0:02

Welcome to TCN Talks . The

0:04

goal of our podcast is to provide

0:07

concise and relevant information

0:09

for busy hospice and palliative

0:11

care leaders and staff . We

0:14

understand your busy schedules and believe

0:16

that brevity signals respect

0:19

. And now here's

0:21

our host , chris .

0:23

Como . Well , hello and welcome

0:25

to TCN Talks . This is my favorite

0:28

time of the month , although this is actually kind

0:30

of a pivot show and this

0:32

show will be airing in February . But it's

0:34

a first because Mark and I this is the

0:36

first time we're doing the show where

0:38

Mark's no longer publishing hospice news

0:40

today . So welcome , mark Cohen , welcome back

0:42

. Thanks , chris , it's always great

0:44

to be here . Well , mark , this is fine

0:46

. This is man . You have like a whole month

0:48

where you're not waking up at 3

0:51

am in the morning and

0:53

I just want to commend you again . Like you know

0:55

, I was kind of complaining to my wife about

0:57

like this is the hardest show to prepare for

0:59

. We're going through so many articles

1:02

and just making sure you know what should

1:04

hospice leaders hopefully not miss

1:06

. And then I think what am I complaining

1:08

about ? Mark would wake up at 3 o'clock in the morning every

1:10

day of the week to produce hospice

1:13

news today . So I have nothing

1:15

to complain about .

1:16

Yeah Well , it's good to be getting up at 6 in

1:18

the morning , good deal . Well , mark , you

1:20

want to go ahead and go first ?

1:22

Sure .

1:24

You know it's great to be here on TCN Talks

1:26

, talk about Hospice and the broader post-acute

1:28

sector , how the media are

1:30

covering them and what hot issues might be lurking

1:32

on the horizon , even

1:35

though I'm not publishing hospice news

1:37

today anymore . Like

1:39

most January's , this past month

1:41

got off to a relatively slow start in

1:44

terms of hospice coverage , but it was an exciting

1:46

month nonetheless , because I published

1:48

my last edition of Hospice News today on

1:50

December 31 . And our friends

1:53

Court Castner and Joy Berger began

1:55

publication on January 1

1:57

of their successor publication

1:59

, hospice Impalative Care Today

2:02

. While remaining true to my

2:04

mission with Hospice News today , court and Joy

2:06

have made a number of significant

2:08

changes to the newsletter . They still

2:10

publish a daily newsletter , one that hits

2:12

readers inboxes at 6 am Eastern

2:15

, seven days a week , but they also

2:17

have an interactive website that hosts the content

2:19

and that will grow in functionality

2:21

over the months ahead . Unlike

2:25

Hospice News today , which was a subscriber-only

2:27

model with no advertising , court

2:30

and Joy have switched to an advertiser-supported

2:32

model and free subscriptions . So

2:35

anybody listening to this podcast

2:37

if you're not already signed up for

2:39

a free subscription to Hospice Impalative

2:42

Care Today , go to

2:44

HospicePalativeCareTodaycom

2:46

All one word , hospicepalativecaretodaycom

2:49

and get your free subscription right

2:51

now and while you're

2:53

probably too modest , chris , I won't be shy in

2:55

informing listeners of PCN Talks

2:57

that TELIAWS Collaborative

2:59

Network is an inaugural sponsor

3:01

of Hospice Impalative Care Today

3:04

. Thank you , chris , thank you TELIAWS

3:06

, absolutely . And for any vendors

3:08

, networks or providers

3:11

looking to get in front of a growing daily

3:13

audience of Hospice decision-makers

3:15

already more than 1,000 strong

3:18

after a month go to the website

3:20

and click on the Sponsors tab and

3:23

Court will be happy to talk to you about

3:25

how you can advertise on

3:27

the website and in the newsletter . Well

3:31

, so much for the commercial . Now back to our regular programming

3:34

. Except , of course , since I'm no longer

3:36

diving headlong into Hospice Media

3:38

coverage all day long . We'll

3:41

be looking at things differently and , hope , a

3:43

more compelling way this

3:45

year . First , some simple metrics

3:47

. The Hospice ImpalativeCare Today platform

3:50

provides us with a variety of

3:52

metrics and we have to give a hat

3:54

tip to Court and Joy for sharing their analytics

3:56

with you and with me for

3:58

use on these podcasts . Court

4:00

and Joy are using a somewhat different categorization

4:04

scheme than I use for the articles

4:07

they run , but looking just at categories

4:09

, these are the broad subjects

4:12

that got the most

4:19

clicks in January . On the new

4:21

Hospice ImpalativeCare Today . Readers

4:24

clicked through on 34,000 items

4:26

in January , the top six categories

4:29

were Provider News with

4:31

7,600 clicks . Clinical

4:33

News with 4,100

4:35

clicks . That included medical marijuana

4:37

, pharmacy issues , end of

4:39

life , doulas , grief and

4:42

similar topics . Palliativecare

4:45

Provider News , which

4:47

had 2,500 clicks . Research

4:49

News with 1,600 clicks . General

4:52

Hospice News at 1,200

4:54

clicks . And Post-Acute News

4:56

at 1,000 clicks

4:58

. Court

5:01

and Joy are running a daily encouragement , each

5:03

day , an inspiring thought , which

5:06

is very much in the spirit of the quotes

5:08

that you use , chris , to close each

5:10

podcast . That category

5:12

garnered 4,000 clicks in January

5:15

, which was 12% of all

5:17

clicks on Hospice ImpalativeCare

5:19

Today . That's a huge number . That's

5:22

pretty cool . Yeah , I mean that's just a huge

5:24

number and I think it speaks to the fact that

5:27

hospice leaders who are interested in scanning

5:30

the environment

5:34

are also looking for ways to

5:36

motivate , to inspire , to encourage

5:38

themselves as well as those with

5:40

whom they work . The analytics

5:42

also allow us to look at the individual articles

5:44

that gained the most clicks in January and

5:47

, considering the newsletter didn't reach 1,000

5:49

subscribers until about a week

5:51

to go in January , the numbers associated

5:54

with the top view most viewed

5:56

articles are simply astounding

5:58

. The most popular

6:01

article from the

6:03

political newspaper Politico

6:05

was headline federal scientists

6:08

conclude there is credible evidence for

6:10

certain medical uses of marijuana . That at

6:12

811 clicks . Second

6:15

place , cdc map shows

6:17

dramatic increase in illness nationwide

6:19

. See where it's worse . That at 807

6:22

clicks , and that was also from a

6:24

political newspaper , politico

6:27

, the Hill . Third place

6:29

was a blog post from the blog

6:31

Kevin MD , titled Rosalind

6:34

Carter's impact on caregivers

6:36

770 clicks

6:38

, and there was a bit of a drop off , but

6:40

not that much . Care planning issues top

6:43

lists of hospice survey

6:45

deficiencies 480 clicks

6:47

for that hospice news article

6:49

. Advanced care planning

6:51

reaches underserved

6:54

across us from hospice

6:56

foundation of america and

6:58

you can complain about it or lean in top

7:01

home . Health leaders brace for 2024

7:04

. That at 474 clicks and

7:06

ran originally in home health care news and

7:09

the last one on on

7:11

this list top five hidden gem palliative

7:14

care news stories from 2023

7:16

, which ran in hospice news and

7:18

had 434 clicks on

7:21

the hospice and palliative care today website

7:24

. It's worth noting

7:26

, I think christa two of the seven most clicked on

7:28

articles originated in

7:30

political publications , and

7:32

that the third most clicked on item

7:35

was from a blog , and then only three

7:37

of the seven most popular

7:39

items were actually published in widely

7:41

read trade publications . So

7:44

why is that ? It might be because

7:46

lots of readers also subscribe to

7:48

those trade papers , their daily

7:50

or weekly newsletters , and they'd already seen

7:53

the articles . It might be because

7:55

hospice leaders and decision makers are

7:58

following public policy issues more

8:00

closely these days probably

8:02

a little bit of both actually ignoring

8:05

the roadmap provided by

8:08

the hospice and palliative care today analytics . My observations from

8:11

my perspective on messaging

8:13

, public relations and issues management

8:16

, you know , includes the following m&a

8:20

news declined in coverage in january

8:22

, which is to be expected with the end of the year . Slowdown in

8:25

transactions like that , nobody , very

8:28

few people , want to be doing due diligence on christmas eve . Negative

8:33

coverage of skilled nursing facilities and their various problems continued

8:35

unabated in

8:38

january and we have to realize or accept

8:40

that at some point and to some degree , that stain

8:46

from skilled nursing is going to spread throughout

8:48

the care continuum .

