[Script Info]
Title: 
[Events]
Format: Layer, Start, End, Style, Name, MarginL, MarginR, MarginV, Effect, Text
Dialogue: 0,0:00:01.28,0:00:04.66,Default,,0000,0000,0000,,[MUSIC]
Dialogue: 0,0:00:17.04,0:00:18.60,Default,,0000,0000,0000,,>> Thank you, everybody,
Dialogue: 0,0:00:18.60,0:00:21.42,Default,,0000,0000,0000,,for [APPLAUSE].
Dialogue: 0,0:00:21.42,0:00:22.80,Default,,0000,0000,0000,,Don't clap yet.
Dialogue: 0,0:00:22.80,0:00:25.84,Default,,0000,0000,0000,,Save that for- you may\Nwant to take that back.
Dialogue: 0,0:00:25.84,0:00:27.76,Default,,0000,0000,0000,,So first, before we\Nstart I just got to
Dialogue: 0,0:00:27.76,0:00:30.42,Default,,0000,0000,0000,,acknowledge Dr. Frakes\Nin the back here.
Dialogue: 0,0:00:30.42,0:00:33.23,Default,,0000,0000,0000,,He was my auditing\Nprofessor
Dialogue: 0,0:00:33.23,0:00:34.78,Default,,0000,0000,0000,,back in the day\Nwhen I was at WHU
Dialogue: 0,0:00:34.78,0:00:36.75,Default,,0000,0000,0000,,so I think he's\Ncome to critique or
Dialogue: 0,0:00:36.75,0:00:39.24,Default,,0000,0000,0000,,take my diploma back,
Dialogue: 0,0:00:39.24,0:00:40.95,Default,,0000,0000,0000,,I'm not sure. We'll\Nsee how this goes.
Dialogue: 0,0:00:40.95,0:00:43.47,Default,,0000,0000,0000,,So a little nervous now.
Dialogue: 0,0:00:43.47,0:00:45.57,Default,,0000,0000,0000,,Thank you. Tell\Nyou a little
Dialogue: 0,0:00:45.57,0:00:47.61,Default,,0000,0000,0000,,bit, just horror story.
Dialogue: 0,0:00:47.61,0:00:49.65,Default,,0000,0000,0000,,So I'm really very young,
Dialogue: 0,0:00:49.65,0:00:51.03,Default,,0000,0000,0000,,Ruben so the reason
Dialogue: 0,0:00:51.03,0:00:52.63,Default,,0000,0000,0000,,I got this job, I had\Nto pay off my bill,
Dialogue: 0,0:00:52.63,0:00:53.87,Default,,0000,0000,0000,,and I'm still trying\Nto pay that off,
Dialogue: 0,0:00:53.87,0:00:56.65,Default,,0000,0000,0000,,so I relate to\Neverybody's questions
Dialogue: 0,0:00:56.65,0:00:58.37,Default,,0000,0000,0000,,regarding\Nhospital billing.
Dialogue: 0,0:00:58.37,0:00:59.41,Default,,0000,0000,0000,,No, not really.
Dialogue: 0,0:00:59.41,0:01:02.53,Default,,0000,0000,0000,,But I did start the\Nhospital back in 1988.
Dialogue: 0,0:01:02.53,0:01:05.31,Default,,0000,0000,0000,,It's hard to believe\Nit's been that long.
Dialogue: 0,0:01:05.31,0:01:07.53,Default,,0000,0000,0000,,Great family to work with.
Dialogue: 0,0:01:07.53,0:01:09.17,Default,,0000,0000,0000,,I don't know\Nif you or many
Dialogue: 0,0:01:09.17,0:01:12.11,Default,,0000,0000,0000,,know this in 2002,
Dialogue: 0,0:01:12.11,0:01:13.72,Default,,0000,0000,0000,,I tried to escape.
Dialogue: 0,0:01:13.72,0:01:16.21,Default,,0000,0000,0000,,I resigned from Pullman\NRegional Hospital as
Dialogue: 0,0:01:16.21,0:01:19.05,Default,,0000,0000,0000,,CFO and moved to\NTucson, Arizona.
Dialogue: 0,0:01:19.05,0:01:22.11,Default,,0000,0000,0000,,I didn't get too far\Nout of town before
Dialogue: 0,0:01:22.11,0:01:24.11,Default,,0000,0000,0000,,Scott asked if I could
Dialogue: 0,0:01:24.11,0:01:25.07,Default,,0000,0000,0000,,stay on and we'd work
Dialogue: 0,0:01:25.07,0:01:26.35,Default,,0000,0000,0000,,out some type\Nof arrangement.
Dialogue: 0,0:01:26.35,0:01:28.58,Default,,0000,0000,0000,,So I still reside\Nin Tucson.
Dialogue: 0,0:01:28.58,0:01:30.44,Default,,0000,0000,0000,,I've been doing\Nthat for 15 years.
Dialogue: 0,0:01:30.44,0:01:32.66,Default,,0000,0000,0000,,So half of my career\Nhas been living in
Dialogue: 0,0:01:32.66,0:01:34.72,Default,,0000,0000,0000,,Tucson and still working
Dialogue: 0,0:01:34.72,0:01:35.92,Default,,0000,0000,0000,,at Pullman\NRegional Hospital.
Dialogue: 0,0:01:35.92,0:01:36.85,Default,,0000,0000,0000,,Pullman Regional\NHospital is
Dialogue: 0,0:01:36.85,0:01:37.45,Default,,0000,0000,0000,,dear to my heart.
Dialogue: 0,0:01:37.45,0:01:39.26,Default,,0000,0000,0000,,I have past board members
Dialogue: 0,0:01:39.26,0:01:40.68,Default,,0000,0000,0000,,in here tonight and they
Dialogue: 0,0:01:40.68,0:01:42.42,Default,,0000,0000,0000,,all know once you
Dialogue: 0,0:01:42.42,0:01:44.16,Default,,0000,0000,0000,,get Pullman Regional\Ninto your system,
Dialogue: 0,0:01:44.16,0:01:45.40,Default,,0000,0000,0000,,it's hard to get it out.
Dialogue: 0,0:01:45.40,0:01:46.86,Default,,0000,0000,0000,,It becomes a part of you.
Dialogue: 0,0:01:46.86,0:01:48.18,Default,,0000,0000,0000,,You believe in the\Ncommunity. You believe
Dialogue: 0,0:01:48.18,0:01:49.52,Default,,0000,0000,0000,,a lot in what we're doing.
Dialogue: 0,0:01:49.52,0:01:51.46,Default,,0000,0000,0000,,I really appreciate that,
Dialogue: 0,0:01:51.46,0:01:53.86,Default,,0000,0000,0000,,especially working\Nwith fine people like
Dialogue: 0,0:01:53.86,0:01:56.57,Default,,0000,0000,0000,,Mr. Adams and Mrs. Eiler,
Dialogue: 0,0:01:56.57,0:01:58.42,Default,,0000,0000,0000,,Dr. Cagiano that have
Dialogue: 0,0:01:58.42,0:02:00.14,Default,,0000,0000,0000,,really become\Nfamily members.
Dialogue: 0,0:02:00.14,0:02:02.84,Default,,0000,0000,0000,,Shauna Patrick, who's\Nmy controller here,
Dialogue: 0,0:02:02.84,0:02:04.70,Default,,0000,0000,0000,,has been with me, Shauna,
Dialogue: 0,0:02:04.70,0:02:06.90,Default,,0000,0000,0000,,we've been together\N16, 17, 18.
Dialogue: 0,0:02:06.90,0:02:08.76,Default,,0000,0000,0000,,I mean, it's been\Na long time.
Dialogue: 0,0:02:08.76,0:02:09.61,Default,,0000,0000,0000,,>> Twenty years.
Dialogue: 0,0:02:09.61,0:02:12.54,Default,,0000,0000,0000,,>> Yeah, it's amazing.\NYou got great people.
Dialogue: 0,0:02:12.54,0:02:15.40,Default,,0000,0000,0000,,So let me start\Nwith a little bit.
Dialogue: 0,0:02:15.40,0:02:17.28,Default,,0000,0000,0000,,One of the nice things\Nabout doing it in
Dialogue: 0,0:02:17.28,0:02:18.72,Default,,0000,0000,0000,,this environment is I've
Dialogue: 0,0:02:18.72,0:02:19.64,Default,,0000,0000,0000,,always believed whenever
Dialogue: 0,0:02:19.64,0:02:20.66,Default,,0000,0000,0000,,I'm talking with anybody,
Dialogue: 0,0:02:20.66,0:02:23.06,Default,,0000,0000,0000,,you have to give\Nthem a takeaway,
Dialogue: 0,0:02:23.06,0:02:25.49,Default,,0000,0000,0000,,you're investing time here
Dialogue: 0,0:02:25.49,0:02:27.68,Default,,0000,0000,0000,,and if I failed to\Ndo that, I failed.
Dialogue: 0,0:02:27.68,0:02:28.90,Default,,0000,0000,0000,,The nice thing is\Nwe're feeding you,
Dialogue: 0,0:02:28.90,0:02:29.42,Default,,0000,0000,0000,,so at least you
Dialogue: 0,0:02:29.42,0:02:31.09,Default,,0000,0000,0000,,give away full, hopefully.
Dialogue: 0,0:02:31.09,0:02:32.62,Default,,0000,0000,0000,,So at any point,
Dialogue: 0,0:02:32.62,0:02:34.42,Default,,0000,0000,0000,,if you want more, feel
Dialogue: 0,0:02:34.42,0:02:36.60,Default,,0000,0000,0000,,free to get up\Nand go get more.
Dialogue: 0,0:02:36.60,0:02:38.18,Default,,0000,0000,0000,,And so, at least\Nthere's one takeaway,
Dialogue: 0,0:02:38.18,0:02:38.99,Default,,0000,0000,0000,,so I feel good about that.
Dialogue: 0,0:02:38.99,0:02:42.30,Default,,0000,0000,0000,,But let's start with\Na little bit here.
Dialogue: 0,0:02:56.05,0:02:59.13,Default,,0000,0000,0000,,Well, words of\Nwisdom here.
Dialogue: 0,0:03:08.78,0:03:10.94,Default,,0000,0000,0000,,So being an account,
Dialogue: 0,0:03:10.94,0:03:12.50,Default,,0000,0000,0000,,the pessimistic side of
Dialogue: 0,0:03:12.50,0:03:14.42,Default,,0000,0000,0000,,me that really ring true.
Dialogue: 0,0:03:14.42,0:03:15.58,Default,,0000,0000,0000,,But our goal
Dialogue: 0,0:03:15.58,0:03:16.98,Default,,0000,0000,0000,,tonight is talk a\Nlittle bit about
Dialogue: 0,0:03:16.98,0:03:19.44,Default,,0000,0000,0000,,healthcare and\Nspecifically
Dialogue: 0,0:03:19.44,0:03:21.100,Default,,0000,0000,0000,,healthcare Finance 101.
Dialogue: 0,0:03:21.100,0:03:25.18,Default,,0000,0000,0000,,We have about an hour so
Dialogue: 0,0:03:25.18,0:03:26.33,Default,,0000,0000,0000,,I'll hold pretty\Ntrue to that.
Dialogue: 0,0:03:26.33,0:03:28.95,Default,,0000,0000,0000,,We'll get you out a\Nlittle probably early,
Dialogue: 0,0:03:28.95,0:03:30.19,Default,,0000,0000,0000,,but really, this\Nis your time.
Dialogue: 0,0:03:30.19,0:03:32.67,Default,,0000,0000,0000,,If there's questions\Nyou have specifically,
Dialogue: 0,0:03:32.67,0:03:35.03,Default,,0000,0000,0000,,I will address those\Nthe best I can.
Dialogue: 0,0:03:35.03,0:03:36.25,Default,,0000,0000,0000,,If there's\Nsomething I don't
Dialogue: 0,0:03:36.25,0:03:37.69,Default,,0000,0000,0000,,know, I'll go find out,
Dialogue: 0,0:03:37.69,0:03:39.41,Default,,0000,0000,0000,,and I'll make\Nsure that you all
Dialogue: 0,0:03:39.41,0:03:42.44,Default,,0000,0000,0000,,know within a few days.
Dialogue: 0,0:03:42.44,0:03:44.49,Default,,0000,0000,0000,,But hopefully, you'll find
Dialogue: 0,0:03:44.49,0:03:46.65,Default,,0000,0000,0000,,this very meaningful in
Dialogue: 0,0:03:46.65,0:03:48.14,Default,,0000,0000,0000,,terms of a better\Nunderstanding.
Dialogue: 0,0:03:48.14,0:03:48.81,Default,,0000,0000,0000,,So that's our goal.
Dialogue: 0,0:03:48.81,0:03:52.25,Default,,0000,0000,0000,,To do that, we have to have\Na baseline of knowledge.
Dialogue: 0,0:03:52.25,0:03:54.09,Default,,0000,0000,0000,,We have to have a\Nworking platform
Dialogue: 0,0:03:54.09,0:03:56.13,Default,,0000,0000,0000,,to communicate\Neffectively.
Dialogue: 0,0:03:56.13,0:03:58.71,Default,,0000,0000,0000,,Because healthcare,\Nlike any industry,
Dialogue: 0,0:03:58.71,0:04:00.61,Default,,0000,0000,0000,,we have acronyms, and
Dialogue: 0,0:04:00.61,0:04:01.79,Default,,0000,0000,0000,,I don't know if\Nit's purposeful,
Dialogue: 0,0:04:01.79,0:04:04.04,Default,,0000,0000,0000,,so nobody else can come\Nin it's like a club.
Dialogue: 0,0:04:04.04,0:04:06.25,Default,,0000,0000,0000,,Or if it's actually\Nthe fact that we just
Dialogue: 0,0:04:06.25,0:04:08.47,Default,,0000,0000,0000,,try to simplify our lives\Nby having acronyms,
Dialogue: 0,0:04:08.47,0:04:09.55,Default,,0000,0000,0000,,and we throw them out as
Dialogue: 0,0:04:09.55,0:04:10.100,Default,,0000,0000,0000,,if they're everyday speak.
Dialogue: 0,0:04:10.100,0:04:12.87,Default,,0000,0000,0000,,So let me talk about a\Nlittle bit of things
Dialogue: 0,0:04:12.87,0:04:13.63,Default,,0000,0000,0000,,just to make sure as
Dialogue: 0,0:04:13.63,0:04:14.81,Default,,0000,0000,0000,,we're going through this,
Dialogue: 0,0:04:14.81,0:04:16.15,Default,,0000,0000,0000,,as I mentioned something,
Dialogue: 0,0:04:16.15,0:04:17.54,Default,,0000,0000,0000,,we're on a common ground.
Dialogue: 0,0:04:17.54,0:04:20.41,Default,,0000,0000,0000,,So first thing, when we\Ntaught gross charges,
Dialogue: 0,0:04:20.41,0:04:23.03,Default,,0000,0000,0000,,this is what we\Nbill the patient.
Dialogue: 0,0:04:23.03,0:04:24.69,Default,,0000,0000,0000,,Isn't what we get
Dialogue: 0,0:04:24.69,0:04:27.29,Default,,0000,0000,0000,,paid but any\Npatient comes in,
Dialogue: 0,0:04:27.29,0:04:28.73,Default,,0000,0000,0000,,it's going to be\Nwhatever they had done
Dialogue: 0,0:04:28.73,0:04:30.37,Default,,0000,0000,0000,,times whatever\Nquantity of whatever
Dialogue: 0,0:04:30.37,0:04:32.61,Default,,0000,0000,0000,,they did and that's
Dialogue: 0,0:04:32.61,0:04:34.56,Default,,0000,0000,0000,,going to be what\Ngets billed down.
Dialogue: 0,0:04:34.56,0:04:37.31,Default,,0000,0000,0000,,From there, we\Nhave contractuals
Dialogue: 0,0:04:37.31,0:04:39.99,Default,,0000,0000,0000,,or deductions\Nfrom revenue.
Dialogue: 0,0:04:39.99,0:04:42.20,Default,,0000,0000,0000,,That consists of\Nthings like bad debt.
Dialogue: 0,0:04:42.20,0:04:44.07,Default,,0000,0000,0000,,We have patients that\Ndon't pay their bills,
Dialogue: 0,0:04:44.07,0:04:46.35,Default,,0000,0000,0000,,hard to believe.
Dialogue: 0,0:04:46.35,0:04:48.31,Default,,0000,0000,0000,,We also take care\Nof the indigent,
Dialogue: 0,0:04:48.31,0:04:50.21,Default,,0000,0000,0000,,those that can't\Npay their bills.
Dialogue: 0,0:04:50.21,0:04:51.95,Default,,0000,0000,0000,,So we have charity care,
Dialogue: 0,0:04:51.95,0:04:54.93,Default,,0000,0000,0000,,ways by which they\Ncan have services,
Dialogue: 0,0:04:54.93,0:04:56.60,Default,,0000,0000,0000,,as part of our mission.
Dialogue: 0,0:04:56.60,0:04:59.33,Default,,0000,0000,0000,,And so they'll come in,\Nand if they qualify,
Dialogue: 0,0:04:59.33,0:05:00.79,Default,,0000,0000,0000,,parts or all of
Dialogue: 0,0:05:00.79,0:05:02.21,Default,,0000,0000,0000,,their bill can\Nbe written off.
Dialogue: 0,0:05:02.21,0:05:03.21,Default,,0000,0000,0000,,And then in addition to
Dialogue: 0,0:05:03.21,0:05:04.69,Default,,0000,0000,0000,,that, we have contracts.
Dialogue: 0,0:05:04.69,0:05:05.99,Default,,0000,0000,0000,,Now, we have a contract
Dialogue: 0,0:05:05.99,0:05:06.77,Default,,0000,0000,0000,,with federal government,
Dialogue: 0,0:05:06.77,0:05:08.31,Default,,0000,0000,0000,,Medicare and\NMedicaid Services,
Dialogue: 0,0:05:08.31,0:05:10.86,Default,,0000,0000,0000,,and they tell us what\Nthey're gonna pay us.
Dialogue: 0,0:05:10.86,0:05:12.80,Default,,0000,0000,0000,,You don't get to\Nnegotiate that.
Dialogue: 0,0:05:12.80,0:05:14.27,Default,,0000,0000,0000,,Under that means you get
Dialogue: 0,0:05:14.27,0:05:16.04,Default,,0000,0000,0000,,told what you're\Ngoing to get paid.
Dialogue: 0,0:05:16.04,0:05:18.21,Default,,0000,0000,0000,,However, other insurance
Dialogue: 0,0:05:18.21,0:05:20.96,Default,,0000,0000,0000,,companies like\NPrimera, Blue Cross,
Dialogue: 0,0:05:20.96,0:05:25.19,Default,,0000,0000,0000,,now Group Health, Molina,
Dialogue: 0,0:05:25.19,0:05:28.91,Default,,0000,0000,0000,,any of those we negotiate\Ncontracts with.
Dialogue: 0,0:05:28.91,0:05:30.45,Default,,0000,0000,0000,,We never get 100%.
Dialogue: 0,0:05:30.45,0:05:31.73,Default,,0000,0000,0000,,Back when I started,
Dialogue: 0,0:05:31.73,0:05:33.17,Default,,0000,0000,0000,,we had contracts that were
Dialogue: 0,0:05:33.17,0:05:35.91,Default,,0000,0000,0000,,98% of charges or\N90% of charges.
Dialogue: 0,0:05:35.91,0:05:37.39,Default,,0000,0000,0000,,And today, the\Nbest commercial
Dialogue: 0,0:05:37.39,0:05:38.89,Default,,0000,0000,0000,,contract we have\Nis right around
Dialogue: 0,0:05:38.89,0:05:43.42,Default,,0000,0000,0000,,73.5% of charges so,
Dialogue: 0,0:05:43.42,0:05:46.63,Default,,0000,0000,0000,,things have changed\Nsignificantly.
Dialogue: 0,0:05:48.23,0:05:51.21,Default,,0000,0000,0000,,That was my sign to\Nrepeat the question.
Dialogue: 0,0:05:51.21,0:05:53.27,Default,,0000,0000,0000,,So is Medicare, Medicaid
Dialogue: 0,0:05:53.27,0:05:55.66,Default,,0000,0000,0000,,around 33, 34% charges?
Dialogue: 0,0:05:55.66,0:05:59.92,Default,,0000,0000,0000,,The write off is around\N45% of charges, 50%.
Dialogue: 0,0:05:59.92,0:06:01.99,Default,,0000,0000,0000,,We'll get into that\Na little bit of why,
Dialogue: 0,0:06:01.99,0:06:04.88,Default,,0000,0000,0000,,what that means and\Nhow that works.
Dialogue: 0,0:06:04.88,0:06:06.78,Default,,0000,0000,0000,,And specifically,\Nit means for
Dialogue: 0,0:06:06.78,0:06:08.06,Default,,0000,0000,0000,,Pullman Regional Hospital.
Dialogue: 0,0:06:08.06,0:06:10.09,Default,,0000,0000,0000,,So if you take that\Ngross charge and you
Dialogue: 0,0:06:10.09,0:06:12.79,Default,,0000,0000,0000,,subtract those write offs,
Dialogue: 0,0:06:12.79,0:06:15.05,Default,,0000,0000,0000,,be it bad debt, be\Nit contractual,
Dialogue: 0,0:06:15.05,0:06:16.93,Default,,0000,0000,0000,,that's really\Nthe net revenue.
Dialogue: 0,0:06:16.93,0:06:19.51,Default,,0000,0000,0000,,That's what the\Nhospital has to
Dialogue: 0,0:06:19.51,0:06:22.43,Default,,0000,0000,0000,,be able to fund\Ncurrent expenses,
Dialogue: 0,0:06:22.43,0:06:23.99,Default,,0000,0000,0000,,which would be\Nsalaries, wages,
Dialogue: 0,0:06:23.99,0:06:26.78,Default,,0000,0000,0000,,benefits, and future.
Dialogue: 0,0:06:26.78,0:06:29.34,Default,,0000,0000,0000,,Things like capital, etc
Dialogue: 0,0:06:29.34,0:06:30.27,Default,,0000,0000,0000,,that ends up being part of
Dialogue: 0,0:06:30.27,0:06:32.16,Default,,0000,0000,0000,,depreciation and the like.
Dialogue: 0,0:06:32.16,0:06:34.55,Default,,0000,0000,0000,,From there, once\Nyou minus all of
Dialogue: 0,0:06:34.55,0:06:36.95,Default,,0000,0000,0000,,those daily operational\Nexpenses out,
Dialogue: 0,0:06:36.95,0:06:38.61,Default,,0000,0000,0000,,that's what we\Nhave in terms of
Dialogue: 0,0:06:38.61,0:06:41.77,Default,,0000,0000,0000,,our basically\Noperating income.
Dialogue: 0,0:06:41.77,0:06:43.93,Default,,0000,0000,0000,,Now, I'll tell you,\Nin healthcare,
Dialogue: 0,0:06:43.93,0:06:45.30,Default,,0000,0000,0000,,margins are small.
Dialogue: 0,0:06:45.30,0:06:47.05,Default,,0000,0000,0000,,In almost especially
Dialogue: 0,0:06:47.05,0:06:48.75,Default,,0000,0000,0000,,critical access hospitals,
Dialogue: 0,0:06:48.75,0:06:50.91,Default,,0000,0000,0000,,most of them don't
Dialogue: 0,0:06:50.91,0:06:53.04,Default,,0000,0000,0000,,have an operating\Nbottom line.
Dialogue: 0,0:06:53.04,0:06:54.99,Default,,0000,0000,0000,,The only way they have a
Dialogue: 0,0:06:54.99,0:06:56.79,Default,,0000,0000,0000,,positive bottom\Nline and many
Dialogue: 0,0:06:56.79,0:06:58.61,Default,,0000,0000,0000,,don't is the fact
Dialogue: 0,0:06:58.61,0:07:00.72,Default,,0000,0000,0000,,through non\Noperating means.
Dialogue: 0,0:07:00.72,0:07:02.78,Default,,0000,0000,0000,,In our particular case,
Dialogue: 0,0:07:02.78,0:07:04.70,Default,,0000,0000,0000,,we have a great community\Nthat supports us.
Dialogue: 0,0:07:04.70,0:07:06.32,Default,,0000,0000,0000,,We're a public\Nhospital district,
Dialogue: 0,0:07:06.32,0:07:08.16,Default,,0000,0000,0000,,and we get tax support,
Dialogue: 0,0:07:08.16,0:07:11.08,Default,,0000,0000,0000,,which has been tremendous\Nblessing to us.
Dialogue: 0,0:07:11.08,0:07:12.62,Default,,0000,0000,0000,,In addition to\Nthat, we have
Dialogue: 0,0:07:12.62,0:07:15.02,Default,,0000,0000,0000,,some properties\Nin which we rent.
Dialogue: 0,0:07:15.02,0:07:17.00,Default,,0000,0000,0000,,We get some rental\Nincome off of.
Dialogue: 0,0:07:17.00,0:07:17.94,Default,,0000,0000,0000,,That's a non operating.
Dialogue: 0,0:07:17.94,0:07:19.93,Default,,0000,0000,0000,,That's not what we're in\Nthe business of doing.
Dialogue: 0,0:07:19.93,0:07:21.30,Default,,0000,0000,0000,,And then other things
Dialogue: 0,0:07:21.30,0:07:23.20,Default,,0000,0000,0000,,are like foundation\Ndonations,
Dialogue: 0,0:07:23.20,0:07:24.80,Default,,0000,0000,0000,,which are very beneficial
Dialogue: 0,0:07:24.80,0:07:26.08,Default,,0000,0000,0000,,to us in order\Nto be able to
Dialogue: 0,0:07:26.08,0:07:28.76,Default,,0000,0000,0000,,provide the spectrum and
Dialogue: 0,0:07:28.76,0:07:31.26,Default,,0000,0000,0000,,the overall care that\Nwe're able to do
Dialogue: 0,0:07:31.26,0:07:34.23,Default,,0000,0000,0000,,here that many\Ncommunities can't do.
Dialogue: 0,0:07:34.23,0:07:35.82,Default,,0000,0000,0000,,So a lot of it is
Dialogue: 0,0:07:35.82,0:07:36.60,Default,,0000,0000,0000,,the support we've had
Dialogue: 0,0:07:36.60,0:07:38.20,Default,,0000,0000,0000,,from the community itself.
Dialogue: 0,0:07:38.20,0:07:40.59,Default,,0000,0000,0000,,So that ends up being\Nthe net income.
Dialogue: 0,0:07:40.59,0:07:42.03,Default,,0000,0000,0000,,And in our business, it's
Dialogue: 0,0:07:42.03,0:07:44.80,Default,,0000,0000,0000,,almost you can't\Nhave a profit.
Dialogue: 0,0:07:44.80,0:07:46.71,Default,,0000,0000,0000,,We're a nonprofit so you
Dialogue: 0,0:07:46.71,0:07:48.57,Default,,0000,0000,0000,,can't have profits,\Nbut we have excess.
Dialogue: 0,0:07:48.57,0:07:51.11,Default,,0000,0000,0000,,We have excess of\Nrevenue over expenses.
Dialogue: 0,0:07:51.11,0:07:53.35,Default,,0000,0000,0000,,What does that mean?\NIt's bottom line.
Dialogue: 0,0:07:53.35,0:07:55.45,Default,,0000,0000,0000,,You call bottom line,\Ncall it net income,
Dialogue: 0,0:07:55.45,0:07:56.89,Default,,0000,0000,0000,,call it anything you want.
Dialogue: 0,0:07:56.89,0:07:58.50,Default,,0000,0000,0000,,It's really your profit.
Dialogue: 0,0:07:58.50,0:07:59.25,Default,,0000,0000,0000,,Now, I'll tell you
Dialogue: 0,0:07:59.25,0:08:00.33,Default,,0000,0000,0000,,a story just for a second.
Dialogue: 0,0:08:00.33,0:08:02.17,Default,,0000,0000,0000,,I'll just digress\Nfor a minute.
Dialogue: 0,0:08:02.17,0:08:04.18,Default,,0000,0000,0000,,And Al probably\Nappreciate this.
Dialogue: 0,0:08:04.18,0:08:05.83,Default,,0000,0000,0000,,My wife's a pharmacist,
Dialogue: 0,0:08:05.83,0:08:08.11,Default,,0000,0000,0000,,and she's probably in
Dialogue: 0,0:08:08.11,0:08:10.41,Default,,0000,0000,0000,,terms of knowledge\Nand brightness,
Dialogue: 0,0:08:10.41,0:08:12.51,Default,,0000,0000,0000,,she outshines me by far.
Dialogue: 0,0:08:12.51,0:08:17.44,Default,,0000,0000,0000,,But last her senior\Nyear she had to
Dialogue: 0,0:08:17.44,0:08:19.72,Default,,0000,0000,0000,,take an online course\Nor one of those
Dialogue: 0,0:08:19.72,0:08:22.32,Default,,0000,0000,0000,,that just to fill\Na GR and I said,
Dialogue: 0,0:08:22.32,0:08:23.90,Default,,0000,0000,0000,,I'll take accounting\Nit'll be simple.
Dialogue: 0,0:08:23.90,0:08:25.54,Default,,0000,0000,0000,,I'll teach you.\NI'll help you.
Dialogue: 0,0:08:25.54,0:08:26.52,Default,,0000,0000,0000,,I thought we were gonna
Dialogue: 0,0:08:26.52,0:08:27.50,Default,,0000,0000,0000,,get divorce our\Nfirst year of
Dialogue: 0,0:08:27.50,0:08:28.74,Default,,0000,0000,0000,,marriage because she
Dialogue: 0,0:08:28.74,0:08:29.84,Default,,0000,0000,0000,,couldn't understand well,
Dialogue: 0,0:08:29.84,0:08:32.16,Default,,0000,0000,0000,,what's this net income\Nor profit or excess?
Dialogue: 0,0:08:32.16,0:08:34.64,Default,,0000,0000,0000,,Why can't you just call\Nit the same thing?
Dialogue: 0,0:08:34.64,0:08:36.84,Default,,0000,0000,0000,,Oh, it is. It just depends
Dialogue: 0,0:08:36.84,0:08:38.94,Default,,0000,0000,0000,,what business\Nline you're in.
Dialogue: 0,0:08:38.94,0:08:40.59,Default,,0000,0000,0000,,Owner's equity is the same
Dialogue: 0,0:08:40.59,0:08:44.80,Default,,0000,0000,0000,,as the net worth\Nis the same as,
Dialogue: 0,0:08:44.80,0:08:46.92,Default,,0000,0000,0000,,etc, and she just\Ncouldn't get it.
Dialogue: 0,0:08:46.92,0:08:49.80,Default,,0000,0000,0000,,I finally just said,
Dialogue: 0,0:08:49.80,0:08:52.41,Default,,0000,0000,0000,,okay, I think somebody\Nelse has to help you.
Dialogue: 0,0:08:52.41,0:08:53.66,Default,,0000,0000,0000,,But we got through it,
Dialogue: 0,0:08:53.66,0:08:54.32,Default,,0000,0000,0000,,and we're still married.
Dialogue: 0,0:08:54.32,0:08:55.38,Default,,0000,0000,0000,,It's been 30 years.
Dialogue: 0,0:08:55.38,0:08:56.93,Default,,0000,0000,0000,,So somehow we made\Nit through that.
Dialogue: 0,0:08:56.93,0:08:59.60,Default,,0000,0000,0000,,But a lot of these terms\Nare interchangeable,
Dialogue: 0,0:08:59.60,0:09:00.58,Default,,0000,0000,0000,,and we'll talk about some
Dialogue: 0,0:09:00.58,0:09:02.77,Default,,0000,0000,0000,,of those so I'll\Nthrow those out.
Dialogue: 0,0:09:02.96,0:09:06.06,Default,,0000,0000,0000,,Here's your first\Nopportunity to have a quiz.
Dialogue: 0,0:09:06.06,0:09:07.77,Default,,0000,0000,0000,,She said, I can't\Nask her questions,
Dialogue: 0,0:09:07.77,0:09:10.51,Default,,0000,0000,0000,,but no, this is for\Nthe whole room.
Dialogue: 0,0:09:10.51,0:09:11.55,Default,,0000,0000,0000,,Let me ask you a question.
Dialogue: 0,0:09:11.55,0:09:13.45,Default,,0000,0000,0000,,This is your first test.
Dialogue: 0,0:09:13.45,0:09:15.41,Default,,0000,0000,0000,,These are reimbursement\Ntheories.
Dialogue: 0,0:09:15.41,0:09:16.53,Default,,0000,0000,0000,,These are different
Dialogue: 0,0:09:16.53,0:09:18.83,Default,,0000,0000,0000,,reimbursement methodologies\Nin healthcare.
Dialogue: 0,0:09:18.83,0:09:22.06,Default,,0000,0000,0000,,One is diagnosis\Nrelated groups, DRGs.
Dialogue: 0,0:09:22.06,0:09:23.57,Default,,0000,0000,0000,,Folks may have\Nremembered those
Dialogue: 0,0:09:23.57,0:09:25.13,Default,,0000,0000,0000,,came back in\Nthe early 80s.
Dialogue: 0,0:09:25.13,0:09:26.88,Default,,0000,0000,0000,,Medicare came down\Nwith that and said,
Dialogue: 0,0:09:26.88,0:09:28.99,Default,,0000,0000,0000,,we're going to say\Nevery patient that has
Dialogue: 0,0:09:28.99,0:09:31.69,Default,,0000,0000,0000,,a x diagnosis of
Dialogue: 0,0:09:31.69,0:09:33.49,Default,,0000,0000,0000,,this will be in\Nthis grouping,
Dialogue: 0,0:09:33.49,0:09:34.82,Default,,0000,0000,0000,,then we're gonna pay y.
Dialogue: 0,0:09:34.82,0:09:36.37,Default,,0000,0000,0000,,So they created this
Dialogue: 0,0:09:36.37,0:09:38.73,Default,,0000,0000,0000,,in order to control\Ntheir costs.
Dialogue: 0,0:09:39.58,0:09:43.13,Default,,0000,0000,0000,,MSDRGs is another\Nmethodologies.
Dialogue: 0,0:09:43.13,0:09:45.53,Default,,0000,0000,0000,,Anybody know\Nwhat that means?
Dialogue: 0,0:09:45.53,0:09:47.43,Default,,0000,0000,0000,,What's the\Ndifference between
Dialogue: 0,0:09:47.43,0:09:48.94,Default,,0000,0000,0000,,a DRG and an MSDRG?
Dialogue: 0,0:09:48.94,0:09:50.81,Default,,0000,0000,0000,,So there's certain things
Dialogue: 0,0:09:50.81,0:09:53.58,Default,,0000,0000,0000,,Medicare don't\Ntypically pay for.
Dialogue: 0,0:09:53.58,0:09:56.41,Default,,0000,0000,0000,,Pregnancies not\Nvery many people in
Dialogue: 0,0:09:56.41,0:09:59.28,Default,,0000,0000,0000,,the Medicare population\Nare pregnant, etc.
Dialogue: 0,0:09:59.28,0:10:01.25,Default,,0000,0000,0000,,So commercial payers have
Dialogue: 0,0:10:01.25,0:10:05.43,Default,,0000,0000,0000,,additional DRGs listed,
Dialogue: 0,0:10:05.43,0:10:06.57,Default,,0000,0000,0000,,which are the MS side of
Dialogue: 0,0:10:06.57,0:10:08.50,Default,,0000,0000,0000,,it, medical surgical side.
Dialogue: 0,0:10:08.50,0:10:12.87,Default,,0000,0000,0000,,Common procedural\Nterminology, CPTs.
Dialogue: 0,0:10:12.87,0:10:15.06,Default,,0000,0000,0000,,Full charges or percent of
Dialogue: 0,0:10:15.06,0:10:17.44,Default,,0000,0000,0000,,charges. And also costs.
Dialogue: 0,0:10:17.44,0:10:18.45,Default,,0000,0000,0000,,Let me ask the question.
Dialogue: 0,0:10:18.45,0:10:21.29,Default,,0000,0000,0000,,Which of these does Pullman\NRegional Hospital get paid
Dialogue: 0,0:10:21.29,0:10:27.68,Default,,0000,0000,0000,,under? Go ahead, Mayor.
Dialogue: 0,0:10:27.68,0:10:28.26,Default,,0000,0000,0000,,>> All.
Dialogue: 0,0:10:28.26,0:10:30.47,Default,,0000,0000,0000,,>> Thank you. Good answer.
Dialogue: 0,0:10:30.47,0:10:31.84,Default,,0000,0000,0000,,Every single one of those.
Dialogue: 0,0:10:31.84,0:10:33.86,Default,,0000,0000,0000,,Not confusing whatsoever.
Dialogue: 0,0:10:33.86,0:10:35.05,Default,,0000,0000,0000,,We just got to figure
Dialogue: 0,0:10:35.05,0:10:36.65,Default,,0000,0000,0000,,out which one and\Nplay the game right.
Dialogue: 0,0:10:36.65,0:10:39.03,Default,,0000,0000,0000,,And by the way, insurance\Ncompanies love to
Dialogue: 0,0:10:39.03,0:10:40.97,Default,,0000,0000,0000,,change what's acceptable\Nand non acceptable,
Dialogue: 0,0:10:40.97,0:10:42.30,Default,,0000,0000,0000,,what's allowable,\Nnon allowable.
Dialogue: 0,0:10:42.30,0:10:43.93,Default,,0000,0000,0000,,We'll get a\Nlittle of that.
Dialogue: 0,0:10:43.93,0:10:44.97,Default,,0000,0000,0000,,But we get paid
Dialogue: 0,0:10:44.97,0:10:46.11,Default,,0000,0000,0000,,under every single\None of those.
Dialogue: 0,0:10:46.11,0:10:48.04,Default,,0000,0000,0000,,So it's really\Ndependent on the payer.
Dialogue: 0,0:10:48.04,0:10:50.31,Default,,0000,0000,0000,,If we had 100% Medicare,
Dialogue: 0,0:10:50.31,0:10:53.33,Default,,0000,0000,0000,,it's so much easier\Nto budget we don't.
Dialogue: 0,0:10:53.33,0:10:57.31,Default,,0000,0000,0000,,We have a variety of\Nvarious insurers.
