AH047 - What Project 2025, RFK Jr., and Dr. Oz Could Mean for the Business of Healthcare Under Trump

Transcript

Lightly edited for clarity.

[00:27] Justin Venneri: Hello and thank you for joining us for this episode of the Astonishing Healthcare Podcast. This is Justin Venneri, your host and director of communications at Capital Rx, and I'm excited to have Robert Longyear back in the studio with me today. Robert was a guest of ours all the way back at the beginning of the year, episode 13. We were talking about value-based care and remote patient monitoring and topics related to his role as co-founder and president of Avenue Health.

Robert, the article you've written recently or articles you've written recently in your Health Tech Happy Hour caught my eye as we're coming up on the end of the year here and what to expect in health policy from a new Trump administration I thought was particularly interesting to have a discussion about. So welcome back to the show. Tell us what you've been up to this year, and we'll get right into it.

Robert Longyear: Yeah, thanks Justin. I'm really glad to be back. I've been looking very closely at the sort of expectations for the next administration. I think the biggest takeaway of anyone who's observing this is probably we don't quite know what's going to happen.

So I'll introduce myself. I'm Robert Longyear. I'm the co founder and president of Avenue Health, which is a telehealth, remote patient monitoring, and chronic care management company. I sit on the Health Technology Policy workgroup of the Consumer Technology Association. I'm a board member of the Commission for Nurse Reimbursement and Research and I sit on the steering committee of the Connected Health Initiative. All those are very focused on monitoring federal and state policies primarily related to health technology telehealth, but also to health workforce issues and payment policy at CMS Education-wise.

I studied healthcare management and policy at Georgetown and as I speak right now I am sitting looking at K Street where my house is in Washington D.C. so you can think about this as just really coming at you from the heart of federal policymaking.

[02:20] Justin Venneri: Awesome. So there was a lot of surprise around the result of the election, just the magnitude of the result, and then of course lots of questions about in particular healthcare and why it wasn't the focus many people expected it might be during the debates and back and forth leading up to the actual election.

So tell us a little bit about what you did, and then we can start to get into what you found when you started looking at things.

Robert Longyear: Yeah. So I was also surprised about the lack of conversation around healthcare, which has been very common in the past several campaign seasons for president. I'm not sure why that is. I know it's a big issue for American households, butit was not top of mind in this particular year. So I thought that was a little strange. So I decided I was going to go look at sort of the previous Trump administration. I went to go read Project 2025, the Project 2025 everybody's talking about from the Heritage Foundation.

And I really wanted to understand what people were thinking about in the Republican Party around health policy for this next administration. So I wrote two articles. One's just sort of a general overview of the Health and Human Services section of Project 2025. And the second one is really looking at comments and analyses of Robert F. Kennedy Jr. And Dr. Oz, who are nominated for the Department of Health and Human Services Secretary and for the CMS administrator. So I wrote two articles and, Justin, you were kind enough to read them and you reached out and it might be interesting to talk about this. So I thought so.

Related Content

• Analyzing Health Policy Priorities under RFK, Jr. and Dr. Oz (Nov 27)
• What to Expect in Health Policy from the Next Trump Administration (Project 2025 Analysis; Nov 7)
• Digital Health Technologies in Rural Health: Bridging the Gap in Care Access and Delivery (Nov 26)
• AH046 - What's Hot In and Around the Pharmacy Supply Chain, with RSM's Tom Evegan

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So a couple things I want to say about the both the pieces and about what we're going to talk about here. First of all, we all have our political opinions, and in the current environment, many of them are very deeply held. I'm going to do my best to be very objective when we're looking at where the next administration might focus. I'm a businessperson and a technology person and a policy research nerd. I'm not a politician. So everything I'm reporting to you is my attempt at really trying to look at the reality of the situation. So with that in mind, there are issues I will discuss that people feel very strongly about.

Please don't come at me with it. I'm just trying to report to you what is out there. So I feel like I need to say that.

