Leadership, Quality, and the Future of Hospice: Guests Chris Comeaux and Cordt Kassner

Eric 00:16

Welcome to the GeriPal Podcast. Alex, this is more than just GeriPal Podcast today. Oh wait, I forgot…I gotta let you introduce yourself, Alex.

Alex 00:25

Oh, this is Alex Smith.

Eric 00:27

This is Eric. I don’t even know how we start this anymore because this is weird, because we’re doing a combo podcast.

Chris 00:34

It’s a combo. This is a podcast within a podcast. And we’re making history here.

Alex 00:38

This is new for us. We’re, building this airplane as we fly it. So we’re delighted to welcome Chris Comeaux, who is a leader, coach, author in hospice and palliative care. His book is called Anatomy of Leadership and he’s the host of TCN Talks with frequent guest host, Cordt. Is that right?

Cordt 01:00

Yeah.

Alex 01:01

…guest host. And TCN Talks is a podcast that’s focused on leadership strategy, innovation, and the future of serious illness care. Chris, welcome to GeriPal.

Chris 01:13

Thanks for having us. This is really cool. Cordt had tweaked me and I’m like, what if we call these guys and say, what if we do a podcast within a podcast? And here we are.

Alex 01:23

And I guess we’re joining your podcast too, because these will be simultaneously. Well, they released around the same time. Our other guest is Cordt Kassner, who is a hospice leader and CEO of Hospice analytics, which provides in depth data on hospice quality, utilization and access, and also publishes Hospice and Palliative Care Today, which is a daily email newsletter about the hottest topics in hospice and palliative care. Cordt, welcome to the GeriPal Podcast.

Cordt 01:55

Alex and Eric, thanks so much. This is such an honor to be here with you guys.

Eric 01:59

I love this too, because I hear both of your voices. It’s like I actually am an avid listener to TCN Talks. I think it brings up a lot of really good points as far as, like, the last one I heard was around Certificate of Need. We’re going to get into all this stuff. So much questions. We’re going to do something different. We’re going to do some roundtable questions just going around talking about hospice leadership quality. But before we do that, on GeriPal, we always start off with a song request. Who has the song request?

Chris 02:31

I have a song request. And so it’s Love Hurts. I’ll tell you why after you perform it.

Alex 02:36

Oh, after. Okay. Well, that’s good.

Eric 02:38

Isn’t there more than one version, like Everly Brothers? And there’s like the Nazareth. Nazareth.

Chris 02:47

Which version, about ready to be performed, is now going to be my favorite.

Alex 02:51

I am not going to sing in the high vocal range of Nazareth. Here’s a little bit.

Alex 02:59

(singing)

Eric 03:40

At the end of the podcast, Alex is going to do the Nazareth version. [laughter]

Chris 03:49

Well, first off, you guys remind us we’re taping this the day before Valentine’s Day. So it had to be some type of love theme. And I thought, this work is so sacred to us and it hurts. But we love it and we do it. And you know, we’ve been pioneers creating powder care, creating a hospice across the country. And they’re days of amazing joy and there’s days of amazing pain. So that’s why I chose it.

Eric 04:11

Oh, that was beautiful. Well, we’re gonna do something different than our usual podcast on our end is that we’re gonna do kind of roundtable discussions as questions, and we’re going to pose questions to each other. And I’m really excited because again, I’m a, I’m a very avid listener to TCN Talks, so I actually, I think I get to start this.

And my question is I’m going to first open up to Gord. Would love to hear others. But one of the things reasons I love TCN Talks is I get hear about all the best hospice news that’s coming around Court. My question is going to turn to you. What are the like, kind of the top news stories that you’ve covered recently?

Cordt 04:50

You know, thanks for the question, Eric. It’s like I said, it’s such a pleasure being here with, with both of you because the GeriPal podcasts we cover in the newsletter on a regular basis, we’ve covered over 50 stories from.

Eric 05:04

That is not the only reason I listen to your podcast.

Cordt 05:08

But it, but it’s so true. It’s such an overlap. And I find myself now, for example, Alex, you introduced me to Lauren Hunt, right, researcher at ucsf. The first thing I do is I go to hospice palliative care today. I log in and I type in Lauren Hunt. I’m like, well, I mean, we’ve probably covered. And sure enough, she pops up like eight times for awards and different interviews that she’s done. And it’s such a great resource to fact check and quickly figure out what’s going on in the field.

I’ve used some of those search results from hospice and palliative care today, dumped them into chat, GPT or Grok and so, you know, summarize these 50 articles or whatever. And it creates a, a great search engine that’s not the entire world wide web. It’s focused on hospice and palliative care stories. So such a fun resource and, and we complement each other so well with, with covering the GeriPal and other stories. In terms of our top stories, we’ve been doing the newsletter two years now.

