At this point, we're going to turn it over to the hospital budget team. We would like to go over overall what we're going to be presenting today. This is a recap of the FY20 budget guidance. I mean, we will be presenting that. We will also show you the budget requests for the Fiscal Year 20 budget considerations, the summary of the results that we saw, the net patient revenue and fixed perspective payment, the change in charges, rates and prices, and this also would include any changes to Medicaid and Medicare and commercial reimbursement. We have key financial indicators, operating margin, bad debt and free care, disproportionate share, payments and provider tax, and the 340B revenue because the legislature liked to see that particular slide a lot and this is included in the other operating revenue. We're showing you ACO participation and then we'll be showing you the timeline of budgets and hearings and the next steps and then final discussion. We will also be showing you system-wide summaries of net patient revenue fixed perspective payment increase of 4.5% or $117.8 million over the 19 budget. We're also showing the operating expenses increase of 5.7% or $155.5 million over 19. Operating margin budgeted at 2.5% and increase over the 19 budget of 2.4%. Just $193.2 million in capital expenditures, those includes the CONs also. Then we have system-wide estimated weighted average of change in charge is 3.2%. We also wanted to show you just a kind of quick look at the income statement system-wide and I wanted to make note that 340B is included in the other operating revenue just below net patient care and fixed perspective payment and reserves. A lot of the hospitals are reliant on that extra income when the net patient revenue doesn't quite meet their expenses so that they get a positive operating margin. Then we would like to show you what went into the budget guide and we'll have Agatha show you this one. Thanks, Lori. So we just want to review the budget guidance because it kind of sets the stage for the budget you're about to see. So you released or established the budget guidance in March 2019. It was sent to all the hospitals and the most important pieces for the presentation you're going to see today are these three items right here. Number one is the 3.5% maximum growth rate target that was set for all the hospitals. Number two, and this was new for this year, is kind of a secondary cap that was set for hospitals that are underperforming. So for hospitals whose FY19 projection shows a minus 2% or greater variance from budget, they would be limited to 5% growth and you don't have to do the math in your head because we have slides that have done all the math for you, but those are two kind of limits that have been set in the budget guidance. And then the third point is just to kind of remind, re-emphasize that the budget guidance, although it didn't set forth a limit for FY21, it did consider FY21. It considered FY20 and FY21 together in terms of if revenues seem to be in line with the all-payer model target, then the Green Mountain Care Board has also established tentatively a 3.5% growth for FY21. So when you're looking at today's figures, remember that FY21 figure is out there as a two-year target. We did some housekeeping with some board-designated assets. We clarified some terminology. This next slide is pretty much just a summary of what was in the guidance and there's no need to go through it now, but just to remind you that this is, because a lot of work goes into the budget guidance this year and this is what the results were from the difference from last year. So once we received all of the hospital's budgets, staff goes through individual hospitals and puts questions against their budgets, comparisons, or we like to know what should we ask every hospital the same questions and then we have individual questions. In this particular round, we asked the hospitals to give us, were their fiscal year 19 projections valid? And if not, give us an update. We ask that every single year. This year, we're asking the question on ACO reserves and other reform payments. We're also asking the hospitals, because it was in their budget orders, if they have connectivity with the V-High through VITAL. Then the next question we asked is, what departments in the projected 19 budget were the expenses exceeding their revenues? Another question was, how can we understand the utilization or census in the hospitals? Give us some kind of statistic that we can start monitoring that type of information. We asked the hospitals, what's the value of one day of day's cash on hand? We're asking some of them for that particular hospital, but also for their parent, so that we have something to compare. The charge-related questions, this one is where we're asking, what is your increase in charge, or it used to be called rate? We're also asking to give it by Medicaid, Medicare, and commercial, and what are your assumptions? Then we have additional specific hospital questions, like for instance, if they had any changes in FTEs, if they had changes in their balance sheet. So every hospital's questions are unique. These analysis will be sent to the hospitals late today or early tomorrow, and we will have them on the web also. The considerations that we were reviewing these budgets is, or you should consider this report, preliminary. We've been talking to the hospitals and found that some of the information in the submissions are incorrect, so we have to inform you of that, they will have that in their responses so that we'll have the correct information when you make your decisions. So usually the board based their decisions on NPR and their rate or change in charge, but there's other items in each of the hospitals that need to be taken into consideration. We review, we are not done reviewing, we're going to continue to do more analysis after this meeting and so that we'll be having tools for the board for their decisions. And then we'll have more analysis at that time. So like I said, this report is definitely preliminary, and it helps the board with their decision making. To Lori's point, through our conversations with the hospitals, we've already identified a couple areas where hospitals submitted something that they didn't mean to submit or it was the wrong number or maybe they missed a key stroke. So part of what we think we feel our job is is to review the budgets and make sure that what's in adaptive is what the hospital meant to put in adaptive. So that's on top of all the analysis we do, we are also trying to make sure that the data is correct. So this is another slide on considerations. So as you go through, this is a slide on FY19 amended budget orders, even though we're talking about FY20. The FY19 budget is the basis for the FY20 budget. So just a reminder that there were four amended budget orders in FY19, two were related to provider transfers and two were related to a change in charge. So just briefly a reminder about that. In FY20, we are seeing some provider transfers and acquisitions being requested, just a reminder that the board and their guidance puts a May 1st deadline on requesting an amended budget order in FY19. For example, the deadline was May 1st. And so if anything happened to the hospital between May 1st and October 1st, we asked them to submit it in their annual submission. So we're seeing some provider transfers and acquisitions and accounting changes that affect both FY19 and FY20. And we have calculations throughout that will help you see what the impact those were. In addition, there are requests for consideration for, this is coming from the UVM Health Network for unique patients and case mix index. And we have slides on that further on. Is this me? Oh, still me. This is just kind of a basic summary slide. This format is familiar to you. The only thing that's different in this than what you normally see is the column that shows participation in the all payer model. We've titled that column budgeted FPP. This is because contracts for FY20 have not yet been signed. But we can see in their budgets that these are the hospitals that are budgeting for FPP. On the right hand column is the hospital's request for MPR FPP and then a percentage of the total. This slide is showing you the percentage changes between the years of net patient revenue fixed perspective payments and the operating expenses. And we also wanted to let you know about the dollar amounts. So the NPR was an increase of 117.8 million over 19. And we found that the largest drivers of that were utilization, change in charge, and provider transfers. But that is not limited to what the changes are, but those are the largest ones. The operating expenses, they increased 5.7% or 155.5 million over the fiscal year 19. The largest drivers of operating expenses were inflation, workforce. We heard that a lot on every single hospital and drugs, which some of them get reimbursement in the 340B. That's in the operating revenue. We also review the capital budgets and they proposed $193.2 million in capital budgets, which are planned and ongoing. So that total for CONs was $94.4 million. There was going to be probably 16 CONs. We wanted to show you the system-wide payer revenue for FPP and NPR growth in fiscal year 20. Commercial increase 6.6% or 92.7 million. Medicaid increase 0.5% or 1.5 million. Medicare increase 2.6% or 23.2 million. And disproportionate share didn't change too much. It's 1.8% or 0.4 million. We also wanted to show you the charge assumptions, which is the estimated weight average of charges 3.2%. That is taking the rates that the hospital submitted, applying that to the previous year's gross revenue and get a weighted average. Most hospitals assume zero increase for Medicare and Medicaid. So we also wanted to show you in these pie charts what's the poor portions of fixed perspective payments by payer and NPR, the NPR and FPP portion. How much is that FPP? And then of FPP payments, what's the percentage by payer? And then on that pie chart, there's a little disclaimer. I don't know if anyone can see it, that this is FPP as reported to us as the payments, does not include reserves. So that would be, if you're looking at an income statement, that would be the fixed perspective payment line. We wanted you to see the operating margins for the system from fiscal year 14 through fiscal year 20. And we are estimating a five-year average of 0.8% or $53.8 million. We also wanted to show you buy the type of hospitals, so perspective payment hospitals and critical access hospitals. We also noticed that fiscal year 18 was where both types of hospitals had quite a dip in their operating margins. And after that dip, there is an increase, but that's the FY19 budget, just so you know that this is actuals all the way up until you get to FY19, and that turns to a budget here. So the next couple slides are going to have lots of numbers on them. This is where we're getting into our system-wide looks. We're moving away from sort of high-level observations, and you'll start to see information on a hospital level. So here we are, MPRFPP as a dollar value. The next slide we'll show it to you as a percentage change. Quickly go through the columns. FY18 actually actually ended the year. Their budget as of FY19, so this includes those amended budget orders that we saw, those four amended budget orders, their projection for the rest of the year, and then their budget for FY20. And then this next slide shows those same numbers, but as a percentage change with the column in bold is really the column that's part of the discussion is the budget-to-budget percentage change from last year to this year. And that's where you see the 4.5% as a system total. So this slide has a lot going on, and we're gonna spend a couple minutes here. And we kind of consider this slide