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 Como

0:23

.

0:24

Hello and welcome to TCN Talks

0:26

. This is my favorite time of the month

0:28

. I have to work really hard , just

0:30

like Mark does , but this is where Mark and I do

0:32

the top news stories of the month . Welcome back

0:34

, mark Cohen . Hey , chris , good morning , glad to be

0:36

here , thank you . It's always

0:38

good to have you , mark , and so we're going to do the top

0:41

news stories of the month of October and I'm

0:43

going to cue you up in just a second and I want to share with you

0:45

. I actually had a call just this past

0:47

week with an interesting technology company

0:49

. They're trying to break into I

0:51

say break into healthcare . They actually had some interesting

0:54

success in other industries and helping with

0:56

staffing challenges , so they're coming

0:58

in and so , anyway , we're talking about it's

1:00

all the challenges within healthcare and

1:02

some kind of way . We got talking about you and I's podcast

1:05

each month and I told them basically

1:07

what we're doing and , first off , they're like so

1:09

this guy , mark Cohen , wakes up every morning

1:11

, sifts through all the news and says these

1:13

are the top news stories of the day . I'm like

1:16

, yeah , and they say and then you and he read

1:18

all of those and try to synthesize here's

1:20

the top news stories of the month . I'm like , yeah

1:22

, like that's incredible . And

1:24

so I have again a deeper appreciation

1:27

for this service that you have provided

1:29

for our movement , our segment

1:31

, our market , and I do

1:33

feel like , in some respects , gosh

1:36

, everybody needs to know about this . And this , this

1:38

is also you and I's attempt , because no

1:40

one would do what you do , mark , waking up

1:42

three , four AM every morning , scouring

1:45

, but then how you and I sift through all this

1:47

and try to synthesize that . These are the top

1:49

ones that we hope that you didn't miss . So

1:51

before we go there , mark , I want to . I

1:53

think we started something we've gotten great feedback on

1:55

it's almost like Mark Cohen's masterclass

1:57

on public relations and communications

2:00

and gotten some really good feedback

2:02

like please make sure Mark continues that . So do

2:04

you have one for us this month ?

