In this episode of the Buried in Work podcast, host Adam Zuckerman sits down with Dr. Fred Mirarchi, CEO and Chief Medical Officer of USACS and MIDEO LLC. Dr. Mirarchi shares his groundbreaking work in revolutionizing advanced directives through the MIDEO platform, a video-based tool that ensures patients' healthcare wishes are understood and respected, even when they can't speak for themselves. Learn about the limitations of traditional paper-based advanced directives, the importance of clear communication in healthcare, and how MIDEO is transforming the way patients, families, and medical professionals approach end-of-life care.

• What are advanced directives and their importance in healthcare decisions? 
• How MIDEO transforms complex end-of-life planning into a streamlined video format 
• Dr. Mirarchi’s personal journey in creating MIDEO and why it’s a game-changer 
• Real-world challenges of interpreting advanced directives in healthcare settings 
• MIDEO's role in improving patient safety and reducing misinterpretation 
• The future of advanced care planning and how MIDEO integrates with existing estate plans 

Show lins:

• Visit MIDEO’s website for more information: mideohealth.com
• Visit Buried in Work for more episodes and resources.
• Use code BIWPodcast for 10% off products at Buried in Work.

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This is the Buried in Work podcast where we share tips and interview experts to help you simplify estate planning and end of life tasks.

Welcome to the next episode of the Buried in Work podcast. I'm your host Adam Zuckerman and today we have a very special guest. It's Dr. Fred Mirachi. Fred is the chief executive officer and chief medical officer of USACS, Mideo LLC and the chairman of the National Palliative Care Committee for USACS. He's pioneering the use of video based advanced care directives through Mideo.

Which is an easy to use platform that communicates your healthcare wishes when you can't. Unbelievably important. You've heard about advanced directives on our other podcasts and we are diving in deep today to talk to Fred about all of the ways that Midio can make this process a little bit easier for you. Now it's relied on by patients, their families, caregivers and medical professionals around the country and there's a lot to talk about so let's hop in. Dr. Maracci, it is great to have you here today. How you doing?

I'm doing very well. Thank you for having me.

Absolutely welcome and a pleasure.

Now, a lot of people who are listening, quite frankly, they're probably unfamiliar with advance directives. So let's start at the top and then we'll work our way through what is an advance directive.

Yeah. So simply stated, these are just paper -based documents. They're paper -based legal documents that supposedly give you a way to have a say in your care when you're not able to speak for yourself. But again, I want to premise these are paper -based and they're legal documents.

Who can make an advance directive?

So anybody can technically make one.

Right? The most common way they come about is people see their estate planning attorney because they had some sort of life event. You know, they got married, they got a will, they had a kid, they got an illness. You know, any number of different life events happen. And then part of a typical estate plan is for you to get what's called a will, right? You you give your assets to somebody else, usually a point of financial power of attorney. And then the other portions of that estate plan are to include a living will or an advanced directive and a healthcare power of attorney. And then you get a big, nice bill wrapped up at the end.

Yep. Hopefully that bill isn't too big and on the Buried in Work site as listeners know you can figure out how to do it on your own, on an online platform or with an attorney's help. And that process really does change from person to person. Now in some states an advance directive is a legal document that the state prescribes. This is the form it needs to be, you have to follow this. In others it's more of a generalized idea. Living will do this and then you can go off on your own.

With all those complexities, how is MIDEO able to navigate the differences from state to state?

So that's a great question. We often get the question of, we're valid in all the states and so on. So the answer to this is MIDEO can kind of transcend this whole process, right? Because every state's got a different law on this. And every state has a different definition on what it is just about. But what we do is we are you. We are you speaking for yourself.

So we are you clarifying what you want from those directives and those documents. Because again, everybody has a different issue, different need and so on. And when I say this, I mean, this is a very important point. These are paper -based documents. They can't speak for you. We hope they were to be able to speak for you. But over five decades of use, we found that they really can't do a good job speaking for you. So you need something. And that's what we do at Mideo and how we transcend and how we hope to revolutionize this whole process because we want to have you have a voice and a say in your care so that you could be seen, heard, and completely understood.

