0:02

Welcome to TCN Talks . The

0:04

goal of our podcast is to provide

0:07

concise and relevant information

0:09

for busy hospice and palliative

0:11

care leaders and staff . We

0:14

understand your busy schedules and believe

0:16

that brevity signals respect

0:19

. And now here's

0:21

our host , chris .

0:23

Como . Hello and welcome

0:25

. Our guest today is Mark Cohen

0:27

. This is really becoming my favorite

0:29

time of the month and I'm looking forward to it each

0:31

time where you and I go back over

0:33

all the top news stories of the month . So

0:36

this is our top news stories for July , but

0:38

before we jump in , mark , I always like to hear something

0:40

new about you . So what does our audience need to know

0:42

?

0:43

Thanks , chris . It's good to be back

0:45

. I was trying

0:47

to think of something interesting and

0:49

I thought back to my first days

0:51

in hospice in 1996

0:55

, 1995 . I

0:58

have what I think was a genuinely unique

1:00

orientation to hospice . I

1:02

was VITAS's first ever VP of

1:04

communications . I was coming to

1:06

VITAS after five years as Chief Spokesperson

1:09

for one of the nation's largest

1:11

, busiest hospitals , jackson Memorial

1:14

in Miami . But I had no

1:16

hospice background At the time

1:18

. The VITAS standard for orientation for

1:20

non-clinical directors and above was

1:23

to spend a week shadowing in the field . But

1:26

the VITAS CEO , hugh Westbrook , thought

1:28

it was really important for me to see every

1:31

aspect of the operation so

1:33

he literally banished me from

1:35

the corporate office in Miami

1:37

for a month and other than

1:39

the Monday morning VP meetings I was

1:41

not allowed to step foot in the corporate office

1:44

after 8 am or

1:46

before 5 pm on a weekday , and

1:49

it was great . I shadowed a

1:51

nurse on the AIDS team who took

1:53

care of homeless patients in Miami

1:56

. I shadowed admissions nurses doing

1:58

visits in both hospitals and

2:00

at home . I followed sales

2:02

reps as they called on discharge

2:04

planners in hospitals , physicians

2:06

back in the days when you could actually

2:08

see a physician skilled

2:10

nursing . I spent the graveyard

2:13

shift with the phone call triage team

2:15

. I spent a Friday with the folks

2:17

who handled commercial insurance approvals

2:19

as they navigated the Friday

2:22

dumps from hospitals . I

2:24

learned so much and carry so much of that

2:26

with me even today , almost

2:28

30 years later . So when I hear that

2:30

some hospice admin staff

2:32

never shadow in the field , I

2:35

do worry about our collective futures

2:38

.

2:39

Yeah , boy , mark , I did not know

2:41

that part of your story and

2:43

maybe it's because I was in Florida and maybe I had

2:46

heard about it from my old CEO , delny

2:48

. But it started in the beginning

2:50

and I would actually require all of my business

2:53

office staff because I had HR

2:55

, finance , it , medical records

2:58

. Everyone once a year had

3:00

to go out and at least do one visit as part

3:02

of their kind of a check off for their annual evaluation

3:05

, and I have carried that forward every year

3:07

until COVID . In

3:09

the last couple of years I was taking about three days , because

3:12

now we have this beautiful network and TCM where

3:14

I try to go with a couple of our members as well

3:16

. So

3:18

anyway , I had no idea that was part of your story

3:20

. When I look back on it , it's actually

3:22

some of my most precious times

3:24

in this work that we've done and I feel

3:26

like you can't get an ivory

3:29

tower if you at least go out and do it at least once

3:31

a year at a minimum .

3:33

Absolutely , it's essential .

3:36

Well , Mark , let's jump in . So what are your top news

3:38

stories for the month of July ?