to be a reference slide, a tool that a board member of the board could use during the budget season. So it's the MPR percentage growth by hospital and I'll just go through from left to right. This first column here, budget-to-projection variance. This is important to consider because it's hitting on one of those criteria in the budget guidance. This is for the hospitals that underperformed in FY19 and whether or not they would be subject to the 5% cap. So the figures in red in this column is any hospital that dipped below the minus 2.0, but also exceeded that 5% gap. So you'll see that there's a 5% limit. You'll see that there's hospitals in that row that definitely went below the minus 2%, but they're not in red because they satisfied the 5% limit. Any questions about that? Excellent, all right, the next column. This line divides the variances with percentage growth. So this line is as submitted and adaptive the percentage growth from last year to this year by hospital. So any hospital whose figure is in red is a hospital that exceeded the 3.5% cap and also that minus, I'm sorry, the 5% limit for the underperforming hospitals. So those are all the red numbers in that column. And then the last column is their percentage change from year to year when you factor in provider transfers and acquisitions and accounting adjustments. So these are the things that happened between May 1st and now that the hospital is bringing to our attention as a transaction or a transfer or an accounting change that affected their budget. And a breakdown of this column to be specific is down below. These are the hospitals that are requesting provider transfers, accounting adjustments, and then specifically accounting adjustments related to ACO accounting. And specifically for ACO accounting, it's bad debt collection fees moved to expenses. So they're coming out of revenue and payment reform investments moved into deductions. One other thing that's worth noting here is that Northwestern Medical Center, they had a dermatology practice, leave their practice in FY 19. And although we're not talking about hospitals specifically, you need this information in order to interpret the chart. So that happened at the beginning of FY 19. If that had been considered for their budget to projection variance, they would go from having a red number here. Am I looking at the right hospital? It would go from a minus 2.1% to a minus 1.4%. I'm sorry, from where I'm sitting, I thought I was pointing at Porter, but so they would go from a minus 2.1% variance to a minus 1.4 variance. So they would not trigger the cap if you factor in the loss of their dermatology practice. Did I make that clear or did I make it less clear? There's a footnote that makes it clear. All right. Next slide. So this slide is specifically about the UVM Health Network. So in addition to requesting consideration for provider transfers and accounting adjustments, the network has also requested consideration for changes in what they refer to as unique patients and case mix index, a change in their case mix index. The network attributes these changes to a population that is sicker and older across the network. So the dollar value and the percentage impact there, NPR is in the chart below, but we don't plan on getting into detail about that today. But are there any questions about this chart and how to interpret it? So my question is, was there substantial supporting documentation that it's different than other hospitals? I mean, all of New England is older demographics like that, it's just curious. No, and we didn't ask for it. We are kind of, we do analysis on the income, all the financial documents, but we learn a lot in the hospital presentations. So we're expecting that UVM, because this is where the budget guidance says unless justified. So this is where the health network would have to come in their budget presentation and justify. Yeah, I think when you read their commentary, that's what they're trying to do, is explain their overall growth at 6.6% of the network and then calling out these two pieces as contributors and then what's left. So I think they're trying to use it to just explain why they're exceeding the cap. Yeah, right, exactly. Okay, more numbers. This is a breakdown of, again, this is a reference, no one has to understand this just by looking at it right away. This is just a reference for, you start to ask yourself, well, what exactly did the provider transfer due to the budget? And sometimes, for example, in Northwestern's case it's a minus because they lost a practice and a positive and it's netting out to a positive number. So this is just a list of everything that came in. We would like to point out that our analysis is not complete. We're following up with the hospitals to make sure that they fulfill the requirements that forth to notify patients when a practice is acquired. We need a little more clarification, at least on a couple practices, whether or not the projections we were given were a partial year impact or a full year impact. And we need more clarification on whether or not these acquisitions were independent providers in the community that were acquired by the hospital or whether they were there expand or whether they were expansions of the hospital's existing services. So still more work to do on this. This chart is showing the preliminary look of the change in charges. We used to call it the price or rate increases. But this year for 2020, we specifically gave the hospitals the definition of what we were looking for and we wanted to know what is your change in charges? But we also wanted to point out that there was on the UVM networks narrative the effective rate of commercial. So that's why you're also seeing that on the far right. This is where you will be making decisions on reducing their change in charge. And how much is that going to affect their net patient revenue? This chart is showing you just that same information on a system look of how the board or past hospital budget commissions affected the rates submitted versus approved through the last decade or more, last two decades. And then we wanted to show you the history of the NPR and FPP from fiscal year 14 through the current budget and all the changes in between. So that you have some history of the growth this one is the percentage change between those particular years. Just real quickly, you'll notice that at the bottom of FY 18, it says 2.9 and there's an asterisk. This is to call out the fact that the year end report that we produced in March at that time that reported the results of FY 18, North country's data was still preliminary. And at that time, the system total was a 3.1% growth since North country has resubmitted and it brings it from 3.1 down to 2.9. So we wanted to call that attention because this could potentially be the first time that we're updating that number in a public setting. And this is the operating margin in dollars from fiscal year 17 to the budget 18. And we wanted to try and give you a five year average for each hospital and then the system total. The next slide is we were, as we've mentioned, this is preliminary. We found out that the five year average for the operating margin percent is incorrect. So we need to correct to make an adjustment on that and repost this slide on the web. But this is the operating mind percentage for each hospital. So this next slide is a summary of utilization and staffing levels. We collect information about utilization on many levels, but the one that we bring to this report is adjusted admissions. So we have the adjusted admissions listed with the total. We also report on staffing levels for non-MD FTEs, for MD physician FTEs and travelers and the system totals are at the bottom. On the right hand side of this chart are the percentage change from last year to this year by hospital and as a system as well. So an interesting note on travelers is that a lot of hospitals budget for zero travelers and then project that they will have travelers. So you'll notice that there's a lot of zeros there for the budget. And you'll notice that there's a lot of zeros over here for the change. But in between is a projection that has travelers in there. So we would encourage board members to look at the, in each staff analysis there's a page for utilization and staff. And that's where you can see more detail. Because we do hear a lot about the use of travelers but we don't see it in the budgets. And we have questions for hospitals about that. The other thing we wanted to mention is like we keep on saying this is preliminary and we already know some of these numbers have to change. Yeah, hospitals detected some issues. So just kind of generally we report on adjusted admissions. It shows an increase of 3% over FY19. Staffing levels are increasing 360 positions which is 2.4% above last year. And we will say that looking at 360 may or may not sound like a lot but a lot of those positions have already been staffed in FY19. So they're building these off of their projection. If you break down that 350 or I'm sorry 360 it's 351 non-physician fteens, 14.6 physician fteens and a drop in travelers. But as Laurie stated we know of at least one hospital that needs to revise their staffing numbers. All right, so we are including these sorts of charts in our standard reporting to the board. These are a handful of key financial indicators that you're familiar with shown from last year's budget the projection and this year's budget. So we will not go over these in detail except to note that we're still falling up with Southwestern. They have a parent company and we are we're asking them about their day's cash on hand with when you include their parent company operating margin and total margin. And then days payable, days receivable and debt service coverage ratio. Every year also asked to show charts on bad debt and how much it's increasing or decreasing per hospital. And we wanted to bring that to light. Last year I had combined bad debt and free care but we'll separate it in this presentation. Again, it's preliminary because these hospitals will probably changing their numbers. We never know. So do you want to mention the height of all the hands? Yeah, because of bad debt and free care it's your high deductible health plans. Bad debt is where people have insurance but they can't pay or refuse to pay, excuse me. And some of it is the high deductible health plans. And all the hospitals seem to have like some kind of collection agent to try and collect some of the bad debt. The free care is where people can't pay for their care. And so this is also where I believe some of the dish payments are also supposed to help some of the hospitals on some of this. So then there's the dish payments and what's happened year to year. This particular slide does not show when it was for the system total over $37 million. Now it's down to 22 million for fiscal year 20. And Grace Cottage does not receive a dish payment. Provider taxes, and I believe this is correct is it's 6% of their net patient rather than fixed perspective payment that they pay to the state. And what we do when we receive these dish payment and provider tax calculations from the budgets we also compare that to what Diva has given us just to see if we should be notifying the board that we should make adjustments or not. Oh, and so for Laura gave me this one because I love the 340B program. I'm fascinated by it. So because it comes up over and over in the hospital budgets narratives that they are increasingly relying on other operating revenue as a way to produce positive operating margins. So this shows history of the short history of the program. And you can see from these numbers how much it grew even from last year. We include this slide even if we don't include it in our preliminary presentations the