Podcasts about Medicare

Under some circumstances, those who are actively employed may postpone their encounter with Medicare. Scam calls and fraudulent letters are increasing in frequency. Don't fall victim to them! Contact me at: DBJ@MLMMailbag.com (Most severe critic: A+)   Inspired by: "MEDICARE FOR THE LAZY MAN 2023; Simplest & Easiest Guide Ever!" on Amazon.com. Return to leave a short customer review & help future readers. Official website: https://www.MedicareForTheLazyMan.com

In today's crazy world smart money seeks safety, quality, liquidity, income, and opportunity in that order. We'll stay with that theme today and reveal what George Soros and Warren Buffett are buying, as well as an emerging opportunity in the Market Intel Segment. Then health insurance and Medicare expert Shelley Grandidge joins us.  Don't miss today's show, MASTERING MONEY is on! the air!!

Be warned--this episode is not for your kids, ok? We are MAD---annoyed in fact that we have to have this conversation---but here we are. In this episode, the Gritty Nurses discuss the current state of prviate vs. public healthcare in Canada. Is healthcare still universal, or are we sliding down a slippery slope?  They discuss what privatized healthcare looks like, whether we should be concerned, and what they think should be occurring.    References: https://www.ipolitics.ca/queens-park/health-canada-concerned-about-ontario-company-that-charges-for-virtual-doctor-visits  https://www.reddit.com/r/ontario/comments/etvke2/has_anyone_every_used_maple_online_doctor/?rdt=48992  https://www.cbc.ca/news/canada/london/maple-health-online-doctor-visits-1.4194285  https://www.cbc.ca/radio/asithappens/maple-health-ceo-private-health-care-1.6777485#:~:text=Brett%20Belchetz%20is%20the%20CEO,services%20billable%20to%20private%20insurers. Follow The Gritty Nurse Podcast! YouTube: https://www.youtube.com/@grittynursepodcast  Facebook: https://www.facebook.com/grittynurse Instagram: https://www.instagram.com/gritty.nurse.podcast/ Twitter: https://twitter.com/GrittyNurse  LinkedIn: https://www.linkedin.com/company/grittynurse

Many of America's poorest and sickest patients are stuck navigating two separate insurance programs — Medicare and Medicaid — to get the care they need.Guests:Jose Figueroa, MD, MPH, Assistant Professor of Health Policy and Management, Harvard T.H. Chan School of Public HealthJean Minkel, PT, ATP, Senior Vice President of Rehab and Mobility Services, Independence Care SystemRochelle Render, advocate and mother of Saleema Render-HornsbySaleema Render-Hornsby, dually eligible personAllison Rizer, Principal, ATI AdvisoryLeslie Walker, Senior Producer/Reporter, TradeoffsLearn more and read a full transcript on our website.We're also excited to share that you can now find Tradeoffs on YouTube! Still not enough Tradeoffs? Sign up for our free weekly newsletter featuring the latest health policy research and news.Support this type of journalism today, with a gift. Hosted on Acast. See acast.com/privacy for more information.

Econ 101: if the Feds force the drug companies to give away their products cheap, who will be incentivized to make drugs in the future? Also, when sending a recorded greeting to space aliens, how many Earth languages should you employ? Finally, how does Medicare cover the cost of therapy services? Contact me at: DBJ@MLMMailbag.com (Most severe critic: A+)   Inspired by: "MEDICARE FOR THE LAZY MAN 2023; Simplest & Easiest Guide Ever!" on Amazon.com. Return to leave a short customer review & help future readers. Official website: https://www.MedicareForTheLazyMan.com

Thank you so much for listening to the Bob Harden Show, celebrating over 12 years broadcasting on the internet! On Thursday's show, we discuss proposed public education reforms for the next legislative session with Pastor Rick Stevens, Co-Founder of the Florida Citizens Alliance. Less Government President Seton Motley and I discuss how the Biden administration doubles down on Bidenomics at the expense of taxpayers. Director of Health Policy Michael Cannon and I discuss proposed legislation to reduce the differential paid by Medicare for healthcare services. We also visit with the former Mayor of Naples, Bill Barnett. We have terrific guests scheduled for Friday's show including Pacific Legal Foundation's William Yeatman, President Steve Brooder from St. Matthews House, Matt Chionis from Gulf Coast International Properties, and author, columnist and Professor Larry Bell. Please access this or past shows at your convenience on my web site, social media platforms or podcast platforms.

This episode is sponsored by KyurMD.com – technically advanced medical apparel.  In the second part of the "We Want Them Infected" series, Dr. Jonathan Howard delves into the allure of the anti-vaccine movement among doctors. He explores the psychological factors, including the pursuit of fame and financial gain, that drive some doctors to embrace contrarian views. Audience capture, a phenomenon where public personalities echo the sentiments of their followers, is discussed as a key factor that reinforces extreme stances and perpetuates misinformation. The episode draws parallels to how public figures like Donald Trump can also fall prey to audience capture. Looking for something specific? Here you go! 00:01 - Introduction to Part Two of "We Want Them Infected" 00:26 - Discussion on the allure of contrarianism and audience capture 01:56 - Comparing audience capture to Donald Trump's changing stances 03:01 - Strategies to prevent falling into the trap of audience capture 03:43 - The importance of humility and openness to correction 06:16 - Engaging respectfully in disagreements on social media 08:12 - The "IKEA effect" and recognizing biases in our ideas 10:07 - Examining arguments used by anti-vaxxers against COVID vaccines 14:15 - Critiquing the demand for more randomized controlled trials 16:01 - The shifting goalposts of critics 18:14 - Reactions of doctors mentioned in the book 20:53 - The consequences of misinformation and what gives hope 24:43 - Encouragement for doctors to speak out against medical misinformation More on Dr. Howard: A distinguished author, Dr. Howard has penned several authoritative textbooks on neurology. Notably, he is the writer behind Cognitive Errors and Diagnostic Mistakes: A Case-Based Guide to Critical Thinking in Medicine. Well before the pandemic emerged, Dr. Howard had a deep-rooted interest in vaccines and the counter-vaccine movement. Preceding the global health crisis, he was a co-author for a book chapter titled The Anti-Vaccine Movement: A Litany of Fallacy and Errors. Throughout the pandemic, he has been actively contributing to the discourse on the mainstream acceptance of anti-vaccine sentiments within the medical field.  His writings on this matter can be found on Science Based Medicine. Moreover, he has collaborated on research papers focused on the neurological implications of COVID-19 patients and the vaccination process for individuals with multiple sclerosis. Find Dr. Howard on his LinkedIn.  Did ya know…  You can also be a guest on our show? Please email me at brad@physiciansguidetodoctoring.com to connect or visit www.physiciansguidetodoctoring.com to learn more about the show! Socials: @physiciansguidetodoctoring on FB  @physicianguidetodoctoring on YouTube @physiciansguide on Instagram and Twitter

Sign up for Economist Podcasts+ now and get 50% off your subscription with our limited time offer*One of the many aims of President Joe Biden's signature legislation, the Inflation Reduction Act, is to cut the cost of drugs prescribed by Medicare, a government health insurance programme for Americans 65 and over. But the policy could have some side-effects for patients far beyond the US.Hosts: Tom Lee-Devlin and Mike Bird. Contributors: Shailesh Chitnis, The Economist's global business correspondent; Tricia Neuman, a senior advisor to Mr Biden; and David Fredrickson of AstraZeneca.*You will not be charged until Economist Podcasts+ launches. If you're already a subscriber to The Economist, you'll have full access to all our shows as part of your subscription. For more information about Economist Podcasts+, including how to get access, please visit our FAQs page. Hosted on Acast. See acast.com/privacy for more information.

