WEBVTT 1 00:00:02.000 --> 00:00:04.719 - The strategic agenda facing hospital and health system 2 00:00:04.719 --> 00:00:06.819 - leaders right now is not a short list. 3 00:00:07.200 --> 00:00:09.839 - Growth in a consolidating market, sustainable margins in 4 00:00:09.839 --> 00:00:12.080 - a reimbursement environment that rarely moves in your 5 00:00:12.080 --> 00:00:12.464 - favor, 6 00:00:12.945 --> 00:00:15.445 - a tech investment cycle that demands both urgency 7 00:00:15.585 --> 00:00:16.404 - and discipline, 8 00:00:16.945 --> 00:00:19.344 - and a workforce story that is still being 9 00:00:19.344 --> 00:00:19.844 - written. 10 00:00:20.464 --> 00:00:23.904 - Eker's fourteenth annual CEO CFO roundtable brings together 11 00:00:23.904 --> 00:00:27.265 - more than 1,500 executive level attendees and nearly 12 00:00:27.265 --> 00:00:30.010 - 400 speakers across four days of sessions that 13 00:00:30.010 --> 00:00:32.350 - are designed to help c suite leaders benchmark, 14 00:00:32.570 --> 00:00:34.510 - pressure test, and sharpen their priorities. 15 00:00:35.049 --> 00:00:37.049 - Not in the abstract, but against the real 16 00:00:37.049 --> 00:00:39.310 - decisions they'll face heading into the next year. 17 00:00:39.530 --> 00:00:40.969 - It's the kind of event you leave with 18 00:00:40.969 --> 00:00:42.810 - a clear sense of where you stand and 19 00:00:42.810 --> 00:00:43.789 - what comes next. 20 00:00:44.295 --> 00:00:46.454 - So join us November second through the fifth 21 00:00:46.454 --> 00:00:48.234 - at the Hyatt Regency in Chicago, 22 00:00:48.534 --> 00:00:50.314 - and come ready to do the hard thinking. 23 00:00:50.695 --> 00:00:54.534 - Register on our events page at beckershospitalreview.com 24 00:00:54.534 --> 00:00:56.295 - by clicking on the events tab in the 25 00:00:56.295 --> 00:00:57.114 - upper right. 26 00:00:58.079 --> 00:01:01.039 - This is Scott Becker with the Becker's Healthcare 27 00:01:01.039 --> 00:01:01.539 - podcast. 28 00:01:02.159 --> 00:01:04.400 - We're joined today by Laura Dirda. Laura is 29 00:01:04.400 --> 00:01:06.500 - the editor in chief at Becker's Healthcare. 30 00:01:06.799 --> 00:01:08.319 - She joins us regularly to talk to us 31 00:01:08.319 --> 00:01:10.239 - about issues that she's watching in health care 32 00:01:10.239 --> 00:01:11.780 - and and what's top of mind. 33 00:01:12.155 --> 00:01:13.754 - Laura, let me turn it to you and 34 00:01:13.754 --> 00:01:14.954 - ask you what are a couple of the 35 00:01:14.954 --> 00:01:17.114 - issues that you're watching. And at some point, 36 00:01:17.114 --> 00:01:19.515 - for people that don't listen regularly, you might 37 00:01:19.515 --> 00:01:21.435 - not know this, but Laura is a huge 38 00:01:21.435 --> 00:01:23.754 - Chicago White Sox fan. And the Chicago White 39 00:01:23.754 --> 00:01:25.674 - Sox have had the biggest turnaround in Major 40 00:01:25.674 --> 00:01:27.739 - League Baseball. They three one hundred lost seasons 41 00:01:27.739 --> 00:01:29.579 - in a row. This year, they're winning the 42 00:01:29.579 --> 00:01:31.420 - division. So at the very end of the 43 00:01:31.420 --> 00:01:34.140 - call, I'll ask Laura also for assessment about 44 00:01:34.140 --> 00:01:35.819 - the White Sox and where they're going this 45 00:01:35.819 --> 00:01:37.579 - year. Laura, let me teed up and start 46 00:01:37.579 --> 00:01:40.219 - with health care. What are you watching closely 47 00:01:40.219 --> 00:01:40.719 - currently? 