Latest / Home Health Revealed (+Palliative and Hospice) / Comfort Over Cure: The Hospice Mindset Shift in Leadership, Documentation, and Compliance

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Comfort Over Cure: The Hospice Mindset Shift in Leadership, Documentation, and Compliance · Home Health Revealed (+Palliative and Hospice)

• 0:03
  Speaker A: Welcome to Home Health Revealed, the podcast for home health and hospice leaders who want to stay connected to the industry and ahead of what's next. Real conversations, real strategy, real impact. Let's dive in. Welcome back, everyone. You are listening to Home Health Revealed. I am Hannah Vail, and today I have one of my very favorite repeat offenders. I mean, repeat guest, if that's the right word. With me, the one and the only Dena Heath from Cantime. So, Dina, welcome.
• 0:37
  Speaker B: Thanks. I'm so excited to be here.
• 0:40
  Speaker A: What is your title now at can time? I know it's changed.
• 0:43
  Speaker B: It is Senior Vice President of Customer Experience.
• 0:49
  Speaker A: And that's such a great position for you. Well, Dina, I'm going to jump right in if you're good with it, with a question. True or false, Dina? Hospice people handle chaos better because they know what real perspective looks like.
• 1:07
  Speaker B: I'm going to say that that's probably more true than not true. I don't know that all hospice people handle chaos better because some people just. Hospice is one of those jobs where it's either for you or it's not for you. There's no in between. So either you love it or you hate it. So you know those people that don't deal with chaos well, they tend to be the ones to go quicker than other people.
• 1:36
  Speaker A: So I think teaching is the same way.
• 1:38
  Speaker B: Yeah, it is. It is. I would agree with that. 100. You know, you, there are some jobs like, you know, I've worked in surgery, I've worked in the er I've worked all these different nursing jobs. And there are some jobs you can take or leave, but hospice is not one of those things. You, you have to have the heart for it.
• 1:54
  Speaker A: Yeah. I know someone who says it like this, and I completely agree. If you're meant to be there, you can't leave. And if you're not meant to be there, you can't say.
• 2:04
  Speaker B: That is. That is correct. That is absolutely correct. You know, I, which I left, like nursing. Nursing. But I'm still doing hospice things. So. Yeah. I can't imagine myself ever doing anything but hospice.
• 2:18
  Speaker A: Yeah. And you're doing some home health kinds of things. You're looking, I mean, you're kind of running the gamut of customer service with Cantime, which can. Time has like, they are cross. Those acute.
• 2:29
  Speaker B: Yes.
• 2:31
  Speaker A: Disciplines. Yes, that's the word.
• 2:33
  Speaker B: Yes. Different.
• 2:36
  Speaker A: So when you think about hospice clinicians, though, what do you think they crave most from leadership and technology support?
• 2:45
  Speaker B: I think the leadership portion of it is, you know, just having a leader that is not a micromanager. They too have a heart for hospice and they just support their clinicians. You know, when something bad happens to a patient, it just doesn't happen to the patient. It also happens to the family, and it usually happens to the nurse and the aide and the chaplain and the social worker, you know, so it affects all of us. So that support is very important. And as far as technology, I think anything that makes a hospice nurse's job or a hospice clinician in general's job easier, you know, to where they're. And I'll give you an example, I'm going out to do an admission. I don't want to carry a bunch of paper with me to know what was wrong with this patient. I want to be able to easily look into my EMR and see where my patient was, what's going on, that type of stuff. So you don't, you don't want to have to dig for stuff. You want it to be right there at your fingertips. And I think that's probably the most important thing.
• 3:47
  Speaker A: Yeah. And you've worked across both home health and hospice. And I've actually talked to a couple of leaders lately who have come from the home health world and are crossing over, either adding on through M and A or adding on hospice and or palliative to their service offerings as an agency. What do you think surprises home health leaders most when they step into hospice operations?
• 4:13
  Speaker B: It is, it is just a different world. You know, it's all about. It's all about the patient and painting the picture. So, you know, in home health, you're going to document very positively. In hospice, you document very negatively and, and that the desired outcome is not the same. The desired outcome for a home health get them well, get them at home, get them back, you know, to being independent. With hospice, the goal is a good death. You know, the payment structure is very different. In hospice, we get paid by the day whether we see the patient or not. That's not the way it works in home health. We don't have to justify, you know, our frequency or anything like that. We're just there to take care of the patient. So it becomes, I mean, it still is a business and it still has to be business oriented. But the way you treat your patients, your clinicians, your, you know, your outside people is very different than what it would be in home health. And I think that's a struggle because not everybody is made for that death and dying, you know, and that support of the family. Because, you know, I've heard It said before, you know, it's not about dying. It's about living the best life you can in the time you have left. So, you know, that's. That's kind of hard for home health people to come in. Even, you know, when you hire people, and I've hired lots of people, you know, it's hard for them to. To come to grips with that.