3:41

Well , it was generally a slower news month

3:43

for counting clips in hospice . In the post-acute

3:45

sector , july lacked the

3:48

headline grabbing stories , like we

3:50

saw in June , with the kerfuffle

3:52

over the fate of a live hospice , the

3:54

fight over the acquisition of a metisys

3:56

that was eventually won by Optum and

3:59

the concerted attacks on the nation's largest

4:01

hospital operator , hca

4:03

, which , as we recall , bled

4:05

over into the hospice sector . We

4:07

simply did not see those kinds of compelling

4:10

stories this past month

4:12

. We also saw some

4:14

subject areas that had been trending

4:16

in May and June dropping

4:18

significantly , if not entirely , out of

4:21

the top 10 , and even my honorable

4:23

mentions . The boomlet and pace

4:25

coverage that I mentioned

4:27

in June subsided to a great degree

4:30

in July . The intense focus

4:32

on physician-assisted suicide , medical

4:34

aid and dying lessened as

4:36

most state legislatures

4:39

that were considering the issue wrapped up their

4:41

work for the year . Similarly

4:43

, the coverage of legalization of medical marijuana

4:45

lessened as the legislatures in

4:48

the remaining states that have not passed it again

4:50

wrapped up their work for the year . Silicide

4:54

and magic mushrooms lost steam

4:56

is an issue that was covered

4:58

more greatly by the general media

5:00

and trade press in months

5:02

previous to July . As for

5:05

trends , while it was a minor one

5:07

, one issue that caught my eye was

5:10

the attention that hospice

5:13

care and of life care for the

5:15

urban homeless population saw

5:17

a little bit of a boost in July with really

5:19

substantive articles on that

5:21

subject . That ran in Akron , ohio

5:24

, sacramento , california and

5:26

Toronto , ontario . So

5:30

the top 10 again . Not as exciting as

5:32

in the last couple months . My

5:34

top story was long-term

5:36

care , assisted living and senior living news

5:38

. I ran 49 articles

5:40

about those subjects

5:42

and hospice news today in July

5:45

and with a quantity like that it's no surprise

5:47

the coverage was widespread

5:49

. But there were a few common themes that

5:52

stood out Increased regulation

5:54

and scrutiny of skilled nursing in some

5:56

states , continued slow

5:58

growth in census recovery

6:00

among skilled nursing and senior

6:03

living . Nursing homes were

6:05

still closing their doors , either for

6:07

quality reasons in some states

6:09

or staffing issues in other states , and

6:12

there was continued pushback significant

6:15

pushback from the industry on

6:17

the proposed staffing mandates from

6:19

the Biden administration . In

6:21

second place , hospice general

6:23

hospice news articles . I

6:26

ran 35 of those in

6:28

July . While there were some positive

6:30

articles , the medias articles were

6:33

about problems in the hospice field . There

6:36

was good coverage , pretty good coverage of

6:38

the reintroduction of the Palliative Care and

6:40

Hospice Education Training Act . That

6:43

generated a fair amount of coverage . But

6:45

there was also coverage of various CMS

6:47

initiatives to better audit

6:49

and monitor hospice quality

6:51

. The journalist Ava Kaufman

6:54

, whose article for ProPublica

6:56

that ran in New Yorker last in the

6:59

New Yorker last December kicked

7:01

off such a firestorm , she was

7:03

back with an update on the CMS

7:05

initiative to focus on hospices

7:08

in California , arizona , nevada

7:10

and Texas . The Washington

7:13

DC must read political

7:15

newspaper Politico

7:17

jumped on Ava's

7:19

bandwagon , jumping into the fray

7:22

with an item that led their nightly

7:24

newsletter headline . Hospice

7:26

has a big problem . But

7:28

Jimmy Carter's hospice admission continued

7:30

to spur good coverage of hospice , especially

7:33

with this article that ran in another political

7:35

publication , the Hill , and

7:38

was titled how Jimmy Carter has changed

7:40

the conversation around hospice

7:42

. In third place

7:45

, news about hospice providers

7:47

total 29 articles . Most

7:49

of them were reasonably positive . There

7:52

were those three articles that

7:54

looked at caring

7:56

for the homeless that I mentioned earlier

7:58

. There was also a great profile

8:01

of the children's hospice in Minnesota

8:03

, which is one of only three such facilities

8:06

in the nation . While

8:09

one rural hospital owned hospice

8:11

announced closure of its inpatient

8:13

units , several other hospices in

8:16

every region of the country announced plans

8:18

either to open or expand or

8:21

to study reopening inpatient

8:23

care centers . So that was a positive

8:25

hit . In July there was

8:27

also an interesting look at the challenges

8:30

to sustaining hospice operations

8:32

in the state of Alaska , which

8:34

once again puts the whole issue of

8:36

rural hospice deserts , you

8:40

know , if not on the front burner , certainly on

8:42

the back burner , for everybody in

8:44

the industry , really not just the folks in

8:46

rural areas

8:49

. General coverage of end-of-life care and

8:51

palliative care news was in fourth

8:53

place with 27 articles

8:55

. It's interesting , though , that

8:57

among those 27 articles there

8:59

was barely any mention of death doulas

9:01

or death cafes in

9:04

the month of July . Instead

9:06

there were a lot of articles about how palliative

9:08

care ought to fit into the

9:11

CMMI models

9:13

. There were also several

9:15

articles that looked at palliative care in

9:17

relation to specific chronic and terminal

9:20