[04:38] Justin Venneri: Yeah, no, it's fair enough. I mean, that was part of the reason I reached out to you. I appreciated the broad disclaimer at the beginning of the article.

Robert Longyear: So, yeah, yeah. A couple things that I think are really important to note for anyone listening to this.So Republican health services policy is something that is not as clearly spoken about as sort of Democrat health policy. Most of the time, when you hear about Republicans in the news talking about health policy, it's usually related to repealing and replacing the Affordable Care act, that's really been the narrative for the last five to 10 years.

But Republicans, if you read a lot from the previous Trump administration and you read Project 2025, what you can find is there's a really big focus on increasing competition in the healthcare services space.

There's a historic focus on privatization of government programs. They're very focused on sort of individual choice and also very, very focused, at least many of them are very focused on abortion related issues and sort of the ability for folks to religiously abstain from certain policies like vaccine mandates and other areas where there may be some sort of religious angle.

Generally. There's also a focus on the reduction of administrative burden from government programs, particularly government health programs. So in Project 2025, there's a pretty significant focus on reducing burden on physicians and on care delivery organizations by streamlining quality metrics and really focusing on trying to reduce some of the forms and documents that have to be filled out.

And then generally there's sort of a belief in deregulation of the free market or deregulation of certain areas in the free market. That's a broad term. I think it's kind of nonspecific. It's hard to really define that in some circumstances. That's my generalization there. It's not necessarily comprehensive, but that's sort of some of the big overarching themes that we see in Project 2025.

[06:42] Justin Venneri: Okay. And I'll link your articles and some of the reference materials in the show Notes, of course. When you got into this, what were some of the key highlights or key findings?

Robert Longyear: I was really interested in looking at the effects to healthcare services first. So I wanted to go look at what policy priorities or ideas were in Project 2025 for Medicare and for Medicaid.

So the first one is Medicare Advantage. So there's generally a big belief in the Medicare Advantage program. There's been some discussion or at least there was some indication that folks may want to make Medicare Advantage the sort of first default option for anybody who is eligible for the Medicare program at age 65.

And so that's a huge shift we would see. So right now we are seeing larger enrollments in Medicare Advantage compared to traditional Medicare. Medicare Part B and Medicare. Medicare Advantage is a huge business right now.

So lots of the large health insurers, they make better margins on Medicare Advantage. And it's been what some people have called a cash cow for the industry. And then Dr. Oz is also a general supporter of Medicare Advantage. So some of his conversations have been in support of Medicare Advantage policy as sort of the default option or even as sort of Medicare Advantage for all, I read somewhere. So that was very interesting, I thought.

[08:09] Justin Venneri: And for years, I mean, Medicare Advantage, proportionally speaking, has been growing right relative to enrollment in Medicare. So this would accelerate that potentially?

Robert Longyear: Yes. I think they were projecting a 50/50 Medicare Advantage to Medicare Part B ratio sometime in the Future, maybe even 2030 last I saw. And I think we reached it last year or this year.

It has been faster than expected. Expected. And so it's not like a massive, massive shift to do this because it already is sort of. I think the enrollment rates are like 70, 30 right now, but it would be a pretty decently sized change to make it a default.

And I think if I recall correctly, Project 2025 goes as far as even thinking about trying to reduce the need for Medicare Part B in the first place. So even kind of eliminating the Medicare Part B fee scheduling processes and rule making processes is something that's in there as well.

[09:03] Justin Venneri: Okay, and then how about Medicaid?

Robert Longyear: Yeah, so Medicaid, the two big policies there are sort of block grants and per capita caps. And you know, we're unclear if Dr. Oz knows about Medicaid, being that he is nominated to be the CMS administrator. So I haven't seen anything about him and his understanding or knowledge of the Medicaid program. It generally speaking, a lot of people in the country don't know the difference between Medicare and Medicaid.

But the two big policies there are really centered around reducing the federal spend on the Medicaid program and also just trying to push sort of more of the responsibility onto states and less onto the federal government. So the two big policies are block granting Medicaid to states as opposed to how it's done currently or implementing per capita cap. So limits on how much an individual can actually sort of spend as an enrollee in a Medicaid program, Both of those would be pretty substantial changes.