Dialogue: 0,0:10:57.31,0:10:59.43,Default,,0000,0000,0000,,Today, our population\Nin terms of Medicare,
Dialogue: 0,0:10:59.43,0:11:02.38,Default,,0000,0000,0000,,Medicaid runs about\N45% of our charges.
Dialogue: 0,0:11:02.38,0:11:04.33,Default,,0000,0000,0000,,Pullman is in a\Nvery good position
Dialogue: 0,0:11:04.33,0:11:06.27,Default,,0000,0000,0000,,from the terms of the\Nability to do what we
Dialogue: 0,0:11:06.27,0:11:07.87,Default,,0000,0000,0000,,do because we\Nhave a very good
Dialogue: 0,0:11:07.87,0:11:09.73,Default,,0000,0000,0000,,pair mix due to\Nthe fact that we
Dialogue: 0,0:11:09.73,0:11:12.27,Default,,0000,0000,0000,,have Washington\NState University
Dialogue: 0,0:11:12.27,0:11:14.36,Default,,0000,0000,0000,,here and SEL here.
Dialogue: 0,0:11:14.36,0:11:15.95,Default,,0000,0000,0000,,Not very many\Ncommunities of
Dialogue: 0,0:11:15.95,0:11:18.85,Default,,0000,0000,0000,,our size in rural America\Nhave that luxury.
Dialogue: 0,0:11:18.85,0:11:21.26,Default,,0000,0000,0000,,Most of them typically
Dialogue: 0,0:11:21.26,0:11:23.88,Default,,0000,0000,0000,,you can think of small\Nfarming communities.
Dialogue: 0,0:11:23.88,0:11:25.39,Default,,0000,0000,0000,,There's a lot of Medicare,
Dialogue: 0,0:11:25.39,0:11:26.63,Default,,0000,0000,0000,,Medicaid, especially.
Dialogue: 0,0:11:26.63,0:11:28.31,Default,,0000,0000,0000,,You think of\NOthello, think how
Dialogue: 0,0:11:28.31,0:11:30.69,Default,,0000,0000,0000,,heavily Medicaid\Ntheir population is.
Dialogue: 0,0:11:30.69,0:11:31.83,Default,,0000,0000,0000,,It's hard to make\Nanything, and
Dialogue: 0,0:11:31.83,0:11:34.34,Default,,0000,0000,0000,,we'll go into why\Nthat is in a minute.
Dialogue: 0,0:11:34.73,0:11:37.49,Default,,0000,0000,0000,,So again, we're\Nstill laying
Dialogue: 0,0:11:37.49,0:11:39.66,Default,,0000,0000,0000,,some framework about\Nhospital Finance
Dialogue: 0,0:11:39.66,0:11:41.57,Default,,0000,0000,0000,,101 because\Nsome of this is
Dialogue: 0,0:11:41.57,0:11:43.27,Default,,0000,0000,0000,,meaningful in\Nhow you approach
Dialogue: 0,0:11:43.27,0:11:44.79,Default,,0000,0000,0000,,services you may provide.
Dialogue: 0,0:11:44.79,0:11:46.25,Default,,0000,0000,0000,,Hospital structures,\Nthese are
Dialogue: 0,0:11:46.25,0:11:47.97,Default,,0000,0000,0000,,really the three\Ntypes of structures,
Dialogue: 0,0:11:47.97,0:11:50.00,Default,,0000,0000,0000,,public, which would\Nbe federal, state,
Dialogue: 0,0:11:50.00,0:11:53.91,Default,,0000,0000,0000,,local ran facilities,
Dialogue: 0,0:11:53.91,0:11:58.08,Default,,0000,0000,0000,,non for profits,\Nand for profits.
Dialogue: 0,0:11:58.08,0:11:59.81,Default,,0000,0000,0000,,In our geographical area,
Dialogue: 0,0:11:59.81,0:12:02.30,Default,,0000,0000,0000,,how many of these do\Nyou think we have?
Dialogue: 0,0:12:02.85,0:12:06.29,Default,,0000,0000,0000,,Think of the quad\Ncities here.
Dialogue: 0,0:12:07.89,0:12:10.10,Default,,0000,0000,0000,,You may not. We have
Dialogue: 0,0:12:10.10,0:12:12.50,Default,,0000,0000,0000,,two public hospital\Ndistricts in this area.
Dialogue: 0,0:12:12.50,0:12:13.50,Default,,0000,0000,0000,,In fact, there are
Dialogue: 0,0:12:13.50,0:12:15.92,Default,,0000,0000,0000,,three public hospital\Ndistricts in this area.
Dialogue: 0,0:12:15.92,0:12:17.54,Default,,0000,0000,0000,,Pullman Regional Hospital,
Dialogue: 0,0:12:17.54,0:12:18.86,Default,,0000,0000,0000,,we're public\Nhospital district.
Dialogue: 0,0:12:18.86,0:12:20.86,Default,,0000,0000,0000,,Number 1A of\NWhitman County
Dialogue: 0,0:12:20.86,0:12:23.26,Default,,0000,0000,0000,,doing business as Pullman\NRegional Hospital.
Dialogue: 0,0:12:23.26,0:12:24.44,Default,,0000,0000,0000,,And then you have
Dialogue: 0,0:12:24.44,0:12:26.52,Default,,0000,0000,0000,,Public Hospital\NDistrict Number 3.
Dialogue: 0,0:12:26.52,0:12:28.13,Default,,0000,0000,0000,,Anybody name who that is?
Dialogue: 0,0:12:28.13,0:12:31.18,Default,,0000,0000,0000,,Whitman. Can anybody name
Dialogue: 0,0:12:31.18,0:12:33.86,Default,,0000,0000,0000,,the other public hospital\Ndistrict Garfield?
Dialogue: 0,0:12:33.86,0:12:36.44,Default,,0000,0000,0000,,Do the hospital\Nin Garfield?
Dialogue: 0,0:12:36.44,0:12:41.70,Default,,0000,0000,0000,,No, they do a\Nassisted living
Dialogue: 0,0:12:41.70,0:12:44.24,Default,,0000,0000,0000,,in home health, but\Nthat's their district.
Dialogue: 0,0:12:44.24,0:12:46.10,Default,,0000,0000,0000,,They used to years\Nand years ago,
Dialogue: 0,0:12:46.10,0:12:47.20,Default,,0000,0000,0000,,there was a hospital,
Dialogue: 0,0:12:47.20,0:12:48.96,Default,,0000,0000,0000,,but they don't\Nhave one now.
Dialogue: 0,0:12:48.96,0:12:50.86,Default,,0000,0000,0000,,So those are\Npublic hospital.
Dialogue: 0,0:12:50.86,0:12:51.96,Default,,0000,0000,0000,,What about non\Nfor profits in
Dialogue: 0,0:12:51.96,0:12:53.48,Default,,0000,0000,0000,,our region? Think of any?
Dialogue: 0,0:12:53.48,0:12:57.07,Default,,0000,0000,0000,,You got Gritman down
Dialogue: 0,0:12:57.07,0:12:59.44,Default,,0000,0000,0000,,the valley, you\Nhave Tristate.
Dialogue: 0,0:12:59.44,0:13:01.52,Default,,0000,0000,0000,,Today, you have\Na for profit in
Dialogue: 0,0:13:01.52,0:13:02.80,Default,,0000,0000,0000,,our backyard you never
Dialogue: 0,0:13:02.80,0:13:04.63,Default,,0000,0000,0000,,had before this last year.
Dialogue: 0,0:13:04.63,0:13:09.52,Default,,0000,0000,0000,,St. Joe's. That will\Nbe a new dynamic.
Dialogue: 0,0:13:09.52,0:13:11.40,Default,,0000,0000,0000,,>> Steve, does Garfield
Dialogue: 0,0:13:11.40,0:13:12.82,Default,,0000,0000,0000,,include the EMS system?
Dialogue: 0,0:13:12.82,0:13:14.26,Default,,0000,0000,0000,,>> It very well could.
Dialogue: 0,0:13:14.26,0:13:16.66,Default,,0000,0000,0000,,So does Garfield's\Nhospital
Dialogue: 0,0:13:16.66,0:13:18.25,Default,,0000,0000,0000,,district include the EMS?
Dialogue: 0,0:13:18.25,0:13:20.20,Default,,0000,0000,0000,,Likely to support that.
Dialogue: 0,0:13:20.20,0:13:22.66,Default,,0000,0000,0000,,I'm not clear on\Nthat, but likely.
Dialogue: 0,0:13:22.66,0:13:25.14,Default,,0000,0000,0000,,They do have\Nsome tax bonds.
Dialogue: 0,0:13:25.14,0:13:27.13,Default,,0000,0000,0000,,So in our population,
Dialogue: 0,0:13:27.13,0:13:29.19,Default,,0000,0000,0000,,you can see this\Nis a distribution
Dialogue: 0,0:13:29.19,0:13:31.45,Default,,0000,0000,0000,,of this across the\NUnited States.
Dialogue: 0,0:13:31.45,0:13:32.95,Default,,0000,0000,0000,,Many are not for profit,
Dialogue: 0,0:13:32.95,0:13:34.31,Default,,0000,0000,0000,,as you can imagine,
Dialogue: 0,0:13:34.31,0:13:36.48,Default,,0000,0000,0000,,supported in one\Nway or another.
Dialogue: 0,0:13:36.48,0:13:37.97,Default,,0000,0000,0000,,Not very many for profits.
Dialogue: 0,0:13:37.97,0:13:39.91,Default,,0000,0000,0000,,In fact, CHS, which is
Dialogue: 0,0:13:39.91,0:13:43.06,Default,,0000,0000,0000,,Community Health\NSystems is one of them.
Dialogue: 0,0:13:44.54,0:13:46.35,Default,,0000,0000,0000,,Almost all of them run
Dialogue: 0,0:13:46.35,0:13:47.49,Default,,0000,0000,0000,,out of Tennessee\Nfor some reason.
Dialogue: 0,0:13:47.49,0:13:48.77,Default,,0000,0000,0000,,I don't know if it's\Na tax advantage or
Dialogue: 0,0:13:48.77,0:13:50.49,Default,,0000,0000,0000,,that's where they all.
Dialogue: 0,0:13:50.49,0:13:52.27,Default,,0000,0000,0000,,RHSC, which actually runs
Dialogue: 0,0:13:52.27,0:13:55.51,Default,,0000,0000,0000,,Tristate is another\None of them.
Dialogue: 0,0:13:55.51,0:13:57.60,Default,,0000,0000,0000,,But many of them\Nare divesting
Dialogue: 0,0:13:57.60,0:13:59.77,Default,,0000,0000,0000,,so if they aren't making\Nmoney, they get out.
Dialogue: 0,0:13:59.77,0:14:01.59,Default,,0000,0000,0000,,I'll tell you,\Nright now, for
Dialogue: 0,0:14:01.59,0:14:02.81,Default,,0000,0000,0000,,profits typically run
Dialogue: 0,0:14:02.81,0:14:05.03,Default,,0000,0000,0000,,margins are\Nworking towards
Dialogue: 0,0:14:05.03,0:14:06.63,Default,,0000,0000,0000,,margins in the\Ndouble digits.
Dialogue: 0,0:14:06.63,0:14:08.25,Default,,0000,0000,0000,,Non for profits\Nare typically
Dialogue: 0,0:14:08.25,0:14:11.05,Default,,0000,0000,0000,,around 1-2% across\Nthe United States,
Dialogue: 0,0:14:11.05,0:14:13.22,Default,,0000,0000,0000,,and we're really no\Ndifferent than that.
Dialogue: 0,0:14:13.22,0:14:14.73,Default,,0000,0000,0000,,You'll have a few that are
Dialogue: 0,0:14:14.73,0:14:16.71,Default,,0000,0000,0000,,higher than that,\Nbut not very many.
Dialogue: 0,0:14:16.71,0:14:18.49,Default,,0000,0000,0000,,You can see how\Nmany are in
Dialogue: 0,0:14:18.49,0:14:21.15,Default,,0000,0000,0000,,urban settings versus\Nrural settings.
Dialogue: 0,0:14:21.15,0:14:25.13,Default,,0000,0000,0000,,So not a complicated\Nsystem at all.
Dialogue: 0,0:14:25.13,0:14:27.06,Default,,0000,0000,0000,,It's very pretty simple.
Dialogue: 0,0:14:27.06,0:14:29.54,Default,,0000,0000,0000,,This is one\Nsegment of that.
Dialogue: 0,0:14:29.54,0:14:31.93,Default,,0000,0000,0000,,Remember, under\Npayment methodologies
Dialogue: 0,0:14:31.93,0:14:33.08,Default,,0000,0000,0000,,we just talked about,
Dialogue: 0,0:14:33.08,0:14:34.73,Default,,0000,0000,0000,,this is one aspect,\Nand this is
Dialogue: 0,0:14:34.73,0:14:37.14,Default,,0000,0000,0000,,just the Affordable\NCare Act, by the way.
Dialogue: 0,0:14:37.14,0:14:39.64,Default,,0000,0000,0000,,And by the way,
Dialogue: 0,0:14:39.64,0:14:43.70,Default,,0000,0000,0000,,you're here. This is you.
Dialogue: 0,0:14:43.70,0:14:46.36,Default,,0000,0000,0000,,So to get paid,\Nthere's really pretty
Dialogue: 0,0:14:46.36,0:14:47.58,Default,,0000,0000,0000,,simple you just got
Dialogue: 0,0:14:47.58,0:14:48.81,Default,,0000,0000,0000,,to work through all\Nof these means.
Dialogue: 0,0:14:48.81,0:14:50.86,Default,,0000,0000,0000,,A lot of regulatory issues
Dialogue: 0,0:14:50.86,0:14:52.64,Default,,0000,0000,0000,,and things so\Npeople wonder why
Dialogue: 0,0:14:52.64,0:14:54.88,Default,,0000,0000,0000,,healthcare is a\Nchallenge in terms of
Dialogue: 0,0:14:54.88,0:14:57.16,Default,,0000,0000,0000,,reimbursement and\Nmaking profit
Dialogue: 0,0:14:57.16,0:14:58.38,Default,,0000,0000,0000,,there are so much.
Dialogue: 0,0:14:58.38,0:15:00.90,Default,,0000,0000,0000,,One of the highest\Nregulated bodies
Dialogue: 0,0:15:00.90,0:15:02.96,Default,,0000,0000,0000,,in the United States\Nis hospitals.
Dialogue: 0,0:15:02.96,0:15:05.14,Default,,0000,0000,0000,,This is just\Nto get payment
Dialogue: 0,0:15:05.14,0:15:06.57,Default,,0000,0000,0000,,under this new\Nhealthcare system.
Dialogue: 0,0:15:06.57,0:15:08.68,Default,,0000,0000,0000,,So there's no\Nadditional taxes
Dialogue: 0,0:15:08.68,0:15:09.85,Default,,0000,0000,0000,,wasted within this at all
Dialogue: 0,0:15:09.85,0:15:11.82,Default,,0000,0000,0000,,it's pretty seamless.
Dialogue: 0,0:15:11.82,0:15:13.52,Default,,0000,0000,0000,,And this is changing\Nall the time, so you
Dialogue: 0,0:15:13.52,0:15:15.16,Default,,0000,0000,0000,,got to learn how\Nto play for it.
Dialogue: 0,0:15:15.16,0:15:16.78,Default,,0000,0000,0000,,This down here, which
Dialogue: 0,0:15:16.78,0:15:18.88,Default,,0000,0000,0000,,is the Medicare\NMedicaid Services,
Dialogue: 0,0:15:18.88,0:15:20.44,Default,,0000,0000,0000,,it's changed\Nsignificantly,
Dialogue: 0,0:15:20.44,0:15:21.66,Default,,0000,0000,0000,,especially under\Nphysicians,
Dialogue: 0,0:15:21.66,0:15:23.48,Default,,0000,0000,0000,,if you recall\Nand how they got
Dialogue: 0,0:15:23.48,0:15:26.06,Default,,0000,0000,0000,,paid just changed\Nthis last year,
Dialogue: 0,0:15:26.06,0:15:30.51,Default,,0000,0000,0000,,and they are going to\Nnow their increases,
Dialogue: 0,0:15:30.51,0:15:36.63,Default,,0000,0000,0000,,which was budgeted\Nand under the SQR,
Dialogue: 0,0:15:36.63,0:15:38.18,Default,,0000,0000,0000,,which was the growth.
Dialogue: 0,0:15:38.18,0:15:40.21,Default,,0000,0000,0000,,That's how they\Ngot additions
Dialogue: 0,0:15:40.21,0:15:41.79,Default,,0000,0000,0000,,every year. Now\Nthey've changed that.
Dialogue: 0,0:15:41.79,0:15:43.39,Default,,0000,0000,0000,,And it's called MACRA, and
Dialogue: 0,0:15:43.39,0:15:45.47,Default,,0000,0000,0000,,the way physicians\Nwill see increases,
Dialogue: 0,0:15:45.47,0:15:47.18,Default,,0000,0000,0000,,there'll be no new money
Dialogue: 0,0:15:47.18,0:15:48.69,Default,,0000,0000,0000,,there'll be winners\Nand losers.
Dialogue: 0,0:15:48.69,0:15:49.97,Default,,0000,0000,0000,,And it's all based on
Dialogue: 0,0:15:49.97,0:15:52.09,Default,,0000,0000,0000,,quality and what your\Nreporting scores are.
Dialogue: 0,0:15:52.09,0:15:53.27,Default,,0000,0000,0000,,And if you do it right,
Dialogue: 0,0:15:53.27,0:15:54.57,Default,,0000,0000,0000,,then your neighbor\Ndoesn't do it
Dialogue: 0,0:15:54.57,0:15:55.81,Default,,0000,0000,0000,,right he loses money,
Dialogue: 0,0:15:55.81,0:15:57.13,Default,,0000,0000,0000,,and you get some\Nof his money
Dialogue: 0,0:15:57.13,0:15:58.61,Default,,0000,0000,0000,,because it's\Nbudget neutral.
Dialogue: 0,0:15:58.61,0:16:00.57,Default,,0000,0000,0000,,And that's the payment\Nincreases that
Dialogue: 0,0:16:00.57,0:16:02.94,Default,,0000,0000,0000,,physicians will see\Nmoving forward.
Dialogue: 0,0:16:02.94,0:16:04.17,Default,,0000,0000,0000,,How many physicians like
Dialogue: 0,0:16:04.17,0:16:06.01,Default,,0000,0000,0000,,to be under that model?
Dialogue: 0,0:16:06.76,0:16:09.35,Default,,0000,0000,0000,,Not many.
Dialogue: 0,0:16:09.35,0:16:12.68,Default,,0000,0000,0000,,How many people have\Nfelt our struggle
Dialogue: 0,0:16:12.68,0:16:14.09,Default,,0000,0000,0000,,even here on a local level
Dialogue: 0,0:16:14.09,0:16:15.71,Default,,0000,0000,0000,,to find a primary\Ncare physician?
Dialogue: 0,0:16:15.71,0:16:17.90,Default,,0000,0000,0000,,A few.
Dialogue: 0,0:16:17.90,0:16:20.06,Default,,0000,0000,0000,,It's been a challenge.
Dialogue: 0,0:16:20.06,0:16:22.46,Default,,0000,0000,0000,,We have people retiring,
Dialogue: 0,0:16:22.46,0:16:24.36,Default,,0000,0000,0000,,and it's hard to recruit.
Dialogue: 0,0:16:24.36,0:16:27.50,Default,,0000,0000,0000,,Pullman's very attractive\Nfrom a destination,
Dialogue: 0,0:16:27.50,0:16:28.67,Default,,0000,0000,0000,,but you can\Nimagine some of
Dialogue: 0,0:16:28.67,0:16:29.90,Default,,0000,0000,0000,,these rural\Ncommunities where it
Dialogue: 0,0:16:29.90,0:16:33.08,Default,,0000,0000,0000,,is really a struggle\Nwhen we struggle.
Dialogue: 0,0:16:33.08,0:16:35.15,Default,,0000,0000,0000,,In fact, we were down in
Dialogue: 0,0:16:35.15,0:16:38.18,Default,,0000,0000,0000,,some of our primary\Ncare practices.
Dialogue: 0,0:16:38.18,0:16:41.03,Default,,0000,0000,0000,,I say our, because it's\Na community when I
Dialogue: 0,0:16:41.03,0:16:42.77,Default,,0000,0000,0000,,think half the\Nproviders they
Dialogue: 0,0:16:42.77,0:16:45.40,Default,,0000,0000,0000,,used to have\Nfour years ago,
Dialogue: 0,0:16:45.40,0:16:48.35,Default,,0000,0000,0000,,and they're trying\Nto recruit in.
Dialogue: 0,0:16:48.35,0:16:49.82,Default,,0000,0000,0000,,It's challenging\Non the market
Dialogue: 0,0:16:49.82,0:16:51.89,Default,,0000,0000,0000,,because why would\Nyou want to do that,
Dialogue: 0,0:16:51.89,0:16:54.36,Default,,0000,0000,0000,,especially under the\Nold payment models?
Dialogue: 0,0:16:54.36,0:16:55.88,Default,,0000,0000,0000,,We're going to talk a\Nlittle bit about that.
Dialogue: 0,0:16:55.88,0:16:57.32,Default,,0000,0000,0000,,The revenue cycle.
Dialogue: 0,0:16:57.32,0:16:58.58,Default,,0000,0000,0000,,So as you think
Dialogue: 0,0:16:58.58,0:17:01.60,Default,,0000,0000,0000,,about Healthcare\NFinance 101,
Dialogue: 0,0:17:01.60,0:17:03.47,Default,,0000,0000,0000,,how we make our money is
Dialogue: 0,0:17:03.47,0:17:05.69,Default,,0000,0000,0000,,through seeing\Nvolume today.
Dialogue: 0,0:17:05.69,0:17:07.49,Default,,0000,0000,0000,,There will be a\Npoint in time,
Dialogue: 0,0:17:07.49,0:17:09.06,Default,,0000,0000,0000,,I think, years from now,
Dialogue: 0,0:17:09.06,0:17:10.76,Default,,0000,0000,0000,,in which the less you see,
Dialogue: 0,0:17:10.76,0:17:12.65,Default,,0000,0000,0000,,the more you make because
Dialogue: 0,0:17:12.65,0:17:14.21,Default,,0000,0000,0000,,it'll be value-based.
Dialogue: 0,0:17:14.21,0:17:15.80,Default,,0000,0000,0000,,You want to keep\Npeople healthy,
Dialogue: 0,0:17:15.80,0:17:16.82,Default,,0000,0000,0000,,which should be\Nreally our mission.
Dialogue: 0,0:17:16.82,0:17:17.78,Default,,0000,0000,0000,,Today, we keep people
Dialogue: 0,0:17:17.78,0:17:18.80,Default,,0000,0000,0000,,healthy that's\Nnot good for
Dialogue: 0,0:17:18.80,0:17:19.82,Default,,0000,0000,0000,,our bottom line,
Dialogue: 0,0:17:19.82,0:17:21.05,Default,,0000,0000,0000,,but it's the right\Nthing to do.
Dialogue: 0,0:17:21.05,0:17:22.66,Default,,0000,0000,0000,,And we're doing\Nthose things today.
Dialogue: 0,0:17:22.66,0:17:24.38,Default,,0000,0000,0000,,We have a whole care\Ncoordination team
Dialogue: 0,0:17:24.38,0:17:25.56,Default,,0000,0000,0000,,over here with
Dialogue: 0,0:17:25.56,0:17:28.61,Default,,0000,0000,0000,,social workers and we
Dialogue: 0,0:17:28.61,0:17:29.78,Default,,0000,0000,0000,,don't get paid a\Ndime for that,
Dialogue: 0,0:17:29.78,0:17:30.71,Default,,0000,0000,0000,,but it's the\Nright thing to
Dialogue: 0,0:17:30.71,0:17:32.26,Default,,0000,0000,0000,,do for our community.
Dialogue: 0,0:17:32.26,0:17:33.89,Default,,0000,0000,0000,,If I was strictly a
Dialogue: 0,0:17:33.89,0:17:35.51,Default,,0000,0000,0000,,for-profit, you know what?
Dialogue: 0,0:17:35.51,0:17:38.51,Default,,0000,0000,0000,,They wouldn't have\Nthat. Your Red Sage
Dialogue: 0,0:17:38.51,0:17:40.22,Default,,0000,0000,0000,,would be open 10:00-2:00.
Dialogue: 0,0:17:40.22,0:17:42.06,Default,,0000,0000,0000,,It wouldn't be\Nopen 7:00-7:00,
Dialogue: 0,0:17:42.06,0:17:44.18,Default,,0000,0000,0000,,because I would be\Ncutting every cost
Dialogue: 0,0:17:44.18,0:17:45.68,Default,,0000,0000,0000,,I could out of\Nthis organization
Dialogue: 0,0:17:45.68,0:17:47.00,Default,,0000,0000,0000,,and putting every dollar I
Dialogue: 0,0:17:47.00,0:17:49.28,Default,,0000,0000,0000,,could to my stockholders.
Dialogue: 0,0:17:49.28,0:17:51.00,Default,,0000,0000,0000,,There would be things\NI wouldn't run.
Dialogue: 0,0:17:51.00,0:17:54.02,Default,,0000,0000,0000,,I would not run\N7.2 physicians
Dialogue: 0,0:17:54.02,0:17:57.05,Default,,0000,0000,0000,,in my emergency\Ndepartment, not 24/7.
Dialogue: 0,0:17:57.05,0:17:58.28,Default,,0000,0000,0000,,I don't have that\Nmany physicians,
Dialogue: 0,0:17:58.28,0:17:59.51,Default,,0000,0000,0000,,but around the clock.
Dialogue: 0,0:17:59.51,0:18:01.82,Default,,0000,0000,0000,,I'd run a bare\Nbones 4.5 FTEs,
Dialogue: 0,0:18:01.82,0:18:03.38,Default,,0000,0000,0000,,run them till the bone\Nand fire and hire
Dialogue: 0,0:18:03.38,0:18:05.66,Default,,0000,0000,0000,,another one coming\Nin two years,
Dialogue: 0,0:18:05.66,0:18:07.24,Default,,0000,0000,0000,,burn them out,\Nget another,
Dialogue: 0,0:18:07.24,0:18:08.54,Default,,0000,0000,0000,,because I could save
Dialogue: 0,0:18:08.54,0:18:10.22,Default,,0000,0000,0000,,hundreds of thousands\Nof dollars.
Dialogue: 0,0:18:10.22,0:18:12.82,Default,,0000,0000,0000,,But the quality of care\Nwouldn't be there,
Dialogue: 0,0:18:12.82,0:18:14.50,Default,,0000,0000,0000,,and you'd just burn\Nthrough people.
Dialogue: 0,0:18:14.50,0:18:15.80,Default,,0000,0000,0000,,It's not that\Ntheir quality is
Dialogue: 0,0:18:15.80,0:18:18.32,Default,,0000,0000,0000,,bad because they still\Nscore very well.
Dialogue: 0,0:18:18.32,0:18:19.52,Default,,0000,0000,0000,,It's the fact that
Dialogue: 0,0:18:19.52,0:18:21.34,Default,,0000,0000,0000,,the experience is\Nmuch different.
Dialogue: 0,0:18:21.34,0:18:23.15,Default,,0000,0000,0000,,I speak from a\Npersonal level
Dialogue: 0,0:18:23.15,0:18:23.81,Default,,0000,0000,0000,,on many of these.
Dialogue: 0,0:18:23.81,0:18:27.34,Default,,0000,0000,0000,,My wife works for\NCHS as a pharmacist.
Dialogue: 0,0:18:27.34,0:18:30.96,Default,,0000,0000,0000,,And I will tell you, it\Nhas been a struggle.
Dialogue: 0,0:18:31.45,0:18:33.98,Default,,0000,0000,0000,,They opened a brand\Nnew facility in
Dialogue: 0,0:18:33.98,0:18:37.97,Default,,0000,0000,0000,,2004, December.\NSound familiar?
Dialogue: 0,0:18:37.97,0:18:40.38,Default,,0000,0000,0000,,We opened ours\Nin December.
Dialogue: 0,0:18:40.38,0:18:44.17,Default,,0000,0000,0000,,They have been burned\Nthrough 15 pharmacists.
Dialogue: 0,0:18:44.17,0:18:46.99,Default,,0000,0000,0000,,They have three\Nat any one time,
Dialogue: 0,0:18:46.99,0:18:48.90,Default,,0000,0000,0000,,and they've burned\Nthrough 15 pharmacists
Dialogue: 0,0:18:48.90,0:18:51.18,Default,,0000,0000,0000,,since she started\Nto today.
Dialogue: 0,0:18:51.18,0:18:53.71,Default,,0000,0000,0000,,We've had one retire.
Dialogue: 0,0:18:53.71,0:18:55.72,Default,,0000,0000,0000,,Tells you a little\Ndifference of
Dialogue: 0,0:18:55.72,0:18:57.79,Default,,0000,0000,0000,,the culture because it's
Dialogue: 0,0:18:57.79,0:18:58.66,Default,,0000,0000,0000,,not about the people,
Dialogue: 0,0:18:58.66,0:19:00.06,Default,,0000,0000,0000,,it's about the\Nbottom line.
Dialogue: 0,0:19:00.06,0:19:02.14,Default,,0000,0000,0000,,So when you think\Nabout revenue cycle,
Dialogue: 0,0:19:02.14,0:19:05.04,Default,,0000,0000,0000,,you think zero to zero.
Dialogue: 0,0:19:05.04,0:19:06.40,Default,,0000,0000,0000,,You'll all be experts.
Dialogue: 0,0:19:06.40,0:19:07.50,Default,,0000,0000,0000,,You can start consulting
Dialogue: 0,0:19:07.50,0:19:09.12,Default,,0000,0000,0000,,businesses after tonight,
Dialogue: 0,0:19:09.12,0:19:11.75,Default,,0000,0000,0000,,because not very many people\Nreally understand this.
Dialogue: 0,0:19:11.75,0:19:13.94,Default,,0000,0000,0000,,Zero to zero. How\Nmuch do you owe when
Dialogue: 0,0:19:13.94,0:19:14.75,Default,,0000,0000,0000,,you come in and do
Dialogue: 0,0:19:14.75,0:19:16.92,Default,,0000,0000,0000,,registration or you\Ncome in for a lab?
Dialogue: 0,0:19:16.92,0:19:18.38,Default,,0000,0000,0000,,Before you have that down,
Dialogue: 0,0:19:18.38,0:19:19.46,Default,,0000,0000,0000,,how much do you\Nowe the hospital?
Dialogue: 0,0:19:19.46,0:19:20.00,Default,,0000,0000,0000,,Nothing.
Dialogue: 0,0:19:20.00,0:19:22.25,Default,,0000,0000,0000,,You come in, you have\Nthat service when
Dialogue: 0,0:19:22.25,0:19:23.84,Default,,0000,0000,0000,,you have that surgery,
Dialogue: 0,0:19:23.84,0:19:25.79,Default,,0000,0000,0000,,whatever, you go\Nthrough a process.
Dialogue: 0,0:19:25.79,0:19:27.34,Default,,0000,0000,0000,,You hit registration.
Dialogue: 0,0:19:27.34,0:19:29.24,Default,,0000,0000,0000,,Within that\Nregistration process,
Dialogue: 0,0:19:29.24,0:19:29.99,Default,,0000,0000,0000,,there's things\Nthat should have
Dialogue: 0,0:19:29.99,0:19:31.07,Default,,0000,0000,0000,,happened either before or
Dialogue: 0,0:19:31.07,0:19:33.84,Default,,0000,0000,0000,,happened during\Nwith authorization.
Dialogue: 0,0:19:33.84,0:19:35.90,Default,,0000,0000,0000,,Does your insurance\Nauthorize you to do this?
Dialogue: 0,0:19:35.90,0:19:37.22,Default,,0000,0000,0000,,Did you have to\Nhave a referral?
Dialogue: 0,0:19:37.22,0:19:37.88,Default,,0000,0000,0000,,If you didn't have to have
Dialogue: 0,0:19:37.88,0:19:38.63,Default,,0000,0000,0000,,a referral, I'm sorry,
Dialogue: 0,0:19:38.63,0:19:39.29,Default,,0000,0000,0000,,you'll have to go back to
Dialogue: 0,0:19:39.29,0:19:41.00,Default,,0000,0000,0000,,your primary care,\Nget the referral.
Dialogue: 0,0:19:41.00,0:19:42.02,Default,,0000,0000,0000,,Then when you can\Ncome back, we'll have
Dialogue: 0,0:19:42.02,0:19:43.36,Default,,0000,0000,0000,,the procedure after that.
Dialogue: 0,0:19:43.36,0:19:44.93,Default,,0000,0000,0000,,If not, and they didn't
Dialogue: 0,0:19:44.93,0:19:46.61,Default,,0000,0000,0000,,require a referral or\Nwe had the referral,
Dialogue: 0,0:19:46.61,0:19:48.20,Default,,0000,0000,0000,,then we have to have\Nauthorization because
Dialogue: 0,0:19:48.20,0:19:49.19,Default,,0000,0000,0000,,if we don't have\Nauthorization,
Dialogue: 0,0:19:49.19,0:19:50.21,Default,,0000,0000,0000,,they won't pay us.
Dialogue: 0,0:19:50.21,0:19:51.100,Default,,0000,0000,0000,,And if we miss that\Nstep, it goes what?
Dialogue: 0,0:19:51.100,0:19:54.50,Default,,0000,0000,0000,,We're out, or we fight\Ninsurance companies.
Dialogue: 0,0:19:54.50,0:19:56.70,Default,,0000,0000,0000,,We write a few letters.
Dialogue: 0,0:19:56.70,0:19:57.98,Default,,0000,0000,0000,,I'll tell you this year is
Dialogue: 0,0:19:57.98,0:19:59.00,Default,,0000,0000,0000,,much better than before.
Dialogue: 0,0:19:59.00,0:20:01.22,Default,,0000,0000,0000,,We've had 64\Ndenied claims.
Dialogue: 0,0:20:01.22,0:20:01.94,Default,,0000,0000,0000,,Last year, at this time we
Dialogue: 0,0:20:01.94,0:20:03.62,Default,,0000,0000,0000,,had 250 denied claims.
Dialogue: 0,0:20:03.62,0:20:06.44,Default,,0000,0000,0000,,Jumping through insurance\Ncompanies' hoops
Dialogue: 0,0:20:06.44,0:20:08.99,Default,,0000,0000,0000,,on trying to get paid.\NThat's this process.
Dialogue: 0,0:20:08.99,0:20:10.70,Default,,0000,0000,0000,,Registration, insurance\Nverification,
Dialogue: 0,0:20:10.70,0:20:12.10,Default,,0000,0000,0000,,point of service\Ncollection.
Dialogue: 0,0:20:12.10,0:20:13.46,Default,,0000,0000,0000,,We don't do a\Nton of that here
Dialogue: 0,0:20:13.46,0:20:14.90,Default,,0000,0000,0000,,because our people\Nare very good
Dialogue: 0,0:20:14.90,0:20:16.31,Default,,0000,0000,0000,,here in Pullman about
Dialogue: 0,0:20:16.31,0:20:17.80,Default,,0000,0000,0000,,paying for their services.
Dialogue: 0,0:20:17.80,0:20:18.62,Default,,0000,0000,0000,,Some places,
Dialogue: 0,0:20:18.62,0:20:19.82,Default,,0000,0000,0000,,they'll require\Nyou to almost pay
Dialogue: 0,0:20:19.82,0:20:20.87,Default,,0000,0000,0000,,your deductible upfront
Dialogue: 0,0:20:20.87,0:20:22.49,Default,,0000,0000,0000,,before they'll\Never treat you.
Dialogue: 0,0:20:22.49,0:20:24.44,Default,,0000,0000,0000,,Financial clearance\Nall the way
Dialogue: 0,0:20:24.44,0:20:26.81,Default,,0000,0000,0000,,through till the\Nvery back end of it.
Dialogue: 0,0:20:26.81,0:20:29.04,Default,,0000,0000,0000,,After we do all of\Nthe billing process,
Dialogue: 0,0:20:29.04,0:20:30.43,Default,,0000,0000,0000,,insurance pays, we go out,
Dialogue: 0,0:20:30.43,0:20:31.60,Default,,0000,0000,0000,,we collect the deductible,
Dialogue: 0,0:20:31.60,0:20:34.00,Default,,0000,0000,0000,,we write off the\Ncontractual write-off,
Dialogue: 0,0:20:34.00,0:20:36.74,Default,,0000,0000,0000,,that account goes to\Nzero, zero to zero.
Dialogue: 0,0:20:36.74,0:20:38.100,Default,,0000,0000,0000,,That's the revenue cycle.
Dialogue: 0,0:20:38.100,0:20:42.85,Default,,0000,0000,0000,,All of those things\Nhave to flow
Dialogue: 0,0:20:42.85,0:20:45.61,Default,,0000,0000,0000,,very fluidly in\Norder to get there.
Dialogue: 0,0:20:45.61,0:20:47.72,Default,,0000,0000,0000,,Sometimes they\Nwork seamlessly.
Dialogue: 0,0:20:47.72,0:20:50.66,Default,,0000,0000,0000,,We can get paid 14\Ndays and be done.
Dialogue: 0,0:20:50.66,0:20:53.14,Default,,0000,0000,0000,,On average, Pullman\NRegional Hospital takes
Dialogue: 0,0:20:53.14,0:20:56.45,Default,,0000,0000,0000,,34 days to collect\Nzero to zero.
Dialogue: 0,0:20:56.95,0:20:59.93,Default,,0000,0000,0000,,How's that compare\Nacross the nation?
Dialogue: 0,0:20:59.93,0:21:01.88,Default,,0000,0000,0000,,Across the nation, it's\Ngotten much better.
Dialogue: 0,0:21:01.88,0:21:03.02,Default,,0000,0000,0000,,It used to be\Naround 50 days.
Dialogue: 0,0:21:03.02,0:21:05.80,Default,,0000,0000,0000,,Now it's about 48 days\Nacross the nation.
Dialogue: 0,0:21:05.80,0:21:07.04,Default,,0000,0000,0000,,We do very well here,
Dialogue: 0,0:21:07.04,0:21:08.46,Default,,0000,0000,0000,,and we've got good payers.