legislators always want to see this information. The other thing is the reason why Copley and Springfield are at zero is because they don't qualify. Right, and the reason Porter shows zero on FY18 is because they were previously recording that in a different in non-operating revenue. So, okay. Moving on. We wanted to show you the ACO participation and this is based on the fixed perspective payments alone not necessarily reserve. And so you can see the changes from year to year for each hospital. So as expected it's growing into the fiscal year 20. The contracts have not been signed yet for fiscal year 20. They're still trying to gather data from OneCare. And then these maps may look familiar. This was Marissa, one of our colleagues back at the office put this together that shows participation in all payer model from performance year zero up to performance year two. And you can see how the participation is growing from year to year. So that concludes the data portion of the presentation. This next part is procedural. So we should probably pause and see if there are any questions. Questions? Tom. I do. So if we could go to five to 15. Yes. 15 you said? No. Okay. Okay. I'm just thinking that the medicating rates might have 1% if the vat is what hospitals have submitted a cost regulation on that and I'm just going to be able to say that the growth might be in. No. Not to compare to this particular process. Because you know it's just a number that is always striking to me that 22% of remoders are insured by Medicaid. And then as last year in the budget process such a small amount is dedicated for that population with the cost shift goes up and that's a relationship I think that we need to be very explicit about so that policy makers can understand either change it or understand it basically. So for those Medicaid numbers include the dish payment reductions in 2017, the amount of dish was I think $35 million. This is all based on what the hospitals are budgeting. If you looked at the number for dish, we could go to slide where the dish is. 33, thank you. Does anybody need slide 15 anymore? No, because it won't make everyone see say. In our calculations usually the dish payment, we try to have it pulled out so you can get a, just a look of the regular payer and then we pull out dish. So presentation included. So it depends on the presentation but in there would not be included. But when you're talking about the dish being reduced that would be on this slide. And like I mentioned, it was the previous years it was at 37 million and now it's down to 22 million based on what the hospitals budgeted. And we take that like I mentioned the budgeted amount compared to what Diva said. And it is a little different for each hospital. Most of hospitals got the most current data from May. But Tom, if your question was does the Medicaid increase of 0.5% or 1.5 million include dish, it does not. That's reported as a separate line item. So actually what that means is that the 1.5 to 1% could even be less if you're gonna get out the dish and you get production if there are any. If there's reductions. So if it's worthwhile just checking in with Diva on the actual hospital, bottom up, seeing if those two tie out after the appropriation process during the last session might indicate that Medicaid might be bumped up a bit. We can do that, but we also want, we'd like you to know that we give them through the year the year to date actual slide fiscal year 19, information to Diva so they can keep their projections up to date. When we get actual data coming in like this fiscal year 18, we give that to Diva. They're also gonna want to see these budgets. So they're gonna constantly update their data. But for us to go back and compare, we don't usually. Starting on page 16, page 16 you have a, I'm just looking at the actuals now, so this money is, it's done, it's fixed. And so if you have the numbers from fiscal year 14 to fiscal year 18, the total amount of that margin is 300, not too low, it's 390, 326 here, but I've done it and the medical center's total margin for that period comes to 316 behind the U.S., so we know that's the number. And so that's 80.4% of all the margin over that five year period. And then here on page 26 you can see that projected margin total is 42 million, 42.5 million. And the UDM medical center shared that as $39.4 million which is 92% of all the margin projected for 2019. And I'm just wondering if you'd make a special look at as to what might be thriving that, because it is out of sync with the medical center's 49% share of NDR that in terms of what's broken through their system is significantly higher than that. And I don't know if that's driven by case mix or what might be thriving it, but I think it's because we're talking tens of millions of dollars here, it's something to understand as to whether or not it's something we should be concerned about or not. We did ask the question for the hospitals to give us their operating margin total, operating margin and total margin, their assumptions in their budget. So it could be addressed in their narratives, like we can, I don't know if you saw that or not but we can, but that would only be for the current years. As you notice as I look at these graphs now over the past year, you see when huge positive and then a whole bunch of negatives for the remaining, among the groups that remain positive. If you look at the bottom line on a gross basis, they owe us $290 million for the operating margin. Great, that's a big number, but it's the distribution of that across all 14 hospitals that issue and as we see, you know, on target and target, there's a lot of hospitals that are on the spectrum in terms of their operating margins. Okay, right, that is something that we're observing and tracking is budgets have, at least in the recent history, have all been for the hospitals, positive operating margins. They budget positively, most of them end positively, but in, what side is this, the next slide? You can see in the next slide how hospitals are ending. There's a lot more in the negative than there used to be and this year in FY20, two hospitals actually are starting off the year they're budgeting with a negative operating margin. Other questions? I have a few questions for you. Okay, if you can go to age 18, and this really just some observations, so when, first of all, great job, it's very, I hope that you guys can get together and really help us as we go through all the upcoming presentations. When we look at the second column in the budget projection change for 19, it's important to note that 10 of the hospitals are missing their numbers this year. Overall, we're getting to about the same place because UDM is about 1.9% and the rest of, well, everyone else is down. But that goes then in context with the requests in the next column on the budget to budget where six of those hospitals that are down are asking for increases significantly above the guidance. So that would be something obviously we're tracking because they're missing, some of these hospitals have repeatedly missed forecasts and really just want to be focusing on making sure we're not looking at some what I call aspirational budgeting because if we're budgeting to define the expense load gets budgeted at that rate and if, in fact, the top line doesn't come in on the normal course of business, not because of any changes that the board imposes, it's very hard to correct that and that's where we only go to page seven, that operating margin page you were just looking at before. It really highlights how many hospitals that have moved in the projection to negative and I appreciate what you were talking about Tom, but I also would look more at the overall rates and being 2.7% for UDM, I mean, what is the right rate to be at and we want it to be positive, obviously. So I mean, I don't look at a 2.7 operating margin as high necessarily the problem is all of the hospitals that are negative, many of which didn't budget to be negative, obviously. So it's missing that top line and we've seen repeatedly where hospitals won't come back in assuming they're gonna get back to the number that they were at before or compared to their budget and then when they miss they are losing money. And so that's a big area of concern and so I would just kind of point out that try that the hospitals are missing and yet overall for the system we're looking at a 4.5% per class when the guidance was 3.5% so something to look at there. When we go to the page 19, maybe there the comments are right, we'll show you what the actual requests are and do I look at these adjustments that we put through here as bringing things really on an apples to apples basis. So if somebody made an accounting change, it wasn't in one year and then put it in the other year, if they had a decision to transfer, that makes an adjustment. So there we're looking at overall 4.7 with one, two, three, four, five, six, half of the hospitals exceeding the guidance. Some of them are pretty significant. So obviously those big things we're looking at and then if we flip to the next page on the commentaries by the new network they've brought up two different factors that it looks like they'd like the board to consider that they're meeting the numbers to exclude these factors. And just a couple of comments on this, this is the first time we're really seeing this and that could have been something that maybe presented to the board earlier because what we don't know is I think many of the hospitals have case mix index issues where the population is sicker and therefore it's costing more to take care of them. And none of the other hospitals have given kind of case mix in it. So what I do, the way I do look at it though is I'd say UVM overall network came in at 6.6 and that's the number they're requesting as a 6.6. Within that these two things do contribute to that and so we'll have to look at how that impacts. The difficult part is we're not seeing that offset elsewhere. Well, the unique patients are contributing three point, you know, we've got about $50 million of adjustments to the numbers but we're not seeing that offset elsewhere. So we'll just be, things we'll have to look at when we're going through the presentations. And one other on page 25, just to ground a little in the history in the past several years, 16 was, or the outlier was 4.4, 17 was 2.8, 18 was 2.9, system-wide, 19 looks like it's gonna be about 3.8 and then again going to 4.5. You know, one of the concerns, the reason we have the 3.5% guidance was to be looking at welfare model and try to look at that two years of how do we look at that? You know, in that context. The other page, you know, just to comment on from the UVM network piece, I would look at it a little more that in the 2019 forecast for UVM it was low, there was no request, I think it was 1.6. Now they're coming in at 3.5 and then next year it was 4.1. Not to say we would accept that, but I looked at it a little differently, like the 19 budget, the request is much lower than what the guidance had been. I think that's that. I think we're all going to be moving into the budget hearings and dig in a lot deeper. There's sort of a lot of hospitals still struggling and one of the variables we did see is if you go to the commercial increase, some of them are very high on the commercial requests and some of the hospitals spoke to the way they got to that number was just getting to 3.5% and then plugging the difference and we'll all want to make sure we're looking at all opportunities for cost savings and things to offset some of the pretty significant commercial asks that both the system and the board are not right, but thanks for all the information and the hard work, you know, putting this together. The one thing we also heard from some of the hospitals when you mentioned