Steve Forbes slams a provision in the Inflation Reduction Act pertaining to price controls, and warns that they will throttle pharmaceutical development that could end up costing lives. Steve Forbes shares his What's Ahead Spotlights each Tuesday, Thursday and Friday.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

On this episode of Raise the Line, we have the privilege of hearing from one of the nation's top healthcare leaders, Dr. Joshua Gordon, who is the director of the National Institute of Mental Health. In that role, he oversees an extensive portfolio of basic and clinical research that seeks to transform the understanding and treatment of mental illnesses, paving the way for prevention, recovery and cure. “Our main role is in trying to make sure that good science is conducted in the service of furthering public mental health,” he tells host Shiv Gaglani. One area of NIMH research that gets less attention than breakthrough medicines is how to make it easier for healthcare systems and practices to adopt best practices and proven treatments. This not only helps improve patient outcomes, but Gordon says it is one element in addressing feelings of a lack of effectiveness that contribute to provider burnout. “If we can increase individuals' efficacy by ensuring that they are trained in evidence-based approaches, and continue to make new treatments available to help those who aren't responding to the old ones, that's one way we can do that.” This is a rare opportunity to hear from a federal agency executive on some of the most pressing and interesting issues in healthcare including the shortage of providers, health equity, social determinants of health, telemedicine and the potential for psychedelics to treat mental health problems.   Mentioned in this episode: https://www.nimh.nih.gov/

Sign up for Economist Podcasts+ now and get 50% off your subscription with our limited time offer*One of the many aims of President Joe Biden's signature legislation, the Inflation Reduction Act, is to cut the cost of drugs prescribed by Medicare, a government health insurance programme for Americans 65 and over. But the policy could have some side-effects for patients far beyond the US.Hosts: Tom Lee-Devlin and Mike Bird. Contributors: Shailesh Chitnis, The Economist's global business correspondent; Tricia Neuman, a senior advisor to Mr Biden; and David Fredrickson of AstraZeneca.*You will not be charged until Economist Podcasts+ launches. If you're already a subscriber to The Economist, you'll have full access to all our shows as part of your subscription. For more information about Economist Podcasts+, including how to get access, please visit our FAQs page. Hosted on Acast. See acast.com/privacy for more information.

1.) MSP Question of the Week  When should I hire my first sales person? --- 2.) Smart Person - Brianna Haun  Brianna's passion is to provide a level of excellence in serving clients, leading a team, and impacting the community through a value driven lifestyle. Gaining a new perspective, shifting a mindset, or creating something new, ignite my soul... https://www.linkedin.com/in/alignconsulting/ https://rss.com/podcasts/aligned/ --- 3.) Notes on the News   Google Anti-trust, Microsoft protects customers from lawsuits resulting from AI use, and GDP Growth beats expectations and Medicare spending has been level since 2010! --- Resources and Links: Kernan Mastermind Roadshow:  September 28-29 – Scottsdale, AZ! http://bit.ly/kernanmastermind https://kernanconsulting-mastermind.mykajabi.com/mastermind-event  Our Social Links: https://www.linkedin.com/in/james-kernan-varcoach/ https://www.facebook.com/james.kernan https://www.facebook.com/karlpalachuk/ https://www.linkedin.com/in/karlpalachuk/ https://www.linkedin.com/in/amybabinchak/ https://www.facebook.com/amy.babinchak/

Neurology Today Editor-in-chief Joseph E. Safdieh, MD, FAAN, discusses the Medicare's proposed coverage of carotid stenting in asymptomatic patients,neuro-oncologists' perspectives on a federal initiative to target persistent poverty in vulnerable patients, and the technological promise of a new optical EMG for neuromuscular disorders.

Learn how a government shutdown would impact your finances. Plus: updates on inflation, retail sales and Delta SkyMiles. In this financial news roundup, hosts Sean Pyles and Anna Helhoski touch on key headlines such as what the latest Consumer Price Index tells us about inflation, the reason why retail sales are surging, and controversial changes to Delta Airlines' SkyMiles program. They then take a close look at the looming threat of a government shutdown in Congress, particularly in the House of Representatives. Learn about the complex backdrop of budget negotiations, the economic consequences of a government shutdown, its impact on federal employees, and precautions you could take in order to prepare for financial challenges during a shutdown. In their conversation, the Nerds discuss: personal finance news, inflation, retail sales, the Consumer Price Index (CPI), Delta SkyMiles changes, a potential government shutdown, the Fiscal Responsibility Act, budget negotiations, government funding, federal employees, essential bills, financial assistance, federal benefits, interest rates, used car prices, rental rates, airfares, Social Security, Medicare, Medicaid, SNAP benefits, government shutdown consequences, and bill prioritization. To send the Nerds your money questions, call or text the Nerd hotline at 901-730-6373 or email podcast@nerdwallet.com.

Dr. Marlene Wust Smith joins Dawn to expand on site-neutral payment systems, and the unfair market we see in big pharma and around hospital employed doctors, and independent doctors. Dr. Marlene Wust-Smith is a pediatrician in Port Allegany, Pennsylvania and is affiliated with multiple hospitals in the area, including Newark-Wayne Community Hospital-Rochester Regional Health and UPMC Cole. She received her medical degree from Weill Cornell Medicine and has been in practice for more than 20 years. Dr. Marlene Wust-Smith: “Electrocardiograms, x-rays, casting, stitches– you name it, the government will pay the “hospital doctor” more. Except that the actual doctor doesn't see a penny of the upcharges. That money is pocketed by the greedy bureaucrats that have hijacked healthcare….The solution is simple: Medicare needs to adopt a site-neutral payment system that pays hospitals the same rate as it pays its independent doctors.” Tune in 10 AM - 12 PM EST weekdays on Talk Radio 1210 WPHT; or on the Audacy app!  

Friends, The central role that Medicare, and CMS, play in our healthcare system can not be overstated. There are approximately 64 million Americans in the Medicare program, with annual payments ...

Season 5 of The ACO Show kicks off with Josh and Brian joined by Travis Broome, Aledade's Senior Vice President for Policy and Economics to discuss the 2022 Medicare Shared Savings Program (MSSP) results. As the largest and most successful value-based care program in American history, the results of this program tell us a lot about the progress of value-based care, and what that means for patients and primary care professionals around the country.

If you've worked for a private employer throughout your adulthood, your Social Security benefits are likely one of the most dependable components of your retirement income plan, but for many with a non-traditional work history, the system has limitations in place that could affect your benefit eligibility. Donna discusses some of the Social Security provisions that you should know about to properly plan for your future retirement income. Also on MoneyTalk, how your MAGI factors into your Medicare premium calculation, and how a 1031 exchange can be used to limit your tax liability on the sale of property.Host: Donna Sowa Allard, CFP®, AIF®; Air Date: 9/18/2023. Have a question for the hosts? Visit sowafinancial.com/moneytalk-radio to join the conversation!See omnystudio.com/listener for privacy information.

As the air crisps and the leaves change, you know what that means: Fall is here! But it also means that Medicare Open Enrollment is about to begin. On this episode, I'm going over five Medicare Open Enrollment mistakes you want to avoid and answering a listener's question about Health Savings Accounts. You will want to hear this episode if you are interested in... Can you draw from two HSA accounts to pay for one individual's medical expenses? [1:43] Is it too early to start looking at enrollment options? [4:13] Is last year's Medicare plan still the best option? [6:02] Should monthly premiums be the only deciding factor for Medicare plans? [7:09] Examining the real cost of Medicare plans [8:50] Will your Medicare plan let you see your doctor? [10:31] Choosing the Medicare plan that's right for you Medicare Open Enrollment starts on October 15th and lasts until December 7th, but is now a good time to start looking at your options? Absolutely it is! You don't have to wait until October to research the best Medicare plan for your needs. Talk to friends and supplemental Medicare representatives, attend seminars, and even go to medicare.gov to compare and contrast the numerous choices available.  One mistake current Medicare enrollees make is assuming that the plan they selected last year is still the best plan for them. Many Medicare Advantage plans offer an initially low or free premium plan to get people to sign up, only to significantly increase the price the following year. You definitely want to compare your options annually to ensure you're getting the best plan for the right price. Understanding the costs and benefits of your Medicare plan A big mistake to avoid during Medicare Open Enrollment is using your plan's monthly premium as the only deciding factor for signing up. While your monthly premium may be low, out-of-pocket costs can get out of control. Prescriptions, labs, and doctor's visits may not be covered by a low premium plan, so you definitely want to do your research. Paying a higher premium for better coverage may be your best option. A huge shock for some Medicare enrollees is finding out their existing doctor will not accept their Preferred Provider Organization (PPO) plan. A PPO is a health care plan that allows members to see out-of-network doctors, usually for a higher price. Just because your plan allows you to see out-of-network providers does not mean YOUR provider accepts that plan. Double-check with your doctor to make sure everything is compatible before signing up. Listen to this episode for more on Medicare Open Enrollment! Resources Mentioned Retirement Readiness Review Chris Humphries Medicare Connect With Morrissey Wealth Management  www.MorrisseyWealthManagement.com/contact