It would probably harm, from a business perspective, the Medicaid managed care industry. So those organizations may see some of the impacts from block granting or per capita caps and generally sort of a contraction of the overall market share in that space or market size, I should say.

[10:22] Justin Venneri: Okay. And we're nearing the end of the year here during the remote monitoring, chronic disease management space. Telehealth... obviously big topic for discussion and we're kind of running out of time on the extension. I believe that's end of this month, end of December. And there was some potential for PBM reform to help with that. Would love your thoughts on telehealth and the timing of everything here.

And I know that's a crystal ball-like question and we have some more for you toward the end. But, like, how do you see things playing out near term?

Robert Longyear: Yeah. So interestingly, telehealth is a huge bipartisan support situation. The Congressional Budget Office has scored it to be sort of rather expensive. So I think the number is somewhere around $20 billion.

So it's definitely a cost. And so Congress is trying to offset that cost. They all are supportive of it, at least in my conversations on the Hill that I've had over the last several years.

And so Republican policy is very much supportive of telehealth for its benefits in rural areas in particular, and Democrats generally like it for its value and access to care. Just generally across the board. I think that the cost scoring is the biggest barrier currently. Dr. Oz is also a huge fan of telehealth. He has explicitly said that he wants to extend the public health emergency flexibilities for direct to the home and direct to consumer telehealth.

So I think that's something that we're going to see now. The deadline for those flexibilities for Congress to Act is December 31, 2024. So we are rapidly approaching that to your point, Justin.

And I think the challenge there is that there's not a lot of days left in session. And like, is this going to be a priority in light of all the other things going on politically?

A month, month and a half ago, everybody was very much thinking that this was going to get passed prior to the end of the year and it was going to extend telehealth for either another year or another two years. So really kicking the can down the road again. But I think that was really the sort of expectation, and now I've heard a lot more uncertainty from folks I talk to that are closer to what's going on on the Hill.

Remote patient monitoring is not telehealth. It is a permanent component of the physician fee schedule for Medicare. So that's something that I like to draw the distinction of. There's generally good bipartisan support of remote patient monitoring. Interestingly, Dr. Oz apparently has experience with wearables and connected medical devices. So it seems like there may be some support out the gate there for those types of programs from him in the CMS administrator role.

So that's something that I think people should lookout for.

[13:06] Justin Venneri: Okay. And in general, I think the more surveys I read, the more stories I read, the more cost data I look at chronic diseases and the associated medical costs for managing that care. Anything in the report? When you took a look at the, you know, Project 2025 and thought about the prior Trump administration, what do you think the mission is or the preferences there as it relates to treatment of chronic diseases?

Robert Longyear: Project 2025 doesn't get that detailed or I would say that clinical. It's very focused on administrative issues and a couple other top priorities. The folks that are nominated though, RFK Jr. and Dr. Oz, are very focused on chronic disease. RFK has said that he wants to the government to stop looking at infectious disease and only focus on chronic disease. So I would just generally say that chronic disease is a big focus of the CDC and of the National Institutes of Health.

And there is a very widely understood belief that that's an area where health system performance needs to improve. So that would be conditions like hypertension, diabetes, COPD, congestive heart failure, big drivers of cost... musculoskeletal conditions.

So everybody's very aware of that and have been working on it for a number of years. But I do think there will be a large focus on chronic disease. And we know that there's going to be focus from RFK Jr. on vaccines.

So and lots of people are writing about this. I'm not going to comment too much on it. We know there's going to be conversation about fluoridation of the water and the benefits or lack thereof of fluoride.

And we know there's going to be focus on on food regulation. So preservatives, chemicals, dyes and nutrition are going to be areas of focus, both sort of potentially through additional research areas or additional research focus through the National Institutes of Health and generally through potential messaging coming out of HHS and some of the other agencies.