diagnoses cardiac , renal

9:22

, parkinson's , oncology

9:24

and then , continuing

9:26

a theme palliative care in rural areas took

9:29

a positive turn . One article

9:32

I ran that actually got a couple of queries

9:34

from readers or comments

9:36

was an article about

9:38

rolling out a five-year

9:41

plan for palliative care that

9:43

was produced by the state of Kansas and

9:47

policymakers there . I also ran

9:49

an article about an innovative model

9:51

mobile palliative

9:54

care clinic that was launched in western

9:56

North Carolina by Four Seasons

9:58

, one of your teleos collaborative

10:01

network members . So , again

10:03

, interesting that rural

10:06

issues related to end-of-life care , palliative

10:09

care , hospice care continue to

10:11

percolate throughout

10:13

the coverage . M&a news was

10:15

in fifth place with 26 articles

10:17

. Even though there were no blockbuster

10:20

deals announced in the last

10:22

month , there

10:24

were several articles that quoted

10:26

various data crunchers

10:28

. The deal volume in hospice

10:31

and home health is starting to creep

10:33

back up after a bit of a

10:35

lull over the last couple

10:38

last quarter or two . The

10:40

biggest hospice specific M&A news

10:42

in July was the announcement

10:44

by two central Pennsylvania not-for-profits

10:47

hospice and community care

10:49

and hospice of central Pennsylvania

10:51

that they have entered into active

10:53

merger discussions . Home

10:57

health , private duty and related fields

11:00

came in six with 26 articles

11:02

. Payment cuts to

11:05

home health is proposed by CMS

11:07

and the move by the National Association

11:09

of Home Care and Hospice to sue

11:12

CMS over the methodology

11:14

they used to calculate those rate cuts

11:16

were the with the big stories

11:18

, the dominant stories for the

11:20

home health news . Labor

11:22

news was number seven with 25

11:25

articles that I ran in hospice news today

11:27

. Typical stuff unionization

11:30

efforts , nursing strikes , contract

11:32

settlements dominated the coverage

11:34

. There was a real interesting explainer

11:37

. They put an exclamation point

11:39

on the month's coverage

11:42

. The headline was why the pandemic was

11:44

a turning point for nurses , flexing

11:47

union power . That

11:49

story likely is not going away anytime

11:52

soon started to see a drop-off

11:54

after that . Seventh category

11:57

the eighth category , physician and nursing

11:59

news , had 18 articles . Nothing

12:02

really knew there . Articles

12:04

that addressed the nursing shortage , efforts

12:07

to roll back provider dependence

12:09

on travel , nursing initiatives

12:11

to expand nursing education

12:13

. Most interesting article

12:16

was probably the state of Connecticut sued

12:18

a for-profit nursing school that

12:21

had abruptly closed , leaving

12:24

hundreds of students in the lurch

12:26

without an education

12:28

, a completed education or a

12:30

degree . Ninth

12:34

category physician assisted

12:36

suicide , medical aid and dying . As

12:39

I mentioned earlier , coverage of this category

12:41

declined significantly as

12:44

the legislative battles over this issue

12:46

mostly dried up for the year . But

12:49

there were 16 articles . Most of those articles

12:51

instead were first person

12:53

accounts by people

12:55

who were either arguing

12:58

to have the option themselves or

13:00

talking about how beneficial the

13:02

option was for a loved

13:04

one . Typical of those was

13:07

a column which ran at the end

13:09

of the month in the Houston Chronicle I'm

13:11

dying . Texas should . Let me choose

13:13

how . I can't remember the last

13:16

time I saw a medical aid and

13:18

dying article from Texas

13:20

and obviously the political prospects

13:22

After that issue in Texas

13:24

are not good , but the Chronicle

13:27

ran the article anyway . My

13:29

tenth category was general news

13:31

of hospitals 14

13:34

articles last month . Coverage

13:36

was a bit confusing Articles

13:39

about how hospital operating margins

13:41

were positive for the third

13:44

consecutive month , quoting a Kaufman

13:46

Hall study . Other articles about

13:48

how dwindling margins are pushing

13:50

hospitals toward a possible

13:53

financial crisis . And

13:56

an article about

13:58

HCA and tenant seeing increased

14:00

EBITDA in Q1 while

14:02

nonprofit hospitals continued to

14:05

struggle . There were also a handful

14:08

of articles about continuing hospital

14:10

layoffs and this

14:12

article which probably got a lot of people

14:14

both in the healthcare sector and

14:16

the public policy sector angry

14:18

. Many hospitals posted

14:20

record margins during the pandemic

14:23

study fines . My

14:26

honorable mentions were news

14:28

about for-profit providers Nothing

14:30

really striking , but there were 13 articles

14:33

. 12 articles about grief and

14:35

bereavement , memory bears

14:37

, grief camps , butterfly releases

14:39

and byline accounts of personal

14:41

grief journeys . News

14:44

about elder care and aging news , wishing

14:47

dream fulfillment articles . They

14:49

saw a comeback with seven articles in

14:52

the past month . Venture

14:54

capital and private equity news

14:57

lead article there . The private

14:59

equity takeover of hospice

15:02

care , medicare

15:04

and Medicaid news and really

15:06

taking a big fall from previous months

15:10

. Medical marijuana news down

15:12

to just five articles . And

15:15

news about HIPAA , ehrs

15:18

and compromised data

15:20

, also with five articles . So

15:23

not a big news month .