8:48

Thank you to our

8:51

tcn talk sponsor , delta

8:53

care rx . Delta care rx is also the title

8:55

sponsor for our april and november

8:59

2024 leadership

9:02

immersion courses . Delta care rx is primarily known as a national hospice

9:04

, pbm

9:07

and prescription mail order company . Delta

9:10

care rx is a premier vendor of tcn and provides not only

9:14

pharmaceutical care but also

9:16

niche software innovations that save their customers time , stress and

9:21

money . Thank you , delta care rx , for all the great

9:23

work you do in the end of life and serious

9:27

illness care .

9:27

Coverage of medical aid and dying came roaring back in january after a very slow

9:32

fourth quarter , both in terms of news about renewed legislative

9:34

initiatives and a handful of

9:38

states , as well as opinion pieces , mostly in those states

9:40

that were both pro and con on the subject

9:44

. The legislation appears

9:46

to be moving this election year in mariland , minnesota and new hampshire

9:51

moving quickly , particularly in minnesota so far

9:53

, and colorado is looking to join vermont

9:57

in origan and liberalizing

10:00

its medical aid and dying laws , something that the anti

10:02

forces one

10:06

would happen once , uh medical aid and dying was legalized

10:08

, advocates would come back and liberalize

10:13

and liberalize and liberalize . Hospital troubles

10:15

are not going away congressional

10:17

scrutiny of what happens when private equity acquires

10:19

a local hospital , tenet

10:24

continuing to shrink its network , with announced hospital sales in south

10:26

carolina and

10:29

orange county california . And steward , which was once considered

10:31

a gold standard from

10:35

a mid-sized for-profit hospital chain , appears to be in

10:37

dire financial straits , if you believe

10:41

the reporting in the boston globe

10:43

and other sources , and is actually a very large uh and is actually

10:45

threatening to close four hospitals

10:47

in massachusetts , which would have

10:49

a huge impact on

10:52

the hospital sector throughout the state

10:54

, uh , and on the hospice side

10:56

. One of the most troubling stories , in my opinion

10:58

, comes out of michigan , where maclaren

11:01

hospital announced at the end of jinguary

11:03

it was closing a tailand cottage

11:05

hospice house in patoski , michigan

11:08

its second such closure in just

11:10

a few months of a local hospice

11:12

house . And what makes the story troubling

11:15

is that when maclaren announced it was

11:17

closing its first hospice house in

11:19

shabuygan , michigan , the patoski

11:21

community rallied to support

11:24

the highland cottage uh and sought

11:26

assurances from maclaren that

11:28

it wouldn't shut highland . Both of these houses

11:30

, while owned by the

11:33

hospital's hospital , were

11:35

, were built largely with donations

11:38

from the community . The community

11:40

in patoski was

11:42

vocal , maclaren was

11:44

basically silent . It's

11:46

a good lesson in how a provider should

11:48

not manage a crisis situation

11:51

or a potential crisis situation . So

11:54

that's my , my thought , a little bit of

11:56

quantitative , a little bit of qualitative on

11:59

the month I know we want to look at , do

12:01

some prospecting ahead for 2024

12:04

later on , but um , back

12:06

to you to talk about your view well

12:08

, great job , first off , because I mean that was a , that was

12:10

a pivot for you .

12:11

I mean , instead of , like you know , you're curating

12:13

every morning and so kudos , I like the

12:15

way you actually did that and getting for

12:17

if you have any new listeners to the show . You

12:20

know mark and I are kind of a yin and yang . Mark does

12:22

it from the perspective of um

12:24

, what would you say , mark , from a ? A publicist

12:27

, long time incredible marketing

12:29

messaging experience . Would you edit that on

12:32

?

12:32

somebody who's been doing um a

12:35

news monitoring literally my entire career

12:37

in public relations .