2:06

I do , Chris . As we get into November

2:08

, it's worth noting that it's

2:10

a very busy time for news buy

2:13

and about hospice providers . There's

2:15

hospice month . Of course , there's Veterans

2:17

Day and there are also all these announcements

2:19

and events related to hospice year-end

2:21

fundraising activities , as well as

2:23

year-end memorial events and

2:26

activities , and often those memorial

2:28

events and activities , such as lights

2:30

of love type events , are

2:33

tied up into small-dollar fundraisers

2:35

for their sponsoring

2:37

hospice . As a result , I see

2:40

probably more news releases from

2:42

hospices this time of the year

2:44

than at any other time of the year , so

2:46

I thought it would be worthwhile to share some basic

2:48

thoughts about news releases that

2:51

hospices are distributing . First

2:54

of all , because they're not

2:56

always tremendously well-written

2:58

and there's a lot of room for improvement

3:00

. First of all , your news releases

3:03

should be written and edited by

3:05

people who actually know how to write journalistically

3:07

the news

3:10

writing . 101 . Mistakes that I see

3:12

on a regular basis in hospice

3:14

news releases at times

3:16

, frankly , are kind of discouraging . One

3:19

common mistake beginning

3:21

your news release with the time element

3:23

, Like today XYZ

3:26

Hospice announced a $5 million campaign

3:28

to refurbish its 20-year-old

3:30

inpatient care center . Whenever

3:33

possible , the most important fact

3:35

should lead your lead sentence

3:37

, and in this case , today is

3:39

the least important fact in

3:41

that lead sentence . So why lead

3:44

with it ? A better lead is Hospice

3:46

XYZ has launched a $5

3:48

million capital campaign to refurbish

3:50

its 20-year-old inpatient center . At

3:52

a fundraising lunch in today , Hospice Board

3:55

Chair Mary Jones said

3:57

blah , blah , blah

3:59

. A second point is the timing

4:01

of a release . There are certain

4:04

commonly accepted rules that are literally

4:06

two , three , four generations

4:08

old now as they relate to putting

4:11

out a news release , and there are hospices

4:13

that simply don't abide by them . The

4:15

most common rule is that

4:17

Fridays are for bad

4:19

news dumps by corporations

4:22

, by government , by politicians

4:24

. If you put out a release on a Friday

4:27

, journalists will assume that

4:29

it's a bad news dump , as

4:31

will knowledgeable lay readers . So

4:34

hold your good news till the next week

4:36

, but don't

4:38

put your release out on Monday morning either

4:40

. Monday morning is the time when businesses

4:43

hoping to influence the stock

4:45

market for the week ahead put out their

4:47

good news . The news release wires

4:50

are flooded with business releases

4:52

on Monday mornings . Your release

4:54

will just get overwhelmed by the tide

4:57

of business news . So wait till

4:59

Monday afternoon . If you can't

5:01

wait any longer , better yet , wait

5:03

till Tuesday morning to put out your

5:05

news release . And finally

5:07

, be careful about

5:09

the verbs that you use to attribute

5:11

statements of fact and opinion in

5:14

your release . If you bother

5:16

at all to attribute things that ought to

5:18

be attributed in a news release , I see so many

5:20

releases these days where people

5:23

are quote , sharing a fact

5:25

or expressing a fact

5:27

. Those are simply not appropriate

5:30

journalistic attributions . Used

5:32

to try to and true action

5:34

verbs like said , stated

5:37

, explained , detailed

5:39

, indicated Verbs like

5:41

shared and expressed just make your release look

5:44

and read amateurish and

5:46

nobody talks like that . Sound

5:49

news release writing still counts and

5:51

if you don't have an experienced writer on

5:53

your staff , then try to find a volunteer in the community

5:56

who can mentor and edit your

5:59

staff or who is trying to write news releases

6:01

. Always room for

6:04

improvement there . So let's now look at the coverage

6:06

in a month where the most popular topics dominated

6:09

the coverage , at least quantitatively

6:12

. Once again in the number

6:14

one position , Chris , long-term

6:16

care , skilled nursing and senior

6:19

living , with 61 articles , two

6:21

a day for the whole month on average

6:23

. The dominant theme , of course , was the

6:25

Biden administration proposal to

6:27

mandate minimum nursing hours in

6:30

nursing homes and the pushback

6:32

from the nursing home industry , their advocates

6:34

and their allies mostly on the

6:36

Republican side of the aisle in both

6:38

Congress and state houses . In

6:41

addition , October is earning season , so

6:44

publicly traded nursing home and assisted living

6:46

companies like Brookdale and Sonita

6:49

put out their quarterly statements , which

6:51

continued to show slow improvement

6:53

post pandemic in

6:55

their occupancy and their

6:57

sales in their expense

6:59

control . Much of the rest of

7:01

the coverage was the same old gamut of negative

7:03

stories for

7:06

the skilled nursing sector

7:08

, particularly about staffing shortages

7:10

. It's worth noting that

7:12

there was a time before the pandemic when

7:15

the nursing home industry was actively

7:17

pushing back on negative coverage

7:19

and trying to tell their positives

7:21

. You just don't see that anymore

7:23

with everything that's going

7:25

on . Right

7:27

behind skilled

7:30

nursing , in second place in October with

7:33

57 articles , was news

7:35

about mergers and acquisitions across

7:37

the hospital and post-acute sector

7:39

. And you know , given the fact

7:41

that financial analysts have been saying that the

7:44

period of high interest rates that

7:46

we're in is going to be drying

7:48

up M&A activity , it's kind

7:50

of surprising to see that large a

7:52

number of M&A stories . In

7:54

the month of October there was coverage in

7:56

a couple of markets about the efforts

7:59

by California based prospect

8:01

medical to sell their failing hospitals

8:03

in places like suburban

8:06

Philadelphia and Connecticut . Those

8:08

hospices that are more reliant on hospital

8:10

referrals need to continue to scan

8:13

the environment for troubled hospital

8:15

providers in their marketplace

8:17

. When a hospital runs into trouble , that

8:20

could affect their stream of referrals

8:22

.

8:23

Thank you to our TCN talks sponsored

8:26

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8:28

also the title sponsor for

8:30

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8:32

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a national hospice , pbm

8:39

and prescription mail order company

8:41

. Delta Care RX is a premier vendor

8:43

of TCN and provides

8:45

not only pharmaceutical care , but

8:48

also niche software innovations

8:50

that save their customers time

8:52

, stress and money . Thank you , delta

8:54

Care RX , for all the great work you do

8:56

in end of life and serious

8:58

illness care .

9:00

You're also starting to see coverage of organized

9:02

efforts by progressive Democrats to

9:04

force regulators to more heavily scrutinize

9:07

roll up acquisitions in

9:09

the healthcare field , including the

9:11

Optum Ometesis deal , and

9:15

then , right behind , m&a activity

9:17

. In third place in October was labor and employment

9:19

news , with 54 articles

9:21

that I ran in hospice news today

9:24

, as

9:26

we've been discussing for several months now , unionization

9:29

activity and outright strikes

9:31

are at a level not seen in a generation

9:33

, maybe two , and it's creeping around

9:35

the edges of the hospice sector . Hospices

9:38

with operations in markets where hospitals

9:41

are battling their unions ought to

9:43

think , for example , about how to coach and

9:45

counsel those of their admissions

9:47

staff and their sales staff who might

9:49

have to cross a picket line to

9:51

enter a referring hospital and

9:54

what the implications of that might be . There

9:58

were 52 articles I grouped in

10:00

October under the end-of-life and palliative

10:02

care category . Coverage

10:04

of death doulas increased pretty significantly

10:07

in October , particularly

10:10

from the law that we'd seen the last couple

10:12

months , and I'm happy to note that there

10:14

wasn't any real hospice bashing

10:16

in the death doula coverage . Last

10:18

month , again , as it months past

10:20

, there were lots of heart-rending personal stories

10:22

from caregivers about their palliative

10:25

care journey with their loved one and there

10:27

were more than a few articles about research studies

10:29

that made it into trade and consumer

10:31

media about the need for

10:34

better and earlier access

10:36

to palliative care for

10:38

certain types of patients or patients

10:41

with certain types of diagnoses . General

10:44

Hospice News saw 44 articles

10:46

last month . Chris , the big news was continuing

10:49

coverage of the modern healthcare

10:51

best places to work awards , which

10:53

saw about a dozen hospices named to

10:56

the list of 75 top providers

10:58

and payors , which obviously

11:00

is quite impressive given the fact that

11:03

hospice is not one-sixth

11:05

of the payer provider market

11:07

. There also was an update

11:09

, can we ?

11:09

make a comment on that Because you

11:11

know , I got to just call that one out . Half of those

11:14

were TCN members , which is pretty cool .

