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 You just have to keep track of and, and there's some proposals in the physician fee schedule. That's that rule that the government Medicare sends out saying, Hey Docs, here's how you're gonna get paid. It's proposed, right? But there's some changes in there. And so I. It's just trying to keep track of some of these things, and it's not all like a feta complete.

So I think where everyone's fine right now, the HHS at the beginning of this year said, look, we're not gonna end the public health emergency for at least 60 days before the end of this calendar year. So we're not quite 60 days yet. But given the Delta variant, I don't know that you're gonna see a termination of the PHA, right?

It just seems very unlikely. And that said, then you're back to like, well, when it does end, what is Congress gonna do? And so conceivably they could have a situation where they're like, what we call over here in dc, like kick the can down the road. We'll just do a bandaid. We'll let you do it for like the next six months or whatever they saw next year, but maybe won't make the wholesale change that would be needed to just.

Allow these policies to continue in perpetuity. That makes perfect sense. The challenge with this one, the challenge, I think a, anyone who's fighting this is gonna have, I, I had Dr. Joseph Vidar on the show and he is the chair of the board of of the American Telemedicine Association, and I asked him this question specifically of should we break down these barriers and.

Do you support this? And he essentially said he's in support of the state regulations around telemedicine and them. You just have to keep track of and, and there's some proposals in the physician fee schedule. That's that rule that the government and Medicare sends out saying, Hey Docs, here's how you're gonna get paid.

It's proposed, right? But there's some changes in there. And so. It's just trying to keep track of some of these things, and it's not all like a feta complete. So I think where everyone's fine right now, the HHS at the beginning of this year said, look, we're not gonna end the public health emergency for at least 60 days before the end of this calendar year.

So we're not quite 60 days yet. But given the Delta variant, I don't know that you're gonna see a termination of the PHA, right? It just seems very unlikely. And that said, then you're back to like, well, when it does end, what is Congress gonna do? And so conceivably they could have a situation where they're like, what we call over here in dc, like kick the can down the road.

We'll just do a bandaid. We'll let you do it for like the next six months or whatever they saw next year, but maybe won't make the wholesale change that would be needed to just. Allow these policies to continue in perpetuity. That makes perfect sense. The challenge with this one, the challenge, I think a, anyone who's fighting this is gonna have, I, I had Dr.

Joseph Vidar on the show and he is the chair of the board of of the American Telemedicine Association, and I asked him this question specifically of should we break down these barriers and. Do you support this? And he essentially said he's in support of the state regulations around telemedicine and them is pretty much living by the standards that they're trying to drive across the country.

Yeah, I mean, I didn't realize it was like you're saying it's a number two in terms of like a hotspot. Oh no. Number two in the other direction, number two in terms of safe. Oh, okay. I was like, yeah, I'm surprised to hear that. Yeah. Gotcha, gotcha. Yeah, I remember that struck me that DC was one of the best.

Areas in terms of combating the spread of, of the virus at this point. First of all, we're gonna do your brief. If people haven't signed up for this, your team sends out a a briefing. It's every Monday. All of our members get it, and our foundation firms, and if you're a friend of time, they can also receive it.

So anyone who wants to be added to. It's pretty much like the pulse check of Washington and all things like health, IT and technology. You can subscribe at policy@chimecentral.org. We can add you. All right, so friend of bill, friend of mine, I'm already a Chime member so I get this and it's actually really good.

So it helps me to keep my pulse on the things that are happening in DC And as we know, the regulatory environment is something that really drives healthcare. So we have to, as IT leaders, we have to understand it. And then you are our voice into it, so to speak back to some of the regulations that are coming.

So we're gonna talk about two things specifically from your letter. The first, we'll talk about the cybersecurity meeting that went on between this administration. Some of the private sector companies, cybersecurity major initiative May was the executive order. July 28th, president issued a national security memorandum, and so there's a lot going on with regard to this.

So let me give you a couple of highlights and then we can discuss a little bit. So the Biden administration announced that NIST. National Institute for Standards and Technology will collaborate with industry and other partners to develop a new framework to improve security and integrity of the technology supply chain.

That's number one. Biden administration announced formal expansion of the industrial control system cybersecurity initiative to a second major sector, which is. Natural gas pipelines. So it was first the electrical grid. Now they're moving to natural gas, and then you have the, the private companies with their announcements.

Apple announced that we'll establish a new program to drive continuous security improvement throughout its technology, supply chain, and it's basics, right? They're gonna drive mass adoption of multifactor authentication, security training, vulnerability remediation, event logging, and incident response amongst their supply chain.