12:39

Thank you , and in fact that's probably the most important part

12:41

that I left out . And then my goal is try

12:43

to do it from a c-suite perspective and , um

12:46

, in my hats , off to to court

12:48

. Enjoy , I mean , mark , you

12:50

know every great leader right wants people

12:52

to pick up where we leave off and

12:54

do even better . They've had a pretty

12:56

dang good first month of you

12:58

know from picking up impressive , yeah

13:01

, really impressive . Just kudos to both of them doing

13:04

what I do . They've actually made my job a little

13:06

bit easier , and part of it is I'm finally

13:08

getting competent at this , now that you know I've been doing it

13:10

a year , but my curating time

13:13

because the way they do it in their

13:15

technology has made it a little bit simpler for

13:17

me , and also now I have a template

13:19

, which you alluded . That's where we're going to go next and a lot

13:21

of people do like their prognostications . In

13:23

december , we thought you know you , and

13:25

I thought it'd be interesting to do it in our

13:27

first show , reviewing january . So we're going

13:29

to go there in a second . So these are . I

13:31

flagged 85 articles and what I'm

13:33

finding now is my categories are staying very

13:35

similar and , interestingly , this category is

13:37

going to have a lot to do with my prognostication

13:39

. So the first category I just call mission

13:42

moments , which to me is just preserving the

13:44

essence of what hospice is , and

13:47

so there's several great articles . Um

13:49

, the first one this one actually was in the uk , a

13:51

smile in the sky drawn for a warchester

13:54

hospice patient , and basically a

13:56

pilot drew a sky , sky

13:59

high smile , um , above

14:01

st richards hospice , and so I thought that was actually

14:03

pretty , pretty amazing hospice

14:06

. So I'm going to continue with hospice mission moments . Hospice

14:08

nurse shares the unexplained

14:10

experience with a patient that changed her

14:12

view on death and dying , and this

14:14

is about nurse julie Mark

14:17

. I can remember being in old National Hospice

14:19

Work Group meetings and I remember

14:21

I was kind of the young , provocative one and I

14:23

said can you imagine a reality TV

14:25

show changing the perception of death and dying

14:28

? And people are like oh wow , that's an amazing

14:30

idea . Well , now you got like Nurse

14:32

Hadley , nurse Julie , that

14:34

are literally putting things out in

14:36

social media channels that are , it

14:38

is actually moving the needle on people's

14:41

perception of death and dying and kind of removing

14:43

the stigma and the fear

14:45

. So that was a great call out . I think Nurse

14:47

Julie has something like over a million followers

14:50

and Nurse Hadley like half a million , and

14:52

so this young generation

14:54

is using social media in an amazing

14:57

way . So back to the mission moments

14:59

. This was a beautiful one . Musician mom 31

15:01

, enters hospice in final days , writes

15:03

a song for her young son my

15:06

art is all I have to leave behind was

15:09

kind of the title and

15:11

her name was Cat Janice and the song was

15:13

Dance you Out of my Head , which

15:15

she wrote for her seven-year-old son , and that

15:17

went viral . So another beautiful

15:19

way of helping really

15:21

impact people on what this amazing

15:24

essence of great hospice care looks like

15:26

, of course , always because of the quarters

15:28

. There was another great article about Rosalind

15:30

Carter , about her impact

15:33

on caregivers , and then there's

15:35

one gentle endings lessons learned

15:37

in hospice for those without a home . This

15:40

actually was about the in-between in Salt Lake

15:42

City , utah . Really cool thing about

15:44

that mark . And so when we started Tilly

15:46

Ass , our team said you know , it's always awkward

15:49

in the office to go , well , do I get a gift for that person

15:51

? We said you know what ? Let's take that off the table . Every

15:53

year we're going to pick a nonprofit that we choose as an

15:55

organization and instead of giving gifts to each other

15:58

, we actually get together and try to make

16:00

a bigger impact on the world . So that's

16:02

the organization that Tilly Ass's team chose

16:04

this year called the in-between , and

16:06

the cool thing is we actually had a matching grant this

16:09

year , so we made a really nice gift to

16:11

them , and so that was just a great article

16:13

. And so the in-between is a hospice

16:15

residence for people that are homeless . So

16:17

really cool mission moment . And then

16:19

our friends at Carolina Caring hospice patient

16:22

enjoys fishing adventure . My

16:24

very first hospice moment at 25

16:27

in Pensacola was

16:29

a very similar circumstance , so that one literally

16:31

almost moved me to tears and kind of brought me

16:33

back to my very early days of kind of falling

16:35

in love in this work that we do and

16:37

let's see here . Powder of medicine this

16:40

is kind of cool in a different way . Powder of medicine

16:43

this was out of atrium health . Palliative

16:46

medicine helps us stage four melanoma

16:49

survivor , reclaim life after

16:51

treatment . So there's a really great article

16:53

, the power of powder care . And

16:56

then high impact articles , core role

16:58

and responsibilities of physicians and hospice

17:00

care , a statement buy in for

17:02

US hospice and powder care positions , our

17:05

good friend journal of powder medicine by Ira

17:07

Bayak and other hospice and powder care physicians

17:10

concerned about hospice care and

17:12

, of course , dr Bayak . Actually

17:14

that was one of our last shows of last year . Actually

17:17

it was a great show , and so I just want to call

17:19

that article out . And then just last

17:21

one in the mission moment . This was really cool

17:24

. It was in psychology today , how

17:26

to live , what the dying tell us , and

17:28

there were five key points in that article . Number

17:30

one , and this is wisdom , I think for all

17:32

of us and , I feel , sometimes those of us

17:34

that are so close to hospice and powder care . Maybe

17:37

we're so close and we forget this wisdom , which is

17:39

why I wanted to call it out . Number one I

17:41

wish I had the courage to live a life true

17:43

to myself , not the life others expected

17:45

of me . Number two I wish

17:48

I hadn't worked so hard you

17:50

and I I don't know what we say about that one . Number

17:53

three I wish I had the courage

17:55

to express my feelings . Number

17:57

four I wish I'd stayed in touch with my

17:59

friends . And number five I wish

18:02

I'd let myself be happier . That was a really

18:04

cool article . So that was my first

18:06

category . Next category was

18:08

I call it , hospice reimbursement

18:11

challenges warning signs , implications

18:13

. So there was an article in Home Health News about

18:16

in-home care providers await updates on

18:18

CMS's Medicaid proposal begin

18:20

preparing for the 80-20 role . I

18:23

actually think this is a cool idea , mark , so

18:25

effectively . It's basically

18:27

kind of capping , like 80% of your

18:29

money needs to go to care , so capping

18:31

the 20% is left over maybe

18:33

for overhead and margin . That's an interesting

18:36

approach and there's something

18:38

very similar that you probably know and probably the insurer

18:40

kind of Medicare Advantage world , and

18:42

so I want to call that out . That might be an interesting

18:45

tactic or toolbox we could kind of throw

18:47

out as we think about future reimbursement design

18:49

, et cetera . Next one was evaluation

18:51

of the Medicare Care Choices Model , mccm

18:54

the final report and so it was actually

18:56

talking about some of the positive outcomes

18:58

from the MCCM , which was more of a concurrent

19:00

care model . And then

19:02

again keeping under reimbursement

19:05

46% of C-suite executives

19:07

in healthcare . So this comes out of beckers

19:09

are prioritizing cost reduction

19:12

. You're going to see . We're going to bring that back

19:14

to themes I'm predicting for this year . The

19:17

next one this is Home Health Care News . Home Health

19:19

Benefit will become a skeleton if Medicare payment

19:21

adjustments continue industry leader

19:23

cautions . And then next

19:25

one MedPak approves hospital

19:28

physician pay bump , doubles

19:30

down on post-acute cuts , and

19:33

so MedPak is basically recommending

19:35

cuts for the post-acute

19:37

realm for 2025 , but pay

19:39

raises for hospitals and

19:41

physicians , which I don't disagree with the physicians

19:43

. But if the future is healthcare in the home , that's

19:46

kind of an interesting one . And so of

19:48

course , medpak has a lot of methodologies by which

19:50

they do what they do . Next

19:52

, and out of Home Care News , surveys

19:54

show 2024 to be

19:56

the year of efficiency for care at home

19:59

organizations , so it feels like we got

20:01

some early warning signs that 2024

20:03

is going to be a cost-cutting year for many

20:05

healthcare industries . And again another

20:07

one MedPak votes to recommend home health payment

20:10

cut and hospice update to freeze

20:12

. So that's kind of even further down in the

20:14

weeds on that MedPak recommendation

20:16

. And then last one and you called this one

20:18

out , mark care planning issues top

20:20

list of hospice survey deficiencies

20:22

, and so that was in an article in

20:24

Hospice News . So my next

20:27

category is Medicare

20:29

Advantage . So these first ones I say are implications

20:31

to hospice reimbursement . Always put Medicare

20:33

Advantage under that as kind of a sub point , because

20:36

we know Medicare Advantage is going to have a lot

20:38

of interesting implications to reimbursement

20:40

in the future . So all of these are

20:42

really interesting , mark . In October

20:45

I started to pick up on negativity

20:49

towards Medicare Advantage , yeah

20:53

, so here's the first one has Medicare Advantage lost

20:55

its luster ? This was in Becker's . Next

20:58

one , denied by artificial intelligence

21:00

, denied by AI how Medicare

21:02

Advantage plans use algorithms to

21:04

cut care off for seniors in need

21:06

, and so that was a pretty big

21:08

article . And then here's

21:11

a blockbuster the government is expected to

21:13

pay Medicare Advantage plans 88 billion

21:16

more than it paid for fee for service

21:18

in 2024 . This is going

21:20

to get to a prediction I'm going to have a little bit later for

21:22

a theme this year , and this MedPak

21:25

report was released shortly after

21:27

UnitedHealthcare Group reported a $22

21:29

billion in profit in 2023

21:32

, almost 15% revenue jump

21:34

. Then a couple more under that theme

21:36

Will we close the Medicare

21:38

Advantage primary gap in 2024

21:40

? That was in MedCity News , this

21:43

one was in McKnight's . As denials climb

21:46

, medpak approves recommendations

21:48

for managed care oversight and

21:51

then a KFF article . Older

21:54

Americans say that they feel trapped

21:56

in Medicare Advantage plans and

21:58

I promise you I'm not just trying to pick out . I've

22:01

seen more mounting volume of these . This

22:04

one was interesting Mark in Houston , memorial

22:06

Hermann drops humana Medicare

22:08

Advantage . I think some healthcare

22:10

people are kind of drawn in line and saying it's

22:12

just not worth it , which is interesting . It

22:14

is kind of a pushback , some

22:17

pushback . Wall Street Journal .