The Crucial Role of Psychedelic Therapy Guides - Mary Cosimano, Former Director of Guide and Facilitator Services at The Johns Hopkins Center for Psychedelic and Consciousness ResearchAll of the promising research into the potential benefits of psychedelics in mental health treatment depends on having skilled professionals who can create a therapeutic alliance with participants and guide the sessions in which the compounds are administered. We could not have a betterRaise the Line guest for understanding this role than Mary Cosimano, LMSW, former director of Guide and Facilitator Services at the Johns Hopkins Center for Psychedelics & Consciousness Research. Since the genesis of psychedelic research there two decades ago, she has conducted over 500 sessions herself as well as serving as a research coordinator.  In this fascinating conversation with host Shiv Gaglani, Cosimano discusses how she prepares for and processes the often-taxing sessions, the common themes that emerge from participants, and what qualities effective guides need to have. On that point, she thinks the role needs to be open to chaplains, nurses, hospice care workers, and others with the right combination of experience and personal qualities, not just to licensed medical personnel.  “What's as important is who they are, what they've done in their life and career, how much work have they done on themselves, do you feel comfortable with them?” This is a fascinating look into the heart of psychedelic-assisted therapy and the meaningful experiences participants can have when they are in the right hands.   Mentioned in this episode: https://hopkinspsychedelic.org/

Sen. Klobuchar talks Medicare drug price negotiation program; Swimming while Black; Comedian Gary Gulman talks new book Learn more about your ad choices. Visit megaphone.fm/adchoices

This episode is sponsored by KyurMD.com – technically advanced medical apparel.  Nick Cienski, a former designer for Under Armour and Arc'teryx, embarked on a mission to revolutionize healthcare attire with KyurMD (pronounced ‘Cure'). His goal was to create high-performance, durable, and stylish scrubs that would enhance the comfort and confidence of medical professionals.  Through innovative fabrics and meticulous design, KyurMD offers scrubs that are not only functional but also long-lasting, repelling bodily fluids and meeting FDA level two certification standards.  Nick's dedication to improving workwear extends to a commitment to combating human trafficking through Mission 14, a nonprofit he co-founded with his wife, aiming to make a positive impact in Nicaragua. Looking for something specific? Here you go! [00:00:00] Introduction to Nick Cienski and KyurMD  [00:01:00] The Shift in Work Attire  [00:03:00] Nick's Inspiration and Background  [00:04:00] The Impact of the Pandemic  [00:05:00] Mission 14 and Human Trafficking Initiatives  [00:08:00] Elevating Scrubs with Advanced Technology  [00:12:00] The Significance of Scrub Design  [00:14:00] Brand Loyalty and the Future of Scrubs  [00:27:00] KyurMD's Inventory Update  [00:28:00] Mission 14 and Fighting Human Trafficking More about Nick Cienski: Kyur® was founded by Nick Cienski, an award-winning designer who has led product design and innovation teams at renowned brands such as Under Armour, Salomon, and Arc'teryx. His gear has been worn by Olympic champions, U.S. Special Forces members, mountain rescue teams, A-list celebrities, and even Sir Richard Branson during his historic Virgin Galactic flight to space. Nick's expertise extends beyond design, as he's an accomplished high-altitude mountaineer who has conquered some of the world's highest peaks. Leveraging his rich history in creating technically advanced apparel, Nick is now revolutionizing the medical apparel market with Kyur®. Their products are sought after by medical professionals around the country who have referred to them as “game changing,” “phenomenal,” and “a major upgrade from regular scrubs;” all proudly manufactured in the USA using American-made textiles. Go here and use Code PGD25 at checkout for 25% off your first order! Did ya know…  You can also be a guest on our show? Please email me at brad@physiciansguidetodoctoring.com to connect or visit www.physiciansguidetodoctoring.com to learn more about the show! Socials: @physiciansguidetodoctoring on FB  @physicianguidetodoctoring on YouTube @physiciansguide on Instagram and Twitter

Join us for a crucial discussion with Peter Keers as we unravel the complex topic of navigating the cost of long-term care. Having researched the options available at age 65, Peter shares insights from his e-book, which aims to assist you in planning your later years in the best way possible. We look into various care levels, the associated costs, and how family members can act as caregivers. Listen in as we delve into the importance of long-term care insurance, particularly for working adults in their 30s.  We explore how to cover long-term care costs with Peter Kears, discussing personal resources, government payments, and long-term care insurance. We examine the potential risks of paying for these costs, the nuances of government programs like Medicaid, and the impact of retirement savings and pensions. Additionally, we touch on the significance of researching and planning ahead and the potential role of selling a home in covering long-term care costs.  In the last part of our chat with Peter, we study how personal resources, government payments, and long-term care insurance can be utilized to cover long-term care costs. Listen as we analyze the details of Medicare and Medicaid, how selling a home may impact Medicaid eligibility and the potential benefits of renting out a loved one's home to finance long-term care. We also discuss the exceptions of long-term care insurance and contemplate the potential of technology to change how care is provided in the future. So, join us and make sure your resources are correctly allocated to ensure a secure future. GET THE E-BOOK HERE! ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ HIGHLIGHTS (0:00:02) - Exploring the Cost of Long-Term Care Peter Kears shares his experience researching long-term care options, outlining levels of care and costs, emphasizing 70% of us will need care, and exploring family as caregivers and long-term care insurance. (0:15:17) - Paying for Long-Term Care Options Peter Kears shares his experience researching long-term care options, risks of paying for costs, government programs, retirement savings, pensions, and selling a home. (0:21:33) - Financing Long-Term Care Options and Challenges 53% of long-term care expenses are paid by personal resources, such as life insurance and home equity, impacted by Covid-19 staffing shortages. (0:25:58) - Financing Long-Term Care and Home Equity Personal resources, government payments, long-term care insurance, Medicare, Medicaid, selling a home, renting out a home, life insurance, term insurance, household items, and jewelry are discussed for financing long-term care. (0:39:34) - Exploring Long-Term Care Insurance Options Peter Kears explores how to cover long-term care costs, exceptions to long-term care insurance, and the potential of technology. (0:47:47) - Online Presence and Call to Action Peter Kears researches options for covering long-term care costs, including personal resources, government payments, and insurance. ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Sign Up for more Advice & Wisdom - email newsletter. ++++++++++++++++++++++++++++++++++++++++ Please help us keep our show going by supporting our sponsors. Thank you. Did you know people with Alzheimer's can receive nearly 200 spam calls a week? You can put a stop to those now. Relevate from NeuroReserve Make Your Brain Span Match Your LifeSpan With Relevate nutritional supplement, you get science-backed nutrition to help protect your brain power today and for years to come. You deserve a brain span that lasts as long as your lifespan. Join Fading Memories On Social Media! If you've enjoyed this episode, please share this podcast with other caregivers! You'll find us on social media at the following links. Instagram Twitter LinkedIn  Facebook

Billing for Point of Service (POS) DocumentationQuestions around billing are ones I get asked quite often and like any other type of billing, billing for point of service documentation can be tricky to navigate. The main reason I find that people want to include their documentation or chart review time in their billable time is not that they are purposely trying to defraud someone or do something illegal, but it's typically because they just want their job to recognize the work they did. That's why this week on The Amplify OT Podcast, I am talking about billing for point of service (or POS) documentation!Join the Amplify OT MembershipAs an exclusive bonus for podcast listeners, you can join the Amplify OT Membership at any time! Join today to take control of your career! It's time to become your own best resource on Medicare and advocacy.In this episode, I cover:How to advocate for yourself if your employer is pressuring you to report minutes in the billing section that are spent documenting or chart reviewing and not with a patient.Instances where you can and cannot bill for documentation time.The main question you need to ask yourself to determine whether or not you can bill for your POS documentation. Examples of instances where billing for point of service documentation is necessary and when it may be inappropriate. Why you cannot bill for documentation or chart review time when you are not with the patient. Amplify OT ResourcesWant to keep learning about how insurance and reimbursement impact you? Then head to AmplifyOT.com/Services to see what resources we have available!CLICK HERE to save 40% off Medbridge Today! CONNECT WITH AMPLIFY OT:WebsiteServicesFree NewsletterInstagramLinkedInFacebookTikTokLINKS MENTIONED IN THIS EPISODE:MDS 3.0 RAI Manual v1.17.1_October 2019 - reference Page 507 Therapy Minutes11 Part B Billing Scenarios for PTs and OTs | CMS Links to IG Reels on Billinghttps://www.instagram.com/reel/Cw8AAgXuQRJ/https://www.instagram.com/reel/Cw8QWX3xkFU/

Heidi Paulius and Mike Filippini with the Senior Health Insurance Information Program at Crossroads of Pella preview the Welcome to Medicare seminar and upcoming open enrollment period for Medicare prescription plans.