11:16

Which is pretty cool and says something about state

11:18

and North Carolina too , since I

11:20

think most of the TCN members were domiciled

11:23

in North Carolina . There

11:25

also was an update on the continuing

11:27

positive movement by NHPCO

11:30

and NAHC toward a 2024

11:33

merger that I classed as General

11:36

Hospice News Starting

11:38

to see a drop-off after

11:40

that . In sixth place , hospice

11:42

Provider News had 35

11:45

articles that I ran in October . On

11:47

the positive side there were slightly more stories

11:49

about hospices opening inpatient units

11:51

than there were stories about hospices

11:53

closing inpatient units

11:55

or closing entire locations or

11:58

programs . I think the most impressive

12:00

story in my favorite feel-good story

12:02

ran in the highly credible Texas

12:04

Observer In far west

12:06

Texas . The headline was in

12:09

far west Texas , one hospice nurse

12:11

brings comfort to the dime . The

12:14

article rides along with and profiles

12:16

the lone , seasoned nurse for

12:18

Midland-based angels care hospice

12:20

as she covers this vast rural

12:23

county , brewster

12:25

County . We've spoken often

12:27

about the unique challenges facing rural

12:29

providers and rural hospices in

12:31

particular and the threat of rural hospice

12:34

deserts , and this article put

12:36

a very friendly

12:38

but impactful

12:41

face on those issues . In

12:44

seventh position was coverage of for-profit providers

12:47

34 articles in hospice

12:50

news today . Last month October's earnings

12:52

season and , as I've noted previously

12:54

, that dominated the coverage

12:56

for the month for the for-profits and

12:59

for anyone new to not-for-profit hospices

13:01

, get used to it . It happens

13:04

every quarter of for-profits every

13:06

three months will dominate their

13:09

earnings will dominate

13:11

their coverage for the month . In eighth

13:13

place there were 29 articles

13:15

about fundraising and development news . That's

13:18

a bit of a bump and it was nice to

13:20

see . I do not

13:22

run stories that announce

13:25

an upcoming fundraiser . I only

13:27

run articles about actual

13:30

fundraising events that have been held . They

13:32

give you a number of people who attended , participated

13:35

. They give you an amount of money that's

13:37

raised . I also cover grants

13:39

received , capital campaigns and

13:41

the like . I

13:44

think this amount of fundraising and development

13:46

coverage is a nice lead-in . At

13:48

least one can hope for the regular

13:50

end-of-year development work that

13:53

not-for-profit hospices do

13:55

in November and December . In

13:57

ninth place was coverage of

13:59

home health and private duty and related

14:02

sectors 25 articles . In October

14:04

the tenor was reasonably positive

14:07

for the home health sector

14:09

. There were numerous stories about home

14:11

health innovations , specifically

14:14

adapting technology to improve

14:16

working conditions for nurses

14:18

and quality oversight , and

14:20

there were also

14:22

reports on efforts by

14:24

home health providers to go upstream

14:26

with Palliative Care , about

14:29

their initiatives to better sell their services

14:31

, market their services to Medicare

14:33

Advantage . It's an interesting

14:35

contrast , the

14:38

relatively positive tone of the home

14:40

health coverage last month to the continuing

14:43

bad news coverage of the skilled

14:45

, nursing and senior

14:47

living sectors that we say . Finally

14:50

, I added a tie for tenth place , a three-way

14:53

tie with 23 articles each for

14:55

news about physicians and nursing , news

14:58

about medical aid and dying and news about

15:00

Medicare and Medicaid . On

15:02

the physician and nursing front , unfortunately

15:06

it was more coverage of burnout

15:08

. I think the coverage of burnout

15:10

is actually increasing month

15:13

to month . On the nursing side

15:15

, there was also increasing coverage

15:18

about advocacy efforts by

15:20

nurses for safe staffing ratios

15:22

and more

15:24

hiring . On the medical aid and dying

15:27

front , again , the most

15:29

impactful coverage were personal

15:31

essays by caregivers whose

15:34

loved ones had chosen to utilize the

15:36

End of Life Option Act in their respective

15:39

state . And on the Medicare side , the

15:41

coverage was largely dominated by

15:43

the continued push-pull over

15:45

Medicare Advantage and what it is and

15:47

isn't doing for consumers

15:50

and for healthcare spending . My

15:54

honorable mentions the folks that the

15:56

areas that didn't make the top 10 were

15:58

hospital news , grief and bereavement news

16:01

, pharmacy and medication , dementia

16:03

care , volunteers , jimmy Carter's

16:05

Hospice Journey , the pandemic

16:08

and governance , transparency

16:10

and social responsibility . A

16:12

couple comments on those , not on all of them

16:15

. The hospital news was mostly

16:17

about closures , layoffs

16:19

, financial problems . It

16:22

wasn't nearly as bad as what skilled nursing

16:25

saw , but it was still a very

16:27

ugly picture . There continued

16:29

to be a smattering of stories

16:32

about the challenges facing rural providers

16:34

and , as you know , I think the

16:36

spotlight needs to continue to

16:38

illuminate that dire issue . For

16:41

pharmacy and medication

16:43

, significant increase in coverage of use of

16:45

psychedelics that

16:47

issue is growing and

16:49

I think both clinical and psychosocial

16:52

hospice staff need to keep an

16:54

eye on the psychedelics issue

16:56

. On dementia care , as

16:59

more and more providers , both

17:01

hospice and home health , frankly launched

17:03

dementia care programs , they're earning some

17:05

positive local coverage . On

17:08

the governance and related issues , as

17:10

we saw with progressives and

17:13

their advocacy on M&A activity

17:15

and fighting roll-ups

17:17

, the progressives are also starting to zero in

17:19

again on large not-for-profits

17:21

that don't appear to be fulfilling their

17:24

charitable mission and that are closing

17:26

programs , not to kind of scrutiny

17:28

anybody likes . For

17:31

the Jimmy Carter Hospice journey , I ran eight

17:33

articles last month , all of them obviously

17:35

wildly positive . Many of them picked

17:37

up by numerous media

17:39

outlets , just didn't run in a single place

17:42

. I think it's worth noting

17:44

that the CEOs

17:47

at both Hope Health and Rhode Island

17:49

and Avau Hospice and Naples authored

17:51

really well-done columns

17:53

that provided a thoughtful and

17:56

well-written take on what

17:58

the Carter Hospice admission means

18:00

to improve and timely access

18:02

to end-of-life care . Those articles

18:04

got picked up by numerous outlets and

18:07

really spread

18:10

their message far beyond the market that

18:12

those two providers serve . That's

18:14

off to them . That's

18:17

my quantitative look at October , chris

18:20

. I'd love to hear what you saw from the C-suite

18:22

and the podcasters share . Yeah

18:24

.

