This transcript has been auto generated
00;00;00;00 - 00;00;26;05
Meg Pekarske
Hello and welcome to Hospice Insights: The Law and Beyond where we connect you to what matters in the ever-changing world of hospice and palliative care. One Size Doesn’t Fit All: Figuring Out What is Your Hospice+. So Bryan we should trademark hospice plus I feel like because we've been using it a lot, hospice plus, you came up with that.
00;00;26;07 - 00;00;43;11
Bryan Nowicki
Yes I've well. Right. Well and you know this and I have to say, you titled this episode and I'm jealous. This is a great title, but yeah, every time we say hospice plus in this episode, I will sneak in a little TM just to protect ourselves, the intellectual property we're generating.
00;00;43;13 - 00;00;53;20
Meg Pekarske
Yeah, exactly. Well, or, you know, because we haven't trademarked it, so it could just be a BM because it's Bryan came up with it.
00;00;53;20 - 00;00;58;15
Bryan Nowicki
Yeah, it's a huge BM. I think we got to think of it that way, so.
00;00;58;17 - 00;01;01;04
Meg Pekarske
Anyway.
00;01;01;06 - 00;01;03;09
Bryan Nowicki
Gonna change, the BM that changed the world.
00;01;03;10 - 00;01;30;10
Meg Pekarske
Yeah, exactly. Hospice plus. So, so but all kidding aside here. What we really want to do explore in this episode because, Bryan, you and I, do presentations with boards and, I'm involved in a lot of restructuring projects with clients, and all of that is about strategic vision for the future and what that looks like.
00;01;30;10 - 00;02;00;06
Meg Pekarske
And, and I think that what I wanted to achieve in this episode, I'm very outcome oriented here, laying out what my goals are was I think it can be really intimidating as a leader. You go to these conferences and everyone's talking about, I'm doing this, I'm doing that, and you feel like you need to do what everyone else is doing and sort of follow the herd, so to speak.
00;02;00;09 - 00;02;20;01
Meg Pekarske
And, I mean, I truly believe people have to change, like there needs to be a pivot. That's why we came up with Hospice Plus. But like, we're we're not going to be the one trick pony. But I don't think what is our plan is going to be the same thing for everyone because the strengths are different. Your market's different.
00;02;20;05 - 00;02;51;06
Meg Pekarske
And so I just want to put that on the table, because I think in talking with people all over the country, I think there's anxiety around like wall so-and-so's doing this and I need to do that. And we saw that, you know, a decade ago when people are doing palliative care and you go to this conference and we sort of confuse because like, oh, they're providing all these free services, and then they talk to me and I'm like, well, you need to consider a beneficiary inducement and other things.
00;02;51;06 - 00;03;15;22
Meg Pekarske
So I, I, I want this and we're not going to talk about every single, you know, hospice plus idea. But I just think having a framework work and I think being okay with you, it might not make sense to do what what the other guy's doing. And so you got to really go back to what your strengths are, what your market is.
00;03;15;24 - 00;03;39;29
Meg Pekarske
And importantly, we're going to explore this a little bit more about what? Great. Bring your board around. Because I think in talking to boards, I there's a little bit fatigue I hear because. So for a long time people have been trying to get palliative care off the ground. And it's been challenging because, there's not a lot of income streams, revenue streams from that.
00;03;39;29 - 00;04;12;13
Meg Pekarske
That's changing a bit. But people might say, well, the last time you came and you wanted to explore, you know, expanding in this area, we lost a ton of money. And, you know, I don't want to go down that path again. And I think it's like, but just because that one thing didn't work out, I think the board needs to realize that there's there's opportunity out there and we can't just say, well, this, you know, this was a money loser.
00;04;12;13 - 00;04;47;04
Meg Pekarske
We're not going to ever do anything different again. We're just going to stick with the Medicare hospice benefit. And, and, let it be so I just talked a lot, Bryan, because I'm passionate about this, but I just I, I, I just feel anxiety for people who feel like I got to do what everyone else is doing. And I think it's the fun work that we get to do is to say, take a breath and go back to your strengths and doing your Swot analysis and what makes sense for you in particular.
