Podcasts about medicare services

Learn more about NetSuite Planning and Budgeting: https://tinyurl.com/bdhm7phf   In this special episode of the NetSuite Podcast focusing on the CFO's agenda for 2025, cohost Megan O'Brien sits down with Jess Wijesekera, SVP of Global Accounting at Vytalize Health, a leading value-based care platform. They start the episode by discussing Jess' background and what brought her to her current role [1:55]. Jess then delves into Vytalize Health and its exponential growth over the last several years [6:26]. Megan and Jess discuss technology and talent issues [15:49]. They end the podcast episode by covering Vytalize Health's priorities for 2025 [31:52].   Follow Us Here:   Vytalize Health: https://www.vytalizehealth.com/   Jess Wijesekera LinkedIn: https://www.linkedin.com/in/jessica-wijesekera-7290196/   Oracle NetSuite LinkedIn: https://social.ora.cl/6000wKFhC X (Twitter): https://social.ora.cl/6007wK2zD Instagram: https://social.ora.cl/6003wK2Hv Facebook: https://social.ora.cl/6005wK2Dv   #NetSuite #CFOAgenda, #Accounting   --------------------------------------------------------   Episode Transcript:   00;00;04;21 - 00;00;28;20 Hello, all you Suite listeners. Thank you so much for tuning in to the NetSuite podcast. I'm Megan O'Brien, a co-host of the podcast. Now you all are in luck because today's episode marks the start of a mini series we are doing called The CFO Agenda. As we approach the end of 2024, we wanted to gauge what's on the docket for finance and accounting leaders.   00;00;28;23 - 00;00;50;23 In the first installment of the series, we have Jess Wijesekera, SVP of Global Accounting for Vytalize Health, a leading value based care platform. If you attended SuiteWorld or if you tuned into NetSuite OnAir to watch the main keynote, you would have seen her make an appearance with NetSuite Founder and EVP Evan Goldberg.   00;00;50;25 - 00;01;19;08 Vytalize Health has grown by a casual 90,778% over the last three years, so this episode is a great pulse check on what high-growth companies are prioritizing this coming year. We talk all about Jess' background and her current role of Vytalize Health, the company's exponential growth, and her plans for 2025. With that, let's go ahead and dive in.   00;01;19;11 - 00;01;45;23 You're listening to the NetSuite Podcast, where we discuss what's happening within NetSuite, why we're doing it, and where we're heading in the future. We'll dive into the details about the software and the people at NetSuite who are behind all the moving parts. We'll also feature customer growth stories discussing the ups and downs of running a company and how one integrated system can help your business continue to scale.   00;01;45;25 - 00;02;03;26 Hi, Jess. How are you today? Hey, Megan. Good. Really great to be here. Good. We're so happy to have you. Yeah. Thank you. All right, well, we're going to dive right in because we have so much to cover. We want to hear, first of all, about your background. Did you always know that you wanted to get into accounting?   00;02;03;29 - 00;02;26;29 I did not. But I was always very good at organizing people and organizing projects. And I think that organization has always really been a part of who I am. It's going to sound silly, but in kindergarten I used to and tell them where and how to jump rope, and they always just happily listened to what I had to say.   00;02;26;29 - 00;02;57;23 And I felt really like a natural leader and I knew I wanted to do something that captured my personality. So, for me, accounting is just a really nice because it's taking project management and organization and unpacking a puzzle takes a lot of patience, which I'm learning to have a lot of patience, but it takes a lot of kindness for interacting with other departments and some tenacity with dealing with service providers.   00;02;57;23 - 00;03;31;23 So, I didn't know I always wanted to do it, but it is feeling like a really good fit. I couldn't help but stalk you a little bit on LinkedIn. You majored in accounting at Villanova, which is where I went. Yeah, Wildcats, you know, so I know I just had a great experience there and I chose it really because they had a very solid business school and I had this accounting professor who taught financial accounting, and he told me that accounting was the hardest major in the business school.   00;03;31;26 - 00;03;58;08 And if I could do accounting, that I could do anything, I could do finance, I could do management, I could do marketing. And he was really right. And I followed my accounting degree up with a master's in finance at Boston College. And it's really worked well, I think, to have this understanding of everything that's accounting is past and everything that's finance is future and we meet in the present.   00;03;58;12 - 00;04;28;26 So it's kind of helped shape my career and where it's gone. That is such a cool perspective on it. And, and speaking of your career, could you talk a little bit about your past roles and your path to where you are now? Yeah, so like many accounting majors, I started at the Big Four, so I was at EY and I stayed longer than most. I was there about 15 years and I did a grand tour of about four offices.   00;04;28;29 - 00;04;55;29 So, I started in Palo Alto, and then did Boston, San Francisco, and I also did a three year secondment in the London office. And every time I felt I was going to leave public accounting, I stayed because I got a new opportunity or worked on a new client or with a new team. And it was this feeling that I could really add value, but also learn something completely new, which added to my skill set.   00;04;56;02 - 00;05;20;15 And I can't even tell you the number of times that I've cried in an audit room. I do think about those experiences and really how it shaped me. I got to work on Warner Brothers and Hawaiian Airlines, and towards the end of my career there, I was a national instructor for 606 when that Rev Rec standard was completely new and nobody knew what to do.   00;05;20;15 - 00;05;48;11 So that helped me with my foundation for where I am now. But after 15 years I decided to go into industry, so I started as an assistant controller. I was at a bottling company and my very first day on the job I realized I've never booked a journal entry in my whole life and a few roles since I have taken on kind of new areas of responsibility and kept growing my own skillset.   00;05;48;13 - 00;06;14;09 And I'm actually really lucky now to have brought on a couple of people I've worked with in the past, you know, kind of through EY and other companies because we just really enjoy working together. So that all of that brought me to my life. Well, I mean, I don't think you've really worked for a Big Four unless you've cried somewhere in an office, so you, you sent that experience home. Probably an office without windows.   00;06;14;11 - 00;06;40;07 Yeah, yeah, yeah, I did my crying in a phone booth, so. Yeah, yeah, No windows. We're all here now. We're all here. And better for it. So speaking of Vytalize, you ended up joining Vytalize Health about two years ago? Can you tell our listeners a little bit about what Vytalize Health does? Yeah, so Vytalize is a value-based care company.   00;06;40;09 - 00;07;10;11 Value-based care is a collection of doctors and service providers and payers that work collectively to have better outcomes for patients. And coincidentally, that's usually at a reduced cost. So, what we do is sit between the primary care physician and CMS, which is the Center for Medicare Services. So we help our physicians strengthen the relationship that they have with their patients.   00;07;10;13 - 00;07;41;13 And if we succeed in that and meet certain quality metrics and achieve these better health outcomes, then CMS as the payer, they give us a share of that. So, I'll use a fancy terminology, but it's really aligning incentives, right? So, we're all incentivized for providing better, higher quality care, not necessarily more care. And it's really working because we're giving these doctors more time to spend with their patients.   00;07;41;13 - 00;08;18;00 So, we provide services like care coordination and virtual home care, in-home care. And it's particularly important for the Medicare population. You know, if you think about 65 plus and then people that are, you know, often not able to get to the doctor, in-home care is so critical. And really, we see ourselves as an extension of the physician so that we operate as part of their practice and really preventing hospitalizations and improving the quality of life and, you know, for an accounting major, that's certainly something I can get behind.   00;08;18;00 - 00;08;42;02 And, you know, the mission and kind of what we're doing, it feels really good. What does a typical day in your shoes look like? So like many companies in the pandemic, we went remote. So I have a little office that I use in a coworking space and I bring my puppy with me and we have a lot of meetings.   00;08;42;02 - 00;09;07;10 So back-to back-video meetings, I do a lot of meetings direct with one on ones, with my direct reports. We are constantly meeting with our EY tax team, Connor Group accounting specialists, so treasury and tax report through me. And then I just took on the FP&A function as well. So, this week was a lot of meeting with department heads to try and craft our budget.   00;09;07;12 - 00;09;34;04 But I find my typical day is really helping my team make good decisions and collaborative points of view and just making sure that we're prioritizing the right thing at the right time. Because like so many companies growing as quickly as we are, you know, you're this can be really long and kind of helping decide what comes first and what can come when, as you know, is a really big part of my job when I also have the puppy.   00;09;34;04 - 00;09;57;04 So she's as cute as can be. And we try and get out of some walks in between all of the meetings. Yeah. So for our frequent listeners, the puppies she's referring to is actually the guide dog puppy that attended SuiteWorld that we talked about in our SuiteWorld. recap. We are obsessed with Mayberry. I think she might be the new NetSuite mascot she's so sweet.   00;09;57;04 - 00;10;19;10 So she's training to become a guide dog for the blind. And I'll have her through next June. And she's part of the Walnut Creek Club here in the San Francisco Bay Area. And she's just a little delight. So her having her experience SuiteWorld in Vegas, I think opened her eyes. I mean, she's doing really great.   00;10;19;12 - 00;10;53;13 She did so good. She was all scared of the casino. Yeah, we all are. So Vytalize Health has this crazy growth trajectory. So the company ranked number one on the Inc. 5000 across all industries after achieving $1.5 billion in revenue for 2023 and a three-year revenue growth rate of 90,778%. Can you delve into the Vytalize Health's growth story and how that all came about?   00;10;53;15 - 00;11;22;19 Yeah. So Megan, work with me here on some math backwards. So to get to 1.5 billion, that means we started as a single health care practice. So we had one practice. It was in Rockland, Maryland, and it still exists, but we've grown from about one medical practice to over 200, I'm sorry, 2600 primary care physicians. We found that we were very good at these additional services.   00;11;22;19 - 00;11;49;15 Right. The care coordination and helping the physicians make better decisions. And instead of growing our own practices, the business went through kind of the modeling approach that we would instead partner with physicians and they would join our value based care program, which is it's called Accountable Care Organizations. So those practices joined our ACO and we taught them value-based care.   00;11;49;18 - 00;12;18;21 And through that we shared a part of our savings with them. And in that model, we were really able to grow quickly. So we went from, you know, just a few thousand Medicare beneficiaries to now over 260,000 patients. And that's a staggering number because we're probably taking care of someone that, you know, and it's part of Medicare's goal to have every Medicare patient in an ACO by 2030.   00;12;18;24 - 00;12;41;04 So for people who don't know what value-based care is, all of the sudden they must participate in value-based care by 2030, in six years we'll be there. And Vytalize is really helping with that transition. And it's working. It's working really well. We're seeing a lot improved outcomes for patients and decreased hospital hospitalizations. And yeah, it's going really well.   00;12;41;10 - 00;13;06;23 Yeah, clearly, clearly clear. So were there any challenges that came with this rapid growth? And if so, how did Vytalize help tackle them? Do you remember Facebook? They used to have this tagline and slogan and it said, ‘Move fast and break things,' right? And I was googling it recently and I was like, I think they have abandoned that tagline.   00;13;06;25 - 00;13;35;10 Yeah, maybe with the move to Meta, they're like, Yeah, maybe not and break things. Yes. So that's the hardest part, right? Is because you can move too quickly and break things and sometimes that's an okay thing. But a lot of the times we should really be adding a lot more thought, a lot more time and a lot more considerations to some of the larger decisions that are going on.   00;13;35;10 - 00;14;02;29 So really, to me, the biggest challenge with this rapid growth is taking the time and the thought process to really think through decisions and not move as quickly as you can. So one of the other things that we've done to kind of circumvent that is adding a policy and procedures committee and a policy and procedures role in our organization.   00;14;02;29 - 00;14;37;20 And I'm not going to take any credit for that because it was already in existence and it was already working really well. But we were able to then write some policies pretty early on that helped our controls and helped our vendor contracts who could engage if vendor who could approve a payment. And a lot of those early policies and we're still writing them, but a lot of those early policies helped us, you know, be able to go to the rest of the business and say, ‘Hey, you know, you can't X, Y, Z because of this policy' or ‘You can, but you must do it in this way.'   00;14;37;24 - 00;15;07;28 And kind of making that consistent across the organization was really helpful for me. Well, that kind of leads into a good question for our listeners here. Any best practices for companies that might be looking to grow or any pitfalls to avoid? I think growth in general is having good technology to scale, right? So how do we make something a repeatable process and how do we put it in a system to be able to make it repeatable?   00;15;08;01 - 00;15;39;14 My app director, Lisa Kemper, and I joke all the time that life is full of one-offs, right? Like this is all a one off and if you're tackling something over here and over there, you would need 300 people in your accounting department to be able to support all of the one-offs. So, we very much we do use this Policy and Procedures Committee, but we're also standing up a lot of our tech products and using NetSuite to be able to get, you know, some standardization.   00;15;39;14 - 00;16;07;11 But also I'll call it kill the one offs, right? We can't be doing an exception. Everything has to fit into a process and become part of the rule. And how has Vytalize Health been using NetSuite? Oh my gosh. We're big, you know, signing some new statements of work all the time. So, yes, I love it. I know the one we just signed was the budgeting and planning tool right now.   00;16;07;11 - 00;16;33;05 So we started with the financials and budgeting and planning. But I would say we're really starting to use a lot of the subledgers in the way that they were intended to be used, and that has been really helpful for us. So, our biggest NetSuite, and I spoke about this at SuiteWorld, is our bank reconciliations. We have, you know, 47 bank accounts and transactions galore.   00;16;33;11 - 00;16;58;00 Right? And sort of as we talk about standardization and automation and killing, the one offs, what we're doing is making sure that we can put something in a process and make it repeatable. And the bank reconciliation module has started to learn the way that we're matching off our bank recs and the way that we're matching off transactions. And it will start to do that for us.   00;16;58;00 - 00;17;21;05 So every time we make a bill payment debit this account credit that account it learns it and then it'll just do it in the background and then we approve it. So this used to take three people their whole full-time job. Not to mention there are a lot of errors in this process. And now that we actually turned on the bank rec module, it's kind of all working for us in the background.   00;17;21;05 - 00;17;47;26 And I was even talking with my accounting manager, Kelly Allen, and I said yesterday I was like, Kelly, how's the bank matching going? And she's like, ‘You know, I don't even hear about it.' It's really working for us. And, and it's been helpful to start to automate these things so we don't have to think about it. And it previously it just felt like we were playing catch up, you know, 45 days.   00;17;47;29 - 00;18;06;14 It would take us to close the books. And, you know, 45 days ago was the end of August or August is long gone by now. Right? We're making business decisions all the time. Do we need more? You know, funding from investors? We want to take a loan, whereas, you know, where are these larger payments coming from? We're going to we can't wait 45 days for anything.   00;18;06;14 - 00;18;32;25 So it's helped us, you know, make some real-time decisions. Well, why is having a strong tech stack so important for Vytalize Health specifically and how did it perhaps help facilitate some of the massive growth that you mentioned previously? We had a previous controller at Vytalize and every time we needed financials, he would say, okay, like I need three days.   00;18;32;27 - 00;19;02;08 He would take, you know, we had QuickBooks and, you know, it was the right size and shape for us when we started. So, we're using QuickBooks and he would take three days to prepare a consolidation and then to do the elimination journal entries. And that was a very manual effort. And three days of those financials and, you know, the manual errors that could exist.   00;19;02;08 - 00;19;23;13 And, you know, it was almost like, well, I don't need it anymore that I asked for that three days ago. We've moved on. That wasn't at least, you know, last week. So finally I looked at him and I was like, we have to get this in NetSuite and we have to do like journal entries and post them on the system.   00;19;23;13 - 00;19;43;21 And, you know, we're going to need elimination entries and we're going to need to have this reporting in a moment's notice. And, you know, when we ask for the report, I need it in 20 minutes, not three days. So we moved it all into NetSuite We've also gotten a tool called Workiva and Workiva connects to NetSuite.   00;19;43;21 - 00;20;09;08 And I'll give a shout out to Ryan Mueller, who's our senior manager of tech accounting and NetSuite syncs with Workiva so we can produce financial statements and reports at a moment's notice. And I can say, you know, I want the Q2 report to investors and I want that Q2 report to include these entities and Workiva pulls the information from NetSuite.   