[This Transcript is Unedited]

National Committee on Vital and Health Statistics

Subcommittee on Standards

September 28, 2016

Courtyard Marriott
Congressional/Monuments Room
1325 2nd Street, NE
Washington, D.C.

P R O C E E D I N G S (4:10 p.m.)

MS. GOSS: We are going to go ahead. Do we have people on the phone? Is there anybody out there on the web listening to us? Okay, the teleconference folks, is there anybody on the teleconference line?

(No response)

MS. GOSS: Okay, we are going to go ahead and try to be mindful of using our microphone since people on the web may still be listening. So today’s Standard Subcommittee working session is specifically to help us advance a number of our work topics and the status of defining the scope of effort on a number of the work topics that we have already identified. And I have those in subsequent slides for our discussion.

What we’ll be showing today in the room is really a reflection of some of the between-meeting work that we’ve been doing. We’ve been developing a detailed outline of the activities that we anticipate needing to tackle in the next 12 months. So as a result of knowing the size of the efforts, we’ll be able to more effectively prioritize our work.

Today I would also like to be able to walk out of here confirming our Subcommittee meeting cycle because there have been some back and forth on when we’re going to be having standing meetings on a monthly basis. I’d really like to garner a better understanding of the Subcommittee’s interest areas. I know that we don’t have everyone here, like Vickie, Linda is currently leading the Privacy breakout session but what we can do is figure out where folks may want to spend more of their time and energy because I know we’re all quite limited.

And as a result of the discussions that we have today then we can better inform the input for the full Committee’s work plan, coordination with the Executive Committee, agenda setting and, of course, the all-important resource and budget planning efforts. This is the goals that I’ve set out there for today. Are there any questions on that?

On this slide, I have six topics listed. They are color coded to kind of track with the in between meetings work. So the Review Committee 2015 Report was in the pipeline as of this morning. Happily, we got full approval for that and now we can finalize that report and move it forward and post it. The RC hearing playbook generation, this is something that we’ve talked about doing because it was such a success, I want to have a template or a roadmap for moving forward into our 2017 hearing and report generation, hard to believe that we’ll need to be tackling that next June. The predictability roadmap for standards development and adoption is something that we’ve been talking about and have come up with a fairly good outline of next steps. And so we’ll be hopefully able to leverage that work.

Three areas that remain on this slide, ACA 10109, 12th Report to Congress in conjunction with the full Committee and the public health standards topics are something that we need to discuss the scope specifically around. Additionally, there have been some anticipated or potential topics emerging and I do not think that what I put on this slide is a complete list so I want to make sure that we’re not being short sided in planning for the work ahead just based upon the six topics that we’ve already identified. So I want to also have some general discussion around these anticipated or potential topics.

And looking to see where we would like to start. If people want to talk about the topics that we think may be emerging for us but not currently on our worklist or they want to start diving into what does the – I’m trying to go back a slide, oh yes, that worked really well. The screen just went blank.

MS. LOVE: Can you walk me through because I’m still feeling like I am on the steepest learning curve in the whole wide world. I mean I should know everything I think by now but I don’t. So when you say NCPDP script, I think I know what that is but then what is the ask and what is the deliverable.

MS. GOSS: Actually in the NCPDP script is only something that popped up in the last week as a result of people reviewing the Review Committee Report and probably Terry can help me explain this.

MS. LOVE: Not so much in the weeds, but I’m just saying what then –

MR. COUSSOLE: Let me even go one step backwards. One of the challenges is getting to – there’s a number of things that we are kind of statutorily required to do. And there are certain timeframes around some of those. Some we’ve made, some we’ve missed. And so they kind of fall – at least to the top of the consideration list. You’ve got to basically I think try to ignore them if we want to not do them in the same sequence. And then the question is are there other topics that we believe have the right level of import in the short term to get inserted inside that schedule and plan.

MS. DEUTSCH: Some of them don’t require a whole thing. The NCPDP one is they want to present the upgrade. I’ll kind of just take it at that. So all they do is they’re going to present it. And then we make a decision. It’s happened a number of times before so it’s not a whole hearing. It’s not any of that.

MS. LOVE: Do they just ask for the blessing before they go to X12? I mean I’m just trying to –

MS. DEUTSCH: Generally, it’s gone through the process and they then present to NCVHS and then NCVHS makes a recommendation and that’s basically what they’re talking about.

MS. LOVE: It’s the important steps to the process to the change.

MS. DEUTSCH: That’s exactly correct. It’s not a statutory required. It’s they did an improvement, a modification and so all they would do is just present –

MS. LOVE: Do you ever go back and –

MS. DEUTSCH: It could be done, if you had a hearing on another topic, it could be added in as just one –

MS. LOVE: But as a Committee member, do I know enough to say that’s good or not good, for the script.

MS. DEUTSCH: They would have to explain it enough that there’s an understanding and then the opportunity to you to ask the questions. That’s in anything. It would be just like in the hearings where you have the opportunity and you ask the questions. If it’s not clear enough for you to make a decision, then you need to ask for it and I guess I’m not talking and –

MS. LOVE: But there would never be a case where the Committee says, no, don’t like it, go back to the drawing board.

MS. DEUTSCH: Yes. If you think about – we have done that. NCVHS did that with the Attachment standard twice and then the last time for the Operating Rules phase IV Operating Rules for Core. So yes, it does not mean that you must yes, 100 percent. You make a decision based on the evaluation criteria that we always have developed and used.

MS. GOSS: I think that is the real key there, is that we do usually okay, something’s coming forward, how do we want to look at this, what’s important to us, set some evaluation criteria. Sometimes that work is actually done offline and then brought to the Committee to finalize, is the way we’ve sort of been handling that.

MS. DEUTSCH: We have been in the letters and in the recommendations we’ve been identifying what the evaluation criteria are and the questions ahead of time. But again, in this NCPDP, there are some questions that probably could be given to them so that they are prepared to provide the answers so a decision can be made. But this just came in. It kind of got attached to a public comment that they made for the RC Report and so the fact was it had nothing to do with the RC Report. It was something that was different and new so that’s why it was tacked on.

DR. SUAREZ: One thing to consider is that with pharmacy standards we work in two different spaces really, maybe more but I’m just going to categorize it into two. One is the administrative related standard for pharmacy. So the use of NCPDP D.0 for transacting claims and other things that are used for HIPAA transactions. So that’s one group and NCPDP maintains those and updates those and things like that.

The other set of standards are related to e-prescribing. That has nothing to do with HIPAA. They are driven by MMA, the Medicare Modernization Act and the National Committee has been the place where NCPDP comes and says we have a new version for e-prescribing. So it’s not HIPAA. It’s not about HIPAA standards. It’s about a transaction that is e-prescribing for which we have advised the Secretary to adopt standards as well. So in some of these cases it’s important, particularly pharmacies, it’s important to consider that we deal with both the administrative transactions and the application of NCPDP standards for a different thing called e-prescribing.

