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#150 Medicare Advocacy for 2027 with Dana Strauss · OT Potential Podcast | Occupational Therapy CEUs

0:00
SPEAKER_00: Once a year, the Centers for Medicare and Medicaid Services, or CMS, proposes payment rules and opens a public feedback period for healthcare providers to shape policy before final decisions are made.
0:15
SPEAKER_00: The proposed 2027 physician fee schedule signals a continued restructuring of clinical payment, redistributing funds towards primary care and behavioral health.
0:27
SPEAKER_00: OTs and PTs cannot miss this year's window of opportunity to comment on this payment rule.
0:34
SPEAKER_00: As straightforward, low-complexity care increasingly moves towards digital pathways, we must advocate that CMS properly values in-person complex clinical reasoning and officially integrates therapy as the third pillar of the primary care team.
0:53
SPEAKER_00: This year's comment window is also a critical opportunity to advocate for key OT and PT coding updates that will help us provide high-value care.
1:03
SPEAKER_00: Namely, one, reimbursing existing evaluation codes by complexity level, and two, creating new non-time-based management codes to capture longitudinal care provided by OTs and PTs.
1:18
SPEAKER_00: At OT Potential, we are equipping you to raise your voice.
1:22
SPEAKER_00: In today's course, we will spend an hour unpacking this proposed rule, detailing our policy asks, and sharing a simple plug-and-play comment template so you can submit your own letter to CMS.
1:35
SPEAKER_00: We'll be led by the incredible Dana Strauss, a doctor of physical therapy and healthcare public policy expert.
1:42
SPEAKER_00: We have a lot to get to today, so let's dive in.
1:48
SPEAKER_00: Welcome to the OT Potential Podcast.
1:51
SPEAKER_00: I'm your host, Sarah Lyon, OTRL, and I wanted to let you know that this podcast may qualify as continuing education for you.
1:59
SPEAKER_00: You are probably listening to this podcast on a free podcast platform, but to gain CEU credit, you will need to be a member of the OT Potential Club, our OT Continuing Education platform.
2:11
SPEAKER_00: You can go to OTpotential.com to learn more.
2:15
SPEAKER_00: Okay, here we go.
2:18
SPEAKER_00: As I mentioned at the top, joining us today is Dana Strauss, PTDPT.
2:24
SPEAKER_00: Dana took her clinical experiences as a doctor of physical therapy and expertise in the health care continuum and transitioned her career to value-based care and policy analysis.
2:36
SPEAKER_00: She believes that the healthcare system can meet everyone's needs better.
2:41
SPEAKER_00: Her passion is moving toward the optimal patient experience and outcomes.
2:46
SPEAKER_00: Dana is optimistic about synergistic payer-provider relationships, making healthcare better for everyone along the care continuum.
2:56
SPEAKER_00: So without further ado, I will patch Dana into our live studio.
3:00
SPEAKER_00: Dana, welcome to OT Potential.
3:01
SPEAKER_00: It's so great to have you.
3:03
SPEAKER_00: Oh, thanks for having me back.
3:04
SPEAKER_00: It's great to be here, Sarah.
3:06
SPEAKER_00: I am so thankful that you're back.
3:09
SPEAKER_00: This feels complicated.
3:12
SPEAKER_00: Like just even re-hearing the intro, I'm like, this is a complicated topic.
3:18
SPEAKER_00: But I was thinking today of this email that I got.
3:24
SPEAKER_00: I got an email that another OT practice for adults of um an OT who just has like a lot of special, like specialization in seeing adults is closing.
3:36
SPEAKER_00: And I, from my vantage point, where I get to interview all these expert people on the podcast, I just have seen this trend of like when OTs get more specialization in seeing older adults, uh, they have a hard time keeping their practice open.
3:54
SPEAKER_00: And honestly, for years I was just like, what is this trend?
3:58
SPEAKER_00: Like, are these, why are these businesses so hard?
4:02
SPEAKER_00: Why aren't there more like dementia clinics?
4:06
SPEAKER_00: Why aren't there more uh aging in place, fall preventions, more services for older adults?
4:12
SPEAKER_00: And I think that what we're going to talk about today is the answer to that question is tucked in this 700-page physician fee schedule.
4:21
SPEAKER_00: Like, unfortunately, it's a very technical question that we're going to tease out today that really affects people who work with older adults, but really affects all of us because how Medicare values OT filters down to all of us.
4:36
SPEAKER_00: So whether or not we know it or like it, we are all impacted by this physician fee schedule.
4:43
SPEAKER_00: You've been on the podcast multiple times.
4:45
SPEAKER_00: We've talked about value-based care, value-based care contracts, um, CMMI.
4:51
SPEAKER_00: I'm curious, coming on like right now, as we're looking at this physician fee schedule, what's just like your general mood?
4:59
SPEAKER_00: Are you hopeful?
5:01
SPEAKER_00: Are you worried?
5:03
SPEAKER_00: What's the advocacy mood in your heart right now?
5:06
SPEAKER_01: Yeah, thanks, Sarah.
5:08
SPEAKER_01: I would say I'm optimistic.
5:10
SPEAKER_01: Um, perhaps more than I've been in in a while.
5:14
SPEAKER_01: Uh and part of that is related to what you just brought up.
5:19
SPEAKER_01: This CMS Center for Medicare and Medicaid Services, the group that's running that um agency today, has is showing a lot of signs that they want to devote more funding levels to caring for those with serious illness and complex conditions and those with dementia.
5:38
SPEAKER_01: So, you know, a lot of those who you just brought up can be hard for therapists whose practices depend on that.
5:45
SPEAKER_01: And it's we'll get to that more.
5:47
SPEAKER_01: It's a bit of a tricky wicket, but I think we have a really good opportunity here to advocate for how we can help um CMS achieve its goals and therefore help our professions and help the patients that we should be able to serve more.
6:03
SPEAKER_01: And certainly we can based on scope, but we don't have billing mechanisms that are conducive to that.
6:11
SPEAKER_01: So, but I yes, I'm I'm I'm more optimistic.
6:14
SPEAKER_01: I feel like CMS in this proposed rule is asking questions that really do create specific openings for us to offer solutions that are really directed at what they're trying to solve for, which doesn't always happen.
6:27
SPEAKER_01: There's there's ears open looking for um feedback.
6:32
SPEAKER_01: And and I would say too, that advocacy in general, it works best when what is good for the profession also solves a problem that CMS cares about now, and when it improves care for patients.