cost savings is the cost savings affect their Medicare cost report settlement, so the less cost, the less of a settlement because they're not going to necessarily get the charge increase that they're requesting instead they have to get it through their costs from Medicare. We heard that quite a few hospitals this last week. I guess the challenge on that would be if in fact they're accurately getting everything they should be for Medicaid and Medicare is these are the hospitals that are losing money and so making sure their cost reports they're getting everything in there that they can. I know they're trying to, I'm not saying that, it's just when you're losing, you know, five or six percent and whether it's plus one or minus one, if you get reimbursed, if they have an operating margin less than that, there's concerns with that. Right. For the questions or comments from the board, at this point I'll open it up to public comments or questions. Kevin, did you want us to finish with the procedural part in case there's a public comment on the process from here on out? It would make sense. Okay. All right. So the timeline, right now we're in the July, August time period where we do staff analysis and we also forward budget materials from the healthcare advocate. We examine all of the hospitals narratives, all the supporting documents they sent to us. We also do statistical analysis and review their budget submissions against the compliance or we'll say the budget guidance and then we have our analysis ready. We've also talked to the hospitals last weekend this week. We have our analysis ready the late this afternoon, tomorrow, final and then we're asking the hospitals to respond by August 9th. Also on this timeline is what we're talking about today is this preliminary presentation. And then we will be asking the hospitals to send their presentations into Abigail or to us by August 14th. So all of them are in at the same time before hearings. And then these are the dates for the hearings August 19th, 21st and 23rd, and then the 26th and 28th. You- You know, I'm a bad guy that is going to make sure that everybody hears to that. Okay. I know that somebody's already requested a change but it won't be granted. Then we go into deliberation August 29th, right after the budget hearings through August 14th, August 14th. And well, actually the 14th and 13th is when we have to have a final decision. And then we formally start writing the budget orders between that time and September 30th. So what we plan to do with staff is to, as Lori said, finalize our questions and send them out today and continue to analyze, listen to the hospital, budget hearings themselves, and then we'll prepare some recommendations. We're also gonna look at the submissions to make sure they're in compliance with the budget orders from last year. So we'll just make sure that everything's kind of, we're following up from the things we asked them to do last year. From the board's perspective, what you'll be doing the next few weeks is to review and evaluate individual hospitals independently. Go to the hearings, review the public comments that come in from the public, any comments that are coming from the Office of the Healthcare Advocate. And as Lori stated, approving the budgets by September 13th. So now we'll look at the questions. Yes, ma'am. I just got a question from Maureen. First, you said that the overall budgets don't show any new volume to UVM, did you say that? No. Or you didn't say that? No. Hold on. Exceeds the caps, but they're different. Well, I understand that, but the question here is whether you're getting redistribution of the patient load across the state. It's from one hospital to another, okay? And if that is true, then that's one thing. You've suggested that in the front end, by saying that at least I forgave another of the spending of 10 of these budgets for aspiration. No, that's it. Okay, 10 of the hospitals for 2019 are missing the top-line rejection that's now in every forecast. On the flip side, the total request for all of the budgets is four and a half percent, which exceeds the three and a half percent. So it doesn't seem like it's showing us the swaying of patients from one application out of that. You know, yeah, that's one thing. Rejection to rejection has been 10 months of missing and it's starting to be, for those of us that if you look at their operating margins, their operating margins are numbered. And so the caution is to really test and you can see that some of the hospitals they're down this year and they're asking for a 12 percent increase next year. If that doesn't happen, they go over expenses, if you've got a problem with many of them are fixed, they can't adjust to their idea and then they lose money. So, you know, a lot of the focus that I've done in the past hasn't just been on the hospitals that exceed the cap, but those that are underperforming and losing money. We don't want to have situations where hospitals continue to go over this money and can't break up an ends and can't sustain that. I was also saying that we've lived through a rebasing discussion not that long ago and it's not something that I think the board has receptive to doing every single year. Other questions or comments? Sure Bob. Thanks. I just, I'm curious, on slide 14 is a reference to the 16 CLA's and the one going from St. Helene Rose. How does that impact the budget consideration versus the board point of point of not? So, I was quickly changing pages but I thought I heard you ask how the CON's. Yeah, it's on slide 14, good morning. Yep, the capital budgets, yep. Do you want to jump on that, Lori? Sure, the CON's are planned. They are not in the operating budgets unless they've been approved. And like if we mentioned an ongoing CON, that means that it had already been approved previously so that would be in the budget. But if it's like UVM's Epic or their Miller Building that's already in the operating budgets. But if it's something that they're like an MRI that a hospital is planning to have that would be one of the CON's. And it's just a mention that they plan to do it. So it gets approved during the course of the year? We will be amending the budget. Assuming that the CON doesn't have a condition that it not impact the budget, which a lot of them do. Right. The vast majority of them do. Well it would have, it could have depreciation impacts but a lot of times that's lagged till later. Correct. And it's gonna have cash flow impacts. So usually when hospitals are looking at their budgets they're assuming in their cash flow that there will be capital expense and they'll make some such depreciation but the actual rules would be there. It typically is not supposed to increase commercial rates to offset CONs to make the numbers stable. Oh. The last note is this year we had a definition of what change in charge was. Previous years we called it increasing rates or prices. Basically now we wanna know what are you changing your charges to Medicare, Medicaid and commercial payers? And what is your overall increase in your change in charges? So this information was on the budget guidance and we also had the hospitals fill out in appendix. Okay, I'm just wondering though what did I actually get with the fixed payment perspective? That would have. So each of these are different terminology changes. So the first is that it clarified that net patient revenue is that addition of the fee-for-service revenue and the fixed perspective payment. So that's one terminology change. A second terminology change was a great increase to change in charge that's unrelated to the NPR FPP. We declared part of the more so the hospitals will say they charge us some rate to everybody. So if the charge is $100, they take a five which that increase goes to $105. But the actual then the change in deductions and actually what passes through would be five percent for commercial that zero for Medicaid or zero for Medicare. So we wanna make sure we're understanding by payer type what the actual change in the charges versus the rate may affect the gross cost at the top. Thank you for the presentation. I want to spend the team even though we've been down in half hour. I want to. That you've been ahead of schedule the whole way and that's really great to see. Keep up a great work. Thank you. The staff analysis will be on the web also this week, later this week. And there's also a lot of other summary documents that people can access on our web. Like we have what is called the trends report that takes all the different statistics and rates it by hospitals. That's a really good report. It'll take some of these measures and you can rate them like UVM and how they measure up against the rest of the hospitals who's number one, who's number 14 and things like that. Thank you.


The First Art of Business is due for deflection. The very portrait that the co-chair of Deputy Secretary for 5th City of Edinburgh, good afternoon city of Edinburgh. I welcome�sh each member of the House of Lords in the spot to meet. The board of Governments asks you to hear the iconic with others, in our capacity as members of the Scottish Parliament or priests and ministers of religion always have a story to tell that can at times lighten our less bright days, what follows is a true story and while I was not essential to it was part of it from the sidelines sometimes a very good place to be. Over and above my parish work I'm also part of the ymgyrchgymhwyddiad ar Ymgyrchgymhwyddiad ymgyrchgymhwyddiad ymgyrchgymhwyddiad. Ymgyrchgymhwyddiad yn ymgyrchgymhwyddiad, y dyweddyn ni'n cael eu cyflwyno, mae'r ddweud yn eu bod yn ymgyrchgymhwyddiad, mae'r ddweud yn ymgyrchgymhwyddiad, ymgyrchgymhwyddiad. Mae'n amser o byddwyr amddangos i gweithio'n gweithio, ac mae'r berthynas o'r dyfanol, oherwydd mae'r cyflwyno. Gwlad ddod y cwestiadau i'r ddod i gyfan gwyfod gwaithadol, ddigon i ddogion y cwestiadau gyfnodol, i gafod i ddim yn ymgyrch yn cael ei angen ac yn ddannu'r cymdeithasol y ffost. Ar ddat y gallai gweld cael ei ysgrifennu'r ddod i'n ddod i gael i'r gweithreitau.�on yn cael ei tynnu mewn gweld ddod i gyfnodol, unsiwltu'r ddeut START, ac yn ym ni, ym chi'n olygu addigio, dwi'n meddwl i trifwyddog i ddigonol. A at Windham, gallwn i fyrda'r amgylch yn i'r lluniau ac yn ddÙf yn ei wneud yr hynny. O'r Llywodraeth yn ei wneud. Ie, roeddwn yn mynd erbyn chesaf i ddangosfodd angwy ar gyfer ydynt i chi'n gweithio ddim yn iaf. Dim byddwn i'r ddweud o gyntaf, mae'r hynny'n ddewch yn iaf'n ddewch. I have often reflected on that night on its humour, on the degree of poignancy but surprisingly also on the accuracy of that statement. The chaplain, of course, leading the service, was looking for another few words, Jesus is born. Perhaps on further reflection, there is no contradiction in either statement. However, we engage in the work that we do as members of the Scottish Parliament or as members of religion, of whatever denomination, essentially we seek the same purpose. That purpose simply put is to enhance the quality and the dignity of the lives that we seek to serve or to minister to. Clearly for someone like myself, engaged in the proclamation of the gospel, it is rooted in the teaching of Jesus Christ. For others, it may be rooted simply in the belief of the good of humanity. What we have in common, then, is an honest and deep desire to make the lives of all those who are trapped in poverty, in homelessness, in addiction or in mental illness better. Therefore, perhaps the old prisoner's words did in fact contain quite a bit of wisdom and, hopefully, will still cause us daily to reflect on the fact that we have the ability to liberate and to make better the lives of those who feel trapped or who are in despair. That, ladies and gentlemen, may I respectfully suggest to you, is our common mission and purpose.


