0:01

Welcome to TCN Talks . The

0:04

goal of our podcast is to provide

0:06

concise and relevant information

0:08

for busy hospice and palliative

0:11

care leaders and staff . We

0:13

understand your busy schedules and believe

0:16

that brevity signals respect

0:18

. And now here's

0:20

our host , chris Como

0:23

.

0:24

Welcome to TCN Talks . This is my

0:26

favorite time of the month where mark cohen

0:28

and I actually review or kind

0:30

of call out the top news stories

0:32

of the month from each of our different perspectives . How

0:34

are you ?

0:34

mark , welcome . I'm great , chris . Thank you

0:36

very much . Glad to be here .

0:39

It's always good to have you . Well , mark you ready to

0:41

jump in . Yeah , you bet month

0:43

, march .

0:44

As you know , ch is a long month and there certainly

0:47

was a significant amount of

0:49

news coverage vital to hospice leaders

0:51

in the month of March . While you'll

0:53

be doing your deep dive into what interested

0:55

you from the C-suite , I'd like

0:57

to review the most read stories in March

0:59

, as calculated

1:01

by hospice and palliative care today , and

1:04

discuss the significance from an issues

1:06

management perspective of

1:08

several of those stories . As

1:10

for the most clicked upon stories , thanks

1:13

to the data supplied by Hospice and Palliative

1:15

Care Today publisher , court Tassner

1:18

, who joined us on last month's

1:20

podcast , out of 512

1:22

articles that the newsletter ran in

1:24

the last month , four garnered

1:27

2,000 plus click-throughs and

1:29

another 16 , a sweet 16

1:31

, if you will , given the time of year received

1:34

1,000 or more click-throughs . Quite

1:36

impressive . Court

1:39

currently reports that its readership

1:42

is subscriber-based

1:44

it's a little over 1,500

1:46

, which means that a lot of

1:48

people are clicking through to some articles

1:50

twice , checking back on them or they're

1:52

sharing the newsletter with others who are

1:54

clicking through to read the articles

1:57

. So really impressive numbers . The

1:59

most clicked upon article had nothing to

2:01

do with Medicare

2:03

, vbid reimbursement rates

2:06

, fraud , mergers and acquisitions

2:08

or any other business-related

2:11

topic . The headline of this article

2:13

in McKnight's Home Care Daily speaks

2:16

volumes , rising suicide

2:18

risk among seniors due to loneliness

2:20

, mobility , financial insecurity

2:23

, study , fines . It's a somber

2:25

topic , to be sure , but it's reassuring

2:28

to know that a patient and family care issue

2:30

like suicide

2:32

prevention suicidal ideation attracted

2:36

so much interest from the readers

2:38

of Hospice and Palliative Care today . Second

2:42

most clicked upon article last month was about

2:44

HHS Secretary Becerra's

2:46

problematic testimony before

2:48

the House Ways and Means Committee . The

2:51

topic of the hearing was the budget , but

2:53

a couple of members grilled him on why

2:55

HHS appears to

2:57

be continuing to grant Medicare licenses

3:00

to proprietors of fly-by-night

3:02

Medicare operations in

3:05

states like California and Arizona . These

3:07

were providers requesting

3:10

licenses who listed

3:12

as their business address the same

3:14

address that 100 , 150

3:17

other Medicare providers

3:19

used in a small

3:21

strip mall office

3:23

building in Southern California or Arizona

3:25

. The

3:28

Secretary was clearly not prepared for

3:30

that line of questioning . Medpac's

3:33

release of its March 2024

3:35

payment policy report , somewhat surprisingly

3:38

to me at least , was only the

3:40

third most clicked upon article last month

3:42

, with only three quarters the views that

3:44

the suicide article had

3:47

For those critics who claim hospice

3:50

is all about the money . The contrast between the

3:52

2,700 views for the

3:54

suicide article and the 2,100 views

3:56

of the MedPAC article presents

3:58

a compelling counterpoint . The

4:01

fourth and last article with 2,000 plus

4:03

views was about the technical corrections

4:05

and clarifications to the CAHPS

4:08

hospice survey . It's worth

4:10

noting that the last two articles appeared

4:12

in technical reports and that

4:14

the Becerra item came from a

4:16

congressional committee report . The

4:19

McKnight story on suicide was the only

4:21

general media story among the

4:23

four most click-through articles

4:25

, all of which had 2,000-plus

4:28

hits . Among the sweet

4:30

16 articles that received between 1,000

4:32

and 2,000 views , the big winner was

4:35

one of many reports on the change healthcare

4:38

hack . In the interest of time , chris

4:40

, I won't go through all 16

4:42

of these articles , as I'm sure

4:44

many landed in your list as well , but

4:47

a few that are worth noting . From my

4:49

issues management perspective would

4:51

include first a column

4:54

by a McKnight's home care editor about

4:56

the end of the VBID experiment

4:58

for hospice , entitled CMS

5:01

Hears you , hospice Providers , and

5:04

the editor wrote I chalk chalk this up

5:06

to a win for providers and a clear

5:08

example of advocacy in

5:10

action . Great

5:14

endorsement for the work that the professional

5:16

organizations like NHPCO

5:20

and LeadingAge

5:23

did on lobbying

5:25

against or

5:27

for broader hospice voice on VBID

5:29

.

5:31

And PHI as well .