00;20;09;08 - 00;20;32;08 And then we can have it ready for an investor immediately. And that has really been a game changer for us. We do a lot of reporting. We have board members and boards of each of our ACOs, so there's about six of those. We need frequent reporting for about six different entities. And then on top of that, we're supporting an audit from Deloitte right now.   00;20;32;08 - 00;20;58;13 For us to pull all of this reporting very quickly and only, you know, I have a team of five here in the US doing accounting, and that is really essential for us to have these tools so that we can, you know, keep our headcount costs low, keep the work interesting for the people that are here, and be also, you know, be providing that to investors.   00;20;58;15 - 00;21;24;18 NetSuite by Oracle, the number one cloud financial system is everything you need to grow all in one place. Financials, inventory, HR, and more. Make better decisions faster so you can do more and spend less. See how at netsuite.com/pod. Well, can you imagine the poor controller just getting an email saying, ‘Hey, we want the numbers' and thinking, ‘Well, there goes three of my days.'   00;21;24;21 - 00;21;47;29 My god, I'd be dreading emails. Yeah. And, you know, sad story about QuickBooks. You have to have separate legal entities. So, we had 16 legal entities that he had. Like, you can't run a report. So we got a bolt on tool. So it's fun. But you know, just to sort of highlight like if you think you can do it, it could probably be done.   00;21;47;29 - 00;22;13;10 So moving to the new technology helped us immensely. Yeah, thank god. Thank god for saving the controller on a click of a button. We've kind of alluded to this, but you participated in a keynote with NetSuite Founder and EVP Evan Goldberg at SuiteWorld this year. What was that experience like? It was so cool. That was really just kind of a highlight for me.   00;22;13;15 - 00;22;35;08 I think the best part was people coming up to me afterwards and saying, you know, they resonate with my message or, you know, they really liked whatever point I had to make. And, you know, yeah, it's cool to be on stage and meet Evan. But really, for me, it kind of came full circle when people, you know, could kind of even tell me back what I said, did I say that?   00;22;35;10 - 00;22;57;26 But yeah, that was that was a really great experience and, you know, fun to kind of share how Vytalize is doing. And, you know, this big award has, has really opened a lot of doors for the company as well. One of the anecdotes really stuck out to me personally in your keynote with Evan was how someone on your team essentially automated himself out of his job doing bank reconcilations.   00;22;57;28 - 00;23;21;26 But he ended up moving to FP&A, which arguably more of a value add for the company. So as more manual task and accounting and finance are automated, what do you think the future of those functions will look like? Yeah, and I have this funny title. My title is global, which you know, often means it's a global company.   00;23;21;28 - 00;23;48;29 But for me, this global title is actually represents to the people on my accounting team and we are all over the world. So the individual who automated himself out of his job, Dether, sits in the Philippines. So it's kind of this added layer, Meggan, that, my goodness, an outsourced role in the Philippines, just automated himself out of a job.   00;23;49;01 - 00;24;21;13 But the people are working to offshore stuff, but like my offshore person is working to automate. And just a quick update on Dether: he has been so helpful with the budgets for us. We are going through our budgeting process right now, as so many companies are, and that budgeting process is really leading to a lot of great conversations with our department heads about what costs we're needing, what vendors we're going to be needing for next year, what strategic initiatives do we have to plan more costs for, where is more revenue to compensate for that?   00;24;21;15 - 00;24;45;29 And he has been so incredibly helpful in that role and I think it's very fulfilling for him so often times, you know, what is the future of the function looks like? It just looks like it's at a higher level and we are starting at the baseline is just moving up, right? So your entry-level position is just doing higher quality work.   00;24;46;01 - 00;25;10;07 Hopefully fewer tears in the audit room now. I think the tears will exist, but I do think people will have a more fulfilling job, start for themselves right out of college or right into the workforce. What skills do you think will become must haves and kind of this new normal? Yeah, I think the go-to skill for me is just a willingness to learn.   00;25;10;10 - 00;25;44;25 You know, I think I even told Evan on stage I don't know everything and I really don't, but at least I know where I can look it up. Or I might know who to ask or, you know, in me and in my team is this willingness to learn and the willingness to change. And I think kind of that positive outlook and that positive environment is something that will forever be a must have, especially as we have all these new these new automation ideas and everything that's new and exciting.   00;25;44;27 - 00;26;09;28 We really just have to embrace it. And getting a little more granular here. What are you looking for when hiring talent? Are there any kind of talent gaps that you are trying to fill? Yeah, and I think especially as a scaling company, I think in any organization you often wear many hats, but as I'm scaling, I'll just use my senior manager of accounting projects as my go to example.   00;26;09;28 - 00;26;36;25 But I'd worked with him before and when I hired him I was like, ‘I just I need help.' And the first thing he says, all the time, Rob Dulgarian, is how can I help? And it's this willingness to learn new skills and the willingness to you know, get in and get your hands dirty, figure something out and, you know, kind of right size, whatever it is that you're working on that.   00;26;36;28 - 00;27;08;13 And that's a skill that the skill that I'm looking for when I hire people, you know, people we have people in Jordan, we have people in the Philippines, and we have people in the US, and kind of across the board. Anytime we're hiring, that's really what we're looking for is, you know, I've never done that before and I don't know how I'm looking for people that say, you know, I've never done that before, but let me explore, you know, how it's just this really positive outlook and where we are.   00;27;08;13 - 00;27;39;27 We especially get that from our global team members. They're just ever so, ever helpful. How do you assuage some of the fears in your team and your leadership, whatever it might be, about being automated out of a job? How do we get people to kind of embrace automation and AI and not really fear it? So I admittedly was unsuccessful at this at my last position, and I have been unsuccessful at this before.   00;27;39;29 - 00;28;24;18 I think it takes the tone from the top and really having, you know, the board, the C-suite, your investors, having those individuals excited and ready to embrace change is where it starts from because not to throw a cliche out there, but it really will all trickle down and having them excited and on board. At my last job, I think the only one that was excited and on board and it was really hard to get change, to get people excited about doing something else because, you know, they often have fear of losing their position and that that fear is very normal and very understandable.   00;28;24;18 - 00;28;51;05 But I think that as long as the, you know, the top of the company is willing to be flexible and encourage that change, I think it'll be a lot more effective. The accounting profession, it's been the news recently due to a shortage of professionals entering the role. So as a leader in accounting, how do you think companies can combat that shortage and attract accounting talent to their teams?   00;28;51;10 - 00;29;17;13 I feel like I'm going to bring this answer back to your previous questions, right? So it feels like automating and, you know, kind of holistically globally, looking at the talent workforce that's there. I mean, I think that's how companies are going to be able to continue to succeed. I kind of saw at the tail end of my career at EY how it was harder to get new accountants in.   00;29;17;13 - 00;29;57;15 And then also combined with COVID, was very difficult to start training people without being without being on site and in the same place together to be able to train. So, you know, from my perspective, I think it'll flex and change over time. Maybe I should teach some more accounting classes and get people excited about being accounting majors. But, you know, I, I do very much think it'll be a combination of roles like global accounting roles throughout the world, combined with this idea of people really embracing and getting change and automation and up and running and tech stack too.   00;29;57;15 - 00;30;31;17 I think one of the other things I wanted to mention is that we've been using Numero and Numero is a tool that we've used through Connor Group. And what Numero does is extract key terms out of documents and summarize technical accounting. So we're using AI to write our technical accounting memos, future state, and we're using a lot of this AI to kind of take and develop things that we would have done manually.   00;30;31;17 - 00;30;56;04 And you don't even think about how manual it is to create a technical accounting memo. But, you know, if I can give this bot a topic and my three lease agreements that can write an ASC 42 memo for me and you know, how cool is that? Because basically what we're doing then is taking the people who used to prepare the work and making them reviewers instead.   00;30;56;06 - 00;31;16;22 And I do think there are some additional challenges of like, how do you review something you've never prepared? But, you know, I think it'll create higher value work earlier in the process for people when they're launching their accounting careers. Yeah, I think taking some of the tedium out of it is going to be huge. So much tedious.   00;31;16;24 - 00;31;38;29 So much teedious staff work. Yeah. And now we have technology. Yeah. I wish I were starting my career now. I think I might consider an accounting career. If we had the. No, I would be terrible at accounting. I'm not organized enough. But then again, I could talk you into it. But maybe someday. But not today. I do come from a family of accountants.   00;31;38;29 - 00;32;06;02 Unknown My family is in medicine. So some helpful lessons for me. Yeah. For a health care company. Yeah. You blended it. Yes. So it was both. Well, we're kind of like coming up on the end of the year, so I wanted to pick your brain kind of around your 2025 agenda. So as SVP of accounting, what are your top priorities going into 2025?   00;32;06;05 - 00;32;32;07 So we are building out all kinds of really great reporting. So we're using the NetSuite Budgeting and Planning tool to also do our financial reporting for us. So what we're doing this year is building our budgets and we're building them at the vendor level. So it'll be able or it'll give us the opportunity to really analyze our budget versus actual at a new level that we've never done before.   00;32;32;07 - 00;32;57;25 So we're pretty excited about that. And then also meeting more regularly with our department heads to be able to have them reflect on how the month went, but then also make any changes in the future, planning for their new hires and any vendor expenses they have. And really, you know, having a well thought out budget and meeting that budget in 2025 is really our biggest priority.   00;32;57;28 - 00;33;22;22 Well, that's huge because, I mean, we keep writing about it, but the role of finance and accounting is becoming so strategy driven, so much about partnering across the rest of the business instead of kind of, you know, reporting after the fact to everyone. It's like working with them and collaborating during the process. Yeah, yeah. And seeing what new contracts are in the pipeline.   00;33;22;22 - 00;34;00;09 How are we going to take those contracts and pull certain levers to be able to maximize them? Yeah, there's a lot to kind of account marrying together, accounting and finance. Are there any challenges that you are worried about or anticipating? Yeah, I think the making sure that as an accounting department we remain inserted into each of the other operating units of the business and that we're working closely with the finance team and kind of ears to the ground with what's going on and when and being able to influence and do that at a much earlier time period.   00;34;00;09 - 00;34;36;21 So I am I am anticipating that to be a new challenge for us. But yeah, we're excited to work on that. And actually, my same bank reconciliation manager who used to do that, this is his new job instead. So we'll hopefully report back on how it goes with his new role. I love it. As advanced technologies such as AI, machine learning, RPA, all that proliferate, do you have any plans to upskill or reskill your existing workforce in the next year and how are you anticipating going about it?   00;34;36;28 - 00;35;07;20 Yeah, so Megan, this answer just makes my heart sing. So we are using our offshore Philippines team to use AI. So our offshore team is going through all of the contracts for us and they're using an AI tool, actually the same AI tool Numero. They're using that tool to go through all of the key contracts that we have and extract the key terms of the contracts.   00;35;07;23 - 00;35;44;07 That is a very typical, you know, staff one accountant role, right? That's what I did as a staff one accountant, and that was my whole job. So now it's been done by a computer. So cool. And it's being reviewed by, by somebody who's offshore and that I mean, it just really makes my heart sing because we're taking this lower-level work and giving more interesting work to the people who are onshore because now they're looking at these contracts and doing things in a way that that they wouldn't have the opportunity to do.   00;35;44;07 - 00;36;05;06 It's often hard to review your own work, right? So now we're getting new skill. We're just going to upskill the people that we have. I think our business right now, we're mainly focused on the current contracts that we have and then expanding our patient population within those contracts. So we're not necessarily taking on new physician practices.   00;36;05;06 - 00;36;28;06 So I think our accounting department will stay steady, but that is the thing we always like to keep on top of our finance folks to see how are we growing the business and how should we grow our accounting department as well. From a broader technology perspective, do you have any goals going into the next year? Yeah, I think just the great financial reporting.   00;36;28;06 - 00;37;01;16 And then we also have Salesforce as a system, and I was super excited to see Evan announce that Salesforce integrations are going to be made a lot easier. So from a tech stack perspective, we are going to start getting the information from Salesforce into NetSuite. And we're yeah, we're pretty excited about that because there's a lot of work that we do with onboarding our customers and that customer onboarding happens in Salesforce, but then it should become part of the customer record that's in NetSuite.   00;37;01;16 - 00;37;30;16 And right now, that's a manual process for us. So having Salesforce integrated would be, would be a really nice to have. Does Vytalize House as a whole company have any overarching objectives going into 2025? Yeah, so very much pure and stable growth. We are really focused on keeping the current physicians that we have and, and as I mentioned, the patients that we're serving or the Medicare patients.   00;37;30;16 - 00;37;56;01 Right. So if you imagine the doctor physician that you go to is your primary, maybe that primary care physician has 2000 patients and 500 of them are Medicare patients. Right. So those 500 lives, that's what's included in our count, right? That 260,000 that I mentioned before. So what we're trying to do next is get access to the other patients.   00;37;56;01 - 00;38;19;19 Right. That would look like contracts with Blue Shield or contracts with Aetna and other payers to be able to influence care over those lives as well. So I'll call that organic growth because we already have those relationships with the PCPs in place. But what we're wanting are contracts and relationships with the other payers, so that that's 2025 for us.   00;38;19;19 - 00;38;39;13 It sounds so exciting. I know. I feel like this business was so hard for me to understand and like the 10th time someone explained it to me, I got it. So I'm sure you guys are getting it in more than more than ten Innovation items. But yeah, it is a really exciting business here. We're thrilled to be a part of it.   00;38;39;17 - 00;39;12;14 Wrapping up here, just you have such a fascinating story coming in, like coming in and working for this high growth company. Is there any final thoughts or takeaways to leave our listeners with? Yeah, and one thing I do on my personal life is that I keep a gratitude journal and it helps me have a really positive mindset and having a positive mindset leaves me open for learning and growth of my personal development.   00;39;12;16 - 00;39;39;26 So I think that's one thing that's just really helped me to stay on top of my game of staying positive and kind of a can-do attitude. You know, I'm certainly not that way all the time. And sometimes my team shakes and says, Just pull back together. But I do really think that, you know, kind of being grateful for where we're at, how well we've done shapes us to have some positivity going into our next chapter for finals.   00;39;40;00 - 00;39;59;02 I love it. What a good note to end on. So being grateful really keeps you open for learning more. Jess, thanks so much for joining us. We really appreciate it. Yeah, thanks for having me. And again, I really am grateful for the opportunity. All right. Back to my journal today. Thank you so much, Megan.   00;39;59;06 - 00;40;26;21 Yeah, thank you. That brings us to the end of another great episode. It's such a great opportunity to get the perspective directly from a high-growth company and from someone like Jess, who has been there and facilitated so much of it. I think it was especially rewarding to hear how she personally was starting to implement AI in the accounting department to increase efficiency as the company expands.   00;40;26;23 - 00;40;47;10 Huge thanks to Jess for taking time out of her busy schedule to chat with us. And as always, a big thanks to our wonderful editing team over at Oracle and to all of you for tuning in. If you want more episodes just like this one, make sure you subscribe to our channel and give us a rating and review until next time.   00;40;47;13 - 00;40;59;08 You just listen to the NetSuite Podcast. Be sure to tune in every week with more NetSuite developments, stories, and insights into the benefits of one integrated system to help you run your business.