Google announced that we'll invest 10 billion over the next five years to expand zero trust. They're gonna help secure the software supply chains and enhance open source security. They're also gonna train up to a hundred thousand Americans with their digital skills certificate program that they launched.

IBM's gonna train 150,000 cybersecurity. Professionals and they're gonna do that in partnership with historically black colleges. Microsoft announced they're gonna invest 20 billion over the next five years to accelerate efforts to integrate cybersecurity by design and deliver advanced security solutions.

And then Amazon also had an announcement here where they're gonna make available to public at no charge. The security awareness training it offers to its employees, and then there's things that go on there. Talk to me about the cybersecurity initiatives. We see coming out of this administration and how they're going to impact or how they're being received by health systems across the country.

Yeah. If anyone who's listening is a reader of our debrief, you may have noticed that one of the quotes to be included from the president from earlier this summer was that they're treating the New War is actually not gonna necessarily be fought on the physical battlefield. It's gonna be being fought.

In the cyberspace, which probably comes as a no surprise to anyone who follows cybersecurity, but you know, you, you do need to treat it as a threat to national security. And so there's a ton of interest in this, and as you noted, it's, there's a hundred day sprint on energy. Now they're gonna move on to gas and we'd like to see them move on to healthcare.

That hasn't happened yet. So many of the initiatives that you've announced or or discussed are actually, there's funding for broad cybersecurity across the entire country. So 16 critical infrastructures we're one of them. Again, I have some figures here I pulled for you on like, I think CISA got 650 million in the beginning of this year.

So that money's in place and then there's in the infrastructure package, there's more money that could potentially be coming. We're obviously looking, that's like being deliberated right now. So we'll be looking for that. But there, there's been a huge infusion of cash into. Department of Homeland Security cisa to try and address some of these challenges.

These efforts are just getting kicked off like the one you just mentioned, the joint cybersecurity, uh, round table, uh, that they just had as a public-private effort. I think you're gonna see CISA trying to do more with public-private partnerships. If you look at their website, it's cisa.gov/jcd dc I mean, industry and CIOs and CISOs will care about this.

So we're gonna be digging in and trying to figure out where it is that they're going to be working with the healthcare sector. And we plan on talking to HHS about this, like where, what's their role? So there's some opportunity here. I think this is just getting started, and there's also potentially gonna be another big infusion of cash into the cyber arena via the federal government.

You have a lot of chief security officers for health systems that are pretty well connected. They have different groups that they have formed. They have different, I wanna say bulletin boards, but that says how old I am. But they have different feeds that are coming into them, almost to the minute what's going on in the world.

They have some early detection systems of. Attacks that are going on and those kind of things. What are some of the things that Chime has specifically for security professionals that's helping them to stay ahead of this, to get connected with one another and to really solidify their security position for their health system?

I, oh, we have so much about, I mean, it's our number one issue in terms of our government affairs shop. This is the number one issue we advocate for on the Hill, so we are constantly looking for the right balance of. Incentives versus penalties, right? I mean, I think we talked on one of your previous shows about HR 78 9 and that was a bill that was signed into law, the very end of the last administration, and that is going to bring some relief in the form of shortened audits.

You'll get credit for using cybersecurity best practices. So things are moving, I think, um, potentially in the right direction, but it still is a very punitive culture. There's a lot that's, I think is gonna be unfolding in the next year. So number one, we have a ton of free resources on our website, so I'll give you all this after the show.

But if you find yourself in a situation where you're having a cybersecurity incident and you're having trouble getting in contact with the right . Federal officials, you can always contact us and we will help you navigate that. We don't have to be involved in what the, you know, nature of the incident is, but we've done that for a few members this year.

Unfortunately, some government agency is not being entirely responsive, or they're having a hard time getting to the right people. We can help facilitate that for you. So that's one thing that we do for members. The other thing is I just mentioned we advocate for more resources for you where your eyes and ears on the ground in Washington DC every day.

'cause you have a real job to do and you don't have time to necessarily, you know, go fight all the fires of insanity in Washington and advocate what you need. So that's what. We also do, we have cheat sheets. We're tracking all the funding issues that are going on right now. Where's the money going?

What's cisa doing? CISA is blowing out their org chart right now. We're gonna try to figure out where is this money going? How can healthcare be at the forefront of this? So we'll be positioning our sector to be at the forefront. And then last but not least. Not self-serving at all, but our health sector, right?