Seen, heard, completely understood. Advanced directors have been along for quite some time in a very traditional format, as paper, as you've spoken about. Why now? Talk about your journey in the medical field. What inspired you to create midio? And why hasn't this already been done in the past, if it's so revolutionary?

Yeah, so, I mean, we could...

We'll take it kind of from the beginning and then we'll hit the why hasn't it been done. So my own personal journey came from experience, right? Like I screwed up and I've admitted this in multiple forums. When I was a young intern, back in the days when interns were actually the head of the house in a hospital system and so on.

You know, I was taking care of a young 55 year old lady who was a mom of a few kids, three kids. And, you she was having a heart attack and she was having a heart attack in front of me. And, you know, I, I was coming through the ICU, making my rounds and she went into cardiac arrest, right? She had that squiggly rhythm and dropped and that's a pretty...

quick moment in life that you have to act as a physician to save that person's life. And all you need to do is shock her chest, you know, with paddles and so on. So I went and I ran and I grabbed the paddles and I ran over to the patient's bedside and I was, you know, all hyped up to shock her. And I had a nurse in front of me screaming, don't shock her, don't shock her, flashing a paper in front of me saying she's a DNR.

And I was paralyzed. You know, it hit me in such a way. I had no idea what to do. I wasn't looking at a DNR order. I was looking at a living will, you know, or an advanced directive. And I thought it was a do not resuscitate order. I thought it meant I wasn't supposed to shock her. An important thing happened to me at that point in time. There was a cardiologist who was an old time cardiologist who was coming through the ICU late at night, you know, take care of his patient. And he saw what was happening. He

Push me aside, he took the old fashioned paddles, he gelled them up, he shocked her chest and she woke up and she spoke with us. And that happens, that's real. That completely happens, it's real. Back in the day, back then, we traded our heart attack with a clot buster called streptokinase and she went home a few days later.

Had that been me alone, she'd be dead today.

Take a step back. So for people that aren't familiar, what is a DNR? Is it a medical order? Is it something else?

Yep. Do not resuscitate order or DNR order as a medical order. And it's supposed to be an immediately actionable medical order that we're not supposed to come in and save your life if you're found dead. If you're found with no pulse and not breathing or pulse or not breathing, just depending on your state law, we're not supposed to act to save your life. So someone has a DNR.

Someone has an advanced directive. It's sitting by the bedside in the hospital and when a doctor comes in and checks your vitals, they're supposed to read this document next to you. So it's pretty vague and it's pretty different everywhere you go. know, back in the day, they were in paper charts, right? You you went and you found the binder and you pulled the paper out of the chart and you went and looked and some hospitals got really savvy and put these, you know, message boards up over the patient's bed and said, you know, patient's name, code status, DNR, whatever.

So it varied all the time. Today they're in electronic medical records. You know, so they're in some sort of banner bar in the electronic medical record, hopefully. If not, you got to go search and dig throughout that electronic medical record to find it.

If it's time sensitive. So I'm thinking back to when my father was in the hospital. Listeners know he had leukemia, went back several different times. Now, if the bed started beeping, the nurse would come in really quickly if it was something important and they just get to work. It's very rare that they would go to the computer beforehand and say, OK, let me check this.

How realistic is that scenario that someone's advanced directives are actually going to be checked at the point in time when the doctors or the people that are treating the individual need to have that information?

Well, checked is different. Known about could be different as well. oftentimes you'll hear things happen inside hospital systems as far as patient reports, nursing reports, physician reports, and sign out reports and so on. So it's not uncommon for the nurse to know that the patient in room 206 is a DNR.

Yeah, because they want to know that hopefully because in their mind they're thinking what they have to or not have to do for them. Unfortunately, that term has been associated with a lack of actions by both nurses and physicians. So they're often looking at that term to figure out what they don't need to do for that particular patient.

Okay, so the advanced directives, if they're filed properly, hopefully the medical team that is treating the individual has the information they need before they actually need the information and they're aware and informed so they can react.

accordingly in a time appropriate matter.

