0:02

Welcome to TCNt alks . The

0:04

goal of our podcast is to provide

0:06

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

0:18

. And now here's

0:21

our host , Chris Comeaux .

0:23

Well , hello and welcome to TCNt alks

0:26

. This is my favorite time of the month

0:28

when I have my good friend Mark Cohen back . Welcome

0:30

back , Mark .

0:31

Be here as always , thank you .

0:33

This is one of our last shows of actually

0:35

2023 , which is kind of crazy

0:37

, and , mark , this has been such a joy . I actually got the

0:39

vision of this show when I was going out for a walk for

0:41

Christmas last year and I thought wouldn't

0:44

it be cool to do a show that would be a service

0:46

to hospice and palliative care leaders and staff In

0:49

one show , in about a 30 , worse

0:51

, 45 minute list , and they could kind of hear what are the

0:53

top news stories of the month . So

0:55

they , as a leader , got the need to know

0:57

, to be able to navigate where things are going in

0:59

the future , and you and I have had a joy doing

1:01

it this year . We've learned a ton One of the cool

1:04

things that's kind of evolved . Instead of me asking

1:06

you what do they need to know about you , because

1:08

they know a ton about you by now

1:10

, is you remind me of some of

1:13

my cool mentors , mark , and you really

1:15

have become that . For me , I

1:17

feel like I seek out human yodas , so hopefully

1:19

you take that as the compliment that it is . Yeah

1:21

, I do , Thank you . And so

1:24

kind of the masterclass portion and man

1:26

, you've been bringing it the last couple months so

1:29

I want to cue you up to start this month . What do you have

1:31

for a masterclass for our listeners ?

1:33

Well , as a writer

1:35

, public relations practitioner

1:37

and a journalist by training

1:39

, for me , hospice month

1:41

is a frustrating time , and

1:44

that's because there is so little to say that

1:46

hasn't been said a thousand times

1:48

before . For

1:51

example , a news release or

1:53

an op-ed column from a hospice provider

1:55

that begins November

1:57

is hospice month . That

2:00

is simply not a lead sentence anyone

2:02

should be proud of . It says nothing

2:05

and , more importantly , it does nothing

2:07

to draw the reader into the news release

2:09

or the op-ed column . Ask

2:12

yourself , why should anyone

2:14

in the general population care

2:16

that November is hospice month ? They

2:19

don't . They won't . In

2:22

fact , here's a simple rule to follow when

2:25

writing news releases and op-ed

2:27

columns and

2:29

anything you write for publication , whether that's

2:32

a news release , a column

2:34

or social media . If the verb

2:36

in your lead sentence is

2:38

is , you might as well

2:40

stop writing because nobody's

2:43

going to read . You need an action verb . So

2:45

how would that translate to hospice

2:47

month ? Well , instead of writing November

2:50

is hospice month , how about writing

2:52

? November's hospice month celebrates

2:55

providers like ABC Hospice

2:57

, which was among the US hospices

2:59

that , in 2022 , cared

3:01

for more than 1.7 million

3:03

people in their final hours , days

3:06

, weeks and months . Or ABC

3:09

Hospice is commemorating National

3:11

Hospice Month by launching a new

3:13

volunteer-driven program to care

3:15

for the pets of our hospice patients when

3:17

those patients are no longer to care able

3:20

to care for their pets , or a

3:22

third option . Anyone

3:24

can contribute to the

3:26

success of November's hospice month at

3:28

ABC Hospice by shopping

3:30

at our fabulous thrift store , donating

3:33

new and gently used items or

3:35

learning about how to become a thrift store volunteer

3:38

. Now , granted , none of

3:40

those lead sentences are Pulitzer

3:42

Prize winners , but they have action verbs

3:44

, they draw people in and they actually

3:46

say something . It might not be the most exciting

3:49

thing in the world , but it's a different way

3:51

to talk about hospice month in

3:53

November . And

3:55

, as I've said before , if you don't have an experienced

3:58

writer on your staff and many hospices

4:00

no longer do try

4:02

to find someone in your community who can

4:04

write and who is willing to work

4:07

with and mentor your staff

4:09

person tasked with writing your

4:11

releases in your social media posts

4:13

. So that's a masterclass for

4:15

this month . Chris Little

4:18

harsh on some of the stuff I see

4:20

every day in November , but

4:22

I think it's important

4:24

to point that out .

4:25

Yeah , well , and maybe Mark doesn't

4:27

need defense for himself , but Mark

4:30

has got so much amazing knowledge

4:33

and gifts and we live at a time because

4:35

of social media , anybody could post anything

4:37

and Mark has spent his life using

4:40

words to tell stories

4:42

and make an impact . And , mark

4:44

, you've been a blessing to me . Recently

4:47

, I released my very first book , the Anatomy

4:49

of Leadership , and you looked

4:51

at a it was actually

4:53

a later draft and I feel like you

4:55

took me behind the woodshed in a good

4:57

way , and when I

4:59

got over myself , I realized you were

5:01

really making a difference and at the end , the book

5:04

became a much better product because of you , and

5:06

I think that's what I want people to know is that

5:08

and you are kind of a dying

5:10

breed because of , as

5:12

you pointed out many times , we don't have people of

5:14

your expertise certainly not in our hospitals and powered

5:17

care programs much anymore and

5:19

then because of social media , there are a lot of people post

5:21

a lot of stuff , but it doesn't mean that they're gifted

5:23

in the way that you are , so

5:25

just want to call that out .

5:26

Well , I appreciate that . I appreciate

5:28

having the advanced look at your book . It

5:31

was a fun read , it was a

5:34

learning read and if

5:37

I contributed to making it a little

5:39

better , I'm happy and pleased

5:41

to have done that . But it certainly is a

5:44

worthwhile read , not just

5:46

, frankly , for CEOs , but

5:48

anybody who is or aspires

5:51

to a management position in the

5:53

post-acute world . I

5:55

hope folks take a look at the book and

5:58

maybe purchase a copy for

6:00

themselves or for their staff .

6:01

I'm going to take a quick shout out . Well , Mark , let's jump

6:03

in . Man , what's your top news stories of the month ?