48 00:01:41.564 --> 00:01:43.405 - Absolutely. Well, thank you so much, Scott. And, 49 00:01:43.405 --> 00:01:45.644 - yes, there are many stories we're watching very 50 00:01:45.644 --> 00:01:47.805 - closely both on the health care as well 51 00:01:47.805 --> 00:01:49.805 - as White Sox side. But, you know, one 52 00:01:49.805 --> 00:01:52.284 - of the things that, we have been reporting 53 00:01:52.284 --> 00:01:54.364 - on and will continue to do is some 54 00:01:54.364 --> 00:01:56.545 - updates on CMS payment schedules. 55 00:01:57.219 --> 00:01:59.819 - In the last couple days, CMS has finalized 56 00:01:59.819 --> 00:02:02.640 - its fiscal twenty twenty seven inpatient payment rule, 57 00:02:02.700 --> 00:02:04.379 - and there's a lot for hospitals and health 58 00:02:04.379 --> 00:02:06.299 - systems to unpack. I think first, when you 59 00:02:06.299 --> 00:02:07.979 - look at the money, hospitals are getting a 60 00:02:07.979 --> 00:02:08.939 - 2.3% 61 00:02:08.939 --> 00:02:11.254 - pay increase, which is just under what CMS 62 00:02:11.314 --> 00:02:13.974 - proposed back in April. And the total inpatient 63 00:02:14.034 --> 00:02:16.694 - payment rises is about 2,100,000,000 64 00:02:16.835 --> 00:02:19.074 - along with new technology add on payments jumping 65 00:02:19.074 --> 00:02:21.474 - to around $779,000,000. 66 00:02:21.474 --> 00:02:23.235 - So not quite as much as hospitals were 67 00:02:23.235 --> 00:02:25.780 - expecting to look at the increase, but, also, 68 00:02:25.780 --> 00:02:28.099 - you know, a lot of other factors are 69 00:02:28.099 --> 00:02:30.340 - playing into how hospitals and health systems are 70 00:02:30.340 --> 00:02:32.979 - thinking about pay for next year. And one 71 00:02:32.979 --> 00:02:35.300 - of those things in in perhaps the bigger 72 00:02:35.300 --> 00:02:37.139 - story coming out of new payment rules is 73 00:02:37.139 --> 00:02:38.680 - the mandatory bundled payments. 74 00:02:39.139 --> 00:02:42.465 - CMS finalized its CJRx, which is the first 75 00:02:42.465 --> 00:02:43.525 - mandatory nationwide 76 00:02:43.985 --> 00:02:46.865 - episode based payment model covering hip, knee, and 77 00:02:46.865 --> 00:02:47.685 - ankle replacements. 78 00:02:48.064 --> 00:02:50.544 - And now we'll start on 01/01/2028. 79 00:02:50.544 --> 00:02:52.224 - That is pushing it back a quarter from 80 00:02:52.224 --> 00:02:53.764 - its original start date. 81 00:02:54.090 --> 00:02:55.389 - Most of the inpatient 82 00:02:55.689 --> 00:02:58.969 - payment system hospitals will be on the hook 83 00:02:58.969 --> 00:03:01.469 - for spending across the surgery, hospitalization, 84 00:03:01.849 --> 00:03:03.870 - the first ninety days of recovery 85 00:03:04.250 --> 00:03:06.409 - within those bundles, and that's something that at 86 00:03:06.409 --> 00:03:06.909 - hospitals, 87 00:03:07.335 --> 00:03:08.694 - some have been doing for a while as 88 00:03:08.694 --> 00:03:11.514 - they participate in these programs, but most haven't 89 00:03:11.574 --> 00:03:12.314 - really consistently 90 00:03:12.615 --> 00:03:14.615 - seen a huge, huge value from doing that 91 00:03:14.615 --> 00:03:16.854 - or or been doing that for all patients. 92 00:03:16.854 --> 00:03:17.254 - So, 93 00:03:17.655 --> 00:03:19.415 - it'll be a big change for hospitals we're 94 00:03:19.415 --> 00:03:22.849 - looking at, especially, orthopedic procedures that are more 95 00:03:22.849 --> 00:03:24.550 - high revenue, high dollar procedures. 