Hey everybody, hope you can all see the PowerPoint. I'm looking over at Cameron briefly to make sure that that is what everyone is seeing right now. Okay, great. You all did a great job walking me through all the technical side of things, but always good to double check before you start talking. Just for some quick introductions, I'm Jay Cohn, Vice President of Government Relations here at Lobbyist, where my portfolio includes a pretty broad range of policy issues, but has a primary focus on healthcare. I've been working in government relations about a decade now, and I've been here at Lobbyist for a little over two years. I've been honored to be partnered with AAOE for really most of that time. We're also joined by Kim Wheeler from here from Lobbyist, who will be providing some useful links, which we'll be sharing during the presentation, as well as also a full breakdown of all the links afterwards, along with a one pager, giving a full breakdown of our top policy priorities, so I encourage everyone to use those links, save them, go through them. I'll be doing pretty top level breakdown of some of these issues, so if anything sparks interest, anything that you might be interested in having a deeper dive on, really encourage you to go through those, and any followup questions, feel free to reach out to me or to the AAOE Advocacy Committee, and we can always kind of dive deeper into that as well. Cameron will be jumping in a little bit later, so I'll let him give a proper introduction at that time. There we go. So why don't we just jump right in and we can get started. So first, what do we do for you? For those who maybe you aren't familiar, you know, I think a good example of the way I like to describe this is that working in healthcare, I understand that everyone on here has more to do in the day than there are hours, but everyone on this call also understands the way that regulations, be it through Medicare, prior auth, telehealth, really anything, how those regulations impact your day. And our job is to work with AAOE to identify which of those regulations are in need of change and to protect AAOE members from those changes looking to make things actually even more difficult. And, you know, in doing that, our first role is to be AAOE and turn your eyes and ears up here on the Hill so that you are all up to date on the latest bills, proposing changes to healthcare, maybe down the road, and also the most recent regulations coming out that can impact your practices in the immediate. At both of those points, propose the legislation and upcoming regulations. Our job is to represent AAOE's permanent presence on the Hill, and more importantly, really act as the bridge to bring AAOE's voice to these important issues. We do that in a couple of different ways. First, by coordinating meetings with key decision makers on the Hill, 32 so far this Congress and counting, to really influence proposed legislation, either promoting it by asking a member to support a particular bill or urging members not to vote for perhaps harmful proposals, or even suggesting specific policies you want to see included in legislation or raise at hearings. We also submit comments to federal agencies, particularly usually CMS, on proposed regulations during what's known as a comment period. And again, we're going to be touching on all this as we go forward with examples. And something I want to make sure I emphasize is that AAOE members participating in these meetings is truly an amazing tool. It really does make the difference. I have been in meetings where having a constituent, having a medical practitioner from the district, from the state, share their story, share their experiences, has actually shifted an office from a no to a yes on a particular bill. So it's been a real honor having AAOE members participate in some of these meetings virtually, and I would encourage everyone on this call, if you haven't done so before, please feel free to be engaged. I really can't encourage enough how important that is. And then also what really establishes AAOE as a trusted resource on health care, where we can have offices reaching out to us for our insights and our recommendations before a bill maybe is even introduced. So for those of you who don't know, and this is a good example of, you know, having our mid-year, why we chose to have this update at this time, we are now currently in August recess, which means that the House and Senate are out of session for a number of weeks. Members go back to their districts, they have town halls, you know, do site visits, something we actually are, I believe, currently orchestrating successfully in Tennessee, Senator Blackburn going to an AAOE member's hospital research clinic. But that does not mean just because it's August recess, people are taking time off. The health policy to do list is pretty long. So I want to give everyone a chance to kind of understand what is top of mind for Congress right now. And then after this, I'm going to run through AAOE's top policy priorities and how these kind of things interplay. So, first, lawmakers left town with a handful of critical health programs set to expire September 30th, and only a few workdays left to finish those reauthorizations. So, as I said, before we get to AAOE's top policy priorities, let's do a quick rundown of what Congress has on its immediate health care agenda. Lawmakers' largest endeavor is going to be agreeing on a federal spending package, which Cameron will touch on in a few minutes. Meanwhile, the two chambers