6:06

Well , between the usual and customary drop off

6:08

in all but breaking news around

6:10

the Thanksgiving holiday and

6:12

with the proliferation of nothing burger

6:14

news releases and op-ed columns

6:16

ostensibly about hospice month , november

6:19

was mostly unexceptional for

6:21

news coverage , chris . The exception

6:24

to the unexceptional , of course and

6:27

it was a hugely impactful exception

6:29

was the ongoing coverage of

6:31

the hospice journey of Jimmy Carter and

6:33

then Rosalind Carter . While

6:35

I only ran nine distinct articles

6:37

and columns in hospice news

6:40

today about the carters , there

6:42

were many more general news updates on

6:44

the carters , particularly one was

6:46

announced in late November that

6:48

Rosalind too had been admitted to hospice

6:50

. Each of those articles ran in scores

6:53

, if not hundreds , of news sources . So

6:55

, as I said , the impact and

6:57

the exposure were huge

7:00

. But in terms of the top

7:02

10 stories of the month , the list evolved

7:04

a little from previous months but

7:06

was largely what you would expect . Number

7:09

one long-term care and assisted living and

7:11

senior living news . Number two

7:13

mergers and acquisition news M&A

7:16

news . Number three general hospice

7:19

provider news . Number four general

7:22

hospice news . Fifth place end

7:24

of life care and palliative care news . Six

7:27

place hospital news . Seventh place

7:29

labor and employment news

7:31

. Eighth place we honor veterans

7:33

and veterans program news . Number

7:36

nine for-profit provider news

7:38

. And number 10 , fundraising

7:41

and development news . So , going

7:43

to the list , I ran 55 articles about

7:45

long-term care , nursing homes , senior

7:47

living and assisted living in November

7:50

and hospice news today . That's

7:52

a decline from previous months which I

7:54

think mostly reflects the lost week

7:56

of coverage due to Thanksgiving

7:58

. The unfunded

8:00

mandate is it's being called by some

8:02

of the proposed minimum staffing

8:05

requirements from CMS for

8:07

nursing homes dominated the coverage

8:09

, specifically

8:11

with pushback from nursing homes , nursing

8:13

home trade associations and politicians

8:16

against the mandate . A

8:19

typical headline , for example , staffing

8:21

mandate would smother nursing

8:23

homes . Those stories were juxtaposed

8:26

with a number of articles about substandard

8:29

care being found in nursing homes in

8:32

various states across the country , although

8:34

few of the articles on either of those issues

8:37

seem to tie the two together

8:40

. And on another related note , we continue

8:42

to see coverage of individual nursing home

8:44

closures and an

8:46

ever slightly growing awareness

8:48

of the ever expanding nursing

8:51

home deserts across rural

8:53

America , parts of rural America . There

8:55

were 42 articles on mergers and acquisitions

8:58

all across the post-acute

9:00

continuum and the acute continuum

9:02

In the hospice sector . These

9:04

were mostly one-off acquisitions by

9:07

for-profit providers , although the

9:09

biggest news was probably generated by

9:11

the pending combination of by

9:13

the Bay Health and Mission Hospice

9:15

in California , which then added

9:17

Hope Hospice , also in the Bay Area , to

9:20

the marriage and an article that I actually ran

9:22

in hospice news today on December

9:24

1 . Hospice provider news

9:26

was in third place with 36 articles

9:28

in November . In hospice news today

9:30

, as in recent months , the greatest

9:33

number of articles concern the opening

9:35

, reopening , closing and renovation

9:38

of hospice and patient units

9:40

. A subset of that

9:42

were articles about the opening of several

9:44

comfort homes not

9:46

tied to any specific hospice provider

9:48

, and two not-for-profit hospices in

9:50

Virginia announced in November

9:52

that they either rebranded or refreshed

9:55

their brands , making that four

9:58

or five , I think , that have done

10:00

so in the last year or two in the Commonwealth

10:02

. So Virginia in that regard

10:04

is becoming an interesting market

10:06

to keep an eye on . In fourth place

10:08

, general hospice news , which also

10:10

saw 36 articles in

10:12

hospice news today . Last month the

10:14

most significant news from a public

10:17

policy standpoint was the

10:19

announcement early in the month that

10:21

Oregon Democratic Congressman Earl

10:23

Blumenauer , one of hospice's most

10:25

consistent champions in Congress over

10:28

more than two decades , would not seek

10:30

reelection in 2024 . Thank

10:32

you , regardless of your personal politics

10:34

, if you care about hospice , you'll agree

10:37

that representative Blumenauer

10:39

will be missed , and it's worth noting

10:41

that in recent years he's worked

10:43

closely on hospice legislation , with the

10:45

Texas Republican Beth Van

10:47

Dunne proving that hospice , after

10:49

more than 40 years on Capitol Hill , can

10:52

still generate some bipartisan

10:54

cooperation and support . Also

10:57

in hospice news , general hospice news . Updates

10:59

on the pending merger of NHPCO

11:01

and NAAC scored several

11:04

articles in November . And with

11:06

regards to general hospice news , it's important

11:08

to keep in mind that I don't run your standard

11:10

hospice month news releases

11:12

and op-eds in hospice news

11:15

today , given that they're almost entirely

11:17

hospice 101 and hospice

11:19

facts that miss and fax articles . So

11:22

those hits are not counted either in

11:24

general hospice news or hospice

11:26

provider news . Fifth

11:28

place end of life care , palliative care

11:30

news also again with 36

11:33

articles in hospice news today . Last month

11:35

this category included a couple

11:37

of substantive articles about how

11:39

to have advanced care planning conversations

11:41

, which obviously were generated by

11:44

hospice month , but they

11:46

were well done and they were unique

11:48

a little bit in their approach . A couple of

11:50

research studies on palliative care earned

11:52

coverage by trade

11:54

publications , which is always nice to

11:56

see on the clinical side , and

11:59

death doulas continue to earn coverage

12:01

in their local markets and what now

12:03

seems to be an every other month phenomenon

12:06

, this month the death

12:08

doula coverage did not take any

12:10

gratuitous shots at hospice

12:12

care . Hospital news , also

12:14

tied with general hospice news and

12:17

end of life care news . With 36

12:19

articles in November , it almost

12:21

seems like the hospital sector has decided

12:24

to go toe to toe with nursing

12:26

homes to see which sector can

12:28

generate more negative coverage in

12:30

a given month . This month's hospital

12:33

not something

12:35

you want to aspire to . This

12:37

month's hospital news was about layoffs and

12:40

consolidation of executive positions

12:42

, as well as continued losses by

12:44

providers , both large and small

12:47

. If they are funded by local

12:49

bonding authorities , they have to release

12:51

their earnings on a quarterly basis , the

12:54

way for-profit publicly traded

12:56

companies do , and it was not pretty

12:58

coverage again this month . It

13:00

of course wouldn't be a month of hospital news

13:03

if somebody wasn't

13:05

investigating one of the large

13:07

hospital systems in your neck of the woods

13:09

, chris . In this case , in November

13:11

, it was the Tennessee Attorney

13:13

General who's going after Ballad

13:15

Health , which serves the Appalachian

13:18

regions of North Carolina , virginia

13:20

, kentucky and Tennessee

13:22

, although I don't think they quite bump

13:25

into much of the service

13:27

area for your tele-ass

13:29

collaborative network .