Next to the stage will be Christopher Ategeka. Chris is an award-winning serial entrepreneur, engineer, futurist, pragmatist, and optimist. He is the founder and CEO at Ucott Inc. A company that created a unique model to support and fund early-stage startups, creating solutions to unintended and willfully ignored consequences of technology. Chris also founded Ucott, a conference whose main objective is to have authentic discussions around exponential technology development and usage that may not be serving humanity's best interests. Chris got into this work from being personally affected by the unintended consequences of technology. He and I were among the 50 million people whose data was breached on Facebook recently, and he believes the conversation can all too often be overly optimistic. Please welcome to the stage Chris Ategeka. Thank you. Good morning, because I was in there for... Hello. How are you? Let's see. That is a headline in The New York Times two days ago. Today, I'll be talking to you about unintended consequences of technologies, and one thing I want to get off my chest right away, I love tech, I use tech, so I am not anti-technology, even though it's hard to believe. But tech is hacking our minds, and our intentions, even our humanity in the process. Algorithms are making decisions for the news we read, who we vote for, even the jobs we take, the people we meet, and even the ads we see. So thanks to SoCAP for actually making it happen that we can have these tough conversations right here. So my name is Chris, and my company is UCOT, and we work really hard to create solutions for unintended consequences of technologies. So I can't wait to share with you what we've been working on, but first, I want to be very clear on one thing. So no one is sitting around complaining that the fork has made our fingers obsolete. No one wants to go back in the days when we're slapping clothes on the rocks to clean them. And my friend Mark over here, he and many like him use exo-seculitans to actually walk. He's paralyzed from waist down. So literally every conversation, every conference, every entrepreneur you meet will tell you how technology is wonderful and it's creating wonders for the world. So since the great side of technology is covered, so today I would like to talk about the dark side of technology that doesn't get attention and the urgency it actually deserves. So I'll go into a few of the examples, and some of them you might be familiar and some of them may be a surprise. So we look at climate change, for instance. We know exactly what we need to do, and the crisis is happening, even though there are some deniers.  So one, we've got to stop taking fossil fuels out of the ground. Two, we've got to stop cutting down trees. And three, we've got to plant more trees.  The thing is, if we don't do these things concurrently, anything short of that is just a band-aid. So we know this for a fact, so why are we not doing this? Why are we not doing all these things at the same time concurrently to mitigate climate change? I'll tell you why. This is the lack of political willpower. Corporations and big money are literally like physically in the way to make this happen, so we need action on a large scale. So another issue we've got to look into is electronic waste.  And it's turning into a work for the nonprofits and the governments to solve. Another issue to look into is synthetic biology, great potential, but also could lead into accidental and purposeful creation on the release of harmful organisms. And the real danger is mostly in the viruses. Smallpox, for instance. Smallpox is potent. But the sequence is actually published online. Anyone can go on, recover it, synthesize it and create some significant help for our human civilization. Falsehoods and misinformation, data breaches and privacy. If the product is free, you are the product. Businesses have to make money. Access to information has now become a battleground for corporations and governments. And when two elephants are fighting, it's the grass that suffers. And guess what? We are the grass.  Parenting. We are outsourcing parenting to devices. Education, oh my gosh. We are making our kids' screens brighter than their futures. Loneliness is becoming a public health crisis. The United Kingdom now has the Ministry of Loneliness. I wish that was a joke. You should check it out. We are the most connected generation, but we are very lonely and disconnected in real life. Tech addiction and depression are on the rise. And there's a new business in town. It's called Tech Rehab Centers. They are really big in Asia and they are coming to town here, so our users have now turned into patients. Automation. Just as an example, there is 29 states in America where driving a vehicle is the number one job. I repeat that. 29 states where driving a vehicle, driving a truck, Uber driver is the number one job. So with automation, we need a new plan because it's going to be a huge disruption. There will be increase in productivity, but workers have to keep reinventing themselves. Inequality is getting automated, Jim Crow is getting automated, and the list is very long. So if we look at the grand daddy of them all, it's artificial intelligence. It's a multi-billion dollar industry with a minimum of zero regulation, driven mostly by corporations who have the big data and the big monies. This should be a point of concern for all of us, or most of us. AI is at that point where we have one foot in the path and one foot in the future, where we're feeding it data, both good and bad, and it can take us in two really good direction or really bad direction. So let me share some benign examples. Some things you might find funny, but they are literally an example of how when we feed data to the system, the system puts out whatever we feed it, we put good things in, good things come out. We put bad things in, bad things come out. So here are some examples. If I, a person of color, go to the bathroom and those soap dispensers and put my hand like this, I'll be able to get soap. If I put it like that, I'll be able to get soap. But I put it like this, I will not be able to get soap. It's a very simple benign example, but that's the kind of data we are actually feeding our systems. So AI will teach our children in the classrooms, how do you protect big money from influencing the classroom? Because the AI that makes it to the classroom will be driven mostly by a person with the most amount of money. So teachers may end up becoming brand ambassadors. Whoever pays the most, that's the AI that makes it into the classroom. But humans have invented, we've messed up and reinvented ourselves, we've reinvented ourselves out of the mess. So a good example is the fire, we invented it, we burned ourselves with it, we created a fire extinguisher, created another example, we invented a car, we run ourselves with it, and all these messes happen, we came up with some rules and stop signs to not mess up with the car. With today's technology, we need to get things right the first time, specifically on these two major, major technologies. So critics may say that's kind of scaremongering. As an engineer, I can tell you this is not scaremongering, it's actually safety engineering. As humans, we're really good at being proactive, but we're really terrible, we're really good at being reactive, but we're terrible at being proactive and kind of work out the things that we know are coming, but we just wait for them to happen before we can take action. So anyone can come up here and lay out all the issues and the reasons and the problems why technology is bad for society. And sometimes it can feel there's a huge inaction because the problems are so many and they're massive in nature, but what are we doing about it? So I got some good news. There's a handful of people who are working really hard and diligently to actually create solutions. So I am one of those, and there's a passionate community out there that are working in silos to create solutions for unintended consequences of technology. So allow me to tell you a little bit about the work that we do at UCOT. So UCOT is, in simple terms, it's an incubator that supports early-stage startups that are creating solutions for unintended consequences of technologies. Some consequences are intended, some of them are actually willfully ignored. Like fake news, for instance, that is something that's created by somebody with some intentions, but they just ignore it because they have some benefit out of it. So that's one component of the company. Here are some examples of the companies that we have in the network and because of time I won't go through them all. The second component to the company is we created this community of individuals who are either funders or entrepreneurs who are creating solutions that we gather every year and we work on these unintended consequences of technology together so that we don't duplicate efforts but actually share resources. Actually, if I can put it in a shameless plug, we have a conference coming up on Tuesday, next week, be there at the Fairmont Hotel. So, I would like to conclude with this and I want to share a personal story here. This is my grandmother. My grandmother happens to be both deaf and mute. She raised me from nine months old and after both my parents died in rural Uganda where I was born. So, I was raised in and around extreme poverty and all its glory, all the things you've heard, I've experienced that. But no one asked for my permission whether or not that's the world I wanted to get born into. Those were just the cards that were dealt to me. So, after many life events, I ended up in America, went to a great engineering school, started good successful companies and won many awards, being on covers and magazines and all that. But I share this to say this. If there is one thing I've learned where there is a will, there is a way. In my early struggling days, if someone asked me about what kind of life I wanted to be born into or enter while entering this world, I would have started with the simple stuff. How about food? Or how about two parents? That's not too much to ask, but no one asked me for my permission of what kind of world I want to get born into. So, ladies and gentlemen, the future generations are literally in that position right now. They are voiceless. They don't vote. They don't participate in markets. And with tech and everything that we are doing, we are affecting them the most. In a way, we are dealing them some cards and do you and I have the power to change that? So, one, go out and vote. It's coming up. And two, you can also vote with your spending power in places where you put your money. We can wait for the big shots with the keys to come and save us, but guess what? They are not coming. We are the ones we've been waiting for and we need to take action right now. And I'm extremely optimistic that this will happen. And I believe we can save the humanity in our only habitable planet we know. So, every single person in this room is affected by technology, whether you know it or not, whether you like it or not. So, here's my ask to you. If you like what you heard or so from this conversation, join the movement. Join the movement and come join us, individuals working really hard and diligently to create solutions for unintended consequences of technology. A hundred years from now, we may have a well-optimized world that works for everyone or we may have no world left to optimize. So, ladies and gentlemen, join our efforts. Thank you very much.