• 5:42
  Speaker A: Yeah, it is. It's definitely a mind shift.
• 5:44
  Speaker B: Yes, yes, it's a huge mind shift, you know, because if you document positive and CMS pulls a record, you're not going to get paid or your patient's not going to continue to get hospice.
• 5:56
  Speaker A: You know, so you say positive. What would it say on there that you would be like, this is positive, this is negative?
• 6:02
  Speaker B: Well, you know, if I. If I'm talking about a patient's ability to sit up and they can, you know, or their mobility in home health, you're wanting to document that they're becoming more mobile, and that is the goal for them to become more mobile. But in hospice, you're looking for ways to take care of them when they become less mobile. And that's, you know, that's what you expect to see with a hospice patient on the trajectory is for them to become less mobile, you know, but how are you going to keep them comfortable and how are you going to maintain their independence when they can't move around as much? And what are the things you're going to do to make that patient feel less like they're dying and more like they're living, even though they're not living the same as you and I?
• 6:52
  Speaker A: Yes. Oh, that's such good, good insight right there.
• 6:56
  Speaker B: Thanks.
• 6:56
  Speaker A: I always love talking to you because I think when I came into this world. Right. Several years ago now, my understanding of hospice since then has changed so much. And we especially look at it from more of that RCM perspective and sequential billing and, you know, some of those topics. But, man, when you take it. And actually, you and I were at a conference together in Texas, New Mexico, that was. It was life changing for me personally. Barbara Carnes was there. We both got to see her. I remember, you know, you were a little bit starstruck, as was I, once I realized who she was. But she talked about hospice in such a way differently than I'd ever heard somebody talking about hospice. And it really did change my thinking.
• 7:48
  Speaker B: From.
• 7:50
  Speaker A: Death. Right. Just angel of Death kind of perspective, to actually helping somebody live the best and make the most of their life, get those opportunities for reflection, forgiveness, spiritual work that needs to be done, you know, so that they can accept this existential experience. And then the care that the nurses are giving for comfort, it definitely switches from we're going to get you better to this is comfort care. And you're getting better, but not in the way that we see better.
• 8:26
  Speaker B: Exactly, exactly. And that's. That is the thing with most people. They see better as. Because it's mama. They see better. And, you know, my son Joseph told me the other day, he was like, no, you're going to live forever. And I'm like, no, I'm not ever. So you need to come to grips with that. I'm not going to live forever. But. But, you know, I think it's all about, you know, it's really about quality. And an example I will use is a friend of mine's mother was in the hospital and she was on a regular floor, and she just continued to get work to get worse. And they moved her to cicu, which, I mean, they did give her some medication, but just that extra attention to her, and the more time they had to spend with her, the better she got. And, you know, we do have those hospice patients that graduate hospice and they go and they live a full life. You know, you see that a whole lot with nursing home patients. Whole lot of nursing home patients.
• 9:25
  Speaker A: Yeah. So. And documentation is kind of. It's the bane of a lot of, you know, clinicians existence. And I get that because they really are focused on the care of the patient. From your view, what is the biggest documentation challenge that hospice agencies are running into in 2026?
