quote where this comes from but you look at um rule versus inner city and then you look at academic versus um community hospital so 15 percent 16 percent is what it was when i started here um and we want to keep it you know around that and slightly less would be would be good for an academic center inner city hospital you know those numbers are in the 30s 30 35 percent um but that's not the situation we have here and unfortunately you know some of that doesn't include some of the transfer situations we have where patients get transferred to uh tertiary care that is actually slightly increased um and as we go through the numbers just to head off another question why did it increase uh it's not just this year it actually increased for available reasons one is standards of care so multi-organ trauma no longer stays at a church at a community hospital it hasn't for about five to ten years the literature supports it needs to be in an academic center um minor heart attacks which i mentioned earlier there was a big push in the mid uh 2000s that those all need to go to uh academic centers or cath cath capable centers we're hoping that'll that seems to be a waste and i think that the literature is turning that around but to back to your question um you know 11 of 15 percent seems to be a number where we're feel certain that the patients that coming in first off need to be there and that the patients that come to the emergency department likely needed an emergency department visit you know our our urgent care is so close patients can self-select um and during the pandemic we actually weren't able to uh select for them which we cannot do anymore of course great okay well thank you what others ask questions about utilization and we'll take up too much time but thank you for that i'll just hop in one of the questions that i had in follow-up to the migration discussion and the reducing out of migration it i didn't get this from your narrative but from the discussion today it sounds like a lot of that focus is uh connected to the dh affiliation um so it am i getting that right so the idea is right now you're transferring folks to albany or to another hospital and what you're hoping is that with the dh affiliation you'll be able to keep more folks in house is that really when you're talking in your narrative about the reducing the out migration is that really the bulk of it or what am i missing tom you want to take that yeah um robin um albany will continue to be our our major source of where we refer patients for i mean the proximities is much closer than dh i think we're going to see more and more of elective work over time going to the dartmouth for admission but i would continue to say that that albany will be the will be the majority of that um you know i think the more we can keep locally again as you as the numbers that sarah show the the cost outside of um svmc are substantially higher and we think what the services at dartmouth help helps us create here with their support we can you know that out migration number and in the numbers old but i think the number was about 50 million dollars of care leaves our region leaves our area per year um we think that you know certainly a portion of that maybe you know up up to maybe over time one third could stay locally here and it can be treated at a lower cost so um but the strategy with dartmouth is to is to provide as much care locally and uh and hopefully we don't have to um you know send um as patients out and also send up to dartmouth and they they really want to have the quaternary care tertiary care patients they don't want to have lower level patients and and we want to keep the lower level patients here in terms of the acuity so that's kind of the strategy yeah and robin and robin robin simply also if we improve access and patients that live in our service area that currently have a primary care patient physician outside of our service area if they can get into our practices they probably will use our services um more so um so that's all tied together kathy yeah the one um already apparent example we referenced is oncology we have many many many patients who've had to go outside because they couldn't get appointments for their treatments they've gone to new york or boss in our dartmouth and now they can get those services here and it's a huge deal i cannot tell you how many obviously cancer is very prevalent so many people have been so disheartening to go outside because they couldn't get appointments and now they can so that's a very big deal yeah to follow up on kathy it's um unfortunately we've had two people in the finance department um uh diagnosed with cancer that couldn't get into c r doctors and they had to receive treatment outside of uh there where they work so uh so now being staffed up we'll be able to um they'll be able to see receive the treatment of the future at our facility thank you um robin can i go ahead yeah of course i'm just gonna sorry i'm going to jump in real quick granular answer to your question i'll just use oncology since kathy gave the beautiful example you asked about d8 so first off back to your original question we're talking mostly about outpatient here not not inpatient that that's the to answer that first thing then the second is if we'll go with oncology what we're saying is without that relationship with dh our ability to be fully staffed is is really not there anymore oncologists do not want to practice in a one and two practice anymore they want to be in a larger practice where they can continue to do academic research and they have the support you know and that's unfortunately due to specialization um they're even further specialized so an example of this is in the past first off we can recruit more now in the past someone may need a particular type of chemotherapy for a short duration for a complicated cancer they would go elsewhere and they would stay elsewhere you know that they wouldn't come back here because what would be the motivation from that other place to send them back we now already have patients that we do 90 of it they need to go up for one or two special things uh but then they they just get referred right back here into the system where they where they belong um the head and neck is a great example uh they used to all go elsewhere now uh head and neck cancers can stay here for the most part they may need to get a little bit of debulking procedure at dhfc and then they return thank you and then just one more quick i hope what i hope will be a quick one is um steve you mentioned increased insurance denials is could you give us a sense of is that self-insured uh ma plans just any trends you've seen in terms of where that's coming from or is it just across the board i i would classify it across the board um united healthcare has been difficult um but we don't have that much volume but when you look at the proportion of of what we're seeing and um you know i i think the real the real answer is across the board thank you i think that's all i have thanks thank you other board questions dr merman i just thanks for the presentation so far i haven't had a chance to comment or question um uh actually i think i might venture just a quick comment which is um you know dr dobs and i are both emergency physicians and we think about the admissions numbers and over time this has been used a lot through research as a marker of acuity but it also seems to be a marker of that availability i don't think these numbers include transfers and there's also an argument that that you know a low admissions number is an incredible amount of work that the emergency provider team has done to try to come up with a solution other than admitting the patient so this it's kind of a complicated number that speaks to a lot of things but i think it's an interesting number to view over time but i think it's it's uh it's it's a very it's a very multifactorial heterogeneous group um the questions i was going to ask the two view or the three four of you is um when you are talking about utilization um one thing that's come up in the primary care advisory group and other situations is other information that we get is on um available visits in a primary care provider schedule for urgent visits and sort of the complexities of trying to fill a schedule to make sure they get their visit numbers versus having availability so that you can get urgent visits in so that they're not having to go to an urgent care or an emergency department that can be seen by a person who knows them is how do you approach uh open slots for uh pcp visits for urgent visits try you want to take that sure well i can say um you know not great uh we've been working at it really hard and that's what we've been doing over the past you know many years but the last year we've started to make some head roads really when i say the last year this this year uh january on and it's by using data that we've um verified and we know to be right on on an individual's uh the primary care physician or provider's schedule so we can actually say do we block off additional time here or do we just double book and then not double book in certain times so right now we're sort of in an experimental phase uh day where where we've looked at which practice is doing it the best which practice out of our six actual primary care including peds has the most availability in slots and so we're mirroring that and i can tell you in about a couple of months how it's going um right now it looks like that's part of the five percent increase we've seen over the past three months is by uh getting urgent visits in they do send people to our own urgent care which is better than some other urgent care because at least it's you know they know each other and it's in the same computer system but it's certainly as you point out not near as ideal as getting them into their own practice so some practices have availability in the morning or afternoon extra slots that sounds great it might not be the best approach it may be a better approach to lighten up the double booking and and go with that so i'll let you know lots of lots of work on it though yeah i i guess thank you for for the attention to the problem and i i wouldn't venture to think that i could understand how to solve it but i i really appreciate your discussion of it and your attention to it um the other question i had for you you mentioned in your narrative some local independent primary care providers retiring some people leaving practice um and i was just wanted to see if i could get an idea of what the landscape is for independent providers in your area if there are independent primary care providers or other if there are any independent specialty providers in your area and if they work with southwest on you know admission privileges or those sorts of things right yeah so they've um they just continue to dwindle i would say that we now have about um less than four fte's of independent primary care maybe maybe five um fte's when i say that because some of them are part time left in the area and that that's compared to probably 15 when i started one of those is the fqhc that is up in it's in our health service area but it's in our link and that makes up the bulk the rest are you know point five practices where people are retiring uh in 2023 and 2024 and one just sort of prematurely retired unfortunately due to some health reasons uh this month so um as far as specialty it's the same it's very few we have some oral maxillofacial surgery which will probably continue to be private for you know many more years in the entire state i think most of them are except probably around uvm and then ophthalmology continues to be independent practices of course they're on medical staff everyone's very close most people don't know the difference from that standpoint it is part of the reason though that we need to get this new practice off the ground pretty quickly where we're training advanced practice providers and then of course the residency program over time okay thanks for that detail any other questions from the board um i just have a follow-up from member homes a question on the potential to come with a with a rate reduction um i wasn't really sure what the answer was and i was looking at the wait times uh report from 2022 and certainly fbmc was pretty high so in terms of member homes's questions obtaining some of the npr through utilization as opposed to rate increase would be beneficial i think um and i guess i wanted to see what your position was on whether you would come before the board for a reduction if the utilization is higher than anticipated because i think it makes it more palatable to accept the rate you requested tom i'll let you answer that well i i think our position is um there shouldn't be surprises and we should come to the board based on if our volume goes up quite a bit more or if our volume goes down i mean i i have to admit i i i see next the next 12 months has been very transitional and every program we're talking about really doesn't doesn't come into place in 2024 it's more 2025 and 26 but um you know hypothetically i i think you know we're open to those type of discussions um but um so but i think it has to be on both sides of the equation in terms of significant increases or significant decreases and how we