I think that those are areas that lots of people are focused on in writing right now. So I was much more interested in looking at health services, payment policies, CMS and telehealth.

Obviously, the other things that have been very publicly stated are sort of NIH research focus areas. So there's going to be a lot of focus on NIH. I believe there's going to be a lot of focus on what's been referred to as revolving doors at the FDA and the CDC... people who have been working there and forming policymaking that also have financial relationships with pharmaceutical companies and the life sciences industry.

I think that's an area to watch. I don't know if it's inherently bad to try and root out conflicts of interest. I think it should always be uniformly applied to the extent that they exist. It's not an area that I know a lot about, but I know that there's going to be a big focus on that from the folks that they're putting in place, including [Dr.] Marty Makary from Johns Hopkins, who is nominated for the FDA commissioner role.

So I think that's going to be a big situation.

[15:56] Justin Venneri: So watch who's coming and going?

Robert Longyear: Yep, I would watch who's coming, going. I think they'll be very public about it. One thing that we can definitely say is clear is that television experience is something that the president is looking for. So I think we're going to know exactly at least what folks are thinking about in a lot of circumstances. I think there's going to be plenty of television appearances for this particular cabinet and appointees for this administration.

The other thing that's really clear in Project 2025 is there's a general reaction against some of the measures that were taken during COVID So the policies in that particular document suggests that there's going to be efforts to remove or reduce the power to implement public health emergencies, or at least put some guardrails around public health emergencies.

There's going to be an emphasis on individual choice and the ability to sort of the term is sort of conscience rights. We see that throughout Project 2025. So people being able to object for religious or spiritual reasons. And then we do see sort of this reaction against mandates and the ability to sort of shut down the government or society due to a public health emergency. So that's something that I think we'll see generally.

And then two other areas that I'm going to be watching closely and what goes on here. Not so much related to the vaccines where this has come up a lot, but I'm really interested in what's going to happen in payment policy and Medicaid policy related to pediatrics.

So I'm very interested in seeing what's going to happen because it seems that RFK does have sort of an angle towards looking towards what's going on in pediatrics and with children. So I'm sure the American Academy of Pediatrics is paying very close attention to that. And then workforce issues and provider burnout.

[17:50] Justin Venneri: Yeah yeah, that's near and dear to your heart and was part of our original, our discussion earlier this year, right. With, you know, what's going on in the workforce an issue and...

Robert Longyear: Yeah, absolutely. So you're right. It is near and dear to my heart. I do research in the area and I also write about workforce issues quite a bit, particularly in nursing. I do think that because Dr. Oz is a physician and he's aware of some of these burnout issues, I wonder if there's going to be some efforts to sort of align some of the administrative burden stuff in Project 2025 with an effort to try and at least spin brand some of those things as trying to reduce provider burnout and improve workplace quality and quality of life for clinicians in the US Health system.

So that's an area that I'm interested in paying attention to.

[18:39] Justin Venneri: Okay. And did you uncover anything or do you have any thoughts on the progression of value-based payments, value-based programs? We talked a bit about CMMI earlier this year.

Robert Longyear: Yes. So there's I've been on the Hill quite a bit over the last, I would say two, three years talking about payments and talking about health, technology, privacy, artificial intelligence. So I have a pretty good idea of where Congress stands on a lot of these issues, just having talked to the major committees quite a bit.

So I don't think we know about how the sort of nominees feel about some of the areas I'm about to list. And I don't think we know how President Elect Trump feels about these types of initiatives. I think it seems to me, and this is a total opinion, that he's deferring quite a bit to RFK Jr. on a lot of the picks for the larger HHS infrastructure.

And it seems to me that that level of trust is there. So he's one to pay attention to on comments related to some of these issues. And again, we don't even know if he is going to be digging into this type of stuff that I'm about to talk about like value based payment. We don't know yet, at least I don't know I should say where that's going to go. But that's something Congress is paying close attention to. So what's going on at CMMI...

