MHA Corner Podcast

Tech-Infused Compassion: St. Croix Hospice Embraces Medalogix and Hospi Corp for Unparalleled Care

Jennifer Maxwell:

I'm Jennifer Maxwell, the CEO and co-founder of Maxwell Healthcare Associates, and it's my distinct privilege to serve as the moderator for this enlightening roundtable chat. Today we have the extraordinary opportunity to delve into the inspiring journey of St. Croix Hospice, an organization that has achieved unprecedented growth, escalating from 900 ADC to an impressive 4,000 plus ADC in just five years.

Before we embark on this insightful discussion, allow me to introduce our distinguished panelists who bring a wealth of experience and expertise to our virtual table. Firstly, Dr. Andrew Mayo. Dr. Mayo is a prominent figure in the world of palliative care. Known for his unwavering dedication to improving the quality of life for individuals facing life limiting illnesses, his passion and commitment have played a pivotal role in the success of St. Croix Hospice. A native of Minnesota, Dr. Mayo was inspired to pursue a career in medicine by his family's long history of dedication to community healthcare and innovation. After completing his family practice residency at Bethesda Hospital in St. Paul, Minnesota, Dr. Mayo spent 17 years practicing in St. Croix Falls, Wisconsin with an emphasis on geriatrics. Dr. Mayo has served on clinical and hospital leadership boards and as a medical director for Luck United Pioneer Home and Frederick Nursing and rehabilitation community. In 2014, Dr. Mayo joined St. Croix Hospice as an associate medical director, where he is now Chief Medical Officer, and in 2023, he was recognized as one of Becker's Hospital's review's 110 CMOs to know. Dr. Mayo received his undergraduate degree from St. Olive College in Northfield, Minnesota and went on to study medicine at the University of Minnesota Duluth. Dr. Mayo continues to pursue additional medical training and holds a hospice medical director certification.

Next, I'd like to introduce Dr. Clay Hoberman. Dr. Hoberman's dedication to healthcare and patient focused approaches has consistently shown throughout his career, making him a trusted advocate for patients facing serious illnesses. As a proud Omaha native, he has woven his distinguished tapestry of education and expertise throughout his remarkable career, beginning with an undergraduate degree from Middlebury College, he then moved on to pursue his doctorate of orthopedics from Kirksville College of Osteopathic Medicine. He then committed his excellence to his completion of a rigorous physical medicine and rehabilitation residency at the University of Missouri. Dr. Hoberman’s has shown unwavering dedication over the past 16 years to the practice of palliative medicine and hospice, showcasing his versatility in inpatient, outpatient, community-based settings and hospice settings. For the last seven and a half years, Dr. Hoberman has been an invaluable asset to St. Croix Hospice, initially joining as a contracted physician and progressively ascending to the roles of full-time medical director and regional medical director.

His stellar qualifications include a board certification in physical medicine and rehabilitation, a board certification in hospice and palliative care medicine, and recognition as a certified hospice medical director. Dr. Hoberman is a distinguished Fellow of the American Academy of Hospice and Palliative Care Medicine, and he compassionately serves as a “my hospice” ambassador for NHPCO and HAN, embodying the commitment to advancing excellence in the end-of-life care.

Jennifer Maxwell:

Now moving on to today's agenda of discussion. We are going to have a conversation that is thoughtfully structured around to cover a range of critical topics in this space. Firstly, Croix Hospice's unique approach Dr. Andy Mayo and Dr. Hoberman will offer a comprehensive overview of St. Croix Hospice, shedding light on what sets it apart from the rest and makes it a beacon of compassionate care within the hospice industry.

Secondly, strengths and innovations, we will delve into the specific areas where St. Croix Hospice has excelled, showcasing its exceptional proficiency and innovation solutions that have contributed to its ongoing success.

Thirdly, its growth strategies, the remarkable growth of St. Croix Hospice from 900 ADC to 4000 plus ADC within five years is an achievement that merits much exploration. Our panelists will discuss the strategies, values and initiatives that have driven this impressive expansion.

We'll delve into the innovation, tools and programs that have set the organization apart and explore scenarios where they have made a significant difference in patient care. Lastly, the future of hospice care. As we look ahead, our panelists will share their insights into the future of hospice care. We'll discuss what hospice care may look like in 2025 and transformative changes we will expect to witness within the next five years.

Let's begin our discussion by inviting Dr. Andy Mayo to provide an in-depth description of St. Croix Hospice, highlighting the unique approach and values that define the organization. Dr. Mayo, please share your insights with us.