We average about 5,000 reads or clicks per story. We track how many times people click on the original source story because that’s what we want to do. We want to provide enough information to get the reader to the source document and then read the source document. Well, if we average 5000 clicks. Our top story so far was a compilation that we pulled together on medical aid and ie it had over 14,000 clicks, which in our, in our readership, that’s a lot.

So it was really taking a look at links to the state departments of health, annual reports for the dozen 15 states that were medical aid and dying is legal, and just a way to compare the information that’s being released and collected and reported. So that was fascinating to me because we track those click rates to look for more stories in those most popular areas. The second category that came up was dementia research. So Monday through Friday, Dr. Joy Berger does a great job as our editor in chief pulling relevant news stories during the week. Saturday, Kathy Wagner is our assistant editor, helps me collect a dozen peer reviewed journal articles.

Eric 07:45

And I thought, give me some examples of them. Let’s drive into our audience. Like what are some of these stories around dementia that your audience is kind of pulling up thinking about?

Cordt 07:58

It’s been fascinating that the most read story around dementia was around falls, so emergency department or hospital admissions and tying that to dementia and end of life care and advanced care planning, which was fascinating to me. I love that our readership is interested in the research. We’ve run articles on the Hope Tool, of course, the quality measures that were released last October, that was about 10,000. The hope tool is going to be replacing the hospice item set and will be a transparent, publicly reported set of quality measures for hospices. Super excited to have that becoming available as an update and improvements to what we currently have.

Eric 08:49

What’s in the Hope tool? Like what are the quality measures in there?

Chris 08:52

Are there?

Cordt 08:53

You know, that’s a great question.

Chris 08:55

Symptom Management’s a big one. Some aspects of pain control. How quickly do we get out there, especially when there’s some type of crisis. We’re going to do a whole podcast, actually, Eric, coming up on that.

Alex 09:05

Oh, great.

Eric 09:06

I don’t want to steal a thunder on that. Do you think it’s going to be better than what we have right now?

Chris 09:13

Well,

Cordt 09:17

maybe I’m alone. I mean, like today’s. Today’s broadcast. No, it won’t be better, but Hospice Item set. Yeah, I think it will be an improvement over Hospice Item Set and Hospice Item set.

Alex 09:30

Is that CMS’s quality metric, or what would you call it? Quality.

Cordt 09:36

It’s part of their quality assessment tools. There’s the Hospice Item set that is pretty much gathered at the hospice level so that the hospice clinicians fill that out and submit it. And then there’s the Hospice cahps, which is the Caregiver Primary Caregiver Survey Assessing quality of hospice that’s completed by the caregiver three to six months after death of the loved one.

Alex 10:03

So those are two different hospice quality metrics.

Cordt 10:07

Exactly.

Alex 10:08

And one of them, the first one that you mentioned, which is based more probably on organizational characteristics and utilization, is changing to be a new set of metrics called Hope that you will be talking about. And you also have your own analytics. That’s Hospice analytics, which we mentioned in the intro. And that’s different. That’s yet a third window into hospice quality.

Cordt 10:32

Correct. What I do with hospice analytics is taking a look at claims and cost reports and these quality measures and presenting that information, making that available to folks. Something else that’s really interesting is I designed a national hospice locator webpage. And first that started out as a directory of every known hospice location, you’d think that would be easy to do, but it’s incredibly difficult and nobody really does that. Membership organizations tend to list their members. State departments of health list hospices in their state.

But if you’re thinking about it nationally, it’s actually pretty complicated and rare. So we started off with just a directory. But two years ago, we created a quality matrix that uses eight different measures across five different tools to create a hospice quality rating for every hospice in the country. So if you search San Francisco, it’s not only a directory of hospices that serve San Francisco, they’re sorted. The rank sort is highest quality to lowest. So that’s another way of quality.

Eric 11:50

I got a question for you. If I had to choose either go to Medicare, compare for my hospice star rating, or I can go to remind our listeners what the site is.

Cordt 12:02

National Hospice Locator.

Eric 12:03

National Hospice Locator. Which one should they go to?

Cordt 12:06

You know, it’s a really, it’s a great question. Of course I’m biased and we’ll say go to the National Hospice Locator.

Chris 12:11

I would say the same thing.

Cordt 12:14

Part of the, part of the reason is because I’m using some of those care compare measures. The best part about care compare is the transparency and that they put that information out. But one of the challenges with the star ratings in particular that you mentioned is only 27, 28% of hospices have calculated star scores. So the vast majority of hospices don’t have one. And so that would lead or leave the caregiver or the hospice patient at a loss if a hospice doesn’t have enough surveys for CMS to calculate that score. So I approach it a little bit differently and create a score for every hospice.

Eric 12:59

Every hospice gets a score.

Cordt 13:01

Exactly. Yeah. The last thing I’d mentioned around the news stories is something you’ve had Ira Bayak on GeriPal before, and he’s talked about his strategic path forward. He calls his final point in his strategy the hospice brand. And being very proud of the hospice brand, what Chris typically calls mission moments in the TCN podcasts. And these are stories about family members describing their end of life experiences with loved ones in hospice, hospice leadership.