Today, we're excited to get to know Dr. Karen Murphy, EVP, Chief Innovation Officer and founding director of the Steele Institute for Health Innovation of Geisinger. Karen has worked to improve and transform healthcare delivery throughout her career in both the public and private sectors. Before joining Geisinger, she served as Pennsylvania's secretary of health addressing the most significant health issues facing the state, including the opioid epidemic. Prior to her role as secretary, Dr. Murphy served as director of the State Innovation Models Initiative at the Centers for Medicare and Medicaid Services leading a $990 million CMS investment designed to accelerate health care innovation across the US. She previously served as president and CEO of the Moses Taylor Health Care System, and as founder and CEO of Physicians Health Alliance. Karen has a PhD, MBA and RN degree!  Founded in 1995, Geisinger is an integrated healthcare system that includes 13 hospital campuses, two research centers, the Geisinger Commonwealth School of Medicine, and a health plan that serves approximately 600,000 members. Geisinger's more than 30,000 employees, 2,500 providers, nearly 500 residents and fellows, and 360 medical students serve and care for the three million residents in Pennsylvania. In this episode, Karen shares her wealth of experiences from RN to CEO of a health system, Geisinger's exciting merger with Kaiser to form Risante Health, and key characteristics of a successful partnership between system and startup, her approach on working with startups as an innovative health system.

One of the after effects of the Covid-19 pandemic has been an increase in people working from home, and a decrease in the need for office space. This has had a dramatic effect on office buildings as an asset class and continues to be a problem with only half of the workforce returning to the office. Many developers are considering re-purposing vacant office buildings into residential and apartment buildings. But doing that can be a lot more difficult than it seems. Today's guest is nearing completion of an office to apartment conversion, and he's here to share his experiences, both good and bad. We'll discuss his challenges working with architects, engineers, and city inspectors, and the delays he's encountered along the way. Andrew will also share the silver lining that makes it all worthwhile and why he's bullish on the Baltimore market. Andrew Hinton is the acquisition lead for GL Capital, which focuses on apartment syndication and development in Pennsylvania, Maryland, and Virginia. Find out more: www.glcapital.io https://www.linkedin.com/in/andrewhintonglc/ Cell: 267-269-0128 Email: ah@glcapital.io Today's episode is brought to you by Green Property Management, managing everything from single family homes to apartment complexes in the West Michigan area. https://www.livegreenlocal.com And RCB & Associates, helping Michigan-based real estate investors and small business owners navigate the complex world of health insurance and Medicare benefits. https://www.rcbassociatesllc.com

Dean Clancy joins Dawn to breakdown the latest campaign regarding Site-Neutral payments and Medicare. Americans for Prosperity is launching a five-figure ad campaign targeting constituents of key Republicans, encouraging them to back site-neutral payments. Such policies aim to ensure that Medicare patients pay the same for drugs regardless of where they're administered. The advertisements are directed at Republicans on health subcommittees for the House Energy and Commerce, Education and the Workforce and Ways and Means Committees plus the GOP Doctors Caucus and New York lawmakers, a spokesperson for the group said. Dean F. Clancy is a senior policy fellow at Americans for Prosperity and a Paragon Health Institute public advisor.  A specialist in U.S. health care, tax, budget, and entitlement policy with nearly three decades of high-level experience in Congress, the White House, and the U.S. health care industry—he played a role in the creation of Health Savings Accounts (HSAs) and is a long-time advocate for making this powerful tool available to all Americans. Tune in 10 AM - 12 PM EST weekdays on Talk Radio 1210 WPHT; or on the Audacy app!

The Managing Partner and Co-Founder of Primetime Partners talks about building a fundamental infrastructure to improve the quality of living of older adults, including applied technology for financial longevity, caregiving, mental health, and resources for social determinants of health. About Abby Abby Miller Levy has spent her career helping businesses and consumer brands grow as an operator, entrepreneur, and advisor, most notably in the wellness sector. Prior to Primetime Partners, she was Senior Vice President of Strategy & Growth at SoulCycle, where she oversaw business development and revenue growth outside the consumer studio business, with an emphasis on building new digital products. Abby teamed with Arianna Huffington to launch Thrive Global, a behavior change technology company focused on employee productivity and wellness. Abby served as President of Thrive Global and remains on the Thrive Board. Abby began her career at McKinsey & Company then led product development at OXO International. She is a graduate of Princeton University and Harvard Business School.  Key Takeaways Financial longevity is a key component to aging well. 50% of Americans are going to run out of money—not just because lifespans are increasing, but because we don't have an adequate infrastructure. People should start financial planning as early as possible. The number one resource to build your retirement savings is a tax free 401k. The second thing is to continue working. Forced retirement is going out the window—70% of Americans want to work longer. Only 11% of Americans have long-term care insurance. Many people assume incorrectly that Medicare pays for long-term care. Added to care expense are hidden costs such as home modification for aging in place. The cost is being borne by families. There are 53 million unpaid family caregivers who pay an average of $7,000 a year to take care of a loved one. Social isolation affects older adults disproportionally—50% of adults over the age of 85 live alone. Older adults don't want to be stereotyped by age. They want to be aligned with their interests and passions versus numeric segmentation. Older adults are heterogeneous in interests, priorities, and attitudes, so marketers must consider microsegments not just sociodemographics.

Today John, Ben, and special guest Bryan Gay from Boomer Insurance discuss Medicare and Medicare Advantage, shedding light on a topic often overshadowed by federal employee health benefits. They start by breaking down Medicare, comparing it to just another insurance company, and exploring the distinctions between Medicare Part A and Part B. You'll gain valuable insights into the affordability and comprehensive coverage provided by Medicare, as well as discover the out-of-pocket limits associated with this healthcare option. Access the full show notes at Mason & Associates, LLC

In this Episode of the Secure Your Retirement Podcast, Radon and Murs discuss Medicare planning for those coming up on Medicare and those already in Medicare. This is a checklist of three main topics to help you understand what you should be thinking about when it comes to Medicare.Listen in to learn how to evaluate your prescription drug needs and choose the right Medicare plan that caters to those needs. You will also learn about Medicare supplements and Medicare Advantage plans, plus how to join our Free Webinar to learn more about Medicare planning from experts.In this episode, find out:Prescription drug plan – understand your prescription needs, if the plan covers your needs and the cadence of your refills.Comparing different part D plans that would cover your specific prescription drugs at the lowest cost.Evaluate your pharmacy network – ensure it's cost-effective and convenient for you.Cost analysis – Look at your prescription drug cost to determine the type of plan to pick.The importance of taking the time to review your plan annually and make changes if needed.Dental, vision, and hearing – Think about the dental, vision, and hearing coverages you need.Integrative plans – Do an educated analysis between Medicare Advantage plans and Medicare gap policies.Doing an individual needs assessment – understand your needs and get an individualized cover.Medicare supplements and Medicare Advantage plans – an outline of what we'll cover on our free webinar.Tweetable Quotes:“There's one part of Medicare that covers hospitals, one part that covers doctor's visits, and then there's a part D which is all about prescriptions.”- Radon Stancil “Just because your neighbor, parents, or a family has a certain type of plan doesn't mean that that's going to apply to you; Medicare and healthcare in general is very individualized for a reason.”- Murs TariqRegister For Our Free Medicare Webinar:info@pomwealth.net with the subject line Medicare WebinarResources:If you are in or nearing retirement and you want to gain clarity on what questions you should be asking, learn what the biggest retirement myths are, and identify what you can do to achieve peace of mind for your retirement, get started today by requesting our complimentary video course, Four Steps to Secure Your Retirement!To access the course, simply visit POMWealth.net/podcast.

