Podcasts about bpci

This episode discusses quality and value in healthcare and how the BPCI program, designed to lower costs and enhance care quality, particularly in the post-acute phase, did not demonstrate notable positive impacts on HF-related measures. What does this mean for the larger health quality landscape? The GameChangerQuality in healthcare is rapidly evolving. There are pressures at the population level that evaluate how we do things; the quality always needs to be safety focused.HostJen Moulton, BSPharmPresident, CEimpactGuestJake Galdo, PharmD, MBA, BCPS, BCGPCEOSeguridadReferenceArticle:Bundled Payments for Care Improvement and Quality of Care and Outcomes in Heart Failurehttps://jamanetwork.com/journals/jamacardiology/article-abstract/2813066 Pharmacists, REDEEM YOUR CPE HERE!CPE is available to Health Mart franchise members onlyTo learn more about Health Mart, click here: https://join.healthmart.com/ CPE Information Learning ObjectivesUpon successful completion of this knowledge-based activity, participants should be able to:1. Define quality in healthcare.2. Review outcomes of hospitals participating in the BPCI program.0.05 CEU/0.5 HrUAN: 0107-0000-24-133-H04-PInitial release date: 04/01/2024Expiration date: 04/01/2025Additional CPE details can be found here.

For a full transcript of this episode, click here. I've been in a couple of meetings lately. In one case, a healthcare company came up with a strategy and deployed it; and the strategy didn't go as planned. The other one, it did go as planned—it worked great. Of course, I'm coming in on the back end like a Monday morning quarterback here; but the plan that failed, I have to say, I wasn't surprised. Had they asked me ahead of time, I would have told them to save their money because the plan was never gonna work, even though the strategy looked like kind of a straight line from here to there. Nor was I shocked by the success of the other plan, even though this one that triumphed had what looked like five extra steps and was slightly counterintuitive if you looked at it cold, without understanding the way the healthcare industry actually works. Here's my point: It might feel like the healthcare industry is chaos monkey central and impossible to predict actions and reactions—and, for sure, there's always unknowns and intersecting variables—but it's not a complete black box. The trick is, as you know and I know, you gotta understand what other stakeholders are up to. You gotta get a bead on what they're doing and what their incentives are because then you can better predict actions and potentially reactions. So, let me state the obvious (that's why listeners tune in to this show as I just said, and it's what we aim to shine a light on here at Relentless Health Value): the pushes and the pulls and the forces. What's going on outside of the organizations or the silos that we work within day-to-day. Because if you're looking to sell to, partner with, not be obstructed by [insert some stakeholder here], then it's very vital to be keyed in on what they're doing or what their customers are doing or what their customers' vendors are doing. This show should feel like it gives you a measure of control (or at least that's my hope) or a method to find the measure of control. And I hope you succeed. That's why I continue to put out these shows. The RHV tribe members want the same thing I want—to fix the healthcare industry for patients and for members—so, thanks for being here and for making actionable the insights that you might find here. I have been so looking forward to doing a show with Ben Schwartz, MD, MBA, orthopedic surgeon and prolific writer of deeply thoughtful and insightful posts on LinkedIn. In this healthcare podcast, we are talking about bundled payments. And today's your lucky day if you think you know a lot about bundles, because most people who listen to this show at least know enough to be dangerous. So, that's our starting point, which is why I asked Dr. Schwartz to talk to me about what most people find surprising about bundles and bundled payments. There are four surprises that we go through in the show today. Listen to the show or read the transcript to find out exactly what they are. So, no spoiler alert alert. But relative to these surprises, we get into the four types of bundles that may or may not be available. And those four types of bundles are: 1. CMS bundles such as the BPCI (Bundled Payments for Care Improvement) and the CJR (Comprehensive Care for Joint Replacement) bundles, and we talk about the current state of said BPCI bundles, which are being sunsetted probably because so many efficient clinical teams are being penalized for getting too efficient. They become victims of their own success the way the program is currently designed, wherein the goalposts keep shifting. 2. Commercial bundles—ie, a bundle that is offered by a commercial carrier such as a BUCA (ie, Blue Cross Blue Shield/UnitedHealthcare/Cigna/Aetna/Anthem) carrier 3. Direct bundle—a bundle that is paid for directly by a plan sponsor such as a self-insured employer 4. Condition- or diagnosis-specific bundle. These types of bundles do not spiral around a surgical intervention at their core, which most of the current bundles do. This may describe CMS's recently announced “Making Care Primary” initiative, but we'll have to see about that. Speaking about the #3 kind of bundle, the employer-direct bundles, especially for musculoskeletal (MSK), let me share a post by Moby Parsons, MD, that I thought captured the entrepreneurial spirit of some of these orthopedic surgeons who are seeking employers to direct contract with and cut out the middleman, etc (which, by the way, is the main topic of an entire show upcoming with Elizabeth Mitchell from the Purchaser Business Group on Health). But Dr. Parsons wrote: “When our bundle business has sufficient growth to ensure the absolute sustainability of our practice against declining reimbursements … in a fee-for-service system, I am getting this tattoo. Don't tell my wife. [And the tattoo is ‘Free Yourself.']” My guest today, aforementioned, is Dr. Ben Schwartz. He's an orthopedic surgeon in the Boston area still in full-time clinical practice. He's grown very interested in healthcare innovation, healthcare technology, and does some advising and investing. Dr. Schwartz also writes a great Substack called Dem Dry Bones. After you listen to this show, please go back and listen to the one with Steve Schutzer, MD (EP294) talking about how to create a Center of Excellence and also the one with Rob Andrews (EP415) about how and why if you are a plan sponsor you might want to consider direct contracting with quantifiably amazing provider groups. Also, if you are an ortho or involved in MSK care, I might suggest following Karen Simonton on LinkedIn, as well as Moby Parsons, MD, and, for sure, of course, my guest today, Dr. Ben Schwartz. Also mentioned in this episode are Moby Parsons, MD; Elizabeth Mitchell; Steve Schutzer, MD; Robert Andrews; Karen Simonton; Peter Hayes; Al Lewis; and Cora Opsahl.   You can follow Dr. Schwartz on LinkedIn and read his blog on Substack.   Benjamin J. Schwartz, MD, MBA, is a fellowship-trained orthopedic surgeon with over 15 years of experience. He has served numerous healthcare leadership roles on both a local and national level with a focus on developing and implementing evidence-based, high-quality musculoskeletal care delivery pathways. Dr. Schwartz is vice chair of the Practice Management Committee for the American Association of Hip and Knee Surgeons and helps advance knowledge of musculoskeletal conditions as a member of the Hip and Knee Content Committee for the American Academy of Orthopaedic Surgeons and editorial board member/elite reviewer for The Journal of Arthroplasty. Dr. Schwartz has extensive experience in value-based care, having personally achieved over $400,000 in savings during his first year in the CMS BPCI-A program. He has received awards for clinical care and professionalism and was named a Castle Connolly Top Doctor in 2022 and 2023. In addition to his clinical work, Dr. Schwartz maintains a strong presence in healthcare technology and innovation as advisor and investor to early-stage digital health companies. He is frequently sought after by clinicians, founders, and venture capitalists for his ability to bridge the gap between real-world medicine and start-ups/entrepreneurship. Dr. Schwartz's passion is thoughtful implementation of technology and innovation to improve healthcare quality, accessibility, costs, and outcomes.   06:07 Where are we in the development of the bundled payments space? 08:09 What are the four types of bundled payments? 09:52 How can bundled payments create perverse incentives? 11:04 What are the positives in bundled payments, and how can they help push us toward value-based care? 13:02 What is surprising about bundled payments? 18:50 EP415 with Rob Andrews. 27:03 How do Centers of Excellence connect back to bundled payments? 29:00 EP346 with Peter Hayes. 30:29 EP294 with Steve Schutzer, MD. 33:38 EP331 with Al Lewis. 33:43 EP372 and EP373 with Cora Opsahl. 37:13 What does Dr. Schwartz think the future is for bundled payments?   You can follow Dr. Schwartz on LinkedIn and read his blog on Substack.   @BenSchwartz_MD discusses #bundledpayments on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcareleadership #healthcaretransformation #healthcareinnovation   Recent past interviews: Click a guest's name for their latest RHV episode! Justin Leader, Dr Scott Conard (Encore! EP391), Jerry Durham (Encore! EP297), Kate Wolin, Dr Kenny Cole, Barbara Wachsman, Luke Slindee, Julie Selesnick, Rik Renard, AJ Loiacono (Encore! EP379)  

This episode discusses quality and value in healthcare and how the BPCI program, designed to lower costs and enhance care quality, particularly in the post-acute phase, did not demonstrate notable positive impacts on HF-related measures. What does this mean for the larger health quality landscape? The GameChangerQuality in healthcare is rapidly evolving. There are pressures at the population level that evaluate how we do things; the quality always needs to be safety focused.HostJake Galdo, PharmD, MBA, BCPS, BCGPCEOSeguridad ReferenceArticle: Bundled Payments for Care Improvement and Quality of Care and Outcomes in Heart Failurehttps://jamanetwork.com/journals/jamacardiology/article-abstract/2813066  Pharmacist Members, REDEEM YOUR CPE HERE! Not a member? Get a Pharmacist Membership & earn CE for GameChangers Podcast episodes! (30 mins/episode)CPE Information Learning ObjectivesUpon successful completion of this knowledge-based activity, participants should be able to:1. Define quality in healthcare.2. Review outcomes of hospitals participating in the BPCI program.0.05 CEU/0.5 HrUAN: 0107-0000-24-133-H04-PInitial release date: 04/01/2024Expiration date: 04/01/2025Additional CPE details can be found here.Follow CEimpact on Social Media:LinkedInInstagram

The Institute for Advancing Health Value has recently released two new Intelligence Briefs highlighting two major impactful events in the movement to value-based care. 2021 MSSP Performance Results Analysis:  The Institute analyzes 2021 performance data, sharing high-level program performance and examining savings across participation tracks, by the provider type, size and location of ACOs, and their experience in the program, and reflects on the future of the MSSP in light of the recently proposed changes to the program and the beginning of CMS's new capitated total cost of care model, ACO REACH. The ACO REACH Final Cohort:  The Institute analyzes the incoming final cohort of provisionally-accepted REACH ACOs within the context of the model's history, analyzing the roster relative to GPDC's current participants, and sharing expectations for the future.  (This Intelligence Brief was sponsored by Bamboo Health.) Check out this special bonus episode where Eric and Dan interview Kate de Lisle on her research analysis on these recent CMS announcements.  You may also download these Intelligence Briefs at  https://www.advancinghealthvalue.org/analysis-of-mssp-2021-and-aco-reach-2023/ Episode Bookmarks: 01:30 Download the new Institute intelligence briefs on the 2021 MSSP Performance Results and the ACO REACH Final Cohort 02:30 Background on Kate de Lisle, Senior Manager of Payment & Delivery Transformation at Leavitt Partners 04:00 Recently announced MSSP Results as an important bellwether for the success of the value movement 05:30 Total program savings of nearly $5.4 billion over the model's lifetime 06:30 5th consecutive year of net savings – has the MSSP demonstrated proof of concept? 07:00 Was 2021 a good year for the MSSP since the net savings wasn't quite as large as the year prior? 07:30 The average per beneficiary PMPM savings amount was $164 (double what it was in 2019) 08:00 81% of ACOs generated savings and 58% earned a Shared Savings bonus.  Quality scores were also high. 08:45 89% of ACOs taking downside risk generated savings (compared to 76% that saved in an upside-only track) 09:15 Risk-bearing ACOs generated $5.3M per ACO (compared to $2.9M for non-risk bearing) 09:45 ACOs led by physician groups realized the most savings. 10:00 Hospital-led ACOs realized a decline in savings. 10:30 Years of experience in the MSSP is no longer a straightforward predictive indicator of performance success. 14:00 Last month, CMS released the names of the 110 provisionally-accepted organizations selected to join the ACO REACH model starting in 2023 15:30 Only 47% of REACH applicants were provisionally accepted. 17:30 New cohort had similar profiles of selected groups accepting Global and Professional Risk. 18:00 New entrants are serving vulnerable and high-risk populations. 19:00 Groups moving from Next Gen ACO to ACO REACH 20:30 Far fewer payer-led ACOs in the new REACH cohort 21:30 What considerations did CMS take into account when selecting for participation in the new REACH program? 22:00 Sustained interest in ACO REACH from VBP enablement companies (e.g.Aledade, agilon health) 23:30 Provider-owned enablement companies participating REACH (e.g. Castell Health) 24:30 Upstart primary care companies accepted into ACO REACH (e.g. Oak Street Health, Iora Primary Care, ChenMed, Cano Health, Cityblock, ConcertoCare) 25:00 ChenMed  (a leading full-risk MA primary care practice in the country) is included in the new ACO REACH cohort. 25:30 OneMedical has also been accepted into the program. 26:30 The Institute for Advancing Health Value has a complimentary membership for provider organizations! 27:00 Will CMMI be sunsetting various APMs, including specialty care models like BPCI and CJR programs? 28:30 Kate speaks about the “weak signals” being broadcasted by CMMI around the future of the APM portfolio. 30:00 What impact will ACO REACH have on the CMS 2030 Goal?

On this episode of Investors & Operators, Jordan sits down with Luke Redman, CEO of Hospital Internists of Texas. Together, they discuss: The transformation of the operations, structures, and strategies at Hospital Internists of Texas The challenges Luke had undergone over the past 5 years of being the CEO at HIT The key equity investment dynamics across the healthcare industry ...and so much more. Luke Redman, CEO of Hospital Internists of Texas, and Jordan had an interesting discussion about healthcare and recent investment dynamics in the PE and M&A community. Luke, who comes from a military background, shared his thoughts on problem-solving and leadership styles in the healthcare industry. They also discussed topics such as leadership development, industry dynamics, the outlooks of healthcare and its subsectors, and the career path of transitioning into different industries. While investment opportunities in areas such as the emergency room and anesthesia are drying up, Luke saw significant upside potential in some other areas. Tune in to find out! Luke Redman's Bio: Luke Redman has substantial experience in healthcare strategy as a provider and payer consultant in insurance group business strategy and accountable care. and now as the CEO of an MSO physician group serving acute and post-acute patients throughout the Austin metropolitan region. Luke's professional experience includes payer contracting, BPCI, ACO, DCE, I-SNP/D-SNP, Medicare Advantage, risk adjustment, revenue cycle, SNF, home health, health policy, and healthcare informatics. In addition to his professional accomplishments, Luke is also committed to serving underserved populations and veterans, having served two tours in Baghdad in support of Operation Iraqi Freedom.