96 00:03:25.010 --> 00:03:27.810 - The has already pushing back on this saying 97 00:03:27.810 --> 00:03:30.370 - the low volume threshold doesn't really give hospitals 98 00:03:30.370 --> 00:03:32.469 - enough cases to actually manage outcomes 99 00:03:33.409 --> 00:03:35.590 - way that they might need to. So, 100 00:03:36.474 --> 00:03:39.194 - there's something that is really important for hospitals 101 00:03:39.194 --> 00:03:40.875 - across the board to be thinking about and 102 00:03:40.875 --> 00:03:42.574 - looking at. And then 103 00:03:42.875 --> 00:03:45.194 - another element that is thrown in there too 104 00:03:45.194 --> 00:03:45.694 - is, 105 00:03:46.395 --> 00:03:49.435 - special payments for rural and small hospitals will 106 00:03:49.435 --> 00:03:51.915 - expire 12/31/2026, 107 00:03:51.915 --> 00:03:53.719 - the last congress acts. And so, 108 00:03:54.259 --> 00:03:56.739 - for these small hospitals and rural hospitals that 109 00:03:56.739 --> 00:03:59.459 - have been depending on, some of these funding 110 00:03:59.459 --> 00:03:59.959 - sources, 111 00:04:00.259 --> 00:04:03.699 - you know, they're really, really advocating strongly for 112 00:04:03.699 --> 00:04:04.680 - those to continue 113 00:04:05.014 --> 00:04:08.395 - as many are facing additional financial challenges and 114 00:04:08.614 --> 00:04:10.875 - constraints as they're trying to serve their communities. 115 00:04:10.935 --> 00:04:12.614 - And even the the large, 116 00:04:13.974 --> 00:04:17.095 - regional and and academic centers are hoping that 117 00:04:17.095 --> 00:04:19.915 - these continue as, you know, if hospitals close 118 00:04:20.330 --> 00:04:20.830 - those, 119 00:04:21.290 --> 00:04:23.230 - hospitals and systems in in the, 120 00:04:23.689 --> 00:04:26.650 - regional larger hubs will have to figure out 121 00:04:26.650 --> 00:04:29.050 - how they're gonna accommodate to provide care for 122 00:04:29.050 --> 00:04:29.790 - those patients, 123 00:04:30.170 --> 00:04:33.194 - within the rural communities and small hospitals. So 124 00:04:33.435 --> 00:04:35.514 - those institutions play a really important role in 125 00:04:35.514 --> 00:04:37.995 - the broader health care ecosystem that it'll be 126 00:04:37.995 --> 00:04:40.154 - important for them to continue to stay funded 127 00:04:40.154 --> 00:04:41.774 - in a meaningful way and, 128 00:04:42.555 --> 00:04:45.455 - looking at how they can, continue their operations 129 00:04:45.595 --> 00:04:47.375 - and provide services for their communities. 130 00:04:47.860 --> 00:04:49.620 - And then finally, when we're looking at quality 131 00:04:49.620 --> 00:04:52.580 - measures, CMS said it will hold Medicare Advantage 132 00:04:52.580 --> 00:04:55.699 - data into the mortality and readmission measures and 133 00:04:55.699 --> 00:04:58.420 - adding some new substance readmission measures that will 134 00:04:58.420 --> 00:04:59.240 - start affecting, 135 00:04:59.939 --> 00:05:02.324 - payment in the 2030 fiscal year. 136 00:05:02.845 --> 00:05:04.345 - And and so hospitals and systems, 137 00:05:04.725 --> 00:05:05.384 - as they're 138 00:05:05.925 --> 00:05:08.085 - making sure they understand what those quality metrics 139 00:05:08.085 --> 00:05:10.324 - are, we'll have to deliver on them and 140 00:05:10.324 --> 00:05:12.485 - and just be very, very sharp with especially 141 00:05:12.485 --> 00:05:14.884 - the new sepsis readmissions measures so that their 142 00:05:14.884 --> 00:05:16.025 - payment isn't impacted, 143 00:05:16.564 --> 00:05:18.025 - in in a few years. 