Dialogue: 0,0:21:08.46,0:21:10.43,Default,,0000,0000,0000,,And some of them,\Nyou can get
Dialogue: 0,0:21:10.43,0:21:11.64,Default,,0000,0000,0000,,this whole process done
Dialogue: 0,0:21:11.64,0:21:13.20,Default,,0000,0000,0000,,within a couple of weeks.
Dialogue: 0,0:21:13.20,0:21:15.64,Default,,0000,0000,0000,,Sometimes it's\Nnot that easy.
Dialogue: 0,0:21:15.64,0:21:16.91,Default,,0000,0000,0000,,We still have accounts
Dialogue: 0,0:21:16.91,0:21:17.90,Default,,0000,0000,0000,,that we're working\Non that are
Dialogue: 0,0:21:17.90,0:21:20.64,Default,,0000,0000,0000,,almost a year\Nold. Got denied.
Dialogue: 0,0:21:20.64,0:21:22.04,Default,,0000,0000,0000,,We appealed the denial
Dialogue: 0,0:21:22.04,0:21:23.15,Default,,0000,0000,0000,,because they didn't\Ntell us they
Dialogue: 0,0:21:23.15,0:21:24.35,Default,,0000,0000,0000,,changed the rule\Non what had
Dialogue: 0,0:21:24.35,0:21:25.86,Default,,0000,0000,0000,,to be authorized\Nbeforehand.
Dialogue: 0,0:21:25.86,0:21:27.05,Default,,0000,0000,0000,,We had the physician write
Dialogue: 0,0:21:27.05,0:21:29.00,Default,,0000,0000,0000,,that this is appropriate.
Dialogue: 0,0:21:29.00,0:21:30.54,Default,,0000,0000,0000,,They are in review.
Dialogue: 0,0:21:30.54,0:21:31.88,Default,,0000,0000,0000,,They deny it. We go\Nback through it,
Dialogue: 0,0:21:31.88,0:21:32.66,Default,,0000,0000,0000,,and we fight it.
Dialogue: 0,0:21:32.66,0:21:34.61,Default,,0000,0000,0000,,We finally get it\Npaid, or a patient
Dialogue: 0,0:21:34.61,0:21:36.100,Default,,0000,0000,0000,,comes in and they\Nsay I have Primera.
Dialogue: 0,0:21:36.100,0:21:38.68,Default,,0000,0000,0000,,Give you the card.
Dialogue: 0,0:21:38.68,0:21:40.01,Default,,0000,0000,0000,,Come to find out, shoot,
Dialogue: 0,0:21:40.01,0:21:41.62,Default,,0000,0000,0000,,no, I don't. We changed.
Dialogue: 0,0:21:41.62,0:21:43.07,Default,,0000,0000,0000,,But you don't get\Nthat until you get
Dialogue: 0,0:21:43.07,0:21:44.39,Default,,0000,0000,0000,,the denial from the\Ninsurance company.
Dialogue: 0,0:21:44.39,0:21:45.95,Default,,0000,0000,0000,,You go back through\Nand they go,
Dialogue: 0,0:21:45.95,0:21:46.56,Default,,0000,0000,0000,,no, I haven't.
Dialogue: 0,0:21:46.56,0:21:47.15,Default,,0000,0000,0000,,Then they give you
Dialogue: 0,0:21:47.15,0:21:48.14,Default,,0000,0000,0000,,a different card\Nand you go through
Dialogue: 0,0:21:48.14,0:21:51.30,Default,,0000,0000,0000,,that process and\Nit takes time.
Dialogue: 0,0:21:51.61,0:21:54.11,Default,,0000,0000,0000,,So this is just\Nhow this segment
Dialogue: 0,0:21:54.11,0:21:55.74,Default,,0000,0000,0000,,would work zero to zero.
Dialogue: 0,0:21:55.74,0:21:57.05,Default,,0000,0000,0000,,You schedule, you come in,
Dialogue: 0,0:21:57.05,0:21:59.39,Default,,0000,0000,0000,,you check eligibility,\Nyou treat, you code.
Dialogue: 0,0:21:59.39,0:22:00.53,Default,,0000,0000,0000,,The coding aspect,
Dialogue: 0,0:22:00.53,0:22:01.67,Default,,0000,0000,0000,,that's your\Nmedical records.
Dialogue: 0,0:22:01.67,0:22:02.87,Default,,0000,0000,0000,,Once it gets coded,
Dialogue: 0,0:22:02.87,0:22:04.26,Default,,0000,0000,0000,,and by the way,\Ndo this right.
Dialogue: 0,0:22:04.26,0:22:07.42,Default,,0000,0000,0000,,So one thing, let's say\Nyou had a total hip.
Dialogue: 0,0:22:07.42,0:22:09.23,Default,,0000,0000,0000,,If the physician didn't\Nwrite that he put
Dialogue: 0,0:22:09.23,0:22:11.51,Default,,0000,0000,0000,,the device in\Nand didn't chart
Dialogue: 0,0:22:11.51,0:22:13.79,Default,,0000,0000,0000,,that he put the device in
Dialogue: 0,0:22:13.79,0:22:16.18,Default,,0000,0000,0000,,but you are\Nwalking around,
Dialogue: 0,0:22:16.18,0:22:17.86,Default,,0000,0000,0000,,evident that you really\Nhad a total hip,
Dialogue: 0,0:22:17.86,0:22:18.59,Default,,0000,0000,0000,,we don't get paid
Dialogue: 0,0:22:18.59,0:22:20.16,Default,,0000,0000,0000,,because it wasn't\Ndocumented.
Dialogue: 0,0:22:20.16,0:22:21.71,Default,,0000,0000,0000,,So if you didn't document,
Dialogue: 0,0:22:21.71,0:22:24.50,Default,,0000,0000,0000,,it doesn't matter if\Nyou did it or not.
Dialogue: 0,0:22:24.50,0:22:26.33,Default,,0000,0000,0000,,You didn't do it. So you
Dialogue: 0,0:22:26.33,0:22:27.71,Default,,0000,0000,0000,,got to document for\Neverything you do.
Dialogue: 0,0:22:27.71,0:22:30.52,Default,,0000,0000,0000,,So a lot of this is\Nmaking sure we educate,
Dialogue: 0,0:22:30.52,0:22:32.06,Default,,0000,0000,0000,,train, and then you
Dialogue: 0,0:22:32.06,0:22:33.44,Default,,0000,0000,0000,,go through the whole\Ncollection process,
Dialogue: 0,0:22:33.44,0:22:34.76,Default,,0000,0000,0000,,which is active\Ncollections,
Dialogue: 0,0:22:34.76,0:22:37.94,Default,,0000,0000,0000,,insurance billing,\Npost collection,
Dialogue: 0,0:22:37.94,0:22:39.54,Default,,0000,0000,0000,,which if somebody\Ndidn't pay,
Dialogue: 0,0:22:39.54,0:22:40.82,Default,,0000,0000,0000,,how do you collect that,
Dialogue: 0,0:22:40.82,0:22:41.90,Default,,0000,0000,0000,,all the way to legal
Dialogue: 0,0:22:41.90,0:22:43.85,Default,,0000,0000,0000,,where you might do liens.
Dialogue: 0,0:22:43.85,0:22:46.85,Default,,0000,0000,0000,,Many times, hopefully,\Nit goes very clearly,
Dialogue: 0,0:22:46.85,0:22:49.22,Default,,0000,0000,0000,,but sometimes it\Ndoesn't work as well.
Dialogue: 0,0:22:49.22,0:22:51.35,Default,,0000,0000,0000,,So this is just\Nanother aspect of
Dialogue: 0,0:22:51.35,0:22:53.78,Default,,0000,0000,0000,,that. This is one bill.
Dialogue: 0,0:22:53.78,0:22:55.58,Default,,0000,0000,0000,,Fifty percent of\Neverything we
Dialogue: 0,0:22:55.58,0:22:57.64,Default,,0000,0000,0000,,do is going to be done\Non the front end.
Dialogue: 0,0:22:57.64,0:22:59.30,Default,,0000,0000,0000,,And most hospitals in
Dialogue: 0,0:22:59.30,0:23:00.32,Default,,0000,0000,0000,,the past haven't treated
Dialogue: 0,0:23:00.32,0:23:04.34,Default,,0000,0000,0000,,the registration staff\Nas a key player.
Dialogue: 0,0:23:04.34,0:23:06.77,Default,,0000,0000,0000,,Fifty percent of getting
Dialogue: 0,0:23:06.77,0:23:08.46,Default,,0000,0000,0000,,this right happens there.
Dialogue: 0,0:23:08.46,0:23:09.92,Default,,0000,0000,0000,,If you don't train\Nthose people
Dialogue: 0,0:23:09.92,0:23:12.29,Default,,0000,0000,0000,,and you don't\Nkeep good people,
Dialogue: 0,0:23:12.29,0:23:15.28,Default,,0000,0000,0000,,you got a 50:50 chance\Nof ever getting paid.
Dialogue: 0,0:23:15.28,0:23:20.33,Default,,0000,0000,0000,,We do a very good job\Nmuch better, 2015,
Dialogue: 0,0:23:20.33,0:23:21.50,Default,,0000,0000,0000,,we wrote off almost two
Dialogue: 0,0:23:21.50,0:23:23.16,Default,,0000,0000,0000,,point some million dollars
Dialogue: 0,0:23:23.16,0:23:24.80,Default,,0000,0000,0000,,in process errors and
Dialogue: 0,0:23:24.80,0:23:27.32,Default,,0000,0000,0000,,things because the\Nfront end was bad.
Dialogue: 0,0:23:27.32,0:23:29.44,Default,,0000,0000,0000,,Now, much of\Nthat we denied.
Dialogue: 0,0:23:29.44,0:23:31.20,Default,,0000,0000,0000,,We got denials and stuff.
Dialogue: 0,0:23:31.20,0:23:33.72,Default,,0000,0000,0000,,We had to fight to get\Nevery penny of it,
Dialogue: 0,0:23:33.72,0:23:35.12,Default,,0000,0000,0000,,and we do very\Nwell at that.
Dialogue: 0,0:23:35.12,0:23:36.59,Default,,0000,0000,0000,,But if we fix it\Non the front end,
Dialogue: 0,0:23:36.59,0:23:38.27,Default,,0000,0000,0000,,we don't have to fight\Nit on the back end.
Dialogue: 0,0:23:38.27,0:23:40.37,Default,,0000,0000,0000,,And so we did a\Ntremendous amount
Dialogue: 0,0:23:40.37,0:23:41.92,Default,,0000,0000,0000,,of effort to clean this\Nup on the front end.
Dialogue: 0,0:23:41.92,0:23:44.46,Default,,0000,0000,0000,,And today, it's\Nbasically gone.
Dialogue: 0,0:23:44.46,0:23:46.48,Default,,0000,0000,0000,,Fifteen percent is in
Dialogue: 0,0:23:46.48,0:23:47.96,Default,,0000,0000,0000,,the actual\Nmedical records,
Dialogue: 0,0:23:47.96,0:23:49.55,Default,,0000,0000,0000,,so the coding\Naspect of this.
Dialogue: 0,0:23:49.55,0:23:51.12,Default,,0000,0000,0000,,This is when it\Ngoes through
Dialogue: 0,0:23:51.12,0:23:53.64,Default,,0000,0000,0000,,our coders, inpatient\Noutpatient.
Dialogue: 0,0:23:53.64,0:23:55.16,Default,,0000,0000,0000,,They read the documents.
Dialogue: 0,0:23:55.16,0:23:56.45,Default,,0000,0000,0000,,What was documented?
Dialogue: 0,0:23:56.45,0:23:58.90,Default,,0000,0000,0000,,What should that CPT be?
Dialogue: 0,0:23:58.90,0:24:00.68,Default,,0000,0000,0000,,Make sure they code\Nall of that out
Dialogue: 0,0:24:00.68,0:24:03.30,Default,,0000,0000,0000,,that DRG, that's\Ntheir job.
Dialogue: 0,0:24:03.30,0:24:04.82,Default,,0000,0000,0000,,If they do very\Nwell at that,
Dialogue: 0,0:24:04.82,0:24:05.93,Default,,0000,0000,0000,,we get paid well.
Dialogue: 0,0:24:05.93,0:24:07.88,Default,,0000,0000,0000,,And then 15% is on
Dialogue: 0,0:24:07.88,0:24:10.36,Default,,0000,0000,0000,,the charge entry\Nnow charges.
Dialogue: 0,0:24:10.36,0:24:12.41,Default,,0000,0000,0000,,So this happens here.
Dialogue: 0,0:24:12.41,0:24:13.61,Default,,0000,0000,0000,,I've talked to nurses.
Dialogue: 0,0:24:13.61,0:24:15.42,Default,,0000,0000,0000,,I've talked to staff\Nmany times saying,
Dialogue: 0,0:24:15.42,0:24:17.27,Default,,0000,0000,0000,,don't make the decision on
Dialogue: 0,0:24:17.27,0:24:19.36,Default,,0000,0000,0000,,what should be charged\Nto the patient or not.
Dialogue: 0,0:24:19.36,0:24:22.67,Default,,0000,0000,0000,,Document\Neffectively so that
Dialogue: 0,0:24:22.67,0:24:24.34,Default,,0000,0000,0000,,we can bill appropriately.
Dialogue: 0,0:24:24.34,0:24:25.73,Default,,0000,0000,0000,,Because if you document
Dialogue: 0,0:24:25.73,0:24:27.08,Default,,0000,0000,0000,,what we did, then\Nwe can bill.
Dialogue: 0,0:24:27.08,0:24:28.46,Default,,0000,0000,0000,,If somebody can't\Npay, I have
Dialogue: 0,0:24:28.46,0:24:29.98,Default,,0000,0000,0000,,all ways to be\Nable to help them,
Dialogue: 0,0:24:29.98,0:24:34.01,Default,,0000,0000,0000,,charity care\Npayment terms.
Dialogue: 0,0:24:34.01,0:24:37.10,Default,,0000,0000,0000,,Let's pay it over\N12 months, etc.
Dialogue: 0,0:24:37.10,0:24:37.88,Default,,0000,0000,0000,,Those types of things I
Dialogue: 0,0:24:37.88,0:24:38.98,Default,,0000,0000,0000,,can help patients with.
Dialogue: 0,0:24:38.98,0:24:40.31,Default,,0000,0000,0000,,But if the nurse upfront
Dialogue: 0,0:24:40.31,0:24:42.28,Default,,0000,0000,0000,,decides the poor\Ncollege student,
Dialogue: 0,0:24:42.28,0:24:44.27,Default,,0000,0000,0000,,they're probably only\Neating Top Ramen.
Dialogue: 0,0:24:44.27,0:24:45.65,Default,,0000,0000,0000,,Let's not bill them.
Dialogue: 0,0:24:45.65,0:24:46.55,Default,,0000,0000,0000,,I won't charge\Nthem for that.
Dialogue: 0,0:24:46.55,0:24:47.93,Default,,0000,0000,0000,,They don't look like\Nthey should be.
Dialogue: 0,0:24:47.93,0:24:50.54,Default,,0000,0000,0000,,Then I have to\Nraise charges
Dialogue: 0,0:24:50.54,0:24:51.95,Default,,0000,0000,0000,,somewhere else to cover
Dialogue: 0,0:24:51.95,0:24:53.20,Default,,0000,0000,0000,,that. That's a\Nloss leader.
Dialogue: 0,0:24:53.20,0:24:54.78,Default,,0000,0000,0000,,So we aren't pricing
Dialogue: 0,0:24:54.78,0:24:57.22,Default,,0000,0000,0000,,effectively for\Neverybody else.
Dialogue: 0,0:24:57.22,0:24:59.48,Default,,0000,0000,0000,,We have means by\Nwhich to handle that.
Dialogue: 0,0:24:59.48,0:25:00.92,Default,,0000,0000,0000,,So let's just bill\Nappropriately.
Dialogue: 0,0:25:00.92,0:25:03.29,Default,,0000,0000,0000,,So that's part of that\Ncharge entry side.
Dialogue: 0,0:25:03.29,0:25:04.49,Default,,0000,0000,0000,,That's what they do.
Dialogue: 0,0:25:04.49,0:25:06.12,Default,,0000,0000,0000,,And then the\Nbilling aspect,
Dialogue: 0,0:25:06.12,0:25:07.34,Default,,0000,0000,0000,,which is your financial
Dialogue: 0,0:25:07.34,0:25:08.90,Default,,0000,0000,0000,,services component to it.
Dialogue: 0,0:25:08.90,0:25:09.77,Default,,0000,0000,0000,,So a little bit
Dialogue: 0,0:25:09.77,0:25:10.97,Default,,0000,0000,0000,,about Pullman\NRegional Hospital.
Dialogue: 0,0:25:10.97,0:25:11.96,Default,,0000,0000,0000,,We'll get a little\Nmore specific.
Dialogue: 0,0:25:11.96,0:25:13.88,Default,,0000,0000,0000,,Those are some high-level\Naspects of it.
Dialogue: 0,0:25:13.88,0:25:14.69,Default,,0000,0000,0000,,We're going to\Ndrill down a
Dialogue: 0,0:25:14.69,0:25:15.95,Default,,0000,0000,0000,,little more about\Nwho we are,
Dialogue: 0,0:25:15.95,0:25:18.11,Default,,0000,0000,0000,,what we do and\Nhow it works.
Dialogue: 0,0:25:18.11,0:25:20.03,Default,,0000,0000,0000,,So today, most people
Dialogue: 0,0:25:20.03,0:25:21.82,Default,,0000,0000,0000,,know Pullman\NRegional Hospital.
Dialogue: 0,0:25:21.82,0:25:23.57,Default,,0000,0000,0000,,But I don't know\Nif very many
Dialogue: 0,0:25:23.57,0:25:24.59,Default,,0000,0000,0000,,people know or\Nhow many people
Dialogue: 0,0:25:24.59,0:25:25.73,Default,,0000,0000,0000,,know we have
Dialogue: 0,0:25:25.73,0:25:27.42,Default,,0000,0000,0000,,Pulman Regional Hospital\NClinic Network.
Dialogue: 0,0:25:27.42,0:25:31.64,Default,,0000,0000,0000,,We own today three clinic\Npractices directly,
Dialogue: 0,0:25:31.64,0:25:32.99,Default,,0000,0000,0000,,which are wholly\Nowned means
Dialogue: 0,0:25:32.99,0:25:34.85,Default,,0000,0000,0000,,Pullman Regional\NHospital is 100% owner.
Dialogue: 0,0:25:34.85,0:25:35.87,Default,,0000,0000,0000,,They're as an LLC,
Dialogue: 0,0:25:35.87,0:25:37.82,Default,,0000,0000,0000,,but really they're 100%
Dialogue: 0,0:25:37.82,0:25:38.84,Default,,0000,0000,0000,,owned by the hospital.
Dialogue: 0,0:25:38.84,0:25:43.54,Default,,0000,0000,0000,,That includes\NPalouse Pediatrics,
Dialogue: 0,0:25:43.54,0:25:47.14,Default,,0000,0000,0000,,Palouse Psychology &\NBehavioral Health, and today,
Dialogue: 0,0:25:47.14,0:25:49.04,Default,,0000,0000,0000,,Pullman Family\NMedicine, who just
Dialogue: 0,0:25:49.04,0:25:52.07,Default,,0000,0000,0000,,joined that clinic\Nnetwork as of April 1st.
Dialogue: 0,0:25:52.07,0:25:54.20,Default,,0000,0000,0000,,So we go back and we\Ntalk just a little
Dialogue: 0,0:25:54.20,0:25:55.43,Default,,0000,0000,0000,,bit as to why
Dialogue: 0,0:25:55.43,0:25:57.14,Default,,0000,0000,0000,,we might get into\Nsome of these.
Dialogue: 0,0:25:57.14,0:25:59.82,Default,,0000,0000,0000,,In addition to this,\Nwe have joint ventures
Dialogue: 0,0:25:59.82,0:26:03.00,Default,,0000,0000,0000,,with really three\Ngroups today.
Dialogue: 0,0:26:03.00,0:26:05.02,Default,,0000,0000,0000,,One is Palouse Surgeons.
Dialogue: 0,0:26:05.02,0:26:08.20,Default,,0000,0000,0000,,The other is under\NPalouse Specialties,
Dialogue: 0,0:26:08.20,0:26:11.54,Default,,0000,0000,0000,,which is Palouse ENT\Nand Palouse Urology.
Dialogue: 0,0:26:11.54,0:26:14.03,Default,,0000,0000,0000,,Those are owned\N40% by Pullman,
Dialogue: 0,0:26:14.03,0:26:15.48,Default,,0000,0000,0000,,40% by Gritman,
Dialogue: 0,0:26:15.48,0:26:17.22,Default,,0000,0000,0000,,and 20% by Whitman.
Dialogue: 0,0:26:17.22,0:26:18.80,Default,,0000,0000,0000,,Three hospitals\Ncame together.
Dialogue: 0,0:26:18.80,0:26:20.78,Default,,0000,0000,0000,,Why would we do that?\NThat's craziness.
Dialogue: 0,0:26:20.78,0:26:23.38,Default,,0000,0000,0000,,Let them Let them\Nsink or swim.
Dialogue: 0,0:26:23.38,0:26:27.80,Default,,0000,0000,0000,,You're on your\Nown. Dr. Cagiano,
Dialogue: 0,0:26:27.80,0:26:29.30,Default,,0000,0000,0000,,would we have an emergency\Ndepartment if we
Dialogue: 0,0:26:29.30,0:26:31.92,Default,,0000,0000,0000,,had no general\Nsurgeons there?
Dialogue: 0,0:26:31.92,0:26:34.70,Default,,0000,0000,0000,,>> It wouldn't be a full\Nemergency services.
Dialogue: 0,0:26:34.70,0:26:35.56,Default,,0000,0000,0000,,>> You couldn't even
Dialogue: 0,0:26:35.56,0:26:36.77,Default,,0000,0000,0000,,offer an emergency\Ndepartment
Dialogue: 0,0:26:36.77,0:26:38.08,Default,,0000,0000,0000,,without having a\Ngeneral surgeon.
Dialogue: 0,0:26:38.08,0:26:39.98,Default,,0000,0000,0000,,You could offer\Nan urgent care.
Dialogue: 0,0:26:39.98,0:26:41.69,Default,,0000,0000,0000,,But by rule and\Nregulations,
Dialogue: 0,0:26:41.69,0:26:43.79,Default,,0000,0000,0000,,you couldn't offer an\Nemergency department.
Dialogue: 0,0:26:43.79,0:26:46.10,Default,,0000,0000,0000,,You wouldn't be a\Nhospital without him.
Dialogue: 0,0:26:46.10,0:26:48.18,Default,,0000,0000,0000,,Well, we had that\Nsituation facing us.
Dialogue: 0,0:26:48.18,0:26:49.82,Default,,0000,0000,0000,,We had one general\Nsurgeon on
Dialogue: 0,0:26:49.82,0:26:52.04,Default,,0000,0000,0000,,the Palouse\Nrunning 365 days,
Dialogue: 0,0:26:52.04,0:26:54.65,Default,,0000,0000,0000,,we're doing three\Nhospitals who said enough.
Dialogue: 0,0:26:54.65,0:26:56.24,Default,,0000,0000,0000,,If the hospitals\Ndidn't jump in,
Dialogue: 0,0:26:56.24,0:26:57.59,Default,,0000,0000,0000,,we wouldn't have\Nhad anybody.
Dialogue: 0,0:26:57.59,0:27:00.14,Default,,0000,0000,0000,,And we said, what\Ndo you need?
Dialogue: 0,0:27:00.14,0:27:05.40,Default,,0000,0000,0000,,I will only take call\None week every four.
Dialogue: 0,0:27:05.40,0:27:08.93,Default,,0000,0000,0000,,We got to have three\Nother general surgeons.
Dialogue: 0,0:27:08.93,0:27:10.34,Default,,0000,0000,0000,,That's the standard, so
Dialogue: 0,0:27:10.34,0:27:11.46,Default,,0000,0000,0000,,the three hospitals\Ncome together.
Dialogue: 0,0:27:11.46,0:27:14.70,Default,,0000,0000,0000,,We have four general\Nsurgeons today.
Dialogue: 0,0:27:14.70,0:27:16.85,Default,,0000,0000,0000,,Do they make enough\Nmoney within
Dialogue: 0,0:27:16.85,0:27:18.48,Default,,0000,0000,0000,,their practice to\Npay for themselves?
Dialogue: 0,0:27:18.48,0:27:21.52,Default,,0000,0000,0000,,No. Because, really,
Dialogue: 0,0:27:21.52,0:27:24.29,Default,,0000,0000,0000,,for this community,\Nyou probably need 3.5,
Dialogue: 0,0:27:24.29,0:27:26.48,Default,,0000,0000,0000,,but it's hard to\Nget a half a doc.
Dialogue: 0,0:27:26.48,0:27:28.76,Default,,0000,0000,0000,,They usually come\Nin wholes for
Dialogue: 0,0:27:28.76,0:27:31.04,Default,,0000,0000,0000,,some reason. I don't\Nwant a half a case.
Dialogue: 0,0:27:31.04,0:27:32.92,Default,,0000,0000,0000,,But no, they\Ncome in wholes.
Dialogue: 0,0:27:32.92,0:27:36.44,Default,,0000,0000,0000,,And so there's a subsidy.\NThere's a support.
Dialogue: 0,0:27:36.44,0:27:37.76,Default,,0000,0000,0000,,But the services\Nthey brought into
Dialogue: 0,0:27:37.76,0:27:39.28,Default,,0000,0000,0000,,the hospital offset that.
Dialogue: 0,0:27:39.28,0:27:41.90,Default,,0000,0000,0000,,That's not always true\Nwithin primary care.
Dialogue: 0,0:27:41.90,0:27:43.49,Default,,0000,0000,0000,,But without primary care,
Dialogue: 0,0:27:43.49,0:27:45.76,Default,,0000,0000,0000,,we wouldn't have\Na hospital again
Dialogue: 0,0:27:45.76,0:27:46.97,Default,,0000,0000,0000,,because they had so many
Dialogue: 0,0:27:46.97,0:27:48.62,Default,,0000,0000,0000,,additional tests\Nthat they order.
Dialogue: 0,0:27:48.62,0:27:49.94,Default,,0000,0000,0000,,But under that model,
Dialogue: 0,0:27:49.94,0:27:51.20,Default,,0000,0000,0000,,if we go back and look and
Dialogue: 0,0:27:51.20,0:27:52.43,Default,,0000,0000,0000,,how many people\Nwant to be under
Dialogue: 0,0:27:52.43,0:27:54.08,Default,,0000,0000,0000,,that payment models that
Dialogue: 0,0:27:54.08,0:27:55.49,Default,,0000,0000,0000,,they were physicians\Nespecially?
Dialogue: 0,0:27:55.49,0:27:58.04,Default,,0000,0000,0000,,Physicians coming out\Nof training today,
Dialogue: 0,0:27:58.04,0:27:59.84,Default,,0000,0000,0000,,they want to take\Ncare of patients.
Dialogue: 0,0:27:59.84,0:28:01.24,Default,,0000,0000,0000,,They don't want to run\Ntheir own business.
Dialogue: 0,0:28:01.24,0:28:03.38,Default,,0000,0000,0000,,They want out of the\Ninsurance world.
Dialogue: 0,0:28:03.38,0:28:05.06,Default,,0000,0000,0000,,Who would want to\Ndo that anyway?
Dialogue: 0,0:28:05.06,0:28:07.88,Default,,0000,0000,0000,,It's a pain. They\Nwant to come in.
Dialogue: 0,0:28:07.88,0:28:09.32,Default,,0000,0000,0000,,And by the way,\Nif they come into
Dialogue: 0,0:28:09.32,0:28:11.14,Default,,0000,0000,0000,,Pullman and\Nunder our model,
Dialogue: 0,0:28:11.14,0:28:14.75,Default,,0000,0000,0000,,no, you have to\Nbe a partner.
Dialogue: 0,0:28:14.75,0:28:15.98,Default,,0000,0000,0000,,And by the way,
Dialogue: 0,0:28:15.98,0:28:17.72,Default,,0000,0000,0000,,your pay is\Ngoing to go down
Dialogue: 0,0:28:17.72,0:28:19.97,Default,,0000,0000,0000,,25% next year compared\Nto this year.
Dialogue: 0,0:28:19.97,0:28:21.16,Default,,0000,0000,0000,,Now, where do I sign up?
Dialogue: 0,0:28:21.16,0:28:22.64,Default,,0000,0000,0000,,That sounds really\Ngood to me.
Dialogue: 0,0:28:22.64,0:28:24.30,Default,,0000,0000,0000,,I have no security
Dialogue: 0,0:28:24.30,0:28:25.37,Default,,0000,0000,0000,,for me and my family.
Dialogue: 0,0:28:25.37,0:28:26.68,Default,,0000,0000,0000,,It's not going to happen.
Dialogue: 0,0:28:26.68,0:28:28.49,Default,,0000,0000,0000,,When you can go to\NSpokane and have
Dialogue: 0,0:28:28.49,0:28:30.05,Default,,0000,0000,0000,,an income guarantee
Dialogue: 0,0:28:30.05,0:28:32.33,Default,,0000,0000,0000,,that's out of the gate 30,
Dialogue: 0,0:28:32.33,0:28:34.25,Default,,0000,0000,0000,,40% higher and you know
Dialogue: 0,0:28:34.25,0:28:35.18,Default,,0000,0000,0000,,you're going to get\Npaid that every
Dialogue: 0,0:28:35.18,0:28:36.95,Default,,0000,0000,0000,,year plus\Nprobably a raise.
Dialogue: 0,0:28:36.95,0:28:39.50,Default,,0000,0000,0000,,You wouldn't come.\NThat's part of
Dialogue: 0,0:28:39.50,0:28:41.03,Default,,0000,0000,0000,,the challenges
Dialogue: 0,0:28:41.03,0:28:42.50,Default,,0000,0000,0000,,Pullman's facing\Nwith recruitment.
Dialogue: 0,0:28:42.50,0:28:44.39,Default,,0000,0000,0000,,So today, that's why
Dialogue: 0,0:28:44.39,0:28:45.77,Default,,0000,0000,0000,,physicians coming\Nout of school,
Dialogue: 0,0:28:45.77,0:28:47.15,Default,,0000,0000,0000,,they want an\Nemployment model.
Dialogue: 0,0:28:47.15,0:28:48.47,Default,,0000,0000,0000,,And we have met that.
Dialogue: 0,0:28:48.47,0:28:50.78,Default,,0000,0000,0000,,We have adjusted our\Npractices to meet
Dialogue: 0,0:28:50.78,0:28:53.51,Default,,0000,0000,0000,,those things\Nbecause access
Dialogue: 0,0:28:53.51,0:28:56.10,Default,,0000,0000,0000,,to care is really\Nimportant on the Palouse.
Dialogue: 0,0:28:56.26,0:29:01.80,Default,,0000,0000,0000,,So we have here about\Nalmost 450 employees,
Dialogue: 0,0:29:01.80,0:29:04.46,Default,,0000,0000,0000,,of which 274\Nare full-time,
Dialogue: 0,0:29:04.46,0:29:07.88,Default,,0000,0000,0000,,174 are part-time.
Dialogue: 0,0:29:07.88,0:29:10.94,Default,,0000,0000,0000,,We have a great\Nvolunteer in
Dialogue: 0,0:29:10.94,0:29:12.71,Default,,0000,0000,0000,,auxiliary team that helps
Dialogue: 0,0:29:12.71,0:29:14.64,Default,,0000,0000,0000,,support our services\Nat Pullman.
Dialogue: 0,0:29:14.64,0:29:15.90,Default,,0000,0000,0000,,Some are here\Ntonight, and I
Dialogue: 0,0:29:15.90,0:29:17.33,Default,,0000,0000,0000,,really appreciate that.
Dialogue: 0,0:29:17.33,0:29:20.28,Default,,0000,0000,0000,,And then we have a very\Nactive medical staff.
Dialogue: 0,0:29:20.28,0:29:22.25,Default,,0000,0000,0000,,And the nice thing\Nis, we've been fairly
Dialogue: 0,0:29:22.25,0:29:24.26,Default,,0000,0000,0000,,successful on recruiting,\Nwhich is good.
Dialogue: 0,0:29:24.26,0:29:25.49,Default,,0000,0000,0000,,It continues to\Nbe the case.
Dialogue: 0,0:29:25.49,0:29:27.17,Default,,0000,0000,0000,,So I'm happy to say
Dialogue: 0,0:29:27.17,0:29:29.42,Default,,0000,0000,0000,,that folks haven't\Nheard we have
Dialogue: 0,0:29:29.42,0:29:30.53,Default,,0000,0000,0000,,successfully recruited our
Dialogue: 0,0:29:30.53,0:29:32.12,Default,,0000,0000,0000,,fourth orthopedic\Nsurgeon to
Dialogue: 0,0:29:32.12,0:29:33.89,Default,,0000,0000,0000,,the Palouse who will
Dialogue: 0,0:29:33.89,0:29:35.87,Default,,0000,0000,0000,,be joining the Inland\NOrthopedic Group.
Dialogue: 0,0:29:35.87,0:29:38.42,Default,,0000,0000,0000,,That's awesome.\NThose guys will
Dialogue: 0,0:29:38.42,0:29:39.92,Default,,0000,0000,0000,,be thrilled because that
Dialogue: 0,0:29:39.92,0:29:40.76,Default,,0000,0000,0000,,will make their quality
Dialogue: 0,0:29:40.76,0:29:42.11,Default,,0000,0000,0000,,of life that much better.
Dialogue: 0,0:29:42.11,0:29:44.18,Default,,0000,0000,0000,,On an annual basis,\Nif you go back to
Dialogue: 0,0:29:44.18,0:29:47.09,Default,,0000,0000,0000,,our knowledge base,\Nwe gross build.
Dialogue: 0,0:29:47.09,0:29:48.44,Default,,0000,0000,0000,,This is when we collected.
Dialogue: 0,0:29:48.44,0:29:49.76,Default,,0000,0000,0000,,I'd love it if we did.
Dialogue: 0,0:29:49.76,0:29:51.53,Default,,0000,0000,0000,,Life would be so\Nmuch easier for me.
Dialogue: 0,0:29:51.53,0:29:55.25,Default,,0000,0000,0000,,But we build out 116,\Nalmost $117 million.
Dialogue: 0,0:29:55.25,0:29:56.54,Default,,0000,0000,0000,,Pullman Regional Hospital
Dialogue: 0,0:29:56.54,0:29:57.54,Default,,0000,0000,0000,,isn't a small business.
Dialogue: 0,0:29:57.54,0:29:59.72,Default,,0000,0000,0000,,We have a pretty\Nsubstantial footprint.
Dialogue: 0,0:29:59.72,0:30:01.88,Default,,0000,0000,0000,,Of that, do you know\Nhow much we have at
Dialogue: 0,0:30:01.88,0:30:04.12,Default,,0000,0000,0000,,the end of the day\Nlast year to work with
Dialogue: 0,0:30:04.12,0:30:06.14,Default,,0000,0000,0000,,to pay future bills
Dialogue: 0,0:30:06.14,0:30:08.96,Default,,0000,0000,0000,,like new equipment\Ntechnology?
Dialogue: 0,0:30:08.96,0:30:11.64,Default,,0000,0000,0000,,A million dollars.
Dialogue: 0,0:30:11.64,0:30:15.72,Default,,0000,0000,0000,,Not a very high\Nmargin in healthcare.
Dialogue: 0,0:30:15.85,0:30:18.66,Default,,0000,0000,0000,,Not a lot to work with.
Dialogue: 0,0:30:18.66,0:30:20.51,Default,,0000,0000,0000,,And that is after we had
Dialogue: 0,0:30:20.51,0:30:23.31,Default,,0000,0000,0000,,donations from the\Nfoundations, etc.
Dialogue: 0,0:30:23.35,0:30:26.84,Default,,0000,0000,0000,,We've got to then\Nreinvest in the future,
Dialogue: 0,0:30:26.84,0:30:28.52,Default,,0000,0000,0000,,and that's the\Nway to do it is
Dialogue: 0,0:30:28.52,0:30:30.50,Default,,0000,0000,0000,,by having some type\Nof bottom line.
Dialogue: 0,0:30:30.50,0:30:33.98,Default,,0000,0000,0000,,>> Steve, with\Nthe robotics,
Dialogue: 0,0:30:33.98,0:30:36.28,Default,,0000,0000,0000,,I can't remember\Nhow much that cost,
Dialogue: 0,0:30:36.28,0:30:38.15,Default,,0000,0000,0000,,but we wouldn't have
Dialogue: 0,0:30:38.15,0:30:40.13,Default,,0000,0000,0000,,been able to all do that.
Dialogue: 0,0:30:40.13,0:30:40.82,Default,,0000,0000,0000,,We'll stick with that.
Dialogue: 0,0:30:40.82,0:30:44.14,Default,,0000,0000,0000,,[NOISE] That's\Nyour profit.
Dialogue: 0,0:30:44.14,0:30:46.35,Default,,0000,0000,0000,,Now there's you\Nmillion dollars.
Dialogue: 0,0:30:46.54,0:30:51.23,Default,,0000,0000,0000,,>> So the question was\Nand the comment was,
Dialogue: 0,0:30:51.23,0:30:52.88,Default,,0000,0000,0000,,in terms of robotics,
Dialogue: 0,0:30:52.88,0:30:55.12,Default,,0000,0000,0000,,and many may or may\Nnot know we have
Dialogue: 0,0:30:55.12,0:31:00.28,Default,,0000,0000,0000,,a da Vinci surgically\Nassisted device
Dialogue: 0,0:31:00.28,0:31:03.35,Default,,0000,0000,0000,,in our OR used primarily
Dialogue: 0,0:31:03.35,0:31:07.08,Default,,0000,0000,0000,,for single site incisions,
Dialogue: 0,0:31:07.08,0:31:10.64,Default,,0000,0000,0000,,laparoscopic procedures\Nwhen the recovery
Dialogue: 0,0:31:10.64,0:31:12.56,Default,,0000,0000,0000,,is so much better\Nbecause you don't
Dialogue: 0,0:31:12.56,0:31:14.21,Default,,0000,0000,0000,,have the open incision
Dialogue: 0,0:31:14.21,0:31:15.26,Default,,0000,0000,0000,,and you don't have all of
Dialogue: 0,0:31:15.26,0:31:19.56,Default,,0000,0000,0000,,the after recovery time.
