Hi, everyone, and welcome to our webinar on the highlights of the 23 final CMS Physician B-Schedule and Ops Rules. I'm joined today by James Veverichek from the ACC, who is the Director of Federal Regulatory Affairs. Thanks for joining us, James. As many of you may know, I'm the Executive Vice President of Revenue Cycle Solutions and Care Transformation for MedAxiom. We're happy to be providing this today to go over some of the highlights. Just a couple of housekeeping announcements. If you are utilizing the platform for Zoom and you're used to utilizing that, you will notice that for our Academy platform, the chat button is where you will find your slides for the handouts for the presentation, and the Q&A button is where you would type in your questions. So the Q&A is where we will monitor questions. We'll try to take some of those throughout as we go through. But really, we want everything in that Q&A button. If you raise your hand, because of the number of folks that we have attending the webinar, the hand raise does not generally work well for us to call on you, so please type in your questions as well. If we don't get to them through the webcast, we will provide answers after also. This webinar does provide AAPC and BMSC CEUs. Please allow up to three business days to receive those. If you need the BMSC CEUs, Jolene can provide those for you, so please send her an email and you should get those certificates. This webinar is for an hour, so you'll get one CEU for your coding CEUs. So we're going to start with a couple of highlights. I'm going to cover from the Physician Fee Schedule, and then James is going to take us through the Ops Rule, and then also some key QPP changes and updates, and then we'll both close out with some advocacy initiatives and getting us an update on those. All right. So first off, we're going to talk about the final rule. When it comes to the Physician Fee Schedule, the conversion factor has been a big topic. It has been updated from $34.60 to $33.06. This does represent a decrease of about 1% compared to 22 for cardiovascular services. Most of this is driven by the changes to the practice expense payments. Many organizations will see different impacts depending on your patient populations and services. So what does that mean? Depending on if you have physicians that are subspecialized or if you have physicians that read certain diagnostic services or E&M services, have a large volume of those, that decrease could be seen in many different ways. So it's different in how it impacts the organizations, but it's overall projected to be a 1% decrease. We do have the ACC advocacy team worked to get the Fee Schedule calculator out to help with some estimations based on impacts, and that can be downloaded from both the MedAxium and the ACC website. You may have seen the link also as we have been posting several of those on the listserv, but that is if you would like to input your services and get an idea of your particular impact that is available. One thing I think is important when we talk about those practice expense values for some of our codes in cardiovascular, such as our E&M, our extended monitoring, our ablation procedures, some pulmonary arterial revascularization, most of those were finalized below the RUC recommendation. So we did take somewhat of a hit, and then we're going to talk at the end about what is continuing to happen around our advocacy initiatives to help with mitigating that or hopefully mitigating those continued changes in this space. This I would consider a win. This is the final EP ablation services, and really looking at those work RVUs, which was a huge advocacy effort by the ACC and many other societies. Where it was finalized, they had originally proposed, for example, our ablation services for SVT, VT, and April 5th to take an additional hit. We did take a hit, but it wasn't as significant, and we did win on some of those work RVUs from a time perspective and that RUC calculation and what the RUC recommended from the survey. The additional ablation codes, that 93655 and 57, those we did take a hit on. However, it stayed the same from last year. So I think, you know, overall, this was definitely a win in our EP for our EP physicians, but nonetheless is a continued cut in those work RVUs as relative to our ablation services. A couple of things around the 23 evaluation and management services. We do have four boot camp coding webinars next week, and those are the in the weeds webinars, and one of them will be getting into the specifics around the updates to the evaluation and management services. In the final rule, they did adopt, CMS did adopt the AMA changes to several of the E&M coding families that they termed as other E&M services. These are hospital inpatient observation care consults, some emergency medicine codes, the nursing facility codes, and some home visits. These basically are now aligned with our office and outpatient services, and these are going to be based on the level of service on your medical decision making as defined for each of the types of services, or your total time of the E&M performed on the date of the encounter. So this will align with the office and outpatient services, but there are a few tweaks to the medical decision making table, and a couple of in the weeds things that we'll go into next week. But overall, I think this too is a win to hopefully simplify and decrease some of that administrative burden around documentation