Dr. Mayo:

Well, first of all, thank you for allowing us to be here with Maxwell Healthcare Associates, and to be able to share some of our experiences and practices that we've been involved in over the last ten years that I've been full time with St. Croix Hospice. We've experienced tremendous growth over the last five years, and I think part of the challenge, and part of our success really comes down to culture. We have had rapid growth, even during COVID. That attention to culture is a very difficult, but I think extremely important part of what allows St. Croix this to continue to grow through challenges. My great grandfather, who was one of the Mayo brothers, had a guiding principle, and that was the best interest of the patient, is the only interest to be considered. When I was first asked to come on board with St. Croix Hospice, having practiced initially as a hospice physician on my days off, I was a family practice physician working with St. Croix Hospice. It became truly evident to me that St. Croix Hospice carried those same values throughout the organization, from leadership all the way down throughout the organization to the hands on caregivers, that philosophy of the best interest of the patient is the only interest to be considered, really permeates our organization.

I think that's one of the things that we keep true to our hearts in delivering hospice care, in our endeavor to be the best hospice provider out there. You know, the other thing that we've really concentrated on, and we may talk about this further in other sections, is our commitment to the Midwest.

In our growth at this point in time, we’ve limited ourselves so far to the midwestern states, and we've largely just grown organically. I think that focusing on where our home is proves important as well in our success. We've largely been asked by communities bordering us as we've been providing care, to come into their communities when they've heard about what we're doing close by, and to provide that same level of service where their residents are.

Jennifer:

Thank you, Dr. Mayo, for providing us with that understanding of St. Croix and their unique approach to how they've kept things growing, as well as discussion of culture and home and the patient being the most and only interest to what you're doing. So now let's turn our attention to Dr. Hoberman and delve into some strengths and the innovations that have propelled St. Croix Hospice to the forefront of the hospice care industry. Dr. Hoberman, the floor is yours.

Dr. Hoberman:

Thank you very much. We're very proud of the work that St. Croix does and the growth that we've experienced so, any opportunity to discuss that and share that is exciting to us. So, thank you for that. I would like to echo, similar to what Dr. Mayo said, our biggest strength is our people. And not to be trite in that statement, but I fully believe that that's our biggest strength. Across ten states, we've built an interdisciplinary team of amazing people who are genuinely motivated and driven by patient first mentality that obviously has driven our growth. These are people helping people through some of their more challenging and intimate experiences that they encounter. That's not necessarily difficult to do, but it is exceptionally challenging to do it well. Our growth, I think, is attributable to our excellent care, which is attributable to our people and our culture. As Dr. Mayo spoke to our drive for excellence in doing that, we've maintained a willingness to adopt new technologies, innovations, and strategies, all of which I think we'll talk about a little bit later in the discussion.

Leveraging those new approaches to gain every advantage we can to provide the highest quality care and to raise the bar in hospice delivery. I think some of the innovations, like I said, we'll talk about down the road, I wanted to open with our greatest strength, which is clearly the people that we have doing this work.

Jennifer:

That's great. Thank you very much, Dr. Hoberman. We're very excited to delve into those next layers, but people and culture are the core kind of to being able to have good quality care, good quality outcomes, and things like that. So very commendable of you guys to continue to do that as you grow as quickly as you do, because culture can go quickly. So now let's take some time and explore some strategies and values that have underpinned St. Croix Hospices remarkable growth. Dr. Mayo, Dr. Hoberman, please feel free to share your thoughts on how you managed to out-recruit to grow the company and at such an astounding rate.

Dr. Mayo:

Yeah, so I think just piggyback on what Dr.Hoberman had said, know our people, keeping people engaged, keeping the focus on the patient, but providing a pathway for our employees to advance their own expertise and personal growth and their growth within the company as well. So, we've secured pathways for employees to gain additional certifications and provide them with a way of climbing up the ladder within the organization. I think providing those opportunities for our employees is very important in being able to deliver that type of care, providing things like car programs. We participate and provide care in very rural areas in the Midwest. I think that that's part of the key, is being able to enable that.

Dr. Hoberman:

Yeah, no, I agree. We've been able to successfully incorporate technology, some of which Dr. Mayo spoke to, non-tech innovations that we've been able to put into place. But we've been able to successfully incorporate technology that allows us to improve effectiveness and efficiency and the care we provide. That's both on the care delivery side and the business side. I think we've been able to successfully navigate the delicate balance of maintaining a high touch, while also bringing on high tech to make better care. We're continuously evaluating technology, including hardware, software, and clinical advancements that are available that certainly may improve our care and effectiveness, both from the clinical and the business perspectives.

Dr. Mayo:

Also, regionalization. From a medical director standpoint, we've begun regionalizing our coverage because we're understanding now more and more the role of compliance, and the role of documentation that's required to be a compliant organization.