6:45
SPEAKER_01: So when the stars align, when incentives are aligned, that's when it's a good time to surface a solution.
6:53
SPEAKER_01: And when, but we do need the professions and the professionals working in those professions to recognize the signs and signals so they can, you know, uh approach the solutions uh with CMS.
7:05
SPEAKER_01: Um, so we have that alignment.
7:07
SPEAKER_01: And then last, I think this is just to keep in mind, because there's some we have some really good solutions.
7:12
SPEAKER_01: I want to remind everybody that these things are an endurance race.
7:16
SPEAKER_01: It takes getting other PTs and OTs to get on the same page about the direction, the priorities that we think are most sensitive to this period of time.
7:28
SPEAKER_01: And we may have to, you know, repeat these recommendations through various channels and look for support, certainly beyond uh with OT potential and reinforced by OT potential, but then to the other professional organizations and other employers who care a lot about this issue too, and other therapists last year we were on talking about last year's physician feed schedule, and there was um a small cut for OTPT, which we really focused on.
7:59
SPEAKER_00: Like, we cannot bear the cost of that cut.
8:03
SPEAKER_00: And I was really proud of both of our professions because I think OTPT had like the highest percentage of a comment rate of any of the professions, even though we actually make up a very small part of the mix.
8:17
SPEAKER_00: So we did a great job at being vocal last year.
8:20
SPEAKER_00: And this year feels, I want to say more almost more fun because we get to be a little more proactive and talk about solving some of the problem, like solving some clear problems that I think do what you just said, like solve a long-standing problem for us and fix a problem for Medicare, like really help us meet the need of this aging population.
8:43
SPEAKER_00: Um, I want everyone to know too, we're going to lay this all out in a simple template.
8:48
SPEAKER_00: We have a blog post that you can go to on OT Potential.
8:52
SPEAKER_00: You can just Google like comment letter template 2027, and we'll have two versions for you.
8:58
SPEAKER_00: We'll have one that you can literally just copy and paste into the Federal Register website.
9:05
SPEAKER_00: Uh, there'll be steps how to do that.
9:06
SPEAKER_00: So we'll have this copy-paste template, and then we'll have um a Google Doc that you can make a copy of and make a slightly longer level letter and share your own thoughts there too.
9:18
SPEAKER_00: Um, so we're going to be talking about so many details today, but I just want everyone to know that you're in good hands.
9:24
SPEAKER_00: It's all laid out nicely for you.
9:26
SPEAKER_00: You don't have to remember everything, but hopefully we can all wrap our mind around kind of the big picture things that you're saying and um make this comment this year and have the same kind of advocacy success that we did in uh last year.
9:41
SPEAKER_00: So we'll have our templates uh for our conversation.
9:45
SPEAKER_00: I just want to start at the very top and say, what is the physician fee schedule?
9:51
SPEAKER_00: Like that is a word I did not know until last year.
9:55
SPEAKER_00: I it was not on my radar.
9:56
SPEAKER_00: I don't if I learned about it in OT school, it like went one ear and out the other.
10:01
SPEAKER_00: What is it and why should we care about it?
10:04
SPEAKER_01: Yeah, none of us learned about it.
10:06
SPEAKER_01: Um, maybe that'll change in the future.
10:09
SPEAKER_01: Yeah, so uh I'm grateful to everybody who's tuning into this, uh, not just for our professions, but because whenever clinicians understand the mechanisms of payment policy, they can become and be leveraged as advocates in a in a really meaningful way.
10:28
SPEAKER_01: And there's just not enough of that.
10:29
SPEAKER_01: So thank you for everyone for caring about this.
10:32
SPEAKER_01: The physician fee schedule is a Medicare rulemaking annual process where the Centers for Medicare and Medicaid Services, which is an agency under the executive branch of government, it sets out how clinicians and outpatient services are paid under Medicare Part B.
10:53
SPEAKER_01: And that includes the relative values that are assigned to our codes.
10:59
SPEAKER_01: So, to explain that a little further, each of the different sites of care, whether it be hospitals or inpatient rehab facilities or physician practices or therapy practices, they have to have their payment updated on an annual basis.
11:17
SPEAKER_01: Everything on the outpatient side can be found in this, it's actually 1741 or something page document.
11:25
SPEAKER_01: It's a good usually of all the payment payment rules.
11:30
SPEAKER_01: And so this is the way that they're updated, but it's not just for Medicare.
11:35
SPEAKER_01: We think, well, it's just Medicare beneficiaries.
11:38
SPEAKER_01: No.
11:38
SPEAKER_01: The what is established under Medicare is what's used also by Medicare Advantage plans and what's used as the baseline for commercial plans and Medicaid plans.
11:51
SPEAKER_01: So everything is based upon the relative rate that Medicare decides for every service for every clinician providing that service.
12:00
SPEAKER_01: So there's thousands and thousands and thousands and thousands of codes.
12:04
SPEAKER_01: Those codes have two parts the relative value units.
12:10
SPEAKER_01: So that's how much CMS decides to pay for a certain service, and that is multiplied by the conversion factor, which is the same for everyone.
12:22
SPEAKER_01: So you could take a hand surgeon doing a hand surgery at 30 relative value units, multiply it by the conversion factor, that's what they get paid.
12:32
SPEAKER_01: Or take a therapy evaluation at two, two and a half relative value units, multiply by the conversion factor, that's how much we get paid.
12:41
SPEAKER_01: So conversion factor is everybody, but how much each service is weighted by CMS is what determines ultimately what we are reimbursed and then what our salaries are based upon.
12:56
SPEAKER_01: And then a lot of the, like just to go a level deeper, there's a lot of little technical changes and changes made to programs that are adjacent to reimbursement.
13:06
SPEAKER_01: So things like the quality payment program, updates to MIPS, the Medicare Shared Savings Program, which is the main accountable care organization program, um, run through Medicare itself, not the Innovation Center.
13:20
SPEAKER_01: So all of these things are updated and they're updated to reflect changes in the needs of the population.
13:30
SPEAKER_01: And so for us as therapists, uh, we I hear so much, we see on social media worries about the conversion factor.
13:39
SPEAKER_01: But to keep in mind, everyone has the same conversion factor, but it's the value units assigned to our codes that are going to determine whether or not we ultimately make more money.
13:53
SPEAKER_01: The conversion factor is just part of what keeps the budget neutral, right?
13:58
SPEAKER_01: There is no more money than the total pot.
