to Stan the energy man here in Think Tech Hawaii, Stan Osserman, I'm into you live and direct from Kailua Hawaii and it's really turning out to be a great start to summer. I actually got some surfing in yesterday. Nice south swell came in and surprised us all. Anyway, this show and just for the record, I don't particularly like to do solo shows. I figured it's probably much more interesting for me to interview some really good people that are doing energy work, clean energy work. But I also have a passion for hydrogen and I feel like there's just not enough information getting out in the normal media and in our newspapers and social media about hydrogen and where it's going. And it really is a game changing technology that's starting to really, really take off around the world. And so I've got a couple of stories today. I'm bringing you hydrogen news from around the world. And the first story I'm actually going to read the whole article to you because I think it's really, really important. It came out yesterday and we're going to we can put the screenshot of it up on the screen so you can you can grab it. But it's by Michael Weyland and it's called by land sea and air. GM or General Motors plans to expand fuel cell business beyond electric vehicle. And the reason I wanted to do this whole article is it really covers a whole bunch of the things that I've been saying, not just for the last year or so, but for the last decade about hydrogen that's finally catching on in the mainstream. It says General Motors plans for hydrogen fuel cells, a long promise technology, are beginning to take shape in the company as it pours 35 billion, that's with a B, billion dollars into electric and autonomous vehicles through 2025. So that's just over the next three and a half, four years. GM began working on the fuel cells more than 50 years with little or no commercial success. They didn't really market anything. But I know this is a fact because GM actually worked with Hcat, my prior employer, back in the 19, excuse me, 2010. And a little bit before that, maybe 2006, 2010 timeframe with fuel cell vehicles being driven by the military here in Hawaii. But GM aims to change that lack of actual exposure in the coming years with its hydro tech fuel cell system, I guess their proprietary name for their special fuel cell system, which could be a dark horse business to grow GM's operations outside of automotive. GM has these tremendous opportunities for fuel cells in the military, commercial vehicles and other forms of transportation, such as rail and maritime. GM is exploring those areas and more as a complementary solution to its emerging battery electric vehicle business known as Altium, U-L-E-I-U-M. I guess that's their other proprietary name for their battery side. And just remember, last week I did a show on the Energy Observer where Toyota had a similarly packaged fuel cell that they put on a floating laboratory that was already put 40,000 kilometers of sea under its hull, testing out the technology. The article goes on to say batteries have a role to fill, but to fully electrify and deal with the breadth of the different applications that we're talking about, you also have to have hydrogen fuel cells that is Charlie Freeze, who leads GM's global fuel cell business. They complement each other extremely well. Hydrogen fuel cell electric vehicles and equipment operate much like battery electric ones, but are powered by electricity generated from hydrogen and oxygen instead of pure batteries or additional batteries. With water vapor and the only byproduct, they also heat. They're filling up with a nozzle that's almost as quick as traditional gas flow-ups using diesel or gasoline. As a general rule of thumb for you says batteries are best utilized to replace vehicles and equipment that use gasoline. Well, fuel cells are better for longer range, and vehicles that are semi-trucks that use diesel fuel. Every market, this is continuous code, every market is going to be a little different, but what's clear is that the world's moving towards electrification, I would say in transportation especially, he said the fuel cell technology has moved down the cost curve dramatically and continues to do that. GM said last week it plans to launch a third generation hydrotec fuel cells with even greater power density and lower costs by mid-decade. It goes on to say that fuel cell vehicles face the same challenges that battery electric vehicles face when they first came out, including consumer acceptance, fueling infrastructure, or lack thereof, and cost. It's one of the reasons why GM is looking outside of the automotive realm to help drive demand for these technologies. GM announced Thursday a deal with Lever Aerospace to develop hydrogen fuel cell-based power generation for demonstrator systems or aircraft. That announcement came two days after the automaker that it was signing a memorandum of understanding with Webtech Corporation to engineer and supply battery and hydrogen fuel cell systems for freight locomotives. If you go to the website and look at this article, it shows you photos of the vehicles and locomotives as well. Anyway, GM also has agreements or partnerships regarding hydrotec, that's their fuel cell system, with Navistar and embattled EV startup, Nicola Motors. The programs are in addition to several prior ones between GM and the US military, involving hydrogen fuel cells, including a pickup truck and an underwater unmanned vehicles with an AD. We use kind of a land-sea air approach preset. It's energy storage density for longer missions, quick refueling and quiet stealth, low thermal initiatives, but it's images. Those are the things that are very important to, especially to the military, to those applications. And those carry over to some other industries as well. Reset General Motors expects to commercialize the fuel cell for real-world solutions soon, declining to elaborate on those plans. GM has a joint venture with Honda Motor, which offers a production fuel cell vehicle called the Clarity to develop and produce fuel cells and a plant in Michigan. The most near-term product that GM has announced is with the Illinois-based truck manufacturer, Navistar. The companies earlier this year announced the collaboration of a fuel cell-powered semi-truck that JD Hunt Transport is expected to be the first customer to pilot semi-trucks and hydrogen fueling systems by the end of 2022. Think about that. That's just literally months away. They're going to have the pilot system up and running. Remember the article said earlier that Navistar was also partnered with a company called Nicola Motors? Well, Nicola really, really got this whole thing started and GM jumped on it. They had a little bit of a rough going for a little while with Nicola Motors, but the project itself is still online. And that's going to come online shortly. And it basically, what it does is it gives the commercial truckers an alternative to diesel fuel. It's actually in the long run cheaper than a diesel truck. The truck itself is and the fuel are part of a system and the truckers can lease the vehicles and the lease comes with the fuel and it's a firm fixed price, which is great compared to diesel and other gasoline and things like that that fluctuate with world oil prices. And that's coming up a little bit later in this show. The next subtitle is Uncertain Future. Go back to the article. Many believe hydrogen can help decarbonize industries where batteries fall short due to their low energy density and higher weight. But the technology is still expected to take a backseat to battery electric vehicles, which are cheaper and easier for consumers and companies to understand. In other words, it's just a matter of people getting used to the hydrogen technology and then it will probably become much more popular. I've explained on the show before, there's other setbacks for battery electric vehicles and the battery technology, but that really sums it up pretty well. Hydrogen's transportation future looks more uncertain given the tug of war with batteries. BTIG analyst Gregory Lewis said in a recent note to investors, we expect hydrogen to be used in a niche application. I'm going to beg to differ with them, but it is one of the problems with getting hydrogen to move forward because we have people who still tend to focus on batteries and overlook their shortcomings just because people are more comfortable with them. The biggest naced air for hydrogen, of course, is the famous Elon Musk, whose company is Tesla and also SpaceX.  