144 00:05:19.419 --> 00:05:21.019 - Thank you very, very much. And what are 145 00:05:21.019 --> 00:05:23.979 - hospitals saying about the increase, the 2.3% 146 00:05:23.979 --> 00:05:24.479 - increase, 147 00:05:25.180 --> 00:05:27.599 - happy, unhappy? What does that look like? 148 00:05:28.139 --> 00:05:30.000 - Yeah. Yeah. Yeah. I mean, I I think, 149 00:05:30.220 --> 00:05:32.555 - you know, by and large, hospitals and health 150 00:05:32.555 --> 00:05:34.175 - systems for sure want, 151 00:05:34.795 --> 00:05:37.435 - you know, are in kind of a a 152 00:05:37.435 --> 00:05:39.935 - financially strapped situation in many ways. So, 153 00:05:40.395 --> 00:05:42.314 - you know, I think they wish that the 154 00:05:42.314 --> 00:05:44.555 - increase was more and think that the value 155 00:05:44.555 --> 00:05:45.455 - that they provide, 156 00:05:45.835 --> 00:05:46.495 - should be 157 00:05:46.990 --> 00:05:48.910 - rewarded as such. I think many of the 158 00:05:48.910 --> 00:05:50.129 - payments have been 159 00:05:50.509 --> 00:05:53.149 - flat or or, you know, not really keeping 160 00:05:53.149 --> 00:05:55.669 - up with what inflation has been, what it 161 00:05:55.790 --> 00:05:58.350 - it's taking to spend on the workforce and 162 00:05:58.350 --> 00:06:01.555 - supplies and everything else, the technology that is 163 00:06:01.555 --> 00:06:02.774 - required to provide, 164 00:06:03.395 --> 00:06:05.735 - high quality health care today. And so, 165 00:06:06.194 --> 00:06:07.714 - putting them into a bit more of a 166 00:06:07.714 --> 00:06:09.314 - a pinch than they would like to see 167 00:06:09.314 --> 00:06:12.035 - with these Medicare payments. And, of course, in 168 00:06:12.035 --> 00:06:15.014 - many ways, the, commercial insurers are 169 00:06:16.189 --> 00:06:18.669 - basing their payments off of what Medicare is 170 00:06:18.669 --> 00:06:21.470 - doing. And so more often than not, we 171 00:06:21.470 --> 00:06:24.829 - see people really wanting and advocating for those 172 00:06:24.829 --> 00:06:25.649 - deeper increases 173 00:06:26.029 --> 00:06:28.664 - in more recognition of what they're doing in 174 00:06:28.664 --> 00:06:30.745 - order to provide care for their communities and 175 00:06:30.745 --> 00:06:31.644 - assuming responsibility 176 00:06:32.104 --> 00:06:33.805 - for the patients at large. 177 00:06:35.305 --> 00:06:38.024 - Thank you. No. Fasting to watch. I know 178 00:06:38.024 --> 00:06:39.625 - we're still in a spot where 60% of 179 00:06:39.625 --> 00:06:41.625 - hospitals are in the black, 40% are in 180 00:06:41.625 --> 00:06:42.204 - the red. 181 00:06:42.550 --> 00:06:44.810 - So still plenty around there approximately. 182 00:06:45.350 --> 00:06:47.350 - So so plenty of challenges being faced by 183 00:06:47.350 --> 00:06:48.650 - health systems and reimbursement. 184 00:06:50.069 --> 00:06:51.290 - Anything else you're watching, 185 00:06:51.670 --> 00:06:53.050 - that we didn't cover yet? 186 00:06:53.509 --> 00:06:56.150 - Yeah. Yeah. Well, along these same lines, I 187 00:06:56.150 --> 00:06:58.595 - think the other big report that came out 188 00:06:58.595 --> 00:07:00.775 - on August 3 was looking at, 189 00:07:01.154 --> 00:07:02.855 - ACA marketplace insurers. 190 00:07:03.555 --> 00:07:06.455 - Those insurers are proposing a a median rate 191 00:07:06.835 --> 00:07:08.275 - increase of 15% 192 00:07:08.275 --> 00:07:09.395 - for 2027, 193 00:07:09.395 --> 00:07:12.139 - and that's the second straight year of double 194 00:07:12.139 --> 00:07:15.500 - digit hikes, according to a Peterson Kaiser Family 195 00:07:15.500 --> 00:07:17.600 - Foundation health system tracker report. 196 00:07:18.060 --> 00:07:19.819 - Some of those key drivers on the medical 197 00:07:19.819 --> 00:07:21.040 - side are that insurers, 198 00:07:21.500 --> 00:07:23.120 - point to about a 10% 199 00:07:23.419 --> 00:07:24.800 - median medical trend 200 00:07:25.964 --> 00:07:28.285 - increase for, 2027, 201 00:07:28.285 --> 00:07:30.145 - citing in the inflation, labor shortages, 202 00:07:31.084 --> 00:07:34.444 - claim severity, then also thinking about GLP one 203 00:07:34.444 --> 00:07:37.165 - drugs and and demand usage there, provide our 204 00:07:37.165 --> 00:07:39.404 - consolidation as well as disputes around the no 205 00:07:39.404 --> 00:07:40.865 - surprises act between 206 00:07:41.330 --> 00:07:44.370 - patients and, or, excuse me, between health care 207 00:07:44.370 --> 00:07:45.830 - providers and insurers. 