MR. LANDEN: It is interesting because the MU requirements for e-prescribing are governed by ONC.

DR. SUAREZ: When it comes to – as a request –

MR. LANDEN: The certification requirements are ONC.

MS. DEUTSCH: Right, but what would come here would not be related to the infrastructure or for the certification that falls under ONC. There are different parts to it. Like we had the – I forgot the name of it now – or when I talked about this morning with the overfill, that is not anything that falls under ONC. It was the fact that there was a need to use one of the fields on the claim to be able to put whatever the amount of drug that was ordered.

It was particularly for long-term care facilities because they don’t always fill a prescription completely. They fill it in increments. Hospice does the same thing and so there needed to be a way to show that this was not fraud or this was not overusing or oversubscribing or prescribing. So there are different things that don’t fall under, as Walter said, doesn’t fall under administrative simplification, doesn’t fall under the requirements of ONC. When we talked about – you all talked about earlier the population health standard. That’s not administrative simplification. It’s still a standard. So there are certain things that do come by.

So I think that for the purposes of this meeting, I would suggest that we kind of put the NCPDP script version kind of on the side, knowing that it’s going to be an extra thing attached to some other larger scope or item so it can be addressed.

MR. LANDEN: I’d like to look more into that. Because I am looking at the ONC’s test scripts and it specifies script standard version number and implementation guide and code set are X-NORM.

DR SUZREZ: Look at the NCVHS letters as well and we are also providing advice on that. But it’s a great point and I think that’s part of what would need to be discussed next year when the Committee and the
Subcommittee get into the discussions about NCPDP standards.

MS. GOSS: I think that what happens is though we are a trigger mechanism for the NCPDP script version change. Something will bubble up I would imagine. Same thing for the DSMO Report and the request to upgrade the HIPAA versions from 50-10 to 70-30 or – I always forget the NCPDP version from D.0 to F.1 or something like that. So those will be triggered for us and we’re going to have to be responsive to those and plan them somewhere in the process and I’m not sure how all this scheduling is going to go.

We also have this HIPAA version 3.0 conversation that’s sort of been bubbling up in our own discussions and then earlier today and as I think as a part of a larger Committee discussion so I think it’s important to have it on our radar but I think the intersection points with Pop Health and PCS need to be sort of brought together from an Executive Committee perspective and figure out where that all kind of fits in. So I think again it’s something probably we could set aside, like NCPDP script, until we get a little bit more either a trigger mechanism or some further conversations.

I think the APCD standards I think would also be okay to just hold tight on until we see where the letter goes, is my thought process. So I think this slide sort of puts a placeholder for things that might bubble up in our world.

DR. SUAREZ: Can I comment on two more items there. One is specifically about the Medicare Social Security Number Replacement Initiative that we heard in – the SSNRI. I think my sense is that this is going to be a significant – new, first and a significant impact to the industry that I think Medicare/CMS is going to be hopefully interested. They’ve been holding – at least starting to hold some of this open call, open mic hearing, not hearings but calls, and I think having the ability for the National Committee to provide some advice and listen to the industry about what this is and how it’s affecting, I think will be very valuable.

And certainly inviting the organizations like WEDI, that I am sure they are going to be taking on a lot of the work. I mean this reminded me immediately of something else back several years ago we worked on the called NPI, the National Provider Identifier. And we worked on it in the National Committee. WEDI worked on it significantly in developing some industry consensus guidance on approaches and more than 20 white papers were published by WEDI about how to handle this.

MS. LOVE: How about guidance to states?

Dr. SUAREZ: Well, to everybody, exactly. Medicaid but also – so this is an important impactful –

MS. DEUTSCH: I have already spoken to the area that is responsible for the SSNRI, to advise them that there might be a request for them to provide – I tried not to say the word hearing because that sounds very weird but, you know, to be able to say that we’d like to have them. So they are aware that they may very well be asked to do it.

MS. GOSS: I wanted to confirm what I heard earlier because I apologize, I had to step out, but I came back in on that conversation, Walter. And what I heard was there’s a work around or there’s already an existing qualifier for the NBI to replace the SSN usage within the HIPAA mandated transactions.

DR. SUAREZ: I had a chance to speak with X-12 leadership on Sunday afternoon actually, about this. And again without speaking on behalf of them, but just transferring some of the information they shared. First of all, this implementation might happen before the adoption of 7030. So that’s the first reality.

So the question was how can this be transferred and used in a 5010 version. They argue that the current location of where we all report the current numbers, various numbers of the – because this is a field that allow providers to report identifiers for many things and one of them is called the – as they call it, HCIN number. HCIN stands for the Health Care Claim Identification Number of Medicare.

And the famous HCIN, or Health Care Identification Number, is the number that Medicare is going to replace because that is the one that is the Social Security number of Medicare beneficiaries with some letter in the front and some control in the back. That’s what’s called HCIN. That’s the actual title of the number.

So they are replacing the HCIN with an MBI, Medicare Beneficiary Identifier. So right now there’s a place to put the HCIN in the transaction. There is a qualifier, a little market that says I am sending you the HCIN by putting XX or XY, whatever code is the qualifier. The argument is to allow that type of a field to report that and there’s ways to declare a qualifier apparently. So apparently there is a way to do it.

They argue that I think it will be possible to do it. So that’s number. So if we have to implement this before 7030. There is going to be a work around to do it and X12 will be working on it to tell the entire industry because this affects every claim that would come through the Medicare system.

For Medicare beneficiaries, and this is not just the 70 million Medicare over 65, this is another 40 million of dual eligible and all sorts of other individuals are a part of the Medicare system. They argue there’s about a $120 million people that are going to be enumerated or change the numbers.

And then the question was in X-12, what happens with 7030. So my question was has anybody requested a change request, as they call it, to modify the data element, the data field to add a new qualifier? Unfortunately, no, nobody has requested that. But they still argue that the next version will be able to also handle this.

It is going to be very difficult at this point to really – even though right now they are at an open comment process of the 7030 version of these transactions and anybody can submit a comment say, hey, what are we going to do with this new Medicare number, my understanding is that 7030 will also be able to include the number. And I asked specifically, well, is the number with enough space to locate it because sometimes you have nine characters. They argue yes, the field is about 80 characters. Then according to what heard from Medicare, the number is going to be about 11.

MS. DEUTSCH: It is going to be the same number with the same –

DR. SUAREZ: Exactly. So I think from a standards perspective it looks like it’s going to be possible but I think it’s going be very important to doing a hearing next year, have that conversation with the Standards group. Have a conversation with the health plans. Have some health plans come and express, here is what we are trying to figure out and what we do.