There's generally bipartisan support for value-based payment reform and transitioning away from fee for service and trying to make CMMI's models perform and save money. And then ultimately if they demonstrate that they save money trying to make them a permanent part of the Medicare program.

Now this is an interesting situation because if we go towards more Medicare Advantage under this next administration, then the role of CMMI is going to be somewhat diminished in some circumstances because a lot of what they do is very focused on Medicare Part B, traditional Medicare.

So it's not to say that Medicare Advantage doesn't participate in value-based purchasing or value-based payment models or even come up with their own value-based payment models. It's still an area that's going on, but the question's gonna be how much is sort of the government paying attention to this or at least the folks that are in the agencies.

[20:48] Justin Venneri: Okay, how about bigger health tech? Electronic health records?

Robert Longyear: Yeah. So stuff going on at the office of the national coordinator - now referred to as the Assistant Secretary for Technology Policy. I believe ASTP, we don't really know how they stand on some of those issues.

Now, Dr. Oz is a physician. I don't. No, I don't think he was practicing during the electronic health record, electronic medical record transition. I'm sure he's aware of some of the issues there. He's not over ASTP or the office of the national coordinator, but RFK Jr. will be over that particular group at HHS. So it's going to be very, very interesting to see what happens with that.

Now, I think it's a fairly bipartisan issue. Having spoken about this on the Hill with folks. Generally people want patients to have access to their own health records. If you look at Project 2025, I think you can take some of the efforts that are being made towards price transparency and flexible spending accounts and health savings accounts that are big portions of Project 2025.

And it's a big part of the sort of Republican strategy for healthcare reform. Putting the dollars and the knowledge and the information in the hands of the healthcare consumer or the patient. They're really pushing that component. So perhaps what comes along with that is emphasis on making sure that electronic health records are accessible to individuals as it should be. Right now.

There's still a lot of issues with data blocking.There's still a lot of issues with being able to get records to different physicians and to individuals as they request them. So I think we probably will see potentially more enforcement action there and we may see even a really big outsized push in that area. If this administration is moving in the direction of trying to put more power and information and control in the hands of the patient or in the hands of the American public or the purchaser.

[22:44] Justin Venneri: Right. We see a lot of issues around, you know, the plan sponsor having access to the plan data. It's a reasonable analog, I think.

Robert Longyear: I think we might see some more action there. There are these sort of like data aggregators that really protect access to this information, that a lot of it is the personal right per the law, for patients to have control over their own electronic health information.

Some of it is good for business and transparency purposes. So that's going to be an interesting place to watch. I do think one of the things that is important to note, and this is something I write about in one of the articles, really, really important, is you can push control and choice to the American consumer, but you also, at the same time, if you're looking to improve competition, need to look at market concentration and market consolidation.

So if the patient only has one hospital to go to in their local area, well, it doesn't matter if they have the choice. They're still going to be kind of forced to go to that, that monopoly, if you will, if they have only two insurance options in their county or two insurance options in their state or even up to four, you know, that's a not a really competitive market in a lot of circumstances.

So I think one place to look at is going to be.what's going on at the Federal Trade Commission and the Department of Justice with consolidation and antitrust activities. I don't think we've heard a lot from at least what I saw in Project 2025 related to HHS and from public comments on mergers and acquisitions and antitrust activities. So Lena Khan has really set pretty aggressive regime at the FTC. What I've read about views on her from both sides are generally positive of trying to improve consumer welfare and trying to break up the power of very large corporations that act as monopolists.

So it'll be very interesting to see what happens there, both inside of healthcare and in technology, the big tech companies and other areas where there's been quite a bit of market consolidation. And to some extent, the Trump administration is claiming that they have sort of a mandate to come in. And that mandate is really driven from a lot of the inflation over the last two, three, four years.

So I think that efforts to try and bring down inflation and cost and improve competition. So that's going to be really important. The other thing that's been talked about by everybody everywhere, all the time I'm kind of done with it, even though I've been writing about it a little bit recently, is artificial intelligence.

[25:24] Justin Venneri: I was just going to say, let me guess AI...