00;04;47;04 - 00;05;12;09
Meg Pekarske
But in as we've put together these different board presentations and talking with, with folks, I think where we start out is, you know, where we've been is not where we're going. And so we have like past, present, future stuff that we talk about. And, you know, there's a couple different highlights that I think are pretty interesting.
00;05;12;09 - 00;05;43;15
Meg Pekarske
And there, the one that that, comes to mind for me is we've had, you know, hospice has gone very mainstream and we've had, you know, growth. Because now I think what does at 49% of Medicare beneficiaries die on hospice now? I mean, it's it's gone up steadily, but it's only a couple percentage points over like the last five years or something.
00;05;43;18 - 00;06;05;03
Bryan Nowicki
Yeah. It was it was 44%, in 2010, 49.1% in 2022, which is 2022 is like the most recent kind of vetted data that, that they put out about that. Yeah, that's that's increasing the percentage, not a super dramatic increase. But it's going up. Definitely.
00;06;05;05 - 00;06;28;04
Meg Pekarske
And it's, you know, it's steady but, you know, betting on that number. Are we going to, you know, get to 75 or 80%. Probably not. Because, you know, sometimes people die suddenly or you know, and that's sort of what Hospice Plus is about is how can we get upstream and care for people, whether or not they ever go on hospice.
00;06;28;04 - 00;06;47;21
Meg Pekarske
Right. And being able to serve, people sort of where they are, when they and and so but but Bryan other the other highlights I think as we've been doing looking back, looking forward sort of statistics.
00;06;47;24 - 00;07;08;14
Bryan Nowicki
Yeah. Well, but we have seen some things, you know, change in some time. Some things stay the same. That median length of stay on hospice has been at 17 to 18 days for over a decade, which I think a lot in the hospice. They say that shows underutilization of hospice. You know, we're not getting people on hospice soon enough.
00;07;08;14 - 00;07;30;04
Bryan Nowicki
If they're only getting 17 to 18 days worth of what is designed to be really a six month benefit. Now we know CMS doesn't look at that, and they look at the other end of the, the bell curve, and they see the patients who are on for three years or five years or whatever and, and say, well, at all costs, we've got to stop that from happening.
00;07;30;06 - 00;08;12;17
Bryan Nowicki
But but I think when you see the median length of stay being that low, and you look at it in the context of the, you know, the rising utilization, baby boomers coming on, and maybe, maybe that's a prospect. There's you kind of look for the opportunity within the data. And I think kind of touching upon your introductory comments, if you go to these conferences and you just say, I'm going to kind of hitch my wagon to the latest and greatest, you're you're missing a step, which is a lot of self-reflection, a lot of assessing yourself, assessing the data in your market and the market at large, and not thinking that
00;08;12;17 - 00;08;39;03
Bryan Nowicki
what worked for somebody else is going to work for you. There was, I'm sure there was, the first hospice to really invest themselves in palliative care and have success. And that was great for them. But, you know, maybe the next best thing to come along is going to be something that works for you. That is different. Get involved in geriatric primary care, something like that, which you're going to make that the next hot topic and people are going to want to follow in your footsteps.
00;08;39;03 - 00;08;51;16
Bryan Nowicki
So, following an footsteps is is risky in itself. So kind of what we're talking about now, what's the the data around there and how can we see the opportunities in the data. That's where the work is done.
00;08;51;18 - 00;09;14;06
Meg Pekarske
Well. And I think working with boards and and doing being part of this process and, you know, being the fly in the wall and getting to hear what people say, I mean, starting with how can I be of service is really the question that we're asking. What does my community need? What do my community partners need? Not what do I want to do.
00;09;14;08 - 00;09;41;26
Meg Pekarske
Right? I think that that, you know, it's it's very much of an outward looking do not what do I want to do? But how can I be of service now? We need to stay in our lane to a certain extent, because this needs to be guided by, well, what are my strengths and my skills? And I think when we look at that, we have a lot of strengths and skills where we're good at having difficult conversations.