Part of that is really regionalizing some of our leadership positions, to be able to provide both education and oversight and to provide good documentation. I think the other thing that has made us very successful is our transparency and availability throughout the organization. I get calls from nurses just about every day. And so, in addition to any administrative duties that I have, I'm also available clinically to support our people, as is Dr. Hoberman. And I think the other thing we've really been working on that has made us successful is the centralization of many of our operations. So, human resources, accounting, intake, that centralization, taking some of the day-to-day activities that aren't necessarily patient focused, and taking those responsibilities away from the clinical teams so that they can be supported, and they can concentrate their efforts 100% on the care of the patient and their families.

As Dr. Hoberman was talking about providing technology not only in the care and assessment of patients, but also providing technology for our nurses and clinicians in terms of offloading burdens that they would otherwise be contending with.

Dr. Hoberman:

To just kind of expand upon that regionalization and centralization. I really think centralization has been an excellent approach that has allowed us, as Dr. Mayo said, to do the things that we're able to do. We're regionalizing physicians and nurse practitioners, we've regionalized our triage phone calls, we've regionalized our HR and our intake, all of those, both clinical and administrative tasks. And really with the goal of diminishing the regulatory and administrative burden on the local branches so that they can go out and care for the patients, which is the reason they exist. So, in doing that, we recognize that we're caring for patients across a wide swath of cultural differences.

For example, you have a large urban center in the twin cities which has a very different flavor and culture than Moberley, Missouri, for an example. So, I think taking some of those tasks out of the branch has allowed the branch to maintain that local culture, and flavor so to speak.

What that also has allowed us to do is really begin to focus on rural hospice, which is well acknowledged as a lacking aspect to hospice care, able to focus on rural hospice, increasing and improving access to care. Certainly, there are many hurdles to providing rural hospice. But, we welcome the challenge, and we've jumped at the opportunity to raise that bar.

Some of the programs that Dr. Mayo has spoken to, beyond centralization and regionalization, has allowed hospice to move into the rural community, providing boots on the ground care there.

Jennifer:

Very insightful. Thank you. Next, we'll delve into some of the innovation, the actual tools programs that have contributed to St.Croix Hospice's success. Dr. Mayo, Dr. Hoberman, I invite you to share the details of these tools and the programs and help us provide some insight into how they've positively impacted patient care.

Dr. Mayo:

So, you know, I think innovation and the acceptance of technology is very important to growth and to good patient care. My great grandfather my great great grandfather, Dr. William Warrell Mayo, who came over originally from England, started his own small practice in Lasure, Minnesota. At one point in time, because he felt it was so essential for his patient's care, he mortgaged his house to buy a microscope, which at that point in time was leading edge technology.

Of course, he got approval from his wife before he mortgaged the house. But that same spirit of early adoption of technology and incorporation of that to better serve patients is at the core of what we do at St. Croix Hospice. By investing in tools such as home care homebase itself, sort of the Cadillac of electronic medical records, we've invested in programs such as nVoq, which help to provide voice-to-text, to eliminate those burdens of documentation that can literally take hours, and to cut down that time so that more of the nurses and clinicians time can be spent hands on with patients.

We've utilized machine learning and artificial intelligent tools such as Muse, which to me has been wonderful opportunity and experience to see technology impact our care plans so that we can provide significant and crucial care at the right time for patients at the most critical times in their life.

And so that technology helps not only our nurses be in the right place at the right time, but also improves the experience for the patients and families in that difficult time. Dr. Hoberman, I think, can provide some insights on some clinical tools that we've been utilizing.

The Macy catheter is something that we're very excited to be using as well.

Dr. Hoberman:

Yeah, I think before we move on to that, I do want to just mention or speak a little bit further about one of the tools that Dr. Mayo mentioned, that being Muse, the predictive analytics software that I found to be dramatically, clinically useful.

We're sitting on troves of data as a field, haven't necessarily done much with that data or known what to do with it, and muse is an excellent utilization of that data. Muse is really combining Home Care Home Base into our medical records, looking for both subjective and objective signs that signify more of an immediate need of care.

At end of life and how that tool is utilized is not necessarily to take any clinical judgment out of the hands of the staff on the ground, but absolutely to highlight, to say, hey, this is what the data is showing and what the chart is showing. This might be somebody that may be moving towards the immediate end of life with the goal of increasing visits and increasing handholding and making sure we're present at that most vital time of the person's trajectory and passage.

So that has become a very significant tool in allowing us to partly do what we do. And so, I don't want to overlook the meaningful use of that. When we look at clinical mean, Dr. Mayo mentioned the Macy catheter, and I would say it's not high tech by any means.