In this healthcare podcast, we're gonna talk about the realities of setting up a clinically integrated network, otherwise known as a CIN. If only the whole process was unicorns and rainbows, but—as you likely suspected—it's not. Setting up a clinically integrated network is hard work, but the payoff for patients and clinicians alike can be worth fighting for. First of all, what is a clinically integrated network? It is a kind of ACO (accountable care organization). It is a legal entity that is a form of an ACO. So, every CIN is an ACO. But not all—in fact, most—ACOs are not CINs.  CINs enable coordinated care. Everybody in the network gets together to figure out how to enable clinicians to (for reals) follow their patients through multiple care settings and plan for an entire care journey. It can really help the patients navigate our crazy healthcare industry by giving them a trusted team that plots out a proactive path toward better healthcare outcomes and then make sure the patient stays on that path. It can be a really beautiful thing. Listen to EP349 with Lisa Trumble for real-world examples of the patient outcomes and experience a CIN can generate. All this for the patient while, at the same time, the total cost of care for Medicare patients goes down, I've heard, about 10% on average; but it can be more, as Lisa Trumble also talks about in episode 349 as aforementioned.  Alright … as we all know in healthcare, what's best for the patient doesn't, in so many cases, mean higher reimbursements. Sadly. So, what financial advantages does going through the time and trouble to create a CIN bring? There are basically four financial opportunities that can be realized with a CIN. I learned some of this from my guest today, Shawn Rhodes, who called strategically managing these four possible financial incentives “a delicate balance”; and as I get into some of them, you will see why. CIN Financial Opportunity #1: Similar to an ACO, if you're a CIN (because you are an ACO), you can participate in the Medicare Shared Savings Program, otherwise known as MSSP. The Medicare Shared Savings Program (MSSP) is the way that ACOs get paid a little something extra if they achieve savings goals for Medicare. The provider shares in the savings. Get it? And CINs are generally well equipped to realize these shared savings goals because to obtain the quality that you have to to pull off the shared savings, being clinically integrated really helps. CIN Financial Opportunity #2: Getting a gang of providers (doctors) together, you can do collective bargaining. So, back to basics with this one. You get a bunch of docs together in a region, then you all go to the big BUCAH plan—meaning the Blue Cross, the Cigna, the Aetna, Anthem, Humana—you go to them together and make your contracting demands, as opposed to each little doc practice going in all by yourself and trying to negotiate David and Goliath style. Now, what the payer might want from your collective crew there, the payer might insist on some kind of value-based agreement. Even if it's an FFS (fee-for-service) contract chassis, they'll attach some kind of quality or outcome component. So again, being organized in a CIN is a bonus either way. CIN Financial Opportunity #3: Your CIN can try to do direct contracting with local employers. Check out EP350 with Katy Talento for more on direct contracting. Actually, Lisa Trumble also mentions this in EP349.   CIN Financial Opportunity #4: Lastly, you can work with local hospitals' quality and efficiency programs. From a hospital financial perspective, they might be interested in the care that happens after an inpatient stay. If the outpatient care at an integrated skilled nursing facility, for example, is good, then the hospital could, for example, reduce readmissions. Now, caveat: I asked (maybe grilled is a better word) our guest in this episode, Shawn Rhodes, about this whole “prevent a readmission” business. Because on one hand, oh wow, you get a couple points back from having lower readmissions—which you can game all day long, by the way. Listen to the show with Dr. Rishi Wadhera (EP326) for more on how to not get dinged for readmissions even if you effectively have readmissions.   So, said another way, the crafty, albeit dubious, power move here if you're a hospital to maximize revenue is to let patients come back to the hospital after discharge but just don't call it a readmission. Call it, I don't know, observational. Then bill fee for service for the whole thing and get the reducing readmission financial incentives. At this point in the time-space continuum, everybody knows this stuff. This is not some kind of secret that I'm spilling here. Anyway, I bring this up because don't forget what I just said: The #4 CIN financial opportunity that Shawn Rhodes had mentioned is hooking up with a local hospital as part of their quality and efficiency program and the hospital looking to the CIN to reduce readmissions. Given the open secret on hospitals and readmissions, my Spidey sense just got really curious. So, when I pressed on this point, Shawn didn't talk about the CIN sharing any financial gains from the reducing readmission incentive program like I might have expected. Instead, he mentioned that having lower readmissions is a way for hospitals to get some negotiating leverage with payers. The next time your hospital's payer contract comes up, you can point to lower readmissions and then demand higher FFS fees. You also might be able to improve throughput of profitable service lines by reducing the number of patients who turn back up after their earlier procedure—which is another way, again, to increase FFS revenues, since the more patients you put through, the more revenue. This is why I like talking to people with a touchstone to the real world. You find out what the actual deal is. Now, I say all this to say that if patients get better care and their care journey is non-fragmented, it's a win-win. And CINs, like most ACOs, have been shown to trim the cost of care with great patient feedback. That's amazing. Just a quick spoiler here, but the seven parameters that Shawn Rhodes and I discuss in this episode which are essential for anyone who is looking to stand up a CIN or basically achieve success—and, I would guess, almost any value-based model—you gotta have an infrastructure that takes into account the following seven things: Patient-first and agile culture Interoperability Patient-centered processes Actionable information (not just data) Clinical integration Strategic planning and alignment of all stakeholders in the CIN Strong leadership My guest in this episode, Shawn Rhodes, has worked in performance and quality improvement for many years. He has worked at a CIN in Bowling Green, Kentucky; and he has overseen multiple value-based programs. Shawn currently serves as regional VP at Caravan Health. You can learn more at caravanhealth.com or connect with Shawn on LinkedIn.   Shawn Rhodes serves as regional vice president at Caravan Health, a services and technology company that helps hospitals and physicians who care for underserved population succeed in value-based care. Shawn collaborates with clients to develop tailored population health strategies and support their efforts to deliver the highest-quality, patient-focused care at the lowest cost. Prior to Caravan Health, Shawn served as the director of clinical integration for a clinically integrated network, Med Center Health Partners, where he oversaw value-based agreements (commercial, Medicare Advantage, Medicaid, BPCI, and employer health plans) with various payers along with ACO activities and quality improvement initiatives within the network. Before his work in value-based care, Shawn served as director of education and organizational development at Baptist Health Hardin, focusing on leadership development and cultural change through Studer Group initiatives. The early part of Shawn's career was spent in industrial equipment design and progressed into the automotive manufacturing industry working with Toyota and Honda on quality and process improvement. He then transitioned to the healthcare industry where he worked for eight years as a consultant specializing in coaching and mentoring hospitals to achieve improved quality, efficiency, and financial performance through process improvement, LEAN techniques, and reengineering. Shawn has a bachelor's degree in mechanical engineering and a master's degree in business administration from Western Kentucky University. He resides in Bowling Green, Kentucky. 08:08 What are the seven parameters to consider when standing up a CIN? 08:25 “Culture trumps strategy.” 09:10 “Communication and education are key components to starting that … process.” 09:26 “How do you get the information to the right person at the right time and the right place?” 09:36 What does interoperability need to look like in a CIN? 10:29 How do organizations communicate with the patient in a CIN? 11:07 Can a clinically integrated network work if it's not patient-centric? 11:37 EP332 with Tony DiGioia, MD.11:49 What's a must-have for a clinically integrated network to be successful? 13:41 “What does that data mean?” 15:34 EP315 with Bob Matthews.15:52 “You really need a go-to person.” 18:57 “The thing with team-based care is, you also have to have team-based accountability.” 20:54 “You've got to build some infrastructure around what you want to do.” 24:37 “Alignment is not an easy task by any means.” 25:15 “There has to be a group decision-making process.” 25:34 EP343 with David Carmouche, MD.25:41 EP341 with Gary Campbell.26:18 How do you define leadership? 27:49 “Start small, get some successes, and it will build as you go.” You can learn more at caravanhealth.com or connect with Shawn on LinkedIn.   Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork What are the seven parameters to consider when standing up a CIN? Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork “Culture trumps strategy.” Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork “Communication and education are key components to starting that … process.” Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork “How do you get the information to the right person at the right time and the right place?” Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork What does interoperability need to look like in a CIN? Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork How do organizations communicate with the patient in a CIN? Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork Can a clinically integrated network work if it's not patient-centric? Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork What's a must-have for a clinically integrated network to be successful? Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork “What does that data mean?” Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork “You really need a go-to person.” Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork “The thing with team-based care is, you also have to have team-based accountability.” Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork “You've got to build some infrastructure around what you want to do.” Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork “Alignment is not an easy task by any means.” Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork “There has to be a group decision-making process.” Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork How do you define leadership? Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork “Start small, get some successes, and it will build as you go.” Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork   Recent past interviews: Click a guest's name for their latest RHV episode! Pramod John (EP353), Pramod John (EP352), Dr Eric Bricker, Katy Talento, Stacey Richter (INBW33), Stacey Richter (INBW32), Dr Steve Schutzer (Encore! EP294), Lisa Trumble, Jeb Dunkelberger, Dr Ian Tong, Mike Schneider, Peter Hayes, Paul Simms, Dr Steven Quimby, Dr David Carmouche (EP343), Christin Deacon, Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333)

Gina DiPietro  0:04  Half a million common elective procedures like hip, knee and shoulder replacements are performed every year in the United States. Most, outside of the hospital - with a one night stay or less. Welcome to Industry Insights: a healthcare podcast presented by Novant Health. I'm your host, Gina DiPietro. Regulatory changes over the past few years have made it increasingly easier to perform orthopedic procedures in an outpatient setting. This shift was driven by the Centers for Medicare and Medicaid Services, or CMS, with a goal of reducing the national spend on health care and creating access at lower cost sites. Here to explain it all is Dr. Bryan Edwards, system physician executive at Novant Health Orthopedics and Sports Medicine Institute, and Zack Landry, system administrative executive for that same institute. You'll hear Zack Landry jump in first. Thanks for listening.Zack Landry  1:03  What we are seeing both nationally and at a local level for Novant Health is that many orthopedic procedures that were once exclusively performed within inpatient hospitals are now actively moving to ambulatory sites of care. So you mentioned common elective procedures like hip knee and shoulder replacement, those are increasingly being performed at outpatient surgery center. So nationally, the impact of that is there's a lot of really value to be gained, you look at close to half a million hip and knee replacements that are performed a year in the US several billion in spend on those procedures a year. So we hear all the time about growth of healthcare spending as a percentage of GDP, we have an aging population, so that we know, you know, those hip and knee replacements aren't going away, there's gonna be more of them. So I think there's a real interest in how can we reduce the cost of care? How can we create more value? How do we make them more cost effective. And so I think that then this you know, confluence of factors that are driving cases to the outpatient space has really put the spotlight on orthopedics, I'd say probably over the last couple of years, especially this year.Dr. Bryan Edwards  2:05  Gina, this started back probably 2014 or 2015. When Medicare (CMS) came up with a program, it was basically the Bundle Care Initiative. So it was a program where Medicare looked at their spend every year, and the highest spend they have on a procedural DRG is hip and knee replacement. So obviously, if you're at the top of their list, there are going to be more eyes upon you. And at that point, they created a program called BPCI, which basically was a bundled program, where the government Medicare was going to pay you a set amount of money for that bundle, and you had to manage it the best way possible. And so that led to a lot of changes and how the patient's journey was mapped out. So focus has got placed on preoperative optimization of patients, better pain control techniques, better mobility, removing skilled nursing facilities from the discharge planning, moving to home with home PT. And to this day, it's the only bundle program for Medicare that's actually done what it wanted to do it actually improved quality could decrease length of stays, decrease readmissions and a decreased cost. And when that was happening, what they also noticed is how many patients that we treat with hip and knee replacements they were being discharged with just one night stays. They also noticed that we were discharging patients same days, I think when the light went off with CMS and said, Well, obviously, the site of service that we're delivering is hip and knee replacements. And if patients are only staying one night, well, that's truly outpatient, that's not really an inpatient resource consumer. And so you started to see things such as knee replacements got taken off the inpatient only list and placed on an outpatient list. And then once the government or Medicare, a Medicare makes a move like that, than the insurers follow. And so over the last several years, that's what's happened. And that was kind of the market forces that pushed all of us to take a hard look, because not everybody is going to go home the same day and certain criteria that we've come up with national criteria, not everybody's going to stay just one night. So is a select group of patients. But this select group of patients are what we're talking about in this shift. Gina DiPietro  4:19  What prompted this shift? Is it revenue driven? Does it improve patient outcomes? Perhaps the combination of both?Zack Landry  4:27  Yeah, I'd say there's a couple things that collectively are both prompting the shift and accelerating the shift. And our partners at SG2, a healthcare consulting firm, they even refer to it as the perfect storm for surgical migration. And so Bryan mentioned some of the regulatory perspective. That's the first one and it really starts with CMS, some of the rule changes that they've had over the last couple of years. They make it easier to perform cases outside of the hospital. So hip, knee and shoulder replacement are those high volume big spend items for Medicare, but there's about 300 procedures that CMS actually is removed from the inpatient only list with those goal of reducing the national spend on healthcare creating access at lower cost sites. The second is clinical perspective. Brian mentioned a lot of those. It's easier and safer now to perform procedures and outpatient surgery centers than it was say 10 years ago, you have advancements in medicine, clinical pathways, technology, and equipment allows our surgeons to provide safer procedures and faster recovery. And so you don't need that long hospital stay, it's now become unnecessary, you have the consumer perspective. Third, there's growing interest by patients and insurers to operate at lower cost. And so they're actually incentivizing payers, our physicians and patients to choose the lower cost settings and sometimes pass those savings along to the patients as well to eliminate out of pocket expense. And then lastly, I'd say you have the impact of the pandemic that we've seen over the last 12 months where in the state of North Carolina elective procedures shut down for about six weeks during the height of the pandemic. And beyond that it's really kind of changed the way that people access care. When you think of elective procedures, especially a lot of people thought it was best to wait it out until the pandemic had clear they had concerns about receiving care in a hospital during COVID. We saw the impact of people who lost access to employer sponsored insurance all together. Those are the ones I'd say that SG2 refers to as the perfect storm for orthopedic migration. So you could say that makes Dr. Edwards and George Clooney and Mark Wahlberg and a lot of ways just as we navigate these rough seas for outpatient migration.Gina DiPietro  6:23  Dr. Edwards, would you agree with that - George Clooney? Dr. Bryan Edwards  6:26  I'm definitely George Clooney, in my mind. Gina DiPietro  6:30  You have to love their sense of humor. You'll notice Zack mentioned faster recovery times. Another practice in orthopedics is something known as enhanced recovery after surgery, or ERAS. It's an evidence based approach to shorten both hospital stays and recovery times and decrease the risk of complications. It starts with making sure that person is ready for surgery. So do they smoke? Are they at a healthy weight, if it's a diabetic is their blood sugar controlled? Here's Dr. Edwards.Dr. Bryan Edwards  7:01  You're making sure that the patient before surgery is medically optimized. Then, in that group of patients, you're also doing a lot of messaging to them that we expect you to go home after one night. So you want the whole team to be kind of in a consistent message you know you're going to gray or take good care of you. It's not like we're rushing patients out the doors just we know that they only need a certain amount of resources to succeed. During the surgical period, we've taken a lot of steps to decrease the patient's pain and discomfort we use an agent called TXA. It's an IV medication given a patient's before HIPAA near procedures, and it substantially decreases the amount of bleeding that they have at the time of surgery. So we've seen significant reductions in post operative pain and swelling from the use of TXA. We have anesthesiologist here that perform peripheral nerve blocks and spinals to patients are avoiding generally anesthesia. So they avoid potential complications from that with the peripheral nerve blocks as well. They're taking far less opioids, so they're not as nauseated and some of our surgical techniques become more minimally invasive. And all of that just came together to, I think, give the patient a experience where they're not in as much discomfort as they were in patients procedures are pretty seamless to just take it to the you know, kind of a neat level. One of Dr. Holmes' hip replacement patients came in went home the next day and play golf six weeks after the hip replacement and got a hole in one on the fourth hole of his route. That's unheard of, you know, playing golf at six weeks wouldn't be thought of two or three years ago, but that shows you the minimally invasive techniques that can be done to get people back to what they want to do.Gina DiPietro  8:41  You talked about the difference between surgeries performed in the hospital versus in ambulatory surgery center. But how does this impact reimbursement?Dr. Bryan Edwards  8:51  Well, that's the main headache for a hospital chief financial officers is that it's significantly less reimbursement. There's three kinds of sites of service we have. We have inpatient hospital with HPD outpatient procedures done in the inpatient setting, if you will, and then you have a freestanding type of Center, which is a totally detached ASC. And as you move from inpatient to hospital outpatient to amatory surgery freestanding, there are significant decreases along the way. So obviously, that is less margin for Novant Health, which then requires the entire organization to sit back and say, Well, okay, well, orthopedics can't do anything about this. This is a market trend. It's what the patients and insurers want. Oh, but yes, we've got this decreasing potential margin head coming. So that's when you have to kind of say, Well, what can we do to mitigate that decrease in margin? Well, obviously, I think there's things that you can do that other systems are, you know, for us in orthopedics. We spent a significant amount of time in Charlotte and in Winston building out our trauma programs inside of Forsyth Medical Center and Presbyterian Medical Center. We're also putting in huge focus with neurosurgery on spine, then there's a point where, you know, orthopedics can only I would say, probably next year, about 95% of what we're going to be doing is outpatient. So then you have to really look at your colleagues and surgical oncology, Heart and Vascular, and really look at your product lines to see, okay, well, where else could we grow on the inpatient side?Zack Landry  10:21  I think that's well stated. I would say kind of at a high level, there's opportunities and risk with the shift out of the hospital. And I think you had the chance to speak with Jesse Cureton, and Melanie O'Connell not so long ago about patient affordability and pricing transparency. And so we know that there's the financial impact of moving and that's a risk for us that we need to manage. But there's also the opportunity to bring lower cost care to patients and the process of going through their clinical steps, the operational steps, workflows of moving a case out of the hospital into a surgery center, it helps us to learn a lot about ourselves. And it helps us to better connect with our consumers. And the reality is that our surgeons, too, are getting a lot of pressure from patients. Well, if we can't do it in a surgery center here, then I'm going to go see another surgeon. So it's always our goal to reduce clinical variation to cut out waste and bring affordable products to our patients. And so we keep that in mind too, as we try and balance the impact to hospital financial margin to with the opportunity to deliver lower cost care.Gina DiPietro  11:20  You are both familiar with this idea, this concept of value-based care where people are shifting away from the quantity of care they provide a patient with the quality of care you provide patients. So it's much more outcomes driven. Would you say that this shift that you're seeing is something that supports that shift in healthcare to make it a more value based approach for folks?Dr. Bryan Edwards  11:44  It definitely what we're seeing is. You know, number one, Zack mentioned earlier for our own company, for Novant Health team members, we launched a bundle over a year and a half ago. Our own team members were able to have their joint replacement in a Novant Health facility and minimal out of pocket for them a tailored experience. Obviously, it's a little complicated because no one's self insured. But we proved that the product work, people liked the fact that they had limited out of pocket. They like the connectivity of the bundle with the digital engagement tools that we had to engage them. So there's no question on quality thinking the competitive marketplace for insurers, especially the self insured employers, they're looking for a great result for their team members at the best price of the company. So we've got that in our bundle division, we've created that product with Novant Health team members, and we're ready to use that product to go after the self insured employers.Zack Landry  12:43  I think that's part of the value of having a diad leadership structure, as well and having Dr. Edwards as the traditional clinical expert, and visionary for orthopedic services, and then, you know, our team of leaders who are more focused on the business side and the financial outcome. I go back as a traditional MBA to the Porter's value equation, how do we improve quality? And how do we do it at lower costs. So value is something that we talk about quite a bit. I think that we're really lucky that we have a couple of things that are unique for us. We have expert Surgeons of every nearly every sub specialty throughout our markets. And then we have orthopedic focused hospitals as well. So when you talk about Charlotte orthopedic hospital, you talk about Clements Medical Center being a mostly orthopedic hospital, we have ASC's that are within close proximity to both of those sites. Now, New Hanover having an orthopedic hospital as part of our organization as well. We really have a lot of opportunities to create Center of Excellence around specialized fellowship trained total joint surgeons, for instance, where we can bring the experts to the table, we can bring experts in inpatient nursing care, we have outpatient facilities that can deliver great low cost care and that same remarkable care that we do in the hospital on an outpatient setting, we look at value in a lot of different ways. And we've been able to successfully attack that in a number of ways, whether that's through cost reduction, whether that's through our readmission rates, which are less than half of the Medicare national average, having that diad leadership and having the clinical experts that can lead that across our institute is something that's helped us be successful in delivering value.Gina DiPietro  14:16  Do you know it healthcare systems are seeing this shift from inpatient to outpatient procedures in other programs outside of orthopedics?Dr. Bryan Edwards  14:24  Yes, with Heart and Vascular. There's been also a push for simple cervical lumbar procedures to be done an outpatient setting. So those are two service lines in addition to us that will feel some of these pressures.Gina DiPietro  14:37  It might be nice to sort of wrap up our discussion with lessons learned. So if you could, what have you experienced as the benefits to this approach that maybe you could recommend as best practice to others as they kind of delve into this?Dr. Bryan Edwards  14:53  I think the things you have to do in this business is you got to listen to the customer and listen to the surgeon. So talking to the patients about what worked, what didn't work, you know how they felt like they move through the journey, you learn a lot about where there's educational gaps, you learn a lot about a quote unquote phone call wasn't answered on the answering service. So how do you kind of streamline and package it, we got a lot of great patient feedback from our employer bundles with Novant Health. That was one of the advantages when that was put together, I get a classic example Gina, is that we saw this little blip in readmission, I believe it was around the 10th or 12th day. For some reason, that was a day where people are going to the emergency room for some issue after their hip and knee replacement. It wasn't a lot, but it was statistically it's why is this and it had to do with how you know several things. But what we figured out is, you know, patient being discharged, we were calling him at like two days or three days after they got home, they were calling him at 14 days. So what we did is we adjusted the calls to start calling them around seven to 10 days, and so we could get ahead of you know, they're constipated a question about their wound. You know, frequently, a lot of after surgery, people have a lot of extremity swelling, and they always think they have a blood clot. So they always want to go to the ER and always want to get an ultrasound. And it's really rare that happens, it does happen, but it's not calm. And so we were able to kind of intercept a lot of those patients, and direct them on an outpatient basis to get you know, we would number one, adjust medications work on the GI issues and then you know, get an outpatient based ultrasound. So that way listening to the consumer, you can keep them out of the ER, you don't have any expenses, keep them healthy. And so once a month, we're always hashing out flows and what worked and what didn't work. So I'd say the key for anyone is listen to your patients and listen to the surgeons. And part of that too is we have a lot of input from our nursing staff and physical therapists. Because, you know, nurses see a lot of what's happening on the floor, Zack sits on a team called a best practices team. And in the best practices team, once every two months, we sit down with nursing leaders, therapy leaders across the company. And we find out a lot about the clinical care delivery on how we can improve.Zack Landry  17:06  I would definitely echo that. I think it's very important to listen to our surgeons and our patients and get the insights from them as to how we're delivering value. The one other thing I'd mentioned is taking the time when you're really looking at value to do some patient journey mapping and really trying to understand what's the perspective of the patient? And what's the experience that they're going through, not just for procedure, not just date of surgery, and a day or two of recovery. But what is their entire journey look like? Starting with the first physician office visit when they're first experiencing knee pain or shoulder pain? What's the education look like leading up to that surgical procedure? The surgical wellness visit the optimization steps, are they getting a full packet of 2000 pages that they have to sort through are they getting education in little bite sized bits that they can understand and be fully prepared to take on that surgery to take on their recovery. And I think as we started to do that, as we pulled together all the frontline team members from every part, whether that was the clinics, the hospitals or home health agencies, partner skilled nursing facilities, as we did that, we started to realize little gaps that might occur 30 days pre op that might affect the readmission on the backside. And so I think taking the time, and it was really time intensive for us to be able to build that for our total joint episodes. But since we did that for our team member total joint replacement, which we started about two years ago, and we've seen that performed extremely well, we've actually seen our patients, on average, save about $3,000 out of pocket, because we've been able to eliminate a lot of the waste. And then also too we've had no readmissions over the last year for anybody that's gone through one of those procedures. So we're really proud of the results. And we want to continue to learn and grow from there.Gina DiPietro  18:50  That's fantastic. And I really liked that point that you made around, you know, someone doesn't want to go home with 2000 pages to read through. So really, you know, breaking it down into bite size info. And I think to making sure it's written in a way that people understand it because medical jargon can be tricky and sometimes go over people's heads.Dr. Bryan Edwards  19:10  You have to also understand that every patient wants to receive information like every other patient, right? So you kind of have to figure out millennials that it's really a Gen Z millennial thing, you know, what do people want and you can't have one delivery mechanism.Gina DiPietro  19:28  Thank you for listening to this episode of Industry Insights. You can find more episodes under the Industry Insights channel of the Novant Health podcast family. There's tons of great content there around creating a culture of diversity and inclusion, using technology to transform care delivery, price transparency, and workforce burnout. So feel free to browse around. We're on Apple, Google, Spotify or anywhere you listen to podcasts.