are taking different paths to reauthorize the Pandemic and All-Hazard Preparedness Act, or PAPA, which is a sweeping emergency response and pandemic preparedness law which looks to improve the nation's public health and medical preparedness and response for emergencies, whether they be deliberate, accidental, or natural. And if you guys didn't pick up on it, as you might imagine, a big topic of focus has been the next pandemic. You know, a lot of focus on COVID, what went wrong, what could have been done better, what can the country do to prepare itself in the event of the next pandemic? So that's something we've been tracking pretty closely. On the House side, PAPA reauthorization is currently split into two bills, HR4421 and HR4420, which Democrats currently oppose because of the measure's lack of language addressing prescription drug shortages. Meanwhile, the Senate's version, S2333, is bipartisan. And I'm sure this isn't a coincidence, does contain some of those drug shortage provisions. Other program reauthorizations, you know, these major bills that we're tracking closely that are set to expire September 30th, include support for graduate medical education and also a fund for community health centers whose bailing sheets rely on that federal cash. And then looking ahead, Senate is expected to return from its August recess on September 5th, while the House is not slated back into September 12th, which really, you can do the math, only leaves about 11 legislative days for both of these chambers to be in session and actually get these things done before the end of the fiscal year, which is a tight turnaround to say the least. But I will say Congress loves doing things at the last minute. So none of this is that surprising. I would expect for a number of these reauthorizations to get done. Congress has set sight on some other health care policy post-recess, with the House and Senate panels advancing more than a dozen bills that are meant to increase transparency, tackle drug shortages and lower health care costs. So we're going to go into that. And then we'll get to the AOE in a moment. So first, looking at the House, the common theme of these bills, most of which have actually been bipartisan, has been an effort to increase transparency for hospitals, insurers, pharmacy benefit managers or PBMs, you'll be hearing that phrase a lot, and for others within the health care system. And within the House Energy and Commerce Committee legislation, there is really the most wide ranging House EMC has really primary jurisdiction over health care. And those those that they've been working on require greater transparency, would require greater transparency for industry players and within the 340B drug program, really impending cuts to safety net hospitals and expand site neutral payment policies to ensure that Medicare patients pay the same for drugs, regardless of where they're administered, among other proposals that they're tracking. Meanwhile, the House Education and Workforce Committee has honed in on transparency measures, approving for bipartisan bills that mirrored or expanded some of the policies advanced by the Energy and Commerce Subcommittee, with a particular focus on pharmacy benefit managers. They have been a particular focus of Congress this year. And then right before recess, the House Ways and Means Committee, who has jurisdiction over Medicare, Medicaid, took its slice of the jurisdictional pie, but was also the only panel to advance partisan legislation. Democrats objected to the removal of a provision that would require the disclosure of ownership changes of health care facilities in an effort to determine the prevalence of private equity players in the system, something that was included in the Energy and Commerce bill. The legislation is more aggressive in expanding site neutral payment policies and a particular focus for AOE. One of the bills did include prior authorization reforms on acquiring Medicare Advantage plans to handle electronic, be handled, sorry, for prior authorizations from Medicare Advantage plans to be handled electronically, among other improvements, which I'll, which I'll also touch on. In terms of what's next, I know it's covered a lot of different, three different committees, over a dozen bills I really touched on here. So what we're going to be seeing next on the House side is Republican leadership has been encouraging these committees to honestly get their acts together and merge these bills into one singular health care package. So I know they've been working on that. We've talked to some committee staff and some other health care staffers during this recess. That is something they're currently working on. And we will, of course, be tracking that to see if any AOE policy priorities are in top or included in that, particularly that prior section. Now looking over at the Senate side, kind of finance prior to recess has been focused on policies targeting pharmacy benefit managers again, and their business practices, and also advancing legislation that would place restrictions on the type of fees PBMs can collect. This has been kind of a part of a larger effort in the back where we see Senator Schumer has made a top priority for him and for the Senate to also move forward on a insulin cap bill as well. Over at the Senate Health Committee, which is chaired by Senator Bernie Sanders, he's been working on his own plan to authorize funding for community health centers, expand the health care workforce, and also improve access to primary care. His