18:26

So I'm going to go there in just a second . Mark . I want to circle

18:28

back on a couple things . First off , always thank you for the master

18:30

class I was actually just thinking

18:33

about you talked about earlier some of your

18:35

professors and just how

18:37

tough in a good way

18:39

and that we live at

18:41

a time where I think we kind of lost sight of the fact

18:43

of mastery is through rigor

18:45

and study and application . I

18:48

just know that's your heart of bringing that , so I just

18:50

want to give you kudos to that . That was just pure

18:52

solid gold master class right there . One

18:55

thing that I call out that

18:57

I've talked about each month is the

18:59

staffing challenge . In fact , this month

19:02

I have a whole staffing category

19:04

. It's the largest flag one that I had . It

19:06

was over almost 30 articles

19:09

, but I've seen a stratification that I

19:11

would call first off the challenges of staffing

19:13

. The second one I call is the

19:15

implications . You started to allude to that

19:17

, mark . I did not have that frame

19:19

of reference of strikes and unionization

19:22

. You're saying that could be a generation

19:24

or two generations , that

19:27

we've not seen that in healthcare . But

19:29

obviously that is the implications

19:32

when you start getting in an untenable situation

19:35

. You're just not enough staff

19:37

. There's no

19:39

easy solutions here , and

19:41

if you don't work on the solution , then people

19:43

feel like I don't have anything else to do

19:46

. I guess in some respects , looking

19:48

through the rear view mirror , I guess this was almost

19:50

predictable , but I also feel like

19:52

it's a little ominous for where we're going . So I don't

19:54

know if you had any other comments on that , but even

19:57

you're making comment about staff crossing picket

19:59

lines . I didn't even think about something like that .

20:05

What if your nurse is married to a telephone

20:08

company worker who's unionized ? He's

20:10

going to have a real problem with his spouse crossing

20:13

a picket line . But

20:15

I think one of the things about the

20:18

unionization is because

20:21

healthcare employers

20:23

try to ignore unions

20:26

. There is this assumption that the unions

20:28

are all about pay , and

20:30

that assumption has been wrong for 40

20:33

years . When the SEIU

20:35

first moved into Florida to organize

20:38

hospitals in the early 80s , it wasn't

20:40

about pay , it was about safe

20:43

staffing , it was about staffing ratios

20:45

. It was about no , you can't

20:47

take a labor and delivery nurse and drop

20:49

her in the emergency department without

20:52

giving her any , without giving her two

20:54

weeks of training . So

20:56

the unions have been talking about staffing

20:58

issues and safety and

21:01

violence in the workplace for 20

21:04

, 30 , 40 years and people just

21:06

had these blinders on that said well , as long

21:08

as we bump the pay rates

21:10

and buy pizza every once in a while

21:12

, we're fine . And that's not what that's

21:15

about . And

21:17

we're seeing the hospitals that have been short-sighted

21:20

about this , the price they're

21:22

paying , and it's

21:24

starting to creep into hospice , and

21:27

a

21:29

good hospice administrator is going to keep an

21:31

eye on that issue and understand

21:34

that this is a lot more than just

21:37

what are you paying them and how many days

21:39

of PTO are you giving them ?

21:42

Yeah , that's why that culture just my

21:44

mentor , quint Studer , used to say culture , each

21:46

strategy all day long , and I think that's

21:48

going to be that in spades as we go forward

21:50

. And the other thing that you alluded

21:52

to this is , you see , just the

21:54

growing mental

21:56

health crisis , the growing , the stress

21:59

we've come out of COVID , but then you also throw

22:01

it into these kind of macro forces that are impacting

22:03

healthcare and people are at their

22:05

wits end . And Quint said that things

22:08

that we use to call the mental and emotional

22:10

health tools in your toolbox for you personally

22:12

, but for the people you lead , are no longer

22:14

soft skills . They're now essential skills

22:16

as a leader , and I feel like

22:19

you've just kind of highlighted that . Mark

22:21

, you said something else that I'm like . Did I hear him correctly

22:23

? So the number of new IPU

22:25

openings was greater

22:28

than the IPU closings , which that

22:30

strikes me as weird , because and maybe

22:32

it's just kind of my purview Since

22:35

COVID we've not seen those IPU units

22:37

being filled like they used to

22:39

, and so I don't know if you have an opinion on that or what you think

22:41

that might be about .

22:43

So I've combination

22:46

of openings and refurbishing

22:48

or expansions . I

22:54

think some , some hospices , see

22:56

an opportunity in competitive markets , see

22:59

an opportunity to differentiate

23:01

themselves from the mass

23:03

of newcomers

23:07

who are coming into their market and trying to skim

23:09

market share . I think

23:11

that part of it is

23:13

, you

23:16

know , it's a

23:18

, it's a dog wagging the tail . In terms of

23:20

capital , campaigns are the easiest

23:22

money to raise . In a lot of ways People

23:26

are more comfortable writing checks for bricks

23:28

and mortar . I think you you also

23:30

see some of these . Some

23:33

of these units are tied to program

23:35

expansions . One

23:37

that hasn't been announced yet that I'm familiar with

23:40

is tied to the opening of a PACE program

23:42

, but there will be hospice inpatient

23:44

there . So so

23:47

I think in some cases it's those

23:49

hospices that are trying to go further

23:51

upstream and they

23:55

need they need a physical location

23:57

to do some of that work . So

23:59

I think it's a lot of issues like that . I

24:02

think also it might just be that there were

24:04

maybe a bit fewer

24:06

closings of units in the last month

24:08

too , so that comparatively the

24:12

difference stood out . But the bottom line

24:14

is it's not all just units

24:16

closing .