• 9:47
  Speaker B: I think it's. I don't know that it's going to be as much of a documentation challenge. I think the challenge is more twofold. You know, there is still a nursing shortage, and you bring these nurses in and you're just hiring because you want a warm body. So it doesn't work well. And, you know, they don't really understand the concept. So, you know, I think it is. Nurse to patient ratio is going to be a huge challenge in 2026, just as it has been because you have so many more patients than you have nurses. I think the right people providing the right care is going to be a big thing too. And I think leaders really have to look at that and go, you know, yeah, she's had 20 years experience in surgery, but how does she feel about death and dying? You can't ask the questions just like, you know, well, have you ever missed work for more than, you know, or whatever? Some of the questions are, you Asked during an inter. You have to ask the questions to see if they're a good fit for your team and your community. And so but I do think, you know, making the documentation easier, making it easier to come in and document it needs to be laid out. Well, AI certainly will help. You know, I, I struggle with AI as a nurse because I, I don't, do not think a computer can predict. But you know, I've seen lots of models where they do predict and they predict it well. So I think a play a huge part from 2026 forward. There are so many companies out there, you know, that are, that are doing AI now for documentation. And I think the ease of documentation. I don't want to have to double document. So if I document my note, is that going to my IDT or am I going to have to turn around and go to my IDT and redocument? Everything I just documented in a note. So, you know, just making it easier. You know, people were very worried about Hope. And what I've said about Hope is, you know, no, I don't want to answer a bunch of extra questions, but Hope really will mandate that a hospice provide better care because you do have to go back and see them. I was raised in a hospice where by a very good hospice leader. I was raised by if your patient called or if you started a new drug, you went the next day anyway. But being in this EMR world and working with lots of different hospices or, you know, demoing to lots of different hospices, you don't see that. So, you know, Hope is not, I mean, it's a few extra questions, but the goal of Hope is to ensure that patients get better care. Do we like the government telling us that? No. But as is obvious by all the fraud that's going on and all the, you know, the states that are, were in that special focus, it's obviously an issue. So this is going to cause those hospices to have to provide better care. So, and, and I've not really heard lots of huge complaints about, about, you know, the extra questions. I mean, the real, the only thing is I, I don't think hospices want us to get to an oasis, but I think it eventually Hope will become the hospice oasis to an extent.
• 13:14
  Speaker A: Yep. I agree. I haven't heard a whole lot, especially from hospices who were already doing the things right. I think for those hospice agencies it was kind of a like, oh, everybody else isn't doing these things.
• 13:27
  Speaker B: Yes, exactly.
• 13:28
  Speaker A: Just a couple of extra questions. But some of the other Things with, you know, pain management and, you know, attention like that. They were like, oh, well, we're already doing these things.
• 13:40
  Speaker B: Yes.
• 13:41
  Speaker A: So it was keeping. It's keeping the honest. Honest.
• 13:45
  Speaker B: Correct. It is. And, and I, you know, I do not think it's a bad thing. I, at first I did, but, you know, the more I looked at it and the more I've talked about it and I've been asked about it, I just, I think it's a really, you know, good step. Now. You can. They could go too far, obviously, CMS could go too far because look how many times they've changed oasis. I mean, it's changed or visit, but yeah, so that's.
• 14:10
  Speaker A: My hospice does have some unique documentation with certifications, with some of their narrative requirements and research. How can leaders make sure their team doesn't end up drowning in the process?
• 14:25
  Speaker B: Again, I think that that is, you know, especially if you have an emr. Does your EMR put, put steps in place to make sure that you're following and you're being compliant? So, you know, do they have hard stops and soft stops for things that you want to make sure that your nurse catches every time they go, Excuse me, you know, is your EMR plotting your HUV visits and your SFV visits for you so that you don't have to miss them? Is your EMR flowing that information from the visit note to the IDT so that, you know, you can talk about it? So I, you know, I, I think that there are lots of things EMRs can do. It's just, it's just doing those. And, you know, I've had people tell me, oh, you're too compliant. Well, you know, sometimes you can be a little bit too compliant. But I, I don't. Being a QAPI nurse from my past, I, I love compliance. So, you know, anything that makes it easier for the nurse to not have to think about it, you know, if you're going to go ahead and plot those, those HIV visits for me so I don't have to think about the timeframe in which I need to make them, and then you don't let me move them outside the time frame that, you know, I'm supposed to make them in, then that, that keeps me from having to think about it as a nurse so I can worry about my patient instead of worrying about what, what I have to document and what kind of business I have to make. So I think that that is probably one of the best things that EMRs can do is, is really, you know, if, if I want A PPS every visit. Can I mandate that a PPS is done every visit through my emr? So those kind of things are very, very helpful for an er. You know, we have a salesperson that works here who says that, you know, we're a push rather than pull technology. And we are because we put that information. Not that I'm here to sell can time, so let me clarify that. But you know, we're, we're putting that information out there so that they don't have to go search for it. It's in front of their face.
• 16:26
  Speaker A: Oh, I like that. Push rather than pull makes life easier.
• 16:31
  Speaker B: It does.
• 16:31
  Speaker A: And cantime does some really neat work around usability. And I know cantime is listening to their clients who are the end users. And I think to your point earlier about AI, there are a lot of AI companies out there who are touting a lot of different things. And when people bring these to me or ask questions about them, that's usually what I tell them. What does your end user think about it? Have you put a test into their hands? So what other things? Let's go ahead and talk about Cantime. How is cantime specifically making compliance less of a chore for their clinicians?
