Facility Planning & Site Neutrality: A.J. Reall, El Camino Health
In this episode of the “Achieving Health” podcast, host Shawn Stack is joined by Jeff Kilpatrick, principal on the facility and capital planning consulting team at Forvis Mazars, and A.J. Reall, vice president of strategy at El Camino Health in California.
A.J. and Jeff discuss the health system’s approach to strategic facility planning amid CMS’ ongoing shift toward site-neutral payment policy, including:
- Modeling potential financial scenarios in an ambiguous and uncertain payment environment
- Educating the C-suite and the board on the impact of site neutrality
- Involving the right teams in strategic decision making around facility planning
Transcript
SHAWN STACK
On today's episode of “Achieving Health,” I'll be joined by my colleague Jeff Kilpatrick and special guest A.J. Reall, VP of Strategy at El Camino Health. They'll explore how site-neutrality payment policies are changing how health systems approach facility planning. So, stay tuned.
ANNOUNCER
This is “Achieving Health,” a podcast from Forvis Mazars, where we delve into the topics that matter most to healthcare organizations across the continuum of care. Our goal is to help you navigate the dynamic healthcare landscape and achieve health at your organization.
SHAWN STACK
Welcome to “Achieving Health.” I'm Shawn Stack, director in the Healthcare practice at Forvis Mazars. Thank you for joining us. For today's episode, we have a special guest, A.J. Reall. A.J. is Vice President of Strategy at El Camino Health, a California health system serving the Bay Area. He'll be sharing insights on how his organization approaches strategic facility planning in light of evolving site-neutrality payment policies from CMS.
My colleague Jeff Kilpatrick, principal on our Facility and Capital Planning consulting team, will be guiding the conversation with A.J. so I'll turn it over to him to get us started.
JEFF KILPATRICK
A.J., you and I have been working together for, boy, just shy of a decade now. Can you share with the listeners a bit about El Camino Health and a bit about your role there?
A.J. REALL
Yeah, happy to, thanks, Jeff. I'm currently the Vice President of Strategy here at El Camino Health. I've been here about eight years and have been working with you and your teams throughout that time. El Camino is a two-campus health system based in the heart of Silicon Valley. In fact, one of our taglines was The Hospital of Silicon Valley when I first got here.
We are a fairly new health system but have been a hospital for about 60 years. So, when I say that, when I first joined El Camino, we had five employed physicians, no ambulatory sites off our hospital campuses. Since then, we made a lot of growth in turning that around into really becoming a health system. But it's definitely been a journey.
So, the topic that we're talking about today actually directly hits that. So, we, when we talk about site neutrality, it is a definite impact on our hospital, which has been funding the health system for a very long time. One other detail that's a nuance for El Camino; we are the operating arm of a public district board, the El Camino Healthcare District.
So, we have two boards. We have a healthcare system board and then a publicly elected district board on top of that. So, when we talk about the cross subsidies on behavioral health and charity care that typically come from health system, it's an additional impact and burden that that does impact the overall district. So, that's an overview of El Camino in general.
JEFF KILPATRICK
Yeah. This conversation would probably be a lot easier if you hadn't grown so much and increased the complexity of your structure, right?
A.J. REALL
Well, the beauty is that we're pretty slow in making those. I mean, most health systems have done a lot of the things that we've done. We've just had to do it at an accelerated pace over the last eight years.
JEFF KILPATRICK
Yeah, absolutely. Well, we've worked together recently on some major facility investments. Can you talk a little bit about how through that process, CMS’ site-neutrality intentions influenced your decision making? And, you know, particularly you'd mentioned not only the executive team having to work through that, but also your governance structure. So, can you talk about kind of overall how it influenced your decision making and those elements in particular?
A.J. REALL
Definitely. And I'm totally going to use you as well, Jeff. I mean, we were thought partners throughout all of this so keep me honest. One of the biggest facility plans we've been developing is a new facility in Los Gatos. It's actually a replacement. So, all of hospitals in California have to be either retrofitted or rebuilt to meet seismic compliance by 2032 now.
And as part of that whole planning process, we had a board member, several board members, but one in particular, who was a healthcare policy expert across the nation. He’s sat down with Donald Trump a few times, as well as several others. He brought up two elements; Inpatient Only lists being eliminated and the impact of site neutrality.