Send us a textAs Mama Dragons, we often find ourselves in places where we have the opportunity to stand up and advocate for our queer children. Today In the Den, Jen sits down with fierce Mama Dragon Debbie Thomas to talk about her experiences of mothering two LGBTQ+ children, and how she learned to advocate for her child in a big way–all the way to the Supreme Court.Special Guest: Debbie ThomasDebbie Thomas is retired after a career working with the public providing assistance through the State of Wyoming and under the Centers of Medicare Services. She is a Mama Dragon living in Central Wyoming and, like many of us, is just struggling to survive in a conservative state.  She was raised in a high demand religion and has 3 grown sons.  Her oldest two sons are part of the LGBTQ+ community. Her oldest son faced discrimination and was refused services from a bakery in Colorado based on who he loved, which ultimately led to the famous Supreme Court case of Masterpiece Cakeshop v. Colorado Civil Rights Commission. Links from the Show: Information on the Masterpiece Cake case: https://www.supremecourt.gov/opinions/17pdf/16-111_j4el.pdf More on the Supreme Court case: https://www.oyez.org/cases/2017/16-111 Join Mama Dragons today: www.mamadragons.orgIn the Den is made possible by generous donors like you. Help us continue to deliver quality content by becoming a donor today at www.mamadragons.org.  Connect with Mama Dragons:WebsiteInstagramFacebookDonate to this podcast

With a potential shutdown on the horizon, the Centers for Medicaid and Medicare Services already has its hands full trying to decipher who no longer qualifies for Medicaid coverage now that we're on the other side of the COVID-19 pandemic. The process has already been hampered with a few issues, and a shutdown could make it worse. To find out how, Federal Drive Executive Producer Eric White spoke with Kelly Whitener, who is an Associate Professor of the Practice at the Georgetown University McCourt School of Public Policy's Center for Children and Families. Learn more about your ad choices. Visit podcastchoices.com/adchoicesSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

With a potential shutdown on the horizon, the Centers for Medicaid and Medicare Services already has its hands full trying to decipher who no longer qualifies for Medicaid coverage now that we're on the other side of the COVID-19 pandemic. The process has already been hampered with a few issues, and a shutdown could make it worse. To find out how, Federal Drive Executive Producer Eric White spoke with Kelly Whitener, who is an Associate Professor of the Practice at the Georgetown University McCourt School of Public Policy's Center for Children and Families. Learn more about your ad choices. Visit megaphone.fm/adchoices

Managed care. It's a substantial part of the gigantic Medicare program. The Centers for Medicaid and Medicare Services figures half of Medicare enrollees gets health care from the Medicare Advantage program. In the words of the Health and Human Services Office of Inspector General, the growth of managed care has transformed how the government pays for and covers health care. This for 100 million people. That's why the IG has made managed care a top priority. For more on its new strategic plan, Federal Drive Host Tom Temin spoke with the Senior Adviser for Managed Care in the OIG's Office of Audit Services, Carolyn Kapustij. Learn more about your ad choices. Visit podcastchoices.com/adchoicesSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Managed care. It's a substantial part of the gigantic Medicare program. The Centers for Medicaid and Medicare Services figures half of Medicare enrollees gets health care from the Medicare Advantage program. In the words of the Health and Human Services Office of Inspector General, the growth of managed care has transformed how the government pays for and covers health care. This for 100 million people. That's why the IG has made managed care a top priority. For more on its new strategic plan, Federal Drive Host Tom Temin spoke with the Senior Adviser for Managed Care in the OIG's Office of Audit Services, Carolyn Kapustij. Learn more about your ad choices. Visit megaphone.fm/adchoices

HOUR 1Tom discusses the forthcoming indictment against President TrumpMore details on the new charges against Trump imminent / (CNBC) The U.S. is seeing a record number of strikes / (CBS News) https://www.cbsnews.com/video/why-worker-strikes-are-on-the-rise/Who is striking / (Axios) https://www.axios.com/2023/06/27/us-workers-strike-jobs-economyExtreme heat swelters across the globe / (NYT) https://www.nytimes.com/live/2023/07/18/world/heat-wave-us-europe-weather?Jesse Watters gets a top spot on FOX News  but is he worthy?/ (NPR) https://www.npr.org/2023/07/17/1188005948/fox-news-jesse-watters-primetime-showDeaths of four women in Portland connected / (NPR) https://www.nbcnews.com/news/us-news/4-oregon-women-found-dead-near-portland-rcna94790A U.S. national, who is believed to be a soldier, crossed into North Korea from South Korea during a Joint Security Area tour and is now allegedly being detained / (NBC News)  https://www.nbcnews.com/now/video/u-s-soldier-crosses-into-north-korea-during-tour-of-demilitarized-zone-188706373547Americans are more flush with money now / (MB) https://www.morningbrew.com/daily/stories/2023/07/17/americans-are-flush-for-now?HOUR 2The Alaska Native Tribal Health Consortium and Southcentral Foundation say in a press release that they are working together to fix problems found by the federal Centers for Medicare and Medicare Services “collaboratively and swiftly.” / (ANS) https://www.alaskasnewssource.com/2023/07/17/alaska-native-medical-center-working-answers-federal-governance-questions/New federal data released last month by the U.S. Department of Agriculture Food and Nutrition Services shows an alarming rate of payment errors in Alaska's Supplemental Nutrition Assistance Program, commonly referred to as SNAP benefits, in fiscal year 2022 (ANS) https://www.alaskasnewssource.com/2023/07/18/alaskas-snap-payment-error-rates-spike-over-divisions-use-expired-certification/Joelle Hall, President of Alaska' AFL-CIO on why we've had more strikes in 2022/23 / http://www.akaflcio.org/Dalton in Mat-Su on VP Mike Pence's interview with Tucker CarlsonLegal experts and conservative political pundits erupted after former President Donald Trump claimed he received a letter informing him that he is a target of the Justice Department's investigation into the Jan. 6th riot / (FOX News) https://www.foxnews.com/politics/donald-trump-january-6-grand-jury-target-conservatives-legal-experts-erupt

In this eye-opening episode of Corruption, Crime and Compliance, Michael Volkov takes a deep dive into the world of healthcare compliance and fraud. He explores the history, the transformation, and the unique challenges of healthcare compliance. He also sheds light on the alarming rate of fraud in the healthcare industry and the efforts to combat it.You'll hear him discuss:Compliance in healthcare traces back to the 1990s. Its rise is largely due to aggressive federal enforcement programs and increasing regulation.Four significant trends in healthcare compliance include: Rising consumer demand, escalating prices, and increasing regulation during the era of HMO controversies.The DOJ's use of criminal tools and prosecutions to combat healthcare fraud and circumvent government regulations.The growing importance of the False Claims Act as an enforcement tool.The establishment of a robust regulatory enforcement regime through the Center for Medicare Services and the HHS-OIG.As the healthcare industry comes increasingly under federal government regulation and control, the risks of healthcare fraud are escalating. Despite the development of proactive compliance programs, the industry struggles to keep pace with the level of fraud, waste, and abuse.Beyond the traditional elements of compliance programs, the healthcare industry faces unique challenges. These include managing interactions with physicians, ensuring data privacy, avoiding the employment of ineligible persons, and navigating the complexities of billing, coding, and overpayments.The False Claims Act poses a significant risk for healthcare providers, with nearly 99% of all cases each year immediately settled. The Act has been applied beyond billing and reimbursement issues to include false representations incorporated into a product or a drug.The DOJ regularly conducts nationwide crackdowns on healthcare fraud, arresting numerous defendants involved in healthcare fraud and opioid abuse schemes. A growing area of concern is telemedicine fraud, which has seen a surge with the rise of remote work during the pandemic.KEY QUOTES:“Healthcare is becoming increasingly under federal government regulation and control. And as this occurs, the federal health care risks of fraud are going to be increasing significantly. Private insurance companies are also experiencing continuous growth of fraud and the healthcare industry is really developing proactive compliance programs, but they struggle to keep up with the level of fraud, waste and abuse that they sort of have to pursue.” - Michael Volkov“…one of the most significant risk areas is physician interactions.” - Michael Vokov“Nearly 99% of all False Claims Act cases each year where the government decides to intervene are immediately settled.” - Michael VolkovResourcesMichael Volkov on LinkedIn | TwitterThe Volkov Law Group

Hospitals bills can be overwhelming and often times, more expensive than we were expecting. Members of Congress are exploring how to lower the cost of health care through transparency and competition. Some federal lawmakers say there bipartisan areas of agreement in health care policy that would address the cost of care. During this recent discussion on Capitol Hill, lawmakers also discussed the US Centers for Medicare and Medicare Services' hospital price transparency rule and how they want this federal agency to hold more hospitals accountable for expensive bills. We breakdown this latest hearing and how it may impact your healthcare.

As technology advances, many things are made more manageable, especially in healthcare. Care strategies and delivery become more effective with easier access to health data that's been automatically recorded and reported to the care team. Remote Therapeutic Monitoring (RTM) became accepted by the Center for Medicare Services as of 2022. Thus, Physical Therapists can now bill for apps and "wearables" that monitor patient motion (HEPs) between PT sessions. James Heathers, the Chief Science Officer for Cipher Skin, joins the podcast to explain how RTMs can be utilized to benefit patients and providers during the episodes of care. Tune in to this episode for a more comprehensive discussion with James Heather!Love the show? Subscribe, rate, review, and share! https://ptoclub.com/

Nearly 700 live-in patients at Laguna Honda Hospital are in limbo after the Center for Medicaid and Medicare Services announced it would pull federal funding following multiple damning inspection reports. San Francisco Department of Public Health officials are scrambling to regain the certification needed for funding. Meanwhile, two former hospital physicians say they warned city officials about a potential crisis nearly 20 years ago.

In a bid to keep rural hospitals open, the Centers for Medicaid and Medicare Services proposes some can apply for a new status that allows them only to provide outpatient care. Insurers selling coverage on the Affordable Care Act exchanges denied 18 percent of in-network claims in 2020. And a federal judge finds drug distributors aren't liable for the opioid crisis in West Virginia See acast.com/privacy for privacy and opt-out information.

