https://www.balloon-juice.com/wp-content/uploads/2015/11/balloon_juice_header_logo_grey.jpg00Betty Crackerhttps://www.balloon-juice.com/wp-content/uploads/2015/11/balloon_juice_header_logo_grey.jpgBetty Cracker2018-04-24 16:25:162018-04-24 16:25:16She hates him as much as we do.
We’ve got a family of purple house finches in the yard with three fledglings. The fledglings are still a bit awkward in flight but do well enough; they can land on our feeders and gorge themselves, as they do pretty much all day.
But they still harass their parents for food. Here’s Father Finch being importuned by a baby, which is flapping its wings and screeching to demand that food be stuffed directly into its maw — just a few feet from a 24/7 all-you-can-eat buffet:
So, Papa feeds the little screecher:
But that just makes the little bird flap harder and screech more loudly:
So he feeds it some more:
It STILL won’t shut up, so Dad says, “Fuck it, I’m out.”
But another hungry chick awaits him on the next branch. Poor Papa Purple.
https://www.balloon-juice.com/wp-content/uploads/2015/11/balloon_juice_header_logo_grey.jpg00Betty Crackerhttps://www.balloon-juice.com/wp-content/uploads/2015/11/balloon_juice_header_logo_grey.jpgBetty Cracker2018-04-24 13:44:282018-04-24 15:15:35Hop on Pop (Open Thread)
Colorado’s economy is red hot. The unemployment rate is just 3 percent. New skyscrapers and apartments are going up everywhere as more and more people throw cash at downtown bars and restaurants, but no one invited Colorado’s public schools to the party.
The National Education Association’s (NEA) annual report found Colorado ranks 46th in the country for teacher pay, with an average annual salary of $46,155; seven-thousand below the national average. Wyoming teachers, which ranks 16th for teacher pay, earned an average annual salary of $58,140.
I suspect this will not age well come election time…
She got a solid seven hours sleep, had breakfast, her morning meds, and I actually lost sight of her for about twenty minutes and when I realized she was not in the same room with me, I looked out the window and she was in the backyard pooping, peeing, sniffing, with her tail up and just prancing about. Being a dog, basically.
When I see her just lying there, being relaxed and comfortable, I can just feel my blood pressure dropping.
There are three major styles of claims based risk adjustment systems. Some systems use only diagnosis information to slot a claim into a risk group. Most systems use diagnosis information. If a specific code is on a claim, the person is placed into the risk group. Some systems only use pharmacy claims where specific National Drug Code (NDC) number corresponds to a risk group. If a person picks up a prescription of a specific NDC, they get slotted into a risk group. Finally there are hybrid systems that use both diagnosis and prescription data.
Diagnosis based systems suffer from severe lag from when a service was performed and when the claim could be processed. Claims are not settled for at least six to nine months after the date of service. Diagnosis is specific. A diagnosis will indicate Type 2 diabetes with or without complications which will drive their own score that drives a monetary transfer.
Pharmacy based systems are fast. Almost all pharmacy is point of sale claims processing. The big challenge with pharmacy based risk adjustment is that very few drugs have only a single use. For instance, oral hormonal contraception have a predominant use of preventing pregnancies but they are also used for a number of other medically valid reasons.
Hybrid systems like the CDPS MRx use both diagnosis and pharmacy data to drive a risk score. I optimized the UPMC Medicaid risk adjustment process for this model. It tended to award higher scores for diagnosis while a pharmacy claim slotted someone in as low as possible in a general category as pharmacy claims covered a much wider array of conditions than a specific diagnosis.
Over the past several years, physicians, hospital systems and insurers have all been trying to reduce opioid prescribing through a variety of means in order to minimize the number of additional people who will become addicted to an opioid. This means people who previously would have been prescribed an opioid are getting prescribed either non-pharmaceutical treatments or alternative non-opioid prescription drugs.
Some of the drugs in the model are used to trigger a multiple schelerosis diagnosis. That is an expensive disease so it is a significant increase in scored morbidity. There are a few important policy considerations that arise from this problem in the model’s data lag.
First, most Medicaid programs use revenue neutral risk adjustment, just like the ACA uses revenue risk adjustment. If everyone’s score increases by the same margin, no one gains or loses money. If there is a differential change in the risk scores that are solely driven by the opioid alternatives driving up MS scores, then some insurers will gain money that they really did not earn and some insurers would lose money that they “should” get.
The incentive in this situation is for a red queen race. Every insurer in revenue neutral risk adjustment where opioid alternatives can score increased risk adjustment payments should seek to maximize the number of people receiving opioid alternatives that score highly in other risk adjusted categories. If one insurer is doing this and no one else in the state/risk adjustment group, that insurer will get a lot of “free” risk adjustment money.