14:01
SPEAKER_01: So it's value units for everybody times conversion factor.
14:07
SPEAKER_00: So once a year, CMS is rewriting this little equation that says this is how much Thereks will get reimbursed for here.
14:19
SPEAKER_00: This is how much therapeutic activities will get reimbursed for here.
14:23
SPEAKER_00: One of my questions off the top is what if I'm a pediatric patient or pediatric therapist seeing Medicaid patients?
14:30
SPEAKER_00: Should I write a comment letter?
14:32
SPEAKER_00: Absolutely.
14:33
SPEAKER_01: Because Medicaid rates are based upon Medicare rates.
14:38
SPEAKER_01: And Medicaid is going to follow a slightly different formula, but it will all be based on whatever the um the RV use R and conversion factor being used in Medicare.
14:51
SPEAKER_01: So no matter who you are, the rates determined in the Medicare physician fee schedule will flow down and impact the rates adopted by all the other payers from Medicaid to commercial, everywhere in between.
15:04
SPEAKER_00: So even if I don't think I need a comment, I probably need to comment.
15:08
SPEAKER_00: That's exactly right.
15:10
SPEAKER_00: Because I follow you on LinkedIn, I now follow multiple people who care a lot about this uh physician fee schedule.
15:18
SPEAKER_00: And people are happy about it, they're mad about it, there's all kinds of reactions this year, as I'm sure there are every year.
15:26
SPEAKER_00: Who's happy this year and who's upset?
15:29
SPEAKER_01: So just to first cover um the conversion factor update, because we're hearing there's a cut to the conversion factor, hearing a lot about that again this year.
15:40
SPEAKER_01: Just to clarify for everybody, CMS actually did not cut the conversion factor.
15:46
SPEAKER_01: The cut that you saw that is being proposed is because uh Congress had gone back and added additional funding to the budget for one year.
16:00
SPEAKER_01: So that was for 2026.
16:02
SPEAKER_01: That's what that we had an increase of 2.5% because of what Congress gave to the physician fee schedule after the fact.
16:10
SPEAKER_01: The cut actually CMS gave us a little increase to the conversion factor, but it was offset by having to take back the 2.5% that's expiring at the end of the year.
16:23
SPEAKER_01: And Congress may go back and decide on another one-year fix, they call it to the fee schedule.
16:29
SPEAKER_01: But we didn't get a cut.
16:31
SPEAKER_01: We actually got a little raise.
16:33
SPEAKER_01: The only way they can make a raise to the conversion factor is if they if the if the cuts and the changes they make to the relative value units altogether, if those lower the expected total spend.
16:49
SPEAKER_01: So to go into your second question about who's happy this year and who's not, well, the the folks that are the happiest are the behavioral health providers.
16:59
SPEAKER_01: This is the fifth year that they have seen a significant increase in the weights of their relative value units, again, which multiplied time their conversion factor.
17:09
SPEAKER_01: And clinical social workers got a 12% increase to their relative value units.
17:15
SPEAKER_01: Clinical psychologists got an 11% increase.
17:18
SPEAKER_01: And then we saw things like geriatrics got 4% or proposed, I should say, 4%.
17:25
SPEAKER_01: Um, PT and OT were one of the biggest winners at 3%, based on some adjustments they're making to um pieces of the RVUs right now.
17:34
SPEAKER_01: Psychiatry also got an increase of 3%.
17:37
SPEAKER_01: The losers, those that are very unhappy and some of them quite vocal about it, are for good reason because they're gonna have a big, big cut if this goes through.
17:48
SPEAKER_01: The worst affected was dermatology at 8%, uh, orthopedic surgery, I believe it's 7%, hand surgery at 5%, um, colorectal surgery at 4%.
18:01
SPEAKER_01: So the theme you're generally seeing has been going the last couple of years more towards behavioral health, increasing the weights of the codes that are billed by those types of providers, primary care, behavioral health, and reducing the RVU weighting for folks like surgeons.
18:22
SPEAKER_01: And what CMS is saying is hey, we believe that we have gone through a period where the weighting has not been sufficient in some categories and has been higher where maybe we didn't have the justification we thought we did.
18:40
SPEAKER_01: This goes into some complexity around recommendations the American Medical Association makes and the way they calculate those RVUs and the pieces of those relative value units.
18:51
SPEAKER_01: But this administration is rethinking where the weight should be.
18:55
SPEAKER_01: And they do cover it later, they do ask some questions about that.
19:00
SPEAKER_01: So that so OTs and PTs have an opportunity here to take advantage of what we're seeing as a trend, the direction CMS is going, and demonstrate that we are also a solution for frontline care that is not being accessed sufficiently, a lot of which has to do with not having sufficient codes to justify that.
19:23
SPEAKER_00: We've seen this rewaiting.
19:25
SPEAKER_00: We have some people upset, we have some people happy.
19:28
SPEAKER_00: Therapy, we saw just a little bump.
19:31
SPEAKER_00: And that has opened this door for us to be more proactive out about kind of this big picture of um addressing the complex care needs that Medicare put out in like requests for information.
19:45
SPEAKER_00: So we really want to tie our advocacy to these requests for information, uh, a primary care one, dementia.
19:54
SPEAKER_00: Can you say a couple other like requests for information and what a request for information is?
20:01
SPEAKER_01: Absolutely.
20:02
SPEAKER_01: So requests for information are specific areas where CMS wants to do something.
20:11
SPEAKER_01: They want to oftentimes create a new benefit for beneficiaries, but they are actively seeking the uh advice and expertise of the community of providers that have the expertise to give them an idea about what would make a good benefit, the problems to solve for.
20:32
SPEAKER_01: So these RFIs, request for information, they can be put out any time of year that CMS wants to put out an RFI.
20:40
SPEAKER_01: When you see it specifically embedded into uh rulemaking, such as the fee schedule, it tends to signal that it's something they want to do.
20:50
SPEAKER_01: Oftentimes the next year, they want to take action on.
20:54
SPEAKER_01: So they're looking by embedding it in the physician fee schedule, they're looking for those that read and comment on the fee schedule to actually see it, to understand it's a signal, to understand they are telling us what they want to act on, and then for us to give feedback on it.
21:12
SPEAKER_01: So they're, you know, like I said, multiple pages long, sometimes 10, 20 pages embedded, just asking for feedback so that they can build a benefit or whatever it is they're trying to do.
