Project goals and public involvement

Welcome to the Sound of Ideas from Iea Sttream Public Media. I'm Stephanie Haney. Thank you for being with us Dangerous, record breaking heat has hit much of the country this week with the National Weather Service issuing an extreme heat warning for the state of Ohio lasting until tonight As a safety precaution, many outdoor events have been called off The city of Cleveland, for example, cancellled all youth outdoor sports through Friday A Wade Oval Wednesday concert was canceled in University Circle, and in the Cleveland Orchestra's free concert at Cane Park, they've decided to postpone that all due to dangerously hot conditions This week, temperatures have gone up to the mid to high nineties, and today the humidity will make the temperature feel as high as one hundred seven degrees To try to combat that heat, many cooling centers have opened around our area We'll start the show talking about how we can protect ourselves from heat related injuries this week and throughout the summer And ahead of one of the most injury prone holidays in the country, we'll ask our experts about staying safe this july fourth Joining us in studio today, we have Commander Ellen Kasmer, public Information Officer and administrative commander with Cleveland EMS, Emergency Medical Services. Thanks for being with us, Commander Kasmmer. Oh, thank you, and good morning. Good morning to you. We appreciate the time Also joining us, we have Dr. Tamana Singh, director, Sports Cardiology Center and co founder and co director of the Women's Integrated Sports Exercise and Research Center at the Cleveland Clinic Also a volunteer with the American Heart Association, dor.or Seng, welcome to the show Thank you so much for having me We would love to know from our audience, how have you been keeping cool the past few days? Do you have questions about safety for our experts, whether that be for yourself, for loved ones, maybe your children or your pets? You can join the conversation by giving us a call at eight six six five seven eight zero nine zero three. You can also email us at SOI at ideaStream d. orgot orr you can send us a message on Instagram at the sound of ideas. Now, Commander Kasmmer, can you tell us what are the most common calls you get during dangerous heat conditions for assistance? Right. So we do see an uptick of what we call heat related emergencies and they can vary anywhere from ust people having basic complaints of I'm cramping up. I just don't feel right. too the most extreme and the most life threatening which is heat stroke So we do see an uptick. Once we get there, sometimes we have to evaluate whether it's a heat related emergency or a chronic condition that's exacerated But definitely we are seeing more people who are just succumbing to these oppressive temperatures, right Certainly, yes. Now doctor Singh, how long is too long for people to be outside during an extreme heat wave? And I know that's a wide range of temperatures. So we'll talk about the weather that we've been having this week, the mid to high nineties Yeah, I mean, that's an excellent question. It really depends upon certainly your background medical history as well as your age and your ability to tolerate the heat. So it really will vary for individuals who are really not heat adapted, I would recommend really avoiding some of that high heat really between noon to three PM. If you are out there and you're already starting to sweat within a couple of minutes, or certainly if you feel nauseous or lightheed, just unwell, get out of the heat because somewhere cool so that you can allow for your body to equilibrate. If you're a little bit more heat adapted, you might have some more wiggle room in terms of your tolerance and your capacity But it really ends up becoming all about how are you feeling? Is your heart rate rising? Is your face getting really flushed? Are you getting dizzy lightheaded, or have you passed out? I think a lot of those things are red flags that really indicate you should get inside and cool off as soon as possible doctor Singh, to follow up on that, are there certain people you mentioned a bit there about who might need to be more concerned about this high level of heat, but are there certain people you could remind us for and really drive that home who should be especially concerned when we're experiencing this high heat of taking care of their safety Yeah, so high risk populations typically include very similar high risk populations to a lot of the things that can ail us whether're related or not. So young children, our elderly population, individuals who are pregnant in this high heat, pregnancy itself is a really high demand on the body. so we really encourage our pregnant women to stay out of it. And then individuals who are in various kind of socioeconomic situations We do see higher, certainly from a cardiovascular perspective, morbidity and mortality and those from low socioeconomic status, so people who really also don't have access to cooling agents or cooler areas. But those are typically, I think, just from a demographic perspective, people who should be wary of heat. From a cardiovascular perspective, individuals who have a history of cardiovascular disease, prior heart attacks, people who are symptomatic from heart disease failure, so maybe some weak hearts or stiff hearts, high blood pressure, certainly uncontrolled from a cardiac lens. thoseose are individuals too who really should refrain from being out in the heat. Thank you for that We have a call now from Thomas in Parma Heights. Thomas, welcome to the Sound of ideeas. Please go ahead Yes, good morning. I would like to remember firefighting crews that are out in Utah and Colorado right now in the heat. fighting for the National Forest Service fighting the crews. Th firefighters died in a fire in Utah in the last week or so And in nineteen sixty nine U fires near Rriverside, California up in the low mountains. It Lake Elsinore is there. and year before I'd arrived, three firefighters on my crew died in fire of it. them by surprise. So when I went to work The first fire we fought was down by San Diego and We did a twenty four hour shift. when we arrived to fight that, it was up above There was a water system up abo San Diego that would have wiped out a dam and all of the recreation areas, but Anyway And I actually when I went to work We