There’s all sorts of things that get wrapped into this hospice brand and those tend to be among our top red stories. People are just excited to see some of the great work that our providers are doing around the country.

Eric 13:52

That’s great. Well, I want to make sure we have time for everybody’s questions. I’m going to pass it on. I think.

Alex 13:58

Cort, I think you’re up.

Eric 13:59

Next question.

Cordt 14:00

You know, I’ve got a question for particularly for Alex and Eric, but Chris as well, you’ve done so much in your GeriPal podcast to shine the light on the real challenges that we face. Things like burnout among clinicians, racial and access inequities, resource constraints, better prognostic tools like eprognosis. What’s one worry or concern that each of you have around the future of the field? What keeps you up at night and on the flip side of the coin, what gets you excited? What makes a difference? What’s something you’ve learned through your podcasts that make a difference in improving our daily work?

Eric 14:45

Great question. I’m going to start. Oh, Alex, go ahead.

Alex 14:49

No, you go first.

Eric 14:50

All right. What worries me the Most right now is, you know, growing up in hospice. Like you said, like you were bringing up, it’s the mission, it’s the heart of hospice that motivates me to continue to do this work. I cover, I’m covering our hospice unit right now. I do palliative care consults. I think both of them are very, they’re very rewarding. I think the biggest challenge is just the sheer amount of money and investment. And the heart of what we do is not necessarily a primary motivator for some of these businesses.

And since you brought up Ira’s article, we’ve both done podcasts with Ira is it is hard to ignore fraud nowadays in the industry, especially with hospice and especially in certain states like California, where, you know, we don’t need 2,000 hospices in LA County. Like, that’s just, it’s just crazy clear, clearly fraud. Like, it’s just, you don’t need 170 hospices in one building in Van Nuys. And I do think as a field we have to take ownership of some of these problems and we have to advocate and we have to advocate very loudly. And I love that folks like AIRA are pushing for us as a field.

Like, we don’t control everything, but man, we can advocate and we should not neglect our voices. And I think that’s the part that gives me the most promise and hope is that like we just did a podcast on, you know, palliative care Light, which was like a derogatory term potentially for like these community based hospices or palliative care organizations that are very much focused on improving access to palliative care, but through different models that we’re used to in academics, using potentially a lot of smaller teams.

Again, I encourage you to listen to that podcast. Certainly a lot of investment going on into that field. But what I left with that is even in those settings, the palliative care providers, the experts, from social workers to physicians, it is important that we have a voice. And I always think back to Diane Myers saying, if you’re not at the table. Wait, was it Alex?

Chris 17:05

If you’re not at the table, you’re on the menu.

Eric 17:08

Yeah. If you’re not at the table, you’re on the menu.

Alex 17:10

That’s right.

Eric 17:11

I’ll popcorn it to you, Alex.

Alex 17:13

Well, mine’s. I’m going a different direction. I’m going to put on my researcher hat as the audience listeners. And you all know I’m a clinician researcher, which means that I get like 80% of my funding through the National Institutes of Health or other research organizations. It’s grants, right? I’m a grant funded researcher. It’s a tough time to be a grant funded researcher. And this is not an issue that’s specific to geriatrics or palliative care, aging research, serious illness research. This runs the gamut. But you know, because this is like the community, I’m very committed to mentoring.

I direct our T32 fellowship in Aging research and also part of the Ascent Collaboratory. It’s a national NIH funded research infrastructure grant that provides like career development type awards and pilot awards. I direct the pilot corps for that. It’s a tough time for the junior people. They’re the ones I worry about the most. You know, people who are trying to get into the field of serious illness research or aging research. It’s so hard for them because many universities aren’t hiring and the NIH grants are just so. It’s tough to get them.

We don’t know what the funding lines are anymore. The priorities are shifting. There are a lot of people who I know, who I mentor, whose areas are just being erased by the nih, you know, forbidden. You can’t do this. You know, grants erased, taken back. And then there’s this whole yo yo effect. Well, then there’s a court battle and then they get it back and it’s like. And then it gets taken away again. It’s really tough. So I worry, I worry that we may lose a generation. I hope not. I hope it’s just a short period. And I hope that there are people who find ways to support those junior researchers who are trying to get into the field and get jobs and get grants and get started.

And I’m hopeful that, you know, we have some mechanisms to do that. And I still worry that it’s going to have a chilling effect on people who are, who might otherwise have gone into research will now instead focus on other things. Clinical work, education, which is great, but we really need the science in order to advance the field. We need science to say, you know, we’ve tested this, we’ve studied this, this is the right thing to do, this is better than that. And whoa, we thought this was good, but turns out we were wrong. We’ve been doing it wrong all along. So that’s what I worry about. How about you, Chris?