5:32

Yep and NOC

5:34

. Sorry for that . Next

5:36

, continuing the run of good news coverage

5:39

for PACE . That goes back many

5:41

months now . That

5:48

goes back many months now . Home health care news took note of the

5:50

trend in a March 19 article headline quote home-focused PACE model continues

5:52

to gain traction across US

5:54

. Looking at the positive

5:57

coverage of PACE , it's sometimes hard

5:59

to believe that there are still fewer than 100,000

6:02

PACE participants nationwide

6:05

, although the number continues

6:07

to grow slowly , something we've

6:09

discussed far too frequently . Chris

6:11

, the subject of rural healthcare deserts

6:13

and the closure of rural providers

6:16

again received a lot of attention last

6:18

March from readers of Hospice and Palliative

6:20

Care Today . This was a Becker's

6:23

Hospital CFO report

6:25

article that looked back at

6:27

the 36 rural hospitals

6:30

that have closed since 2020

6:32

. And , as we've said before

6:34

, when the one local hospital

6:37

closes in a small community , it's

6:39

bad for quality of life , home values

6:41

, economic development , employment

6:44

and also every other provider in

6:46

the continuum from local clinics

6:48

and physician practices to skilled nursing

6:51

, home health , hospice and local

6:53

pharmacies . In

6:56

its report , headlined Hospice

6:58

Group Pushes for Clarity in New York State

7:01

Budget as Some Warm

7:03

to For-Profit . The

7:05

hyper-local 24-hour cable

7:08

newscast Spectrum News , serving

7:10

upstate New York , contrasted

7:12

the state's last place ranking

7:14

in hospice access and utilization

7:17

, with suggestions that

7:19

the state may be opening to

7:21

for-profit hospice but

7:23

tying that potential opening

7:25

to the ever-growing interest at

7:28

HHS , ftc and Congress

7:30

in the ramifications of the

7:32

growing presence of private equity across

7:34

the healthcare continuum . And

7:37

one last article I found noteworthy from this

7:39

suite 16 of highly viewed articles was

7:41

this report from Becker's Hospital CFO

7:43

entitled why

7:45

Not-for-Profit Healthcare Systems Need Positive

7:48

Margins , attributed to

7:50

the big four accounting firm

7:52

Deloitte , although the article obviously

7:55

focused on large not-for-profit hospitals

7:57

, every not-for-profit hospice

7:59

leader should be scanning articles like this

8:02

for best practices on how

8:04

to talk about profitability and sustainability

8:07

of their mission-driven organization

8:09

. Profitability and sustainability of their mission-driven

8:11

organization . And before the listeners of this podcast who are at for-profit

8:14

providers start rolling their eyes , you

8:21

too should be scanning articles like this , if only to keep up to date on how your not-for-profit

8:23

competitors ought to be messaging . I'll

8:25

hit the pause button here , chris , but

8:27

I do want to note that , as we're taping

8:29

this segment between

8:31

the Elite Eight and Final Four

8:34

, the women's NCAA basketball

8:36

tournament we did a little trash talking last

8:38

year when your LSU Tigers

8:41

defeated my Iowa Hawkeyes to capture

8:43

LSU's first ever NCAA

8:45

championship . We agreed last year that it was

8:47

a great moment for women's

8:49

collegiate athletics , and

8:52

this year's rollercoaster rematch

8:54

between LSU and Iowa and

8:56

the Elite Eight certainly gave the sport another

8:58

huge boost . This time

9:00

my team emerged victorious and by the

9:02

time this podcast airs I guess we'll

9:05

know whether they prevailed in Cleveland at

9:07

the Final Four . We'll know whether they prevailed

9:09

in Cleveland at the final four . I'd like to close with a reminder

9:11

, chris , that Hospice and Palliative

9:13

Care Today , the newsletter we've

9:15

been referencing and the successor to my

9:18

newsletter , hospice News Today operates

9:20

on a free subscription model . There's

9:22

a growing audience of hospice decision makers

9:25

reading the daily newsletter , which

9:29

accepts only limited advertising . If you're listening to this podcast

9:31

but have not yet subscribed to Hospice and Palliative

9:34

Care today , you should fix that as soon

9:36

as this podcast is over . Back

9:38

to you .

9:38

Chris . All right , thank you , mark

9:41

, and we'll definitely include a link , as we've been doing

9:43

the last couple months , as to your trash-talking

9:45

hats off to the Iowa Hawkeyes

9:47

. Caitlin Clark is incredible , gosh

9:50

, if we're going to be beat as LSU Tigers , what

9:52

a great team to be beat by and what an amazing

9:55

Final Four . I'll always

9:57

draw a corollary back to leadership and hospice

9:59

. When you get four amazing programs like

10:01

that Connecticut , south Carolina , iowa

10:03

and LSU just the competition

10:05

elevates the whole sport , which

10:07

is why great hospice care right , mark

10:09

, right , we don't want those horrible hospices

10:11

. Great hospice care elevates everyone

10:13

.

10:14

So , yeah , I can't wait to see it . Except correction

10:17

your home state of North Carolina . You said

10:19

Final Four and you said LSU . It's

10:21

North Carolina State , yes

10:24

, my bad , my bad absolutely .