MS. GOSS: I just want to pause for a second. So from a SSNRI perspective we want to have some level of conversation about that, whether it’s a hearing or something else, but we are thinking that we need to sort of get our arms around that because it could blow up or it may be even something that fits with Review Committee. Maybe it doesn’t have to be separate. It can maybe be something we get – I don’t know, we’ll figure it out. So I’m up to 10 issues now that we have identified.

MR. COUSSOLE: Can I ask a process question. So if we’re with 7030 the transition, how does that decision actually get made? What’s the sequence of events that goes into making that determination?

DR. SUAREZ: Yes, the sequence is basically once the X-12 transactions, let’s talk about 7030 specifically, are completed, which I expect will be next year –

MS. DEUTSCH: 2017.

MS. GOSS: Let’s call them technical reports.

DR. SUAREZ: Yes, the technical reports.

MS. GOSS: Very big distinction because 7030 the standard is already done.

DR. SUAREZ: The 7030 standard per se is a standard that has been in place for already four years or so. But this is the technical reports that are the HIPAA implementation guides officially to be referenced.

MS. DEUTSCH: It is always the implication guides that we adopt.

DR. SUAREZ: So once that is completed next year, then there is presumably a request that goes to the DSMO, the way I understand it, goes to the DSMO saying we are recommending that this be adopted as a national standard. Then the DSMO, which is the three standard development organizations, three data content committees, get together, agree and this is agreed, let’s say –

MR. COUSSOLE: The recommendation comes from whom? Who makes the request?

DR. SUAREZ: It could be X-12 as the one that makes the recommendation.

MS. GOSS: It’s a generic change request process at –

DR. SUAREZ: Once the DSMO agrees then they come to NCVHS and present DSMO proposal saying, we are hereby recommending that NCVHS recommend to the Secretary to adopt a 7030. And then NCVHS – normally what we have done is conduct a hearing about the plan to move to 7030 and then make the recommendation to the Secretary and then the Secretary starts the rulemaking process.

Assuming that everything goes in timeline, I think we’re technically looking at probably like 2020 before the formal compliance date comes because there’s adoption and rulemaking and all these processes. So we’re probably talking about three or four years to complete the process.

MR. COUSSOLE: Part of the reason I am asking and this is my own education here, is that we’ve got I think Alix mentioned 10 items or whatever the number is going to end up being that we are going to consider. It can be a number of them worked on at the same time depending on the sequencing of activities that has to happen.

That’s where I think one of our big challenges is going to come in to say not only – because we do we believe these are the right things, and then we start laying them out on a calendar with work effort, and sure these four can go roughly the same time because the overlap makes sense. And these can’t because it doesn’t.

That is why I think one, we have to think through as well, and sorry, so this is really my education to making sure I understand the runway for some of these things.

MS. GOSS: This is important though. Keep going with – what you’ve just said is really important to our process so us knowing from a committee perspective what we think is the effort that we have to undertake, what’s the output that we have to generate, helps us with that mapping out of the resources. That’s why I think we’ve been trying to get the discussions to happen so that then Terri and Nick and I, can kind of figure out how that all fits and then work with the Executive Committee and the dollars that are available to support us.

MR. COUSSOLE: One of the things we started laying out and Terri took kind of a first crack at this is to say, hey, look, for this particular item, Review Committee report 2017, what’s the sequence of events needs to be and if we back that up into here’s what the end game needs to be or here’s where we start and you can start from either point there but then you still have to figure out the work.

So okay, this happens in this quarter and this will happen in the next quarter and this will happen in the next quarter. You start laying it out and realizing okay, this takes so much amount of work for the committee, subcommittee versus the full committee, and it ties you in a knot. So I think that’s the kind of exercise that we’re starting to iterate, really just starting to iterate through.

MS. DEUTSCH: I think of what you really all should look at is you have these items of I’m going to call them tasks, and now you have to figure out which ones have to be first on a priority. Once you have the priority then you can do the laying out because I’m going to go back to the script version. It may be one of the 10 but it doesn’t have to be done separately.

It can be a rider with something else because all it’s going to probably be is NCPDP coming in saying what it is that they want. And so that’s the type of thing that I think before you go and lay out the calendar of events over the years, is to do that and that ties in with what you said earlier about what are the statutory mandates and those I would assume, would be a priority and then the others would follow.

MR. LANDEN: Three comments. First, I agree that as we look at these items, there are several of them that have a significant degree of overlap so as we lay them out they’re not going to be sequential. We’ll be able to – one hearing could work for three of them, at least in part.

Second, on the Social Security Removal Initiative, I’d be interested in how deep of a dive would we really need to do on that because it’s legislatively mandated. CMS is running with it. I don’t see a big value add unless we discover something troublesome of the industry there.

And then, my final point, item number 11, if the 2017 budget bill passed by Congress removes the prohibition about working on a national patient identifier, we may need to add that to our list and that will be very interesting because of the SSRI.

MS. GOSS: It hasn’t been mandated yet. It’s prohibited by statute at this point.

MR. LANDEN: It’s prohibited in the budget bill and that’s been renewed annually. Word on the street as of a month ago was that the opposition to removing that this time around is disappearing so if it passes, we may find ourselves having to look at that. If it doesn’t pass we’re done for another year.

MS. GOSS: And it would be huge for us. So I like that NPI prohibition lifted.

DR. SUAREZ: Two quick comments to react to that. The first one is on the Social Security Number Removal Initiative. Even though it’s mandated by MACRA and there’s timeline, there’s a lot of process steps that are not written and that I think the Committee would have an opportunity to comment on to help the industry move forward with it and really inform CMS about that process. Because there’s a lot of internal process – I mean Kaiser Permanente I can tell you right now is looking into these and we’re beginning to get a little concerned about the amount of systems that this will affect and the sequencing of activities.

And one of the things that has been said, again by CMS in some of the messages, is that in order to access the number, they are not going to send you, send providers or send anyone, a list of all the numbers because that’s actually part of the reason they are doing this is fraud and abuse control and they don’t want to send a file with three million numbers, or two million or one million numbers, whatever number you have, until – this is the former number, this is the new number in one file. Because that will be exposing a lot of the data to a lot of sources, a lot of potential risks and risk of breach and other things.

So they have initially at least said they are not going to communicate to providers what are the NPIs of all your patients that are Medicare. You provider are going to have to obtain it from the member when they show up and say this is my new card and this is by the way, my new number. So you now have to put that number into your system and map it to you.

So I think all those are some of the example processes that a National Committee discussion through a workshop, hearing, whatever input opportunity there is, will allow the industry to bring in and communicate and discuss really openly.