of comprehensive histories, comprehensive physicals that aren't needed to level the service, and really focusing on that medical decision making and time. From a prolonged service perspective, CMS did not adopt the CPT, AMACPT prolonged services codes, but they are implementing a specific G codes that will be relative to those times. If you look at the final rule and you read several of the comments around the evaluation and management services, it definitely can make your head spin in some aspects, because they go back and forth about many of these in the detail little guidelines are relative to what CMS policy is versus AMA coding principles. But overall, they did agree with the majority of the AMA revisions. Prolonged services is the area in which that a lot of they're not been aligned with, and we've seen that even on our office side of things. So next week, we'll go into the weeds about the specific G codes and also the specific guidelines, examples, and all of those things to provide education for moving forward into 23 for your providers. Just as an example, when you look at 22 to 23 for observation care services, both initial and subsequent, now in 23, those are going to go to our hospital inpatient codes. So our admission H&P codes, some of us refer to them as, and they've changed the heading to hospital inpatient or observation care, and that's for both initial hospital visits and subsequent rounding visits we refer to them as. They did keep services in place for admission and discharge services on the same day for observation care, but that also has always included hospital inpatient. That includes both the admission and discharge on the same day. And then, of course, hospital inpatient or discharge management services, our discharge codes have also been combined. So we'll get in the weeds of those next week, but hopefully this does represent a simplification that will help us as we continue to look at ways to improve efficiencies in our documentation, but still be able to support the care of our patient and provide the care that we need to support their treatment. This is the final work RV use for our evaluation and management services. This is just provided as a reference. The ones in red do show that there is an overall decrease in the work RVU and the green shows that there's an increase in the work RVU. So you can see this is around our initial admission codes, our rounding visits took an increase. When you look at discharge services, so our discharge codes that are 30 minutes or less or greater than 30 minutes, those took an increase. So when we talk about an overall 1% decrease, that's why we say it's a mix of the services depending on what your position provides and how your providers use these codes and provide the services within the areas of both inpatient observation care, all of those different areas of service impacted with the practice expense and also across our diagnostic and procedure services. Couple of things around telehealth services. So the PHE, the public health emergency, right before the call, James and I were talking, they did and on October 13th extend that to January. As you know, or remember, there is a 60 day notice period if they were going to expire it. I imagine we haven't heard anything. We're within that 60 days. I imagine it is going to be extended again. When you look at the public health emergency, they are maintaining some of those telehealth codes as category three codes through 23 to gather further information to consider a permanent status. Also, many of the elements around the flexibilities that are under the public health emergency policy will remain in place 151 days following the end of when they announced the end of the public health emergency. So again, it is not going to be an abrupt. It is over today. We'll have a 60 day notice and then post the end, following the end, we will have that 151 days which will remove many services that are only temporary allowed and usually everyone asks about audio services. It seems that the discussion in the final rule really focused on audio services, audio only services, will not be something that they're looking at keeping permanent unless it is in that mental health care space which has been instrumental throughout the PHE. So we'll see, but I don't anticipate we'll see regular telehealth visits that can be audio only. I think that's where we're going to come into play with our non-face-to-face service E&Ms that continue to expand both around our portal use, our telephone services or chronic care management as examples. Also, post that 151 day public health emergency, the modifier will no longer be required, but they will go back to the appropriate place of service. Again, we have time to see how that's going to all pan out, but I think this is telling us that the plan is to bring it back to that place of service that would truly represent telehealth claims. And then there is some new proposals and we'll touch on it in ops as well around direct supervision through that virtual presence and how they're seeking additional information both on the physician fee schedule side and James will touch on the ops side as well as making that permanent. A few miscellaneous highlights. Many of us know and have been waiting for this when they did delay that split shared services in the hospital setting would be finalized to be just based on time in 23. They've kicked that can down the road and said they'll delay it until 24. So