So the health, if you're not a member of the health sector and you have no idea what this is, it's free. We are super involved, meaning Chime and A are very, very involved in this. And we have members who lead up some of the work groups. For example, 4 0 5 D Super on sexy name Bill. Oh my gosh. If you ever heard about 4 0 5 D and cybersecurity best Google it now.

This will be what you'll be able to, um, get credit for. So these are cyber practices developed in conjunction with the federal government, not mandatory, right? It's just voluntary use. But let me bring something back to you. You mentioned that White House Roundtable, did you notice that there's a piece in there?

There were two attendees that were specifically called out who offer cyber liability insurance scrolled kind of down to the bottom. You know what one of them said is, as a condition of getting cyber liability insurance, we are gonna mandate that you meet certain best practices. What would those best practices?

Maybe it's something that we, maybe we could get them to convince 'em to say, Hey, this is something we've developed in the healthcare sector. It's developed by. CISOs in conjunction with the federal government. Right now, the use is voluntary. That would be amazing. Right? But that little morsel that's buried in there is very interesting because we've been hearing from members that they are getting sledge hammered over costs and that their liability insurance is going up so much so that they have to get a second policy, like a supplemental, and even their first policy wouldn't even cover what they had last year.

So we're collecting, it's like I'm a detective, right? , I'm like collecting all the information about what's going on, trying to get ahead of it and trying to position the provider or community's interests. In healthcare Of course. Yeah. So that's interesting. Resilience, a cyber insurance provider announced it will require policy holders to meet.

Mm-Hmm. , a threshold of cybersecurity best practices as a condition of receiving coverage. And coalition. Again, a provider announced it will make its cybersecurity risk assessment and continuous monitoring platform available for free to any organization. So that's interesting as well. Alright, so the next thing we're gonna talk about is the HIPAA rule.

There's been a proposed HIPAA rule that's out there. And there's two documents I'm looking at. One is your cheat sheet, which has an awful lot to look at. And then the second document I am looking at is the chime response. Okay. So let's start with summary of key proposals. So on January 21st. The last day of the Trump Administration, US Department of Health and Human Services issued a proposed rule on HIPAA to modify the standards for privacy and individual identifiable health information under the Health Insurance Portability Act.

All right, so that's hipaa. And one of the things you have underlined big letters here. This is a proposed rule. Nothing in this rule is in effect until HHS issues a final rule. Alright, so how far along in the process are we? Are we like. In the beginning. Third, are we closer to the completion? You would think that that would be an easy and straightforward question to answer.

That is not easy and straightforward and I mean, the comment period closed like a few months ago. We do have someone presenting from OCR. Next week on the rule, it's free to anyone. Bill, you wanna join the webinar? You can listen, hear all about the HIPAA rule. So I think we're still in the early process.

Anyone who pays attention to rulemaking knows it takes like years, like years to, to get something out the door. But the mistake we make as CIOs is we say, well, this is gonna take a while, and then all of a sudden it becomes a final rule and then we're like, oh man, we've got a lot of catching up to do. So.

What you're doing is making people aware, hey, it's out there, so that they can plan accordingly. Although. Some, some of this might not actually come to fruition or maybe none of this would come to fruition. That's a potential. Yeah, I mean, I think what we wanna do is like, we don't wanna just like be like, oh, the funnel rolls here.

Look at that . Like, you know, like it's more like, let's grease the wheels. It's kind of like I do with my son, I'm like, like let me mentally prepare you for what's coming next. Right? So you just have to be like, let me just wet your appetite and just be like, here's what's happening right now. Nothing you have to do to comply, but like there's some more, I don't know, sprinkled in there.

Mandatory use. APIs and things like that. So you wanna kind of pay attention. And the other thing too, about this rule, which is so fascinating, again, I I find it fascinating because there were like a zillion, there were dozens of questions Bill thrown out at the industry. Hey, what do you think of this?

What do you think of that? You're like, this isn't really a rule, it's like an RFI in some ways. So it was a lot of like, Hey, what do you think of? All right, so let's give people a little bit of a taste of what's in this. So it provides patients access to their records within 15 business days rather than 30.

And 15 business days is what? That's at least, uh, 20 to 20 days of actual days allows patients to direct their PHI and an EHR to third parties, including other providers, creating a second pathway for patients to obtain their data under the rights of access authority. requires that covered entities allow every app that want to register with an API to provide access for an individual, assuming this is practical for the ce, and barring any security concerns.