The second policy consideration is whether or not we want to intentionally use the fact that risk adjustment lags clinical reality as a fairly strong incentive for insurers to aggressively move people off of opioids and towards the prescribed alternatives? If the state uses revenue neutral risk adjustment, this policy had no direct monetary impact on the state but may lead to fewer people newly addicted to opioids.
Finally, a broader point needs to be raised. Most health insurance systems that require some type of guarantee issue and community rating needs risk adjustment to counter-act the cherry picking incentives every insurer faces. Every risk adjustment system is flawed. Diagnosis based systems have a significant lag between the event and data generation while pharmacy based systems have wider error bands due to the multiple indications most drugs can be used. The critical question is how much error should we tolerate, in what direction and to what purposes? And from there, how often do we need to update models to account for changes in clinical practice?
Milliman’s deep dive on the CDPS MRx model showed a critical exploit that aggressive insurers using that model can use to generate millions of dollars of additional revenue that is not supported by the underlying claims. They also lead to several critical questions that we need to think about.
https://www.balloon-juice.com/wp-content/uploads/2015/11/balloon_juice_header_logo_grey.jpg00David Andersonhttps://www.balloon-juice.com/wp-content/uploads/2015/11/balloon_juice_header_logo_grey.jpgDavid Anderson2018-04-24 06:57:432018-04-22 21:38:59Risk adjustment and practice changes
Tonight is the Trump Occupancy’s first official state dinner, and somebody managed to persuade Lord Smallgloves that if he wanted a well-done steak with ketchup, he could eat his own meal early. (And you thought you hated *your* job.) Because the guest of honor is French, and/or because the only Democrat on the guest list is Louisiana Governor Bel Edwards, a Cajun-influenced side dish is included on the menu.
Possibly because the thought of sheep always gets bloviating wingnuts amorphously aroused, Erik Son of Erik, Founder of Red State Trike Farce Strike Force and Professional Christianist, decided to take public offense. Mockery ensued!
This menu is why I could never be President: https://t.co/GjDFxf24PM I'd serve fried chicken and mashed potatoes with sweet potato pie for dessert. None of this unpronounceable froo-froo garbage.
Jambalaya. I at least expected something nominally foreign to American palates like creme brûlée or bouillabaisse but no…he's intimidated by jamba-friggin-laya. Do you want to Supersize that mayonnaise slushy Erick? https://t.co/iSavlTOZkx
https://www.balloon-juice.com/wp-content/uploads/2015/11/balloon_juice_header_logo_grey.jpg00Anne Lauriehttps://www.balloon-juice.com/wp-content/uploads/2015/11/balloon_juice_header_logo_grey.jpgAnne Laurie2018-04-24 05:47:392018-04-24 05:47:39Tuesday Morning Open Thread: Culinary Ed for Jingoists
This weekday feature is for Juicers who are are on the road, traveling, or just want to share a little bit of their world via stories and pictures. So many of us rise each morning, eager for something beautiful, inspiring, amazing, subtle, of note, and our community delivers – a view into their world, whether they’re far away or close to home – pictures with a story, with context, with meaning, sometimes just beauty. By concentrating travel updates and tips here, it’s easier for all of us to keep up or find them later.
So please, speak up and share some of your adventures and travel news here, and submit your pictures using our speedy, secure form. You can submit up to 7 pictures at a time, with an overall description and one for each picture.
You can, of course, send an email with pictures if the form gives you trouble, or if you are trying to submit something special, like a zipped archive or a movie. If your pictures are already hosted online, then please email the links with your descriptions.
For each picture, it’s best to provide your commenter screenname, description, where it was taken, and date. It’s tough to keep everyone’s email address and screenname straight, so don’t assume that I remember it “from last time”. More and more, the first photo before the fold will be from a commenter, so making it easy to locate the screenname when I’ve found a compelling photo is crucial.
https://www.balloon-juice.com/wp-content/uploads/2015/11/balloon_juice_header_logo_grey.jpg00Alain the site fixerhttps://www.balloon-juice.com/wp-content/uploads/2015/11/balloon_juice_header_logo_grey.jpgAlain the site fixer2018-04-24 05:00:312018-04-23 17:07:57On the Road and In Your Backyard
One of those “just in the family” things they don’t talk about in front of the Yankees, apparently, because I don’t remember hearing about it before. This year’s commemoration gets a more fitting memorial. Angela Helm, at The Root:
On Monday, Alabama is set to observe Confederate Memorial Day, commemorating the sons of the South killed in the U.S. Civil War. No surprise there. Alabama loves fighting with Mississippi for the title of “most racist state” (though they actually may be running neck and neck with “everything south of the Canadian border” if we’re keeping it real).
