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That's the beckershospitalreview.com events page. See you in Chicago. This is Scott Becker with the Beckers Health Care Podcast. We're we're thrilled today to be joined by a brilliant leader, Renee McGinnis, and and Renee is the CEO at NVNA and Hospice. She's gonna tell us about some of the key trends facing visiting nursing and hospice and and a lot more. Renee, can you start off by telling us about about yourself and your career and about, quite frankly, about NVNA and Hospice? Absolutely. Thanks for having me, Scott. Yes. So I am a registered nurse, for many, many years, too many to to tell, and, you know, worked in in hospitals and so on. But in been in home health and hospice a good bulk of my career, and very really passionate about community health care, in particular, you know, end of life care, serious illness, and palliative care. And I am the CEO. I've been the CEO for 10 years, was in many other positions within this organization before that. And we are a full scope, full continuum of care, home health, hospice, palliative care, serious illness care, chronic disease, on the South Shore. So we cover 27 towns from Quincy down to Plymouth and the coastal towns and out to Bridgewater. And, you know, we're growing and expanding. There's such a huge need. Probably our average age is about 72. We have patients that come home from, you know, knee surgery or hip surgery and need therapy at home for a few weeks. And then we have patients with very, very serious illness, and then end of life care. We also have a hospice home, residential 12 bed hospice home in Hingham called the Pat Roach Hospice Home, and that is for patients on our hospice services or coming from hospitals or other, post acute areas that need that 247 care. Maybe, you know, their loved ones are tired and they just wanna be the family or, they don't have someone that can be there as their caregiver at end of life with hospice. Thank you very, very much. And and talk a little bit about what trends you're watching closely. Is there enough nursing staff to take care of all the hospice and visiting nurse needs? What does that look like? Is there an imbalance, or how does that look today? Yeah. No. There isn't. There isn't. I mean, nursing as you know, there's a national nursing shortage. So what happens is, you know, we're competing with the hospitals, and, we're not that far from Boston. So we're you know, the commute can be tough due to the traffic, but we're, you know, half hour from the city. So we're competing with big salaries, and home health and hospice is not reimbursed at a rate where we can really afford and sustain some of these salaries and and then the health benefits. So we're an independent nonprofit organization. We're not part of a system. And so it's you know, we don't have that type of leverage. So it it's very challenging for sure. And in terms of the long run, what does that look like in terms of the ability to keep on thriving? You know, talk about reimburse what's relatively flat for so many of these types of things. You need to have enough staff and enough people to make it all go. Is that the biggest limiting factor in the longest the demand is there. There's just a there's an incredible amount of need, 340,000,000 people, 330, 340, 350, 350, whatever the number is, and a number of nurses that's not grown in years right now. Yeah. What does that look like in terms of being able to take care of people and and grow? And you've been growing tremendously. So how how what's the secret there to the growth in a in a period of time of of GLG demographics? Yeah. That those are all good questions, Scott. I talk about every day. So, and as you probably know, in many like, a huge organization, a very large organization in Philadelphia just closed their doors because they couldn't sustain anymore. Vermont, Maine, it's it's really becoming it's gonna be an access to care issue. For us, in home health, what what people may not know is, you know, it's kind of the forgotten child because it's the smallest tiniest budget, right, for anybody. For the for the overall federal government, we're the smallest piece of their Medicare budget. You know, for Medicaid, we're the smallest piece of that budget. The commercial payers are really the elephant in the room. The Medicare Advantage Plans are really killing home health. They pay us about 50 to 60% below our direct cost. We have no negotiating power, And, the authorization process is so cumbersome, and the, trying to get paid from these organizations is cumbersome. So the infrastructure and the staff I need just to get the bill out the door and then to collect, is really difficult. So that is increasing in this state, the penetration. I did just see a in Becker's healthcare this morning that, they said that many of the, in I think it was Pennsylvania, some of the Medicare Advantage Plans are backing out because they're not seeing the reimbursement they wanna see. But their margins were big, very big. And so this is a problem. Commercial payers overall pay home health, like I said, 50 to 60% below our direct cost. And and and what happens there is well, as Medicare Advantage grew so much, it it ends up being more than half of Medicare today. You got more and more health systems more and more health systems dropping out of Medicare Advantage because because of exactly the issues you're talking about. Just feeling like they're not getting paid well off by Medicare Advantage, that, you know, for a period of time, insurance marches on it were so huge, and care was being denied, was not authorized, all kinds of issues that improved margins of the Medicare Advantage payers to the detriment of providers. How much of your population that you see is a Medicare population if your average age is 72? I take it a decent amount. Medicare, Medicaid, maybe supplemental policies, but a lot of Medicare and Medicaid. Yeah. So we have I mean, actually, because of the region in which we serve, it it just depends on where you are. We do Medicare is a 68% is straight Medicare. For us, 65 to 68%. But a lot of my sister agencies that are, you know, independent, they can be at 50%, and then the commercial payers make up the rest. And of that, about 15% is Medicare Advantage, and then the rest is, you know, straight commercial payers. So it's it's a huge challenge, and it's one that, as an industry, we never negotiated well 40 years ago. So now we've just been, you know, letting it go, letting it go. Now people are having to close their doors. And what I'm trying to do, and so thank you for asking me these questions, is I'm trying to be more