And then on the rider, the way we have seen it is the rider, which is a budget rider, this time around came with a little bit of extra wording, stating basically that – clarifying basically that HHS is not prohibited from working on this anymore. HHS is now able to work on it, study the issue, identify concerns, identify even opportunities and even come up with some recommended approaches but at the end, in order to adopt a national standard for patient identification, HHS rulemaking is congress through rulemaking.

That’s the difference. Whereas with NPI, the NPI was adopted through rulemaking with patient identifier, they clarify hey, HHs go ahead and work, whatever you want to do, study the issue, convene things. We now have the opportunity if we wanted to do it. In fact, I personally approached the leadership of HHS to try to start the process this year but clearly we have in Oregon a lot of things and, of course, the current state of political development with the new administration coming with election and all these things and Congress finishing the cycle, they decided let’s not bring that up at this point within the National Committee, we can look at it and revisit that next year. So it is an opportunity that the National Committee has. It is now permitted under the current rider which is written and I have actually the language and I sent it to HHS.

MR. LANDEN: By current you mean the 2016 budget.

DR. SUAREZ: Yes, the 2016 budget.

MR. LANDEN: I am sorry. I would not have spoken had I known that interpretation had been accepted.

DR. SUAREZ: No it’s perfect. It’s just perfect because it does open up the opportunity. And there’s of course a lot of initiatives like CHIME and HIMMS putting out and even ONC has a project, patient matching project, patient identification solution project. All these – it’s really pushing and I think it’s very important that the National Committee consider this for next year. It’s really pushing the industry toward saying one of the biggest interpretability challenges we have is identification of patients. And without that, we’re still going to be developing and depending on matching.

And we’re not going to be able to treat 30 or 20 percent or really exchange data. It was yesterday mentioned in the testimony that they provided – of course, this is National Health IT Week and so there’s a lot of activities around this and yesterday there were some presentations about interoperability and one of the comments was that, yes, patient identifier is blocking the ability to exchange data in about 20 to 25 percent because of inability to match the right patients. Anyway, I think that’s a very important area for next year.

MS. GOSS: I scribbled notes and put them all on one flip chart, the 11 things I’ve heard bubble up so far, that’s all I’m doing.

DR SUAREZ: Here is another one, number 12. It’s a little thing called UDI, the unique device identifier. So some of you might have heard how much even Congress got into this drafting legislation that will require the UDI to put in claims. And then in testimony and then in hearings, sort of questioning and pushing really in many ways, CMS to change their position.

CMS’s position was we don’t want, we don’t think we need this in the claim and they were not supportive. As of about three months ago, they completely changed their position and now they are saying we want this. They officially send a letter to X-12. The first time I think I’ve seen it in many years. Andy Slavitt, the administrator of CMS, sent a letter to the leadership of X-12 requesting that this be included in the 7030 basically.

Fortunately, X-12 had already taken this and they have right now about three different approaches to this, very quickly the UDI, as some of you know, is composed by two components, something called the DI, the device identifier which is the actual identifier of a particular device. It’s a very long, let’s call is serial number, let’s say. That’s the DI of the UDI. And then there’s the PI. PI stands for production identification. And that is the component of the UDI that defines the date the device was manufactured, the lot, a whole bunch of things about the production. So right now, the DI component

MS. GOSS: Can you back up because I am a little lost. So UDI, unique device identifiers already in 7030. There’s something now called PDI?

DR. SUAREZ: No, no. The UDI has two parts, the DI and the PI. Those are two separate parts of the UDI. The UDI has a DI which is the device identifier, let’s call it the serial number of the actual device. It’s a total random number. That’s the DI. And the PI is the production identification information which is the lot number, the date of production, the cycle, those sort of things. X-12 has approved –

MS. DEUTSCH: Can’t that be captured under 7030?

DR. SUAREZ: Yes. X-12 has adopted – let us just say they are working through the decision about incorporating the DI portion in it and there’s questions – there are three different approaches right now and they are finishing the argument but I think that is going to be one of the questions I would suggest for the National Committee next year, to consider asking X-12 about how is the UDI being incorporated.

MS. DEUTSCH: I guess the question is are we looking at 2017 and 2018 or are we just looking at 2017?

MS. HINES: I think we want to look at what needs to get done and then we’ll map out the time.

MS. DEUTSCH: I think it makes a difference in the fact that if you have a list like that, that’s not going to be in one year.

MS. GOSS: Oh, I don’t think anybody’s expecting we’re going to get all this stuff done.

MS. DEUTSCH: If you are talking about 2017-18, that helps in the prioritization that I talked about and so that may be the way to look at it, is if you do the numbering then you can figure which part can fall under 17, which part can go to 18 and which have to be tabled and looked at again because priorities will probably change.

DR. SUAREZ: Alex is just listing all of them without yet starting to even think about which one goes in 17 –

MS. GOSS: That is correct. I’m trying to get one universal list.

MS. LOVE: And some are going to change because I know that the NUBC really rejected putting the UDI in the NUBC core.

DR. SUAREZ: There’s been some change, primarily because CMS sent a formal letter saying we now need this.

MS. LOVE: So that could change our position as well which is huge for the states.

DR. SUAREZ: It’s largest payor in the country so when they send a letter, you tend to pay attention to it. I’m not saying that they were the ones that – I think there was a lot of debate and finally there have been agreement that this will be –

MR. LANDEN: And as an aside, the UDI is already required for ONC certification beginning next year.

DR. SUAREZ: Well, yes, the UDI is part of the EHR record.

MR. LANDEN: So the EHR will be not only required to capture it but to parse it in those six or seven different components that Walter named?

DR. SUAREZ: Yes, the 2015 addition certification criteria includes the requirement that EHR is to be certified starting this year, well next year, they will be required to have the ability to capture the UDI in its various components and there’s about four or five. And actually I read to the X-12 group the NIST certification script, the actual testing script to evaluate whether this – and the testing script said can you capture this component of the UDI, and separately in different fields, it’s not like in one single field. No, you have to be able to capture it in separate fields in the EHR and parse it out. I just want to know the manufacturing date. Well, that’s one component –

MS. GOSS: I have a basic question for you Walter. So 7030 – so the UDI, are you trying to make it a separate topic or would you make it a part of any DSMO request that would come along or something –

DR. SUAREZ: Great point. I wasn’t trying to make it a separate topic. I was just trying to bring it up to the National Committee as a –

MS. GOSS: That made it a separate topic – the way we put it here. That’s where I was getting confused because it would be something –

DR. SUAREZ: And I apologize. I didn’t mean to say this is a separate topic. This is really more a topic as to when X-12 comes and says we’re ready to recommend to go to 7030, my suggestion is one of the topics to discuss with X-12 is what is the status of incorporation of UDI.