I find this amusing, not just because of the abiding ridiculousness of the holiday itself—which for me and most black people is a dressed-up way of reveling in institutional racism and anti-blackness (contrary to claims of “love of heritage”)—but because I just so happen to be in Alabama today, Monday, for a press preview of a memorial and museum dedicated to those both forgotten and annihilated through acts of racial terror across the country, and I will touch this holiest site on … Confederate Memorial Day…
… [H]ere in America, the God some trust is not on the dollar bill, it is the dollar bill. Here, as we all were whispered songs of “sweet lands of liberty,” black Americans perished in a nightmare of running blood and burning flesh and mass rape for pleasure and profit; that story all but erased from history and replaced with men playing war games, re-enacting so-called acts of valor for an indefensible premise…
The national lynching memorial, the National Memorial for Peace and Justice, will stand atop a hill, in remembrance of the more than 4,000 victims of racial terror on U.S. soil, which the Montgomery, Ala.-based Equal Justice Institute has meticulously tracked for six years.
The accompanying Legacy Museum: From Enslavement to Mass Incarceration, located in a former slave warehouse, will also tell the tale of our sojourn here: from enslavement to widespread public executions, to Jim Crow, to the continued violence against black bodies through mass incarceration and police violence.
The museum and memorial are but two drops in a bucket recognizing the true “legacy” of this nation; it’s a befitting tribute to those who weren’t able to throw up statues and establish holidays, their bodies sometimes snatched and ripped apart for keepsakes. It finally acknowledges, in a lasting way, what this country wrought upon its literal children, drafted into another war they never signed up for, but one in which they certainly perished, strange fruit hanging from poplar trees…
Fred Hiatt, in the Washington Post:
In the Riverfront Park of this state capital, you will find a series of panels depicting the city’s history. They will tell you when the first white settler arrived, how riverboats transformed Montgomery into a trading hub for cotton “and many other important commodities,” and how the city became the cradle of the Confederacy.
They will not tell you that the most important of those other commodities was human beings.
It is the sort of lacuna, says Bryan Stevenson, that allows people to “achieve political victories by celebrating the greatness of America.”
“The question is, which decade are black Americans supposed to want to relive?” Read more
https://www.balloon-juice.com/wp-content/uploads/2015/11/balloon_juice_header_logo_grey.jpg00Anne Lauriehttps://www.balloon-juice.com/wp-content/uploads/2015/11/balloon_juice_header_logo_grey.jpgAnne Laurie2018-04-24 01:36:172018-04-24 01:44:42Late Night Horrorshow Open Thread: The Proper Commemoration of "Confederate Memorial Day"
So what I am being told is that cooking calf liver, letting it cool, slicing it into tiny pieces, and hand feeding it to your dog, making sure she goes to the bathroom, and then tucking her into bed is a bit over the top?
I THINK NOT!
Truth be told, the last picture looks like a hostage video and she might be blinking “SAVE ME FROM THIS CRAZY PERSON.”
https://www.balloon-juice.com/wp-content/uploads/2015/11/balloon_juice_header_logo_grey.jpg00John Colehttps://www.balloon-juice.com/wp-content/uploads/2015/11/balloon_juice_header_logo_grey.jpgJohn Cole2018-04-24 00:08:522018-04-24 00:13:37Maybe Just One More Dog Post
WOW🐊 – No fear from “Mr. Duck” 🐥when District 3 Deputies assisted a licensed trapper with a 9’ gator removal from a residence within the Eagle’s community on Muirfield Drive🐊 pic.twitter.com/tiVPn7WYH3
https://www.balloon-juice.com/wp-content/uploads/2015/11/balloon_juice_header_logo_grey.jpg00Adam L Silvermanhttps://www.balloon-juice.com/wp-content/uploads/2015/11/balloon_juice_header_logo_grey.jpgAdam L Silverman2018-04-24 00:04:232018-04-24 00:04:24Late Evening/Early Morning Open Thread: Floriduh! Gator Goes Swimming!
Looks like Rear Admiral Doctor Ronny Jackson may have erred in inviting the kind of scrutiny no mere physician to the powerful usually encounters:
Republicans and Democrats on the Senate Veterans Affairs Committee are raising concerns about allegations involving Rear Adm. Ronny Jackson, President Donald Trump’s nominee to lead the department of Veterans Affairs and are reviewing them to determine if they are substantial enough to upend his nomination.