loud and be an advocate to so people understand when they sign up for a Medicare Advantage Plan, I can't tell you how many people we have call us and say, I can't go to this post acute rehab that I wanna go to because it's out of network. Can you help us? I'm like, I can't because those other places you wanna go, they're not taking your Medicare Advantage Plan. I I can't help you. And so and we're considering several not taking several plans as well just because it's just such a loss for us, that we have to balance. You know, we take, obviously, our share of Medicaid population because that's what every community does. But to on top of that, to be taking the Medicare Advantage I mean, Medicaid pays more than Medicare Advantage. Right. Which is which is simply amazing when you put that stat out there that the Medicare Advantage, we got these managed care payers that have some power are paying less than Medicaid, not not even in that generous Medicaid state that you're in. You're in a you're in a okay Medicaid state as the reimbursement. Not horrible, not great, but that's a fascinating stat. That's a scary stat, quite frankly. Yeah. Exactly. 100%. And I I really believe, Scott, and I'd love to hear what you have to say about this, but I really think until the consumer is loud enough and says no and doesn't sign up for these programs, I don't know what to say. It's they have so much power and leverage and and so much reserve they're sitting on. You know? Well and so much of it is a governmental power type issue as well in that the insurance companies I mean, just the the the the president Trump was very pro Medicare Advantage. President Biden came in against Medicare Advantage, but then, of course, once he and his team listened to the power of the insurance lobby, they became very pro Medicare Advantage, and it's been Medicare Advantage off to the races under both administrations, quite frankly. And and until enough health systems and enough patients express concerns with it, we're gonna keep on moving in that direction. I I I think what's really happened is we've taken Medicare. Medicare Advantage is end up costing more to the government than traditional Medicare, and we've ended up essentially just adding on another layer of middle person cost to the whole program. It's it's literally it you know, it with it's it's literally an insanity in terms of a way to solve problems by adding another layer onto the whole thing. But, theoretically, it might sound good, but in practice, it's not worked out so well so far. But I don't know what's gonna happen and at what point you know, younger Medicare, enrollees, I I think are maybe more capable of trying to figure out which Medicare plan to be on once they get to be like my father's age, like, 90 plus. It's very hard for them to think through it. Yeah. It's hard for anybody. They don't make it easy. And, you know, you think to yourself what I say to people is just educate yourself. I don't wanna tell people do or don't, but what I wanna do is educate them. So what we see on our end in and and I know there was a big article that came out about, you know, hospitals saying it's just unbelievable how they wait to be discharged because there's no post acute place that's taking or the authorization is so cumbersome, and they're getting a certain amount of money. And so the other days they're in the hospital, there's no reimbursement. Right? And then they can't get them into a post acute setting. And I think, you know, I say, why not be a little loud about this? You know, people are like, oh, well, you don't wanna upset. Upset who? I wanna upset I wanna upset the system and say, this is not okay because what's gonna happen is the patients are gonna suffer. That's who's gonna suffer. They're not gonna get the care they need in their home where they want it. Right? And they want all the care to go to the home, but no one's figured out how to pay for it. And we are the lowest cost provider, and we are the solution to keeping people out of the hospital. So We could not agree more. Renee, what are you most excited about heading into 2020 5? You're a great advocate for the hospice and and visiting nursing world. What are you most excited about heading into this next year? Yeah. Well, I'll tell you. You asked me how we're able to grow and how we're able to do it. So we have, you know, we have a cushion that we had from from way, way, way many years ago that has never really been used to go back into operations. So we're using some of that for growth, but we also do a lot of fundraising. So we have a very big philanthropy program. We're actually in a capital campaign now over 5 years, $20,000,000 campaign. We raised 4.2 last year. We're gonna raise close to 6,000,000 this year, and that really truly is filling the gap. And it's allowing me to hire, educate, train, retain employees, and pay the you know, our health care costs for benefits this year are going up 20%. So to be able to to do that, we need I need philanthropy to fill the gap. We have a hospice house which loses, it's residential, and so it loses quite a bit of money. And we do offer charitable care. If people can't afford the room and board, then we take them anyway. It's what we do. It's a mission. That's that's our charity piece of the organization. No. It's magnificent. And what's happened, of course, in health care, big not for profits, not for profits, everybody's relying more and more on philanthropy to fill the gaps. There's just no way around it. It's become a very big, big issue and very important. Yeah. It really is. And I will tell you, the joy of it is I've met so many incredible people, so generous, so kind, just wanna do the right thing. They wanna give back. They've been successful, and it's just so heartwarming to see, and they really care about the mission. So I'm excited to next year to really we're expanding, we're growing, and we want to message more and more why it's important to have a community home health and hospice. When I say community, someone who's gonna give back to the community, who's gonna be part of the community. It's not just about the bottom line. It's not a private equity company owning a health care company when that business model works in many ways, but not in health care. Renee, I can't thank you enough for joining us. Where could people learn more about MVNA and and hospice? Where could they learn more about it? Yeah. So you can learn more at, www.nvna.org. Go to our website, and you can learn more about us. And we we love to answer any questions anyone has. Renee, thank you so much for joining us today. Just fantastic what you're doing. Thank you. Thank you.