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Farzad Mostashari Profile picture
Farzad Mostashari
@Farzad_MD
Founder, Aledade/ Former National Coordinator for Health IT/ NYC Health Dept/ CDC EIS Officer
m rose Profile picture Duxinaro Profile picture Aaron Glimme Profile picture Chris Pilkington Profile picture Supriyo SB Chatterjee Profile picture 13 subscribed
Nov 2, 2023 • 12 tweets • 4 min read
1/ Final rule for Physician Fee Schedule is out.

let's see how the Medicare Shared Savings Program provisions played out compared to the proposed rule.

(tl;dr mostly as proposed- incremental improvements to the nation's most mature, and most successful value based program) 2/ risk adjustment should be updated to the new "v28" approach for performance and benchmark years.

✅

my only complaint is that it's only applied moving forward- if it's good policy why not allow existing contracts to update?

Sep 11, 2023 • 8 tweets • 3 min read
1/ What are the factors driving the mysterious slowdown in Medicare cost growth?

It's been a longstanding dinner conversation among health policy folks, and I have one idea to add to the mix that I haven't seen discussed yet.. Image 2/ There were lots of theories batted around in the article and the followup from @sangerkatz

My fav: "Talk Therapy Actually Works" (@ZekeEmanuel)

Policymakers setting expectations of cost control inhibit investments and behaviors that drive cost growth
nytimes.com/2023/09/09/ups…
Dec 24, 2022 • 27 tweets • 11 min read
1/ Warning!

nerdy Medicare payment deep dive

OMNIBUS EDITION

You've read the headlines ("Medicare pay cuts partially averted") but to understand what led us here--and what's to come-- we need to go deeper

Also, some cool tangents on effective/ineffective financial incentives 2/ let's walk through the weeds of

"a temporary patch on an expiring pandemic patch for the unintended consequences of a good-will effort to fix pay imbalance between primary care & specialists, made worse by a failure to predict future inflation, w a sop to value-based pay"
Dec 22, 2022 • 17 tweets • 8 min read
1/ Medical Debt- a holiday story

A few years ago, I found myself poring over a printout of ED frequent fliers with a PCP in Mississippi.

The office manager knew why they were going to the ED.

“They’re not going to show their faces here. They all owe us money.” 2/ Because of the Emergency Medical Treatment & Labor Act, the ED would see them even if they owed money

But thousands more dollars would have been added on top of the prior debts

His bills will climb. His credit score will drop. Collection agencies will start hounding him
Nov 1, 2022 • 23 tweets • 13 min read
1/ Let's flip through the Physician Fee Schedule Final Rule just out, w shared savings focus

Here's a little trick to get past all the pesky comments (that people spent 1000's of hours developing and submitting), and right to the meat of the matter:

CTRL-F "we are finalizing" 2/ First up: we want to increase participation!

strong evidence for providing upfront capital, especially to rural, underserved, low income ACOs (see AIM)

Good idea to expand it 👍

Lots of comments about eligibility criteria, repayment, etc etc.

"finalized as proposed"
Oct 1, 2022 • 7 tweets • 3 min read
1/ Medical practices (and staff) are often damaged by hurricanes too, and the need for care will rise over the next few days to weeks

I'll summarize here some tips that our @AledadeACO Louisiana team have assembled to help others w the recovery process

(eg grab your diplomas) 2/ The needs - and the damage to care capacity- can persist for weeks

“I’m trying to caution [residents]. You do not want to get hurt now. There is not adequate services to take care of you if you cut your leg with a chainsaw, if you fall off a roof,.."

Sep 19, 2022 • 19 tweets • 9 min read
1/ there's been a lot of promise, but also disappointment in the influence of self-insured employers on improving the quality and cost of the healthcare they pay for.

I'm going to do a readout on what may go down as a seminal meeting last week

there's a big idea brewing.. 2/ first off, let's review the obvious.

*US healthcare relies overwhelmingly on employers to provide health insurance

*they aren't happy

*Many employer-led health reform efforts end in failure

(this is a good @commonwealthfnd summary of failures) commonwealthfund.org/blog/2021/no-s…
Aug 30, 2022 • 16 tweets • 6 min read
1/ One of the best parts of the CMS Medicare Shared Savings Program is the transparency

Hot off the presses: Independent practices working with @AledadeACO generated over $390M in savings for in this flagship value-based program...while increasing primary care access and quality 2/ There were 475 organizations in the program.

Getting savings is not easy.

Kudos to the physician groups with the highest savings rates in the country:

Top marks go to Aledade partner PMA in Pennsylvania.

Amazingly, the Mississippi COMMUNITY HEALTH CENTER ACO came in #4
Aug 26, 2022 • 7 tweets • 3 min read
1/ A year ago, there were a lot of healthcare tech companies valued on "top-line" revenue growth

That's no longer true.

So what's the right measure to value fast growing healthcare tech companies?

(thanks @BessemerVP @stephenkraus and @SofiaGuerraR) Image 2/ To some crusty traditionalists (and the newly minted value investors out there), it might be "bottom line" - EBITDA

But if I'm CEO of a company with great fundamentals and a huge market ahead of me, shouldn't I be investing now in future growth/profits (vs stockpiling cash)?
Jul 26, 2022 • 5 tweets • 4 min read
1/ How many times have we heard that newly minted doctors don't want to work in independent practice anymore?

("they don't want to work as hard, be practice owners")

We @AledadeACO are launching a program to support 20 PGY2 family medicine residents in proving that's nonsense 2/ We listened to what docs in training said were barriers-

*Residency training programs are hospital centric
*Few practice owner mentors/ role models
*Fewer financial supports/subsidies
*Less perceived opportunity for innovative practice models

We can solve for that!
Apr 14, 2022 • 30 tweets • 9 min read
1/ After 2 years of working hard to avoid getting-- and spreading-- COVID, the pandemic finally caught up with my family.

