Trascrizione completa di Part Two | CMS Leader Explains Hospice Fraud, Medicare Risks, and the Future of Healthcare

question, because again, that's a little deeper than I normally go. 00:02:30.479 --> 00:02:42.080 But I mean, at the end of the day, I think they're still trying to figure out was the lessons learned enough to make it a more permanent policy change, or is it something that we just want to say we learn from it and move on? 00:02:42.400 --> 00:02:42.800 Gotcha. 00:02:42.800 --> 00:02:44.400 So it sounds like jury's still out. 00:02:44.639 --> 00:02:46.960 I I would say the jury is still out, yeah. 00:02:47.280 --> 00:02:47.680 Gotcha. 00:02:47.680 --> 00:02:53.120 We do have a podcast coming out with a CEO of a company who's actually she and I kind of debated it. 00:02:53.120 --> 00:02:57.680 I I am not for the actual V bid carve in, because I do think hospice is different. 00:02:57.680 --> 00:03:00.000 It's so hard for people to choose it. 00:03:00.000 --> 00:03:06.879 Um, one of the most alarming things in the data that I saw, Kim, and I think this alarmed the insurance companies, is the family. 00:03:06.879 --> 00:03:12.240 I'm gonna overstate this, but the family almost felt like the insurance company was the death panel. 00:03:12.240 --> 00:03:15.680 Like they didn't trust the insurance company to make the referral to hospice. 00:03:15.680 --> 00:03:19.360 And then the insurance company was kind of stuck like, how do we make these referrals? 00:03:19.360 --> 00:03:22.400 So there weren't good referrals, the length of stay wasn't good. 00:03:22.400 --> 00:03:27.280 And you know, these insurance companies are spending a lot of money for healthy aging marketing. 00:03:27.280 --> 00:03:27.680 Yeah. 00:03:27.680 --> 00:03:32.719 And and that could could concern them that if then they're the one responsible to make that. 00:03:32.719 --> 00:03:38.639 So to me, hospice is so different that it would make sense to keep it outside of the car vent, but that's my two cents. 00:03:38.639 --> 00:03:41.039 We've got a podcast where I debate it with a lady who's very well. 00:03:41.680 --> 00:03:42.719 I'll have to listen to that one. 00:03:42.719 --> 00:04:02.000 I mean, from what I was able to gain from doing some quick recon on this, I I would say that um it was definitely not overwhelmingly conclusive from our side that this was something that should be, but they viewed it as a valuable um takeaway in terms of good information to help inform how we make policy decisions in this area going forward. 00:04:02.000 --> 00:04:03.039 But I agree with you. 00:04:03.039 --> 00:04:09.439 I mean, conceptually, the Kim Brandt personal opinion, not that of CMS, is that it is a distinct type of service. 00:04:09.439 --> 00:04:13.919 And I to me it doesn't make sense to carbon, but I am not the one making that call. 00:04:14.080 --> 00:04:15.439 So understand. 00:04:15.439 --> 00:04:21.759 Well, Kim, let's talk about something that you guys have just been just incredible on, which is the waste, fraud, and abuse. 00:04:21.759 --> 00:04:25.199 Um, so talk about just I'll

give you the mic for a little bit. 00:04:25.199 --> 00:04:31.120 Talk about some of the work you guys have been doing because you've been doing some pretty big stuff, making a lot of national headlines. 00:04:31.360 --> 00:04:32.000 Um and Dr. 00:04:32.000 --> 00:04:36.879 Oz, if you follow his social media, um follow it this week, later this week as a teaser. 00:04:36.879 --> 00:04:40.879 You're gonna see some big stuff uh starting Wednesday night uh through Friday. 00:04:40.879 --> 00:04:42.319 We've got some big stuff happening. 00:04:42.319 --> 00:04:44.959 But yes, um, I am super excited about this. 00:04:44.959 --> 00:04:47.680 This is um this is my third tour at CMS. 00:04:47.680 --> 00:04:51.279 And the reason I decided to come back was because not only is Dr. 00:04:51.279 --> 00:05:00.639 Oz incredibly persuasive as you can imagine, um, but also he um agreed uh if I was to come back, I said, I really want to tackle waste, fraud, and abuse. 00:05:00.639 --> 00:05:02.560 I don't feel like we've ever gotten it right. 