it will be based on who furnishes the substantial portion of either the history, the physical exam or the medical decision making, or spends more than half of the total practitioner time to define that level of service. So it will remain the same as it is in 22 and 23 and then we'll see what's going to happen in 24. From a perspective of appropriate use, they did not move forward with any of the penalties or any of the appropriate use implementation timeline. That was actually not discussed a lot in the final rule, but it's definitely they have a website dedicated to appropriate use and I think we've postponed this one enough that it'll be interesting to see if or what happens around that perspective. One that I think is important for us in our programs to remember is that the global surgery package continues to be a conversation around the physician fee schedule and really looking at does they, do they have strong evidence to support the value of the RV use or are they inaccurate? Our global surgery services are those codes that we have for device implants as an example that would have that 90 day period and that would just be an example. Are they valued correctly? I do believe CMS continues to look at comments regarding this and strategies for improving that surgical package, but it's always important just to remember if you're not tracking and billing for your post-op visits and those things within the global period for those services, surgical services that would apply, that again helps in gathering that data and the accuracy of that information. All right, before I turn it over to James, James, do you have any additional comments on everything I covered in the physician fee schedule rule or do we have any questions out there relative to? Yeah, Nicole, I don't see any questions. There was a couple of things I thought I might offer a couple extra nuggets on if that's all right. On the telehealth flexibilities, you have the slide up there with the, what the rules did was implement 151 day kind of grace period after the public health emergency ends before those flexibilities disappear. That's really all the rule did. It was implementing a law that was passed. It wasn't some sort of policy decision that CMS made. There are some other bills in Congress currently and probably they will come back in the next session of Congress in a month or soon after that look at extending those sorts of flexibilities through the end of 23 or in some instances through the end of 2024. So that's activity that's out there that we're tracking and paying attention to and trying to figure out how best to fit things in for what's going to be good for patients and the cardiology team. Similarly, you were talking about audio only. That's one that, yeah, as you said, that will have to go away at some point or again, Congress will have to change the law because the way that it's written with the audio for that program and the sort of originating site limitations from I guess maybe we could call it the legacy telehealth program at this point, you know, from way back in 2019, the way it had, I guess I'll say functioned for all that time. And then you mentioned a couple other things you mentioned was in the kind of cost estimate of the prediction of an overall 1% reduction for cardiology that really does reflect the entire universe of services and all of the different practice patterns and all of the different payment policy change inputs that go into any individual fee schedule rule. So it's hard to link it back to any one thing specifically. So like you have the changes for the other E&M services that on net are pretty good for cardiology overall, but then also because that's increased spending, it comes out of the conversion factor when they try to keep a check on spending there. Yeah. So I was just going to harken back to that briefly. Yeah. Great. Thanks so much for those insights. Absolutely. I don't know if that shook anything else loose you want to cover and I still don't see any questions, I don't believe. No, I think we're good. I was telling James and I were chatting before this for everyone, you know, a lot of what went into the proposed rule came into the final rule. And I think there weren't really many big surprises. Would you say James from the physician fee schedule rule? Yeah, I think a couple of nice surprises in a sense you talked about clawing back some of the value on the ablation services. I too view that as a win. It's, you know, it's not a home run. We would have loved to have gotten a home run, but we got some value back and to see them delay this split shared policy for another year while they continue to try to better understand the impacts that's going to have, I think was a good one that I honestly didn't see coming. They tend to propose what they want and they tend to finalize what they want often. So to see that delayed a year, I don't, you know, they referenced using that time to better understand it and consider other alternatives and, you know, better understand stakeholder concerns. So we'll see if any of that goes anywhere and whether they might walk that back entirely or not, or come up with an alternative that we haven't envisioned yet. I agree. That was one I'm very happy that they did stall for at least another year because it was going to impact a lot of us operationally in how we use our APPs and really supporting our care teams across our universe for sure. I suppose the alternative is it doesn't