10:26

And the men's NC State , yeah , and Duke

10:28

absolutely In the men's NC State and Duke absolutely as well . So really

10:30

really good college basketball this year . All right back

10:33

to hospice . So , mark , I feel like I'm

10:35

getting to drive kind of a really cool sports car

10:37

now . So all of this great data that court's

10:39

giving back , I get to kind of compare to

10:41

what I flag and now I get this really cool dashboard

10:43

. So I flagged 100 articles this past

10:45

month , which is kind of cool because having

10:48

a hundred articles , the number of articles

10:50

corresponds with the percentage . So this is kind

10:52

of high level . Now I'll go through the detail . My

10:54

categories now that have been consistent . So the first

10:57

category is mission moments that's about 7%

10:59

of the articles I flagged . Next

11:01

category is reimbursement challenges , warning

11:03

signs , implications that was 18%

11:06

. Competition to be aware of that was

11:08

12% . Workforce challenges 18%

11:11

. Patient , family , future , customer

11:13

, demographics and trends that's almost a

11:15

quarter . So about 23% . That

11:18

seems to be my biggest category each month

11:20

and maybe because I'm taking it from

11:22

the C-suite perspective , those looking

11:24

out of the windshield kind of trends

11:27

are pretty important to be able to flag . Next

11:29

, regulatory and political that was 4% . Technology

11:32

and innovations that was 12% . I've

11:34

got a maybe it's a weirdly titled

11:36

category , but just the speed of change

11:39

, resiliency and culture . Things had

11:41

0% on that one this month , another

11:43

one I call the human factor You'll see when I

11:45

get to that one article that was 1% . And

11:47

then , finally , about just articles of interest

11:50

that I want to highlight . That was

11:52

actually 4% . So those are my categories , so

11:54

let me go through them . So first , mission moments . The

11:56

first one , a daily Sentinel

11:58

article , is titled living a special life . To

12:01

the end it was a beautiful

12:03

article . It was about a Grand Junction high school

12:05

, colorado Mesa university graduate , enthusiast

12:07

friend of Coach K and lover of sunsets

12:10

and sunrises . It was

12:12

just today's a good day to have a good day . The

12:14

sun will come up in the east and it will set in the west

12:16

. All you have to do is match its energy

12:18

. It was a mantra of Andy Smith

12:21

and again , he was a graduate of Grand

12:23

Junction High School in Colorado Mesa . Just

12:25

a beautiful mission moment . Then

12:27

they had a couple of articles . I won't go through them in

12:29

detail , but President Carter kudos to

12:31

him . I think Mark and I have been calling him

12:33

out for what a year and almost

12:35

a quarter now , of just the

12:37

gift that he has been to the whole hospice movement

12:40

and being very open about his journey

12:42

. So there are a couple of great articles . It

12:47

was Northeastern Global News and an ABC News article . And then a global news

12:49

article because my kids love the new Dune

12:51

movie . Man's Dying Wish was to see the newest

12:54

Dune film . A director actually

12:56

made it happen before the release and so that

12:58

was actually pretty cool . And then there was a Harvard

13:00

Business Review I'm sorry , harvard

13:02

Business School article Case

13:04

Histories of Significant Advances Cicely

13:07

Saunders and the Modern Hospice Movement

13:09

. The case history describes the role of Dom

13:11

Cicely Sanders in shaping the modern

13:14

hospice movement and it's

13:16

narrated in first person through the words

13:18

of her brother , christopher Saunders , as

13:20

told to one of the authors of the paper . So I

13:22

thought that was pretty cool . I'll put that in a mission moment

13:24

and around out this section inspirational

13:27

duo a boy with terminal

13:29

condition and his puppy tackle a hundred

13:31

kilometers challenge for hospice care . This

13:34

was in the UK and just a beautiful mission

13:36

moment story . So that was my first category

13:38

, mark . So the next category was reimbursement

13:41

challenges . So again this was about 10%

13:43

. First one it was kind of a busy

13:45

month for kind of regulatory things . So

13:48

, first off , the physical

13:50

year for 2025 , hospice

13:52

payment rate update proposed rule , and

13:54

so this was from CMS . They're proposing an update

13:57

percentage of 2.6% for next

13:59

year . We'll actually have Judy

14:01

Lundperson coming on a podcast and

14:03

she's going to talk about that a little bit . There are some really

14:06

, I'll say , cool things

14:08

actually were packed into the new release

14:10

of this wage index . Next

14:13

one is this seems kind of like these

14:15

are maybe two sides of the coin . This one was MedPAC

14:18

. Medpac releases

14:20

the March 2024 report and

14:22

in that report they're basically recommending

14:24

no update to hospice . So

14:26

this would be future , beyond 2025

14:28

. And they actually recommended payment reductions

14:30

for three post-acute sectors

14:32

skilled nursing , home health and inpatient rehab

14:35

. So we'll see how that plays out . Medpac

14:37

makes those recommendations and it goes through

14:39

the process that it goes through . Next

14:41

one was nearly 53% of hospices

14:44

undergo multiple

14:46

audits simultaneously . It was an article

14:48

by Jim Parker and hospice news just

14:50

talking about something about 53%

14:53

. So greater than half of the whole field

14:56

is undergoing multiple audits simultaneously

14:58

and of course , that's because the government figures out . They

15:00

make about $5 for every $1 they

15:02

spent on those audits . Next

15:05

is hospice welcomes , vbids , demise

15:07

, and so , as many of

15:09

our listeners know by now that the VBID demonstration

15:11

is being sunset in December Multiple

15:15

. I've been on a couple of podcasts . We've had guests on

15:18

our podcast . We even went back and recorded

15:20

an addendo with Katie Lanz talking

15:22

about that . So that's been all over the news . Next

15:25

, providers meet with OMB to prevent

15:27

the devastating effect of the 80-20

15:29

provision . This is in home care

15:31

, private duty . So stakeholders have been busy

15:34

in Capitol Hill voicing concerns about the controversial

15:36

provision of the proposed

15:39

Medicaid access rule . But the long story short

15:41

of it , the rule is an 80-20

15:43

rule that says 80% of the Medicaid

15:45

payment for personal care must

15:47

go towards the workers' compensation . The

15:50

Medicaid payment for personal care must go towards the workers' compensation

15:52

. So it's an interesting way of kind of capping margins in that kind of segment

15:54

field , if you will . So kind of interesting and always

15:57

take note of those things because you may go . Well , we don't have

15:59

private duty . I always find it funny , mark

16:01

, they call it Centers for Medicare and Medicaid Innovation

16:04

, because you kind of look at what they do to other people and

16:06

you wonder at some point does

16:10

it come to you ? So I think it's kind of paradoxical . It's called innovation

16:12

, all right . Next one is value-based

16:14

care , now driving home-based primary

16:16

care growth . And this was

16:18

interesting this was in McKnight's , when

16:20

the independents at home . So the Centers

16:23

for Medicare and Medicaid Services home-based primary care

16:25

initiative concluded at the end of 2023

16:27

, after more than a decade . It marked the end of an era

16:30

. Over the period of the model , the rise

16:32

of value-based care has given providers a wealth

16:34

of opportunities to bring primary care into

16:36

patients' homes . And then the last

16:38

one in this section CMS cracked

16:41

down on fraudulent hospices providers

16:43

in full effect in 2024

16:45

, expert says . Which is kind of contrary

16:47

to what you were saying about the HHS director

16:49

being on the hot seat . But in recent

16:51

years , unscrupulous hospice providers have cropped up

16:53

in California and other states . In response

16:56

, cms has prepared a slew of tools

16:58

to curtail the fraud . States continue

17:00

to feel the effects . As an example , a hospice operator

17:03

last week was convicted in a fraud

17:05

scheme for billing nearly $3

17:07

million in services that patients

17:09

did not need , according to the Department of Justice

17:11

. All right , so now segueing to

17:13

my next category , which is my Medicare

17:15

Advantage category . I had about

17:18

eight articles in that section . I

17:20

won't highlight all eight of them , but here's just kind

17:22

of an appetizer of them . Nearly half of the health

17:25

systems are considering dropping Medicare Advantage plans Mark Nearly half , which

17:27

is interesting because now we know that greater half of the health systems are considering dropping