00;09;41;26 - 00;10;12;23
Meg Pekarske
We have staff that are great at that. We can manage to a budget because we've always been paid on a, you know, per diem. We have, from a client service perspective, you know, typically most people have very good hospice experience. So customer satisfaction and is really good. I mean, there's lots of things that we have strengths that can be applied in different ways.
00;10;12;23 - 00;10;37;28
Meg Pekarske
So I think starting with that, how can I be of service? What is my community need? What do my community partners need. You know, and and also with payers, you know, what do they need to help with problem solving sort of idea as opposed to just, oh, I heard, you know, some hospices are setting up a management services organization.
00;10;37;28 - 00;11;03;15
Meg Pekarske
So I'm going to do that too. And I'm going to, you know, do a JV with the hospital because I heard someone else is doing that or, you know, whatever. I think getting back to, you know, what our community needs of us is, is really important because I think when you start there, you might end up in different, different places.
00;11;03;18 - 00;11;04;06
Meg Pekarske
So and I.
00;11;04;06 - 00;11;27;22
Bryan Nowicki
Think and I think outreach is, is is something that you should embrace. You can go so far to try to figure out, well, what do what is my community need? What are the other health care providers in the community need? But you kind of do your homework to a certain extent and then, engage with those other folks and find out directly from them.
00;11;27;22 - 00;11;50;07
Bryan Nowicki
What do they need? Here's what we can offer part of it or examples. But what do you need? Because we think, you know, we can come together and, you know, provide whether it's, want better outcomes. You want to like you said, we're good at staying within a budget with the per diem. What better, quality readings from patients?
00;11;50;09 - 00;12;15;19
Bryan Nowicki
The reduced costs. Want to try to reduce your costs? Big hospices could have a really effective way about, going about reducing costs and bereavement. So, you know, bereavement care, that's kind of something that hospices engage in, and kind of looking at articles. They're partnering with schools and partnering with other health care providers about bereavement care.
00;12;15;21 - 00;12;31;04
Bryan Nowicki
But looking at your skill set and then saying how, how is this helpful to others in the community? And then, you know, communicate with those other folks in the community and, and try to come together with what is it that we can offer that you need? And we will try to fill that need.
00;12;31;07 - 00;12;59;25
Meg Pekarske
But but importantly, we have to make money doing that, right? And so forth. But I am also a huge brainstorm nurse. I think getting all these ideas out on the table. But then we have to have the lens from which we evaluate all of these, which is one thing I think is critical, is we desperately need to be diversified from a payer star standpoint.
00;12;59;27 - 00;13;35;16
Meg Pekarske
So how hospice, I think more than you know, most provider types are so heavily Medicare focused. So going into another business line that, like all of your revenue is Medicare might not be the best thing, right? And because we all know that's why audits hit hospices so hard, because if they're going to audit you and they do statistical extrapolation, they can, you know, apply that to 90% plus of your revenue, right?
00;13;35;16 - 00;14;18;08
Meg Pekarske
Because it's all mostly Medicare. So I think been thinking about, okay, of all these great ideas we have and problems rather solve, you know, how can we get paid doing this. And is it something other than Medicare. And, and we provide this with all of the staff shortages that we have and all this, who can do this service because if we already are short staffed for our nurses, for hospice, getting into a super nurse heavy business, is is that going to necessarily be possible given the staffing realities we have?
00;14;18;11 - 00;14;43;11
Meg Pekarske
And also thinking about how we could leverage technology in providing some of this service too. So the Lanza's that's a great idea, but I'm not going to be able to staff that. I can barely staff, you know, my hospice much less, you know, another service line. But I think so when we explore like adult day care with folks.
00;14;43;13 - 00;15;09;07
Meg Pekarske
Right. You don't necessarily need nurses to do that. And you don't necessarily maybe even need CNAs to do that, depending on that. So thinking about the staffing realities of doing that, you know, can I get paid to do that. So like bereavement, great mission focused. But can we really get paid to do that? And it's not that we don't do that.