alter your workflows at all, but then it would certainly alter the way that those services are captured in the payment space, right? Yeah, I think it would impact too some of how we utilize our APPs, particularly in the hospital and what has been a real advantage to utilizing them because they spend an extensive amount of time with the patients. And I think that would alter some of that and we would lose some of that great education and services that they are able to provide. So interesting how that will unfold. Well, let's move into OPPS on the next couple of slides. We've got just a few takeaways for everybody from the OPPS rule, which is, you know, the forgotten little brother to the fee schedule of sorts. But so the way that the payment formulas work with facility payment systems is they tend to get positive updates while in the fee schedule, we tend to be pretty flat. So the OPPS update is 3.8% after a market basket update with a little bit of productivity adjustment there. So you see the numbers right before you. And this is something that we're constantly mindful of. I'll probably circle back to this as it relates to some discussions of Medicare payment reform more broadly in a bit at the end. With the pandemic, there's been some discussions and back and forth about what since the outpatient system is based on reported cost data, which cost data should we use at this point? Do we want to pay based on data from the pandemic? Do we want to pay based on data for the pandemic? So Nicole included a little information here about which data they're bringing in. So I think that that is exactly as you have it there. At one point, there was discussion of like maybe a blend of 50 of inside the pandemic and 50% outside the pandemic, trying to anticipate what care and costs are going to look like in future years, which sounds really hard to do. So that's a lot more actuary science than I have. And then finally, a piece on this slide that the agency did finalize, again responding to legislation, was creation of another class of facilities called rural emergency hospitals, trying to, you know, build a stronger foundation for care in rural areas with some particular payment incentives. And let's look at the next slide, please. Just some modest flux in the inpatient-only list. Those of you who geek out on these sorts of lists of services that are in company, the different rules, a couple years ago there was a proposal to entirely delete the inpatient-only list. And then it was brought back, but with the idea of maybe having it be a little more flexible to add and remove things. We just see a few we just see a few services added and removed here. I'm sorry, removed only, and then added to another list, the ASC cover procedures list. I don't think we have that referenced here, but oh, no, there it is. And then, you know, there's flux between sites of service. So, you know, we will continue to see movement in that direction, I think. But the general approach has been, like, there's probably some services that are just, we want to have them limited to the inpatient facility until people demonstrate that there's some evidence that they can be done elsewhere safely. And, you know, perhaps at that point, we can also save the system some money. I'm going to gloss over opioids here, because I know I have not actually read that. But I think that, yeah, there was some opioid and non-opioid management proposals that Nicole highlighted here. A thing that we didn't see Nicole reference earlier, ACC has worked on this with AHA, with AACBPR, with some other groups, trying to get the sort of flexibilities we have for remote direct supervision of CB rehab and some other services, honestly. I've read that pacemaker, EP sort of device checks would lend themselves to this quite well. But we have not been able to get that advanced beyond the PHE so far, despite doing some outreach and providing some additional studies and data about the safety. And as best as we can understand it, kind of the science moving in real time, the efficacy. So I think that'll continue to be a thing that we try again next year, because they are allowing it to continue for a while and still at least saying that they're accepting additional information for how they might approach that. And then for those that are doing clinical trial pieces in your practices or facilities, I guess it came up somehow that when people are getting expensive devices inside category B IDE studies, the invoices or the EOBs might unblind them to whether or not they got the item that's being studied. So agency discussed and ACC was actually, our science team was like, oh, that makes a lot of sense from a developing the science perspective, supportive of a proposal to kind of split the difference on that. And so if you're doing one of those trials and you've got 10 patients, then you're going to get half the payment for every one of those 10, as opposed to the full payment for five and not the payment for the other five. I think that's the only OPPS slides. Nicole, anything else you want to expand on? Yeah, I would just see the rehab space or anything. Yeah, I would just echo, you know, I think everyone is really waiting to see what's going to happen with that. I think the advantages to what it's done to our rehab services and the services we've been able to provide to patients, I know everyone has their fingers crossed on that one. So it'll be interesting to watch it as we continue to go