00:05:02.560 --> 00:05:06.399 I feel like there's a lot that can be done differently, and I'd really like to go big on it. 00:05:06.399 --> 00:05:22.879 And then not only have we done so at CMS, but now as you probably saw last week, the vice president kicked off his new uh fraud task force, which isn't just healthcare fraud, it's fraud against all government programs, which is amazing to have that kind of focus from the highest levels of government, if you will. 00:05:22.879 --> 00:05:31.759 But then here at CMS, um, we have just been going gangbusters um literally since the moment I hit the ground last year, and certainly since stock draws came in April. 00:05:31.759 --> 00:05:38.879 So a few of the things that we have done, the very first thing we did, which is one of our uh biggest accomplishments, was set up a war room. 00:05:38.879 --> 00:05:42.160 It's called the Fraud Detection Operations Center or the F doc. 00:05:42.160 --> 00:05:51.519 And from March 31st to December 31st of last year, we stopped $1.8 billion in suspect payments for just high-risk providers. 00:05:51.519 --> 00:05:58.079 So a very small number of providers, but providers who showed up on our radar real time before the claims were paid. 00:05:58.079 --> 00:06:08.319 Like, you know, as claims were coming through, we saw them, we were flagging about five providers a day, which I know doesn't sound like a lot, but actually given their volume, it was it was a fair amount. 00:06:08.319 --> 00:06:11.040 And so we were, you know, going through and reviewing these. 00:06:11.040 --> 00:06:21.040 And as a result, we stopped 1.8 billion, 1.5 billion of that was related to durable medical equipment, DME, things like oxygen, wheelchairs, CPAPs, etc. 00:06:21.040 --> 00:06:22.800 So that was a big part of it. 00:06:22.800 --> 00:06:28.319 Um, and then um about another hundred thousand or hundred million, I'm sorry, was um labs. 00:06:28.319 --> 00:06:30.000 So it was laboratory stuff. 00:06:30.000 --> 00:06:37.680 So hospice was not one of the areas in the F Doc that popped up, but it was something that we were seeing um certainly across the board. 00:06:37.680 --> 00:06:47.120 And then since then, the F Doc as of today has actually stopped 2.2 billion, and we've been able to kick almost 400 providers and suppliers out of the program. 00:06:47.120 --> 00:06:56.079 And so that is a significant amount of uh money saved to the program and a good number of the people that we were able to kick out that just weren't good partners. 00:06:56.079 --> 00:06:58.879 So let's talk about hospice in particular. 00:06:58.879 --> 00:07:10.000 LA County, everybody knows, is kind of the epicenter of all of this, but as people were getting shut down there, or as you know, people were getting more scrutiny there, they were starting to move and are starting to move. 00:07:10.000 --> 00:07:15.759 California to Arizona, California to Nevada, California to maybe Texas. 00:07:15.759 --> 00:07:18.000 Um it's definitely been a migratory pattern. 00:07:18.000 --> 00:07:33.920 That's part of the reason that we were visiting the hospice in Las Vegas uh last or earlier this year, because of the fact that we were talking to the Nevada folk about the fact that they've seen a 7x increase in the number of hospices in Nevada just in the last decade or so. 00:07:33.920 --> 00:07:37.519 In LA, it's been an even greater um increase. 00:07:37.519 --> 00:07:42.800 There's now just in LA County 1,800 hospices that are listed. 00:07:42.800 --> 00:07:49.199 That's 4.5 times more than the number of Starbucks in LA, just to put it in perspective. 00:07:49.199 --> 00:07:55.120 And so as a result, we believe that upwards of 900 to 1,000 of those are just completely false. 00:07:55.120 --> 00:07:56.399 So almost 50%. 00:07:56.399 --> 00:08:04.000 And so our team has been extremely focused on going and looking at them to suspend, which means that we suspend payments. 00:08:04.000 --> 00:08:12.000 They no longer get paid by Medicare or revoke, which means that we just kick them out entirely of the program so that they cannot bill anymore. 00:08:12.000 --> 00:08:16.399 We've been great partners with um a lot of boots on the ground people out there. 00:08:16.399 --> 00:08:27.439 Uh Sheila Clark, who works for uh some of the um hospice advocacy organization, the senior Medicare patrol, other partners have been just super helpful in helping us to really look at what's happening. 00:08:27.439 --> 00:08:30.079 But unfortunately, a lot of this is due to organized crime. 00:08:30.079 --> 00:08:42.879 These are people who um, you know, foreign entities buy sham, you know, um operations, set up things using um stolen Medicare beneficiary identifiers, or they'll just go out and sign people up. 00:08:42.879 --> 00:08:49.679 Um, one of the most common scams is to just send people to someone's door and say, hey, would you like a 40-inch TV? 00:08:49.679 --> 00:08:56.720