22:20

Five years ago , you never would have seen

22:22

a negative story about Medicare Advantage

22:25

. It was all . This is where the future

22:27

is going , and every provider

22:29

needs to jump on this train before

22:31

it leaves the station . And

22:35

the Medicare Advantage providers had

22:37

this great head start and

22:40

they haven't managed it as well as they could

22:42

have , and now they're dealing with a

22:44

less than favorable environment , at least

22:46

from

22:48

some perspectives political

22:50

and media , as well as

22:52

consumer .

22:53

Well said . Next one Wall Street

22:55

Journal Exclusive Signed and Neers Deal

22:58

to Offload Its Medicare Business , so that's

23:00

kind of interesting . And then last

23:02

one , swarma CMS Report

23:04

, evaluation of Phase 2 of

23:07

the Medicare Advantage Value-Based Insurance

23:09

Design , as we all know as VBID as the acronym

23:11

Model Test . First three years of implementation

23:14

. The executive summary is Mixed Results

23:16

, and so that's the summary on

23:18

that one . And then there was an

23:20

article that was the 10 biggest Medicare Advantage

23:22

Stories in 2023

23:25

, but I'm not going to regurgitate it because it really is

23:27

a lot of similar . So by next

23:29

category , I just say competition , to

23:31

be aware of . As we know we go forward , there's

23:33

so many different flavors of competition

23:35

coming towards hospice powder care programs

23:38

. So the first one Medicare certifies

23:40

hospices in California in spite

23:42

or despite the state ban on

23:45

new licenses , and so that was an

23:47

Ava Kauffman article , and we know that Ava

23:49

Shure has created a lot of interesting year for

23:51

us in 2023 with their exposes

23:53

, especially at some of these fraudulent hospices

23:56

. Next one

23:58

Best Buy Health Plans Bigger

24:00

Healthcare Presence in 2024 . That

24:03

was an article , and they're actually partnering with Atrium

24:06

to talk

24:08

about more hospital-level care at home . This

24:11

next article Acute Hospital Care

24:13

at Home Data Release Fact Sheet . So

24:15

this is just some data around hospital at

24:17

home . And then this next category

24:20

, again all in the spirit of competition , but

24:22

this one more in the M&A , merger and Acquisition

24:24

Realm PE firms

24:26

adapting hospice roll-up strategies

24:28

. I just was at Home Care 100 a couple

24:31

of weeks ago . Definitely saw a lot

24:33

of that . So private equity firms in the

24:35

hospice space are adapting their roll-up strategies

24:37

as economic uncertainties

24:40

persist . Next one is Scientific

24:42

American . Hospice providers must be

24:44

better regulated . Too many hospice

24:46

providers in the US are run by private equity

24:48

and for-profit corporations . So again

24:51

, that's a theme I'm going to call out that I don't think

24:53

is going to go away , and I don't think that's a bad thing

24:55

that it doesn't go away . Kff

24:57

, to Tackle Financial Distress . Hospitals

25:00

and Health Systems Are Turning to

25:02

Mergers , which again , mark , I think is

25:04

going to get to some of UNI's predictions

25:06

. Our sponsor of

25:08

this show , stateserve , announces

25:10

acquisition of DeltaCareRx . So

25:12

StateServe and DeltaCareRx are coming together

25:14

and they have some future innovations envisioned

25:17

, as you can bring those two ancillary service

25:19

offerings together this

25:21

one in hospice news to affiliate or

25:23

acquire trends in non-profit

25:26

hospice consolidation . So certainly

25:28

our readers are hearing trends here and

25:30

then this was in Med City News

25:32

St Luke's Merger will be the first of many

25:34

M&A deals in the hospital sector

25:36

this year . And

25:38

then the last one in this section , bright

25:41

Spring Health files to go public

25:43

for the second time . Bright Spring

25:45

Health Services officially filed plans for an initial

25:47

public offering , human , the

25:49

home and community-based service provider

25:51

. First planned to go public in 2021

25:54

but decided against it . Now they're going full speed

25:56

ahead . So then my

25:58

next category , mark , is workforce challenges

26:00

, and then I always have three sub

26:02

stratifications under that . The first one is these

26:05

articles paint the picture of the issues . I had several

26:07

there . Policymakers and providers

26:09

must take steps to prevent staff

26:11

mass turnover . Researchers

26:13

say that was a McKnight's article . And

26:16

then another McKnight's article healthcare , ranked

26:18

second among industries with workers

26:20

frustrated by low pay . And

26:23

then another interesting one danger

26:25

on the job . Workers suffer the most

26:27

injuries . In these top 25

26:30

jobs , unfortunately , healthcare had

26:32

number three , number five , number six , number

26:34

10 , number 11 , number 20 , number

26:36

23 and number 24 . And

26:39

four is the top 25 areas

26:41

for most injuries on the job . And

26:43

then the last one in that first category profound financial

26:45

workforce challenges persist for

26:47

senior living providers as 2024

26:50

begins . My next category

26:52

under staffing challenges , say these are

26:54

like the implications of the staffing

26:56

issue . And so CMS confirms

26:59

nursing home staffing ratios to finalize

27:01

this year that whole issue of well

27:03

, the government's going to mandate . We fixed

27:05

the problem but yet there's this huge outcry

27:07

because 85% of nursing homes cannot comply

27:10

with the staffing mandate . And so

27:12

our Dr Bayak and I debated that a little

27:14

bit because he was talking about staffing

27:17

ratios and I think we could learn a lesson . But

27:19

I also don't think it's throwing the baby out with the bathwater

27:22

, but just there kind of one

27:24

size fits all approach for the nursing home , I think

27:26

is a good caution for us . And

27:28

then this is the last category . These are the ones that

27:30

give me hope , mark and I noticed as we

27:32

look through the room here at 2023 , I start to see

27:34

more and more articles of the solutions

27:37

to the staffing challenge . So that's my third

27:39

subcategory . Under staffing , new

27:41

grant funded healthcare . High schools aim

27:43

to help address North Carolina staffing shortages

27:46

. That was a really great article . Another

27:48

one home based leaders are focusing on culture

27:50

, creative benefits to mitigate staffing

27:52

challenges . And then under

27:55

this was in the US

27:57

News and World Report , best

27:59

healthcare jobs in 2024 . Hopefully

28:01

that mitigated those top injury jobs . And

28:04

then this next one was sleep pods

28:07

, coffee bars and co-working

28:09

spaces . Hospital staff lounges

28:11

get a makeover and so kind of taken

28:13

a page from Silicon Valley and

28:15

how that's actually coming to staff lounges in healthcare

28:18

. And then this

28:20

one titled a not so silent

28:22

battle tackling nursing burnout

28:24

with innovative solutions . And

28:26

then interesting is sub points in that

28:28

article the need for innovation , mobile

28:30

communication for patient care , education

28:32

, training , the role of clinical scorecards All

28:35

right . The next one is work college students

28:37

with ideas of how to promote senior living

28:39

careers to younger generation , some

28:41

really great , like you know . Basically they are the focus

28:44

group , right . So college students and ideas

28:46

of how to pitch to the younger generation

28:48

to recruit them into healthcare . Another

28:50

article is healthcare ready to embrace more

28:53

young nurses . We're going to have to . When

28:55

you look at millennials and Gen Y , they're going

28:57

to have to be part of the solution to just the volume

29:00

silver tsunami versus

29:02

the number of people needed to actually take care of the

29:04

silver tsunami . So then my

29:06

next category in work I continue to call it

29:09

patient , family and future customer

29:11