down the path of the PHE and expiration and all of those things. A couple of slides up, we've got just a few points in the QPP, MIPS, APM sort of space here. So here we've included the thresholds for 2023. And then also the weights for the different categories. Most of these are directly written into statute. So now I think we're just to a significant degree in kind of a stasis period with these programs unless or until they're further changed. A thing we did see some movement in was the continued enhanced emphasis on electronic measures. And so what the agency did was agree to extend kind of an incentive offer through 2024. And then noting here, maybe, I don't know how many people this would still apply to at this point. A colleague of mine, I know would know this, but I do not, is how many people are actually even still using the CMS web interface, but that is slated to be sunset. And on the next slide, we've got a little bit of information about the MVPs program, the MIPS Value Pathways Program. This first started being shopped two or three years ago as a way to kind of streamline the diverse and complex MIPS program. So there are different pathways for different specialties or different disease states. And in the cardiology space, we've got the heart disease MIPS value pathway. And so it offers a limited, a more tailored and limited set of measures that people can report through the pathway. And so this is voluntary for starting next year and for a few years after, but there is an intention. I think that it is likely going to be made required down the way as early as 2028, I think is the date most likely at the moment. They did change some of the measures around to allow for more flexibility and applicability to cardiovascular specialties like EP and interventional cardiology. And, you know, I didn't engage and look closely at all of the different MVPs out there, but they did add other pathways. I just wouldn't summarize here. I don't know that they'd be relevant outside of the one that we do have noted here in the heart disease space. Nicola, do you have something to offer on the pathways? Yeah, what I would say, and, you know, Kathy's not on our webcast today and we miss her because this is definitely one of her many areas that she dives into, but I would say if you, you know, looking at this and taking it off the back burner and really looking at how you'll be impacted by this and looking forward on those advancing care measures and how these MVPs are going to look in the future, I think it's something to put on your radar. I know many of us have back-burnered this as we've been going through the pandemic and have competing priorities, but I think as we look at that value proposition, we're going to continue to see this and look at your reports, look at your attribution, and also just what's coming up in the changes. I think that's right. One last item in this QPP space, I guess it's kind of QPP, but the agency made some moves and proposals that they did finalize to try to encourage smaller ACO participants in rural or underserved areas to try to get more participation in the ACO program and NSSP. So, the incentive that they were dangling is a shorter period of, maybe that's the standard five years, I don't remember if that's the normal length or not, but to do one-sided risk, which is probably more appealing than two-sided risk. And then there's continuing, I think this is a continuation, a policy to allow a 10% bonus in ACO MIPS for certain health equity metrics that I don't know specifically what those are offhand, but if anyone wants to know more, I think we can help you find that. I think like a lot of things, ACOs and NSSP tends to, we tend to think of it a lot of times as sort of a primary care lens, which doesn't necessarily apply as much to cardiology, but a lot of cardiologists are sneakily inside ACOs through their systems, so this does end up impacting them, although it's hard to know exactly how sometimes. So, we're going to close, I think, with a few just informational things on ACC advocacy. So, thanks again, Nicole, for inviting us to kind of co-host this webinar for the MedAxium audience, but hopefully this is still well in alignment. The thing that, and just down the hall, I was speaking with our congressional lobbyists earlier today, speaking with, on a large webinar with the American Medical Association and lots of other societies yesterday, really big push to try to fix these short-term cuts again. It feels like it's 2003 with the SGR, but it's not. So, what we're looking at, Nicole, had the conversion factor up at the beginning, and that's a four and a half percent reduction in PCHO payment just from the conversion factor. So, that four and a half percent, some of it is, Congress filled a hole two years ago and then last year again partially to avoid conversion factor reductions, and so we've just kind of piggybacked that on and are still holding those looming cuts from when we worked to avoid cuts during the pandemic that were viewed as really disruptive, and I think these sorts of cuts are always really disruptive. So, that four and a half percent fundamentally is three percent of a conversion factor reduction that balances the office and outpatient E&M adjustments of two years ago, and then the other one and a half percent, it roughly balances the adjustments to the facility and other E&Ms that are being implemented in 2023. So, it's just this kind of funny money game of we're going