This week Zac and Benjamin discuss Apple’s updated offer on the Developer Transition Kit, the stalled state of Apple Car talks, new features coming in iOS 14.5, Dan Riccio’s not so secret project at Apple, Apple’s first AR app for Apple TV+ shows, and more. Sponsored by TextExpander: Visit textexpander.com/podcast and select 9to5Mac Happy Hour to save 20% off your first year! Sponsored by ExpressVPN: Take back your Internet privacy today and get 3 months free with a 1-year package at ExpressVPN.com/HappyHour. Sponsored by LinkedIn Jobs: Go to LinkedIn.com/HAPPYHOUR and get $50 OFF toward your first job post! Follow Zac Hall @apollozac Benjamin Mayo @bzamayo Subscribe Apple Podcasts Overcast Spotify Read More Default music player can be set to Spotify in iOS 14.5 beta Bloomberg: Dan Riccio's secret 'new project' is AR/VR headsets, Srouji expands role iPhone 12 mini sales continue to lag in early 2021, new data suggests Older Apple TV losing CBS All Access channel next month, AirPlay suggested CBS and Showtime bundle no longer available through Apple TV app, ahead of Paramount+ launch Apple offering free battery replacement for 2016/2017 MacBook Pro that won't charge past 1% Apple Glasses displays to use micro OLED; in trial production Apple Maps adding new Waze-like features for speed traps, accidents, and other road hazards Apple TV+ acquires movie rights to 'Dolly' starring Florence Pugh Fraudulent Website Warning gets privacy boost in iOS 14.5 Apple increases Apple Silicon DTK return credit from $200 to $500 For All Mankind S2: Come for the alternative space timeline, stay for the character drama [Interview] Hyundai and Kia confirm they are no longer in talks with Apple regarding Apple Car production https://youtu.be/j_OtJ41PIcE 9to5Mac Happy Hour is live streamed on our YouTube and Facebook pages every Thursday at 4 p.m. ET/1 p.m. PT! Transcription Developer Transition Kit update Zac Hall: [00:00:00] This week on 9to5Mac Happy Hour. We're going to talk a little bit about Apple car. A lot about IO is 14.5 features and some Apple glasses streamers. And then some Apple TV plus stuff has come up this week. So let's start out with the developer transition kit update. We spoke last time. Yeah. I mean, I broke the news to you about how like, you know, halfhearted the deal was, and, and then you broke the story to me on, on how they fixed it. So what, what, what are the details there? Yeah.  Ben Mayo: [00:00:47] Like. There was a very muted response, I think, to DTK thing. And, and look, we, you know, we're privileged people to even get the development of first place, so to be able to afford it right. But everyone was based on the precedent of what they did for the Intel to for the past PC to Intel position where, when the DTK went back, what got replaced was an iMac of equivalent value. And then this. Pregnant comes along. Obviously they never promised it. Right. So you can't get too mad. Right? They, you said that the, the, the, the transaction was stated, you pay $500, you get to use this thing, and then we want it back done. But there was like, you know, is that what they're going to offer us a nice little bonus. And I sit with, thank you. And what we got slapped with last week was a $200 credit that you had to use by the end of may. Which just feels terrible, like, especially as a, not me. Cause I didn't actually get any M one compatible stuff out yet, but a lot of the developers that do get that kit, they're the most dedicated people in the community they're rushing to support, you know, Apple's latest platforms on day one, often with the bad quality apps as well, right. Just the bad, you know, just the bad quality developers or the people getting that care. And they're like, You coming off Aqua's biggest quarter ever. And what do they give you? They give you a tangible credit on something you paid $500 for. And you've got used by the end of may, before it could be an immediacy before WWC. Any of the cool rumor stuff actually comes out and it's like, do you want to get this map book that you might've already bought? Well, incredibly. They actually had a change of heart. I can't believe they actually changed the moment, but on February 6th they sent out a new email and the new email basically said, we understand, we heard you, and this is what we're doing instead. So rather than a $200 credit that expires at the end of may. Now all of us fancy developers can get a $500 credit. Which is the same price as what we paid for the drug in the first place and the credit doesn't expire until the end of December. So it runs through the end of this year, better than you'll get a dreamed of. So now my forthcoming. Cool. M one X six inch mapper pro would have been $500 cheaper because I paid phones and I was a bit last year prepaid a little bit. I prepared. Yeah.  Zac Hall: [00:03:00] That's very good at that because it especially feels good. Like if they would've just on that had been like, Okay, cool. But because it was so half-hearted before, you know, it was more than half, but it was less than half the, the value that was like, Oh, this really is a good value compare because it was so low  Ben Mayo: [00:03:17] before. Yeah. And now we feel great about it. And they also clarified that for people that have actually already bought M one staff and they didn't need it, they'll be able to use the credit on any purchase in the Apple store that helps them with development. But I think it just basically means you can buy whatever you want with it. No. Okay. So get you some AirPods, max, pay an extra $50 and get some AirPods,  Zac Hall: [00:03:36] man. They really, they help with development. I mean, they do a lot of things with them. Yeah,  Ben Mayo: [00:03:40] definitely. I'm going to make everybody, I'm going to make an edit buddy compare and go against Rambo.  Zac Hall: [00:03:44] I'm going to make an everybody's to come back. Ben Mayo: [00:03:48] No, but I'll be saving mine for the property. Okay. $3,000 end up having to spend or whatever on the 16th mapper pro at the end of the year. Good call. Like it's a nice, it's at least the, at least they listened to the community, right? Like there's been no, quite a lot of, you know, roundabouts of does Apple really care about the community? Do they really care about the big PayPal? Did any come out the people that are giving them subscription revenue every five seconds, or did they actually care about like, you know, the small people, the indie developers and at least the fact that they saw this response and they. Did something about it? You know, it's got to make people feel good versus the kind of like sour taste in the mouth. So I have indeed prepared the packaging as the email asks me to call now I await my email turf to send it back. Are you ready?  Zac Hall: [00:04:29] Are you allowed to mail things in the UK right now?  Ben Mayo: [00:04:32] That is a good question actually. Like, I mean, technically if they do a courier service, I can like drop it off at the door. If they expect me to go to the post office, then I guess I'll have to negotiate with the British government that sending back at him. One developer kit is a, an essential  Zac Hall: [00:04:47] service. Does he have to be the theater to do this? Basically? All right.  Ben Mayo: [00:04:51] Let's go with, you have to return it promptly. I think like you get the voucher to use, but by the end of the year, but they want the thing back sent back. What should it be?  Apple Car Talks Zac Hall: [00:04:58] This should be a reality, reality show. It's planet. What is it called? Planet of the apps? Here's season two. Let's talk about some Apple car stuff, because we spoke over the last few weeks about how Apple is talking with they slash Kia about manufacturing, the Bali of their car, just doing the, making the Apple cart for Apple  Ben Mayo: [00:05:22] Foxconn of the iPhone, but for the cab. Zac Hall: [00:05:24] Yeah. And Hyundai was pretty chatty about it. And then they were like, we're not actually working with them. Just really bizarre stuff. It seems that there's at least reporting this week that that all talks between Apple and Hyundai slash Kia have stopped. You know, we don't know if it's because of the chattiness in the press or, or what, but just this is all weird to me. That's all I'm going to say.  Ben Mayo: [00:05:48] I mean, maybe in the Steve jobs era, if a company said something slightly too early, They get caught off and never spoken to ever again. But yeah, it's a bit beyond the childishness of that nowadays. Like  Zac Hall: [00:06:01] whatever. Well, it was reportedly buying beads and it was going to be for 3.3. Billion dollars. 3.2. Yeah. 3.2 million. And then it ended up just being three flat because of Dr. Dre celebration video. Yeah.  Ben Mayo: [00:06:16] That was actually the reason, but that was like float around as the reason it's  Zac Hall: [00:06:19] good head Canon.  Ben Mayo: [00:06:20] Why not outside? Well, that's $3.6 billion investment that kids get, or you just spent half, not only getting 1.8. No, but that's obviously not how it works. Right? Like, you know, Apple can't back down like. It felt, you know, cause Foxconn leaks stuff about the iPhone quite often, like we see those internal presentations where they're like the iPhone 12 is going to have 5g and they have a do a little PowerPoint slide for everybody and it leaks and you know, they never get repercussions of that stuff cause they haven't got a choice like they have to. And if Apple wants us manufacturing of their car, They only have a very limited number of options. And if they've already basically signed the dotted line for, you know, a $4 billion deal with Highlander, they're not going to back out of that just because it leaked out to the price it's just unrealistic. But I think what the truth here is because the news is basically like a client, Diane, the affiliate Kia basically. Did a legal fight in this week that said they had that they aren't in discussions with Apple and corporate and driving a car. So that kind of like flattened the idea, right. Even though crazily, we were just talking, the reason it popped up in, you know, even on the podcast so much was like, you know, CNBC and ruse were like saying, is it as if it was like a signed deal and it's going to be announced on February 17th, if you remember that. Like, so the fact that those massive publications have got the wrong end of the stick, that's kind of crazy, but I don't know. I  Zac Hall: [00:07:31] haven't due on that date. Yeah,  Ben Mayo: [00:07:34] you're wa it's just a boring out February 17th. Now there's Apple car announcement. Yeah. Yeah. I don't know what, obviously Apple is going to be making a car like, or at least they are currently again, looking to make a car based on this latest rumor. It seems like the enthusiasm and the hype train is probably a bit premature. I think they're still gonna do it. Right? Like, but maybe it's not announced in February. Maybe it will be later in the year. Maybe they've found all those suppliers they're negotiating with maybe, maybe the high end icon and Kia deal was like on the table, but it wasn't like signed. So then they'd been looking around talking to other people and now they'd like, you know, maybe found someone else for instance. So that's how I read it. Obviously it's like, you know, the automotive industries and our special specialty, but just in terms of like the Apple rumors fair, that's how I kind of see it. But. Like, like as soon as there's a, if you're only in the anti-Apple car camp, as soon as there's a report, that's like, Oh, now they're not there to Africa. Everyone's like, Oh, I told you, so this is the Apple television set all over again that never going to make one. It's just all flummery and made up words and, you know, Chinese whispers, like it's not real. You can't say that, like, you know, we just talked about that. Hide the poor chassis had a, you know, had a body and chassis, right? Like they're building this team out and they're going to probably not to make the next iPhone. Yeah, they're going to be making hardware, some hardware contribution to the car market at some point, maybe in five years, maybe in 10 years. And I know as we still know just about all this there's, the autonomous driving aspect is still way underway. There was that. Did you see the filing that they released with the California government, that the number of hours or the number of miles driven by the Apple cart? You know, like prototypes basically doubled over 2020. So they're obviously, you know, ramping it up and they're disengagement went down. So like they get in there. Right. And I assume they're trying to time it so that when the autonomous system is ready to go, it will be perfectly timed with the hardware being ready to actually ship the car. Yep.  Zac Hall: [00:09:32] And even though we don't have anything for February 17th anymore, they send that one crazy river. The day after February 18th. The next American Mars Rover will arrive at Mars and land. So now that you've got that vacancy in your calendar next Thursday. All right. Do you have to take a sponsor break here?  Sponsored by TextExpander Ben Mayo: [00:09:54] Sure. This episode, thanks to our friends at smile software for sponsoring happy hour. Take your time back with the power of text expander, repetitive typing, little mistakes, searching for answers. They're taking precious time away from you and your team. And we text expander. You can get that time back, tend to things you type into reasonable snippets that can be used again and again and again. Copy and paste superpower. Get ahead of your productivity by taking advantage of text expander. It removes the repetition out of your work. So you focus on what matters. The most safe time and be consistent while you're at it, Texas band, it makes it easy to give your team the right words for every situation and they get it right every time. Whether you need to keep legal, happy, or delight customers with effective answers, you can rest easy in the knowledge that you and your team have got it covered and giving people consistent messaging, Texas band, you keep your team accurate and current all the changes and latest messaging for your business and brand. Share your text and images with your entire staff to keep them on track. And even as an individual, of course, you can use tastes, expanders, powerful shortcuts, and abbreviations to streamline and speed up everything that you type. Just create a pathless snippet once, and then you can use the assigned abbreviation to let Texas band fill it out and do the rest of the job for you. Time and time again, no more repetitive typing and no chance for human error. TextExpander works everywhere. You type Slack, Google docs, email web browsers, the law, and you can install. Take this banner on Mac windows, Chrome and there's iPhone and iPad apps as well. Unlock your productivity with text expander listeners. To this show, you can get 20% off their first year subscription. Visit textexpander.com/podcast. To learn more and sign up once again. That's text expander.com/podcast.  Setting Spotify as default music service for Siri Zac Hall: [00:11:37] Thanks. TextExpander. IOS 14.5. We discussed this last week that this software update that's in beta right now for developers and public beta testers things like the redesigned podcast app. The ability to unlock your, your, your iPhone with your Apple watch on your wrist. If you're wearing a mask very, very useful, which last  Ben Mayo: [00:11:55] week you hadn't used. Cause you didn't turn it on. Yeah. It's very  Zac Hall: [00:11:57] useful when you turn it on. Yeah. Approached pretty well. It's a little bit weird whenever it says that your watch is not close enough to the phone, even though you're holding your phone and your watch wrist hand. But yeah, last. But we still have new things to talk about. And I was fortunately five, some, some new things that have been discovered. So let's begin with Spotify. What's what's new at Spotify as it comes to iOS for two point. Oh  Ben Mayo: [00:12:21] yeah. So obviously the HomePod supported third-party music services on it natively. Very recently, right. And Pandora have adopted that. We're still waiting for others to do it like Spotify. And then if you go back to iOS 13 Apple added the Siri kit, media intense, which let you control third party music apps. Like you can do the, the Apple music app through Siri on the iPhone. But there was no facility. And I was 13 up to now to be able to specify like, I don't want to use Apple music. I want to use Spotify predominantly. So if you just asked a generic music request to Siri, like, you know, play Taylor Swift, it would always. Go to Apple music. You'd have to explicitly say play Taylor Swift on Spotify for it to instead route the request to the Spotify application on the iPhone. Right? What now? Well, wasn't actually announced, this is like a feature or thing. It's just kind of turned up in the, in the Bayer. So maybe it's like premature and they're going to take it out or they haven't decided it's going to ship yet or not. But what people have discovered in foreign 0.5 is that when you interact with Siri for the first time after updating with music, it'll actually prompt you. To pick a default music service. And what it does is it brings up a little list on the screen of Apple music, Spotify, Pandora, all the, all the apps that you have installed that support the Siri kit, media intense. So all the apps that previously you could use via Siri by saying, you know, play this song on Spotify, I'll play a song on Pandora, or would those apps now appear on a. It will list as part of the series. Have you experienced any happens one time, no cheesy D for music service. And so if you pick Spotify from then on, when you just a unqualified requests, like play this album, play this playlist, play this artist it weren't a full-time music anymore. It will, it will be as if you said on Spotify at the end of it. So you're basically getting a default music service through Siri for the first time, which is pretty cool. It's also kind of strange. It just kind of popped out the blue, like it's like, Oh, here we go. Like, Oh wait, we're not going to read it. You announced it as a feature. I mean, already with Aras 14, they announced, you know, you can set your default web browser or default email app. Right. And yeah, they work to a limited extent, but they do work, but you know, they've sneaked in here and offered it for music. The thing is they could offer this for like every Siri kit, domain you know, there's like messaging reminders, mapping, and navigation, and. So far in filling this Ivy only offers you default options for music, which spell it, but  Zac Hall: [00:14:48] there you go. I would love if it worked with the reminders. I mean, with the things that you could just use things as your reminders app,  Ben Mayo: [00:14:56] and it would be to say on things every single time  Zac Hall: [00:14:59] with things, you know? Yeah. Yeah. And also there's a really good example of this being used already with what Amazon does. With echo products and the Alexa app, because you set the category for your preferred. Music streaming service and your preferred music radio service. So you could say, I want my on demand stuff to come from Spotify, but my streaming stuff to come, or my radio and an algorithm radio to come from Pandora. You know, I think there's probably more likely that you've got the same for both, but that's how far. The, the ecosystem goes it it's an obvious next step, perhaps when UI for this, especially. So it's discoverable because it's of how do you invoke it now? You just talk, you talk to Siri and then it, you, you ask it to use Spotify and then it, then it. Suggested  Ben Mayo: [00:15:46] for you. Yeah. Basically I think the way it works is first time you update the phone book five, whenever you next, make a music requests, it would say pick a default service, and then you choose it from the list. Or afterwards you can like specifically ask Siri to change your default music service. And then it will give you the options. Or this is meant to give you the options. But yeah, like you're right. It's not very discoverable because if you, if you choose Apple music the first time, and then you forget, there's no like. You UI to change it with the web browser and Safari stuff. If you go into settings and you go onto Safari, it says like default browser. And it says, you know, if you pick Chrome or something, instead as of the current beta, if you go into the music app where you've selected, like Spotify, it doesn't have any interface, they changed it back. So they should definitely add that. And if they're going to keep adding more and more of these like default preferences, they need to like, Make us a dedicated section of settings where it just has all the stuff listed and you can tweak it to your heart's content.  Zac Hall: [00:16:34] Yeah. They have a series settings  Ben Mayo: [00:16:35] section. So by the way, I think this has still has the same limitations as the HomePod music thing, where. Like, if you pick a third party service, it will try and use that for podcasts or audio books and music. Like it only knows this, the audio domain, it doesn't have subcategories beyond that. So it's a bit of an issue there. Like if you're using Spotify for music and podcasts, when it's fine, right. Or if you only ask for music, like personally, for me, if I did use it, I use Apple podcasts at the moment, but if I did use a third party podcast app and I wanted to use Spotify, it wouldn't actually bother me. Cause I don't know. I never asked Siri to. Play podcasts. If you see what I always ask her to play music, but I never I to play podcasts. I don't know why is it just a rally because it's not reliable. Yeah. I mean, that's probably one of them. No, I mean, right. Like it's so it, you know, it's better than nothing obviously, but ideally down the road they'd have like, you know, it doesn't need to be complicated. You just have every single category and it says whap, you want to use by preference and you can still use the other ones just by saying their name. But it's a nice, they've done it. And obviously there's the antitrust thing having over here that this probably helps them assuage some of that criticism. Maps getting Waze-style accident/speed trap reporting Zac Hall: [00:17:41] Yeah. Something else that I, I discovered this week with Siri is I was on my motorcycle and I was using AirPods for audio navigation and a series set over the AirPods. Did you know, or you can now tell me about accidents along your out. And I was like, Oh, okay, cool. So then I tried it in the moment and I said, Siri, there's an accident. And then gave me the definition of accident and asked me if I wanted it to read more. And I said, no, but it was okay. It it's the, the voice activated version of this new user interface that's in maps and maps has a little bit of a redesign in terms of the current you're you're. Now you're currently navigating screen. I think everything's just, there's like more rounded buttons and it's just tweaked a little bit. But what they've definitely added in there is the ability to get feedback. Along the route to say. There is a, there's an accident that I had. There's a speed trap ahead so that if you're going to come around the corner and there's a police officer taking, you know, taking radar, then you can Mark that in the same fashion as what, as what the app ways does. And ways it was a dependent and then it was bought by Google. And so now it's a Google property. Apple now has full control of their map data in, in many parts of the world. So this is, I guess, just one more example of, of where they go from, from there by owning their own data. And it's. Yeah. I, I don't, I don't expect it to be as robust as what yeah. It's just because of the whole networking thing. I mean, it's just a beta right now, but maybe, you know, come iOS 15, Iowa, 16, this isn't in the wild and other people know about it. And the ability to do this. With Siri is useful because I believe to do the, do the report, an accident with ways you have to tap through the user interface or make a Siri shortcut for it, which who does that. And so they have it, the ability to have it as a Siri command and say, Hey Siri, there's a, there's an accident I had is, is useful. I, once you get down the, the wording the right way, excuse that I didn't quite do it for some reason.  Ben Mayo: [00:19:52] Yeah. So the, the categories that you can report for is accident, hazard and speed check. That's what they call it. And so you've got a red icon, you got a yellow icon, you've got blue icon You like, this is cool and it's great. They're doing it. Cause you know, we've seen that when they control the data for their maps, they can offer better experiences. Right. And they've delivered that with a rural map data. And if they can build on that with, you know, navigation, directions and smarter. Stuff there. It'd be great, but like, there is a kind of social networking chicken and egg aspect to this, where to actually the reason why he's valid, always not because you can report accidents it's because other people report accidents and then it routes you around them. Right? Like, so for this to work well, this stuff actually has to be used. People have to report it. And so then when you go to you know, do a map, do a rooting with Siri on. Apple maps in the future. He actually gives you a better route because it can be informed by the upcoming accidents or the hazards. Or even like, I dunno, I dunno how they're going to fully expose this yet. Cause this is just a beta for reporting, but like, cause for stuff like hazards and accidents. Yeah. Obviously it's going to just like route you around them. Right. And that's hopefully what you would do, but for something like the speed check stuff, is it going to like, I guess, I guess they have speed camera. You like smokers on the map as a vice 14 anyway. Yeah. There's police  Zac Hall: [00:21:12] markers for speed, for track, for speed cameras and then red light cameras. And then they also tell you, like, if you're actively navigating, CA will tell you as part of your directions red light camera had, so yes, I guess it may be, Oh, I don't know that that way is quite, does that I think weighs it has some of it. It will give you an alert. Yeah, it, it notifies you. So th th but this will be good was once that it's actively in a non beta version of iOS and people are heavily using it  Ben Mayo: [00:21:43] out of character for them to offer you to like, report speed cameras.  Zac Hall: [00:21:46] I didn't set out  Ben Mayo: [00:21:47] to me like, cause I feel like in the past, and maybe I've got the impression that that was the kind of thing Apple maps was never going to do because you know, Apple wants you to follow the law in all circumstances, but. I mean, if they're going to show you the speed cameras on the map, they might as well let you have to use the report. It's big cameras as well. Yeah.  Zac Hall: [00:22:05] I mean like, well, remember when Apple went head to head with the FBI over encryption, you know, I know this is different,  Ben Mayo: [00:22:13] but funny thing where it's like, because he's not on a mission to like break the law, but it's kinda like. This helps you break the law. Do you know what I mean? Like, it's, it's a weird thing like Apple's brand to have, but the reality is every other mapping app that has, you know, user contributed data, crowdsource data offers the speed check stuff, so they couldn't not do it right though.  Zac Hall: [00:22:32] Mainly maybe I'll get pulled out of the band and we'll hear your story about how it was, it was in Rogan turn, who included this stuff,  Ben Mayo: [00:22:40] but yeah, like it'd be, it's cool that they've added the reporting and then we'll have to wait and see how they actually like expose it on routes to, you know, to actually be useful. Yep. That's all  New fraudulent website warning behavior Zac Hall: [00:22:48] right. And then the last thing that we've noticed this week, and now it's 14.5 is how fraudulent website warning the setting works and I was watching the 0.5 because it's already there in previous versions, but how it behaves a different is that right?  Ben Mayo: [00:23:04] Yeah. So I bet you remember the story, the background of this, because, but do you remember like, was it a year or so ago? There was a big up that Apple was reporting. Web browsing hits to Baidu in China. Okay. And basically, so the safe browsing feature, this is existed for ages and this is on every browser, right? When you visit a website, it checks against a database to see if it's like. You know, bad, right? Or it's like a scam or whatever. And if it's in the database, it can show that alert on the screen instead of actually taking it to the website. But to do that, you know how to do it, it's somewhat on private, right? Because it's basically having to send the website that you're on to a third party to validate it and send you back. The response now is more complicated than that because they like hash the around and they only send parts of it. And, you know, they try and make it good. But at some level, You're sending every page, you visit somebody else. And this happens in the U S and most of the world through Google's fraudulent safe browsing service. It's used by Firefox. I think it's used by those browsers. It's used by Safari and then in China, because Google is blocked in China, they use the Baidu version and about a year or so ago, there was like a semi privacy scandal because it was like, Apple sending every website you visit to China, you know, that kind of, that kind of story. What they've done in 14.5 is they basically taken the privacy protections to another level because now rather than. Safari browser contacting like the Google service directly. It first contacts like an Apple endpoint and the Apple endpoint contacts, Google abide you on the back end. So basically your IP address now no longer gets sent to Google or Baidu or whoever else they use for fraudulent search in the future. So it's slightly more privacy preserving in that way, because. Your IP addresses any of it, getting to share to Apple because then they go and make the request for you for, to Google and to think anything. So it's an improvement. And as they continue to tout you know, they're focused on privacy and security. It should be their prerogative to do this wherever they can, like tying down the hatches in every, in every single way. Like, if you want to talk the talk, you gotta walk the walk and this is a way to do it.  Zac Hall: [00:25:12] Well, that makes sense to me. Do you think any other podcasts, Apple podcasts, podcasts for the iPod max every week? Ben Mayo: [00:25:19] Talk about AirPods max every week, no podcast with poke us whip. It was nice every day. Yeah. So fine. Now I only know that you're the one that does it. So yeah,  Zac Hall: [00:25:31] I just wanted to mention it because it's every week I'm consistent here. All right. Let's take a sponsor break.  Sponsored by ExpressVPN Ben Mayo: [00:25:37] We are sponsored this week by express VPN. 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Well, you can just switch over to Canada with express VPN and just keep watching Michael Scott of course, express VPN works with more than just Netflix. You can do the same kind of thing with other streaming services, like being to access the BPCI player from the U S the BPCI player that, you know, I enjoy express VPN is. Super fast. Unlike some other VPNs, you can stream every express VPN with zero buffering across your phone laptop and on the big screen with support for smart TVs and more so stop paying full price to streaming services and only getting access to a fraction of their content to get your money's worth. Go to express vpn.com/happy hour. Don't forget to use our link so you can get three extra months free. That's E X, P R E S S vpn.com/happy hour. One more time. Express vpn.com such happy hour to learn more and sign up. Okay. Have you  Zac Hall: [00:27:24] ever seen the American office? Cause now that  Ben Mayo: [00:27:26] you've got your own, I've seen the American office, then you have your own version over there. I actually prefer the American office to the British one. Okay, cool.  Details on Dan Riccio’s secret project Zac Hall: [00:27:34] All right. Good to know. Let's talk about Dan Richie. O's secret project. We discussed this whenever Apple made their. No vague mysterious pressure leads to say that the Dan ratio is no longer going to be what the VP of hardware. And he was now going to be working on a, a secret project. I think, I think the guesses were, were two things, you know, Apple glasses or Apple car, and then you can narrow it down and say, well, which one's more likely to happen, you know, sooner you know, domestic gas. And there's also w w w you know, our, our former colleague Mark Harmon at Bloomberg, he had reported this week that, that. That reports on what it is now, just a guess, but, but based on reporting. So what is Dan working on?  Ben Mayo: [00:28:16] Man? Go into Bloomberg. Dan Richo is transitioning to oversee the AR headset, the AR slash VR headset. He's on the team that's developing future Apple and VR headsets. There's obviously the reamer that is going to be kind of like a developer version or a super high end, like $3,000 headset coming in 2022. You know, that's going to have super high resolution displays and it's going to be expensive. And, but the idea is this will come out and then down the road, they're going to do one that is like, actually, what's going to be as big as the iPhone. So, you know, like the Apple watch or larger ambitions, like the $3,000 headset is not going to have Apple watch ambitions. And you know, that blue book report from a couple of weeks ago said they aim to sell one per store per day or something. So which is like 200,000 units a year, which then know that that is  Zac Hall: [00:29:00] cheaper than some of the original Apple watch models.  Ben Mayo: [00:29:03] It's true. Yeah. They're not going to come out where they are with the AR headset in solid gold. Yeah. So Bloomberg says the Apple is hitting roadblocks and developing its AI has so, and that's the first one. So I guess Russia Rickio is gonna, you know, step back from his day-to-day responsibilities of doing or with Apple, hydro engineering. So we can help ship the. You know, the developer buy a prototype wherever you want to call it, industry focused one out the door. And then after that's done, be able to move on to get the, you know, the mass consumer one on the way. Yeah. It says the app has informed staff that they also transitioned in the group. That's Connie work on in-house displays and camera technology under Johnny  control. So, so Ruggie is obviously the one that's managing Silicon design and the a team leader for, you know, the M one chips, the eight, 14 series, all that stuff, and motive, modems, currently charged practices and modems. We haven't yet seen. The Apple modem come out, but that's obviously in development, that was last room. It's becoming like 20, 23, 20, 24. What's the hold up for  Zac Hall: [00:30:08] max getting cellular is  Ben Mayo: [00:30:12] if they wait too, if they really do wait to 2024 to give you a say about it, that'll be  Zac Hall: [00:30:17] good. The, the low traffic. Cause there's like nothing in licensing fees. Cause it's so, so low volume.  Ben Mayo: [00:30:23] Yeah. The Goodwill of the  architecture transition will have more than died out. But yeah, that's interesting. Cause they're moving under his domain as the rumors that Apple are developing their own micro led displays. Right. They're going to ship fully custom displays, probably starting with the Apple watch. At some point there's been on an offering that they've got a little like headquarters near, near like a dedicated building Apple park where they're like growing. Cause Marco lady's like organic. So you're like. Growing the screens, and then you work out to make one or two of them and it's like, Oh, this is great. And then you've hit the problems of how do you make a million of them. So that's, that's kind of where micro led is sitting at the moment. It's like, you can make some in a lab and they look really cool. And then how'd you get you is up to actually be practical. But if that's going to reach his head, that probably means that probably signals this closer to being done because generally a lot of the time Apple like incubate something. And then when it's like getting close to prime time, they then go and give it to lo. The head of the, the head of the group.  Zac Hall: [00:31:22] Otherwise you're not going to waste that executives time on something that's R and D.  Ben Mayo: [00:31:26] Yeah, like R and D projects, aren't going to get that kind of attention. Right. I think we saw the same kind of thing with the Apple watch or like the iPad, like the VPs that they work on the iPhone. And then as the iPad got close to ship, they pick, you know, some of their favorite VPs to go and head up the iPad project to actually get out of the door. Same with the Apple watch. And obviously the same things playing out here where they are Those inside Apple hope that Ricky owes hardware expertise will help move past the issues that they're having. But did you say work on the project is still being led by Mike Rockwell? So he's still leading what bimbo describes as well over a thousand engineers working on the AR and VR headsets, but. They hope that re that Ricky has influence is actually going to make a difference in getting the thing out the door. And finally Bloomberg basically says that around last March Rickio had handed oversight of many, many of his responsibilities already, like electrical engineering, product design and project management for the iPhone. And most of Apple was other major products to John Turner's who don't obviously John Tony's and now they have the SVP of hundred engineering, but it seems like this, this transition has been long in the works and it started last year and now it's been formalized basically. Very cool.  Apple Glasses displays to use micro OLED Zac Hall: [00:32:33] And, and there is this well, where are we in Apple glasses? I mean, what, what's your timeline that you think this is going to be more than just the $3,000 thing that  Ben Mayo: [00:32:44] we, the problem with the, the real glasses, right? Is that. Current technology can't make them like, you just have battery problems. Like if you want something to have a decent battery life, like if you want to, if you're gonna, if you, if you need to product that you're going to wear all day long, it needs to have all day battery. Is that the same? Probably with the Apple watch, right? Like. And people complain about the Apple watch battery life. Like there is a limit on how much stuff people are gonna accept to be able to charge on a regular basis. And the very minimum for all that gas is, is you wanna be able to wear them all day long? Like you can't, you can't have AR glasses. Do you wear for like three hours and then even the trucks? Yeah. Yeah. Like that's just stupid. Like people cause people that obviously, if you don't need glasses to see, it's like, okay, you've put in your bag, but people are gonna, they're not gonna carry two pairs of glasses around. Do you know what I mean? Like you just going to need. They're going to need to last a long time. But to last a long time, you need bigger batteries, but then that means you kind of a slim and slender design, which they looks bad, so they can't be made. Right. That's the current issue with the air gas it's thing, like the headsets it's going to like HoloLens. Right. And that's just a big thing that, you know, you look like a a submarine controller with a, you know, the whole, the mask on and everything like, and that's fine if you're doing industry work or you're just playing games in the comfort of your own home. Although I don't, I doubt that the $3,000 headset is going to be a big hit in terms of gaming at that price point. Just cause it's so expensive. Right. And, but if you're trying to make a lifestyle AR Garcia's product, no, I had set. There's a reason. None of them exist. Right? The closest you saw was like Google glass, but that wasn't anything close to the actual AR experience. It was like a little screen that was in the top of the heads of display. Yeah. Heads up display. Yeah. The Google glasses. It was like an Apple watch that you could see by looking forward rather than looking at your wrist. Right. And maybe Apple does ship a portal like that sooner than anything else, but that's not going to be like, obviously what they want to do with like a proper AI and mixed reality AR experience. So I think, I think they are project is like, Still years away. So when did Lynch join for the Apple watch? That was like 2012, 2013, basically. I,  Zac Hall: [00:34:47] I, I, it had to be after 2013 because I started at 95 back in April, 2013, I think we both said, and, and  Ben Mayo: [00:34:58] after that, so it was probably 2013, 2014, basically in the airport shipped. No, he's gotta be longer than 24 because the airport was announced at the end of the year. Like, yeah. So it's gotta be, it's probably around 2013, probably sometime in 2013. So, I mean, if you work on the airport's timeline, you've got two more years, but yeah, but you can't just copy and paste that over to this cause it's good. Different, different ball game. Right. But yeah, I think you've at least got two years. Let's put it that way.  Zac on motorcycle helmet with CarPlay Zac Hall: [00:35:23] Yeah. A friend Chaos Tiana on Twitter. Yeah, a few weeks ago he sent me a link to. A motorcycle helmet that I think in his words apparently works with CarPlay and the apparently is pretty strong there because it looked at it and it's called highlights. I ride and the whole Apple glasses thing. Got me thinking about this again. What it is. Yeah, it's a six, it costs about $600 us dollars. You add it to any helmet I already have, and this is whole system that there is like Bluetooth and voice control. And speakers, which you can already do all those things with the helmet, but it also has one of those little tiny prism lenses that you have, I guess, angled so that you can see through it as you're writing and projected on Google glasses. Exactly. Like Google us. And they, they work out in some way to project apps, like ways Google maps and they even show CarPlay projected. No, I'm not so sure how they achieve that. You know, I know that there's aftermarket ways to have wireless CarPlay on an existing car play system. And it's like, it runs a version of, of ILS on that little dongle and in a way that's not very trustworthy, but it works. This thing, I don't have one to test it out yet, but it just, the, the premise alone to have a heads-up display, like, like this, or not, not even AR glasses, but this thing that attaches to your, to your helmet is just you put your helmet on and then you can see, you know, with translucency. So you, you see through it, but it's also on the road. There's that? And that's something that you can. Apparently by today, I don't want to risk $600 on trying to get it, but that's out there and it made me think this is a thing that would be useful for, for, you know, the Apple glasses in the future. You know, definitely not the HoloLens version, but, but the long-term goal Because right now I'm navigating, you know, if you're in the car, not your phone or have a screen and your car screen. I Mount my, my, my phone on the, on the handlebars and that works out really well, but sometimes the phone's in my pocket and I'm using the watch and that's a little bit too far from my comfort zone. And so this would be neat to have, and it certainly isn't the full CarPlay experience, you know And the other thing I, I, I stumbled upon today and looking at looking for the first thing that I lied. I ride product. It's something called life map and it's still not really AR I mean, it, it tries what this does is it's, it's, it's a full motorcycle helmet. So the first thing you put on your helmet of any type, this thing is the helmet itself. And it's got this, you know, project, your bolts in the Google glass style. And it overlays, I guess it looks at the road and overlays. Lane guidance on the road and that's this big thing. And it costs $2,500, which I thought about. So that was interesting to be the single obligation use of something like this. And then they promise availability in Q3 of 2022.  Ben Mayo: [00:38:21] No, it's a bit, a bit of a wide off. Then you could buy an Apple cart by that time.  Zac Hall: [00:38:24] Yes, this says specific Q3, you know, usually you see like the first half, second half, or like two, one, you know, but say Q3 the first half of the second half of the year, we think we'll start this thing. But  Ben Mayo: [00:38:37] that's what I hope they do on the Apple cart, by the way, when they eventually do make one, like as the. Not just a heads up display, but like, you'd be a proper overlaid light. So you almost get like a mixed reality AR experience projected onto the road. We'd like, cause I always talk about how we need it on the Apple maps on the IFO, where you get the little augmented reality thing to point you left and right. Which I still haven't shipped, but they should totally do like do that on the actual car. And then maybe if you're like sitting in traffic, you can like press a button and it zooms forward to the what do they, what do they call their Google street view? What's it code? Look around, look around. Yeah. So, you know, you get stuck in traffic and you just want to see what you're getting to. You press a little button and then you know what you're looking at instead zooms forward. And you can almost pretend like you're already there. Like, that's what I want from the applicant. It's gotta be that cool. Like, yeah. Zac Hall: [00:39:21] A friend, a friend of mine has a BMW SUV that projects out onto the road. We're not really under the road, but just on the windshield. And you see things like your, your. Miles per hour. And I guess they do there is that you don't have to look down at the dash. You'd just look ahead and you see those things, but it's not intrusive. And it's just, it's kind of a neat, it's kind of a neat gimmick kind of a neat demo, but yeah. Yeah. I've  Ben Mayo: [00:39:45] seen them, maybe those two they're there as a parallel, they're more like the Google glass experience, right. Where you get a little projection in the corner. Sure. And then the real deal was like, Yeah, it can actually just intellect it, superimpose over anything on the, on the screen, like interacting with the environment. Yeah. Yeah. The all the investments we're seeing them do in Apple maps, whether it's their own map day, a look around car accident, reporting all of that stuff that all feeds into the eventual car product, right? Like, I don't think there'd be half as interested in developing these Apple maps features if they didn't have hardware ambitions to actually ship a car in the future. Cause it's all gonna, it's all gonna go in there. And you're like, do they keep adding new features to CarPlay, which is great, but all that stuff's going to be rolled into like the actual Apple car eventually. Yep.  Apple TV+ news Zac Hall: [00:40:28] And on the topic of AR a couple of things for the Apple TV plus. So first I published my review of for all mankind this week. So I've seen, I've seen all of season two. I can't say much about it, except that I very much enjoyed it. And then you can read my view review, which has no spoilers but just general sentiments about the season. And the bottom line for me is that if you like season one, You might've seen the trailer for it and thought this is going to be vastly different, but the trailer is. You know, it's an action trailer and the show is, is a scifi drama. And so if you'd liked all the character development and interactions and stories and season one you get that same thing, but, but you know, in 10 years later in season two so I, I thought it was very enjoyable and I got to do some  Ben Mayo: [00:41:14] interviews with him. Can I ask you a question about that? You can if you're not there to answer, that's fine, but Is there. Cause the only thing I didn't like about forum kind season one is that quite a lot of it felt like a, a drama in the ground. Right. And it almost felt like it, it w it, you know, it didn't have to be related to space. It was just like family, I, which is fine. And intuitions the story on season two. I know you're saying it's like, you know, the actions in the trailer and then there's the thing, but is it still like family stuff or is it more like, you know, like space, cold wall bowels? Do you see what I mean? Like, even if it's just talking about it, I would, I would  Zac Hall: [00:41:45] say that there's as much like family drama on the ground again, but the further they go into the show, the deeper they're integrated within this is the space program. These people work in this space program and that the drama is because of the space program. Not just because they're. You know, a family of three or four. And, and, and there's, there's certainly more space because they're further along  Ben Mayo: [00:42:08] and they're yeah. The train has gone, like with guns walking across the moon, I want the moon conflict with the Russians life, big shoe out, you know, based on your description, it doesn't sound like that's quite, I would also say  Zac Hall: [00:42:18] that that is something I mentioned in the review. You know, the, the cold war was largely. Tension building up of what's going on, what could happen with nuclear weapons and that, that didn't and, and it's kind of this season is a bit like that too, where the tension builds up throughout the season. And then I also mentioned in the review that if there's one thing that I could critique about it, it's that it, it. Well, a couple of concerns is if you do a 10 year jump every season, are you really going to have the same cast every year? You know? And, and the, as you can see, probably from the trailer, I imagined the way that the character at Baldwin, his age, wasn't very it, it, it caught, it took you out of the scene. When he was, you know, had like fake gray hair and like way too dark of a tan I mean that's realistic, but also it's distracting. But so there's the concern of, you know, are, are the characters that we're following and care about now? Are they going to be in future seasons? No, we'll see. And then the other thing is because it is tension building up the season and then near the finale that there's, there's so much happening all at once. That it, you definitely get pay off, but it becomes hard to keep track of some of the things that's happening in your life. You know, it kinda, they, they, they don't spread it out across the show. It's, you know, they could have been like three or four arcs that they, that they had and that's the season. And instead it was cold war style buildup. It really models the cold war, you know, as, as history. But it's, it's nice. And then the first, this won't even be a spoiler that, you know, I can totally see this in the first You know, a few minutes in the first episode, there's a new drill. Montage is only in that first episode, but it's just very entertaining. If you're a fan of history to see all the things that happen differently, including John Lennon, narrowly escaping assassination. So it's, it's neat to see how many things are different. And of course, in the series a, in the season, Ronald Reagan's president, I think it was kind of an undertone, but in the first season, I think Ted Kennedy was president, which never happened. He ran, but it didn't wasn't elected as president. And now we're back to reality. Maybe the timing of the years are off, but then the events are what shifted, but it's. I also think it's it's, you know, you don't have to care about space stuff to really appreciate it. It's it's the drama all on its own. Now that this year, I know more about space stuff than I did a year ago when the first season was, was available. And I picked up on some of the Easter eggs, the trivia you know, there's, there's things like LC 39 C being a launch launch complex 39 C that's at the Kennedy space center. There is one now. As a 2015 for very small rockets. And I think it's about to open soon, but in the seventies, eighties, there was not a C launchpad. There's just a and B. And the idea and the show is that they just, they just mentioned it. That there's about to be a shuttle taking off, right? No, from LCD United sea. And it's to say that the shuttle program is so successful, that they have more launchpads at that one watch complex. And so if you're. Space fan and you know, the kind of the history there, those things will stand out as, as, as the trivia, you also see an eighties Tesla equivalent and, you know, things like that. It's entertaining. So it's  Ben Mayo: [00:45:27] it's it's Oh yeah. They can say, yeah, they released like a second, like feature at trader thing and there's like, Oh, cool. Yeah, yeah, yeah.  Zac Hall: [00:45:34] In the range of like comical, like  Ben Mayo: [00:45:37] it's 60  Zac Hall: [00:45:37] miles. Yeah. But so, so y