demographics and trends . And

29:13

so it really started to see a lot of articles

29:15

, which I find heartening because if you get an

29:17

idea of the trends then you will know how to navigate

29:20

. So here's a few . Seniors

29:22

spend the equivalent of three weeks a year on

29:25

healthcare . Study shows that's

29:27

actually sad , so can we mitigate

29:29

that ? Of course there's a lot of the argument

29:31

of hospice and power of care , and so

29:33

viewpoint care fragmentation , care

29:36

continuity and care coordination

29:38

how they differ and why it matters

29:40

this actually was a GMO article . Healthcare

29:42

in the US is characterized by fragmentation

29:44

, with many patients seeing multiple physicians

29:46

. 35% of Medicare beneficiaries

29:49

saw five or more physicians , so

29:51

I think that's a problem to be solved

29:53

. Next one anorexia

29:56

nervosia evaluating

29:58

disparities I probably didn't say that right more evaluating

30:00

disparities in places of death and

30:03

the United States over 22 years using

30:05

the CDC wonder database . Lot

30:07

of interesting data too much for me to cover in this show

30:10

. Study found that death in the Holman

30:12

Hospice was more common than in medical

30:14

or hospital nursing facilities , and all four

30:16

analyzed groups , and there's a lot of kind of

30:18

sub points under that . Let's

30:20

see another one why hospice utilization

30:23

rates have fallen . This is a hospice news

30:25

. National hospice utilization rates

30:27

have fallen since 2020 . Although

30:29

the total number of patients served remain consistent

30:32

. Of course we know COVID played a large

30:34

part in that . Several good

30:36

mutual friends of you and I have used the term

30:38

. There was a death pull forward

30:40

. So , covid , pull some death forward . Those

30:42

may have been people we would have been serving in

30:45

the future . Another big kind

30:47

of statistic or trend the 100

30:49

club . Mark , I'm praying you're going to be part of this

30:51

. Us centarians

30:54

are set to quadruple by 2054

30:56

. And I hope I'm going to follow in your path in that

30:58

too . As life expectancy's increased

31:01

and birth rates declined , us has anticipated to

31:03

trend older in the coming decades

31:05

. So we're going to see more and more centarians

31:07

as we go forward in the future . And

31:10

this is one work you've called out in the past as

31:12

a big trend . Rural hospitals are caught in

31:15

an aging infrastructure conundrum

31:17

Just the whole challenge of they can't

31:19

upgrade their capital structure because

31:21

they're reimbursement situation , and

31:23

which hints the word conundrum . Here's

31:26

another one is healthcare relying too much on family

31:28

caregivers . And then there's

31:30

a modern healthcare article . The Biden administration is demanding

31:33

hospitals offer more clarity to family members

31:35

on their role in home-based services

31:37

. This one

31:39

was out of the Falls Church news

31:41

press a looming crisis millennials

31:44

caring for their aging parents . Millennials

31:47

which are between 1981 and 1996

31:49

, comprise roughly 73 million Americans by

31:52

2030 , all boomers and over

31:54

70 million Americans in total will be ages

31:56

65 or older . This represents a 25%

31:59

increase . And just then goes on to talk about how

32:01

that millennial generation may

32:03

end up being the one stepped on the shoulder to be

32:06

asked to care for that generation To

32:09

our healthcare system . This was actually from the

32:11

JP Morgan conference . I've actually

32:13

got some sub points when we get to our trends under

32:15

that one . But the discussion

32:18

at this JP Morgan conference sustainability

32:20

of our healthcare system and talking

32:22

about the concern , the status quo

32:25

is an existential threat to our

32:27

healthcare system . And they're worried

32:29

at the same time that the healthcare system is losing

32:31

the public stress which makes it only harder

32:33

to fix the system while also

32:36

delivering quality of care and accessibility to

32:38

our population . And

32:40

then another one under trend it's unbelievable

32:42

how our retired congresswoman son found

32:45

her months before death . This

32:47

is just concerning me , mark . I bet you picked

32:50

up on this one . She was 89 years old

32:52

, a trailblazing politician . Eddie

32:54

Bernese Johnson of Democrat in Texas

32:56

should not have died on December 31

32:58

. She was the first nurse ever elected to Congress

33:00

. Johnson's family plans to sue Baylor

33:03

Scott and White Health , claiming negligent

33:05

post-surgery care at the hospital's

33:08

rehab center that led to her death . She

33:10

was known as EBJ and she represented

33:12

the Dallas area of Congress for 30 years . That is

33:14

not the type of press that you want . Everyone

33:18

is important , but that is definitely not the kind of press

33:20

you want on someone who's had such a great history

33:22

in healthcare . So

33:24

the next one is the prevalence of hospital

33:26

diagnostic errors . Nearly

33:28

a fourth of patients who are transferred in ICU

33:30

or dying hospitals are misdiagnosed . So

33:33

that was a trend . Some health agencies

33:35

grapple with the acuity creep as patient

33:38

needs become more complex , as

33:40

we've seen for years , mark Wright , the hospital

33:42

has to get them out quicker and quicker , so

33:44

that as you push one part of the balloon , that

33:47

acuity is showing up in the community and

33:49

in the home in a lot of different ways

33:51

. And let's see just one more under

33:53

I didn't realize I had picked out so many trend

33:55

articles this month Quality of data

33:57

on profit status reported via

34:00

Care Compare . This was in the Journal of Pain

34:02

and Symptom Management , our good friend Joan Tino we

34:04

had her on the show last year For profit

34:06

. Hospice providers differ in key process

34:09

areas of care and bereave family care perceptions

34:12

of the quality of care . And then they just

34:14

they're really basically stratifying and delineating

34:16

quality of care difference based upon

34:18

profit status . So

34:21

those are my trends . Luckily , I only have

34:23

my next ones , only have just a few Regulatory

34:25

and political . I just had one I called out Scrutiny

34:28

to private equities involvement in healthcare

34:30

. Higher prices , worse outcomes do not

34:32

serve patients . That was a Boston Globe

34:34

by the editorial board

34:37

. So then my next category

34:39

is technology intervention . I do have a few

34:41

here , one that we've got to be careful of

34:43

. I guess you could also just say this is a

34:45

trend , but healthcare data breaches hit

34:47

new highs in 2023 . That was called

34:50

out in modern healthcare Our

34:52

record 133 million

34:54

just think about that Individuals

34:56

were impacted by healthcare data breaches in 2023

34:59

. Also under technology

35:01

chat bot performance and defining and differentiating

35:04

powder care , supportive care and hospice care

35:06

. Now , this was maybe

35:08

a cautionary tale . They actually looked at

35:10

artificial intelligence and how good it's

35:12

kind of navigating which service

35:15

line patients should be in . Executive

35:17

summary is eh , we're not quite there yet

35:19

and Jeff and I use a lot of

35:21

artificial intelligence and some of our tools

35:24

and what we do , and I think we could kind of say the same

35:26

thing . The interesting thing

35:28

is that it's rapidly improving

35:30

. The more data you feed it , the quicker it gets

35:33

smarter . So next one

35:35

McKnight's lack of incentives bar

35:37

home health hospice providers from creating interoperable

35:40

solutions . Long-term

35:43

and post-secure organizations have not received the same

35:45

support as other care settings , especially

35:47

for interoperability . Amen , I've

35:49

been saying that for a long time and finally

35:52

got an article kind of backing it up , which is one reason