Committee members have been told about allegations related to improper conduct in various stages of his career, two sources said.
No further details are out yet, beyond the characterization that these are “some fairly raw allegations,” as Sen. Richard Blumenthal (D-CT) put it. Pure speculation here, but to my ears this has the ring of #MeToo about it.*
This is clearly not what R. Adm. Jackson anticipated when he too the fatal step of accepting anything from Donald Trump.
No sympathy for him: he did what he did, and he willing chose to pursue a post for which he was clearly ill-placed to fill. Any sane person would realize the move would bring his conduct under scrutiny. If bad things are about to rain down on him…well, welcome to the major leagues, son.
But it is also a reminder: Trump diminishes every single person who touches him.
*Update: It appears it may be workplace issues other than sexual harassment. Memo-to-self: when you don’t know, you don’t know.
I will probably at some point get back to posting about politics and other stuff, but not right now. Here’s a little video of nothing, really, other than the panoramic view from my chair:
Also, Devon sends along these pictures of her previous foster Yuki who stayed here for about ten days. She is doing quite well at her forever home. Here she is with her new big brother and BFF Bogart:
And here she is just being adorable:
I don’t know if you all remember, but she had rickets and her legs were crookeder than Forrest Gump’s, but they are looking really good.
Not much going on here other than me driving myself insane watching every little thing Lily does- “she didn’t eat that much is something wrong with her stomach oh she ate a lot of that maybe I should get more how long has it been since she went to the potty oh it looks like she is pooping I need to check that shit out am I imagining things or is she breathing shallow her nose looks a little dry I wonder if that means anything should I be doing anything should I be concerned she just wants to be upstairs maybe she’s just sick and tired of being fussed over…”
I’m nuts. I can not even imagine being the parent of a sick child. We need single payer.
https://www.balloon-juice.com/wp-content/uploads/2015/11/balloon_juice_header_logo_grey.jpg00John Colehttps://www.balloon-juice.com/wp-content/uploads/2015/11/balloon_juice_header_logo_grey.jpgJohn Cole2018-04-23 21:06:292018-04-23 21:06:29Oh Fer Fuck's Sake Not Another Dog Post
Kaepernick accepted the award—which has gone previously to Belafonte, artist and activist Ai Weiwei, Malala Yousafzai, and Nelson Mandela—on Saturday, where he delivered remarks condemning the brutality committed against minorities by the U.S. criminal justice system…
https://www.balloon-juice.com/wp-content/uploads/2015/11/balloon_juice_header_logo_grey.jpg00Anne Lauriehttps://www.balloon-juice.com/wp-content/uploads/2015/11/balloon_juice_header_logo_grey.jpgAnne Laurie2018-04-23 18:25:032018-04-23 18:25:03Monday Night Open Thread: Congrats to Colin Kaepernick
I just want to make a quick follow on to Anne Laurie’s post by getting to the real meat of the issue that the New York Times framed the reporting on Secretary Clinton from 23 July 2015 forward by publishing an inaccurate story with a thoroughly misleading headline. Leave all the self defensiveness of different NY Times reporters aside. It is all sound and fury signifying nothing but the all too human self defensiveness when someone is involved with a major screw up.
Since this is going to be long, here’s the Bottom Line Up Front (BLUF) since 1/2 the post is going to be after the page jump.
Bottom Line Up Front
The New York Times wrote an inaccurate story with a completely misleading headline that framed all future reporting on this issue and which also further framed Secretary Clinton as criminal in her behavior as Secretary of State.
As a result the New York Times blew the larger story, which is that US governmental IT is so bad and lagging, not to mention insecure, that utilizing a private server was both not prohibited according to the rules in place at the time that Secretary Clinton became Secretary of State, and that it still isn’t much better.
That the real political question, if there really was one, was about political calculus and optics. As in should Secretary Clinton have been considering the potential future political optics when deciding to go with the personal server if she was still considering running for President again in the future?*
Reporters, both at the New York Times and other newspapers, networks, and/or platforms DID NOT then and DO NOT now understand classification, classification issues, nor the classification review that occurs when a FOIA request is made!
Political reporters did not realize then, and still do not realize now, that they were being manipulated to achieve the aims of Judicial Watch in an attempt to achieve Judicial Watch’s political goals in regard to both Secretary Clinton and the 2016 election.
And now on to the actual post.