208 00:07:46.529 --> 00:07:47.589 - But the policy 209 00:07:48.050 --> 00:07:48.550 - is 210 00:07:48.930 --> 00:07:50.850 - actually doing a lot of work here too. 211 00:07:50.850 --> 00:07:52.790 - Insurance companies flagged that 212 00:07:53.214 --> 00:07:56.334 - expiration of the enhanced premium tax credits is 213 00:07:56.334 --> 00:07:57.794 - one factor that is, 214 00:07:58.814 --> 00:08:00.435 - boosting rates because it, 215 00:08:01.214 --> 00:08:03.134 - it is shrinking the risk pool and and, 216 00:08:03.854 --> 00:08:05.935 - healthier people are still the ones most likely 217 00:08:05.935 --> 00:08:08.699 - to drop coverage when subsidies shrink. And so 218 00:08:08.699 --> 00:08:11.360 - that's leaving insurers with sicker and and costlier 219 00:08:11.420 --> 00:08:12.400 - pool of patients. 220 00:08:12.779 --> 00:08:15.660 - And then after the subsidy premium payments already 221 00:08:15.660 --> 00:08:18.480 - rose 58% on average this year, and so 222 00:08:18.620 --> 00:08:21.439 - looking at more next year, will be particularly 223 00:08:21.814 --> 00:08:23.654 - challenging for a lot of those patients that 224 00:08:23.654 --> 00:08:25.115 - really need that health insurance. 225 00:08:25.574 --> 00:08:28.615 - And then regulatory changes in along with HR 226 00:08:28.615 --> 00:08:29.115 - one, 227 00:08:29.814 --> 00:08:31.495 - that will go into effect next year are 228 00:08:31.495 --> 00:08:33.654 - cited as factors as well within some of 229 00:08:33.654 --> 00:08:34.394 - these challenges. 230 00:08:34.870 --> 00:08:38.470 - And then proposed changes for 2027, the range 231 00:08:38.470 --> 00:08:41.429 - from about a 1% decrease to around 54% 232 00:08:41.429 --> 00:08:41.929 - increase, 233 00:08:42.629 --> 00:08:44.629 - with most insurers landing between a 10 to 234 00:08:44.629 --> 00:08:45.509 - 25% 235 00:08:45.509 --> 00:08:47.990 - increase. And that's really important for, 236 00:08:48.545 --> 00:08:50.644 - all in health care to understand. Obviously, 237 00:08:51.105 --> 00:08:53.904 - as the insurance becomes more expensive on the 238 00:08:53.904 --> 00:08:56.085 - marketplace, it is possible that, 239 00:08:56.545 --> 00:08:59.264 - there'll be fewer people that decide to purchase 240 00:08:59.264 --> 00:09:01.105 - it, and go that route. There may be 241 00:09:01.105 --> 00:09:03.045 - more uninsured patients, more uncompensated 242 00:09:03.425 --> 00:09:05.899 - care, and hospitals and systems are preparing for 243 00:09:05.899 --> 00:09:08.379 - that reality, not only for those who may 244 00:09:08.379 --> 00:09:10.879 - not be eligible for Medicaid next year, 245 00:09:11.180 --> 00:09:13.580 - but also for these folks too who may 246 00:09:13.580 --> 00:09:16.460 - decide not to repurchase or or purchase through 247 00:09:16.460 --> 00:09:18.605 - the ACA marketplace because, 248 00:09:18.985 --> 00:09:21.404 - the insurance increases are are too high. So, 249 00:09:21.945 --> 00:09:24.745 - it's definitely gonna be an interesting landscape towards 250 00:09:24.745 --> 00:09:25.705 - the end of the year as we look 251 00:09:25.705 --> 00:09:27.245 - at insurance coverage, and, 252 00:09:28.185 --> 00:09:30.185 - executive teams have the work cut out for 253 00:09:30.185 --> 00:09:31.769 - them to make sure there's access to care 254 00:09:31.769 --> 00:09:33.490 - and and understand what they're gonna need in 255 00:09:33.490 --> 00:09:35.809 - order to be ready for additional, 256 00:09:36.209 --> 00:09:36.709 - uncompensated 257 00:09:37.009 --> 00:09:38.389 - care and uninsured patients. 