In exchange, if you sign this, you get a 40-inch TV and we'll come by and you might get some light housekeeping or something like that. 00:08:56.720 --> 00:09:04.320 And instead, sort of like I told you with the six-pack example earlier in this episode, um, you know, they get paid thousands of dollars a month. 00:09:04.320 --> 00:09:07.440 And legitimately the beneficiary doesn't get anything for that. 00:09:07.440 --> 00:09:16.879 And then when the beneficiary goes to actually get legitimate Medicare services, they can't get them because um they think they're on hospice. 00:09:16.879 --> 00:09:23.039 And so getting any kind of curative treatment is not allowed because they're signed up for hospice. 00:09:23.039 --> 00:09:25.840 So um we've also been sending letters now. 00:09:25.840 --> 00:09:39.200 We've sent thousands of letters out in California, Nevada, and Arizona to all of the people who have allegedly elected hospice, and we've had a fair hit rate, a high hit rate of people writing back and saying, I'm not signed up for hospice. 00:09:39.200 --> 00:09:40.960 I never agreed to be on hospice. 00:09:40.960 --> 00:09:43.279 But the fact is now we're double checking. 00:09:43.279 --> 00:09:54.399 Um, so we're not only checking on the validity of the people who are there to make sure they're good partners, watching their billings, making sure they're actually legit, but we're also making sure the beneficiaries know that they're signed up. 00:09:54.399 --> 00:10:01.440 So they don't have a situation where they go to get real services that they need, curative services, and told they can't. 00:10:01.840 --> 00:10:02.080 Wow. 00:10:02.080 --> 00:10:04.080 Well, Kim, kudos to you and your team. 00:10:04.080 --> 00:10:05.440 I don't know if you know um Dr. 00:10:05.440 --> 00:10:06.639 Ira Byock. 00:10:06.639 --> 00:10:12.320 He's written some amazing books, kind of like the he's like the father of hospice in some respects. 00:10:12.320 --> 00:10:16.399 There's there's a lot of matriarchs of hospice as well, so he's not the only one. 00:10:16.399 --> 00:10:19.600 But he has written a book called The Strategic Path Forward for Hospice. 00:10:19.600 --> 00:10:22.320 But in that paper, he coined a lovely phrase. 00:10:22.320 --> 00:10:28.480 As you've already learned, the majority of hospice people are just kind, caring, beautiful-hearted people. 00:10:28.480 --> 00:10:31.759 But he said, collegiality ends a criminality. 00:10:31.759 --> 00:10:36.000 I've known about some of this stuff for a while, and it's like, why is no one doing anything about this? 00:10:36.000 --> 00:10:39.600 And so kudos to you guys that you are doing something about it. 00:10:39.600 --> 00:10:42.000 So this leads to my question. 00:10:42.000 --> 00:10:46.000 Um, and it kind of goes back to that, you know, provider number thing. 00:10:46.000 --> 00:10:53.600 And so a lot of the nonprofit hospices have larger programs and they don't play that game of provider numbers. 00:10:53.600 --> 00:11:02.960 So if the outside audit firms are looking for uh a nice fishing hole, the fishing hole is bigger where you've got more patients per day. 00:11:02.960 --> 00:11:12.399 So it feels like sometimes they pick on some of the nonprofit providers because when you look at those provider numbers, well, they're just like 30 patients a day, 20 there. 00:11:12.399 --> 00:11:16.879 But that entity might be aggregating those numbers for financial purposes. 