Chris 19:44

Gosh, what do I worry about, man? I was thinking of Eric’s first question of court about like top news stories of the month or top stories. I mean, we go through what, Cordt 72,000 probably in a year, and I probably I flag like a hundred of them, twelve hundred out of a year. And I think that’s the challenge. Right? How do you bring it down to one thing? We do have what I use in my framework, Alex. And when we do the top news stories of the month, we actually did five years of research and there are eight challenges that we know eight challenge categories or themes at every hospice and palliative care program is faced with.

So every month I organize the articles I flag based upon those categories. So my direct answer should be these basically eight categories. The mission moments, reimbursement challenges, competition to be aware of, workforce challenges, patient and family future customer demographics and trends, regulatory and political challenges, technology and innovation challenges, the speed of change in resiliency, challenges that humans could deal with.

One that I call kind of the human factor and then always have my catch all just Chris category. So those categories, every month I’m flagging articles that build kind of my own research behind it. And so any of those, we could do probably hour podcasts on any of those themes. But any follow up questions to me on those broad categories, I think we’ll

Alex 21:05

have some follow up questions as we go. I certainly have some that will expand on some of those categories.

Chris 21:12

And one more I’d add Alex, because when we were in the green room the first time we all got to meet. I’m very passionate about leadership. It kind of goes in that. So you know, John Maxwell is one of the guys I’ve always read and kind of followed my whole life. He says everything rises and falls on leadership. So you know what’s heavy on your heart about research? It all comes down to leadership. So those young people that may feel jaded right now, if they will just whatever pathway opens up for them, if they’ll go to school, there’s and just keep going to school there, your sphere of influence will grow.

And you never know how those things that feel like little side trails may come back and you’ll harvest things that can help you for the big game that maybe you thought was going to be where you’re going to be from the very get go. That all comes back to the whole journey of leadership. Why I wrote the book the Anatomy of Leadership to give people a framework.

Cordt 21:59

Alex, I just comment on your thought around the researchers and I, I really appreciate that the concern about the next generation and where this is going. And I’ll be honest, I thought to myself how exciting that we have a next generation of researchers interested in gerontology, interested in hospice and palliative care and an end of life care. Like, probably all four of us have been around long enough that there was a time there weren’t very many, like, people lining up at the door for. To enter into research in these fields. And it’s exciting that. That there are people interested in it.

Eric 22:39

Alex, I’m going to ground this. Do you feel like there’s more or less right now, given the uncertainty, like, people are they wanting to commit many years of their life to research fellowships

Alex 22:51

and I think it’s still early to say.

Cordt 22:54

Yeah.

Alex 22:54

I mean, we’re. The major change came with the change in the federal administration, which is what, a year and a half in or a year? God, it feels like longer, but it is.

Chris 23:09

It does. But you’re right, it’s probably a year and a quarter.

Alex 23:12

Yeah.

Chris 23:13

By the time the show airs anyway.

Alex 23:14

So I think it’s tough to say.

Chris 23:16

Yeah.

Cordt 23:16

Okay.

Eric 23:17

But you’re hopeful.

Alex 23:20

Yeah, I agree, Cordt. I’m hopeful and I love the fresh new ideas that are bubbling up from these new investig educators looking at these problems that are seemingly intractable with fresh eyes. And I worry that some of them just are going to be so disillusioned with what they read and what they hear about and what they hear from other junior people. And the fact that just a lot of universities aren’t hiring researchers right now. It’s tough to get a job, you

Chris 23:48

know, Can I add some of that, Alex? Cordt and I had Ira on and we did a podcast as almost like a gift for the holidays to people, just kind of time with our. From his heart. And he said something so profound. They sat around a fire in Colorado at some. I guess it was in Estes park. Right, Cordt? And there was no research, there were no textbooks, there were no classes. You know, you think about the early days of where he was and think of where we are today, the challenges, the mountain range of challenges in front of them in the, you know, early 80s, et cetera.

We have different challenges and that same spirit that they kind of address them with. We shouldn’t let these challenges take us out. You know, what will they say about us a generation from now? Just like how we’re Talking to the IRA’s, you know, future when Alex and Eric are on somebody else’s podcast 20 years from now. What did you guys do in 2026 when those challenges came? I feel like that’s. This is our time.

Eric 24:41

What’s your challenge? What are you thinking? What are you worried about?

Cordt 24:45

You know, I think some of the themes that you’ve. You’ve mentioned the Waste, fraud and abuse is a concern. We have so many absolutely fantastic hospice and palliative care providers out there. And yet the country often looks at hospice as it’s a one stop shop, like it’s all one hospice and they don’t get the differentiation between the providers. So when you see an article that’s talking about fraud or something inappropriate going on, it tarnishes the entire field. And that concerns me. I think we need to, to clean that up.