I think he's going to be eating those words in about 10 years. It just takes a little while to get there. So to wrap the article up, it says, but there's a growing market for the technologies amid an increase and an increase in legislation globally that's targeting decarbonization. Fortune Business Insights forecast that the global fuel cell market will be $29 billion with a B by 2028. The key, as GM is targeting it, they bring down the cost for commercial customers, many of whom have set routes and site for fueling stations rather than customers alone. Industrial applications like steel, refining, and chemicals where green hydrogen can be produced and consumed on site avoids transportation costs, and they are poised to be heavily heavy adopters of green hydrogen. Lewis said additionally, hydrogen for industrial use is already gaining traction in some nations zero emission policy. Again, the synergies of hydrogen technology reverberate across everything. Like we talk about electrolyzers to make green hydrogen. Well, the interesting thing about that is the byproduct that we throw away is pure medical grade oxygen. And if you're using a fuel cell to make electricity, you're also generating a little bit of heat. That's why I injected that the fuel cell doesn't just make water and electricity. It also makes heat. When you're making heat, you can capture the heat. We call it cogeneration. And you can use that heat to also make electricity or air conditioning or other things. So the article, this article that focuses on GM brings in the entire spectrum of what fuel cells are being targeted for. And when a company like GM talks about spending the amount of money they're talking about in the billions of dollars, after already investing almost 20 years of research and many, many hundreds of millions of dollars in refining these technologies, you've got to understand that this technology is on the cusp of taking off. So the next article I have, and I'm not going to read the whole article, I'm just going to summarize it, but it's called it's too late to avoid a major oil supply crisis. And as I mentioned, when I was talking about in the GM article, the one thing that I have learned from, and I always will keep an eye on the carbon energy market as well, not just the hydrogen focus guy, but that carbon side is so volatile in terms of whether there's available fuels, whether there's a, you know, when we had OPEC basically jerking us around because they control the oil supply that the world needed, we would go through heavy price, you know, ungodly price increases. And then the next week it would plummet and nobody could predict. If you talk to any businessman, they'll tell you that when it comes to raw materials or supplies that they need to produce whatever they're manufacturing, if they can stabilize that, if they can get, you know, a multi-year contract at a fixed price that they can work with, they know they can maximize their profits by having a stable cost of their raw materials. Well, energy is virtually a ubiquitous raw material in manufacturing. It's something that every manufacturer has to have, whether you're into computers or making silicone chips or making bread in a bakery, fuel costs are critical. And if you can stabilize them, you've really, really got your economy under control. So this article, it talks about how with changes that the U.S. has made in its energy policies and with other circumstances, the cost of energy is going to become very unstable and probably go up quite a bit. So the oil, this is a quote from some of the articles that says, share wells have a naturally high decline year to year that can be avoided temporarily by fracking. But make no mistake though, lack of new drilling will start to show a decline in production as early as next year. And as we all know, lack of supply, increase demand, price goes up. Because what's not said in so many articles is, fortune has been spent on by Wall Street banks over the last 15 years looking for the new super oil fields with little results. In other words, they spent a lot of money looking for more oil that we have access to, and they haven't really found them. So you have all the fracking and all of the shale oil and things like that that we're counting on to keep our energy independence going, even before President Biden jumped in and shut down pipelines and things. Even the fracking of things that we're using are of limited value because they're declining. As the shale drilling fleet has been depleted, Gulf Deepwater platforms are also in steep rates of decline. It says, and most of the employees from last year's oil market crash have moved on never to return. So of the U.S. conventional oil wells, we lost 25% due to the marginal production rate that we experienced over the last year due to COVID and manipulation in the markets that drove some of our companies out of business. And when I say that, it's like when you are a company that invested heavily in fracking or shale oil recovery, and all of a sudden the prices of oil drop, now you can't pay back your loans because you borrowed so much money to buy all this equipment. A lot of those companies went bankrupt, their employees are gone, and they've gone on and moved on to new technology. They're not going to stay in the oil business. So as we talk about hydrogen growing in popularity and growing in viability in the energy system and transportation, you have to kind of keep looking at what's going on in the oil side of it. So what I'd like to do now is just go through a bunch of articles that came my way from Keith Malone, my good friend from the California fuel cell partnership, and I'm going to read through just the list of the articles, and then I'm going to pick a few of them and kind of focus on them. The first one is Jaguar and Land Rover are beginning testing of a prototype hydrogen Land Rover vehicle this year. So not only is GM bullish on hydrogen fuel cells, but Honda makes the clarity, Toyota makes the Mirai, Hyundai makes the Nexo, and they also have a SUV model, and Hyundai is in production. These are companies that are in production. You can buy these vehicles from Toyota, Honda, and Hyundai right now, and GM is coming online. You can bet that BMW, Ford, almost all major motor companies that are doing that are starting to really put out electric vehicles, Volvo, etc. You can bet that within a couple years they'll be complimenting their electric vehicle line with hydrogen fuel cell vehicles because as infrastructure gets put together in the U.S. and across Europe, and people can travel comfortably with hydrogen, they're going to go that way because of the range that you can get and the speed of refueling you can get, much more convenient than with electric vehicles. It says Honda fuel cell technology