00;15;09;07 - 00;15;34;20
Meg Pekarske
But in terms of Hospice Plus and how are we expanding our revenue streams and creating, you know, a diversified platform. So we are here to serve the community for another 100 years. Right. And that's why we need like a ten pronged stool. Right now we have one prong stool if all you're doing is hospice. Right. And so we need at least two other legs.
00;15;34;20 - 00;15;39;25
Meg Pekarske
Right? I don't think there's a two legged chair. There's a three legged.
00;15;39;28 - 00;15;43;09
Bryan Nowicki
It's not a good one. Yeah. Yeah. Legs is the minimum.
00;15;43;15 - 00;15;50;26
Meg Pekarske
Yeah. Oh or a pogo stick I guess if like hospice is a pogo stick. Yeah.
00;15;51;01 - 00;15;57;24
Bryan Nowicki
But but we could move to stilts. But that's still pretty precarious. Yes. So that's third leg of.
00;15;57;27 - 00;16;20;29
Meg Pekarske
So. So we have you know, what staff do I need to have to do this. You know, is it a diversified care source. Does it align with strengths that I already have? Can I use technology? I can't remember, Bryan. Some of the other things we have on our list is sort of filters or lenses, so to speak, of things that you should be looking at.
00;16;20;29 - 00;16;40;11
Meg Pekarske
Because again, I think we want to do, you know, with groups of people within our organization and our board of lots of different ideas, but then we need to filter this down into what actually makes sense. And so these were some filters you and I came up with when we were doing a presentation.
00;16;40;13 - 00;17;03;15
Bryan Nowicki
Well, yeah, I think part of it is, you know, a startup cost. Is this something you start on your own? Can you acquire an operating an entity that's already out there to kind of complement what you're doing? So you don't have the expertise by the expertise and maybe the two in combination are, you know, make it two one plus one equals three.
00;17;03;15 - 00;17;12;13
Bryan Nowicki
In other words, you kind of take advantage of combining a couple to to provide even more opportunities for yourself. So yeah.
00;17;12;15 - 00;17;40;11
Meg Pekarske
Well, and I think that we've seen and worked on transactions of like home health companies, geriatric primary care. I mean, we've also worked with clients and starting those up from scratch. We've also have had clients who started a home health agency that sort of went dormant and they restarted it. So sometimes when you start things, it actually wasn't the right time to do that.
00;17;40;11 - 00;18;06;28
Meg Pekarske
And now maybe it is until you bring it back or like you said, you buy it. Because if you can find someone who's doing a really good job in this space, you know, there's no pride in this whole I got to do it myself, right? I mean, I think that there can be a real benefit, to, to, you know, buying other people's, expertise.
00;18;06;28 - 00;18;43;00
Meg Pekarske
Then I think an exciting part of palliative care these days is that I do think people and payers in particular, including non Medicare payers or Medicare Advantage payers of palliative care, right, isn't really well defined. I always say it's defined by what you can get paid to do. And I think we're getting paid to do more or they're more money about if that parlays into chronic care management or case management services or supportive care.
00;18;43;02 - 00;19;12;09
Meg Pekarske
But we also know that people want to age in place. And and again, that totally aligns with something we're great at, which is going into people's homes and providing that as a place of service. And so I think that that is so critical because that's probably one of the number one things when people age that they want to age in place and they want to age at home, no one wants to, you know, go to a nursing home.
00;19;12;12 - 00;19;34;26
Meg Pekarske
You know, a lot of those folks don't want to die in a hospital if they don't have to. And so that is such a great strength. That is, it's pretty complicated to provide care in, in the home. And I think we take for granted that we've sort of mastered that. But a lot of lessons learned, like for the hospital at Whole Bottle.
00;19;34;26 - 00;19;59;16
Meg Pekarske
Right. Like that. That was a whole new thing that that started during Covid, that that campus, I think, saw some real benefits to. There's a report that just came about, but some of the benefits of, hospital at home. But but everything is moving to the home. And so that being the place of service and I think that's not, about private pay.