Dialogue: 0,0:31:19.56,0:31:22.13,Default,,0000,0000,0000,,It's pretty seamless.
Dialogue: 0,0:31:22.13,0:31:23.30,Default,,0000,0000,0000,,That's probably\Na wrong word
Dialogue: 0,0:31:23.30,0:31:23.99,Default,,0000,0000,0000,,for an accountant really,
Dialogue: 0,0:31:23.99,0:31:25.07,Default,,0000,0000,0000,,but it seemed to fit.
Dialogue: 0,0:31:25.07,0:31:26.99,Default,,0000,0000,0000,,[LAUGHTER] So\Nit is seamless.
Dialogue: 0,0:31:26.99,0:31:28.97,Default,,0000,0000,0000,,It's pretty much a\Nstitch, and they're done.
Dialogue: 0,0:31:28.97,0:31:30.05,Default,,0000,0000,0000,,But it's amazing what
Dialogue: 0,0:31:30.05,0:31:31.19,Default,,0000,0000,0000,,they can do within that.
Dialogue: 0,0:31:31.19,0:31:33.50,Default,,0000,0000,0000,,That machine alone\Nwas over $1 million.
Dialogue: 0,0:31:33.50,0:31:34.76,Default,,0000,0000,0000,,And we had a lot of
Dialogue: 0,0:31:34.76,0:31:35.96,Default,,0000,0000,0000,,people in the\Ncommunity saying,
Dialogue: 0,0:31:35.96,0:31:37.84,Default,,0000,0000,0000,,man, why would you\Nbuy such a thing?
Dialogue: 0,0:31:37.84,0:31:39.80,Default,,0000,0000,0000,,We were successful,
Dialogue: 0,0:31:39.80,0:31:41.14,Default,,0000,0000,0000,,and our main\Nreason to do it
Dialogue: 0,0:31:41.14,0:31:42.50,Default,,0000,0000,0000,,wasn't because we'd\Nhave an edge in
Dialogue: 0,0:31:42.50,0:31:43.94,Default,,0000,0000,0000,,a market and drive a lot
Dialogue: 0,0:31:43.94,0:31:45.72,Default,,0000,0000,0000,,of business. It\Nwas recruitment.
Dialogue: 0,0:31:45.72,0:31:47.09,Default,,0000,0000,0000,,Folks coming out of
Dialogue: 0,0:31:47.09,0:31:49.25,Default,,0000,0000,0000,,urology school today are
Dialogue: 0,0:31:49.25,0:31:50.96,Default,,0000,0000,0000,,trained on a da Vinci.
Dialogue: 0,0:31:50.96,0:31:52.04,Default,,0000,0000,0000,,Are they going to come to
Dialogue: 0,0:31:52.04,0:31:53.34,Default,,0000,0000,0000,,a market that has none,
Dialogue: 0,0:31:53.34,0:31:54.80,Default,,0000,0000,0000,,and that's the only\Nthing they've known?
Dialogue: 0,0:31:54.80,0:31:57.41,Default,,0000,0000,0000,,No. So we were\Nsuccessful in that,
Dialogue: 0,0:31:57.41,0:32:01.22,Default,,0000,0000,0000,,and Dr. Keizur has a\Npartner now, Dr. Smith.
Dialogue: 0,0:32:01.22,0:32:03.68,Default,,0000,0000,0000,,And that was a\Ngreat value.
Dialogue: 0,0:32:03.68,0:32:05.63,Default,,0000,0000,0000,,Dr. Smith, by the way,
Dialogue: 0,0:32:05.63,0:32:06.92,Default,,0000,0000,0000,,the two of them combined
Dialogue: 0,0:32:06.92,0:32:10.49,Default,,0000,0000,0000,,today are doing\Ntwice the volume.
Dialogue: 0,0:32:10.49,0:32:13.42,Default,,0000,0000,0000,,The volume was there.\NWe didn't get it all.
Dialogue: 0,0:32:13.42,0:32:18.16,Default,,0000,0000,0000,,So now Moscow also\Nvalued from that,
Dialogue: 0,0:32:18.16,0:32:20.80,Default,,0000,0000,0000,,but the whole community\Nvalue from that.
Dialogue: 0,0:32:20.80,0:32:23.04,Default,,0000,0000,0000,,And so it was\Nreally important as
Dialogue: 0,0:32:23.04,0:32:26.35,Default,,0000,0000,0000,,a part of our services\Nthat we offer.
Dialogue: 0,0:32:26.35,0:32:29.67,Default,,0000,0000,0000,,We're going to switch
Dialogue: 0,0:32:29.67,0:32:30.71,Default,,0000,0000,0000,,gears a little bit here,
Dialogue: 0,0:32:30.71,0:32:31.91,Default,,0000,0000,0000,,and that's a lot of this.
Dialogue: 0,0:32:31.91,0:32:33.81,Default,,0000,0000,0000,,If you want more, come
Dialogue: 0,0:32:33.81,0:32:35.50,Default,,0000,0000,0000,,to board meetings,\NStephan.
Dialogue: 0,0:32:35.50,0:32:38.22,Default,,0000,0000,0000,,It's an\Never-evolving thing,
Dialogue: 0,0:32:38.22,0:32:39.36,Default,,0000,0000,0000,,and it'll be\Ndifferent next year.
Dialogue: 0,0:32:39.36,0:32:40.99,Default,,0000,0000,0000,,This presentation would\Nbe different than it
Dialogue: 0,0:32:40.99,0:32:43.11,Default,,0000,0000,0000,,is this year because\Nit's changing every day.
Dialogue: 0,0:32:43.11,0:32:45.81,Default,,0000,0000,0000,,But how does Pullman\NRegional Hospital
Dialogue: 0,0:32:45.81,0:32:47.11,Default,,0000,0000,0000,,develop its prices?
Dialogue: 0,0:32:47.11,0:32:49.10,Default,,0000,0000,0000,,Because that's an\Nimportant question.
Dialogue: 0,0:32:49.10,0:32:52.53,Default,,0000,0000,0000,,Do we price higher\Nthan our competitors?
Dialogue: 0,0:32:52.53,0:32:54.07,Default,,0000,0000,0000,,Do we price\Ndifferently than
Dialogue: 0,0:32:54.07,0:32:56.42,Default,,0000,0000,0000,,our competitors?\NHow do we do it?
Dialogue: 0,0:32:56.42,0:32:57.80,Default,,0000,0000,0000,,I will tell you\Nwhen I first
Dialogue: 0,0:32:57.80,0:33:00.79,Default,,0000,0000,0000,,took over in 1995,
Dialogue: 0,0:33:00.79,0:33:03.21,Default,,0000,0000,0000,,I struggled with\Nhow hospitals,
Dialogue: 0,0:33:03.21,0:33:04.59,Default,,0000,0000,0000,,especially the ones I was
Dialogue: 0,0:33:04.59,0:33:06.21,Default,,0000,0000,0000,,involved with because\NI came out of
Dialogue: 0,0:33:06.21,0:33:08.33,Default,,0000,0000,0000,,trying to combine\NPullman Regional
Dialogue: 0,0:33:08.33,0:33:09.59,Default,,0000,0000,0000,,and Gritman Medical Center
Dialogue: 0,0:33:09.59,0:33:10.99,Default,,0000,0000,0000,,and ran the\Ncorridor for three
Dialogue: 0,0:33:10.99,0:33:12.80,Default,,0000,0000,0000,,years in a joint venture.
Dialogue: 0,0:33:12.80,0:33:13.98,Default,,0000,0000,0000,,I was assistant CFO.
Dialogue: 0,0:33:13.98,0:33:15.43,Default,,0000,0000,0000,,And Gritman did exactly
Dialogue: 0,0:33:15.43,0:33:17.15,Default,,0000,0000,0000,,the same way we did it.
Dialogue: 0,0:33:17.15,0:33:21.18,Default,,0000,0000,0000,,And what you do\Nand what we did,
Dialogue: 0,0:33:21.18,0:33:23.67,Default,,0000,0000,0000,,ashamed of it\Nback then, is
Dialogue: 0,0:33:23.67,0:33:25.12,Default,,0000,0000,0000,,you developed\Na new service.
Dialogue: 0,0:33:25.12,0:33:26.31,Default,,0000,0000,0000,,You went out and\Nfigured out what
Dialogue: 0,0:33:26.31,0:33:27.77,Default,,0000,0000,0000,,the pricing was\Non many of those.
Dialogue: 0,0:33:27.77,0:33:29.53,Default,,0000,0000,0000,,Let's say it's X-ray\Nand you wanted to
Dialogue: 0,0:33:29.53,0:33:31.89,Default,,0000,0000,0000,,do MRs. What's the\Naverage price?
Dialogue: 0,0:33:31.89,0:33:32.97,Default,,0000,0000,0000,,What are other\Npeople charging
Dialogue: 0,0:33:32.97,0:33:34.85,Default,,0000,0000,0000,,for this service?
Dialogue: 0,0:33:34.85,0:33:36.20,Default,,0000,0000,0000,,That's how you\Ndeveloped your prices.
Dialogue: 0,0:33:36.20,0:33:37.43,Default,,0000,0000,0000,,What is CMS\Ngoing to pay us?
Dialogue: 0,0:33:37.43,0:33:39.75,Default,,0000,0000,0000,,Well, CMS pays this and\Nyou two times that.
Dialogue: 0,0:33:39.75,0:33:41.53,Default,,0000,0000,0000,,Just a rule of thumb.\NThat's what you do.
Dialogue: 0,0:33:41.53,0:33:42.61,Default,,0000,0000,0000,,And then every year you're
Dialogue: 0,0:33:42.61,0:33:45.05,Default,,0000,0000,0000,,going in the budget, I\Nthink I'll raise it.
Dialogue: 0,0:33:45.05,0:33:47.02,Default,,0000,0000,0000,,Yeah, 5% sounds good.
Dialogue: 0,0:33:47.02,0:33:48.67,Default,,0000,0000,0000,,And you do that\Nfor 20 years,
Dialogue: 0,0:33:48.67,0:33:53.10,Default,,0000,0000,0000,,and what do your prices\Nreflect? Nothing.
Dialogue: 0,0:33:53.10,0:33:56.11,Default,,0000,0000,0000,,They're meaningless.\NSo we said,
Dialogue: 0,0:33:56.11,0:33:57.85,Default,,0000,0000,0000,,that's not what we want\Nto do in our pricing,
Dialogue: 0,0:33:57.85,0:33:59.29,Default,,0000,0000,0000,,and we want to be\Nfair and adequate.
Dialogue: 0,0:33:59.29,0:34:01.36,Default,,0000,0000,0000,,So we go through\Na structure in
Dialogue: 0,0:34:01.36,0:34:04.34,Default,,0000,0000,0000,,which we evaluate\Nwhat are our costs.
Dialogue: 0,0:34:04.34,0:34:05.89,Default,,0000,0000,0000,,Because we got to\Ncover our cost.
Dialogue: 0,0:34:05.89,0:34:06.67,Default,,0000,0000,0000,,If we don't\Ncover our costs,
Dialogue: 0,0:34:06.67,0:34:09.64,Default,,0000,0000,0000,,we aren't here.\NPretty obvious.
Dialogue: 0,0:34:09.64,0:34:11.84,Default,,0000,0000,0000,,What's our\Nrequired profit?
Dialogue: 0,0:34:11.84,0:34:14.00,Default,,0000,0000,0000,,Nasty word. That's\Na four letter word.
Dialogue: 0,0:34:14.00,0:34:15.61,Default,,0000,0000,0000,,It's actually\Nmore than four,.
Dialogue: 0,0:34:15.61,0:34:19.82,Default,,0000,0000,0000,,No five. No it is\Nsix. I can count.
Dialogue: 0,0:34:19.82,0:34:23.50,Default,,0000,0000,0000,,It's a six-letter\Nword. Profit. We got
Dialogue: 0,0:34:23.50,0:34:24.79,Default,,0000,0000,0000,,to have excess\Nbecause we need to
Dialogue: 0,0:34:24.79,0:34:26.32,Default,,0000,0000,0000,,reinvest back into\Nthe facility.
Dialogue: 0,0:34:26.32,0:34:27.67,Default,,0000,0000,0000,,We have to buy equipment.
Dialogue: 0,0:34:27.67,0:34:28.81,Default,,0000,0000,0000,,We need technology.
Dialogue: 0,0:34:28.81,0:34:29.95,Default,,0000,0000,0000,,If not, you're going
Dialogue: 0,0:34:29.95,0:34:31.42,Default,,0000,0000,0000,,to be obsolete in\Na little while.
Dialogue: 0,0:34:31.42,0:34:35.53,Default,,0000,0000,0000,,And then, really, your\Nprices only matter.
Dialogue: 0,0:34:35.53,0:34:37.94,Default,,0000,0000,0000,,If I was 100% Medicare,
Dialogue: 0,0:34:37.94,0:34:40.54,Default,,0000,0000,0000,,I'll charge you nothing
Dialogue: 0,0:34:40.54,0:34:41.77,Default,,0000,0000,0000,,because I get paid
Dialogue: 0,0:34:41.77,0:34:43.27,Default,,0000,0000,0000,,cost under\NMedicare program.
Dialogue: 0,0:34:43.27,0:34:44.92,Default,,0000,0000,0000,,It doesn't matter\Nwhat I cost.
Dialogue: 0,0:34:44.92,0:34:45.82,Default,,0000,0000,0000,,I don't matter what I
Dialogue: 0,0:34:45.82,0:34:46.93,Default,,0000,0000,0000,,charge because\Nthey're going to tell
Dialogue: 0,0:34:46.93,0:34:47.65,Default,,0000,0000,0000,,me they're going to pay so
Dialogue: 0,0:34:47.65,0:34:49.12,Default,,0000,0000,0000,,why do I matter anyway.
Dialogue: 0,0:34:49.12,0:34:51.50,Default,,0000,0000,0000,,But that's not true\Nacross the board.
Dialogue: 0,0:34:51.50,0:34:52.75,Default,,0000,0000,0000,,It does matter.
Dialogue: 0,0:34:52.75,0:34:55.40,Default,,0000,0000,0000,,So prices have to\Nreflect your pair mix.
Dialogue: 0,0:34:55.40,0:34:57.36,Default,,0000,0000,0000,,What are the\Ninsurance companies?
Dialogue: 0,0:34:57.36,0:34:58.99,Default,,0000,0000,0000,,We go through\Nthat process,
Dialogue: 0,0:34:58.99,0:35:00.24,Default,,0000,0000,0000,,and then we evaluate on
Dialogue: 0,0:35:00.24,0:35:02.86,Default,,0000,0000,0000,,every single price\Ndown to the CPT level,
Dialogue: 0,0:35:02.86,0:35:05.12,Default,,0000,0000,0000,,which is by procedure.
Dialogue: 0,0:35:05.12,0:35:07.64,Default,,0000,0000,0000,,What's our cost\Ncompared to the market?
Dialogue: 0,0:35:07.64,0:35:11.10,Default,,0000,0000,0000,,What's the market? If\Nour costs are too high,
Dialogue: 0,0:35:11.10,0:35:14.44,Default,,0000,0000,0000,,is it fair for me to\Nraise my prices 5%?
Dialogue: 0,0:35:14.44,0:35:16.16,Default,,0000,0000,0000,,Probably not.
Dialogue: 0,0:35:16.16,0:35:18.41,Default,,0000,0000,0000,,I should probably\Ncontrol the cost.
Dialogue: 0,0:35:18.66,0:35:21.67,Default,,0000,0000,0000,,If my costs are\Nwithin reason,
Dialogue: 0,0:35:21.67,0:35:24.79,Default,,0000,0000,0000,,then is it okay to\Nraise 5%? Well, maybe.
Dialogue: 0,0:35:24.79,0:35:26.72,Default,,0000,0000,0000,,But if I have $45 million
Dialogue: 0,0:35:26.72,0:35:29.11,Default,,0000,0000,0000,,in the bank or\N$150 million,
Dialogue: 0,0:35:29.11,0:35:30.67,Default,,0000,0000,0000,,and I want to\Ncharge 10% more,
Dialogue: 0,0:35:30.67,0:35:32.05,Default,,0000,0000,0000,,because as a CFO,
Dialogue: 0,0:35:32.05,0:35:33.73,Default,,0000,0000,0000,,I'd like to have\N180 million.
Dialogue: 0,0:35:33.73,0:35:35.12,Default,,0000,0000,0000,,That's probably not fair,
Dialogue: 0,0:35:35.12,0:35:37.08,Default,,0000,0000,0000,,either 'cause I have\Ntoo much cushion.
Dialogue: 0,0:35:37.08,0:35:38.59,Default,,0000,0000,0000,,Now, I'm gouging.
Dialogue: 0,0:35:38.59,0:35:40.64,Default,,0000,0000,0000,,So we look at\Nthat as well.
Dialogue: 0,0:35:40.64,0:35:42.72,Default,,0000,0000,0000,,So we want to be\Nfair and equitable.
Dialogue: 0,0:35:42.72,0:35:43.69,Default,,0000,0000,0000,,And I don't want to charge
Dialogue: 0,0:35:43.69,0:35:44.53,Default,,0000,0000,0000,,more than the market.
Dialogue: 0,0:35:44.53,0:35:46.56,Default,,0000,0000,0000,,And in our market, we\Nlook at six hospitals.
Dialogue: 0,0:35:46.56,0:35:48.48,Default,,0000,0000,0000,,We have to do blended\Nbecause it would be
Dialogue: 0,0:35:48.48,0:35:51.04,Default,,0000,0000,0000,,collusion if I was to\Ncall Tricity and say,
Dialogue: 0,0:35:51.04,0:35:53.36,Default,,0000,0000,0000,,what do you pay?\NWhat do you charge?
Dialogue: 0,0:35:53.36,0:35:55.60,Default,,0000,0000,0000,,I wouldn't be Ryan, I'd go
Dialogue: 0,0:35:55.60,0:35:57.13,Default,,0000,0000,0000,,jail and I don't\Nlook good in orange.
Dialogue: 0,0:35:57.13,0:36:00.55,Default,,0000,0000,0000,,So we do a compilation\Nof six hospitals,
Dialogue: 0,0:36:00.55,0:36:02.41,Default,,0000,0000,0000,,and we have an external\Ngroup do this.
Dialogue: 0,0:36:02.41,0:36:04.50,Default,,0000,0000,0000,,And we say, what\Nis the price
Dialogue: 0,0:36:04.50,0:36:06.84,Default,,0000,0000,0000,,on an average\Nin the market?
Dialogue: 0,0:36:06.84,0:36:08.68,Default,,0000,0000,0000,,Now, in some areas,\NI will tell you,
Dialogue: 0,0:36:08.68,0:36:10.15,Default,,0000,0000,0000,,specifically an MR,
Dialogue: 0,0:36:10.15,0:36:12.28,Default,,0000,0000,0000,,we were too high\Ntwo years ago.
Dialogue: 0,0:36:12.28,0:36:14.40,Default,,0000,0000,0000,,I had the orthopods\Ncall me and
Dialogue: 0,0:36:14.40,0:36:17.38,Default,,0000,0000,0000,,say they're getting\Na lot cheaper,
Dialogue: 0,0:36:17.38,0:36:18.94,Default,,0000,0000,0000,,and people are starting\Nto shop because
Dialogue: 0,0:36:18.94,0:36:20.71,Default,,0000,0000,0000,,of the fact of high\Ndeductible plans,
Dialogue: 0,0:36:20.71,0:36:22.24,Default,,0000,0000,0000,,where they have $1,500 out
Dialogue: 0,0:36:22.24,0:36:25.03,Default,,0000,0000,0000,,of pocket,\Nthey're shopping.
Dialogue: 0,0:36:25.03,0:36:27.76,Default,,0000,0000,0000,,We need to look at
Dialogue: 0,0:36:27.76,0:36:30.24,Default,,0000,0000,0000,,our market a little\Ntighter than broader.
Dialogue: 0,0:36:30.24,0:36:32.44,Default,,0000,0000,0000,,When you pull Spokane\Nhospitals in,
Dialogue: 0,0:36:32.44,0:36:33.58,Default,,0000,0000,0000,,Tricity hospitals
Dialogue: 0,0:36:33.58,0:36:34.69,Default,,0000,0000,0000,,in they're probably\Ntoo broad.
Dialogue: 0,0:36:34.69,0:36:36.74,Default,,0000,0000,0000,,So we narrowed that\Nmarket and say,
Dialogue: 0,0:36:36.74,0:36:38.89,Default,,0000,0000,0000,,what should we charge\Nfor that service?
Dialogue: 0,0:36:38.89,0:36:41.68,Default,,0000,0000,0000,,And that's how we\Nestablished our prices.
Dialogue: 0,0:36:41.68,0:36:44.64,Default,,0000,0000,0000,,So now getting into
Dialogue: 0,0:36:44.64,0:36:46.44,Default,,0000,0000,0000,,just reimbursement\Nand how we get paid.
Dialogue: 0,0:36:46.44,0:36:48.67,Default,,0000,0000,0000,,Medicare, Medicaid,
Dialogue: 0,0:36:48.67,0:36:51.66,Default,,0000,0000,0000,,people remember in 1997,
Dialogue: 0,0:36:51.66,0:36:55.99,Default,,0000,0000,0000,,the Clinton administration
Dialogue: 0,0:36:55.99,0:36:57.60,Default,,0000,0000,0000,,balanced the budget.
Dialogue: 0,0:36:57.60,0:36:59.54,Default,,0000,0000,0000,,And as a result of that,
Dialogue: 0,0:36:59.54,0:37:01.33,Default,,0000,0000,0000,,there were two\Nhospitals and
Dialogue: 0,0:37:01.33,0:37:03.28,Default,,0000,0000,0000,,rural communities\Nclosing every
Dialogue: 0,0:37:03.28,0:37:05.53,Default,,0000,0000,0000,,week and people not
Dialogue: 0,0:37:05.53,0:37:07.32,Default,,0000,0000,0000,,having access to\Ncare anymore.
Dialogue: 0,0:37:07.32,0:37:09.43,Default,,0000,0000,0000,,It's a bad thing. So\Nthey came out with
Dialogue: 0,0:37:09.43,0:37:11.11,Default,,0000,0000,0000,,this determination
Dialogue: 0,0:37:11.11,0:37:13.44,Default,,0000,0000,0000,,called critical\Naccess hospitals.
Dialogue: 0,0:37:13.44,0:37:18.37,Default,,0000,0000,0000,,It's critical for our\Nweakest population
Dialogue: 0,0:37:18.37,0:37:20.52,Default,,0000,0000,0000,,in terms of Medicaid,
Dialogue: 0,0:37:20.52,0:37:23.11,Default,,0000,0000,0000,,people that can't\Npay in our elders
Dialogue: 0,0:37:23.11,0:37:24.91,Default,,0000,0000,0000,,to be able to access care
Dialogue: 0,0:37:24.91,0:37:26.28,Default,,0000,0000,0000,,in these communities,
Dialogue: 0,0:37:26.28,0:37:27.67,Default,,0000,0000,0000,,we need to do\Nsomething about it
Dialogue: 0,0:37:27.67,0:37:29.70,Default,,0000,0000,0000,,because if we,
Dialogue: 0,0:37:29.70,0:37:31.21,Default,,0000,0000,0000,,federal government\Nnot paying them
Dialogue: 0,0:37:31.21,0:37:33.31,Default,,0000,0000,0000,,enough to stay\Nin existence,
Dialogue: 0,0:37:33.31,0:37:35.38,Default,,0000,0000,0000,,basically, they're not\Ncovering their cost,
Dialogue: 0,0:37:35.38,0:37:36.85,Default,,0000,0000,0000,,there's not enough volume,
Dialogue: 0,0:37:36.85,0:37:38.26,Default,,0000,0000,0000,,and they can't survive.
Dialogue: 0,0:37:38.26,0:37:41.48,Default,,0000,0000,0000,,So that came out. So\NMedicare pays us today,
Dialogue: 0,0:37:41.48,0:37:45.82,Default,,0000,0000,0000,,our cost plus 1%. Now,\NI'll tell you what.
Dialogue: 0,0:37:45.82,0:37:47.44,Default,,0000,0000,0000,,It's not plus one\Nbecause we still
Dialogue: 0,0:37:47.44,0:37:49.24,Default,,0000,0000,0000,,have remember a\Nfew years ago,
Dialogue: 0,0:37:49.24,0:37:50.11,Default,,0000,0000,0000,,sequestration,
Dialogue: 0,0:37:50.11,0:37:51.08,Default,,0000,0000,0000,,Everybody thought\Nthat went away.
Dialogue: 0,0:37:51.08,0:37:53.62,Default,,0000,0000,0000,,It's still not. We\Nget cost minus 1.
Dialogue: 0,0:37:53.62,0:37:54.58,Default,,0000,0000,0000,,So we lose money on
Dialogue: 0,0:37:54.58,0:37:56.96,Default,,0000,0000,0000,,every Medicare\NMedicaid patient.
Dialogue: 0,0:37:57.27,0:38:00.01,Default,,0000,0000,0000,,Doesn't mean we shouldn't\Ntake care of them.
Dialogue: 0,0:38:00.01,0:38:01.58,Default,,0000,0000,0000,,We should care for them.
Dialogue: 0,0:38:01.58,0:38:03.48,Default,,0000,0000,0000,,But we will\Nnever make more.
Dialogue: 0,0:38:03.48,0:38:05.29,Default,,0000,0000,0000,,By the way, I forgot\Nto tell you something.
Dialogue: 0,0:38:05.29,0:38:07.28,Default,,0000,0000,0000,,It's not truly cost.
Dialogue: 0,0:38:07.28,0:38:09.50,Default,,0000,0000,0000,,It's allowable cost.
Dialogue: 0,0:38:09.50,0:38:12.52,Default,,0000,0000,0000,,You know who\Ndetermines allowable?
Dialogue: 0,0:38:12.52,0:38:14.62,Default,,0000,0000,0000,,The federal government.
Dialogue: 0,0:38:14.62,0:38:16.32,Default,,0000,0000,0000,,So you know those\Nsame physicians I
Dialogue: 0,0:38:16.32,0:38:18.03,Default,,0000,0000,0000,,told you about in the\Nemergency department?
Dialogue: 0,0:38:18.03,0:38:19.38,Default,,0000,0000,0000,,Because physicians can
Dialogue: 0,0:38:19.38,0:38:21.04,Default,,0000,0000,0000,,bill a professional fee.
Dialogue: 0,0:38:21.04,0:38:23.19,Default,,0000,0000,0000,,In addition, we build\Nthe technical field,
Dialogue: 0,0:38:23.19,0:38:24.54,Default,,0000,0000,0000,,which is the nursing staff
Dialogue: 0,0:38:24.54,0:38:26.91,Default,,0000,0000,0000,,and the room board.
Dialogue: 0,0:38:26.91,0:38:28.59,Default,,0000,0000,0000,,The way Medicare\Nlooks at it,
Dialogue: 0,0:38:28.59,0:38:29.94,Default,,0000,0000,0000,,then that professional\Nfee covers
Dialogue: 0,0:38:29.94,0:38:31.20,Default,,0000,0000,0000,,that physician cost.
Dialogue: 0,0:38:31.20,0:38:33.33,Default,,0000,0000,0000,,If there are\Nadditional costs,
Dialogue: 0,0:38:33.33,0:38:35.01,Default,,0000,0000,0000,,like you want them 24/7,
Dialogue: 0,0:38:35.01,0:38:35.97,Default,,0000,0000,0000,,but there's not a patient
Dialogue: 0,0:38:35.97,0:38:37.82,Default,,0000,0000,0000,,there, that's\Nyour problem.
Dialogue: 0,0:38:37.82,0:38:39.09,Default,,0000,0000,0000,,That's not our cost.
Dialogue: 0,0:38:39.09,0:38:40.78,Default,,0000,0000,0000,,So that's non allowable.
Dialogue: 0,0:38:40.78,0:38:43.42,Default,,0000,0000,0000,,So it's not 100%\Nof your cost.
Dialogue: 0,0:38:43.42,0:38:44.71,Default,,0000,0000,0000,,It's what Medicare\Nsays will be
Dialogue: 0,0:38:44.71,0:38:46.72,Default,,0000,0000,0000,,100% of your costs.
Dialogue: 0,0:38:46.72,0:38:48.25,Default,,0000,0000,0000,,And then our\Ncommercial players
Dialogue: 0,0:38:48.25,0:38:49.57,Default,,0000,0000,0000,,have to make up\Nthe difference.
Dialogue: 0,0:38:49.57,0:38:50.90,Default,,0000,0000,0000,,This is the rub.
Dialogue: 0,0:38:50.90,0:38:52.99,Default,,0000,0000,0000,,This is where\Ncommercials are fighting
Dialogue: 0,0:38:52.99,0:38:54.19,Default,,0000,0000,0000,,back because
Dialogue: 0,0:38:54.19,0:38:55.42,Default,,0000,0000,0000,,we have employers\Nthat are saying,
Dialogue: 0,0:38:55.42,0:38:56.77,Default,,0000,0000,0000,,wait, I can't have
Dialogue: 0,0:38:56.77,0:38:58.87,Default,,0000,0000,0000,,double digit\Nincreases year
Dialogue: 0,0:38:58.87,0:39:01.08,Default,,0000,0000,0000,,in and year out\Non our premiums.
Dialogue: 0,0:39:01.08,0:39:02.28,Default,,0000,0000,0000,,We say the same thing.
Dialogue: 0,0:39:02.28,0:39:03.49,Default,,0000,0000,0000,,We provide healthcare, and
Dialogue: 0,0:39:03.49,0:39:04.63,Default,,0000,0000,0000,,we don't like\Nit either when
Dialogue: 0,0:39:04.63,0:39:07.45,Default,,0000,0000,0000,,our insurance for\Nour employees
Dialogue: 0,0:39:07.45,0:39:09.37,Default,,0000,0000,0000,,goes up by 10 or 12%.
Dialogue: 0,0:39:09.37,0:39:10.96,Default,,0000,0000,0000,,So we start going,\Nokay, how are we doing
Dialogue: 0,0:39:10.96,0:39:12.42,Default,,0000,0000,0000,,differently? But we're\Npaying ourselves.
Dialogue: 0,0:39:12.42,0:39:14.16,Default,,0000,0000,0000,,I was like, oh, geez,
Dialogue: 0,0:39:14.16,0:39:16.06,Default,,0000,0000,0000,,can we do this\Ndifferently?
Dialogue: 0,0:39:16.06,0:39:18.01,Default,,0000,0000,0000,,So commercials\Nhave really pushed
Dialogue: 0,0:39:18.01,0:39:19.93,Default,,0000,0000,0000,,back on what they\Nused to pay us.
Dialogue: 0,0:39:19.93,0:39:21.28,Default,,0000,0000,0000,,That's why I don't get 95%
Dialogue: 0,0:39:21.28,0:39:22.54,Default,,0000,0000,0000,,of charges anymore.
Dialogue: 0,0:39:22.54,0:39:24.70,Default,,0000,0000,0000,,And now I get 73.5% of
Dialogue: 0,0:39:24.70,0:39:27.30,Default,,0000,0000,0000,,charges by some contracts,
Dialogue: 0,0:39:27.30,0:39:28.57,Default,,0000,0000,0000,,because they're trying to
Dialogue: 0,0:39:28.57,0:39:30.25,Default,,0000,0000,0000,,drive that price down.
Dialogue: 0,0:39:30.25,0:39:32.22,Default,,0000,0000,0000,,>> Are those two\Ncosts the same?
Dialogue: 0,0:39:32.22,0:39:35.95,Default,,0000,0000,0000,,>> So are those two\Ncosts the same? Yes.
Dialogue: 0,0:39:35.95,0:39:37.57,Default,,0000,0000,0000,,>> The left and\Nright of diagram?
Dialogue: 0,0:39:37.57,0:39:39.40,Default,,0000,0000,0000,,>> They are. So it's
Dialogue: 0,0:39:39.40,0:39:42.12,Default,,0000,0000,0000,,your total cost to\Nprovide that service?
Dialogue: 0,0:39:42.12,0:39:45.67,Default,,0000,0000,0000,,>> Is that a\Nvariable cost of
Dialogue: 0,0:39:45.67,0:39:47.05,Default,,0000,0000,0000,,providing that service as
Dialogue: 0,0:39:47.05,0:39:49.86,Default,,0000,0000,0000,,opposed to is there an\Noverhead allocation?
Dialogue: 0,0:39:49.86,0:39:52.80,Default,,0000,0000,0000,,>> Let's go there.\NLet's talk about that.
Dialogue: 0,0:39:52.80,0:39:54.90,Default,,0000,0000,0000,,So when are we\Ngoing to get there?
Dialogue: 0,0:39:54.90,0:39:57.67,Default,,0000,0000,0000,,So yes, and yes,
Dialogue: 0,0:39:57.67,0:39:59.48,Default,,0000,0000,0000,,it is a variable.
Dialogue: 0,0:39:59.48,0:40:03.82,Default,,0000,0000,0000,,But understand in\Nour who we are
Dialogue: 0,0:40:03.82,0:40:06.97,Default,,0000,0000,0000,,from we being a\Nrural hospital,
Dialogue: 0,0:40:06.97,0:40:08.80,Default,,0000,0000,0000,,it's semi-variable.
Dialogue: 0,0:40:08.80,0:40:10.75,Default,,0000,0000,0000,,At only a certain\Nlevel can you
Dialogue: 0,0:40:10.75,0:40:14.59,Default,,0000,0000,0000,,go down before\Nyou hit a floor.
Dialogue: 0,0:40:14.59,0:40:17.46,Default,,0000,0000,0000,,We have to by a\Ncertain amount,
Dialogue: 0,0:40:17.46,0:40:20.58,Default,,0000,0000,0000,,if we're going to offer\N24/7 emergency care,
Dialogue: 0,0:40:20.58,0:40:22.12,Default,,0000,0000,0000,,and I can't have nobody
Dialogue: 0,0:40:22.12,0:40:23.44,Default,,0000,0000,0000,,in there when you show up.
Dialogue: 0,0:40:23.44,0:40:24.58,Default,,0000,0000,0000,,Somebody has to be
Dialogue: 0,0:40:24.58,0:40:25.39,Default,,0000,0000,0000,,there with the\Nlights on to
Dialogue: 0,0:40:25.39,0:40:27.64,Default,,0000,0000,0000,,care for you.\NThat's the floor.
Dialogue: 0,0:40:27.64,0:40:29.35,Default,,0000,0000,0000,,So it's a semi-variable.
Dialogue: 0,0:40:29.35,0:40:31.33,Default,,0000,0000,0000,,So there is some\Nfluctuations
Dialogue: 0,0:40:31.33,0:40:33.16,Default,,0000,0000,0000,,in those costs\Nbased on volume.
Dialogue: 0,0:40:33.16,0:40:34.82,Default,,0000,0000,0000,,But it's really hard, and
Dialogue: 0,0:40:34.82,0:40:36.36,Default,,0000,0000,0000,,I'll share a\Nlittle bit about
Dialogue: 0,0:40:36.36,0:40:37.93,Default,,0000,0000,0000,,Pullman's approach to that
Dialogue: 0,0:40:37.93,0:40:39.97,Default,,0000,0000,0000,,on how you control\Nthose variable costs.
Dialogue: 0,0:40:39.97,0:40:40.66,Default,,0000,0000,0000,,I will tell you
Dialogue: 0,0:40:40.66,0:40:42.70,Default,,0000,0000,0000,,from a productivity\Nstandpoint,
Dialogue: 0,0:40:42.70,0:40:44.46,Default,,0000,0000,0000,,what's the number\None expense
Dialogue: 0,0:40:44.46,0:40:46.27,Default,,0000,0000,0000,,you have in healthcare?
Dialogue: 0,0:40:46.27,0:40:48.16,Default,,0000,0000,0000,,What's your highest cost?
Dialogue: 0,0:40:48.16,0:40:49.28,Default,,0000,0000,0000,,>> People.
Dialogue: 0,0:40:49.44,0:40:53.08,Default,,0000,0000,0000,,>> People. We're a\Nservice industry.
Dialogue: 0,0:40:53.08,0:40:56.65,Default,,0000,0000,0000,,Sixty percent of our\Ncosts relate to people.
Dialogue: 0,0:40:56.65,0:40:57.97,Default,,0000,0000,0000,,What's the\Nnumber one thing
Dialogue: 0,0:40:57.97,0:40:59.76,Default,,0000,0000,0000,,that you try to control?
Dialogue: 0,0:40:59.76,0:41:03.10,Default,,0000,0000,0000,,People. Because I can cut
Dialogue: 0,0:41:03.10,0:41:06.22,Default,,0000,0000,0000,,a lot at trying to\Nchisel down utilities,
Dialogue: 0,0:41:06.22,0:41:07.27,Default,,0000,0000,0000,,but I can't turn off
Dialogue: 0,0:41:07.27,0:41:09.82,Default,,0000,0000,0000,,enough lights if I\Nwas one staff member
Dialogue: 0,0:41:09.82,0:41:12.19,Default,,0000,0000,0000,,less to cover that cost
Dialogue: 0,0:41:12.19,0:41:13.34,Default,,0000,0000,0000,,of turn off all the\Nlights every day
Dialogue: 0,0:41:13.34,0:41:14.100,Default,,0000,0000,0000,,when somebody walked\Nout of the room.
Dialogue: 0,0:41:14.100,0:41:17.02,Default,,0000,0000,0000,,So there is some\Nvariability.
Dialogue: 0,0:41:17.02,0:41:19.66,Default,,0000,0000,0000,,Now, one of the\Nchallenges there is how
Dialogue: 0,0:41:19.66,0:41:23.89,Default,,0000,0000,0000,,predictable are\Nour services.