have to deal with that great understood thank you i i have no other questions any questions from the health care advocate related to utilization or the conversation so far hi director limburg uh there i just have one question but before i do that uh so a sampaish health policy analyst with the office of the health care advocate um just is the plan Sarah still to have questions that don't fit into these tabs come at the end great um so my question i'm not sure if this neatly fits in but um in the narrative on page seven you noted that outpatient revenues combined the medical group represents around 81 percent of net patient service revenue and i'm wondering if the partnership that you talked about with dartmouth do you expect to grow that percentage at all well as as i as i reported earlier um as we improve access and improve outpatient utilization we will probably see outpatient revenues go up but there's also a chance that inpatient revenues as we start bringing people back and and into the hospital into the inpatient area that may go up so the percentages may when you start using percentages while the absolute dollar may go up the percentages may fluctuate a little bit i do i do believe that overall um you know we're getting to you know we're at 81 percent on the outpatient side um it it probably will ultimately long term you know if i had a crystal wall probably be between that 80 and 85 percent but if we start getting some of those uh services that out migrate to abany and we keep them home um it may push that outpatient percentage down because inpatient utilization may go up as tom just talked about but most of those increases in inpatient i believe we're going to be in 25 and 26 as we get the services up um and running and working more collaboratively with dartmouth now that we're at an affiliation of dartmouth so we got to be careful about percentages is my is my gosh i agree um and you talked about becoming a regional referral center i'm wondering if you expect as that comes online do you expect patients from you know states like massachusetts to be referred like it's part of the goal to grow out of state patients or is it more really reducing the out migration within vermont the first step is to improve the out migration or decrease that out migration um if we can if we can get our tentacles out into new york state and bring back patients uh and improve um our our volumes that will that will help the hospital that will help vermonters because it will reduce the cost of care um in in our facility uh because we'll be able to spread that cost over a wider base because part of it part of one of one of our challenges is is our size uh and if we can get some more throughput uh we can reduce the cost per episode here tom yeah and just to add what steve says sam i i think um you know you have to realize as we build services and programs i think organically you're going to see more people traveling to our institution for care because you know the areas of new york areas of the berkshires i mean they there's a good relationship in terms of people not wanting to travel down the pits field or are down to you know base state hospital for their care they'd rather come somewhere closer by so i think you'll see some of that happening but clearly the the biggest piece we're going to focus on is other vermont or is living in vermont here trying to have them stay close to home for care and that's a that's that's a that's the huge amount of the 50 million dollars i talked about earlier that's out my brain try yeah sam i just i've put some granular um examples here you know in the past community hospitals haven't received patients often they don't typically have a good process to receive a patient from a lower level of acuity or frankly from another community hospital it just doesn't happen to have a service so let me just give an example you know having four or five general surgeons at every community hospital is is hard on each hospital they may not quite have that business but what happens is you have patients that present to nbrh or to grace cottage or to some other hospital they don't happen to have that surgeon on so in the past those would go to tertiary care centers and that's just really not the best you know way for us to all collaborate and work together so smc is trying to like some other community hospitals say here's what we have here's the phone number to call let's make this easy if you have a patient they don't happen to have that service that day or you don't ever have that service and we do let's take care of the patient here rather than in albany or bay state you know that's where these patients go if they can't get into uvm or or dhmc plus there are call centers now with uvm and dhmc who are trying to do this by phone they're trying to say where can this patient go who happens to be at you know at brow borough or some hospital that just for some reason doesn't have that service this day let's do it in a coordinated way we believe smc is has the size and capacity to be able to take on these patients and provide that service again rather than transferring them out of state which we have just seen is more expensive thank you that's all from us for now wonderful so in the interest of time i think if you could just give us a high level kind of the cost inflation spread that you use for your budgetary purposes and what proportion of that kind of is driven by the pharmaceutical growth so you know we used in the budget four to five percent depending on the commodity depending on what we're seeing in in some of the contracts now some of the periodicals said you should probably use a higher number some of the periodicals said you probably should use a lower number we feel that the four to five percent is a good range we also we also historically have always tried to be a little tight on that to create thought process with our managers so they can find efficiencies and create and you know one of the things that i've used over the past 12 years at southwestern i've used it over 25 years is and is a software product that is off the medicare cost report and gives a lot of information the cleverly associates they calculate a cost index and we've always strived to be better than one on their cost index because below one on their cost index it's that means you're efficient so we also look at that and we've tracked that now for all the years i've been in southwestern and we've made improvements each and every year so using the philosophy of challenging our managers not always putting full boat inflation into the into the budget has worked to create some efficiencies but we got to always remember safety patient safety comes first employee safety comes for you know they're 1a and 1a a so we can't jeopardize that but we got to you know we create a lot of creative thought process with our managers so overall that's our philosophy and that's what we put in the budget as for the pharmaceuticals we put a you know there's a 6.4 percent increase in overall costs you know 340 b savings and a 4 price increase now that this is one area where we believe and we've had a lot of discussions collaboratively with the Dartmouth pharmacy team that will be able to save some money just not in 340 b but with purchasing other pharmaceuticals through through some of the integration and also looking at our formulary and looking at other types of you know going from name brand to generic and I know Trey has been actively involved with some of our physicians in our pharmacy department and he can talk a little bit about that just in general terms if you don't mind Trey on the the differences between name name brand drugs and non-name brand drugs and well mostly some the opportunity there is on the monoclonal antibodies you know the infusions like the remicade and the cost that is paid for those medicines you know it's very complicated depends on the payer and sometimes it's the generic and sometimes there's a better deal with the you know with the name brand but what we have found out is that there's a fourth category there and it allows for remicade that's unlabeled as remicade but is made in the same plant under the same conditions not generic because it's made under the same conditions as the brand that's much cheaper and so that in itself is a significant cost savings there's also opportunity of course similarly in oncology drugs and that's probably the biggest opportunity we won't be able to realize that this year I think this is more of a you know nationwide approach but also working with DHMC to figure out ways to get better prices on oncology drugs we I think everybody can agree on that particular aspect. Wonderful and how do these inflationary pressures translate to your budgeted charge increases and the realized commercial revenue off of those? So Sarah you know what we do is you know we put our assumptions together on the expenses and we look at everything and then we go back and we look at our revenue models looking at inpatient outpatient you know all the services and that's how we you know we build it and we build our target of you know this year we built a target making it a transitional year from a year where we lost money to a one percent operating margin and that's how we you know we build it we look at the governmental payers we look at all the payers and all the things we're doing to improve revenues without putting in on the charge increase and this year you know we settled in on the charge increase that we requested you know and and we all you know in the narrative we talk about that we don't we didn't increase all our charges by that amount we we're increasing approximately 70 percent because there are some charges that and taking the physician practices all all of our payments are pretty much off of a fee schedule so why increase our charges are already higher than that fee schedule so there's no need to increase those charges anymore because there's a delta already and the fee schedule is only going up and and why keep increasing the charges so so we look at the sensitivity of our charges we look at i download again from cleverly associates i'm able to get charges off of publicly data and and we compare ourselves more than once a year to what people in Vermont are paying what people in massachusetts are paying what people in new york are paying on the charge level uh and we try to position our charges accordingly and and there are some things that um you know we every once in a while have to do onesy two z adjustments but for every time we adjust one up we bring one down when we find that we're high uh and i think three four years ago uh we explained this at length that and our budget presentation so we're very sensitive to um how we build our our our charge increase to commercial payers um and and you know tom also talked about earlier in his presentation our community groups well one of the things that we hear in the community groups cost of health care going up okay and that and that's driven off you know off of the commercial rate increase we get from the employers so so we hear that loud and clear any interview questions sir as a long-winded answer yeah no that i think that's good um and i do want to leave plenty of time for board uh questions uh related and hca questions related to um the inflationary assumptions and uh price increases uh but before i open it up to them just two things we're asking all pps hospital or one thing we're asking all pps hospitals is if uh between when you built your budget and now we know that the medicare final um inpatient rate did go up a smidge from 3.8 to 3.1 um can you help us understand uh how that affects uh your budget so so it went up a smidge as you to use your word uh which is less than 150 thousand dollars on our budget um and however we have another assumption in our budget uh related to the medicaid rate increase which uh did not get approved in the budget um so they kind of the from governmental payers perspective i see that as a push i also see some risk possibly in the outpatient uh area because the final rule for outpatient starting in january has not been finalized yet so um you know there's always then the medicare inpatient the ipps which you just talked about but we always we sit around this august timeframe uh and that usually gets approved later on uh and it's not always the same as the ipps um the inpatient perspective payment increase so it's it you know and i don't want to sound um it's it's almost a rounding error in our budget um so um but you know it's another risk and maybe it's an opportunity 150 000 but we have a risk for medicaid of 100 i believe it's 140 000 um so you know they kind of negate each other and and you know again it's not a significant number and um you know i i'm actually go ahead steve just to jump in and sarah yeah what is not a rounding error in which has us greatly concerned is the fact that we may lose our eligibility for 340 b um if we don't hit the the numbers there so that that is a and that's something that we did not budget for and it's a it's a five million dollar impact so that is one that we are losing sleep over and um and it's still yet to be seen as to how that plays out for us yeah yeah understandable um all right well in the interest of time we want to turn to our public comment