24:17

Yep , no , that's good , and actually

24:19

you got me thinking about some projects that we're working on and so maybe

24:21

that's a good promising trend Mark . Before

24:23

I jump in , I always kind of ask you like

24:25

, because you know my purview , I'm trying to think about

24:27

what do C-suite hospice

24:29

powder care leaders , but also staff , need to know

24:31

. What's just your general gestalt

24:34

and so is the volume more this month . My

24:37

perception is it was pretty similar . I flagged

24:39

slightly more than I did last month , but any

24:41

comment as far as just the general gestalt

24:44

.

24:45

Yeah , it was . The really common

24:47

topics were had more

24:49

coverage and just the general

24:52

run of the milk topics were

24:55

either flat or a little low . So overall

24:58

it was about the same , but the mix

25:00

was different .

25:01

And in the show prep you mentioned something almost like ominous

25:03

signs on the dashboard . Did that interpret you correctly

25:06

? Maybe ominous is too strong of a word ? Just

25:08

some warning lights on the dashboard .

25:10

Well , just we were talking about

25:12

just the various warning signs

25:14

out there in terms of pharmacy deserts

25:16

, healthcare deserts , hospice deserts

25:19

, hospital deserts , staffing . So a

25:21

lot of red lights , or at least yellow

25:23

flashing lights , going off right now , and

25:26

hospice leaders

25:28

need to be more

25:30

aggressive in their issues management . They need

25:33

to be peeking out over the

25:35

edge of the silos in which they operate

25:37

and they need to be scanning the horizon

25:39

and not just focusing on their

25:42

sole market where they're doing business

25:44

.