Dialogue: 0,0:41:23.89,0:41:25.06,Default,,0000,0000,0000,,Can anybody tell me
Dialogue: 0,0:41:25.06,0:41:26.08,Default,,0000,0000,0000,,how many people are\Ngoing to come into
Dialogue: 0,0:41:26.08,0:41:27.10,Default,,0000,0000,0000,,the emergency department
Dialogue: 0,0:41:27.10,0:41:30.12,Default,,0000,0000,0000,,between seven tonight\Nand nine tonight?
Dialogue: 0,0:41:30.12,0:41:32.35,Default,,0000,0000,0000,,Is there a football game?
Dialogue: 0,0:41:32.35,0:41:34.66,Default,,0000,0000,0000,,Probably higher\Npredictability that
Dialogue: 0,0:41:34.66,0:41:35.11,Default,,0000,0000,0000,,I'm going to have
Dialogue: 0,0:41:35.11,0:41:36.70,Default,,0000,0000,0000,,more admissions into
Dialogue: 0,0:41:36.70,0:41:38.83,Default,,0000,0000,0000,,my emergency department\Nthan I have when?
Dialogue: 0,0:41:38.83,0:41:40.74,Default,,0000,0000,0000,,>> And more ambulance\Nruns from the city.
Dialogue: 0,0:41:40.74,0:41:44.53,Default,,0000,0000,0000,,>> Exactly. You can\Nhave some of that,
Dialogue: 0,0:41:44.53,0:41:45.90,Default,,0000,0000,0000,,but it's still variable,
Dialogue: 0,0:41:45.90,0:41:47.65,Default,,0000,0000,0000,,and it doesn't\Nalways come.
Dialogue: 0,0:41:47.65,0:41:51.52,Default,,0000,0000,0000,,When we had the\NApple cup here,
Dialogue: 0,0:41:51.52,0:41:53.38,Default,,0000,0000,0000,,we staffed a whole\Nunit just in
Dialogue: 0,0:41:53.38,0:41:55.39,Default,,0000,0000,0000,,case because\Nthe year before
Dialogue: 0,0:41:55.39,0:41:56.86,Default,,0000,0000,0000,,we were inundated
Dialogue: 0,0:41:56.86,0:41:59.53,Default,,0000,0000,0000,,and we didn't\Nhave that many.
Dialogue: 0,0:41:59.53,0:42:01.56,Default,,0000,0000,0000,,That's the\Nchallenge we run.
Dialogue: 0,0:42:01.56,0:42:03.52,Default,,0000,0000,0000,,We can run on an\Ninpatient unit,
Dialogue: 0,0:42:03.52,0:42:04.78,Default,,0000,0000,0000,,med surg unit,
Dialogue: 0,0:42:04.78,0:42:09.68,Default,,0000,0000,0000,,two inpatients to\N12 inpatients.
Dialogue: 0,0:42:09.68,0:42:11.80,Default,,0000,0000,0000,,And that can be a\Ndifference in hours,
Dialogue: 0,0:42:11.80,0:42:13.66,Default,,0000,0000,0000,,and it can be a\Ndifference in days.
Dialogue: 0,0:42:13.66,0:42:16.30,Default,,0000,0000,0000,,So we have 25 beds\Nacross the board,
Dialogue: 0,0:42:16.30,0:42:18.84,Default,,0000,0000,0000,,OB, ICU, and med surg,
Dialogue: 0,0:42:18.84,0:42:23.12,Default,,0000,0000,0000,,and we can have\Ncensus from 2-25,
Dialogue: 0,0:42:23.12,0:42:24.73,Default,,0000,0000,0000,,and that can be\Nwithin the week,
Dialogue: 0,0:42:24.73,0:42:26.20,Default,,0000,0000,0000,,and then back to\Nfive and then to 10
Dialogue: 0,0:42:26.20,0:42:27.49,Default,,0000,0000,0000,,and it's
Dialogue: 0,0:42:27.49,0:42:29.20,Default,,0000,0000,0000,,really hard to get\Nthat predictability.
Dialogue: 0,0:42:29.20,0:42:31.88,Default,,0000,0000,0000,,How do some hospitals\Ndeal with that?
Dialogue: 0,0:42:31.88,0:42:33.82,Default,,0000,0000,0000,,I'll tell you, a lot of\Nyour for profits etc.
Dialogue: 0,0:42:33.82,0:42:35.70,Default,,0000,0000,0000,,will say, okay, staff,
Dialogue: 0,0:42:35.70,0:42:37.51,Default,,0000,0000,0000,,I hired you full time.
Dialogue: 0,0:42:37.51,0:42:39.28,Default,,0000,0000,0000,,You have a family and\Nkids. That's all right.
Dialogue: 0,0:42:39.28,0:42:40.40,Default,,0000,0000,0000,,Come on in. Well,\Nwe're going to pay you
Dialogue: 0,0:42:40.40,0:42:42.07,Default,,0000,0000,0000,,full time. I'm sorry.
Dialogue: 0,0:42:42.07,0:42:43.12,Default,,0000,0000,0000,,I don't have enough\Npatients, go
Dialogue: 0,0:42:43.12,0:42:46.58,Default,,0000,0000,0000,,home without pay.
Dialogue: 0,0:42:46.58,0:42:47.86,Default,,0000,0000,0000,,I do that to you
Dialogue: 0,0:42:47.86,0:42:49.58,Default,,0000,0000,0000,,three or four\Ntimes this month.
Dialogue: 0,0:42:49.58,0:42:51.49,Default,,0000,0000,0000,,Guess what? You're\Ngoing to the hospital
Dialogue: 0,0:42:51.49,0:42:53.29,Default,,0000,0000,0000,,down the street that\Ndoesn't do that to you.
Dialogue: 0,0:42:53.29,0:42:54.70,Default,,0000,0000,0000,,We don't low census,
Dialogue: 0,0:42:54.70,0:42:55.84,Default,,0000,0000,0000,,and a lot of\Nit's low census.
Dialogue: 0,0:42:55.84,0:42:57.80,Default,,0000,0000,0000,,We don't do a lot of\Nthat here because
Dialogue: 0,0:42:57.80,0:43:01.08,Default,,0000,0000,0000,,your actual turnover rate
Dialogue: 0,0:43:01.08,0:43:02.41,Default,,0000,0000,0000,,increases significantly.
Dialogue: 0,0:43:02.41,0:43:03.28,Default,,0000,0000,0000,,It's better to retain
Dialogue: 0,0:43:03.28,0:43:04.24,Default,,0000,0000,0000,,those employees than it is
Dialogue: 0,0:43:04.24,0:43:06.55,Default,,0000,0000,0000,,to be training new\Nemployees all the time.
Dialogue: 0,0:43:06.55,0:43:08.71,Default,,0000,0000,0000,,That's part of the\Nchallenges we have here.
Dialogue: 0,0:43:08.71,0:43:10.19,Default,,0000,0000,0000,,And that's why\NMedicare decided,
Dialogue: 0,0:43:10.19,0:43:11.58,Default,,0000,0000,0000,,we'll pay you at\Nleast your cost
Dialogue: 0,0:43:11.58,0:43:13.94,Default,,0000,0000,0000,,because when you\Nhave enough volume,
Dialogue: 0,0:43:13.94,0:43:15.64,Default,,0000,0000,0000,,you can cover those\Nloss leaders every
Dialogue: 0,0:43:15.64,0:43:17.58,Default,,0000,0000,0000,,now and then because\Nyou have enough volume,
Dialogue: 0,0:43:17.58,0:43:19.36,Default,,0000,0000,0000,,and your variability\Nis a lot greater.
Dialogue: 0,0:43:19.36,0:43:20.59,Default,,0000,0000,0000,,Here it's not, so that's
Dialogue: 0,0:43:20.59,0:43:22.18,Default,,0000,0000,0000,,why Medicare came\Nin and said,
Dialogue: 0,0:43:22.18,0:43:24.06,Default,,0000,0000,0000,,we'll pay your cost.
Dialogue: 0,0:43:24.06,0:43:27.76,Default,,0000,0000,0000,,Problem with that is\Nthere's no incentive to
Dialogue: 0,0:43:27.76,0:43:31.46,Default,,0000,0000,0000,,control your costs. I'll\Ngive you an example.
Dialogue: 0,0:43:31.46,0:43:33.28,Default,,0000,0000,0000,,A lot of our total hips,
Dialogue: 0,0:43:33.28,0:43:36.36,Default,,0000,0000,0000,,total joints are\NMedicare population.
Dialogue: 0,0:43:36.36,0:43:38.26,Default,,0000,0000,0000,,No surprise. Hey,
Dialogue: 0,0:43:38.26,0:43:40.70,Default,,0000,0000,0000,,you had one? Two.
Dialogue: 0,0:43:41.19,0:43:43.09,Default,,0000,0000,0000,,>> Which your bodies work?
Dialogue: 0,0:43:43.09,0:43:47.04,Default,,0000,0000,0000,,>> Of course. Does it help
Dialogue: 0,0:43:47.04,0:43:48.67,Default,,0000,0000,0000,,Pullman Regional\NHospital to
Dialogue: 0,0:43:48.67,0:43:50.23,Default,,0000,0000,0000,,negotiate with Smith\Nand Nephew and
Dialogue: 0,0:43:50.23,0:43:54.08,Default,,0000,0000,0000,,Depew on those devices\Nand save money?
Dialogue: 0,0:43:54.08,0:43:56.59,Default,,0000,0000,0000,,Does it help\Nour bottom line
Dialogue: 0,0:43:56.59,0:44:00.20,Default,,0000,0000,0000,,for especially the\NMedicare population?
Dialogue: 0,0:44:00.48,0:44:04.36,Default,,0000,0000,0000,,Thank you. Not one bit.\NI get paid my costs.
Dialogue: 0,0:44:04.36,0:44:06.90,Default,,0000,0000,0000,,Where's my incentive\Nto control the cost?
Dialogue: 0,0:44:06.90,0:44:09.79,Default,,0000,0000,0000,,However, we did\Ngo and we do.
Dialogue: 0,0:44:09.79,0:44:12.01,Default,,0000,0000,0000,,I negotiated\Nwith Depew and
Dialogue: 0,0:44:12.01,0:44:14.20,Default,,0000,0000,0000,,Smith and Nephew a\Nyear and a half ago,
Dialogue: 0,0:44:14.20,0:44:18.55,Default,,0000,0000,0000,,we saved 1.2 Million\Nin our device costs.
Dialogue: 0,0:44:18.55,0:44:20.82,Default,,0000,0000,0000,,Most of that goes to\Nthe federal government.
Dialogue: 0,0:44:20.82,0:44:23.20,Default,,0000,0000,0000,,It's the right\Nthing to do,
Dialogue: 0,0:44:23.20,0:44:25.69,Default,,0000,0000,0000,,because that will\Nsave eventually,
Dialogue: 0,0:44:25.69,0:44:27.07,Default,,0000,0000,0000,,if every hospital worked
Dialogue: 0,0:44:27.07,0:44:28.18,Default,,0000,0000,0000,,hard at doing\Nthose things,
Dialogue: 0,0:44:28.18,0:44:29.29,Default,,0000,0000,0000,,that saves critical access
Dialogue: 0,0:44:29.29,0:44:31.09,Default,,0000,0000,0000,,hospitals the\Nchopping block.
Dialogue: 0,0:44:31.09,0:44:33.13,Default,,0000,0000,0000,,If I lost critical
Dialogue: 0,0:44:33.13,0:44:34.69,Default,,0000,0000,0000,,access hospital\Nreimbursement today,
Dialogue: 0,0:44:34.69,0:44:35.59,Default,,0000,0000,0000,,remember that $1 million I
Dialogue: 0,0:44:35.59,0:44:36.88,Default,,0000,0000,0000,,told you we had last year,
Dialogue: 0,0:44:36.88,0:44:39.74,Default,,0000,0000,0000,,take five million\Noff of that.
Dialogue: 0,0:44:39.86,0:44:43.48,Default,,0000,0000,0000,,We would have\Nlost $4 million.
Dialogue: 0,0:44:44.18,0:44:46.80,Default,,0000,0000,0000,,We wouldn't last.
Dialogue: 0,0:44:46.80,0:44:50.01,Default,,0000,0000,0000,,You would be amputating\Nmajor services.
Dialogue: 0,0:44:50.01,0:44:51.57,Default,,0000,0000,0000,,There'd just be\Nthings you would
Dialogue: 0,0:44:51.57,0:44:54.14,Default,,0000,0000,0000,,not do in this market.
Dialogue: 0,0:44:54.14,0:44:56.01,Default,,0000,0000,0000,,It just would\Nnot be there.
Dialogue: 0,0:44:56.01,0:44:57.39,Default,,0000,0000,0000,,No, ICU.
Dialogue: 0,0:44:57.39,0:44:58.77,Default,,0000,0000,0000,,You wouldn't have\Na hospital around
Dialogue: 0,0:44:58.77,0:45:00.51,Default,,0000,0000,0000,,this area that had an ICU.
Dialogue: 0,0:45:00.51,0:45:03.28,Default,,0000,0000,0000,,Behavior health?\NForget it.
Dialogue: 0,0:45:03.28,0:45:05.26,Default,,0000,0000,0000,,Those people are\Non their own.
Dialogue: 0,0:45:05.26,0:45:08.01,Default,,0000,0000,0000,,Good luck on managing\Nyour drugs and
Dialogue: 0,0:45:08.01,0:45:11.76,Default,,0000,0000,0000,,your problems because\Nyou couldn't afford it.
Dialogue: 0,0:45:11.76,0:45:14.28,Default,,0000,0000,0000,,Positive margin areas.
Dialogue: 0,0:45:14.28,0:45:15.80,Default,,0000,0000,0000,,These are where\Nwe make money,
Dialogue: 0,0:45:15.80,0:45:17.70,Default,,0000,0000,0000,,especially on a\Ncommercial side.
Dialogue: 0,0:45:17.70,0:45:19.60,Default,,0000,0000,0000,,Imaging, surgery,\Npharmacy,
Dialogue: 0,0:45:19.60,0:45:21.56,Default,,0000,0000,0000,,women's health,\Nlab pathology.
Dialogue: 0,0:45:21.56,0:45:23.72,Default,,0000,0000,0000,,And we don't actually
Dialogue: 0,0:45:23.72,0:45:25.39,Default,,0000,0000,0000,,have a pathologist
Dialogue: 0,0:45:25.39,0:45:26.47,Default,,0000,0000,0000,,that is part of\Nthe hospital.
Dialogue: 0,0:45:26.47,0:45:27.61,Default,,0000,0000,0000,,They're actually\Na group out of
Dialogue: 0,0:45:27.61,0:45:29.11,Default,,0000,0000,0000,,Spokane that reside here.
Dialogue: 0,0:45:29.11,0:45:31.21,Default,,0000,0000,0000,,But those are your\Nmoneymakers today.
Dialogue: 0,0:45:31.21,0:45:33.32,Default,,0000,0000,0000,,Your negative things,\Nmedical groups,
Dialogue: 0,0:45:33.32,0:45:35.00,Default,,0000,0000,0000,,physician practices.
Dialogue: 0,0:45:35.00,0:45:38.11,Default,,0000,0000,0000,,Oftentimes, for every\Nemployed physician
Dialogue: 0,0:45:38.11,0:45:39.28,Default,,0000,0000,0000,,across the nation,
Dialogue: 0,0:45:39.28,0:45:42.06,Default,,0000,0000,0000,,in primary care\Ncosts $110,000.
Dialogue: 0,0:45:42.06,0:45:44.24,Default,,0000,0000,0000,,That's net.
Dialogue: 0,0:45:44.24,0:45:45.34,Default,,0000,0000,0000,,That's the bottom line.
Dialogue: 0,0:45:45.34,0:45:47.02,Default,,0000,0000,0000,,That's the loss.\NYou cover.
Dialogue: 0,0:45:47.02,0:45:50.16,Default,,0000,0000,0000,,I'm pretty close to that.
Dialogue: 0,0:45:50.16,0:45:52.16,Default,,0000,0000,0000,,Not quite. I'm\Npretty close.
Dialogue: 0,0:45:52.16,0:45:54.34,Default,,0000,0000,0000,,Transitional care units,\Nyour home health,
Dialogue: 0,0:45:54.34,0:45:56.30,Default,,0000,0000,0000,,your ICUs, your\Nemergency department.
Dialogue: 0,0:45:56.30,0:45:58.68,Default,,0000,0000,0000,,There's so much\Nfixed cost in those.
Dialogue: 0,0:45:58.68,0:46:01.09,Default,,0000,0000,0000,,Now, my physicians
Dialogue: 0,0:46:01.09,0:46:02.88,Default,,0000,0000,0000,,would say they make money.
Dialogue: 0,0:46:02.88,0:46:04.72,Default,,0000,0000,0000,,But they do, in essence,
Dialogue: 0,0:46:04.72,0:46:06.32,Default,,0000,0000,0000,,because they order tests.
Dialogue: 0,0:46:06.32,0:46:08.18,Default,,0000,0000,0000,,People end up going\Nto the surgery.
Dialogue: 0,0:46:08.18,0:46:09.79,Default,,0000,0000,0000,,It's important to\Nhave all of them.
Dialogue: 0,0:46:09.79,0:46:12.01,Default,,0000,0000,0000,,You can't have one\Nwithout the other.
Dialogue: 0,0:46:12.01,0:46:14.42,Default,,0000,0000,0000,,So how much did that cost?
Dialogue: 0,0:46:14.42,0:46:16.66,Default,,0000,0000,0000,,You go to a store and\Nyou look and say,
Dialogue: 0,0:46:16.66,0:46:20.95,Default,,0000,0000,0000,,okay, what's that TV\Ngoing to cost me?
Dialogue: 0,0:46:20.95,0:46:23.00,Default,,0000,0000,0000,,You can see exactly\Nwhat you want.
Dialogue: 0,0:46:23.00,0:46:24.55,Default,,0000,0000,0000,,No one patient that come
Dialogue: 0,0:46:24.55,0:46:25.57,Default,,0000,0000,0000,,through the\Nemergency department
Dialogue: 0,0:46:25.57,0:46:27.70,Default,,0000,0000,0000,,with the same thing\Nis exactly the same.
Dialogue: 0,0:46:27.70,0:46:29.98,Default,,0000,0000,0000,,You come in, I\Ndo your hip.
Dialogue: 0,0:46:29.98,0:46:31.33,Default,,0000,0000,0000,,Your hip isn't the same as
Dialogue: 0,0:46:31.33,0:46:33.52,Default,,0000,0000,0000,,your hip and your hip.
Dialogue: 0,0:46:33.52,0:46:35.50,Default,,0000,0000,0000,,How long it takes\Nthat surgeon
Dialogue: 0,0:46:35.50,0:46:37.21,Default,,0000,0000,0000,,because you had a\Ncomplication within
Dialogue: 0,0:46:37.21,0:46:39.58,Default,,0000,0000,0000,,there can be significantly
Dialogue: 0,0:46:39.58,0:46:40.66,Default,,0000,0000,0000,,different than\Nthe person that
Dialogue: 0,0:46:40.66,0:46:42.10,Default,,0000,0000,0000,,had no complication.
Dialogue: 0,0:46:42.10,0:46:43.93,Default,,0000,0000,0000,,The resources\Nand intensity
Dialogue: 0,0:46:43.93,0:46:45.31,Default,,0000,0000,0000,,of services are\Nmuch different.
Dialogue: 0,0:46:45.31,0:46:47.95,Default,,0000,0000,0000,,In some areas you're\Ngoing to get paid more
Dialogue: 0,0:46:47.95,0:46:50.76,Default,,0000,0000,0000,,because that DRG\Nwill reflect that,
Dialogue: 0,0:46:50.76,0:46:52.81,Default,,0000,0000,0000,,but not always use the\Nway Medicare pays you,
Dialogue: 0,0:46:52.81,0:46:54.18,Default,,0000,0000,0000,,they pay you off a DRG.
Dialogue: 0,0:46:54.18,0:46:55.51,Default,,0000,0000,0000,,Now, there are two\Ndifferent DRGs,
Dialogue: 0,0:46:55.51,0:46:57.49,Default,,0000,0000,0000,,one with complications,\None without.
Dialogue: 0,0:46:57.49,0:46:58.72,Default,,0000,0000,0000,,But you might have been
Dialogue: 0,0:46:58.72,0:47:01.45,Default,,0000,0000,0000,,the same surgery\Nwithout a complication.
Dialogue: 0,0:47:01.45,0:47:03.58,Default,,0000,0000,0000,,But you might have\Nbeen in the OR
Dialogue: 0,0:47:03.58,0:47:05.47,Default,,0000,0000,0000,,because when that\Nsurgeon was in there,
Dialogue: 0,0:47:05.47,0:47:06.60,Default,,0000,0000,0000,,it took a lot more time.
Dialogue: 0,0:47:06.60,0:47:08.60,Default,,0000,0000,0000,,It took him 45 minutes
Dialogue: 0,0:47:08.60,0:47:11.16,Default,,0000,0000,0000,,where the other patient\Ntook 20 minutes.
Dialogue: 0,0:47:11.16,0:47:13.32,Default,,0000,0000,0000,,The resources are\Nmuch different.
Dialogue: 0,0:47:13.32,0:47:15.55,Default,,0000,0000,0000,,But the amount that\Nwe're going to get paid
Dialogue: 0,0:47:15.55,0:47:17.92,Default,,0000,0000,0000,,is the same for that\Nparticular insurance.
Dialogue: 0,0:47:17.92,0:47:19.72,Default,,0000,0000,0000,,But if you go back to\Nthose methodologies,
Dialogue: 0,0:47:19.72,0:47:22.00,Default,,0000,0000,0000,,remember those cost,
Dialogue: 0,0:47:22.00,0:47:25.54,Default,,0000,0000,0000,,fixed percentage\Ncharges, DRG, MSG,
Dialogue: 0,0:47:25.54,0:47:29.36,Default,,0000,0000,0000,,MSERG, those all have\Ninfluences within this.
Dialogue: 0,0:47:29.36,0:47:31.30,Default,,0000,0000,0000,,So those are\Nall different.
Dialogue: 0,0:47:31.30,0:47:32.68,Default,,0000,0000,0000,,Hey, we're just\Ntalking about
Dialogue: 0,0:47:32.68,0:47:33.58,Default,,0000,0000,0000,,you, by the way.
Dialogue: 0,0:47:33.58,0:47:35.80,Default,,0000,0000,0000,,We're talking about\Northopedic surgeries.
Dialogue: 0,0:47:35.80,0:47:38.94,Default,,0000,0000,0000,,Not you specifically,\Njust talk prices.
Dialogue: 0,0:47:38.94,0:47:42.58,Default,,0000,0000,0000,,Welcome, by the\Nway. So again,
Dialogue: 0,0:47:42.58,0:47:44.05,Default,,0000,0000,0000,,some reimbursement\Nmethodologies
Dialogue: 0,0:47:44.05,0:47:44.68,Default,,0000,0000,0000,,and we've talked about.
Dialogue: 0,0:47:44.68,0:47:45.55,Default,,0000,0000,0000,,Under the hospital,
Dialogue: 0,0:47:45.55,0:47:46.93,Default,,0000,0000,0000,,you have percentage\Ncharges.
Dialogue: 0,0:47:46.93,0:47:49.64,Default,,0000,0000,0000,,You have per\Ndiems, case rates,
Dialogue: 0,0:47:49.64,0:47:54.36,Default,,0000,0000,0000,,a mix of the DRG, MSDRG\Ncomponents to it.
Dialogue: 0,0:47:54.36,0:47:58.93,Default,,0000,0000,0000,,APGs, which is an\Noutpatient payment scheme,
Dialogue: 0,0:47:58.93,0:48:00.90,Default,,0000,0000,0000,,we have none\Nof those here.
Dialogue: 0,0:48:00.90,0:48:02.68,Default,,0000,0000,0000,,They do have them, and
Dialogue: 0,0:48:02.68,0:48:04.42,Default,,0000,0000,0000,,they are significant\Nacross the nation.
Dialogue: 0,0:48:04.42,0:48:06.42,Default,,0000,0000,0000,,We're just fortunate some
Dialogue: 0,0:48:06.42,0:48:08.11,Default,,0000,0000,0000,,insurance companies\Nwant me to go to there.
Dialogue: 0,0:48:08.11,0:48:09.97,Default,,0000,0000,0000,,Primera wants us\Nto go to that.
Dialogue: 0,0:48:09.97,0:48:12.90,Default,,0000,0000,0000,,However, in order\Nto do that,
Dialogue: 0,0:48:12.90,0:48:14.48,Default,,0000,0000,0000,,the system behind that to
Dialogue: 0,0:48:14.48,0:48:16.96,Default,,0000,0000,0000,,capture all that\Nwould cost us 50,000,
Dialogue: 0,0:48:16.96,0:48:18.48,Default,,0000,0000,0000,,so I asked Primera\Nto pay for that.
Dialogue: 0,0:48:18.48,0:48:19.87,Default,,0000,0000,0000,,They didn't want\Nto, so they keep
Dialogue: 0,0:48:19.87,0:48:21.56,Default,,0000,0000,0000,,paying me percent\Nof charges.
Dialogue: 0,0:48:21.56,0:48:23.12,Default,,0000,0000,0000,,But there's a\Nbig investment.
Dialogue: 0,0:48:23.12,0:48:25.09,Default,,0000,0000,0000,,We're moving towards VBS,
Dialogue: 0,0:48:25.09,0:48:26.76,Default,,0000,0000,0000,,which is value\Nbased purchasing.
Dialogue: 0,0:48:26.76,0:48:29.05,Default,,0000,0000,0000,,Bundled. Anybody heard\Nof bundle payments,
Dialogue: 0,0:48:29.05,0:48:31.57,Default,,0000,0000,0000,,especially the joint\Nreplacement program
Dialogue: 0,0:48:31.57,0:48:33.73,Default,,0000,0000,0000,,that CMS has done\Nacross the nation?
Dialogue: 0,0:48:33.73,0:48:35.10,Default,,0000,0000,0000,,That's a movement.
Dialogue: 0,0:48:35.10,0:48:36.22,Default,,0000,0000,0000,,What that's\Ndoing is saying,
Dialogue: 0,0:48:36.22,0:48:37.36,Default,,0000,0000,0000,,we're going to give you
Dialogue: 0,0:48:37.36,0:48:40.62,Default,,0000,0000,0000,,this pot of money\Nbetween your physician,
Dialogue: 0,0:48:40.62,0:48:43.00,Default,,0000,0000,0000,,hospital, nursing home,
Dialogue: 0,0:48:43.00,0:48:44.41,Default,,0000,0000,0000,,and everything\Nelse in between,
Dialogue: 0,0:48:44.41,0:48:46.90,Default,,0000,0000,0000,,PT, etc., you\Ndivvy it out.
Dialogue: 0,0:48:46.90,0:48:48.13,Default,,0000,0000,0000,,You've got to\Ndeal with only
Dialogue: 0,0:48:48.13,0:48:49.94,Default,,0000,0000,0000,,that component of it.
Dialogue: 0,0:48:49.94,0:48:51.86,Default,,0000,0000,0000,,Problem with that is
Dialogue: 0,0:48:51.86,0:48:53.56,Default,,0000,0000,0000,,if you're not on\Nthe same team,
Dialogue: 0,0:48:53.56,0:48:55.88,Default,,0000,0000,0000,,you got winners\Nand losers.
Dialogue: 0,0:48:55.88,0:48:58.26,Default,,0000,0000,0000,,So I'll tell you right\Nnow a bundle payment,
Dialogue: 0,0:48:58.26,0:48:58.69,Default,,0000,0000,0000,,we're going to work
Dialogue: 0,0:48:58.69,0:49:00.18,Default,,0000,0000,0000,,really closely\Nwith physicians.
Dialogue: 0,0:49:00.18,0:49:02.23,Default,,0000,0000,0000,,I'm sorry, nursing home,
Dialogue: 0,0:49:02.23,0:49:04.69,Default,,0000,0000,0000,,you're out because\NI don't want
Dialogue: 0,0:49:04.69,0:49:06.19,Default,,0000,0000,0000,,that patient with\Nnursing home because
Dialogue: 0,0:49:06.19,0:49:07.93,Default,,0000,0000,0000,,then I have to give them\Nsome of that money.
Dialogue: 0,0:49:07.93,0:49:09.37,Default,,0000,0000,0000,,So we're going to try\Nto do everything we can
Dialogue: 0,0:49:09.37,0:49:10.99,Default,,0000,0000,0000,,to keep them within\Nthis little group.
Dialogue: 0,0:49:10.99,0:49:12.04,Default,,0000,0000,0000,,That's why you need
Dialogue: 0,0:49:12.04,0:49:13.38,Default,,0000,0000,0000,,to work collectively\Ntogether,
Dialogue: 0,0:49:13.38,0:49:15.85,Default,,0000,0000,0000,,because usually\Nthere's winners
Dialogue: 0,0:49:15.85,0:49:17.29,Default,,0000,0000,0000,,and losers in\Nthose things.
Dialogue: 0,0:49:17.29,0:49:18.55,Default,,0000,0000,0000,,But that's where\Nit's moving.
Dialogue: 0,0:49:18.55,0:49:19.72,Default,,0000,0000,0000,,These value based things
Dialogue: 0,0:49:19.72,0:49:21.97,Default,,0000,0000,0000,,are evolving\Nsignificantly.
Dialogue: 0,0:49:21.97,0:49:23.83,Default,,0000,0000,0000,,Eventually, a lot\Nof our payments
Dialogue: 0,0:49:23.83,0:49:24.88,Default,,0000,0000,0000,,will be based on keeping
Dialogue: 0,0:49:24.88,0:49:26.08,Default,,0000,0000,0000,,people out of the system,
Dialogue: 0,0:49:26.08,0:49:27.82,Default,,0000,0000,0000,,which ultimately should\Nbe what we're doing.
Dialogue: 0,0:49:27.82,0:49:29.60,Default,,0000,0000,0000,,That's in the\Nbusiness we're is
Dialogue: 0,0:49:29.60,0:49:30.85,Default,,0000,0000,0000,,taking care of\Nthose in needs
Dialogue: 0,0:49:30.85,0:49:32.80,Default,,0000,0000,0000,,and trying to keep\Npeople healthy.
Dialogue: 0,0:49:32.80,0:49:34.98,Default,,0000,0000,0000,,But you can't make\Npeople be healthy.
Dialogue: 0,0:49:34.98,0:49:37.57,Default,,0000,0000,0000,,So, these are the\Nbasic overviews,
Dialogue: 0,0:49:37.57,0:49:38.41,Default,,0000,0000,0000,,and we've talked\Na little bit
Dialogue: 0,0:49:38.41,0:49:39.46,Default,,0000,0000,0000,,of that within that.
Dialogue: 0,0:49:39.46,0:49:40.78,Default,,0000,0000,0000,,So you've got for us
Dialogue: 0,0:49:40.78,0:49:42.52,Default,,0000,0000,0000,,we critical\Naccess hospitals.
Dialogue: 0,0:49:42.52,0:49:44.76,Default,,0000,0000,0000,,Other systems\Noutside of that,
Dialogue: 0,0:49:44.76,0:49:48.44,Default,,0000,0000,0000,,PPS hospital, progressive\Npayment systems,
Dialogue: 0,0:49:48.44,0:49:50.14,Default,,0000,0000,0000,,those are your\Ntypical urban.
Dialogue: 0,0:49:50.14,0:49:54.07,Default,,0000,0000,0000,,They're going to get\Nthis DRG fixed rate.
Dialogue: 0,0:49:54.07,0:49:55.48,Default,,0000,0000,0000,,And the more\Nthey see then,
Dialogue: 0,0:49:55.48,0:49:56.92,Default,,0000,0000,0000,,the more they're\Ngoing to make because
Dialogue: 0,0:49:56.92,0:49:58.62,Default,,0000,0000,0000,,they can cover\Ntheir overhead.
Dialogue: 0,0:49:58.62,0:49:59.92,Default,,0000,0000,0000,,Critical access\Nhospitals were
Dialogue: 0,0:49:59.92,0:50:00.67,Default,,0000,0000,0000,,not able to do that,
Dialogue: 0,0:50:00.67,0:50:01.48,Default,,0000,0000,0000,,so that's why they came
Dialogue: 0,0:50:01.48,0:50:03.65,Default,,0000,0000,0000,,up with this methodology.
Dialogue: 0,0:50:06.74,0:50:09.93,Default,,0000,0000,0000,,I covered that. We will\Nmove on from that.
Dialogue: 0,0:50:09.93,0:50:11.98,Default,,0000,0000,0000,,I probably covered that.
Dialogue: 0,0:50:11.98,0:50:14.64,Default,,0000,0000,0000,,So hospitals converted to
Dialogue: 0,0:50:14.64,0:50:17.76,Default,,0000,0000,0000,,these CAH since\Ncost reimbursement
Dialogue: 0,0:50:17.76,0:50:20.64,Default,,0000,0000,0000,,was and is greater
Dialogue: 0,0:50:20.64,0:50:21.81,Default,,0000,0000,0000,,than the reimbursement\Nwe would
Dialogue: 0,0:50:21.81,0:50:23.64,Default,,0000,0000,0000,,have received under PPS.
Dialogue: 0,0:50:23.64,0:50:26.32,Default,,0000,0000,0000,,So that's why it was\Nimportant to move to.
Dialogue: 0,0:50:26.32,0:50:28.29,Default,,0000,0000,0000,,There's requirements\Nto stay that.
Dialogue: 0,0:50:28.29,0:50:30.51,Default,,0000,0000,0000,,Back under Obama, he
Dialogue: 0,0:50:30.51,0:50:33.51,Default,,0000,0000,0000,,had within his\Nproposed budget plan,
Dialogue: 0,0:50:33.51,0:50:35.94,Default,,0000,0000,0000,,you couldn't be a\Ncritical access hospitals
Dialogue: 0,0:50:35.94,0:50:38.64,Default,,0000,0000,0000,,within 10 miles of\Nanother facility.
Dialogue: 0,0:50:38.64,0:50:40.23,Default,,0000,0000,0000,,Or you would lose
Dialogue: 0,0:50:40.23,0:50:42.44,Default,,0000,0000,0000,,your critical\Naccess designation.
Dialogue: 0,0:50:42.44,0:50:45.38,Default,,0000,0000,0000,,Do you know how far\Nwe are from Gritman?
Dialogue: 0,0:50:45.38,0:50:48.45,Default,,0000,0000,0000,,9.2 miles. Why didn't we
Dialogue: 0,0:50:48.45,0:50:50.14,Default,,0000,0000,0000,,build it up the\Nhill, another.
Dialogue: 0,0:50:50.14,0:50:51.42,Default,,0000,0000,0000,,But the issue was,
Dialogue: 0,0:50:51.42,0:50:52.89,Default,,0000,0000,0000,,who cares if it's 10?
Dialogue: 0,0:50:52.89,0:50:55.90,Default,,0000,0000,0000,,Why not 15? Why was it 10?
Dialogue: 0,0:50:55.90,0:50:58.46,Default,,0000,0000,0000,,Because it was a\Nbudgetary number.
Dialogue: 0,0:50:58.46,0:50:59.61,Default,,0000,0000,0000,,They looked to see how
Dialogue: 0,0:50:59.61,0:51:00.86,Default,,0000,0000,0000,,much could they capture.
Dialogue: 0,0:51:00.86,0:51:02.84,Default,,0000,0000,0000,,That helps our budget.
Dialogue: 0,0:51:02.84,0:51:06.04,Default,,0000,0000,0000,,Fortunately enough,\NCongress did not pass that.
Dialogue: 0,0:51:06.04,0:51:07.62,Default,,0000,0000,0000,,They didn't even\Nentertain that.
Dialogue: 0,0:51:07.62,0:51:09.12,Default,,0000,0000,0000,,We only had to go a few
Dialogue: 0,0:51:09.12,0:51:11.13,Default,,0000,0000,0000,,times to DC to fight that.
Dialogue: 0,0:51:11.13,0:51:13.35,Default,,0000,0000,0000,,But that was\Nthe discussion.
Dialogue: 0,0:51:13.35,0:51:16.08,Default,,0000,0000,0000,,What's the mileage?
Dialogue: 0,0:51:16.08,0:51:17.25,Default,,0000,0000,0000,,You know what I\Nwould have done,
Dialogue: 0,0:51:17.25,0:51:18.39,Default,,0000,0000,0000,,Mayor, come and say,
Dialogue: 0,0:51:18.39,0:51:20.34,Default,,0000,0000,0000,,please close down\NBishop Boulevard,
Dialogue: 0,0:51:20.34,0:51:22.38,Default,,0000,0000,0000,,Mike us go around.
Dialogue: 0,0:51:22.38,0:51:25.05,Default,,0000,0000,0000,,Let us go half a mile.
Dialogue: 0,0:51:25.05,0:51:28.71,Default,,0000,0000,0000,,Exactly. Something. We\Njust 0.8 of a mile,
Dialogue: 0,0:51:28.71,0:51:31.08,Default,,0000,0000,0000,,please figure\Nsomething out.
Dialogue: 0,0:51:31.08,0:51:33.84,Default,,0000,0000,0000,,So, Irene, part\Nof your question,
Dialogue: 0,0:51:33.84,0:51:35.13,Default,,0000,0000,0000,,cost typically\Nin hospital.
Dialogue: 0,0:51:35.13,0:51:36.69,Default,,0000,0000,0000,,Variable cost\Nincludes your supply,
Dialogue: 0,0:51:36.69,0:51:38.04,Default,,0000,0000,0000,,your implants,\Nyour staffing,
Dialogue: 0,0:51:38.04,0:51:39.09,Default,,0000,0000,0000,,your food, your dietary,
Dialogue: 0,0:51:39.09,0:51:40.89,Default,,0000,0000,0000,,your pharmacy,\Nfixed costs,
Dialogue: 0,0:51:40.89,0:51:42.99,Default,,0000,0000,0000,,CEO, core staffing,
Dialogue: 0,0:51:42.99,0:51:45.78,Default,,0000,0000,0000,,utilities, bad\Nyour debt service,
Dialogue: 0,0:51:45.78,0:51:47.19,Default,,0000,0000,0000,,and then your\Nphysician compensation
Dialogue: 0,0:51:47.19,0:51:49.42,Default,,0000,0000,0000,,because many of them\Nhave a fixed payment.
Dialogue: 0,0:51:49.42,0:51:50.19,Default,,0000,0000,0000,,Not all of them.