The real issue here is that the New York Times got the initial reporting wrong, used a terribly misleading headline, and that almost three years later seemingly NO ONE in the news media, especially the US political news media, still has any understanding of how classification works! This whole mess is the result of reporters not bothering to learn, or acting as if they don’t know, how the actual Freedom of Information Act (FOIA) process works, including classification review. That whenever a FOIA request is made a review is done to determine if classified information can now be declassified and released pursuant to the request. And, equally importantly, that material that was deemed unclassified at the time it was created and/or transmitted should now be retroactively up classified as a result of changed circumstances. Nor did anyone bother to actually investigate that all of this resulted from Judicial Watch weaponizing the FOIA process in an attempt to create just this type of situation, which it could then exploit the political news media in order to achieve Judicial Watch’s own political goals.
The story certainly seemed like a blockbuster: A criminal investigation of Hillary Rodham Clinton by the Justice Department was being sought by two federal inspectors general over her email practices while secretary of state.
It’s hard to imagine a much more significant political story at this moment, given that she is the leading candidate for the Democratic nomination for president.
The story – a Times exclusive — appeared high on the home page and the mobile app late Thursday and on Friday and then was displayed with a three-column headline on the front page in Friday’s paper. The online headline read “Criminal Inquiry Sought in Hillary Clinton’s Use of Email,” very similar to the one in print.
But aspects of it began to unravel soon after it first went online. The first major change was this: It wasn’t really Mrs. Clinton directly who was the focus of the request for an investigation. It was more general: whether government information was handled improperly in connection with her use of a personal email account.
Much later, The Times backed off the startling characterization of a “criminal inquiry,” instead calling it something far tamer sounding: it was a “security” referral.
And the evolving story, which began to include a new development, simply replaced the older version. That development was that several instances of classified information had been found in Mrs. Clinton’s personal email – although, in fairness, it’s doubtful whether the information was marked as classified when she sent or received those emails. Eventually, a number of corrections were appended to the online story, before appearing in print in the usual way – in small notices on Page A2.
But you can’t put stories like this back in the bottle – they ripple through the entire news system.
So it was, to put it mildly, a mess. As a result, I’ve been spending the last couple of days asking how this could happen and how something similar can be prevented in the future. I’ve spoken to the executive editor, Dean Baquet; to a top-ranking editor involved with the story, Matt Purdy; and to the two reporters, Matt Apuzzo and Michael S. Schmidt.
The story developed quickly on Thursday afternoon and evening, after tips from various sources, including on Capitol Hill. The reporters had what Mr. Purdy described as “multiple, reliable, highly placed sources,” including some “in law enforcement.” I think we can safely read that as the Justice Department.
The sources said not only was there indeed a referral but also that it was directed at Mrs. Clinton herself, and that it was a criminal referral. And that’s how The Times wrote it initially.
“We got it wrong because our very good sources had it wrong,” Mr. Purdy told me. “That’s an explanation, not an excuse. We have an obligation to get facts right and we work very hard to do that.”
By Friday afternoon, the Justice Department issued a terse statement, saying that there had been a referral related to the potential compromise of classified information, stating clearly that it was not a criminal referral. Mr. Purdy says he remains puzzled about why the initial inaccurate information was confirmed so clearly. (Update: Other news outlets also got confirmation of the criminal referral as they followed The Times’s story. They did not report, as an earlier version of this post suggested, that she herself was the target of the referral.)
I want to highlight something that I quoted from Sullivan above because I think it is highly significant:
(Update: Other news outlets also got confirmation of the criminal referral as they followed The Times’s story. They did not report, as an earlier version of this post suggested, that she herself was the target of the referral.)
Sullivan clearly recognized that The Times reporting set up all the subsequent reporting. This is significant. Had The Times gotten it right, then the framing would not have been set that there were two criminal referrals for Secretary Clinton made by two Inspectors General regarding her handling of emails. The Times was the initial point of transmission, as the paper of record, for this inaccurate information.
https://www.balloon-juice.com/wp-content/uploads/2015/11/balloon_juice_header_logo_grey.jpg00Adam L Silvermanhttps://www.balloon-juice.com/wp-content/uploads/2015/11/balloon_juice_header_logo_grey.jpgAdam L Silverman2018-04-23 17:16:202018-04-23 20:41:56A Quick Follow On Regarding How The New York Times Inaccurately Framed The Coverage Of Secretary Clinton
https://www.balloon-juice.com/wp-content/uploads/2015/11/balloon_juice_header_logo_grey.jpg00Alain the site fixerhttps://www.balloon-juice.com/wp-content/uploads/2015/11/balloon_juice_header_logo_grey.jpgAlain the site fixer2018-04-23 17:11:082018-04-23 17:11:08Quick Site Maintenance