Gaffr after being 2-1 to the good with about 5 minutes of normal time and I imagine you probably scratching your head as to how we've most lived that game before too. I'm not scratching my head because as you can see what happened in front of me and where we could do better. So obviously it devastated that we actually did lose the game because it was a game that we were the dominant team again but we put ourselves under pressure with the first goal that we can see. I thought we responded really well to it and grew back into the game straight away. I think we had some brilliant chances before half time we should have equalised but after going 2-1 up we went away from what's got us our success in the last 7 or 8 games. I've been on the front foot and we stepped backwards and that's our harsh lesson for us all to understand why we're playing the way we do, defending the way we do, how we're always on the front foot as soon as you go back you give the emphasis to the opponent and to the way they've punished us. It was very nearly a performance like we've seen, the likes of us that has brought us the success over the past 9 games so how frustrating is it to work so hard and get back into the game and get ahead in the game and then like you mentioned to have the signs right in front of you to see what went wrong in those final 10-15 minutes of the game to end up losing them? It's really frustrating because we're so strong on it and the major part of that is we've had success from it. I know when we first started pressing the way we do and playing on the front foot the players had to be convinced that this is a good way of defending and also turning into an attacking phase and play and we've had to be wards from that. I just thought at 2-1 you've got to fight instincts sometimes because you have to have a lot of discipline and trust your chain and trust what we've done over the last couple of months to stay on that front foot, stay in aggressive positions because it's an age old thing in football where you want to hang on to a lead, certainly maybe you get the leading goal so close to when the full-time whistle is that you start looking at the clock and you're not focused on what we've been doing so well for so long and you just step backwards and it's a harsh lesson, well it's a harsh lesson as I've said to players it's a harsh lesson if we learn from it or if we don't learn from it and get better then it's what we are and in the last 10 minutes we didn't look like a good team, we didn't look like a proactive team, we looked like somebody was hanging on and that's not been our way, we've been really good at being brave and courageous and pressing the ball and supporting each other and trusting each other and we just went back and took a backward step and I've just watched the second goal after we go 2-1 up and it's just a catalogue of us going backwards and from then playing out from the back and what we've been brilliant at is not allowing teams to do that and turn it over and it's a hard slap for us today because after that we still want to go and get the winning goal and we've just become too open a little bit and we've just made lazy mistakes really Is it something that comes with time in terms of our mentality? You've not just still not been here all too long, two months or so Getting into that mindset of taking the lead in a game and being able to successfully see it out and showing those traits that you need in order to be able to win again Yeah, in football every team can win the odd game, win a game or win, draw, lose, win, draw, lose, whatever it is The good teams are consistent with understanding what they're good at, what they've brought on success and then repeat it and repeat it and repeat it It's like adjustments because obviously the opponents you play are slightly different but your identity and your focus on the games has got to be consistent, how you do it and that last ten minutes, I'd say the last ten minutes, the minutes between us going two-one up and them conceding we won that team again Yeah, so you go for a season, like you say, we've only been here a couple of months and apart from the first one-half games it's gone really well but the last fifteen minutes of that has shown us that we can't rest we can't sort of think we've achieved anything which I've been repeating that when we won six on the bounce, okay but we've got to win next week, we've got to stay consistent and today in spells was a lack of consistency in our phases of play and like I say it's a hard slap in reality, it's a reality check really if you come off what we've been doing so well you can get punished


Next question is from Turtle Wave. How long did it take you to fall in love with the journey, not the destination? That's a good question. When you love the journey, you're gonna go hit the destination and surpass it. So this is always a goal. This was a goal for me for my clients all the time. My goal was to get my clients to love the environment of going to the gym, to love the experience, to love exercise, because I knew if I could get them to do that, that they would never stop. That it was always something that they looked forward to, that they knew that it made them feel good in the moment, they enjoyed that whole thing. I wouldn't have to worry about them ever stopping. That was always the goal. Now, me personally, that really happened to me and solidified for me. I mean, I always loved working out from day one, but it really solidified for me years ago when I was working out. For me, years ago, when I had somebody very close to me get very, very sick and they were terminal. It took them, for about a year and a half, they were terminal before they passed away. And I continued to exercise and I started to fall in love with exercise for different reasons that I had loved it before. It wasn't about the pump or the sweat or the weight that I was lifting or how strong I felt or the intensity of the workout. Those are all things I loved before. It was the meditation aspect of it. It was the feeling good. It was the present, the being present moment aspect of exercising. When I'm working out, I'm here. My mind isn't spinning in a million different directions. And so in that year and a half period, I started to really fall in love with the journey in a more complete way, at least when it came to exercise. Now, here's the cool thing about this and I've seen this with young clients. It bleeds over into everything else.  If you can enjoy the process, everything else is easy. Yeah, I think for me, I always loved working out and I loved self-improvement and I was sort of a junkie towards that. I always wanted to do better in any, especially athletic realm. I wanted to be better. I wanted to move faster. I wanted to get stronger. So I always enjoyed that, but I think it really just dawned on me where you could go with this fitness, like where I could take it to new levels was when I stopped being an athlete and when I just finally accepted the fact that like I don't have to work out to produce something that I measure out on the field. Like it's not, that's not all it equates to. Like there's more to this. There's ways of benefiting your body from a physical standpoint, but also a mental, emotional standpoint too, where this was something that it just turned into, I'm doing this to benefit my body and to make me feel good and be healthy. I wasn't in it to be healthy. I was in it for performance exclusively. And so once I moved back here from Chicago, I struggled with that. And that was a thing like what am I doing? Why even work out? Because I worked out to then go play something and then display whatever skills or things I've been working on or if I was stronger or more explosive, like that mattered. And now like it just didn't translate the same. So I just started to have to reframe it and look at it in a completely different lens. And then it just finally, I just accepted it and became something that I just, I fell more in love with it because it was really benefiting me and everything just with my lifestyle. I don't think I arrived here until not that long right before mind pump. For me, I was very on or off all the time. And when I was on, I had a goal. I had something coming up and so I was gonna get myself into shape. Even this is years of being a trainer and I use my trainer knowledge and experience to whip myself into shape or to accomplish fitness goals that I had. I don't think it was until I fell out of shape and I left fitness for that little two year hiatus when I was in marijuana. And when I was doing that and I realized how unhappy I was.  I was still kind of working out. I've never not worked out for a longer period of time than a few months, right? I think probably two months has been the longest I've ever not worked out at all. But I was very inconsistent. I was eating terribly. I wasn't moving at all. And I was kind of working out while I was doing the marijuana thing. And, you know, I had reached that financial goal and I saw just my whole life was kind of in disarray. Like it just, my relationships with my family, my friends, you know, my relationship with money, everything was kind of all changing around that time. And when I did back into fitness and exercise and like full time, the attitude was different. It wasn't like I'm doing this because I have this major goal. Although I did use the transformation goal thing to kind of catapult Instagram and things like that. It really wasn't the main motivation originally, right? Originally it was like, I miss fitness and I miss the way I feel and how it affects like your point cell every part of my life. And after I did the whole and it didn't come completely full circle until I got to walk away from competing. Cause obviously, so my mindset was there right before mine pump.  But I go, okay, well I'm also going to build a business around at the same time. So let's put this out on Instagram and YouTube and drive traffic to me. And then it wasn't until after being able to walk away from competing where I was on this very strict regimen of what I was doing training and dieting. And so I think really just in the last, you know, probably four years or so, do I feel this way? And the way it looks as far as what, how does it look different for me today than it does then is what I've mentioned on podcasts many times. There's lots of times where, you know, a day of exercise may be, you know, Katrina and I go somewhere and do a two and a half hour hike somewhere or I may just work on my squat or I may just do mobility for a while or I'm doing, I look at it a lot different. It was always like goal-based before. If I was in the gym lifting in my mid to late 20s, I was doing it to accomplish something.  I was in pursuit of building more muscle or more strength. It always, there was always an end goal in it. It wasn't like I'm doing this to enhance my life. Today it's 100% that. Today it's, I want to feel better. I want to sleep better. I want to be stronger. I want to have energy. I want to be able to play with my son. I don't want my joints to hurt. And so therefore every day, I'm trying to do something that's related to health and it just looks different.  It doesn't look like that because sometimes it's not how it pans out for me. And I'm okay with that today where in the past I would write that off as, oh, I'm gonna train because I don't have time to do this or, you know, go for a hike that's not really gonna help me build more muscle. So I'm not gonna do it. And so that's really come full circle for me in the last probably five to six years really. Yeah, I used to, with clients, we would have this conversation later on when I realized that I wasn't doing a good job getting people to stay consistent. And the conversations I would have is I'd say, okay, what are your favorite things to do that involve movement and activity? And they'd say, oh, I like dancing. Like that's your cardio. So can you dance twice a week, you know? Or can you dance a little bit every single day?  Shouldn't I be running? Like no, no, no. Do that, you enjoy it. I know you're gonna do it because you love doing it. The structured workout will be with me. Let me do the structured workout. And then I know my goal was, I'm gonna make them love this. And usually it wasn't the workout itself that they loved. It was the way they felt and the environment and the people and they developed this good relationship. But yeah, this is key. And it's funny how all of us are talking about how we all worked out for years before this became a thing. This doesn't happen overnight. Well, it's also, it's a process. I also think that's, I mean, when we had that very first talk on Mind Pump, this was the things that we felt were important to communicate to the masses that wasn't being talked about. Everything's about body fat percentage, lose again. How do you get lean? How do you get all these five pound goals? Right, and there was just, I think a much more important conversation we all do. I think there was a much more important conversation that need to be had with the masses. Like, yes, if we wanna get down and break down macros and talk about planning out a plan for someone to accomplish something, we've all proven that we can do that to ourselves and do that to other people. But when you talk about long-term behaviors and changing people's lives, that this becomes a part of their journey and not just a short goal for a wedding or Vegas or something they have, that it sounds a lot different. And the things you communicate are a lot different. There's a lot of the motivation behind what we do. It's a crucial part to personal growth, you know? And that's something that is very obvious when you're in it, but you gotta be in it. Totally.