in about 10 minutes i would say this is a good time for board and hca to ask other questions that you would like to clear up remembering that our decision will be to establish a net patient revenue number in the order for fiscal year 24 um and think about how that relates to the commercial price to get there so um board questions oh i'm sure you have questions maybe okay i have nothing else i have one more um which is around um just understanding the medicaid redetermination assumptions i i think i saw in your submission that you are assuming some increase in bad debt related to the medicaid redeterminations which makes sense if people are shifting from medicaid either to uninsured or um commercial did you have any assumptions around commercial since if people do manage to shift from medicaid to commercial the reimbursement rate will increasingly will significantly increase so robin we discussed with our you know we've been uh with our charity care financial counselors whatever we want to call them um uh staff and um when we were talking about how do we you know account for this and how do we budget for this and susan um the person who has most contact with the patients uh didn't believe that there would be a movement from medicaid to commercial um she didn't think the people that she deals with and works with um she's not she she didn't get a sense that many of these patients would be moving that way and i got to go with her she interviews these people she actually goes to their houses and uh um so she she was not really she said steve a big chunk of these people may end up in my office sort of bad debt you know may end up bad debt financial counseling discounted services but she didn't see um a a large percentage of those patients moving up to commercial um and the assistant director jennifer helfrich she she she had the same feeling and she's my data guru um and she says she can't recall um now granted during the pandemic and the health emergency there was no incentive uh but she says i i don't recall too many even before that uh that people went off from medicaid and became commercial um that is that you know sorry steve is that because she thinks people just get lost in the paperwork because certainly if they're losing medicaid because their income has increased they should be eligible to potentially move into the exchange with a subsidy she um she she said um um if i recall her conversation she says you know yeah there's a couple robin but um she she wouldn't you know she their feedback to me was don't do it okay uh and they're the lying people don't put any more money into commercial because you think a lot of medicaid uh people are gonna move to commercial you know robin there's going to be a couple okay there's going to be some uh but i don't think it's a material amount uh based upon what they say um and i got to go with them and they've been right they've been right uh more times than than i can i can tell you um in my career that's all for me okay sal this is tom walsh um maybe i missed it will you be um covering the cost report tap yep we can look at that now um so southwest uh is a larger small rural hospital um and they may their case mix index is 1.4 so between the 25th and 50th percentile uh this i suspect is uh distorted by the corporate relationship um so i don't know uh how to interpret that without some more information but 36 percent would be on the whisker there uh as far as cash uh from fiscal year 22 it was 11 million uh they are moving some money around for that ed modernization project yeah can i just interject uh on cash cash for operations um keep in mind uh as we outlined in our narrative our days cash on hand and the days and the cash that gets reported on the medicare cost report is scmc's cash okay we uh um the way we have our corporate structure set up we have cash um in the parent organizations our investments are in the parent organization so uh we sit um at about um 100 call it 100 our goal was 190 days it's probably not going to get there um but um so so on the using the cost report um i just want everybody to know that there's other cash available and yes we are also we have a foundation that um has cash and that is contributing to our our um our ed modernization project um and of that 30 million dollars for the ed modernization project uh about more than half of it is coming from donor money um so um you know we have we have that and i think that's in a couple of the other measurements when you look at the total margin of the organization um you'll see that the money coming in for that construction project the accounting rules say you got to transfer it in and it ends up uh in the total margin um so just just be aware of that and that's all cash coming in from the foundation yeah all completely yeah important uh caveats uh profitability uh for ibadar per discharge right at the median so that number more fiscal year 22 lower than people would ideally like to see um and this cost per discharge is quite striking at 8 000 uh which is below the 25th percentile so that again is a cost uh calculated by cost center uh ccrs so and and and this data on the cost uh i paid special attention to this compared to our cleverly um benchmarks and uh it it it's consistent uh with what we've been using over the years that's great thank you sarah and um i just wanted to take a moment to have to really a couple comments right this is um thank you for your your presentation to us and what you've described as your community focus and your addition of primary care service lines and mental health focus and substance use disorder focus is is really outstanding and thank you so much for that similarly the nursing team story is outstanding um and the what the cost per aggressive discharge data shown here is also outstanding but i did want to ask about the ratio of administrative and general salaries because that doesn't quite fit the picture of the rest of your organization um but this suggests that this um portion of of salaries going forward administrative and general expenses is is um on the very high end um compared to the um money being spent on clinical care and i was just hoping you'd help us try to understand yeah tom i i have not been able to to i believe that's um that's cost reporting um techniques and um we can get back to you on that i i believe um i i was a little perplexed on that one as well uh because we do spend more on the cleverly information we spend more on on clinical this is an opposite of of what i saw on on cleverly so i think this is a work in process and we can dive into that and get sarah a response so she can forward to you because i i think this is just a cost report thing um right because i know from all the other benchmarks i look at that's that's not the case yeah it is one for you okay go ahead tom um for your organization it's the piece that doesn't fit yeah it's um so i'm just helping us with it would be great um and just one more bit of kudos um your your um staffing decisions right what we see across um you know socially responsible hospitals across the country faced with difficult times um they don't fill open positions they reduce administration they avoid cuts to service lines all the things that you were describing earlier and um so just uh it's really been the flood we're hearing you and i'm thankful you've started us off thank you other questions from the board uh that you want to have before we say goodbye for this year i just have two questions i'd love to ask one is in the capital expenditures you have a seven million dollar IT infrastructure upgrade is is that to switch to epic to align with Dartmouth or what's what is that so so our seven million dollars is our capital budget for 2024 that's our routine that's the total capital budget for the organization on routine capital that does not include the emergency room the completion of the emergency room project um and of that two million upwards to two million dollars will be spent on IT infrastructure and i would classify that in in in two ways every year you have to for cyber security and for just IT we need to spend money and the second piece of that is going to be to build our infrastructure to be able to receive um and and and utilize Dartmouth's Hitchcock to move to epic uh but that's a three year at least a three year journey so just to repeat the seven million dollars is our total capital budget routine capital budget which about two million is IT and you know let's call it a million million two will be for that infrastructure to move towards Dartmouth and do you do you have an estimated expense of that transition to epic the that's what that's going to cost southwest that the the estimate that we had the last estimate we have could be as high as 20 million dollars but part of our relationship with Dartmouth is that we'll find for funding a range is for that outside of the hospital interesting great but the other question I have is a little bit more conceptual which often when we look at hospital consolidations around the country increases costs of delivering care increases insurance costs um you talked a lot about the decreases in costs through affiliation with Dartmouth do you other than IT upgrades do you suspect increase in costs and how do you think you can manage avoiding that trap of so many other organizations well it comes down to you know uh paying attention to details as Tom spoke earlier the Dartmouth model is is a little different and some of the um I worked for two huge um systems one's a nationwide system and one was a system in New Jersey before it came up to Vermont um and I can tell you that um um Dartmouth does not um utilize the same models that um those systems um did increase costs to the member hospitals um and you know there there are tons of examples of what how costs are increased but I think Dartmouth is very cautious on not adding cost on to the smaller hospitals and we are focused on in our budget you know we are focused on um supply chain reducing our supply chain um costs um by we're the ability for us to purchase under there you know they buy they buy a hundred thousand of a widget uh and we buy a thousand of it well now you know at a hundred and one thousand we can get a price a better price um so we're focused on that um cost of borrowing will be less fees um around certain things that we do we can reduce because there's there's more mass um and uh we're committed to making sure that and so and and I don't want to speak for Dartmouth management but they're committed not to burden us with uh high administrative costs um as other systems have done and and we're going to manage that uh Tom you want to say something yeah just you know um yeah um David I think um two things is Steve touched upon I think Dartmouth has a true focus on not building corporate overhead actually in um I mean most assistants Steve's talking about has very very large corporate overhead and also to reduce administrative costs is another area of a focus that that Dartmouth is talking about and we're talking about too and the other thing is that in a lot of the system wide um managed care negotiations are centralized and that is not the case each hospital negotiates separately um it's not centralized um negotiations and I think that's you know when you start having this a single single signature on managed care contracts that's where you can start seeing costs going on too so that's not the that's not the philosophy that Dartmouth has in their system and their in our integration was approved without having that in place so that's that's another thing so and also the fact that we know we are you know two hours away and so in a sense it's you know we have to be able to to run our operations and and I think that's going to allow us to to you know focus very closely on the the costs that we incur locally here well thank you well I I wish the best of luck for all of us that that continues and we'll see it unfold all right questions from the advocate good morning still barely um Mike Fisher healthcare advocate first off I 100 caveats about the data we have so far about redeterminations May and June numbers were not typical groups July's numbers we don't even have yet but they were greatly infected impacted by the flood but we have I just wanted to in response to member lunges question about movement of people to um possibly to commercial um I guess I hope you're wrong Steve because we have a sizable number of people who are losing you know again 100 caveats about the first couple months but you know 40 of those being reviewed and remember we're doing 200 000 through the year so it's a lot of people who are moving off of medicaid and um so I wanted to make that point first um many of them may move back and you know I shouldn't go down this rabbit hole but I want to make that point and then ask a question I noticed that your your bad debt your uncompensated care generally has increased um 22 it was in the 7 million dollar range and objective for 24 it's in the 10 million dollar range is that the answer to that question the same answer you gave Robin about increased number of people of moving off of medicaid to not being able to pay correct you know and and you know the other you know of course price increase over the two years has a factor in that number