were trained like athletes and I wasn't trained at first. so I suffered heat exhaust in at least twice. They laid me down in the shade I recovered and they sent me back to work in an hour or two. So I don't know if that was the right We were young and we could do it I wonder if any of your experts Have any idea about the for the weather service and how that's going to affect ces including firefighters, but also including normals regular people who are going to endure this extreme heat. Sorry for the length of this, but I think we owe a debt to the people who are fighting in the forest fires all over the West Certainly, Thomas, thank you very much for sharing your experience and also for that reminder that we should be appreciative of our first responders and our professionals who help take care of us. And Commander Kasmar, I want to ask you, know, Thomas brought up a lot of things there. Feel free to address anything that you might be able to speak to. But I want to ask you specifically about balancing the safety of the EMS professionals that come out and respond to people in this high heat. How do you do that It is a challenge because our first priority is to get to that patient and take care of them and manage them. and inhat related, They're in the same environment most likely initially So the balance there is to try to get them And there a little bit of dime take advantage of hydration and a few minutes and air conditioning because they're right back out there. And I do want to say to the Cleveland and all the surrounding fire departments, it is very hard and very dangerous They're not just in regular clothes fighting fires They're all geared up. So their body temperatures, they have to be very mindful. And I know Cleveland does a very good job managing their personnel to make sure that they stay safe And for this gentleman's experience, it was years ago. I don't know. I can't speak to if that was the right thing to do or not. pererhaps I might make a different decision. But I'm glad that he is still here and able to relay that message to us. Certainly, certainly. doctor Singh that brings me to a follow up question for you. Can you tell us what happens to our bodies when our bodies get too hot? Why is this high heat so dangerous Yeah, so heat stimulates a couple of different things in our body. From a cardiovascular perspective, what happens is is the vessels in our body get a little larger or they vasodilate. and that's really to allow for heat to get to the surface of our skin so that it can dissipate and allow for us to lose some of that heat and cool off. The brain also sends signals to our sweat glands to release sweat through our skin as well turns into water vapor helps to cool us off. But a cardiac lens, when we're sweating and when we're vasodilating, what can happen is that our blood pressure goes down. we also get dehydrated. When we're dehydrated and our blood volume goes down, the demand on our heart increases. So our heart rate actually has to go up And I would say that the heart rate goes up about ten beats per minute on average for every degree of increase in heat. That increase in heart rate creates a higher demand on the heart's ability to pump out enough blood to the body. And that demand can be an issue, not so much for individuals who are otherwise healthy and certainly heat adaptation helps. but for people who have issues with getting those vessels to get a little larger or already have challenges to the blood flow of their heart muscle, and those vessels are so diseased that they just can't compensate and account for the increase necessary in cardiac output or the ability for that blood to get out to the body at a more rapid rate That certainly increases things like the risk of having a heart attack for people who are really dehydrated and get overheated. We can certainly see heat related illness, heat stroke, when temperatures for the body are greater than one hundred four. and that can be catastrophic in individuals who have cardiovascular disease. And because that blood is just a little bit thicker For people who are at risk for blood clots, they're now more hypercoagulable, which is basically just a big term for saying the risk for having more clotting has increased in consequence to the heat If you're just joining us here on the Sound of Idas, we are talking about the extreme heat we've been experiencing here in Northeast Ohio and that others are experiencing around the country to an even greater degree with higher temperatures for extended periods of time If you have a comment or a question for our medical experts here that we have today, the phone number to call is eight six six fiveive, seven, eight, zero, nine, zero three. You can also send us an email at SOI at ideastream.ot orga or you can send us a message on Instagram at the Sound of ideas Commander Kasmmer, let me ask you, how do you help people who are experiencing heat related injuries? How do the EMS and other responders here in Cleveland help people immediately over the phone? What does that look like? So our priority dispatch allows us based upon the callers questions, answers to questions to kind of guide them through. We give pre arrival instructions. So if it's heat related, they can advise you know, to start some cooling process, which really is the first thing that we can do, like remove them from their environment U Cool wet rags. fan them if they have heavier clothing on, you know, reduce the amount of clothing they have and try to get them just a little more stabilized until we can get them in the back of the ambulance, which is a much more controlled environment at least ambient airwise, right? And what does that look like when a paramedic arrives to a location for a heat related incident? Right. So depending on what the nature of the call is, we get there, we do an initial assessment. And heat related, obviously, we want to remove them from that environment as quick as we can, dependent again on the situation, right So get them in the back of the squad continue further assessment. We're checking their vital signs And then as we're doing that, the air is on, we're cooling them. If they need to be more actively cooled, we have ways to do that with I'll just say ice packs, right? So just ice packs like you can get at the store, but we use them medically. the air conditioning reduce their clothing And then we