Partners in cancer care – who are advanced practice providers? In the first episode of ASCO Education's podcast series on Advanced Practice Providers (APPs), co-hosts Todd Pickard (MD Anderson Cancer Center) and Dr. Stephanie Williams (Northwestern University Feinberg School of Medicine), along with guest speaker, Wendy Vogel (Harborside/APSHO), discuss who advanced practice providers are, share an overview of what they do, and why they are important to oncology care teams. If you liked this episode, please subscribe. Learn more at https://education.asco.org, or email us at education@asco.org   TRANSCRIPT Todd Pickard: Hello everyone, and welcome to the ASCO Education Podcast, episode number one of the 'Advanced Practice Providers' series, 'APPs 101: What and Who Are Advanced Practice Providers?' I'd like to introduce my co-host for this series, Dr. Stephanie Williams. My name is Todd Pickard. I'm an advanced practice provider, I'm a PA, and I work at MD Anderson Cancer Center in Houston, Texas. I'm also the Executive Director of Advanced Practice and my clinical practice is in urology. Dr. Williams, how about you introduce yourself? Dr. Stephanie Williams: Thanks, Todd, and thanks for this opportunity to present this incredibly important topic. I am currently retired from clinical practice. I had been in practice for over 35 years both in an academic setting, a private practice, and more recently in a large institutional, multi-specialty institutional type of practice. My primary clinical care has been in stem cell transplants and cellular therapy. And we have used APPs, both PAs and NPs for a couple of decades in our particular area. Todd Pickard: Great, thanks for that. I'd also like to introduce you to our guest panelist today, Wendy Vogel from Harborside, who is a certified oncology nurse practitioner with over 20 years of clinical experience and expertise. We're excited to be chatting with Wendy today about the basics of advanced practice providers and who they are. This will be an introduction for the rest of the upcoming episodes of APP Podcasts. Wendy, why don't you tell us a little bit about yourself and your practice. Wendy Vogel: Thanks, Todd. It is a pleasure to be here. I appreciate you asking me to talk. I am an oncology nurse practitioner as you said. I do a high-risk cancer clinic and do that a couple of days a month. And I am also the executive director of APSHO, the Advanced Practitioner Society for Hematology and Oncology. Todd Pickard: Great! We're looking forward to a robust and informative discussion today between the three of us. So, I'd like to get started with some basics. Wendy, do you want to always start with a definition of advanced practice registered nurse? Wendy Vogel: Okay, great question! So, APRNs or advanced practice registered nurse include nurse practitioners. It can include clinical nurse specialists, nurse anesthetists, and nurse midwives. And generally, APRNs hold at least a master's degree in addition to some initial nursing education as a registered nurse. Some APRNs have doctorates like the DNP or Doctorate of Nursing Practice. But licensure for APRNs generally falls under the State Board of Nursing.   So, we're also required to have a board certification, usually as some sort of generalist as in family medicine, pediatrics, geriatrics, women or acute care. But in oncology, many APRNs also carry oncology certification. Todd Pickard: Excellent! Thanks for that. I'll go ahead and add to the conversation by defining physician assistant. So, physician assistants are individuals who are trained in the medical model and are licensed to practice medicine in team-based settings with physicians. Very much like advanced practice registered nurses, we come from a variety of backgrounds, and our education model is really focused on thinking about the patient the same way that our physician colleagues do. We're trained in really taking a very broad look at patient care, and our education as a generalist model. PAs are certified by the National Commission on Certification of Physician Assistants, which is one national certification that includes all of the content areas in which we will practice. Dr. Stephanie Williams: For those out there who don't know, what are the differences between a physician assistant and an APRN? Or are there differences in practical terms, in terms of how we practice our field? Wendy Vogel: That is a great question, Stephanie, thanks for asking that. We function very much the same. The main difference is just in our educational background, where nurse practitioners come from a nursing background and the nursing model of care, and I'll let Todd speak to where PAs come from, but basically, our functions are very much the same. Todd Pickard: I very much agree. If you are in a clinical setting, and for some reason, Wendy or myself failed to identify who we are, you wouldn't really detect a distinction between the care either of us provide, because we are there in that provider setting and we're really there to assess the conditions you have like appropriate history in physical examination, think through differential diagnosis or a workup, create a diagnosis and then a therapeutic plan and also to educate you as the patient or to make an appropriate referral. So, really, when APPs, PAs, and NPs work side by side, there's really not a lot of difference in what people detect in what we're doing and how we're doing things. But there are some educational differences, which are pretty minimal. So, for example, one small difference is that PAs include surgical assisting as part of our core fundamental training, and our APRN colleagues generally don't. So, in my institution, we do have nurse practitioners that go to the OR and do assisting, but in order to get there, they did a Registered Nursing First Assist Program, it's a certification. So, they learn those fundamentals of sterile technique and surgical technique. So, in essence, there's really not a whole lot of difference. Dr. Stephanie Williams: I think what I was struck with about the difference was the history and the fact that PAs came out of the Mobile Army Surgical Hospitals. To me, that was just fascinating. I think Duke was the first graduating class. Wendy Vogel: You know, the role of the APRN has really changed drastically. It began in the 1960s, because there were not enough primary care providers, particularly for children in the urban and rural areas of the US, and the first nurse practitioner program was in 1965, at the University of Colorado. So, gosh! Have we come a long way since then, both the PA role or the NP role. When was the first PA role, Todd, when was that? Todd Pickard: We were born at the same time in 1965, we just happened to be at Duke University and y'all were in Colorado. You know, I think that the most important thing about working with advanced practice providers is that you look to work with somebody who has the competencies, the skills, interpersonal communication, and the pertinent experiences because honestly, I know fantastic APRNs, I know fantastic PAs, and I know some of either profession that really just don't quite fit a particular role. And so, there is some kind of mythology around PAs and APRNs, and who should work where, like PAs should be more procedural and more in surgery, and nurse practitioners should be more in medicine in the hospital. And really, there's nothing in our training that defines that per se, I think it's just a natural progression of we're over 50 now, so our professions are middle-aged. And we're starting to really have our feet underneath us. And I think people who've worked with PAs or NPs really understand, it's about the individuals and what they bring to the table. It's not really about the initials behind our names, because honestly, that's not what makes me do good work. It's not that I have the PA or NP behind my name. It's my commitment and dedication to my patients and supporting the rest of my team. Wendy Vogel: I think Stephanie, that's why we use the term advanced practitioner, advanced practitioner provider because it doesn't single out either one of us because we are functioning in the same manner. It's easier to say than say, PAs and NPs, so we just say, APPs. Todd Pickard: Yeah. And it doesn't mean that we don't identify as individual professions, because we do. I mean, I'm a PA, but I am part of a larger group. And part of that larger group is identifying as advanced practice provider because, at my institution, there are over 1000 of us, and we are a community of providers, and that's the way that we sense how we function within the team and within the institution. And so, it's really about that kind of joint interprofessional work. And speaking of work, Wendy, tell us a little bit about what are typical things that advanced practice providers do? Wendy Vogel: It might be easier to say what we don't do. I've got a list. Do you want to hear my list? Todd Pickard: Yeah, lay it on us. Wendy Vogel: Okay, here you go. Staff and peer education, survivorship care, palliative care, hospice care, pain management, acute care clinics, case management, research, cancer patient navigator, genetic services, lung nodule clinics, quality improvement. We're writers, we're authors, we're speakers, we mentor, and we do all kinds of public education. We can have clinical roles with faculty and professional organizations. We do procedures like bone marrows, paracentesis and suturing, and all that kind of stuff. We do a lot with all the other things like diagnosing, all the things you said earlier, diagnosing, ordering lab tests, ordering chemotherapy, etc. Todd Pickard: I think what's amazing about advanced practice providers is the flexibility we have to fill in gaps on teams or in service lines, no matter what that is. You know, I like to say and I'm sure everybody thinks that they originated this, but I feel that advanced practice providers are the stem cells of the team because we differentiate into whatever is necessary. At my institution, we recently had a gap in how our peer-to-peers were handled. Many times, you order an MRI or a PET scan, and the payer will, the day of or the day before, say, ‘Oh, I need to talk to somebody.' How that gets to the clinical team and when the clinical team has time to do that, it's really hard to coordinate. So, we created a team of advanced practice providers who spend one day a week doing the regular clinical roles, but then the rest of the time, they are dedicated to facilitating these peer-to-peer conversations. They have over a 95% success rate. And the payers, the medical directors, have actually gotten to know them. And so, they'll say, ‘Hey, I want to talk to so and so because she's fantastic and knows our program, and it's really easy to have these conversations.' And so, patients are taken care of and these business needs are taken care of, and then our clinical teams can really focus on what they're there for, which is to see those patients in and out every day. So, that's the power of advanced practice, its flexibility, filling in gaps; we can bend and morph to whatever we need to do because one of the things that's in our DNA is part of PA and advanced practice RN, we're here to serve, we're problem solvers or doers, too. When we see something, we pick it up and take care of it. That's just in our nature. Stephanie, tell us a little bit about your experience working with an advanced practice provider, is what Wendy and I are saying ringing true, or what's your experience? Dr. Stephanie Williams: Oh, absolutely! As I look back on my career, I'm not certain that I could have accomplished much of what I did, without my team members and advanced practice providers, both PAs and NPs. We also use them in an inpatient setting. And I can't remember Wendy mentioned that to take care of our stem cell transplant patients, because of residency, our requirements were removed from our services, and they became the go-to's to taking care of the patients. It actually improved the continuity of care that the patients received because they would see the same person throughout their 4 to 6-week course in the hospital, they also helped run our graft versus host clinics. I hate that term physician extender because they're really part of our health care team. We are all healthcare professionals working together, as Todd beautifully mentioned, for a common goal to help that patient who's right there in front of us. And not only that, from a kind of selfish viewpoint, they help with a lot of the work, doing the notes, so that we could all split up the work and all get out on time and all have at least some work-life balance. And I think that's a very important part of any team is that we can each find our own work-life balance within the team. So, I feel that they're a very important part of the oncology healthcare team. And I would recommend that everyone who wants to take care of patients, incorporate them into their team. Wendy Vogel: Can I say something right here that you mentioned that I'm so glad you did, which was physician extender. That is a dirty, dirty word in the AP world now because we don't know what part we're extending, that is not what we do. And also, we don't want to be called mid-level providers because – you can't see but I'm pointing from my chest to my belly - I don't treat just the mid-level, nor do I treat in mid-level care. I give superior care. I just give different care. And I give care on a team. And the last one is a non-physician provider. That is also a no-no because I wouldn't describe a teacher as a non-fireman, nor would I describe you, Stephanie, as a non-nurse practitioner. So, I don't want to be a non-physician provider either. Todd Pickard: It is an interesting phenomenon that even after 50 years, so many different places, whether it's the Joint Commission, or the Centers for Medicaid and Medicare Services, whether it's a state legislator, an individual state, an individual institution like Memorial Sloan Kettering or an MD Anderson or a Moffitt, everybody comes up with these different terms. And it's so interesting to me. Physicians are either physicians, doctor, sometimes they're called providers. But as a PA, who's an advanced practice provider, those are the two things that resonate with me: either call me PA or call me advanced practice provider. All these other names seem to just be, it's an alphabet soup, and it really doesn't carry any meaning because some places just come up with these strange terms. And I agree, physician extenders has been the one that always has amused me the most because it reminds me of hamburger helper. Am I some noodles that you add to the main meal so that you can extend that meal out and serve more people? I think what Wendy and I are really trying to get at, I know this has been with a little bit tongue in cheek, but we are part of the team. We work with physicians in a collaborative team-based setting, just like we all work with social workers and schedulers and business people and pharmacists and physical therapists. I think the main message here is that oncology care and taking care of patients with cancer is a team effort because it is a ginormous lift. It's a ginormous responsibility and our patients deserve a full team that works collaboratively and works well and has them in our focus like a laser, and I know that's what APPs do. Dr. Stephanie Williams: I think that's well said, Todd. What I enjoyed in the clinic in particular, was sitting down and discussing patient issues and problems with my APPs. And we worked together to try to figure out how to resolve issues that would come up. But we also learned from each other, you're never too old to learn something from people. I just felt the interaction, the interpersonal interaction was also very satisfying as well. Wendy Vogel: I think that the job satisfaction that comes from being a team player and working together is so much higher and that we're going to experience so much less burnout when we're working together each to the fullest scope of our practice. Todd Pickard: So, Wendy, one of the things that people ask a lot about when they work with advanced practice providers is, ‘Well, gosh! How do I know that they have this training or this experience or this competency?' And then the question arises about certification. So, let's talk a little bit about certification and what that means and what it doesn't mean. So, tell me, are advanced practice providers certified? And are they required to get a variety of certifications throughout their career? Let's talk a little bit about that. Why don't you open up the dialog. Wendy Vogel: Okay, happy to! So, to be able to practice in the United States, I have to have a board certification. And it can vary from state to state, but generally, it has to be either a family nurse practitioner certification, acute care nurse practitioner, geriatrics, women's health, pediatrics, there are about five. So, you are generally certified as one of those. There are a few oncology certifications across the US, board certifications to be able to practice at the state level, but not all states recognize those. So, most of us are educated in a more generalist area, have that certification as a generalist, and then can go on to get an additional certification. So, many nurse practitioners in oncology will also get an advanced oncology nurse practitioner certification. So, that's a little bit different. It's not required to practice. But it does give people a sense that, ‘Hey, she really knows what she's doing in oncology.' Todd Pickard: The PA profession has one national certification, and it is a generalist certification. It's probably similar to USMLE, where you really are thinking about medicine in its entirety. So, whether that be cardiology, orthopedics, family medicine, internal medicine, geriatric, psychiatry, or ophthalmology. I mean it's everything – and oncology is included as well. And that certification really is the entree into getting licensure within the states. It's basically that last examination that you take before you can get that license just to make sure that you have the basic knowledge and fundamentals to practice. And so, I always respond to this kind of question about certification, I say, ‘Well, is it really the experience and the onboarding and the training that one gets on the job and the mentoring and the coaching that one gets from our physician colleagues and other advanced practice providers that brings them the most value? Or is it going through an examination, where basically you're responding to a certain amount of information, and you either pass it or you don't, and you can get a certification? I'm not saying there's not value in that, but I'm also making the argument that if you are working with your APPs well, and they have good mentors, and they have good resources, they're going to be excellent clinicians. And having an additional certification may or may not make some huge difference. Many times I see people use it as a differentiator for privileges or something. It's really an external kind of a pressure or a desire, it doesn't really have anything to do with patient care. I mean, Wendy what has your experience been around that need for additional certification? Wendy Vogel: I've seen it used in practices to merit bonuses, which isn't really fair when a PA does not have that opportunity to have a specialty certification per se. So, I've seen it used negatively. I'm a great believer that any additional education that you can get is beneficial. However, I will say just like you said, if you are getting your mentoring, you have good practice, you're doing continuing education, then it's essentially the same thing. To be able to have an oncology certification, I had to practice for a year and I had to take a test that really measured what I should know after one year. And that's what a certification was for that. Is it beneficial, do I want it? Yeah, I want it. Do I have to have it to practice? No. Todd Pickard: I think that is a great way to segue to having a brief conversation about how you bring APPs in? I mean, just at a very high level, should people expect for an APP to come in right out of school and just hit the ground running without any additional investment? And I could ask the same question about a resident or a fellow who completes an oncology training program. Do you just put those people to work? Maybe that's an older model, and now really mentorship and that additional facilitated work is, I think, critical. So, I'll start with Stephanie, tell us a little bit about what's your experience been with advanced practice providers, or even young physicians as they enter the workforce? What's the role of onboarding or mentoring program? Dr. Stephanie Williams: So, it's important. We had a set process for bringing on our new APPs and it pretty much followed the guidelines from the American Society of Cellular Transplantation in terms of the knowledge base that they would need to know. So, it was a checklist. And we would also have them do modules from ASCO's oncology modules, as well looking at primarily hematologic malignancies, so they could get a background there. And then we would slowly bring them on board. Usually, they would start taking care of autologous patients, a certain subset of patients, and then move on to the more complicated patients. We did the same clinic, whether they were clinic or inpatient APPs. So, it took us about three to four months to onboard our APPs. In terms of a fellow becoming an attending physician, I'd like to say that there's specific onboarding there. Unfortunately, sometimes they're just, ‘Okay, these are your clinic days, this is when you start.' I mean, you're right Todd, we really need to work more on onboarding people. So, that one, they like their jobs, they're not frustrated, and they want to stay and continue to work in this field. I see many times after two or three years, if they're not onboarded properly, they just get frustrated and want to move on to a different area. Wendy Vogel: We know that most of the advanced practitioners who come into oncology don't have an oncology background, PA or NP.  They just don't, and we don't get a lot of that in school. So, it takes months, it would probably, I dare say, take 12 months of full-time practice to feel comfortable in the role. But how many practices particularly in the area that I've practiced in you get this AP, and you throw them in there, and in four weeks, you're supposed to be seeing patients. How can you make those decisions when you haven't been properly mentored? So, absolutely important to have a long onboarding time till that APP feels comfortable. Todd Pickard: Yeah, I think that it is critically important that we set up all of our team members for success, whether they be physicians, or PAs, or nurse practitioners or nurses, or pharmacists, and I think that is the role of onboarding and mentoring, having people who will invest time and energy in what you're trying to accomplish. You know, Wendy is spot on. Advanced practice providers have specific types of training within their educational program. As a PA, my focus in oncology was to screen for and detect it. So, to understand when a patient presents with a mass or some symptoms that may make you think that, oh gosh, maybe they've got acute leukemia or something else and looking at those white counts and, and understanding. But that transition from identifying and screening and diagnosing cancers is very different than how do you care for specific types of tumors and specific disciplines, whether it be radiation oncology, surgical oncology, medical oncology, cancer prevention. There's a lot that folks need to be brought up to speed about the standards of what do we do in this practice and how do we care for these types of cancers? And that really is the role for the onboarding and mentoring. You know, you may be lucky, you might get an advanced practice provider who used to work at a big academic cancer center in the same field, whether it be breast medical oncology or GI, and yeah, that's a much easier task. That person probably really needs mentoring about the local culture, how we get things done, what are the resources, and which hospitals do we refer to. But for the most part, working with an advanced practice provider means that you've got a PA or an NP, who has a strong foundation in medical practice. They know how to care for patients, they know how to diagnose, they know how to do assessments, they know how to critically think, they know how to find resources, and they know how to educate. But they may not know how long does a robotic radical prostatectomy patient going to be in the hospital? And how long does it take to recover and what are some of the things you need to be considering in  their discharge and their postoperative period? That is very detailed information about the practice and the local resources. Every advanced practice provider is going to need to have that kind of details shared with them through mentorship, and a lot of it is just how do we team with each other? What are the roles and responsibilities? Who does what? How do we have backup behaviors to cover folks? So, a lot of this really is just deciding, ‘Okay, we've got a team. Who's doing what? How do they work together and how do we back each other up?' Because at the end of the day, it's all about the team supporting each other and that's what I love about advanced practice. Wendy Vogel: Very well said, yes. I had an AP student yesterday in clinic, who told me - I was asking about her education in oncology and what she got - and she said, ‘Well, so for lymphoma, we treat with R-CHOP. So, a student, of course, raised their hand and said, ‘What's R-CHOP? She's like, ‘Well, the letters don't really line up with what the names of the drugs are, so, just remember R-CHOP for the boards.' So there you go. That's kind of what a lot of our education was like specific to oncology. And again, I'm a little tongue in cheek there also. But Todd, are you going to tell everybody about the ASCO Onboarding tool that's now available? Todd Pickard: Absolutely! ASCO has done a really great job of trying to explore what advanced practice is, and how teams work together. All of us are part of the ASCO Advanced Practice Task Force. One of the things we did was really to look at what are some best practices around onboarding, orientation, scope of practice, and team-based cancer care, and we created a resource that is available on the ASCO website, and I think that it is a great place to start, particularly for practices, physicians, or other hospital systems that don't have a lot of experience with advanced practice. It's a  great reference, it talks about the difference between orientation and onboarding. It gives you examples of what those look like. It talks about what are the competencies and competency-based examinations. So, how you assess people as they're going through the onboarding period. It has tons of references, because ASCO has done a lot of great research in this field, around collaborative practice and how patients experience it, and how folks work on teams, and what do those outcomes look like. So, I highly recommend it. Wendy, thank you for bringing that up. It's almost like you knew to suggest that. Well, this has been a really, really good conversation. I'm wondering, what are some of those pearls of wisdom that we could all provide to the folks listening? So, Stephanie, what are some of your observations that, you know, maybe we haven't just thought about, in your experience working as a physician with advanced practice providers? Dr. Stephanie Williams: One, it's important to integrate them into the team, and, as Wendy mentioned, to mentor them – mentor anybody correctly, in order for them to feel that they're contributing the most that they can to the care of the patient. I think there are other issues that we'll get into later and in different podcasts that come up that make physicians hesitant to have nurse practitioners or physician assistants. Some of those are financial, and I think we'll discuss those at a later time. But really, that shouldn't keep you from employing these particular individuals for your team. It really is a very rewarding type of practice to have. You're not alone. You're collaborating with other providers. I think it's just one of the great things that we do in oncology. Todd Pickard: I wanted to share a moment as a PA, advanced practice provider, when I most felt grateful for the opportunity to work as an advanced practice provider. My clinical practice has been in urology for the past 24 years for the main part. I've had a few little other experiences, but mainly urology, and I'll never forget a patient who was a middle-aged lady who had been working with transitional cell bladder cancer. It was superficial. So, the treatment for that is BCG and repeat cystoscopies and surveillance. And I walked into the room and I was going to give her BCG installation, and she was so angry. I wanted to know what was going on. I thought, gosh, should I make her wait too long or something else? So, I asked her, I said, ‘How are you doing today? You seem to be not feeling well.' And she said, ‘Well, I'm just so tired of this. I don't understand why y'all don't just fix me. Why don't y'all just get this right? Why do I have to keep coming back?' And as I looked at the medical record, this patient had had superficial bladder cancer for years. And I thought, ‘Has nobody ever really kind of sat down and mapped this out for her?' So, I asked her to get off the examining table, and I pulled the little paper forward, so I had someplace to draw. And I drew a big square and I said, ‘This is a field, just think of any big field anywhere near you. And it's full of weeds.' And I drew some weeds on there. And I said, ‘You know we can pull them out and we can pluck them, and we can put some weed killer in that field,' I said,  ‘do you think that if you come back in three months and there will be any weeds on that field?' She said, ‘Of course, there will be. There are always weeds because they always come back. It's very hard to get rid of.' And I said, ‘Well, this field is your bladder. And the type of cancer you have are like these weeds, and we have to constantly look for them, remove them, and then put this treatment down, that's why you come.' And she started crying. And I thought, ‘Well, I've blown it.' Because this was in the first couple of years of working as a PA in urology. And I said, ‘I'm so sorry. I really apologize.' She said, ‘Don't you dare apologize to me.' I said, ‘Man, I've really blown it now.' She said, ‘Todd, I've had this disease now for this many years. This is the first time I've ever fully understood what's happening to me. I am so grateful to you.' I will never forget this patient. I will never forget this experience. And I'm extraordinarily proud. It's not because I'm the smartest person in the world. I just happened to investigate, take the time, and I drew it out. I explained it in the simplest of terms because I wanted her to understand. And then whenever she came back, she always wanted to see me. So, it was great. I really developed a really lovely relationship with this patient. It was very rewarding. Wendy, can you think of a story that you have about an advanced practice provider that makes you particularly happy or where some big lesson was learned? Wendy Vogel: Yeah. I love your analogy. That's a great analogy. I think that part of what I love to do is similar to you, Todd, in that I like to make things understandable because I consider myself an East Tennessee southern simple person, I want to understand things in the language that I understand. So, I like using a language that a patient understands. I think if I was to say about some of the proudest things, or what makes me so excited about oncology is what we've seen in our lifetime. So, Todd, you and I practice probably about the same number of years and we could say we remember when Zofran came out, and how that revolutionized chemotherapy nausea and vomiting – Stephanie's nodding here, too. We all know that. And then wow! When we found out that we could maybe cure CML, that we're having patients live normal lives in our lifetime, that we've seen non-small cell lung cancer patients living past a year that are metastatic – Oh my gosh! This is such an exciting field and we learn something every day. There's new drugs, there's new treatments, there's new hope, every single day, and that's what makes me proud to be a part of that. Todd Pickard: Yeah, I think that oncology and the work that we get to do as a team is so incredibly rewarding. It's challenging, and we have losses, but we also have wins, and those wins are amazing, and transformative, not only for us but for our patients. So, some final pearls of wisdom. I'll share and then Wendy, I'll turn it over to you. One thing that I really want to convey to folks is to know about the state that you work in and what are the practice acts for advanced practice providers. Because, unlike our physician colleagues who have a very standard scope of practice across the country, advanced practice can drastically change from state to state and place to place even from institution to institution. So, be aware of that, so that you can build your team-based practice around what are the constraints, what is the scope of practice, and you can comply with that. It just takes a little bit of pre-work at the beginning. It's not daunting. These things are written in English. We're all smart folks. We can understand them and we can build our teams in the right way. So, just keep that in the back of their mind. It is not an obstacle. It's the instruction manual of how to build your team. That's all it is if you just think about it simplistically like that. So, Wendy, what's one or two things that you would say you really want our listeners to understand about advanced practice? Wendy Vogel: I loved what you said, Todd, both of our PA Associations and our Nurse Practitioner Associations have that information online, so it's very easy to find. But I think I would say, don't be afraid to stand up for yourself as an advanced practitioner or as a physician who wants an advanced practitioner. Don't be afraid to stand up for yourself and your scope of practice, know what you can do, know what you can't do, know and demand the respect that you deserve. I would always say that just don't forget that ‘no' is the first step to a ‘yes,' and keep on trying. Todd Pickard: I think we can all appreciate that sentiment, whether we be a PA an NP or a physician. Many times, we're advocating for our patients within our systems or our practices or with our payers or insurance providers. And yeah, sometimes you start from a place of ‘no' and then you work until you get to that ‘yes', or at least a compromise, if you can get to a 'maybe,' that's a good place too. Stephanie, any particular last words of wisdom or wrap us up with our conclusion? Dr. Stephanie Williams: Thanks, Todd and Wendy, for sharing your insights today. It's always a pleasure chatting with you both. Stay tuned for upcoming episodes where we plan to dig deeper into the various types of APPs, how they are trained, what a day in the life looks like for an oncology APP, their scope of practice, and the importance of team-based care, especially in oncology. Thank you to the listeners as well. Until next time. Thank you for listening to the ASCO Education Podcast. To stay up to date with the latest episodes, please click subscribe. Let us know what you think by leaving a review. For more information, visit the comprehensive education center at education.asco.org.   The purpose of this podcast is to educate and inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product , service, organization, activity or therapy should not be construed as an ASCO endorsement.  