00:11:16.879 --> 00:11:20.720 So they get to fly under the radar screen for the audit and we get picked on. 00:11:20.720 --> 00:11:31.200 So how do you how do you make sure, because I love what you're doing, how do you make sure that the good actors don't get kind of inadvertently as collateral damage in some of this? 00:11:31.519 --> 00:11:44.080 No, it's a great question, and we struggle with that all the time, uh, quite honestly, because you know, you want to cast a wide net, but you don't want to catch such a wide net that we make it administratively burdensome or difficult for the good guys to be able to maintain. 00:11:44.080 --> 00:11:56.559 And one of the ways that we do that during normal sort of just routine business is to do what we call um targeted probe and education, which means that we'll do an audit and we'll, you know, do that initial audit. 00:11:56.559 --> 00:12:03.840 Maybe it's of you know the care plan or whatever it is, you know, on the hospice, and we'll determine if there are things that look right or or not right. 00:12:03.840 --> 00:12:08.320 And then we go back to the provider and give them a chance to update it, to get it right. 00:12:08.320 --> 00:12:10.879 We explain the rules, we tell them what they need to know. 00:12:10.879 --> 00:12:17.919 Um, they have a chance to then resubmit, sort of like uh a teacher says, uh, it doesn't seem like you really got this right. 00:12:17.919 --> 00:12:21.679 Why don't you take another try and send it back and we'll give you maybe a better grade? 00:12:21.679 --> 00:12:22.879 Sort of similar to that. 00:12:22.879 --> 00:12:24.879 We give them the sort of the redo. 00:12:24.879 --> 00:12:34.399 Um, then if they don't get it right after that, then we give them one more try, but we're a little more serious about it, saying, okay, you really need to get it right this time. 00:12:34.399 --> 00:12:38.320 So it's kind of your third try or you're out, so to speak. 00:12:38.320 --> 00:12:50.480 And so on the third try, if they haven't gotten it right after two series of education and things like that, that's when we really go hard and actually, you know, really double down on going after the money. 00:12:50.480 --> 00:12:56.720 So the way it should work with legitimate providers is they should have sort of uh a multiple try sort of thing. 00:12:56.720 --> 00:12:59.919 They shouldn't necessarily get dinged, you know, right away. 00:12:59.919 --> 00:13:03.440 We try to work with them, we try to work through the education

process. 00:13:03.440 --> 00:13:08.720 And then sometimes they don't know that they're affiliated with bad entities or bad actors. 00:13:08.720 --> 00:13:18.080 And so sometimes we have to sort of then some of these legitimate hospices have a medical director that might be associated with some people that are bad actors that they don't know about. 00:13:18.080 --> 00:13:32.960 And so sometimes we have to really work with those legitimate uh providers to be able to say, hey, um you might want to reconsider your working relationship with uh some of the people you're affiliated with, because those affiliations could be tainting them by association as well. 00:13:32.960 --> 00:13:35.600 So we always try to give the benefit of the doubt. 00:13:35.600 --> 00:13:48.720 We always believe in due process, but the fact of the matter is that in some cases, particularly in hospice, durable medical equipment, and some of these other high risk, high fraud areas, um, we're occasionally going to catch some good actors. 00:13:48.720 --> 00:13:54.000 And we try really hard to make sure that we get them out and get them back right when we do. 00:13:54.000 --> 00:13:56.960 And my best advice is when that happens, come to us. 00:13:56.960 --> 00:13:59.440 If you're one of those people, you need to come to us. 00:13:59.440 --> 00:14:01.679 You need to let us know, hey, raise your hand. 00:14:01.679 --> 00:14:10.320 You know, our contractor might be focusing on them because we've told them to focus on people that have certain discharge rates or certain, you know, other characteristics. 00:14:10.320 --> 00:14:13.600 Let us know, and then we'll hopefully be able to get it squared away. 00:14:13.600 --> 00:14:20.960 If you're actually doing things the right way, we'll have an independent review done and hopefully we can get you back and out of the net, if you will. 00:14:21.600 --> 00:14:22.000 Perfect. 