258 00:09:39.730 --> 00:09:41.649 - Thank you. And you do see sort of 259 00:09:41.649 --> 00:09:42.149 - some 260 00:09:43.009 --> 00:09:45.809 - slight reduction in total number of people in 261 00:09:45.809 --> 00:09:46.870 - Medicare Advantage 262 00:09:47.384 --> 00:09:48.365 - or or the percentage. 263 00:09:49.065 --> 00:09:50.045 - Is that accurate? 264 00:09:51.545 --> 00:09:52.105 - Yeah. I 265 00:09:52.665 --> 00:09:54.985 - that that's been what, you know, we we've 266 00:09:54.985 --> 00:09:57.144 - seen from the reporting, when you're looking at 267 00:09:57.144 --> 00:09:58.764 - Medicare Advantage. I think, obviously, 268 00:09:59.225 --> 00:10:02.320 - it differs based on, which aspects of Medicare 269 00:10:02.320 --> 00:10:04.480 - Advantage you're looking at. But, you know, I 270 00:10:04.480 --> 00:10:07.840 - think it is obviously heavily marketed to patients 271 00:10:07.840 --> 00:10:09.139 - and something that, 272 00:10:10.000 --> 00:10:12.240 - you know, on the starkness of it seems 273 00:10:12.240 --> 00:10:14.000 - like it provides a lot of benefits. But 274 00:10:14.000 --> 00:10:15.840 - as many health care providers know on the 275 00:10:15.840 --> 00:10:17.414 - back end, it can be just such a 276 00:10:17.414 --> 00:10:17.914 - challenge 277 00:10:18.615 --> 00:10:20.054 - to administer and, 278 00:10:20.615 --> 00:10:22.955 - may not always provide the benefits that, 279 00:10:23.735 --> 00:10:25.334 - these Medicare Advantage Plans, 280 00:10:26.214 --> 00:10:27.894 - in the same way that say they do. 281 00:10:27.894 --> 00:10:28.934 - I think we've heard, 282 00:10:29.334 --> 00:10:31.495 - just about a good number of denials coming 283 00:10:31.495 --> 00:10:33.440 - through some of these plans. And so, you 284 00:10:33.440 --> 00:10:34.080 - know, as, 285 00:10:34.879 --> 00:10:36.259 - patients and and, 286 00:10:37.200 --> 00:10:38.339 - beneficiaries and members 287 00:10:38.639 --> 00:10:40.639 - have that experience, they may decide to do 288 00:10:40.639 --> 00:10:43.839 - something different, or we may see, continued increases 289 00:10:43.839 --> 00:10:46.080 - in the Medicare Advantage Plans just because of 290 00:10:46.080 --> 00:10:46.575 - how 291 00:10:47.054 --> 00:10:49.455 - much they've been able to kind of integrate 292 00:10:49.455 --> 00:10:50.514 - themselves within, 293 00:10:51.375 --> 00:10:53.554 - the Medicare beneficiary population. 294 00:10:54.575 --> 00:10:56.095 - No. Thank you so much. And it does 295 00:10:56.095 --> 00:10:57.875 - seem like you you are seeing some more 296 00:10:58.335 --> 00:11:01.269 - insurers exit some Medicare Advantage markets 297 00:11:01.649 --> 00:11:03.730 - and also some health systems exit their contracts 298 00:11:03.730 --> 00:11:05.649 - with Medicare Advantage payers, but fasting to watch 299 00:11:05.649 --> 00:11:07.730 - a sort of tipsy topsy, you know, up 300 00:11:07.730 --> 00:11:09.570 - and down of the Medicare Advantage market and 301 00:11:09.570 --> 00:11:10.789 - where that's going. Wow. 302 00:11:11.169 --> 00:11:13.475 - But, Laura, as always, I I wanna thank 303 00:11:13.475 --> 00:11:14.834 - you so much for joining us today on 304 00:11:14.834 --> 00:11:17.315 - the Beckers HealthCare podcast. I always learn something. 305 00:11:17.315 --> 00:11:18.834 - Thank you for joining us. You do a 306 00:11:18.834 --> 00:11:21.794 - fantastic job. Thank you very, very much. Absolutely. 307 00:11:21.794 --> 00:11:23.414 - Thank you, Scott. It's always a pleasure.