The system for coordinating organ donations and transplants in the United States is broken, according to experts who have testified over the course of many years to Congress. In this episode, hear their testimony about what is wrong with the current system and then we'll examine the bill that aims to fix the problems. Please Support Congressional Dish – Quick Links Contribute monthly or a lump sum via Support Congressional Dish via (donations per episode) Send Zelle payments to: Donation@congressionaldish.com Send Venmo payments to: @Jennifer-Briney Send Cash App payments to: $CongressionalDish or Donation@congressionaldish.com Use your bank's online bill pay function to mail contributions to: Please make checks payable to Congressional Dish Thank you for supporting truly independent media! Background Sources August 3, 2022. Senate Finance Committee. Lenny Bernstein and Todd C. Frankel. August 3, 2022. The Washington Post. February 10, 2020. Senate Finance Committee. The Bill Audio Sources July 20, 2023 Senate Committee on Finance, Subcommittee on Health Care Witnesses: LaQuayia Goldring, Patient Molly J. McCarthy, Vice Chair & Region 6 Patient Affairs Committee Representative, Organ Procurement and Transplantation Network (OPTN) Matthew Wadsworth, President and CEO, Life Connection of Ohio Raymond J. Lynch, MD, MS, FACS, Professor of Surgery and Director of Transplantation Quality and Outcomes, Penn State Health Milton S. Hershey Medical Center Donna R. Cryer, JD, Founder and CEO, Global Liver Institute Clips 30:40 Sen. Ron Wyden (D-OR): HRSA, the Health Resources Agency, is on track to begin the contract process this fall and we're just going to be working here to complement their effort. 36:30 Sen. Chuck Grassley (R-IA): In 2005, I started the investigation of the deadly failures of UNOS, the monopoly tasked with managing the US organ donation system. Since then, more than 200,000 patients have needlessly died on the organ waiting list. There's a reason that I call UNOS the fox guarding the hen house. For nearly two decades, UNOS has concealed serious problems [at] the nation's organ procurement organizations, known as OPOs, instead of working to uncover and correct the corruption. This human tragedy is even more horrific because many of these deaths were preventable. They were the result of [a] corrupt, unaccountable monopoly that operates more like a cartel than a public servant. 44:45 LaQuayia Goldring: As a toddler, at the age of three, I was diagnosed with a rare kidney cancer that took the function of my left kidney. And when I was 17, I went back into complete renal failure and I received a first kidney transplant at that time. Unfortunately, in 2015, I went back into kidney failure. And at that time, I wasn't ready for another transplant, but I didn't have a choice but to go back on dialysis. I've been waiting nine agonizing years for a transplant, dependent upon a dialysis machine five days a week, just to be able to live. I was told that I would receive a kidney transplant within three to five years. But yet I am still waiting. I am undergoing monthly surgeries just to be able to get my dialysis access to work so that I can continue to live until I get a transplant. The UNOS waitlist is not like one to 100, where everybody thinks you get a number. I'm never notified on where I stand on the list or when I will get the call. I have to depend on an algorithm to make the decision of what my fate will be. 47:55 LaQuayia Goldring: Just a few weeks ago, a donor family reached out to me to be a directed kidney donor, meaning they chose me specifically for a kidney transplant. But unfortunately, due to the errors in the UNOS technology, I was listed as inactive and this was a clerical error. And all that they told me was this was a clerical error, and they could not figure out why I was inactive. But when it came down to it, I'm actually active on the transplant list. 51:45 Molly McCarthy: The Federal monopoly contractor managing the organ donation system, UNOS, is an unmitigated failure. And its leadership spends more time attacking critics than it does taking steps to fix the system. I've seen this firsthand in my five years as a patient volunteer with the OPTN and three years ago, I stepped into the role of Vice Chair of the Patient Affairs Committee, or PAC. 53:45 Molly McCarthy: Further, I have been called by a board member telling me to stop focusing on system outage and downtime of the UNOS tech system. He told me that having downtime wasn't a big deal at all, "the donors are dead anyway." That comment speaks volumes to me about the lack of empathy and respect UNOS has for donor families. 55:00 Molly McCarthy: Congress needs to break up the UNOS monopoly by passing 1668, ensuring that HHS uses its authority to replace UNOS as its contractor. 1:00:15 Matt Wadsworth: Break up the OPTN contract and allow for competition. 1:00:40 Matt Wadsworth: I commend this committee for introducing legislation to finally break up this monopoly and I stand ready to work with you in any way possible to ensure that this bill passes. It's the only way this industry will be able to save more patients' lives. 1:02:10 Dr. Raymond Lynch: I want to differentiate between organ donation, which is the altruistic decision of the donor patient and their family, and organ procurement, which is the clinical care provided by OPO staff. This is what turns the gift of donation into the usable organs for transplant. Organ procurement is a clinical specialty. It's the last medical care that many patients will ever receive. It's reimbursed by the federal government and it's administered by OPOs that are each the only provider in the territory to which they hold federal contracts. Right now patient care delivered by OPOs is some of the least visible in American healthcare. I can't tell you how many patients were evaluated by OPO workers in the US in 2022. I can't tell you how many patients were examined, or how many families were given information about donation, or how many times an OPO worker even showed up to a hospital to do this clinical duty. This lack of information about what OPO providers actually do for patients is a root cause of the variability in rates of organ procurement around the country. My research has shown that what we call OPO performance is a measurable restriction on the supply of organs that results in the unnecessary deaths of patients with organ failure. For example, if the lowest performing OPOs from around the country had just reached the national median over a recent seven year period, there would have been 4957 more organ donors, yielding an estimated 11,707 additional organs for transplant. Because many OPOs operate in a low quality data environment and without appropriate oversight, almost 5,000 patients did not get adequate organ procurement care, and nearly 12,000 other patients did not receive life saving transplants. 1:03:55 Dr. Raymond Lynch: OPO clinical work is currently not visible, it's not benchmarkable, and it's not able to be adequately evaluated, analyzed, or compared. However, much of the hidden data about how OPOs provide care to patients is known to one entity and that entity is UNOS. 1:05:20 Dr. Raymond Lynch: We need a new network of highly skilled specialist organizations, each attending to areas of expertise in the management of the OPTN contract. 1:21:15 Sen. Marsha Blackburn (R-TN): When we look at OPTN, and look at the Securing Organ Procurement Act, the bill would strip the nonprofit requirement for the manager of the Organ Procurement and Transplantation Network, which would open the door for profiting from organ procurement and donation. And to me, this is something that I think many people really fear, especially people that are on a waitlist. And so what I would like for you to do is to address that and address those concerns. And why or why not you think the Act has it right. Dr. Raymond Lynch: Thank you, Senator. I think it's unfortunate that people would be afraid of that and it needs to be changed. Many of the patients that you referenced are waitlisted at for-profit hospitals. For-profit is a part of American healthcare. And I can tell you that our not-for-profit entity doesn't work. And there are for-profit hospitals and for-profit transplant centers that do work. So patients don't need to be afraid of that. They do need to be afraid of the status quo. 1:28:30 Sen. Ben Cardin (D-MD): Ms. Cryer, do you have any views as to why it's much lower percentage chances for a racial minority to be able to have a transplant? Donna Cryer: Yes. And it really does come down to UNOS not doing its job of overseeing the organ procurement organizations. We know from many studies that black and brown communities donate organs in the same percentage they are the population. So it is not a problem of willingness to donate. It is a problem, as Miss Goldring was starting to discuss, about UNOS not ensuring that OPOs go out into the communities, develop relationships far before that horrible decision is needed to [be] made to donate the organs of a family member. 