can startert things like IivVys, which will also help with the immediate hydration and a cooled body temperature And then we go based upon the condition that they have and further treating. Thank you for that We've got an email now in from Barb. Barb writes in, The temperature on Friday is supposed to be ninety or higher until evening. The temperature at sunrise, Friday morning will be between seventy eight and eighty degrees. So the heat wave does not end tonight Barb is emailing in based on what we said at the beginning of the show that the extreme heat advisory will be lasting until tonight. We did double check on that and the advisory has been extended until eight PM Friday. So Barbara, thank you for that note. Again, there is an extreme heat advisory in our area until eight PM on Friday, that will not be ending tonight. Thank you very much, Barb We also have an email in now from David in Akron. David writes. I am in my mid sixties and like to be outdoors a lot. Does heat like we are experiencing now affect my musculular skeletal health. Thank you for the question, David, Dror Sing, is that something you're able to speak to? Yeah, definitely. So I love being outside as well. I love to run. I did my run this morning. what I can say is he can definitely impact our muscular health from a performance perspective. So these are times to really lean into more aggressive hydration with electrolytes. I usually tell my active patients water really flushes right through you but taking in some extra salt, even if you have some history high blood pressure. If you're losing so much salt through your sweat, that salt and that electrolyte, particularly before you are outside will help your muscles from cramping. We can see more aggressive muscle breakdown if we are more dehydrated, which is why I always say kind of you know listen to your body, you know, make sure that you're actually feeling okay when you're outside. And again, if you have any of those red flags feeleeling a bit confused, feeling nauseous, feeling like your face is getting too flush, you can't control it, potentially noticing that you've been excessively sweating and no longer are sweating. And of course, from a muscular perspective, if you're feeling really crampy, feel like your legs are just not moving as well as they should, those really again are indications to respect the heat let it win this round and go inside and cool off. doctor Singh, thank you for sharing some of those symptoms that are good indicators that you do need to get inside out of the heat or to some shade or something that's going to be a cooler location for you Do we need to take into consideration? We knew there will be events happening this weekend. It is the fourth of July. That is a holiday that can be associated with drinking alcohol, for example. In this highat heat, is there anything that needs to be especially taken into consideration when you add alcohol or other substances to the mix? Definitely. So one, if you're able to try to have your events as early in the day as possible or potentially more late in the day when you're really just not in the sun in the extreme heat, If you're having your barbecues going, really stay away from that flame and that know heat kind of rising into your face. And if you do choose to drink adult beverages or alcoholic beverages, just remember that alcohol is a dehydrating compound. And so if you are drinking you're going to be more likely to notice that you're going to be more dehydrated. You really should lean into again, some electrolyte repletion, certainly hydration. But once you get going, if you're someone who grabs a beer and grabs another and grabs another, know maybe either drink less or don't drink at all, or maybe swap that out with extra hydration and electrolytes Oftentimes you really don't feel that dehydration like you're drinking, usually the day after is when we see a little bit more consequence of more profound dehydration and certainly from a cardiovascular perspective, that can certainly lead to things like abnormal heart rhythms, most commonly atrial fibrillation, which listeners may know about an irregular rhythm. We see that oftentimes with very heavy alcohol drinking the day before. And then certainly if you have heart disease or heart failure or other heart problems, alcohol really is going to exacerbate it. know My particular viewpoint on it is it's a toxin. And if it's something that you can avoid, particularly to enjoy your day more, especially with this heat wave, then you know why not lean into some Fresh fruity popsicles. Sounds good to me. I had a strawberry popsicle last night and it was quite delicious actually. ' is the season. Very nice. Yes. Commander Kasmer, what do people need to keep in mind specifically regarding children or pets and safety? We hear a lot about cars, but other things as well. What should people know? Right. So one thing I like to put out there is that ofentimes people with younger children, veryery, very young children don't compensate as well, but as they as they get a little bit older they do compensate and they compensate for a long time until they don't compensate So your signs that you're watching for, once you do see them, it kind of amps up necessity to get some medical attention to it, right? But dress your child like you would dress yourself, right? if the child's taking a nap and you don't feel you need a blanket, then maybe the child doesn't need a blanket. And I'm speaking of children who don't have any chronic health issues. that's a special And our pets are the same way, right? We want to be careful with our pets. We don't want to leave people or children or pets in the car It doesn't matter if the windows are cracked, right? The car is still heating up about ten degrees more than the ambient air in most situations, limit their exposure outside too, right? So let's say you have a sprinkler, a pool, a local splash pad, that's great. that helps to cool the body, but you can also limit their time in the sun. to help ing their body temperature down also. So it's kind of just a bit of moderation, right? Just like with the alcohol drinking adult beverages, right? It's moderation. So if you want to partake in it, absolutely, it's summer. We all want to have fun. We want to enjoy the kids being home from school. We love our pets, right. But we have to be mindful that you know on