00:14:22.000 --> 00:14:25.440 So, Kim, now go back to like maybe looking out to the future. 00:14:25.440 --> 00:14:32.559 So many hospice leaders are maybe a little concerned, but more anticipating where is federal policy heading? 00:14:32.559 --> 00:14:43.279 If you're giving advice to hospice executives today, what capabilities or strategic shifts should they be thinking about as they prepare their hospices for the future? 00:14:44.080 --> 00:15:04.720 Um, you know, I think some of it is what we already talked about in terms of the fact of the matter is I think the future of hospice is definitely more from that Medicare-defined benefit at the very end of life to more sort of a broader, managed, and earlier stage care model, if you will. 00:15:04.720 --> 00:15:08.879 I think it's kind of, you know, thinking about it in a little bit different way. 00:15:08.879 --> 00:15:13.519 Again, not knowing exactly what we'll do as a result of the VBID and things like that. 00:15:13.519 --> 00:15:28.720 I'm not going so far as to say that, you know, VBID is going to do it, but I think,

you know, the fact of the matter is that um there's gonna be a little more of a shift towards, I would say, models that support both treatment and comfort, sort of that curative and palliative a little bit. 00:15:28.720 --> 00:15:33.759 And I think people are gonna be very, very focused on analytics and data. 00:15:33.759 --> 00:15:35.759 As I said, we're getting more into that. 00:15:35.759 --> 00:15:53.039 I think people are going to need to be looking at length of stay by diagnosis, live discharge rates, um, you know, uh CCN, uh, you know, cap exposure, like we talked about before, referral patterns by source, um, the cost uh per patient versus reimbursement overall. 00:15:53.039 --> 00:15:57.679 Those are all things that I think um we are becoming much more data-driven. 00:15:57.679 --> 00:16:00.159 Like I said, we're trying to use data to drive quality. 00:16:00.159 --> 00:16:10.399 I think that hospice providers, and frankly, all providers in healthcare are gonna have to become much more data-centric as well, because that's just the future and that's where we're going. 00:16:10.399 --> 00:16:20.399 So I think it's a little bit of a mind uh shift in terms of broadening the mindset of what is hospice now, because I think what is hospice is gonna shift a bit. 00:16:20.399 --> 00:16:29.440 Like I said, it's going to be a little more of I think a longer, not just your last six months, which was we've now learned thanks to this episode, is not something that was ever set. 00:16:29.440 --> 00:16:34.240 Uh, but it is now sort of thinking about how it is that you know you can think about that. 00:16:34.240 --> 00:16:45.120 And then I think also it's that, you know, how do you think about palliative care and um what does that mean and sort of um where does hospice fit into that overall? 00:16:45.440 --> 00:16:46.000 Yep. 00:16:46.000 --> 00:16:49.519 So you very we brought you to our teleos network. 00:16:49.519 --> 00:16:51.440 You did a great presentation in PHI. 00:16:51.440 --> 00:16:52.799 You came and talked to our network. 00:16:52.799 --> 00:16:57.840 And in that meeting, you mentioned a chili cook-off, but in the context of technology, and I made it out. 00:16:57.840 --> 00:17:03.759 I'm like, if ever get Kim my podcast, I'm gonna ask her, what the heck is a chili cook-off related to technology? 00:17:03.759 --> 00:17:05.119 Um, can you talk about that? 00:17:05.359 --> 00:17:06.319 Yeah, I'd love to. 00:17:06.319 --> 00:17:09.359 Um, so the chili cook-off um was kind of my idea. 00:17:09.359 --> 00:17:15.759 Um, we were thinking about it more as a uh, okay, how do we get a bunch of people to get together and determine who has the best thing? 00:17:15.759 --> 00:17:17.599 And so we called it a chili cook-off. 00:17:17.599 --> 00:17:18.960 And some people got way into it. 00:17:18.960 --> 00:17:21.200 We even had like hot sauce and everything. 00:17:21.200 --> 00:17:27.039 Um, but what we had was 250 plus um tech companies that all came together. 00:17:27.039 --> 00:17:36.720 And what was really cool about it was they all brought their best machine learning, um, AI, other types of approaches to how they would help combat healthcare fraud. 