um but uh we believe that that that number you know we've you know I've looked historically you know when we have our meetings done on what the budget for bad debt and charity care with the with the staff around the front lines um you know we look at our historical trends what we said um what we and what we actually came in at um all but uh 2020 we were pretty much on target um so um you know I'm pretty confident that uh we'll we shouldn't go over but you know the world's changing quickly uh with this redetermination and it's a wild card but um um part of the team's thought process was um we are going to see see that increase a it's in price and b it's in some volume but not a lot okay your your ratio of bad debt to free care is in the three to one range um and um we've held out a uh an aspirational goal of asking hospitals to attempt to achieve a one-to-one basis um you have a concept of what it would take to um to change that ratio take um you know I kind of and some people like this and some people don't but there are there are patients that will cooperate and work with us okay and um uh then there's patients that won't um so you know improving and adding adding staff uh to go out and um try to convince people um you know it's going to take it's going to take some work uh and and right now we don't see the return on our investment there um because at the end of the day the people that will work with us will work with us and you can't force them so the people who end up in charity care I I wish everybody from bad debt would work with us because we can move them into charity care or some sliding scale okay as as as the you know as our policy calls for but um it um it it's a difficult thing you know I I you know I've been in the business you know and as Sarah said I'm sunsetting um um and um you know I've been a CFO over 32 years and I still haven't found the secret sauce to get everybody to to work with us um and and turn that number from the bad debt to into charity care maybe the the you know maybe my secret sauce wasn't any good I don't know but we're working diligently to qualify as many people as we as who who want to qualify and I think that's the difference um and and and you know there are people though that if they cooperate we usually can find them something sliding scale Medicaid you know you we can get them into a program but the ones that don't cooperate that totally ignore us that is the real frustrating part of it so I think I won't respond to what's going on in people's lives that lead them to not respond or what impacts that has on their ability to get care you've heard me say that a hundred times so I won't go down that road but um we treat everybody like but I will say I think I think the question for me becomes you know what is different what is happening different at different hospitals to lead to different outcomes here some hospitals are landing at a better ratio from our perspective a better ratio of bad debt to free care and so I'll persist in asking that question at other hospitals but that's it yeah um and then my last question is um I think we may have asked this question in the past and I don't know if you can help give us any uh insights to it in your bad debt category um it would be good for us to have a better understanding of what pay you know to what extent those people are from the you know uninsured versus uh commercially insured versus medic care um and unable to pay them so um I think what you're what you're asking and we can dive down you're looking for you know how much of it is is true um bad debt true charity care free care then how much comes from patients that have a high deductible plan where they can't pay their deductible portion and how much is coinsurance and deductibles is that is that what you're asking uh no not exactly I would call all of it true okay all of it yeah yeah but but but I am particularly interested in at this moment in the amount of medic care bad debt um you know that's an area where I think we have some public policy options that I think you and the hospitals and the health care advocates office will agree on um but it would help us to have some uh insight as to the amount of bad debt that you bad debt and free care that you have for people on medic care okay we can follow up later we don't follow up like yeah yep uh thank you thank you board thank you uh I think this would be a good time to offer a chance for a public comment I remember what number I'm supposed to count to 11 20 okay so hearing none uh we'll just give southwest if you could keep your remarks brief sorry to go over time but just uh any last uh comments you want to leave the board with before we let you off the hook for this year so Tom before before you make your final comments can I make a final comment um I'd like to thank the Greenmount Care Board you know as Sarah pointed out I am retiring and I'd like to especially thank Sarah for you know this I'll call it this tool I think the tool has been a help we haven't totally dissected it but and I just want to thank the Greenmount Care Board staff and the board members for the years you know sometimes it's been challenging but it is it's an evolution and thank you Sarah thank you board and keep this tool up Sarah I think it will be helpful you need to tweak it a little bit but thank you everybody thank you Steve for your service and actually Steve stole my my closing comment I wanted to thank him officially too I think he's sort of tremendous job and and thank the board this is a this is a tough year for all of us and and we're entering into some uncharted waters with our new relationship but our commitment is to continue to focus on our mission our community um and um and we'll certainly be as transparent as you know as possible and certainly um try to reduce surprises and make ourselves available to sit down at any point in time to talk to the board and update them update you on where we are and and what the what the concerns are and what the future direction is so thank you for your time today all right I think that concludes this hearing uh I don't probably want to take it from here chair Foster sure um yeah thank you all and you know congratulations on the forthcoming retirement um and we appreciate the presentation we'll take a break we're going to take a full hour break there's a couple things board members have to do in between so we'll come back at 107 and have a good day


Tonight, on EKB Evening News at 6, a widow accuses Eric Seacon of causing her husband's death. Good evening, I'm Cindy Mae Johnson. The continuing legal saga surrounding a Stanville attorney took a different turn today. Over the past couple of weeks, Eric Seacon has been accused of fraud by the Social Security Administration and slapped with a class-action malpractice lawsuit filed on behalf of former clients whose disability benefits were briefly suspended. Today, attorneys for Emma Burchett filed suit against Kahn. The complaint alleges that Kahn's actions led to the suspensions, which in turn set in motion a series of events that ended with Leroy Burchett's suicide. Prestonsburg attorney Ned Pillerstorf and Pikeville attorney Noah Friend, who represent Burchett, say after he received his suspension letter, Leroy Burchett stopped taking his medications, including antidepressants, and sank into depression, which ended with his death. Friend told EKB News, Kahn must be held accountable. The way the law works is it says when you do something that foreseeably leads to the injury or death of someone, you can be held responsible. People rely on their attorneys, especially in cases like Social Security, to practice these cases professionally and properly because these benefits are absolutely essential to people's everyday lives. Mr. Kahn practiced these cases so poorly and committed this fraud that he should have known that this sort of thing would happen. When the benefits were suspended for Mr. Burchett, it led to a lot of distress and problems for him and he ended up committing suicide. And Mr. Kahn has got to be held responsible for that because he should have known that the way he practiced these cases, that this was going to happen. EKB News reached out to Kahn's office today seeking comment. We did not receive an answer prior to this newscast. In addition to his wife, Leroy Burchett, left behind three minor children. Yesterday, EKB News reporter Shannon Deskins reported on the continuing sewage spill from Grundy and efforts to monitor the situation both at Fish Trap Lake and upstream. Today, Shannon spoke with officials in Pikeville to see what effect, if any, the spill is having in that community. She filed this report. In the past few weeks, a lot of attention has been given to the massive sewage spill in Buchanan County, Virginia, but for the most part, the focus has been on Fish Trap Lake and the river that feeds into it. But there are several communities that rely on the Levi's Afork of the Big Sandy River below the Fish Trap Dam spillway. For instance, the water supply for the city of Pikeville comes from that river. But officials with UMG and Pikeville told us that there has been absolutely no change. And the hundreds of water samples they have taken since the spill began. We went with waterplanks, like I said, we sampled about 25 samples per day, and we haven't seen any change in anything so far. And that is great news, especially for tourism in the city, as many people spend time on the river during the summer months. Sean Cochran told us that they haven't seen that anyone is shying away from the river this summer. If anything, we've seen an uptick, especially since school let out this past weekend was one of the busiest weekends that we'd had on the river with kayaking rentals. And then also there was a large group of kayaks that went through that were privately owned, very large group this weekend. So no, we're not seeing any effects from it really at all. In addition to tubing and kayaking for fun, many anglers flocked to Pikeville to fish the river designated as a blue water trail by the Kentucky Department of Fish and Wildlife. A blue water trail means that it's been recognized by Kentucky Fish and Wildlife. And three years ago, Kentucky Fish and Wildlife actually did come in and do testing. And they look for a number of things, flora and fauna, access to and from the river, you know, how well the fishery is. All those factors figure into becoming a blue water trail. At the time, we were only the 14th, I think, in the state to be certified as a blue water trail. So, you know, I personally went fishing two weeks ago and caught 17-inch smallmouth on this stretch of river. So, you know, we haven't really seen any effects from this whatsoever. For EKB Evening News at 6, I'm Shannon Deskins. The former general manager of the Mountain Laurel Mining Complex has been sentenced to 41 months in jail and $15,000 for extortion and tax evasion related to an elaborate seven-year kickback scheme. 45-year-old David E. Runyon of Del Barton was sentenced by U.S. District Judge Thomas E. Johnston. Runyon admitted he and other Arch Coal employees received $1.8 million from vendors over a seven-year period in exchange for continued business. In addition to the sentence, Runyon will be required to pay $1 million in restitution to Arch Coal and more than $325,000 to the IRS. Three administrators of a defunct nursing facility pleaded guilty Friday and Monday to a single charge of racketeering. According to the indictment, Bryan Center of Weber City owner, Avie Klein, regional vice president, Alicia Dietrich, and Bryan Center administrator, Vicki Cox, concocted a wide-ranging scheme to defraud patients, employees, vendors, and the Medicare and Medicaid programs. This included not providing adequate care, deducting premiums from paychecks without enrolling workers in insurance, withholding bill payments, and billing for services not provided. Under the terms of Klein's plea agreement, he won't face any jail time that will be required to pay a $250,000 fine, $419,000 in restitution, and $872,000 for the costs of the investigation. Dietrich and Cox will not face any fines or restitution, but the government will seek incarceration between 1 and 27 months. Klein and Cox will be sentenced August 24th. Dietrich will be sentenced September 2nd. Coming up, the Pikeville Farmers Market is holding their grand opening this weekend, and Pike County Relay for Life, hosted a very special event last night. We'll be back to tell you about it in two minutes. During all of this month's Relay for Life events, the focus is usually on having fun and raising money for cancer research. Last night, EKB News reporter Courtney Levern attended an event where the emphasis was on the end goal for all of those stricken with cancer. Last night, the Relay for Life Survivors Dinner was held at the East Kentucky Expo Center to honor all of those who have beaten cancer. It was a free dinner and volunteers assisted with handing out the turkey dinners to the survivors. It was a night of celebration and remembrance for all those who have fought this battle. Debbie Freeman was the hostess of the evening and talked about the benefit of this event.  