will continue to play a role in their EV strategy. Germany is going to support 500 megawatt of electrolyzers around the world with $1.1 billion in German investment. Opium, which is a car company, unveils its hydrogen-powered sedan prototype and opens the first 1,000 pre-orders. Then another company completes its light-duty hydrogen fueling infrastructure network study for British Columbia that talks about their plan to actually populate British Columbia with network of fueling stations to accommodate fuel cell vehicles. Southern California GAF says H2 Hydrogen House was named a fast company in 2021 for world-changing ideas. I don't think these related to the hydrogen house by Mike Stritsky over New Jersey, but H2 Hydrogen Home by SoCal GAF is supposed to be a pretty remarkable, basically off-the-grid, self-contained, fully sustainable structure. There's a couple articles from Norway. Norway Roadmap for Hydrogen includes Node and Research, British Petroleum and Acre, and a Stratcraft joint forces for offshore wind in the Norwegian North Sea. A lot of that wind is being converted to hydrogen, so it can be shipped as ammonia to outline communities and used in fuel cells to generate electricity in these communities. They can come off of coal-fired power plants. I just read the article on GM to supply electric batteries, hydrogen fuel cell systems for the locomotive. Japan has a big bet on hydrogen, and they said it could revolutionize the energy market, and that's the story from Wall Street Journal. San Francisco Bay Area's AC Transit has ordered an additional 20 fuel cell electric buses from New Flyer. Now AC Transit in San Francisco is one of the larger public transportation systems in the U.S., and they've actually been using fuel cell vehicles for probably, I would say, close to 10 years now. And the feedback, because I've talked to people there and talked to the state agencies that have developed those county agencies, and the feedback from the customers is outstanding. In fact, they've literally reported that some people will wait at a bus stop just for a fuel cell bus rather than driving a diesel bus, because it's so much more comfortable, air conditioning works more effectively, it's so much quieter, and it's nice to move the ride. The last couple of articles from Keith Malone's newsletters, U.S. must take a leading role in hydrogen use for our energy future. That's kind of a broad sweeping statement, but I can tell you that there's a lot of other countries that are much farther ahead in hydrogen infrastructure and deploying hydrogen technology than the U.S., and the U.S. needs to be the leader. The U.S. leads in so many ways, but this is a profound change in the way we use energy on our planet to clean up the environment and treat the planet more respectfully, and if we don't take that lead, somebody else will, and we should be doing it because we have the capacity and we have the resources, and quite frankly, we have the intellectual capital to make it happen. The last article says why green hydrogen is reaching a tipping point, and it goes into a lot of the details that I've kind of covered already in a lot of this, and you see it in the articles that we're talking about is that whether it's aviation or ground transportation, locomotives, tips, boats, hydrogen is such a clean, simple, few moving parts, just, I would call it a, we used to say it's just an exquisite or it's a, it's just a very, very beautiful system, and you get into looking at all the moving parts, all the pieces that go into it. It's clean, it's safe, you don't have to go into mines with child labor in foreign countries who start producing these things. The fuel cells went from being heavy uses of platinum, which is a metal that's hard to get, and we'd get mine in many other countries using labor, but Toyota by itself reduced the amount of platinum used in electrolyzers and fuel cells by 95%. The fuel cells that are in cars today that are like 114 kilowatt fuel cells in the Toyota Mirai use about the same amount of platinum that's in a regular catalytic converter in a regular gasoline car now. It's just amazing. So things are beginning to gel with hydrogen, and it's really starting to kick in around the world. And I'm going to keep everyone small, I'm going to keep bringing you news from around the world, but Germany is supporting that 500 megawatt, that's a lot of electrolyzers around the world. That includes 16 companies joining H2 Global Foundation, and they're expecting to have the first electrolyzers out in 2024, again not very far down the road. Oh, that Hopium, that company Hopium that unveils their hydrogen powered sedan prototype, their website for the article is www.ernewswire.com, and you can look up, or you can just Google Hopium, H-O-P-I-U-F. The Hopium team has already fully committed to carrying out the next steps to get this vehicle online. Oh, the founder of Hopium is Oliver Lombard, who was the youngest winner of the 24-hour of Le Mans race, founded Hopium to manufacture high-end hydrogen-powered vehicles as an achievement, resulting from his experiences acquired on the racetrack. So this Hopium vehicle is probably a pretty high-tech like racing vehicle, you might want to check it out. Now let me see, talked about Southern California gas, that hydrogen house, they claim it's going to be built later this year in the city of Downey, E-O-W-N-E-Y, and they claim it's the first fully integrated demonstration project with solar panels, batteries, electrolyzers that convert solar energy to hydrogen, and a fuel cell supply to supply direct electricity to the home. In addition, the hydrogen will also be blended with natural gas and used in the home's heat pump and H-Back system, water heater, clothes dryer, and gas stove. The home will be functioning, have the function and feel of a typical home today, but will be fueled or energy powered by reliable and clean energy 24 hours a day, seven days a week, 365 days a year. Normally these systems, and we're pretty familiar with them here in Hawaii because of Blue Planet, you'll have solar panels that will charge up batteries, and when they're done charging batteries, if they're still making electricity, they make hydrogen. So every bit of that power from the solar panels is used, not wasted, and it all goes into running your home. Now, when I say you can do that, the amazing part is that a typical house only puts about half of its roof under solar to make enough electricity for that house to run 24 hours or more. Now, if you throw transportation, like say you wanted to run your hydrogen fuel cell car or charge your electric car at home, you would have to almost double the amount of power you need to be generated, maybe even a little bit more. So if you think about it, if you build your houses oriented properly in Northern Hemisphere, oriented with a roof mostly facing south, you should be able to put on your single family roof enough solar panels to make all the electricity your house needs, all the fuel your vehicles need, and still have a supply of hydrogen that's enough to back up things in case you have cloudy days or a storm that takes off some of your solar panels or other natural disasters. And besides that, when you have a bunch of those independent houses that can work like that, there's less pressure on the grid because there's less demand in the whole grid, and those houses can take care of themselves and maybe even take care of their neighbors. I'm going to wrap it up for today. That's really good up-to-date on what's going on around the world, and I'll keep doing it when I see new things come up. But until next Tuesday, I'm Energy Man Simon on the floor.