Just like another topic to them, now this is a totally separate topic, I think the national media should have a specific event, is the Medicare Beneficiary ID but anyway –

MS. HINES: In our remaining 40 minutes I would like to propose is that we go back to something Nick was saying which was all of these things have steps that have to happen in order to reach some level of completion and I’d like to propose that just like for the full Committee we have this beautiful quarter by quarter plan that why don’t we start very big picture and lay out those things that we think that you think you want to do between now and say December 2017, so Q1FY18. And then we can work backward because otherwise it’s just too big of a jumble.

MS. GOSS: I was going to propose a process step here. So I think we’re thinking the same way which is that we clearly now – I believe these top items, the 2017 RC hearing, predictability roadmap, ACA, HIPAA report to Congress and I think that’s the 12th and public health are things that we’ve already been discussing as key things we want to explore. We have this other list below it and some of these are legislatively or statutorily required, on the top. On the bottom, things to happen, triggers need to happen for us to even get them on our radar so I think it’s good to keep a working space.

MS. HINES: Another piece to keep in mind is this Committee doesn’t have to do all of this alone. Some of those things are actually full Committee wide.

MS. GOSS: Like the HIPAA Report to Congress, however, Terri has done the majority of the lift – at least in the last report and so I’m keeping it up here elevated because I’m waiting to figure out what the resource issue are because I know like PCS needs to be a part of writing that. I think there needs to be an Executive Committee strategy visioning discussion so there’s a lot of pieces that go into that.

What I would like to propose is I would like to know what everybody thinks are their priorities because I know for me, predictability roadmap is a priority. I know probably APCD might be a priority for Denise. But I don’t know where every –

MS. LOVE: It is not a burning one but I guess my question is and I agree with where you are going – but looking over their list, there may be a few things that don’t have to be dealt with but does the Committee like to stay ahead of things, like on the beneficiary conversion. Or do we react after the industry has had some experience or do we get ahead of it. I’m just trying to think from –

MS. HINES: I think we should have that discussion when everyone’s in the room tomorrow. But I do think that with this precious time we have – facetime we have, we ought to come away with this doing what Alex is suggesting and Nick as well and list out what do you want to get done and by what quarter and then we can go backward and map out the plan.

MS. GOSS: We already have this spreadsheet of how these can kind of map out and what the steps are. I think what I don’t have is I don’t know where all of your opinions are as Committee members as to what’s really – because quite frankly, if you’re going to leave it up to me, I’m going to drive our effort towards road map. So I want to know one, what’s your priority and two, where are you willing to put in some extra time and effort to help the process move forward.

MR. COUSSOLE: One of the challenges of doing that, it’s a little bit of a chicken and egg game we’re playing. So if you say let’s map out the model right on the calendar and then let’s figure out the priorities and let’s figure out the priorities to map out the model. I think we’ve got to decide – if we’re going to pick the top five, pick them, start mapping it out and you’re going to realize it doesn’t work.

MS. GOSS: How about everybody pick their top five and prioritize them.

MS. LOVE: So let’s do top five.

MS. DEUTSCH: And remember that some of the ones that you have below the line can be something that you can add on to as –

DR. SUAREZ: I was going to suggest that because in the bottom list the first three items are really consolidated under the HIPAA 3.0 which is the transition, I mean the change.

MS. GOSS: No, I think this to me is separate and that it’s a visioning effort that links with – unless I didn’t hear you right – PCS and population health.

DR. SUAREZ: Oh, I didn’t understand that to be that.

MS. GOSS: This is where – it goes back to some of the innovation discussion or pushing the envelope to look 10 years out as a whole Committee. That’s where that discussion is. I do think these two do go together.

DR. SUAREZ: Those two do go together and really those two mean basically receiving a recommendation from the DSMO process it. That’s the action item really, is receiving a DSMO recommendation and processing it for recommendation to the Secretary.

MS. GOSS: Until we get the change request, if you look at X-12’s timeline, we’re kicking it out to the end of the 2017 – at least midyear 2017, NCPDP will probably be blown out of the water on that timeline. I have that there in my folder but we’ll get NCPDPs before we get the next one but we’ll probably do them all together from a resource perspective.

MR. LANDEN: Alix, I am assuming there’s a large overlap between HIPAA 3.0 and the revenue Review Committee hearing for next year.

MS. GOSS: I don’t know. I think that the Review Committee hearing next year needs to look at all those recommendations that we identified and we’re looking for people to report on and we have to figure out how the universe of those recommendations, where we want to focus in next year. I think we need some time to kind of decide where we want to go on that and get feedback because I’m not sure –

MR. COUSSOLE: I think the question might become how much you want to be looking forward versus looking backward. How much do you want to report on what’s happened, progress, status, versus how much do you want to start –

MS. GOSS: You just made a really great point, whether you meant it or not. Part of the confusion we have is the Standard Subcommittee versus the Review Committee. You know what I mean, like that’s part of – what I didn’t realize was I’ve lumped everything in here for both the Committees and they are not. Part of it is retrospective, part of it is perspective and I apologize for lumping all of those together. That might have confused things.

MR. LANDEN: My view on that is we just completed a retrospective. I think it’s imperative that next report be a forward looking report, not to exclude a little bit of an update of what we just did today or voted on today, not did today.

MS. DEUTSCH: When you are talking about forward looking, because the requirement under the Review Committee is to review the adopted standards and Operating Rules, et cetera. So when you’re talking about forward, how are you relating that back to what the statutory requirement is.

MR. LANDEN: Future adoption and the – if we need to change anything for HIPAA transactions. The conversation next year will mean an implementation date into the 2020 and later years.

MS. DEUTSCH: So you are talking about changes to the adopted standards and Operating Rules, recommendation for changes. Okay. That is in the review.

MR. LANDEN: Yup. And it also fits into the 10109 –

MS. DEUTSCH: Well, the 10109 – if we can just put this aside for a just a moment because I have a question – the RC Report talks about changes that need to be done to the standards and the Operating Rules. I think you’re both saying the same thing. If you’re looking at the Review Committee Report and you’re looking at what areas you want to focus on, you can look at those areas that you want to go into more depth about what needs to be recommended or what progress has been made since the 2015 Review Committee hearing so it can be addressed that way.

MR. LANDEN: I think the distinction I’m making is as we’re talking about looking backwards, we’re measuring progress, we’re identifying next incremental steps, I think the look forward what my thing is much more radical. Should we be on an entirely different path 10 years from now?

MS. DEUTSCH: And you see that as part of the Review Committee as opposed to the Standards Subcommittee.

MR. LANDEN: Absolutely.

MS. GOSS: I don’t see it as part of the Review Committee. I think it’s a part of the Standards Subcommittee and it’s a part of the HIPAA 3.0 conversation, based upon how we are chartered from a Review Committee versus Standards Subcommittee perspective. It’s getting to semantics.

MR. LANDEN: As long as we do it, I’m okay as to what bucket we put it in.