Any CE or business associate that makes a secure standards-based API available cannot deny the app registration because that would be denying individual access. Replaces the exercise of professional judgment standard with a standard based on good faith belief concerning an individual's interest.

Replaces a provision that lets. CEUs or disclose PHI based on a serious and imminent threat. And then there's a bunch of others. Changes to fee structure, prohibits unreasonable patient identity verification requirements and so forth. So the response from Chime is a lot of it really makes sense. I'll push back on some of it and then you can tell me the reasoning, but HIPAA and information blocking, essentially what you guys are saying is, you know what?

Bring these two together, not bring 'em together. Right, but make the definitions the same to define a, a covered entity, the same define a provider the same, just get these two groups together to make the definitions the same. That would make life easier for us rather than having to figure that out. Is that right?

That's correct. Okay. The next one, individual rights access. So 30 to 15 days. Now I, when I first read that, my initial response is to say. This is the digital age. Of course, we can do this in 15 days, but there is a reason why this isn't as clean, cut and straightforward as the people looking at healthcare saying, Hey, you guys are Luddites.

Come on with APIs. You should be able to get that down to one day. There's reason. So what, what's the reason that Chime is pushing back on behalf of our membership? It's really about threading the needle, right? So when you're dealing with absolutes, like we can't deal with absolutes in every scenario.

Like if you turn, I mean, I don't know anyone's gonna read our what, what I would call our manifesto, but if you read into the comments a little bit more, you'll say that we generally agree that in most standard cases, 15 D should be totally reasonable. It's probably even closer, like maybe even a five. But the problem is arises when you have these outlier situations and we got a lot of pushback from our children's hospitals because there are issues involving, you're asking for one example custody.

It's a very thorny issue. So I'm not in a children's hospital, but I take it face value that they've dealt with this many, many times. So something like that would be difficult. There could be also a cyber incident. There could be a situation where maybe your EHR goes down for a day or two and some, maybe some like costly days are lost.

It's probably mostly things like, I would say, these custody incidences. We, I think if you're having a major, uh, natural disaster, probably OCR would deem that a natural disaster area and waive some stuff, but in the absence that they didn't, we're just looking for, you have to either have some sort of exception Yeah.

Or just keep it as it is and know that most people hopefully will be doing, you know, it less than 30 days. Yeah. And, and the exception process is gonna be key there. Having worked in healthcare, I know that . From state to state, there's a different exceptions, age limits for children and whatnot. So it's pretty interesting.

So addressing forms access is your next one. We were concerned about the implications of proposals involving personal health applications, calling for covered entities to transmit electronic health information to P, which is personal health applications, without requiring those to include privacy and security controls or sign a, b, a A.

That's an interesting one to me in that you're not gonna have 'em sign a, b, a, A, I mean, signing ABAA would require them to sign it with. If they're a national entity, every health system across the country, which would be interesting. But one of the reasons they're doing this is to sort of free the data and get the data into the hands of the the patient.

And that would be a significant block, I think, and it would almost be inviting them into the bureaucracy of healthcare. I don't know if you've tried to get a contract signed by a health system, but we streamlined the process to get it down to 30 to 45 days. And prior to that, it was three to four months to get a, a contract signed.

So BAA would just be, would just put a stop to this so that, that one, I, I'm not really a fan of the priva. Privacy and security controls is a problem. We absolutely have to. Address. That's one of the problems we have to address with these PHAs coming in and requesting the information. What am I missing as I talk about this?

Is there an aspect of this that I'm missing? So, you know, this actually goes back to for, for your loyal listeners, the, the term information blocking. Right. So, I mean, we fought this battle and we with many other spot it and we lost, we lost it during the last ministry. , and it's super disappointing because this is all about there being too parallel, but different universes.

You have HIPAA over here and those who have to comply with hipaa and there are penalties for non-compliance. And then there's the other app community that is basically the wild west and they are not governed by hipaa. So while patients do actually have the right to, and we completely, strongly support a patient's right to have access to their information where all patients bill, don't you want your information when you ask for it?

Absolutely. So of course we do. However, that being said, I think as consumer where like the patient turn consumer, you start to look at these privacy terms and conditions in the app, I'm pretty sure that most people have not read them. I have. Okay. And, and it's like scrolling down through like, what is it?

10 pages on your phone, a four point font to figure out that they actually are going to send it to their third party, repurpose it, commoditize it. So it's more about transparency and that is something that, that battle was lost when we were dealing with the. CMS and the O one C interoperability roles.