00:17:36.720 --> 00:17:42.319 Like what were the things that they thought could really help us at CMS move the needle in a sustainable way? 00:17:42.319 --> 00:17:56.960 And the reason it came about was because in my first, oh, let's say six to eight months here, probably eight months um here at CMS, I met with over a hundred different vendors, every single one of whom claimed they could save the program $2 billion or more. 00:17:56.960 --> 00:17:59.440 And I would love it if that was the case. 00:17:59.440 --> 00:18:02.640 And I'm sure many of them actually thought they could, and maybe they could have. 00:18:02.640 --> 00:18:05.279 I I honestly don't know, but I didn't know. 00:18:05.279 --> 00:18:08.559 I did not feel like I was the one that could make that call. 00:18:08.559 --> 00:18:12.720 There were so many options to choose from, like a real chili cook-off. 00:18:12.720 --> 00:18:17.200 How was I going to determine who the best one was and where I was going to get the best dollar? 00:18:17.200 --> 00:18:26.319 So we had Mitre Corporation, who is one of our contractors, um, go ahead and just basically independently uh analyze all the proposals. 00:18:26.319 --> 00:18:27.599 They picked the top 10. 00:18:27.599 --> 00:18:29.599 Um, the top winner was Millen Inc. 00:18:29.599 --> 00:18:37.359 Um, they won with um a really creative proposal that was um kind of innovative, and we're now pilot projecting with them on that. 00:18:37.359 --> 00:18:44.559 Um, but what's really cool is you can go on our www.cms.gov slash fraud. 00:18:44.559 --> 00:18:54.079 So again, cms.gov slash fraud, you can go there and you'll actually see a white paper, which I think posted last Friday if all went well. 00:18:54.079 --> 00:19:01.759 Um but there's a white paper that summarizes um what we found, um, talks about the top 10 submissions and kind of gives you more intel. 00:19:01.759 --> 00:19:10.400 But the whole goal of this was to really help us find out if there were things that we were missing or if there were approaches that we should be thinking about. 00:19:10.400 --> 00:19:20.319 And what we found was we were aware of most of what was out there, but there were creative and unique ways of using a lot of that technology, which we hadn't really thought about. 00:19:20.319 --> 00:19:23.359 And so it really opened our eyes to sort of what was out there. 00:19:23.359 --> 00:19:32.720 And our hope in issuing the white paper is for those who don't have the resources, money, or time to do a 250-plus entity cook-off, if you will. 00:19:32.720 --> 00:19:39.279 Um, this will give them some good information to be able to help them as they think about what tools and resources could be useful to them. 00:19:39.279 --> 00:19:40.640 So um we loved it. 00:19:40.640 -->

00:19:42.000 I think you're gonna see more. 00:19:42.000 --> 00:19:45.440 Um, we we just had a provider directory bake off. 00:19:45.440 --> 00:19:47.599 Um, we love food here at CMS. 00:19:47.599 --> 00:19:57.599 Um, so you know, who knows what we'll have uh later this year, but I'm hopeful we'll be able to do another round of it this time on Medicaid tools, because we're really focused on Medicaid program integrity now. 00:19:57.599 --> 00:20:01.119 And I'd love to be able to um see what works on the Medicaid side. 00:20:01.119 --> 00:20:04.720 But it was a really great um, I'm very excited by the outcome of it. 00:20:04.720 --> 00:20:05.839 Congrats to Milliman. 00:20:05.839 --> 00:20:06.799 They did a great job. 00:20:06.799 --> 00:20:15.440 But more importantly, it helped us to really think very closely about what tools we're using and what tools we need to use to be able to keep crushing fraud. 00:20:15.759 --> 00:20:18.960 In our show notes, we're gonna include a link to that white paper then, Kim. 00:20:18.960 --> 00:20:20.720 So, last question to you. 00:20:20.720 --> 00:20:27.759 When you step back from all the regulatory stuff, what do you hope hospice looks like in let's say 15 years from now? 00:20:28.400 --> 00:20:29.599 It's a great question. 00:20:29.599 --> 00:20:37.359 I think for me, what I hope hospice looks like is a sort of merging of the experience I've had between my family members. 