ADAM: Hey guys - Adam Peebles and Jason Nardella are back for another week of Prescription for Growth. Thank you so much for joining us, we're really excited to dig in. Got a lot of great content to review with you today. So with that, I think, Jason why don't we jump into a question that's really been coming up has been very timely; we've talked about it before here but I think continues to be on the forefront of a lot of our partners minds and then also, I'm still surprised a lot of people aren't thinking about this. So it's kind of a polarizing topic where some people are really focused and really worried, and other people are still very focused on COVID and the impact of COVID what's happening, but that is site neutral payments. And so we're hearing a lot come out of DC. A lot of different policy components are being, are being finalized right now. AHA tried to stop this and were defeated pretty quickly and abruptly. And so it looks like site-neutral payments is coming down the pipe very quickly. And so love to just get your thoughts on what, what our partners are talking about, what your clients and friends are saying about site neutral and in particular, what hospitals can really be doing to address what is inevitably inevitably gonna be a multimillion dollar shortfall that they're not gonna be seen with some of those legislations. So I'll turn it over to you, but maybe you could also start with just a quick intro of what really site-neutral is and go from there.

JASON: Yeah, no, no problem. So what the government is trying to do with the site-neutral payments is effectively stop paying the differential for encounters that are done in a hospital license space. Hospitalized space is very expensive, it's something that has a lot more regulations around it a lot more codes, fire codes, and all that kind of stuff around it. No longer is CMS trying to give you that bump in differential payment to essentially pay that back for you. So if they're gonna try to do is level playing field, get everybody to what they call a site-neutral payment, which of course will be the lesser of the two payments between sort of an ASC type of location and the hospital location. But the thing, the first thing that we want to do, and it's really important is just understand what the hole is, right. It's important to understand exactly what you think could be the impact so then we can start to strategize ways of filling that hole and actually recovering from it. So I'm in the Midwest now so we'll just jump maybe into Illinois, we'll look at colonoscopies those can be done both in the hospital and the ASC. Depending on your GI doctor, we can get a pretty high volume here but let's just talk about maybe 5,000 of these, what the potential impact would be in Illinois. What's going on behind the scenes here is we actually took all the reimbursement data from the 835s for each one of these states and we selected sort of the top 20 ish procedures that are done both in the ambulatory side your ASC potentially and then the hospital size. The average of those reimbursement by state is really what we're looking at here and when we look at this number, this $5.6 million that's your average loss if you went from sort of an HOPD payment for 5,000 colonoscopies to that site-neutral payment, you're out about $5.6 million. It comes out to I think, math is right here by a $1000 per procedure here. So what do we do with this information? What do we learn from it? Well, just understanding, I think is the very first part going into next year or whenever this does get rolled out, you've got a potential for at least $5.6 million reduced NPSR. How do we recover that? One we could look at our private contracts that are coming up and we can really try to push the envelope on that and try to recoup as much as we can from the private insurers on sort of this whole. Another one is looking to your market and being a little bit more strategic on where you're gonna get your volume. Where are you going to get your money from? What are your high margin businesses? What are the high volume businesses? And trying to find those areas where you've got a bunch of volume and actually some pretty good margins to try to fill this hole but certainly we'll restart everywhere is just identifying it. So want to show this tool it's accurate, it's, down to a state into a select code level so give it a shot and then from there if you've got any other questions, please feel free to reach out to myself or Adam.

ADAM: Yeah, I think that's so critical Jason and I think for everyone that's watching, you can easily gain access to this. All you have to do is go to So also posted below the video so that you can easily access it. Go in here. Again, this is really meant to give you a gauge for what that dollar amount is. So many people don't know where they're starting from and so just being able to comment it's not your specific reimbursement codes of course, but it is gonna start to show you in general, are we talking about a multimillion dollar loss here for a specific code? Are we talking about a few hundred thousand dollars? And it will allow you to start to nail it on where you need to be focusing and then it'll start to really spur that out. Do you have questions? Feel free to ping me Jason, and we'll certainly follow up with you about that, but also thank you so much for joining us for another week of Prescription For Growth videos. Again we hope you got some value out of this take a look it's below in the comments and we'll see you next week. Thanks guys.