Thursday, March 23, 2017

Recap of #TrumpHealthcare Tweetchat – A Success In Spite of Hashtag Confusion

Last night, the second or third instance of a new tweet chat about the American Health Care Act (AHCA) – increasingly known as ‘Trump Care’ took place. This chat was ‘sponsored’ by @physicianswkly and largely moderated by Dr. Linda Girgis (@drlindamd) a Family Medicine expert, clinical assistant professor at Rutgers Medical School (@RWJMS) and popular healthcare social media personality.

In spite of some fairly widespread confusion about the hashtag associated with the chat – the correct hashtag being #TrumpHealthCare – the chat did take place with 145 participants sharing 296 tweets for a total of3.7M impressions. See my commentary on these stats at the end of this post.

Since I was unable to participate in the chat, I’ve summarized what transpired based on the tweets I was able to obtain from @Symplur. I'e also added a few comments on certain tweets.

Here are the topics and associated contributions from chat participants:
Handle
Tweet
@physicianswkly
Please keep it civil & focused on policy & facts. Please no Trump rallying or bashing. Thanks for joining. Let's go!
@physicianswkly
15 MINUTE WARNING! let's stick to just the facts please. No Trump bashing or rallying! Trolls will be ignored.…

Topic #1: Do you think the #ACHA / #TrumpCare will be an improvement on the #ACA / #ObamaCare? Why/why not?
@drlindamd
Not much will change. I think the problems in the system have been getting worse and this will just continue.
@dfisher_p2
If 24 million people were to be uninsured under #AHCA, not sure how that is an improvement
@drlindamd
Not in its current form. Mandate is still there except worse in that 30% penalty goes to ins cos!
@idpharmacist
Not if this data are true: Many Trump voters would pay more #TrumpHealthcare bill
@misterchambo
Not in its current form. Mandate is still there except worse in that 30% penalty goes to ins cos!
@dfisher_p2
It's estimated that 79% of the tax breaks under the #AHCA would go to millionaires, that is not helpful to the masses

@ShimCode Comment: I agree with @misterchambo and @jorient: The estimates from the CBO can be very un-reliable. And it’s not their fault, projections and estimates are just that: projections and estimates. 
@mloxton
No. KHN and CBO pretty much show that it serves fewer, and reduces care. Cost savings at the expense of coverage
@misterchambo
Don’t trust the CBO! Makes as much sense as having Zeke Emanuel advise the President.
@jorient
What has the CBO ever gotten right? ACA enrollment?! A weatherman that bad would be fired
@lorenaolsonmd
Even if they're close, it is a total disaster!
@dfisher_p2
The manager's amendment included the increase of the inflator used for per-capita Medicaid inflation +1%
@misterchambo
Solutions for healthcare include: expanded HSAs, Price transparency, HD catastrophic policies and DPC. Will reduce cost.
@misterchambo
Or, more succinctly put, get insurance companies and government out of healthcare! Funding yes, medical direction no.
@drlindamd
Great points! I agree and I honestly think they are no solution to most people.
@dfisher_p2
But, block grants would not be available for the elderly and disabled.
@dfisher_p2
Managers amendment also accelerates the repeal of all other ACA taxes from 2018 to 2017
@drlindamd
Do you think this will have a big impact?
@dfisher_p2
Still no help for the low-income, elderly (or nearly elderly) individuals
@drlindamd
I think if this happens, we are going to see the frailest left with minimal coverage.

Topic #2: What’s the most impactful change in “manager’s amendment” to #AHCA made by House Republican leaders late Monday night?
@rogerbeauchamp
Correct! And 3rd party keeps 25 to 31 percent of the premium dollars, even those spent for primary care

@ShimCode Comment: IMO and that of many others, the above comment is ignorant of reality and history. And also ignorant of the key Medical Loss Ratio mandate passed in the ACA.
@jorient
Maybe >50% of $3 trillion goes to something that provides no medical goods or service to actual person
@misterchambo
Agree on exec salaries. Much better results with waste, fraud and abuse. Get middlemen out of the equation.
@jorient
Problem is 90% of expenditures go thru 3rd party. Drain the swamp!
@jorient
Tax credits should go to taxpayers, not insurance companies

@ShimCode Comment: A generally bad idea! Many people may keep the money and not pay their insurance premiums.
@drlindamd
Excellent point! But no one is looking at these 3rd parties too much: insurance cos., big pharma.....

Medicaid Block Grants & Giving Power Back to the States

@drlindamd
States would be allowed to choose a block grant rather than a per capita cap.
@dfisher_p2
States would be able to choose a block grant rather than a per capita cap to fund their adult and children populations
@dfisher_p2
Manager’s amendment takes $1B to fund the administration of the Medicaid per capita cap/Patient State Stability Fund
@mloxton
Selling insurance across state lines is fine by me so long as they meet the higher of state and federal specs
@drlindamd
Agree. But I still don't think it will help the people who can't afford it too much.
@mloxton
Interesting that the "sell across states" thing may create a gap for telehealth to grow
@jorient
Avoiding state mandates is whole point of cross-state purchase. Guaranteed issue (pre-existing’s) kills individual market
@jorient
Redistributing exec salaries: a drop in the bucket. Only a small piece of losses to the Swamp
@bburtcpa
I’m not for this Trump law, but this is wrong headed logic. The taxes were an abomination to begin with to introduce failed Socialist policy.

Topic #3: What will result, good & bad, from @SpeakerRyan’s plan to eliminate payroll taxes that help pay for #Medicare?