1:56:45 Sen. Elizabeth Warren (D-MA): And among the many reforms the legislation would support HRSA's proposal to break up the OPTN monopoly contract into multiple smaller contracts, which would allow some competition and allow the best vendors in the business to manage different parts of the transplant network operation. That means hiring IT experts to do the IT. It means hiring logistics experts to do logistics, and so on. 1:57:15 Sen. Elizabeth Warren (D-MA): UNOS does not want to lose control, so they're pushing to have the government limit eligibility only to nonprofit vendors that have worked in the past on organ donation, meaning, for instance, that the IT company that is hired to run OPTNs computers systems would have had to have worked on an organ transplant network in the past and be a nonprofit. So Ms. McCarthy, the requirement UNOS wants would seem to make it so that only one organization could apply for the new contract: UNOS. 1:58:35 Sen. Elizabeth Warren (D-MA): Right now, Congress has an opportunity to root out corruption in this system, but if we don't act before the current contract expires we won't have another shot for years. August 3, 2022 Senate Committee on Finance Witnesses: Brian Shepard, CEO, United Network for Organ Sharing (UNOS) Diane Brockmeier, RN, President and CEO, Mid-America Transplant Barry Friedman, RN, Executive Director, AdventHealth Transplant Institute Calvin Henry, Region 3 Patient Affairs Committee Representative, Organ Procurement and Transplantation Network (OPTN) Jayme Locke, M.D., MPH, Director, Division of Transplantation, Heersink School of Medicine, University of Alabama at Birmingham Clips 36:15 Sen. Ron Wyden (D-OR): A 1984 law created the first computerized system to match sick patients with the organs they need. It was named the Organ Procurement and Transplantation Network. Someone needed to manage that system for the whole country, so the government sought to contract an organization to run it. UNOS was the only bidder for that first contract in 1986. The contract has come up for bid seven other times, UNOS has won all seven. Today, the network UNOS overseas is made up of nearly 400 members, including 252 transplant centers, and 57 regional organizations known as Organ Procurement Organizations, or OPOs. Each OPO is a defined geographic service network. Families sitting in a hospital room thinking about donating a loved one's organs does not have a choice of OPOs. 37:40 Sen. Ron Wyden (D-OR): Between 2010 and 2020, more than 1,100 complaints were filed by patients and families, staff, transplant centers, and others. The nature of these complaints runs the gamut. For example, in a number of cases, OPOs had failed to complete critical mandatory tests for matters like blood types, diseases, and infection. Our investigation found one patient died after being transplanted with lungs that a South Carolina OPO marked with the wrong blood type. Similar blood type errors happened elsewhere and patients developed serious illness. Some had to have organs removed after transplant. Another patient was told he would likely die within three years after an OPO in Ohio supplied him with a heart from a donor who had died of a malignant brain tumor. UNOS did not pursue any disciplinary action. In a case from Florida, another patient contracted cancer from transplanted organs and the OPO sat on the evidence for months. In total, our investigation found that between 2008 and 2015, and 249 transplant recipients developed a disease from transplanted organs. More than a quarter of them died. 38:55 Sen. Ron Wyden (D-OR): Delivering organs has been another source of life threatening errors. We found 53 such complaints between 2010 and 2020, as well as evidence that this was just the tip of the iceberg. In some cases, couriers missed a flight. In others, the organs were abandoned at airports. Some organs were never picked up. Many of these failures resulted in organs being discarded. 39:20 Sen. Ron Wyden (D-OR): It's reasonable to assume that many more errors are going unreported. Why? Because filing official complaints with UNOS appears to accomplish zero productive oversight or reform. Organ transplant professionals repeatedly told the Finance Committee that the complaint process was, and I quote here, "a black hole." Complaints went in, UNOS went quiet. In interviews with the Committee UNOS leaders have dragged their feet, dodged tough questions, and shifted responsibility onto others. investigations and disciplinary measures rarely amount to much more than a slap on the wrist. Only one time -- just once -- has UNOS recommended that an OPO lose their certification. 55:05 Diane Brockmeier: We must update the archaic technology system at UNOS. As OPOs, we are required to work with UNOS technology DonorNet every day. DonorNet is outdated, difficult to us,e and often slow to function when every minute counts. Manual entry subjects it to error and OPO and Transplant Center staff are not empowered with the right information when time is critical. I did serve in leadership roles on the OPO Committee from 2017 to 2022. Committee members and industry leaders voiced repeated requests to improve DonorNet. The consistent response was UNOS IT did not have the bandwidth to address this work. The limitations of the UNOS technology are delaying and denying transplants to patients that are dying on the waitlist. Poor technology impacts the disturbingly high kidney discard rate in the United States, where one in four kidneys never make it to a patient for transplantation. Critical time is lost due to the inefficiency of DonorNet, wasting time on offers that will not be accepted. Of course an available organ should be offered to the patient in this sequence. However, far too much of the matching, particularly on older donors and organs that are difficult to place, are left to the individual OPOs and transplant centers to find each other despite, rather than facilitated by, UNOS technology. Mid-America Transplant intentionally identifies surgeons who accept kidneys that have been repeatedly turned down many times. These are life saving options for those patients. In May of 2022, one of these patients was number 18,193 on the list. Relying on DonorNet alone, that kidney would never had been placed and the chance to save a life would have been wasted. 55:20 Diane Brockmeier: UNOS lacks urgency and accountability around identifying and remediating this preventable loss of organs, and they are not required to publicly report adverse events when patients are harmed, organs are lost, or the quality of patient care is deemed unsafe. UNOS does not require clinical training, licensure, or certification standards for OPO staff delivering critical patient care. In this environment, who's looking out for the patient? Who's being held accountable for poor patient care? No OPO has ever actually been decertified, regardless of its performance or its safety record. 57:55 Diane Brockmeier: When an OPO goes out of sequence to place an organ that would otherwise be thrown away, UNOS requires an explanation; however, when organs are recovered and discarded, you must remain silent. 58:05 Diane Brockmeier: We must remove conflicts to ensure effective governance. From 2018 to 2020, I served as a board member for the OPTN. Serving on the board of the OPTN automatically assigns membership to the UNOS board. My board experience revealed that at times UNOS actions are not aligned with its fundamental vision of a life saving transplant for everyone in need. How can you fairly represent the country's interest and a contractor's interest at the same time? 58:35 Diane Brockmeier: Board members are often kept in the dark about critical matters and are marginalized, particularly if they express views that differ from UNOS leadership. Preparatory small group calls are conducted prior to board meetings to explore voting intentions, and if the board member was not aligned with the opinion of UNOS leadership, follow up calls are initiated. Fellow board members report feeling pressured to vote in accordance with UNOS leadership. 59:10 Diane Brockmeier: To protect patients, I urge Congress and the administration to separate the OPTN functions into different contracts so that patients can be served by best-in-class vendors, to immediately separate the boards of the OPTN and OPTN contractors, and to ensure that patients are safeguarded through open data from both the OPTN and OPOs. 1:00:45 Barry Friedman: Approximately 23% of kidneys procured from deceased donors are not used and discarded, resulting in preventable deaths 1:00:55 Barry Friedman: Organ transportation is a process left to federally designated Organ Procurement Organizations, OPOs. Currently, they develop their own relationships with couriers, rely on airlines, charter flights, ground transportation, and federal agencies to facilitate transportation. In many cases, organs must connect from one flight to another, leaving airline personnel responsible for transfers. While anyone can track their Amazon or FedEx package, there is currently no consistent way of tracking these life saving organs. 1:01:45 Barry Friedman: Currently there is no requirement for OPOs to use tracking systems. 1:02:20 Barry Friedman: I also believe there's a conflict of interest related to the management of IT functions by UNOS, as the IT tools they offer transplant centers come with additional costs, despite these being essential for the safety and management of organs. 1:02:35 Barry Friedman: UNOS is not effectively screening organ donors so that they can be quickly directed to transplant programs. UNOS asks centers to voluntarily opt out of certain organs via a filtering process. As a result, OPOs waste valuable time making organ offers to centers that will never accept them. Time wasted equates to prolonged cold ischemic time and organs not placed, resulting in lost organ transplant opportunities. 1:03:10 Barry Friedman: Due to the limited expertise that UNOS has in the placement of organs, it would be best if they were no longer responsible for the development of organ placement practices. The UNOS policy making [process] lacks transparency. Currently OPTN board members concurrently serve as the board members of UNOS, which creates a conflict of interest that contributes to this lack of transparency. UNOS committees are formed in a vacuum. There is no call for nominations and no data shared with the transplant community to explain the rationale behind decisions that create policy change. 1:11:35 Dr. Jayme Locke: The most powerful thing to know about this is that every organ represents a life. We can never forget that. Imagine having a medication you need to live being thrown away simply because someone took too long to get it to you. Your life quite literally in a trash can. Organs are no different. They too have shelf lives and they are measured in hours. Discarded organs and transportation errors may sound abstract, but let me make this negligence real for you. In 2014, I received a kidney that arrived frozen, it was an ice cube you could put in your drink. The intended recipient was sensitized, meaning difficult to match. The only thing we could do was tell the waiting patient that due to the lack of transportation safeguard, the kidney had to be thrown in the trash, the final generous act of a donor in Maryland. In 2017, I received a kidney that arrived in a box that appeared to have tire marks on it. The box was squished and the container inside had been ruptured. We were lucky and were able to salvage the kidney for transplant. But why should luck even play a role? 1:12:45 Dr. Jayme Locke: In one week, I received four kidneys from four different OPOs, each with basic errors that led to the need to throw away those life saving organs. One due to a botched kidney biopsy into the kidneys collecting system, another because of a lower pole artery that had been cut during procurement that could have been fixed if someone involved had assessed the kidney for damage and flushed it before packing, but that didn't happen. Two others arrived to me blue, meaning they hadn't been flushed either. 