Hopefully that's a key word.

If they are doing that or maybe they're not, what are the problems that Mideo is solving differently?

Fred Mirarchi 08:4

So again, when we look at what these things are, right? They're paper, right? And more recently, they've become digitized paper from certain companies that have gotten into the digital fields and digital storage areas and so on. But again, they're paper in every sense of the word.

They're a document and they are nothing more than language in a piece of paper that has to be interpreted. Interpreted is, I guess, a nice way to say guess, and guess what you want. We don't really know what you want as a patient when we look at your advanced directive. Your clinical history sometimes gives us a little bit more guidance and so on.

But in the end, you're hoping that a person like me, who really is a medical stranger to you, right? Because I don't know you, but you're hoping like a person like me is going to have the notion and education and training to be able to read that document and make a good interpretation on your behalf. So what we're trying to do with MEDEO is transcend that. We're trying to take that guesswork completely away from it all and essentially have you again be seen, heard, and importantly understood to that next medical provider. Because Adam, me and you could have a great conversation here. We can have a bite.

Fantastic conversation here. Me and you could be spot on as far as what you want, what you don't want, and so on. But guess what? This conversation is going to end. And you're going to walk out of your office. I'm going to walk out of my office. And then you're going to be the victim of that next medical stranger in your care. It be a paramedic. could be a nurse. It could be an ER doctor. could be an ICU doctor, a trauma doctor, a surgeon. You're a victim of that next medical stranger that essentially will have their own understanding of what they thought you documented and why you documented it.

That's huge. That's a lot of confusion. And what we're doing with Mideo is transcending that to make it so that we set a best practice here so that, again, you're seeing, you're heard, you're understood in a way that a physician or medical team would actually need to understand that information.

So I'm going to push back on that a little bit because I like to play devil's advocate. So you say best practice. sounds like what Mideo is trying to do then is improve the advanced directive to make it more clear. It's not just taking it and putting it into a video format.

You think that your approach is actually more clear for individuals to understand?

Absolutely. And again, these are important documents. We know they have benefits. We know advanced directives can save money. We know that we hope anyway that they can align with patient wishes and promote fulfillment of family wishes and so on. It's a broken process. It's a broken process that has never really enveloped technology and essentially made the process safer despite

decades. We've known for five decades now that these things have issues. It wasn't until we started publishing some research studies called the Triad Research Series that we started to show where these issues are and how these issues are coming about.

This morning, I had a conversation with the president -elect of the National Association of Estate Planners and Councils. what they do is advocate for a collaborative approach to help people solve their estate planning challenges. So your CPA does this, your estate planning attorney does that. You're coming at this from the perspective of a seasoned, experienced medical professional. How do we know that what you're doing is going to check the boxes of a collaborative approach if an estate planning attorney comes in looks at the documents or the product that Mideo provides?

Oh absolutely. And in full disclosure, we actually presented there last year and we're presenting there again this year in Disneyland. So just speaking from experience and working with that organization. So our approach is not to be rid of the advance directive. It's not to be rid of the attorney doing the advance directive. Our approach is just that, provide a collaboration of agreements between attorneys and medical professionals so that, look, every state, again, we've said this, has different legal requirements around it. We want your legal requirements met.

And the best way to do that is when a state planning attorney or an elder law attorney, and then we want to provide the medical consultation and we want to provide the information back to that attorney because we have attorneys that actually have the wrong understanding of what these documents are as well. We have attorneys that have the right understanding of these documents as well, just like we have physicians on both sides of that issue as well. So again, our approach is always to be collaborative.

When people come to us, they're oftentimes in one of many positions or always actually in one of many positions on the spectrum.

There's individuals that already have an estate plan, they have their will, they have their trust, they even have their key context information and what to do with their pets, which is an example I like to give in the event that they're incapacitated or something happens. Then you have people on the totally opposite side of the spectrum, people that do not have anything done at all. They're trying to get their ducks in row for the first time, whether they're an elderly individual or someone who is 25 years old, just got married and is thinking about having a family, a major life events.