Hey guys! Welcome back to my channel! So for this video I'm going to be showing you guys how to dress vintage using modern clothing and how to do that all on a budget. Now if you guys have not seen my vintage fashion video where I break down how to dress vintage to begin with, make sure you guys check that out. I'm going to link it down below, but if you guys have already seen that and you're kind of familiar with the vintage world, this video I'm going to be showing you guys how to use modern clothing to save a lot of money or any of that kind of hassle. So let's go ahead and get started. So this video is sponsored by ThreadUp. It is a website where you can get gently used clothing for a lot less than the retail price. So as you can see on the website they have a ton of stuff, different brands, different colors, different sizes, they've got belts, shoes, purses, so much to choose from so you can't go wrong with ThreadUp. And aside of being able to get some good deals, you are also helping to save the environment so that's an extra plus.  Now if you guys find anything that you guys love, make sure to use my code for 30% off on ThreadUp. So this is a great place to start off to look for pieces. So we're going to go ahead and open, oh not show my address, we're going to go ahead and open the box, see what's inside and start styling. One of the outfits I'm going to show you guys today is the one I'm wearing right now. So this outfit was inspired by that kind of 1950s soda pop vibes. I was going for like super girly, almost Barbie-esque and that's why I paired like this aqua color which is very, very 1950s with this hot pink. Now the cardigan is from J Crew which is a great brand to look for on the ThreadUp website because J Crew carries a lot of vintage style cardigans in regards to the color and also the cut so definitely look for that brand. And the dress is actually from NBD, I've never heard of it, but the dress is gorgeous so yeah. Now the retail price of this outfit will literally blow your mind. The cardigan retail price was $110 and the dress was $225. But all thanks to the ThreadUp gods, the cardigan was marked down to $21 and the dress was marked down to $48 which is way more affordable and actually really cool. So here is outfit number two which is honestly to die for. This is what really makes the dress look vintage, this square cut. Also the fit and flair also makes it look vintage and the print as well because vintage Barbie in the 50s with her bathing suit outfit looked exactly like this but not a dress. Now this dress is from the brand Love 80 and it was originally $71 retail but of course on the ThreadUp website it was only $16.99. Now I would wear this dress for a lot of occasions actually. I'd wear it for the night maybe like on a date night out. It would be perfect for a carnival. It'd be perfect for going to the mall and you just add like a sun hat with like cat eye glasses. It can work in a lot of ways so yeah I love it. So this outfit right here is one of my faves. It is so like Minnie Mouse like nautical. Let me just show you. Let me just show you. Now this outfit would be great for a lot of daytime events. I wouldn't necessarily wear this at night but I would wear this to like a boating event. I would wear this to go like buy a dock somehow. You know sometimes if you go for like I don't know fish and chips by the dock. It's a perfect outfit and I would honestly wear this to Disney as well because I like dressing up so yeah. Now the brand on the top is called Odill and it retailed for $60 and I got this for $17.99. Now the brand of the skirt is by Blue Rain and it was retailing for $30 and I got it for $14.99. So this outfit looks very vintage because one starters is the polka dots. The polka dots were very popular in the 1950s especially the polka dots with the navy which is very loose seal ball. Also the top has a boat neckline with no sleeves which is totally Audrey Hepburn and the skirt has like a cute little scallop design which was I believe popular in the 60s early 60s. So here are all the outfits that I've compiled using only modern clothing. So thank you guys so much for watching. I really hope you guys enjoyed this video. If you did be sure to give it a good little thumbs up. Thank you Theta for sponsoring this video. It has been such a delight. Make sure to subscribe and turn on that notification bell so you know when I post more vintage content like this and I will see you guys on my next video.


Uh, we don't have any sort of set order, but I'll just ask any board members who have questions or comments to, to please go ahead and obviously don't be shy. I can start to be like, oh, no, go ahead.  Yes. All right. Um, I'm just, I'm trying to understand, um, the commercial rate, the commercial price increase. And I know that, you know, from the narrative, it says 3.6% increase, but I also realized there's additional rate growth expected because of unrealized prior rate increase allowances that didn't occur. And so I'm just looking at, you know, the tables here, and I see, if you can just turn to the, let me just say, think of which, which, yeah, so there's 2 places where I see commercial price. One is in the 10.2% here. And then on the other page, I see the 3.6%, which is presumably the, uh, charge master increase just for this year. And then the 8.6, which is just for this year, and I just want to understand Sal and then maybe Jen, if you want to add on to this, I'm trying to make sure that I understand what is the actual, uh, in the pocket cost of commercial, you know, rate payers in your community, what are they going to feel this year in terms of the commercial rate increase? Is it the 8.6? Is it the, yeah, just maybe if everybody could answer that, somebody could answer that. I'll just start by saying, so yeah, this is designed to just catch the annual from 23 to 24. And this would factor in that 1.5 million that again, I think is an area of risk, uh, in terms of, uh, Gifford's ability to, um, realize, uh, the full amount. So that would be the highest amount if they were to get that all in their negotiation, which in other words, if the carriers were willing to retroactively apply previously approved rate increases, it would be the increases this year would reflect those that have been approved in previous years, but not implemented due to the, um, work on the charge master as well as the, um, EMR upgrade that they're rolling out. Is that fair, Jen? I don't want to. It is, but I think if I could say that the total, um, Board Member Holmes for the one and a half million is from the 22 3.5%. And as well as the FY 23 3.65% requests that we had, those are the dollars of combined of those two years. This year is 3.6%. As you see on the chart here, that is $853,000. So in total, it would be 2.3 million in net, um, that we are requesting of the commercial payers. Hopefully that helps with the pie. It does. And in terms of the charge master increase from 2022 or the last time that it was actually updated to now, what is that going to look like? That would be the total of 10.2 that you saw on the other chart between 20. This one's 23 to 24. The other percentage is 22 to 24. Okay. That's what I thought. I just wanted to make sure it was is all. Everybody's on the same page about where all these moving parts are the price. Okay. And then the other area that was a bit unclear for me was in the labor expenses. Um, and I recognize that some of that is driven by provider transfers that are, you know, distorting that I also, in the narrative, it was a little bit unclear. In the section under labor expenses, there's a discussion about having, you know, a wage analysis done and it said that the wage analysis suggested that, you know, the wages were significantly below market. Considering affordability, GMC implements it only half of the increases in fiscal year 22 deferred the remaining half to fiscal year 23. And then it said that the next paragraph talks about the expertise of the compensation consultant. Suggesting that there's going to be proposed increases in again to catch up in the fiscal year 2024 budget. So I'm trying to understand exactly what the wage increases were. Exclusive of provider transfers. I don't want that muddied in here, but just what were the wage increases for existing employees between 21, 22, 22, 23, and now 23, 24, just so that I can understand where some of this is coming from and when they were implemented. Is that a possibility? If you have to follow up with that, Jen, that is totally fine. I'm just trying to understand what's in the narrative where this 22% growth rate in labor expenses is coming from apart from provider transfers. And so tracking that over time. Sure. And I apologize. I really should have been a bit more clear in that statement. So what I really should have said was we incorporated the consultant's proposed 2024 cost of living adjustment of 4% into our budget. And if it helps, I can share the word wide board member homes if that helps. So in FY 2022 between market increases and a cost of living adjustment of 3%, that expense was $1.7 million in total. In FY 23 between the market increases, the remaining market increases that we mentioned in the narrative, as well as a 3%, or excuse me, 