So, as I'm sure the listeners know, back in November, the OPPS rule came out. And two things really came from that November timeframe. Site neutrality was declared and the first step, really, was the reduction of payments for infusions at the grandfathered outpatient hospital departments. And then the separate is the announcement that the Inpatient Only list was going to be eliminated by 2029, with musculoskeletal being the first element of that being eliminated.
So, with those, the board, I think many boards when they hear stuff like that, they start panicking to an extent. And ours was no different, except we had the one member who helped us understand that this is coming. We just don't know the details of it. So, we engaged Jeff and your team to do a better job of really quantifying what that would look like.
JEFF KILPATRICK
Yeah, you compound that with One Big Beautiful Bill, with the state of Medi-Cal, so the hits keep coming and coming. And it seems like for a board, particularly of your structure, you know, they're not living and breathing healthcare like you and I are every day. And I find when I deal with site neutrality and the Inpatient Only list, every time I have to get out a pad of paper and sketch it out again, I can only imagine how hard it was for you to develop a point of view that your board agreed on with the executive team and understood kind of what that meant as a long-term scenario. Can you first talk through how you accomplished that?
A.J. REALL
Oh, it was a painstaking process as you know well. It took a lot of scenario planning, helping them understand what it, what all of it would mean at a high level, but then really getting them down into the granular level as well. We don't typically want to invite the board into the granular management level, but our board in particular really wanted to know the details.
JEFF KILPATRICK
Yeah.
A.J. REALL
I personally wanted to eliminate the paralysis that typically comes with things that are this unknown.
JEFF KILPATRICK
Yeah. Do you feel like they have a widely held view now? Was the board able to coalesce around not certainty, but at least clarity of how both the outpatient, excuse me, the Inpatient Only list and site neutrality may play out and a scenario that they could coalesce around in terms of timing?
A.J. REALL
I think at the highest level, yes, they have coalesced around something, but I'll clarify that further. So, they know that site neutrality is coming. They don't know when. And so, creating a framework that helped them understand a little bit more on the timing was beneficial. So, there's three real areas; there's the short-term, which is one to three years.
There's a medium, three to seven. And then the more slow-moving things which are eight years-plus. The known knowns are things like the CMS, the rulemaking; these things are already happening. So, drug administration, imaging to an extent, the IPO phaseout. Those are all things that we know are happening within the next one to three years, and they feel comfortable with that.
Beyond that is a little bit harder. So, these are things like the targeted legislation, the off-campus focus as far as eliminating or creating site neutrality for the sites that are beyond the 250 yards from a hospital, those grandfathered outpatient departments, those are the type of things that are most likely going to happen in the next three to seven years.
And the slow is the most difficult for us to forecast, but these are more full on-campus parity, by statute or regulation, in order to make that site neutrality really have a sway in things. However, that one is also very politically heavy.
JEFF KILPATRICK
Yeah.
A.J. REALL
And so again, that's where the lack of clarity falls into, is what will that look like in the next eight to 10 years?
JEFF KILPATRICK
So, we had worked together a little bit on that. Maybe we could talk about how we used that to educate the board, both governance and management, on the magnitude of the change and how that affects the facility choices that you were facing. So, do you want to talk about that, the scenarios we kind of put together and how that led to your board having a better understanding of the changes and the magnitude of the implications?
A.J. REALL
Yeah, happy to. So, the sensitivity analysis that we did have three major buckets with a few different scenarios underneath. So, and please correct me if I'm wrong, but I believe they were, the first scenario was inpatient discontinuation and a shift of surgical care to outpatient. Then, full site neutrality with the surgical rates reduced.
And then the third scenario was the combined element of both of them. And so that, and then we did different scenarios of how much shift there would be from inpatient to outpatient, how much of the commercial volume would shift to parity with what we're estimating the CMS rates to be?
JEFF KILPATRICK
I think what you and I were working with mostly is there are probably four or five dimensions that we needed to think through, and each of those dimensions had three or four or five different ways that they could play out. Which, if you do the math on that, leads to chaos, right? And trying to walk the board through a set of scenarios that they could grasp and how that impacts facility development, I think that was the real art of this.
The math was the math, but getting them to understand that it's ambiguous, but it's, we can quantify the ambiguity to an extent, right? And then they need to understand that there are discrete sets of changes that are going to perform differently under different scenarios.
A.J. REALL
Yeah. The most fun thing about strategy is creating some structure around ambiguity. I mean, I love the problem statements and trying to really figure them out. And your team was very helpful in bringing us along in that.