In this episode of the Move to Value Podcast, we have a conversation with Robert Mechanic, MBA, Executive Director of the https://www.institute4ac.org/ (Accountable Care Institute), who shares ways to understand a patient population. Transcript: What is the Institute for Accountable Care and what is its primary mission? So, Thomas, we are a fairly new organization. We're an independent not-for-profit. We were formed several years ago, and our primary mission is building on the available research and contributing to the available research on the impact of Accountable Care. Both to inform public policy and sort of future development of Accountable Care programs. And also, to support organizations that are committed to value-based care. So, I'd say, we combine, we're a little bit unique. We combine elements of a think-tank, a data analytics shop, and a consulting firm. We like solving complicated problems, preferably using empirics, data analysis. Half of our staff are programmers, data scientists, and statisticians. And we like to work on problems that have practical implications for organizations who are trying to improve care or for national policy. And I guess, the last thing I'd say, our special sauce is we have a data use agreement with the Center for Medicare and Medicare Services, where we have access to 100% of the Medicare programs claims data. And obviously that allows us to ask all kinds of interesting questions and learn all kinds of interesting things. How does your work document and promote the best practices for Accountable Care? So, I'd frame the question, Thomas, a little bit differently. As you know, organizations can put best practices in place, but you know, whether they're successful, it's all about execution. And when we get into Accountable Care, everybody's program, for example your care management program, is going to be different. So, what we can do, is we can help a particular organization, or a group of organizations, evaluate whether a particular program is achieving its performance goals. So, does your care management program improve quality? Does it reduce spending? And because we have all this data, we can do this sort of scientifically with a comparison group that we match to your patients, in your geography, and we can look at, you know, how their spending changes compared to the spending of the group that you enroll in your programs. Another area that we do too, in this kind of work, is we help organizations develop and implement best practices through learning collaboratives that we organize and we facilitate. So, two examples of that would be we work with a group of a dozen ACOs building home-based care programs, and we bring in outside experts, but a lot of the work is also peer-to-peer. ACOs helping each other. They're working on the same problems. And we're currently doing a collaborative working on addressing the social determinants of health and how do you build a strategy, and how do you build the right infrastructure to have an impact. How does the Institute for Accountable Care partner with Accountable Care Organizations? Yeah, I mean, I think there are a couple of other areas. One is, you know, because of the data, we can help people understand their own performance compared to peers. So, an ACO, or a group like an ACO, has all their own data, of all the utilization of their patients, but they don't really see everything else that's happening around them. So, what we can do, is we can, you know, look at other providers in their market, or we can look at other providers nationally, that are trying to do the same thing that they are, and we can say, gee, you know, are you doing better or worse than them? Can we identify why? Are there certain areas, you know, you are doing great in managing hospital care, but you're not so good in keeping people out of nursing homes and rehab hospitals. So, we can help organizations with that, we have a number of partnerships....