these extreme days, maybe we just take it back bit right. spepend some time outside, but spend some time inside. discussing things as a family, haveave a popsic schoolle Right. Yeah, so that's what we would suggest. Okay Dct.or Singh, I want to ask one go ahead please, Dror Singh, go ahead. Thene thing I would say about pets is dog lover or a dog owner myself is just be mindful of their pawuse. There's so many informals out there about the ambient temperature and what the dog will actually feel on its paws. and weather like this can really burn their paws. So if you're able to get little shoes for them, get them or really limit their exposure to heat, get them out early early in the morning before the sun's out. And what I usually do is I'll put the palm of my hand on the ground If it's already feeling like it's going burn my hand within about five to seven seconds, it's too hot for your dog. So just be mindful because I think sometimes, you know, we are not out there all the time barefoot, but our dogs are. doctor Singh I want to ask you one final question before we say goodbye to you. There are some medications like SSRIs and antihistamines that can make people more susceptible to heat related injuries. So can you tell us what people need to know about that and if there are extra steps that people who are taking these medications need to take in order to stay cool So if you're already on an SRSRI, you know As someone who in the cardiovascular leine, I'm not a major prescriber of that class of medications. but I would say if you're someone who's stable on those medications, I would talk to your provider about whether or not there's any need to adjust. This is hopefully something that's going to be a temporary period of time, and I would err on the side of Continuing your medications as advised for the sake of your own personal health. But I definitely would say talk to your prescriber or your provider about what you may or may not want to do with respect to those medications. Similarly with antihistamines, you know it really depends upon kind of how your allergies are responding to kind of the degree of heat and our climate What's going on in the air. If it's something that helps to control some of your symptoms, I think leaning into it a little bit is reasonable. But again, I would talk to your provider about what specific recommendations may be important for you, particularly in the heat. Okay. doctor Tamana Sing, Sports Cardiology Center and co founder and co director of the Women's Integrated Sports Exercise and Research Center the Cleveland Clinic, also volunteer for the American Heart Association. Thank you very much for your time today Thank you so much for having me. We stay cool, everybody. Yes, we will certainly try Commander, I have another question for you. I want to talk about this weekend being the fourth of July. A lot of people will be outside watching fireworks with friends Do you see this fourourth of July celebration bringing maybe particularly enhanced risks for people with the high heat With maybe larger crowds expected because of America's two hundred fiftieth birthday, what should we be keeping in mind the same thing we're looking for regularly with heat emergencies. And I wanted to add in if I could say, we want to really look and take care of each other, right? So in those heavy crowds, you know, give a little space to each other because you know, the body heat will radiate, give a little space, but also be mindful. Be mindful of the people around you, how they're looking, how they're feeling U we also want to just make sure that if we're going to be out there and we're going to be to prepare yourself as best as possible I know some venues do not. allow water in. But if that's the case, try to like prehydrate yourself, right? Put yourself in a good position. Don't be drinking before you go to a concert tryry to avoid that. hydrate yourself, eat healthy And those are some of the things you can do to to kind of curb whatever risk you might have going into it Ultimately, you're kind of putting yourself in that situation. So just if you're mindful, I think it's helpful that we do hydration, rest, and moderation. That's what I always think in any extreme temperature, moderation really is the key in your activities. Right, Thankk you for that. Commander Ellen Kasmer, addministrative commommander with the Cleveland Emergency Medical Services and Public Information Officer, we appreciate your time today Thank you very much We're going to take a quick break now and when we come back, we will learn about Ohio being part of a Medicare pilot program using artificial intelligence trying to reduce fraud But critics are saying it's causing a headache for patients who need care This is the Sound of idedas. I'm Stephanie Haney. Stay with us You're with the sound of ideas from ideea Stream public media. I'm Stephanie Haney. Thank you for staying with us. Ohio is one of six states testing out a Medicare pilot program that the federal government hopes will reduce fraud and waste in the system The program has been called WSR, which stands for wasteful and inappropriate service reduction It's being used to require prior authorization for certain services that the government deems costly and unnecessary, and it operates using artificial intelligence The government says the program will save money at the federal level and protect patients from unneeded care But critics say its rollout since January has been rocky. leading to errors, delayed care and reimbursement wits of up to eight weeks for healthcare providers. An audience member inspired us to look into this program by asking a question about it on our show last week about aging well Anita in Cleveland Heights called and said she was on a traditional Medicare program. She's a senior and was shocked to discover after the fact that she needed prepproval from her insurance to see certain doctors and was facing a hefty bill that she would now need to appeal Joining us by video to learn more about this program and what it means for Ohioans, we have Dr. Care Katz Gary is president of the Ohio State Medical Association, which represents doctors in the state. Gary, thanks for being with us. Hey, Stephanie, good morning. Thank you for inviting me onto your program, talk to you and your listeners about how physicians and their patients are experiencing the Weiser