Robert Longyear: But yeah, the cybersecurity and artificial intelligence and to some extent like health data privacy and consumer data privacy are going to be big areas of focus, at least Congress has been looking at that for the last two years, all of those areas really closely.

Cybersecurity became really important under HIPAA after the change healthcare debacle. It was, it was a big situation. And I actually remember sitting in a meeting with the Senate help committee, one of the staffers, and they asked me, what do you think about cybersecurity? You know, this Change Healthcare thing happened. And I was like, well, to be honest with you, I don't think that's so much of the problem. I'm like, the cybersecurity people on one hand are going to be trying to defend against people who are equally smart hackers.

And so there's this battle that's going on and companies need to really take the steps they need to take to be compliant and to protect data. But I said I think the biggest issue is the consolidation of all the claims going through one company. So I'm like, this is another example of sort of that harm that comes from having all of your eggs in one basket. So I think that it's more of a antitrust issue or sort of a decentralization issue and not so much of a cybersecurity issue, although some people might disagree with that.

[26:44] Justin Venneri: It's an interesting take. So what else haven't we talked about or haven't you shared thus far that you think that is top of mind for you that you think is pretty interesting, or that could be surprising that we should be watching?

Robert Longyear: A couple of things. One, this is all my opinion, so I'm just looking at what's available to read about and I'm really trying to sort of guess in a lot of these circumstances. But the first thing that if you read Project 2025, HHS section, you will come away with the number one prior for the author of that section and presumably for anyone who supports that is really abortion issues.

So everywhere in HHS there's going to be sweeping efforts to limit access to abortion medications and telehealth access to abortion medications. And there may be some efforts at the FDA to potentially un-approve - I don't even know if you can call that - but sort of recall or kind of rescind the approvals for certain drugs. So that's very clearly stated in Project 2025. What's interesting about that is Kennedy has stated in the past that he is pro choice and does not favor any legislation banning abortion.

So what's really interesting is the Senate, which is controlled by Republicans who are historically very pro life or, or antiabortion, actually allow him to go in as HHS secretary. And then equally interesting is if they do, what does he do about that particular agenda that is stated in Project 2025? That again is not necessarily the administration's policies. It is a product of the Heritage Foundation.

So it's not necessarily what Trump wants, it's not necessarily what folks in Congress want. But I think it's a, it's an indicator of at least the thought on some of the issues related to HHS.

The other thing, Justin, that I think is really interesting is, and this is, it's hard to pin this down, but Kennedy has also apparently said that he favors a single payer system with a private option. And that is really, really kind of against what is very historically important for the Republicans in Congress trying to sort of repeal some of those more single payer policies that were a part of the Affordable Care act, like the individual mandate.

And I think that it's going to be very interesting to watch again if that causes any trouble during the Senate hearings for confirmation. Now, I think there's other nominees that are taking up a lot of the attention.

So the question is, is he going to kind of slide by and really be installed there? Dr. Oz also appears to be very interested in artificial intelligence. And some of the sources I saw indicated that he's also aware of the risk of bias if the training data is too narrow and is not generalizable. And so I think because Vivek Ramaswamy and Elon Musk are involved, I think there's going to be sort of AI regulations or deregulations that are going to occur mostly on the, on the national defense side of the equation.

I don't know how that's going to impact the rules and regulations around artificial intelligence and health, which in my conversations with folks on the Hill, generally they see as a separate issue from general artificial intelligence or artificial intelligence for other use cases.

So it's going to be interesting to see what happens in healthcare with that. At CMS, in Project 2025, there's a very, very specific call out for the use of artificial intelligence to crack down on fraud, waste and abuse.

So thing algorithms to identify patterns in the data to crack down on fraud, waste and abuse. So that's something that I think is definitely going to happen. Interesting. I don't know why it hasn't happened already. I think it's probably a good idea. But that's something that is very explicitly stated, which is kind of uncommon to see that type of thing in policy documents unless it's specifically towards tech policy.