25:45

Well said and that's a perfect segue , that Mark

25:47

. So this month I flagged 125

25:50

articles and either I'm a slow learner or I'm just

25:52

catching on . But I'm now seeing that

25:54

there are common themes each month and they're

25:56

not budging very much . So I'm

25:58

going to do my report out just slightly different

26:00

this month . So I'm going to go over the themes and I

26:02

want to dig deep on two of them . First

26:05

theme that I'm calling out just because I have been

26:07

raised a nonprofit and mission moments

26:09

. I think reconnects as to why we do this work

26:12

. But the article is that you cite it from President

26:14

Carter and then again shout out to Diane

26:16

and Jason they did an awesome job . There's

26:18

also a cool article in kind of that category

26:20

I'll call mission moments , again about

26:23

a hospice patient goes skydiving to

26:25

check off an item on the bucket list

26:27

, and so you know about adding life

26:29

to days when days can't be added

26:31

to life , and that to me was just a beautiful

26:33

one . We know not every hospice mission moments

26:35

like that , but when you do say this , pretty awesome . The

26:38

next category is the staffing and

26:40

again I probably had close to 30-something articles

26:43

, my three categories . I'm now having

26:45

to substratify staffing because

26:47

it is consistent and I think this

26:49

is no easy solution

26:52

. That's why , when we were talking about the modern healthcare best places

26:54

to work , and then the implications

26:56

, which is like unionization

26:58

, striking as

27:00

resources get scarce

27:03

I'm a student of history so you mark

27:05

, people go to war when resources

27:07

get scarce . When some respects

27:09

, this is exactly what's occurring

27:12

. Staff feels like I don't know what else to do

27:14

, and if leaders aren't working on the problem

27:16

because there's no software

27:18

you could go and buy , there's not a quick task

27:20

you could put in place . This is a huge

27:22

issue that's gonna literally play out the

27:25

rest of my career as the silver tsunami

27:27

continues to crash on shore . So

27:29

my substratification is the challenges

27:31

. So there's about nine articles just

27:33

painting the picture of the challenges . There was a really

27:35

good one in CNN that healthcare

27:38

workers face a mental health crisis , and that

27:40

was a really good article , kind of

27:42

unpacked all the different challenges . The

27:44

second substratification I call it the implication

27:47

. So what we're talking about is the unionization

27:49

. I've never seen this number of strikes

27:52

in healthcare in my career going

27:54

on 28 years now , and

27:56

so Kaiser Permanente and

27:59

Pittsburgh nurses were rallying for a 31%

28:02

hike in starting wage . There

28:04

was an article I'm not sure if I actually

28:07

highlighted it on mine , but

28:09

in the negotiation work you probably remember it the

28:11

CEO basically said we may take

28:14

away benefits and I thought , wow

28:17

, that's a strong

28:19

negotiation tactic and I

28:21

just think , okay , you might win the battle , but you're

28:23

gonna lose the war because of where this thing

28:25

was going . So that one just man , it almost leaped off

28:27

the page . So that was the second category

28:29

of staffing . I called the implications . But

28:32

maybe a little bit of light dawning

28:34

on the edge of kind

28:36

of the horizon here is what I call solutions

28:38

, and this month I saw about 13

28:41

articles just different ways

28:43

people are working on this , like one I was

28:45

actually . This article House

28:47

hopes to remedy the nursing shortage with international

28:50

students . Some great articles

28:52

about just home health , home care

28:54

, what people are doing to address

28:56

the staffing woes . Of course there are a lot of interesting

28:59

articles about like kind of the gig

29:01

economy and technology that allows people to take

29:03

shifts . So you see a lot of that , a

29:05

lot of that , and of course those are gonna be sexy

29:07

because it has the lore that it's a quick fix

29:10

, but at least they're working on the solution . There's

29:12

a $1.6 million grant to help older

29:14

workers train for CNAs

29:16

. And so a lot of

29:18

good articles again about solution . So that was

29:21

my second big category . Third category

29:23

, I just call it reimbursement . Lots

29:26

of articles about 13 in that category

29:28

, some good , some challenging . The good is

29:30

ACO reach has actually saved over 300

29:33

million , almost 400 , 371

29:35

million . That was pretty positive . Let's

29:38

see here . Congress calls on CMS

29:40

to revise propose hospice special

29:42

focus program . The SMFP First

29:44

year of hospice . Vbit is the hardest for payers

29:47

and providers . Risk

29:49

adjustment rules may affect powder care companies

29:51

. So just again 13 articles . I'm not gonna cite

29:53

all of them , mark , when I wanted to ask

29:55

you under that one because this just came out yesterday

29:58

as you and I are at the end of the month here taping

30:00

the show . So

30:02

I've never seen someone sue

30:04

CMS . And actually then when

30:07

so home health sued because

30:09

they were gonna get a rate decrease and

30:11

then it came out yesterday that the government

30:14

is reversed , now it wasn't a huge

30:16

, but I think they were looking at a 2.8%

30:18

decrease and I think they ended up getting like

30:21

it was basically a delta of about 3%

30:23

. It was a little bit better than break

30:25

even . Have you ever seen that in your life

30:27

where someone to sue CMS over a proposed

30:29

rate cut or whatever , and then it

30:31

actually kind of ends up they end up kind of

30:33

winning .

30:34

Well , we certainly seen cases

30:36

where CMS puts out a proposed

30:39

rate and then they walk

30:42

it back partially , and that's

30:44

what happened here . I mean , was the suit a legal

30:46

tactic or was the suit a

30:49

public relations and public

30:51

policy tactic to

30:53

rally their troops

30:55

on Capitol Hill and in

30:57

the media to put pressure on CMS

30:59

and the Biden administration to not

31:01

go through with the draconian cut ? Was

31:03

the suit a rallying cry to

31:06

the thousands of members

31:08

of the National Association of Home Care and

31:10

Hospice to pick up the phone

31:12

, to get on email and contact

31:15

their member of Congress , their

31:17

member of senators , and encourage

31:20

them to call out CMS to

31:22

reverse the proposed cut ? So

31:26

was it a tactic or a strategy ? I'm

31:28

not a regulator , I'm not a regulatory

31:30

lawyer , so I don't

31:33

know whether anybody's sued like that before

31:35

, but

31:38

to me it looks like it's part of a typical lobbying , grassroots

31:41

lobbying . It was an essential part of

31:44

a coordinated grassroots lobbying campaign

31:46

.

31:46

Yep , no , that's good , and I think all of us

31:48

need to put that back in our memory banks as we

31:50

journey into the future . So

31:53

my fourth category I call Warning Signs for Healthcare and

31:55

you're gonna see a lot of themes here . But

31:58

there are several articles . But out of those articles

32:00

staffing challenges , reimbursement

32:03

challenges , as value-based care as we move more to value-based

32:05

care while dealing with actual cost

32:08

and inflation and probably the biggest article I think

32:10

kind of summed it up was

32:12

gosh . I didn't realize I'm calling out so

32:15

many ex use articles this month , but this one

32:17

was called Warning Signs for the US Healthcare

32:20

System are piling up and just talking about

32:22

the confluence of all of

32:24

those things I just called out . And then there was a modern

32:26

healthcare article about dozens of hospitals . Health systems

32:28

are seeing credit system

32:31

downgrades and

32:33

, mark , I think your adage is we need to be aware because , as

32:35

hospice and pedicure providers , if

32:37

hospitals catch a cold , does

32:42

it implicate us even worse , because we're further downstream

32:44

? Now I'm starting to have a

32:46

lot of questions and I have a little bit of a different viewpoint

32:48

. I think that at least the

32:50

hospices we work with they've gotten really smart

32:53

and in serving their mission their

32:55

tentacles are in all parts of the community . We

32:57

have as good relationships with the CCRC and

33:00

home health agencies as you do with the

33:02

hospital , but still a

33:04

lot of our communities you think about the number of

33:06

people employed and working in hospitals

33:08

, et cetera and I think that usually

33:10

the biggest confluence I think a bond ratings

33:13

right mark , I think is like in the spring . So

33:15

I think that's something we're gonna have to watch for in 2024

33:17

. Now there are a couple of articles start

33:20

talking about . Some hospitals are starting to turn the corner

33:22

, so maybe by the time we get to

33:24

the spring and I think basically what they'll do is

33:26

either they downgrade or they put them on like a performance

33:29

improvement plan , but they just felt like

33:31

a red light on the dashboard . Any comments

33:33

that ?

33:35

Yes , I think there's two

33:37

ways to look at that . When hospitals

33:39

get a cold , do

33:41

hospices get pneumonia ? One

33:44

is my concern with that is

33:46

more on the governance

33:48

transparency mission fulfillment

33:51

issue . When Senator

33:54

Charles Grassley of Iowa starts going

33:56

after the largest hospitals because he

33:58

not for profit hospitals , because

34:00

he claims they're making too much

34:03

money and not spending any money on

34:05

mission , that puts every

34:07

mission driven provider

34:09

at risk . I

34:12

think we need to separate that from the

34:14

financial . Good news , bad news

34:16

, whatnot ? Most

34:19

hospices fortunately I

34:21

guess fortunately are not dependent on bond

34:23

ratings the way capital intensive hospital

34:26

providers are . I think there's

34:28

a bit of a dichotomy there . Hospitals

34:32

are at risk on the financial side , hospitals

34:34

are at risk on the reputational side . I

34:36

think the greater risk for hospices in

34:39

many respects is any bleed

34:41

through on any

34:44

cracks in the wall of mission fulfillment

34:46

on

34:49

the social responsibility side .