initial proposal, and people who maybe follow politics won't find this particularly surprising, was budgeted as a pretty massive increase in federal funding from current levels, which actually made it untenable even amongst Democrats on the Senate side. However, that legislation has led to emerging talks with Republicans on a compromise, which honestly probably was Senator Sanders' intention all along, just to move the ball and set the goalposts where he would like to see health care legislation move this early in Congress. And then the last thing I'd like to touch on, something I have heard from some AOE members before, is also a topic on drug shortages. House Republicans have said that they want a more extensive approach to the legislation tackling drug shortages rather than just having it tucked into some few provisions in the bill that we've already mentioned. And as part of that effort, Republicans on the House have released a discussion draft just before August recess that would initiate studies to examine the problem of drug shortages, set up a pilot program allowing the FDA to speed pre-approval for inspections for new sterile manufacturing facilities and also reduce or offer exemptions for some of the penalties drug companies have to pay when the price of drug prices rise faster than inflation. So, yeah, this is something where we now have this draft, discussion draft circulating. Democrats weren't too happy that they weren't actually included in that drafting process and weren't even notified that when it was going to be dropped. So that's not a great way to kick things off. But I think the message we can take away from here is that we have the Democrats on the Senate side introducing their versions of health care priorities, being encouraged to now work bipartisan to have a compromise. Meanwhile, on the House side, we have Republican leadership telling their members to take these many health care proposals, some partisan, some bipartisan, and craft one singular package. So it certainly seems that before the end of this year, we will likely see some kind of health care movement on a number of these priorities. And of course, we'll be there to provide updates and make sure AOE is properly informed. So having run through kind of what's top of mind for Congress at this point, what are AAOE's legislative priorities? And while these are likely to be included in the REopt and larger packages I just talked about at the moment, a number of these priorities, particularly the physician fee schedule and telehealth, are tied to the end of 2024. There's a sunset there. Having spoken to committee staff and the primary sponsors on these bills, it certainly looks like that 2024 deadline, kind of just touching on this with the September 30th deadline, is where we can look to see a number of these health care policies, you know, hopefully move and actually get passed from this Congress. So that gives us plenty of runway to meet with offices and raise awareness on these issues and really keep engaged. First, on the physician fee schedule, you know, I'm saying it's something I'm sure all of you are more than familiar with, year over year cuts to Medicare physician reimbursement jeopardize your ability to keep doors open and care for patients in your communities. While costs of running medical practices have gone up 47 percent, physician payments have actually declined 26 percent from 2001 to 2023. One in just important inflation, making it difficult for many practices and in particular, small, rural and low income serving practices to stay open. In fact, the number of doctors not accepting Medicare has more than doubled since 2009. So, you know, with a combination of constant battles over reimbursement rates, red tape and paid below what services cost being an ongoing problem, you know, for honestly for decades now, AOE has been strongly supporting the Strengthening Medicare for Patients and Providers Act, that's H.R. 2474, which would tie the annual physician fee schedule updates to inflationary measures, a move that we view as both fair and efficient. And while that obviously won't solve all the problems, it's certainly one of the recommendations we've actually have made previously. Last Congress on this issue came up and it's something that we just actually had a meeting today with Senator Lankford's office where this came up and they said this is something that they are tired of having groups like AOE, AHA, every major hospital medical group coming in, telling them this is a crisis that has to be fixed. They're almost as tired of it as I'm sure you are. And they are working, I've been told, on a permanent fix on the Senate side as well. So it does seem we have some good momentum on this. Just as a bit of background on this H.R. 2474, the lead sponsors, Representative Earl Ruiz, Democrat from California, bipartisan bills currently being worked on in both the Energy and Commerce and the Ways and Means Committee. On prior authorization reform, patients are now experiencing significant barriers to medically necessary care due to prior requirements for items and services that, as you all know, were eventually routinely approved anyway. Actually, in a recent survey, the American Medical Association, AMA, found that 34 percent of physicians reported a serious adverse event for patients including death and disability due to prior obsolete. So we have been very supportive of the Health Care Price Transparency Act, H.R. 4822, which proposes improvements for the use of prior off, including establishing