21:25
SPEAKER_01: There's several, um, just to touch on a couple, as Sarah said, there's one on redesigning primary care.
21:32
SPEAKER_01: So CMS is asking questions about whether primary care should be paid prospectively, for an example, whether there should be a tech enabled care uh direction where certain care is paid for at one level and then human care is paid at another level.
21:50
SPEAKER_01: There's a request for information about an Al, essentially an Alzheimer's disease benefit is what they're signaling, a way to create service.
22:00
SPEAKER_01: Uh or care that can be delivered and built for specific to those with dementia.
22:06
SPEAKER_01: And there's an RFI on whether CMS should think about moving away from the CPT and HICSPIC standard of coding.
22:16
SPEAKER_01: And a lot of detailed questions that they pose around why is it problematic to use the CPT system?
22:24
SPEAKER_01: What alternatives might we use?
22:26
SPEAKER_01: What would we base that on?
22:29
SPEAKER_01: There's, you know, there must be 50 questions just embedded in that RFI.
22:34
SPEAKER_01: But I think really important takeaway for PT and OT here is they're looking at ways to reimburse for care that is cognitive in nature, not necessarily task or intervention or surgical-based, but is based on the care that does not have good reimbursement and that they want to be able to change the way they've always done things.
23:03
SPEAKER_01: And not too surprising given what else we've seen, you know, the innovation center under the same administration thinking about and proposing to do.
23:13
SPEAKER_01: So when we see this, it's an open mind.
23:16
SPEAKER_01: These are broad requests for information.
23:19
SPEAKER_01: It's a chance to provide very specific feedback.
23:23
SPEAKER_01: Um, and we luckily have lots of ways to show how we can be a solution if a benefit is constructed that's um that makes sense and that includes us.
23:34
SPEAKER_01: Oh, one final there's a specialist, a specialty care RFI asking about how specialists can be brought more into accountable care arrangements and more part of longitudinal care.
23:47
SPEAKER_01: So those are the four biggies that I think we would care about.
23:51
SPEAKER_00: So from these requests for information, we can tell that CMS is looking into the future, is thinking about how are we going to meet the complex care needs of this aging population, which loops me back to my first anecdote of we know as OTs and PTs, we are highly trained in meeting those needs.
24:16
SPEAKER_00: And we currently cannot make the math math a lot of the places.
24:20
SPEAKER_00: Like it is so hard for us to really have practices that specialize in meeting those needs.
24:26
SPEAKER_00: Why is now the moment to look at our code set with fresh eyes?
24:32
SPEAKER_00: We've had our codes forever, aren't they good enough?
24:36
SPEAKER_00: Like, why do we need to re-examine what's at our disposal?
24:40
SPEAKER_00: Why is now the critical window?
24:43
SPEAKER_01: Great question.
24:44
SPEAKER_01: And I think because of the breadth and scope of the questions being asked, the proposals being made, and seeing what CMS is trying to solve for, it gives us a chance to what I think Sarah and I, as we were talking about this and reviewing and thinking about what we could solve for that would be again good for everyone.
25:10
SPEAKER_01: You know, we had this aha moment where we do a tremendous amount of cognitive-based work, but what we are reimbursed for, what we have a number of billing codes for, is for task-based, activity-based, treatment-based care.
25:29
SPEAKER_01: And that care is extremely important.
25:33
SPEAKER_01: However, it does not reflect the wide scope of all the things that therapists do as they assess and manage patients along, you know, an episode that they're with that patient and even thinking about them, you know, patients beyond a time when they may be in their clinic.
25:56
SPEAKER_01: We have been reimbursed historically for two, essentially two time-based codes, unless you're in a real specialty area.
26:05
SPEAKER_01: Like I know there's a handful of other smaller, you know, non-time-based codes, but for all of us, eval and re-eval.
26:13
SPEAKER_01: And the evaluation is one moment in time.
26:16
SPEAKER_01: But the reality that that OTs and PTs know is that every time an OT and a PT is seeing a patient for a subsequent visit after the eval, we are reassessing, we are making tweaks and changes, we are assessing compliance and tolerance to a plan, we're adjusting progression.
26:37
SPEAKER_01: We came up with a long laundry list of things that we do that we're not paid for.
26:44
SPEAKER_01: Why?
26:45
SPEAKER_01: Because we don't have codes that address assessment and management.
26:50
SPEAKER_01: The parallel you might think about in the physician space is evaluation and management codes, right?
26:55
SPEAKER_01: Doesn't mean you're treating necessarily, you're managing a condition, but we have a lot of these activity-based codes.
27:03
SPEAKER_01: And the I, you know, what's interesting about that, if you think historically back to when our degrees were bachelor's degrees and we could all practice as therapists at the bachelor's level, that maybe it was probably still inefficient, but it was more appropriate.
27:24
SPEAKER_01: And now we have a highly skilled, trained, expert workforce in our codas and PTAs who really are the experts.
27:35
SPEAKER_01: And I don't want to take anything away from PTs and OTs that are experts in treatment either, but our PTs, A's, and Codas are really experts in that hand-on, hands-on care that's described in the THERE Act, the THEREX, the codes that are the bread and butter.
27:53
SPEAKER_01: But the fact of the matter is we spend important and we would spend more important time on assessing and managing, on things like coordination of care, on reassessment, again, loads that can fall into that bucket, but we're not paid to do it.
28:11
SPEAKER_01: We're paid for the treatment.
28:13
SPEAKER_01: And that is why, going back to Sarah's original point, you know, we have essentially this big gap when it comes to managing more medically complex, more frail patients who need more coordination of care, who where it really matters that we understand and can collaborate with other providers, where reassessment and changing a treatment plan may be heavily dependent on things like, if it's dementia, on behavior, on things that are not within our direct control all the time, but that we have to make adjustments for.
28:51
SPEAKER_01: And so it makes sense that we really struggle as therapists to find adequate reimbursement for things like, especially on the OT side, managing things like dementia and the behavioral health type work that OTs do because we just don't have the billing mechanism.
29:11
SPEAKER_01: And that is very different from what providers at the top of scope with direct access.
29:17
SPEAKER_01: There's no one like us in the billing top-of-scope provider community that just has an evaluation code and everything else is based on the time and has is specific to an activity.
29:30
SPEAKER_01: So let me leave it there and see, you know, Sarah, what is there anything else you wanted to point out about kind of the aha moment we had?
29:38
SPEAKER_00: I want to translate one thing for our OT audience.