Where do you fit in then if somebody already has documents, they already have an advanced directive and they want to improve it, or the other side of the equation, somebody has a doctor and they're already covered under insurance with a primary care physician. How do you guys integrate that? Are you overtaking work that's already been done and saying our stuff is better, so this is what is directive, or is it complimentary and then it actually complicates things?

So look, I want to kind of break this down a tiny bit.

Let's first start with that person who hasn't done anything, right? And needs to do something, but is still resistant and doesn't want to do anything. That individual is going to have something done to them that most likely will not align with their goals and wishes and values. It will happen. I can tell you it will happen. It will happen from experience. I've been in that situation time and time and again. Now to that person who already has an estate plan, right? They already have an advanced directive. They already have their healthcare power of attorney appointed and everything like that. You're not done, okay?

started the process, you've been told for years that this is all you need to do, you are not done. Because right now you have something in place that's going to allow someone else to impact your care and treatment. And not just your agent, it's got to be medical professionals. So what we're doing in these respects is we built a medical practice surrounding this. Okay, we want to get patients in wellness. So if you're 40, and you just got married, and you have a will, we want to see you as well wellness and do what's called

age specific advanced care planning for a 40 year old. We want to make sure that 40, 50, 60 year old who's in wellness or early illness doesn't get under resuscitated. And that happens. I can tell you that happens from experience. I've done it myself. It is a real risk to you to be under resuscitated if you have that piece of paper alone. Now take the next step. You already have it. You're aging. You got an illness. You got some comorbid conditions.

And again, this is why we developed this into a medical practice because we want to see you in wellness. We want to see you in early illness. We want to help you transition into whether you get advanced illness and then that phase of end of life. That's a very significant transition that needs to occur. And unfortunately, a number of the primary care doctors today are too busy. They're too busy doing the all the other aspects that they need to do for Medicare wellness and this metric and that metric by whatever insurance plan seems to have a bug up their butt that day.

You know, so it really becomes important for people to realize that you want to focus with a group in an organization that isn't going to be one and done with you. And again, you want to make sure that you're involved, you stay involved and that you have an advocate in your corner when you do advanced care planning.

Adam Zuckerman

Absolutely understand that. The question I really want to drive home, because I'm still a little bit unclear about it, is if I already have an estate plan and documents, I already have a primary care physician.

Where do you guys fit in then? So if I were to come and get a mideo profile done, I get my advanced directives after I already have one, do you then mail it to my attorney and say, this is an update? Do you reach out to my primary care physician and say, hey, we're also part of the team now?

Yep, great question. So as we go through things, we have patients that come in in two ways. They either come in a young, healthy population that does it themselves.

or we have a facilitated approach. Now part of a whole process as far as when we're done with patients, again, whether you come and do it yourself or whether you come facilitated, is we have a whole fulfillment team that essentially takes a look at your information. Okay, we make sure everything is compliant, measures up, is not gonna cause issues, discordance, and then our typical process involves doing things to do what's called care coordination. Okay, you're primary care doctor. So if you came to us and it wasn't from your primary care doctor,

we're going to send them a letter and findings of what we did as far as your evaluation and treatment. Even if you were referred from that primary care doctor or were not referred, we're still going to do that same thing. Same thing with your attorney. Whether it comes from an attorney source or not, we're still going to coordinate with that attorney, whether elder law or state, because again, we want to make sure that we're not adding confusion and that if they have documents that are particularly confusing that we help.

clarify that information for you. The other things we do is to make sure that you actually have stuff yourself. To make sure you have ID cards yourself, to make sure that you have magnets for your refrigerator to guide those paramedics when they come into your house, because that's where we train paramedics to look for advanced directives on the sides of refrigerators. So it's a whole fulfillment process that we look to do care coordination, which I think is maybe answering your question as far as how we would integrate with that existing patient who's got an existing attorney and an existing doctor.

Okay, that's helpful. So when people are coming to you, they can be referred by an attorney, they can be referred by a website like us, they can be referred to you by a physician. Yep. Who pays for it? Are they paying out of pocket then? Does insurance pay for this?