electronic prior authorization, requiring HHS to establish a process for real time decisions for items and services that are routinely improved, as well as encouraging plans to adopt prior off programs that adhere to evidence based medical guidelines in consultation with physicians. Now, there is some, as I mentioned, I think previously, some complications around this bill. It was passed out of committee with all Republican. In fact, Representative DelBene, who is the main champion for prior off reform in the House, actually complained that this was even included in this partisan bill. So keeping all that in mind, the bill clearly has no chance of a thing moving in the Senate. But the key element on the prior off reform, we know it's bipartisan. So we are supportive of the bill as using it as an example of what prior off reforms we would like to see in, say, a larger health care package. And then finally, we have telehealth. As some of you may be aware, Congress has extended the telehealth flexibilities for Medicare through 2024 coming out of the public health emergency. And it is widely believed to be one of the few truly bipartisan sure things to pass this Congress. And while there are numerous, more than a dozen easily telehealth bills that we're tracking, we are paying particular attention to the Connect for Health Act of 2023. That's H.R. 4189 or F2016, which would permanently expand access to telehealth services, ensuring that Medicare beneficiaries can continue to receive this essential care. And the reason for that is that Senate bill at last count has 59 co-sponsors, actually more Republicans than Democrats, even on the bill, which shows a clear mark from the Senate side. At least this is the standard that we think should be included in any telehealth extension bill. From our perspective, we'll see what the House wants to do. But in the end, this will likely be what we're looking at. And just some of the top line elements of this bill, it would permanently remove all geographic restrictions on telehealth services and expand originating sites to include the home and other sites, allow more eligible health care professionals to utilize telehealth services. It would remove unnecessary in-person visit requirements for telemental health services, permanently extend the authority for the hospice face to face recertification to take place via telehealth, and also allow for the waiver of telehealth restrictions during public health emergencies. Again, I know I'm going through a lot right here. We have a full one pager that we'll be sharing afterwards, as well as links with summaries to all these bills. So no one has to be concerned if they're if they're not taking notes fast enough. We already did that for you and we'll be providing a full breakdown after after this webinar. But then last but certainly not least, the physician owned hospitals is a topic where we're pushing this Congress. Physicians understand the importance of quality, efficient and cost effective patient care. And that's why physician owned hospitals play such a vital role in the American health care system. Not only are physician owned hospitals among the top facilities in the country. I think Joseph, who I have on a lot of our calls, had 10 of the top 40 are physician owned hospitals in the country. A recent analysis actually found that physician owned hospitals are also saving Medicare three point two billion dollars over the last 10 years. And so really this restriction on physician owned hospitals penalizes physicians and patients. And that's why we're strongly pushing the patient access to higher quality health care act, H.R. nine seven seven four seven zero, which would repeal the ban on new physician owned hospitals and in turn help ensure lower cost, increased access to care, and more options for patients. We actually just met with Senator Lankford. He is the lead sponsor on this bill on the Senate side. Had a great conversation about what we're going to be doing to encourage more Democrat buy-in from this bill. Right now on the Senate side, it's all Republican. On the Democrat side, there is one Democrat making it bipartisan there, but obviously needs stronger Democrat buy-in. The data is on our side. I think your stories, for those of us on the call who are part of a physician-owned hospital, that we can be reassuring Democrats that this is not an effort to decrease care. Anytime you see a mention to a Democrat that we want to tinker with the Affordable Care Act, they get their hackles up a little bit, but that is not the case with this bill. This is purely about expanding care, better access to care. We have Senator Lankford's full support on this, and the staffer is going to be keeping in touch with us. Hopefully, if this bill comes up for a hearing, hopefully, A, we can not only be submitting questions on this, but we'll also be angling, hopefully, even to testify at a hearing on this bill. Thank you for the poll. Before we get to the next slide, I'd love to get... I know I wrote a lot of stuff out here. I'd love to get some input from those of you on the call to see what are your top priorities? Where are you experiencing most in your practices? There is an other on there. If there isn't something that you feel that I have not covered, if you feel there is something that maybe A, we should be taking more attention to, let us know. The only way we're going to know what your top policy concerns are is if you share them with us. I said I'd love to see what people feel about the issues we just