29:42
SPEAKER_00: When you say cognitive work, I think we um, because we do treat cognition, you're not talking about us treating cognition, you're talking about the clinical reasoning or the therapist cognitive work.
29:55
SPEAKER_00: That's right.
29:56
SPEAKER_00: Um, and that's what we don't have time for.
29:57
SPEAKER_00: I want to link this back to my aha moments on the podcasts, where this summer we had Dr.
30:04
SPEAKER_00: Chad Cook on and we talked all about therapeutic ritual.
30:09
SPEAKER_00: And what he has studied and talked about on the podcast was how important that usually that time with the patient where they you are just sitting with them and they are feeling heard.
30:23
SPEAKER_00: And you they're telling their story, you're reorienting to your goals as assessed as therapists, our mind our minds are like whirling on like taking in that information.
30:35
SPEAKER_00: And what I hear you saying is that really valuable time that he would say affects treatment outcomes, 15 to 30 percent.
30:43
SPEAKER_00: Like it's we know that that drives improved the outcomes.
30:46
SPEAKER_00: We don't have clear codes for that.
30:49
SPEAKER_00: And instead, what our codes incentivize us to do is to eval as quickly as we can and then get patients, therapeutic activity, neuromuscular re-education.
31:03
SPEAKER_00: And then when they come into treatment to immediately go into those codes because we're not paid clearly enough.
31:11
SPEAKER_00: I mean, there's people find ways to categorize that as patient education, but it's not like quite capturing the work of assessment and management.
31:22
SPEAKER_00: So what you're saying is it's time to look at our codes again because they were written when we were bachelors, and now's the moment because Medicare is literally asking for information like this.
31:38
SPEAKER_01: And cares about finding a solution to help address the quality gaps that occur in the serious and complex population, those with dementia, and we are a solution that can be leveraged because we have the licenses and the scope, but we can't be leveraged because we have no way to deliver that care and bill for it.
32:04
SPEAKER_01: And if we're billing for theracs or therapic, we need to be to be following Medicare guidelines.
32:10
SPEAKER_01: We need to actually be delivering that.
32:12
SPEAKER_01: So without having codes that reflect the actual, and when I say cognitive, right, right, thank you for clarifying.
32:21
SPEAKER_01: I mean that work that isn't necessarily specifically with our hands or a patient doing something at the very moment.
32:28
SPEAKER_01: It means the work of a of the highest level direct access clinician that manages patients independently.
32:37
SPEAKER_01: And that matters to CMS a lot, and they have to know that we can be a solution.
32:44
SPEAKER_00: So if we want to propose a solution to this problem that CMS is looking for solutions for, it needs to be pretty simple, it needs to be elegant.
32:56
SPEAKER_00: What's the idea that we propose to them?
32:59
SPEAKER_00: How do we modernize our code set?
33:02
SPEAKER_01: And we went through a few different options here to Sarah's point, trying to keep it simple.
33:08
SPEAKER_01: What we've thought about is twofold.
33:10
SPEAKER_01: The first is something everyone is probably familiar with, and that is um being having a differential payment for evaluation if it's low, moderate, or complex.
33:23
SPEAKER_01: And also, you know, meeting CMS's moment, we're in a place where there will be in the not too distant future some level of low complexity care across medicine, and that will touch us too.
33:39
SPEAKER_01: The lowest complexity, least skilled work will be taken by technology.
33:45
SPEAKER_01: It's it's it's as much of an inevitable as anything.
33:48
SPEAKER_01: Um, how far it goes, we, you know, we hope not too far.
33:53
SPEAKER_01: But the point is, is we want to be able to document and perform moderate and high complexity evaluations and be reimbursed for that.
34:04
SPEAKER_01: So that is number one.
34:07
SPEAKER_01: And then the second, which we think is is a really powerful and to Sarah's point, elegant, is to have access to a low, moderate, or high assessment and management code.
34:21
SPEAKER_01: So assessment and management meaning what we described before, the work that's done to coordinate care, to manage a patient, to coach and train them, to listen and provide feedback, the things that are not reflected in activity codes.
34:40
SPEAKER_01: Assessment and management can also include the primary treatment you're going to do.
34:46
SPEAKER_01: So what we've proposed is something like uh what would be considered a third up to think about like a 30-minute visit.
34:54
SPEAKER_01: Well, we're not suggesting it's time-based, but we're suggesting that there are more time you're going to spend assessing very complex patients and less time and complexity with lower complexity patients and some primary treatment to address the main thing you're managing with that patient at that visit.
35:14
SPEAKER_01: Um, so that being a non-time-based, you know, the top of scope visit when that visit is performed by a PTR at OT.
35:25
SPEAKER_01: And then the ability then to add on an additional treatment code.
35:30
SPEAKER_01: So if I'm assessing a patient, my primary activity, let's say it's manual therapy, that'll that will be part of my assessment and management code that I submit.
35:41
SPEAKER_01: And then the additional code might be I'm working on Thereks or Seract, and I'm going to put that additional code on.
35:48
SPEAKER_01: So that would be the other thing that could be done as another, if you think about really integrating team-based care, there could be dyads where you know PTs and PTAs work in combination with one another, where depending on how the practice is set up, maybe the OT is doing that assessment and management visit, and then the OTA is taking over to provide that additional treatment.
36:12
SPEAKER_01: Lots of ways to go about this, and lots of ways this could be fine-tuned, but most importantly, something that reflects what CMS is trying to solve for, what directly we are capable of, given our licenses, that that is not reflected presently in the work that we can bill for, bottom line.
36:38
SPEAKER_00: Let me say what I understand this would look like if I'm the what I mentioned before, seeing carpal tunnel, something simple.
36:51
SPEAKER_00: It your billing for the eval time stays the same.
36:54
SPEAKER_00: You're at that low complexity eval, and you do some treatment at the end.
36:59
SPEAKER_00: That's your eval visit.
37:01
SPEAKER_00: What would be different with this new code is when they come back, you could sit, you would spend a little more time sitting down, understanding where they're at, reorient to goals, and you would build this, you would um build this management code, and then you would go into your other uh Therx therapeutic activity or other standard codes.
37:23
SPEAKER_00: Um, so for those low complexity, it's it's pretty similar, except for on a treatment visit, you get a tack on this uh management code.
37:33
SPEAKER_00: Who it would really benefit is someone seeing a high complexity patient.