35:54

why we don't exactly have a love relationship

35:56

with our EMRs . But I'm going to have a prediction

35:59

about that when we get to trends . Home

36:01

systems sorry , health systems want

36:03

tech to make it more human or to

36:05

make their healthcare delivery more human . That

36:07

was in Becker's Predictive analytics

36:10

and action how machine learning is driving successful

36:12

outcome for value-based end of life care

36:14

programs . This was the interesting work I

36:16

bet you picked up on this . Microsoft

36:18

seeking a chief medical officer

36:20

Huh , microsoft

36:23

is looking for a chief medical officer . That

36:25

should tell us something . And then

36:27

in Becker's article , what Amazon's latest

36:29

healthcare play could mean for ASEs

36:32

, which is ambulatory surgical centers . And

36:35

then here's the seven health tech predictions

36:37

for 2024 , which , in just a

36:39

second mark , I'll let us segue to our

36:42

trend predictions . So number one

36:44

enhance user-friendly digital technology

36:46

, multi-problem solutions , ai

36:49

integration , healthcare that starts at home

36:51

. Increase investment in proactive

36:53

care , aging population

36:55

focus , diversification of revenue

36:57

streams and how health tech platforms

37:00

are going to enable all of those trends

37:02

. And then just a last couple

37:04

to round out my last couple categories . This

37:07

category , I'm just calling it the speed of change

37:09

and resiliency . In other words , we

37:11

live at a very interesting time and so

37:13

there's a lot of change coming at us and this just says

37:15

creative thinking is needed to save

37:18

rural hospitals . And so , just

37:20

talking about the challenge of rural hospitals and

37:22

they really got to think outside

37:24

the box and , mark , you and I are involved in

37:26

a fascinating email exchange between you and I

37:28

and a CEO in Kansas , and

37:30

it wasn't about rural hospitals , but it was even about

37:32

more of their community and economy , and

37:34

I thought that was brilliant . I wouldn't say what it was

37:37

, but to me it's . That type of bold thinking

37:39

is going to be needed in certain sectors , especially

37:41

the rural hospitals , where we're going to end

37:43

up with healthcare deserts if we don't do something different

37:46

.

37:46

Now the irony there is that

37:49

the solution , one

37:51

of the solutions , is 50 years old . When

37:54

you look at so

37:56

many of the small rural , ex-urban

37:59

hospitals , they were either built or

38:01

they were modernized and

38:03

expanded with money from a federal program

38:05

called Hill Burton , which

38:08

provided essential capital funding

38:10

to rural

38:13

and ex-urban facilities . That

38:15

money ran out I think in the

38:17

70s or 80s

38:20

, but it was . You can't go

38:22

into a rural community and not

38:24

find a hospital that didn't

38:27

have Hill Burton money on it and

38:29

they in places like Florida

38:32

, where there used to be a healthcare cost

38:34

containment board that

38:37

published annual financial data

38:39

, you would actually see they had to amortize

38:41

the Hill Burton money

38:43

over 25 years actually . So you would

38:46

. I remember looking at hospital

38:48

cost reports when I was at Jackson Memorial Hospital

38:50

in Miami and still seeing some Hill Burton

38:52

money being reported at some

38:55

smaller hospices in the state of

38:57

Florida . It worked , but

39:00

it was federal money , which

39:02

some people think is evil . It was an

39:05

infrastructure program which has been

39:07

polarized in

39:09

today's environment and

39:11

one hates to think

39:13

what rural

39:16

healthcare would look like today if there had

39:18

not been a Hill Burton program . And

39:20

the question , the interesting thing is

39:23

, no rural advocates are out there saying

39:25

, hey , we had a solution and it worked

39:27

. Why don't we do it again ?

39:30

That's fascinating , Mark . I've never heard that before . When

39:33

did that run out , do you know ?

39:35

I'm not an expert on it . I

39:38

was at Jackson in the early 90s and you

39:40

were still seeing some

39:43

of that 25-year amortization playing

39:45

out , but it was mostly . It

39:48

had its heyday in the 60s , I

39:50

believe . I do not know whether it was

39:52

part of the great society . I wondered

39:54

it might have actually . Well , it might have been

39:56

passed during the Eisenhower Kennedy years

39:58

actually , I don't know , but it

40:01

worked . But

40:04

heaven forbid we should go bring back something

40:06

that worked , especially if it involves federal

40:09

money .

40:10

Well , maybe you and I could solve things

40:12

, because you know what ? I think we

40:15

always try to stay away from politics , but I think probably

40:17

you and I are two ends at the spectrum , but

40:19

we love working with each other because really about solutions

40:22

not what side of the coin

40:24

are you on , and that's what's so sad about today

40:26

is let's bring common sense back

40:28

and actually make solutions , because there is a place , for

40:31

I totally get what you're saying . There

40:34

is a place because if you just go to the major metropolitan

40:36

areas , well then you're going to end up with these deserts

40:39

and how do you make

40:42

investment smartly ? And look what it

40:44

did for those communities actually over

40:46

the years ? So , wow , that's pretty cool .

40:50

One of the last hospitals small

40:52

hospitals that closed last year in Missouri

40:55

. It closed

40:57

very suddenly . One of the things

40:59

the CEO said was infrastructure

41:02

falling apart and we don't have the money to deal with it

41:04

. We can't modernize

41:06

, so we got to close .

41:09

Well , mark , I have one last category and we're

41:11

going to go to our trends . So this category , I'm going

41:13

to call it the human factor , and so this

41:16

is an article . Doctors are pushing

41:18

Hollywood for more realistic

41:20

depictions of death and dying on TV . I

41:22

thought that was pretty cool and , yeah , because

41:24

that shapes culture and so kudos

41:26

that they're actually pushing for that .

41:29

So , mark , let's segue now that

41:32

actually , chris , is something that is

41:34

being repeated . There

41:36

was a Robert Wood

41:38

Johnson funded initiative

41:41

in the early 2000s called

41:43

Last Acts , where

41:45

they were dealing

41:47

working with . One segment

41:50

of that was working with writers , producers

41:52

, directors , creative types in

41:55

Hollywood to

41:57

better portray end of life situations

41:59

on television and movies

42:02

, and

42:05

they were the last acts . Experts

42:07

were available for consults with

42:10

showrunners TV showrunners , for example

42:12

and they

42:14

staged a number of events out

42:16

in Hollywood for the creative community

42:19

. They brought in experts

42:21

. I remember attending an event that

42:23

had John

42:25

Milch from Hospice

42:27

Buffalo , whose brother was

42:30

a major figure in television

42:33

production , the genius behind

42:35

NYPD Blue . I remember Susan

42:38

Toll , who recently retired from

42:40

Oregon Health Science

42:42

University in a leading

42:45

bioethicist , particularly

42:47

with an emphasis on end of life care , was a panelist

42:49

as well as one

42:52

of the Beatles founders . That's why I was out

42:54

. There was a panelist . They

42:56

did some good work and the

42:58

funding ran out and nobody picked it up . And

43:01

now we're back to square one

43:03

doing the same thing 20 years later .

43:05

I'm like , I feel like there is a theme I didn't predict

43:08

, which is what is old , is new or it should be . Well

43:11

, let's segue Mark . So again , a lot

43:13

of these , a lot of folks do these kind of shows in December

43:15

. We thought it'd be much cooler to do it now

43:18

. So kind of your prediction of kind of themes

43:20

or trends we're gonna see this year , and then I'll do the same

43:22

.