4% aggregate cost of living adjustment that we just did here in the beginning of May. That was a $2.3 million expense. And then for the 4% increase in FY 2024, and this is for a cost of living adjustment. So unless the market moves again, we're hoping that we're remaining a bit static there. That expense is $835,000 in total. Hopefully that helps clarify it. And I apologize for the terms. So what was the market adjustment plus the cost of living in each year? So you've given me dollars and the cost of living for each year. So it'd be just helpful to understand what was the market adjustment plus the cost of living for each of those years. Just so we can get a sense of how much catch up had to happen because of the market. Oh, I can isolate the market, but I could definitely get that back to you. That's great. Yeah, that was aggregate for both items. So I can certainly isolate the market adjustments and send that to you. Certainly. And then my final question is, in I think most experiences, EMRs implementation always come with some productivity reductions. It's, you know, just it's sort of par for the course it seems when hospitals implement these big EMR shifts. And I'm just wondering how you've factored in, if you factored in reduction in utilization simply because of the EMR implementation. Great question. That doesn't normally happen with an implementation. However, we feel that the operational efficiencies because we're going from a lot of manual processes in the current EMR to more automated processes in the new EMR. We feel that's going to counteract any productivity decline that we would see in the FY 2024 budget. We feel pretty confident about that with the way we've built the new EMR. Okay. All right. Well, thank you so much. Back to you, Chair Foster. All right. Thank you. I heard member lunch. Go ahead if you have some questions. Thanks. Hi, Jen. Thanks. And Dan thanks for joining us. I'm wondering if you could speak a little bit to your ACO participation in 2024 what you're expecting for programs. We will be participating in the Medicaid and MVP programs that are offered through one care for FY 24. Thank you. And then also I'm wondering how you are thinking about the Medicaid redeterminations and if you've included any budgetary impacts related to changes in coverage. We've not included any assumptions regarding the redeterminations in this budget. One could estimate that we would possibly return to our 2019 percentages for bad debt and free care, but I hesitate to do that for two reasons. Honestly board member lunch. One is the changes that we've been implementing with our pre registration process that we mentioned in the narrative. That would certainly have a more positive impact for those particular patients. And the other way other item that we have was the way we were classifying our average generally billed discount prior. That was in bad debt instead of in the contractual line. So it was an accounting change that we did. And that would certainly have an impact. You know, and the other thing obviously is I really don't want to run the risk of understating my net revenue and overseeing my bad debt assumptions for something that's a bit unpredictable for us at the moment. That makes sense. One thing I'm a little curious about in terms of the approach that we've seen in this area is there doesn't seem to be a lot of assumptions related to people moving from Medicaid reimbursements to commercial reimbursements which certainly I think that you wouldn't expect the entire population, but you would expect a little bit of that to some degree. So I don't know if you have any thoughts on that, Jen, but I welcome them if you do. How much just in our experience thus far, it's been a couple of months here when I have conversations with our financial advocate and fortunately has been in the other direction. It's going to self pay. I think she maybe had one individual that she was able to see recognize going to commercial. It's a little early in that I think at the moment, but you know, obviously we would like to see it going into the commercial bucket as well. But from current experience just in the last couple of months in my conversations with her, it's really been going from Medicaid to self pay currently. Thanks. I think that's, I think my other questions have already been answered. Thank you. Good morning, Jen and team. This is Tom Walsh. I just have a question about the cost report. If we could go back to that tab please, Sarah. Jen, it was very helpful. I think, as you explained, things like nursing education can be categorized in one bucket allocated to one bucket for a cost report and allocated to another bucket for a finance report. And I'm wondering if you could just help us understand, you don't have to go into any great detail about your particular organization, but help us understand how a finance team decides which bucket to place those kind of shared services that are not either directly administration or direct patient care. How do people decide where to allocate those? There are some rules that we do follow from a cost reporting standpoint that we do adopt when we're classifying those as well in our financial statements. There's some variation though that is that happens among the hospitals, the one that I pointed out, obviously. And so you try to look at those of what is really directly associated on the clinical side and try to parse those out as best as possible versus those that might have dual purpose. So for example, they have administrative duties, but also may have clinical duties and try to isolate those two components of an FTE, so to speak, or salary. And that's how we do it here. We really scrutinize the difference between the two so that we can make sure we're putting it in the right place. And as you heard me mentioned, we continue. It takes some time when you're evaluating cost reports over the years to start just refine that and where those departments should actually be and we've been making those necessary changes. But I think that really kind of sums up how we look at it and how we would want to classify those on both the income statement and the cost report. So it seems that's excellent. Thanks. It helps me a lot. And it seems like each of the reporting requirements has its own set of rules that every organization would have to follow. But there are also areas where discretion is needed. And when say a regulator starts looking at one, it's only then that there would start to be a standardization among the facilities the regulator is looking at, because there's quite a bit of discretion allowed if I'm hearing you correctly. There is I think, you know, Sarah and I had sidebarred on coming up with maybe a more standardized approach for all of us to report. So that you're evaluating an apples to apples versus an apples to oranges, because that particular line on the cost report can also, I don't want to get too weedy, but there's something called a home office cost report. In my past we have filed one of those and it takes all of the overhead expenses from, let's say, a network structure and put some all in that line where there could be some clinical functions and that that you would want to parse out. And I think, you know, I'm happy to work with the staff as well in creating maybe work apples to apples standard approach to, you know, this and I think there's definitely some variability when you're in a small home. Study when you're in a small hospital because you wear many hats. So, you know, we do time studies so we can isolate some of that as well but I think to try to mitigate that variability we can maybe come up with a standardized approach for the hospitals to report. So I hope we're able to take you up on that offer of helping create a standardized way that we could use across the state, because the discreet the different forms, having different rules, and still allowing for discretion is true across the country, with all the hospitals that make up the peer groups. So, helping us create a standardized way within our state would be, I think, really helpful long term. So, thank you very much. Dr. Irving, do you have any questions or comments? Yeah, I just have one quick question. Thank you both for the. There's more than two of you all three of you so far spoke for the presentation and submission. Mr. Bennett, I just had a quick question for you. I could go to either I guess with regards to the New England Alliance for Health Group Purchasing. Does that also help you with insurance contracts and negotiations? So we participate in NIA both in terms of our employee benefit insurances and also with our normal group purchasing supplies, that sort of equipment, that sort of thing. So we do get, you know, we do have advantage of that purchasing power on the employee benefit side of things. And some of the business insurance has been on all of them. We don't, we don't go through them for all of our, for all of our business type insurances. But when you negotiate with insurance carriers, they're not involved in that process. Oh, no, no, I'm sorry for reimbursement. You mean. Yes. Oh, I'm sorry. No, they are not for that. Sorry. I apologize for the lack of clarity. Do you do that directly from Gifford with the carriers