00:20:37.359 --> 00:21:09.039 So I would love it so that if someone so chooses, like my mom did, to be able to die in their own home or has the luxury of dying in their own home, that they're able to do that with medical professionals who can help provide the family with the tools and resources needed to be able to help that person die with dignity in their home, but also help them understand the dying process and what's needed to help manage that and help them do so in a as pain-free and sort of comfortable manner as possible. 00:21:09.039 --> 00:21:21.519 Um, I think, you know, some of the challenges of being in a facility are you can't control the environment, you can't control, you know, when and how um pain medication is always delivered and things like that. 00:21:21.519 --> 00:21:25.759 And I think those are some of the challenges we faced with my uncle when he was in a facility. 00:21:25.759 --> 00:21:32.960 They were wonderful people, but there were, you know, it was not the most stress-free end of life, so to speak. 00:21:32.960 --> 00:21:54.720 And so I think what I'd love is whether it's in a facility or whether in a home, you know, we all have an agreement as to, you know, how to make sure that the people that are dying and their family members have the support and the resources needed to be able to help that person exit in as calm and just, you know, uh stress free environment as possible. 00:21:54.720 --> 00:22:04.000 And I think so many hospices, like I said, we went to the the Nathan Adler hospice and It was really impressive

to me what they were doing to really help those patients. 00:22:04.000 --> 00:22:06.000 Um, that it was a beautiful environment. 00:22:06.000 --> 00:22:10.079 It was um, you know, really seemed like incredibly talented staff. 00:22:10.079 --> 00:22:11.759 That's what you hope everybody would have. 00:22:11.759 --> 00:22:14.319 You want to be able to have, I mean, it was almost like being in Hawaii. 00:22:14.319 --> 00:22:16.240 They had the palm trees, they had a Lanai. 00:22:16.240 --> 00:22:18.160 I mean, it is a truly first class facility. 00:22:18.160 --> 00:22:24.559 And I don't mean to keep calling them out, but it really struck me because they to me that embodies sort of what you want. 00:22:24.559 --> 00:22:33.599 You want to have it so that people feel that they are loved and comforted and are just able to go out in a way that pays tribute to the lives that they've had. 00:22:34.079 --> 00:22:35.440 So Kim. 00:22:35.440 --> 00:22:36.720 Kim, final thoughts. 00:22:36.720 --> 00:22:38.880 You've got the year of hospice and powered care leaders. 00:22:38.880 --> 00:22:39.839 What final thoughts? 00:22:40.160 --> 00:22:42.960 I think final thoughts are continue to engage with us. 00:22:42.960 --> 00:22:56.000 One of the best things that I found over my past year now here at CMS, particularly because so much of it has been spent focused on hospice issues, is the more you tell me, the more we learn and the more we can make changes. 00:22:56.000 --> 00:23:02.240 And um, there has been such a great dialogue with the hospice community, particularly on the fraud and abuse piece of it. 00:23:02.240 --> 00:23:06.240 Again, I don't claim to be influencing uh things on the payment side, but Dr. 00:23:06.240 --> 00:23:06.960 Oz does. 00:23:06.960 --> 00:23:08.160 He influences both. 00:23:08.160 --> 00:23:11.519 And the fact is, you have his ear, use it. 00:23:11.519 --> 00:23:18.720 Um, continue to talk to him, continue to talk to us, tell us where you're seeing issues, tell us where you're feeling the pain points, because Dr. 00:23:18.720 --> 00:23:30.640 Oz is very committed, as is Chris Kump, as is our whole leadership team, to making sure that people do age and die with dignity and want to make sure that we are doing all we can from a program perspective to do that. 00:23:30.640 --> 00:23:39.119 My part of that is to get rid of the sketchy actors so people don't get caught up in that or have it so that they can't get hospice services because it looks like they already have. 00:23:39.119 --> 00:23:41.359 Um, so I'm trying to do my part on that part. 00:23:41.359 --> 00:23:42.160 And then Dr. 00:23:42.160 --> 00:23:46.480 Oz and uh Chris Klomp and the others are are thinking about the payment sides of it. 00:23:46.480 --> 00:23:50.240 But the most important part of all this is having that dialogue with us. 00:23:50.240 --> 00:23:57.599 The more you tell us, the more you influence uh with us through letters or just visits or even when we come and visit you. 00:23:57.599 --> 00:24:01.359 I think that has been, I think, the most eye-opening uh eye-opening. 