37:39
SPEAKER_00: Because right now, those people, we have to code whether it's a low, moderate, or high eval, but those people, it's all paid the same, which makes no sense.
37:49
SPEAKER_00: How do we even get to this?
37:51
SPEAKER_00: I'm even like, oh, I should have led the podcast with this because this is the thing that just makes the least sense.
37:56
SPEAKER_00: That I'm sure we're all like, why are we doing this if we're not getting paid?
37:59
SPEAKER_00: So someone who's seen a dementia patient will get paid for the much, much harder work of seeing someone who has dementia, depression, diabetes, and has a lot more complex care needs.
38:13
SPEAKER_00: That person would get paid more for that eval.
38:16
SPEAKER_00: And then at the treatment visit, they would also get paid more again based on the complexity of what that management is looking like.
38:25
SPEAKER_01: And it parallels what physicians do in evaluation and management, right?
38:31
SPEAKER_01: So they're they're billing for an evaluation at a certain level of complexity.
38:39
SPEAKER_01: Theirs go one to five.
38:41
SPEAKER_01: So they're choosing that complexity code.
38:43
SPEAKER_01: Each level of complexity is a higher reimbursement.
38:46
SPEAKER_01: And then the management is going to be whatever they're doing based upon what they found.
38:53
SPEAKER_01: Because therapy is not a one-time treatment, it's a one-time making a plan, engage the patient, they return, right?
39:01
SPEAKER_01: It's it's structured a bit differently.
39:04
SPEAKER_01: I think that this just has not been something that we have, we've thought about how we think about, well, how do we get to build EM codes?
39:12
SPEAKER_01: I think this is a slightly different and more specific ask that is very accurate for the work that we do.
39:22
SPEAKER_01: Again, a moderate complexity patient, whatever you're doing that that highest level work around, what you're assessing and managing with that patient.
39:32
SPEAKER_01: And then whatever it is that your your primary focus of your treatment visit is would be captured in that assessment and management code.
39:40
SPEAKER_01: I guess I would also say for patients that are very, you know, who are not going to need, we believe are not going to need additional assessment on every visit, it would be perfectly appropriate to continue having that second, third, fourth visit with the coda or the PTA and not incorporate an assessment and management visit.
40:01
SPEAKER_01: But the way we've structured it now, it's the only way you get that full review, is when there's a significant change.
40:10
SPEAKER_01: So you haven't, you've now waited until something has so got gone so downhill that now you can do a full reevaluation and get reimbursed for it.
40:21
SPEAKER_01: In the case of what we're proposing, we're saying patients, especially as they get more complex and multimorbid and maybe difficult hands-on treatment, whatever it is, that work needs more frequent assessment prior to there being something that goes wrong and needs a full reevaluation.
40:43
SPEAKER_01: And we, it's just a shift in thinking that is, I, you know, I've looked at this a hundred ways.
40:49
SPEAKER_01: We've talked to Sarah and I have talked about this a bunch in the last couple of weeks.
40:53
SPEAKER_01: It's such a great fit that meets the moment in time.
40:56
SPEAKER_01: It will allow more team-based care and it'll allow a lot more flexibility for therapists and therapy teams to think about how to design a practice that meets the specific needs of their population.
41:11
SPEAKER_00: You said at the beginning we have to propose win-win solutions.
41:16
SPEAKER_00: I look at this for therapists, and I'm like, no-brainer that this is a win.
41:22
SPEAKER_00: Like we're finally getting reimbursed for complexity.
41:25
SPEAKER_00: We're capturing, we have this huge workforce now of doctoral and masters-trained uh therapists that we did not have when these codes were written.
41:35
SPEAKER_00: It's a win because we're really capturing that skill set that we've worked so hard on.
41:41
SPEAKER_00: Won't Medicare look at this though and be like, it sounds like you're just asking for more money and uh we have like one pie to distribute, that's a no.
41:56
SPEAKER_01: I think that that is if it presented that way, sure, it can it can be looked at that way.
42:04
SPEAKER_01: I almost think our assumption that a proposal for something non-time-based, different from R of L's is something maybe we have been either apprehensive about proposing or it just didn't fit the moment in time.
42:25
SPEAKER_01: Or we maybe have not always viewed ourselves as being what I again I use the term cognitive therapy, cognitive care, because that is what's used in in primary care and behavioral health.
42:40
SPEAKER_01: It is that cognitive, they call that cognitive work, not just the hands-on or the surgical work that has been under-reimbursed for decades, right?
42:50
SPEAKER_01: So we again, this goes with the whole we are we should be part of the primary triage, primary care three-legged stool, we like to say.
43:02
SPEAKER_01: But right now, as we have imagined our professions and as we have you know, plugged along over the years, it's it's that we haven't, I don't, I believe we haven't positioned ourselves as part of the cognitive care team and really focused on the hands-on work we do.
43:23
SPEAKER_01: And that hands-on work is no less valuable, it's a crucial part of the care that OT and PT professionals provide.
43:32
SPEAKER_01: But that has remained static.
43:35
SPEAKER_01: And as we have chosen to upskill and increase our level of education and work on top of scope and get direct access, we now have the capability to do so much more of this higher what they call, you know, like I say, cognitive work, that we just don't, we can have the ability and the license and the scope, but if we have no way to Bill for it, we end up with therapists leaving for cash pay, for therapists not being able to function and caring for complex patients, like those with dementia, like you bring up your great example.
44:11
SPEAKER_01: Um, and even just to survive, right, in a in a flat, if you think about a flat reimbursement environment, we cannot keep up.
44:21
SPEAKER_01: And it really goes back to how we need to make the case that just like primary care and just like behavioral health have so successfully done, we can contribute so much more, but we have to have a way to get reimbursed for it.
44:37
SPEAKER_01: We're a workforce ready to be activated, and we can continue and will continue to deliver the hands-on care, and we'll be leveraging our codas and PTAs, but we have a gap in what we can, you know, flex positively about our skill set and it and it boils down to billing and incentives.
44:58
SPEAKER_00: So now's the time to ask for something like this because it's just the right moment in time.
45:06
SPEAKER_00: Like we see behavioral health being valued differently, we see primary care being valued differently, and we need to make the case that we are part of that similar, like conservative, that conservative care team.
45:21
SPEAKER_00: Like cognitive work is usually figuring out conservative care, like the most simple way to move the patient forward.
45:29
SPEAKER_01: It aligns with longitudinal care, conservative care, upstream care.
45:34
SPEAKER_01: Yes.