JEFF KILPATRICK
Do you think we got there? It sounded like the board finally understood and was able to move forward.
A.J. REALL
No, they did. I mean, I the best part was talking to that board member again, who's the policy expert and saying literally I asked, did we get it right? And he said, I have no idea, but what I saw from your team was better than what I have seen from others. I mean, it helped create that structure in chaos and create decisions. So, it wasn't paralysis, analysis paralysis.
JEFF KILPATRICK
Yeah.
A.J. REALL
We were able to see, and I'm stealing some thunder, but we were able to see that just having those ORs in the hospital as outpatient ORs would fund everything if rates were, they remained outpatient rates, hospital outpatient rates, for two years. And then subsequent from that, it was just additional benefit to us. But again, the timing element was key in making the decision and the board was definitely on board with it.
JEFF KILPATRICK
A.J., would you feel comfortable sharing a little bit about the actual discrete decisions that we were making? And kudos to your management team. It was an incredibly thoughtful question, and the board, that they were asking us to look into.
A.J. REALL
Yes. Well, I'm sure I'm going to miss some of the questions, because a lot of this work was a couple of years ago.
JEFF KILPATRICK
Yeah.
A.J. REALL
But there was a key question as to how big do we want to build this. Can we fill it? That was one of the first questions. Then the two questions that really came from this work was one, should we build it as big as we initially thought, given site neutrality, should we focus that billion plus dollars on ambulatory growth?
Most especially in the ASC world? Or, and that gets to the third question, should we have a hospital with a freestanding ambulatory surgery center and MOB space? Because site neutrality is going to be implemented, would there be a cost benefit by building an ambulatory site rather than hospital-based?
JEFF KILPATRICK
Yeah.
A.J. REALL
I think those are the three big issues that we talked to you about.
JEFF KILPATRICK
Exactly right. Exactly. And yeah, it's just the point about how do we structure the OR physical layout to optimize clinical care, efficiency, and reimbursement in a set of unknown policy environments. And, you know, this is one of those places where the math was pretty unambiguous that the best answer happened to align all three of those together. So, the least costly one from an operation perspective was not to duplicate two platforms, but to have one integrated operating platform.
And I think we just may have gotten lucky on the math here, but it made the decision making, I think, much easier because we didn't have to say to the board, well, operationally one of these is better whereas from a gas on payment structure, another one is so, that was, that at least helped the storytelling a lot.
A.J. REALL
It did. And I mean, I think there were additional strategic benefits other than the cost side that we thought about during it, but also after. And we talked about three different levels of ambulatory sites or site-neutrality impacts. There are the ones that are grandfathered. So, those that are beyond 250 yards, we all know that those are going to get affected first.
They need to be at parity with ambulatory rates. Then there's freestanding, on-campus ambulatory sites. And as of right now those are at the exact same. We're seeing the exact same as a hospital or hospital outpatient department. And then there's the actual part, though, as you indicated, the buildings that are integrated into the hospital that are just a hospital outpatient department.
And the conversation that we were having is how would we optimize for optionality in our forward work, given the risks that we are anticipating. So, the first, again, we know the grandfathered sites are going to be affected. If you look at the definition of an on-campus freestanding HOPD, I would also hypothesize that those are at risk in the future.
Well, when we were talking about that, it was a cost benefit to just have them integrated. But also, there was a concern that if it was freestanding, would that be at risk more quickly than the actual integrating them into the hospital? Again, all speculation, but it was a concern that having a freestanding might put it at risk of losing those HOPD rates more quickly.
JEFF KILPATRICK
Yeah, boy, I remember running this math with the team and it was really complicated. And I think you and I did a pretty good job of walking the governance team through that. And finally, they accepted the fact that, as you said, the analysis was on-point and it unlocked a little bit of that paralysis.
And so, you're in a point now where you publicly have been able to announce the project and get past the education point, the point-of-view point, the analytics point. And now moving towards, in the near future—maybe it doesn't feel like the near future, but nearer future—getting shovels in the ground.
A.J. REALL
Yes. I can't tell you how excited I was when we finally got to publicly announce that. As a strategist, nothing is ever fast enough, to your point. But no, we're really excited to actually have a groundbreaking here in the future, and it aligns with a lot of the other work that we're doing. Again, as I mentioned, building an actual health system with an ambulatory footprint.