Great question. again, a number of the one, well, one of the biggest reasons that we actually aligned with US Acute Care Solutions because they had a national footprint, you know, they're in 30 states, they have 500 hospitalist programs, 500 emergency department programs. So the concept was to build it in a way in a medical practice so that it was then compliant to bill patients insurance for doing it and make it so that you... patient has coverage for it.

And that's what we've been done. We've been very successful in doing that. There are also cash way pays to do what we do, but our most common way anymore is to go through insurance and essentially just get credentialed in the states where patients are and essentially provide services. You know, we have patients in 43 states. We have patients in six countries, you know, depending on how we get that patient and what's compliant and who we're credentialed with, you know, we build our insurance.

So where, what are the seven states, if you know off the top of your head that you aren't working in right now?

Off the top of my head. I don't know that but I actually get that for you Yeah, and and hopefully by the end of the year we'll be in those seven states as well

All right now functionality. I like to refer to the mom test. I love my mom very much I occasionally have to help her out with her iPhone or passwords How do things work? What are the steps involved to create a video advanced directive with you guys and does it pass the mom test?

It's funny so, part of my own personal journey was a bit on my own father. My father essentially was killed because of the understanding of his do not resuscitate order and so on. So I was very adamant that I was gonna make sure mom was protected. and you know, in this whole process of doing this was to make sure that, you know, I could be with her when she wasn't there. Now, to pass the mom test, you know, we essentially developed this in a way because that was the biggest concern we always had.

Could the elderly population and the frail population be able to go through and do this and would they feel comfortable doing it? So we built processes where we take advanced care planning educators and coordinators and we facilitate the approach. When a patient comes into our practice and they come through a scheduled approach or facilitated approach, they're handheld the whole way through.

Everything from turn on your phone to turn on your computer to you know, this script or this living will and this is how we're going to get you to upload it and this is how we're going to get you to record this. Everything is so white glove for them that essentially it takes that whole feeling, that fear of technology away from that aging patient. I will also tell you, I was pretty surprised, our aging population of patients, especially with COVID, changed.

You know, our 60 to 70 year old age population are now pretty savvy with phones and computers. You know, same thing. We even have a contingent of 70 to 80 that are still pretty savvy with computers and phones. So, you know, probably two sources to that are one Facebook because everybody wants to watch their grandkids grow up and so on. And it seems to be the best way to do it. You know, the other is the fact that people in the time of Covid had to get so savvy with using their phone and their camera feature or their phone that it's really transcended the aging population and use of technology.

Alright, so you said phone, you said computer. I'm assuming that also means tablet. I'm assuming that means Android or Apple, yeah?

Yep, yeah. So we have apps that are available, and we use apps in both Apple as well as Android products and so on. And we use those apps to facilitate the approach in addition to web -based applications that we do. So somebody can do this all from their computer, or they can do it from a combination of their computer and their phone or tablet.

Our most preferred way is a combination of their computer and some device, phone, tablet, whatever, it streamlines it a lot faster for us.

Is it possible for people to do it in their doctor's office or in their attorney's office? Are you partnering with professionals as well? Or is this a, after you leave, you need to figure this out on your own?

Yeah, no. So we do have some. We don't have any physicians to date in primary care practices that are utilizing our stuff. We just get referrals from them.

As far as attorneys, same thing. In time, we'd love for this to be a paralegal process in an attorney's office where you come in for your estate plan and then you get your medical consultation and then the paralegal takes it from there for that attorney. But to date, we get some referrals from practices. We have some practices in the Maryland area that actually refer to us. And then essentially we get them from just referral sources. But no one that has embedded this into their practice yet.

He probably references Maryland because that's where I'm recording from today, everybody. Legal and medical compliance. So he's legally binding. What about HIPAA and other regulations?