00:24:01.359 --> 00:24:16.160 I mean, obviously I've had personal experiences, but the interaction I've had with the professionals in your community has made a huge difference in how we've approached our fraud fight, but it's also really influencing how we're changing our thinking about hospice in general, and that's huge. 00:24:16.160 --> 00:24:17.920 So just keep it up. 00:24:18.720 --> 00:24:20.559 Okay, we're based in North Carolina. 00:24:20.559 --> 00:24:21.359 If you and Dr. 00:24:21.359 --> 00:24:30.720 Oz ever want to kind of make it down here, we have some amazing programs all over the country, but we've got a good conglomeration of them in the Carolinas, and so Carolinas are beautiful. 00:24:30.720 --> 00:24:33.119 So if you ever want to pay a visit down here, we can create some crazy. 00:24:34.160 --> 00:24:37.200 I have a feeling we'll be heading that way at some point over the next few months. 00:24:37.200 --> 00:24:38.880 So I'll definitely keep that in mind. 00:24:39.119 --> 00:24:41.680 All right, and thanks for the work that you guys are doing, Kim. 00:24:41.680 --> 00:24:44.079 The fact that you took time for this podcast, thank you. 00:24:44.079 --> 00:24:45.519 I know how busy you are. 00:24:45.519 --> 00:24:51.279 I I work crazy hours, I look like a slacker compared to how hard you and your team are working. 00:24:51.279 --> 00:24:54.240 That says the world about how much you care about what you're doing. 00:24:54.240 --> 00:24:55.279 So thank you for that. 00:24:55.279 --> 00:25:00.160 And I love how you guys have engaged the whole hospice field, wanting to make it better. 00:25:00.160 --> 00:25:02.559 And so that's that's a refreshing change. 00:25:02.559 --> 00:25:03.200 So thank you. 00:25:03.440 --> 00:25:04.160 Well, thank you. 00:25:04.160 --> 00:25:10.000 We are so grateful to have you all as partners and uh I hope to significantly reduce the amount of fraud. 00:25:10.000 --> 00:25:15.039 So we aren't talking about that anymore, and we can focus more on how we can do a better job of providing good care. 00:25:15.039 --> 00:25:15.839 That's the goal. 00:25:16.480 --> 00:25:20.640 We don't want to, they're like so in at the bottom of the class. 00:25:20.640 --> 00:25:23.680 We want to be talking about this is what great care looks like. 00:25:24.240 --> 00:25:24.799 Exactly. 00:25:25.039 --> 00:25:27.119 Yeah, so you can eliminate those that part. 00:25:27.119 --> 00:25:28.640 So well, thank you again. 00:25:28.640 --> 00:25:30.400 To our listeners, we want to thank you. 00:25:30.400 --> 00:25:32.960 At the end of each episode, we want to share a quote, a visual. 00:25:32.960 --> 00:25:36.799 The idea is create a brain bookmark, a thought prodder about our podcast subject. 00:25:36.799 --> 00:25:38.319 This one's gonna be a fun one. 00:25:38.319 --> 00:25:43.759 We want to further your learning and your growth and thereby your leadership, and we want it to stick like a brain tattoo. 00:25:43.759 --> 00:25:45.759 Please be sure to subscribe to our channel. 00:25:45.759 --> 00:25:47.359 We don't want you to miss an episode. 00:25:47.359 --> 00:25:52.480 We'll make sure we include a link to the article that Kim mentioned and maybe a couple other resources as well. 00:25:52.480 --> 00:25:56.319 You know, it's easy for us to rail against the world and be frustrated by things. 00:25:56.319 --> 00:25:59.200 Let's be the change that we wish to see in the world. 00:25:59.200 --> 00:26:03.759 So thanks for listening to the TCN talks / Anatomy of Leadership podcast. 00:26:03.759 --> 00:26:06.640 And here's our Brain Bookmark to close today's show. 00:26:06.880 --> 00:26:18.079 "The system we build today determines how we and the people we love will one day be cared for." by Kim Brandt. 00:26:18.079 --> 00:26:42.960 Thank you, USI, for sponsoring this podcast.