program. Thank you so much Also joining us we have Darius Taer, a correspondent with KFF Health News who has reported on this program, Darius, welcome Hi, Stephanie. How's it going? Great, great. happappy to have you here. Thank you so much, Darius If you're in our audience and you want to be part of this conversation, you can email us at SOI at ideatream dot org or you can call us at eight six six five seven eight zero nine zero three or send us a message on Instagram at the sound of ideas Darius, can you talk about the concerns of Medicare waste that brought about the announcement of this pilot program? How big of a problem is it that was attempted to be put into practice to solve with this program So the Trump administration is very focused in general in terms of waste fraud and abuses they perceive it. And one of the expressions of this concern is this WSer program, which introduces prior authorization on what they characterize as abuse practices for, you know, kind of a baker's dozen of services. Some of those services like skin substitutes had raised concerns with independent watchdogs you know, so for that skin substitute program, spending had surged by about seven hundred percent over over two years. There were some major concerns there. There had also been some other services like spine epidurals and kpho facies, which are for spinal fractures, which doctors had raised concerns or independent watchdogs and raised concerns were overused, not necessarily that they were fraudulent, but that perhaps they were being used in situations that weren't warranted medically. The claim was what we can do is use prior authorization, we can have patients and doctors apply to use the service. We can have a reviewer with artificial intelligence and with clinicians who will give a thumbs up or a thumbs down on this program. And it'll be very fast. You know, they say these applications will go through in three business days That's how it looked on on paper and how they described it itss worked But across the six states that they're piloting on, which includes Ohio, but also Washington State, Arizona, Oklahoma, Texas and New Jersey, we're seeing a lot of patients and their doctors sort of say, hang on a second. This isn't as smooth as we were told it was going to be. This isn't as streamlined We get applications with sometimes rather odd or absurd comments. So one doctor in Arizona told me that he had applied to do a injection to the neck and the reply was, well This patient isn't eligible for a thoracic procedure. Well, the thoracic region is in the mid back. So you know, something got garbled there And so that's kind of the reality on the ground as I and my colleague, Lauren Saucer heard it as we reported this story. Okay. Dr. Kats, have you been hearing anything from doctors about the rollout so far? Have they been seeing delays in care or outright denials for care for patients Yeah, listen What's most important is that the patient and the physiciian stay at the center of the medical decision making. They're the ones that should be deciding what's appropriate and what's not. Now as this program has rolled out, we've seen some challenges. We've heard from our members that there have been difficulties, delays, examples like what was just given I'm These are problems. Anytime that reform I causes unnecessary barriers, that's a problem. And we need to look into that. We need to have it fixed. by the entities that are administrating this program. Now I will say that over the past couple of months, the number of complaints that we've had from our members has dropped off. Now, I don't know if that's from improvement in the program peopleeople getting used to the program or people giving up on the program. I don't know We hope that we will get a six month data update from our CMS vendor and use that data to actually make recommendations on policy change. Thank you for that, Dr. Kats, and CMS being the Centers for Medicare and Medicaid Services. Now Darius, in your reporting, you found that the Centers for Medicare and Medicaid Services officials say that humans are making the final decisions on approvals. But AI's role in the process is causing denials could be entirely AI's fault. Can you tell us about that So what sort of some doctors and their billing specialists were telling me was that They get wr denials like this sort of thoracic issue I kind of mentioned earlier. And it's like this seems like there was some sort of information garbled in here. It seems like one of these so called AI hallucinations where, you know, the AI kind of seems to u got something garbled or or you know, make something up and and so their suspicion is that it's AI. Now I was told, yeah by CMS and the vendor I did speak with that AI does not make the final solution, but Nevertheless, there's this kind of persistent set of complaints that we get these very strange you know, denials that that They just seem to be a little odd that they wouldn't be made by a human. Dr. Katz, last year's federal budget by the Trump administration, the federal budget bill, included major funding cuts to Medicaid and health insurance marketplaces. Are you concerned that there's an overall trend of making it harder for patients to access care in hospitals to operate Given these cuts, these proposed cuts and cuts that we're seeing Yeah, I think as we look at the, u the budget proposals that went through last year and the cuts in Medicare, Medicaid, public funding of healthcare as those have been drawn back or even in this case a wiser made more difficult to access. I think we're going to start seeing some more pressure on communities, particularly rural communities that are more dependent on Medicare, Medicaid funded services Every time every time it is difficult or more difficult for a patient to access health care it creates harm. That harm could be a delay or it could be that they just decide not to get that healthcare and then they have a bad outcome and they end up in the emergency department spending more dollars than they would have had they gotten that healthcare in the first place. So anyime you reduce the services to a community Anytime you reduce their access to healthcare, there's going to be a price to pay down the road. and I'm very concerned that we're on that pathway. doctor Katz, what are your thoughts on preuthorizations in general? the idea that patients