Last week the Supreme Court blocked the OSHA vaccine mandate for large businesses. While this is a huge ruling, how exactly did this overturn and how was it decided? During this pandemic we have seen decisions being made based on doctrine. Do administrative agencies have the authority to implement medical mandates based on their interpretation of science?  To help us unpack what happened and where we might be headed with this ruling is our guest, attorney Ryan Heath. He does an amazing job explaining how OSHA had over reached their authority and power as interpreted by the Supreme Court. Remember that currently  healthcare facilities that operate under CMS ( Center for Medicare Services) still need to comply with vaccine mandates and this is a completely separate path that will play out differently. Time will tell. Ryan Heath is a licensed Arizona attorney with a background in criminal defense. He is also president and CEO of The Gavel Project, a new nonprofit organization that provides education and support to the public regarding the recent Covid-19 mandates/issues. Its mission is to fight unethical government/employer mandates and  protect the freedom of Americans, especially children. LINKS: The Gavel Project:  https://www.thegavelproject.com Ryan Heath on Substack: https://thegavelproject.substack.com/archive Universities and The Covid-19 Money Trail: https://www.thegavelproject.com/articles/universities-the-covid-19-money-trail-ryan-heath Supreme Court Blocks Ruling: https://rollcall.com/2022/01/13/supreme-court-blocks-vaccine-or-mask-mandate-for-larger-employers/ Sponsor:  Thanks to our sponsor MR Insurance! Please reach out to Michael Relvas' team, where their goal is to assist physicians in obtaining the most comprehensive coverage available to fit their unique situation. Click here!  www.mr-disability-insurance.com/bsfreemd Our Advice! Everything in this podcast is for educational purposes only. It does not constitute the practice of medicine and we are not providing medical advice. No Physician-patient relationship is formed and anything discussed in this podcast does not represent the views of our employers.  The Fine Print! All opinions expressed by the hosts or  guests in this episode are solely their opinion and are not to be used as specific medical advice.  The hosts,  May and Tim Hindmarsh MD, BS Free MD LLC, or any affiliates thereof are not under any obligation to update or correct any information provided in this episode. The guest's statements and opinions are subject to change without notice. Thanks for joining us! You are the reason we are here.  If you have questions, reach out to us at doc@bsfreemd.com or find Tim and I on Facebook and IG. Please check out our every growing website as well at  bsfreemd.com (no www)  GET SOCIAL WITH US! Instagram:: https://www.instagram.com/bsfreemd/ Facebook: https://www.facebook.com/bsfree

In this week's episode, host Ari Kwiatkowski covers the impact of breaking Supreme Court news regarding the OSHA vaccine mandate. Ari, an avowed SCOTUS nerd, reviews the reasons that the justices struck down the OSHA mandate, while upholding that of the Centers for Medicaid & Medicare Services. With their assessment, the Supreme Court said that OSHA overstepped its authority, veering into the public health arena. Ari reminds employer-listeners that they are still able to enact their own vaccination mandates, and she also explores what's next for these issues. As Ari points out, the SCOTUS decision is far from the last word! Stay tuned for more updates. DISCLAIMER: This material is for informational purposes only and does not constitute legal advice or a legal opinion, and no attorney-client relationship has been established or implied. Thanks for listening.

Pro. 8:22-31 "The LORD possessed me at the beginning of His way, Before His works of old. (23) I have been established from everlasting, From the beginning, before there was ever an earth. (24) When [there were] no depths I was brought forth, When [there were] no fountains abounding with water. (25) Before the mountains were settled, Before the hills, I was brought forth; (26) While as yet He had not made the earth or the fields, Or the primal dust of the world. (27) When He prepared the heavens, I [was] there, When He drew a circle on the face of the deep, (28) When He established the clouds above, When He strengthened the fountains of the deep, (29) When He assigned to the sea its limit, So that the waters would not transgress His command, When He marked out the foundations of the earth, (30) Then I was beside Him [as] a master craftsman; And I was daily [His] delight, Rejoicing always before Him, (31) Rejoicing in His inhabited world, And my delight [was] with the sons of men.A Democrat in Illinois Decides the Unvaccinated are Second Class Citizens https://www.foxnews.com/us/illinois-democrat-unvaccinated-coronavirus-bill “An Illinois Democrat who claims the unvaccinated are "clogging up the health care system" has proposed a bill that would force them to pay all of their medical expenses out of pocket if they become hospitalized with the coronavirus.  The measure, set forth by State Rep. Jonathan Carroll, comes alongside news that the average coronavirus hospitalization cost is now $24,033, according to data from the government-run Centers for Medicaid and Medicare Services. "The vaccine is proven to be the one thing that is stopping the severity of COVID-19, and we are seeing more variants popping up," Carroll told WCIA." "The experts are telling us, ‘This is now becoming a disease of the unvaccinated.' The people that are choosing to get vaccinated are not the ones that are clogging up the health care system, it's the ones that aren't.” Carroll's proposed bill states that "a person who is eligible to receive a COVID-19 vaccine and chooses not to be vaccinated shall pay for health care expenses out-of-pocket if the person becomes hospitalized because of COVID-19 symptoms." Medical Marxism in Canada Continues to Get Crazier https://noqreport.com/2021/12/06/fully-vaccinated-canadian-family-imprisoned-as-medical-tyranny-hits-ludicrous-speed-over-omicron-scariant/Our Women are Safe… for Now https://www.politico.com/news/2021/12/06/ndaa-women-draft-dropped-523829 “Compromise defense policy legislation set to be filed Monday will not require women to register for a military draft, according to two people with knowledge of the negotiations, a stunning turnaround after the proposal gained bipartisan support in both the House and Senate this year.” “Leaders of the House and Senate Armed Services committees left the provision out of the final version of the National Defense Authorization Act, despite the fact that both chambers' bills would have expanded the Selective Service System beyond men.”

Episode 38: Rev. Jeanette Salguero Co-lead Pastor, The Gathering Place, Executive Vice President, National Latino Evangelical Coalition in Orlando, FL . On today's episode, Rev. Salguero talks about what a Confident Woman looks like, how to be assertive while dealing with gender stereotypes in the work place. She also talks about being a woman that is driven, but also who knows when to rest and how to find a rhythm while having different responsibilities. She encourages woman to learn to be, instead of do, set boundaries, and not let the opinions of others weigh down your life. The Rev. Jeanette Salguero—pastor at the multicultural The Gathering Place in Orlando, FL, and vice president of the National Latino Evangelical Coalition—is a powerful voice on issues that affect Latino communities in the United States. Focusing on immigration, education, and health, Salguero’s leadership offers an important voice for growing diversity and changing demographics in our country. In addition to her advocacy work, Salguero has provided consulting leadership for governmental agencies such as the Department of Health & Human Services, the Centers for Medicaid & Medicare Services, and the American Psychological Association around minority health disparities. Jeanette has worked extensively on consulting around issues of multi-cultural integration with para-church organizations and denominations such as the Wesleyan Church, the Reformed church in America, and the Church of the Nazarene.To connect with Rev. Jeanette Email: salguerojvs@gmail.comFacebook:https://www.facebook.com/PastorsSalgueroSubscribe to this Podcast and if you have any comments or questions email: beautymarkspodcast@gmail.com

Working past 65 doesn't necessarily allow you to delay enrollment into Medicare. Centers for Medicare Services has strict guidelines on what individuals can do and must do when working past 65. Failure to comply can result in lifetimes penalties and delays in coverage.In this webinar, Mr. Norce will cover your Medicare options and responsibilities when you or a spouse is considering working past 65. It is imperative that you learn exactly how Medicare views your situation when working past 65.Here's What You'll LearnDecisions made for you-Employer sizeTo Enroll or Not to enrollMaintaining creditable coverageHSAs and Medicare after 65Creating a Special Enrollment PeriodApplication process for Part BCOBRA and Medicare-Be carefulJohn is the founder of Medicare Portal with over 31 years in the insurance industry. During this time, he has assisted thousands of clients with their Medicare experience – from education, to enrollment, to lifetime policy support. John remains highly active in the insurance industry by serving on the boards of two local insurance associations. Additionally, John is a certified continuing education instructor, providing courses on Medicare to his fellow agents. insurance agent, medicare advantage plans, sign up for medicare turning 65 medicare mistakes medicare enrollment when to sign up for medicare medicare supplement medigapFollow Knowledgeable Aging:Facebook: https://www.facebook.com/Knowledgeable-Aging-102638398162823Twitter: https://twitter.com/KnowledgeAgingInstagram: https://www.instagram.com/knowledgeableaging/LinkedIn: https://www.linkedin.com/company/knowledgeable-aging/?viewAsMember=trueSpotify: https://open.spotify.com/show/05OHF9FkmhzCO5PDsyGfGqNewsletter: https://www.knowledgeableaging.com/newsletter/

When the Department of Health and Human Services transforms its back office and mission technologies two themes emerge. The first is more typical of an IT modernization effort — consolidation and reduction of systems and contracts. The second theme is less concrete with a focus on both internal and external customers. Rajiv Uppal, the chief information officer at the Centers for Medicaid and Medicare Services, said his IT modernization strategy leans toward the second theme. For Jose Arrieta, who became the CIO at HHS in May, the customer, too, is critical but in the short term IT modernization was more about cutting costs. Hear more on this week's Ask the CIO with Federal News Network Executive Editor Jason Miller.

Trump’s Center For Medicaid and Medicare Services has just proposed a new rule, the ‘Medicaid Fiscal Accountability Rule’ that would, passed, threaten funding to many Hospitals that provide services to Medicaid patients thereby reducing the poor’s access to healthcare. Call your congressperson at 202-224-3121 and urge them to speak out against this proposed rule..

Tennessee's block grant proposal to alter our Medicaid/TennCare program has been submitted to the Centers for Medicaid and Medicare Services and they have opened a Federal Comment Period through December 27. The proposal continues to be unacceptable for the health care of 1.4 million Tennesseans including 1/2 of our children. Over 1,650 comments opposing the original plan were made in October. The podcast urges listeners to submit a comment again, using the resources of the Tennessee Justice Center and encourage others to do so as well. Let's stop this harmful plan and get on with Medicaid Expansion so we can insure working families and reverse our opioid and rural health care crises. www.tnjustice.org/stoptheblockText: JUSTICE4TN TO 52886volunteer cpate@tnjustice.comSupport the show (https://feeds.buzzsprout.com/362855.rss)

Bob Blancato is the President of Matz, Blancato and Associates, the National Coordinator of the bipartisan 3000-member Elder Justice Coalition and of the Defeat Malnutrition Today coalition, and the Executive Director of the National Association of Nutrition and Aging Services Programs. Bob has more than 20 years of service in the Congressional and Executive branches, including the senior staff of the U.S. House Select Committee on Aging and an appointment by President Clinton to be Executive Director of the 1995 White House Conference on Aging. Most recently, Bob is the Immediate Past Chair of the Board of the American Society on Aging and on the National Board of AARP. He also serves on the Advisory Panel on Outreach and Education of the Centers for Medicaid and Medicare Services. He was recently selected by Next Avenue as a 2016 Influencer in Aging. Bob is a contributing blogger to Next Avenue, writing on aging issues. He holds a BA from Georgetown University and an MPA from American University. Bob has won numerous awards for advocacy, including being knighted by the Italian Republic in 2011. --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app

Bob Blancato is the President of Matz, Blancato and Associates, the National Coordinator of the bipartisan 3000-member Elder Justice Coalition and of the Defeat Malnutrition Today coalition, and the Executive Director of the National Association of Nutrition and Aging Services Programs. Bob has more than 20 years of service in the Congressional and Executive branches, including the senior staff of the U.S. House Select Committee on Aging and an appointment by President Clinton to be Executive Director of the 1995 White House Conference on Aging. Most recently, Bob is the Immediate Past Chair of the Board of the American Society on Aging and on the National Board of AARP. He also serves on the Advisory Panel on Outreach and Education of the Centers for Medicaid and Medicare Services. He was recently selected by Next Avenue as a 2016 Influencer in Aging. Bob is a contributing blogger to Next Avenue, writing on aging issues. He holds a BA from Georgetown University and an MPA from American University. Bob has won numerous awards for advocacy, including being knighted by the Italian Republic in 2011. --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app