JEFF KILPATRICK
Yeah.
A.J. REALL
But really, the work that was done on understanding site neutrality has affected not just this project, but a lot of our overall health system footprint growth.
JEFF KILPATRICK
Yeah. So my recollection, and correct me if I'm wrong here, is that we probably interacted in some way about this project for, I don't know, five years, maybe a little more, maybe a little less.
A.J. REALL
In some way or another, yes.
JEFF KILPATRICK
Yeah. And so, if you reflect on that, right, that whole journey of that amount of time and, you know, getting the board up to speed on why we need to do this kind of that whole journey, how should systems be thinking about balancing that near-term optimization, long-term payment risk, an uncertain demand environment, regulatory environment as they're approaching major facility investments?
Anything that you would call out that you really learn through that journey, or you said, boy, if I could do it over, I might do this element five degrees to the left or the right?
A.J. REALL
This is a tough one because I think there's definite differences between our competitive and regulatory environment to others. But at the same time, there are definite principles that I think can help. So, I think as, I love the term optimizing for optionality. It's as vague as you can possibly get. But the concept is there.
We wanted to make sure that we had capacity in our hospital for, as we build up to the high tertiary level of care, that we can bring volume from ambulatory or from academic medical centers as they develop their quaternary care. We need to have capacity in our ORs for that, even though we all know that inpatient discharges are going to decline in our scenarios, we planned about 5% over the next 10 years.
We did want to make sure that we had capacity for outpatient surgery and all of the other things that are projected to increase while we are also planning for the changes in site neutrality. So, we didn't want to constrain ourselves on the outpatient, the hospital outpatient side while we continue to develop the ambulatory side. At the same time, we didn't want to cannibalize our hospitals while we have those HOPD rates and build an ASC right next door.
So, there's a definite timing and being very deliberate about how you spend the capital in these strategy discussions. So, be much more quick than we were on the strategy and strategic thinking side of things, but be deliberate about how you're investing that capital. I wouldn't say that it's the right thing for everybody to invest in the hospital ORs. It was for us, but there's definitely, making sure that you bring the implications of site neutrality into those discussions is going to be key.
JEFF KILPATRICK
Yeah. I was impressed with how thoughtful both your executive team and your governance were on these. And to your point, you know, we did a lot of work to support that thoughtfulness, but we knew what the options were for the facility, what the demand options were, who the physicians were that could support those options and that volume.
And then ultimately, what the risks were from changes in payment structure. So, kudos to your executive team and your board. Do you think they were more worried about you moving too fast in preparing for an uncertain future or too slow for that uncertain future and being unprepared as it unfolds?
A.J. REALL
I think it, again, being a small health system, the concept of spending one plus billion dollars on a replacement hospital was one of the biggest factors that caused them to need more detail than I probably would have anticipated.
JEFF KILPATRICK
Yeah.
A.J. REALL
That said, in the not-too-distant past, we've had competitors announce huge amounts of investment in our market. And so, there is an increased urgency among the board and management. And so, things have sped up, given that they feel that there is now a burning platform, but I don't think they see it now is moving too slow. But during the process they were very, very pleased with how we were bringing them along.
JEFF KILPATRICK
Yeah.
A.J. REALL
Now from my standpoint, again, nothing is fast enough. But they were; again bringing them along, as you mentioned, they visit it, we live it every day. And so, it took them a while to digest what we were telling them. And so, we had to give them not bite-sized pieces, but a progression of information to really to help them understand the impacts of the Inpatient Only list, what it was, how it impacted us separately, then site neutrality, and then how it all worked together overall, how it all impacted the overall project.
JEFF KILPATRICK
Yeah. And, you know, to your point about us living it every day and nothing being fast enough, like we want to see that we're prepared quickly. But I've also seen clients that have gotten out pretty far in front of these structures and been prepared and left a lot of money on the table because there was a known change that was coming.
But to your point, the timing was unknown. So, they beat it by five years, which made it completely the wrong decision. Was your board more worried about, from an execution standpoint, from you getting out too far in front of it and leaving money on the table, or from being too slow and being caught flat-footed and seeing your patient volumes decline because you didn't have the appropriate settings to care for the patients?
A.J. REALL
Well, I think I would actually frame it as something that I've seen in other boards. It's looking at something as a whole. And to what you indicated, they make a decision on a known incoming—in this case a change in regulation or legislation—and so, they make a decision and run with it rather than breaking it down into the overall time frame.