Dialogue: 0,0:51:50.19,0:51:51.72,Default,,0000,0000,0000,,So are very\Nproductivity based,
Dialogue: 0,0:51:51.72,0:51:53.04,Default,,0000,0000,0000,,and so the more you see,
Dialogue: 0,0:51:53.04,0:51:53.67,Default,,0000,0000,0000,,the more you made,
Dialogue: 0,0:51:53.67,0:51:56.19,Default,,0000,0000,0000,,but that's changing\Nin their environment.
Dialogue: 0,0:51:56.19,0:51:59.94,Default,,0000,0000,0000,,So really some of
Dialogue: 0,0:51:59.94,0:52:01.98,Default,,0000,0000,0000,,these really truly\Nare semi variable.
Dialogue: 0,0:52:01.98,0:52:03.96,Default,,0000,0000,0000,,There's only a\Ncertain level
Dialogue: 0,0:52:03.96,0:52:05.37,Default,,0000,0000,0000,,that we can go down to.
Dialogue: 0,0:52:05.37,0:52:06.93,Default,,0000,0000,0000,,So this is supposed to\Nbe a true and false.
Dialogue: 0,0:52:06.93,0:52:08.68,Default,,0000,0000,0000,,I'm just going to give\Nyou the answers here.
Dialogue: 0,0:52:08.68,0:52:11.55,Default,,0000,0000,0000,,Generally, in many are
Dialogue: 0,0:52:11.55,0:52:13.20,Default,,0000,0000,0000,,not sensitive to volume.
Dialogue: 0,0:52:13.20,0:52:17.06,Default,,0000,0000,0000,,If we saw 15,000 emergency
Dialogue: 0,0:52:17.06,0:52:19.05,Default,,0000,0000,0000,,department visits or
Dialogue: 0,0:52:19.05,0:52:21.30,Default,,0000,0000,0000,,5,000 emergency\Ndepartment visits,
Dialogue: 0,0:52:21.30,0:52:22.59,Default,,0000,0000,0000,,I'm sure hoping\Nthe hospital
Dialogue: 0,0:52:22.59,0:52:24.82,Default,,0000,0000,0000,,still keeps one CFO.
Dialogue: 0,0:52:25.64,0:52:29.31,Default,,0000,0000,0000,,It's tongue and\Ncheek. So I'm
Dialogue: 0,0:52:29.31,0:52:31.12,Default,,0000,0000,0000,,hopefully not\Nvolume dependent.
Dialogue: 0,0:52:31.12,0:52:32.84,Default,,0000,0000,0000,,But at some point,
Dialogue: 0,0:52:32.84,0:52:36.36,Default,,0000,0000,0000,,like even our human\Nresources, at some point,
Dialogue: 0,0:52:36.36,0:52:38.04,Default,,0000,0000,0000,,we need additional\Nsupport when we
Dialogue: 0,0:52:38.04,0:52:40.22,Default,,0000,0000,0000,,have a few years ago,
Dialogue: 0,0:52:40.22,0:52:43.68,Default,,0000,0000,0000,,we had 300 employees.
Dialogue: 0,0:52:43.68,0:52:45.45,Default,,0000,0000,0000,,Now we have 450.
Dialogue: 0,0:52:45.45,0:52:46.65,Default,,0000,0000,0000,,The amount of paperwork
Dialogue: 0,0:52:46.65,0:52:47.82,Default,,0000,0000,0000,,and processing\Nthe payroll,
Dialogue: 0,0:52:47.82,0:52:49.62,Default,,0000,0000,0000,,etc, is more intensive.
Dialogue: 0,0:52:49.62,0:52:50.91,Default,,0000,0000,0000,,So we either have to find
Dialogue: 0,0:52:50.91,0:52:53.84,Default,,0000,0000,0000,,system applications to\Ndo that, technology,
Dialogue: 0,0:52:53.84,0:52:56.04,Default,,0000,0000,0000,,or we have add\Nresources and
Dialogue: 0,0:52:56.04,0:52:59.01,Default,,0000,0000,0000,,staffing to be able to\Nhelp support those.
Dialogue: 0,0:52:59.01,0:53:03.64,Default,,0000,0000,0000,,So cause volume increase.
Dialogue: 0,0:53:03.64,0:53:04.95,Default,,0000,0000,0000,,What happens to your fixed
Dialogue: 0,0:53:04.95,0:53:06.40,Default,,0000,0000,0000,,cost per unit of service?
Dialogue: 0,0:53:06.40,0:53:07.71,Default,,0000,0000,0000,,So volume goes up, and
Dialogue: 0,0:53:07.71,0:53:09.00,Default,,0000,0000,0000,,I have a fixed cost, me.
Dialogue: 0,0:53:09.00,0:53:10.78,Default,,0000,0000,0000,,Let's say we have\N100 patients,
Dialogue: 0,0:53:10.78,0:53:12.66,Default,,0000,0000,0000,,and we allocate\Nthe cost of
Dialogue: 0,0:53:12.66,0:53:15.72,Default,,0000,0000,0000,,administrator over\Nthose 100 patients.
Dialogue: 0,0:53:15.72,0:53:17.43,Default,,0000,0000,0000,,Now I have 200.\NWhat happens
Dialogue: 0,0:53:17.43,0:53:18.70,Default,,0000,0000,0000,,to that cost per unit?
Dialogue: 0,0:53:18.70,0:53:21.34,Default,,0000,0000,0000,,It goes down. Same thing.
Dialogue: 0,0:53:21.34,0:53:23.86,Default,,0000,0000,0000,,If we have 200 and\Nit goes down 100,
Dialogue: 0,0:53:23.86,0:53:26.83,Default,,0000,0000,0000,,that cost per\Nunit goes up.
Dialogue: 0,0:53:27.05,0:53:30.18,Default,,0000,0000,0000,,Same with variable cost.
Dialogue: 0,0:53:30.18,0:53:31.41,Default,,0000,0000,0000,,Units of service equals
Dialogue: 0,0:53:31.41,0:53:33.48,Default,,0000,0000,0000,,patient days for\Nroom and board,
Dialogue: 0,0:53:33.48,0:53:36.32,Default,,0000,0000,0000,,revenue, and charges\Nfor ancillary services.
Dialogue: 0,0:53:36.32,0:53:40.30,Default,,0000,0000,0000,,Reimbursement under\NPPS hospitals.
Dialogue: 0,0:53:40.40,0:53:42.52,Default,,0000,0000,0000,,You decrease your volume.
Dialogue: 0,0:53:42.52,0:53:44.88,Default,,0000,0000,0000,,What happens to\Nyour reimbursement?
Dialogue: 0,0:53:44.88,0:53:46.32,Default,,0000,0000,0000,,It goes down.
Dialogue: 0,0:53:46.32,0:53:47.84,Default,,0000,0000,0000,,The less you see,\Nthe less you make.
Dialogue: 0,0:53:47.84,0:53:49.88,Default,,0000,0000,0000,,That's traditional.\NWe all know that.
Dialogue: 0,0:53:49.88,0:53:52.83,Default,,0000,0000,0000,,You go to Walmart.\NThey sell 1,000 TVs.
Dialogue: 0,0:53:52.83,0:53:55.08,Default,,0000,0000,0000,,They sold thousand TV.
Dialogue: 0,0:53:55.08,0:53:56.79,Default,,0000,0000,0000,,They sell 2000 and\Nthey mad more.
Dialogue: 0,0:53:56.79,0:53:58.78,Default,,0000,0000,0000,,The more they sell,\Nthe more they make.
Dialogue: 0,0:53:58.78,0:54:01.56,Default,,0000,0000,0000,,Guess what?\NKirklaxs hospitals,
Dialogue: 0,0:54:01.56,0:54:04.18,Default,,0000,0000,0000,,that's counterintuitive.\NIt's not true.
Dialogue: 0,0:54:04.18,0:54:07.06,Default,,0000,0000,0000,,If I see less patients,
Dialogue: 0,0:54:07.06,0:54:09.21,Default,,0000,0000,0000,,what's my reimbursement\Nfrom Medicare going
Dialogue: 0,0:54:09.21,0:54:12.04,Default,,0000,0000,0000,,to be? It's higher.
Dialogue: 0,0:54:12.04,0:54:16.52,Default,,0000,0000,0000,,Catch. Why? Because\Nthey pay me my cost.
Dialogue: 0,0:54:16.52,0:54:18.88,Default,,0000,0000,0000,,My cost per unit went up.
Dialogue: 0,0:54:18.88,0:54:20.58,Default,,0000,0000,0000,,So, the less I see,
Dialogue: 0,0:54:20.58,0:54:22.71,Default,,0000,0000,0000,,the more I make,\Nmore I see,
Dialogue: 0,0:54:22.71,0:54:24.56,Default,,0000,0000,0000,,the less I make\Nbecause I'm
Dialogue: 0,0:54:24.56,0:54:26.54,Default,,0000,0000,0000,,only ever going to\Nget paid my cost.
Dialogue: 0,0:54:26.54,0:54:28.26,Default,,0000,0000,0000,,It's counterintuitive.
Dialogue: 0,0:54:28.26,0:54:30.45,Default,,0000,0000,0000,,And so that's\Nalways confusing.
Dialogue: 0,0:54:30.45,0:54:31.38,Default,,0000,0000,0000,,It doesn't matter\Nif you're sitting
Dialogue: 0,0:54:31.38,0:54:32.58,Default,,0000,0000,0000,,on the board or\Nnot, yes, sir.
Dialogue: 0,0:54:32.58,0:54:36.38,Default,,0000,0000,0000,,>> But don't Medicare\Ndefine what I mean,
Dialogue: 0,0:54:36.38,0:54:37.80,Default,,0000,0000,0000,,they have\Nobservation bids,
Dialogue: 0,0:54:37.80,0:54:39.38,Default,,0000,0000,0000,,which you get\Npaid less for
Dialogue: 0,0:54:39.38,0:54:41.20,Default,,0000,0000,0000,,versus a regular bid.
Dialogue: 0,0:54:41.20,0:54:43.61,Default,,0000,0000,0000,,So they're defining\Nyour costs going to be
Dialogue: 0,0:54:43.61,0:54:44.69,Default,,0000,0000,0000,,that observation bid
Dialogue: 0,0:54:44.69,0:54:45.83,Default,,0000,0000,0000,,that's all I want\Nto reimburse.
Dialogue: 0,0:54:45.83,0:54:47.92,Default,,0000,0000,0000,,Are they doing those\Nkind of things still?
Dialogue: 0,0:54:47.92,0:54:49.52,Default,,0000,0000,0000,,>> So the question really
Dialogue: 0,0:54:49.52,0:54:51.56,Default,,0000,0000,0000,,is under Medicare\Nreimbursement,
Dialogue: 0,0:54:51.56,0:54:53.66,Default,,0000,0000,0000,,how do they define\Nhow they'll pay you?
Dialogue: 0,0:54:53.66,0:54:55.88,Default,,0000,0000,0000,,Do they drive business?
Dialogue: 0,0:54:55.88,0:54:58.16,Default,,0000,0000,0000,,I'm phrasing this.
Dialogue: 0,0:54:58.16,0:55:00.47,Default,,0000,0000,0000,,>> Nursing homes,\Ntoo. Cheaper over
Dialogue: 0,0:55:00.47,0:55:02.52,Default,,0000,0000,0000,,there than they are\Nthan regular hospital.
Dialogue: 0,0:55:02.52,0:55:03.51,Default,,0000,0000,0000,,>> So are they driving
Dialogue: 0,0:55:03.51,0:55:05.02,Default,,0000,0000,0000,,businesses to\Ncertain things like
Dialogue: 0,0:55:05.02,0:55:08.16,Default,,0000,0000,0000,,observation, like\Ninpatient care?
Dialogue: 0,0:55:08.16,0:55:10.32,Default,,0000,0000,0000,,Is it better to have\Na Medicare patient
Dialogue: 0,0:55:10.32,0:55:12.32,Default,,0000,0000,0000,,in an inpatient\Nbed or an obs bed?
Dialogue: 0,0:55:12.32,0:55:14.24,Default,,0000,0000,0000,,Obs Observation, sorry,
Dialogue: 0,0:55:14.24,0:55:16.72,Default,,0000,0000,0000,,abbreviation. Which\None's better?
Dialogue: 0,0:55:16.72,0:55:18.78,Default,,0000,0000,0000,,For Medicare, honestly,\Nhaving them in
Dialogue: 0,0:55:18.78,0:55:19.83,Default,,0000,0000,0000,,an observation bed is
Dialogue: 0,0:55:19.83,0:55:23.08,Default,,0000,0000,0000,,better because\Nthen Medicare,
Dialogue: 0,0:55:23.72,0:55:26.19,Default,,0000,0000,0000,,constituents or\Ncustomers have
Dialogue: 0,0:55:26.19,0:55:27.92,Default,,0000,0000,0000,,to pay 20% of that charge.
Dialogue: 0,0:55:27.92,0:55:29.52,Default,,0000,0000,0000,,If they're in an\Ninpatient bed,
Dialogue: 0,0:55:29.52,0:55:30.42,Default,,0000,0000,0000,,they have a straight
Dialogue: 0,0:55:30.42,0:55:31.86,Default,,0000,0000,0000,,deductible and it's done.
Dialogue: 0,0:55:31.86,0:55:33.84,Default,,0000,0000,0000,,And if they met that\Nearlier, it's done.
Dialogue: 0,0:55:33.84,0:55:36.96,Default,,0000,0000,0000,,So Medicare population has
Dialogue: 0,0:55:36.96,0:55:38.80,Default,,0000,0000,0000,,to pay for that 20%.
Dialogue: 0,0:55:38.80,0:55:40.92,Default,,0000,0000,0000,,So having them in an\Noutpatient setting
Dialogue: 0,0:55:40.92,0:55:43.42,Default,,0000,0000,0000,,makes a lot more\Nsense for Medicare.
Dialogue: 0,0:55:43.42,0:55:44.82,Default,,0000,0000,0000,,They have requirements, so
Dialogue: 0,0:55:44.82,0:55:47.14,Default,,0000,0000,0000,,now they have\Nit used to be
Dialogue: 0,0:55:47.14,0:55:52.14,Default,,0000,0000,0000,,based on certain\Ncriteria based driven,
Dialogue: 0,0:55:52.14,0:55:53.97,Default,,0000,0000,0000,,now it's based on
Dialogue: 0,0:55:53.97,0:55:55.47,Default,,0000,0000,0000,,how many midnights\Nyou're in.
Dialogue: 0,0:55:55.47,0:55:57.06,Default,,0000,0000,0000,,Are you in two? If you're
Dialogue: 0,0:55:57.06,0:55:58.08,Default,,0000,0000,0000,,in two, then you're knobs.
Dialogue: 0,0:55:58.08,0:55:58.94,Default,,0000,0000,0000,,If you're in\Nmore than two,
Dialogue: 0,0:55:58.94,0:55:59.98,Default,,0000,0000,0000,,then you're in in.
Dialogue: 0,0:55:59.98,0:56:01.48,Default,,0000,0000,0000,,It's based on that.
Dialogue: 0,0:56:01.48,0:56:03.54,Default,,0000,0000,0000,,So by the way,
Dialogue: 0,0:56:03.54,0:56:05.55,Default,,0000,0000,0000,,we asked for that,\Nand we all hate it.
Dialogue: 0,0:56:05.55,0:56:06.42,Default,,0000,0000,0000,,Now, we said, we don't
Dialogue: 0,0:56:06.42,0:56:07.65,Default,,0000,0000,0000,,like the way\Nyou're doing this.
Dialogue: 0,0:56:07.65,0:56:08.73,Default,,0000,0000,0000,,You got to\Nsimplify, and then
Dialogue: 0,0:56:08.73,0:56:10.06,Default,,0000,0000,0000,,they simply we\Ndidn't like it.
Dialogue: 0,0:56:10.06,0:56:13.56,Default,,0000,0000,0000,,So some of the things
Dialogue: 0,0:56:13.56,0:56:14.79,Default,,0000,0000,0000,,that are influencing\Nhealthcare and
Dialogue: 0,0:56:14.79,0:56:16.20,Default,,0000,0000,0000,,why it's getting\Nchallenging.
Dialogue: 0,0:56:16.20,0:56:17.85,Default,,0000,0000,0000,,We had a major change in
Dialogue: 0,0:56:17.85,0:56:20.31,Default,,0000,0000,0000,,our classification ICD 10,
Dialogue: 0,0:56:20.31,0:56:22.32,Default,,0000,0000,0000,,which is your diagnosis
Dialogue: 0,0:56:22.32,0:56:25.00,Default,,0000,0000,0000,,and related\Nclassifications.
Dialogue: 0,0:56:25.00,0:56:28.92,Default,,0000,0000,0000,,This changed from\NICEC 9 to 10 in 2014,
Dialogue: 0,0:56:28.92,0:56:30.66,Default,,0000,0000,0000,,actually, in 2015, and
Dialogue: 0,0:56:30.66,0:56:32.50,Default,,0000,0000,0000,,it really\Nsubstantially changed.
Dialogue: 0,0:56:32.50,0:56:33.80,Default,,0000,0000,0000,,The coding aspect\Nwent from like,
Dialogue: 0,0:56:33.80,0:56:36.84,Default,,0000,0000,0000,,8,000 codes to 80,000.
Dialogue: 0,0:56:36.84,0:56:38.70,Default,,0000,0000,0000,,And so it's got a\Nlot more specific.
Dialogue: 0,0:56:38.70,0:56:41.70,Default,,0000,0000,0000,,It's really hard to\Nrun today to get
Dialogue: 0,0:56:41.70,0:56:45.18,Default,,0000,0000,0000,,any comparables is\Nalmost impossible,
Dialogue: 0,0:56:45.18,0:56:46.95,Default,,0000,0000,0000,,especially on\Ninpatient care
Dialogue: 0,0:56:46.95,0:56:48.03,Default,,0000,0000,0000,,or surgeries and stuff
Dialogue: 0,0:56:48.03,0:56:49.68,Default,,0000,0000,0000,,because of the\Nfact that ICD
Dialogue: 0,0:56:49.68,0:56:50.85,Default,,0000,0000,0000,,10 is so specific,
Dialogue: 0,0:56:50.85,0:56:53.28,Default,,0000,0000,0000,,like they literally\Nhave some.
Dialogue: 0,0:56:53.28,0:56:56.12,Default,,0000,0000,0000,,If you hit by a car\Non a rural road,
Dialogue: 0,0:56:56.12,0:56:57.70,Default,,0000,0000,0000,,then you code it to this.
Dialogue: 0,0:56:57.70,0:57:00.26,Default,,0000,0000,0000,,But if you were hit by\Na dog, it's different.
Dialogue: 0,0:57:00.26,0:57:01.68,Default,,0000,0000,0000,,I could throw some up,
Dialogue: 0,0:57:01.68,0:57:02.79,Default,,0000,0000,0000,,and you'd be like, really?
Dialogue: 0,0:57:02.79,0:57:05.82,Default,,0000,0000,0000,,That's a code. And they\Nare that specific.
Dialogue: 0,0:57:05.82,0:57:06.72,Default,,0000,0000,0000,,It's really strange.
Dialogue: 0,0:57:06.72,0:57:08.06,Default,,0000,0000,0000,,Some of them\Nare hilarious.
Dialogue: 0,0:57:08.06,0:57:09.45,Default,,0000,0000,0000,,I don't know how they\Ncame up with them,
Dialogue: 0,0:57:09.45,0:57:10.52,Default,,0000,0000,0000,,but they are like,
Dialogue: 0,0:57:10.52,0:57:12.93,Default,,0000,0000,0000,,bit by a shark while scuba
Dialogue: 0,0:57:12.93,0:57:16.68,Default,,0000,0000,0000,,diving. Did they live?
Dialogue: 0,0:57:16.68,0:57:19.16,Default,,0000,0000,0000,,Inpatient quality\Nreporting,
Dialogue: 0,0:57:19.16,0:57:20.25,Default,,0000,0000,0000,,the macro which I
Dialogue: 0,0:57:20.25,0:57:22.35,Default,,0000,0000,0000,,talked about earlier on\Nphysician reporting,
Dialogue: 0,0:57:22.35,0:57:23.62,Default,,0000,0000,0000,,this is significant.
Dialogue: 0,0:57:23.62,0:57:26.84,Default,,0000,0000,0000,,You could have\Nupwards of 9%.
Dialogue: 0,0:57:26.84,0:57:29.73,Default,,0000,0000,0000,,Now, for physicians\Nthat can be
Dialogue: 0,0:57:29.73,0:57:32.97,Default,,0000,0000,0000,,a huge swing in their\Npay in any one year.
Dialogue: 0,0:57:32.97,0:57:34.84,Default,,0000,0000,0000,,Yet, on the other side,\Nif you do it well,
Dialogue: 0,0:57:34.84,0:57:37.23,Default,,0000,0000,0000,,you might gain\Nreadmission rates.
Dialogue: 0,0:57:37.23,0:57:38.20,Default,,0000,0000,0000,,We got to monitor that.
Dialogue: 0,0:57:38.20,0:57:39.03,Default,,0000,0000,0000,,All of these things are
Dialogue: 0,0:57:39.03,0:57:40.89,Default,,0000,0000,0000,,reporting requirements\Nthat we have to do.
Dialogue: 0,0:57:40.89,0:57:42.82,Default,,0000,0000,0000,,We don't get any\Nadditional money,
Dialogue: 0,0:57:42.82,0:57:43.56,Default,,0000,0000,0000,,but if you don't do them,
Dialogue: 0,0:57:43.56,0:57:45.49,Default,,0000,0000,0000,,then you make less money.
Dialogue: 0,0:57:45.83,0:57:51.27,Default,,0000,0000,0000,,So one of the things\Nin that in summary,
Dialogue: 0,0:57:51.27,0:57:53.13,Default,,0000,0000,0000,,as we start to\Nwrap this up,
Dialogue: 0,0:57:53.13,0:57:55.23,Default,,0000,0000,0000,,why does our\Nfoundation help us?
Dialogue: 0,0:57:55.23,0:57:58.54,Default,,0000,0000,0000,,There are many non\Ncost based programs.
Dialogue: 0,0:57:58.54,0:58:03.62,Default,,0000,0000,0000,,Psych and rehab,\Ndon't make money.
Dialogue: 0,0:58:03.62,0:58:07.30,Default,,0000,0000,0000,,So by providing\Ncertain services
Dialogue: 0,0:58:07.30,0:58:09.51,Default,,0000,0000,0000,,and continue to\Nsupport those
Dialogue: 0,0:58:09.51,0:58:11.01,Default,,0000,0000,0000,,across the\Ncontinuing to have
Dialogue: 0,0:58:11.01,0:58:13.20,Default,,0000,0000,0000,,the foundation helping\Nus within that so
Dialogue: 0,0:58:13.20,0:58:15.66,Default,,0000,0000,0000,,that we can be self\Nsustaining and
Dialogue: 0,0:58:15.66,0:58:16.68,Default,,0000,0000,0000,,self determining in our
Dialogue: 0,0:58:16.68,0:58:19.51,Default,,0000,0000,0000,,future is really\Nimportant.
Dialogue: 0,0:58:20.18,0:58:23.06,Default,,0000,0000,0000,,Skilled nursing\Nfacilities, SNIFs,
Dialogue: 0,0:58:23.06,0:58:24.50,Default,,0000,0000,0000,,home health agencies,
Dialogue: 0,0:58:24.50,0:58:26.78,Default,,0000,0000,0000,,non reimburseable\Ncost centers.
Dialogue: 0,0:58:26.78,0:58:28.29,Default,,0000,0000,0000,,It's just certain things\Nthat we don't get
Dialogue: 0,0:58:28.29,0:58:29.61,Default,,0000,0000,0000,,any payment for,
Dialogue: 0,0:58:29.61,0:58:30.69,Default,,0000,0000,0000,,but we want to continue to
Dialogue: 0,0:58:30.69,0:58:31.74,Default,,0000,0000,0000,,provide those\Nservices because
Dialogue: 0,0:58:31.74,0:58:34.53,Default,,0000,0000,0000,,it's important to\Nour community.
Dialogue: 0,0:58:34.53,0:58:36.57,Default,,0000,0000,0000,,That's where the\Nfoundation that's where
Dialogue: 0,0:58:36.57,0:58:38.88,Default,,0000,0000,0000,,being a public hospital\Ndistrict really help.
Dialogue: 0,0:58:38.88,0:58:41.88,Default,,0000,0000,0000,,Other things within\Ncost reimbursement cost
Dialogue: 0,0:58:41.88,0:58:44.30,Default,,0000,0000,0000,,per head that are\Nnon cost services.
Dialogue: 0,0:58:44.30,0:58:45.57,Default,,0000,0000,0000,,Things like today are
Dialogue: 0,0:58:45.57,0:58:47.28,Default,,0000,0000,0000,,care coordination, I\Nmentioned earlier.
Dialogue: 0,0:58:47.28,0:58:49.62,Default,,0000,0000,0000,,This the right\Nthing to do.
Dialogue: 0,0:58:49.62,0:58:52.70,Default,,0000,0000,0000,,Honestly, it costs\Nus money to do it.
Dialogue: 0,0:58:52.70,0:58:54.20,Default,,0000,0000,0000,,We look to grants, and
Dialogue: 0,0:58:54.20,0:58:56.13,Default,,0000,0000,0000,,that's part of the\Nfoundation's efforts
Dialogue: 0,0:58:56.13,0:58:58.32,Default,,0000,0000,0000,,to bring in those type
Dialogue: 0,0:58:58.32,0:58:59.82,Default,,0000,0000,0000,,of things to help\Noffset that.
Dialogue: 0,0:58:59.82,0:59:01.34,Default,,0000,0000,0000,,It doesn't dollar\Nfor dollar,
Dialogue: 0,0:59:01.34,0:59:03.21,Default,,0000,0000,0000,,but it's caring\Nfor patients and
Dialogue: 0,0:59:03.21,0:59:05.07,Default,,0000,0000,0000,,getting them in\Nthe right place so
Dialogue: 0,0:59:05.07,0:59:06.30,Default,,0000,0000,0000,,that their care is better
Dialogue: 0,0:59:06.30,0:59:07.38,Default,,0000,0000,0000,,so that they\Ndon't end up in
Dialogue: 0,0:59:07.38,0:59:08.52,Default,,0000,0000,0000,,the emergency\Ndepartment with
Dialogue: 0,0:59:08.52,0:59:10.59,Default,,0000,0000,0000,,a major problem\Ndown the road.
Dialogue: 0,0:59:10.59,0:59:12.30,Default,,0000,0000,0000,,Those are really\Nimportant things to do.
Dialogue: 0,0:59:12.30,0:59:15.10,Default,,0000,0000,0000,,Nobody's paying\Nfor you today.
Dialogue: 0,0:59:16.58,0:59:18.15,Default,,0000,0000,0000,,Some of the things
Dialogue: 0,0:59:18.15,0:59:19.65,Default,,0000,0000,0000,,the foundation has\Nreally helped us with in
Dialogue: 0,0:59:19.65,0:59:22.59,Default,,0000,0000,0000,,their giving\Nthe whole hydro
Dialogue: 0,0:59:22.59,0:59:24.24,Default,,0000,0000,0000,,works pool therapy,
Dialogue: 0,0:59:24.24,0:59:25.62,Default,,0000,0000,0000,,underwater\Ntreadmill, we would
Dialogue: 0,0:59:25.62,0:59:26.86,Default,,0000,0000,0000,,not have had that.
Dialogue: 0,0:59:26.86,0:59:28.38,Default,,0000,0000,0000,,The system we had had
Dialogue: 0,0:59:28.38,0:59:30.03,Default,,0000,0000,0000,,failed and would\Nnot be obsolete.
Dialogue: 0,0:59:30.03,0:59:32.37,Default,,0000,0000,0000,,It'd basically be probably
Dialogue: 0,0:59:32.37,0:59:35.61,Default,,0000,0000,0000,,a mosquito pond.\NIt'd be gone.
Dialogue: 0,0:59:35.61,0:59:38.26,Default,,0000,0000,0000,,And that helped\Nus tremendously.
Dialogue: 0,0:59:38.26,0:59:41.61,Default,,0000,0000,0000,,The 3D mammography unit
Dialogue: 0,0:59:41.61,0:59:42.69,Default,,0000,0000,0000,,where you have\Nbeen blessed
Dialogue: 0,0:59:42.69,0:59:45.06,Default,,0000,0000,0000,,with happened in 2014,
Dialogue: 0,0:59:45.06,0:59:47.50,Default,,0000,0000,0000,,the 2015, various areas,
Dialogue: 0,0:59:47.50,0:59:49.56,Default,,0000,0000,0000,,a lot of different\Nareas, services.
Dialogue: 0,0:59:49.56,0:59:53.78,Default,,0000,0000,0000,,In 2016, the OR project.
Dialogue: 0,0:59:53.78,0:59:55.19,Default,,0000,0000,0000,,And then now one of
Dialogue: 0,0:59:55.19,0:59:57.76,Default,,0000,0000,0000,,their major efforts is\N2017 on the expansion.
Dialogue: 0,0:59:57.76,0:59:59.27,Default,,0000,0000,0000,,And as we look to that,
Dialogue: 0,0:59:59.27,1:00:00.64,Default,,0000,0000,0000,,why we needed that.
Dialogue: 0,1:00:00.64,1:00:03.14,Default,,0000,0000,0000,,In 2004, when\Nwe opened this,
Dialogue: 0,1:00:03.14,1:00:05.54,Default,,0000,0000,0000,,we thought we plenty\Nof space forever,
Dialogue: 0,1:00:05.54,1:00:07.08,Default,,0000,0000,0000,,and now we're\Nout of space.
Dialogue: 0,1:00:07.08,1:00:10.13,Default,,0000,0000,0000,,With volume increasing\Nas much as they have,
Dialogue: 0,1:00:10.13,1:00:11.94,Default,,0000,0000,0000,,as much as 25, 30%,
Dialogue: 0,1:00:11.94,1:00:13.58,Default,,0000,0000,0000,,we need more space.
Dialogue: 0,1:00:13.58,1:00:15.68,Default,,0000,0000,0000,,And that will be the\Ncase for a while.
Dialogue: 0,1:00:15.68,1:00:17.34,Default,,0000,0000,0000,,Then there's I've\Nprobably got this
Dialogue: 0,1:00:17.34,1:00:19.02,Default,,0000,0000,0000,,out of order, but\Nthe surgery project,
Dialogue: 0,1:00:19.02,1:00:20.19,Default,,0000,0000,0000,,which is well\Nunderway and should
Dialogue: 0,1:00:20.19,1:00:21.96,Default,,0000,0000,0000,,be done by August,
Dialogue: 0,1:00:21.96,1:00:23.49,Default,,0000,0000,0000,,end of August and\Ncoming online
Dialogue: 0,1:00:23.49,1:00:25.41,Default,,0000,0000,0000,,by September, which\Nwill be perfect.
Dialogue: 0,1:00:25.41,1:00:29.58,Default,,0000,0000,0000,,So summary Healthcare\Nfinances is complicated.
Dialogue: 0,1:00:29.58,1:00:32.40,Default,,0000,0000,0000,,I mean, we can't do it\Njustice in an hour.
Dialogue: 0,1:00:32.40,1:00:34.11,Default,,0000,0000,0000,,I hope that you got\Na little bit of
Dialogue: 0,1:00:34.11,1:00:36.15,Default,,0000,0000,0000,,taste of the\Ncomplexity and what
Dialogue: 0,1:00:36.15,1:00:38.30,Default,,0000,0000,0000,,it means within\Nour institution
Dialogue: 0,1:00:38.30,1:00:40.08,Default,,0000,0000,0000,,on how we manage that.
Dialogue: 0,1:00:40.08,1:00:42.21,Default,,0000,0000,0000,,But each input is unique.
Dialogue: 0,1:00:42.21,1:00:44.70,Default,,0000,0000,0000,,Therefore, care delivery\Nmust be flexible.
Dialogue: 0,1:00:44.70,1:00:46.100,Default,,0000,0000,0000,,It can't be stagnant.
Dialogue: 0,1:00:46.100,1:00:48.72,Default,,0000,0000,0000,,Everybody we're going\Nto treat you the same.
Dialogue: 0,1:00:48.72,1:00:50.08,Default,,0000,0000,0000,,We'll put you on\Na conveyor belt.
Dialogue: 0,1:00:50.08,1:00:51.69,Default,,0000,0000,0000,,We'll run you through
Dialogue: 0,1:00:51.69,1:00:53.08,Default,,0000,0000,0000,,because you're\Nall the same,
Dialogue: 0,1:00:53.08,1:00:55.90,Default,,0000,0000,0000,,and I can then control\Nall my costs that way.
Dialogue: 0,1:00:55.90,1:00:57.70,Default,,0000,0000,0000,,And we can't do\Nthat in healthcare.
Dialogue: 0,1:00:57.70,1:00:59.22,Default,,0000,0000,0000,,Physician orders drive.
Dialogue: 0,1:00:59.22,1:01:01.74,Default,,0000,0000,0000,,Physicians still drive\Neverything we do.
Dialogue: 0,1:01:01.74,1:01:04.04,Default,,0000,0000,0000,,Without physicians\Nin our community,
Dialogue: 0,1:01:04.04,1:01:05.66,Default,,0000,0000,0000,,we would not\Nhave a hospital.
Dialogue: 0,1:01:05.66,1:01:08.22,Default,,0000,0000,0000,,They still drive\Neverything
Dialogue: 0,1:01:08.22,1:01:09.98,Default,,0000,0000,0000,,that the care today.
Dialogue: 0,1:01:09.98,1:01:12.34,Default,,0000,0000,0000,,So orders drive\Nprovisions of care,
Dialogue: 0,1:01:12.34,1:01:14.64,Default,,0000,0000,0000,,adding to the variability.
Dialogue: 0,1:01:14.64,1:01:17.13,Default,,0000,0000,0000,,Payment is also\Nvariable depending
Dialogue: 0,1:01:17.13,1:01:20.04,Default,,0000,0000,0000,,on who's the\Ninsurance payer?
Dialogue: 0,1:01:20.04,1:01:22.12,Default,,0000,0000,0000,,What coverage do you have?
Dialogue: 0,1:01:22.12,1:01:25.12,Default,,0000,0000,0000,,Does your insurance\Ncompany cover that today?
Dialogue: 0,1:01:25.12,1:01:26.74,Default,,0000,0000,0000,,Not tomorrow? By the way,
Dialogue: 0,1:01:26.74,1:01:28.26,Default,,0000,0000,0000,,one of those\Nthings that we
Dialogue: 0,1:01:28.26,1:01:30.10,Default,,0000,0000,0000,,want an example of\Nthis. What do I mean?
Dialogue: 0,1:01:30.10,1:01:33.54,Default,,0000,0000,0000,,Primera decided, and\NI'll say this wrong,
Dialogue: 0,1:01:33.54,1:01:38.25,Default,,0000,0000,0000,,and please correct\Nme those that, no.
Dialogue: 0,1:01:38.25,1:01:41.64,Default,,0000,0000,0000,,But Propathol is\Nthat the right word,
Dialogue: 0,1:01:41.64,1:01:43.78,Default,,0000,0000,0000,,the administration\Nof the drug with
Dialogue: 0,1:01:43.78,1:01:46.54,Default,,0000,0000,0000,,anesthesia drug,\Nespecially colonoscopies.
Dialogue: 0,1:01:46.54,1:01:48.22,Default,,0000,0000,0000,,Doctor Jones likes that.
Dialogue: 0,1:01:48.22,1:01:49.60,Default,,0000,0000,0000,,It works very\Nwell. He wants
Dialogue: 0,1:01:49.60,1:01:51.04,Default,,0000,0000,0000,,the CRNA in the room.
Dialogue: 0,1:01:51.04,1:01:52.42,Default,,0000,0000,0000,,>> It's patients\Nwagon too.
Dialogue: 0,1:01:52.42,1:01:53.97,Default,,0000,0000,0000,,>> Man. I loved it.\NI had that done.
Dialogue: 0,1:01:53.97,1:01:56.02,Default,,0000,0000,0000,,It was awesome. I\Nremember nothing.
Dialogue: 0,1:01:56.02,1:01:57.51,Default,,0000,0000,0000,,But, you know, I\Ngot to tell you,
Dialogue: 0,1:01:57.51,1:01:58.65,Default,,0000,0000,0000,,when I came out of\Nit, I had it done
Dialogue: 0,1:01:58.65,1:02:00.21,Default,,0000,0000,0000,,here I didn't\Ndo it at home.
Dialogue: 0,1:02:00.21,1:02:01.89,Default,,0000,0000,0000,,And I had John O'Brien,
Dialogue: 0,1:02:01.89,1:02:03.81,Default,,0000,0000,0000,,my materials manner\Ncome in and make
Dialogue: 0,1:02:03.81,1:02:04.77,Default,,0000,0000,0000,,sure I got to where I
Dialogue: 0,1:02:04.77,1:02:06.57,Default,,0000,0000,0000,,needed to go after\Nwe were done.
Dialogue: 0,1:02:06.57,1:02:09.03,Default,,0000,0000,0000,,And I told him, Hey,
Dialogue: 0,1:02:09.03,1:02:10.52,Default,,0000,0000,0000,,call my wife,\Ntell her I died.
Dialogue: 0,1:02:10.52,1:02:11.74,Default,,0000,0000,0000,,'Cause I thought\Nit'd be funny.
Dialogue: 0,1:02:11.74,1:02:12.60,Default,,0000,0000,0000,,I don't remember actually
Dialogue: 0,1:02:12.60,1:02:15.24,Default,,0000,0000,0000,,saying that. I'm glad\Nhe didn't call her.
Dialogue: 0,1:02:15.24,1:02:16.50,Default,,0000,0000,0000,,But I thought it\Nwould be funny,
Dialogue: 0,1:02:16.50,1:02:18.03,Default,,0000,0000,0000,,I guess, apparently.
Dialogue: 0,1:02:18.03,1:02:19.23,Default,,0000,0000,0000,,He's probably\Nwhat you tell
Dialogue: 0,1:02:19.23,1:02:20.19,Default,,0000,0000,0000,,people under that stuff.