15:26

So , mark , this is always fascinating

15:28

. It's funny . I feel like I'm starting

15:31

to live my life like slow down

15:33

, try to smell the flowers and you notice more things

15:35

. Taking this project with you , I

15:37

just feel like it's opening my eyes to things

15:39

I've never noticed before . And I was asking

15:41

you in pre-show prep I've

15:44

been around hospice now almost 28 , 29

15:46

years and we've always hypothesized

15:48

is there some interesting rhythm when

15:50

you have a lot of deaths ? Whatever I've learned recently

15:53

is the only real time is January

15:55

. You really do see it in the data . So

15:57

what I'm wondering is is there a rhyme

15:59

or rhythm to the volume

16:02

of what's going on in articles ? Like you , I

16:04

feel like , okay , I'm picking up

16:06

similar themes , so that makes me feel like , okay , mark's

16:08

the master If I'm catching those , I'm getting a better

16:10

idea of the gestalt of what's going on in our segment

16:12

. But is there something that

16:15

drives ? Is it like people are on vacation

16:17

or is there something else going on there ?

16:20

I think there's some of that continuing

16:22

cutbacks in news

16:25

coverage in general because newspapers

16:27

are shrinking , but that has an

16:29

impact , although online news

16:31

is actually growing in a lot of ways

16:33

. So I think that balances out

16:35

. I think one of the biggest factors

16:38

is just the diminution of

16:40

the number

16:43

of people out there pitching stories

16:45

for hospice . When I went

16:47

to VTAS almost 30 years ago , every

16:49

major not-for-profit provider had a

16:52

VP level person who was

16:54

either directly responsible

16:56

for public relations and communications

16:58

or had a senior director reporting

17:00

to her or him . Nowadays

17:03

, that provider more likely than

17:05

not has a manager or maybe a

17:08

director doing that level

17:10

of work and of course , the bulk of their

17:12

work now is focused on social

17:14

media as opposed to traditional

17:18

media . You

17:20

see it in the quality of the press release , the

17:22

quality of the writing in the press releases

17:24

that come out . I see press releases that

17:26

will get an F in a journalism 101

17:29

class for the way they write , the

17:31

leads , the use of passive voice , the

17:34

lack of attribution , the weak attribution

17:36

, and that does

17:39

have an impact . On the other hand

17:41

, you do have close

17:45

to 50 not-for-profit

17:47

news organizations

17:50

out there at the state and national level

17:52

, either covering health care news or covering

17:54

policy news that

17:56

are digging into health

17:58

care issues to

18:01

the greater degree or as greater degree

18:03

as the best newspapers did 25

18:05

years ago . So

18:09

it's hard to put an exact cause

18:11

on it and

18:13

you know some . You know things like Ava

18:16

Kaufman's article from ProPubica

18:19

in December . You know that article drove

18:21

coverage for a couple of months and

18:23

you know you still have that potential in

18:26

the in the field .