For instance, if we had gone with what one of the board members had indicated, we probably wouldn't have found out that building a replacement hospital actually did make financial sense and it could pay for itself prior to site neutrality taking place. There was not a motion on the floor necessarily, but the definite discussion on why are we even rebuilding this given site neutrality coming in.
JEFF KILPATRICK
Yeah.
A.J. REALL
So, in that case, they thought we were moving too fast in making the decision or the recommendation to rebuild the hospital. So, being able to break it down in helping them understand, even though there's a lot of unknowns about it, we can get pretty good guesses as to the timing of this. And given that, they were able to understand, okay so, if we do this now, it will make financial sense and strategic sense. If we wait an additional five years, it won't make sense.
JEFF KILPATRICK
Yeah, absolutely. One of the things that I remember about our work together was that we had a guiding team. You had the CEO involved. It had your strategy leadership, it had your finance leadership, it had clinical leadership, it had your facilities leadership. It had your physicians there. So, it seemed like all the right perspectives were at the table.
As you think about that experience, anything that we, that you would reflect on could have been done to get folks aligned on exactly what you said; boy, this is going to be expensive. it's going to be expensive in an uncertain environment. Any guidance you would give for others who are about to undertake a similar scale of investment in an uncertain future, about how you bring together the right team and lead them—the executive team, not the governance team but the executive team—holistically through this kind of a journey? How you include them, how you walk them through it to arrive at a point of view in a decision in the most efficient and effective way?
A.J. REALL
Yeah. So, taking a step back, you and I have been involved in a lot of different projects, not all of them with this one. So, we got engaged in, you and I got engaged on this one about what, a year and a half ago?
JEFF KILPATRICK
I think that's about right. Yep.
A.J. REALL
Prior to that, there was about five years of work. And again, you alluded to this. You and I were engaged here and there with elements of it, but not in a holistic approach to the Los Gatos Hospital redevelopment plan.
JEFF KILPATRICK
Right.
A.J. REALL
What made it effective was getting all those people in the room, identifying what gaps in information or critical thinking needed to be addressed, creating frameworks around those, and then really moving forward.
So, the biggest key for me was getting the right people in the room. If you really want to make the right decision, you need to better define the problem. So, the prior five years, I wasn't involved as much and there was a lot of work on what we could put into it as far as services and programing, but there wasn't a lot of critical thinking or framework development around what are the regulatory implications?
What effect the Inpatient Only list has on site neutrality? What is the market growth? All the different elements that typically go into strategy. They were lacking when we first got engaged. So, the work that you and I did was really creating that analytics foundation and structured thought in order to create a real programing for the site. Not atypical from many other health systems that I’ve been a part of, but without that, again, it was an analysis paralysis for several years before this strategy team really got engaged.
So, defining the problem, identifying what types of things, what gaps exist, and what analytics need to be in place was one of the key areas. And making sure that you have the right thought leadership at the table.
JEFF KILPATRICK
Yeah. When you're going to spend $1 billion on a hospital, it's actually not that hard to get everybody's calendar cleared. So, that probably helped our journey. And I think you're right, right? The documents that you and I reviewed all identified these critical or these important elements of the design, and there were a lot of them, but it was the difference between the important many and the critical few, right?
I think we got it down to the critical few. The other lesson I think we learned is again, when you're going to spend over $1 billion on a facility, taking the time to align people that what you learned, at least for me, the first couple years in your healthcare career, that an inpatient bed costs $1 million is just incredibly outdated, right?
A.J. REALL
Especially in the Bay area. But yeah.
JEFF KILPATRICK
Yeah, exactly right. Yeah. And that took a, that was a journey in and of itself to kind of rebase, to your point, in the Bay Area in California coming out of COVID, etc., when prices have increased by so much. And so, that was part of that journey to understand not only are we in a regulatory environment that's changing, but we're in a cost environment that's shifted pretty dramatically as well.
A.J. REALL
Yeah. And I just realized one other thing that I didn't mention. So, physician alignment is one of the biggest strategic priorities for El Camino in general, but for most of the health systems in the Bay area. And if you think about the implications of the Inpatient Only list, it now gives physicians complete discretion as to what should be inpatient or outpatient.