13:31

A couple of my team members live in their service area

13:33

, so it really did start in that eastern Tennessee

13:35

area .

13:36

Yeah , labor and employment news

13:39

was in seventh place . There

13:41

was a significant drop off in

13:43

labor and employment news in November only

13:46

25 articles . News

13:48

about strikes , far

13:50

outpaced news of new union

13:53

organizing efforts . I don't know whether

13:55

that's a positive or a negative for

13:57

the healthcare sector , but there

13:59

were an awful lot of stop the

14:01

work stoppages in the news . Even

14:03

with the lower clip count In

14:06

this headline demonstrates , I think , why even

14:08

healthcare executives and right to

14:10

work states ought to be scanning labor

14:13

and employment news across the sector . The

14:16

headline read Labor Department targets facilities

14:19

in southeast for wage violations

14:21

, something I don't think anybody wants

14:23

to see happen . With this being

14:26

November , there were 23 articles about

14:28

veterans in hospice care and in

14:31

hospice news today , news to the coverage

14:33

involved pinning ceremonies under the auspices

14:36

of we honor veterans . My editorial

14:38

guideline for hospice news today is simple

14:41

If a provider pins a veteran

14:43

, if the provider is a hospice

14:45

patient and if there's a news article

14:47

, I'll run it in hospice news today because

14:50

I think it's important that

14:52

people see that hospice

14:55

news today . Readers see that other

14:57

providers are generating local coverage

14:59

for their pinning ceremonies . But

15:01

while 23 articles is a nice

15:04

number for a month with veterans

15:06

day or Memorial Day in it . It feels

15:08

a bit like , frankly , for-profit

15:11

provider news came in ninth , with

15:14

22 articles last month . A vast

15:16

majority of that coverage involved the

15:18

quarterly earnings releases from publicly

15:20

traded companies and then the subsequent

15:22

conference calls that they conduct with

15:25

financial analysts . And

15:27

to counter that in 10th place there

15:30

were 21 articles about fundraising

15:32

and development news in

15:35

November . It was your typical assemblage

15:37

of news about grants received and

15:39

events held . Couple

15:42

interesting articles , though . One provider , haven

15:44

Hospice in north central Florida , used

15:46

hospice month as the newspaper on which to

15:49

hang A general news article

15:51

about how shopping at , donating

15:53

to or volunteering for their thrift stores

15:55

is a great way to give back and

15:58

support local quality of life and

16:00

be supportive of hospice month . Certainly

16:04

an innovative approach . There was also

16:06

a small not-for-profit hospice in Texas

16:08

that took advantage of their local

16:10

giving Tuesday to give

16:12

away coffee and donuts to anyone

16:14

who came by as a way for this

16:17

hospice to say thanks for

16:19

the support that it received for recent

16:21

capital campaign . Kudos

16:24

to those who look out , who

16:26

look for out of the ordinary ways to

16:28

promote local giving . My

16:31

honorable mentions would not quite enough

16:33

oomph to make the top 10 included

16:35

. Physician in nursing news

16:38

. Home health and private duty news , physician

16:41

assisted suicide and medical aid

16:43

in dying , medicare and Medicaid

16:45

news , pharmacy and medication news

16:48

and grief and bereavement news . I

16:50

think the most notable category here is pharmacy

16:52

and medication , for two reasons . First

16:55

, the growing coverage of psychedelics . The

16:58

more coverage psychedelics get , the more likely

17:00

your admissions nurses , care

17:02

team members , physician leaders will

17:05

be asked about your policy about this . So

17:07

my recommendation as a public relations

17:10

practitioner best to be prepared

17:12

with a statement before the question

17:14

is first asked . And

17:16

the second reason this category stands

17:19

out is a continuing focus

17:21

on pharmacy deserts across

17:24

broad swaths of rural America

17:26

. If I were a hospice provider

17:28

I would be engaging with my pharmacy

17:31

benefit manager now to

17:33

see how they are adapting to this growing

17:35

issue . Also

17:38

notable among the honorable mentions , frankly

17:40

, is the relative lack of coverage of

17:42

home health and private

17:45

duty news . Only 17 articles

17:47

in a month . That's

17:49

called national hospice and

17:51

home health month . Better

17:53

than the negative coverage that hospitals

17:56

and skilled nursing got , but a

17:58

significant

18:01

deficiency , I think . Finally

18:03

, chris , also worth noting are a couple of categories

18:05

that saw little coverage in November . We're

18:08

into the holiday season yet I

18:10

only ran nine articles about hospices

18:12

doing wish and dream fulfillment

18:14

for patients . That's a little

18:17

light . On the positive

18:19

side of sparse coverage , I

18:21

ran only six articles about healthcare

18:23

fraud and abuse , the second

18:25

month where that number has been comparatively low

18:27

, and also low

18:30

for the month , believe it or not . I

18:32

ran only three articles about medical marijuana

18:35

, which reflects the fact the legislative

18:37

work in the states is mostly shut down

18:39

for the year , thanks

18:42

in part to the work that Rosalind Carter did in the last

18:44

decade or so of her life

18:46

, focusing on caregivers . There

18:49

were a relatively large number of articles on

18:51

caregiver burdens last month Nine

18:53

. The best headline in that bunch

18:55

caring for aging parents

18:57

doesn't have to be this hard . And

19:01

, as per usual , there were only a handful

19:03

five articles on governance

19:06

, transparency , not-for-profit status

19:08

, charity care and executive compensation

19:10

. They weren't good news for

19:12

the not-for-profit sector . The most

19:14

damning headline as hospital expenses

19:17

rise , charity care spending falls

19:20

, and that's worth noting for

19:22

the hospice sector , for the not-for-profit hospice

19:24

sector , when your charity care is about

19:26

1% of your budget and

19:29

when hospitals are now being attacked because

19:31

their charity care spending has fallen

19:33

to about 1% of their budget

19:36

, hospices need to really think

19:38

hard about whether they want to

19:40

center their mission fulfillment messaging

19:42

on providing charity care . That's

19:46

my take on November , chris , what was your

19:48

take on November ? From the C-suite .