An industry inflection point is coming in the transition to value: federal and state governments are feeling an insurmountable level of pressure as public debt and spending increase, large employers are reeling from high healthcare costs, and provider organizations are being crushed by the current environment as they realize that FFS is perilous in the middle of a pandemic. Health system executives not leading with a strategy in health value are increasingly facing significant financial uncertainty. The coming industry shift to value is all but inevitable, however, pivoting successfully will require long-term strategic planning and investment in cultural alignment, technology and infrastructure, and partnerships. When Travis Turner heard Dr. Don Berwick speak about the transformation to population health and value-based payments, he listened. Berwick had said the worst position to be in when transitioning from fee-for-service is static, stuck with a foot in each canoe – the change must be fast to achieve critical mass that enables modifying provider behavior. This became a priority for Travis, something that has been aggressively pursued and which has driven to his organization's success. This week, we speak with Travis Turner, SVP Chief Population Health Officer and COO of Mary Washington Medicare Advantage at Mary Washington Healthcare. Mary Washington Health Alliance is a physician-led, physician governed CIN – founded in 2013, the ACO has 437 participants that cover around 60,000 lives. During the 2017 MSSP performance year, the ACO achieved $11.9 million in savings. For the first three years it participated in the CMS Bundled Payment for Care Improvement program, it achieved $12.6 million in savings. The ACO now participates in the Next Generation ACO model and is active in the BPCI Track 2 for all 48 episodes of care. Episode Bookmarks: 3:30 The inflection point in value-based care for employers, providers, and government 4:40 The value-based care journey of Mary Washington Health Alliance (MWHA) over the last 7 years 6:15 Transitioning from the upside-only MSSP to taking institutional risk in the NextGen ACO and BPCI programs 7:25 Entering downside risk by applying lessons learned from other value-based contracts 7:40 Reaching a critical mass in value to change the behavior of providers 8:00 Don Berwick's influence on MWHA's fast transition to value 10:00 “There has to be a bottom-up, top-down acceptance at every level for population health to succeed in a value-driven organization.” 10:30 Travis reflects on the slow uptake of value-based care in the national landscape and how learning environments will catalyze adoption 11:10 VBC is key to partnering with independent physicians 11:30 “Reaching critical mass in value is all about achieving the Triple Aim. That will overcome any perceived risks of demand destruction.” 12:15 The challenges of adapting to CMS changes to payment models 13:30 NEJM on care patterns in Medicare and the challenges of fragmented, uncoordinated care 14:30 “A true, clinically integrated network will be able to drive enterprise-level change with data.” 15:30 The challenges in siloed initiatives like Oncology Care Model and ESRD Treatment Choices Model in driving system change 16:00 Democratization of data with FHIR-based technologies and how that will improve population health analytics 16:45 Success in clinical integration means treating all patients the same (even those that are not attributed to value-based contracts) 19:15 Taking advantage of clinical integration by entering into single-signature commercial agreements 19:45 Stark and Anti-Kickback concerns associated with clinically integrated networks 20:15 The win-win-win advantages of employer and health system partnerships 20:45 Single negotiated rate advantages with clinical integration 22:25 How FFS can co-exist with VBC in reaching critical mass in value