The other thing that kind of comes to mind is around some of the ownership issues that a dozen years ago we were talking about nonprofit for profit. Well, today we’ve segmented both of those. There are articles out now about differences between church based nonprofits and freestanding nonprofits. That’s interesting. And then we segment the for profit side into independent publicly traded companies and private equity backed. And what does that mean? And I honestly don’t think we have answers to any of that yet. We’re participating in some research studies around trying to answer those questions.

But there’s a conflict between the mission and the money. And it’s yet to be seen who’s going to win and how that’s going to impact patient care, which is what it boils down to me. If quality of care improves, ownership doesn’t matter. If it’s going down, that’s a concern. And again, ownership doesn’t really matter. But we can probably segment this and unpack this a little bit more than we have to date.

Eric 26:31

Yeah, I think the research that we have is that it does. So there’s good and bad hospices and there’s heterogeneity amongst hospices, but there seems to be more heterogeneity amongst for profit hospices than non for profit hospices. Knowing that the field is evolving. Right. Like even in hospitals, we see that, you know, nonprofits are starting to look a lot like for profits and how they’re acting and operating and what they’re worried about. Is that your sense too?

Cordt 27:02

Keep an eye on it? It is, absolutely. And the larger the provider, the more homogeneity there is, the more they all look the same.

Eric 27:13

Yeah, Chris, I think you’re up.

Chris 27:16

Yeah. So my question is, since originally how we got together was around Iris Framework, what do you think of Iris Framework? And maybe for the listeners, I’ll repeat it. Zero tolerance for waste, fraud and abuse. Clinical and programmatic standards. Making meaningful data readily available. Driving competition based on quality. Embracing and promoting our authentic brand. What do you think about it? Is it, is it needed and what’s your Opinion about it. You’ve debated it, talked to em about it. Cordt and I use it a heck of a lot.

Eric 27:44

Yeah, you use it when you talk about kind of the. Every time you bring up those stories, you bring it up. Alex, I’ll turn to you on this first. I took the first one.

Alex 27:56

Just trying to put together my thoughts. I think it’s a great framework. It’s aspirational and I appreciate that. I worry a little bit that it’s unobtainable in the United States because we live in a system that is so capitalist and for profit dominant and where you can potentially end up playing whack a mole, squashing down one mechanism by which people are profiting off of people who are seriously ill and dying in ways that are concerning. Because profit by itself is not bad. It’s just when the profit motive leads to a decrease in quality that would become concerned.

So I guess the critical part of me would say, can you really have zero tolerance? I mean, we should aspire to have zero tolerance for waste, fraud and abuse. And we don’t live in a country with a national healthcare system and we are almost always being reactionary. I would love it if we could be more proactive. But I remember Eric and I were giving grand rounds at UCSF and you pulled up this slide that you’d done some research about not just hospice, but for profit ownership of nursing homes and assisted livings. And weren’t they also like 70, 80%

Eric 29:17

there’s money in medicine.

Alex 29:19

Yeah. So for all like hospice, you know, it just. It is what it is. Like, we are. There are people out there who say we should have only nonprofit. I don’t think our Bayock’s saying that. I’m not going to put that on him. But he doesn’t.

Eric 29:32

He specifically says that. He doesn’t argue that. Yeah, I would argue. I’m going to be optimistic here. I’m going to be optimistic and say that’s where I feel there’s been like, oh, you know what? This is really bad. But it’s not our problem. And I think that there are things that we can advocate for and this is our problem. Like if brand is important, like Court said is this is tarnishing our brand people. If people are associating hospice with, you know, people talking about fraud, that’s happening in places like la, like they’re associating that with hospice, then I have to have like 15 more minutes of discussion with the patients when I’m talking about that. And then I actually like even Medicare.

Compare the Reason I hate Medicare Compare is it starts off alphabetically, and if you’re in a place like Los Angeles, it literally only goes to the letter C. Because it’s letter c. You’re at 300 and it maxes out at 300. It’s pointless. You know, you could fix Medicare Compare, but that’s not the problem. It’s that you have over 300 hospices in one county, which is just insane. And I’m just going to plug one podcast that TCN did on Certificate of Need. Yeah, because not every state looks like California. Not every state looks like Texas. Right, Right. Chris, can I ask you what is Certificate of Need? Because our Jared Pal podcast audience may not know that.

Chris 30:58

You bet. In a lot of states, I think it’s about 26, 23 Cordted. Actually looked it up for me. And so it’s less than half of our states, there is a law called certificate of Deed. So the opposite, it would be like the state of Texas. There is no Congress. I was having dinner with my godfather or serial entrepreneur. Hey, Chris, what have you been doing? Your life, your career? Hospice. Oh, my God. A lot of people dying. That’s a great business. I need to look into that.