19:51

Before I jump in , mark , there's a couple of things I just wanted

19:53

to mirror back to you . It feels like

19:55

looking at nursing homes , pharmacies

19:57

and hospitals and maybe even

19:59

to frame my comment , think

20:01

of the bell-shaped curve . Our

20:03

mutual good friend , peter Benjamin , always talks

20:06

about jumping the S-curve Hospitals

20:09

, pharmacies and nursing homes . There's no doubt they're

20:11

on the right side of the curve . I believe they're

20:13

further down than hospices today . Hence

20:15

my comment . It feels like a cautionary

20:17

tale for us when you look what's happening

20:20

to them , which is why this show is

20:22

so important . How do we make sure

20:24

we don't bind ourselves there that the hospital

20:26

has nursing homes and pharmacies ? Would

20:28

you agree with that or would you push back ?

20:29

Absolutely . I mean that's why you do

20:32

issues management . That's why you do

20:34

the scanning that I do . You

20:38

need to . There are certain markets

20:41

that are the forerunners

20:43

of problems . If the issue is labor

20:46

issues and unions , you

20:49

almost always want to look at what's going on

20:51

in California , because if it

20:53

happened in California or Oregon

20:56

, washington state , before it happens anywhere

20:58

else , that doesn't mean you don't pay

21:00

attention to it because it's not happening in your

21:02

state . That means you pay attention to

21:04

it because it might be coming to your state

21:06

in the next several years . Issues

21:09

management is what I've done my whole career and

21:12

what I'll continue to do , even when I

21:14

stop publishing hospice news today and

21:16

working with my communications

21:18

consultant clients . Bidally

21:21

important . It's

21:23

not a skill that's ingrained in

21:25

a lot of hospice senior leaders

21:28

.

