Farzad Mostashari Profile picture
Mar 6, 2018 20 tweets 10 min read Twitter logo Read on Twitter
1/ There was a very important speech today by @SecAzar today at the @FedAmerHospital that I'm going to annotate for you.

Anyone who’s been waiting for a clear declaration of this Administrations beliefs and intentions re #ValueBasedCare - here it is

2/ @SGottliebFDA is killing it at @US_FDA
and everyone loves @NIHDirector precision medicine stuff
who's to say @SeemaCMS can't make delivery reform happen faster?

---->"This is no time to be timid"
(translation, some people aren't going to like this, and we don't really care)
3/ Our spending on Medicare and Medicaid has tripled since I was last at the Humphreys Building, and while I understand that sounds fantastic to all you hospital folks, I assure you, we're not happy about it.
4/ Here's the diagnosis....yep, it's still how we pay for care.

We don't differ with the last guys on that, but we are going to be more bad-ass about implementing it
5/ Setting the stage here:
1) We believe in consumerism
2) We believe in markets and competition
3) We believe you have to focus on a few things (this is at the top of the list)

We have a lot of respect for the experienced old hands like Mike Leavitt and Mark McClellan
6/ There's been a lot of check-the-box on "value"
A lot of hospitals have taken a half-hearted swing at accountable care without fundamentally changing anything.
Some say give up on it... they're wrong
No turning back.
We're charging forward.
We're going to be bold (that again!)
7/This administration and this President are not interested in incremental steps.
We are unafraid of disrupting existing arrangements simply because they’re backed by powerful special interests
(I didn't annotate that- that's just what he said)
He's at FAH saying we're not afraid
8/ Don't mistake our belief in markets and the private sector for an unwillingness to take aggressive action to create the right conditions. Federal intervention-perhaps even an uncomfortable degree
The current system may be working for you, but it's not working for everyone else
9/ Let's start with #HealthIT
We've made progress with #EHRs
But patients still can't get their own damn records
We're not going to be all technocratic about this
Patients ought to have control of their records in a useful format, period.
Stay tuned for @SeemaCMS at #HIMSS18
10/ Next up, price transparency
Personal story re outrageous facility fees, cause I didn't just fall off a turnip truck.
We're going to make you tell people what things will really cost them, or else you will get a consequence.
Also pharma too, and I'm talking about you, PBMs
11/ Number third, how CMS pays for stuff
we still intend to lead the peloton,
let commercial plans follow our lead.
MACRA calls for advanced APMs,
(and we're not even going there with ACA)
and CMMI is just what we need to test new payment models
12/ We know we freaked people (Tom) out with the Mandatory Bundles and the Part B Drug Payment thing, but guess what? We won't do those things again, but we will rock your world even bigger. I can't tell you just now (I'm a lawyer, ya?) but you will see. (whispers "competition")
13/ As just one example-
Kiss your ACO squatting days goodbye, and then drown them in the well
We give you three years to learn how to take risk. Max.
We will give you more upside and more flexibility, but you gotta step up, ACO
14/ We hear you on the whole "quality measures are a freaking waste of my time" thing. I heard you. you don't have to yell, I get it. we've even done a new campaign #PatientsOverPaperwork We're reading through your comments and still don't exactly see how to do this, but we will
15/ You know what the opposite of competition is? Consolidation.
We don't like it.
(unlike the other guys) we know that you don't become Geisinger when you buy-up/ bind-up those physician practices. So we are going to make sure that physician-only ACOs have a level playing field
16/ And we will get out of the way of good ideas-
We won't get all ticky-tacky on "beneficiary protection" and "inducement" stuff.
Call Ubers for all your patients. for all I care.
16/ Did I already tell you that we're not afraid to f you up?
Well, we're not afraid to f you up.
a) we have to
b) we will kind of enjoy it, actually.
17/ Actually, it doesn't have to be this way.
You can decide you actually want to embrace this.
Then we can be friends, and you can help your patients, and help yourself too.
Maybe all you good ones can sit together so we know who you are.
I assure you: Change is possible, change is necessary, and change is coming.

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More from @Farzad_MD

Aug 30, 2018
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
Jul 26, 2018
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
Apr 25, 2018
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"

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
Oct 19, 2017
Here are the 2016 #MSSP #ACO results you’ve been waiting for. Results are very different for physician-only

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
Read 5 tweets

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