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Farzad Mostashari
@Farzad_MD
, 5 tweets, 5 min read Read on Twitter
Here are the 2016 #MSSP #ACO results you’ve been waiting for. Results are very different for physician-only

#Physician_Led_ACOs_Kick_Butt
Sometimes the rainbows and unicorns are right in front of you
@amitabhchandra2 @Michael_Chernew @C_Garthwaite @JMichaelMcW
…And these #ACO savings are in the context of super-low per capita Medicare national inflation of about 1% per year @porszag
These #MSSP #ACO results are *despite* a risk adjustment approach that (unlike every other risk contract) is capped, hurt over 1/2 of ACOs
Did #MSSP #ACO savings come at the expense of patients?
Nope!
More prevention
Quality up
Hospitalizations down
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#MSSP #ACO #Physician_Led_ACOs_Kick_Butt

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Farzad Mostashari
@Farzad_MD
1/ 2017 #MSSP #ACO Results!
ACOs have scaled rapidly across the country!

In aggregate, the 472 ACOs were accountable for nearly 9 million Medicare beneficiaries and $95 Billion- that's a quarter of all fee for service, and almost half of the entire Medicare Advantage market.
2/ If you add up all the actual costs versus benchmarks, these 472 ACOs were collectively $1.1B under their benchmarks (more on whether that's the right counterfactual later).

Medicare shared $780 million in payments with the ACOs, netting the taxpayer $313M
But wait!

There's lots of evidence that the benchmark under-estimates the savings produced. @JMichaelMcW et al have shown convincingly that a true "difference in difference" approach would show substantially higher net impact.

The green eyeshades folks at CMS OACT said add 60%
Read 26 tweets
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Farzad Mostashari
@Farzad_MD
It's strange that everyone on health policy twitter is not going apes over the Hospital Outpatient Prospective Payment System (#OPPS) rule released today

It contains one hugely significant proposal that hospitals will fight bitterly...but could actually help them in the long run
Background- there are two different CMS payment systems for historic/operational reasons, one for professional services, and the other for hospital outpatient depts.

Up until now, there had never been an effort to make sure that equivalent services would have same payment rate.
In fact, the same procedure paid for in hospital OPD setting ended up being reimbursed at a much higher rate than the exact same procedure at a doctor’s office.

Here’s how @MartinSGaynor and Paul Ginsburg and I described it in our “Making Markets Work” White Paper
Read 13 tweets
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Farzad Mostashari
@Farzad_MD
1/ A little bit of history here…

When I was national coordinator for health IT, we did an RFI with CMS for “Advancing Interoperability and Health Information Exchange"

federalregister.gov/documents/2013…
2/ If you’re a student of this stuff, it’s pretty topical- including a section on patient-centered information exchange on promoting #BlueButton - including through Medicare Advantage, … which is now on the verge of becoming a reality
3/ Another idea I was pretty excited about was using inpatient/post-acute Conditions of Participation as a vehicle for getting information sharing - on the argument that it really is a basic health and safety requirement
Read 11 tweets

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Shari Wassell 🎄
@ShariWassell
🇺🇸 Today marks one month since the 2018 Election! I think the Dems are finally done "finding" votes 🙄. Congratulations are in order! With so much attention on voting/election fraud, the good news has been overlooked. Here is a list of seats the Republicans flipped! #MAGA #KAG
🇺🇸We really haven't celebrated our 2018 Election wins, because we've been too busy analyzing the massive fraud these past 30 days. Listed here are the winning Republican Senators, who all received endorsement from President Trump! 😀 #winning
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❌❌Dump The NDP❌❌
@dumpthendp
@mikepegger @Fujikatsan @DtotheIzzoAcres @Brian_Pallister I have read several sources, most do hold Sweden up as "the best concept"

I'm not going to post those as they are easy to find

I found some contradictions even among the positive ones, so it is a little confusing

It seems Sweden put the tax into general revenues

1
@mikepegger @Fujikatsan @DtotheIzzoAcres @Brian_Pallister Like I said not 100% sure on details, so my points are based on what I can see, which may not be correct

The gov did make a commitment to spending BIG on environmental objectives

That seems different form Canada, where there is "promise" the money all comes back to prov

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@mikepegger @Fujikatsan @DtotheIzzoAcres @Brian_Pallister The gov seems more interested on wealth redistribution then committing all cash to projects to further reduce carbon

Is there "demands" on % that must be spent on those projects?

Sweden now has "communal heating" where a central repository is shared among several houses
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Read 31 tweets
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Nick Bluhm
@nick_c_bluhm
What are physician-led ACOs doing differently than Health System ACOs? [thread]
CMS released the 2017 MSSP results. While there will be thoughtful analyses of these results, I wanted to examine the multi-year trends in ACO performance. I also sought to understand the difference in performance between health system-led ACOs and physician-led ACOs. (1/n)
This analyses had three principal findings: first, by the fourth performance year, physician-led ACOs, whether due to performance improvements or attrition, lose less money than do health system-led ACOs; (2/n)
Read 23 tweets
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Kate Starbird
@katestarbird
Excited to release our upcoming #CSCW2018 paper describing how disinformation agents from the Internet Research Agency in Russia participated in online discourse about the BlackLivesMatter movement and police-related shootings in the U.S. during 2016:
faculty.washington.edu/kstarbi/BLM-IR…
Following up on network analysis showing RU-IRA agents were active on both “sides” (pro- and anti-) of the politicized BLM conversation, we conducted a deep qualitative analysis, showing how RU accounts impersonated “authentic” voices.
The content on one “side” was typically very different from the other—(on the left) exhibiting pride in African American identity, (on the right) using racist memes targeting African American people. But it did converge around some themes, e.g. attacking the "mainstream media”.
Read 11 tweets
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Travis Broome
@Travis_Broome
Diving into the new #ACO #MSSP rule.
s3.amazonaws.com/public-inspect…
So right off the bat we are talking about a July 1, 2019 start where existing ACOs would extend their current contracts six months and new entrants wouldn't start till July 1. This is disruptive hopefully they left the door open to a Jan 1 start.
Very substantial changes as we thought there would be with the new administration and a long time in coming for the rule. The reg text changes themselves run 78 pages
Read 25 tweets
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Duncan Jones
@ManMadeMoon
8am PST tomorrow. Join me for a trickle of @Mute info! #ItBegins
So some of you may be aware that I have previously called @Mute my “Don Quixote.” I did this, as much like Terry Gillian’s fabled film of that name, it seemed everything was against Mute ever being made. In fact, here’s an early draft... from 2003!
Back then the film was a very different beast. It was set in London, contemporary and the cast would have been Cary Grant, Boris Karloff & Bela Lugosi. Ok. Maybe not that cast...
Read 9 tweets

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