That was fantastic. So unlike sort of Evalut where, you know, you've got the CT and you've got the cusp overlap and you're sort of ready to go, this is…you just go to the, you know, standard three cusps and then just go ARIO caudal until the valve is co-planar. Yeah, it's…can't tell if it's on, but my wife tells me I'm very loud anyways. So it's, you know, I don't think that it's really easy sometimes to measure the membranous septum. It's somewhat confusing and so forth on the CT. This doesn't require any CT planning. All you do is, you know, as I showed in that DNA and as you said. And so in that regard, I think it's a very reproducible technique. So Molly, are you sending anybody home the same day? This is a setup. Again, it's a total setup because I feel like we're up here in many different conferences and I always say the same thing when he presents his same-day discharge stuff. I'm not against same-day discharge, not really due to safety. I think it's safety. No, we don't. I think it's a very scary, slippery slope pathway for a way for our reimbursement to get reduced even more if we do…if everybody ends up doing same-day discharge. It's not something that I would like. I mean, we spend…TAVR itself is getting easier to do. We know how to pick them. We take care of them. But the time and energy before and after to take care of these patients, I would just hate to see our reimbursement cut. And right now, if we do same-day discharge, I feel like that's the first thing that Medicare is going to do, is cut our reimbursement. No, I think it's a very, very rational point. I mean, converting TAVR to an outpatient DRG would be bonkers, yeah. Well, I don't even think it would be an outpatient…I mean, it would be probably what…the same thing that they do for Watchman, which is an inpatient code, and we send people home every day. But I just think that they would…that they would severely cut our reimbursement to that inpatient DRG. And it's a real catch-22. We all need beds. We have no beds, and this is a way to get a bed. On the other hand, we're all very worried about the payment. Can I ask a mechanistic question? So I'm still torn about, like, the use of beta blockers after TAVR. So when we have a bundle branch block, for example, the first instinct is to hold the beta blockers, because you don't want to have heart block. But if you hold the beta blockers, then you have…then your sinus rate increases. Like, you're already pacing things, is what I'm talking about. So is it…do you guys know, has anybody done a study of this? I think we should not be holding beta blockers after. I would tell you what we do. We hold the beta blockers unless they're AFib patients, because 9 times out of 10, those AFib patients come back in with AFib with RVR and get deemed with readmission. So we hold…so I don't hold the beta blocker in AFib patients for that reason. But no, I have not looked at it to see what the… It seems like the beta blocker may be beneficial, you know, and we're holding it, like, out of fear of a pacemaker. But I think you're more likely to have block if you're…like, you're testing. You're testing the block. Yeah. Yeah. I agree. I agree completely. I mean, we're…and mechanistically, it doesn't make sense, right? We're worried about down at the bundle branches, not at the AV node, where the beta blocker works. Cliff, you had a question. I want to go back to what you and Dr. Zerlup were talking about in terms of reimbursement. You know, the TAVR CPT codes are due for re-evaluation, like, next year, and we all get upset when there's a reduction in reimbursement for these procedures, yet when we are so proud of how fast we do things and how fast we discharge people, we have to realize that this results in us being paid less for what we do. Because the one thing you can be certain of is when Medicare re-evaluates these CPT codes, the thing that they measure is how long these procedures take, and the less time they take, the less you're going to get paid. Now, our interventional radiologists are very good at this because they always survey long times for all their procedures, yet we in cardiology seem to take some pride in how fast we can put in a stent, how fast we can do a TAVR. I can do a TAVR in 15 minutes. Well, guess what? You're going to be paid for 15 minutes of work. The original TAVR codes had a procedure time of something like 253 minutes. Well, guess what? It's going to go down less. So don't complain when you're going to get paid less to do a TAVR in a couple of years. Thanks, Glenn. And that is a good segue into we're going to get surveyed for coronaries, all right, and the RUC, and pay attention. Do not, you know, we can't teach, apparently, about what to say, but don't put down your quickest, right? You will get paid less, so, and take the time to do it, and it's, you know, it takes an hour or two to do it, so this is just, please fill out those RUCs, and not the fastest case you've ever had.

medical procedures

reimbursement

ARIO caudal

valve positioning

membranous septum