That’s the problem. And so states where there’s a certificate of need, you can’t do that. Actually. There’s a formula that determines if there’s a need. And so it basically creates the ability to create controlled competition to make sure people have choice. But you balance resources and the capitalists are like, that’s bad. You should always have competition. I’m sorry. Free market works when all the elements of free market are in place. You don’t have all the elements in free market in health care, which is why you need C O N. I’m okay with the capitalist system. I’m junior capitalist in nature. But in healthcare, it does not work if you. It’s just a free for all.

Eric 31:54

Yeah.

Chris 31:55

If that was the case, you know, hey, let’s go to Texas. Let’s go build a hospital in Dallas. Because there’s a lot of people there. What about the poor people in Lubbock, Texas? You know what? We don’t worry about them. We want to go where the people are. That’s the point of CO N is it gets resources where you need it.

Eric 32:09

And let’s be honest, especially like in the hospital setting, the way hospital people in hospitals get selected into hospices. It’s not Medicare compare. It’s not a quality metric. It’s who can admit this patient is fast enough so we can decrease our length of stay in the hospital for many hospitals. So it is not. This is not a true free market. And people don’t have say they don’t even know where to look for that.

Chris 32:35

But I am optimistic that’s changing with the baby boomers. I think we’re on the cusp of a lot of sea change. Things blowing in the favor of things I think we would all believe in, like people choosing the best. You know, you go buy a car, you want to get the best or whatever it is. Healthcare has not been that case. And maybe the baby boomers will be the generational force a lot of those good market things that it’s not all free. You should have sift good need and things. You have regulation and good rules. And for a game to work, it’s not, well, let’s just throw all the rules out. Hell, college football has rules. And so with healthcare, oh, we just don’t need a sift of need. Well, what game does that actually work in?

Cordt 33:08

Yeah, yeah. Eric, you were mentioning about your frustration with care compare. I recently had the experience of helping a friend of mine out. He was looking for an oncologist. I said, well, I’m in healthcare ish. I’m, you know, how can I help? And I. So I look went to care compare, and I’m looking up, you know, physician compare. And it says, well, this one’s half a mile from your house, this one’s two miles from your.

Like, that was the rating, like you said, alphabetical for a physician compare. It’s by distance to your location. And I’m like, you know what? If the, if the best oncologist on the planet for this particular disease is at ucsf, I’m flying to ucsf. Like, this is. That is not an issue. If I need to go to Mayo or, you know, wherever, no problem. So mileage doesn’t help me at all. And so how do we fix that? How do we correct that kind of a. Of a metric?

Eric 34:07

Yeah, yeah. And how do we make sure that every hospice has a quality measure? So when we’re looking at them like, how many aren’t star rated in Medicare?

Cordt 34:17

Compare. Over 70%, like, don’t have a star rating.

Eric 34:23

Why put them up there? Why name them? Like, we should shame them. There should be like a dishonor roll on Medicare compare if they don’t have a star rating.

Chris 34:33

Well said. Totally agree. And Eric, you started this by asking me my question about Arra. Alex, I wanted to say the brilliance of what Ira has done is we’re Talking about it. Oh, yeah, that’s the brilliant. And he will tell you he’s gotten pot shots from the nonprofits and the for profits. I’m like, this one, you know, you’re succeeding. You got him talking about it, you got him thinking about it.

Alex 34:52

I love that he started up and really started a conversation pushing, pushing, pushing on this issue.

Cordt 34:57

Yeah, well. And I’ve been encouraging boards and organizations to consider to talk about his paper and his strategies and assess, like, where are we today? What’s our baseline measurement? And I like how he is empowering clinicians and people in the field, leaders in the field, to have a structure to think about. Well, I can plug in and make a difference here, because we should all be plugging in to our spheres of influence. Right. And maybe that’s in the research circles, maybe that’s in the hospital setting. How do we do that?

And he’s kind of issued the challenge to say we should be involved in these conversations. We should not just be turfing this to Medicare and say, well, you made it, you broke it, you fix it. He’s saying, no, we’re the experts in this and we need to be in the conversations. And I completely agree.

Eric 35:58

I guess my question to you on this AIRA topic, because he didn’t just mention hospice, he mentioned palliative care. You know, same thing, standards for palliative care. What do you think we should do there? Because this is a tough nugget because hospice is a little bit standardized of what they should be delivering. And, man, you see one palliative care program, you kind of see one palliative care program. Chris.

Cordt 36:23

Absolutely right. And I think the challenge is there, what are the standards of care? And there are some standards that are out there, but there’s not really that data collection and transparent reporting of results to compare. Like, right now, I’m starting a research project across the state of Maine. We’re contacting every hospital, every hospice, every known palliative care provider in the state of Maine. And it’s really, we’re at the beginning stage, like, who’s providing palliative care, how many consults, how many patients? What does this look like? What’s your interdisciplinary team look like?

Eric 37:00

How do we define what palliative care is? You know, somebody calling up and, you know, sending somebody a squeezeball, which I have seen as somebody wanting to label that a palliative care clinic.