18:28

Wow , thanks for that answer , because it shows that you

18:30

know there's no one thing right , it's multiple things

18:32

. Well , let me jump in and I'll

18:34

have you comment at the end , and so this is always

18:36

interesting . Recently , I wrote a blog and I feel like

18:38

you and I doing this show is

18:40

indicative of the subject that I put in that blog , which

18:43

is a Stephen Covey quote from years ago

18:45

, that he says no one looks

18:47

at the world as the way it is . We look

18:49

at the world as the way we are , and I

18:51

put a visual on there that every person has a

18:53

window strapped to their forehead by which they

18:55

look at the world . If you come to appreciate

18:58

that fact , that's why that's why I love working

19:00

with you . First off , you have standards

19:03

and grammar standards and writing that

19:05

I just think you're masterful there and I think

19:07

it's making me better in that area . But how you

19:09

look at it and how I look at it is different , and

19:12

kind of putting it together , I think we have a better

19:14

chance of making what is really going

19:17

on in the world . So with that , I've

19:19

got about ten themes . I actually

19:21

had only about 50 articles this month , so as

19:23

you were calling out the volume , it did feel less

19:25

. So here are my themes and I'll go through

19:27

each one individually , a grouping

19:30

that I would call . There were several futuristic

19:32

articles and I really loved because

19:34

they were very innovative and forward-thinking . So

19:36

that was my first category . A lot of regulatory

19:39

impacts , several

19:41

power of care articles . One that actually was

19:43

related to our work at Four Seasons on CMMI

19:45

, a Medicaid article

19:47

that really jumped out at me for what it talked about

19:50

Cyber threats , which is something

19:52

I just want to kind of ring the clocks

19:54

in on that one . And so

19:56

not that it's new , but gosh

19:58

, the volume seems a lot more . A

20:01

lot of M&A strategic moves category

20:04

. The private equity impact

20:06

on health care , another

20:08

kind of category of financial woes . And

20:10

then the biggest category that now I'm seeing

20:12

this theme every month a

20:15

large volume of staffing articles

20:17

. The good thing that I'm starting to see in a trend

20:19

is , I feel like people are starting to work more on solutions

20:22

, and it's not just woes us . We're short staffed

20:24

, whether the government can

20:26

fix it the

20:28

way they seem to be fixing it . Well , we're going to mandate

20:31

staffing ratios . Well , that's interesting

20:33

to mandate something where there's not enough people . And

20:36

then just the last kind of category that I'll wrap

20:38

up with is what I would call innovative remembrance

20:41

services . So let me kind of go into all

20:43

ten of those . So the first one again , was

20:45

about kind of futuristic and here's

20:48

several that just jumped out at me . First off

20:50

, senior living . Former shopping malls

20:52

are being repurposed for senior housing

20:55

. Interesting , I got a call from

20:57

a family friend who actually sold his assistant

20:59

living facility . Business was being brought back in

21:01

because the actual occupancy

21:05

is so low and they're trying to figure out how did they repurpose

21:07

those facilities ? And then I quite

21:10

often I'll drive by shopping malls and

21:12

think you know what are those things going to become

21:14

? And it's interesting , in certain markets they're

21:16

repurposing it to senior housing . Now

21:19

another New York Times article that jumped out at

21:21

me as cases soar for dementia . Dementia

21:23

villages are looking at the future of home

21:25

care . And it actually talks about a village and I think it

21:28

was overseas . Was it in Amsterdam

21:30

? Fascinating

21:32

? It looked like a typical Dutch town with a

21:34

restaurant , theater , pub , a cluster of quaint

21:36

two-story brick town homes . Many

21:39

of the people here don't realize that they're

21:41

living in the world's first so-called dementia

21:43

village and it could be difficult for

21:45

visitors to tell the difference between residents

21:47

and the plainclothes staff and I thought that

21:50

is super innovative and I think we're hopefully

21:52

going to see more type of innovation like that . In

21:54

fact I think we're going to do a podcast later this year

21:56

about innovations in Alzheimer's dementia

21:59

care . Next one was former CMS

22:01

administrator Andy Slavitt considers

22:03

PACE the ultimate senior

22:06

care model and so , coming from Andy Slavitt

22:08

, that really jumped out at me . And

22:10

then the article that you cited Jimmy Carter

22:12

has changed the conversation around hospice

22:14

and that was actually in the Hill . And

22:17

man Jimmy Carter's been with us

22:19

five months in hospice care and

22:21

you and I talked several times . Mark , just the

22:23

blessing . I always loved

22:25

the adage from secondhand lines , that movie

22:27

about going out with your boots on , in

22:29

other words , making an impact right to the end

22:32

. And man kudos to Jimmy Carter because

22:34

he is using every part

22:36

of his life to make the world a better place and helping

22:39

change the conversation of what hospice is

22:41

. So that article was calling that out . And

22:43

then the last one in that kind of futuristic category

22:45

why life spark and alleric hearing

22:47

, or addressing patient

22:49

and caregiver wellness . And

22:53

so usually those of us in the serious illness space

22:55

, people think that oh

22:57

, we just kind of help , people accelerate

22:59

the demise , but kind of changing the conversation

23:02

with home-based primary care and wellness , but