You're like, Hey, how about when a patient says, requests that there's some sort of disclaimer that comes up and says, I'm gonna read these to you. Do you sell identifiable information? Make it plain in English? People who you know, maybe are at a high school level could understand this, or maybe who don't have English as their first language.

Yes. Is it used only for research? Do you use the data for marketing? What is your documented patient consent process and do you securely destroy data? Even these would be somewhat nuanced, but we lost this battle and so the FTC and ONC and you know, decided not to go down this road, and so until you basically shore up these requirements, but probably is gonna take an act of Congress, then we're stuck with a situation.

Patient turn. Consumer is just sending their information out to who knows where. I. It could even be widely known apps that, and you don't know what they're doing with the data. So it becomes, it becomes an issue. So it's transparency really. We're not gonna say, no, you should go do it. I mean, yes, but you know, it's kinda like buyer beware.

Before people get the wrong impression, like, oh, this might change in this administration. Mickey Pathy spoke at the last Chime event and he's, he's for this availability of the information to the public health applications. He's also for securing it. And shoring up the rule. But it's, the reason the battle was lost is not because it was the last administration.

The reason it was lost is because it's bipartisan. It's the 21st Century Cures. Absolutely. It's, it's the, the everybody's saying, and you and I are saying the same thing. We want access to our health record now. Yeah. The, the rules have to. Set it up in a way that protects us as individuals. We don't know what we don't know as individual patients, and that's what Judy Faulkner was talking about.

That's what Chime is, is trying to defend is say, look, you, you need to understand that this could get out in the wild and people can start using this for. Commerce and anything. So they, they do use it and they, they commoditize the data and the data aggregators get it. And everyone knows now today that data cannot be really anonymized.

So what you're dealing with is a situation of like, if you have GPS location tracking data, just about any piece of data becomes health data. I mean, I could spend an entire show talking about this , pull the string bell woo woo woo. Pretty passionate, but I mean it . So we just want some guardrails around this.

And, and the thing is, you're right, the guardrails are not gonna magically pair. So basically you have to be an informed consumer and figure out where your day is going in a nutshell. So you have three, three more things. You have strengthening the access right to inspect and obtain copies of PHI readily available should be designated to mean that the information is available in the patient room during the appointment, can be pulled up and reviewed within the time designated for the appointment.

It's interesting, I, I read that, I don't wanna that on the.

It's hard. I mean, of course you want, if say, say I go and get an X-ray to that and I might wanna just get the X-ray, have it portable leave. Right? That would be so nice. And they could, or show me on the screen. But sometimes it's not as easy as just having something right there. And so, I mean, I think we've all been in a busy clinical setting.

One setting is not busy and clinical right. Especially these days, right? You, you're going to chase down something like, oh, I gotta go to this department. Or it's like stuck in the computer, you know? I mean, it's like, it's not as easy. So I think all we're saying is if it's right there and probably defer to the provider or the clinician as to the level of readiness.

Uh, clinic offices, EE everything that we were setting up had some sort of flat panel on the wall. They became so inexpensive, they're actually cheaper than an iPad at this point, which a lot of people are putting in different hospital rooms. And so in every one of those rooms, we were putting a flat panel that you could essentially, you could broadcast the medical record up or an image up and just have the conversation with the patient.

But I, I can understand why this could be a challenge if it's not already thought through and being in the workflow. So I, again, I'm, I'm glad you're pushing back on that again. It's just clarity around these things. What are you asking? What are you requiring? Our health system was seven and a half billion, and so yeah, we could put flap panels on it every wall in the clinic, but Chime represents.

Health systems that are much smaller than that and are not swimming in cash, that they can just do that kind of work. So you have to represent the entire spectrum of health systems. I think you just mentioned like ambiguity, when the government uses terms like you have to make information indefinitely available.

I. That is the kind of thing that makes a provider's hair stand up on their neck like forever. What do you mean the last 10 years kind of thing? Do I have to go into boxes and stuff? So it's just that level of ambiguity. We have to have like bright lines. We operate better with certainty. Yeah, I, I remember in the state of California, we had to keep records for 28 years and our EHR had been in place for.

13, 12 years When I got there and I was sort of looking at our storage and how it kept growing and growing and growing, I'm like, we should just factor in that our storage is gonna have to grow by this amount every year for the next forever, because we're gonna have to keep this information for at least 28 years.

And I, and I, I don't even think that was long enough. If people, if you see people at birth. Then you see them again when they're 50 years old. I think they expect you to still have their medical record and all the information associated with it. So yeah, retention is, is always an interesting issue for healthcare professionals.