00;19;59;16 - 00;20;25;01
Meg Pekarske
So assisted living in large part is all private pay dollars. Right? So I think we've always said, well, we can't do this if we have to charge the patient, there needs to be a payer source. But people are paying out of pocket for assisted living services. So, you know, there there are opportunities that people will pay for sort services.
00;20;25;03 - 00;20;46;28
Meg Pekarske
And like for example, case management services, you know, checking in on people, seeing how they're doing, you know, assistance with tasks around the house. I mean, there's a whole lot of different things that people need help with and that people have funds to pay for themselves privately, even if insurance doesn't cover it. So.
00;20;47;00 - 00;21;16;01
Bryan Nowicki
Yeah, and I think that's why we're a little cautious about, you know, utilization. It's just going to keep going up and up and up. It's that's not necessarily the case. That's not what patients necessarily want. But always end on, on hospice for an extended stay. I mean they might want to, have one of these alternative, health care delivery systems working for them for a longer term that they get comfortable with.
00;21;16;03 - 00;21;39;09
Bryan Nowicki
And, and go, who are those entities who are currently doing that? How can we leverage their expertise into ours? So kind of looking at, at providers as competitors, but also potential collaborators, is is something to be open minded about. And I think with a lot of, a lot of the the analysis is really come to it with an open mind.
00;21;39;09 - 00;22;07;07
Bryan Nowicki
Don't really rule anything out, as you're trying to figure out what what are the opportunities out there, finding that diverse payer source, diverse payers? It would would be a huge boon mitigating a lot of the risk that that we see all the time. And like you said, I think those payers are out there, the the market wants something and maybe they need someone to define what it is that they need.
00;22;07;09 - 00;22;20;18
Bryan Nowicki
So we talked about filling the need but also creating the need or at least identifying, hey, this would be attractive to a lot of people. They just don't know it yet. That's another way to look about look at what are the opportunities that could be available.
00;22;20;20 - 00;22;59;16
Meg Pekarske
Well, and like in my life, not just my lawyer to life, but perspective is so important. Like you're a better person if you go and talk to other people about what they think about stuff. Right. And so I think making sure as we're exploring these things that we have different diluent things that we talk to about the staff, because just because, you know, I'm the CEO doesn't mean my ideas are the best ideas or that that I have all of the ideas.
00;22;59;16 - 00;23;32;20
Meg Pekarske
Right. And so when when we're coming at it from how can I be of service? What does my community need that's not interject and say, I know what that is before I even ask the question. And so I think sometimes when planning gets to be an effective and I'm not saying, you know, this goes on and on and on, but I think not just having the same five people sit around the table who drink the same Kool-Aid is you're not going to have diversity of thought.
00;23;32;23 - 00;24;18;26
Meg Pekarske
And it's different people, including, as you said, like our who's going to be our consumer and what do they need, what problems are they trying to solve and, and whatnot. I think that there has been a lot of interest and is, I feel like over the last number of years, which is an amazing program, but talk about like, financial investment, Bryan, you're saying, you know, on our list of filters, like, how much does it take to get off the ground, like starting an adult day care program, you know, balancing that word of like essentially starting up a Pace program where I have to have a really expensive building and I have to
00;24;18;26 - 00;24;49;09
Meg Pekarske
have so much cash. And I mean, I gotta, you know, have additional expertise on my team because it's, you know, now I'm sort of a provider, right? I'm being a payer and I'm a provider and, and, you know, I got to deal with paying claims. I mean, it's it's a big undertaking. Really exciting. But but I don't think that just because you're not doing pays, like, there's not a whole lot that we could be doing to be of service.
00;24;49;09 - 00;25;22;01
Meg Pekarske
And when you think about it and a lot of your competitors might just be doing, as I always say, the one trick pony hospice, and they're not really in these other spaces. But, so it's another way that you can, compete. But I always like going back to the how can I be of service going, asking people what they need and then figuring out does that align with my skill set and all these other sort of filters that, that we have?
