iiinova — where your digital self keeps evolving

Reposted by mwfriedberg.bsky.social

Aaron Blackshear @aaronblackshear.bsky.social · 06/10/2026

This is a good summary of the problem, objective without putting all of the blame on payers or providers. The "risk adjustment specialists" and consultants are a problem, looking at you some of my actuary friends, billing $500+/hour to add a bunch of bloat to the system

What we can agree on

This entire enterprise — risk adjustment specialists spamming doctors, who are already nose-deep in documentation burden, to document diagnoses that often do not affect patient care, while insurers publish reports that fail to capture the nuance of the issue, leaving the public angry and confused — highlights a more general problem with respect to how the U.S. health care system works.

By design, hospitals and insurers are meant to compete with each other, with hospitals trying to collect as much money as they can for providing care, and insurers trying to pay as little as possible. Hospitals bolster their side by hiring risk adjustment specialists and employing AI tools, while health insurers hire payment integrity specialists and employ different AI tools.

Patients lose out because the administrative bloat inflates the cost of medical care, while making costs less transparent and harder to contest. Ultimately, the fix should be structural: At a minimum, we need to overhaul the list of secondary conditions that are eligible for bump coding. CMS attempted to do this in 2019, when it proposed downgrading or eliminating many bump codes based on new data showing they were not associated with increased costs. But hospitals pushed back, and the effort eventually stalled.

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mwfriedberg.bsky.social @mwfriedberg.bsky.social · 06/10/2026

Remarkable writing by a resident physician…surprised not to see more attendants blowing the whistle on this. “I’m a doctor. Here’s what I want the public to know about AI tools and health care costs”: www.statnews.com/2026/10/06/a... via @statnews.com

statnews.com

I’m a doctor. Here’s what I want the public to know about AI tools and health care costs

“We can document honestly and still wind up inflating hospital bills,” writes a frustrated doctor.

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Jeff Linder @jefflinder.bsky.social · 24/09/2026

This NEJM "Clinical Decisions" is about whether you should do a physical exam in an otherwise healthy person. How about the TOTALLY UNNECESSARY testing that's being done here. "Pursue a laboratory workup"?! For what!? ht: @ishaniganguli.bsky.social www.nejm.org/doi/10.1056/...

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mwfriedberg.bsky.social @mwfriedberg.bsky.social · 04/08/2026

Surefire ways for vendors to make huge $ in health care without helping anyone: 1. Monetize regression to the mean 2. Monetize selection 3. Monetize the float Level up! These are not mutually exclusive…you can do all three!

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mwfriedberg.bsky.social @mwfriedberg.bsky.social · 27/07/2026

Has there ever not been an imminent devastating physician shortage?

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mwfriedberg.bsky.social @mwfriedberg.bsky.social · 13/07/2026

There is nothing quite like a national advocate imploring you to do something you already do. If the NAM didn’t write about it, I guess it doesn’t exist 🤷🏻

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mwfriedberg.bsky.social @mwfriedberg.bsky.social · 29/06/2026

Health care journos: for the Nth time, don’t ever quote a doctor without checking their Open Payments profile to see if they have a financial conflict of interest on exactly the thing you are quoting them about. It’ll take you a whole 60 seconds…

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mwfriedberg.bsky.social @mwfriedberg.bsky.social · 04/06/2026

Now available: BCBSMA’s 5th annual health equity report www.bluecrossma.org/myblue/equit... As usual, there’s a good amount of methods detail at the bottom, plus links to all previous years of our report.

bluecrossma.org

Health Equity Report | Blue Cross Blue Shield of Massachusetts

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mwfriedberg.bsky.social @mwfriedberg.bsky.social · 29/05/2026

Hive mind: who is your go-to expert for detailed knowledge of per diem FQHC payments (PPS)?

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Reposted by mwfriedberg.bsky.social

Michelle Meyer @michellemeyer.bsky.social · 07/05/2026

🚨New paper from our Behavioral Insights Team🚨: we randomized patients without activated patient portals who had new lab results to receive one of two emails emphasizing a key portal feature—immediate access to results—or to no contact beyond usual system efforts to encourage enrollment.