The dinner was open to all survivors and the theme this year was centered around the 1950s. One of the survivors in the crowd was Ross Dameron, an 84-year-old man that is a 64-year survivor of six different types of cancer and he shared his story. My cancer story started in 1948 when I was in the Air Force. We was guarding some chemicals and I believe my cancer developed from that. It was a cancer of the thyroid gland, but I just enjoyed life, I played guitar, I played bluegrass guitar, I just enjoyed this supper and banquet every year so much and it's a good thing that all the people do. The crowd consisted not only of survivors who have beaten cancer, but of current cancer patients that are still undergoing treatment. If anyone missed the dinner, there is another event they can attend on Friday. The Relay for Life Walk is Friday night at Bob Amos Park so if survivors didn't get to come, we'll have a survivor tent up there that will be the 50s theme as well and we'll have free food and fun. We try to carry that on over into the week so if you didn't get to come here tonight, try to come by the tent and join in on the fun. For KB Evening News at 6, I'm Courtney Levering. This Saturday marks the 2015 grand opening for the Pikeville Farmers Market at the Pike County Cooperative Extension Office. While it's still early in the growing season, Saturday's market will include local meats, honey, produce, and farm fresh eggs. Some specialty items like jams, roasted duds, and pimento cheese will also be available. Local artists will be on hand with their wares. Other events include face painting and a cooking demonstration. Vendor Charlie Pinson says because the market depends on local growers, patrons will find different items for sale at different times of the year. As a farmer here in Eastern Kentucky, there is a season to everything. The early season in the spring will be like cabbages, broccoli, lettuce, greens, onions, and then it'll move into a few weeks after that you'll get like your zucchinis. You'll get your tomatoes and corn will come in somewhere in July. Hopefully the 4th of July we'll have our first corn. Then later on you'll have melons and then you'll have in the fall months you'll have like water melons, you'll have kushaws, you'll have pumpkins, you'll have different kinds of squash and things. And then again it'll turn around again. You go back to the cool crops which are, or cold crops is what they're called. You go back to broccoli, cabbage, lettuce, and like kale, mustard, turnip, so everything kind of goes in the season. And the season really depends on the temperature and the humidity in the air, like the cold crops, the cabbages, the lettuces, the broccoli, those kind of things. They've got to have that cool nights. The market is officially open Saturdays from 9 until 1 and Tuesday evenings from 4.30 to 7 through at least October. If you'd like to know what's featured every day or take a look behind the scenes, visit the Pikeville Farmers Market Facebook page. During the month of June, the Commonwealth of Virginia is observing Move Over Awareness Month. The observance is intended to alert drivers to the need to slow down and move into another lane when you see police, fire, highway workers and tow trucks on the side of the road. The awareness campaign is intended to improve safety for emergency responders and highway workers according to the National Law Enforcement Officers' Memorial Fund. Since 2005, 123 police officers have been killed as a result of being struck by vehicles. Coming up, a Mingo Central basketball player signed a national letter of intent today. Andrew Joyce will tell us where he's going. But first, let's check in with the weather. An EKB chief meteorologist, Latham Hopkins, has all that. We'll be back to do it in two minutes. Hot date today. A little on the toasty side. Temperatures today. Upper 80s did not hit a record today. I thought we were going to do it. It was so close. But we have another shot during the day tomorrow. Doppler radar. Another thing that we've not had to worry about today. Any kind of showers. And those showers have been either far to the south or far to the west. But nothing here across our region. I want to point out a couple of things here on the satellite and radar composite. If you've been out, you've noticed that it looks like we have cloud cover, but it's really not the clouds that you're seeing out there. We actually have smoke across our region. If you look closely right in through here, you'll see the hazy skies. That is smoke from a forest fire that is ongoing in Canada. And it has just been cruising right across the Ohio Valley and now moving off. And you can see right off the east coast of the U.S. So while it looks like we have some cloud covered is not the case, but it will make for a pretty nice sunset tonight. We should see some colors of orange and red as opposed to what we normally see. So get out there and check that out this evening. As far as temperatures are concerned, a lot of red on the map. 85 in Pikeville, 86 Prestonsburg, 86 in Painesville. 80 right now in Dorton, 83 Whitesburg, and 85 in both West Liberty and in Sawyersville. Temperatures tonight. We've dropped back into the mid and upper 60s. It's going to be a pretty muggy night. Just wait till tomorrow because the forecast highs are back in the upper 80s. And you see some of the shading of the purple there. And that's temperatures flirting with if not exceeding 90 degrees. And I think around 90, 91 will be the forecast high for tomorrow. Once you add the humidity in with that, it's going to be a little more uncomfortable tomorrow as well. So that is what we have to look forward to. What are we talking about? Well, it was so popular yesterday. We had to throw it in there again today. The muggy meter. Yes, yesterday it was right in between the noticeable category and the uncomfortable category. Well, tomorrow we're just going all out uncomfortable. The dew points will be up. That means the humidity will also be up and that will make for an uncomfortable day.  Very high. You could have a sunburn in a matter of about 15 minutes. So reduce your time outdoors, especially between the hours of 10 o'clock and four o'clock. Stay in the shade. Rare the SPF as well. Around 30 SPF is what you need as far as the sunscreen is concerned. All right, that pollen count for tomorrow back to 6.2 out of a possible 12 in the moderate category. Back to near eight as we head into the day on Friday and with the humidity levels returning on Saturday, we go back down into the moderate category at 6.5. Seven day forecast time. Tomorrow still I think we'll be on the dry side 90 degrees, but that daily threat of showers and thunderstorms during the afternoon and evening hours that will return Friday, Saturday, Sunday, even into early to middle parts of next week, each and every day temperatures in the mid to upper 80s. No relief as far as the heat is concerned. Summer is here. Not officially, but it's going to feel like it. Oh, I call it summer now. It's okay. Well, June 1st I think is when you officially say summer is here. But now we've got Relay for Life in Pike County Friday night. Got to keep those showers off for that. Mainly in afternoon. Once we get to the evening hours, we usually see those showers die down. So that's typically what we see as far as that's concerned. I think the relay is about six o'clock that evening. So hopefully we'll be okay. All right, fingers crossed. Thanks, Layton. We're going to be back with sports in just two minutes. Stay with us. Andrew, I know a personal hero of yours from what the 70s had a record fall. Well, tied at least. Okay, tied. Yeah. So it's all still good. You're okay. Now I've got two heroes. All right, that's good. Last night the Reds and Phillies at Great American Ballpark and history was made. Cincinnati Hall of Famer Johnny Bench had three home run games in his career. He was all along with that record until last night in the Reds 11-2 win over the Phillies. Add Joey Vato to the short list of three homer games. Vato with his first and the third, a 412-foot shot to center field in the fifth. This one, 395 feet. It just clears the rail. And finally in the seventh, Vato goes deep to right center field. This one, a 380-foot home run. Vato, three home runs. Now tied with Johnny Bench for that record. In this afternoon, the Reds and Phillies in the series wrap up. Cincinnati was looking to sweep. This one was loaded with excitement.  It was not a good day for Reds shortstop, Zack Cosart. He was injured trying to beat out this throw at first. He left the game with a knee injury and we'll have more details tomorrow after examination. Brian Pena had a much better day. He's one of his four hits. Four for four on the day for Pena. Evanda Jesus comes to the plate. He jacks a three run homer to left and the Reds will go on to knock off the Phillies after a raaldus Chapman comes on. In the ninth, he'll get this final out for his twelfth save of the year. Reds win 5-2 for the series sweep. Pena, four for four. Evanda Jesus with the three run homer and rookie starter John Moskott's first career win on the mound. Reds win 5-2 for the sweep and will go on to face the Cubs. That's coming up tomorrow. The first of a four game series, Cincinnati will take on their National League Central rival beginning Thursday. And the Kentucky High School Baseball All-State selections were released today. The area selected third team All-State was Johnson Central's Jordan Blanton and Painesville's Matt Miller. In softball, All-State starting with first team from SINGLEA, Caitlin Estevez from Jenkins, Jazzy Howard and Laylee Burchell from McGuffin County. Second team SINGLEA All-State selection was Melissa Bartley from Jenkins and Sydney Jones from Shelby Valley. Also an honorable mention from SINGLEA is Whitney Creech. In double A, second team All-State softball, Richelle Fairchild from Johnson Central. And in basketball news, Mingo Central's Dikembe Dixon signed a national letter of intent today solidifying his college choice. Dixon averaged 22 points, 11 rebounds, five blocks and three stills per game last season. Out of a number of schools including Division I, SEC schools and local schools, Dikembe Dixon decided this decision was the best for him. Well, I'm going to UIC which is University of Illinois, Chicago. I mean, I'm happy with the decision at first I wasn't. The school was great. I talked to everyone there, they all act like they wanted to have me there so I feel like I'll be a great fit there because they actually was telling me stuff that I wanted to do and helped me reach my goals and I don't feel like the other schools were going to do that. Plus I wanted to play as a freshman by weighing playing time options and finding a good fit for him and his family. Yeah, at first I didn't think I thought that I should have went high major. I mean, I had high major schools but me and my dad talked about it and he said if you went to high major you might not get as much playing time as you would as a lower major so we came to the conclusion that I need to go there. For EKB Evening News at 6, I'm Makayla Colley. Thanks Makayla. The University of Illinois at Chicago is coached by former Indiana assistant Steve McClain. UIC is a member of the Horizon League. And it was recently announced that Johnson Central basketball star Braxton Blair has committed to play with Alice Lloyd College. Blair averaged 15.4 points, 4.9 assists, 5 rebounds and 2 steals a game. Blair helped lead the Eagles to their fourth straight regional championship all tournament MVP from the 15th region. Good luck Braxton. And in game 3 of the NBA Finals, the Cavaliers put on a show to hold off the Warriors. Cleveland jumped out to a 20 point third quarter lead and had to fight off a late golden state rally for the 96-91 win. The Cavaliers were led by LeBron James 40 points and a surprising 20 from Matthew Delevedova to take two games to one lead in the rest of seven series. Game 4 Thursday night in Cleveland. Thanks Andrew. I heard LeBron James came up on the Daybreak Morning Show this morning too. King James? Yeah. Heard a little talk about that this morning. Is it because that's easier to talk about than Delevedova? Yeah, we try to keep it to a syllable or two. Good idea. Delevedova. I won't even try. I'm calling Dele. That's even easier. It's easier. I like it. We'll be back in two minutes. Stay tuned. Now, for fair-skinned people like me we've got an SPF warning coming up pretty soon, right? If you do indeed, especially tomorrow at UV index about 10 out of a possible 11 about as high as you can go 90 degrees for tomorrow 89 on Friday. And we stay in the mid and upper 80s each and every day through the weekend and early next week with that daily threat of an afternoon shower or storm. For me, it means sunscreen and a hat. And tonight we've got more good classic music coming up. I love classic music and Ted Meadows does it right with full throttle video a brand new edition tonight at 7. Sounds like a not to be missed event. That's going to do it for us tonight on EKB Evening News. Remember you can get more local news anytime by listening to the radio stations of East Kentucky Broadcasting. You can follow EKB News and EKB TV on Facebook and Twitter. We're going to leave you tonight with some background music from around the Russell Fork. Good night. Thanks for watching.