MR. COUSSOLE: I guess the real question is could you do it together or would you need to separate it? Would you have the same people, the same kind of folks, the same organizations, the same –

MR. LANDEN: And the question is how would you separate it.

MS. GOSS: And I think that some of the visioning about how we could be more efficient, I think some of that may come out of even the Roadmap discussions.

MS. HINES: I feel like the Roadmap is kind of foundational to so many aspects of the work.

DR. SUAREZ: How do you suggest we say our top five.

MS. LOVE: Thank you, Walter. What I was going to propose is that everybody just take a piece of paper and write them down because I don’t have the fancy, smancy stickers we can all walk up and vote them. Otherwise you just walk up and put a slash mark if you want to –

MS. LOVE: I don’t know what I’m voting on exactly, public health. Just tell me, in a nutshell –

MS. GOSS: In a nutshell, thinking about what we heard in that hour long discussion, actually hour and a half discussion earlier today. That is the framing up of what we would pursue in the public health conversation. What we discussed earlier today.

MS. LOVE: You mean with Delton.

MS. GOSS: With Delton, yes. And the whole Committee. It’s really taking that framework and moving it forward.

MR. LANDEN: And I’d also suggest that we just put the legislatively mandated ones there. They are not really optional.

MS. DEUTSCH: That is where the ACA 10109 is mandated.

MS. GOSS: So put an LM by the ones that – we have three legislatively mandated.

MS. HINES: Honestly, Alex, I think that the public health piece is – you’re the main, with some help, you’re the main person out of this Subcommittee, I wouldn’t put that on your plate per se.

DR. SUAREZ: I was going to suggest exactly that. You can take off public health and that will be a Committee level priority.

MS. HINES: Now you have got three legislatively mandated tasks and one optional task that would actually inform –

MS. DEUTSCH: And the HIPAA report to Congress is also a full Committee –

MS. GOSS: I have such a hard time reconciling that we – it is full but we end up doing a lot of the work – and that’s the question. We’ve got to pick where we can put Terri’s time.

MS. HINES: I would argue with three LMs and one optional that informs pretty much everything else.

MS. DEUTSCH: You stopped it off at five, you’re talking about the top five but you drew the line – if you’re going to –

MS. GOSS: My top five could be any of these.

MS. DEUTSCH: Exactly. If you’re going to be doing the waiting, you have the priority ones that are starred because they are mandated but if you’re going to be looking at priorities, I think you should just go through the exercise of everybody raising their hands, what they think is a priority and see if the line does fall at the top five.

MS. GOSS: The only reason the line was here was just because we’ve talked about the stuff above the line but not below the line. So that was the reason for that. So I think it’s fair. Let’s at least consider it because I do think I just saw consensus – tell me if I’m wrong – that Predictability Roadmap is really a critical component but it’s not –

MS. DEUTSCH: Can I make a suggestion – just start with the first one and just ask people to say what they think is the priority and then you’ll see the raised hands and make the latch marks. Because that’s how you started out the discussion is saying you were going to ask everybody to vote on their top five.

MS. GOSS: Yes, I’m sorry. I didn’t quite track with what you just said.

MR. COUSSOLE: I think the question is how do you get to a one.

DR. SUAREZ: One suggestion is simple. How many people do not think that the three legislatively mandated should be done in 2017. Anyone believes that the three –

MS. HINES: And how many think it should be done in 2017?

MS. GOSS: No offense we have got too many people trying to drive the process and we’re getting nowhere.

DR. SUAREZ: How would you prefer to handle the selection of the top five?

MS. GOSS: I want you to write them down on a piece, a sticky and give them to me.

MS. LOVE: Do we exclude the LMs or keep those or –

MS. GOSS: You tell me what your top five are because quite frankly just because it’s legislatively mandated, doesn’t mean that we can’t get to it but doesn’t mean that it’s number one priority. For me, I’ll tell you Predictability Roadmap for me is more important than a 2017 RC hearing or an ACA 10109. But I think we have to do all of them.

MS. HINES: To make it easy, just do ABCDE and then people can just give you their letters.

DR. SUAREZ: Don’t vote for public health because that’s a full Committee.

MS. GOSS: I disagree with you, Walter. I think you should say whatever you think are your top five on this list and we’ll work it out because that also tells me where people want to put their time and energy which helps us then start to divide up the work.

DR. SUAREZ: It is not necessarily going to be driven by this Subcommittee, public health, so why – I mean this Subcommittee could identify something else instead of public health.

(Doing a tally of order of priority)

MS. DEUTSCH: All right. So what it looks like is the Review Committee has been numbered as one, four and two but the one that seems to be consistent is Predictability Roadmap at three ones and one four. The 10109 had two twos, a five and a three. The HIPAA Report to Congress had two threes, a two and a four. And then we had the others. If you look at it this way it appears that number one is Predictability Roadmap. Number two is 10109 and three is the HIPAA Report to Congress.

DR. SUAREZ: What about the first one though?

The first one has numbers one, four and two and then HIPAA 3.0 has five and three. And SSNRI has five and four. So it looks like the report on the Review Committee becomes number four and the 3.0 becomes number five and the SSNRI is number six. Just by the frequency. That’s the only way I did it was by frequency. Does that sound like what you all think?

DR. SUAREZ: Sounds good.

MS. GOSS: So then I also propose that there might be some overlap in some of these but I think we’ve got a clear flow. I’m curious of these – if you had to pick two to work on in 2017 as your focal area, what would they be? Rich, if you had time to spend one to two days a month dedicated to a topic, what would be your top two topics? I’m just going to put mine right here. I’m going to my two favorite topics and that’s what I’m going to look for each of you to do so we can start to figure out if there’s a way to divide us up to kind of conquer some of this stuff.

MR. LANDEN: For me it would be HIPAA 3.0 and Predictability Roadmap.

MS. DEUTSCH: Are you saying then there’s only two topics for 2017?

MS. GOSS: I am not. I am saying that likely –

MR. LANDEN: Just trying to figure out if we have a natural lead on any of these things.

MS. GOSS: I’m trying to get the co-chairs and staff some support so we can divide up.

MS. LOVE: I don’t understand much about the Predictability but I sense it’s important. But my real, I guess my world collides with number six and perhaps ACA. I think ACA is something that’s going to hit us hard.

MS. GOSS: Okay. Nick.

MR. COUSSOLE: I fall into the same place you did from a personal perspective. We’ll have to figure out how to mix it up.

DR. SUAREZ: I think those two are critical forward thinking, one and five.

MS. LOVE: The SS and ACA because I just think that’s hitting hard and fast.

MS. DEUTSCH: So essentially the ones that are mandated none of you thought were important to take on in 2017.

DR. SUAREZ: Well, that’s part of the challenge because –

MS. GOSS: Please don’t think that the prioritization – we have to do what we’re obligated to do. These, the preferences of this is just to help me figure out who to recruit to help with that.