for reimbursement? Or do you have a in between company that helps you with that? Yeah, I knew it was going to point to me. Yes, we do use a third party firm in that negotiation process. That doesn't mean that we don't have a direct line of communication with the payers either. But we do use utilize a third party. Thank you. I had just a couple on the. The labor. The number of fte's went down pretty significantly to 87 down to 191. I assume that's mostly due to the provider transfers. And then the. The compensation per fte jumped up fairly significantly around the same time. And I was wondering if you could speak to that was that because of the types of. Providers that were transferring out or what else could you attribute that to. Or I think there are two issues. That are contributing to the opposing relationship that we're seeing here. One is that. We moved a considerable amount of fte's into our Gifford shared services division. Those were originally reported in GMC as well as our daycare. And so we did move those fte's out of what we report for just the hospital. And I think that's a little bit of the distortion there and why you're saying such a deep dive in that particular line. And then also, you know, I think it's important to from the salary line that, you know, staff vacancies would have an impact on this calculation. And also we report actual fte's in the calculation that we provide versus total position fte calculations. So if we do have a higher turnover, which we do here at Gifford in any of those mid to lower salary ranges, then that calculation of dollars on that upper line is actually going to look higher. So I think that's the reason we're seeing those that opposing relationship there. And then in terms of the anesthesiologists that you used, you currently employ directly any anesthesiologists and how has that number changed over the last few years. We, Dan, you'll have to correct me if I'm wrong. I want to say it was last year or the year before we are using a contracted service similar to as I mentioned that OB hospitalist service that we're using now. So we do not have any employed anesthesiologists any longer, although the anesthesiologists that we that were employed with Gifford did transition to that organization. And we've had some turnover with them over the last year or two. But in terms of us actually having that as an expense, it's in a purchase service line versus a salary line for the anesthesia service. And Dan, I don't know if you want to add anything to that. No, I think that answered it. I think it's been two years. Is that correct Rebecca? Yes, yes, so it's been two years and we've had that service. And I was curious how that has worked out from both, you know, availability of anesthesiologists when you need them and then in terms of the cost. Rebecca, do you want to jump in on the yes. So Rebecca oversees the contract and the staffing of that service. Yes. Thank you. So one of the big changes that was made over the course of time was we moved from an all MD service to a mixture of MD and CRNA, which has actually gone really well. As Jen said, we did transition all of the clinicians at the time over to the contracted service and over time we have replaced them with different folks as they've moved on to different places. Most of our anesthesia providers live right here in our community, even though they're contracted providers, they live close by or they stay in housing that we have here. And so they are still available immediately. You know, we have a 20 minute time for them to come in, but most of them are here within just a couple of minutes. So they're still 24 seven and they're still available with us. We've had a really great working relationship with the organization and we have a really nice open line of communication back and forth between them. And have you found this to be a cost savings with the complement of providers that Rebecca mentioned, going from an all MD model to a combination of MD and CRNA, we did have a cost savings there. It was don't hold me to this that it was in the ballpark in about a half a million dollars. And this third party. Is it just made up of anesthesiologists that used to work at Gifford or are there others. And then it's a compound question apologize, but then the second part of it is, are they working with other hospitals or just Gifford. We have a the group that's here with us now are not necessarily there. They're not all the folks who were here when we made the transition. And for the most part, the group that's here consistently only work here. We do have folks, which is the benefit of going with this organization, who float from other other local hospitals when we have someone out on vacation or, you know, some other type of leave. And can you speak at all to how many other hospitals they may be working with. I wouldn't have intimate knowledge of that for each one of them, but generally speaking, it's, it's 1 or 2. So they're here in there and they're somewhere else. But not they're not coming from all over the place. And but this particular group that we're contracted with works with a handful of other hospitals in Vermont and I'm sure. Can I just ask a follow up question because I think I'm a little confused by the word group, whether that means it sounded like Jill you were speaking about the people who come work at Gifford as opposed to the organization they work for. And then I think Dan was talking about and maybe Owen was asking about the group that the individuals work for so can I just get a little clarification there. So we we contract with a third party anesthesiology group. So it's a it's a private company that employees anesthesiologist and CRNA is that group then contracts with hospitals to provide that service at their hospitals. And that that company that anesthesiology group works with a handful of hospitals. Within the, you know, within the region close to us in Vermont and New Hampshire, Rebecca was noting that the individual doctor. Anesthesiologist and CRNA is that work at Gifford may also work at one or two of those other hospitals that their company contracts with and it just varies by their personal preference. But that did I did I get it. Yes, thank you. Okay, that's what I thought I heard, but I just wanted to clarify so that it was a little clear. Business is confusing. I want to follow up on some of what others had asked about this retroactive adjustment to the charge master. Is it accurate that Gifford has not increased the gross charge on any of the services in three years? Is it three years? Two 20 is starting in FY 2022. We were not able to implement that increase. We were hoping that we could implement that increase. We were originally supposed to go live with our EMR in July of this fiscal year in 2023. So we were hoping that we may and we mentioned this in our hearing last year that that was our hope. Unfortunately, we did have to postpone our go live to October. So now we're two years of those increases. We've not been able to implement. Any of them. Any of them. On any service line. Right, right, right. And just so I'm clear, the issue exactly was why couldn't you. So there were two things that were creating this particular issue. One was we needed to completely rebuild our charge master. There was a lot of revenue code changes that needed to be implemented location of service lines and things of that nature. So we've completely rebuilt that and we're prepared to go live with that obviously with the new EMR. And also we needed to implement or not even implement, but undergo a price analysis and a price study of our current pricing structure. And we've also done that in tandem as we've been getting up for our go live. And so those two things really have prevented us from implementing those price increases.  And I certainly wouldn't want to put that additional percentage on prices that we needed to reduce. So those two things were really why we were not able to do that. Okay. And, you know, maybe somebody asked this, but what happens if the insurance companies don't agree to these increases? Well, there's always a negotiation obviously between us and the payers. You know, we do without getting too much in the weeds of our contracts. There is language in our contracts that point to the approvals by Green Mountain Care Board. We have, in the last two years as well as this year, have sought quite low price increase requests. So we are hoping that our negotiation with them will take that into account. I don't know if you saw, but I just point out for your awareness that the care board issued rate review decisions this year that said that the rate increases we allow in our hospital budget decisions are not an entitlement and that insurers are required to negotiate based on affordability, access, and quality. Anyway, last question. Sorry, I think if I could share a posture. I do, you know, those two years they were approved obviously by the board and we want to be transparent in our budget and share with you that that's what we were doing.  