Medicare Part A and B does NOT cover transportation. Some Medicare Advantage Plans will cover a certain number of rides per year to take you to the doctor, hospital or other medical facilities but that is an additional benefit. There is also a very limited scope of what you can use those services for. However, that may change in the future. Uber and Lyft are pitching an idea to Medicare and CMS (Center for Medicare Services) that they should be able to provide transportation as part of Medicare benefits or additional Medicare Advantage Plan benefits. Nothing has been set in stone but it’s a win-win situation for all parties. Uber and Lyft get government funding so they get paid and you are able to have transportation provided to you and it’s covered under your healthcare. The idea is that Medicare beneficiaries are provided a certain benefit amount ($1000 for example) a year and they can use that towards a ride from Uber or Lyft. As we said, nothing is set in stone but it is a very exciting idea that we hope gains some traction. If you have any questions regarding Medicare, please give our office a call at 1-855-368-4717 or visit one of our pages: https://www.seniorhealthcaredirect.com/ https://www.facebook.com/MedicareBob/ https://twitter.com/MedicareBob https://www.youtube.com/channel/UCy_avKva4VN0DBEgjP7I43w?view_as=subscriber

Welcome to this "ASCO in Action" podcast. This is ASCO's monthly podcast series where we explore policy and practice issues that can impact oncologists, the entire cancer care delivery team, and most importantly, of course, the patients we care for, people who have cancer. My name is Clifford Hudis, and I'm the CEO of ASCO as well as the host of this "ASCO in Action" podcast series. And for today's podcast, I am really delighted to have with me Dr. Manali Patel, chair elect of ASCO's health equity committee. Dr. Patel is here as our guest today to talk about some interesting issues for that committee and for all of us in ASCO. Our conversation today is going to focus on ASCO's recent position statement on Medicaid waivers. For those of you who aren't following this or have been tuned out for a little while, there are several states that have recently submitted waivers to the Centers for Medicare and Medicaid Services-- what we generally call CMS-- asking for the agency to approve changes to the Medicaid program in their state individually that would make eligibility, continued coverage for care, cost sharing, and other program benefits dependent on the beneficiary's work status. Some state waivers have also requested the authority to cut coverage for beneficiaries based on them not paying premiums, on eligibility re-determinations, and on other work requirements. Simply put, these are challenges because they could restrict some access to care, and they put ability to work into the mix for oncologists to consider. So here at ASCO, we're concerned. We're concerned especially that Medicaid work requirements may hinder patient access to essential cancer care services. They may reduce the already limited time that physicians have available to spend with their patients, because they will require, in some cases, doctors to do work related to assessing employability. And our position statement, therefore, recommends that federal and state policymakers take very specific steps to ensure that new Medicaid requirements do not harm patients with cancer. So to dig deeply into this, Dr. Patel has joined us. And I welcome you, Dr. Patel. And thank you for coming on this discussion today. Well, it's an honor and a privilege to be here today. Thank you. So I want to start with a little more background on the type of waivers that we're talking about here. And there's always a nomenclature that's confusing to the outside world. These are called 1115, 1-1-1-5 waivers. What is their intended purpose in the Medicaid program? Section 1115 of the Social Security Act gives the secretary of health and human services essentially the authority to waive particular provisions of the Medicaid program in hopes to further the Medicaid program's objective. 1115 waivers provide states an avenue to test new approaches in Medicaid that can potentially improve their programs but that may differ from what the federal program rules currently are. These 1115 waivers are subject to public comment. They must be budget neutral for the federal government. And while there is great diversity in how states have used these waivers over time, generally these waivers reflect the priorities that are identified by the states and the current administration. And just out of curiosity, who submits the terms or the concepts that are being considered in these waivers? Do they bubble up from the state? They come down from the federal government? Do they come from some other source? What's interesting about these waivers is that they do come from the states themselves. However, there is great encouragement by the administration in terms of what waivers they would encourage states to apply for and which waivers they would approve. The secretary of the health and human services is the one that makes the authority for approving the waivers themselves. But the states themselves are the ones that submit the waiver provisions in hopes that it will align with what the administration's goals and encouragements are. And just, again, for background, historically, before we get to the present, has it typically been the case that there's heterogeneity in these programs around the country, or is this something new in terms of these waivers encouraging local experimentation and variation? Historically, most waivers have been very small in scope until the 1990s. There are still a wide range and great diversity in how states have used these waivers over time. But there's been homogeneity in terms of the wide range of purposes for which they've been used. Most of these are to expand eligibility and to help to simplify Medicaid enrollment processes, all with the goal to help improve the Medicaid program. Historically, many states have applied for waivers to reform care delivery and present an opportunity for states to institute reforms that go beyond just routine medical care, but that focus on providing evidence-based interventions that have an opportunity to improve health outcomes for this particularly disparate patient population. For example, Oregon used its waiver to establish a partnership between managed care plans and community providers to provide behavioral health and oral health services for its Medicaid beneficiaries. In 2012, the enactment of the Affordable Care Act allowed a new category of low-income adults to become eligible for Medicaid. And therefore, several states in 2012 applied for demonstration waivers from the Obama administration to test different approaches to expand eligibility and recently included the introduction of premiums and co-payments. Most recently, in 2017, the Centers for Medicaid and Medicare Services encouraged new approval processes, including the potential for many states to obtain a 10-year extension. Previously these were five-year extensions. In January of 2018, states were encouraged by the administration to apply for waivers to make employment, volunteer work, or the performance of some other service a requirement for Medicaid eligibility, as you discussed earlier in the podcast, and to impose premiums and increases in cost sharing. Now, this is different. A number of states now have waivers that have been approved, as well as ones that have been pending, that include these provisions that have not previously been approved in the past. And also, that includes drug screening and testing, eligibility time limits for patients, and lock-out periods if beneficiaries cannot pay for their premiums or cost sharing. So there are a couple of concepts that your introduction raises. And I think it may even come as a surprise, at least to some of our listeners, that Medicaid beneficiaries have any premiums. And I want to make sure we're all clear. Are we talking about dollars coming out of the pocket directly of Medicaid recipients in the form of premiums? We are. And we're also talking about cost sharing in terms of patients being now required to provide cost sharing for services that they are receiving through Medicaid. And can you expand on each of those areas about what we mean? What kind of dollars would a Medicaid recipient be paying in premiums? And what kind of cost sharing dollars might they be at risk for in a typical program? The concern now is that Medicaid is state by state. So in any individual state, these premiums and cost sharing can vary greatly. In some cases, it's 50% of cost sharing of the services provided. In other cases, it's less than that. In other states, there are waivers for the premiums or cost sharing and have never been imposed. So to answer your question, it varies widely. And it can be as great as the premiums and cost sharing that we're seeing in Medicare and patient populations that are enrolled in Medicare. But it can also be as great as the premiums and cost sharing that we see in private health plans. It will be surprising, I think, to many people to hear this, because I think for most people there's at least a perception that Medicaid represents insurance and access of nearly last resort and is not for people of means. So the idea that there's a cash flow out of the beneficiaries into this program or into their care in this program, I suspect is not something that's widely known. Right. I would agree. It's not widely known. And it comes as a shock that we would expect patients that would be eligible for Medicaid, given the provisions of what Medicaid has been there to serve and was enacted to serve, that we're seeing patients experience the financial toxicity perhaps even more so than patients that may be in public health plans. Yeah, that's interesting. And it relates at least tangentially, I'm sure, to some of the recent data that's come out of ASCO addressing the rate of financial toxicity in the form of choices around spending and choices, unfortunately, to go into debt that we've heard from the general population. It's got to be presumably even tighter in this population, right? Right. And with costs rising at an unsustainable rate for cancer care delivery services, what I think is also a shock to the public is understanding that all of those costs eventually are coming back to the patients themselves to bear the burden of the cost that we're seeing. Every year, my own health care premiums and health insurance premiums are rising. Benefits are being cut in these private health plans. And we're seeing the same occurring for the limited services that are available in Medicaid programs. And because states have the authority to make these programs reflect what its state's priorities are, there's wide variation in the same way that there is wide variation between each individual public and private health plan outside of these states. Within the states, there's a significant degree of diversity in terms of what services states are providing through Medicaid. And I guess one last question before we move on is-- it sounds like you've answered this already, but I want to be clear-- the program really is taking shape right now, right? This is not the way it's been historically. Is that a fair roll-up of what you've said?   That is extremely fair. I think prior, as early as the 1990s, these waivers were really to expand eligibility. And they were meant to improve the program for its objectives to increase access, equitable access, to high-quality medical care. And now what we're seeing are provisions that are directly inhibiting this access. Yeah. This is amazing. So turning now to the current reality and our response to it, we have concerns, as we've already alluded to, specifically regarding the work requirements, in two directions, I would say. First, of course, we're concerned about the direct impact on patients. But I think in addition to that, we're worried about the impact on the system as a whole. And my question to you is what would you like our listeners to know about how these waivers might have an impact on people with cancer? Right, so I'm deeply concerned about the waivers failing to promote the intended objectives of the Medicaid program, as I've discussed previously in our conversation today. These waivers directly inhibit access to high-quality cancer care. These new provision to waivers can be extremely detrimental by restricting access to coverage for those not only with an ongoing cancer diagnosis, but restricting access to services that can help to prevent cancer. And patients that are enrolled in Medicaid are those patients that may be at highest risk for developing cancer. Disruptions in care, delays in treatment, dis-enrollment in coverage-- all of these gaps in care delivery have been shown to directly adversely impact cancer care outcomes. And to think that these disruptions are now being imparted and imposed into Medicaid eligibility requirements is quite concerning. Many patients have to stop working entirely. Many are dramatically reducing their work hours to comply with evidence-based treatments. Many have debilitating side effects that prevent them from working and are at risk for life-threatening infections and illnesses when their blood counts may be low. These worse outcomes also affect patients that are cancer survivors, who face long-term effects and increased health risks related to their cancer. So the imposition, also, of lifetime limits and lock-out periods are detrimental to ensuring that patients have equitable access to cancer care. And you know, one of the other areas that isn't obvious at first-- I had to look into this as well-- is the downstream impact on the clinicians caring for these patients. Can you explain to our listeners, why would a doctor even become aware of this? How would this take time from the doctor, these kinds of work requirements? Well, when I think about my own practice and how I spend-- and I think studies have also validated that we spend over 50%, or up to 50%, of our time in front of the computer with administrative paperwork burden. These restrictions, in terms of these new restrictions for Medicaid, will increase the requirement for additional paperwork. And that paperwork is going to have to directly come from the oncology practices and the providers that are seeing these patients. These restrictions and requirements that will be imposed on us are going to exacerbate our already limited time. Do you think that the assessment of ability to work would also fall to the oncologist? That's a concern, I think, that it might drive our docs to find themselves in a funny relationship, an uncomfortable one, with their own patients?   Oh, certainly. I do believe firmly that it will come to the providers providing care for these patient populations. We are already required to provide disability placards and make that assessment in our clinics. And it does make it-- it interferes with a therapeutic relationship with our patient population. And you alluded to this already, the fact that many patients diagnosed with cancer ironically have to stop working, both because of the time and effort it takes to get treated, but also because they're just not well. So I've heard, at least, the comment that these work requirements technically might not apply very much to cancer patients because of the-- again, the technical work requirements would be waived for patients who are sick. Do we have any sense, in real-world implementation, how this plays out? It's unclear if states will be able to make those exceptions. And if you have an exception for patients with cancer, I can list several other terminal illnesses as well as curable illnesses that may similarly have exemptions. And it's unclear if these exemptions will be adhered to. One concern, and I think one of our recommendations have been that if there will be requirements for work requirements, that at least they not occur for a minimum of a year after a patient has undergone active treatment and that caregivers of patients should be seen in a similar light. But to answer your question, it's really unclear if there will be provisions made and exemptions made for patients with cancer. I do certainly hope that to be the case. And that's certainly why advocating for this and advocating against these work requirements for our patient population is this especially important from all stakeholders. Well, that's a perfect segue for us to turn to ASCO's recommendations. That is what we're advocating for. And I wonder if we could start, if we think about the recent ASCO position statement on Medicaid waivers, what are the specific recommendations that you want us to know about in terms of what we want policymakers to do? What's our focus? Our main focus and the underlying mission of ASCO's recommendations are, again, to ensure that all patients have equitable access to high-quality cancer care. And the main focus of these recommendations are that waivers really should not create delays or barriers to receipt of timely and appropriate cancer care. Secondly, states should consider patients that are in active treatment exempt from any work requirements for the reasons that we've discussed and consider the primary caregivers in a similar light. There should not be lock-out periods or lifetime limits or elimination of retroactive eligibility for at least a year after a patient's last treatment. And additionally, these uncompensated burdens on providers really should not be posed on providers. ASCO also recommends that waiver applications and amendments be open to a full and transparent public comment period. So that last point, it seems like that's an obvious one for all of us wanting good government, and even in our daily lives. What is it that we're worried about with this transparency? Why is it so important that these 1115 waivers be handled in a transparent way? And I'm almost embarrassed to ask that question, because it's hard to see the argument against transparency. Why do we have to make that argument? Right. Well, it's key. Transparency is key. We have to make this argument all the time in many other facets of health care as well.   But it's key to ensuring that we all understand what the implications of these waivers have on our patients, on our practices, but also on our personal lives, and that we have a chance to comment publicly on the waiver. I think states may look at each other's waivers and begin to make provisions for their own waivers or apply for waivers based off of what another state has been approved to demonstrate or to test. And so I think it's extremely important that we all have a chance to publicly comment on these waivers and to understand what's in the waivers themselves prior to them being approved. So I guess in addition to our public statement on the waivers and the position statement and then hopefully having the opportunity to address these in public, are there any other next steps that we need to be taking formally as ASCO? Is there anything else that's on the agenda for us? ASCO is currently conducting and helping state affiliates develop letters and comments to their own state officials as they design and submit the waivers. I think it's extremely important that we continue to advocate. ASCO's advocacy team from the state level is keeping an eye on waivers and opportunities to partner with state affiliates on problematic waivers that may be coming from their own states. But beyond analysis and these comment letters, ASCO is also coordinating meetings with state affiliate leadership and with state policymakers to discuss concerns about ongoing and the current Medicaid waivers as well as ones that may come up. So it's just another plug for our regular listeners for engagement through, for example, our Hill Day and our ACT Network and so forth to keep the pressure on and the awareness up with our legislators, right? Right. Certainly. This is a topic that will continue to evolve, and so it's extremely important that we're keeping ourselves up to date and that ASCO is helping us to keep abreast of what new developments may be occurring on these waivers on a state-based level. Well, that's great. I don't think there is, but is there anything else that we've left out that listeners should know about the current state of the Medicaid play for us? Well, I don't think so. I think we covered most. But as we all know, Medicaid is currently evolving. It's always evolving, and currently more so in a direction that I would have never assumed we would be evolving into. The concerns that are always raised are legislative cuts, caps to the program, uncertainty about revenues, federal legislation that may have an effect on state actions on Medicaid. And now there are growing concerns about substance use disorder and opioid epidemic use that may make Medicaid play a larger role in these issues than we had previously considered. There's a lot to chew on there. I want to thank you, Dr. Patel, for joining me today for this "ASCO in Action" podcast. I hope our listeners find this clear and informative. I think it raises really important issues for all of us. I want to remind everybody that ASCO's position statement on Medicaid waivers is just one of our many that address policymakers in various ways. Our overall goal is to preserve and enhance access to high-quality care for all Americans. I'll remind you that our 2014 policy statement on Medicaid reform called for major changes to the Medicaid program to ensure access to high-quality cancer care for all low-income individuals. And then, our 2017 principles for patient-centered health care reform called for access to affordable and sufficient health care coverage regardless of income or health status, the point being, this is a long-term commitment by our leadership and our volunteers. And this is something that clearly is going to remain at the top of our agenda. If you're interested, and I hope you are, you can read the complete ASCO position statement online. It's available at ASCO.org/medicaid-waivers. And this is, again, made available to you on the web. And I hope that this is informative. With that, until next time. I want to thank everybody for listening to this "ASCO in Action" podcast.