21:28

Yup , that's well said . Well

21:31

, as I go into my mark , I guess

21:33

it's the end of the year , so I'm in a reflective mode

21:35

here and this is technically our

21:37

last show . We'll talk about the very end , with you

21:39

actually producing hospice news today . You

21:42

just did a release today , so I'll give you a little airtime

21:44

at the end to talk about that . Maybe

21:48

I'm finally getting competent at this and what

21:50

I'm starting to see is thematically

21:53

or at least I have my themes each

21:55

month and now they're becoming consistent

21:57

and then I'm kind of putting the volume of

21:59

the articles in these themes . The

22:02

first theme I'll just call it the mission

22:04

moment theme , and this is where the Carter's have

22:06

been just an amazing gift

22:08

to our industry . For years we've been trying

22:10

to help people understand hospice

22:13

is not just about death . The death

22:15

is one part , it's just one event

22:17

and this journey and this care

22:19

model where we really can't add life

22:22

to days maybe your last days

22:24

, your last months , hopefully last months

22:26

and then , of course , then Rosalind

22:29

Carter and , as you were talking , about

22:31

her caregiver work . So that was my

22:33

first category . It looks like I've got about seven

22:35

articles in there , but also

22:38

one additional article . Mark , I

22:40

don't know how much you follow social media

22:42

. But Nurse Julie has

22:44

become very . She's got millions of followers

22:46

and she's doing

22:49

some very bold I will call it even edgy

22:51

things things that I've learned

22:53

of 28 years in this industry and

22:55

like what does death look like towards the end

22:57

? She's putting this on video and social

23:00

media and so the article was this

23:02

hospice nurse is educating people about that

23:04

actively dying phase of death

23:06

, and here's the key to me as the

23:08

punchline to alleviate people's fears

23:10

. I mean , I remember years ago when

23:12

we were doing a lot of analysis of the patient

23:14

satisfaction , knowing what

23:16

to expect , because death

23:19

is not something people have generally done multiple

23:21

times in their life , and

23:23

so I put that in that category . I

23:25

actually called Nurse Julie before she

23:27

had millions of followers and

23:30

asked her if she'd be on our podcast . And

23:32

then , next thing , I know she started

23:35

her own podcast , which was super cool , and

23:38

she actually now has a retreat in Western

23:40

North Carolina that she recently conducted . But

23:42

I wanted to call that one out because that's kind of

23:44

what I would call under kind of the mission moment

23:46

category and the next category

23:48

which I feel like is going to be certainly

23:50

the rest of my career and I plan on working still

23:53

quite a while is just the whole staffing

23:55

challenge , workforce challenge

23:57

, staffing challenge . And now I've started

23:59

to like substratify it into

24:02

like three categories . First category

24:04

is articles that are basically painting the

24:06

picture of the challenge , and there were several here

24:08

. A Fox News article a quarter of US

24:11

medical students are considering quitting school

24:13

and most may not even treat patients

24:15

. When

24:18

you look at the volume of the silver tsunami

24:20

of the baby boomers , the math just doesn't

24:22

work for the number of people . Now there could

24:24

be some interesting things . If

24:27

Elon Musk has the truck

24:29

striving themselves , what's going to happen with all the truck

24:31

drivers ? Maybe those are going to be some of our

24:33

future healthcare workers . But if you just look at some

24:36

of the math , this is why the staffing

24:38

shortage and why , I think , mark , we're seeing

24:40

which is my next category what

24:42

are the implications of the shortage . So

24:45

I think I had one , two , three , four , five articles

24:47

just painting the picture of the shortage the

24:50

USA Today article why do nurses

24:52

suffer from burnout , forced

24:54

overtime , understaffing and workplace

24:56

violence ? It feels like the shortage

24:59

is exacerbating in some pretty ugly

25:01

ways . Which is then the next category

25:03

the implications . So I

25:06

have certainly have never seen the level of unionization

25:08

and strikes in healthcare . And

25:10

so beckers or nurses of

25:12

ascension vote to unionize

25:15

hospitals . In Providence hospital

25:17

nurses set to strike , hca

25:20

workers strike at three hospitals in California

25:22

. So to me this is the implications of

25:25

the fact that they're just not enough people . Now

25:27

luckily and I only start to see this

25:29

about mid-year there's starting to be a third

25:31

sub-category

25:34

of potential solutions

25:36

. They had about six articles

25:38

in that category . So this one Mass

25:40

General Brigham Hospital workers to receive

25:43

average 21% raises , which

25:45

has got to be pretty tough

25:48

because that hospital is not

25:50

getting 21% increase in this revenue

25:52

. So that's coming from somewhere . You push the balloon

25:54

, the balloon pops out somewhere else . Home

25:58

health sector improving turnover rate continues , increasing

26:00

compensation . This

26:02

one hospice news breaking down costs , returning

26:05

an investment of hospice , death

26:07

doula partnerships and I put that under solutions

26:09

. We've been talking about this in our TCN

26:11

network mark . There may be disciplines

26:14

that do not exist in the interdisciplinary

26:16

team today , like maybe paramedicine

26:18

, maybe death doulas , maybe community

26:20

health workers , that we're going to have to figure out how

26:23

to weave that into the IDG because they're

26:25

just not going to be enough nurses , even if

26:27

you have the best place to work , which of course we encourage

26:29

a lot of people . We work with this

26:31

next one Home Health Souris Survey lower

26:34

turnover and widespread sign-on

26:36

bonuses . So that's part of their solution . Which

26:38

my early mentor who

26:40

you know marked my first CEO in hospice always

26:43

said the death nail of an organization

26:45

is when they start to have to pay people bonuses

26:47

to come to work for them . And

26:50

the day and time when I was seeing that was mostly

26:52

in the long-term care area . And

26:54

then there was an interesting article about the first 90 days

26:57

. What a medicine would be out of change

26:59

to retain new hires and really

27:01

working hard on that first impression in the

27:03

first 90 days . So that was

27:05

my second category and will continue

27:07

to be as a staffing challenge Now , right after

27:09

that one . I just

27:11

feel like I have to highlight this because I feel like it's so

27:14

wrong-headed . But the whole staffing

27:16

mandate in the nursing homes and there are

27:18

one , two , three , four , five , six , just

27:20

about seven , eight articles

27:22

about the staffing

27:24

mandate is not the solution . And

27:27

God bless their heart is the southern

27:29

term , bless the heart of our legislators

27:31

, because mandating a staffing solution

27:33

would be like me saying , well , I'm just going

27:35

to mandate , I could make , I should make a billion

27:38

dollars a year . I can mandate that all

27:40

day long , but it doesn't make it so , and

27:43

so it's interesting . There's an article that I think

27:45

it came out just yesterday and Mark and see if I could

27:47

find it here . But basically senators

27:50

are starting to get wise to the fact that this

27:52

is wrong-headed and they probably need to just

27:54

eliminate it . Yeah , here it is CMS

27:56

blocking nursing home staffing mandate . Senators

27:58

are getting behind it . It's gaining steam among

28:01

senators , and so mandating

28:03

staffing ratios is not going to fix the

28:05

fact that the volume of people that need care

28:07

does not match the volume of people that

28:10

exist today and are projected to

28:12

exist . And then there's some interesting

28:14

challenges in the nursing

28:16

schools and the med schools that are cranking

28:18

out our healthcare workers , that

28:20

there's a huge bottleneck there . And

28:23

then you get some really screwed up stuff , like you've

28:25

highlighted in past months Mark of where the

28:27

really fraudulent nursing diplomas were being

28:29

issued . So

28:32

that's my next category on staffing . Now

28:35

, third category , that are

28:37

or fourth category that keeps coming out I'll

28:40

just call it implications

28:42

or maybe warning sides to hospice

28:44

reimbursement . Some are good , some are

28:46

not so good , and so concurrent

28:48

hospice care improves quality and reduces

28:50

cost . So I think that's kind of an indication

28:52

of maybe eventually do we get a concurrent care model