00;25;22;01 - 00;25;42;20
Meg Pekarske
And and, Bryan, we could probably, take a couple of those from some of the presentations. We've done a few of those slides and include them on the podcast. Now it's just, because we've covered sort of a lot here. But what those filters are, I think could be helpful for, for folks.
00;25;42;23 - 00;26;06;29
Bryan Nowicki
Yeah. Oh, absolutely. I think I think we do that we have some data on, on the market out there that might be helpful to kind of get the conversation going within your hospice, about kind of how do we how do we look at this data, look at these filters and, and start to think about what value we can add to the community and what payers we can attract or locate.
00;26;07;01 - 00;26;37;23
Bryan Nowicki
And I think, in these kinds of discussions where there's a lot of brainstorming, it really requires creativity. It's good to have a diverse board, a lot of different backgrounds, in different business community, health care community, just, kind of retired citizens, whoever, but combine it with, hospice staff people, and get all that perspective, and, and kind of bringing those groups together.
00;26;37;25 - 00;26;49;02
Bryan Nowicki
So that they can kind of, just enhance the, the arena of ideas that you can start to share. And in that brainstorming really become more effective.
00;26;49;04 - 00;27;16;26
Meg Pekarske
Well, this is stuff I love to do, and I love it because I, I learned a ton when we get to work on these kinds of projects. And I think when we did our Gallup strength assessment on our team, I think like learning is my number one thing that I love to do. So, so I always learn from from our clients and it's a lot of fun and it makes me better at my job being a lawyer.
00;27;16;28 - 00;27;18;06
Meg Pekarske
So when I.
00;27;18;06 - 00;27;26;04
Bryan Nowicki
Get I'm all about and I'm all about relationships, as you know, from that same personality survey, who would've thought?
00;27;26;07 - 00;27;57;24
Meg Pekarske
Yeah. So yeah, that that's sure was interesting. Our, our Gallup strength assessment thing. But, so while this is a fun conversation and something I'm super passionate about and so, so I guess it's like legal adjacent, because we work all over the country. So I see lots of different things about how people approach things. And so, I'm always happy to, to be part of board conversations.
00;27;57;24 - 00;28;09;12
Meg Pekarske
So call me up and I'm happy to, to do that. And it's the most fun thing I get to, to do. So, I could start doing it for free. Bryan I almost like it that much.
00;28;09;12 - 00;28;13;21
Bryan Nowicki
Oh, well, that's cut, cut off the tape.
00;28;13;24 - 00;28;39;04
Meg Pekarske
But it's really it's really, it's fun to be part of of the future that way. So anyway, thanks for for, letting me do a lot of the talking today, Bryan. You know, I get overzealous. We've worked together a long time, so, you know, I can't fake it when I'm passionate about it. You know, Bryan.
00;28;39;26 - 00;28;42;17
Meg Pekarske
I, I just go off., so.
00;28;43;04 - 00;28;53;25
Bryan Nowicki
Oh, and I just, I just, like the the like the I listen, when you are passionate about something, you have so much good to say. I just try to take it all in, contribute where I can.
00;28;53;28 - 00;29;07;03
Meg Pekarske
So thanks for we almost like flipped it there. You are almost like host that I was like asked so but it wasn't. I let you interject so it wasn't a total monologue, but oh no.
00;29;07;05 - 00;29;11;08
Bryan Nowicki
I, I contributed.
00;29;11;10 - 00;29;13;25
Meg Pekarske
Thank you. And until next time.
00;29;13;28 - 00;29;18;17
Bryan Nowicki
Very good. Thanks, Meg.
00;29;18;20 - 00;29;22;28
Meg Pekarske
Well, that's it for today's episode of Hospice Insights: The Law and Beyond.
00;29;23;00 - 00;29;32;05
Meg Pekarske
Thank you for joining the conversation. To subscribe to our podcast, visit our website at huschblackwell.com or sign up wherever you get your podcasts.
00;29;32;07 - 00;29;38;27
Meg Pekarske
Until next time, may the wind be at your back.