MS. DEUTSCH: Who are we missing, is it just Linda?

MS. GOSS: I think it’s just Linda, except if you want to look at the Review Committee aspect of it, we had Vickie and Bill and whether they fit in and want to keep playing –

MS. HINES: My guess is we could get Bill involved in the HIPAA Report as the incoming chair and as it having broader than just the Subcommittee if we need to get outside help. So that would be one thought to explore with him. And then Linda, I don’t know what she – she probably can’t take the lead on any of them because she’s already got her lead role.

MS. GOSS: I think for me this has been very helpful to at least narrow down our thinking and I think that quite frankly, Nick and Terri and I need some time to synthesize this into the spreadsheet that we were working on. I think also what we need to do is, before we depart I’d like to go back –

MS. DEUTSCH: Can I just play devil’s advocate for a moment? I’m a little confused about where the priorities are because the Review Committee hearing is mandated and it should be June of 2017 because it’s no less than every two years. The ACA 10109 is mandated as being every three years, and the last time NCVHS handled it was 2012.

So I understand that there – and I’m not saying any of them are less important and I understand that predictability is very, very important. But by basing it on the statutory requirement and what you’ve all been mandated to do, some of the things may have to be done even though it may not be exactly what you all are very interested in. So you have 2017.

There’s not time to have any hearings in November because it’s two months away. But February is a time to start and I think that you need to think about how this is going to be handled that you’re able to do what you want to do, what you think is important and also to meet the requirements that have to be done statutorily.

MR. COUSSOLE: In my mind I think there’s a distinction between what we might personally have the biggest interest in and what we’re going to work on. I think we’d all love to be able to pick – it would have been nice if there were six of us and we each would have said I’ll lead this one, I’ll lead that one, I’ll lead this one. So that was a good exercise but it didn’t work out ideally because there’s a number of us that have –

MS. DEUTSCH: But something did come out of it. It does show that your thoughts of the need for Predictability is very high. So that is a priority of all of the lists that you have on the left hand side. It is number one from that list for you. And it surprises me that the HIPAA 3.0 was considered in something of all your interest but you already talked about the fact that it probably can be tied perhaps indirectly with the Review Committee if it’s done in a way that it’s looking at what’s been adopted. So I think you can touch upon the HIPAA 3.0 and then –

MR. COUSSOLE: I will be honest with you, I was going there exactly because I think that many of us have an interest in trying to push that forward into a more forward looking activity. Also recognizing that is not a six-month kind of activity, it’s a six-year plus activity. So recognizing also the reason it’s fifth and not first or second is because we know we have to do the other things as well. If we can tie some of that in while we’re doing that I think it lets us at least, leverage some of that capability.

MS. HINES: So I’ve also heard conversations that if work were forwarded on the Predictability Roadmap, it could actually help inform the RC hearing.

MS. DEUTSCH: That would be true if you would be able to come up with a Predictability Roadmap in a short period of time because remember it’s about two and a half months that you have to plan ahead of time for any of these hearings and that’s still being a little tight. And so to say that –

MR. COUSSOLE: Is there a reason why the RC hearing would need to be in June instead of in the fall.

MS. DEUTSCH: Because the first one was in 2015. Does it have to be exactly June? No.

MR. COUSSOLE: I’m just trying to think because that’s one thing if we did something in February that would inform another hearing it would have to then probably not be in June because you wouldn’t have enough time to do that.

MS. DEUTSCH: So if you put it to September I don’t think anybody would be splitting hairs.

MS. HINES: What I have heard is that if there could be some lead up developmental work on the Predictability Roadmap over the fall and into early 2017, products from that could then inform say a September RC hearing. So a lot of these really do need to be on a PERT chart so that you can see how they all relate and I’m happy to help if you need help just technically with PERT chart type things. We can do that for you.

MR. LANDEN: Terri, just to be clear, nothing in my rankings, putting the mandatory things last was meant to imply that we don’t have to do the mandatory ones or that we should not do them. We have to do them.

MS. DEUTSCH: Exactly.

MR. LANDEN: Just to get a sense of what the priorities are will help us scope and sequence and do the next steps.

MS. DEUTSCH: The one I am concerned about is the 10109 because we’re already in 16 and it’s definitely more than three years and if you don’t do it early on in 2017, you’re now pushing it to five years and when you were talking about 3.0 and moving forward, actually I see HIPAA 3.0 tied in with the ACA 10109 because you can look at forward. So again, there are ways of putting those together which is better than in the Review Committee because it does say look at what’s been adopted. So I think this helped a great deal for all of you to see it but I really do think that you need to look at when you’re going to do the 10109 and it sounds like the Review Committee is probably not going to be in June but in September. And that’s okay.

MS. GOSS: I think you have jumped to conclusions at this point. I don’t even have that kind of thoughts and I feel like these are all things we’ve got to sit down and just kind of play with them now that we’ve got a little bit better idea about where they could land. And I think your point about there’s an overlap – I don’t think we’ve given time to vet that, that almost needs to be done so we could even think about the efficiencies and that’s why I keep trying to push give Nick and Terri and I a chance to take this feedback and develop it but what –

MS. DEUTSCH: Because from a budgetary point of view, they may be looking at we can have a hearing for two days. We did it with the Review Committee so there’s less involved with travel. There are ways of looking at it.

MR. LANDEN: We may be able to combine things, extend dates.

MS. DEUTSCH: Exactly. And that’s when I was talking about the NCPDP script, that could be a one-hour presentation and you can tack it on to any of the hearings. So there are ways of combining them.

MS. GOSS: I agree. One of the things we’ve been talking about is the Subcommittee’s meeting cycle and we have done a variety of surveying and I know MaryAnn has been helping us. And quite frankly, I lost track of where we’re at on that.

MS. HINES: Can I weigh in on that? Bill Stead and I have been talking about how to organize the work moving ahead and one thought we had was to carve out, actually create a standing meeting time for each of the Subcommittees and it would be monthly. He and I would be on it weekly but you all – so we’d pick a time and we’d always have a Subcommittee meeting. So I would really encourage you to find a time rather than –

MS. DEUTSCH: We have done the Doodle and we have done all of that. The only problem we have is that there hasn’t been a response to the request. So it may mean that we’ll have to go back out again. I think it’s really important that you all help with the time and so looking at your calendars, seeing what you can move if possible and perhaps we can send the Doodle out again.

MS. GOSS: If you are going to be coming up with a new game plan, to Terri’s point, we just go do it again but I think we’re on the same page. I think we need at least one two-hour working session and what I would like to ultimately see us have is a tool – I don’t know what that tool looks like yet, whether it’s a Word document, chart, I don’t know what it is, Excel spreadsheet. But we’re going to have something that’s going to help the group orient every month based on our priorities.

