is that we want to identify where there is opportunity for patient quality care improvement. And that through identifying that improvement, we will also identify avoidable costs, right? So that we're not, so that people aren't shorting the bundle, that the bundle has some methodology behind it and to say, okay, we've looked at all this data. It's very interesting when you look at the claims data, by the way, you see things that you're like, oh, I can't believe it, right? Because everybody thinks they're practicing a certain way, but when you actually look at the data, you find stuff that you're like, wow, I can't believe we have all these people still doing open abdominal hysterectomies, right? I mean, you find stuff like that. And so then you start to lay that against your clinical practice guidelines about how you hope folks would practice, like Bob was talking about getting rid of variation in the system. And then, but you don't want the payer to take away that money, right? And fee for service, if you take away those avoidable costs, you lose the money, right? Because you're not filling those codes. So the thing is, is then to create basically a model where that money comes back to pay for all the things you do that don't get paid for right now. But you have to get those quality metrics in because you need people to change, you need clinicians to contemplate their clinical behavior or the numbers won't work, right? And so you want to put quality metrics in that'll say, get people to think about, okay, how am I going to do diagnostics on this patient? Oh, here's some practice tools and quality metrics that help me sort of figure that out. Okay, then I can manage my $3,000, $2,000 price that I agreed to and hopefully cover things I couldn't cover before, because I'm not doing things I didn't do before. But you want to, that's how you sort of want to work it. Ryan, the other thing is it's not quite as easy like to say, oh, the urodynamics catheter is going to cost more next year. So we're going to have to charge more for that. Like we have to build all of our stuff off of Medicare claims data. And Medicare claims data doesn't separate it down to how much did you pay for each of the little supply elements they said, here's how much we're going to pay for this as a whole. So it gets a little bit trickier there. And the other thing is, it's not just the big hitting items. I kind of showed it as a big hitting item, but if somebody is getting like a dipstick urinalysis in the office, and then they're sending every single one of those for a UA, like that's a very small cost. But if it's happening every single patient, you could like, over the course of all the people in the country who have stress incontinence, you could save a whole lot of money that way. And so we're just trying to find the areas where we can incentivize people to make proper decisions and be more cost effective in their utilization. And at the same time, get a little bit more return for us. Like my nurse calls every single patient post-op day one to check on them, see what's going on. It's a 15 minute conversation. We don't get paid a penny for that. And so then you can say, well, you know, we're going to give you some money back for this because we're going to save you money by cutting down the number of your dynamics. But in return, you're going to give us some money for these services that you're not currently paying for right now. And that's where it becomes an iterative process that we just got to see how it works. Yeah, and I agree. And so, and just probably because John and I trained at the same place, you know, we had instituted kind of the home day one call and the home day 14. And so once again, if we can catch patients via phone call, and maybe they have signs of urinary tract infection, and we send them for a culture and then treat them as an outpatient versus them coming into the ED somewhere, then we've saved the system significantly in doing that. So I think as we build these models, to some degree, we're also going to be setting up clinical care pathways, if you will, that then people can kind of model their care on. And we'll have the data as best as we can, some actual claims data, and then there will be some art with some estimation in it that will hopefully support what we're doing. One thing we didn't probably articulate very well is that these payment models have a payment part to them, right? It isn't just negotiating for a number. It is, that's part of it. But then it's also negotiating for how the money comes back, right? So if you look at the ASCO model, and they're probably one of the farthest along, they have one of their fairly well-known members doing a big demonstration project with Blue Cross Blue Shield of New Mexico, Barbara McEnany, and she actually had a CMMI Medicare innovation project too. And so in their model, they have a $750 upfront payment to the patient on their first visit. Extra, right? And then they have management fees that come in. So you still bill fee for service up to a point, right? And then because they're proving through their modeling that through drug choice, ER visit reduction, and some other complication reduction, their total savings to the system is X, right? On a kind of P&L form. But they're saying to get that savings, you have to give the physician these management fees, particularly this $750, which probably not everybody can get $750, but $750 first patient visit fee to really work that whole patient up, really get the care plan going, et cetera. And then you have these smaller additional management fees that come on every time the patient gets a chemo visit, and they have extra nurse management, et cetera. So you've got to bring those savings back to your methodology, whether it's through per patient, per beneficiary, per month add-on fees that come in through some sort of G-code, et cetera, or it's an activity-based fee that you put in like this big upfront first patient visit fee, or whether it's shared savings at the back end where you have a benchmark, you share, you split 50-50, or whatever like ACOs are. But there's some money coming back in from the savings you've created. Now, and the oncology care model that CMS is doing, it's a six-month model for a six-month chemotherapy regimen, and every chemotherapy visit, the participants get 160 p.m. p.m. extra payment, right? But then they've got to meet their benchmark for savings and quality at the end and do what we call true-up and go against the bench, and have good quality scores. So I think that what we have to see once we see this data is if we get some savings by getting on to more kind of classic evidence-based care, then how do we bring that money back to the system to cover the cost? Is it a patient management fee? Is it a special code that you bill for the extra nurse time, the extra management? We got to figure all that out. But most folks are trying to drive in some sort of patient management fee, so you're not totally dependent on having a savings at the end of the year. It's upfront to pay for the cost incurred to take care of that patient through the year. So we'll see. And definitely, we're not, you know, promoting getting rid of urodynamics or anything like that. I guess, you know, but in this kind of simple or straightforward SUI, I mean, unfortunately, we already know the data's there, right? But, I mean, anybody with mixed, anybody with more than stage two, I mean, they fall in the complex, and I mean, they're either current, you know, still be through the current fee for service, or there may be an APM for them in the future, but obviously, that would still include, you know, your dynamics.

patient care quality

data analysis

avoidable costs

clinical practice variations

cost-effective decisions