45:36
SPEAKER_01: The care that is underutilized and under incentivized, and CMS has been actively working to shift dollars towards.
45:53
SPEAKER_01: We have not been seen as having the same predicament, blocking our ability to fit that, it's to fill that gap, right?
46:03
SPEAKER_01: To send some of this as a frame of mind, right?
46:05
SPEAKER_00: We're saying that little investment in more preventative, conservative, upstream care is going to save money overall because we're going to help prevent the fall.
46:15
SPEAKER_00: We're going to help prevent um some hospitalizations, we're going to help prevent the need for surgery.
46:22
SPEAKER_00: Um, I know you said a couple other guardrails in this template that you're working on.
46:27
SPEAKER_00: What other guardrails do we need to introduce along with the idea of this code set?
46:33
SPEAKER_01: Yeah, so I mean, things like this would really be um for therapists only.
46:39
SPEAKER_01: I mean, it would it, if a therapist assistant is seeing a patient and the the PT or the OT doesn't, it wouldn't be billed.
46:48
SPEAKER_01: If we were audited, it would make sense that the patient's assessment is being done and it would be clear in the documentation.
46:57
SPEAKER_01: I don't think we're going to have any difficulty justifying this work.
47:01
SPEAKER_01: When you take a look at the laundry list of activity of services we can provide that we often do provide for free on our off hours in pajamas, we do these things anyway.
47:15
SPEAKER_01: So guardrails are, you know, things like this would be done one time per visit at the most.
47:23
SPEAKER_01: So as again, assessing and doing that kind that cognitive work of engaging a patient, activating them, re-you know, evaluating how they did with their exercise program, answering their questions, coordinating care with other providers.
47:39
SPEAKER_01: And then the primary treatment activity of that visit would be incorporated as the guardrail, right?
47:46
SPEAKER_01: Those two things would be combined together.
47:49
SPEAKER_01: Assessment, and then whatever you're doing to manage the condition that they're there to see you for.
47:55
SPEAKER_01: Their whole people.
47:57
SPEAKER_01: And part of the limits to our codes is that it treats it imagines that we are addressing a body part or a activity, not a condition or an impairment, as we use in therapy.
48:13
SPEAKER_01: To address an impairment, you must be constantly assessing it.
48:17
SPEAKER_01: Unless someone is very stable, again, and not every visit needs to have this done.
48:22
SPEAKER_01: Visits with only OTs and PTs or OTAs and PTAs would not have this build.
48:28
SPEAKER_01: Um, we also were suggesting it cannot be done the same day as an evaluation.
48:33
SPEAKER_01: And uh we we want to suggest that there's an outcome measure that we're being evaluated for that is really well standardized and that reflects the direction CMS is going for quality and outcomes measures.
48:48
SPEAKER_01: And the Promise Global Health 10 is a really strong quality measure that can be used across therapy types.
48:59
SPEAKER_01: If you're a primary OT or PT or you're doing more specialty work, the Promise 10 is patient-reported outcomes, which is one of the gold standards for quality measures.
49:11
SPEAKER_01: And um it is it fits along with what CMS would consider a guardrail, right?
49:17
SPEAKER_01: They should, so we're proposing, we're not just saying we should be able to do this because we have the scope and you should give us a new billing code set for this.
49:25
SPEAKER_01: We are saying we are going to put our money where our math is, and we suggest you evaluate us all across um across the continuum on the ability to achieve good scores on the promise 10, uh, the promise global health 10 measure set.
49:45
SPEAKER_00: I feel like what you're introducing is pretty simple, but I'm having to work so hard to wrap my mind around it.
49:52
SPEAKER_00: Well, one, the physician fee schedule is so confusing in itself.
49:57
SPEAKER_00: And then commenting is this intimidating process because you're commenting on this 600 or 1600 page document.
50:06
SPEAKER_00: But the two things that we're advocating for this year, and we encourage others to, is paying by complexity for our evals.
50:16
SPEAKER_00: That's something we've honestly been asking for for a while, but this is the moment to re-ask for it.
50:23
SPEAKER_00: And then considering adding a management code.
50:26
SPEAKER_00: So even though it's complex, it's these two kind of simple things.
50:30
SPEAKER_00: If people comment, um, as I mentioned before, we have a copy and paste template.
50:37
SPEAKER_00: We have a longer template if you want to share more.
50:40
SPEAKER_00: And both of them, there's just a little bit of space to tell about the therapist's story and how this might impact how this relates to their practice.
50:52
SPEAKER_00: What's your advice for that segment?
50:54
SPEAKER_00: Like, how do we connect our stories to what Medicare wants to hear in a paragraph or two related to this topic?
51:06
SPEAKER_00: Um, what's your advice for people as they look at that section?
51:10
SPEAKER_01: Think first about what Medicare is telling us they care about.
51:14
SPEAKER_01: They they care about reimbursing for work that um will help help manage more effectively the complex population, the dementia population, the behavioral health population.
51:28
SPEAKER_01: So they're looking for that.
51:30
SPEAKER_01: And they we want to connect, have CMS connect to direct patient stories.
51:37
SPEAKER_01: So we all of us make assumptions about, you know, policymakers must just understand what we do.
51:43
SPEAKER_01: They, you know, because we do it every day, it seems commonplace, right?
51:48
SPEAKER_01: How could they not never make that assumption because truly few people outside of our profession really understand that the important dynamic between a therapist and a patient and the work that's involved and the barriers we have because of our limited capacity to provide.
52:12
SPEAKER_01: We don't we don't have treatment codes that match the work that we're doing.
52:16
SPEAKER_01: So we want to demonstrate patient stories where we have barriers to providing all the care that we can evaluate and assess is needed and think about care broadly, right?
52:32
SPEAKER_01: Care is everything from you know, help like looking at transitions, you know, assessing um, you know, if a patient has deteriorated medically and you're assessing that, it is coordinating with providers, it's providing feedback and answering questions.
52:51
SPEAKER_01: That work is not being done by many people in the healthcare continuum.
52:56
SPEAKER_01: It just truly isn't.
52:58
SPEAKER_01: And so showing how what we are capable of doing, why we have a barrier to be able to provide it, and be specific about you know, where you have skills, where you have solutions that you would be easily able to deploy if you had a mechanism to assess and bill for that care.
53:23
SPEAKER_01: And we have you have to make it real.
53:26
SPEAKER_01: It is, you know, a lot of why behavioral health got so much traction was because of COVID, right?