In this episode, we interview Ken Terry, author of one of the best-researched books we've ever seen! The new book, Physician-Led Healthcare Reform: A New Approach to Medicare For All, explores why we must, and how we can, get doctors to change how they practice. Most employed physicians and independent physicians alike feel powerless. Hospital-employed doctors feel like cogs in a machine, and community doctors are increasingly threatened by forces beyond their control. The biggest problems of physicians--both employed and independent--are a loss of professional autonomy, overwhelming administrative requirements, and the conflict between business and patient care imperatives. This book, directed to physicians, healthcare administrators, health policy experts, politicians, and consumers, explains why the U.S. healthcare delivery system must be restructured to lower costs--and how to do it. Physician-led healthcare reform will give them back a large measure of control and pride in their work. Ken Terry has been writing about health care for more than 25 years. He was a senior editor at Medical Economics, has contributed to numerous publications, including Medscape Medical News, Information Week, and FierceHealthIT, and has received several journalism awards, including the Neal Award from American Business Media. He's also authored the book RX for Health Care Reform. You can read more of Ken's work, including articles and blogs at his website: https://physicianledreform.com. Episode Bookmarks: 3:33 The progression of value-based care over the last decade (e.g. hospital VBP program, BPCI, the mandatory bundled payment program CCJR, CPC, MSSP) 6:20 Consolidation of the healthcare system and employment of doctors driving up costs 7:33 ACOs led by health systems are not as successful as physician-led ACOs in the MSSP 7:58 The first wave of managed care did little to move provider organizations towards taking financial risk (with the exception of Kaiser Permanente and a few others) 9:18 The push towards value-based purchasing in the Obama Administration (e.g. P4P, bundled payments) did not go far enough to change industry appetite towards risk 10:00 Advancement of medical technologies have been driving up healthcare costs (not lowering them) 10:42 “The evidence shows that where you have more primary care physicians, where you coordinate care, and where you pay to keep people healthy, you get better outcomes at lower cost.” – Dr. David Nash 11:31 Research by Barbara Starfield showing that a higher ratio of PCPs to the population is associated with a lower mortality rate from all causes, heart disease and cancer 11:50 States where a higher percentage of physicians who were PCPs have higher quality of care and lower cost per beneficiary 13:00 The impact of medical school debt burden on the supply of primary care physicians and the relegation of PCPs to lower tier status in the medical community 13:51 How Advanced Practice Providers are filling the void to meet unmet primary care needs 14:32 Retail clinics and urgent care centers competing with PCPs 14:53 “The best way to reduce costs and improve outcomes in healthcare is to have larger groups of primary care doctors taking financial risk and competing on quality of care in local areas.” 15:20 Changes that would need to occur before we implement Medicare-For-All health reform (i.e. hospital payment parity, corporate practice of medicine restrictions) 16:10 Proposing federal requirements of hospitals divesting of their medical practices 16:35 Medicare-For-All option that would pay PCPs Medicare rates unless they join a larger primary care group and take financial risk for a larger upside opportunity 17:22 Primary care groups choosing high-value specialists to contract within their network 17:51 Placing primary care in charge of the healthcare system to build medical neighborhoods