Alright, let's go in a different direction. This is an interest one. So you gave me this article, telehealth Limits Battle over state lines and licensing threatens patients options. I assume this is about the state. It is. All right, so this is about the challenge of practicing medicine across state lines and the different state mandates that we have, and some states don't allow you to practice telemedicine.

For example, Johns Hopkins Medicine in Baltimore recently scrambled to notify more than a thousand Virginia patients that their telehealth appointments were no longer feasible. Their medical director said. And telemedicine at Johns Hopkins was not an option for them. Virginia is among the states where the emergency orders are expiring or being rolled back.

So what happened is during the the pandemic, we had the emergency order to allow the practice of telemedicine across state lines, and now that's rolling back to state control in some cases. And so Johns Hopkins, which is in Maryland, cannot practice medicine in Virginia. So that's one of the main things this article's talking about.

You picked this article, what aspect of this do you wanna talk about? Well, I mean, at the beginning of the pandemic, there was all that, those analogies, which I really didn't care for, about toothpaste going back in tubes. Right? Remember that like we're gonna, oh, things me great, it's gonna make here forever.

I still have my toothpaste , so it's. I just wanted to highlight that these issues around telehealth are ongoing and they are not. I don't think that you're gonna see some big, sweeping piece of legislation. I mean, it's always possible, right? But it's expensive and we haven't seen a number that fixes . Some of the more systemic issues that like around like the originating site piece, that would have to be a change in Congress.

And so there are some things that CMS has done, and then there's some things that Congress has done, but there are still outstanding issues. China supports the . A physician's or a clinician's ability to be able to be in a different location from where their patient is, irrespective of the license their, the VA does it?

I know it's a little bit different. The VA's a closed system, but we believe that that barrier should be removed. But it's more to highlight that we still have some challenges and we have retractions of payers going backwards that the state level, like you just mentioned. My son gets care in Maryland and I'm in Virginia and it's like a two hour schlep up there, so it's not super easy.

I think Maryland rolled back some of their telehealth provisions as well, so some of the states are going backwards. Even in the, even in the midst of like the Delta variant uptick, you still have these retractions going on, so we're just paying attention to what's going on with. With telemedicine, we're gonna have another free cheat sheet available on Monday, so I'll send you the preview bill.

But you know, just trying to keep track of what's going on, what's changing, what's been permanently removed, what's still an issue. One of the good things that we've seen is around mental health, right? Mental health is gonna be able to, they have the ability to have tele in perpetuity with . You get your services via telehealth and perpetuity because Congress changed that.

So that's really helpful. That was actually a while ago. In the support act, there's a few things that you just have to keep track of and, and there's some proposals in the physician fee schedule. That's that rule that the government and Medicare sends out saying, Hey Docs, here's all you're gonna get paid.

It's proposed. Right? But there's some changes in there. And so . It's just trying to keep track of some of these things, and it's not all like a feta complete. So I think where everyone's fine right now, the HHS at the beginning of this year said, look, we're not gonna end the public health emergency for at least 60 days before the end of this calendar year.

So we're not quite 60 days yet. But given the Delta variant, I don't know that you're gonna see a termination of the PHA, right? It just seems very unlikely. And that said, then you're back to like, well, when it does end, what is Congress gonna do? And so conceivably they could have a situation where they're like, what we call over here in dc, like kick the can down the road.

We'll just do a bandaid. We'll let you do it for like the next six months or whatever they saw next year, but maybe won't make the wholesale change that would be needed to just. Allow these policies to continue in perpetuity. That makes perfect sense. The challenge with this one, the challenge, I think a, anyone who's fighting this is gonna have, I, I had Dr.

Joseph Vidar on the show and he is the chair of the board of of the American Telemedicine Association, and I asked him this question specifically of should we break down these barriers and. Do you support this? And he essentially said he's in support of the state regulations around telemedicine and them controlling who can practice medicine in their state.

So he's not for breaking this down. I'm not saying that he speaks uniformly for the ATA, but I'm saying that it's, it's interesting that people in key positions. Are not necessarily advocating the, the way you think they would and, and saying, look, it's time to break down this barrier. And I think if I were a health system.

There's a , I'm trying to think of how I would say this. There's a competitive protection in place that the state provides by not allowing people from the state next door to practice telemedicine in our state. It means our physicians are going to be employed. They're gonna be the ones delivering care in our state, and I don't have to worry about that level of competition.