53:33
SPEAKER_01: It the real patient examples all over the news, the TV, magazines online about the terrible state of the of the ment and mental health of our population was just so exacerbated, and the stories were so front and center.
53:53
SPEAKER_01: Once things like that are elevated and you can picture real scenarios where we have a real problem, that led to years now of new codes, new services, additional billing, higher weights of billing to encourage providers to care for Medicare beneficiaries and to keep the workforce and allow the workforce to be able to manage the complexity around behavioral health.
54:25
SPEAKER_01: It's not very different for us.
54:28
SPEAKER_01: We have to make it bring the emotional side, the real side of what it's like to be a therapist caring for a patient that's complex.
54:37
SPEAKER_01: And complex could look a lot of different ways.
54:40
SPEAKER_01: Highly skilled, a lot of reassessing and assessing, you know, dementia, lots of things are complex and don't fit into our billing codes.
54:49
SPEAKER_01: Use those examples.
54:50
SPEAKER_01: There is no right or wrong in these letters.
54:53
SPEAKER_01: You can put what is expresses for you what barriers you are having, and how the solution that you're proposing would allow you to solve for the things that CMS wants to solve for.
55:48
SPEAKER_00: Again, just Google it and you will find it.
55:51
SPEAKER_00: Please, I hope everyone who listened today comments to Medicare.
55:57
SPEAKER_00: It's intimidating, but do it.
55:58
SPEAKER_00: I hope everyone comments and then I hope they also text three friends who are also therapists and encourage them to comment.
56:06
SPEAKER_00: Um, they don't have to use our template, they can use another one.
56:09
SPEAKER_00: I think the important thing is that they are hearing from therapists and hear that we are a solution that is underutilized.
56:16
SPEAKER_00: I think we can all agree on that.
56:18
SPEAKER_00: We're at the end of the time, but I just want to end with one more quick thing.
56:23
SPEAKER_00: Is change possible?
56:25
SPEAKER_00: Like, I think the government, I think Medicare, I think things aren't gonna change.
56:30
SPEAKER_00: Like my letter does not matter.
56:34
SPEAKER_00: Why should I spend five minutes doing that?
56:36
SPEAKER_00: Is it possible?
56:37
SPEAKER_00: And are my five minutes worth it?
56:40
SPEAKER_01: A hundred percent possible.
56:42
SPEAKER_01: CMS has a lot of authority to make changes within their own authority.
56:49
SPEAKER_01: Things are a lot harder with Congress.
56:51
SPEAKER_01: A whole lot more stars have to align, and you're asking for money.
56:55
SPEAKER_01: But with CMS, it's it's a matter of deciding where to allocate dollars.
57:01
SPEAKER_01: We are a very important solution.
57:06
SPEAKER_01: We have watched CMS, I'll say one more thing.
57:09
SPEAKER_01: We have watched CMS put out codes that are brand new, that address medical complexity, that address behavioral health integration, that are, you know, if you if you asked some people, could that have been done 10 years ago, maybe they would have said, no, that's crazy.
57:29
SPEAKER_01: But CMS is wants to be able to create the incentives for care to be provided to the patients who are most vulnerable and to make it very practical for everybody.
57:44
SPEAKER_01: Those complex patients, those with dementia, medical complexity, functional, big functional limitations.
57:52
SPEAKER_01: The practical piece to this is they are by far the highest cost beneficiaries that all of us, that CMS and taxpayers, have to account for.
58:03
SPEAKER_01: There are not enough trained professionals out there and with the right incentives to help give them a better quality of life, have better health outcomes.
58:15
SPEAKER_01: And we are a solution to that.
58:17
SPEAKER_01: So we are we owe it to the population, to the public, and to ourselves to offer these smart solutions that are perfectly aligned with our capabilities.
58:28
SPEAKER_01: Yes, absolutely change can happen.
58:31
SPEAKER_01: We're gonna all need to work together and build support and momentum around these smart asks.
58:37
SPEAKER_00: And I would say our profession went through the hard work of training this workforce through master's and doctoral level.
58:46
SPEAKER_00: And on a personal level, we went through the hard work of going to school to have the skill set to manage complex patients, and we don't have the codes for it.
58:56
SPEAKER_00: So I just hope every therapist thinks this asks.
58:59
SPEAKER_00: I is I want to um also, as we're closing up, just say uh specifically to OTs and OTAs and PTAs who are such an important part of our team.
59:10
SPEAKER_00: I think it feels like on the face, this isn't about their services, but I feel like this is about our profession at a whole.
59:20
SPEAKER_00: And I see this as raising their status as well.
59:23
SPEAKER_00: So I hope that no OTAs and PTAs hesitate a moment at this, that they also get behind this advocacy and make a request and put their own anecdotes about what this means for them.
59:38
SPEAKER_00: Um, so I hope we all do it from OTs to OTAs from new grads who have that doctorate to uh people who have been in the field for a long time.
59:49
SPEAKER_00: Um, I just hope every OT takes the moments to comment.
59:54
SPEAKER_00: And Dana, thank you so much for explaining this to us and for your elegant ideas.
1:00:00
SPEAKER_00: I just want to be like, we couldn't do this without you.
1:00:03
SPEAKER_01: I just don't want us to be professions that are top of scope only in name and license.
1:00:08
SPEAKER_01: If we're going to be top of scope and help the most vulnerable, help the majority of the population that cannot go cash-based, we have to have the mechanisms in place for us to deliver that care.
1:00:20
SPEAKER_01: And I know we can get to a place where in the not too distant future, where our scope of practice matches the scope of what we are able to be reimbursed for as healthcare professionals with a high level of education and training.
1:00:35
SPEAKER_00: So well said.
1:00:36
SPEAKER_00: Thank you for your vision, for your advocacy, and for making it easy for the rest of us.
1:00:42
SPEAKER_00: I so appreciate your time today, Dana.
1:00:44
SPEAKER_00: Thank you so much for this conversation.
1:00:46
SPEAKER_00: Thank you so much, Sarah.
1:00:48
SPEAKER_00: It's so great to be back.
1:00:53
SPEAKER_00: Thank you for joining us on the OT Potential podcast.
1:00:57
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1:01:06
SPEAKER_00: Once you're in the OT Potential Club, you will find a five-question post-course quiz connected to this episode.
1:01:13
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1:01:22
SPEAKER_00: Okay, I want to thank you for joining us today, and we'll see you next time.