It's a tube, and it's a rectal tube. For those that aren’t aware, it's micro enema medication delivery. It's dramatically changed my approach to patient care in the sense that previously, I think that most of us would not look at rectal administration of meds as something that meets people's quality of life goals.

However, we go back to the rural hospice setting. This is a tool that nurses keep in their trunk, available the moment they decide, and we decide as a team that it's the right thing to do. It has significantly replaced a lot of our subcutaneous or IV medication, our PCA’s and things like that, where even in an urban setting, still may take us three to 4 hours to get all those pieces in place. We can utilize the Macy catheter within 10 or 15 minutes. What we've seen is we've gotten clinical improvement, symptom management achievement in time frame measured in minutes rather than hours or days. And so, it has changed the way we've approached some symptom management. It's been a great tool.

So, I think we're always on the lookout for things that are going to improve the care that we deliver. And the feedback from that tool has been significant, from the nurses who have utilized it, to families and patients that have experienced it. Contrary to my beliefs previously, it has not increased anybody's burden. We've not disrupted anybody's comfort. We've achieved quite the opposite with an intervention that I think lots of us reflexively believe may be not the right thing to do.

Dr. Mayo:

As I listened to Dr. Hoberman talk about the Macy catheter and what we talked about with Muse and nVoq and Home Care Home Base, I think the term “time is of the essence” is very appropriate in hospice that is very true. Time is of the essence, and we have one chance to do hospice right for patients and their families. And these tools, these technologies, and these clinical advancements all help in providing special attention to time, either by cutting down the amount of work and time that a nurse or clinician needs to spend documenting or being there at the right time for a patient providing timely symptom control for patients through the use of the Macy catheter. All these technologies help to improve the time that we spend with patients and how we spend the time with them.

Dr. Hoberman:

Just a few more points I would like to point out. I think we do exceptionally well. They're not necessarily innovative tools or programs, but more from an organizational structure standpoint. We've invested lots of time and energy into building a very robust quality assurance program and partners very well with what we would say is kind of standard setting compliance program as well. And so those aren't sexy or exciting things if there is such a thing in the hospice world. But those are two components of our organization that, hands down, allow us to continue to provide excellent care, allows the staff to focus on what's important, while at the same time maintaining high compliance and high regulatory standards awe have experienced such significant growth.

Dr. Mayo:

I think the technology has also promoted special programs that we've developed at St. Croix Hospice, like the “Voyage Vigil” program really has enabled us to identify those times when we need to provide more vigil care for patients. And so out of that was born the “Voyage Vigil” program. Other programs that we've developed at St. Croix Hospice, the “North Star Dementia Care” program, “Bridge Care”, understanding that when patients are admitted on a Friday or a Saturday, that they need that extra touch through the weekend, and so that we provide daily visits through the weekend, making sure that their onboarding and comfort levels with hospice are insured over a weekend or a holiday time period.

And so, we've started adding a lot of different programs. The “Navigate Falls” prevention program, wound care specialty program, I think all these programs just help to set the bar higher for what hospice care can be, and all of that, coupled with the technology and clinical advancements.

Jennifer:

incredible, incredible information and amazing work done through the use of not only just quality care, to your point, Dr. Hoberman, but also emphasizing technology to lift up those types of the non-sexy programs, like you said, but are so instrumental for making organizations strong and healthy and able to continue to provide that level of care, as well as Dr. Mayo, you talking about the use and the leveraging of technologies that births out new programs because things were able to be identified, right? Like, how could we do this differently? And I think that that's very well attributed to your success within the organization.

So, lastly, we'd like to conclude our discussion with a forward-looking perspective. Our panelists will share their versions of the future of hospice care, both in 2025 and over the next five years. We'll explore the anticipated changes, innovations and challenges that will help shape the landscape of the end of life. Care, gentlemen?

Dr. Mayo:

Yeah. So where do we start? I think that we're, of course, going to see continued regulatory oversight. I think that with the innovations of AI and analytics, I think that there's going to be innovations coming through that will help with not only compliance, but also with quality assurance and being able to effectively respond to inquiries about services.

So, I would anticipate in that role the amount of data that we have and technology developing around that will see further innovations through the use of technology. I think both clinically, predictably, but also in response to quality assurance and to response to CMS and oversight. I think from sort of the nuts and bolts, I think we're going to have a lot of challenges moving forward in changes in payers.

I think with VBID coming online, how is hospice reimbursement going to look when we have to contract with different value-based organizations? And I think that will be a challenge to many. You know, Dr. Hoberman and I have always talked about what our hopes are for hospice and the outlook for really providing that care upstream from where we currently do.

