Farzad Mostashari Profile picture
Apr 25, 2018 11 tweets 9 min read Twitter logo Read on Twitter
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
4/ We had a public session (with terrific colleagues Cindy Mann and @PatrickConwayMD) to discuss the RFI results, and sure enough, there was support for doing this

@PatrickConwayMD 5/ How this is framed was prescient:

HHS will implement policies that encourage electronic HIE
• Could evolve from incentive and reward structures to electronic HIE *as standard business practice* for providers

That’s what Condition of Participation means- it’s just expected
@PatrickConwayMD 6/ It also pointed to how Medicaid and State policies could encourage this data sharing-

HT/ @claudiawilliams @ThomasNOV @kdmertz @JessPKahn @julieboughn

• incorporate HIE into payment
•Medicaid HIE funding
opportunities to contribute to HIE
infrastructure costs
@PatrickConwayMD @claudiawilliams @ThomasNOV @kdmertz @JessPKahn @julieboughn 7/ Several states have taken up the mantle-

As part of their Medicaid #1115 demonstration waiver, Florida tied receipt of the low income pool payments to participation in the Florida Event Notification Program

participation went to almost 100% overnight


@AledadeACO is now operating in 20 states, and where discharge notifications are universally available are almost always where there is was a policy hook for hospital participation
@AledadeACO 9/ This is what data blocking looks like- connecting to the health information exchange is
“a low priority”
“resource limited”
“waiting for EHR switchover to be completed”

and in unguarded moments..
“why would we give away data that’s a strategic asset?”
“join the hospital ACO"
@AledadeACO 10/ So where are we 5 years later?

It is time.

As @SecAzar said, "it will require some degree of federal intervention — perhaps even an uncomfortable degree. That may sound surprising coming from an administration that deeply believes in the power of markets and competition."
@AledadeACO @SecAzar 11/ The infrastructure is in place- we have spent billions on hospital EHR subsidies. Over 1B on state HIE infrastructure & governance

We have evidence from state demos that *it is possible* to share information if you are motivated

@SeemaCMS isn’t afraid of hospital lobby

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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
Mar 6, 2018
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.
Read 20 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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