43:23

Yeah , I broke mine down to

43:25

two types the very

43:27

obvious themes and the

43:29

not so obvious , and I'm doing this

43:31

not from the perspective of the

43:33

care continuum as a whole

43:35

, but from the hospice perspective

43:38

. So my top five most

43:40

obvious themes are mergers and

43:42

acquisitions , including

43:44

affiliations among like-minded

43:47

not-for-profits , as well as roll-up

43:49

strategies by for-profits

43:52

, publicly traded and private

43:54

equity funded Medical

43:56

aid and dying . It's an election year , and

43:59

this in those states

44:02

that have democratic legislatures

44:04

and democratic governors . The

44:06

consensus after the last

44:08

election was that let's

44:10

hold this off for an election year

44:12

where we can force Republicans to take

44:14

a vote on a social issue

44:17

that 70% of the population

44:19

is in favor of . So we will see

44:22

some votes on medical aid , aid and dying

44:24

this year , at least in democratic

44:26

states . Labor activism

44:28

is going to continue

44:31

in the healthcare sector and I believe

44:33

it will continue to bleed

44:35

ever so slightly over onto

44:38

the post-acute side of the sector

44:40

. Number four

44:42

I think for-profits

44:45

, mostly private equity , will

44:48

continue to come under attack and investigation

44:50

in this election year . But

44:52

that you know not-for-profits

44:55

, particularly on the hospital

44:57

side , do not have a pristine

45:00

record on things like community benefit

45:02

and meeting community need

45:04

, and so not-for-profits will not

45:06

be immune to attack and investigation

45:09

. And there's always the risk that

45:11

those attacks on not-for-profits in

45:13

the hospital sector again can

45:15

bleed over into the post-acute

45:18

sector . And finally

45:20

, nursing homes will continue to be under tremendous

45:22

stress and that will have

45:25

an impact on the

45:27

hospice world . And you know , we just

45:29

keep in mind that a lot of those

45:32

fraudulent or

45:34

fly-by-night for-profit hospices

45:36

that you mentioned earlier , a lot of them build

45:39

their business in the nursing home side , and

45:42

so it'll be interesting to see how

45:44

stress in the nursing home sector

45:46

plays out in the for-profit

45:48

, not-for-profit divide

45:51

in the hospice sector . So

45:53

five topics

45:56

, themes that I think are not quite

45:58

so obvious , although they're certainly not hidden . I

46:01

think , just as

46:03

you're gonna see medical aid and

46:05

dying moving in democratic states

46:07

in this election year , I think you'll

46:09

see continued efforts

46:11

to rollback certificate of need in

46:14

Republican and Southern states

46:16

this year , if only because

46:19

it's likely

46:21

that those supermajorities

46:24

and some of those Republican states

46:26

might dwindle a bit after

46:28

the 2024 election . So this

46:31

would probably be the time for the libertarians

46:33

who wanna destroy certificate

46:35

of need to strike this year

46:37

while they have what might be the

46:40

largest political

46:42

majority that they're gonna have in

46:45

the near future . My second question

46:47

is we mentioned NHPCO

46:50

a little bit when you mentioned , dr

46:52

Bayak . How will the combined

46:54

NAHC and NHPCO

46:57

evolve

47:00

, particularly in terms of how

47:02

it negotiates or how it navigates

47:04

the for-profit , not-for-profit

47:06

divide in hospice

47:08

? There's not as much of a divide in

47:11

the home health sector , so

47:14

NAHC doesn't necessarily bring

47:16

the same perspective on that or same history

47:18

as NHPCO . And

47:21

one question is in terms of not-for-profit

47:24

perspective , will

47:26

the NAHC NHPCO

47:28

merger end up being a boost

47:30

to the national partnership for

47:33

hospice innovation ? Certainly

47:35

might seem likely there . Third

47:38

, less obvious theme is the

47:40

growth of collaborative networks and affiliations

47:43

versus outright mergers on

47:45

the not-for-profit side in hospice

47:47

. I don't see that dying out

47:49

. It's just a matter of . It's a long

47:52

decision-making tale for

47:54

most not-for-profit boards to get

47:56

to that point and there've been

47:58

a lot of discussions in recent years

48:00

. So that means they're solely moving toward

48:02

making a decision perhaps . Fourth

48:06

, pharmacy deserts and drug shortages

48:08

how they affect both rural

48:10

areas and inner city neighborhoods

48:13

. And what does that do for

48:16

Hospice providers

48:18

and what does

48:20

that do for the pharmacy benefit

48:22

managers who are playing

48:24

increasingly important

48:26

roles in the provision of hospice care ? And

48:29

my fifth , least obvious , is hospital

48:31

financial ills , closures , the

48:34

spreading of hospital deserts and rural

48:36

areas . I don't think the hospice

48:38

sector fully appreciates how

48:41

that is a risk to the

48:44

, how how big a risk

48:46

that can be to the hospice sector and

48:48

I think we need to continue to keep our eye on that

48:50

.

48:51

Those are good .

48:52

Those are my themes .