to give you more RVUs here, and then we're going to take it away from everyone all together at the end. So, working to avoid that through legislation with Congress. If you haven't already, you'll probably be getting, if you're signed up in the grassroots alert network at ACC, we're going to be pushing grassroots alerts to get more contacts to Congress this week, really pushing for them to get this done before the end of the year. That also includes the four percent PAYGO cut that is a different budgeting gimmick of sorts that stems from the way that Congress fixed certain problems in the American Rescue Plan Act two years ago or a year and a half ago. And so, you know, trying to get that warded off again, and I think that there's a, you know, we're pretty confident about that one. It's the conversion factor one that is seemingly going to be a taller hill to climb. And the sequester, if everyone remembers, gosh, a decade ago with the Bipartisan Budget Commission, after Congress closed the government one of a few times during the Obama administration, everyone got together and decided we'll build a compromise that would be so bad no one would ever take it. We'll cut the military two percent, and we'll cut healthcare two percent, and that'll incent us to fix these problems. And here we are, we've all decided to pull that trigger by not getting anything meaningful done. So these sequester cuts are in effect. We got them kind of mitigated at the first half of the year. It was a one percent cut that started on April 1st, and then the full sequester of two percent finally did take effect in July. So that is in effect, and every indication we've heard from our lobbyists and important congressional committee staff and members is, you know, this law has been on the books for a decade now. Like anything we would do is a bonus. It's not averting a cut, it's a bonus. And that's been disappointing to hear some of the language used on the Hill is like all of these, uh, we've been talking about avoiding cuts, and they talk about it as a payment bonus. So if you're, if you assume the existing law is the baseline, anything above that is a bonus in their mind. And then, so that pivots us into, on the next slide, we talk about, you know, some, the need that we, for some long-term Medicare payment reform here. Some of you may have seen the AMA has a set of policy principles for payment reform. That the ACC and pretty much everyone in the House of Medicine are comfortable in and support. It's not part of this slide deck, but we referenced it with the market basket update that the OBPS system is getting well. The conversion factor baseline for the fee schedule is no positive update whatsoever. You know, over 20 years, there's a compelling chart that shows us over 20 years and you see the, the hospitals and the other payment systems have a nice gradual march of increasing payments and physicians is just basically flat since 2000. Something seems really flawed about that. So trying to get something more long-term implemented there that allows for that to not be the case in the future. We'll see what, what happens with that, but that's, you know, we're trying to build a bridge to get to that. And, you know, that's going to probably include something with paying for value, whatever that means to different audiences and making sure that beneficiaries get high quality care. But also trying to, where we can address administrative burdens and processes that don't make sense and, you know, getting stability in the system. So I think that's our last slide, Nicole. Yeah, I know we have, we don't, I think most of our questions have been about the, the slides and getting access to them. Also, we do have some resources here that are available. And of course we have plenty also on the MedAxium website, but this definitely helps with all of the information that we have in the slide deck. Whoops, sorry about that. One thing too, we mentioned earlier, the boot camp sessions, those will be our deep in the weeds coding sessions next week. So please remember to join us and we'll get into the weeds of those impacts on our CPT coding changes. So that's going to cover any of our procedures, diagnostics, a little touch on E&M there, surgery, any of those areas for our practices. And then Tuesday, Jolene and Tammy are going to take us through venous diagnostic and procedure services. And then Jamie and I are going to dive into E&M changes. So that'll be some in the weeds information, both around the AMA, the final rule and how we're applying it in our programs and also to help with education of your teams. And then lastly, we're going to cover OBLs and ASCs. And James, I was, I was going to ask you, are you still seeing on the OP side? I know we talk about the inpatient only list and, you know, with some services being added to the ASC list, not, not a lot of them are cardiovascular focused. Do you still see that push of going to that outpatient environment and really on, we didn't talk about the inpatient side, but seeing that, that flux there from in outpatient, from inpatient to outpatient. Yeah, it wasn't so much in the rules. I think it's more kind of percolating out there more broadly and it is going to continue to come back. I know there are some services that are on the inpatient, sticking with, starting with the inpatient only list. I know there's some services on that list that I think increasingly there's, there might be a growing comfort level