Bundled payment programs are designed to promote value-based care and remain largely voluntary. With the deadline to renew or modify contracts rapidly approaching and Medicare’s acceleration towards mandatory models, a four-person panel with varying perspectives discusses whether linking payments to clinical episodes can reduce Medicare expenditures while maintaining or improving quality of care. Learn more about various alternative payment models created to achieve value-based care using AAOS' Value-Based Care Continuum guide. Hosted by: Kristen Coultas, AAOS Advocacy Communications Director 

John Kalamara, business intelligence analytics manager of DataGen, chats with Managed Healthcare Executive's Briana Contreras, about the Centers for Medicare and Medicaid Services, or CMS’, recent announcement of the changes they’ve made for participants in their value-based programs, specifically those in bundled-care programs like BPCI Advanced, whose episodes were affected by COVID-19. For more information on these changes, visit the link here ( http://datagen.info/bpci-advanced/ ) .

Chad Giese, Associate Principal, Cardiovascular, Sg2 and Josh Aaker, PhD, Director, Cardiovascular, Sg2 Our cardiovascular service line leaders, Chad and Josh, talk about a few of the trends our members are asking about most frequently including procedural shift to outpatient settings, learnings from bundles, challenges managing heart failure patients and advances in structural heart programs.  Read more from Chad and Josh on our blog Sg2 members can tap into more CV resources at intel.Sg2.com. Show Notes: [02:35] Three big takeaways about the future of CV care. [05:36] The benefits and challenges of the hospital-to-ambulatory shift. [10:01] What’s next for BPCI advanced. [14:22] The difficulty in managing congestive heart failure. [21:02] Guidelines and the future of structural heart. [23:22] Managing volume at multiple hospital organizations.   Subscribe Today! Apple Podcasts Spotify Google Podcasts Android RSS Feed  

Win Whitcomb, MD is the CMO for Remedy Partners - the largest convener in the United States. He & Craig McAllister, MD talk about the nation's reliance on fee for service and the opportunity and challenges of scaling value-based care programs. Listen to find out the benefits and challenges of value-based care for payers, purchasers, and providers.

Now that CMS has opened the application period for Cohort 2, there are lessons to be learned from those that have come before us. Ginger Biesbrock, PA-C, MPH, MPAS, AACC, Vice President of MedAxiom Consulting, explains that the consensus from participating groups has been favorable and provides key lessons learned from their experience.Learn more about the next open enrollment period at medaxiom.com/bpci-advanced and join us at our upcoming webinar: BPCI Advanced: Insights and Lessons Learned from Cohort 1 CV Participants, on Wednesday, May 22, 2019 at 1:00 pm. Register at medaxiom.com/events

Rich Daly interviews Michael Wolford, a senior manager at DHG Healthcare, about the early results of Bundled Payments for Care Improvement Advanced. Also, five reasons why health systems will need advanced cost accounting in a segment sponsored by Strata Decision Technology.

Alternative Payment Models will impact your organization's future revenue, whether participating in voluntary models or waiting for mandatory payment policies to take effect. So what role will BPCI Advanced play in this new era, what is "BPCI Advanced Plus", and what are the current drivers and challenges among providers, payers and self-insured employers? David Terry is CEO and Founder of Archway Health. Joel Sauer is Executive Vice President of MedAxiom Consulting.Contact: HeartTalk@medaxiom.com Learn more: https://www.medaxiom.comContact: HeartTalk@medaxiom.com Learn more: https://www.medaxiom.com

If you missed the BPCI Advanced enrollment window in 2018, another opportunity is coming soon! How should your group get ready for it? What chance do cardiovascular groups have, to reach the APM-participation threshold, and thus, qualify for a 5% bonus? David Terry is Chief Executive Officer and Founder of Archway Health, a data analytics company focused on bundled payments and innovative payment models. Joel Sauer is Vice President of MedAxiom Consulting.Contact: HeartTalk@medaxiom.com Learn more: https://www.medaxiom.com and cvtransforum.com

Listen NowThis past January 9th CMS announced Bundled Payment for Care Improvement (BPCI) Advanced.  This five-year Medicare bundled or episode-based payment demonstration, that begins this October 1st, will succeed the agency'a five-year BPCI demonstration that sunsets this September 30th.  BPCI Advanced, also voluntary, will be considerably less expansive than its predecessor in that, among other things, it will include just 32 clinical episodes (29 inpatient and three outpatient), and offer only a single, 90 day retrospective bundled payment under one risk track.During this 28 minute interview Mr. Dave Terry briefly defines Archway's business model/s, posits what attributes describe successful bundled payment providers, summarizes the findings from a recent study, he coauthored, of BPCI reimbursed total hip arthroplasty surgeries, how CMS has improved bundled payments under BPCI Advanced, or moreover in financial benchmarking and in quality measurement, the legitimacy of criticisms regarding care fragmentation and competition with other pay for performance models and likely success of the demonstration.Mr. Dave Terry is currently CEO of Archway Health.  Previously, at Partners Healthcare in Boston, Mr. Terry negotiated global cap and pay for performance contracts with managed care plans.  Prior still at Harborside Healthcare, he led a home care agency that managed Medicare and commercial episodes of care within a single payment.  As a partner with The Chartis Group, Mr. Terry developed provider networks and risk sharing models for Medicare Accountable Care Organizations (ACOs).  Mr. Terry holds an MBA from the Harvard Business School and a BA from Columbia University.  He currently serves on the board of Bottom Line, a national educational non-profit, and is a past board member of the Harvard Business School Health Industry Alumni Association.For information on BPCI Advanced to go: https://innovation.cms.gov/initiatives/bpci-advanced. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Listen NowCMS has been experimenting with Medicare bundled payment arrangements, where the provider is reimbursed a total fee (either prospectively or reconciled retrospectively), for three decades.  Under ACA authority CMS' Center for Medicare and Medicaid Innovation (CMMI) has launched several five-year bundled payment demonstrations, most notably BPCI that began in 2013.  The BPCI demo allows providers to voluntary accept a bundled payment for any one of 48 Diagnosis Related Groups (DRGs), for example a heart attack, under three care models.  Model Two is the most popular.  It begins with an anchor acute hospital stay followed by 30 to 90 days of post acute care.  The most common Model Two bundle is for hip or knee replacement surgery.  Recently, the Lewin Group completed its third evaluation of the BPCI.  Regardless of the demonstration's performance to date, has it moreover reduced spending and/or improved care quality and outcomes, it is anticipated CMS will renew the BPCI demo in the very near future since the current demo times out this September. During this 25-minute discussion Mr. Clay Richards discusses naviHealth's BPCI's efforts, the company's BPCI financial and quality results to date, Lewin Group's most recent BPCI evaluation and how the demonstration can be improved under a reauthorized BPCI demonstration.  Mr. Clay Richards is CEO of naviHealth, a post-actue care transition company and one of the nation's largest BPCI convenors.  The company, founded in 2012, partners with approximately 50 hospitals in 25 states, collectively they account for over 40,000 BPCI care episodes  annually.  Prior to joining naviHealth, Mr. Richards served as Senior Vice President of Healthways, Inc.  Mr. Richards' community service includes serving on the Martha O'Bryan Center Board, the Oak Hill School Board and on the Vanderbilt Owen Graduate School of Management Board of Visitors.  Mr. Richards was graduated from Washington and Lee University and from the University of Mississippi School of Law.Information on naviHealth is at: https://www.navihealth.com/.Information on the BPCI demo and the Lewin Group's evaluation can be found at: https://innovation.cms.gov/initiatives/bundled-payments/.   This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