17:29

Medicare Advantage plans Mark nearly half , which

17:31

is interesting because now we know that greater about

17:33

50% of total Medicare participants

17:35

are in MA plans . And so

17:37

you see this really interesting , tough

17:40

jockeying . In fact , in the area where I

17:42

live in North Carolina recently

17:44

the largest insurance company

17:47

in the hospital were basically loggerheads

17:49

sent out a notice and said you know , as

17:51

of this date you may not have United or

17:53

this hospital will no longer accept . I

17:56

guess I said the insurance company out loud . Anyway

17:58

, it was a public news and so you

18:01

see a lot of that throughout the country where health

18:03

systems I think are digging in and

18:05

basically not kind of accepting whatever

18:07

the rates that the insurance

18:09

company All right . So here's another one , a

18:12

fond farewell musings on the end of the Medicare

18:14

Advantage Hospice Carven demonstration . That

18:16

was a Hush Blackwell podcast with Meg Prokarski

18:19

. I was honored to be on that with her and

18:21

we talked about the VBID . Next , the

18:23

states where Medicare beneficiaries have

18:25

Medicare Advantage plans . That was in Becker's

18:27

. 26

18:30

states now have more than half of the Medicare enrollees in MA plans and

18:32

, by the way , our listeners . I should have pointed out the

18:35

wonderful thing is now partnering with Hospice about

18:37

care . Today , all of these articles on

18:39

our site is now actually a PDF

18:41

download that goes along with our

18:43

, so you could get kind of a summary of what I'm reading

18:46

from here If you're kind of more of a quicker

18:48

reader than kind of a listener . Summary of what I'm reading

18:50

from here , if you're kind of more of a quicker reader than kind of a listener . Next one is

18:52

UnitedHealthcare . Humana and Aetna continue to outgain their peers

18:54

in Medicare Advantage and now

18:56

these Medicare plans that represent more

18:58

than half of all Medicare beneficiaries

19:00

in MA plans . So

19:03

those are kind of the top MA providers . Another

19:06

one home health disparities . Medicare

19:08

Advantage patients receive fewer visits

19:10

and worse outcomes . So Medicare

19:12

Advantage and how they partner with home health not

19:15

some good outcomes there . And then just the last

19:17

one MA cost management tools may

19:20

be hurting home health quality outcomes

19:22

, so very similar to the one that I just cited . Next

19:25

category is , of course , the

19:28

competition to be aware of . So we had

19:30

about 12% of my articles there

19:32

. Here's just kind of again an appetizer

19:34

. Private equity-backed consolidation divides

19:37

physicians Fewer physicians

19:39

only 46.7 in 2022

19:42

, compared with 60% in 2012,

19:44

. Work in practices wholly owned by doctors . Work and practice is wholly

19:46

owned by doctors . So in other

19:48

words , you're seeing a lot more private

19:51

equity , basically , and how that's

19:53

dividing the physician profession . Next

19:56

, the FTC and Department of Justice signal

19:58

greatly increased scrutiny of private

20:00

equity firms , acquisitions in health

20:02

care . So

20:08

you're seeing a lot more hearings and scrutiny about the influence

20:11

of private equity and what it's doing to healthcare . And

20:15

then next , for-profit nursing homes are cutting corners on safety and draining resources

20:17

with financial shenanigans , especially at mid-sized chains that dodge

20:20

public scrutiny . It was in a

20:22

publication called the Conversation Overall

20:25

. Private equity investors wreak havoc on nursing

20:27

homes , slashing RN hours

20:29

per resident day by more than 12%

20:31

, and it says the aftermath is grim

20:34

, with a dawning 14% surge

20:36

in deficiency score index . All

20:39

right , so that's that category . This is kind of another

20:41

subcategory in the competition . I just call it mergers

20:43

and acquisitions , and so MA

20:45

volume may shift from hospice to home

20:47

health , and so this is a hospice news

20:50

and kind of a project in for 2024

20:52

. Next this was pretty big news Steward

20:55

to sell highly desired

20:57

physician group to Optum

20:59

. The Dallas-based Stewart Healthcare

21:01

plans to sell its physician group to United

21:03

Healthcare Group's subsidiary

21:06

, optum , and the Boston Globe reported

21:08

on this on March 26 . And

21:12

then another , maybe related articles . I kind of find at the same time United's

21:14

purchasing this group , the department

21:16

. So should the Department of Justice break

21:18

up United Healthcare Group ? This is a MedCity

21:21

News . The Department of Justice has reportedly

21:23

recently launched an antitrust investigation

21:26

into United Healthcare Group , which

21:28

begs the question of whether the healthcare giant

21:30

should be broken up . Experts have many

21:32

varying opinions on that . And

21:34

then this was in Home Healthcare

21:37

News , what the UnitedHealthcare Group

21:39

antitrust investigation

21:41

means for a medicine in the home

21:43

health industry . And

21:45

then , mark , this is one I'm sure didn't escape your

21:48

notice I started my career at Covenant Hospice

21:50

in Pensacola . Vitas to buy

21:52

hospice assets of Covenant Care in Florida

21:54

and Alabama , and

21:57

so VITAS for an aggregate purchase

21:59

price of $85 million . And

22:02

that's where I started my hospice career . So that

22:04

includes the Pensacola market , all

22:06

the way throughout the panhandle towards Tallahassee

22:08

and into Alabama . Next

22:11

, private equity set sites on home care

22:13

and hospice . New report

22:15

finds the home care segment increasingly

22:17

has become an attractive target for private equity

22:19

buyers , particularly personal

22:21

care and hospice . Private

22:24

equities plot against older Americans

22:26

, and so this was in the Journal of American Geriatrics

22:29

. Over

22:35

the past decades , more than 140 private equity investment firms have acquired

22:37

entities and major components of healthcare in the United States . All right , so next

22:39

category is workforce challenges , and

22:41

so you might probably remember , mark , I kind

22:43

of substratify those into three categories

22:46

. The first category is these articles

22:48

paint the picture of just the challenge of

22:50

what's going on in the workforce . So this

22:52

first one , 20 states facing acute

22:55

nursing shortages , 20 states that

22:57

was actually in Becker's Next workforce

23:00

trends that CFOs must know

23:02

. Here's the list . Number one resentment

23:05

, resentee-ism , resentee-ism

23:08

I've never heard that word before , but just a

23:10

lot of resentment going on in healthcare . Number

23:12

two rage applying . Like I'm

23:14

ticked off my employer , I'm going to go play at this other

23:16

place and then you wonder why they don't actually

23:19

follow through on the application or the interview or whatever

23:21

. Number three acting your wage

23:23

, kind of interesting play on words . Lazy

23:26

girl jobs , kind of that . Gig economy

23:28

. Career cushioning bore

23:31

out bare minimum Mondays and quick

23:33

talk . So it was kind of a provocative

23:35

article . But there's a lot of interesting kind

23:38

of quips and kind of plays on words in that one . All

23:40

right , so that was the first category of workforce . The next

23:42

category is the implications of the workforce

23:45

shortage . Well , this first one . We've

23:47

seen a lot of this , especially

23:49

last year and now coming into this year , home

23:51

care unionization efforts beginning

23:54

to tick back up . And

23:57

then 2,300 University of Michigan

23:59

health workers unionized as

24:01

part of growing labor movement . And

24:03

then back in my own home state

24:05

, new Orleans , nurses rally before union

24:08

contract negotiations . This is for

24:10

University Medical Center in New Orleans . Nurses rally before union contract negotiations . This is for