Okay so our next speaker is Xieok Xiong Liu from the University of Zürich and he will talk about the symmetrization of very curvature in the magnetic moment. Okay, hello everyone, I'm very happy to be able to talk today. In this talk I will talk about how to symmetrize the very curvature and the magnetic moment with one-year interpolation. At first I will talk about why I need the symmetry. The recently I'm doing, I'm trying to calculate the conductivity as a response function of different order of electric field and magnetic field and all the conductivities can be solved by a Barry Boseman equation and each of the conductivity should be a function of energy and very curvature and magnetic moment. For example, looks like this integral for something over all the brain zone and here is a nonlinear anonymous Hall effect conductivity. So to make the conductivity converge we need a very dense k-grade and we need a lot of time to calculate. A easy way to reduce the calculation time is only to calculate the symmetry reduce the k-grade. But usually the if we use one-year interpolation, the one-year function slightly break the symmetry a little bit like this one. Here is a plot of a very curvature z component of one band from Togono-Talurium. The Talurium have C3 rotation. We can see is roughly half the C3 rotation but for the details not it's clearly here. It break a little bit C3 rotation and the details around here as well. If we only calculate the reduced k-grade it's like this. Now we do have some symmetry but the first problem that's the two-figure equivalent which is other. I think it's no because you only choose part of the k-point from the non-symmetric data site. You will lose some information and it showed in the result here. Here is a very curvature dipole result based on different energy and some energy use reduce the k-grade converge to a different result with the full k-grade. The second problem is we can clearly see with only part of the k-point the data is not smooth. The non-smooth data will give us a lot of noise when we evaluate the integral. That means we need more k-point to converge. It also showed in the in the result here with full k-grade is have a very good convergence here but with part of the k-grade is not. In this part because there is a well point we should have the bad convergence it's understandable. If we focus on the normal part here without well point and the band intersection the convergence is bad with reduced k-grade. So that's why I am thinking about if I have a symmetric data site can we improve it? The most cheaper way for me to have some symmetry is directly symmetrized the output from 1 year 90 and have some symmetry. Okay the basic idea to symmetrize the Hamiltonian is from Tommy who is the postdoc in University of Freiburg. The basic idea is following. Let's think about two dimensional grade. The yellow dot means original point and each orange dot means the position of autumn. That means at each unit cell we have only one autumn located at the zero point. Let's assume if each autumn only have one S orbital how to symmetrize this hopping? The idea is find all the oh from here only consider the C3 rotation only find all the symmetry in equivalent hopping and sum together calculate the average we can get a symmetric hopping map. It's only for the S orbital but for the P orbital or D orbital we need to rotate the orbital as well like here. If we want to rotate the orbital from beta prime to beta we can build a local coordinate system at beta and another local coordinate system at beta prime which after C3 rotation we can find a projector to the E prime system to E system. The projector it should be the rotation matrix of the orbitals I mean the one-year functions. Okay if our Hamiltonian is respect to the symmetry we can have this relation of the hopings. If we break the symmetry a little bit we can use this function to symmetrize the hopings and this symmetrization method is implemented in one-year tools only for the Hamiltonian. But for me only Hamiltonian is not enough I need to symmetrize a barrier curvature and magnetic moment. And actually if we consider a well point at a high symmetry point the barrier curvature is more sensitive with the symmetry than the energy eigenvalue. If we break the symmetry a little bit the well point will have to move a little bit away and around the high symmetry point. If we consider the high symmetry point the energy eigenvalue will give us a little gap. But the barrier curvature is changed very fast around the band intersection that's the number if we only consider the the high symmetry point the value of the barrier curvature will be definitely different with it on the right on the well point. That's one point and another point is energy eigenvalue is just the number but the barrier curvature is a vector they can break the symmetry in three-dimensional space. That's why I say it's more sensitive. Okay to try to symmetrize it we need to know how to interpolate a barrier curvature. To interpolate the barrier curvature we need to first interpolate the barrier connection A. With Vanier function they have two terms one is A terms and one is D term. The A term we can use a position element to calculate and D terms is used. Hamiltonian is enough. Hamiltonian we already know how to symmetrize it and how to symmetrize the position element. Actually it's the same way. The only difference we need a additional S is the rotation matrix because it's a vector. We need to rotate in a vector again. There is some special event when r equals to zero because when r equals to zero the diagonal element is of the A matrix is Vanier-Centers. If we rotated Vanier-Centers by S the Vanier-Centers sometimes from the home unit cell changed to another unit cell. We need an additional term to push the Vanier-Centers back to the home unit cell. For the magnetic moment the spin part is very simple. We can use the same formula. For the orbital part first we need to find the interpolate function as well like this. The omega we already know and the new term is the G term. The G term is the details is a lot of another matrix which is new for us is the B and C matrix. We need to know how to symmetrize these two matrix. For the B matrix we can use the totally the same way with the A matrix to symmetrize it. For the C matrix which is the tensor matrix so we need two rotation matrix to rotate the vector each vector column. So up to here we can finish the symmetrize the energy eigenvalue and bary curvature and magnetic moment all I need. Let's move to the spin orbital copy. Before I only talk about how to rotate the axis of the orbital if we have spin orbital coupling the simple idea is to add the spin rotation matrix to the orbital rotation matrix P to make it working for a spin orbital coupling system. And for a magnetic system we need an additional input which is the magnetic moment of each autumn. We can use that to to improve the group from space group into magnetic group to find the which symmetry is respect to our system. Okay from the result part we made a same result as before after symmetrization. Here we have a totally perfect symmetry now. From the result side if we only use a reduced k-grade after symmetrization it can converge to very close to the full k-grade calculation before symmetrization and keep a very good convertency this part and this part except the venue point part. Okay that's all I want to talk today. Thank you very much. Okay so there is time for a few questions if you are joining on Zoom please raise your hand virtually with the button or write your message in the chat and we will read your question otherwise fair in presence here just raise your hand and I'll give you the microphone. So let's you have like a px orbital you do a threefold rotation then it becomes a combination of px and py. Yeah and then can you still do this averaging or not? Actually it is to change by group of orbitals just like they're based on the complex axis just like x, y, d. I mean px, y, d we will fix together. Oh so it still works. And then just like like this minimum is maximum authorization. Is there is there a simple answer to why does it break the symmetry or? I'm not sure. I don't know okay maybe somebody can comment on that I'm kind of confused. Okay any other questions? I've seen none so if not we can thank again our speaker and move to the next stop that is actually connected to yours right it's like a sort of part one and part two right the talk of me. Okay so it will be a sort of a continuation of this work. Oh okay so you're giving part one. Yeah the prequel. Oh you can use this one I think you're louder.


G'day and welcome to another video on the basal ganglia. Today we're going to be talking about the direct and indirect pathways. Models used to describe the influence of the basal ganglia on conscious movement. First of all we're going to write out the bits that are involved. We've got the cortex, the motor cortex, which occupies this part of the gray matter. We've got the striatum represented by the putamen solely in this model. We've got the globus pallidus externa, the globus pallidus interna, the thalamus in the midline, but the subthalamic nucleus underneath the thalamus of course. And we've got two parts of the substantia nigra, the pars reticulata and the pars compacta. When we talk about these pathways there are two neurotransmitters that enter the discussion. Glutamate which provides an excitatory signal and GABA which provides an inhibitory signal. The end result is always excitatory output from the thalamus to the cortex. But the role of these pathways is to to modulate the strength of that excitation. The direct pathway increases the level of that excitatory output. So we can think of it as an excitatory pathway. The indirect on the other hand reduces the level of that excitatory output. So it's effectively an inhibitory pathway. I'm going to quickly write out the neurotransmitters released by each of these parts we've got listed on the left. This is only relevant to these particular pathways. So the cortex releases glutamate, striatum, globus pallidus, both parts, release GABA, the thalamus and the subthalamic nucleus release glutamate, the pars reticulata, GABA and the pars compacta as we'll discuss down the track releases dopamine. Okay, so let's get stuck into the direct pathway first. The cortex initially provides excitatory input to the striatum. That's going to increase its level of GABA output. And that GABA output is going to act on the globus pallidus interna and the substantia nigra pars reticulata in the direct pathway. So these both release GABA as you can see on the left. And they both release GABA on the thalamus. But because they've been inhibited by the striatum, that GABA output's going to be decreased, which allows the thalamus to provide a strong excitatory output to the motor cortex, which we'll see as increased muscle movement. Okay, over to the indirect pathway now. As before, the cortex excites the striatum with glutamate. But that's where the similarities end. The striatum then releases GABA on the globus pallidus externa. It's connected to the subthalamic nucleus, but because it's inhibited, there's going to be a reduced inhibitory signal to the subthalamic nucleus, which allows it to provide a strong excitatory signal to the globus pallidus internal. The excited internal globus pallidus provides a strong inhibitory signal to the thalamus. And as a result, we've got a reduced excitatory output to the cortex, which we see as reduced muscle movement. So as we mentioned, the past compactive functions to release dopamine, and it does that on the striatum. In the direct pathway, that's released onto D1 receptors of the striatum. The functional outcome of that is an excitatory signal, so increased activity of the striatum, increased GABA output, which leads to an increased excitatory signal to the cortex, the essential function of the direct pathway. On the other hand, in direct contrast in the indirect pathway, we see dopamine being released on D2 receptors, which has an inhibitory effect. An inhibited striatum, in this case, reduces the inhibition of the thalamus. So what we see on both sides is an increased as a result of dopamine release from the substantia nigra, past compacta. Okay, now let's have a run through of those pathways close up. Okay, I feel like I've said excitatory and inhibitory enough for one day, so thank you for watching and we'll see you next time.