In this episode, Christine Gordon and Kate Gillespie of Virtua Health System discuss their recent involvement in Medicare’s BPCI program and what future developments may hold. Learn how to listen to The Hospital Finance Podcast on your mobile device. Mike Passanante: Hi, this is Mike Passanante. And welcome back to the Hospital Finance Podcast. Today, I am joined Read More

In this episode, Andrew Wilson, Research Team Leader at the Altarum Institute’s Center for Payment Innovation, discusses the results of their study, “Debunking the argument that the Bundled Payment for Care Improvement Program (BPCI) contributed to higher procedure volumes.” Learn how to listen to The Hospital Finance Podcast on your mobile device. You might also like: Strategies for navigating Read More

Former Congressman Tom Price is our new Secretary of Health and Human Services, making him the chief law enforcement officer of health care policy in the United States. In this episode, hear highlights from his Senate confirmation hearings as we search for clues as to the Republican Party plans for repealing the Affordable Care Act. We also examine the 21st Century Cures Act, which was signed into law in December. Please support Congressional Dish: Click here to contribute with PayPal or Bitcoin Click here to support Congressional Dish for each episode via Patreon Mail Contributions to: 5753 Hwy 85 North #4576 Crestview, FL 32536 Thank you for supporting truly independent media! Recommended Congressional Dish Episodes CD048: The Affordable Care Act (Obamacare) CD123: Health or Profits Bill Outline H.R. 34: 21st Century Cures Act Bill Highlights Title I: Innovation Projects & State Response to Opioid Abuse Authorizes funding for research programs, if money is appropriated Authorizes $1 billion for grants for States to deal with the opioid abuse crisis The effects of this spending on the Pay as you Go budget will not be counted Title II: Discovery Creates privacy protections for people who participate as subjects in medical research studies Orders the Secretary of Health and Human Services to a do a review of reporting regulations for researchers in search of regulations to cut, including regulations on reporting financial conflicts of interest and research animal care. Allows contractors to collect payments on behalf of the Secretary of Health and Human Services Title III: Development Gives the Secretary of Health and Human Services additional data options for approving drug applications Expedites the review process for new "regenerative advanced therapy" drugs, which includes drugs "intended to treat, modify, reverse or cure a serious or life-threatening disease or condition" or is a therapy that involves human cells. Allows antibacterial and antifungal drugs to be approved after only being tested on a "limited population" The drugs will have have a "Limited Population" label Speeds up the FDA approval process for new medical devices that help with life-threatening or irreversibly debilitating conditions and that have no existing alternatives. Devices addressing rare diseases or conditions are allowed be approved with lower standards for effectiveness; this provision expands the definition of "rare" by doubling the number of people affected from 4,000 to 8,000. Each FDA employee involved in drug approvals will get training for how to make their reviews least burdensome. Title IV: Delivery The new Secretary of Health and Human Services will have to develop a strategy to "reduce regulatory and administrative burdens (such as doucmentation requirements) relating to the use of electronic health records" Prohibits health information technology developers from certification if their system allows information blocking. Developers, networks, or exchanges caught blocking information can be fined $1 million per violation. "Public-private partnerships" will develop the rules for exchanging health record information. Creates a job in the Medicare & Medicaid Services department for an investigator of pharmaceutical and medical device manufacturer complaints. Title V: Savings Reduced funding for the Prevention and Public Health Fund Sells more oil from the Strategic Petroleum Reserve Title VII: Ensuring Mental and Substance Use Disorders Prevention, Treatment, and Recovery Programs Keep Pace With Technology Authorizes money to be used for mental health services and substance abuse treatment Title IX: Promoting Access to Mental Health and Substance Use Disorder Care Creates a telephone and online service to help people locate mental health services and substance abuse treatment centers. Title XIV: Mental health and safe communities Creates a pilot program to test the idea of having court cases with mentally ill defendants heard in "drug or mental health courts" Title XVII: Other Medicare Provisions Prevents the government from canceling contracts with Medicare Advantage organizations due to their failure to achieve a minimum quality rating before 2019. Additional Reading Article: Trump's HHS Nominee Got A Sweetheart Deal From A Foreign Biotech Firm by Jay Hancock and Rachel Bluth, Kaiser Health News, February 13, 2017. Article: Tom Price belongs to a doctors group with unorthodox views on government and health care by Amy Goldstein, The Washington Post, February 9, 2017. Article: New stock questions plague HHS nominee Tom Price as confirmation vote nears by Jayne O'Donnell, USA Today, February 8, 2017. Article: HHS Pick Price Made 'Brazen' Stock Trades While His Committee Was Under Scrutiny by Marisa Taylor and Christina Jewett, Kaiser Health News, February 7, 2017. Article: Tom Price, Dr. Personal Enrichment by David Leonhardt, The New York Times, February 7, 2017. Article: Donald Trump's Cabinet Pick Invested in 6 Drug Companies Before Medicare Fight by Sam Frizell, TIME, January 17, 2017. Article: First on CNN: Trump's Cabinet pick invested in company, then introduced a bill to help it by Manu Raju, CNN, January 17, 2017. Publication: How Repealing Portions of the Affordable Care Act Would Affect Health Insurance Coverage and Premiums, Congressional Budget Office, January 17, 2017. Article: Under 21st Century Cures legislation, stem cell advocates expect regulatory shortcuts by Kelly Servick, Science, December 12, 2016. Article: Highlights of Medical Device Related Provision in the 21st Century Cures Act by Jeffrey K. Shapiro and Jennifer D. Newberger, FDA Law Blog, December 8, 2016. Article: Republicans reach deal to pass Cures Act by end of year, but Democrats pushing for changes by Sheila Kaplan, STAT, November 27, 2016. Article: Introduction to Budget "Reconciliation" by David Reich and Richard Kogan, Center on Budget and Policy Priorities, November 9, 2016. Article: PhRMA companies push hard on House bill to ease testing of new drugs by Alex Lazar, OpenSecrets.org, June 16, 2015. References Financial Disclosure: Periodic Transaction Report: Thomas Price, United States House of Representatives, September 6, 2016. OpenSecrets: Senator Mitch McConnell 42 U.S. Code: Office of the National Coordinator for Health Information Technology, Cornell University Law School. Senate Vote: H.R. 34: 21st Century Cures Act Innate Immunotherapeutics:Top 20 Shareholders Innate Immunotherapeutics: Company Overview GovTrack: H.R. 4848 (114th): HIP Act Sound Clip Sources Hearing: Health and Human Services Secretary Confirmation, Senate Health, Education, Labor and Pensions Committee, January 18, 2017 (Part 1) and January 24, 2017 (Part 2). Watch on CSPAN Part 1 Part 2 Timestamps & Transcripts Part 1 47:45 Senator Patty Murray: I want to review the facts. You purchased stock in Innate Immunotherapeutics, a company working to develop new drugs, on four separate occasions between January 2015 and August 2016. You made the decision to purchase that stock, not a broker. Yes or no. Tom Price: That was a decision that I made, yes. Murray: You were offered an opportunity to purchase stock at a lower price than was available to the general public. Yes or no. Price: The initial purchase in January of 2015 was at the market price. The secondary purchase in June through August, September of 2016 was at a price that was available to individuals who were participating in a private-placement offering. Murray:It was lower than was available to the general public, correct? Price: I don’t know that it was. It was the same price that everybody paid for the private-placement offering. Murray: Well, Congressman Chris Collins, who sits on President-elect Trump’s transition team, is both an investor and a board member of the company. He was reportedly overheard just last week off the House floor, bragging about how he had made people millionaires from a stock tip. Congressman Price, in our meeting, you informed me that you made these purchases based on conversations with Representative Collins. Is that correct? Price: No. What I— Murray: Well, that is what you said to me in my office. Price: What I believe I said to you was that I learned of the company from Congressman Collins. Murray: What I recall our conversation was that you had a conversation with Collins and then decided to purchase the stock. Price: No, that’s not correct. Murray: Well, that is what I remember you hearing it—say—in my office. In that conversation, did Representative Collins tell you anything that could be considered “a stock tip?” Yes or no. Price: I don’t believe so, no. Murray: Well, if you’re telling me he gave you information about a company, you were offered shares in the company at prices not available to the public, you bought those shares, is that not a stock tip? Price: Well, that’s not what happened. What happened was that he mentioned—he talked about the company and the work that they were doing in trying to solve the challenge of progressive secondary multiple sclerosis which is a very debilitating disease and one that I— Murray: I’m well aware of that, but— Price: —had the opportunity to treat patients when I was in practice. Murray: I’m aware— Price: I studied the company for a period of time and felt that it had some significant merit and promise, and purchased the initial shares on the stock exchange itself. Murray: Congressman Price, I have very limited time. Let me go on. Your purchases occurred while the 21st Century Cures Act, which had several provisions that could impact drug developers like Innate Immunotherapeutics, was being negotiated, and, again, just days before you were notified to prepare for a final vote on the bill. Congressman, do you believe it is appropriate for a senior member of Congress actively involved in policymaking in the health sector to repeatedly personally invest in a drug company that could benefit from those actions? Yes or no. Price: Well, that's not what happened. 1:06:50 Senator Bernie Sanders: The United States of America is the only major country on earth that does not guarantee healthcare to all people as a right. Canada does it; every major country in Europe does it. Do you believe that healthcare is a right of all Americans, whether they’re rich or they’re poor? Should people, because they are Americans, be able to go to the doctor when they need to, be able to go into a hospital, because they are Americans? Tom Price: Yes. We’re a compassionate society— Sanders: No, we are not a compassionate society. In terms of our relationship to poor and working people, our record is worse than virtually any other country on earth; we have the highest rate of childhood poverty of any other major country on earth; and half of our senior, older workers have nothing set aside for retirement. So I don’t think, compared to other countries, we are particularly compassionate. But my question is, in Canada, in other countries, all people have the right to get healthcare, do you believe we should move in that direction? Price: If you want to talk about other countries’ healthcare systems, there are consequences to the decisions that they’ve made just as there are consequences to the decision that we’ve made. I believe, and I look forward to working with you to make certain, that every single American has access to the highest-quality care and coverage that is possible. Sanders: “Has access to” does not mean that they are guaranteed healthcare. I have access to buying a ten-million-dollar home; I don’t have the money to do that. Price: And that’s why we believe it’s appropriate to put in place a system that gives every person the financial feasibility to be able to purchase the coverage that they want for themselves and for their family, again, not what the government forces them to buy. Sanders: Yeah, but if they don’t have any—well, it’s a long dissert. Thank you very much. Price: Thank you. 1:46:34 Senator Michael Bennet: So, I ask you, sir, are you aware that behind closed doors Republican leadership wrote into this bill that any replacement to the Affordable Care Act would be exempt from Senate rules that prohibit large increases to the deficit? Tom Price: As you may know, Senator, I stepped aside as chairman of the budget committee at the beginning of this year, and so I wasn’t involved in the writing of— Bennet: You have been the budget committee chairman during the rise of the Tea Party; you are a member of the Tea Party Caucus; you have said over and over again, as other people have, that the reason you’ve come to Washington is to reduce our deficit and reduce our debt. I assume you’re very well aware of the vehicle that is being used to repeal the Affordable Care Act. This is not— Price: Yes. Bennet: —some small piece of legislation. This is the Republican budget. Price: Yes, I'm aware of the bill. Yes. Bennet: But do you support a budget that increases the debt by $10 trillion? Price: No. What I support is an opportunity to use reconciliation to address the real challenges in the Affordable Care Act and to make certain that we put in place at the same time a provision that allows us to move the healthcare system in a much better direction— Bennet: Do you support the budget that was passed by the Senate Republicans— Price: I support— Bennet:—to repeal the Affordable Care Act that adds $10 trillion of debt to the budget deficit? Price: Well, the reconciliation bill is yet to come. I support the process that allows for and provides for the fiscal year ’17 reconciliation bill to come forward. 2:38:37 Senator Chris Murphy: But do you direct your broker around ethical guidelines? Do you tell him, for instance, not to invest in companies that are directly connected to your advocacy? Because it seems like a great deal: as a broker, he can just sit back, take a look— Tom Price: She. Murphy: —at the positions that you’re taking— Price: She. She can sit back. Murphy: She can—she can sit back— Price: Yeah. Murphy: —in this case—look at the legislative positions you’re taking, and invest in companies that she thinks are going to increase in value based on your legislative activities, and you can claim separation from that because you didn’t have a conversation. Price:Well, that’s a nefarious arrangement that I’m really astounded by. The fact of the matter is that I have had no conversations with my broker about any political activity at all, other than her— Murphy: Then why wouldn’t you tell her— Price: —other than her congratulating— Murphy: Why— Price: —me on my election. Murphy: But why wouldn’t you at least tell her, “Hey, listen; stay clear of any companies that are directly affected by my legislative work”? Price: Because the agreement that we have is that she provide a diversified portfolio, which is exactly what virtually every one of you have in your investment opportunities, and make certain that in order to protect one’s assets that there’s a diversified arrangement for purchase of stocks. I knew nothing about— Murphy: But you couldn’t have— Price: —those purchases. Murphy: But you couldn’t have a diversified portfolio while staying clear of the six companies that were directly affected by your work on an issue? Price: Well, as I said, I didn’t have any knowledge of those purchases. Murphy: Okay. 2:54:20 Senator Elizabeth Warren: One of the companies—it’s the company raised by Mr. Franken, Senator Franken—and that is Zimmer Biomet. They’re one of the world’s leading manufacturers of hip and knees, and they make more money if they can charge higher prices and sell more of their products. The company knows this, and so do the stock analysts. So on March 17, 2016 you purchased stock in Zimmer Biomet. Exactly six days after you bought the stock, on March 23, 2016, you introduced a bill in the House called the Hip Act that would require HHS secretary to suspend regulations affecting the payment for hip and knee replacements. Is that correct? Tom Price: I think the BPCI program to which I think you referred I’m a strong supporter of because it keeps the decision making in the— Warren: I’m not asking you about why you support it. I’m just asking, did you buy the stock, and then did you introduce a bill that would be helpful to the companies you just bought stock in? Price: The stock was bought by a direct—by a broker who was making those decisions. I wasn’t making those decisions. Warren: Okay, so you said you weren’t making those decisions. Let me just make sure that I understand. These are your stock trades, though. They are listed under your name, right? Price: They’re made on my behalf, yes. Warren:Okay. Was the stock purchased through an index fund? Price: I don't believe so. Warren: Through a passively managed mutual fund? Price: No. It’s a broker— Warren: Through an actively managed mutual fund? Price: It’s a broker-directed account. Warren: Through a blind trust? So, let’s just be clear. This is not just a stockbroker, someone you pay to handle the paperwork. This is someone who buys stock at your direction. This is someone who buys and sells the stock you want them to buy and sell. Price: Not true. Warren: So when you found out that— Price: That’s not true, Senator. Warren: Well, because you decide not to tell them—wink, wink, nod, nod—and we’re all just supposed to believe that? Price: It’s what members of this committee, it’s the manner of which— Warren: Well, I’m not one of them. Price: —members of this committee—Well, I understand that— Warren: So, let me just keep asking about this. Price: —but it’s important to appreciate that that’s the case. Warren:Then, I want to understand. When you found out that your broker had made this trade without your knowledge, did you reprimand her? Price: What—what I did was comply— Warren: Well, you found out that she made it. Price: What I did was comply— Warren: Did you fire her? Did you sell the stock? Price: What I did was comply with the rules of the House in an ethical and legal and— Warren: I didn’t ask whether or not the rules of the House— Price: —above-board manner— Warren: —let you do this. Price: —and in a transparent way. Warren: You know, all right. So, your periodic transaction report notes that you were notified of this trade on April 4, 2016. Did you take additional actions after that date to advance[audio cuts out] the company that you now own stock in? Price: I’m offended by the insinuation, Senator. Warren: Well, let me just read what you did. You may be offended, but here’s what you did. Congressional records show that after you were personally notified of this trade, which you said you didn’t know about in advance, that you added 23 out of your bill’s 24 co-sponsors; that also after you were notified of this stock transaction, you sent a letter to CMS, calling on them to cease all current and future planned mandatory initiatives under the Center for Medicare and Medicaid Innovation; and just so there was no misunderstanding about who you were trying to help, you specifically mentioned— Unknown Speaker: Your two minutes are up, Senator Warren. Thank you. Warren: —hip and knee replacement. 2:58:20 Senator Johnny Isakson: This is very important for us to all understand under the disclosure rules that we have and the way it operates, any of us could make the mistakes that are being alleged. I’m sure Senator Franken had no idea that he owned part of Philip Morris when he made the statement he made about tobacco companies, but he has a WisdomTree Equity Income Fund investment, as disclosed in his disclosure, which owns Philip Morris. So, it’s entirely possible for any of us to have somebody make an investment on our behalf and us not know where that money is invested because of the very way it works. I don’t say that to, in any way, embarrass Mr. Franken but to make a point that any one of us who have mutual funds or investment managers or people who do that, it’s entirely possible for us not to know, and to try and imply that somebody’s being obfuscating something or in otherwise denying something that’s a fact, it’s just not the fair thing to do, and I just wanted to make that point. Senator Al Franken: This is different than mutual funds. Isakson: It’s an investment in Philip Morris. Unknown Speaker: Alright. Unknown Speaker: Thank you. Warren: And my question was about what do you do after he had notice. Unknown Speaker: Senator Warren, your time has been generously… Senator Kaine. 3:21:09 Senator Tim Kaine: Do you agree with the president-elect that the replacement for the Affordable Care Act must ensure that there is insurance for everybody? Tom Price: I have stated it here and— Kaine: Right. Price: —always that it’s incredibly important that we have a system that allows for every single American to have access to the kind of coverage that they need and desire. Kaine: And he’s— 3:31:52 Senator Patty Murray: You admitted to me in our meeting that you, in your own words, talked with Congressman Collins about Innate Immuno. This inspired you to you, in your own words, study the company and then purchase its stock, and you did so without a broker. Yes or no. Tom Price: No. Murray: Without a broker. Price: I did not. Murray: You told me that you did this one on your own without the broker. Yes? Price: No, I did it through a broker. I directed the broker to purchase the stock, but I did it through a broker. Murray: You directed the broker to purchase particularly that stock. Price: That's correct. Murray: Yeah. 3:34:42 Senator Patty Murray: Will you commit to ensuring all 18 FDA-approved methods of contraception continue to be covered so that women do not have to go back to paying extra costs for birth control? Tom Price: What I will commit to and assure is that women and all Americans need to know that we believe strongly that every single American ought to have access to the kind of coverage and care that they desire and want. 3:36:38 Senator Patty Murray: The Office of Minority Health was reauthorized as part of the ACA. So will you commit to maintaining and supporting this office and its work? Tom Price: I will commit to be certain that minorities in this country are treated in a way that makes certain—makes absolutely certain—that they have access to the highest-quality care. Murray: So you will not commit to the Office of Minority Health being maintained. Price: I think it’s important that we think about the patient at the center of all this. Our commitment, my commitment, to you is to make certain that minority patients and all patients in this country have access to the highest-quality care. Murray: But in particular—so you won’t commit to the Office of Minority— Price: We—Look, there are different ways to handle things. I can’t commit to you to do something in a department that one, I’m not in—I haven’t gotten it yet— Murray: But you will be. Price: —and— Murray: You will be, and— Price: Let me put forward a possible position that I might find myself in. The individuals within the department come to me and they say, we’ve got a great idea for being able to find greater efficiencies within the department itself, and it results in merging this agency and that agency— Murray: I think—I think that— Price: —and we’ll call it something else. Murray: Yeah. I—okay. Price: And we will address the issues of minority health— Murray: I just have a minute left, and I hear your answer. Price: —in a big, big way— Murray: You’re not committed, okay. Price: —and make certain that it is responsive to patients. Part 2 14:50 Senator Ron Wyden: Congressman Price owns stock in an Australian biomedical firm called Innate Immunotherapeutics. His first stock purchase came in 2015 after consulting Representative Chris Collins, the company’s top shareholder and a member of its board. In 2016 the congressman was invited to participate in a special stock sale called a private placement. The company offered the private placement to raise funds for testing on an experimental treatment it intends to put up for FDA approval. Through this private placement, the congressman increased his stake in the company more than 500 percent. He has said he was unaware he paid a price below market value. It is hard to see how this claim passes the smell test. Company filings with the Australia’s stock exchange clearly state that this specific private placement would be made at below-market prices. The treasury department handbook on private placement states, and I will quote, they “are offered only to sophisticated investors in a nonpublic manner.” The congressman also said last week he directed the stock purchase himself, departing from what he said was typical practice. Then, there’s the matter of what was omitted from the congressman’s notarized disclosures. The congressman’s stake in Innate is more than five times larger than the figure he reported to ethic’s officials when he became a nominee. He disclosed owning less than $50,000 of Innate stock. At the time the disclosure was filed, by my calculation, his shares had a value of more than $250,000. Today his stake is valued at more than a half million dollars. Based on the math, it appears that the private placement was excluded entirely from the congressman’s financial disclosure. This company’s fortunes could be affected directly by legislation and treaties that come before the Congress. 30:49 Senator Orrin Hatch: First, is there anything that you are aware of in your background that might present a conflict of interest with the duties of the office to which you have been nominated? Tom Price: I do not. 51:36 Senator Ron Wyden: Will you commit to not implementing the order until the replacement plan is in place? Tom Price: As I mentioned, Senator, what I commit to you and what I commit to the American people is to keep patients the center of healthcare, and what that means to me is making certain that every single American has access to affordable health coverage that will provide the highest-quality healthcare that the world can provide. 1:24:34 Senator Richard Burr: Are you covered by the STOCK Act, legislation passed by Congress that requires you and every other member to publicly disclose all sales and purchases of assets within 30 days? Tom Price: Yes, sir. Burr: Now, you’ve been accused of not providing the committee of information related to your tax and financial records that were required of you. Are there any records you have been asked to provide that you have refused to provide? Price: None whatsoever. Burr: So all of your records are in. Price: Absolutely. Burr: Now, I’ve got to ask you, does it trouble you at all that as a nominee to serve in this administration that some want to hold you to a different standard than you as a member of Congress, and I might say the same standard that they currently buy and sell and trade assets on? Does it burn you that they want to hold you to a different standard now that you’re a nominee than they are as a member? Price: Well, I—we know what’s going on here. Burr: Oh, we do. Price: I mean— Burr: We do. Price: It’s—and I understand. And as my wife tells me, I volunteered for this, so… 1:26:49 Senator Richard Burr: As the nominee and hopefully—and I think you will be—the secretary of HHS, what are the main goals of an Obamacare replacement plan? Tom Price: Main goals, as I mentioned, are outlined in those principles, that is imperative that we have a system that’s accessible for every single American; that’s affordable for every single American; that is incentivizes and provides the highest-quality healthcare that the world knows; and provides choices to patients so that they’re the ones selecting who’s treating them, when, where, and the like. So it’s complicated to do, but it’s pretty simple stuff. 1:34:58 Senator Johnny Isakson: Any one of us can take a financial disclosure—and there’s something called desperate impact, where you take two facts—one over here and one over there—to make a wrong. Any one of us could do it to disrupt or misdirect people’s thoughts on somebody. It’s been happening to you a lot because people have taken things that you have disclosed and tried to extrapolate some evil that would keep you from being secretary of HHS when, in fact, it shouldn’t be true. For example, if you go to Senator Wyden’s annual report, he owns an interest in BlackRock Floating Rate Income Fund. The major holding of that fund is Valeant Pharmaceuticals. They’re the people we jumped all over for 2700 percent increases last year in pharmaceutical products. But we’re not accusing the ranking member of being for raising pharmaceutical prices, but you could take that extrapolation out of that and then indict somebody and accuse them. Is that not true? 1:51:30 Senator Michael Bennet: I wonder whether you also believe that it’s essential that there be a floor for insurance providers. You know, some of the things that the Affordable Care Act require for coverage include outpatient care; emergency services; hospitalization; maternity and newborn care; prescription drugs; rehab services; lab services; preventative care, such as birth control and mammograms; pediatric services, like vaccines; routine dental exams for children younger than 19. I’m not going to ask you to go through each one of those, but directionally, are we headed to a world where people in rural America have to settle for coverage for catastrophic care; are we headed to a place where there is regulation of insurance providers that say if you are going to be an insurance market, you need—particularly if we’re in a world where your son had crossed state lines —there has to be a floor of the services you’re willing to pay for? Tom Price: I think there has to be absolutely credible coverage, and I think that it’s important that the coverage—that individuals ought to be able to purchase this coverage that they want. 1:56:45 Senator Pat Toomey: When we talk about repeal, sometimes I hear people say, well, we’ve got to keep coverage of pre-existing conditions because, you know, we’ve got to keep that. And when I hear that, I think that we’re missing something here, and here’s what I’m getting at. There’s obviously a number of Americans who suffer from chronic, expensive healthcare needs. They’ve had these conditions sometimes all their lives, sometimes for some other period of time. And for many of them the proper care for those conditions is unaffordable. I think we agree that we want to make sure those people get the healthcare they need. Now, one way to force it is to force insurance companies to provide health-insurance coverage for someone as soon as they show up, regardless of what condition they have, which is kind of like asking the property casualty company to rebuild the house after it’s burned down. But that’s only one way to deal with this, and so am I correct: is it your view that there are other perhaps more effective ways—since, after all, Obamacare’s in a collapse—to make sure that people with these pre-existing chronic conditions get the healthcare that they need at an affordable price without necessarily having the guaranteed-issue mandate in the general population? Tom Price: I think there are other options, and I think it’s important, again, to appreciate that the position that we currently find ourselves in, with policy in this nation, is that those folks, in a very short period of time, are going to have nothing because of the collapse of the market. 2:18:05 Tom Price: Every single individual ought to be able to have access to coverage. 2:29:45 Senator Tim Scott: My last question has to do with the employer-sponsored healthcare system that we’re so accustomed to in this country, that provides about 175 million Americans with their insurance. In my home state of South Carolina, of course, we have about two and a half million people covered by their employer coverage. If confirmed as HHS secretary, how would you support American employers in their effort to provide effective family health coverage in a consistent and affordable manner? Said differently, there’s been some conversation about looking for ways to decouple having health insurance through your employer. Tom Price: I think the employer system has been absolutely a remarkable success in allowing individuals to gain coverage that they otherwise might not gain. I think that preserving the employer system is imperative. That being said, I think that there may be ways in which individual employers—I’ve heard from employers who say, if you just give me an opportunity to provide my employee the kind of resources so that he or she is able to select the coverage that they want, then that makes more sense to them. And if that works from a voluntary standpoint for employers and for employees, then it may be something to look at. Scott: That would be more like the HRA approach where— Price: Exactly. Scott: —employer funds an account, and the employee chooses the health insurance, not necessarily under the umbrella of the employer specifically. Price: Exactly. And gains the same tax benefit. 2:58:00 Tom Price: What I’m for is making certain, again, that the Medicaid population has access to the highest-quality care possible, and we’ll do everything to improve that because right now so many in the Medicaid population don’t have access to the highest-quality care. 3:20:50 Tom Price: Our goal is to make certain that seniors have access to the highest-quality healthcare possible at an affordable price. Senator Bob Menendez: Well, access without the ability to afford it, and I’ll end on this— Price: That's what I said, affordable price. 3:28:45 Senator Sherrod Brown: If you and he are working together, are you going to suggest to him that we find a way in repeal and replace to make sure there is guaranteed healthcare for our nation’s veterans? Tom Price: Well, I think it’s vital, again, as I’ve mentioned before, that every single American have access to affordable coverage that’s of high quality, and that’s our goal, and that’s our commitment. 3:30:52 [regarding a disabled child coverd by Medicaid] Tom Price: We are absolutely committed to making certain that that child and every other child and every other individual in this nation has access to the highest-quality care possible. Senator Bob Casey Jr.: Okay, so not an access—he will have the medical care that he has right now or better—if you can come up with a better level of care, that’s fine—but he will have at least the coverage of Medicaid and all that that entails that he has right now. And that’s either a yes or no; that’s not— Price: No, it’s not a yes or no because the fact of the matter is that in order for the current law to change, you all have to change it— Casey: No, but here’s— Price: —and if I’m given the privilege of leading at the Department of Health and Human Services— Casey: Here’s why it’s yes— Price: and I respond to— Casey: You should stop talking around this. You have led the fight in the House, backed up by Speaker Ryan, for years— Price: To improve Medicaid. Casey: —to block grant Medicaid, okay? Price: To improve Medicaid. Casey: To block grant Medicaid. What that means is, states will have to decide whether or not this child gets the Medicaid that he deserves. That’s what happens. So you push it back to the states and hope it works out… Cover Art Design by Only Child Imaginations