24:12

the University of Medical Center in New Orleans . And then this was an interesting

24:15

article , kind of provocative Are the robots coming

24:17

for my nursing job ? And so

24:19

it talks about , while medication dispensing robots

24:21

, telemetry , electronic fetal monitoring

24:24

, artificial intelligence , other technological

24:26

advances have altered our work as nurses

24:29

, and fears that robots will replace

24:31

us and send nurses into the historical

24:33

career dustbin . Maybe

24:35

we could talk about that afterwards . I don't think that'll be the case

24:37

, but maybe it might eliminate

24:39

the things that aren't the best part of the job . Next

24:43

is home care-based employment exceeding

24:45

pre-pandemic levels . So almost on

24:47

all aspects of healthcare , now that

24:49

it actually is actually now beyond

24:52

what was before pre-pandemic , which

24:54

I think is just going to continue to go in that direction

24:56

as you look at the silver tsunami of

24:58

baby boomers , smaller wage

25:00

increases predicted for 2024

25:02

. And so now , as things kind of leveling

25:05

out they're kind of predicting , and also inflation

25:07

is leveling out somewhat , although still prevalent

25:09

. Next is is healthcare

25:11

paying enough attention to nurse leaders

25:13

? And so , just talking about the survey

25:15

of 2,400 nurse leaders they

25:18

were surveyed 35% of respondents indicated

25:20

they were considering an exit from their roles

25:22

, 35% . 12%

25:24

said they intend to leave , 23%

25:26

said they may leave within the next six months

25:28

. And then last article

25:31

, before we move to solutions roughly 1,000

25:33

nursing home workers hit the picket lines across

25:36

the Twin Cities area , and that was a CBS News

25:38

report . All right , so on the solution

25:40

side , I actually had eight this month . I'll

25:43

just give you an appetizer of them . But

25:45

the good thing is I love whenever I see a month of

25:47

a lot more kind of solutions

25:49

of what do we do with those staffing challenges , home

25:52

care providers , creative benefit packages

25:54

are paying off . So some really kind of cool

25:56

quips there of some interesting innovations and

25:58

benefit packages . Next

26:01

one in Becker's , inside Jefferson's

26:03

push to engage retired

26:05

nurses . So interesting innovation

26:07

of how to take those retired nurses who are not

26:09

looking to work full-time again but still

26:11

would like to be doing something . So that was a great article

26:14

. Providence's chief nursing

26:16

officer all hospitals should be using

26:18

these three tools . Number one

26:20

, robots , which is kind of what I was saying earlier

26:22

, wearable monitors and virtual

26:24

nursing , and that being

26:27

part of the solution , which I think it's going to have to

26:29

be there , just not going to be enough human beings

26:31

, considering the volume we're going to have to care for

26:33

. Next , in the MedCity news

26:35

, how the analytics of care can balance

26:37

workforce capacity , and

26:40

just a little sample on that US

26:42

healthcare is experiencing a supply and demand crisis

26:44

as it races to keep pace with the

26:46

aging population , midst of workforce

26:49

shortage and mounting financial pressures , and

26:52

the situation appears unlikely to improve , and

26:54

it's not going to anytime soon . And

26:56

recent projections anticipate a shortfall

26:58

of 139,000 physicians

27:01

in the next decade . And one

27:03

limiting factor preventing the efficient management

27:06

of the workforce resource is lack of data

27:08

and inoperability . In other words

27:10

, what the article is saying is how do we take data

27:12

and then get people to the right place at the right

27:14

time , in other words , spread them so that

27:16

way they can make maximum efficient use of the time

27:18

that they have ? All right , so a few

27:21

more States eye and deny a four-day

27:23

work week . The shortened work week appeals

27:25

to most Americans . A July

27:27

survey found that 81% full-time US

27:30

workforce supports a four-day work schedule

27:32

. 89% would sacrifice something

27:34

else for an extra day off and so but

27:36

interesting multiple states have introduced their own legislation

27:39

to support it , but varying levels

27:41

of success . I have a feeling this is going to keep coming

27:43

up over and over again . Next , physicians

27:46

grow louder on non-competes . As

27:48

you're getting more of a scarce resource , physicians

27:50

are pushing back on something that's been somewhat traditional

27:53

in healthcare , which is contractual non-compete

27:55

clauses . And then just

27:57

last one here in this section , where

28:00

hospices are investing their 2024

28:02

recruitment and retention dollars and

28:04

just had some really good quips and suggestions

28:06

of really smart investment

28:09

in those recruitment

28:11