28:55

. Hospice industry groups are

28:57

lobbying Congress to change CMS's

29:00

special focus program that

29:03

is concerning what got passed as far as the SFP

29:07

, because it

29:09

could take some people doing good work and

29:11

then put them on this special focus program

29:13

and it's not a place that you want to be and

29:19

you end up on that . You could get frequent surveys

29:21

and if you don't pass that survey your Medicare

29:24

license could be revoked . That's what we're talking about

29:26

here , kind of like game

29:28

over type stuff . Value

29:30

based payment models are driving nonprofit

29:32

hospice affiliations , which we'll

29:34

get to one of the other categories that you call

29:37

out as well , which is mergers and acquisitions

29:39

. We're seeing a lot more of that . All

29:42

Medicare beneficiaries and ACOs could

29:44

impact home based care providers . We

29:46

have a show coming out later this month with Bob

29:48

Tavari is on accountability

29:51

care and accountability care organizations . Daily

29:54

industry still in shock following the release

29:56

of the home health final rule which had that

29:58

SMFP . Medicare's

30:01

end of life model offers

30:03

a promise for care and savings . So

30:05

that's kind of on the positive side . There's been

30:07

some interesting studies we've highlighted this year , like

30:09

the NORC study , the

30:11

I forget the other acronyms like

30:14

the kneebrook study I know I'm not

30:16

getting it right , but they actually showed significant

30:18

savings in hospice and out of care

30:21

and NEEBER study that's the one I'm forgetting

30:23

NEBR study and

30:25

actually , even with very long length of stay

30:27

Alzheimer's patients , that study showed some

30:29

pretty significant savings . So

30:33

that's my fourth category . My next

30:35

category I kind of call

30:37

this one warning signs on the dashboard

30:39

that we just got to pay attention to

30:42

. And so hospital CFO

30:44

report hospital margins Interestingly

30:47

this one are holding steady , which is

30:49

a little bit better than what we're reporting most of the rest

30:51

of this year . We're going in the opposite direction

30:53

. This one says

30:55

not a viable industry in any

30:58

way . Nursing home operators

31:00

raise the alarm , which is

31:02

what you're alluding to . This next one

31:04

healthcare bankruptcies are rising

31:06

. Here are five major filing

31:08

so far in 2023 . That was pretty

31:10

eye-opening . This next one

31:12

pharmacy deserts are putting the health risk

31:14

of black and Latino Americans at risk

31:16

, as we're getting more and more of these deserts

31:19

pharmacy deserts , non-profit

31:22

hospitals . Financial outlook slightly

31:24

upgraded for 2024 . And

31:26

so we'll see if that actually holds true until

31:28

next year . Old nursing occupancy

31:31

tops 82% for the first time since

31:33

April of 2020 . So that one's a little

31:35

bit on the positive side . So I guess

31:37

if I would summarize this kind of lights

31:40

on the dashboard it's kind of some mixed signals

31:42

in this month Rule

31:44

, hospitals in crisis mode , so

31:47

that would balance . And then the next one I put in this category

31:49

, use cited or ready work , which is the ballot health

31:51

, and then really kind of calling out

31:53

this . It's really a sanction

31:56

. Monopoly is what it is , and now that

31:58

they're going back and looking at data , that

32:00

monopoly is not working out so well based

32:03

upon the quality data measures et cetera , all

32:05

right . This next category I'm starting to call

32:08

kind of demographic trends

32:10

. One is like the lights

32:12

on the dashboard of the people providing health care

32:14

. This is more where the trends of what

32:16

we're seeing , where things are going , and there are a lot of interesting

32:18

articles I've put in this category . More Caring

32:21

for aging parents doesn't have to be this

32:23

hard . You called that one out . You

32:25

think you're prepared to care for an aging parent

32:28

. Think again . Elder care

32:30

is a problem growing more urgent by the day

32:32

. Despite rent hikes

32:34

, senior living communities have become more

32:36

affordable than other residential

32:38

options . That one was kind of eye opening

32:40

why long-term care

32:43

, health insurance falls short for so many

32:45

people and then caregiving

32:47

comes with a lower death

32:49

risk but higher financial cost

32:51

. They had

32:53

an interesting article about enhancing dementia

32:55

care , and the new empowering caregivers is

32:58

basically called the guide model . I put

33:00

that because why that's coming out is because the huge

33:02

forecasted trend of more people

33:04

living with Alzheimer's and dementia how

33:07

family caregivers navigate the extra costs

33:09

of tending to loved ones . There

33:11

was a Kaiser family , a KFF article

33:14

facing financial ruin as cost

33:17

sore for elder care . This

33:20

was an interesting one . Us life expectancy

33:22

climbs in 2022 after

33:24

the COVID retreat , so

33:27

actually after that retraction

33:29

now life expectancy going back a little

33:31

bit . And then a

33:33

New York Times article when the neighbors are all

33:35

older too . I found some interesting

33:37

demographic stuff in there . And then

33:40

the last one was a nursing home care

33:42

continues to outpace most categories of

33:44

national health spending . So I baked

33:46

all that into interesting kind of demographic

33:48

trends et cetera . Next category

33:51

, mark . I actually call it basically

33:53

my innovation category

33:55

, if you will , just trying to keep an eye on some

33:57

interesting innovation . Arben University

34:00

receives a grant to expand telehealth services

34:02

across all of rural Alabama

34:04

, so that kind of an encouraging innovation

34:06

. This one was interesting

34:08

. Maybe after I get through it , mark , if you got

34:10

a comment on it . Amazon once inspired

34:13

fear in the healthcare industry

34:15

, but no longer . I thought that

34:17

was an interesting article . The

34:20

church home CEO in the future of managed

34:22

care and said fighting the market

34:24

is not a winning strategy was the subtitle

34:26

of that article . And then this is one that

34:28

jumped out of me . I did put that on an innovation because

34:30

I was kind of like damn , I wish I'd have thought of that . The

34:33

United Arab Emirates UAE's

34:36

first community powered hospice to

34:38

boost powder care in Abu Dubai and

34:41

I thought that's actually pretty smart . Cleveland Clinic

34:43

was one of the first ones to kind of diversify

34:45

and become a global healthcare provider . I've

34:49

never seen the date on what their margins

34:51

are out of there compared to their healthcare , their

34:53

American healthcare markets , but my

34:55

guess is that's the diversification strategy someone's

34:57

looking at . Also under

34:59

innovation , new VR training model

35:02

helps teach powder care providers

35:04

jolly good communication skills

35:06

. There's some really interesting stuff

35:08

that now that I keep seeing these articles on VR

35:11

. Talk to a peer who's writing

35:13

a book we might even have on a podcast

35:15

next year , mark you may have . You may know this . They're

35:18

prescribing VR in lieu

35:20

of opioid medications and getting good

35:22

outcomes , which is just fascinating

35:24

to me . Providers

35:26

are hitting obstacles to scaling powder

35:28

care . But in that article there's some interesting innovations

35:31

. And last was just art therapy program

35:33

using AI artificial intelligence generated

35:36

images . So that was my innovation

35:39

category . Then my seventh category I just

35:41

won't call these out , but there's just a lot of articles on

35:43

Medicare Advantage , as you know . Maybe

35:45

one of them I will actually call out , because

35:47

Papa was one that we highlighted early

35:49

as an innovation . Papa

35:53

started in South Florida . It's kind of an Uber

35:55

meets caregiver type

35:57

service , but Papa slated to

36:00

lose dozen more customers . It

36:02

became a darling of Medicare Advantage plans

36:04

but all of a sudden it's hit a lot of

36:06

interesting challenges . So I'll just put that under

36:09

the MA category .

36:10

Thank you to our TCN Talks sponsor

36:13

, Delta Care Rx .

36:15

is also the title sponsor for our May

36:18

and November 2023 leadership

36:20

immersion courses . is

36:23

primarily known as a national hospice

36:25

, PBM, and prescription

36:27

mail order company .

36:30

is a premier vendor of TCN and

36:32

provides not only pharmaceutical care

36:34

but also niche software

36:36

innovations that save their customers time

36:39

, stress and money . Thank you , ,

36:42

for all the great work end-of-life do in

36:44

and serious illness care

36:46

.

