician non-competes.

They shouldn't be used to stifle competition if physicians find that hospital (or private equity) employment was not all they hoped it would be
8/ @JoeBiden was the first presidential candidate of a major party to explicitly call out the need to tackle market concentration in healthcare

But they can go beyond antitrust authority to ensure better care and lower costs for all.

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More from @Farzad_MD

11 Apr
1/ in our continued COVID field epidemiology series

"What's the question?"

April 2021 edition: "Are the vaccines effective against the variants?"

We have wet lab data, (limited) clinical trials reports, but what about field epi?

What epi design/surveillance would answer it?
2/ Why do I think it's "The Question" of this moment for field epi to try to answer?

I'm going to be joining @Bob_Wachter @cmyeaton @inthebubblepod tomorrow in our continuing "Safe or Not Safe" series, and Variant vs Vaccine will make all the difference

3/ I am 100% certain that everything I am saying here is much better understood by city/state epidemiologists @CSTEnews and @CDCgov experts.

But they are too busy to tweet, aren't free to talk openly, and may not control their own work/ resources.

And that's exactly the problem
Read 16 tweets
29 Mar
1/ COVID Deaths are lower than horrible peaks, but seem to have plateau'd- as cases rise in several states are we due for another surge in deaths?

I don't think so.

(vaccines work)
2/ It's important to remember just how much deaths lag infections. Many of the deaths being reported today will have first become infected a month ago, or even longer

The death data does not yet reflect the big surge in vaccine administration that happened in the past few weeks
3/ The recent surge in vaccinations has been impressive, and the group with the highest vaccination rates (appropriately) are the 65+

As @aslavitt46 reported, 73% of elderly vaccinated now (and 36% of adults) 👏👏👏
Read 5 tweets
3 Mar
1/ this is the most detailed description of the lab-leak hypothesis I have seen (and I don't buy it)

It posits a "chopped-and-channeled version of RaTG13 or the miners’ virus that included elements that would make it thrive and even rampage in people?"
nymag.com/intelligencer/…
2/ to be clear, I've seen first-hand-in a 7 month-old baby-the scourge of a lab-produced bioweapon that was exfilitrated (anthrax 2001).

I agree w @mlipsitch position that the risks of creating Gain of Function pathogens w increased infectivity/deadliness outweigh the benefits ImageImage
3/ beyond artful prose and connect-the-dots suggestions, here's the idea:

That a bat virus sample (RaTG13) was manipulated in Wuhan lab to be more infectious through the lego-block addition of key genetic mediators of human infection

But that's not what the sequence looks like Image
Read 7 tweets
1 Mar
1/ It took us over 6 months to have the epi studies that answered these questions.

That's one of the less recognized failures of an institution I revere, the CDC

They should have sharpened the questions, designed the studies and put dedicated epi resources behind them, quickly
2/ It took forever to do a proper serosurvey, to answer the IFR/CFR question

Understanding the primary role of asymptomatic spread was a game changer, took 6 months?

We are *still* debating kids as vectors.

Do we really know if vomiting indicates COVID?
3/ a few months later, we had other questions that needed answering-

Are we improving on timeliness of testing? 

Are we protecting the elderly? Where? (how?)

Is IFR declining within age groups?

Where were the focused surveillance activities to answer these key questions?
Read 5 tweets
22 Feb
1/ COVID has been a public health catastrophe

500,000 extra deaths, taking an average of 13 years each- 6.5 million years of life lost

That dropped US life expectancy by a full year

Did we erase a decade of progress? Will a child born today live a year less than last year?
2/ At first blush, it can seem confusing.

If life expectancy dropped by a year for 320 million Americans, shouldn't that translate to 320 million years of life lost, not 6.5 million?

OTOH, I trust the CDC. Here's the paper cdc.gov/nchs/data/vsrr…

seems legit. so what gives?
3/ Here's some more data- why did life expectancy plummet in 1917-1918 (by 10 years!) then rebound completely?

Life expectancy is the average number of years a group of infants would live if they were to experience prevailing age-specific death rates throughout their life
Read 8 tweets
29 Jan
1/ Please send all your #HealthIT eAsy fiXeS to @mickytripathi1

He'll love receiving & responding to them

The more the merrier! Make sure to include "just"

I'll start! ("likes" will demand a thorough response from @ONC_HealthIT)

>You should just get everyone on the same EHR<
2/

>You just need to create a universal patient identifier<
3/

>You just need to stop messing with the free market, industry will figure it out<

And introducing my guest speakers @DavidBlumenthal @HealthIT_Policy @HealthPrivacy @Fridsma @amalec @claudiawilliams
Read 5 tweets

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