I thought I would share some of the things I learned along the way. Image 2/ *Infection*
Our behavior didn't change, but the virus did. As @ScottGottliebMD has noted- it sure seems like the most recent BA2 surge is increasingly hitting the remaining uninfected, who've been limiting social interactions, social distancing, masking
Mar 17, 2022 • 9 tweets • 4 min read
1/ Jeff Zients was the right person to lead the US response when we faced unimaginable organizational challenges in getting a whole of government response into operations.

He and his team really did an admirable job, but communicating to the public was mostly Walensky and Fauci 2/ communicating to the public, in the midst of intense partisanship, evolving science, and evolving virus has been....difficult.

Fair or not, we have not had a single national credible, trusted spokesperson, managing public communications in a time of uncertainty (and anger)
Jan 12, 2022 • 27 tweets • 13 min read
1/ Would you want your employees, your customers, your partners, and government regulators to hear what you tell investors?

It's not done! Different audiences will understand and react to the same thing very differently

I'm going to take that risk today, show you my deck 😱🙏 2/ I'm going to walk through what I presented and said yesterday at the big healthcare investor meeting #JPMHC22

In a normal year, to hear the coveted private company presentations you'd have to be there, investors and executives crammed into small rooms

camera crews outside
Jan 8, 2022 • 7 tweets • 2 min read
1/ Tom captures well this reality.

Where we are now with vaccinations, therapeutic- and with the Omicron variant- is very different from March 2020, or December 2020, or even October 2021.

We were not wrong to urge NPIs when the population was spike naive, and R0 was 2.5 2/ in fact, these actions, painful as they were, bought us time for the vaccine rollout, and saved hundreds of thousands of lives.

But we can't insist on the same prescriptions when the disease has changed, for fear of being called "inconsistent", or "giving up"
Jan 8, 2022 • 4 tweets • 1 min read
1/ The biggest challenge with the Omicron surge is hospital and ICU capacity, w a lot of infections in a short period, and health care workers out with infection

Anecdotally, many hospitals aren't cancelling elective procedures yet-because of finances (Anyone have data on this?) 2/ Could the remaining relief funds from @CMSGov be conditioned on hospitals deferring elective surgeries? ie framed as compensating for foregone elective procedures?
Dec 24, 2021 • 17 tweets • 6 min read
1/ We are all seeing the massive wave of Omicron sweep through our communities

Severity will make the difference between a bad winter and a horrific one

We keep saying "hospitalizations are still low, but it's early"

When is it time?

In NYC, it should be showing now. 2/ If you look at the counts of COVID cases and subsequent hospitalizations, they tend to track each other quite closely, but with a lag of 5-6 days

Deaths follow hospitalizations, by about 12 days. (it's too soon for that)

[Big props to my alma mater @nycHealthy for #opendata]
Dec 21, 2021 • 9 tweets • 4 min read
1/ A big part of understanding the relationship between COVID cases and mortality is understanding the age structure of the waves

I've been looking at NYC "Respiratory" syndrome for ED visits (I was a member of the group that pioneered its use for public health 20 years ago) 2/ During prior influenza seasons, NYC would have up to 1,000 extra emergency department visits a day, much of the increase driven by babies and children (low prior immunity). Their share of ED visits would increase from ~20% to 40%

COVID19 was a completely different story
Dec 21, 2021 • 6 tweets • 2 min read
1/ The rate of Omicron infections in NYC is unprecedented.

I'd estimate 100,000 infections occurred ... yesterday. Maybe 300,000 over the past 10 days.

1% hospitalization rate would mean 3,000 admits to come over the next few days

I hope it's much less than that (86 so far). 2/ Complicating matters, after driving down influenza (and RSV) to undetectable levels last year, we let up on social distancing, masking, and they have come back

So at least part of the increase in ED visits and hospitalizations will be due to influenza/RSV (especially in kids)
Dec 18, 2021 • 9 tweets • 3 min read
1/ The wide range of predictions here is appropriate given how little we know about severity.

Many are pointing to the @imperialcollege @nfergus study as support for a belief that Omicron has similar severity than Delta.

I don't think it does.

Let's dig in 2/ the paper is here if you want to read it for yourself. imperial.ac.uk/media/imperial…

They looked at UK COVID cases with (n=208,947) and without (n=15,087) the dropout associated w Omicron, and perform regression analyses to see what factors could predict Omicron

Date, for one
Dec 17, 2021 • 17 tweets • 5 min read
1/ Omicron is ripping through America right now, to an extent we won't fully realize until later

At this point, I think most people can hope to delay infection, but not to avoid it.

I don't think herd immunity is a realistic goal anymore

Here's what I think it means for us 2/ Even as the Delta wave continues to kill over a thousand people a day, Omicron is already here, and there is no reason to believe that the explosive growth we have seen in other countries, and in local outbreak (like Cornell University) isn't happening across the US already.
Oct 23, 2021 • 19 tweets • 7 min read
1/ Let's do an exercise together:

We've often heard people say something like "this innovative new service/company is good for patients and saves money, but there's no business model for it/ current reimbursement doesn't support it"

Step 1: Let's generate examples: 2/ I'll start.

But this is a group exercise, I need your nominations. Please try to give suggestions with some evidence behind them

*Advanced Care Planning
*Hospital at home
*Diabetes prevention program
*"SDOH" care navigation

(Used to be, telehealth)