I’m also hoping that maybe there will be some people who can help us with some in between work, specifically things that we’ve already identified, like around the Predictability Roadmap and I would like to specifically, for instance, call upon Rich to take a look at some things that I’ve been trying to develop and really critique it. Because these are instruments that we’ll need to use in coordination discussions with the stakeholders. So I think having a standing meeting every month, having a standing tool that allows us to focus ourselves in will be helpful with agenda setting. And so from my perspective, I’m not sure if we should wait for you to set the next steps on the monthly meeting or –

MS. HINES: I think when we get back to our respective ranches, we should just get that done. We need to get it on the calendar. The question is do you want a monthly two-hour meeting?

MS. LOVE: I think that’s what we already –

MS. HINES: I can tell you that with Pop Health, we’ve met weekly for about seven months and there’s no way we could have pulled off yesterday without it. And not everybody makes every weekly call – I’m sure you can’t do weekly but that’s how four of us were able to get that event done.

MS. DEUTSCH: I think that is probably a better idea. If there’s a map and you know what’s going to happen then you can plan out and realize that at a certain time you’re going to have to do it every week if you have a project that you’re trying to get to.

MS. HINES: You have projects there.

MS. DEUTSCH: I understand that but it hasn’t been mapped out yet.

MS. GOSS: I can’t do every week.

MS. HINES: Okay. So that’s why I’m asking. In order to get this work done, what do you want and I’ll work with Bill and we’ll get it set up. If you’re really clear that weekly is out of the question, then forget about it.

MS. GOSS: Maybe it’s not for Nick or Terri. It’s going to be really hard for me –

MR. LANDEN: We need to when we’re starting to set up through the Doodle poll was a monthly two-hour call and we got like three responses and we’re working on some more.

MS. GOSS: If you want to shorten it, make a biweekly call for 90 minutes because quite frankly we spend at least 30 minutes circling the wagons before we get into any productive discussion.

MS. HINES: I think that’s the problem of a monthly call is you’re sort of off focus for a little while. Having some continuity really helps and if you just did an hour every other week or something, you might get more traction because you have forward movement and you can get work done in between calls.

MS. GOSS: What do you think, Nick?

MR. COUSSOLE: I can do – I think there is some value in setting up once a week, recognizing that not everybody is going to make every one as long as we can get enough continuity that matters. We can’t set it up once a week and then people show up once a month because it will be just as unproductive as trying to do it once a month for a couple hours.

MS. HINES: So I am wondering if we should do biweekly, which increases the likelihood that people will make the call.

MS. GOSS: Maybe we did not get traction because I know the times weren’t working so maybe we try biweekly – and generally do people want to do morning, afternoon, don’t care? A lot of people have standing schedules.

MS. LOVE: For mountain time, I appreciate not morning because –

MS. HINES: What’s your earliest, Denise?

MS. LOVE: 9:00 mountain.

MS. GOSS: I will have a challenge doing something in the middle of the day so for me the end of the day will be more likely better but I want to respect that other people have early work shifts.

MR. COUSSOLE: The end of the day is easier for me as well.

MS. HINES: Maybe end of the day is easier for me. Mornings are just a mess.

MS. GOSS: So what’s end of the day for the two of you, what’s your latest?

MR. COUSSOLE: I can be as late as we need to be.

MS. GOSS: Because we also don’t want to be braindead so what about like a 4:00 to 5:30, like make it an hour and half biweekly. I’m just throwing something out here. I am a little concerned that I’m not sure that that syncs with Terri’s schedule.

MS. DEUTSCH: Since I start at 6:00 a.m. in the morning,

MS. HINES: Can you go home and telework?

MS. DEUTSCH: Yeah, I can do it from home.

MS. GOSS: So I would propose that we do a Doodle for 4:00 to 5:30 and figure out which days of the week work for you and –

MS. HINES: Just no Mondays or Fridays.

MS. GOSS: Okay. Tuesdays, Wednesdays, Thursdays, anybody else have a conflict on a Tuesday, Wednesday, Thursday?

MS. HINES: I can’t do it on Wednesday.

MS. GOSS: Okay, Tuesdays or Thursdays? That’s what we’re looking at. That makes it really easy.

MS. DEUTSCH: Wednesdays better for me.

MS. LOVE: I can’t do Tuesday.

MS. HINES: Don’t schedule around me. My schedule changes each month almost –

MS. DEUTSCH: Why don’t we do a Doodle for Tuesday, Wednesday and Thursday and let’s see how many people –

MS. GOSS: And maybe we make one – it doesn’t have to be the same day every other week. Just to really confuse people.

MR. COUSSOLE: I just need to get the logistics right. But I think Thursday works for me. Tuesday, Wednesday or Thursday generally I can make work in the afternoons.

MS. DEUTSCH: So it sounds like Tuesday, Wednesday and Thursday from 4:00 to 5:30.

MR. LANDEN: I have a standing meeting Tuesday at 4:00.

MS. DEUTSCH: I think we have to just see how many people on each of those days because I think it’s going to be a problem for everyone and perhaps if we see –

MR. COUSSOLE: Thursday is probably the best day if I had to pick one.

MS. DEUTSCH: And perhaps we do an alternate that one week it will be – I’m making it up – Tuesday, one week it’ll be Wednesday if it means that everybody can’t do all of them. So at least you’ll have the majority of –

MS. GOSS: Just out of curiosity Thursdays, did that not work for somebody?

MS. HINES: Sounds like we are landing on Thursday at 4:00 Eastern.

MS. HINES: That’s what I just heard. So travel notwithstanding, Thursdays at 4:00 Eastern is this looking. I’d have to check with Bill and obviously he’s changing his work schedule a little bit too to accommodate.

MS. DEUTSCH: Bill is planning to be on all of the calls for every Subcommittee?

MS. HINES: Not all the calls for every Subcommittee but I’m assuming this would be one.

MS. LOVE: I think Thursdays are safer for me because Mondays are just treacherous.

MS. HINES: So do you want Marietta to go ahead and set up a biweekly Thursday call from 4:00 to 5:30 for Standards/RC or just Standards?

MS. GOSS: We are all one big posse, let’s make it Standards/RC. Biweekly for 90 minutes. 4:00 to 5:30 Eastern the Standards plus Bill and Vickie.

MS. HINES: Starting?

MS. GOSS: One moment please, let me look at a calendar. Oh gosh, could we – Nick, any preference, start the 13th?

MR. COUSSOLE: I’m just looking. That’s good. Works for me.

MS. GOSS: So it is going to be every two weeks, so it’s like the 13th then the 27th which is going to – it’s not going to be a standing week, it’s just going to run on its cycle of every other week, just to clarify. So it is 5:30 and I’d like to propose that we adjourn for happy hour.

(Adjourned at 5:30 p.m.)