talked about and to get your feedback. I think I'll just give a minute for a drink, and you guys, I'll take this poll for just a moment. I'll end the poll right here. No big surprise. Physician fee schedule, top of mind. We'll actually be covering that the most recent CY24 physician fee schedule update in just a moment and prior offer form. Prior offer form, definitely something, like I said, is top of mind both for us and for Congress as well as the physician fee schedule. Honestly, I think healthcare staffers are just tired of having us come in year after year, telling them how much these problems exist, telling them they need to fix it. It certainly seems that that engagement of being in their face and telling them how much we need change is having an impact. I would not be surprised if we actually get some real concrete steps this Congress. On the FY24 budget update, I'm going to actually turn things over to Cameron for this one. Cameron, if you want to step in, introduce yourself, give us that budget update, and then we're going to be moving on to regulations after that. Absolutely. Good afternoon. My name is Cameron Wheeler. I've been with the firm about a month now, but I bring a lot of experience with municipalities and some transportation issues and healthcare as well. Really enjoy working with AAOE. I'm going to put the links for FY24 up before I talk about them just for everybody's review. There you go. I'll send out all the links afterwards as well. I know there's a lot. While appropriations are not a top AAOE priority, it will be a top priority for Congress before the October 1st deadline. The House and Senate Appropriations Committees, through their 12 respective subcommittees, hold hearings to examine budget requests and needs of federal spending programs. Then the House and Senate produce appropriations bills to fund the federal government. If Congress does not take any steps when they return from recess to pass the budget or a continuing resolution, we could face a government shutdown. Fortunately, House Republicans are looking to pass a short-term continuing resolution to keep the government funded until early December. This continuing resolution, or CR, will give Speaker McCarthy a few extra weeks to negotiate with some of the more conservative members on the additional appropriations bills he's assured lawmakers that the House will take up. However, members of the House Freedom Caucus and other GOP conservatives are threatening the passage of these appropriations bills. These conservatives demand billions in cuts. Overall, the House leadership is negotiating with their more conservative members that are now arguing about the agreed-upon FY24 appropriation numbers from the budget deal. They had previously made that with the House, and they say that they represent a ceiling and not a guarantee, and the White House and Senate are likely to disagree with that. So at the same time, frontline Republicans, those House Republicans that won districts that voted for Biden in 2020, are beginning to find their voice and push back on the more hot-button issues that conservatives are demanding be included in addition to the cuts on federal funding. And this internal debate over funding among Republicans in the House also extends to Senate Republicans opposed to any serious cuts to military spending. Democrats, meanwhile, have no incentive to ease the tension and continue to sit back and allow the internal Republican debates over federal spending continue with an eye on the 2024 elections. So this deadlock raises the possibility of a partial government shutdown, a prospect that some GOP conservatives do not fear. So for the House Health and Human Services, they would receive $103.3 billion, down by about $14 billion from the 2023 enacted level, with cuts spread across major agencies and programs, including a $3.8 billion cut for the National Institutes of Health. And this bill was voted out of the House subcommittee on July 14. So the Senate Health and Human Services, on July 27, the Senate Appropriations Committee voted 26 to 2 to advance a $224.4 billion spending measure to the Departments of Labor, Education, and Health and Human Services that proposes boosts for medical research, including including Alzheimer's and opioids efforts. The mostly bipartisan process in the Senate stands in sharp contrast to the House, where Democrats voiced concerns with top line spending and a number of new riders during the subcommittee markup. For HHS, the bill would provide the Health and Human Services Department with $117 billion, down from $120.7 billion from fiscal year 2023 spending, and less than $144 billion in President Joe Biden's request. And I'll turn it back over to Jake for our continuing slides. Thanks, Cameron. So before we move over to the regulatory update, and then after that, we're going to touch briefly on the, I can't believe we have to say this now, will be 2024 presidential update. Cameron, I know you've been keeping tabs on the questions people have been asking. So you may want to run through a couple of those, maybe the ones that you've seen the most people raising questions on before we move on. I don't currently have any questions that I've seen asked in the chat here. All right, I will take that as a vote of just how well we're doing and read nothing else into it. I will though say, if anyone has any questions, please put them into the chat. And then if, like I said, after this chat is over, the webinar is over, feel free to email myself or Addy or anyone over