@mloxton
I think the HSAs tie up money, block grants are a sneaky way to throw people of insurance, and caps are just cruel
@mloxton
Unclear, but likely to be a logistical and HR nightmare
@drlindamd
Medicare will not be able to continue. It needs to be funded somehow.
@jorient
All Ponzi schemes die. Medicare is in deficit financing situation.
@jorient
Medicare promised it was only about funding. Whose bread I eat his song I must sing

Topic #4: @cynthiaccox of @KaiserFamFound posted this chart to show what happens w/ #AHCA tax credits. What do you make of it?

@dfisher_p2
I'll see your chart and raise you this one  https://t.co/cvRsY2sRFo
@drlindamd
Tax credits will help people pay for coverage. However, premiums are rising.
@drlindamd
Tax credits will not fix rising premiums/deductibles. Health insurance still unaffordable for many.

Direct Primary Care and Insurance Companies 
@jorient
Cheaper and better to buy care directly for needy. Why should managed-care cartel get even 15%?
@misterchambo
Agreed 100% on direct purchase for needy! Two Medicaid DPC pilots being worked on right now w/a possible third!
@jorient
Why is insurance a Holy Grail? It profits from selling something people can't or don't use.
@laughinhart
Insurance used to be helpful until Government got into healthcare.
@mloxton
Because it's "the market" and Wall St loves loves loves it. From any other perspective, it's just waste, adds no value
@jorient
Why not mandate as condition of employer tax exclusion that workers could take insurance value of health plan in cash?
@mloxton
From a value chain pov, health insurance has almost zero value add. In QI terms "Muda" that should be eliminated :)
@physicianswkly
But isn't #AHCA for people without insurance through work?

Topic #5: As a provider only, not based on political view, what is your take on the proposed defunding of #PlannedParenthood?

@drlindamd
Many girls and women go there for annual gyn exams and birth control. Teenage pregnancy/STDs will increase.
@drlindamd
For many women/girls, this is the only healthcare that they receive.
@mloxton
As an analyst and one time EMT, a cruel disaster that worsens everything it claims to seek. It makes no medical sense
@dfisher_p2
21% of counties have no safety-net family planning alternative should their local Planned Parenthood close
@dfisher_p2
Planned Parenthood is the nation’s leading reproductive health care provider and advocate
@physicianswkly
Thoughts on proposal to phase out #Medicaid expansions in 2020 & restructure of funding into lump sum for each state?
@mloxton
V shortsighted except for states with dwindling population. For rest, it's a massive time bomb that kills low SES ppl
@drlindamd
We need to make sure patients don't get hurt by this. We need to make sure those covered are truly eligible.
@drlindamd
Many people are gaming the system. Need to eliminate fraud and waste while not harming any patients.
@drlindamd
States will have a harder time budgeting for Medicaid.

Didn’t see any Trump Fans – But Several Bashers. Surprise!
@antisocial1972
@realDonaldTrump and why, look at his new #trumphealthcare, its shows he #HATES WOMEN, THE POOR, PPL SUFFERING FRM MENTAL ISSUES
@joyouswarrior
@realDonaldTrump This #PresidencyThing doesn't seem to be working out, Donnie. #UTTERFAILURE

Confusion about the Hashtag

There was a LOT of confusion about the hashtag associated with the tweetchat which I believe was due to two primary reasons:

1. Was it #TrumpHealthCare or #TrumpCare?

The #trumphealthcare tag too closely resembled the politically charged #trumpcare tag. Realistically, a more accurate hashtag would be #RyanCare. I suggest that if @physicianswkly intends to continue these chats, that an alternate tag be selected.

Handle
Tweet
@mandibpro
Linda, do we have topics, or free-flow?
@mloxton
Not seeing questions, am I missing something?
@physicianswkly
Really? they've all got the #TrumpHealthcare hashtag...
@drlindamd
Weird, I am not seeing all the tweets either even with the hashtag.....
@physicianswkly
Is big gov't blocking us?
@physicianswkly
Are people seeing these questions?
@idpharmacist
Only if I go to your specific feed @physicianswkly - even if checking "latest" tweets not visible? Not sure why...
@physicianswkly
Thanks! Not sure what's going on here
@physicianswkly
Gonna try retweeting the questions, b/c that seems to allow people to see them... let us know 
@drlindamd
We are using #Trumphealthcare. Not many were using it before our first chat. Definitely will look at it before next chat
@physicianswkly
The tweetchat hashtag is #TrumpHealthcare. Just mentioned #TrumpCare b/c that's a popular hashtag that the use of could pull more people in
@physicianswkly
Thanks for taking over the question-asking @DrLindaMD since our questions/tweets weren't being seen. Hope yours are!

2.  Confusing Promotion

The chat was promoted with the #TrumpCare tag. For instance:

The participant would have to review the above image to actually learn that the proper hashtag was #TrumpHealthCare.

Update: I stand somewhat corrected based on comment from 'anonymous.' And see my response to anonymous. 

Comments on The Chat's Stats 

Based on the generally controversial nature of healthcare and healthcare reform in the United States, the Donald Trump presidency and the fact that there was clear confusion as to the hashtag associated with the tweetchat, the stats for last night's #TrumpHealthCare tweet chat should be taken with a grain of salt. I suspect that many of the tweets intended for this chat were coded with #trumpcare and ended up not being seen - or counted in the Symplur numbers.



As a veteran of many healthcare tweetchats, I will share that 145 participants are very high number of participants for a chat; especially given there were only 296 total tweets from all those participants. Out of those 296 tweets, I filtered out over 200 as retweets and tweets that were clearly off-topic.

You can find the entire list of tweets from this chat here.

If you're interested in healthcare, healthcare reform, and healthcare data, technology and services topics, consider following me on Twitter where I share as @ShimCode.