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mwfriedberg.bsky.social @mwfriedberg.bsky.social · 20/03/2026

Well reported story on the coding arms race, now fueled by AI www.bostonglobe.com/2026/03/20/b... As usual, the rich systems use this to get even richer…and while not mentioned in the article, this has important implications for quality measurement too.

bostonglobe.com

Sepsis hospitalizations have tripled in Mass. But is it real or a billing game? - The Boston Globe

Hospitals and insurers are harnessing the power of artificial intelligence and other tech tools to protect their businesses.

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Reposted by mwfriedberg.bsky.social

Bob Herman @bobjherman.bsky.social · 21/01/2026

Pretty galling what the first urologist tried to do here. www.statnews.com/2026/01/21/w...

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mwfriedberg.bsky.social @mwfriedberg.bsky.social · 09/12/2025

There’s a lot going on, but I’m going to plug my favorite authors on my favorite esoteric/devastating/unknown-to-HSRs methods issue, with the best paper title I’ve seen in a long time psycnet.apa.org/record/2025-...

psycnet.apa.org

APA PsycNet

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Behavior Change for Good Initiative @bcfginitiative.bsky.social · 24/10/2025

We hope you can join us & @pennchibe.bsky.social for a virtual keynote presentation from Amy Finkelstein about rethinking common inferences in healthcare. Wednesday 10/29 at 12 PM ET. Register here: bit.ly/3VIvfC2

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Reposted by mwfriedberg.bsky.social

Brendan Nyhan @brendannyhan.bsky.social · 12/09/2025

Friends don't let friends give preregistration a bad name. Exploratory findings are fine; you just have to label them!

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mwfriedberg.bsky.social @mwfriedberg.bsky.social · 26/08/2025

Not a fan of any disease that begins “new world”

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mwfriedberg.bsky.social @mwfriedberg.bsky.social · 13/08/2025

Proposition: Hearing the words “best practice” is a near-perfect indicator of terrible decision making.

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mwfriedberg.bsky.social @mwfriedberg.bsky.social · 04/08/2025

My fealty to the leader who will stop the spam

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Ole Goltermann @olegolt.bsky.social · 22/07/2025

Serious concerns about a new cortical biomarker for pain sensitivity jamanetwork.com/journals/jam... We (with @tspisak.bsky.social, @christianbuchel.bsky.social) published a commentary on Chowdhury, Bi et al. (2025, JAMA Neurology) raising serious concerns about their reported results. 👇 1/13

jamanetwork.com

Concern About Predictive Performance of a Pain Sensitivity Biomarker

To the Editor Chowdhury et al1 evaluated a biomarker for pain sensitivity, combining peak alpha frequency and corticomotor excitability. The authors report outstanding performance (validation set area...

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mwfriedberg.bsky.social @mwfriedberg.bsky.social · 21/07/2025

Kinda misleading headline, but article covers some very important proposed changes to the role of the RUC and other aspects of RBRVS. www.nytimes.com/2025/07/21/u...

nytimes.com

An Attack on the Medical Establishment Buried in an 1,800-Page Regulation

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grahamabra.bsky.social @grahamabra.bsky.social · 17/07/2025

Ma’am, would you like several fiddly tests whose results about 1% of the medical community can interpret correctly followed by *maybe* a surgery or would you like a once a day pill that will probably sort things?