Looking at how can we expand the spirit of the hospice benefit to those patients that aren't currently eligible for that benefit. Because all the studies have really been coming in showing the significant, not only the monetary savings that hospice provides, but also the experience that patients and families have being involved in hospice and palliative care, and the more favorable perception of the care that they've received when hospice and palliative care are involved.

And I think that's both Dr. Hoberman's and my hope is that we will see hospice be more incorporated and seen as part of the continuum of care the U. S. Healthcare system has to offer. I’ll let Clay chime in here.

Dr. Hoberman:

Yeah, no, those are all excellent points.

I think looking at the future of hospice, it's arguably an unknown. I have certainly a long wish list of things that I would like to see. There are certainly some aspects as a field that I think we need to collaboratively work through together. As Dr. Mayo was speaking on, I think a large part of that is around the culture and acceptance of death and ends of life and what that care can look like. We have a duty and obligation not only to our patients and families, but to the practice of hospice, to ultimately assist in changing that culture around death, care that we provide, and that can be provided. Hospice, with open arms and hearts, meets people in their dark corners. When the rest of medicine retreats under the guise of, quote, nothing left to do, hospice shrugs that off and shows up, and we meet people where they're at and we come with a whole group of people to do that well.

We need to continue to move hospice into the mainstream continuum of healthcare. We need to remove this palpable, hard stop that people feel often precedes a hospice admission, right? Where you move from this all or nothing approach, we're either going to do all of this or none of this, and then that's hospice. I think that is an ineffective or inappropriate way to use that. And I think, again, it comes down to the culture and acceptance of end-of-life care. Dr. Mayo talked about VBID and value-based approaches, you can look to hospice as the OG of value-based payment. Since our inception 40 years ago, we've been paid on a per-diem basis. We've had to learn how to take set dollar amounts and care for patients in the best way possible. I think we've done that well, but that payment model has forced us to do more with less, to be more innovative as we've been speaking about, and to be very future focused.

I think there is certainly a regulatory disconnect between payer and patient care. I mean, essentially, at some point, we get audited to death, and it really overlooks the point of what we're doing, and that is providing human, patient centered care at an intimate part of life. I would love to see hospice move into the world of acceptance like OB is accepted. We don't question whether we should get OB involved at the beginning of life. I don't think we should question whether hospice should be involved at the end of life. It's good holistic care. And so, I think we need to continue to do things that move the culture in that direction from a kind of a bulleted list things that I would like to see.

I think, number one, concurrent care is an invaluable approach to hospice. The VA has a concurrent care program with hospice that functions very, very well. That eliminates that arbitrary, strict six-month approach that I think is the result partly of this anemic utilization of hospice that we're still experiencing.

I mean, 50% of Medicare deaths are utilizing this great service. That's great. When we look at it that way, if we look at the other half that's not receiving it, we have a lot of work. Concurrent care, I think, gets us closer to that approach, and so, I would love to see CMS start to adopt and evaluate more of a concurrent model.

We absolutely need greater system wide integration from a healthcare system standpoint. We are still set to the side. We're carved out. Because of all the things we've been talking about, we're seen as this distinct, separate entity rather than part of the continuum of healthcare. Culturally, I think, again, that's an uphill move, but we're getting there.

I think we need more involvement in the advocacy world as Dr. Mayo talked about from a regulatory standpoint, those of us who do this work are very focused on improving program integrity and that's a whole different discussion that we can save for a later date. But those are some of the things we need to work for.

I think we need to better define what palliative care is so we can better define what hospice is and how we utilize all these similar but somewhat different aspects of our healthcare in that spectrum. And again, like Dr. Mayo mentioned and we spoke to earlier I think we need to utilize data.

We've been slow to incorporate that in the hospice world because it just feels a bit cold in the world that we're working under. But as Muse has shown us that data is invaluable and we can learn to be high tech and high touch and that allows us to be better and provide better care which is really ultimately what we're here to do.

Jennifer:

Wonderful. This has been an incredibly enlightening conversation with the two of you. I really appreciate the time and want to say thank you all for joining us in this enriching roundtable chat. Look forward to continuing robust and engaging discussion about the journey, the strengths, the innovations, and the tools and the future of St. Croix Hospice. Thank you both.

Dr. Mayo:

Well, thank you so much. It's absolutely been our pleasure to be here. Yeah, thank you, Jennifer. Thank you. And thanks well held, for allowing us to share a part of our story.

Dr. Hoberman:

Thank you, Jennifer. Thank you, Maxwell Healthcare Associates, for allowing us to share a part of our story.