at AOE. And if they don't have the answer, they'll forward it along to me and we'll be certain to get that over to you. Okay, so no one be intimidated by this slide. This is the position fee schedule update. This was a, on July 14th, as I'm sure many of you know, CMS released its highly anticipated proposed position fee schedule. The almost 2000 page document, it was about 1920 pages, if I'm not mistaken, lays out how the agency proposes to pay doctors in the Medicare system in 2024. I cannot emphasize this enough. I'm going to just give a very top line kind of breakdown of even just some of the topics that this proposal touches on. Cameron, I know, is putting into the chat a great CMS summary of the position fee schedule proposal. There's also, I believe, within that a frequently asked questions link, as well as the full text for those of us who enjoy doing a 2000 page quick read. This is also something that AOE is commenting on. Comments are due September 11th, so we are working on a response to this. And I would also flag that we, again, have that bill in the House that would amend at least some of these concerns. So I'm going to run through this. I'm sure there might be some questions. And again, we're here for that. So first, you know, top of mind, I'm sure for everyone, is the doctor pay cut. The proposal would cut Medicare payments to doctors by 3.34% to $32.75 next year, as compared to the current $33.89 in 2023. This reflects the expiration of the 2.5% statutory payment increase for 2023, which grew, of course, many criticism from doctor groups, including AAOE. You know, we argue it would hurt efforts to bolster primary care doctors' pay and prospects for value-based care. And the move really underscores also the bind that CMS finds itself in, trying to balance incentivizing doctor behavior with its obligations to cut spending. Again, this really comes as both parties in Congress eye how to improve physician pay to reverse the trend of practices closing or merging with hospitals. So there's a lot of different plays here when it comes to this physician fee schedule cut. Other elements that we're tracking within the proposal is hospital price transparency. The agency proposes significant changes to the way hospitals post prices for their services, so consumers can understand them, and competition would hopefully increase, which would, in turn, theoretically reduce costs. Hospitals aren't currently required to post their prices in any standardized way, and CMS proposes adopting a certain template. On telehealth, CMS proposes bolstering telehealth payment rates for virtual providers caring for patients in their homes. The agency says doctors need additional compensation because they offer a significant amount of telehealth while maintaining their physical offices. CMS doesn't expect that its costs will rise substantially, despite proposing higher provider payment rates. CMS also took further steps to facilitate telehealth access through the end of 2024, again, kind of mirroring that congressional extension that eased telehealth rules through 2024. And I will also say, again, on the telehealth, that's another thing we're likely going to be seeing interplay with Congress, where they're almost certainly going to be pushing that waiver, make it permanent. So that's something else we'll be tracking in both CMS and over in Congress. Remote patient monitoring is another element of this. The agency proposes allowing federal qualified health centers and rural health clinics to bill separately for remote patient monitoring, but it does keep in place regulations limiting billing for remote monitoring for established patients or those using the technology before the public health emergencies end. Some other significant proposals included paying for intensive outpatient care provided by opioid treatment programs beginning January 1st, creating a new benefit category for intensive outpatient care, and then also permitting doctors to fulfill requirements that they supervise the provision of certain medical services virtually through 2024. And then something else that was actually raised up as a top policy issue was also MIPS. So for MIPS, CMS proposes updating 12 existing value pathways and adding also five new ones, including women's health, infectious disease, mental health, and substance use disorder, quality care for ear, nose, and throat, and also rehabilitative support for musculoskeletal care. It would also establish a performance threshold for 2024 to be the mean final score across MIPS clinicians in 2017 through 2019, which is 82 points, and also keeping performance category weights the same from performance year 2024. So as I mentioned in terms of what's next, the agency is taking comments on this through September 11th. AAOE is working on a focus on physician fee schedule cuts and also on the specific MIPS proposals. We're also working on actually two separate but inline comments that we'll be submitting. And for those who don't know, all those comments must be read. They must be actually put in front of a human being to review them. I have seen, I can't remember the example, but even just very recently, there was a major push from the healthcare industry back. There was over 20,000 comments submitted, and CMS actually came out and amended their proposal. So submitting these comments really do have an impact, and it's also very good to see AAOE's name, you know, on that pile of people providing comments where we can hopefully have CMS wondering to themselves, what does AAOE