34:51

My next category , mark , I would call it demographic

34:54

trends . Again , I think that

34:56

my categories aren't going to change much , but

34:58

this is what I want to just call out a couple of things . Here

35:00

are some articles that put under demographic trends

35:02

. They're more in due dimension . Villages actually

35:05

work and we just don't know was basically

35:07

kind

35:09

of the punch line of the article why

35:12

more seniors are living in poverty . I

35:14

heard Joan Tino give a great presentation

35:16

about the demographics of that . As we go further

35:18

into the baby boom population For

35:21

LT levels decline . Health trajectory

35:23

improves after nursing homes

35:26

stay for acute patients . That

35:28

was kind of interesting , maybe positive

35:30

for them . Home-based primary

35:32

care can lead to modest improvements in the avoidable

35:35

hospitalizations . Hospices

35:38

bought by PE private equity

35:41

public companies had more dementia

35:43

patients . Again , this is kind

35:45

of you call it statistics demographics

35:47

. New report reveals caregivers

35:49

greatest needs . That was a really

35:51

great article by McKnight's training , education

35:54

and resource needs . A modern healthcare

35:56

article about how one hospice has

35:58

built trust in LGBTQ patients

36:01

with sage certification . Washington

36:04

Post life expectancy in the US is falling

36:06

amid surges and chronic illness

36:08

, which in some respects I guess we've been kind

36:11

of predicting for a while , which

36:13

is why we knew the silver tsunami is going to be

36:15

something we have to be aware of In a Wall

36:17

Street Journal article , more

36:20

men are taking care of their aging parents and

36:22

the learning curve is steep . So I just want

36:24

to call out those because a lot of demographics

36:27

. Now , my next category was I just call it innovation

36:29

. Lots of interesting technology

36:32

innovation like a Papa

36:34

digital health literacy program

36:36

helps Papa improve members access to

36:38

care solutions , and just a lot

36:40

of great articles about just different

36:42

technological or kind of care

36:44

model innovations . And , by the way , as

36:46

Mark and I call these out again

36:48

, we could take a three hour show

36:50

just trying to go in depth in all these articles . Mark

36:53

and I are always . You guys just have to

36:55

send us an email . We'll give you a download

36:57

of basically these articles that we flagged

37:00

and we'll get you connected with Mark to actually

37:02

get subscribed to hospice news today , so

37:05

that way you could be reading the same daily

37:07

that we are . But then again we kind of

37:09

synthesize and say here are the ones that you shouldn't

37:11

miss . So the seventh category

37:13

mark you called out as well A lot of interesting articles

37:15

about Medicare Advantage . Again , this to me , is a

37:17

category that's not going to change . There

37:20

was one that I wanted to call out

37:22

. It was related to care

37:25

. It actually surprised me . But then I

37:27

talked to Peter Benjamin earlier this week

37:29

and he said it out loud

37:31

. It was basically about minority populations

37:34

, that here it is Medicare Advantage

37:36

growing among people of color who live

37:38

in rural areas and I guess I just

37:40

had not considered but the fact that this

37:43

is the way Peter described it made so much sense

37:45

to me . He said if you think about people that have

37:47

a lot of minority populations

37:50

because they're either below the poverty

37:52

line or struggling with means

37:54

having any health insurance and

37:56

then to be able to sign up for Medicare Advantage plan to get

37:58

all these supplementals , you can see why

38:00

that be incredibly attractive . And

38:02

it just stuck in my brain when he said that . I'm like , of course

38:05

and then I saw the article about actually

38:07

citing the statistics there that

38:09

actually amongst minority and people of color

38:11

that MA is growing quite a bit . So

38:13

that's the Medicare Advantage category .

38:15

Yeah , chris , this category . Just

38:17

on that . The flip side to that is

38:19

when you look at that question

38:21

from the perspective of

38:24

rural hospitals , and

38:26

the line coming from

38:28

the rural hospitals is Medicare Advantage

38:30

is killing us because

38:33

they're just killing us on rates . So

38:38

there's good and bad there Almost

38:41

a mismatch right .