Dialogue: 0,1:02:20.19,1:02:22.56,Default,,0000,0000,0000,,It was awesome.\NBut premier
Dialogue: 0,1:02:22.56,1:02:24.42,Default,,0000,0000,0000,,decided, we're not\Npaying for that.
Dialogue: 0,1:02:24.42,1:02:26.42,Default,,0000,0000,0000,,It's an additional cost.
Dialogue: 0,1:02:26.42,1:02:29.18,Default,,0000,0000,0000,,Even though a physician\Npreference is that,
Dialogue: 0,1:02:29.18,1:02:30.88,Default,,0000,0000,0000,,they're just not\Ngoing to pay for it.
Dialogue: 0,1:02:30.88,1:02:34.35,Default,,0000,0000,0000,,So we help\Nsubsidize that for
Dialogue: 0,1:02:34.35,1:02:35.91,Default,,0000,0000,0000,,the CRNAs because it's\Nreally important to
Dialogue: 0,1:02:35.91,1:02:38.66,Default,,0000,0000,0000,,a physician for that\Naspect of care.
Dialogue: 0,1:02:38.66,1:02:40.38,Default,,0000,0000,0000,,That's what insurance\Ncompanies do,
Dialogue: 0,1:02:40.38,1:02:41.76,Default,,0000,0000,0000,,so that insurance\Ncompany is
Dialogue: 0,1:02:41.76,1:02:43.72,Default,,0000,0000,0000,,part of that negotiating\Nthose raised,
Dialogue: 0,1:02:43.72,1:02:46.05,Default,,0000,0000,0000,,payer mix regulations have
Dialogue: 0,1:02:46.05,1:02:49.26,Default,,0000,0000,0000,,a big influence of how\Nand what we do here.
Dialogue: 0,1:02:49.26,1:02:50.62,Default,,0000,0000,0000,,We're going through\Npart of that,
Dialogue: 0,1:02:50.62,1:02:51.69,Default,,0000,0000,0000,,within the next\Nfew months,
Dialogue: 0,1:02:51.69,1:02:53.70,Default,,0000,0000,0000,,we'll have a review by
Dialogue: 0,1:02:53.70,1:02:55.35,Default,,0000,0000,0000,,an outside agency\Nthat will come
Dialogue: 0,1:02:55.35,1:02:57.03,Default,,0000,0000,0000,,in and evaluate\Nhow we're doing,
Dialogue: 0,1:02:57.03,1:02:58.78,Default,,0000,0000,0000,,are we meeting the\NMedicare standards?
Dialogue: 0,1:02:58.78,1:03:00.99,Default,,0000,0000,0000,,Technology\Nchanges rapidly.
Dialogue: 0,1:03:00.99,1:03:02.52,Default,,0000,0000,0000,,How do we\Nreinvest in that?
Dialogue: 0,1:03:02.52,1:03:04.32,Default,,0000,0000,0000,,So we need a profit\Nin order to reinvest,
Dialogue: 0,1:03:04.32,1:03:05.79,Default,,0000,0000,0000,,or the foundation\Nhas stepped in in
Dialogue: 0,1:03:05.79,1:03:07.95,Default,,0000,0000,0000,,many gaps where we\Ndidn't have that
Dialogue: 0,1:03:07.95,1:03:09.48,Default,,0000,0000,0000,,to be able to\Noffset that and
Dialogue: 0,1:03:09.48,1:03:11.40,Default,,0000,0000,0000,,help us continue to offer
Dialogue: 0,1:03:11.40,1:03:14.07,Default,,0000,0000,0000,,high quality\Ntechnology and
Dialogue: 0,1:03:14.07,1:03:15.93,Default,,0000,0000,0000,,keep our prices\Nreasonable.
Dialogue: 0,1:03:15.93,1:03:17.82,Default,,0000,0000,0000,,And then many\Ndifferent players in
Dialogue: 0,1:03:17.82,1:03:22.84,Default,,0000,0000,0000,,healthcare. Yes, sir.
Dialogue: 0,1:03:22.84,1:03:24.84,Default,,0000,0000,0000,,>> Truly a negotiable rate
Dialogue: 0,1:03:24.84,1:03:27.63,Default,,0000,0000,0000,,what I hear from
Dialogue: 0,1:03:27.63,1:03:30.51,Default,,0000,0000,0000,,insurance companies\Nstandard here,
Dialogue: 0,1:03:30.51,1:03:31.86,Default,,0000,0000,0000,,what is the limitation?
Dialogue: 0,1:03:31.86,1:03:33.56,Default,,0000,0000,0000,,You may want to negotiate
Dialogue: 0,1:03:33.56,1:03:34.71,Default,,0000,0000,0000,,you're only\Ngoing to be told
Dialogue: 0,1:03:34.71,1:03:36.00,Default,,0000,0000,0000,,how much you're\Ngoing to get.
Dialogue: 0,1:03:36.00,1:03:37.95,Default,,0000,0000,0000,,>> So the question\Nis, is it
Dialogue: 0,1:03:37.95,1:03:40.83,Default,,0000,0000,0000,,a truly negotiated\Nrate or you just told?
Dialogue: 0,1:03:40.83,1:03:43.80,Default,,0000,0000,0000,,Medicare or Medicaid,\Nthey're the big boy
Dialogue: 0,1:03:43.80,1:03:46.88,Default,,0000,0000,0000,,you're told. You\Ndon't negotiate.
Dialogue: 0,1:03:46.88,1:03:49.74,Default,,0000,0000,0000,,Other commercial\Npayers, you do
Dialogue: 0,1:03:49.74,1:03:52.34,Default,,0000,0000,0000,,have the opportunity\Nto negotiate.
Dialogue: 0,1:03:52.34,1:03:56.88,Default,,0000,0000,0000,,You're negotiating power\Nis limited by even
Dialogue: 0,1:03:56.88,1:03:59.74,Default,,0000,0000,0000,,within our community wall
Dialogue: 0,1:03:59.74,1:04:02.12,Default,,0000,0000,0000,,by who's negotiating what?
Dialogue: 0,1:04:02.12,1:04:04.83,Default,,0000,0000,0000,,The more players and\Nas we talk about
Dialogue: 0,1:04:04.83,1:04:06.06,Default,,0000,0000,0000,,fully integrated health
Dialogue: 0,1:04:06.06,1:04:07.26,Default,,0000,0000,0000,,systems where you have
Dialogue: 0,1:04:07.26,1:04:09.06,Default,,0000,0000,0000,,physicians and\Nhospital and
Dialogue: 0,1:04:09.06,1:04:10.47,Default,,0000,0000,0000,,all that working\Ncollectively,
Dialogue: 0,1:04:10.47,1:04:12.82,Default,,0000,0000,0000,,you have more\Nnegotiating power.
Dialogue: 0,1:04:12.82,1:04:14.94,Default,,0000,0000,0000,,So then you do have\Nthe ability to
Dialogue: 0,1:04:14.94,1:04:17.07,Default,,0000,0000,0000,,go and see now,
Dialogue: 0,1:04:17.07,1:04:19.14,Default,,0000,0000,0000,,at some point, you got\Nto approve outcomes.
Dialogue: 0,1:04:19.14,1:04:20.67,Default,,0000,0000,0000,,If you're improving,\Nthis is what we're
Dialogue: 0,1:04:20.67,1:04:22.44,Default,,0000,0000,0000,,doing, and we're\Nworking on that,
Dialogue: 0,1:04:22.44,1:04:24.16,Default,,0000,0000,0000,,part of the center\Nof excellence with
Dialogue: 0,1:04:24.16,1:04:26.38,Default,,0000,0000,0000,,the orthopedic surgeons
Dialogue: 0,1:04:26.38,1:04:27.98,Default,,0000,0000,0000,,is in developing that.
Dialogue: 0,1:04:27.98,1:04:29.70,Default,,0000,0000,0000,,At some point,\Nwe will develop
Dialogue: 0,1:04:29.70,1:04:31.44,Default,,0000,0000,0000,,a bundle payment\Nthat we can take to
Dialogue: 0,1:04:31.44,1:04:35.62,Default,,0000,0000,0000,,a Primera or to a\Nuniform and say,
Dialogue: 0,1:04:35.62,1:04:37.41,Default,,0000,0000,0000,,why would you want to\Nsend your patients to
Dialogue: 0,1:04:37.41,1:04:39.28,Default,,0000,0000,0000,,the West Side to\Nhave this done here?
Dialogue: 0,1:04:39.28,1:04:40.71,Default,,0000,0000,0000,,Here's our outcomes.\NBy the way,
Dialogue: 0,1:04:40.71,1:04:43.08,Default,,0000,0000,0000,,our prices are half
Dialogue: 0,1:04:43.08,1:04:45.02,Default,,0000,0000,0000,,of what they\Nare over there.
Dialogue: 0,1:04:45.02,1:04:46.53,Default,,0000,0000,0000,,So why wouldn't you\Nwant to have it done
Dialogue: 0,1:04:46.53,1:04:48.03,Default,,0000,0000,0000,,here, keep them local?
Dialogue: 0,1:04:48.03,1:04:49.59,Default,,0000,0000,0000,,But if you can\Nprove that, you
Dialogue: 0,1:04:49.59,1:04:50.90,Default,,0000,0000,0000,,got to have statistics\Nto do that.
Dialogue: 0,1:04:50.90,1:04:52.35,Default,,0000,0000,0000,,You got better\Nnegotiating power.
Dialogue: 0,1:04:52.35,1:04:54.90,Default,,0000,0000,0000,,>> How long\Nnegotiation look for?
Dialogue: 0,1:04:54.90,1:04:57.00,Default,,0000,0000,0000,,>> Typically, two\Nto three years.
Dialogue: 0,1:04:57.00,1:04:58.35,Default,,0000,0000,0000,,So right now I'm
Dialogue: 0,1:04:58.35,1:05:00.46,Default,,0000,0000,0000,,working on the\NPrimera contract.
Dialogue: 0,1:05:00.46,1:05:02.85,Default,,0000,0000,0000,,Hospital loan,\Nit's really hard
Dialogue: 0,1:05:02.85,1:05:05.25,Default,,0000,0000,0000,,because Grandma just\Nsigned last year,
Dialogue: 0,1:05:05.25,1:05:09.06,Default,,0000,0000,0000,,so I'm not going to get\Nany better than that.
Dialogue: 0,1:05:09.06,1:05:12.06,Default,,0000,0000,0000,,If I had an isolated\Nmarket, I could.
Dialogue: 0,1:05:12.06,1:05:14.25,Default,,0000,0000,0000,,So I would take\Nthe same contract
Dialogue: 0,1:05:14.25,1:05:16.76,Default,,0000,0000,0000,,that Tristate can\Nget with Primera,
Dialogue: 0,1:05:16.76,1:05:20.07,Default,,0000,0000,0000,,but they have one\Neighth the number
Dialogue: 0,1:05:20.07,1:05:22.80,Default,,0000,0000,0000,,of covered lives\Nin their arena,
Dialogue: 0,1:05:22.80,1:05:24.90,Default,,0000,0000,0000,,so they can get 90 plus\Npercent of charges.
Dialogue: 0,1:05:24.90,1:05:27.10,Default,,0000,0000,0000,,They just don't have\Nthe same volume we do.
Dialogue: 0,1:05:27.10,1:05:29.44,Default,,0000,0000,0000,,Were here, they can\Ndrive a lot of that.
Dialogue: 0,1:05:29.44,1:05:32.34,Default,,0000,0000,0000,,But it's getting more\Nand more challenging.
Dialogue: 0,1:05:32.34,1:05:35.46,Default,,0000,0000,0000,,Have people heard of\Nwhat narrow markets are?
Dialogue: 0,1:05:35.46,1:05:37.35,Default,,0000,0000,0000,,Okay, so we have
Dialogue: 0,1:05:37.35,1:05:40.50,Default,,0000,0000,0000,,one in our arena. It's\Na catalyst group.
Dialogue: 0,1:05:40.50,1:05:42.78,Default,,0000,0000,0000,,They went directly to
Dialogue: 0,1:05:42.78,1:05:44.73,Default,,0000,0000,0000,,the Blue Cross of Idaho
Dialogue: 0,1:05:44.73,1:05:47.37,Default,,0000,0000,0000,,to a very isolated market,
Dialogue: 0,1:05:47.37,1:05:48.51,Default,,0000,0000,0000,,and they said, We'll
Dialogue: 0,1:05:48.51,1:05:50.07,Default,,0000,0000,0000,,take care of\Nthose patients.
Dialogue: 0,1:05:50.07,1:05:52.02,Default,,0000,0000,0000,,If that patient\Ngoes outside,
Dialogue: 0,1:05:52.02,1:05:56.58,Default,,0000,0000,0000,,so these are self\Npurchased insurance plans.
Dialogue: 0,1:05:56.58,1:05:59.78,Default,,0000,0000,0000,,If that patient goes\Noutside of the market,
Dialogue: 0,1:05:59.78,1:06:03.10,Default,,0000,0000,0000,,they have a $50,000\Ndeductible.
Dialogue: 0,1:06:03.10,1:06:04.74,Default,,0000,0000,0000,,So they can go to Gritman.
Dialogue: 0,1:06:04.74,1:06:06.32,Default,,0000,0000,0000,,They can't come\Nto Pullman,
Dialogue: 0,1:06:06.32,1:06:08.30,Default,,0000,0000,0000,,because that's how narrow
Dialogue: 0,1:06:08.30,1:06:09.75,Default,,0000,0000,0000,,they did the market.
Dialogue: 0,1:06:09.75,1:06:13.30,Default,,0000,0000,0000,,They kept it in Idaho.\NThose are happening.
Dialogue: 0,1:06:13.48,1:06:16.37,Default,,0000,0000,0000,,>> [inaudible] for\Npricing supply and
Dialogue: 0,1:06:16.37,1:06:18.92,Default,,0000,0000,0000,,demand in theory,\Ndetermines price.
Dialogue: 0,1:06:18.92,1:06:21.92,Default,,0000,0000,0000,,So how has the\NPullman Hospital done
Dialogue: 0,1:06:21.92,1:06:23.56,Default,,0000,0000,0000,,in demand growth
Dialogue: 0,1:06:23.56,1:06:25.58,Default,,0000,0000,0000,,compared to\Npopulation growth?
Dialogue: 0,1:06:25.58,1:06:28.08,Default,,0000,0000,0000,,How are we competing\Nwith the other guys?
Dialogue: 0,1:06:28.08,1:06:30.60,Default,,0000,0000,0000,,>> How are we competing\Non supply and demand?
Dialogue: 0,1:06:30.60,1:06:32.48,Default,,0000,0000,0000,,>> Are we\Nincreasing demand
Dialogue: 0,1:06:32.48,1:06:35.30,Default,,0000,0000,0000,,as fast or faster as\Nthe population growth?
Dialogue: 0,1:06:35.30,1:06:37.07,Default,,0000,0000,0000,,>> Not in all areas.
Dialogue: 0,1:06:37.07,1:06:41.24,Default,,0000,0000,0000,,So a lot of that is\Ncontingent on providers.
Dialogue: 0,1:06:41.24,1:06:42.71,Default,,0000,0000,0000,,And can you get a provider
Dialogue: 0,1:06:42.71,1:06:43.97,Default,,0000,0000,0000,,within those specialties?
Dialogue: 0,1:06:43.97,1:06:45.05,Default,,0000,0000,0000,,One of the things we're
Dialogue: 0,1:06:45.05,1:06:46.64,Default,,0000,0000,0000,,actively trying\Nto recruit, too,
Dialogue: 0,1:06:46.64,1:06:49.28,Default,,0000,0000,0000,,and we have been\Nsuccessful here just
Dialogue: 0,1:06:49.28,1:06:52.12,Default,,0000,0000,0000,,recently is in non\Ninvasive cardiology.
Dialogue: 0,1:06:52.12,1:06:54.48,Default,,0000,0000,0000,,The other areas in\Npulmonology and sleep.
Dialogue: 0,1:06:54.48,1:06:56.08,Default,,0000,0000,0000,,The demands there,
Dialogue: 0,1:06:56.08,1:06:57.41,Default,,0000,0000,0000,,we have to outsource\Nthat today,
Dialogue: 0,1:06:57.41,1:06:59.21,Default,,0000,0000,0000,,so an outside group\Ndoes all of that.
Dialogue: 0,1:06:59.21,1:07:00.74,Default,,0000,0000,0000,,All of those funds\Ngo outside of
Dialogue: 0,1:07:00.74,1:07:03.23,Default,,0000,0000,0000,,our market to be\Nable to do that,
Dialogue: 0,1:07:03.23,1:07:04.88,Default,,0000,0000,0000,,because we may\Ndo the study
Dialogue: 0,1:07:04.88,1:07:07.37,Default,,0000,0000,0000,,here but the providers\Naren't here.
Dialogue: 0,1:07:07.37,1:07:08.93,Default,,0000,0000,0000,,So there's no\Nreinvestment back into
Dialogue: 0,1:07:08.93,1:07:11.62,Default,,0000,0000,0000,,the community for\Nthose like services.
Dialogue: 0,1:07:11.62,1:07:13.08,Default,,0000,0000,0000,,So in some areas,
Dialogue: 0,1:07:13.08,1:07:14.24,Default,,0000,0000,0000,,it's a real challenge
Dialogue: 0,1:07:14.24,1:07:15.78,Default,,0000,0000,0000,,because it's\Nspecific on that.
Dialogue: 0,1:07:15.78,1:07:17.51,Default,,0000,0000,0000,,In other areas now\Nwe're keeping up,
Dialogue: 0,1:07:17.51,1:07:18.86,Default,,0000,0000,0000,,and that's one of the\Nreasons we're looking
Dialogue: 0,1:07:18.86,1:07:21.11,Default,,0000,0000,0000,,at building the fourth or
Dialogue: 0,1:07:21.11,1:07:23.52,Default,,0000,0000,0000,,adding same day\Nservices expansion
Dialogue: 0,1:07:23.52,1:07:25.70,Default,,0000,0000,0000,,is because the demand\Nhas been there.
Dialogue: 0,1:07:25.70,1:07:27.68,Default,,0000,0000,0000,,We are at capacity\Nand we have
Dialogue: 0,1:07:27.68,1:07:29.90,Default,,0000,0000,0000,,just no more room in\Norder to get that.
Dialogue: 0,1:07:29.90,1:07:33.32,Default,,0000,0000,0000,,Now, I say that almost\Ntongue in cheek,
Dialogue: 0,1:07:33.32,1:07:34.70,Default,,0000,0000,0000,,because there's a lot to
Dialogue: 0,1:07:34.70,1:07:36.02,Default,,0000,0000,0000,,do with physician\Npreferences.
Dialogue: 0,1:07:36.02,1:07:39.02,Default,,0000,0000,0000,,And if you're a physician
Dialogue: 0,1:07:39.02,1:07:41.16,Default,,0000,0000,0000,,and Dr. Tinsted\Ncould speak to this,
Dialogue: 0,1:07:41.16,1:07:43.13,Default,,0000,0000,0000,,you don't want to start\Nsurgery at 6:00 at
Dialogue: 0,1:07:43.13,1:07:45.28,Default,,0000,0000,0000,,night unless it's\Nan emergency.
Dialogue: 0,1:07:45.28,1:07:47.15,Default,,0000,0000,0000,,You prefer to get\Nin and get out,
Dialogue: 0,1:07:47.15,1:07:48.23,Default,,0000,0000,0000,,and so you get back\Nto your clinical
Dialogue: 0,1:07:48.23,1:07:49.58,Default,,0000,0000,0000,,care for your patients.
Dialogue: 0,1:07:49.58,1:07:51.80,Default,,0000,0000,0000,,And so most\Nphysicians have
Dialogue: 0,1:07:51.80,1:07:52.94,Default,,0000,0000,0000,,blocked schedules\Nbecause then
Dialogue: 0,1:07:52.94,1:07:54.12,Default,,0000,0000,0000,,they can control\Ntheir life.
Dialogue: 0,1:07:54.12,1:07:55.04,Default,,0000,0000,0000,,They don't want to just,
Dialogue: 0,1:07:55.04,1:07:57.05,Default,,0000,0000,0000,,what do you have today?
Dialogue: 0,1:07:57.05,1:07:58.34,Default,,0000,0000,0000,,We'll call and see if we
Dialogue: 0,1:07:58.34,1:07:58.94,Default,,0000,0000,0000,,can get them in today.
Dialogue: 0,1:07:58.94,1:08:00.66,Default,,0000,0000,0000,,That doesn't work very\Nwell in their life.
Dialogue: 0,1:08:00.66,1:08:03.10,Default,,0000,0000,0000,,So you have to have\Nthat capacity.
Dialogue: 0,1:08:03.10,1:08:04.82,Default,,0000,0000,0000,,But in order to do that,\Nsometimes you have
Dialogue: 0,1:08:04.82,1:08:05.99,Default,,0000,0000,0000,,those downsides\Nbecause nobody
Dialogue: 0,1:08:05.99,1:08:06.67,Default,,0000,0000,0000,,wants to start 2:00,
Dialogue: 0,1:08:06.67,1:08:07.82,Default,,0000,0000,0000,,3:00, 4:00 in\Nthe afternoon.
Dialogue: 0,1:08:07.82,1:08:09.66,Default,,0000,0000,0000,,If we could run 24/7
Dialogue: 0,1:08:09.66,1:08:12.54,Default,,0000,0000,0000,,in those areas and\Npeople willing to do it,
Dialogue: 0,1:08:12.54,1:08:15.23,Default,,0000,0000,0000,,you could control the\Ncost much better.
Dialogue: 0,1:08:15.23,1:08:16.67,Default,,0000,0000,0000,,But you can't today
Dialogue: 0,1:08:16.67,1:08:18.05,Default,,0000,0000,0000,,because a lot of it's\Nbest off preface.
Dialogue: 0,1:08:18.05,1:08:19.58,Default,,0000,0000,0000,,>> Practical areas\Nyou'll be dealing with.
Dialogue: 0,1:08:19.58,1:08:21.30,Default,,0000,0000,0000,,>> You might.
Dialogue: 0,1:08:21.91,1:08:23.51,Default,,0000,0000,0000,,>> [OVERLAPPING]\NWhat you have in
Dialogue: 0,1:08:23.51,1:08:24.59,Default,,0000,0000,0000,,this market is, well,
Dialogue: 0,1:08:24.59,1:08:26.39,Default,,0000,0000,0000,,I can go 9.2
Dialogue: 0,1:08:26.39,1:08:27.65,Default,,0000,0000,0000,,miles and I can
Dialogue: 0,1:08:27.65,1:08:28.90,Default,,0000,0000,0000,,start at 7:00 so\NI'll take it there.
Dialogue: 0,1:08:28.90,1:08:30.53,Default,,0000,0000,0000,,Oh, no, wait you\Nstop. We want
Dialogue: 0,1:08:30.53,1:08:32.10,Default,,0000,0000,0000,,them here we don't\Nwant you to do that.
Dialogue: 0,1:08:32.10,1:08:33.83,Default,,0000,0000,0000,,So some of that\Npredictability
Dialogue: 0,1:08:33.83,1:08:34.82,Default,,0000,0000,0000,,and stuff is very
Dialogue: 0,1:08:34.82,1:08:36.35,Default,,0000,0000,0000,,challenging in\Nour markets just
Dialogue: 0,1:08:36.35,1:08:38.51,Default,,0000,0000,0000,,based on providing\Nhealthcare.
Dialogue: 0,1:08:38.51,1:08:40.64,Default,,0000,0000,0000,,So I don't know\Nif that totally
Dialogue: 0,1:08:40.64,1:08:42.82,Default,,0000,0000,0000,,answered it\Nadequately or not.
Dialogue: 0,1:08:42.82,1:08:44.26,Default,,0000,0000,0000,,We can talk more\Nif it didn't,
Dialogue: 0,1:08:44.26,1:08:47.49,Default,,0000,0000,0000,,no. Other questions?
Dialogue: 0,1:08:49.00,1:08:51.84,Default,,0000,0000,0000,,>> You must have\Nfigures too.
Dialogue: 0,1:08:51.84,1:08:54.23,Default,,0000,0000,0000,,>> I have a good figure.
Dialogue: 0,1:08:54.23,1:08:56.42,Default,,0000,0000,0000,,>> [OVERLAPPING] who's\Ntop of the game.
Dialogue: 0,1:08:56.42,1:08:58.04,Default,,0000,0000,0000,,But even a surgeon
Dialogue: 0,1:08:58.04,1:08:59.70,Default,,0000,0000,0000,,knows that they're\Nonly good for
Dialogue: 0,1:08:59.70,1:09:02.46,Default,,0000,0000,0000,,so many hours of\Nsolid surgery
Dialogue: 0,1:09:02.46,1:09:04.31,Default,,0000,0000,0000,,before they get a
Dialogue: 0,1:09:04.31,1:09:05.84,Default,,0000,0000,0000,,little punch drunk,\Ntoo, a little bit.
Dialogue: 0,1:09:05.84,1:09:08.62,Default,,0000,0000,0000,,So they know that\Nyou can commit
Dialogue: 0,1:09:08.62,1:09:12.00,Default,,0000,0000,0000,,a surgery unit for how\Nlong and of course,
Dialogue: 0,1:09:12.00,1:09:14.00,Default,,0000,0000,0000,,that affect\Nyour price too.
Dialogue: 0,1:09:14.00,1:09:17.08,Default,,0000,0000,0000,,>> Well, yeah, and\Nthat's really dependent.
Dialogue: 0,1:09:17.08,1:09:19.04,Default,,0000,0000,0000,,You're exactly right.
Dialogue: 0,1:09:19.04,1:09:24.71,Default,,0000,0000,0000,,The quality of care\Nof your providers,
Dialogue: 0,1:09:24.71,1:09:26.81,Default,,0000,0000,0000,,be it your\Nnursing staff to
Dialogue: 0,1:09:26.81,1:09:29.30,Default,,0000,0000,0000,,your physicians\Ndiminishes greatly
Dialogue: 0,1:09:29.30,1:09:32.00,Default,,0000,0000,0000,,if you don't give them\Nenough rest time.
Dialogue: 0,1:09:32.00,1:09:35.54,Default,,0000,0000,0000,,And so one of the\Nkey importances
Dialogue: 0,1:09:35.54,1:09:38.12,Default,,0000,0000,0000,,of recruitment\Nis to provide,
Dialogue: 0,1:09:38.12,1:09:41.18,Default,,0000,0000,0000,,and especially physicians\Nbreak in between,
Dialogue: 0,1:09:41.18,1:09:44.34,Default,,0000,0000,0000,,so they aren't on\Ncall all of the time
Dialogue: 0,1:09:44.34,1:09:45.96,Default,,0000,0000,0000,,because you will\Nburn them out
Dialogue: 0,1:09:45.96,1:09:48.70,Default,,0000,0000,0000,,and in short order.
Dialogue: 0,1:09:48.70,1:09:52.22,Default,,0000,0000,0000,,Same goes for your nursing\Nand support staff.
Dialogue: 0,1:09:52.22,1:09:53.30,Default,,0000,0000,0000,,If they don't have rest
Dialogue: 0,1:09:53.30,1:09:54.77,Default,,0000,0000,0000,,between shifts, and\Nwe used to do this.
Dialogue: 0,1:09:54.77,1:09:56.00,Default,,0000,0000,0000,,So you'd be done,
Dialogue: 0,1:09:56.00,1:09:56.98,Default,,0000,0000,0000,,and you had to go late
Dialogue: 0,1:09:56.98,1:09:58.32,Default,,0000,0000,0000,,because the\Ncase went late,
Dialogue: 0,1:09:58.32,1:09:59.75,Default,,0000,0000,0000,,and you were on call,
Dialogue: 0,1:09:59.75,1:10:00.74,Default,,0000,0000,0000,,and you got called back,
Dialogue: 0,1:10:00.74,1:10:02.24,Default,,0000,0000,0000,,and then you had\Nto come back in at
Dialogue: 0,1:10:02.24,1:10:03.17,Default,,0000,0000,0000,,7:00 in the morning to
Dialogue: 0,1:10:03.17,1:10:04.19,Default,,0000,0000,0000,,start it all over again.
Dialogue: 0,1:10:04.19,1:10:06.98,Default,,0000,0000,0000,,The quality goes down.
Dialogue: 0,1:10:06.98,1:10:10.60,Default,,0000,0000,0000,,Now what we do is we\Nhave a call shift.
Dialogue: 0,1:10:10.60,1:10:12.40,Default,,0000,0000,0000,,And then when they're
Dialogue: 0,1:10:12.40,1:10:13.92,Default,,0000,0000,0000,,not on call, then\Nthey're off.
Dialogue: 0,1:10:13.92,1:10:15.20,Default,,0000,0000,0000,,So they don't\Ncome in the next
Dialogue: 0,1:10:15.20,1:10:16.91,Default,,0000,0000,0000,,day that's a\Ndifferent group.
Dialogue: 0,1:10:16.91,1:10:18.42,Default,,0000,0000,0000,,So you have to have staff,
Dialogue: 0,1:10:18.42,1:10:20.56,Default,,0000,0000,0000,,which adds some cost,
Dialogue: 0,1:10:20.56,1:10:23.00,Default,,0000,0000,0000,,but it provides a\Nbetter quality of care.
Dialogue: 0,1:10:23.00,1:10:24.35,Default,,0000,0000,0000,,Plus rest between shift,
Dialogue: 0,1:10:24.35,1:10:25.37,Default,,0000,0000,0000,,we guarantee a\Ncertain amount
Dialogue: 0,1:10:25.37,1:10:26.72,Default,,0000,0000,0000,,of rest between shift
Dialogue: 0,1:10:26.72,1:10:30.16,Default,,0000,0000,0000,,so that they aren't\Nonly getting eight,
Dialogue: 0,1:10:30.16,1:10:31.37,Default,,0000,0000,0000,,that they're\Ngetting 10, so
Dialogue: 0,1:10:31.37,1:10:32.72,Default,,0000,0000,0000,,they get a full\Nnight's sleep.
Dialogue: 0,1:10:32.72,1:10:34.55,Default,,0000,0000,0000,,>> You're speaking\Nof staff, there's
Dialogue: 0,1:10:34.55,1:10:35.63,Default,,0000,0000,0000,,a difference in cost
Dialogue: 0,1:10:35.63,1:10:37.28,Default,,0000,0000,0000,,too depending on if you
Dialogue: 0,1:10:37.28,1:10:40.02,Default,,0000,0000,0000,,have your own staff\Nversus travelers.
Dialogue: 0,1:10:40.02,1:10:42.35,Default,,0000,0000,0000,,We have allowed travellers
Dialogue: 0,1:10:42.35,1:10:43.52,Default,,0000,0000,0000,,here from time to time.
Dialogue: 0,1:10:43.52,1:10:44.80,Default,,0000,0000,0000,,>> Yeah, occasionally.
Dialogue: 0,1:10:44.80,1:10:46.28,Default,,0000,0000,0000,,>> [inaudible]\NSwedish in Seattle.
Dialogue: 0,1:10:46.28,1:10:48.32,Default,,0000,0000,0000,,>> Yeah, 2.5 times\Nthe cost for
Dialogue: 0,1:10:48.32,1:10:51.00,Default,,0000,0000,0000,,traveling compared to\Nwhat you can keep here.
Dialogue: 0,1:10:51.00,1:10:53.32,Default,,0000,0000,0000,,You're typically\Ndoing that in areas.
Dialogue: 0,1:10:53.32,1:10:56.76,Default,,0000,0000,0000,,Most of the time here\Nin our market now,
Dialogue: 0,1:10:56.76,1:10:58.31,Default,,0000,0000,0000,,not when you were\Non the board,
Dialogue: 0,1:10:58.31,1:10:59.60,Default,,0000,0000,0000,,we had a problem back then
Dialogue: 0,1:10:59.60,1:11:01.37,Default,,0000,0000,0000,,just turnover because you
Dialogue: 0,1:11:01.37,1:11:03.26,Default,,0000,0000,0000,,were doing a lot of\Nlow senses, etc.
Dialogue: 0,1:11:03.26,1:11:04.55,Default,,0000,0000,0000,,Today, if we have
Dialogue: 0,1:11:04.55,1:11:06.38,Default,,0000,0000,0000,,a travelers generally do
Dialogue: 0,1:11:06.38,1:11:08.26,Default,,0000,0000,0000,,to somebody that's\Non maternity leave.
Dialogue: 0,1:11:08.26,1:11:09.48,Default,,0000,0000,0000,,It's a planned event
Dialogue: 0,1:11:09.48,1:11:10.37,Default,,0000,0000,0000,,you know they're\Ngoing to be out
Dialogue: 0,1:11:10.37,1:11:12.62,Default,,0000,0000,0000,,for 12 weeks.\NIt makes sense.
Dialogue: 0,1:11:12.62,1:11:13.88,Default,,0000,0000,0000,,You're going to\Npay a little more,
Dialogue: 0,1:11:13.88,1:11:15.86,Default,,0000,0000,0000,,but you wouldn't want\Nto hire because you
Dialogue: 0,1:11:15.86,1:11:18.04,Default,,0000,0000,0000,,made a commitment to\Nemploy them forever.
Dialogue: 0,1:11:18.04,1:11:19.78,Default,,0000,0000,0000,,So you do short term\Nstuff like that.
Dialogue: 0,1:11:19.78,1:11:22.31,Default,,0000,0000,0000,,We don't have nearly\Nthe travelers we
Dialogue: 0,1:11:22.31,1:11:26.13,Default,,0000,0000,0000,,used to. It's\Ntypically that.
Dialogue: 0,1:11:28.69,1:11:32.81,Default,,0000,0000,0000,,>> Do you think the\Nvalue based system
Dialogue: 0,1:11:32.81,1:11:34.18,Default,,0000,0000,0000,,will survive if
Dialogue: 0,1:11:34.18,1:11:37.02,Default,,0000,0000,0000,,the Affordable Care\NAct went away?
Dialogue: 0,1:11:37.02,1:11:39.38,Default,,0000,0000,0000,,That was in the\NAffordable Care Act,
Dialogue: 0,1:11:39.38,1:11:42.36,Default,,0000,0000,0000,,meaningful use, etc.
Dialogue: 0,1:11:42.36,1:11:43.61,Default,,0000,0000,0000,,>> So, will the value
Dialogue: 0,1:11:43.61,1:11:47.00,Default,,0000,0000,0000,,based payment\Nsystem continue
Dialogue: 0,1:11:47.00,1:11:52.78,Default,,0000,0000,0000,,to exist if the Affordable\NCare Act changes?
Dialogue: 0,1:11:52.78,1:11:54.68,Default,,0000,0000,0000,,The Affordable Care\NAct will change,
Dialogue: 0,1:11:54.68,1:11:56.87,Default,,0000,0000,0000,,inevitably, it'll\Nchange somehow.
Dialogue: 0,1:11:56.87,1:11:58.38,Default,,0000,0000,0000,,It doesn't matter\Nwhat administration,
Dialogue: 0,1:11:58.38,1:12:02.12,Default,,0000,0000,0000,,it will change. I do.
Dialogue: 0,1:12:02.12,1:12:05.33,Default,,0000,0000,0000,,Health care at\Nthe rate it was
Dialogue: 0,1:12:05.33,1:12:09.00,Default,,0000,0000,0000,,going is non sustainable\Nit has to change.
Dialogue: 0,1:12:09.00,1:12:10.56,Default,,0000,0000,0000,,You can't continue to have
Dialogue: 0,1:12:10.56,1:12:13.31,Default,,0000,0000,0000,,escalating payments\Nand expect
Dialogue: 0,1:12:13.31,1:12:14.33,Default,,0000,0000,0000,,anybody to be willing
Dialogue: 0,1:12:14.33,1:12:17.94,Default,,0000,0000,0000,,to do and be able\Nto pay for it.
Dialogue: 0,1:12:17.94,1:12:19.31,Default,,0000,0000,0000,,So what does\Nhave to change.
Dialogue: 0,1:12:19.31,1:12:22.13,Default,,0000,0000,0000,,How we deliver healthcare\Nneeds to change.
Dialogue: 0,1:12:22.13,1:12:23.51,Default,,0000,0000,0000,,We're reactionary,
Dialogue: 0,1:12:23.51,1:12:25.60,Default,,0000,0000,0000,,but America has done\Nthat to himself.
Dialogue: 0,1:12:25.60,1:12:27.11,Default,,0000,0000,0000,,We've done to ourselves.
Dialogue: 0,1:12:27.11,1:12:28.52,Default,,0000,0000,0000,,We don't want\Nanybody telling us
Dialogue: 0,1:12:28.52,1:12:29.87,Default,,0000,0000,0000,,what to do we\Njust want to make
Dialogue: 0,1:12:29.87,1:12:31.79,Default,,0000,0000,0000,,it better when we\Ndidn't do it because
Dialogue: 0,1:12:31.79,1:12:35.22,Default,,0000,0000,0000,,that's a lot of\Nhow we live.
Dialogue: 0,1:12:35.22,1:12:38.08,Default,,0000,0000,0000,,I didn't take care of\Nmyself, but fix me now.
Dialogue: 0,1:12:38.08,1:12:40.06,Default,,0000,0000,0000,,So some of that\Nneeds to change.
Dialogue: 0,1:12:40.06,1:12:42.71,Default,,0000,0000,0000,,That getting in front\Nof that and changing
Dialogue: 0,1:12:42.71,1:12:44.08,Default,,0000,0000,0000,,our culture and how we
Dialogue: 0,1:12:44.08,1:12:46.32,Default,,0000,0000,0000,,respond to that\Nneeds to change.
Dialogue: 0,1:12:46.32,1:12:48.22,Default,,0000,0000,0000,,So, yeah, I do believe
Dialogue: 0,1:12:48.22,1:12:49.85,Default,,0000,0000,0000,,in some sense, it will.
Dialogue: 0,1:12:49.85,1:12:50.90,Default,,0000,0000,0000,,There's demonstrations\Nthat are
Dialogue: 0,1:12:50.90,1:12:53.93,Default,,0000,0000,0000,,showing how it will be.
Dialogue: 0,1:12:53.93,1:12:55.66,Default,,0000,0000,0000,,I don't know\Nwhat it'll take.