Would you just take a look at that wheel of my top five? 97 Joe Flacco, 97 Ray Lewis, 97 Shadow Corner Devonte Adams, 97 Strong Safety Derby James, 97 Defensive Rookie of the Year, Will Anderson Jr. Are we about to go to the playoffs? Is this the NFC Championship? No? We're 3-0 with this absolute monster team. 90 offense, 93 defense, and 91 overall. And I tell you what, we have earned every step of this squad. Well, it's good boys, welcome back. Hope you're having an amazing day. There's really only a few positions left that are real liabilities. Colby Sorsdahl, Derek Parrish. We gotta get you gentlemen out of there. Nelson Aguilar, Steve Smith Sr. Other than that, that's only four spots on offense that need filling. And let me tell you, if there's a hole that needs to be filled, I'm gonna fill that hole, okay? If there's one thing I've learned, I have janitor herpes. And then on defense, 96 Sean Taylor, 97 Derwin. We got Spoon Stingley Adams at corner with Kermarty as a backup. And then the D-line is nasty. We even added 87 Detackle Ultimate Legend Geno Atkins. Only real things I can mess with here is outside linebackers, MLB2, and honestly Spoon and Stingley are a little bit outdated. But defense is looking great too, to keep it simple. Season seven so far has been one of the craziest, most OP seasons. I'm hoping we can keep that up, but damn man, keep in mind, two losses could set me right back to three and two, and all of a sudden we're in a scary spot. So until I make the playoffs, we're never really set.  You guys know exactly the rules. Let's get our first of three wheel spins. Weekly wildcard top 12. So weekly wildcard is the promo that our prestige Jamar Chase is from. They're honestly just like random. Players that, you know, otherwise weren't getting upgraded cards, kind of like Jamar Chase, which is why it worked out. We are going to sort by program. So we'll go weekly wildcards. Then I need to switch it to time remaining. We can choose one player out of the top 12. Let's go baby, time remaining and look who it is. Shit. It's actually the last guy we wanted to see because we already have him. So not Jamar Chase, but there's D Winters. He's nuts in your mouth. Christian Darisaw, dare I saw your nuts in my mouth. Lucas Patrick, I don't have a good one. Levante David, nothing. Paulson Adibo, Paul, son.  Could be worse. Case Keenum.  Greg Van. Wow. Whoa, whoa, whoa, whoa, whoa, whoa, whoa.  It's too busy making my jokes. Wait a minute. Okay. We have two heater options, two really good options. 96 right guards. I would move him to right tackle. And we would be finished on the O-line. Or, and I'm kind of leaning in this direction, PS2. Patrick Sartan. We've had him on the squad before and he's always been amazing. 6-2-2-0-2. I'd put him at corner two and then I would move spoon to corner three and Stingley to corner four. He is 99 pursuit, a hard 99. He's actually so good. We got to do this. He's going to be a lot more impactful than a right guard at right tackle because I can pick up a lot of guys to do that. In fact, I could just pick up Darasaw too. I think we go Sartan. I wonder if he gets any good discounted abilities. Looks like he does have a 6 ability slot. Hopefully these are discounts. Flat Zone KO. The way I'm going to use him, he's never really going to be in a flat zone. Okay. But he does get pick artists for free. And honestly, when Flat Zone KO is free, you got to take it, right? Don't think we'll get a lot of use out of that. But damn, that boy is looking good. So the new CB1 is Patrick Sartan, which I actually think makes more sense. He's more of a true corner than Devonte Adams. Devonte Adams still kind of scares me. Stingley CB4 and where is my CB3? Devon witherspoon. Yeah. Okay. Those adjustments went perfectly. All right. Patrick Sartan never thought that we would be adding weekly wildcard 96 Sartan to the squad, but I still avoid a wheel about baby. You got to love his second wheel spin. It's a top 12 day, baby. All right. We started the entire auction house by 95 to 96 overall players. And I can choose one of those players.   I should have written this as 94 to 95 or 96 to 97. I'm going to be honest though, 96 to 97 is not fair, because the absolute best cards in this game are 97 overalls. I don't think I should be entitled to that. Otherwise, that's basically a jackpot spin. I'm going to go 94, 95. I apologize on the typo. I already cheated this season with the Devonte Adams. So we're going 94, 95. So 94, 95, one player out of these 12. See my father, CJ Stroud. Steve Largent. Jair Alexander is limited. Love that card, but we probably don't need it. Mike Allstock. Honestly, I really like that. Randy, because I could take Randy Moss or Steve Largent. Dante Wittner is a no. Both Derek Henry's are no's. Two is a no. Seguan's a no. Ricky will is a no. I'm going to be getting a lot of halfbacks. I'm going to take Allstock. Here's my reasoning for Allstock. There are so many opportunities to get wide receivers. There are not a lot of good opportunities to get fullbacks. And 94, Mike Allstock is the best fullback in this game. 94 speed, 94 impact block, 87 lead block. This is the move here. Now Jameer Gibbs will be excited on iFormation runs. And to our third and final wheel spin of the episode, you're watching this video on March 6th, I believe. So I don't think Trent Williams has come out yet. Just thought I'd say that. Oh, darn it. All right. There's an AK crew jackpot, which lets me get the limited. So this promo was basically trios of players or groups of players that had nicknames. It's kind of hard to describe. Gale Sayers, Randall Cunningham. Neither of these are limited, so they're options, but I can't use either of those guys. There's also a 96 Troy Aikman. Can't really use him. 96 Emmett Smith is like a minor upgrade, but I don't want to take out my boy. And then there's Ed Tuttle-Jones, Night Train Lane, B Smode, and Michael Irvin, which are some of the craziest cards in this game, but those are the limited, so I can't get them. Let's look at the 94-95s. Ray Nitschke, Wild Man. I had him last season. He was pretty damn good. Ken Riley, The Rattler. They do Justin Madabueke with Unstoppable Force is so good. He's a really good option right now. Definitely could pick up a wide receiver.  Oh my god. You know exactly who I'm going for. I can't believe I forgot about this. Tori Hall! I don't know how many of you remember this story, but my first ever YouTube video, eight years ago, yes, eight years ago, I was playing Madden Mobile 16, and I was recording a video on how to make coins or some shit, and I'm opening a pro pack as an example. And I pulled 92 overall legend Tori Hall. My reaction was so cringy and so funny at the same time. This guy's a legend in my heart, man. So much nostalgia. I have to go Tori Hall. 95 speed. Like he's not that insane. He actually is a really good wide receiver, but he's not that insane. He gets ankle breaker as an X factor. It might be funny to tinker around with, but I don't know. Gets route, tech, wide receiver apprentice or evasive. Really don't need any of those either. I think we just raw dog Tori Hall, and pray he doesn't get pregnant. Some awesome upgrades today. We upgrade the wide receivers, we get our full back, and we grab Patrick Sertan. I gotta say though, if I lose this game and I don't get to keep Tori Hall, that's gonna make me really sad. Like nostalgia sad. Not just like I lost the Wheel of Mutt game sad. We are now at 93 overall. Congratulations to the squad. Tori Hall is a 96. Here's the thing though. Ankle breaker is zero AP. And how often do I really activate freight train on Jameer Gibbs? Not very often. I'm gonna rock. I'm gonna try this ankle breaker ability on him. All right boys, a 93 overall. Filled some serious holes on that team. Of course, all that's left is the challenge wheel. This is a really important one for me today. And we'll talk about it after I see what the challenge is. I got this one before, and I think there was a rage quiz. This is a perfect challenge to get again. 100 plus yards with two separate players. These are all purpose yards, so Jameer Gibbs could have 50 rushing, 50 receiving. That is 100 yards for him. And then Tori Holt could have 100 receiving. Now the reason I say this is so big is because if I lose the game, but complete the challenge wheel, I am allowed to salvage one player. I'm obviously not planning on losing, but I really want Tori Holt on this team. Chef E84 has got Dan Marino. Chuck Hawley, Ray Lewis. Joe Flacco, Ray Lewis, Devonte Adams. Let's get it baby. I'm taking on my former Wheel of Mutt team. Oh, he's got Super Bowl McCaffrey, huh? With the light it up. With light it up evasive. Starting in dollar three, two. I'm on Ray Lewis. Something tells me he's going to want to go McCaffrey a lot. Oh my God. Sir Tan, how do you have the ball? Did Spoon just swap the ball into Sir Tan's hands? Oh my God, he did. Patrick Sir Tan.  