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American Statistical Association History of Statistics @hos-asa.bsky.social · 12/07/2025

Time for your yearly reminder that “We need less research, better research, and research done for the right reasons”. #OTD 1948 Douglas Altman b (d 3 June 2018) “One of the most influential medical statisticians of the past 50 years” he led reforms in medical research reliability & reporting. 1/3

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mwfriedberg.bsky.social @mwfriedberg.bsky.social · 05/06/2025

Mandatory reading for health services researchers: recent BCBSMA Foundation primer on Medicaid provider taxes www.bluecrossmafoundation.org/about-us/new... This has to be one of the most important aspects of Medicaid policy that almost nobody knows about. Critical to interpreting Medicaid spending

bluecrossmafoundation.org

BCBSMA Foundation Report Highlights Impact of ‘Provider Tax’ on MassHealth Program | Welcome to Blue Cross Blue Shield of Massachusetts

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mwfriedberg.bsky.social @mwfriedberg.bsky.social · 22/05/2025

Attention health services researchers: funding opportunity here

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Aaron Schwartz @aschwartz.bsky.social · 11/04/2025

In 1989, New York City and its unions temporarily replaced utilization review with sham review for half the participants in the city's health insurance plan. Utilization review had happened before nonemergent hospitalization and ambulatory surgery. Treatment status was blinded. What happened? ...

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Darren Dahly @statsepi.bsky.social · 24/03/2025

Here is the video I made, inspired by this wonderful tweet. www.youtube.com/watch?v=dSOj...

youtube.com

Why we randomize

YouTube video by Darren Dahly

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Reposted by mwfriedberg.bsky.social

Seema Jayachandran @seema.bsky.social · 03/03/2025

I learned a new term today: rollup. When an outside investor consecutively acquires many of the small firms in a local market and consolidates them. When this occurs with anesthesia practices, prices increase by 18%. I'm paraphrasing an NBER summary of this paper: www.nber.org/papers/w33217

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mwfriedberg.bsky.social @mwfriedberg.bsky.social · 19/01/2025

Now live: Blue Cross Blue Shield of Massachusetts’ 5th annual health equity report www.bluecrossma.org/myblue/equit... We publish these ~70 metrics every year to be transparent and accountable to our members, accounts, providers, and communities we serve.

bluecrossma.org

Health Equity Report | Blue Cross Blue Shield of Massachusetts

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Reposted by mwfriedberg.bsky.social

Stacie Dusetzina @dusetzinas.bsky.social · 17/01/2025

HHS announces the next 15 drugs to negotiate under Part D! Great to see this progress. Quite a few cancer treatments, which will mean more savings potential than in the first year's drug list (cancer drugs get limited or no rebates today). Good news for taxpayers and Medicare spending!

hhs.gov

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mwfriedberg.bsky.social @mwfriedberg.bsky.social · 14/01/2025

New iOS email folder design is interesting. Anybody know if you can train this thing to block all political fundraising emails? Same for text messages. That’s my #1 priority.

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mwfriedberg.bsky.social @mwfriedberg.bsky.social · 28/12/2024

Assigning (well, inviting 😉) some manuscripts to reviewers tonight. Methods point: If reviewers are rated and sorted on a 6-point scale (higher=better) for the quality of their reviews, why do I almost always prefer a 5.8 reviewer to a 6.0 reviewer?

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mwfriedberg.bsky.social @mwfriedberg.bsky.social · 23/12/2024

Ok. All I want for the holidays is for every last person on earth to realize that an SBP target of 135-140 mmHg is not, and has never been, standard or usual care.

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Patrick Chovanec @prchovanec.bsky.social · 05/12/2024

Whatever profession you choose, I guarantee there is someone out there who holds you personally responsible for the world’s ills. Now imagine if they felt entitled to take the law into their own hands.

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Aaron Blackshear @aaronblackshear.bsky.social · 05/12/2024

Read a little bit more about this, and goddammit we're getting played you guys. The original link from the ASA is very dishonest. They are moving to the CMS standard for anesthesia billing. In other words, they are going to pay the same way they do for Medicare and Medicaid.

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mwfriedberg.bsky.social @mwfriedberg.bsky.social · 24/11/2024

Re-posting this for new followers who care about measure validity in primary care (or anywhere else)

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mwfriedberg.bsky.social @mwfriedberg.bsky.social · 21/11/2024

This is amazing. A great model of academic-industry collaboration for public good.

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