Dialogue: 0,1:12:55.66,1:12:57.38,Default,,0000,0000,0000,,But today,
Dialogue: 0,1:12:57.38,1:13:00.08,Default,,0000,0000,0000,,part of the problem is\Nthe fragmentation in
Dialogue: 0,1:13:00.08,1:13:02.00,Default,,0000,0000,0000,,healthcare and the lack of
Dialogue: 0,1:13:02.00,1:13:03.17,Default,,0000,0000,0000,,communication between
Dialogue: 0,1:13:03.17,1:13:04.80,Default,,0000,0000,0000,,even us and our providers.
Dialogue: 0,1:13:04.80,1:13:05.78,Default,,0000,0000,0000,,You think you're all on
Dialogue: 0,1:13:05.78,1:13:06.71,Default,,0000,0000,0000,,the same page,\Nbut you're really
Dialogue: 0,1:13:06.71,1:13:08.51,Default,,0000,0000,0000,,not in all sense.
Dialogue: 0,1:13:08.51,1:13:11.92,Default,,0000,0000,0000,,So streamlining that,
Dialogue: 0,1:13:11.92,1:13:14.00,Default,,0000,0000,0000,,integrating a\Nlot of that will
Dialogue: 0,1:13:14.00,1:13:16.22,Default,,0000,0000,0000,,have a lot of\Nimpact on that.
Dialogue: 0,1:13:16.22,1:13:18.08,Default,,0000,0000,0000,,And I do believe that
Dialogue: 0,1:13:18.08,1:13:20.20,Default,,0000,0000,0000,,it will take\Nsuch a foothold.
Dialogue: 0,1:13:20.20,1:13:23.42,Default,,0000,0000,0000,,It started out at 20%\Ndemonstration expecting
Dialogue: 0,1:13:23.42,1:13:24.46,Default,,0000,0000,0000,,two years value based
Dialogue: 0,1:13:24.46,1:13:25.50,Default,,0000,0000,0000,,purchasing will represent
Dialogue: 0,1:13:25.50,1:13:28.19,Default,,0000,0000,0000,,80% of the payments\Nin two years.
Dialogue: 0,1:13:28.19,1:13:29.72,Default,,0000,0000,0000,,They originally\Nthought it would be
Dialogue: 0,1:13:29.72,1:13:31.58,Default,,0000,0000,0000,,five but that's how
Dialogue: 0,1:13:31.58,1:13:33.56,Default,,0000,0000,0000,,quickly it has\Nbroadcast it out.
Dialogue: 0,1:13:33.56,1:13:35.16,Default,,0000,0000,0000,,So it's here to stay,
Dialogue: 0,1:13:35.16,1:13:37.56,Default,,0000,0000,0000,,and we've got to learn\Nhow to deal with it.
Dialogue: 0,1:13:37.56,1:13:39.40,Default,,0000,0000,0000,,The problem will be
Dialogue: 0,1:13:39.40,1:13:41.90,Default,,0000,0000,0000,,is we're under this\Npayment model,
Dialogue: 0,1:13:41.90,1:13:43.91,Default,,0000,0000,0000,,which the more we do,\Nthe more we make,
Dialogue: 0,1:13:43.91,1:13:44.87,Default,,0000,0000,0000,,in some sense, I just
Dialogue: 0,1:13:44.87,1:13:46.13,Default,,0000,0000,0000,,contradicted something\Nelse like this.
Dialogue: 0,1:13:46.13,1:13:48.50,Default,,0000,0000,0000,,But that's the\Nhealthcare system
Dialogue: 0,1:13:48.50,1:13:51.58,Default,,0000,0000,0000,,today, fee for service.
Dialogue: 0,1:13:51.58,1:13:54.58,Default,,0000,0000,0000,,Tomorrow, when we\Nfinally get there,
Dialogue: 0,1:13:54.58,1:13:56.00,Default,,0000,0000,0000,,I don't know what\Nit'll look like.
Dialogue: 0,1:13:56.00,1:13:58.49,Default,,0000,0000,0000,,When it's value based and
Dialogue: 0,1:13:58.49,1:13:59.69,Default,,0000,0000,0000,,you're providing value
Dialogue: 0,1:13:59.69,1:14:01.58,Default,,0000,0000,0000,,and keeping\Npeople healthy,
Dialogue: 0,1:14:01.58,1:14:03.50,Default,,0000,0000,0000,,how do you\Nbridge that gap?
Dialogue: 0,1:14:03.50,1:14:05.22,Default,,0000,0000,0000,,That'll be the challenge.
Dialogue: 0,1:14:05.22,1:14:07.46,Default,,0000,0000,0000,,And hopefully you\Nhave enough to
Dialogue: 0,1:14:07.46,1:14:10.70,Default,,0000,0000,0000,,survive that\Nperiod of time.
Dialogue: 0,1:14:10.70,1:14:12.29,Default,,0000,0000,0000,,And so it's\Nreally important.
Dialogue: 0,1:14:12.29,1:14:13.73,Default,,0000,0000,0000,,Now, we utilize again,
Dialogue: 0,1:14:13.73,1:14:15.74,Default,,0000,0000,0000,,I'm promoting Ruben\Nand his staff.
Dialogue: 0,1:14:15.74,1:14:17.60,Default,,0000,0000,0000,,But that's what\Nwe've determined
Dialogue: 0,1:14:17.60,1:14:20.24,Default,,0000,0000,0000,,as part of that\Npathway there to
Dialogue: 0,1:14:20.24,1:14:24.17,Default,,0000,0000,0000,,survive those time\Nperiods so that
Dialogue: 0,1:14:24.17,1:14:26.21,Default,,0000,0000,0000,,we aren't falling behind\Nin technology and
Dialogue: 0,1:14:26.21,1:14:28.28,Default,,0000,0000,0000,,other things so that\Nwhen you get there,
Dialogue: 0,1:14:28.28,1:14:29.48,Default,,0000,0000,0000,,you can't provide\Nit because you're
Dialogue: 0,1:14:29.48,1:14:31.37,Default,,0000,0000,0000,,too far behind\Nthe curve anyway.
Dialogue: 0,1:14:31.37,1:14:33.83,Default,,0000,0000,0000,,>> When will it come\Nthat you're going
Dialogue: 0,1:14:33.83,1:14:35.72,Default,,0000,0000,0000,,to be dictated that I
Dialogue: 0,1:14:35.72,1:14:37.82,Default,,0000,0000,0000,,don't need to have\Nanother MRI just
Dialogue: 0,1:14:37.82,1:14:40.76,Default,,0000,0000,0000,,because I had one here\Nfor the specialist.
Dialogue: 0,1:14:40.76,1:14:42.44,Default,,0000,0000,0000,,And the insurance\Ncompany is going
Dialogue: 0,1:14:42.44,1:14:44.06,Default,,0000,0000,0000,,to say you already\Nhave one MRI
Dialogue: 0,1:14:44.06,1:14:45.80,Default,,0000,0000,0000,,for that particular injury
Dialogue: 0,1:14:45.80,1:14:47.18,Default,,0000,0000,0000,,you don't need to\Nhave another one
Dialogue: 0,1:14:47.18,1:14:52.07,Default,,0000,0000,0000,,or they won't approve\Nthe second one.
Dialogue: 0,1:14:52.07,1:14:54.41,Default,,0000,0000,0000,,>> So the question is,\Nwhen will that happen?
Dialogue: 0,1:14:54.41,1:14:56.03,Default,,0000,0000,0000,,When will that occur?
Dialogue: 0,1:14:56.03,1:14:59.00,Default,,0000,0000,0000,,Meaning, will\Ninsurance companies
Dialogue: 0,1:14:59.00,1:15:00.22,Default,,0000,0000,0000,,dictate the fact that
Dialogue: 0,1:15:00.22,1:15:02.63,Default,,0000,0000,0000,,somebody else ordered\Na secondary test
Dialogue: 0,1:15:02.63,1:15:05.64,Default,,0000,0000,0000,,that has already been\Ndone? Is that fair?
Dialogue: 0,1:15:05.64,1:15:07.34,Default,,0000,0000,0000,,I'm doing this for her.
Dialogue: 0,1:15:07.34,1:15:08.90,Default,,0000,0000,0000,,She's told me I got\Nto repeat these,
Dialogue: 0,1:15:08.90,1:15:12.17,Default,,0000,0000,0000,,so I'll get paid tonight.
Dialogue: 0,1:15:12.17,1:15:14.96,Default,,0000,0000,0000,,No, I'm not getting\Npaid anyway.
Dialogue: 0,1:15:14.96,1:15:17.27,Default,,0000,0000,0000,,It's cost, I'm\Ngoing to paid cost.
Dialogue: 0,1:15:17.27,1:15:20.99,Default,,0000,0000,0000,,So the question is,\Nwhen will that happen?
Dialogue: 0,1:15:20.99,1:15:25.73,Default,,0000,0000,0000,,It's happened, that\Nhappens today.
Dialogue: 0,1:15:25.99,1:15:29.18,Default,,0000,0000,0000,,Insurance companies,\Nif you had an MR,
Dialogue: 0,1:15:29.18,1:15:30.41,Default,,0000,0000,0000,,they aren't going\Nto approve.
Dialogue: 0,1:15:30.41,1:15:33.56,Default,,0000,0000,0000,,That's part of that\Nwhole pre authorization.
Dialogue: 0,1:15:33.56,1:15:36.14,Default,,0000,0000,0000,,If they see you had\Nthis test done,
Dialogue: 0,1:15:36.14,1:15:38.88,Default,,0000,0000,0000,,they're not approving\None for another one.
Dialogue: 0,1:15:38.88,1:15:40.94,Default,,0000,0000,0000,,They'll deny it, so you
Dialogue: 0,1:15:40.94,1:15:42.77,Default,,0000,0000,0000,,won't get it. So\Nthat happens today?
Dialogue: 0,1:15:42.77,1:15:48.89,Default,,0000,0000,0000,,[inaudible] Exactly.
Dialogue: 0,1:15:48.89,1:15:50.42,Default,,0000,0000,0000,,So some of that's\Nhappening today.
Dialogue: 0,1:15:50.42,1:15:52.55,Default,,0000,0000,0000,,Now, is there\Nduplication of services?
Dialogue: 0,1:15:52.55,1:15:54.44,Default,,0000,0000,0000,,Yes. That still\Nhappens in some sense,
Dialogue: 0,1:15:54.44,1:15:56.75,Default,,0000,0000,0000,,but more and more\Nthat's changing.
Dialogue: 0,1:15:56.75,1:15:58.46,Default,,0000,0000,0000,,So one of the things that
Dialogue: 0,1:15:58.46,1:16:00.71,Default,,0000,0000,0000,,is when you\Nstart looking at
Dialogue: 0,1:16:00.71,1:16:02.21,Default,,0000,0000,0000,,an integrated\Nmodel and you
Dialogue: 0,1:16:02.21,1:16:04.64,Default,,0000,0000,0000,,start looking about\Ncoordination,
Dialogue: 0,1:16:04.64,1:16:06.38,Default,,0000,0000,0000,,it's when you're all\Non the same team.
Dialogue: 0,1:16:06.38,1:16:08.93,Default,,0000,0000,0000,,Well Dr. Joe is
Dialogue: 0,1:16:08.93,1:16:10.43,Default,,0000,0000,0000,,much better at\Nthis than I am.
Dialogue: 0,1:16:10.43,1:16:11.51,Default,,0000,0000,0000,,I'm going to\Nsend my patient
Dialogue: 0,1:16:11.51,1:16:12.59,Default,,0000,0000,0000,,there because
Dialogue: 0,1:16:12.59,1:16:13.96,Default,,0000,0000,0000,,I know that patient\Nwill come back,
Dialogue: 0,1:16:13.96,1:16:16.42,Default,,0000,0000,0000,,and we're not competing\Nagainst each other.
Dialogue: 0,1:16:16.42,1:16:19.31,Default,,0000,0000,0000,,That'll be important\Nto control costs.
Dialogue: 0,1:16:19.31,1:16:20.39,Default,,0000,0000,0000,,Because today we compete
Dialogue: 0,1:16:20.39,1:16:21.17,Default,,0000,0000,0000,,against each other for
Dialogue: 0,1:16:21.17,1:16:24.05,Default,,0000,0000,0000,,the same patient for\Nmany different services.
Dialogue: 0,1:16:24.05,1:16:27.04,Default,,0000,0000,0000,,We have a few more\Nminutes. Yeah, Pat.
Dialogue: 0,1:16:27.04,1:16:28.43,Default,,0000,0000,0000,,>> Steve, what do you see
Dialogue: 0,1:16:28.43,1:16:31.04,Default,,0000,0000,0000,,as the overriding benefits
Dialogue: 0,1:16:31.04,1:16:33.52,Default,,0000,0000,0000,,of acquiring other\Nmedical practices.
Dialogue: 0,1:16:33.52,1:16:35.27,Default,,0000,0000,0000,,That's the first\Npart of my question.
Dialogue: 0,1:16:35.27,1:16:36.70,Default,,0000,0000,0000,,And the second part is,
Dialogue: 0,1:16:36.70,1:16:40.94,Default,,0000,0000,0000,,do you see us acquiring\Nmore in the future?
Dialogue: 0,1:16:40.94,1:16:42.59,Default,,0000,0000,0000,,>> So the question\Nis, what are
Dialogue: 0,1:16:42.59,1:16:43.98,Default,,0000,0000,0000,,the advantages\Nof acquiring
Dialogue: 0,1:16:43.98,1:16:45.42,Default,,0000,0000,0000,,other medical practices,
Dialogue: 0,1:16:45.42,1:16:48.50,Default,,0000,0000,0000,,be it physician\Npractices or anything?
Dialogue: 0,1:16:48.50,1:16:50.84,Default,,0000,0000,0000,,And will we look
Dialogue: 0,1:16:50.84,1:16:52.48,Default,,0000,0000,0000,,to acquire more\Nin the future?
Dialogue: 0,1:16:52.48,1:16:53.69,Default,,0000,0000,0000,,I will tell you\Nthis Pullman
Dialogue: 0,1:16:53.69,1:16:54.80,Default,,0000,0000,0000,,Regional Hospital has not
Dialogue: 0,1:16:54.80,1:16:55.94,Default,,0000,0000,0000,,aggressively ever gone
Dialogue: 0,1:16:55.94,1:16:57.40,Default,,0000,0000,0000,,out and tried to buy any.
Dialogue: 0,1:16:57.40,1:17:02.18,Default,,0000,0000,0000,,We have reactionarily\Nresponded to requests.
Dialogue: 0,1:17:02.18,1:17:06.00,Default,,0000,0000,0000,,So Plus Pediatrics\Nas an example, 2009,
Dialogue: 0,1:17:06.00,1:17:10.54,Default,,0000,0000,0000,,remember, Al, Dr.\NFrosted, and Mike.
Dialogue: 0,1:17:10.54,1:17:13.94,Default,,0000,0000,0000,,When Al decided he\Nwas going to retire,
Dialogue: 0,1:17:13.94,1:17:16.25,Default,,0000,0000,0000,,Mike realized I'm\Ngoing to be basically
Dialogue: 0,1:17:16.25,1:17:17.63,Default,,0000,0000,0000,,the only pediatrician
Dialogue: 0,1:17:17.63,1:17:18.95,Default,,0000,0000,0000,,on the blues, I\Ndon't want it.
Dialogue: 0,1:17:18.95,1:17:20.34,Default,,0000,0000,0000,,And I don't want\Nthis headache.
Dialogue: 0,1:17:20.34,1:17:21.86,Default,,0000,0000,0000,,And by the way, I\Ncan make more money
Dialogue: 0,1:17:21.86,1:17:23.33,Default,,0000,0000,0000,,by being a locum and
Dialogue: 0,1:17:23.33,1:17:24.59,Default,,0000,0000,0000,,traveling and\Ngetting out of here
Dialogue: 0,1:17:24.59,1:17:27.26,Default,,0000,0000,0000,,and making a\Nlot more money.
Dialogue: 0,1:17:27.26,1:17:30.50,Default,,0000,0000,0000,,So they realized that
Dialogue: 0,1:17:30.50,1:17:31.70,Default,,0000,0000,0000,,in order to\Nhave pediatric,
Dialogue: 0,1:17:31.70,1:17:33.23,Default,,0000,0000,0000,,which Al had\Nestablished on
Dialogue: 0,1:17:33.23,1:17:35.60,Default,,0000,0000,0000,,the Palouse and\Ncontinued to be here,
Dialogue: 0,1:17:35.60,1:17:36.95,Default,,0000,0000,0000,,they needed\Nsomething different.
Dialogue: 0,1:17:36.95,1:17:38.69,Default,,0000,0000,0000,,They came to the\Nhospital and said,
Dialogue: 0,1:17:38.69,1:17:41.32,Default,,0000,0000,0000,,would you be willing\Nto look at this?
Dialogue: 0,1:17:41.32,1:17:43.91,Default,,0000,0000,0000,,And for the sake\Nof the community,
Dialogue: 0,1:17:43.91,1:17:45.22,Default,,0000,0000,0000,,we responded and say,
Dialogue: 0,1:17:45.22,1:17:46.86,Default,,0000,0000,0000,,yeah, we'll look at that.
Dialogue: 0,1:17:46.86,1:17:48.71,Default,,0000,0000,0000,,Most of everything we've
Dialogue: 0,1:17:48.71,1:17:50.87,Default,,0000,0000,0000,,done has been in\Nresponse, too.
Dialogue: 0,1:17:50.87,1:17:53.12,Default,,0000,0000,0000,,So many providers today,
Dialogue: 0,1:17:53.12,1:17:54.62,Default,,0000,0000,0000,,when they look\Nat the model
Dialogue: 0,1:17:54.62,1:17:55.73,Default,,0000,0000,0000,,of reimbursement\Nand trying
Dialogue: 0,1:17:55.73,1:17:56.51,Default,,0000,0000,0000,,to recruit into it,
Dialogue: 0,1:17:56.51,1:17:58.40,Default,,0000,0000,0000,,are facing challenges\Nand saying,
Dialogue: 0,1:17:58.40,1:17:59.98,Default,,0000,0000,0000,,people don't want to\Ncome to that model,
Dialogue: 0,1:17:59.98,1:18:01.07,Default,,0000,0000,0000,,they will come to the\Nhospital and say,
Dialogue: 0,1:18:01.07,1:18:02.48,Default,,0000,0000,0000,,can we look at\Nsomething different?
Dialogue: 0,1:18:02.48,1:18:03.65,Default,,0000,0000,0000,,We'll always look and say,
Dialogue: 0,1:18:03.65,1:18:05.10,Default,,0000,0000,0000,,what does that look like?
Dialogue: 0,1:18:05.10,1:18:07.34,Default,,0000,0000,0000,,So there's no future plans
Dialogue: 0,1:18:07.34,1:18:09.60,Default,,0000,0000,0000,,right now to continue,
Dialogue: 0,1:18:09.60,1:18:12.59,Default,,0000,0000,0000,,but we would respond,\Nbeing the thing.
Dialogue: 0,1:18:12.59,1:18:14.66,Default,,0000,0000,0000,,Some have decided to\Nstay independent,
Dialogue: 0,1:18:14.66,1:18:17.00,Default,,0000,0000,0000,,the advantages that we're
Dialogue: 0,1:18:17.00,1:18:19.84,Default,,0000,0000,0000,,starting to see\Nthat are coming.
Dialogue: 0,1:18:19.84,1:18:21.59,Default,,0000,0000,0000,,I talked about\Ncare coordination,
Dialogue: 0,1:18:21.59,1:18:23.20,Default,,0000,0000,0000,,I mentioned a couple\Nof different times.
Dialogue: 0,1:18:23.20,1:18:25.73,Default,,0000,0000,0000,,There are new\Nreimbursement models that
Dialogue: 0,1:18:25.73,1:18:28.44,Default,,0000,0000,0000,,will pay you per member\Nper month to do that.
Dialogue: 0,1:18:28.44,1:18:30.64,Default,,0000,0000,0000,,Most all that resides\Nin primary care.
Dialogue: 0,1:18:30.64,1:18:31.91,Default,,0000,0000,0000,,We had no access
Dialogue: 0,1:18:31.91,1:18:33.52,Default,,0000,0000,0000,,because we had\Nno primary care.
Dialogue: 0,1:18:33.52,1:18:36.23,Default,,0000,0000,0000,,Under our clinic\Nnetwork provider
Dialogue: 0,1:18:36.23,1:18:38.06,Default,,0000,0000,0000,,that to get to
Dialogue: 0,1:18:38.06,1:18:39.65,Default,,0000,0000,0000,,the new revenue\Nstreams that are
Dialogue: 0,1:18:39.65,1:18:42.71,Default,,0000,0000,0000,,emerging under these\Nvalue based models,
Dialogue: 0,1:18:42.71,1:18:44.40,Default,,0000,0000,0000,,that's one of\Nthe advantages
Dialogue: 0,1:18:44.40,1:18:47.28,Default,,0000,0000,0000,,of coordination\Nand integration.
Dialogue: 0,1:18:47.28,1:18:49.60,Default,,0000,0000,0000,,So that's coming,
Dialogue: 0,1:18:49.60,1:18:51.94,Default,,0000,0000,0000,,and we're getting\Nahead of some of that.
Dialogue: 0,1:18:51.94,1:18:54.36,Default,,0000,0000,0000,,Contract negotiation\Nbecause you're all going
Dialogue: 0,1:18:54.36,1:18:55.49,Default,,0000,0000,0000,,to the same\Nperson and you're
Dialogue: 0,1:18:55.49,1:18:56.87,Default,,0000,0000,0000,,not divide and conquer,
Dialogue: 0,1:18:56.87,1:18:58.97,Default,,0000,0000,0000,,you're going\Njointly, we'll
Dialogue: 0,1:18:58.97,1:19:01.42,Default,,0000,0000,0000,,also have some\Nadvantages there.
Dialogue: 0,1:19:01.42,1:19:03.50,Default,,0000,0000,0000,,>> You just took\Nover Pullman
Dialogue: 0,1:19:03.50,1:19:05.04,Default,,0000,0000,0000,,Family Medicine\Nas of April.
Dialogue: 0,1:19:05.04,1:19:05.86,Default,,0000,0000,0000,,>> Correct.
Dialogue: 0,1:19:05.86,1:19:06.36,Default,,0000,0000,0000,,>> So how do
Dialogue: 0,1:19:06.36,1:19:10.56,Default,,0000,0000,0000,,those competing\Npractices recruit?
Dialogue: 0,1:19:12.88,1:19:14.70,Default,,0000,0000,0000,,>> Well,
Dialogue: 0,1:19:14.70,1:19:16.40,Default,,0000,0000,0000,,I'm sure I understand\Nyour question.
Dialogue: 0,1:19:16.40,1:19:17.42,Default,,0000,0000,0000,,>> Do they recruit\Nseparately?
Dialogue: 0,1:19:17.42,1:19:18.10,Default,,0000,0000,0000,,>> No.
Dialogue: 0,1:19:18.10,1:19:19.31,Default,,0000,0000,0000,,>> If they were\Nasked to recruit
Dialogue: 0,1:19:19.31,1:19:24.92,Default,,0000,0000,0000,,a general physician\N[inaudible]
Dialogue: 0,1:19:24.92,1:19:27.48,Default,,0000,0000,0000,,>> So I see your\Nquestion now.
Dialogue: 0,1:19:27.48,1:19:30.40,Default,,0000,0000,0000,,So the question\Nis, is today
Dialogue: 0,1:19:30.40,1:19:32.09,Default,,0000,0000,0000,,Pullman Family\NMedicine may
Dialogue: 0,1:19:32.09,1:19:34.62,Default,,0000,0000,0000,,have an opening. How\Ndo they recruit?
Dialogue: 0,1:19:34.62,1:19:36.89,Default,,0000,0000,0000,,How's the hospital\Ninvolvement with
Dialogue: 0,1:19:36.89,1:19:38.50,Default,,0000,0000,0000,,that compared to like\NPalouse Medical Group?
Dialogue: 0,1:19:38.50,1:19:40.01,Default,,0000,0000,0000,,Today we're\Nworking closely
Dialogue: 0,1:19:40.01,1:19:41.09,Default,,0000,0000,0000,,with Pullman\NFamily Medicine,
Dialogue: 0,1:19:41.09,1:19:42.14,Default,,0000,0000,0000,,identifying what the needs
Dialogue: 0,1:19:42.14,1:19:43.18,Default,,0000,0000,0000,,are of the community,
Dialogue: 0,1:19:43.18,1:19:46.08,Default,,0000,0000,0000,,what type of provider\Nshould be there?
Dialogue: 0,1:19:46.08,1:19:49.22,Default,,0000,0000,0000,,We work with them jointly.
Dialogue: 0,1:19:49.22,1:19:50.63,Default,,0000,0000,0000,,Palouse Medical Group\Nbecause they're
Dialogue: 0,1:19:50.63,1:19:53.64,Default,,0000,0000,0000,,independent are out\Ndoing their thing.
Dialogue: 0,1:19:53.64,1:19:55.60,Default,,0000,0000,0000,,They're trying\Nto recruit in.
Dialogue: 0,1:19:55.60,1:19:58.98,Default,,0000,0000,0000,,There's still a\Ncompetitive model.
Dialogue: 0,1:19:59.11,1:20:01.67,Default,,0000,0000,0000,,The nice thing is,\Nin our market,
Dialogue: 0,1:20:01.67,1:20:03.77,Default,,0000,0000,0000,,I'll tell you\Ntoday, we work
Dialogue: 0,1:20:03.77,1:20:04.73,Default,,0000,0000,0000,,closely with them and
Dialogue: 0,1:20:04.73,1:20:05.87,Default,,0000,0000,0000,,have a lot of\Ncommunication.
Dialogue: 0,1:20:05.87,1:20:08.24,Default,,0000,0000,0000,,So thankfully enough, it
Dialogue: 0,1:20:08.24,1:20:11.87,Default,,0000,0000,0000,,isn't eat what\None can and kill.
Dialogue: 0,1:20:11.87,1:20:15.74,Default,,0000,0000,0000,,It's whatever I do for\Nme is just my thing,
Dialogue: 0,1:20:15.74,1:20:17.57,Default,,0000,0000,0000,,and it's that tragedy\Nof the commons,
Dialogue: 0,1:20:17.57,1:20:18.20,Default,,0000,0000,0000,,which we're all going to
Dialogue: 0,1:20:18.20,1:20:19.43,Default,,0000,0000,0000,,fish out of the same pond.
Dialogue: 0,1:20:19.43,1:20:21.26,Default,,0000,0000,0000,,The more fish I\Nmake or catch,
Dialogue: 0,1:20:21.26,1:20:22.19,Default,,0000,0000,0000,,the better off I am
Dialogue: 0,1:20:22.19,1:20:23.64,Default,,0000,0000,0000,,until we're all\Nout of fish.
Dialogue: 0,1:20:23.64,1:20:25.92,Default,,0000,0000,0000,,That doesn't happen\Ntoday. We do coordinate.
Dialogue: 0,1:20:25.92,1:20:27.35,Default,,0000,0000,0000,,So there's some\Ncommunication
Dialogue: 0,1:20:27.35,1:20:29.52,Default,,0000,0000,0000,,which is nice\Nin our market.
Dialogue: 0,1:20:29.52,1:20:31.48,Default,,0000,0000,0000,,It's not a stream\Nline, though,
Dialogue: 0,1:20:31.48,1:20:32.99,Default,,0000,0000,0000,,because we don't have\Nthat involvement.
Dialogue: 0,1:20:32.99,1:20:34.07,Default,,0000,0000,0000,,Yes, sir.
Dialogue: 0,1:20:34.07,1:20:37.06,Default,,0000,0000,0000,,>> When you talk\Nabout coordination,
Dialogue: 0,1:20:37.06,1:20:39.29,Default,,0000,0000,0000,,you see changes in
Dialogue: 0,1:20:39.29,1:20:42.00,Default,,0000,0000,0000,,the hospitals,\Nfor example,
Dialogue: 0,1:20:42.00,1:20:44.58,Default,,0000,0000,0000,,with all of the\Nhospitals in this area,
Dialogue: 0,1:20:44.58,1:20:47.72,Default,,0000,0000,0000,,some of them might\Nend up closing.
Dialogue: 0,1:20:47.72,1:20:49.32,Default,,0000,0000,0000,,>> That's a\Ngreat question.
Dialogue: 0,1:20:49.32,1:20:50.84,Default,,0000,0000,0000,,So the question is,
Dialogue: 0,1:20:50.84,1:20:52.64,Default,,0000,0000,0000,,in this area will
Dialogue: 0,1:20:52.64,1:20:55.78,Default,,0000,0000,0000,,all hospitals\Nexist, long term?
Dialogue: 0,1:20:55.78,1:20:57.53,Default,,0000,0000,0000,,Will some in danger of
Dialogue: 0,1:20:57.53,1:21:00.96,Default,,0000,0000,0000,,closing or is there\Nbetter models?
Dialogue: 0,1:21:02.80,1:21:05.78,Default,,0000,0000,0000,,I couldn't\Nprofessionally tell you
Dialogue: 0,1:21:05.78,1:21:09.16,Default,,0000,0000,0000,,that all will exist\Nand should exist.
Dialogue: 0,1:21:09.16,1:21:11.66,Default,,0000,0000,0000,,There's a lot of\Nduplication of services.
Dialogue: 0,1:21:11.66,1:21:16.26,Default,,0000,0000,0000,,And I lived the cord\Nrun for three years.
Dialogue: 0,1:21:16.26,1:21:20.12,Default,,0000,0000,0000,,It doesn't make sense\Nto have three RMRIs in
Dialogue: 0,1:21:20.12,1:21:22.55,Default,,0000,0000,0000,,a basically 20\Nmile radius when
Dialogue: 0,1:21:22.55,1:21:25.88,Default,,0000,0000,0000,,they're almost\N$2 million each.
Dialogue: 0,1:21:25.88,1:21:27.66,Default,,0000,0000,0000,,Now, you still\Nmay need two
Dialogue: 0,1:21:27.66,1:21:28.52,Default,,0000,0000,0000,,because of volume,
Dialogue: 0,1:21:28.52,1:21:29.68,Default,,0000,0000,0000,,but it should be\Nvolume driven.
Dialogue: 0,1:21:29.68,1:21:33.38,Default,,0000,0000,0000,,I do eventually\Nbelieve for this area,
Dialogue: 0,1:21:33.38,1:21:36.20,Default,,0000,0000,0000,,there has to be\Ncoordination of that.
Dialogue: 0,1:21:36.20,1:21:38.60,Default,,0000,0000,0000,,You could have a very
Dialogue: 0,1:21:38.60,1:21:43.85,Default,,0000,0000,0000,,effective and\Ninpatient care unit.
Dialogue: 0,1:21:43.85,1:21:45.20,Default,,0000,0000,0000,,And they focus on that
Dialogue: 0,1:21:45.20,1:21:46.86,Default,,0000,0000,0000,,and they do it very well.
Dialogue: 0,1:21:46.86,1:21:49.06,Default,,0000,0000,0000,,And still in communities,
Dialogue: 0,1:21:49.06,1:21:50.54,Default,,0000,0000,0000,,I'm pointing\Noutside because
Dialogue: 0,1:21:50.54,1:21:51.34,Default,,0000,0000,0000,,I think Pullman\Nought to be
Dialogue: 0,1:21:51.34,1:21:53.63,Default,,0000,0000,0000,,central because they are.
Dialogue: 0,1:21:53.63,1:21:57.06,Default,,0000,0000,0000,,They're the middle.\NAnd then outside that,
Dialogue: 0,1:21:57.06,1:22:00.59,Default,,0000,0000,0000,,you could have outpatient\Nsurgery centers
Dialogue: 0,1:22:00.59,1:22:02.78,Default,,0000,0000,0000,,or support or urgent\Ncare centers,
Dialogue: 0,1:22:02.78,1:22:05.63,Default,,0000,0000,0000,,etc, but you work\Ncollectively.
Dialogue: 0,1:22:05.63,1:22:07.01,Default,,0000,0000,0000,,I believe long term,
Dialogue: 0,1:22:07.01,1:22:08.28,Default,,0000,0000,0000,,that's where it'll get to.
Dialogue: 0,1:22:08.28,1:22:11.12,Default,,0000,0000,0000,,I think until\Nreimbursement dictates
Dialogue: 0,1:22:11.12,1:22:12.46,Default,,0000,0000,0000,,that, it won't change.
Dialogue: 0,1:22:12.46,1:22:14.62,Default,,0000,0000,0000,,And under a critical\Naccess model,
Dialogue: 0,1:22:14.62,1:22:16.18,Default,,0000,0000,0000,,because we get\Npaid our costs,
Dialogue: 0,1:22:16.18,1:22:18.32,Default,,0000,0000,0000,,what advantages is\Nthere to do that?
Dialogue: 0,1:22:18.32,1:22:22.14,Default,,0000,0000,0000,,So, today we have a\Nfake glass bottom,
Dialogue: 0,1:22:22.54,1:22:24.35,Default,,0000,0000,0000,,there's not a lot of
Dialogue: 0,1:22:24.35,1:22:25.31,Default,,0000,0000,0000,,incentives to\Ncontrol class.
Dialogue: 0,1:22:25.31,1:22:26.62,Default,,0000,0000,0000,,There's some.\NThere's not a lot.
Dialogue: 0,1:22:26.62,1:22:28.46,Default,,0000,0000,0000,,But if that\Nmodel went away,
Dialogue: 0,1:22:28.46,1:22:30.47,Default,,0000,0000,0000,,problem is, could you\Nreact quick enough?
Dialogue: 0,1:22:30.47,1:22:32.64,Default,,0000,0000,0000,,I think that some of\Nthat's happening,
Dialogue: 0,1:22:32.64,1:22:34.79,Default,,0000,0000,0000,,we are partners in
Dialogue: 0,1:22:34.79,1:22:36.44,Default,,0000,0000,0000,,the general\Nsurgeon practices,
Dialogue: 0,1:22:36.44,1:22:38.15,Default,,0000,0000,0000,,the specialty practices,
Dialogue: 0,1:22:38.15,1:22:40.46,Default,,0000,0000,0000,,medication oncology\Ncoming on board.
Dialogue: 0,1:22:40.46,1:22:41.78,Default,,0000,0000,0000,,That will be collective.
Dialogue: 0,1:22:41.78,1:22:44.50,Default,,0000,0000,0000,,More and more that\Ncommunications happening.
Dialogue: 0,1:22:44.50,1:22:47.02,Default,,0000,0000,0000,,I think that'll evolve\Nlong term. How long?
Dialogue: 0,1:22:47.02,1:22:50.48,Default,,0000,0000,0000,,I have no idea. I\Nrealize at some point,
Dialogue: 0,1:22:50.48,1:22:51.20,Default,,0000,0000,0000,,if that happens, and I
Dialogue: 0,1:22:51.20,1:22:52.73,Default,,0000,0000,0000,,think that\Nultimately needs
Dialogue: 0,1:22:52.73,1:22:55.14,Default,,0000,0000,0000,,to I don't know if you.
Dialogue: 0,1:22:55.14,1:22:56.81,Default,,0000,0000,0000,,>> That was going on in
Dialogue: 0,1:22:56.81,1:22:58.97,Default,,0000,0000,0000,,Reagan's time when they
Dialogue: 0,1:22:58.97,1:23:00.53,Default,,0000,0000,0000,,had if you wanted
Dialogue: 0,1:23:00.53,1:23:04.30,Default,,0000,0000,0000,,a MRI and Gritman\Nwanted one,
Dialogue: 0,1:23:04.30,1:23:06.70,Default,,0000,0000,0000,,there was a committee\Nthat determine
Dialogue: 0,1:23:06.70,1:23:08.75,Default,,0000,0000,0000,,whether you ought\Nto have one
Dialogue: 0,1:23:08.75,1:23:11.52,Default,,0000,0000,0000,,because of the\Npopulation and the size.
Dialogue: 0,1:23:11.52,1:23:14.03,Default,,0000,0000,0000,,And that went away.
Dialogue: 0,1:23:14.03,1:23:15.71,Default,,0000,0000,0000,,>> I think\Neventually you'll
Dialogue: 0,1:23:15.71,1:23:16.88,Default,,0000,0000,0000,,come back to some of that.
Dialogue: 0,1:23:16.88,1:23:17.99,Default,,0000,0000,0000,,I do believe\Nthey'll drive.
Dialogue: 0,1:23:17.99,1:23:19.16,Default,,0000,0000,0000,,>> Some of us\Nremember there was
Dialogue: 0,1:23:19.16,1:23:29.09,Default,,0000,0000,0000,,a vet school that\Nalso [inaudible].
Dialogue: 0,1:23:29.09,1:23:30.47,Default,,0000,0000,0000,,>> >> That was my love of
Dialogue: 0,1:23:30.47,1:23:31.76,Default,,0000,0000,0000,,working for two\Nfacilities.
Dialogue: 0,1:23:31.76,1:23:33.30,Default,,0000,0000,0000,,That was awesome.\NBy the way,
Dialogue: 0,1:23:33.30,1:23:35.20,Default,,0000,0000,0000,,it is a little after 7:00.
Dialogue: 0,1:23:35.20,1:23:37.37,Default,,0000,0000,0000,,I do want to be\Nrespectful of your time.
Dialogue: 0,1:23:37.37,1:23:39.24,Default,,0000,0000,0000,,I have nowhere to go,
Dialogue: 0,1:23:39.24,1:23:40.19,Default,,0000,0000,0000,,I will stick around if
Dialogue: 0,1:23:40.19,1:23:41.12,Default,,0000,0000,0000,,there are other questions.
Dialogue: 0,1:23:41.12,1:23:42.86,Default,,0000,0000,0000,,But I appreciate the fact
Dialogue: 0,1:23:42.86,1:23:43.99,Default,,0000,0000,0000,,that you all team\Nout. Thank you.
Dialogue: 0,1:23:43.99,1:23:44.00,Default,,0000,0000,0000,,[APPLAUSE]
Dialogue: 0,1:23:44.00,1:23:45.36,Default,,0000,0000,0000,,>> Thank you, Steve.
Dialogue: 0,1:23:45.36,1:23:48.39,Default,,0000,0000,0000,,>> Yeah, Ruben.\NThank you very much.