And so, you know, that is what we are seeking from them. But I understand what you're saying. I appreciate that. And thank you for the transparency. I think it's really, it's really critical. And I want to point out that I really do appreciate the fact that you guys had guidance three years in a row, which I don't know how many hospitals have done that, but that makes this job a little bit easier for us. The last question I had was about how physicians are generally compensated. And if you could speak to just the general methodology for compensating physicians. And one of the things I'm trying to understand is whether or not physicians are rewarded or incentivized for increasing revenue, either through increased volumes or increased procedures or which types of procedures. So, we compensate again, we're speaking about the specifically about the hospital. We compensate our physicians based on salary. So we derive a salary utilizing national surveys and then we evaluate them. We've evaluated our compensation salary portion of the compensation based on the national surveys. In addition to that, we do have incentive programs. And there's two components to that. The first one is based on a, again, looking at national surveys, looking at work RBU. So that is a productivity standard. And so that's a component of the incentive. The second component of the set of the incentive is what we call citizenship. And that incentivizes activities that where our providers are doing community outreach activities where they are participating in medical staff quality type activities. Things that promote the practices things that promote a community health, those sort of things. And for both the salary component and the work RBU component, we target the the median on the surveys. And Mr. Bennett, is there a set split between the work RBU and the citizenship component of the incentive cop or can that vary? For the most part, there is a dollar, there is a dollar limit on how much we pay out on that. But I'm trying to understand it. So it's about so it's about half and half. In terms of those incentives would typically be about equal the amount that they were able to earn through that. Right. Okay. So the incentive cop, the median of the surveys you look at is $100 and a position hits it 100%. 50% would be due to their RBU performance and 50% would be due to the assessment of their citizenship. So let me let me just let me let me take that example and come back and try to explain it. So if the median is $100. You know, we would pay them somewhere in the range of $80 on a salary. And then they would have the opportunity to earn $10 for citizenship and $10 for work RBU. I get it. To get to that median. If 100 is the median. Understood. That helps. Thank you. I should have started with that. Sorry, that would have been. Oh, as I misunderstood, that was great. I don't have any other questions. Mr. Sutter or director Lindberg, do you guys have any follow up or you guys all set. We're set just again, testament to this being the second of two hospitals under benchmark and just shouts outs. But the advocate may have some questions as I see Eric has arrived. Great. All right, I will turn to the healthcare advocate. Thank you so much and apologies for the sound if you can hear heavy machinery in the background my neighbor has decided to restart construction and in an odd coincidence, they work at Gifford. Which made me laugh very hard this morning. And they're wonderful. So I just want to point out that that that we had nothing to do with that. I didn't think you did. It's supply chains fall to the fact that they didn't have windows. So again, I want to echo Sarah's comment that you deserve to be applauded for coming at or under guidance for now years. And that is a level I think the level of commitment to your patients and their pocketbooks that honestly is good to see and perhaps should be heard across more of the system. So my questions are going to be for Jen and it's really I'm trying to understand. And member launch asked about this a bit but I'm trying to understand the change in booking of a GB discounts to bad that and I think what's so correct me Jen or chime in I think what's so I think you're saying that you had a self pay person who was going to charge a GB for a service to say that services is 200 on the charge master and a GB is 100 that then they come in and regardless and they owe 100 regardless if they pay that amount or not that the difference in the charge master and a GB so that added hundred gets booked as bad debt. And I know like this doesn't actually have an impact on the bottom line I'm just trying. It's important to me just I'm trying to understand how to use free care and bad debt. Right so like I'm not working at the bottom line level I'm kind of in the middle of it but I don't want to make false conclusions. Let's see if I can kind of use your example Eric kind of adjudicate this the way we normally would an organization. So taking that $200. Let me back up to the bad debt versus contractual that I mentioned earlier. So we do automatically out of the gate and give a 50% discount for self pay patients on that $200 charge so that hundred initial dollars used to go to the bad debt line. We now change that net we consider as a contractual adjustment right off of the the charge. So that remaining $100 if the patient for example qualified for some free care. Let's say they qualified for 50% of that $100. So then reduce their portion, their obligation to $50. If they were not able to pay that $50 of their obligation after 120 days and conversations trying to get them on payment then that $50 we would transfer to bad debt. Okay. Does that help clarify it? There's resources and things that we do from an accounting standpoint but that's really the gist of how you're to kind of adjudicate that example you gave me. And with that switch due to the change in GAAP accounting standards so that you know where they were trying not to have so many ways of booking things by industry type or was that something you guys took on or a mix of the two? It's a mix of the two from the revenue recognition versus how we should be classifying that initial discount. Okay. And so I understood Jen like this idea of the problems of looking at like looking longitudinally at bad debt because of this change. Now, but I'm wondering like if we look out, if we look at the system as a whole, so not just, you know, Gifford, right? Like could we, is it reasonable to expect that we're seeing similar, like similar changes in accounting across time amongst internal to each of the individual hospitals? Like that it's kind of difficult to compare or cross hospitals to likely? I don't want to speak for others but I think it's fine that perhaps the majority of the hospitals probably classified the way I was describing but I don't want to speak for them obviously. You know, there might be a couple that here and there that are putting that to the bad debt portion versus the contractual line. But I can only say my experience, but obviously, you know, I just don't want to speak for them but I would presume that that's the same structure that they adopted. Okay. Okay, that makes sense and it's helpful and then just one last thing for me when you're talking about the 2024 budget and you're looking at free care and you're saying you're aligning that. You're aligning that with historical trends from before and after or during continuous coverage, not after because that's right now. I'm wondering had you thought about or had you included in that like what the effect of the implementation of Act 119 will be and if your free care policies become more generous due to that because that's like a quarter worth of impact right July 1 July, August, yeah. Correct. We're moving in that direction now to adopt what is stipulated in the Act 119. It will have an impact because it does change that threshold because currently we're at 300% of care. So that is going to change that bit of obviously we're we're going to adopt that we're going to be looking at that because we've been waiting for our go live. And then really start to adopt that obviously we'll meet the deadline. But it to answer your question it certainly will have an impact on the amount that you see in those two two lines just because currently it's under that threshold is stipulated. Okay. Yeah, I think you know what's what's interesting and I don't I haven't looked at Giffords FAP in a while, but it seems like you probably also in addition to the FL changes the limits the actually. I mean it may not affect Gifford as much but for some hospitals, the statewide criteria instead of being put at the limited to the service area is a, it's going to be a really big impact for some hospitals. I don't know if that works out for Gifford but that's kind of there's some things that are kind of way deep inside of Act 119.  