and retention dollars . All right , mark

28:13

. The next one is the biggest one , so I will

28:15

skip around in this one , because this had 23 articles

28:18

but patient , family and future

28:20

customer demographics and trends . You

28:23

call this one out 36 rural hospitals

28:25

have closed since 2020 . Now

28:28

, next month , I just bumped into an interesting article

28:30

that actually did some margin

28:32

analysis and that had some kind of mixed results

28:35

in it , almost kind of saying that the rural

28:37

hospitals aren't any worse off than all the other

28:39

hospitals . So I have a feeling

28:41

, you know , I'll talk about that next month . Next

28:43

one mortality risk following end-of-life

28:45

caregiving . We've known this for a long time A

28:48

population-based analysis of hospice

28:50

users and their families . Here's

28:53

a couple of key points . Exposure to end-of-life

28:55

caregiving may increase mortality risk

28:57

for the surviving family the longer

28:59

the hospice duration . In being the

29:02

only nearby family member are risk factors

29:04

. Gender and relationship modify

29:06

survivor's mentality risk . Having

29:08

more family members is protective against

29:11

a survivor's mortality risk . Makes

29:13

common sense if you think about it . Right . If just one

29:15

person's carrying that burden Having

29:17

a spouse with dementia is particularly risky

29:20

for surviving widow's health based upon

29:22

that data , all right . When

29:24

the American dream becomes survival short

29:27

, doc chronicles rural health

29:29

care crisis . And so this was in PBS

29:31

, and really , if

29:34

dreams were lightning . Rural healthcare crisis

29:36

a startling look at the challenges facing

29:39

rural communities , in which hospitals are closing

29:41

and leaving residents without options

29:43

for care . All right , let's

29:45

see here . Long-term care costs can cripple

29:47

families with aging loved ones , and

29:50

so this was in the Modesta B . Next

29:53

, most Americans would rather feel 25%

29:56

healthier than live 25%

29:59

longer . So in other words , it's about quality

30:01

of life . Here's how to lengthen your health span

30:03

. That was actually in Fortune , and

30:05

so really great article . This one a little alarming . But when Medicaid

30:07

comes after the family home . This was in the . But when Medicaid

30:09

comes after the family home , this was in the New

30:11

York Times and as family

30:13

members in fact my own wife's family just kind of journeyed

30:16

this . Federal law requires states to seek

30:18

reimbursement from the assets usually the home

30:20

of people who died after receiving

30:22

benefits for long-term care . Let's

30:25

see next . This was a KFF article . The cost

30:27

of long-term care financial ruin

30:29

is baked into the system . Thousands

30:31

of readers reacted to the articles in Dying

30:33

Broke , a series about the financial burden of long-term

30:36

care in the United States . They

30:38

offered assessments for the government market failures

30:40

to drain the lifetime savings of so many

30:42

American families . So a couple

30:45

of thematic articles there and you can see why I called

30:47

it out in kind of trends . Let's

30:49

see here the US prison population Mark

30:51

. I thought this is another interesting kind of macro

30:53

trend . The US prison population

30:56

is rapidly graying and

30:58

prisons are not built for what's coming

31:00

. We know that court is pretty passionate

31:02

about the Angola project and I

31:05

think that's going to be an interesting , maybe like

31:07

a best practice that hopefully we might get to

31:09

see . But I didn't know . Like I

31:12

saw some of the data about

31:14

the aging of our prison population . Let's

31:17

see here . What else do I want to call out

31:19

Scary state . Two-thirds

31:21

of nursing home operators . Two-third

31:24

fear closure

31:26

without some type of staffing relief

31:28

. Of nearly 450 nursing home

31:30

providers surveyed , two-thirds are concerned

31:32

that escalating workforce challenges may force

31:34

them to close their facility . And

31:37

Mark , you called this one out rising suicide

31:39

risk among seniors due to loneliness , mobility

31:42

and financial insecurity . All

31:44

right , so I think that's all . Again , I have a whole

31:46

bunch more . Again , if you guys want to get

31:48

a copy whenever you see it being

31:50

pushed , we have a link and you could get all of the

31:52

ones I cited under that category . Next

31:55

, regulatory and political . The next will go a lot quicker

31:57

because I only had a few under those . So

31:59

, regulatory and political the hospice special

32:01

focus program . What is it and why

32:04

is it important ? This is about how the program

32:06

aims to shed light on poorly performing hospices

32:08

. Cms

32:13

has publicly stated it's looking closely at the hospice industry due to increasing concerns regarding