Obviously, there are more granularity details in all of that, but what we did as a group was evaluate the physician alignment strategy and needs in order to fill that new hospital and create plans that align to it. We didn't really think about the implications on how the Inpatient Only list and site neutrality affect that work, but as we started executing on it, we've seen the importance of it because the physicians typically follow where the financial incentives are in the long term.
JEFF KILPATRICK
Right.
A.J. REALL
So competitively, we have a competitor that has announced large ambulatory footprint and a new hospital in our area and would be financially incentivized to take volume to those new sites. Separately, we have publicly traded and PE-backed ambulatory surgery center organizations actively recruiting physicians in our market. So again, physician alignment has been one of the key priorities for us in order to execute on both this strategy as well as others. And it did, the Inpatient Only list and site neutrality, where it did have an impact on that.
JEFF KILPATRICK
Yeah. And I thought your, again, your leadership was incredibly thoughtful about not just assuming that the volume would show up at a new location but being clear on what are the options to align physicians. Who could those physicians be? What does that mean in terms of facility design kind of globally, right? What services are in there, what is the layout, what do kind of touch and feel look like?
But then, to your point about exactly this decision, if you were to separate the OR and fund it differently, right, so you're not using tax-exempt funding, that gives you all kinds of options for alignment tools, which makes the decision even harder, because now you're putting in another strategic element and a facility decision, which is uncertain enough because of site neutrality and because of the operational decisions.
So, that level of complexity but thought as well, that you put into it reflected the fact that you were thinking about how do we accommodate and not just, not in a negative way, but how do we ensure the physicians remain aligned and choose El Camino, because you are in such a competitive environment?
A.J. REALL
Yeah.
JEFF KILPATRICK
Great. So, we're moving towards the end of our time. Anything that we haven't talked about that was key for you to achieve alignment from governance, from the management team, particularly in line of both site neutrality, the regulatory changes and spending over $1 billion on a new facility; anything that you would kind of leave the listeners with or anything we haven't talked about?
A.J. REALL
One of the things that we've taken from this work and continue to extend it on is make sure you're designing for convertibility. So, our ORs are able to do outpatient volume and additional capacity for inpatient in the future. But also, we are building our ambulatory surgery footprint to make sure that we have the ability to switch to ambulatory side when that becomes a larger reality.
When we did the analysis, 80% of our surgeries are already outpatient. So, the Inpatient Only list doesn't really affect us. But 60% of the more dual-setting procedures bring in that additional volume. So, we wanted to keep that. But at the same time, if you look at the impact of site neutrality, if we don't have somewhere to shift that volume when site neutrality does take effect, we're going to drop that margin by over 50%. So, it's make sure you have that convertibility infrastructure in place.
JEFF KILPATRICK
Yeah.
A.J. REALL
Another element is making sure that you sequence the capital. So, our Los Gatos hospital is defensible under the base and moderate scenarios that we did with your team. We want to make sure that we are planning and implementing that quickly, while in parallel we're looking at the ambulatory footprint side of things.
I don't want anybody to think that we decided against doing ambulatory surgery. It just made sense for us to do it in the hospital and in parallel to an ASC strategy separately. The only other thing that we needed to do subsequent to that is really get more granular on the payers. So, we did a very, very broad definition for how much commercial volume is going to shift.
And then the other thing was Medicare Advantage. So, Silicon Valley is a heavily-aging population, as are many places across the country. But the impact on Medicare Advantage, site neutrality with Medicare Advantage, we didn't get quite as granular in. So, that's something that we've been working on recently because those CMS rules tend to ripple through. Without negotiations they get implemented quickly. We want to make sure that we had a better understanding of that.
JEFF KILPATRICK
Yeah. A.J., I appreciate you taking the time this afternoon. This has been a really important conversation. It's been a real pleasure to support you and your team through this journey and through several other journeys. So, thanks for making the time this afternoon and look forward to continuing to support you over the next 10 years.
A.J. REALL
Well, it's been a pleasure. Thank you. Jeff.
SHAWN STACK
I'd like to thank A.J. and Jeff for joining today's episode. I also want to thank our listeners for tuning in and following “Achieving Health” wherever you listen to podcasts. If you want to learn more about the topics we discussed here today, be sure to check out our show notes for related content and information about how to get in touch with me and the team here at Forvis Mazars.
I'll be back with my co-host Chad Mulvany next Wednesday, July 22, for the next round of “Washington Watch” updates. Until then, here's wishing good health for you and the communities you serve.
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