need to get prepproval because before they can receive certain services through their insurance Well, as I said at the opening, The healthcare decision belongs between a patient and his or her physician That happens in the exam room at the bedside and really shouldn't be happening anywhere else. now. We do support reducing waste and abuse and even the use of AI when it improves care. But as I've said before, Whether or not any preauthorization actually reduces that or just simply is a barrier to delay care. is the real question And you really have to look at it like this. So some of the stories that were in the KFF paper that came out was patients having to make repeated trips to the physician's office to fill out additional paperwork When you think of the population that is mostly impacted by the Wiser prorogram, we recognize that these are elderly patients who often have caregivers to help them with transportation and accompanying them to physician's office to help be logisticians for and advocates for the patient. And so anytime you have to have that patient go back to the doctor. their caregiver has to take off work The county has to arrange transportation in some cases. These are lots of resources that are being put in place for something that may not make an impact on the patients ultimate outcome anyways It merely delays that and delays are problematic Daria, some other part of your reporting noted that the process might actually be raising costs for the government because of more appeals, which is raising the question of whether this is actually helpful for the goal of reducing wasteful federal spending. Can you tell us quickly about that Yeah, so basically, Medicare has a very complex structure. You have kind of the folks over here in the Mid Atlantic who kind of set out the rules for the program You have these administrative contractors who you know kind of do a lot of the nuts and bolts of actually putting out payments, determining coverage policies And now I have this third entity, these tech vendors who are ucing this prior authorization application Now Due to all of kind of these complex interactions, what seems to be happening is that doctors are appealing the decision from the prior authorization vendors to these administrative contractors. The administrative contractors are compensated by Medicare, that is to say the folks you know, for the expense of running these appeals. And so what Medicare acknowledged to me is that, you know, they're kind of There are more costs associated with these heels now where it all adds up to is uncertain. You know, I know the doctor Dror Katz could have alluded to a need for more data, which is something You hear again and again from people who study prior authorization, whether it's in a pilot program like this, or in Medicare Advantage or in private sector insurance, is that we don't necessarily know how prior authorization works under the hood. Darius, thank you so much. I'm so sorry to cut you off. we're out of time for this segment. I want to thank you for your time today. Darius to herear a correspondent with KFF Health News. We appreciate it. and also dor. Gary Katz, president of the Ohio State Medical Association. Thank you for your time Thank you very much We do know that there is a legislative effort to repeal the WSer program, and we will continue to follow this. So thanks for being part of this conversation with us. For our members and our audience. We'll now take a quick break And on the other side, we'll hear about people documenting graves connected to the Revolutionary War. This is the sound of ideas. I'm Stephanie Haney, will' be right back This is the Sound of Idas from Idea Stream Public Media. I'm Stephanie Haney. Thank you for staying with us As America approaches its two hundred fiftieth birthday, Americans are paying a bit more attention to the country's founding and the events surrounding seventeen seventy six. Over the last year, more than five hundred Ohioans volunteering their time took part in collecting data about those who actually served in the Revolutionary War. The Revolutionary War Graves Iidentification Project was an undertaking from the Ohio History Connection. with the purpose of verifying and documenting the final resting places of those veterans buried in Ohio Idea Streams Drew Mazias spoke with Krista Horx, project manager for the Ohio History Connection about the Graves project Here's that conversation Krista Horox, welcome to the Sound of Ideas. Thank you. Thanks for having me. Yeah, and for those that are unfamiliar, can you talk a little bit about the Ohio History Connection and the kind of sites that you manage and the museums that are kind of in the portfolio? Sure. So we have the Ohio History Connection has sites all over Ohio. We have our kind of our main site here in Columbus, Ohio called the Ohio History Center But we have sites all over the state, lots of different focuses around history. Some of our sites are you know prehistoric mound works. someome of them are more Ohio history progression throughout the different subcultures. We have sites that focus on African American history, for example. So we have a little bit of everything, If it's Ohio and it's history, we're there for it. So we're broadcasting out of WKSU, which covers twenty two counties in Northeast, Ohio. What are some of the maybe popular sites that are part of the Ohio history connection network up here in Northeast Ohio that you see a lot of people visiting or show interest in. Yeah. so you know related to this project, we have Fort Lawrence, which is out of Boliver, Ohio. That's the only Revolutionary War veteran site here in Ohio. So definitely check out Fort Lawrence. Some of our other popular ones are Sanbrun Village in New Philadelphia. We also have Zor Village and Zor. So it's really great. All of those areas you can kind of even do in like one big day or weekend trip We have a lot of great sites up there. so definitely check our website and see what see what we have in your area. And the reason we invited you onto the Sound of Ides today was to talk about the America two hundred fifty Revolutionary War Graves project. Can you give us a sense of what that project is and where did this idea even come from Yeah. so when the project started, the America two hundred fifty Ohio Commission, was working specifically with people with the Sons of