32:15

fraud , waste and abuse . And then the secretary

32:18

. How do you say his name ? You said Mark is Becerra

32:21

Becerra , secretary

32:23

Becerra . So his testimony . This

32:26

was on a different one . We're with you on telehealth

32:28

flexibilities . And so how ? The flexibility

32:31

that came out of COVID and the basic saying we're with

32:33

you health care . So hopefully maybe they'll

32:35

codify those things to stay going forward

32:37

. This was a hospice news

32:39

article by Holly Vossel how

32:41

CLN laws influence hospice

32:44

quality and program integrity

32:46

Variations in hospice state

32:48

. Cln the acronym state laws

32:50

are raising program integrity concerns

32:53

. And then last one , in this section , legislation

32:56

aims to increase scrutiny of private

32:58

equity healthcare acquisitions and

33:00

we'll , of course , pointed that out a little bit earlier as

33:02

well and one of my favorite

33:05

categories , which is technology and innovations

33:07

. And so let's see here I've got

33:09

how many . I've got 12 articles . So

33:11

again I'll do an appetizer Five

33:14

weeks of uncertainty , how the change

33:16

breach has unfolded . I mean , mark , this is probably

33:19

the most impactful cybersecurity attack

33:21

that I could think of , as far reaching

33:23

throughout healthcare . And then now

33:25

there's even starting to be government hearings about

33:27

how did this happen ? And then also

33:30

kind of the reaction to it . And there's

33:32

also been some kind of blowback to

33:34

. You know , a lot of people have had cashflow crisis

33:36

and United has offered some things , but

33:38

some people feel like it was maybe

33:40

not enough as far as what it could have been . And

33:44

coming out of that , double your

33:46

cyber security spending . Cio

33:48

warns amid change healthcare attack

33:50

, and so obviously I think that's

33:52

going to be really interesting on the backside . Next

33:55

, digital avatars and personalized

33:57

voices how AI is hoping to restore

33:59

speech to patients . That was actually

34:02

in JAMA , and the conversation is part

34:04

of a series of interviews with the editor-in-chief

34:06

and guests exploring issues surrounding the

34:08

rapidly evolving intersection of

34:11

artificial intelligence and medicine . And

34:14

then this was in modern healthcare , which

34:16

I felt like this probably maybe

34:18

because you think , oh , ai , maybe it's going to just

34:20

change everything tomorrow . This says give

34:23

generative AI another decade

34:25

to revolutionize healthcare , and

34:27

just talked about what

34:30

it's going to take for us actually to get to that point

34:32

. So another decade , we'll probably be blown

34:34

away where we're going to be , and so you'll see

34:36

a trajectory throughout the next 10 years

34:38

. Let's see here . The US healthcare

34:41

system should focus on pre-acute

34:43

care , not post-acute care

34:45

. I think that's a term we've been using for quite a

34:47

while . This was in Forbes . Us

34:49

healthcare system focuses an enormous

34:52

amount of money and attention on post-acute

34:54

care medical treatment patients receive

34:56

after they've been discharged from a hospital . But

34:59

would it be more cost-effective and far better for

35:01

patients to refocus on what you might

35:03

call pre-acute care and

35:06

how we prevent those re-hospitalizations in

35:08

the first place , amen . I feel like we

35:10

spent a lot of our career in that and with hospice-empowered

35:12

care . Let's see here . I'll

35:14

kind of skip a few . Let me do one more

35:16

how AI will help the world's

35:19

top hospital CEOs transform

35:21

healthcare . That was in Newsweek and

35:23

again kind of that . It's

35:26

a sexy title . Artificial

35:28

intelligence is quickly showing the potential to

35:30

revolutionize many aspects of caregiving

35:32

, from cancer diagnosis to clerical

35:35

work . With the release of Newsweek's ranking

35:37

of the world's best hospitals , executives

35:39

at leading hospitals around the world told us how

35:42

they're going to use the power of AI to transform

35:44

the future . All right , last couple articles

35:46

, mark . This next one is I always kind of put

35:48

it in the human factor

35:51

category . It says what you should

35:53

and shouldn't say to a friend going

35:55

through a major illness . It was an

35:57

MSN article and

35:59

just here's kind of five key points . I

36:02

love you , I'm here for you . I don't

36:04

exactly know what to say , but I'm thinking of you

36:06

. I can't imagine how you're feeling , but

36:08

whatever your emotions , you're experiencing are perfectly

36:10

valid . Let me do X

36:13

, fill in the blank for you how does that sound ? And

36:16

you don't have to say anything . I just thought that was a

36:18

great human interest article . All

36:20

right . The last one , I kind of put my 10th category

36:22

is things I wanted to kind of call out . This

36:25

was interesting for me because kind of it's the

36:27

windsock of where things are blowing in the future

36:29

Five C-suite

36:32

roles that talent leaders are looking

36:34

out for . So think about that Talent

36:36

leaders , talent recruiters Number one

36:38

. Chief information officers

36:40

and cybersecurity executives Number

36:43

two data analytics and

36:45

business intelligence executives . Number

36:47

three dual C-suite

36:50

roles . So people are playing multiple roles

36:52

, let's say like a chief experience officer and

36:54

chief nursing officer or chief experience

36:56

officer , chief operating officer . The

36:59

fourth is chief population health

37:01

officers and then the fifth , chief

37:03

clinical officers , chief nursing officers

37:06

and service line executives . So

37:08

busy month , mark , busy month

37:10

. Any comments on that before I hand it to you

37:13

for your masterclass ?

37:14

A lot of

37:16

things for readers , hospice

37:19

leaders to keep an eye

37:21

on , and it's great to have hospice

37:23

and palliative care today to help you sort

37:26

through everything and pick out

37:28

that which is most important to you while

37:30

keeping you abreast of a broader

37:32

field of interest .

37:34

Thank you to our TCN Talks sponsor

37:36

, deltacarerx . Deltacarerx

37:40

is also the title sponsor for our

37:42

April and November 2024

37:44

Leadership Immersion Courses

37:46

. Deltacarerx is primarily

37:49

known as a national hospice PBM

37:51

and prescription mail order company . Deltacarerx

37:55

is a premier vendor of TCN and

37:57

provides not only pharmaceutical care

37:59

but also niche software

38:01

innovations that save their customers

38:03

time , stress and money . Thank

38:06

you , deltacarerx , for all the great

38:08

work you do in the end-of-life and

38:10

serious illness care no-transcript

38:48

for a second month in a row .

38:50

And like last month , where the subject was

38:52

shorthanding the name of your hospice , this

38:54

month's topic likely will be a bit uncomfortable

38:57

for many . The subject

38:59

stock photography On

39:01

your website and your printed marketing

39:03

materials and if you utilize

39:06

a paid news release distribution

39:08

service , perhaps even to accompany

39:10

your news releases , if you choose

39:12

to pay for a stock photograph to

39:14

accompany your release , if you choose to pay for a stock

39:16

photograph to accompany your release , stock photography photographs , often

39:18

using paid models , you either

39:20

obtain for free from a website or

39:22

other provider or purchase from a

39:24

commercial source . They

39:35

do nothing to define your brand , differentiate your brand from your competitors or

39:37

communicate an accurate hospice message . One reason why that's the case is that there are

39:39

so few stock photos that show someone who

39:43

might possibly remotely

39:45

look like a hospice patient , so

39:48

that many hospices end up using photos

39:51

of seniors , even seniors

39:53

in a hospital bed or wheelchair , who

39:55

look like they are more likely to go out and play

39:57

three sets of tennis or a round of golf

39:59

than die within the next six months

40:02

. Stock photos of seniors generally

40:04

are more appropriate to sell an incontinence

40:07

product or an erectile dysfunction

40:09

medication than they are to illustrate

40:11

the benefits of a timely and appropriate

40:14

admission to hospice the

40:17

benefits of a timely and appropriate admission to hospice but the photographers

40:20

in the photo agencies that sell photos to marketers of every description . There isn't a

40:22

whole lot of money to be made taking and

40:24

selling photos of people who look like

40:26

they're terminally ill . So even

40:28

if you're convinced that you don't need photos of

40:30

healthy , smiling people when describing

40:33

the benefits of hospice on your website , there

40:35

are not a whole lot of realistic looking photos

40:37

from which to choose . That

40:40

, of course , assumes you're even willing to pay for stock

40:42

photography , and while there is

40:44

a lot of expensive stock photography

40:47

available to anyone with a credit card , most

40:49

hospice marketers find themselves limited

40:52

by budget to utilizing

40:54

either rights-free stock photography

40:56

, photography for which there is no

40:58

cost , or stock photography with

41:01

a ridiculously low purchase price

41:03

of , say , $100 for

41:05

a photo . Using

41:11

no-cost or low-cost photography raises another problem the fact that your competitors might