Workers' compensation payers are under increasing pressure to consider and protect Medicare's interests when settling claims. In this edition of Inside Workers’ Comp, Deborah Robinson Stewart, National Manager of Medicare Services at Genex, breaks down the basics of MSAs and offers insight of when they should be established.

With special guest Glenn Krauss, RHIA, BBA, CCS, CCS-P, CPUR, CCDS, C-CDI, PCS, FCS, C-CDAM, Senior Consultant with Federal Advisory Partners in Washington, D.C., and co-host Sharme Brodie, RN, CCDS, AHIMA Approved ICD-10-CM/PCS Trainer, CDI education specialist with ACDIS and full-time instructor for the CDI Boot Camps.  To view "Writing an Effective Daily Progress Note," please click here.  To view "Documentation Guidelines for Medicare Services," please click here. To view "Senate committee advances bill that expands telehealth access for chronically ill Medicare patients" as featured on In the News, please click here.

This morning on the award-winning For the People, host John Voket replays a segment with the founder of The Pantry - a student food pantry at Norwalk Community College; checks in with Starling Physicians to learn how participation in Medicare Services nationwide oncology care model will benefit cancer patients across the nation; and we'll circle back to hear about some of the important points and key takeaways from last month's the Public and Affordable Housing Research Corp's conference in Hartford.

Welcome, Medicare Nation! Today’s episode is a Q & A in which I answer questions from two listeners. If you have a question for me about Medicare, then email me: support@themedicarenation.com.  Let’s jump right in! From Mike, in Pleasanton, CA: If my doctor drops out of my HMO network, can I change to a Medicare Advantage plan that the doctor currently takes? Here’s the thing, Mike: when you enroll in Medicare Advantage, you are in a “locked-in” period unless you have a “special election.” A special election can occur for a number of reasons: if you moved to a different county with new plans, or if CMS (Center for Medicare Services) decided to terminate a Medicare Advantage policy and you need to find a new one. Another situation for special election would be if you are still working, at age 65 or over, and are covered under your employer’s plan and aren’t on Part B. If you need to drop your employer’s coverage and enroll in Part B, then a special election would exist. Unfortunately, doctors can drop out of an HMO or PPO anytime, although they do have to give 60 days’ notice.  Mike, you will have to change doctors unless this occurs between October 15 and December 7, which is the open enrollment period, or unless you have a special election period. Your situation would not be considered for special election. It’s unfortunate, but it is very common and happens to many people each year. The doctors do this because of money, but keep in mind that if you follow a doctor to another plan, then the same thing can occur again. I hope this helps. Visit www.callsamm.com or www.medicare.gov for more information.   From Sharon, in Austin, TX: How much will I have to pay to be in the hospital for 7 days? Well, Sharon, the answer depends upon your plan. If you have original Medicare, Part A, then you have what I like to call  “accommodations insurance.” This means overnight stays are covered, with a deductible of $1288 for any stay of 1-60 days. All services and procedures in the hospital would then be covered for you. From days 61-90, you would pay $322/day for the same coverage. Of any stay of more than 90 consecutive days, you can draw on your lifetime reserve of 60 days at a cost of $644/day. Keep in mind, though, that those extra 60 days are a “lifetime piggy bank” of days, and you can’t get them back once you use them. The old adage, "You use them - You lose them," applies here. If you have a Medicare Advantage plan, then they are all different. An HMO will have a smaller network, and your co-pay will range from $0-$250/day. A PPO network is larger, therefore, your co-pay for an inpatient hospital stay will range from $0-$425/day. You would need to contact your Medicare Advantage Carrier to determine the exact amount of what your inpatient hospital co-pay will be. There are also Medicare Supplements (MediGap) plans, such as the F plan, G plan, and N plan. For these plans, you pay your monthly premium, but then have $0 out-of-pocket "medically necessary" inpatient hospital stays. Other Medicare Supplement (MediGap) Plans have a Part A deductible. Again, you need to contact your Medicare Plan customer service representative to determine your exact cost. Sorry, I can’t be more specific since I don’t know your plan, Sharon, but I hope this information is helpful for you. Thanks for the question!   Do you have questions or feedback? I’d love to hear it! I may answer one of your questions on the air! email me: support@themedicarenation.com Thank you for listening! If you enjoyed this podcast, please subscribe and leave a 5 star rating and review in iTunes! (Click here)     Find out more information about Medicare on Diane Daniel’s website! www.CallSamm.com

Kidney care is complex and often fragmented. A new pilot program by the Center for Medicaid and Medicare Services is in play. Its name is End-Stage Renal Disease Seamless Care Organization (ESCO). Doug Johnson, MD, Medical Director for Dialysis Clinic Incorporated, along with his team Dr. Toros Kapoian, Kathy Searson, Karen Nugent, Bob Motacki, Wayne Dwyer describe how they plan to improve care coordination and be more efficient with resources.

Welcome to today’s episode, which covers Medicare fraud.  The Medicare Strike Force and the Health Insurance Preventive Enforcement Action Team (HEAT) exist to stop fraud in its tracks.  Do you think fraud is a widespread problem?  Take a look at the statistics:  in 2011, $15-60 billion was lost to Medicare fraud, and the Center for Medicare Services (CMS) predicts that $65 billion yearly is issued in error.  Those are huge numbers!  My guest today will  help explain the ongoing efforts to stop the fraud! Anne Frederickson works for one of the volunteer programs trying to help in the fight against fraud.  Ann is a project manager in Ohio for the Senior Medicare Patrol at Pro-Seniors, which is a non-profit, long-term care and advocacy program in Cincinnati.  Ann has been in this position since 2002, and has also worked in geriatrics and hospital administration for 30+ years.  Ann hosts a weekly radio program, “Medicare Moment” on WMKV 89.3 FM. Explain what Senior Medicare Patrol (SMP) is all about. SMP volunteers help Medicare and Medicaid beneficiaries prevent, detect, and report potential fraud.  Across the state of Ohio, there are 3 paid staff members and 50 trained volunteers.  The SMP program exists in all 50 states and US territories. Tell us about the background of the SMP program. The program began in 1995 as part of Operation Restored Trust (ORT) in partnership with the Department of Health and Human Services and the Center for Medicare Services.  The push to institute the program was spearheaded by two senators from Iowa. What exactly do the volunteers in the SMP do? Volunteers do outreach and group presentations, manage exhibits at health fairs and events, and help with one-on-one counseling.  Their “bible” is a personal health care journal, which is a tool to record information from health care providers.  Beneficiaries are encouraged to use the journal to keep track of their information.  Nationwide, SMP volunteers have recovered $106 million for Medicare and Medicaid.  They also seek to educate people to detect fraud and abuse. What are some examples of the kinds of fraud SMP volunteers would find? Billing for services and/or supplies never provided Luring beneficiaries into providing Medicare numbers for free services, and then billing Medicare Equipment or insurance plan providers tricking senior center participants into giving up their personal information What advice can you give about fraudulent calls during this open enrollment time? NO ONE calls a senior and asks for any information unless they are the agent of record that has already been dealing with the beneficiary.  You can put your phone number on the DO NOT CALL list, which subjects callers to severe fines if they violate.  Many states also have programs with access to free information.  Call the SMP about anything that looks suspicious on your monthly summary notices.  DO NOT ever be reluctant to call when you have questions.  The Fraud Hotline is 866-357-6677. How do listeners get involved and learn more about SMP? The best way is to visit the website at www.smpresource.org.  There is a drop-down menu for each state.  Online training is available, along with group education training and one-on-one training. Are people allowed to donate to the SMP? YES!  It’s best to contact your local group.  All SMP’s are hosted by local non-profit community groups, a state agency, or local county agency. Would you like to tell us briefly about your radio show? The show is “Medicare Moment,” and airs on public radio.  It features different guests who talk about health care topics, Medicare, Social Security, and other subjects for seniors and caregivers.  The 15-minute show airs weekly on WMKV FM. Resources: www.stopmedicarefraud.gov www.smpresource.org Thank you for listening! If you enjoyed this podcast, please subscribe and leave a 5 star rating and review in iTunes! (Click here)       Find out more information about Medicare on Diane Daniel’s website!  www.CallSamm.com          

Welcome Medicare Nation!  Today’s guest from the American Lung Association is Dr. Norman Edelman.  Dr. Edelman has an years of experience that includes:   Norman H. Edelman, M.D. is Professor of Preventive Medicine, Internal Medicine, and Physiology and Biophysics at the State University of New York at Stony Brook. From 1996 - 2006, he served in a dual capacity as Vice President for Health Sciences and Dean of the School of Medicine at Stony Brook.  A graduate of Brooklyn College, Dr. Edelman received his M.D. degree from New York University, where he was elected to the Alpha Omega Alpha honor medical society. He received postgraduate training at Bellevue Hospital in New York City and went on to be a Research Associate at the National Institutes of Health, National Heart Institute, and then Visiting Fellow in Medicine and Advanced Research Fellow of the American Heart Association, Cardiorespiratory Laboratory, Columbia University, College of Physicians and Surgeons, Presbyterian Hospital. What is the American Lung Association? It was founded originally to combat tuberculosis, and was quite successful in helping get it under control.  Now it concerns it’s with all lung diseases, an advocate for clean air, and smoking cessation. What are the benefits of quitting smoking? Smoking is the leading preventable cause of death in the US, ahead of even obesity.  Stopping smoking can improve your healthy at any age.  Stopping the progression of the disease is important in order to prolong life. Does Medicare cover Lung Cancer Screening? Medicare recipients meeting certain criteria, Medicare will pay for a Lung Cancer Screening at no cost to you.  To be eligible, you must meet the following criteria:   If you smoked at least 30 pack years (a pack a day for 30 years) If you stopped less than 15 yrs ago 55-77 years old This screening can reduce death from lung cancer by 20%, by detecting nodules in the lungs.   COPD and Emphysema - what’s the difference? They are both cause primarily by smoking and air pollution.  COPD is what used to be called chronic bronchitis.  They now are combined under one diagnosis for ease. How does one get oxygen for home use? A physician would determine that you don’t have enough oxygen in your blood when at rest, and then prescribe supplemental oxygen.  Physician would fill out a form that certifies this meets the Medicare criteria, and once this is done, oxygen would be provided at no charge. What is Pulmonary Rehab and who needs it? Teaching people how to breathe properly.  Allows people to exercise and condition your heart and muscles so that they require less oxygen to function.  This eases shortness of breath.  If you have chronic lung disease, you should ask your Doctor if you would benefit from pulmonary rehab. What types of breathing exercises can improve lung function? The incentive spirometer can be a great exercise to increase oxygen capacity.  Any form of cardio exercises will allow the lungs to improve. Is there a correlation between early onset asthma and later stage COPD? Asthma sufferers frequently progress into COPD.  Asthma is a broad term and really can mean a lot of different things to a lot of different people.  They can be different in biology and in our ability to treat them. How important is an inhaler with these diseases?   They can be life saving.  They are very effective for treating asthma and flare ups.  The American Lung Association is concerned about the affordability of inhalers.   Who are the lung disease specialists?   Start with your primary care physician.  They can then refer you to a Pulmonologist, who specializes in treating lung diseases. What diseases does the American Lung Association help with? Pulmonary fibrosis Lung cancer Infectious lung diseases Allergic lung diseases They also have a helpline and the number is on the website.   The website is a treasure trove of information - www.lung.org   Freedom from Smoking - Smoking Cessation program.  Best treatment  combines an accountability program, along with a pharmaceutical.   Got questions about Medicare Services for Lung Disease?  Send them to support@medicarenation.com.  We will address them in future episodes.   Thank you for listening! If you enjoyed this podcast, please subscribe and leave a 5 star rating and review in iTunes! (Click here)       Find out more information about Medicare on Diane Daniel’s website!  www.CallSamm.com  

Dr. Joseph Newhouse is a Professor of Health Policy and Management at Harvard Medical School and the Harvard School of Public Health and a Professor at Harvard's Kennedy School of Government. Stephen Morrissey, the interviewer, is the Managing Editor of the Journal. J.P. Newhouse and A.M. Garber. Geographic Variation in Medicare Services. N Engl J Med 2013;368:1465-8.