What's up, bone par fam? I hope everybody's having a fantastic day out there. As you can see, we have a lot of cool parts on the table today. And this is the cam kit that we are installing in Project Sub-Zero, which is going to be the HemiSwap regular cab Dakota. It's going to be absolutely awesome. The cam kit that we purchased for Project Sub-Zero is from Flying Ryan Performance. FRP, very, very known, respectable tuner, and he has a lot of good stuff. And the custom cam that we went with is the FRP Tomahawk Cam, an absolute amazing cam for just about any Hemi out there. Alright, Mopar Fam, we're going to start right off the rip with the meat and potatoes. The FRP cam kit, this is his full cam kit. This kit is basically put together for the guy that still is running a stock camshaft and has not upgraded anything yet. So this kit will come complete with absolutely everything you need to swap in or upgrade your camshaft minus the fluids. That is pretty much the only thing you will need to buy is fluids and then of course custom tuning. So we're going to go over exactly what all is included with the full cam kit from FRP. So the first thing is obviously the camshaft. This will be the camshaft of your choice. He has many, many custom camshafts for pretty much any Hemi or build that you're putting together. We went with the Tomahawk Cam, which is a very popular camshaft, but this is an awesome NA camshaft and it also works very well with nitrous. Here's a couple sound clips of the Tomahawk Cam in action. Alright, no doubt about it. The Tomahawk sounds absolutely amazing. In the camshaft kit, you're going to get a full complete set of non-MDS lifters. Basically also known as Hellcat lifters, but these are Mopar OEM lifters and you get a complete set. Now we follow that up with a complete set of MDS solenoid delete plugs. Now these are optional if you want to use them.  This comes with both valve cover seals and then you're going to get a timing cover kit. Comes with the timing cover gasket and the seal. Also in the kit you're going to get a comp phaser lockout kit or limiter depending on your camshaft choice. We're going with a lockout kit on this cam, but you get the lockout limiter. Alright, and then we're going to follow that up with.  This comes with all the seals necessary to replace the manifold gaskets. And then you're going to get a full set of pack springs. Comes with all the springs to upgrade your factory valve springs. And also in the kit you will get a full set of hardened push rods to upgrade your push rods. And he also supplies you with a new crank bolt, new camshaft bolt, and a complete set of the driver side and passenger side head bolts. So you're going to get all brand new head bolts.  You're going to get both driver and passenger side head gaskets in the kit as well, along with a set of exhaust manifold gaskets. So as you can see, this is a really, really legit cam swap kit. This is probably one of the best put together kits that I've seen. That absolutely comes with everything. And you really cannot beat the price for this. Absolutely everything you see on the table is going to run you about 2000 bucks. And I can tell you right now, I have looked around at many other places for camshafts and stuff like that. And you are going to be very hard pressed to beat the price of this kit for everything you get. Not only that, most kits won't come with head bolts, camshaft or crank bolts, as that's usually an upgrade or extra price. Again, I really feel like this is a very, very good deal for what you're getting. You're getting a custom camshaft of your choice and absolutely everything you need gasket wise and hardware wise to get this thing in your car or truck and going. So the other thing I want to go over real quick is in the camshaft box, you're going to get a cam card. And I think that's really cool because there's some tuners out there that will not send you a cam card. So if you're not using them for tuning, it can be a hassle sometimes to get your camshaft tuned. So I think that's a really awesome thing that you're actually going to get a cam card. I'm not going to show the specs on it on the video due to the fact I'm not trying to broadcast all of his specs to the world, but just know you will get a cam card that has all the specs on the camshaft. And the other thing you're going to get in the box is a little tube of assembly lube, which is for the camshaft lobes. So that's pretty neat. I can tell you the last comp cam that I bought, this did not come with that. So pretty neat little deal that that is included with the Texas speed camshafts. You know, sometimes the little things go a long way. That's really cool. Now the other thing I do want to note is we ordered this last Saturday and we actually received every single item on this table, the entire kit. We got it within about three days. So we received everything inside of a week and I was not expecting that, but very, very quick response from flying Ryan and super fast shipping. Now the other thing I do want to note is I actually had a pretty long conversation with Ryan on the phone. We spoke for probably about an hour between this Dakota build and my personal truck frostbite. So stay tuned. There's a lot of awesome things coming between both these trucks and you're going to see a lot more FRP stuff on the channel. So that said, obviously FRP will be tuning this Dakota Hemi swap build that we have going on. And we are also putting something together for frostbite here very soon. So stay tuned. I have a lot of new stuff and a lot of new changes coming to frostbite that a lot of you guys are going to be really, really interested in. I'm going to save that for another video coming up soon. So stay tuned on that. The response time, the shipping, the quality of the products, and just the overall experience so far with dealing with Ryan has been phenomenal. Again, like I said, we had a very long conversation. I sent him a message asking about a cam kit for the Dakota. And it was actually a Saturday morning I sent him a Facebook message. He responded pretty much instantly within a matter of two or three minutes. He actually responded back to me, you know, not trying to bother him on a Saturday by no means, but I asked him if I could talk to him on the phone. And pick his brain for a little bit. And he actually called me. He actually called me within about five to 10 minutes. And we had an hour conversation on a Saturday when he's normally closed. So that goes a long way in my book. You know, he's a standup guy so far. And I think we got some really big things coming up soon. So as always guys, stay safe out there. Don't forget, hit that subscribe button. If you haven't subscribed, give the video a thumbs up. Comment down below what you think of the complete cam package. Also put a comment down there if you are using FRP and what your experience has been so far using Fly and Rhyme performance. If you're already tuned and or if you've already bought products from them, put a comment down there below. I'm sure it'll help out some other people. If they're shopping around for a camshaft, maybe your feedback will help them out or point them in a direction they need to go. So y'all have a blessed day. We'll see y'all in the next one.


jump this morning as Americans head to the polls today. The S&P 500 gained 2.3% in morning trading heading for a second straight gain. The stock market has spent most of the year trying to recover from the economic fallout of the pandemic and now faces a potentially contentious election. Here's a live look at the big board right now. Up about 2.5%. Let's bring in Melissa Armo. She's the founder and owner of the Stock Swoosh. Melissa, it's great to see you on this election day. So walk us through what these numbers mean. I was talking to a friend of mine who's an analyst at a big Wall Street firm and he suggested that the market is predicting a calm election, not a contentious one, with a winner that makes a clean victory. What are you hearing? Are you there? I am, Melissa. Can you hear me? Yeah, I can hear you. I lost you for a second. As far as the election goes, I think the market is going to be very unhappy if we don't have an answer within the next 24 to 48 hours and I think that we could see a lot of volatility if we don't. If we do find out who wins, let's say Tuesday night, Wednesday, Thursday morning, the latest, I definitely think you're going to see a big reaction from the market. Whether it's up or down depends on really who wins. Now, as far as the overall trend of the market, I think the overall trend of the market is going to remain bullish no matter who wins. The market for most of the life of the market is always in an uptrend, but I think the selling that we saw in the last few weeks, not today, we're taking profits because they were being cautious. The market has had a nice run up here since the stream volatility going into the end. So a number of analysts caution against making drastic bets on the stock market post-election. Do you agree with that advice? I would wait, to be honest with you, and I'm very, very cautious until the market gets close to the highs. I mean, that's very conservative, but to be honest with you, that's really what I'm looking at. So even if we were up today, even if we rally tomorrow, even if we get an answer tomorrow, I want to see more follows who are breaking out. So that would mean really getting up and over the highs. Otherwise, we still might fall. And why am I saying that? And this is regardless who wins. Because many businesses are still, the Congress has not passed a stimulus bill. I'm thrilled that the numbers were a lot better last week. GDP was better than expected last week. The unemployment claims finally got under that 800,000 number last week. All of that is good. But I think the problems that you're seeing in Europe with the shutdowns could affect the U.S. And again, it doesn't matter who wins. We don't want to shut down again. The Labor Department, Melissa, is also releasing its job report for October on Friday. What do we expect to see from that? Looking for a number that's under eight percent, which would be great. I think if we could get any kind of strong numbers that you could see at the nice rally on Friday, because if we don't know who wins the election, I don't see people jumping back in long this market or any particular legal problems. What if this goes on? Some of the states are allowing people to mail in ballots even today. And they're counting, I think, through November 10th. The market really wants an answer on the unemployment numbers on Friday are going to be awash, even if they're positive, if we don't know who's president. And I want to say one thing about Pennsylvania, because that has been in contention and it's neck and neck with Trump and Biden in Pennsylvania. There's a group of voters in Pennsylvania. There's an Amish and Mennonite community. They typically don't go out and vote. Something that people really have encountered because some of them don't have electricity and they haven't been polled. It's a huge group of people in Pennsylvania that no one knows how they're going to vote talking about that depending on which way they vote. That's a really interesting story that you're right. I mean, I don't think we've talked about that at all. Listen, Melissa, before we let you go, I know we've been talking about the impact of the election, but you did mention COVID and that we don't, you know, investors don't want to see a mass shutdown again. But we're looking sort of across the pond at what's happening in Europe. And we've kind of been watching Europe to see what could be happening with us. I'm wondering how much investors are looking at Europe and factoring that in when they're making their decisions. Well, that was part of the reason why you saw the big sell-off last week. We sold off last week once they announced that they were shutting down. And in Germany and France and there are certain specific areas over there in England as well, that would just be devastating to certain groups and certain sectors. One of them would be airlines. Boeing is up today with the market, but that looks still really weak to me. The earnings were not good on Boeing last week. A lot of these airlines are ready to announce, this was back two months ago, that they're going to have more layoffs by the end of the year if they don't get more stimulus money. A chance that we could get a stimulus passed before the end of the year. Let's say Trump loses and Biden wins. It's going to be like a lame duck session and I don't know if Congress is going to pass a stimulus before the end of the year. Then you're going to see more layoffs with certain of these sectors, and they will drag down the market because Boeing affects the Dow because you remember there's only 30 stocks in the Dow. Boeing is a big one in there.  And again, it's all going to kind of go together. And don't forget one more thing. January 1st, that deadline is looming out there for people that have pushed back on the evictions. So like in New York, the evictions were pushed off and all the people that are, let's say they don't. Well, there's going to be a lot of people out on the streets that don't have any stimulus money. They're kicked out of their homes or kicked out of other apartments. I mean, this is devastating to some people. And so that is less than two months away and less than want to push the date back again. Yeah, that's all, you know, important things to remember to wrote for us to remember. And I know that, you know, for a lot of landlords, you see, have their builds mounting. They've already sort of put in those requests for evictions. And they're just kind of waiting for, you know, the courts to start start firing up again. Melissa Armo, thank you very much. Thanks for having me.