• 17:06
  Speaker B: Well, again, when we onboard a new agency, we have a gold standard site that we copy from that has no patient information and it's just a gold standard site. And so we put that gold standard out there and we lay these things, things out. Now we do give the agency to the opportunity to change those if they want them. However we're, we're telling agencies and we're doing this based on agencies who've had surveys with CHAP or JCO or their state and you know, what things were good and what things worked and what things kept them out of trouble. And so we've set this up and so when we build a site for an agency, we build it already in that framework of this is what's going to keep you compliant plant so that you don't have to worry as an administrator or as a QOPI nurse. Did my nurse do this? Because guess what? I made it mandatory for them to do it. So I don't, my QA is not as has, does not have to be as in depth as it would be if I didn't have those hard stops in place if I'm a, you know, manager. So that really keeps the workload down. And then, you know, we, we have that ability for when your clinician gets to that point to where you really trust them and you Know that they're documenting the way that they should be documenting, that you turn it on, where their stuff just gets approved automatically. So it doesn't even come to qa. You can always pull a sample, but it doesn't even come to qa. So, you know, things like that make it a whole lot easier for the agency, for the surveyor, for the administrator. You know, all that information goes into reports that you can pull. We even have a hospice care index report. Now, obviously that hospice care index report does not compare it to all agency, I mean, to all the agencies nationwide, because we can't pull that information in. But it does give you a sense of where am I with what I'm doing now? So all those things that Medicare looking at, we have all of those things in a report and we show you where you are in your agency. So we do all that kind of stuff to help so that, you know, agencies can do that better. We even have for several states, we even have the state report. States with com license mostly have, a lot of times have to provide a report to show, you know, the need, do we need another CO and do we not? So we've even developed those reports for states, for the agencies that have provided those for us so that they don't have to go look at a year's worth of stuff. We just pull it all into a report and boom, they're done.
• 19:39
  Speaker A: So all of those really data that people, it's data that they need. But sometimes data can scare people.
• 19:47
  Speaker B: It can.
• 19:49
  Speaker A: How do you help the teams not just collect data and have it, but then use it.
• 19:55
  Speaker B: So we try to really listen to our customers. You know, I know a lot about hospice. I can tell you about hospice all day long. I could go be a hospice nurse tomorrow, an administrator, but I'm not in it every day currently. So when administrators or, you know, clinical people come to us and go, hey, we really need this, then we really look at that. Does it benefit everybody? And then when we put out a new report, with the new report, we put out all the guidance with the report, we put out what the numbers mean and so, you know, they don't have to worry about. How do I figure this out? We've given you a walkthrough of what each one of these fields means for this number.
• 20:39
  Speaker A: When you see agencies, you're talking with agencies and you're right, you can talk about hospice with your eyes closed and in your sleep. Where do you see agencies growing right now? Particularly ones who are embracing technology and that data driven care.
• 20:56
  Speaker B: I think they're going to grow rapidly. What I, you know, with all the mergers and M and A and all that, it's kind of hard to say because people are just getting bought up. I mean, the agency that I worked for, we covered every county except for two in the state of Alabama, plus some counties in Tennessee, and then came in and we were bought, you know, or they were bought. I wasn't with them then. They were bought by a bigger agency. And so I think smaller agencies have an advantage if they use the technology and they grow their business to stay away from that, which will keep their employees longer because people don't want to go to work for a big corporate. A lot of people, you know, in hospice they want to work small and mom and pop and you don't see many of them anymore. But I was just at a AHPCO meeting yesterday and the hospices that were there, there's one hospital, two hospices that are large nationwide hospices. But the hospices that were there, they're non for profit. They open their own hospice. They do their stuff. So, you know, I think people that, that do that and that allow their clinicians to really take and spend the time with their patients, they will grow rapidly. Where some of these larger entities that have bought up these small hospices and take that feel out of it are not going to grow as much as the smaller agencies, if that makes sense.
• 22:34
  Speaker A: Yeah, I mean, I feel like what I'm thinking about as you're talking is if an agency, if we can get the perks of the large agency with the culture and feel of the mom and pop, that to me is going to be. That's the golden ticket. That's where is really going to explode. I agree about revenue and stuff, but I think we, if we think about hospice specifically, we have to think about the culture that we're handing off to the nurse.
• 23:04
  Speaker B: Right, exactly. And you know, I've worked for, for large agencies before that that have a very good culture, you know, but, but it starts with the administrator in their office. And you know, unfortunately with large companies like that, sometimes they just hire warm. And you can't do that in hospice. You just, you can't. I mean, I don't think you should do it for anybody, but especially in hospice.