23:04

not just for the patient , for the caregiver as well

23:06

. Thought that was very innovative . So that was

23:08

my first category . The second category I call

23:10

regulatory impacts . You cite it . One of them

23:12

knock is suing CMS

23:15

because the home health payment cuts almost

23:17

up to 6% , and so

23:20

I imagine I don't

23:22

want to say it's an act of desperation but it's

23:24

a very aggressive act because a 6%

23:26

cut in this inflationary

23:28

environment would be disastrous for them . And

23:32

then a couple articles about the 36

23:34

month rule to curb hospice

23:37

license flipping , and so again I love

23:39

the analogy used earlier . Ava

23:42

Kaufman's article has created

23:44

a wake and I didn't even think about how you said the

23:46

volume of that wake really drove a lot of our

23:48

first quarter . But it's driven

23:50

a lot of regulatory conversation and

23:52

I think this is one of the ones that's a

23:55

good side effect of the article that she

23:57

brought about not allowing people

23:59

just to kind of create a license and try to flip

24:01

it and just create a profit , almost like there

24:03

were little properties on the monopoly board . Hospice

24:07

leaders to lawmaker strengthen CMS

24:09

oversight of the accreditors

24:11

, so that way accreditation actually

24:13

means something and so consistency among

24:15

the accreditors . That was a great article . And

24:18

then the political one that you pointed out , mark

24:20

, about hospice care has a big problem , and

24:22

then they actually talked about 325

24:25

prominent doctors in the field wrote

24:28

that in recent years we observed an increasing

24:30

prevalence of serious deficiencies in hospice

24:33

care and high variability in quality

24:35

of care . And of course , arab Iyak is one . Cited

24:37

instances of poor care increasingly

24:39

common the signature

24:41

of some of these are retired include pioneers in the field

24:44

, including two thirds of the living former presidents

24:46

of the American Academy Hospice and Pout

24:48

Care Medicine Professional

24:50

Society for Physicians . But they asked , saying

24:52

the journal cited litany of wrongs not enough physician

24:55

involvement at patient care managed

24:57

being large nurse caseloads and adequate

24:59

interdisciplinary care teams . Nurse

25:02

, doctor , social workers , chaplains , others . The core

25:04

generally takes place in patients homes or

25:06

overwork not properly trained . Again

25:08

, I think about where you started , about . You know even

25:11

in your role that you had to go out in the

25:13

field in the beginning . So that was my second

25:15

category regulatory impacts . Third

25:17

category was Pout of Care . A good volume

25:20

of articles on Pout of Care that jumped out , but one

25:22

that was really made me smile because

25:24

I almost felt like our work was forgotten . There

25:26

were two CMI

25:28

grants in the country to prove

25:31

Pout of Care . One was Sutter and

25:33

one was the other and it was Four Seasons

25:35

. We partnered with Carolina Caring and

25:38

a lot of kind of acute care providers , but it

25:40

was also home-based Pout

25:42

of Care and also clinic-based Pout of Care , but

25:44

citing the great data showing

25:47

that we actually did save money and that Pout of

25:49

Care is a good model and it might be a good place

25:51

for the government to put future healthcare dollars , so

25:54

I was pretty stoked about that one . And

25:56

then there was one about Medicaid expansion . So this

25:58

is my fourth category of Medicaid . Medicaid

26:01

expansion improves outcomes and

26:03

here was , to me , the line that really caught

26:05

my eye without crowding

26:07

out other patients . Now that's

26:09

a headscratcher for me because it talks about how

26:12

more people are getting access

26:14

to Medicaid and that basically saying

26:16

part of the I guess , debate

26:18

against expanding Medicaid is you're

26:20

gonna have those patients crowding out healthcare

26:23

and throughout is . I

26:25

guess those people are not going for care today . Some

26:27

of them are showing up in free clinics et cetera

26:29

, but , based upon this study , they're

26:31

not crowding out other patients , which

26:34

is interesting because we have all these healthcare

26:36

workforce shortages et cetera

26:38

. But I thought that was a great data point and

26:40

a pretty good study . Next category

26:42

I will call cyber threats

26:45

and so kind of grouped this one into there

26:47

. But basically next year and I had a $31

26:49

million false claim

26:52

act allegations . I've never seen

26:54

that against an EHR provider . Mark , maybe

26:56

you have . You've been kind of paying attention

26:58

this longer than I have . I didn't know if that's

27:00

an interesting harbinger source , but I have had

27:02

many CEO friends of

27:04

mine that say , when you look at a lot of

27:06

these EHR vendors and what they sell

27:08

and charge , and my heart

27:11

goes out to them because it's a hard job

27:13

to create a good software program , but you

27:15

kind of trust that the programs are

27:17

supposed to work and just the issues

27:19

that a lot of them have in terms of performance et

27:21

cetera . So that one jumped out at

27:23

me . But then the vast majority HCA has

27:25

hit with lawsuits following a massive data

27:27

breach . In fact I've seen a lot of

27:30

almost like what do you call it like

27:32

spam email related to that . And

27:34

then modern healthcare had an article . The hacking

27:36

price problem is nearing a crisis

27:38

in healthcare and so we've

27:41

tried to call that out to our T-SEM members

27:43

. I gotta imagine cybersecurity

27:45

insurance is gonna continue to go up just because

27:48