If Amazon wants to take Amazon care and bring it into my state, they're gonna have to stand up as some sort of mechanism to have doctors in this state provide care for those patients. So there's a protection, there's not consensus across this that it should come down. I'm in the same camp, I'm in the chime camp.

I'm like, I don't understand. Uh, why a doctor in Philadelphia can't see me in New Jersey or a doctor in Maryland can't see me in Virginia. That makes no sense to me. Yeah. There's certain groups that oppose this because they say that your liability or your your ability is a patient to, you know, seek recourse of something that happens in your care is more limited that way because you're in two different physical locations.

That's the counter argument to this. I think we just wanna see, and that there are, I mean, I'm not an expert in the, uh, interstate compact, but there's some licensing agreements that you can enter into where, um, it makes it a little bit less burdensome. Like I think we just wanna see some of these barriers removed and I let other people fight some of these very technical issues on the state front that you're referencing that involve like the house of medicine.

We just know that that's one barrier. And I would just, I mean, I guess the reason I pointed this out is that this is still really kind of like a hot mess in terms of we've made a lot of progress, but there's a patchwork of, so 50 states doing 50 things. The federal government can't, you don't have the authority to remove everything they need to remove, like here's an example we just commented and I'll send you

My colleague Andrew wrote the, the comment letter. He, we just commented the, to the federal government on the physician fee schedule, as I just mentioned. And there's some of these issues, you can pick them apart in here and like how do you define home? Okay. For example, the statute may say. Give authority for mental health if you're receiving services via mental health and at the home, does that mean that you're also sitting in your car?

Maybe 'cause home is not a safe place for you. Home is in the statute. I mean, I'm getting kind of, I'm wonking out here on you with you Bill, but it's like how do you define home? Could it be your car? Could it be like your friend's apartment? I don't know. I mean, we just, those are kinds of things that end up kind of wrapping us around the axle here in terms of like trying to sort through this morass.

Yeah, the term home really became fluid in the pandemic . I mean, I, I had friends. I'm like, where are you living today? It's like, I literally, I had somebody say to me, we're in our rv. I'm traveling all over the country. I'm still working every day, but today I'm in this campground. Like, okay, I don't even know how to handle it.

The Snowbird RV situation where you're got a home in St. Massachusetts and then like, I wish it was Snowbird rv. It wasn't Snowbird rv, it was somebody who was like. 38 years old has been going in the office all the time and they have three kids and they're like, you know what? I can do this job from anywhere.

They're not requiring me to go into the office and I'm this summer, I'm gonna take my kids. We're going, we're going. And they did. And he literally worked from Sounds life. From a campground, and there's parts of what's going on right now in the pandemic, I hope never change, and the ability to take three months travel with your family and still go to work would be one of those things.

I think that would be exceptional. All right, I'm gonna close with this. You've been great. Thank you. Speaking of my daughter just came in and like good things about the pandemic is that I actually can like put my kids on the bus and like hug my daughter. She can't see her 'cause she's like popping in and out.

Guest appearance. Okay. Bye-Bye . And now you've been Zoom pom pie, my daughter,

You're welcome. Oh, thanks Angel. Love you. Love you too. So yeah, I get to like be a real person and see my kids in the morning and it's really great. And I'll go hug 'em. They just got off the bus right after we get done with you. Yeah. That's fantastic. Alright, so last article, predicting the future of healthcare.

10 takeaways from HIMSS 21. Let's just go to their 10 things we could comment on 'em. Wow. I forget what they are. So you're have to remind me. There's like so many of 'em. AI and machine learning gain steam. Here's the funny thing, I'm gonna read these and I'm gonna try not to be cynical, but when I was a consultant and I, I did consulting for a fair amount of my career, and we would have this thing that we would do when we were getting ready to put a presentation together and we were getting to the final, we would review it as a team and anytime somebody would, would see something that was so obvious, it really shouldn't be on the slide deck.

The people in the audience would essentially just say, no, duh. Like, artificial intelligence and machine learning is gaining steam in healthcare. No, of course it is. It's gaining Mm-hmm. It's gaining everywhere. And I had a conversation this morning with, uh, head of innovation for one of the health systems.

And she was telling me just it's really getting to be pretty cool what they can do with the data that's starting to get cleaned up and artificial intelligence to pinpoint things, to identify things before they actually happen to get ahead of things like. We used to have to wait for all the HCAP stuff to get in, but now we can almost predict what our HCAP scores are gonna be based on, on certain variables and those kinds of things.