the American Revolution, and we wanted to do something around the Revolutionary War veterans. We have an estimated seven thousand buried here in the state. and a lot of people just don't realize we have this much connection to the Revolutionary War because of course, the state of Ohio was not yet established. We only really have one Revolutionary War site, which is Fort Lawrence, up in Tuscar' County So very close to you guys, deffinitely check it out. So we just wanted to make sure that these veterans and their graves sites were not forgotten. Some of these veterans are really some of our earliest settlers here in Ohio. So yeah, that was kind of where the project started. So the goal of the project, again, is to identify all seven thousand revolutionary W veteran graves sites. So we're using an app called Survey one hundred twenty three that we push to the public on Memorial Day of twenty twenty five. And really anybody can download the app on their phone, go out to cemeteries, find revolutionary war veteran grave sites document them that collects GPS coordinates, photographs, and then information from the gravesite itself And then we have a dashboard that all this information gets uploaded to. And the goal of it is so that anybody can always look at this map, see very good documentation on conditions of graves sites. The photographs will help judge conditions. Everything will go up on our dashboard live on our website And that's really the way we're trying to collect the information about all of these veterans. Awesome. And I like that you talked about, you people not necessarily thinking about Ohio when they think about the Revolutionary War. They might think of Aostin or Philadelphia, kind of East Coast. But how did these veterans come to be buried in Ohio? Were they bodies from the Revolutionary War? Were they people that then settled here? Give us a little more history on on what is contained in these graves Yeah. So these are all veterans. They're all survivors of the war. And they chose to come here later in life. So huge tracks, hundreds of acres of the Ohio country was given to revolutionary War veterans as payment for their service Some of those veterans chose to come here to Ohio, but a lot of them really sold their land off to to surveyors and things and then other veterans, you know that maybe didn't receive the land purchased it later to move here. But yeah, we see some of these veterans that they might not have came over to, you know what became Ohio until maybe in their seventies and eighties. So they chose to come later in life with their families. but that's how really so many of them ended up being buried here. wasas really because so much of that land was payment for for their service. Yeah. and you alluded to earlier the condition of some of these graves, you know, you have a picture on the website of of some markings that are they're pretty hard to read. So what do these graves look like? Are they in various conditions? Are people able to identify all of them? some of them Anonymous, tellell us more about that Yeah. so they definitely are in all different types of conditions. A lot of graves sites are the original markers. so the ones the original gravestones actually put in by the families after these Vveerans passed away, but a lot of them are replacements as well. So some of them are military markers that have been placed over time or more recent documentation so that those veterans know wouldn't be forgotten in recent history. But there is plenty of veterans whose gravesites are lost. So I would not be surprised by the end of the project if we have a couple hundred or even one thousand of these veterans where we just don we don't really know where they're at. We might know what cemetery they're buried in, but we don't know where their gravesite is We also have ones that we know they're here somewhere in Ohio, mayaybe we know what county they're in, but we just don't know where they're buried. So we have lost the information around a lot of these graves sites In the past two hundred plus years that these veterans came here to Ohio. So that's really, you know the big drive for the project is we don't want to keep losing their graves sites. Gravestones are fragile. they erode over time. There's not a whole lot we can do to stop that. But if we have good information about where they're buried now and we have good documentation of what their graves sites conditions are now thenen even fifty or one hundred years from now, researchers can take the information that we collected as part of this project and all of these public members have helped us with so that they can always be remembered and we won't forget these veterans through the passage of time. Yeah what's that collection of data and graves looked like in terms of public involvement, whereere these people finding these? What's that information and that again, that data collection kind of look like Yeah. so we had really great help from the Sons of the American Revolution. When we started the project, they were able to give us all of their statewide data. And it really gave us a starting point to know what veterans are here, but also to be able to push that information out to the public and say, these are the veterans we know about, These are the people we need to go find. And working with other groups, including the Daughters of the American Revolution, as well as local genealogy and historical society groups, they've really helped us kind of even more information to these veteran graves sites or even account for veterans that might not fall in everybody's records. But that was something we learned very early on when the project went live. We had a lot of people who wanted to help with the project, but they're you know, maybe they're not cemetarians, they're not historians. They're not people that necessarily know where to get started with this. So we created a lot of public rearch information on our landing page so that people say, okay, I can look at this map and I can say, these are the veterans I know are buried around me. Now I just need to get out there, get to the cemetery and find their exact burial location, find their gravestone. So that's been really great. And we have probably now over six hundred contributors to the project. When the initial set of data collection ended on Memorial Day of this year We had about five hundred