All right, on defense, he's got some abilities out there. Well, I tell you what, I'm glad he threw that pick early. So if I could, so I can throw to Tori Holt over the middle and he should have a high success rate. I like that.  What a heater. What was that blitz? Sir Tan eight. I'm actually kind of like getting stonewalled here. Okay. Another blitz. Let's go Tori Holt. Skill move. Oh, they're not going to lie. I thought that the skill move was going to activate and I'd break that tackle. But damn, dude, that whatever defense he just threw at me was a lot. It was too much to handle. So we go three and out on the opening drive, but this is why we have ButtCurt to pin kicks just like this. We start the game with the defensive stop and a field goal, but I am no closer to my challenge wheel and I got to figure out his defense. So that was a quick minute. Oh my God. First in 10. Let's get another stop. Dude, this guy is going to go McCaffrey all day. All right. We got to get ready to cover him. Here we go, baby. Come on. Pink Warner, Logan Wilson.  Go McCaffrey. Go McCaffrey.  Maybe stretch alert bubble. No. Hey, Nick Bosa. Everybody thinks Nick Bosa discriminates but he doesn't. He'll fly out white quarterbacks too. Come on. Let's get some pressure here. Great defense. No. No. I was on it. He overplayed it. Yo, he switched on to try to snag that and he overplayed it. I've been caught doing that in the last couple of episodes too. Now we go with the Blitz. I got to cover McCaffrey if he's on a wheel. He is. Yup. If you don't block McCaffrey there, you don't got time to throw. Fourth and 15. From the 49. All right. We're going to play dollar. We're going to play deep. I'm going to go on spoon. He shouldn't have anything. Oh, what a play, but he missed it. I pulled spoon out of that purple. Oh my God. I just got bailed. Did somebody get home and affect that throw or what? Because I just got bailed straight up. Is he going with the same Blitz? No, this is actually different defense. Before he was sending a six-man Blitz at me with the linebackers. All right. Now, keeping in mind, I do have an RPL out of this. Zone Alert Omaha, which I can throw to George Kittle and he's going to pirouette. I got to just take that play out of my rotation, man. If they pirouette, no chance you get yards on it. All right. Second and 11. Gibbs is going to be wide open. Beautiful work, Gibbs. But I am getting hunked down. I thought I might have the wheels to get around that. No serve. I'm going to put Gibbs in the middle here. I'm going to put Tori Holt underneath. See how this looks. Gibbs is there. Keep it simple. Don't complicate things, Matt. Go smoke screen out of Tori Holt. See what their zone drops look like. Beautiful. I love that. Tori Holt. A lot of people put their zone drops super deep like that. Makes it possible. Just like this same thing right here. All right. Seven for eight, 40 yards. Offense is looking good right now. We're not hitting them with any nukes, but not everybody's Oppenheimer. There's the Blitz. Gronk. Oh, I had Gibbs on a touchdown. Shit. That's all right. That's all right. We're going to get it anyway to make this 10 to 0. End of the first, it's 3-0. Dude, wait a minute. This is a really interesting way to activate Tori Holt. This is jet pass fake zone. So this is a pass. So this should consider Tori Holt. I was going to say it should use his ankle breaker, but I'm realizing that ability is not so great because you have to use a skill move. So if you don't use a skill move and under shit, let's see if he's in man. He is Tori Holt. Whip roll. The goats. You don't need the ability. You really don't. 9 to 0. I'm going for 2. We're already at a two possession lead. I'm going to go Tori Holt on a hitch. And I got to quick throw this right there. Boom. Holt. Oh, no. God, that's a dot. Got to keep mixing my defense up. Let's guess pass here. And I'll go on Ray in case he runs an inside zone. He does not have McCaffrey, but he does have that. Damn it. Toping that zone KO on Shaunty might be enough. I'm going to send a risky blitz. I'm sending Sir Tan and Logan Wilson here. Oh, and he throws the Shaunty. Let's go. Get out of there. That's cool. Dude, stop. That Shaunty is so good. I see George Kittle pressed. I'm going to go Jamir. Another knockout, damn. Love this formation so much. We get all styled as a blocker and then Holt. That beautiful corner out right there.  Oh, that's Donald Parham, middle linebacker. I don't know if you guys have seen that card. It was like a Madden stream exclusive or something. It's not on the auction house. The card is nasty. Third and 10, dude. Every once in a while, he just starts to kill me with his defense. Oh, here we go. Holt. Single cover. It's got him. Go, Tori Holt. It's going to take. Had a legend, bro. A Madden legend. Now my two-point conversions are really big because if I can make this a 17-point game, well, this shit's about to be all she wrote. Oh, Tori, I need you, buddy. I need you. Oh, my God.  And then I get to my two-point conversions and I am dogwater. You know what's even sadder? If I just kick both PATs, I'd have 17. But honestly, if I lose this game, I deserve it. We're playing so well right now. Let's just keep doing that. Ray, Ray. Oh, my cat forgot me. Or did he? Excellent decision to freeform because I might have actually lurked you there. All right. My responsibilities, McCaffrey. Play action. Nice block pickup, McCaffrey. Good morning. Oh, he's gone. Naturally, he's gone after that. I don't know why we are cooking so hard right now, but we are cooking so hard. No challenge wheel needed for Tori Holt. Well, okay, so in this game, I definitely did not complete my challenge wheel. So there's no way I can try and finesse it. But we do keep the players we added and another spin on the rage quit wheel, baby. Let's get it, boys. Big rage quit wheel spin here. This is how we keep absolutely building this like just monster team. Is this right here? What does that say? Worst position plus five? That really doesn't help us that much, unfortunately, because I have a silver right tackle in. But at the very least, I can now put in a 73 right tackle, which is an upgrade. So I will happily do that. Blake Freeland.  You know, not every upgrade is going to be a 97 overall limited, guys. Come on. We have to be, we have to take everything we can get in Wheel of Mud. Even a 68302 63 speed Blake Freeland. Gentlemen, I'm sorry for a short episode. Nothing makes me sadder than a short episode of Wheel of Mud. But what if I promised you a banger next episode? Would you forgive me? Gentlemen, I love you. Thanks for watching as always. I'll see you guys in the next Wheel of Mud. Peace.


Ukraine wants F-16 aircraft President of Ukraine Volodymyr Zelensky has called on the participants of the meeting in the Ramstein format to provide Ukraine with F-16 aircraft and long-range missiles, Union informs. Zelensky was speaking during an online address at the beginning of the meeting of the contact group on Ukraine's defence issues, the so-called Ramstein 8, which is taking place at an airbase in Germany. He thanked them for the unity, dialogue and format of cooperation with Ukraine within the Ramstein and expressed confidence that this unity will become even stronger. Do we have much time? No. Terra does not allow for discussion. Terra, burning city after city, becomes defiant when they, the Russians, feel that the defenders of freedom are running out of weapons against it. The war started by Russia does not allow delays. I can thank you hundreds of times and it will be absolutely fair and honest if we talk about what we have already done. But hundreds of thanks are not hundreds of tanks. All of us can say a thousand words during discussions, but I cannot replace weapons with words, which is needed against Russian artillery or air defence missiles which are needed to protect people from Russian air strikes. Zelensky stressed. He called on the delegates to the meeting not to allow a world order where hatred will reign and to increase their efforts to help defend Ukraine against Russia. It is in your power to guarantee the artillery and ammunition we need.