In this episode, Christine Gordon, Manager of Reimbursement, and Kate Gillespie, AVP of the Orthopedic and Spine service line, of Virtua Health System discuss their experience participating in Medicare’s BPCI program and the factors that were instrumental in their success with bundled payments to date. Learn how to listen to The Hospital Finance Podcast on your mobile device. Michael Read More

Listen NowToday, CMS launched the agency's second bundled payment demonstration, a mandatory five-year initiative in approximately 800 hospitals nation-wide.  It's titled, the Comprehensive Care for Joint Replacement (CJR).  The CJR essentially reimburses hospitals a predetermined amount for a 90-day hip or knee surgical and rehab episode of care.  CMS is emphasizing hip and knee replacement surgeries because they account for the single largest Medicare dollar amount and highest percent of annual 30 day episode spending.  This demonstration follows CMS's voluntary Bundled Payment for Care Improvement (BPCI) demonstration that provides bundled payments for 48 care episodes (including hip and knee replacements) via four care model designs.  How successfully hospitals, orthopedic surgeons and various post acute providers manage these care episodes will be important if CMS is to better control Medicare spending growth.   (Listeners will recall I discussed moreover the theory of bundled payment arrangements with Harold Miller this past September 23rd.)  During this 29 minute conversation Mr. Gera provides and overview of Signature Medical Group and their orthopedic bundled payment work under both CMS's BPCI and CJR demos.  More specifically, he discusses how hip and knee replacement surgical patients are identified, how the bundled payment care team is assembled, how the care episode is manged, how quality is measured, profit sharing conducted and moreover principles his organization has developed to succeed under these capitated payment arrangements.  Mr. Jim Gera is the Senior Vice President of Business Development for Signature Medical Group, Inc., a multi-specialty group of physicians located in St. Louis and rural Missouri.   Among other related activities Mr. Gera co-authored an Advanced Payment Medical Accountable Care Organization application and a successful CMS Strong Start for Mothers and Newborns grant award.   Recently he has also served as a Chair for several CMS innovation grant reviews.  Mr. Gera's previous experience includes working with other physician group practices, in outpatient facilities and in managed care both in Medicare Advantage and Special Needs Plans.  Mr. Gera received his MBA from Southern Illinois University at Edwardsville.For more on CMS's CJR demonstration see:  https://innovation.cms.gov/initiatives/cjrFor more on Signature Medical Group see: http://www.signatremedicalgroup.com/  This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com