36:47

My next category is

36:50

basically all related to

36:52

basically

36:54

the mergers and acquisitions category , Forbes

36:57

, who really owns nursing homes and how the

36:59

feds are about to learn a whole lot

37:01

more and so the government is really

37:03

pushing on the private equity ownership

37:06

of nursing homes and kind of picking

37:09

on that as part of the problem . It's interesting

37:11

I talked to someone about this just this past week

37:13

. Mark and actually has grown up

37:15

their family owned a bunch of nursing homes and

37:18

he said the challenge is that okay , let's say

37:20

they say bad , bad business

37:22

, they just go incorporate somewhere

37:24

else and so it's kind of like you push the balloon

37:26

to come out somewhere else and so how do you really prevent

37:29

that American system as a capitalistic

37:31

system and can they really prevent that

37:33

? Or is this all grandstanding ? That

37:36

was kind of interesting . Modern

37:38

health care article and the mergers and acquisitions CMS

37:41

rule could prompt private

37:43

equity and reach to sell nursing

37:45

homes . Modern health

37:47

care , SIGNA and Humana and TOX

37:49

After I saw that mark it's like man

37:52

. That was almost predictable , I imagine if I

37:54

was Humana and SIGNA . I'm looking

37:56

at United thinking , well , how are we going to compete with United

37:58

? So do SIGNA and

38:00

Humana merge and does that pass the

38:03

whole ? You know

38:05

, antitrust and all that sort

38:07

of stuff . Of course , on this category

38:09

I put NHC and NHPCO as

38:12

well , the Virginia ones that you

38:14

called out also , and

38:16

then my last category almost

38:18

became a catchall . I'm kind of leaving it as my

38:20

flexible category and

38:22

just put some stuff that's interesting and

38:25

so , but this was about the pharmacy desert . Cvs

38:27

Formuses are at a breaking point in peerling

38:29

companies reinvention

38:31

plans , and so you know , I actually

38:34

spent some time on that last month . My users

38:36

didn't listen to it . I strongly advise you to go back and

38:38

we got some really good discussion around what's going

38:40

on with pharmacies . But there are two more articles

38:42

. Virginia pharmacies say low reimbursement

38:45

rates keep them struggling . Then a Washington

38:47

Post article which really can reiterate what you and

38:49

I talked about last month about

38:51

the US pharmacy industry is crumbling . Then

38:54

, also in this kind of catchall category , many

38:56

Americans with dementia can't get the

38:59

hospice care they need . Something

39:01

that I'm just wrestling with and I

39:03

think I need to do a couple more shows on

39:05

Alzheimer's and dementia mark is

39:07

hospice the best model for

39:10

dementia and Alzheimer's care , and

39:12

you've got the Neber study says we save

39:14

a lot of money . There's a

39:16

line from my podcast , mark with Joan

39:18

Tino , that just was like a brain tattoo and

39:21

she said the challenge of Alzheimer's and dementia

39:23

patients is that the decline is by

39:25

inches and I think that is

39:27

what makes it hard to fit within the hospice and powder care

39:29

model . I'm not saying it's not the right model

39:32

, but at least we're some discussion with

39:34

some really smart people . And

39:36

let's see , and the last one

39:38

, our dear friend Carol

39:41

Fisher , who's had best

39:43

in the United States , number one rated

39:45

podcast in the UK and the United

39:47

States about domestic violence called

39:50

the girlfriends . Well , interesting article

39:52

. Carol's like now peering her two loves

39:54

. She spent most of her career in hospice

39:56

and powder care but now this wildly successful

39:58

, almost unexpected podcast . So

40:01

the article was a silent epidemic domestic

40:03

violence and trauma among hospice

40:05

patients and staff . And it's interesting

40:08

because I've got a couple of team members have been super

40:11

just passionate about trauma , informed

40:13

workplaces and we've been bringing

40:15

a lot of tools to the hospices

40:18

we work with but for their teams to

40:20

basically have mental and emotional health tools

40:22

. But then Carol's actually shedding the light

40:24

on the people we're caring for . Many

40:26

of them have experienced horrible

40:29

stress and trauma in their lives via domestic abuse

40:31

. And then you get the confluence of that at

40:33

the end of life and what do you do about that ? And so it'd be

40:35

interesting to see kind of how Carol

40:37

kind of appears this platform

40:40

that she's kind of almost stumbled into as

40:42

we go forward . So those were all my mark

40:44

and I had no honorable mention

40:47

, but thank you . You actually

40:49

highlighted the release of my new book , the Anatomy of Leadership

40:51

. It's available now on Amazon . So

40:53

that's the only one I kind of put an honorable mention this month

40:55

, because everything else fit into those categories . Any

40:58

comments on any of those articles ?

41:02

Well , I think , on dementia

41:05

issues something

41:08

that's getting starting to get a little attention

41:11

and , you know , is

41:13

hospice the right form

41:15

of care or model of care ? But

41:17

the other half , you know , you have the

41:19

patient , but then you have the caregiver and

41:22

the impact on the caregiver the caregiver

41:24

is a

41:27

son or daughter who is still in the workforce

41:30

the impact on

41:32

their ability to continue in

41:34

their employment and continue

41:36

to make money , or do they have to

41:38

take early retirement or

41:40

a years long leave and deplete

41:43

their savings ? Then you

41:45

have the mental , physical , emotional

41:47

impact on the caregivers . So

41:49

you know , the advantage

41:51

that hospice has is it's

41:53

a model of care that incorporates

41:55

the entire family , everybody

41:58

who's part of the patient's

42:00

life , and

42:03

that's probably the right direction

42:05

to go . I don't know if it's the

42:07

right model , but it has

42:09

to be part of the direction

42:11

that we go when we figure out what to

42:13

do with the

42:15

best way to provide dementia care . It

42:17

has to incorporate the caregivers

42:20

at home or it will fail .