have to say about this? They always have something really insightful, fact-based, and data-driven. So we've done a really great job on those in the past, and that's something we're working on currently. And again, this goes really well in hand with that Strengthening Medicare for Patients Act, Patients and Providers Act, I should say, HR 2474, which we're working on over on the congressional side. The second regulation that we're tracking very closely is this payment model RFI. It's a request for information seeking input regarding the design of future episode-based payment models. Responses to this request for information could be used to inform potential future rulemaking or other policy developments. Specifically, CMS and HHS is requesting input on a broader set of questions related to care delivery and incentive structure alignment and six foundational components, including clinical episodes, participants, health equity, quality measures, interoperability, and multi-payer alignment, payment methodology and structure, and also model overlap. And then in addition to maintaining or improving quality care, reducing Medicare spending, CMS intends to test an episode-based payment model with goals to improve care transition for the beneficiary and increase engagement of specialists within value-based accountable care. AAOE is, as I mentioned before, putting together comments on this. Those comments are new this week. But we actually already have a working draft that will be hopefully finalized early tomorrow. And then again, we'll be submitting our proposals on this as well. Overall, we're very supportive of an episode-based payment model that includes different payment levels for outcomes and end-of-the-year reimbursement for meeting certain standards. So yes, that's another example of us keeping AAOE engaged. So before I get to the election update, curious to see, Cameron, if we have any questions regarding these regulation updates. And I'll also mention, we track many regulations. I think I've probably shared close to a dozen already this year. These are just two examples of regulations that AAOE is going to be commenting on. So there's plenty more out there. I'm sure you guys have seen those updates in your inboxes. But these are just the two, I'd say, top regulations that we're currently tracking. No, I don't have any questions in the chat or the Q&A yet. All right. All right. So 2024 election preview. There's a lot going on on this. I'm going to do my best not to get into the more partisan elements that may be even going on. So we'll kind of keep this more on the data front. So with about two weeks until the first Republican presidential debate for 2024, there are eight candidates that have met those qualifications. Former President Donald Trump, Florida Governor Ron DeSantis, South Carolina Senator Tim Scott, entrepreneur Vivek Ramaswamy, former New Jersey Governor Chris Christie, Doug Berman, wealthy former software entrepreneur, and also former Vice President Mike Pence just recently made that threshold. As of right now, President Trump holds a healthy lead over really any of his challengers. Generally speaking, it was about 30%. I have seen it go north of 40% recently. Just to give you an idea of who really that front runner is, still certainly on the Republican side, Donald Trump. And then on the Democratic side, President Biden is a Democratic nominee. And while there are some announced challengers to his candidacy, lacking any formal debates or primaries, he will almost certainly be the candidate unless he chooses otherwise. And I just want to kind of get a snapshot of where we currently are. Again, this is just a snapshot, as I'm sure we've all experienced before. Polls do not mean election results. But as of right now, Democrats do hold, generic Democrat does hold a slight lead over the generic Republican with votes, which is what that big American map would show. And then in terms of the Biden versus DeSantis and Biden versus Trump, Biden does on average hold a slight, let's call it one point lead. But really, it's those unsures, those undecided that as always will be the prime focus for this election cycle. So that is our AAOE mid-year update. Curious to see if anyone has any questions. Again, I know we've discovered a lot of material. We'll be providing that full breakdown with links, helpful documents. I'm our one pager, so everyone has a chance to review. And if there's any questions you have as follow up, please feel free to reach out to either me or to Cameron or to AAOE. I'm sure they can forward those along as well. But I think I can put a pause there and see if we have any questions. All right. Well, I think I can hand things back off. Jessica, if you guys want to come back on, I'm happy to take a step back. All right. So thank you so much, everybody, for joining us for this webinar. It was a great session. Thank you to Jacob and Cameron also for providing this update. Like Jacob said, if anybody has follow up questions, feel free to reach out to us and we'd be happy to facilitate getting those if you've got anything specific you want to reach out to. But as always, these webinars will be populated into the Learning Center. So if you wanted to revisit any of this information, you can always go there to review the information. Thank you, everybody, for your attendance today. And we will see you on the next webinar.

physician fee schedule

CMS

episode-based payment models

2024 election

Medicare payments

hospital price transparency

telehealth payment rates