• 23:30
  Speaker A: No, I agree. Okay. So staffing aside, because we know that's an issue, it's. I don't know that we can fix it.
• 23:40
  Speaker B: We cannot. I wish we could.
• 23:42
  Speaker A: If you, if you had a magic wand and could fix one pain point in hospital, not staffing what would it be?
• 23:54
  Speaker B: Gee, that's. That's hard to ask somebody who just loves hospice. There are no pain points in hospice. I think probably the biggest pain point that it would be, would be the documentation and making sure that that's correct and making sure that your rcm, it is correct. Because, you know, you know, as you know, if I send in a lot of claims that get rejected because I don't know what I'm doing, which is why people like Healthcare Partners are fabulous, you know, I don't know what I'm doing then, and I get a lot of rejections. Guess what I'm going into next? The TPE audit. So I think, you know, you, you. I think probably the biggest pain point is making sure you know how to bill and you're billing correctly and making sure your documentation matches. I think those are, and those are, those are pain points that have been around forever. So I don't know that the pain points themselves have changed, you know, and, and just making sure you take care of your patients. Because in the end, if you take care of your patients, then everything is going to work out. If you have a good RCM person and if you don't, call Health Rev.
• 25:12
  Speaker A: Call Health Rev.
• 25:13
  Speaker B: That's right.
• 25:14
  Speaker A: No, I think, I think it is really those, let me put it, maybe ecosystem partnerships, people you can trust with every level of the process. So if it is documentation, looking at, how can I help my clinicians be more complete in their documentation, meet compliance, have documentation that truly tells the story of the patient and because that's really the evidence of great patient care, to be the best bedside clinician. But CMS is never going to see your patient. You're building a paper patient.
• 25:49
  Speaker B: Don't document it. You didn't do it. You know, and I think that these partnerships are good. I also think that, you know, and again, not here to try to sell, but, you know, if your EMR is not doing this for you, then either you demand it from your EMR and they give it to you. Are you changing an EMR is painful for anybody. But look for an EMR that will provide you the stuff that you need, you know, because that one change could make a total difference in your business.
• 26:23
  Speaker A: Yes. Yeah. It is a foundational business decision.
• 26:27
  Speaker B: It is, it is. And so you have to, you know, and I am, I will say this. I am seeing hospices, especially larger hospices. And I'm not talking about like the LHC or the gentivas of the world. I'm talking about, you know, just large, not for profit hospices in a state. You know, they're really digging in to see what your EMR does. And I mean, they're doing demo after demo after demo after demo after demo because they want to see very specific. And so, you know, they're not making the. These decisions lightly, which is wonderful.
• 27:01
  Speaker A: Yeah, no, it. Dig in, take the time. Because it is painful to switch.
• 27:07
  Speaker B: It is.
• 27:08
  Speaker A: It's kind of like getting into a marriage.
• 27:11
  Speaker B: Yeah. Yeah. That's why I'm not married now. Yeah.
• 27:18
  Speaker A: Dina, it is always a joy. You, you know, just love it. Well, next time we do a podcast, we need to do it from somewhere, live somewhere warm.
• 27:35
  Speaker B: And somewhere with.
• 27:36
  Speaker A: Are you going to Achcu?
• 27:38
  Speaker B: Yeah, I am going to Achchu. Yeah, I will be there. Are you going in March?
• 27:43
  Speaker A: Yeah, yeah, I'll be there.
• 27:45
  Speaker B: Yeah, we can do it then.
• 27:46
  Speaker A: Yeah. Okay. Well, we'll have to get a coffee while we're there, and hopefully there will be some sunshine because I desperately need some.
• 27:54
  Speaker B: I understand you. You really do need some sunshine. I mean, 15 inches of snow is a lot of snow. Not the most snow I've heard of out of this storm, but it's a lot of snow. 22 inches is the most I've heard.
• 28:09
  Speaker A: I know. Well. And once it comes, it doesn't matter how much it is. It just stays. And you just. You look outside and it's still white and fleshy. So you're like, well, all right, here we go again. Every day. Every day. But we will get some coffee and some sunshine. I am looking forward to it.
• 28:26
  Speaker B: I am, too. I cannot wait to see you in March.
• 28:30
  Speaker A: And for our listeners, don't forget to subscribe to Share. Check out cantime. If you are considering an EMR and you want something that has a great balance of compliance as well as people who are amazing, like Dina to work with and have that support. It makes documentation easier. You need to check out cantime and if you are looking for revenue cycle, please head on over to healthrebpartners.com I would love to talk with you. And until next time, we will keep telling this pasta story.
• 29:02
  Speaker B: Well.