42:22

That is very well said , and you know the interesting

42:24

challenge . I actually have had a family situation by

42:26

Godfather and so my aunt has gone

42:29

through dementia , Alzheimer's

42:31

, and there are substandard

42:33

hospices out there and the first thing

42:36

of healthcare is first do no harm . If you

42:38

do not know what you're doing , from a pharmacotherapy

42:40

standpoint you could actually create

42:43

a worse situation , and so

42:45

it's not a

42:47

no brainer in how you clinically provide

42:49

. But God knows , most of the actual

42:52

support of the care model is absolutely to

42:54

the caregiver , and so I think

42:56

it's worth a discussion of some really smart people . The

42:58

good thing about the CMI article about

43:00

the guide model coming out it actually is keeping

43:03

the caregiver in mind and is actually

43:05

going much further upstream with an opportunity

43:07

to partner with home-based primary care

43:09

, palliative care . The interesting thing

43:11

we're kind of journeying right now is could you take some of the

43:13

excess capacity in hospice inpatient units

43:15

because there's a respite benefit in this guide

43:17

model and utilize ? But then

43:20

quite often right innovation doesn't

43:22

square with regulations , so would that

43:24

create legislative or just licensure

43:26

issues with hospice inpatient

43:28

units ? Mark before we go .

43:30

I just want to jump in on that too . I

43:33

think the issue is going to get more

43:35

play , at least

43:37

in December , because of what Chevrolet

43:40

has done . They produced

43:42

in-house , by the way , without an ad

43:44

agency , and incredibly

43:46

moving Five-minute

43:49

and 20-some-odd second commercial

43:51

about a family at

43:54

the holidays where the matriarch

43:56

of the family has dementia

43:58

and what a granddaughter

44:01

does to give

44:03

her a good day , and you

44:06

can't watch that commercial without getting

44:08

emotional at best or crying

44:10

yeah .

44:13

But I saw it , mark , I thought I like that's

44:15

a hospice mission moment is what it felt like . Yeah

44:17

.

44:18

And that ad is so well done and

44:20

it moves so many people that at least

44:23

in the dementia care , post-acute

44:26

care , end-of-life care segments

44:28

of social media , it is blowing up the

44:30

internet and I think

44:33

that's a good thing in this case , so that , well

44:35

, you know , it's things like that that

44:37

help move the needle on a question

44:39

like what do we do about

44:41

dementia care ? Yeah , that's great .

44:44

Well , mark , before we go , I definitely want

44:46

to first off , I want to thank you . I

44:49

have such a deep appreciation for you and what you've

44:51

done in hospice news today , waking

44:54

up four and three o'clock in the morning to produce

44:56

a service to hospice and healthcare leaders

44:58

, and so , thank you , you're welcome . You're

45:00

segwaying and you've got a plan and

45:03

the cool thing is you're not going to keep doing these podcasts

45:05

in next year . But you want to talk about what your plan is ? Yeah

45:07

, sure .

45:09

Well , it was a fun year to talk

45:11

about media coverage in hospice

45:13

and I appreciate the opportunity and

45:15

appreciate the opportunity to

45:17

spend this time with you every month . I've

45:21

been publishing hospice news today in one form

45:23

or another since October of 2012

45:26

. And it's a labor of love

45:28

, but it is a labor and

45:30

I've decided to scale

45:33

back , and so I announced

45:35

a year ago that I was going to cease publication

45:38

, and about a half a dozen

45:40

parties contacted me , some

45:43

more serious than others , about what it would take

45:45

to pick it up , and the

45:48

winner of the sweepstakes was

45:50

court Casner , phd , the

45:54

brains and the number cruncher behind

45:56

hospice analytics . He

46:00

was one of my first paid subscribers

46:02

to hospice news today and a fan

46:04

for a long time , and he's figured

46:06

out a way to move the newsletter

46:08

forward . It will change , it

46:11

will evolve , the

46:13

subscription model will change , but

46:15

I'm excited about his plans for it . He's

46:18

been incredibly thoughtful . We've been working

46:20

behind the scenes really

46:22

since about September , maybe

46:24

even late August , on this transition

46:26

and come January one

46:29

he will become the publisher of what

46:31

he's going to call hospice and palliative care

46:33

news today , and

46:36

it's going to be both a newsletter

46:38

and a website . He'll be bringing

46:40

on an editor , who will

46:42

be named in another week or two , and

46:46

I think it'll be exciting for folks . I

46:48

think the readership will expand because

46:50

of the way he's going to handle the subscription

46:52

model and for me I

46:55

get back six to eight hours a day

46:57

that I seven days a week . So

46:59

I'm looking forward to continuing to doing my

47:01

work of providing strategic

47:04

communications consulting to a

47:07

handful of hospice providers and

47:10

a couple of vendors who serve

47:12

mostly not-for-profit

47:14

hospice providers . So wouldn't mind

47:16

picking up another couple clients , given

47:18

the extra time I'll have .

47:22

And that would be like getting master class all of the time . So

47:24

just a plug from work on that .

47:27

And you know what a lot of people do is they hire me to mentor

47:29

the young communicator

47:33

who's the sole communicator

47:35

on their staff , and that's a lot of fun for me

47:37

and it's always a learning experience

47:39

for the 25-year-old

47:43

that I'm working with , and we

47:45

have an impact on the

47:47

public image and the public messaging

47:49

of the hospice providers when we do that almost

47:51

immediately . So it's a high

47:53

impact and engaging

47:56

and fun and

47:58

something I look forward to continuing to do

48:00

for several more years .

48:02

Well , my wife will not watch a movie

48:04

if there's not a happy ending , and I feel like we

48:06

have a cool happy ending , as this is our last show

48:09

of 23 . Because you've got a

48:11

great plan I love . Court till last is actually

48:13

going to be partnering with court in his newsletter . We're

48:15

going to be one of the first advertisers in it , when

48:17

I first knew that you were retiring . Now

48:19

you get to take your great work . It's going

48:21

to evolve , it's going to be a new

48:24

version . It's going to keep serving leaders

48:26

. You get to keep doing your great work . You and I

48:28

get to keep doing this wonderful podcast . It's

48:30

all awesome . It's all a good happy ending

48:32

.

48:33

I agree it's great .

48:35

All right , Mark , we appreciate you and thank you for your

48:37

work that you continue to do and we'll continue to

48:39

do , and thank you for your many years of service

48:41

and our listeners we do thank you . This

48:44

is Mark and I's final new story of the month , but we'll

48:46

have a couple of other podcasts this month that we'll be releasing

48:48

, as we always do . I actually ran this

48:50

quote by Mark and this feels very appropriate

48:53

. It's from one of my favorite leadership

48:55

authors , John Maxwell . He said that leader is

48:58

one who knows the way , goes

49:00

the way and shows the way . Thanks

49:02

for listening to TCNtalks .