We can actually get ahead of this stuff and, and do things to impact it. So AI and machine learning is number one. Telehealth. Is going to gain steam again. I'm gonna say no, duh. Of course it is. Interoperability, fervor is toned down, but focus remains. Okay. So that's an interesting one to me. Do you think the interoperability fervor is toned down at this point, or do you think it it's still gonna maintain its high level of visibility for us, no.

I, I think it's because, I mean, of current event, I think it was. At Hans when O one C and CMS were gonna launch their big rules, and then everything got pushed back and the pandemic set in. And so it, it became a little bit of a sideshow and think, and we had to have some delays in there. Right. So it's, I mean, it's still happening.

I think it's gonna take center stage again too. Like, I think President for example, tonight is addressing the nation, uh, I, I believe it's 5:00 PM to talk about the Delta variant and some of his plans. And then you also had that 17 page plan, I think it was 17 page, um, document that he put out the other day of how to like address pandemics In the future, I bring this all back to say about interoperability.

We'll probably still have it stay in the sun because we need to have better interoperability and standardization for the public health infrastructure. Structure the same problems we had last year. Oh, shocker. Bill, guess what? You can't solve 'em in a year. And there's still a problem today. Like one, one example.

I know you might be like, oh, I've heard this before. Patient identification. That's a problem. Another area too that I think will continue to see it stay is the transfers of care. We still had, we had high tech for hospitals, high tech for doctors, and then nothing for post-acute long-term care. And they're still out there and some of them are savvy, but, but they need help.

They need some government assistance to help facilitate these care handoffs because at the end of the day, it's about the patient. And so the hospitals will probably be the ones that get penalized. We're, we're paying attention to this very closely at Chime, and those are places where I think interoperability could really, really flourish.

But we have to, we have to put some attention into those areas. Yeah, I agree. I think interoperability will remain strong through the next four years and for a lot of reasons, but, all right, so next one, health equity will take top to bottom interests and Mm-Hmm. careful touch with technology. I'm not sure what they mean by that, but I will say this.

Health equity is a topic I hear CEOs talking about across the board, and I now see that starting to permeate the entire organization. It, it used to be something, and again, this might be my cynical side, that felt like there was lip service to, but not a lot of action towards, and now it feels like. It's starting to permeate policies within organizations and training within organizations and, and programs for reaching the underserved in communities.

So it seems to be that is, that is really taking center stage at this point, uh, rising importance of cybersecurity. I think we both agree with that. One. again, I, I just come back to, I dunno what you're talking about. If this was on a slide deck and I'm, I'm using the polite way of saying no duck consulting, they would say, I would say.

In the next year, cybersecurity is gonna take center stage and they would say, no, duh. Of course it's gonna take center. It's because it has over the last six months. Of course it's going to, uh, how, how, how healthcare fraud and OIG enforcement are evolving. That's interesting. I did read an article on this.

There's a lot of data that they've collected now and are looking at all the activity around telehealth and they do intend to increase their . Enforcement and looking at false claims and whatnot, and, and that is evolving over the next couple of years. I assume you're hearing the same thing. Yeah, we don't, I mean, we don't spend a ton of time on the fraud thing, but having sat in the provider state for, for like two decades, I know a fair amount about what they're doing.

And the CMS uses ai. Speaking of ai, that's a wildly used tool. Like, I'm sure the credit card companies have been using it forever. Well, the government, I'd say probably in the past maybe 10 years, has deployed CMS at least engaged the use of those tools in a greater manner to spot where they think that there's fraud.

I mean, OIG and CMS, they'll tell you like, listen, most providers are not just providers, but like most people who bill Medicare are largely . Individuals and companies, but it's those who are not who they need to go after and they, they make everyone else look bad. And there's some very egregious cases of it and it, and they're usually wildly reported.

Yep. And they close this out with two others. Mental health is a key post pandemic challenge and we know that's the the case. We've really changed things on people that were already struggling prior to the pandemic. And then, uh, f the fem tech industry speaks up and breaks out, so we'll have to keep an eye on those things.

Mari, we are at the end of our time. I wanna thank you for like, once again educating me on all the things that are going on in DC and, and doing it in a way that doesn't make me feel as dumb as I really am about some of these things. I mean, there's, there's so much going on. I appreciate the fact that, you know, all the acronyms.

Well, I hope to God that people aren't like, oh, what a snooze does, talking about hiphop. But you can always call me or reach out to me and we can dive into these very, um, mundane but important issues. So thank you so much for having me. Bill, what a great discussion. If you know of someone that might benefit from our channel, from these kinds of discussions, I.

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