Yeah. So HIPAA, other regulations, security features. You know, this is something that we spend a lot of money and time on.

you know, as far as hiring chief technology officers to make sure that we actually exceed those standards. You know, your medical records are kept in high trust certified systems. Ours is particularly the Athena one medical record system, but they're very similar to other epic and Cerner systems and so on. And then on the technological side, we have to do the things that are required, you know, and again, we exceed what's required. So levels to high trust levels. And then you have to wait for that time to get your certification to occur. Not to mention some states are,

set up in very similar to Maryland or set up in a way where you have to insert things into their records. So you actually have to meet certifications before you can be able to do that.

Okay. Does it change state to state then for you? So the process you start off and go, are you in Arkansas?

So we don't change our process specifically for Mideo because again, we're looking for Mideo to be that voice of you and to clarify what you have in your documents. So what we like to do is to make sure that wherever we see a patient that they have

whatever paper based document and we also give them a paper based version of MIDEO as well which equates with that advance directive law in that state as well. So but we still still take the extra step to make sure that if your state requires a notary then your documents came through and are notarized. you know it doesn't then it doesn't. If you need two signatures it needs two signatures. Quite frankly we regardless use two signatures anyway.

just because of the fact that some states still require two signatures.

So when we, not through the app and not through the do -it -yourself, but through our facilitated approach, if we have to get online notary services, then we get online real -time notary services involved.

What about if it's do -it -yourself and I need to have a notary, two witnesses that aren't related to me, 18 -year -old or of sound mind, yada, yada, yada?

Fred Mirarchi

So in the do -it -yourself process, then no, we don't have any online notary services available. But again, in that respect, we're not replacing your documentation.

Your documentation is coming through to us in a compliant fashion that is compliant with whatever state it occurred in. So again, in that situation, our midio is essentially the voice of you and the video of you explaining what you want and the reason you put those documents together.

All right. So I'm going to go back to the question that we had earlier, where on the one hand, you have a lot of documents, you come to you. And from the other side, I've done nothing. You're my first stop. Does that mean that I get the documents printed and then I have to go and get them notarized myself?

If your state requires a notary. Yeah, if your state requires a notary and you know, we typically if people are going to have their documents done elsewhere, then we typically want their documents to be done and compliant at the time of their visit and so on or at the conclusion of their visit if they're going back to their attorney to do them and so on. But if it doesn't require a notary, it's not a big deal.

OK. Insurance companies, you work with most major companies or is it just a few right now?

Fred Mirarchi 4:57

No, so the major payer is actually reimbursed for what we do. Medicare has been great. Medicare is really probably our biggest payer right now as far as coming in in patients. And fortunately for patients, if you have Medicare and you have some sort of supplemental plan, either through AARP or your teacher's union or wherever you were employed before, you come through quite frankly and openly at times with no payment at all out of pocket for this. So that's been a very rewarding thing to tell a patient that, I

I can do this for you and you're going to get all this value out of this seeing a doctor. And guess what? There's no out of pocket, but others require copay. And if you're young in that young population, you know, under 65, non Medicare and just traditional insurance or commercial insurance, we even get reimbursed from them. And the only thing that's different is just whatever the contract is, according to your, whoever you got your insurance for, as far as your copayment.

When do the clients find out how much they owe, if they owe anything. Is there a process in the beginning where they can say, here's what I have, this is what my scenario is, and you go up, you're free, or nope, you owe us X amount of money?

Yeah, I mean, if they call us and give us permissions to actually enable us to do that, yep, we're able to pre -verify their benefits. But again, if they have Medicare coverage, they're covered. And if they have one of the majors, they're usually covered. If they're not covered, you want to pay completely out of pocket, what's the rate? Yeah, so we made it so that we would stick

And this was kind of a stickling point within the organization too, but fortunately we're physicians in this organization, so we tend to win out on that decision making. So what we do is typically we'll take whatever Medicare would reimburse and assign a cash value to it. And so for typically somebody coming through to get our full facilitated approach, we don't charge any more than $350 for it.

You know, and that gives you an hour of time with a physician as well as that medical consult in addition to that entire fulfillment package. So you're actually speaking with a doctor during this process. You're speaking with a physician, a physician who's been trained, you, not just a physician, a physician who's been trained in these particular aspects of what we do.