48:53

Damn , those are good , those are really

48:56

good . I mean , I'm just sitting there going , man , that

48:58

is like gold right there . So

49:01

I took a broader perspective . I actually

49:03

really like yours . And so , first off , there

49:05

was when I was I was going to incorporate

49:07

this into the top news stories of the month . But

49:09

you know some smart people at Becker's , and

49:11

so Becker's hospital review had the 12 health

49:13

care trends and issues were following for 2024

49:16

. I was going to call that out First

49:18

off . Number one health care has a worsening numbers

49:21

problem and it's talking about staff compared

49:23

to volume , but also the economic model . Number

49:25

two payers have become massive

49:27

. United health care is over $200

49:30

billion now . Number three the largest

49:32

employer physicians is one of the world's

49:34

largest insurers . I think I just said

49:36

who they were . Number four governmental

49:39

health care payers between Medicare and Medicaid

49:41

are now combined to be larger

49:43

than the commercial payer sources . Number

49:45

five technology is part of the solution

49:47

, but not the entire solution

49:49

. Number six the movement to value

49:52

based care is still very much a work

49:54

in process . Number seven Medicare

49:56

Advantage now covers more than half of the Medicare

49:58

population . Number eight mental

50:01

and behavioral health in the United States has reached a

50:03

critical stage , with a worsening

50:05

imbalance of needs and demands versus

50:08

supply . This is one that really bothers

50:10

me , mark , and several different ways

50:12

I'm trying to figure out how to wrestle with this . One . Number

50:15

nine Washington DC tends to make

50:17

noise about the impact of private equity and health

50:19

care . I guess you could insinuate what they

50:22

tend to make noise about it , but are they going to do

50:24

anything about it ? It's a tough one to do something

50:26

about . Number 10 , aging

50:29

well and preventive health is seeing a growth

50:31

in interest . Number 11 , diabetes

50:34

, obesity drugs can have a large positive

50:36

long term impact on health care . And

50:38

number 12 , hospital margins largely

50:40

improved in 2023 , but

50:43

hospitals face huge long term

50:45

financial challenges . So that was really

50:47

good from Becker . So here's my own and , interestingly

50:50

, since it's a prediction of trends or themes

50:52

, this is exactly how I'm going to continue to organize

50:55

what I'm harvesting each month , mark , that I hope

50:57

C-suite leaders don't lose . The

50:59

first one is hopefully there will continue to be

51:01

a theme of mission moments , although I want to

51:03

kind of put a caution . There have been

51:05

some bad health care stories , especially

51:07

in hard to staff areas really

51:10

feel like a warning sign . There is one

51:12

in Atlantic Journal Constitution a

51:15

78 year old veteran's final days

51:17

at a Georgia senior care home , raising

51:20

troubling questions about care of the facility

51:22

in the state's oversight . Why I'm calling

51:24

that out is I pray that we see a lot

51:26

of great mission moments , like I called out today , where

51:29

staffing is challenging . Then we're

51:31

going to get , oh , that horrible facility they

51:33

can't get staff to , don't have any staff . It's horrible and

51:36

you know what do we expect in

51:38

a situation like that ? So maybe

51:41

we'll have an adult conversation about it this year and

51:44

then there may be under mission moments . Will

51:46

2024 be the tipping point for health

51:48

equity where we're honest about

51:51

it and we're going to do something about it Because there are

51:53

a lot of challenges in the health equity space ? My

51:55

second theme I predict I'm going

51:57

to continue to be reimbursement challenges and

52:00

warning signs and implications to our future

52:02

reimbursement . You saw in a lot of the

52:04

kind of prediction earlier on our

52:06

articles . A lot of people are going

52:08

to be cost cutting this year , tightening

52:10

their bills , ensuring up their financials . I think

52:13

you're going to see a lot of that . Medicare

52:15

Advantage . I think we're going to see a lot more negative press

52:17

this year , mark , about Medicare Advantage plans and

52:19

at least I mean they're not a panacea . They're

52:21

not a silver bullet and maybe

52:24

they've been a victim of their own success , so to speak , but

52:27

I think there's some very real problems that we need to

52:29

call out . I mean especially like the artificial

52:31

intelligence , where within seconds

52:33

you get a denial of a claim , and that's just kind of how

52:35

the system works . Third

52:37

category competition . We're going to continue

52:39

to see more and more competition , more

52:41

merger and acquisition , as you predicted , and

52:45

I do think there's going to be more scrutiny and debate

52:47

about this whole role of private equity and

52:49

health care . That's a tough one . I

52:51

don't know what the solution is , but it seems

52:53

like we need to have an adult conversation about it

52:55

. Number four we're

52:57

going to continue to see workplace challenges , or

52:59

workforce challenges , just

53:02

the volume of need compared to staffing

53:04

. I do pray we're going to see a lot more

53:06

solutions , and here's the cool thing that

53:08

I've seen last year that I believe

53:10

this trend is going to continue . The employee

53:12

is going to continue to be elevated . Duh

53:14

, it feels like a duh moment , but it

53:16

should be , and so that's one positive

53:18

. Amidst this challenge is you have a scarce resource

53:21

, appreciating our most amazing

53:23

asset we have , which is the people

53:25

that are giving the care . Fifth , I

53:27

think we're going to continue to see macro trends

53:29

because the demographic is shifting

53:32

of people getting health care as our

53:34

baby boomers are aging . I think there's going to be a lot

53:36

more enlightening data and if

53:38

we're paying attention , what do we learn from that

53:40

data and how does it shift our care models ? Of

53:42

course there's going to be lots of regulatory and political

53:44

wrangling . Of course there's going to be a big election here

53:46

, so there'll be a lot of articles around that

53:48

. Next category , we're going to see a whole

53:50

lot under technology innovations . But

53:53

here's a prediction amongst that that I

53:55

believe we're going to see more direct to consumer

53:57

products and health care and

53:59

application of technology in that space

54:01

. And what can we learn from that in the hospice

54:04

and powder care space ? And here's

54:06

a kind of bold prediction I

54:08

feel like hospice electronic medical

54:10

records are finally going to start to get better

54:12

. I probably could do a whole

54:15

show maybe I will this year about kind of why

54:17

it's been such a challenging situation

54:19

. You know , just simplistically where

54:22

the biggest organizations are providing EMRs

54:24

to hospitals . We've been at the tail

54:26

end of health care and there hasn't been a whole lot of place

54:28

for resource and private equity money

54:30

. But that is changing . I'm not

54:33

saying it's going to be fixed in the next year . I

54:35

just think the trend line , like our better

54:37

, our worst years are behind us and our better

54:39

years are ahead of us as far as tools

54:41

in the hospice and powder care

54:43

space and technology tools , and

54:45

then the last category is just

54:47

the speed of change and resiliency

54:50

. This is our ability to deal with change

54:52

. My wife gave me a Christmas present three

54:54

years ago and it talked about kind

54:57

of trends in history and about every hundred

54:59

, 120 years or so , there's just a massive

55:02

amount of change . Guess what we

55:04

live in one of those times . And so the ability to be

55:06

resilient and to be able to maybe

55:08

even throw change out of our lexicon , and

55:10

just about innovation and growing

55:13

and just rising to the challenge of our day , and

55:15

so I think we're going to see a lot of articles on both sides

55:17

of that equation . So those are my my theme

55:19

predictions . Any final thoughts , mark ?

55:23

It will . You know , confucius has

55:25

cursed us to live in interesting times

55:27

.

55:29

Well , mark , we're just a truncated masterclass

55:32

. We had a lot to cover this month , but I

55:34

think your masterclass is always appreciated , so

55:36

you want to end us with that .

55:38

Sure , two tips for

55:40

hospice leaders regarding

55:43

their written communications . These

55:46

are tips that I give every one of my clients

55:49

and anybody else who asks for advice

55:51

on how they can do a better job of communicating

55:54

. So my first tip find

55:56

them a crew to writing coach . Whether

55:58

you have a skilled writer on your staff which very

56:00

few hospices do these days or

56:03

whether you try to make do with someone who is not

56:05

an experienced writer on your staff , everyone

56:08

can benefit from a second

56:10

set of eyes on their copy and

56:12

the Council of the Season writer For

56:15

a hospice . You can look to retired

56:17

teachers , journalists , public

56:19

relations practitioners or marketers

56:21

among your volunteers , and

56:23

if that doesn't work out , then just try

56:25

going to people who work in those professions

56:27

and asking them if they would

56:29

mentor whoever you are the

56:32

writer on your staff is . I've

56:34

done a lot of that mentoring over the years and

56:37

it's fun and it's

56:39

rewarding . Second , the

56:41

second recommendation pick

56:44

a style guide , or

56:46

two or three . Actually , most

56:48

people use the AP style guide , but

56:50

you can also use the style guides that are

56:52

published by the New York Times

56:55

, the Wall Street Journal , washington Post

56:57

used to publish one and compliment

56:59

that with a classic

57:01

how to guide , which

57:04

for me is Strunk and White's elements of

57:06

style , which is almost 100 years old

57:08

now and still incredibly relevant

57:10

, and then add something more

57:12

modern to compliment

57:15

or provide

57:17

a different perspective than Strunk and White

57:19

. Woe is me . By

57:21

Patricia O'Connor Eats , shoots

57:23

and Leaves or Dryers . English

57:25

Books like that can be really

57:27

helpful in turning an OK writer

57:30

into a very good writer .

57:32

Wow , thank you , mark . Well , to our listeners

57:34

, it's been a long show , but we have a lot to cover

57:36

. Mark always , always , appreciate having you . We're

57:38

looking forward to having you next month and we continue . And

57:41

to our listeners , we'll always end with a quote . This one

57:43

was chosen by Mark and Mark , I think , is even more

57:45

profound now that we've done the show . It's

57:47

from George Santayana , the Spanish American

57:50

writer and philosopher those who cannot

57:52

remember the past are condemned

57:54

to repeat it . And then , I would add , are

57:56

not . Thanks for listening to TCN

57:58

Talks .