41:13

choose to use either the exact

41:15

photo or a similar

41:17

photo from a set of photos with

41:19

the same model in the same setting

41:21

, and my question is how does that

41:23

help define and differentiate

41:25

your hospice brand ? If

41:28

you choose to rely on stock photography to

41:30

illustrate your brand , there are definite risks and

41:32

rewards the reward of paying

41:35

nothing for the photographs you

41:37

use versus the risk of your crosstown

41:39

competitor using the same photo

41:42

. Now you can purchase

41:44

stock photography . Paying , say

41:46

, $500 for a photograph likely

41:48

limits the number of your competitors who would

41:51

even consider buying that same photograph

41:53

. You can even spend a lot more

41:55

to secure exclusivity

41:57

, meaning the photo can't be sold

41:59

to anyone else during a specific time

42:02

frame , usually a year or two , or

42:04

maybe a specific geographic

42:06

market . Many hospices , however

42:08

, will say that they would never spend several

42:11

hundred dollars for a stock photograph , but

42:14

they insist on using stock photographs . And

42:17

to those who say I couldn't possibly

42:19

pay $500 for a photo

42:21

, what I'm hearing you say is

42:23

our valued 40-year-old

42:25

brand isn't worth $500

42:28

. But there are other

42:30

solutions aside from stock photography

42:33

. One is to build your own photo

42:35

library using a local photographer

42:37

and actual patients , with

42:39

appropriate permissions , of course , from patients

42:41

and families . Another , less

42:44

obvious solution is to stop using

42:46

photos of people to illustrate your website

42:48

and your marketing materials altogether

42:51

. You can use objects or

42:53

symbols , or you can use drawings

42:55

of people and situations instead of actual

42:57

photographers . As

43:00

there are libraries of stock photographs

43:02

, there are also libraries of illustrations

43:05

, all done in a singular style

43:07

, many of them with a healthcare theme . Some

43:10

are actually quite good and the cost is

43:12

usually quite manageable usually

43:14

cheaper than stock photography and it allows

43:16

you the drawings , allow

43:18

you to change the color palette so you could end

43:20

up with drawings

43:23

that are reflective of the color palette of your

43:25

brand , for example . I'm

43:27

sure that by this time some listeners are

43:30

wondering whether this is much ado

43:32

about nothing . I've

43:34

got probably a dozen real-life examples

43:36

from my career in healthcare communications

43:38

, chris , that demonstrate there actually

43:40

is much ado , and I'll close with

43:43

two . First , there

43:45

is a universally recognized stock

43:47

photo rights-free of

43:50

a young Black woman , likely a nurse , dressed

43:53

in scrubs with a stethoscope

43:55

slung around her neck . The photo

43:57

is at least 35 years old

43:59

. I remember seeing it when I

44:02

was at Jackson Memorial Hospital in the

44:04

early 1990s and it

44:06

is the go-to

44:08

photo for nurse recruitment

44:10

advertising . It is so

44:12

overused , even today

44:14

, in fact , that any clinician who

44:17

spent any time at all looking for

44:19

a next job has likely run

44:21

into the photo and the promotional materials

44:24

from dozens of prospective

44:26

employers . Employers

44:28

use this photo to convey the sense

44:31

of a young , diverse workforce , I

44:34

think , to the clinician who's seen the

44:36

photo multiples of times it

44:38

actually sends a different message that

44:40

you are no different than any of a dozen

44:43

other providers seeking to recruit

44:45

clinicians . And

44:47

then a personal story . In the mid-1990s

44:50

I joined a small hospital system

44:52

that had undergone a million-dollar rebranding

44:55

a year earlier . Cardiothoracic

44:57

surgery was one of the few highly

45:00

profitable service lines at this hospital

45:02

and it was a huge part of our TV

45:04

, print and outdoor advertising

45:06

campaigns . The print and outdoor

45:09

advertising designed by the agency

45:11

that had led the rebrand used a

45:13

retouched photo of an older

45:15

male receding hairline in

45:17

a suit and tie , with his hands

45:20

raised toward the heavens , standing

45:22

in the surf . The hospital was

45:24

located on the east coast of Florida . I

45:27

asked the agency about the photo and they assured

45:29

me it was unique to our campaign . But

45:32

about six months after I got to this hospital

45:34

system , a national LASIK surgery

45:37

chain that had offices in

45:39

and around our market launched

45:41

a large national outdoor advertising

45:43

campaign featuring the same

45:46

photo of the business-suited

45:48

elder male reaching skyward without

45:51

the surf . Our agency

45:53

, in fact , had used a low-dollar

45:55

stock photo with very limited

45:57

exclusivity rights as the centerpiece

46:00

of a campaign supporting our most

46:02

profitable service line . Now

46:05

, since I'm competing here , in this case

46:07

with a national advertiser

46:09

, there was no way I was going to convince

46:11

them to end

46:13

their campaign , so I had no choice but

46:16

to take down the billboards and redesign

46:18

the print advertising . The agency

46:20

did not discount its fee when redesigning

46:22

the campaign and

46:28

within a year or so the agency no longer handled our

46:31

account . The

46:33

bottom line stock photos may be budget-friendly , at least in the

46:35

short run , but they are generally costly to your brand and there are

46:37

better solutions . So

46:41

that's our master class this month

46:43

. I hope it causes a stir among people

46:45

who have plastered the

46:47

same stock photography their competitors

46:50

use all over their website and

46:52

their print materials . It's really a discussion

46:54

that people ought to be having , particularly

46:57

when they're approaching a rebrand .

46:59

Thank you , mark . You're always thought-provoking . When

47:01

you were talking about the one that's gotten used

47:03

, that's really old . Your point is

47:06

that if everyone's using

47:08

the same picture , you're not painting

47:10

any picture very unique . It's almost like if

47:12

you walked into my home and I had pictures on the wall

47:14

and it was the stock photography

47:16

that comes with the advertisement , as opposed to pictures

47:18

of my own family . That doesn't

47:21

tell you very much about our family . It doesn't

47:23

feel very personal and that's the vision

47:25

that kept coming to me . There's no joke

47:27

that my wife and I , years ago , we brought this amazing

47:29

comedian to one of our hospice events and

47:31

one of his key funnies was

47:34

he goes you know the first two kids . You got pictures

47:36

all over the house and by the last two kids you

47:38

just keep the stock picture that's in there

47:40

. It's got a funny

47:42

way of making your same point . And so

47:44

well . I appreciate you , mark . You always make us think

47:47

and to our listeners , we really appreciate

47:49

you . Make sure you subscribe Also

47:52

. Pay this forward to lots of your friends in

47:54

the hospice field . And

47:58

so , as always , mark and I want to leave you with a quote . This one is from Minot Simmons no

48:00

pleasure , philosophy , no sensuality

48:03

, no place . No power , no material

48:05

success can for a moment give such

48:07

inner satisfaction as

48:09

the sense of living for a good purpose

48:12

. Thanks for listening to TCN Talks

48:14

.