All right. How do patients prepare before their evaluation? What do they need to research, learn, bring to the app, the computer?

Yep. So not much is the answer. You know, coming with your insurance cards and driver's licenses is great just because we need to facilitate that for your appointment. If you have documents, we want you to have your documents with you. This way we can upload them in one snap, you know, to make sure that we have everything for you. And then typically speaking, if patients have a big medication list, we like that because we like to see drug interactions. We like to see if certain drug interactions put them at risk and we're able to take that risk and actually put that on their ID card as well.

which then becomes as a medical alert for that particular patient. just speaking here openly and candidly, one of the biggest ones today is blood thinners. Patients who are on blood thinners for any number of reasons, they have no idea what risk that puts them in. And I can't tell you how rewarding that's been alone to just make sure patients are informed of the risks of their drugs that they're taking.

What do see as the future of advanced care planning and how do you guys fit into it?

Yeah, so future has to change. know, this whole thing started with advanced care planning around 2016 or so when the election was happening and it was all about death panels, right? You know, and everybody was like, Medicare is going to pay for you to die and this, that and the other thing. Well, unfortunately, there are some people that are using advanced care planning for that purpose because keeping people alive is expensive. And that's what it comes down to. It is expensive.

You know, so, but the reality of it is, that advanced care planning should be something that we do and put in place for people as they transition and not just be for end of life. Okay? Cause if you make it just end of life, people aren't going to do it. You know, they're not going to do it because it's very hard to get people to just align with end of life care treatments and so on and decision making and putting that stuff in place. And again, which is why we decided to medicalize it, to medicalize it and to make it part of a practice because we want to see our patients do well.

We don't care if you live, we don't want to sound callous and say we don't care if you die. We just care to make sure that you have a voice in saying you're care, you know, and to make sure that we do what's right for you. Because doing what's right for you carries lots of benefits. One, to you, you know, and two, it's to the healthcare system. Because if we do what's right for you and you don't want all this aggressive care and treatment, well then we can take those resources and use them elsewhere. But if you do want treatment, we don't want people screwing up on you and not providing the levels of care and treatment that you do want.

Mm -hmm. All right. Good conversation. Learned lot about advanced directives, about the services that Medio is offering. What's the one topic that you wish we focused on or questioned that we didn't? So here's your opportunity.

I think safety. We have to make sure that we talk about safety in anything that we do with advanced directives. Any question about end -of -life care should come around safety. Any question around euthanasia should come around safety. mean, the amount of states that are adopting euthanasia policies today is growing very quickly. And I don't really have a stance for or against. I kind of walk the middle and want people to decide what they want. Yeah, but when we do things that are not very structured and not with good oversight, then there can tend to be abuses in the system. And those abuses in the system tend to affect patient safety. OK. And to me, I want to see millions of them become that patient safety tool.

I want to see it become a tool that makes sure that a patient who wants to receive aggressive care and treatment gets it, who doesn't, wants to forego it and elect palliative type interventions, or for that person in the middle that we just need more time to figure things out on. We need a stop -cut measure for patients to make sure that we do what's right for patients, as opposed to thinking we're doing what's right for patients.

All right. Dr. Maraci, if people want to find out a little bit more about MEDEO.

Where can they go? So simply go into our website, mideohealth .com or searching Google and just searching mideo. If you happen to be tech savvy and want to get into the app store or the Google Play Store, you just type in midio card or midio advanced directive and you should see our apps pop up.

Sounds good. Well, I appreciate you for the time and the candid conversation. We enjoyed everything and that wraps up another Bury It and Work podcast episode where we feature tips and stories from industry professionals who specialize in making estate planning end of life tasks and estate transitions more manageable. you enjoyed the podcast,

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Dr. Maracci, thanks again. It has been an absolute pleasure.

Thank you. Thank you for having me.

Thanks for listening to another episode of the Buried in Work podcast. Remember, you can save 10 % on our estate preparation package and games with code podcast10 at buriedinwork .com.