38:42

So the customer is signing up for more Medicare Advantage

38:44

but then when they try to go to the hospital , it's

38:47

then having the impact in the long term may

38:49

be closing their local community hospital

38:51

because they can't survive with those Medicare

38:53

Advantage rates to the hospital . That's a great call

38:56

out . The next one

38:58

, work , is after more Medicare

39:00

Advantage . I just want to spend a little bit of time on this one . But

39:02

pharmacy , and so I

39:05

flagged about six articles this month

39:07

on just challenges in pharmacy . So

39:09

probably many of you have heard in the news are

39:12

Walgreens and CVS Formuses going to walk

39:14

out , and so there's

39:16

an article about that . Other chains are walking

39:18

out again CVS , walgreens . I

39:21

was lost more than 10% of pharmacies

39:23

since 2008 . Pharmacy

39:25

desert shortage of pharmacists

39:27

leaving main customers in peril . Washington

39:30

Post drugstore closures leaving millions

39:32

without access to a pharmacy . Right

39:35

Aid Health Florida , right Aids bankruptcy

39:37

plansters worry of new pharmacy deserts

39:40

. So I reached out to a mutual friend of

39:42

you and I and I'm like what's going on and

39:45

here's my perception of the executive summary

39:47

and I think it's an interesting . It's

39:49

a cautionary tale to where we

39:51

could be headed as hospice and powder care

39:53

providers . And first off , there

39:55

. We know , just listen to the

39:57

news , right , pharmacy manufacturers and

40:00

what you pay in America for

40:02

a drug compared to what you go to South

40:04

America is crazy . So that's one

40:06

part of it . And then you put these PBMs in

40:08

the middle , which could be where we're

40:10

headed with . Well , how do we get

40:12

to Medicare Vantage plans , et cetera ? You've

40:14

highlighted a couple of articles last couple

40:16

of months . I think it was Sanchin with scan

40:19

is like the middle people between

40:21

MA providers are horrible

40:24

In some respects . That's what the PBMs

40:26

have become , and they had this interesting

40:28

I'm not gonna geek out , but I think it's

40:30

called a DIR , basically

40:32

a charge that they charge these local

40:35

pharmacies . So the local pharmacies

40:37

that they're tailing to this healthcare food chain , and

40:39

they're getting squeezed by the middle people

40:41

, the PBMs , and , of course , the manufacturers

40:43

and the places that they used

40:45

to make their margins are going away . At

40:47

the same time . We all know staffing is a

40:49

challenge . It is in the pharmacy as well . So

40:52

you're getting inflationary pressures on the wages

40:54

and these pharmacies are just , they

40:57

have nowhere else left to go . They've lost their

40:59

past high-mortgage products , if you will

41:01

. And then one interesting observation

41:03

. This one's a little bit more of a hypothesis than

41:05

substantiated . But I didn't think about it until

41:08

this person shared that Amazon

41:11

is now cutting into more of the over-to-counter

41:13

, and the over-to-counter in these pharmacies

41:15

was one of the last places they still had margins

41:17

, so now people are getting their over-to-counter meds

41:19

. So all of that is confluencing at the same

41:21

time . So , mark , I don't know if you have any comments , but

41:23

that to me was kind of eye-opening . And

41:26

just one more , especially in the rural areas

41:28

. Just one more challenge where if

41:30

you don't have primary care , you don't have a local community

41:32

hospital . Sometimes a pharmacy is

41:35

the last part of healthcare that you have

41:37

.

41:37

So I think , on the OTC issue , I had this

41:39

thought just this morning actually , because

41:41

my

41:43

closest CVS is a suburban

41:45

CVS and there are very few products

41:48

that are locked up on the OTC

41:50

shelves . But there's also another

41:53

CVS downtown that I patronize

41:55

and everything is locked up . So

41:57

if you wanna take anything off the shelf

41:59

that costs more than a couple bucks , you have

42:02

to go find a staff person who doesn't exist

42:04

, and that person has

42:06

to go knock on the door and get a key from a manager

42:08

to open something up so you can buy

42:10

a $20 item and I say you know what ? At

42:13

that point it's easier to sign on to Amazon

42:15

and have it shipped directly to my door . So

42:18

as retail pharmacies

42:20

in higher crime areas deal

42:23

with that problem by restricting

42:27

access to product on their shelves , they're just

42:29

driving more people to

42:32

Amazon or some other mail

42:34

order fulfillment to

42:37

get their high markup OTC

42:39

products . So just another problem for

42:42

the retail pharmacy industry .

42:43

Well , just to round out that , my mark , my number

42:46

nine category , was the nursing home mandate

42:48

, and I actually I think that's another

42:50

cautionary tale . So our

42:52

legislator is infinite wisdom . Oh

42:54

, you have a staffing problem in long-term care , we're gonna

42:57

mandate staffing levels . Well

42:59

, you can't mandate something that is such

43:01

a systemic problem . Or you're gonna mandate

43:04

that people have more children and then they go to nursing

43:06

school and you crank them through nursing school quickly and they

43:08

go to long-term care . We're not really

43:10

working on the problem via mandate . I kind

43:12

of get the spirit of it , but that

43:14

is causing a lot of consternation . I had almost

43:17

12 articles kind of flagged in that category

43:19

. And then my 10th category , rounding up

43:21

my top 10 , is merger and acquisition

43:24

. So that's my top 10 . I

43:26

had about seven honorable mentions , probably

43:28

the biggest one to call out , or maybe

43:30

the two biggest ones . The ransomware attacks

43:32

just continue to be concerning . And

43:34

then you called it out I won't call

43:36

it attacks , but the calling out of nonprofit

43:38

hospitals . And are they really fulfilling

43:41

? In fact that was the one of the articles

43:43

nonprofit hospitals must live up

43:45

to their end of the bargain . And

43:47

then a hospital lobby clash

43:49

over a nonprofit service , again just interesting

43:52

, kind of another cautionary tale for us in

43:54

the nonprofit hospice space

43:56

. So Mark any final thoughts before I close with

43:58

our quote .

44:02

Oh , we are condemned

44:04

to live in interesting times .

44:07

Yeah , the Chinese parable . Maybe you live in interesting

44:09

times , which is why Mark and I do this . I

44:11

was thinking about it and it's hard to then

44:13

try to also say , guys , these are the warning

44:16

signs , but here's all the solutions . That's not

44:18

the point of this show but , as Mark alluded

44:20

, that as hospice and pedicure leaders

44:22

we can't put our head in the sand , and

44:25

which is a perfect segue to the quote that

44:27

Mark picked out for today . It's actually from Indra

44:29

Newey , the ex CEO

44:31

of PepsiCo says lifelong

44:33

learning is a survival mantra

44:36

of the future . Lifelong learning Leaders

44:38

must understand coming trends

44:40

and technologies . That's why we do this show

44:43

. They must study whatever's driving

44:45

change in depth . It must go

44:47

back to being students , and I think that's

44:49

a great piece of wisdom . Again

44:51

, mark and I are always reach out to us , shoot us an

44:53

email . There's always a link in the summary of the

44:55

podcast . We glad to share

44:57

with you these articles . At worst

44:59

, at least by listening to this , you'll be more informed

45:01

of these kind of warning signs that are coming

45:03

at us . So that way , all together , we

45:05

can kind of navigate this future , because the work

45:08

that we do in hospice and pedicure is

45:10

so impactful , it's so important we know we walk

45:12

on sacred ground and

45:14

we have to lead to make

45:16

sure that we're here 10 , 20 , 30 years

45:18

from now , so that wonderful care is

45:21

still being provided to those that need it . So , mark

45:23

, thank you as always . Appreciate you , chris , appreciate

45:26

it .

45:26

It's an entire listen .

45:27

Yeah , absolutely , it's our listeners . Thanks for listening

45:30

to TCN Talks 바로isucicom

45:38

.