Cordt 37:13

Well, exactly. And in Maine, many states have a definition from the state legislature, or you default to the World health organization or AAHBM or, you know, whoever some CAPSI’s definition is often used. Yeah, which I. I don’t care. Like, pick one and let’s evaluate against it. Not just the presence of it, but to your point, Eric, quality, Who’s good at this? How do we actually assess quality in palliative care? And it’s fascinating because it seems, in my experience anyway, palliative care has a much stronger research base behind it from the beginning compared to hospice. And so these questions have been asked at a much earlier stage in the game, which excites me. I think that’s absolutely moving in the right direction. Alex, have you seen that kind of research in palliative care separate from hospice in terms of assessing quality within palliative care?

Alex 38:19

I think it’s just starting. I think it’s too early to say we have good published data about that. And that’s part of the problem with a lot of research in this area is there’s a big lag between when data becomes available to study and when we need it. Like, so I know people, including mentees who have grants to study this or have put in grants to study this, but, you know, it’s probably years away from publication. I’m sure there are some people out there who I’m not thinking of offhand, who are working on this. Okay, is it my turn?

Can I ask a question? Can we shift topics? Let’s talk about leadership. Chris, major focus of your work, your podcast, your book is about leadership and you interview people on TCN Talks who are leaders in hospice and palliative care and leaders who are outside of hospice and palliative care. I’d love to hear from you and from Cordt and from Eric what you have learned that is like take home messages that are pearls of wisdom for our listeners about leadership.

Chris 39:28

I love that question. Thank you. It’s very much in my place of passion. And I was thinking about what you were saying earlier, Alex, about these young people coming out and maybe the. The road is going in a different direction, what they’re thinking. So a couple of great lessons I’ve learned over my life. I’ve had incredible mentors from growing up in corporate America, but yet I landed in hospice at the age of 25. You got to go see for yourself.

The Japanese call it gimba, which means go see for yourself. And no matter what I’m working on in leadership, like actually in about four weeks, I’m going to go out in a full day with patient visits in hospice. The beauty of you guys get to do, still you’re in leadership. You’re doing a podcast, but you’re actually face to face with patients. I think it’s important as leaders that no matter how your role evolves, maybe you’re a senior vice president or chief of something, you gotta go see for yourself. Always make sure you’re still close to the action. Abraham Lincoln was always one of my heroes.

I love always reading history. Abraham Lincoln had this amazing team of rivals of leaders around him, but he had this news reporter and people on the battlefield that had the backdoor access to him, that it was ability for him to know what was really going on. He would go out himself. Those are great leadership lessons. And so now when you’re young and face to face, be a sponge, all of that. But then as you evolve and you have leadership positions, don’t forget some kind of way you’ve got to stay connected to the mission. And because you could get in your ivory tower and then making decisions not based upon the reality, I think is the beauty of our just doing the podcast, you guys.

As Jared Powell, your listeners are in the action on day to day basis, hospice and bout of care. Most of my listeners are on the leadership side. And like you’re. Eric was pushing a court earlier, like give me the specifics. And he was giving you a framework that’s exactly kind of leadership on a day to day basis. The leaders are given a framework. Staff’s like, but this is where the issue is. You need both to actually get great outcomes. So that’s the first one. Never lose sight of going see for yourself. Second is we live at a time where there’s so much coming at us.

You know, instant messaging, social media, your email, all the stuff where you put your influence is one of the most powerful tools that you have in your toolbox. But yet everything’s coming at you to diffuse yourself. If you turn off the lights and you lit a cigarette lighter, it provides a little bit of light, a focus light as a I beam or a beam of light would actually cut through a steel I beam, where you put your focus is huge. We actually call that influence in the anatomy of leadership. So as you go forward, if you’re too diffused, it’s hard to make a difference.

So where you’re putting your focus and your influence is absolutely huge. And we live at a time where everything is screaming at you to go wide. And yet I’m not saying just go very, very thin, but where you put your influence is going to determine what your impact is on the world. That’s a huge leadership lesson. I wish I would have gone back and someone could have told me that in my early 20s.

Cordt 42:26

That’s great.

Eric 42:27

I love the. The. What was. What did the Japanese call?

Chris 42:30

You said Gimba, which I just say, go see, man.

Eric 42:33

Like during COVID That was. That was for me, a great place to see, like, who were the real leaders? Like, who were the people that I looked up to and was the people that were there, that were present. And that really influenced me kind of how I think about, like, the leader that I want to be is. You gotta be there. How? I don’t want to use battle metaphor, but, like, in the trenches is a good metaphor. Court, what do you. What do you think?