But yeah, Act 119, it's weird how that played out. So I had a look at it with a magnified glass. I mean, I've read through it a few times to Eric and we're happy to work with healthcare advocate on, you know, the changes that we're implementing or or some as you mentioned that we already have in place. So in terms of providing free care statewide, and not just within our health service area. Thank you so much, Jen. And again, thank you for coming in in a way that conforms with the guidance. Can I just ask a quick follow up question on on Eric's question. I'm sorry I missed in the initial the $200 charge that you give the 50% discount upfront. Where do you where did you say you put that in accounting. How does that. It goes in our contractual allowance line. And is that reflected in the exhibit dying in the in the budget submission. Yes, that would flow through our contractual and the two lines that we entered at the very bottom we added the bad debt and free care that would be net of that discount but the contractual line would contain that discount. So, so that first $100 deduction would go under free care. That first hundred line would go under contractual allowances. Okay, because there's I'm just trying to fit there's not a contractual allowances on exhibit nine I'm just trying to figure out which one. Oh, is that I believe that might be the one that is just gross and net Sarah if I recall. Okay, so. Our detail. If you look at our income statements, there's a contractual allowance line. That's a negative number. And that will reflect where that is hitting on the income. All right, I'll read through that. Thank you. I had a quick follow up on the third party that negotiates the rates with the insurance companies. Is that Helms and co. Yes. And if it's in the contract that the insurance companies have to pay the amount approved by the GMC be. Why do you have to pay a third party to negotiate. Not all of the contracts have that in there and that's not the only thing that we utilize Helms for we work with them to build. What we call a matrix so that we almost have a contract management type of methodology so we can look at inpatient versus outpatient versus professional how much we should be getting from each of those contracts. So they don't only do the negotiation, but they also assist us in creating the different amount of reimbursement by each service by each pair. The other thing that Helms and company also assist us with is anytime a pair makes a change to their policies. We do ask Helms to alert us of those pair policy changes. If we also notice that our claims may not be adjudicating in accordance with those contracts, we work with Helms to decipher, you know, that delta that we might be experiencing and have that conversation with the partners as well so that we can ensure we're getting reimbursed at the rate that we were contracted. So there's, there's other functions that that particular third party does versus just the negotiation. I hope that helps. Yeah. I'm sure I would just add to that that is a small organization like Gifford and I assume that, you know, the majority of the hospitals in for monitor in somewhat the same boat there's only so much bandwidth we can that that we have to do some of these more technical activities so it is more efficient and in some case we don't have a lot of other options, but to work with some people who do this on a full time basis. And if I could, it's it's much more cost effective than it would be hiring an FTE for that additional set of services. No, I understood. Yeah, no, appreciate that very much. Okay, I have nothing else. I will open it up to public comment. Yeah, and I have to say, I've done a fair number of hearings now at the care board and the only hearings I've never had a public comment on our hospital budgets, which I find so surprising. Every other hearing we have there's so many public comments. We'll probably get some Wednesday. All right. Well, yeah. Okay. Well, be that as a may, I will turn it back to you guys for your closing statements and thank you very much for your presentation and for observing the budget guidance. Well, thank you, Chair Foster. I appreciate the opportunity to talk with you all today. And again, thank you all from your team for the work that you've put into this as well. So, I would just conclude by stating that, you know, given my opening comments, we wanted to stress the level to which different is a community focused organization. We do work with very closely with with our community members to assess what the needs are in the community and then with our leadership and our board and our medical staff and others to ensure that we are organizing our services in a way that that can meet those needs. And we do leverage the relationships both local and from a wider region to meet those needs. As you've heard about both in my comments earlier and then obviously with some of the other services that we that we contract and work with. I just want to again thank you for the opportunity today. And as always, please feel free to reach out to us if you have any follow up questions and have a great weekend. Great. Thank you all very much. We will adjourn until 10am.


Hey Psych2Goers, thank you for your support and welcome back to another brand new video. Is there someone around you who has been acting strange lately? Perhaps they've been more quiet than usual, or maybe they've been lashing out at everyone who hangs out with them. Well, one reason that may be affecting their behavior could be that they're feeling down but don't want to or have trouble with expressing their sadness. So if you're worried about your friend or loved one, here are six signs that they may be secretly feeling down. Number one, they often put themselves down. Everyone experiences self-doubt sometimes, whether it's shying away from social interactions, refusing to take on an important role, or feeling a general lack of confidence. People may put themselves down as a form of defense mechanism. So if you see someone being really critical and harsh on themselves on a regular basis, you may want to check in on them and ask how their day, week, or month has been. Perhaps there's a distinct reason behind their self-depreciation, one which they have been waiting to share. Number two, they're often moody. Does your friend lash out at you for no reason? Sometimes people may become irrationally upset at trivial matters because they feel down. Although it's easier said than done, try not to take it personally and understand the true cause of their emotions. Conversations that start with, can you tell me how you're feeling lately? Or please let me know if something's wrong. May help invite those you care about to open up about their hidden issues, even if they start venting at you, just by speaking out their thoughts. They're likely to move on from their negative emotions faster. Number three, they lose interest easily. Do you know someone who's always nonchalant about everything? Losing and gaining inspiration is a natural part of human behavior, and some may feel more confident on certain days more than others. However, if you notice someone canceling all their plans, refusing to try anything new, and they tend to just display an unusual amount of carelessness, they may have given up the act of seeking joy and passion in life. This may be because they're trying to suppress their sadness or are spending most of their time trying to combat their own negative thoughts and emotions. Number four, they stay quiet. Have you noticed you're usually talkative and open friend behaving very quietly lately? This change in how they act may be a sign that they're secretly feeling down. Their behavior to not speak may be because they're trying to keep their brewing issues within themselves. After all, staying quiet can be seen as a natural defense mechanism for those who are experiencing sadness or even depression. Again, if there are severe symptoms of the latter, please seek a health professional immediately. Number five, they're constantly anxious. While sadness doesn't necessarily cause anxiety, the two emotions do often relate. Some of the signs of anxiety to look for are restlessness, fast breathing, heavy sweating, and constant trembling. There might be something that they truly fear, which can lead to other negative emotions and cause them to become really upset. In these cases, it's good to let them know that you care about their well-being and will be there to listen. With your support, it's more likely that they'll feel comfortable with you to open up about some of the issues that they may be facing. And number six, they lack sleep. Have you ever gone to bed only to be bombarded with a stream of intrusive thoughts that keep you awake? Unwanted, troubling thoughts often occur after experiencing traumatic events or even a stressful day. When your mind learns that you're in a safe place, those intrusive thoughts tend to resurface. Therefore, people who are secretly feeling sad may experience a lot of restlessness and inconsistent sleep. You might want to check in on your coworker or friend if you hear them talking about having constant problems getting a good night's rest. So do you know someone who shows any of these signs that we've mentioned? If you know someone who displays all of the above symptoms and more, it may be wise to consult a mental health specialist such as a therapist or psychologist to check if they're depressed. If you found this video helpful, be sure to like and share this video with those who might benefit from it. Subscribe to Psych2Go and hit the notification bell icon to get notified whenever Psych2Go posts a new video. The references and studies used in this video are added in the description below. Thanks so much for watching and we'll see you in the next one.