But AI has transfused into everything that we talk about these days, that's for sure.

[30:54] Justin Venneri: So last question for you, Robert. What was the most astonishing or surprising thing you found in doing this analysis and writing it up for public consumption? Or what do you think is the most potentially surprising thing we could see out of the next administration based on the work you've done?

Robert Longyear: So I think that a lot of what goes on in health services is going to be pretty consistent with what we see in some of these documents. I think there will certainly be surprises. The article I wrote generally about Predator 2025 and about Dr. Oz and RFK Jr. As it relates to HHS and CMS policy, I try to suggest that this may be an opportunity in certain areas for a lot of bipartisan action.

So there's going to be very contentious debates around abortion. Obviously there's going to be very contentious debates around vaccines and information misinformation, the interpretation of scientific studies. So I think that's going to be uncomfortable for a lot of people and it's going to be a very significant shift from how HHS and NIH have, have operated for quite a while.

But I do think in value based payment and in price transparency and in health technology and telehealth, we may be able to see some pretty significant leaps and bounds. One thing that I would be happy about is if we really were able to focus on workforce shortages in rural areas and places in the country that don't have enough physicians, don't have enough specialists, through a really aggressive telehealth strategy.

So I think like the debate around telehealth right now is the flexibilities for being in home as opposed to having these sort of distant and far sites or near sites. I can't remember exactly the terminology, but basically allowing people to access telehealth in the home is the flexibility for certain services and then the physicians can receive or providers can receive payment from Medicare for it.

It would be really cool to see us not just be reactive to telehealth and say, well, I guess people like it now, so we should cover it in Medicare and really sit there and say, can we proactively try and alleviate some of these programs? And HRSA, the Health Resources and Services Administration, spends a lot of money on trying to solve some of these issues with really like expensive and broad approaches to trying to solve some of these workforce shortage issues.

It's hard to move people around and you're fighting market forces in a lot of circumstances. So the use of technology to get specialty care in a lot of places through a really carefully planned strategy is something I'd really like to see.

[33:42] Justin Venneri: Do you think we'd see some like bonus payments, incentives or things for taking care of patients in certain regions or counties? Is that kind of what you're leaning toward.

Robert Longyear: Yeah, we've seen that in recent years actually. So we've seen some efforts by CMS to use payment policy to try and allow rural hospitals through the inpatient prospective payment system to be more competitive. So there's been some calculation changes to give more money to some of those areas to allow them to attract clinicians, the workforce to the areas where they are sort of located.

And so I think some sort of really intentional, well designed strategy, whether through sort of centralization or through incentives to promote the delivery of these types of services throughout the country, it probably can be done and would solve a lot of problems that people have been talking about for a really long time. If you go to PubMed and you type in "workforce shortages" like, you will have plenty of time to read stuff.

[34:41] Justin Venneri: There's a lot. Yep, for sure.Well, Robert, this has been great. Thanks so much for joining me again. You know, I hope you have a great rest of the year and a happy new Year and look forward to staying in touch.

Any parting thoughts? Best way to get in touch with you?

Robert Longyear: Please do subscribe. It's free to subscribe to Health Tech Happy Hour, my Substack. I guess everyone has one these days, but it allows me to just kind of write and hopefully share some interesting things. I work in healthcare because I want to ultimately make a better performing health system and try and make quality of life better for our colleagues who live near us and our neighbors.

So that's my purpose for writing the newsletter. And then generally speaking, hopefully it's helpful for if you're looking at this from a business perspective, you're able to sort of plan for potential changes in your particular space coming in this new administration.

And if you're working policy, you know, definitely tell me if I'm wrong about some of these things. I'd like to learn from others that have observed some of these things and who may know better than I do.

[35:43] Justin Venneri: That's the nature of knowledge capital exchange, right? Everyone gets smarter and things improve over time.

Robert Longyear: Absolutely.

[35:50] Justin Venneri: Well, have a great rest of your day. Thank you, Robert.

Robert Longyear: Yep, thanks, Justin.

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