of the just the volume of attacks or ransomware

27:50

attacks , phishing attacks , et cetera . Sixth

27:53

category I would actually call M&A

27:55

strategic moves , and one that was in North Carolina

27:57

, mark . So Blue Cross , blue Shield , north Carolina got

27:59

state legislature , a

28:02

law they got approved that allowed them to take

28:04

I think the number is five billion off their

28:06

balance sheets , so nonprofit insurance

28:08

company and basically create a separate

28:10

holding company and what they're trying to do is position

28:13

themselves to compete against the United

28:15

, the Humanas , et cetera . So that

28:18

was a big deal . So it was not only in North Carolina

28:20

but it looks like New Jersey as well . That

28:23

was a big move . One that I felt was encouraging

28:25

is Walgreens is shifting its focus to

28:27

strategic home-based care partnerships

28:30

where , as CVS

28:32

, etna seems to be more of , we gotta own it all

28:34

, walgreens looking for more strategic partnerships

28:36

. I thought that was encouraging . Three

28:39

pillars of radiant health , hospice , senior

28:41

living partnership with CareSource so my

28:43

good friend and your good friend , kent Anderson

28:46

and at Ohio's and then United

28:48

Church Homes and how they're aligning with

28:50

the payer , caresource and

28:52

then up home-based primary

28:54

care , why hospices are pursuing home-based

28:56

primary care . And then the articles

28:59

about UnitedHealthcare going all in on the

29:01

Metasys . Unitedhealthcare's profits

29:03

are up despite higher Medicare Advantage costs

29:05

and I think , yep , that's

29:08

it for that category . So that was kind of all my kind

29:10

of merger acquisition strategic move category

29:12

. Next category I'll call the

29:14

financial woe category . So

29:16

senior living healthcare bankruptcy filings

29:19

are set to triple . This

29:21

was in the Triangle Business Journal . Dwindling

29:24

margins are pushing hospitals towards potential

29:26

financial crisis and you and I kind

29:28

of did an off the record for just the TSM

29:31

membership about that mark . And I

29:33

love your adages . You know , if hospitals catch

29:35

a cold , do we catch the flu ? Or

29:38

have we kind of positioned

29:41

ourselves in such a way where we're not as dependent

29:43

upon hospitals maybe as we

29:46

were in the past ? And then a Wall

29:48

Street Journal article about some hospitals that spent

29:50

big on nursing during the pandemic are

29:52

now short on cash . So

29:54

I think you mentioned about kind of record high

29:56

margins for

29:59

hospitals during COVID , maybe

30:01

artificially inflated , and now they're

30:03

really in a world of hurt . I think the statistic is

30:05

something . I think Kaufman Hall

30:07

maybe 60% mark 56%

30:10

of hospitals in America in negative margin

30:12

territory , although I think that was starting

30:14

to tick up just slightly in the last quarter

30:16

. This is

30:18

a category onto its own . I even know

30:21

how to . I guess it's really sub under

30:23

the financial woes , but just like hmm

30:25

, this is interesting . But Papa

30:27

is an organization I've watched with interest , mark

30:29

. You know it kind of comes out of South Florida . It

30:32

actually inspired my boys to start their own company called

30:34

Elders Angels , where they were doing chores

30:36

for elderly people as a summer job . But

30:39

Papa is an app where you basically gather all

30:41

these needs for elderly people , but it was also a

30:43

lot of home care , private duty etc . But

30:46

basically a senator is pursuing

30:48

abuse allegations against Papa

30:51

, and so on one hand

30:53

, certainly that's never acceptable . You're putting people

30:55

in someone's home , so how do you credential

30:57

those people ? But providing

31:00

that level of organization , because

31:02

home care is such a tough business , to talk about shortage

31:04

of staff , you're competing against Chick-fil-A , walmart

31:07

, all these other places . So I

31:09

worry about that one , or maybe what is the future

31:12

implications of that ? And so just

31:14

something that really jumped out at me . And then this

31:16

next category I

31:19

would call kind of the private equity impact

31:21

on health care , and you cited some of

31:23

those , mark . But regulators and lawmakers need

31:25

to act on the growth of private equity in health

31:27

care . Health care merger guidelines

31:30

update would increase scrutiny of health care deals

31:32

. So there are increasing those merger guidelines

31:34

. Health care private

31:36

equity ownership worsens quality

31:39

and raises costs , according to a study

31:41

. And then private equity

31:43

who employs your doctor ? So

31:46

private equity is who is employing your

31:48

doctor is increasing and

31:50

, interestingly , in a project I'm involved in , we

31:52

just bumped into that and a great

31:54

doctor , a great heart , had

31:56

this great promise of what private equity is going to

31:59

do for his practice and the disenchantment

32:01

and literally having to shut down his firm

32:03

. A lot of overpromise and

32:05

under deliver . And then the last one I think you

32:07

called out specifically , the private equity takeover of

32:09

hospice care . And then my last

32:11

and 10th category , which I think is going to probably

32:14

be almost every month , is just the staffing challenges

32:16

. So there are about 10 interesting articles

32:18

. One from Fortune these companies

32:20

are serious about keeping older employees , so

32:22

now they're offering grandparent leave . Mark

32:26

, I think technically you're a baby boomer

32:28

, right , I guess , more than technically you're a baby boomer

32:30

and I don't know what

32:32

you think . Right in the middle there's