Cordt 43:01

You know, I kind of echo what Chris was saying as a social worker background, I think about those grassroots movements and Robert Greenleaf’s, you know, the epic book, which is now probably, you know, a thousand years old, Servant leadership, that you think about the leader at the top who’s making these decisions. But you have to have the feedback from. From everybody. And I remember being the CEO of the Colorado Hospice Organization, and one of the first things the board said was, you need to go out on patient visits with each member of the interdisciplinary team to understand what we even do.

I’m like, I absolutely need to do that. And that was my favorite learning piece in that position was just going out and like, I’m the tag along. And I loved that. The other piece that I would mention in terms of the leadership, I’m taking a class right now around AI stuff, and one of the questions posed was, what’s the greatest obstacle to integrating AI into your. Whatever your field is? And the first thought that came to mind was leadership is the biggest obstacle that resistance to change. And, you know, but really you need the support of the leaders in your organization, in your field, to actually create change.

Eric 44:30

Alex, what’s yours?

Alex 44:32

I mean, there’s so many good points could be made here. I like Chris’s idea of having a focusing effect that if you have a dark room and you light a lighter, everybody’s going to look at that lighter. Right. And I think it’s critical, especially at these times when, as Chris was saying, there’s so many distractions and different avenues you could go down that you have some focus. But I’ll also be contrarian here and say that if you look at my career, even though when I write my, like, NIH biosketch, I can try to come across as very focused, I’m incredibly unfocused. Like, one of my standard grand rounds talks is like confessions of an unfocused researcher.

Because I’ve really had, like, more like several areas in which I’ve had focus rather than like one specific, you know, dominant area of focus. But I think the underlying principle is that I’m. I’m dedicated to advancing hospice, palliative care, geriatrics, gerontology, aging research, serious illness research. Like, I’m mission driven in that way, and if aligns with that mission, then I’m all for it, you know, and within that somewhat broad purview, I just love the intellectual of curiosity of, like, working with different issues, different problems, whether they’re like, bioethics issues or epidemiologic issues.

So I agree with the focus and also that it’s. It’s gotta be interesting. Like, it’s gotta. You’ve gotta keep it interesting and gotta keep it fresh for you and for the people who you lead. Right. They have to continually have, like, a renewed sense of purpose.

Chris 46:14

Okay, I’ll reconcile that. Eric, before you go to. I love where Alex just took it. Actually, I think, Alex, you just took it to the wisdom of the hospice model. Interdisciplinary work is one of the secret sauces of hospice. So in my focus, it absolutely doesn’t mean you have to be monocular, but, like, you take someone who’s so curious, like you, what I’d say you. You’re focused, you just took it to the mission, but you’re also hyper focused on being curious. And so I think you could still make that a superpower in your focus. And I think the future is much more interdisciplinary.

You know, I don’t know what you think about Elon Musk, but he’s brilliant. So many ways he took interdisciplinary into the manufacturing area. No one ever did that. You had electrical engineer, Silo, the mechanical. He put them in teams and like, interdisciplinary. He, like, literally adopted the hospice model in manufacturing and transformed it. So I think that we have some secret sauces in the hospice space, pedicure space, that are part of the future. So I love you took it in that direction.

Alex 47:13

I’m sure there are some of our listeners who would like to euthanize their Teslas.

Cordt 47:18

Yeah.

Eric 47:21

I actually feel from a Elon perspective, it’s not the leadership that I look at, mainly because I think he takes credit for everybody else’s innovations as his own. And that’s like the worst flip side to it.

Alex 47:34

He’s a complicated individual.

Eric 47:35

Yeah. And I was very complicated to the intractical problems. Like, like, you can think about, like, money in medicine as an intractable problem. You can think about like quality and palliative care. Like these are big hard problems. I’m going to bring it back to hospice too is, you know, there was once a time a social worker slash nurse slash doctor who tackled an intractable problem, which is death and medicine’s reluctance to actually care for people who are dying. That was Dame Cicely Saunders, who created the first hospice and is still kind of like we think about.

I get interdisciplinary team in one that’s kind of hurt, but also somebody that we, we look at as somebody who tackled an intractable problem. Again, it’s not like all of a sudden we fixed it. You know, many decades later, we’re still working on making this even a better model of care. And that’s kind of the leadership that I think is important to model. Not just the fact that she had sherry behind her desk and that she, she had people drink sherry with her during her one on one mentorship meetings.

Chris 48:46

Maybe you need to adopt that, Eric. I’m liking that.

Eric 48:48

I know. Sherry Doer, you just break out the little glass. Alex can break out his guitar. We can have a little coming together. Well, according Chris, I want to thank you to be on this podcast, our shared podcast, TCN and Cherry Pal. But before we leave, Nazareth version of Love Hurts.

Cordt 49:08

Alex.

Alex 49:10

No chance, no chance. Here’s a little bit more.

Alex 49:17

(singing)

Eric 49:59

Oh, that was fun. Thanks, Chris and Cordt.

Chris and Cordt 50:02

Thank you.

Eric 50:04

And thank you to all of our listeners for your continued support.

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