Ravida on todella huomioida, joka on lisäksi, että voidaan arvoi kohdella kohdella, ja haluaa kovaa hienojen kohdella, joka on kohdella kohdella acidin, kohdella uudelleen kohdella, ja hieno kohdella acidin ja anamonioon kohdella. Ja tämä on jopa kohdella kohdella, josta ei ole technology yet in a market, and this makes possible to maximise the recovery from the waste for the stream. So we are very excited about it. And then what comes to peltixy, this is also a potential step in a polishing step in the end of the treatment plant, which makes possible to adjust the effluent quality to very low figures and that way help to prevent eutification in the peltixy. And this bonus return program is very interesting for us because we are able to meet potential clients, potential municipalities and also potential end users, which are very important to know because otherwise you are not making things which are fulfilling the needs of the clients on both sides. And then on the other hand the technical development needs always a sort of third-part evaluation and that's one opportunity in this program to get that type of support for our thoughts and maybe some new ideas which we haven't found yet, so that's one value of bonus return.


Let's get started. Yeah, Alameda, how big was the touchdown yesterday? And where would you have been scoring on the corner and getting up the sideline there after y'all had a year when I showed you? Two possessions for us at the end of the half and the end of the game, put points on the board to help us get us in a position to win the game. So I just did my part, did what I was supposed to do, and everybody else did what they were supposed to do, and helped us contribute to winning.  It looked like you cut us to just five different guys, it was eight or 10 or 71. Did y'all think y'all had them on the heels doing that drive? Just everybody doing their job, you know. That's really it. Everybody being on the same page and just not, you know, being tense or anything. We've been in that position before, you know. Ended a half to just put points on the board, you know, and then it helps coming out of halftime when defense, you know, has a 10-point lead. So it's everybody doing their job. The way that you know, it's one, the majority of your team is somewhat similar to that. Can that be, can you be comfortable with that being a team identity? I don't think you can ever be comfortable in this league with anything that you do. You have to always find ways to improve. So once you get comfortable, that's when you start losing. You start doing the little things wrong. It just becomes a snowball effect. So I don't think we can ever be comfortable. Well, I'm not saying just being comfortable, I'm talking about comfortable with that, with being able to win that way, understanding that we cannot win it. Can that be a team identity? I mean, it can. Just with any other team, it could be their identity as well. Just think it's about winning, you know, doing our job, executing, each playing, just doing the basic things right. You feel like it's your own. You feel like it's your team's identity? I don't necessarily, I don't know. I don't really know what you're trying to get at, to be honest, but it was a good win for us and everybody did their job, played their part. Jose, how do you describe just the swings of momentum of motion, whatever, in the fourth quarter where 10 minutes left, y'all are up 18, they score a touchdown with a minute left and then you get a 60 yard or you're right into field goal range. How do you describe it? Just keeping our poise and like I said, just everybody doing their job, like just going back to the basics and executing, executing in critical situations and, you know, just whenever your number is called, just being able to make a play for the team. Talking about everybody in their job, I know we were talking to Dave Regan earlier in the week who's kind of talking about how this offense is at its most productive point. You're spreading the ball out and everyone's involved. So you kind of speak to that and how you kind of saw that play out today. Just as I've been saying, this is everybody doing their job, you know, whenever their number is called, just making a play, doing what you're supposed to, protecting the ball and then just, it's contagious. Like it's a contagious thing when you see people make plays that, you know, have been working really hard, you know, throughout the week and this whole year. So it definitely is a good thing to see that other people, a lot of us are touching the ball and just helping us win. You've kind of gone through this a few times this year of having to tend to out there for the last second, but do you think this kind of frees confidence in y'all that like we know in these situations we can get the job done? Definitely.  You know, it just helps us believe really that we can win and we can do it. And then I've been saying this, I'll keep saying this is about execution, in critical moments. All right, cool.


Demon presence have not saved levels. Lockdown, okay? Demon presence have not saved levels. Lockdown.


Good morning everyone. So WebRTC. What is WebRTC? So beyond that, let's discuss what's RTC. RTC is real-time communication. So real-time communication is long, bad thing. The thing which we have been doing for ages, the modes have been changing. It may be offline, then it converted to online. When we go to online, we have been doing this real-time communication using flash plugins, using different plugins on the browser. So what's new in that? We have been doing that on browsers for long back. What's new we are doing in WebRTC? Why it's real-time communication on Web a new thing? So the real-time communication on the web, initially it was done using plugins which are not native to Web. So yes, why we should do it? Because with the advent of WebRTC, everything is on Web. It's built on JS. It's a plugin-free, it's a JavaScript-based, it's a cross-platform. When we say plugin-free, it's native to your browser. All you have to do is just run your code. You don't need to install any flash plugin, you don't need to install any other plugin. It has no dependencies. It's right in your browser. All you have to use the APIs. JavaScript-based. So now what you are doing, video chat, maybe audio chat or maybe screen sharing, file sharing, that's just another JS app. That's nothing more than that. Just a JavaScript code that handles everything of it. Cross-platform. So when we say cross-platform, that means it runs across browsers. You can chat from Firefox to Chrome without any plugin. You don't need to install any plugin on Chrome or maybe Firefox.  The same thing. On the same code. So as I said, by Renderi, the founder of JavaScript, the best person to talk about JavaScript in the day I saw, WebRTC is a new front-end in the long-world for open-end previews. And yeah, I truly support that. How? So how to get started with WebRTC? Have you ever used WebRTC, anyone of us? Ever used WebRTC? Or do you guys know someone, some project that has been using WebRTC? So how many of you use WhatsApp Web? That's using WebRTC. So when we say WebRTC, it doesn't mean this is a video call or this is an audio call. It includes data also. The communication can be in the form of data also. So that's what WhatsApp Web has been doing. So how to start with WebRTC? So basically it's divided into three parts. First one is get use of media. Second one is RDC peer connection. Third one is RDC data channel. It may sound something complicated. I'll just make it easy for you guys. So first part, we collect the data. Second part, we just collect the peers. Third part, we actually ensure that the peer has been delivered. The message has been delivered to the peer. That's a complete lifecycle of WebRTC application. So when we talk about get use of media, have you ever used any camera app on your mobile browser? Or any camera app on your desktop browser? So any, for example, any app which is built on Web uses the camera, the camera of your phone or maybe camera of your browser. That uses get use of media. So what does get use of media does? Basically it extracts the information from your camera. Basically the data in bytes form. And maybe it can be audio, it can be video, it can be anything. So as we get use of media, get the media of the user. It present a stream of audio and video and or video. It can be audio or video together. It can be audio itself. It can be just video, depending on the situation, depending on the requirement of the project. For example, suppose we have a camera app. All we need to do is click a photo of you and maybe create a frame from it and send to your friend. So what we have to do? Just grab the get use of media and extract the image which is captured by your camera. And transmit it as a stream to your friend. It's as simple as that. Now the second part, RDC peer connection. So as by name, peer connection. So these are the APIs which ensure that your peer has been connected and the communication can take place. Peer to peer communication as by the name. It ensures that the network, the communication between peer and other peer has been generated. It is responsible for signal processing, collect handling, bandwidth management. So this layer, this API take care of these all issues. For example, if you are on 3G, but your friend is on maybe 2G. So there should be a common ground so that both can get the same video or audio quality the other one is getting. So that is ensured by this API. So it works on bandwidth of the connection and it takes both of the bandwidth. The bandwidth of the user 1 or bandwidth of the user 2. Codec handling. So it depends on the browser version of your computer. It can be old version, it can be new version. And there comes the problem of codec. So that is managed by RDC peer communication, peer connection. And third one is RDC beta channel. So this one is basically used. Suppose we want to share a file over internet. That is done by this. And other one which we use is screen sharing. If you want to share your screen, for example, in Google Hangouts, while chatting we can share our screens so as to get more information about the person. Or maybe suppose we are presenting someone during a meeting, we need to present someone. We share screen. So that is taken care by this API, RDC data channel. So basically what we say when we say about real-time communication, it's just not the video and audio. It's about the data also. The data of your screen, it is screen shot basically. That is being shared to the other person. And that's not coming from your camera but your computer screen. So that's taken care by RDC data channel. So these are the things which you do on browser. Everything till now what I explained was working on browser. For example, the peer connection, the user media, all these are browser APIs. Whatever they do, it is constrained to browser. It has nothing to do with server, it has nothing to do with backend things. Everything is written in JavaScript and deployed on servers just to get the code. But yes, when we communicate from one browser to another, we need a common place. So there comes the server. So we have two types of server, term and term. So these are the server dedicated for passing the signals between the peers. They just ensure that the peers are connected. So this is architecture. Basically there is a peer. There is a metadata translator. And there is a standard, a standard server. And there is a term server. So the difference between standard and term server, this ensures the stability. This ensures the connection. So the major challenge is an ear bag for WebRTC was like, are we ready? And an ear bag, that question was a big, big and huge. Were we ready for getting into the real world? But an year after, this is a stat. As you can see, almost every browser support it. And I can say, if it's supported, that means we are going good. So WebRTC is production ready and being deployed everywhere. Who is using Google Allo and Do? Hangouts, Whatsappware, FBA.in, Google conference. These all are using WebRTC. Every of these sites are using WebRTC for their solution. Because the thing is, whatever is on web, it has to be cross-platform. It can be deployed on mobile, it can be deployed on tablets, it can be deployed on anywhere. And these are the few resources. When we want to get started with it, we can get started with WebRTC experiments.com, WebRTC.org. So that's it from my side. Thanks usual. That was a quick one.