32:35

another article here about how

32:37

people are going to work way past . Yeah , here it goes

32:39

almost half a baby boomer's workers

32:41

are expected to work past 70 and not

32:43

retire , which makes

32:45

me smile . I think that's definitely going to be me

32:47

, but I think the baby boomers are actually part

32:49

of the solution

32:51

to our staffing challenges , but not in a

32:54

more traditional sense and a much more flexible

32:56

thinking in a much different

32:58

way about your workforce sense . So , anyway

33:00

, in fact , thinking about companies are thinking about

33:03

grandparent leave . There was another term , maybe

33:05

it was a grand maternity leave or something

33:07

like that you and I read about last month . Alright

33:09

, in this one , the Kaiser Family Foundation

33:11

29% of nursing homes would

33:14

meet the four hour federal staffing mandate

33:16

Just the third . So , government

33:18

, by mandating something that doesn't actually

33:21

solve the problem of a shortage of people

33:23

, you actually have to have adult conversations about

33:25

things like immigration and things like that . Or

33:28

how do you incentivize people to go into healthcare

33:30

? But just mandating the staffing is a

33:33

bit of a disaster , especially for our

33:35

long term care brothers and sisters . Home

33:38

care daily congressman this

33:41

is a home care daily congressman introduces

33:43

task force to address the nursing shortage

33:45

. Isolation

33:47

and loneliness linked to death . But it was

33:49

an actual McKnight's article just

33:51

talking about isolation and loneliness , and

33:54

the reason why I put that one under kind of

33:56

staffing is , I mean , a

33:58

lot of people working in healthcare , going

34:00

into homes or kind of the solution to loneliness

34:02

, but yet we know we have this huge shortage of people

34:04

. Let's see the baby

34:07

boomers . When I called out they're going to work past

34:09

the age of 70 and not retire , this

34:11

was in McKnight's Latino

34:13

workers , underrepresented in healthcare , so

34:16

another great segment . How do we recruit

34:19

more people , latinos

34:22

into healthcare ? What do we do to reach out to those

34:24

communities and show , hey , it's

34:26

a great career , it's a great way to spin your

34:28

kind of life on a good purpose , if

34:30

you will . In this one , the next generation , new nurses

34:33

have more options and more burnout , and

34:35

so , and then North Carolina

34:38

nursing homes is , complaints jump almost

34:40

40% due

34:42

to surveyors , but it's because of scarcity of

34:44

workers . And then senior

34:46

living balancing cost benefits , challenging

34:48

recruiting and retaining workers . And

34:51

then another one about a career pathway

34:53

programs can actually mitigate workforce

34:55

shortages . And then I think I'll say today article

34:58

about the doctor shortage . I think the

35:00

projection of a shortage of primary care

35:02

physicians is anywhere from , seems

35:04

like 40,000 to 125,000

35:07

, based upon kind of projected needs

35:09

. Yeah , up yet 37,800

35:12

to 124,000 . Demand

35:14

will exceed supply . And

35:17

I think that's it , mark , on my top 10 . And

35:19

then I had a couple that were actually in just real

35:22

quick under kind of my honorable mention

35:24

category , the two that were kind of a similar

35:26

theme I would call innovation and remembrance services

35:29

. A great article

35:31

in the Boston Globe that you pulled out

35:33

the unexpected intimacy of a Zoom Memorial

35:35

service , and it was a well thought through article

35:37

about how just the blessing

35:40

of how people who couldn't have been at that Zoom service

35:42

people chose to dress up Some

35:44

people didn't dress up in just ways they

35:46

help people who can get over the technology but

35:49

just how meaningful it was of a Zoom

35:51

Memorial service . And then one that actually

35:53

came out of here in western North Carolina in

35:55

the Mountaineer , a funeral before death . Gratitude

35:58

parties surround a dying love

36:00

one with families and friends , and so instead of

36:02

waiting for the love one to die

36:04

, actually having a gratitude party

36:07

and they specifically didn't

36:09

call it a remembrance of life ceremony

36:11

or celebration of life , since that's kind of got a connotation

36:13

of post death , and so I thought that one

36:16

was great . And then one that always

36:18

I keep my eye on , mostly because you're the first one

36:20

to bring it to my attention , as this

36:22

was in KFF . So Kaiser

36:24

Family Foundation , a non-profit

36:26

hospital's big tax breaks

36:28

state scrutinized the required charity

36:30

spending . So that's my mark . So any final

36:32

thoughts from you ?

36:34

I think we covered just about everything this month

36:37

. It was in much easier month to

36:39

cover and we'll

36:41

see whether August continues to downturn

36:43

or whether things pick up again . If

36:45

they pick up again , let's hope it's on the positive

36:47

side , not the negative side .

36:49

Yep , absolutely Well , I

36:51

was actually going through my

36:54

gosh . I want to call it . I think it's Golden Leaf

36:57

. It's a book of poems and writing . The

36:59

two things jumped out at me made me think about you , mark . So

37:01

this is our quote in today . Two quotes

37:03

clear riders , like clear fountains

37:05

, do not seem so deep as they

37:07

are . The turbid look the

37:09

most profound , and that's by Landor

37:11

. And then this one I really thought about , mark

37:13

Pit . These sentences are like

37:15

sharp nails which force truth

37:18

upon our memory , and that's by Dittorat

37:20

. Thanks for listening to TCN Talks

37:22

.

37:51

Music .