1:13:15 Dr. Jayme Locke: Opacity at UNOS means that we have no idea how often basic mistakes happen across the country, nor can we have any confidence that anything is being done to redress such errors so they don't keep happening. 1:13:40 Dr. Jayme Locke: Women who have been pregnant, especially multiple times, are harder to match, contributing to both gender and racial disparities in access to transplant. This is a very real example of how a constrained pool of organs and high discards disproportionately hurt women and women of color, who are more likely to have multiple pregnancies. 1:14:25 Dr. Jayme Locke: Number one, immediately separate the OPTN board from any of the boards of any contractors. Number two, bring in real experts to ensure our patients are served by the best of the best in each field, separating out key functions of the OPTN, including policy, technology, and logistics. And number three, ensure that patients are safer by holding all contractors accountable through public adverse event reporting and immediate redressing of problems. 1:22:00 Sen. Chuck Grassley (R-IA): The system doesn't seem to be fair to racial minorities or people living in rural communities. So what are your efforts underway to understand the root causes and help make the system fairer to patients on the waiting list to explain the factors that result in the disparity for minorities in rural populations in the process? And how can the federal government address a problem if we have to be involved in addressing it? Dr. Jayme Locke: One of the most important things that we don't currently do is we don't actually account for disease burden in terms of examining our waiting lists. So we have no way of knowing if we're actually serving the correct people, if the correct people are actually making it to the waiting list. Disease burden is super important because it not only identifies the individuals who are in need of transplantation, but it also speaks to supply. So areas with high rates of end stage kidney disease burden, like the southeastern United States are going to have much lower supply. And those waiting lists predominantly consist of African American or Black individuals. So if you want to make a truly equitable organ system, you have to essentially get more organs to those areas where there are higher disease burdens. I think the other thing is that we have to have more focus on how we approach donor families and make sure that we have cultural competence as a part of our OPOs, and how they approach families to ensure that we're not marginalizing minority families with regard to the organ donation process. 1:30:00 Brian Shepard: The OPTN IT system that UNOS operates has 99.99% uptime. It is a highly reliable system. We are audited annually by HRSA.... Sen. Ben Cardin (D-MD): My information shows it's had 17 days down since I think 1999. That's not correct? Brian Shepard: In 23 years, yes, sir. Sen. Ben Cardin (D-MD): Okay, well, every day there's a loss of life, isn't it? Brian Shepard: That's the total amount of time over the couse of -- Sen. Ben Cardin (D-MD): I hope our national event system isn't down 17 days a year. Brian Shepard: The system has never been down for a day. And to my knowledge, and I have not been at UNOS since 1999, there's been maybe one event that was longer than an hour, and that was three hours. But the total amount of time since 1999 -- Sen. Ben Cardin (D-MD): So you're satisfied with your technology? You think you have the right technology? You're satisfied with your tracking systems now? You think everything is okay? Brian Shepard: We constantly improve our technology. We're subjected to 3 million attempts a day to hack into the patient database and we successfully repelled them all. So we are never satisfied with our technology, but we do maintain 99.99% uptime. We disagree with the USDS analysis of our systems. 1:37:25 Brian Shepard: If you're asking whether UNOS can prevent an OPO from operating or for being an OPO -- Sen. Rob Portman (R-OH: Well not prevent them, but require them to do something .You don't have the ability to require them...? Brian Shepard: The peer review process has significant persuasive authority, but all the payment authority and all the certification and decertification authority live at CMS. 1:39:00 Sen. Rob Portman (R-OH: Do you think there should be tracking of organs in transit? Brian Shepard: I think that's a very beneficial thing. UNOS provides an optional service that a quarter of OPOs use. Many OPOs also use other commercially available trackers to do that. There is not a single requirement to use a particular system. 1:41:55 Sen. Elizabeth Warren (D-MA): Mr. Shepherd, you are the CEO of UNOS. We have documented these problems and you've received more than 1000 complaints in the last decade alone. So tell me, in the 36 years that UNOS has had the contract to run our national organ system, how many times has UNOS declared its OPO Members, any OPO members, not in good standing. Brian Shepard: Two times, Senator. 1:43:20 Sen. Elizabeth Warren (D-MA): How many times has UNOS put an OPO on probation? Brian Shepard: I don't know that number off the top of my head, but it's not a large number. Sen. Elizabeth Warren (D-MA): It's not large, in fact it's three. 1:45:20 Brian Shepard: Approximately 10% of the budget of this contract is taxpayer funded. The rest of that is paid by hospitals when they list patients. 1:49:30 Sen. Todd Young (R-IN): Once an OPO is designated not in good standing, Senator Warren referred to this as toothless. It does seem toothless to me. I'll give you an opportunity, Mr. Shepherd, to disabuse me of that notion and indicate for me what penalties or sanctions are actually placed on an OPO when they are designated not in good standing. Brian Shepard: The statute does not give UNOS any authority to offer sanctions like that. The certification, decertification, payment authorities belong entirely to CMS. UNOS's statute doesn't give us the ability -- Sen. Todd Young (R-IN): So it is toothless in that sense. Brian Shepard: It is designed to be, by regulation and contract, a quality improvement process, in contrast to the oversight process operated by a federal agency. 1:51:15 Sen. Todd Young (R-IN): To what extent is UNOS currently tracking the status of all the organs in transit at any given time? Brian Shepard: UNOS does not coordinate transportation or track organs in transit. We do provide a service that OPOs can use to use GPS trackers. Some of the OPOs use ours and some use other commercially available products. Sen. Todd Young (R-IN): So why is it, and how does UNOS plan to optimize organ delivery if you don't have 100% visibility into where they are at any given time? Brian Shepard: I think that the GPS products that we offer and that other people offer are valuable, they do help in the delivery of kidneys. Only kidneys travel unaccompanied, so this is a kidney issue. But I do think that GPS trackers are valuable and I think that's why you've seen more and more OPOs use them. 1:52:50 Sen. Ron Wyden (D-OR): Mr. Shepherd has said twice, with respect to this whole question of the power to decertify an OPO, that CMS has the power to do it. UNOS also has the power to refer an OPO for decertification under the OPTN final rule. That has been done exactly once. So I just wanted it understood with respect to making sure the committee has got what's really going on with respect to decertifying OPOs. 2:00:15 Dr. Jayme Locke: Obviously people have described that we have about a 25% kidney discard, so one in four. So if you look at numbers last year, these are rough numbers, but that'd be about 8000 kidneys. And really, I think, in some ways, these are kind of a victim of an entrenched and cumbersome allocation algorithms that are very ordinal, you have to go sort of in order, when data clearly have shown that introduction of multiple simultaneous expiring offers would result in more efficient placement of kidneys and this would decrease our cold ischemia time. 2:00:50 Dr. Jayme Locke: So if you take UNOS's organ center, they have a very rigid system, for example, for finding flights and lack either an ability or interest in thinking outside the box. So, for example, if there are no direct flights from California to Birmingham, Alabama, instead of looking for a flight from San Francisco to Atlanta, understanding that a courier could then pick it up in Atlanta and drive it the two hours, they'll instead put on a flight from SFO to Atlanta and allow it to go to cargo hold overnight, where it literally is rotting, if you will, and we're putting extra time on it. Sen. Ron Wyden (D-OR): Just to make sure everybody gets this. You're saying you've seen instances of something being put in cargo hold when it is very likely to rot? Dr. Jayme Locke: That is correct. So if the kidney arrives after 10pm at the Atlanta airport, it goes to cargo hold. We discovered that and made calls to the airlines ourselves and after several calls to the airlines, of course they were mortified, not understanding that that was what was happening and actually had their manager meet our courier and we were able to get the kidney out of cargo hold, but this went on before we figured out what was happening because essentially they fly it in, it sits in cargo hold, it comes out the next morning to catch the next flight. Instead of thinking outside the box: if we just get it to Atlanta, it's drivable to Birmingham. And those hours make a difference. Sen. Ron Wyden (D-OR): That sounds way too logical for what UNOS has been up to. 2:03:05 Sen. Ron Wyden (D-OR): Miss Brockmeier, UNOS has developed this organ tracking system. Do you all use it? I'm curious what you think of it. Diane Brockmeier: Thank you for the question, Senator. We did use and participate in the beta pilot through UNOS and made the decision to not move forward using their product, and have sought a commercial alternative. Sen. Ron Wyden (D-OR): And why was that? Diane Brockmeier: Part of the issues were some service related issues, the lack of the interconnectivity that we wanted to be able to facilitate a more expedited visual tracking of where the organ was. Sen. Ron Wyden (D-OR): Was the tracking technology low quality? Diane Brockmeier: Yes, sir. 2:11:25 Sen. Ron Wyden (D-OR): All right, let's talk for a moment about the boards that are supposed to be overseeing these, because it looks to me like there's a serious conflict of interest here and I'll send this to Ms. Brockmeier, and perhaps you'd like to get to it as well, Mr. Friedman. The Organ Procurement and Transplantation Network, which is the formal title of the organ network that operates under federal contract administered by HHS, and UNOS, which is the contractor that operates the network and controls information about the network, have the same boards of directors, despite efforts by the government to separate them. That means the people who look out for the best interests of UNOS, the multimillion dollar nonprofit, are the same people who look out for the interests of the entire organ transplant network. Sure sounds like a conflict to me. 2:12:55 Diane Brockmeier: I think there should be an independent board. I think the division of the responsibilities of the board and by the inherent way that they're structured, do pose conflicts. It would be like if you had an organization that was a supporting organization, you'd want to hold it accountable for its performance. And the current structure really limits that opportunity. 