and ninety contributors just through the app alone. So we never really anticipated that when the project started. just how much interest, how much involvement and that the public loves to be part of this. This is you know, one of the few America two hundred fifty projects that they can really contribute to, they can be part of. And I think it really helps empower people and make them feel that much closer to this big anniversary that we're all living through. Yeah, and these graves obviously tied to the veterans of the American Revolution. else does it teach us about Ohio during this time period, some of these settlers that ended up passing away in the early nineteenth century. Does it help historians or people that are working at museums paint a better picture of what this state or territory was like hundreds of years ago Yeah, definitely. These A lot of these veterans were the original settlers in these towns in these cities. They were the ones that really helped builduild Ohio into what it is. So a lot of these gravesites are some of the oldest in the state. and a lot of these veterans, understandably, are buried on back then what was small private cemeteries because a lot of you know, they were moving out west, they were moving to area that hadn't been previously inhabited We know we're learning a lot just about their stories and what they did to help build Ohio But also from a cemetery point of view, it's helping us realize just how fragile and how unknown Some of these cemeteries in these gravesites could be because of course, even though we're just documenting the veterans for this project, these veterans had wives, they had children, they had family who lived and died here with them as well. So we're really starting to see just again how many of these gravesites have been lost over time and what can you what really needs to be done to help preserve and protect cemeteries in the future? You had mentioned genealogy earlier and you just mentioned the families of these veterans Have you talked to or been able to connect with any descendants of these veterans? Are there folks that can trace their lineages back to some of these early settlers of Ohio Oh yes, absolutely. And that's been a huge involvement with the project. Of course, people want to, if they know they have a veteran here buried in Ohio, they want to make sure that they get out, make sure that veteran is collected as part of the project and accounted for in the database. We've also had people reach out to us from all over the country who say, I know that You know, ancestor, my veteran is buried in Ohio, I want to make sure nobody forgets about them. So that's been, you know, kind of very heartfelt as well to see even, you know, nationwide efforts being done because people know that, you know, maybe their family started here in Ohio. I've learned a lot myself. I always knew that I had one revolutionary War veteran In my family. so of course, I took my children and my dad and we went out and documented his graves site. But then through the course of this project, I've learned I actually have twenty seven Revolutionary War veterans in my history. And about five of them are buried here in Ohio. So it's just it's so fascinating. It's so you just you learn so much in the stories that these Guys can tell us through their history and through the documentation that still exists for them is just it's so remarkable. and even if people don't have, you know genealogical connections to these veterans, knowing the veterans in your area, knowing what they did for maybe your town or city or your village can be so empowering to you know, remember how important our local history really is to us. Well, the final survey will come out on july fourth on the two hundred fiftieth anniversary. What other events or programming does Ohio History Connection have in store for the America two hundred fifty celebration? Yeah, so July is our big picnic month. So there's picnics going on all over the state in celebration of, you know the big fourth of July event. We have a big two hundred fifty picnic going on in downtown Columbus on the fourth, but there's a number of other picnics. I think there's you know well over two hundred now across the state So definitely check the America two hundred fifty Ohio website, see what picnics are going on in your local area around this month. And you know just get together and celebrate. This is such an incredible milestone that we all get to experience, that we all get to live through. There won't be another two hundred fiftieth anniversary, so just get out there and you know, be part of it. Krista Horox is a project manager with the Ohio History Connection. Thanks so much for talking to us today on the Sound of Idas Thank you so much for having me Again, that was coordinating producer Drew Mazzia, speaking with Christopher Horwx from the Ohio History Connection. And as we mentioned, that final grave survey comes out on Saturday. We'll have a link to that at ideaSream. org slash Si. That's it for today. and this week, if you missed any part of today's show, you'll hear a rebroadcast tonight at nine on eighty nine seven WKSU. You'll find every episode of The Sound of Idas wherever you get your podcasts and on YouTube To get the last word on today's topics, you can email us at SOI at ideeaStream. org and find us on Instagram at the Sound of Ideas. Yesterday, we talked about the latest Supreme Court rulings, and Tom sent us a message about a case that we did not discuss yesterday, The court striking down a campaign finance law that limited how much political parties can spend on candidates. Tom Ronan The ruling on campaign contribution limits was based on the argument that monetary contributions are political speech protected by the First Amendment, but the ruling is not a win for free speech. It's a consolidation of power for corporations and billionaires. Without limits, the influence of the average citizen is diluted, and our interests are usurped by the interests of the few and the rich Thank you for that time The Sant of Edas' team is off tomorrow in honor of the July fourirth holiday. So in our place, we'll have a special program, How to two hundred fifty, your guide to America's big Birthday I'm Stephanie Haney. Thank you for keeping the conversation going. Stay safe and hydrated. Have a great weekend. We'll see you back here on Monday