with the notion that they could be done as outpatients. And in some instances are with other payers outside of Medicare. So I think that is an area that, you know, whether it's the 2024 rulemaking or not, I don't know for certain, but I think that is something that we'll start to see some, well, you know, it will, the movement that it has existed up to now will snowball a bit more, you know, when some of the, and then some of it stems from the pandemic, I think people were already thinking of some of the more familiar now kind of structural heart interventions as being things that maybe it was heading in that direction. And then in the pandemic, when they were trying to keep people out of hospital, it was like, well, you got your tab or get out of here. And, you know, I think that once there's more data to show how, you know, not just as a safe, but is it also similarly affected and that people thrive in that setup? Well, you know, that might be one area, for example, that we start to see some desire to get that off the inpatient only list. And then with ASCs, you know, the way that the standards have kind of been recharacterized around what constitutes surgery that can be done in an ASC, like a lot more things could move into that space. I think it's a matter of, again, showing that there's a comfort level and evidence that you can have the same outcomes there. But also like the way that that payment system is built, you know, it's just roughly like 60% of the OPPS payment. So I think there will be interest for certain things and there will be other services that people will look at it and decide the numbers don't work. You know, I think, for example, a lot of EP device placement services are already on the ASC list and they're not done there because people can't make the math work. At least as my understanding of it, there could be other reasons too. But there does seem to be also, we've observed this and you maybe heard it from Dr. Blackwell, in tandem with discussions around private equity, which is not what we're going to talk about here. But, you know, I think continued interest by some facilities and setting up ASCs in concert with physician groups to try to mitigate the risk that they might be facing of people, you know, leaving those sorts of integrated practices. Yeah, I would say too, we are seeing how your health systems are going to continue to partner too with that ASC space and their physicians. And, you know, I think we've seen traction in some of the EP services in the ASC. But again, when you look at that device costs and what makes sense to, you know, have done there, I think everyone's still trying to make sense of that. A few folks have asked about where they can find the inpatient only list. It's usually pretty easy to find under the Medicare addendums. We can provide that link on that, but they have updated that list. They've also updated the telehealth approved lists and the categories. So we can provide those links for you as well to be able to access that. It's been, you know, when we talk about inpatient only with Watchman and TAVR and those things, as you mentioned, James, it's been interesting to see programs have really done some amazing things to safely take care of the patient, get them out of the hospital and really have them not be an inpatient with the PHE and everything that's been going on. So I do think we'll see some changes in that. I just think, again, it takes time for that as well. All right. And I think James sent that link out for the inpatient only list. I attempted to. Yeah, there's a link for all of the addenda that go with the OPPS. Oddly, the inpatient only list is in the OPPS rule. Oh, okay. Quirk. But there are many addenda there, and it is one of them. Someone asked for addenda E. Maybe it's addenda E. Okay. So it will be in there in the various OPPS addenda. We could also, I don't know if this is, yeah, I already have it downloaded onto my computer. I don't know that there's a way for me to share that. Yeah, we can definitely send it out if you didn't get it. You know, Google is our friend, I always say. So I can always find it. I probably would not have looked in the OPPS rule for that. You know, I wouldn't have gone there. That wouldn't have been my first place to go, but good to know it's there. That's how they keep us on our toes. That's how we keep our value, is knowing those weird things so we can help guide others. Yes. So I hope that we see most of you next week on our bootcamp series. We appreciate James and the advocacy team supporting this and doing this combined effort. Also, let your teams know if you're in the coding side or you're in the weeds, let your administrators know that that calculator is available. We do get requests for that often. We'll make sure that that link is available to you through our sessions next week as well. But we do appreciate your time. James, do you have anything else? I did also drop the calculator, at least I tried to, in the chat for everyone. So hopefully people have that. That's the ACC-hosted one. I think the one that you guys offer is the same tool, just with a different format or interface. Yeah, I don't have anything else. I'm just trying to give people a little bit of a sense of things and thanks for the chance to connect and it's always nice working with you. All right, sounds good. You too, James. Everyone have a good afternoon. Thank you very much.

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