2:19:50 Dr. Jayme Locke: And if you think about IT, something as simple as having a system where we can more easily put in unacceptable antigens, this was a debate for many years. So for context, we list unacceptable antigens in the system that allows us to better match kidneys so that when someone comes up on the match run, we have a high probability that there'll be a good tissue match. Well, that took forever and we couldn't really get our unacceptable antigens in, so routinely people get offered kidneys that aren't going to be a match, and you have to get through all of those before you can get to the person that they really should go to. Those are simple examples. But if we could really have transparency and accountability around those kinds of things, we could save more lives. 2:23:10 Sen. Ron Wyden (D-OR): Mr. Shepherd told Senator Warren that only 10% of UNOS funds come from taxpayer money and the rest comes from fees paid by transplant centers who add patients to the list. But the fact is, Medicare is the largest payer of the fees, for example, for kidneys. So we're talking about inefficiency, inefficiency that puts patients at risk. And certainly, taxpayer dollars are used to cover some of these practices. May 4, 2021 House Committee on Oversight and Reform, Subcommittee on Economic and Consumer Policy Witnesses: Tonya Ingram, Patient Waiting for a Transplant Dr. Dara Kass, Living Donor and Mother of Transplant Recipient LaQuayia Goldring, Patient Waiting for a Transplant Steve Miller, CEO, Association for Organ Procurement Organizations Joe Ferreira, President, Association for Organ Procurement Organizations Matt Wadsworth, President and CEO, Life Connection of Ohio Dr. Seth Karp, Director, Vanderbilt Transplant Center Donna Cryer, President and CEO, Global Liver Institute Clips 5:15 Tonya Ingram: The Organ Procurement Organization that serves Los Angeles, where I live, is failing according to the federal government. In fact, it's one of the worst in the country. One analysis showed it only recovered 31% of potential organ donors. Audits in previous years found that LA's OPO has misspent taxpayer dollars on retreats to five star hotels and Rose Bowl tickets. The CEO makes more than $900,000. Even still, the LA OPO has not lost its government contract and it has five more years to go. 30:00 Rep. Raja Krishnamoorthi (D-IL): Unusual among Medicare programs, their costs are 100% reimbursed, even costs unrelated to care. So, extravagant executive compensation and luxury perks may be passed off onto the taxpayer. 46:55 Dr. Seth Karp: We have 10 hours to get a liver from the donor to the recipient, and about one hour to sew it in. For heart, we have about six hours. Time matters. 47:55 Dr. Seth Karp: Last year, I had the opportunity to co-write a viewpoint in one of the journals of the American Medical Association with TJ Patel, former Chief Data Scientist of the United States. In that article, we provided evidence that the metrics used to judge the performance of organ procurement organizations are basically useless. Until the recent OPO Final Rule, performance was self-reported, and OPO employees admitted to having gamed the system. When threatened with decertification, one of the OPOs themselves successfully argued that because the performance data were self reported and unaudited, they failed to meet a reasonable standard and the OPO should not be held accountable. In other words for decades, the metrics supposed to measure performance didn't measure performance, and the results have been disastrous, as you have heard. 49:45 Dr. Seth Karp: Whenever I, and quite frankly most everyone else in the field, gives a talk on transplantation, we usually make two points. The first is that organ transplantation is a miracle of modern medicine. The second is the tragedy that there are not enough organs for everyone who needs one. I no longer use the second point, because I don't believe it. Based on my work, I believe that there are enough organs for patients who require hearts, lungs, and probably livers, and we can make a huge improvement in the number of kidneys available. In addition to improving OPO performance, new technologies already exist to dramatically increase the organ supply. We need a structure to drive rapid improvement in our system. 54:00 Joe Ferreira: One common misconception is that OPOs are solely responsible for the entire donation and transplantation system, when, in fact, OPOs are the intermediary entity and their success is highly dependent on collaborations with hospitals and transplant programs. At the start of the donation process, hospitals are responsible for notifying any OPO in a timely manner when a patient is on a ventilator and meets medical criteria to be an organ donor. Additionally, transplant centers must make the decision whether to accept or decline the organs offered by OPOs. 57:55 Matt Wadsworth: As geographic monopolies, OPOs are not subject to any competitive pressure to provide high service. As the only major program in all of health care 100% reimbursed for all costs, we do not face financial pressures to allocate resources intelligently. 1:02:10 Rep. Raja Krishnamoorthi (D-IL): Mr. Ferreira, I'd like to turn to you. You run the OPO called the Nevada Donor Network. I have your OPO's 2019 financial statement filed with the CMS. It appears that your OPO spent roughly $6 million in 2019 on administrative and general expenses. Interestingly, in 2019, I see your OPO spent approximately $146,000 on travel meetings and seminars alone. And your itemization of Administrative and General has an interesting line item for $576,000 for "ANG". It took me a minute but that means you have an "Administrative and General" subcategory in your "Administrative and General" category. Very vague. Now Mr. Ferreira, I was informed by Mr. Wadsworth, a former executive of yours at the Nevada Donor Network, that your OPO has season tickets to the NHL's Las Vegas Golden Knights, isn't that correct? Joe Ferreira: That is correct, Mr. Chairman. Rep. Raja Krishnamoorthi (D-IL): And you also have season tickets to the Las Vegas Raiders too, right? Joe Ferreira: That is correct. Rep. Raja Krishnamoorthi (D-IL): And according to Mr. Wadsworth and others, your OPO took a board retreat to Napa Valley in 2018. Joe Ferreira: That is correct. Rep. Raja Krishnamoorthi (D-IL): And Sonoma in 2019, right? Joe Ferreira: That is correct. Rep. Raja Krishnamoorthi (D-IL): Mr. Ferreira, what you're spending on the Raiders, the Golden Knights, Napa Valley and Sonoma have one thing in common: they have nothing to do with recovering organs. 1:10:30 Dr. Seth Karp: In 2019, there were six heart transplants that were performed using donors after circulatory determination of death. And I don't want to get into the technical aspects of that. But in 2019, that number was six. In 2020, that number was 126. This is a new technology. This is a way that we can increase the number of heart transplants done in United States dramatically. And if we think that there were 500 patients in the United States waiting for a heart in 2020, 500 patients that either died or were delisted because they were too sick, and you think in one year, using a technology, we got another 100 transplants, if we could get another 500 transplants out of that technology, we could almost eliminate deaths on the on the heart transplant waiting list. That technology exists. It exists today. But we don't have a mechanism for getting it out to everybody that could use it and it's going to run itself through the system, it's going to take too much time. 1:24:05 Rep. Andrew Clyde (R-GA): You know, I'm a little disappointed that we're discussing race as a factor in organ transplant. We're all one race in my opinion; color makes no difference to me. We're the human race. And to me, the interjection of race into this discussion is very concerning. Discrimination based on race was outlawed almost 60 years ago through the Civil Rights Act of 1964. Now, I'm not a medical doctor, and I have very little knowledge of medicine. But last year, there was an article that came out in LifeSource and it says, "Does my race and ethnicity matter in organ donation?" And so my question here is for Dr. Karp. In your experience, would you agree that a donor's organs are more likely to be a clinical match for a recipient of the same ethnicity? Could you comment on that? Is that actually a factor, or not? I mean, we're all human beings, we all, you know, have similar bodies. Dr. Seth Karp: Yes. So there definitely are certain HLA types that are more common. That is race-based. So the answer to that question is yes. Rep. Andrew Clyde (R-GA): Okay. All right. And so if you have more of one particular race, more donations of one particular race, then naturally you would have more actual matches of that particular race. Is that correct? Dr. Seth Karp: That would tend to be the case. Rep. Andrew Clyde (R-GA): Okay. All right. All right. Okay, that's just a question that I wanted to clear up here. 1:34:20 Donna Cryer: We'd like to see investments in languages that are spoken by the community. Educational resources should be, as required by law, for those with limited English proficiency. They should be in the languages spoken by the community. They should be hiring diverse staff to have those most crucial conversations with families. The data shows, and certainly experience and common sense shows as well, that having people of color approaching families of color results in more donations. Executive Producer Recommended Sources Music by Editing Production Assistance