WEBVTT 00:00:02.000 --> 00:00:09.000 Alright! Welcome. My name is Chelsea Prize. I'm an education associate here with Capcard to welcome you to. Today's briefing. 00:00:09.000 --> 00:00:19.000 Voices from the field, findings from caps. 1st annual palliative pulse survey before we dive in. I just want to briefly provide you with some instructions on how to participate in today's webinar. 00:00:19.000 --> 00:00:25.000 If you need technical assistance for myself, as the cap. See, host, please use the chat function and select host from the Dropdown menu. 00:00:25.000 --> 00:00:30.000 You may also use the chat function to comment on the presentation with fellow attendees, and we encourage you to do so. 00:00:30.000 --> 00:00:36.000 It's best to direct these comments to everyone by making sure that option is selected in the Dropdown menu in the chat. 00:00:36.000 --> 00:00:46.000 Before you submit, we will be monitoring the chat throughout the session, and you can also use the reactions on your zoom control panel to engage with some of the presentation questions that we'll have thrown in. 00:00:46.000 --> 00:00:50.000 When we do open up for audience questions, you can also use the QA. Panel. 00:00:50.000 --> 00:00:56.000 To submit questions. This option allows you to submit anonymously. Should you wish to do so. 00:00:56.000 --> 00:01:01.000 The webinar recording and slides will be available on caps website under the on demand. Webinars page. 00:01:01.000 --> 00:01:04.000 Where you can find all of our recorded webinars. 00:01:04.000 --> 00:01:12.000 And we are very excited to announce the Save. The date is, Live for the return of Cape's National seminar. So join us in Philadelphia, September 15, th through 17.th 00:01:12.000 --> 00:01:15.000 2,025. 00:01:15.000 --> 00:01:43.000 Registration will open early 2025. So we'd love to see you there. 00:01:43.000 --> 00:01:44.000 Thank you, Chelsea. Hello, everyone! Thank you for joining us this afternoon. We are very excited. 00:01:44.000 --> 00:01:49.000 Lastly, we ask you to provide your feedback on the session in the very brief survey. You'll see pop up in your browser once we end. So with that we'll go on to our presenters for today. Who are Bryn, Bob and Capco, Rachel Heightner, Caps Associate director for research and insights, and Dr. Andrew Ash Capsi education consultant. So with that I'll go ahead and and hand it over to the presenters today. 00:01:49.000 --> 00:01:56.000 To be talking about this today, and to share the results of our 1st annual survey that we've called the palliative pulse. 00:01:56.000 --> 00:02:03.000 Next slide, please. 00:02:03.000 --> 00:02:13.000 So Chelsea's gonna populate. I have a couple of little quotations that are gonna pop up on the screen here. Thanks, Chelsea. So before we dive in. We wanted to do a little just. 00:02:13.000 --> 00:02:21.000 Raise your hand, Poll, so please use a reaction. In the zoom, or even in the chat. If. 00:02:21.000 --> 00:02:28.000 You can relate to any of the statements on the screen about frustrations people have had when providing palliative care. 00:02:28.000 --> 00:02:39.000 So programs and individuals have been cut based on basic programmatic cost revenue assessments that fail to account for palliative care's overall value to the organization. 00:02:39.000 --> 00:02:45.000 Team members are being isolated from each other just to accommodate the increasing patient load. 00:02:45.000 --> 00:02:50.000 Think my favorite hospital staff introduced me as pre hospice. 00:02:50.000 --> 00:02:54.000 Did I do my best, and who will take over when I am gone? 00:02:54.000 --> 00:02:57.000 Okay, look at all those hands flying over the screen. So. 00:02:57.000 --> 00:03:02.000 I think we can say some people can relate to some of these. 00:03:02.000 --> 00:03:05.000 Okay, wonderful. And next slide, please. 00:03:05.000 --> 00:03:10.000 Now, here's another one. So similarly, if you could do the same thing. 00:03:10.000 --> 00:03:17.000 Raise your hands and then, or say it in the chat. If you can relate to any of these statements about what brought people joy. 00:03:17.000 --> 00:03:23.000 So, being a part of a team which is collaborative and our approach with patients, we're all voices are equal. 00:03:23.000 --> 00:03:25.000 I really do love the people I work with. 00:03:25.000 --> 00:03:32.000 Helping reduce human suffering is extremely rewarding, because it helps me feel like I am making my part of the world a better place. 00:03:32.000 --> 00:03:38.000 Even in small ways, and I love my job all of it. 00:03:38.000 --> 00:03:42.000 Okay, this is great to see all these streaming by on the screen. 00:03:42.000 --> 00:03:46.000 Fabulous. Thank you all for doing that with us. 00:03:46.000 --> 00:03:50.000 Next slide, please. 00:03:50.000 --> 00:04:05.000 Thanks, Rachel. So I wanna set the stage here by talking about why we did. The Poly is also in the 1st place, and it was kind of exactly what's happening right now, which is, we really wanted to feel like we were having 2 way street communication with the field. 00:04:05.000 --> 00:04:14.000 We, as a Capc team, talk to as many people working on palliative care programs as we can every day of the year to understand. 00:04:14.000 --> 00:04:16.000 And what are the challenges that you're dealing with. 00:04:16.000 --> 00:04:19.000 Where is there exciting activity going on that we want to know about. 00:04:19.000 --> 00:04:25.000 How is everything that's changing in the healthcare environment around us, affecting palliative care teams. 00:04:25.000 --> 00:04:32.000 But we can't know if those conversations we're having throughout the year are really representative. 00:04:32.000 --> 00:04:36.000 Of what's going on in the diversity of programs across the field. 00:04:36.000 --> 00:04:38.000 And so we launched the polls to try. 00:04:38.000 --> 00:04:41.000 Do just that. We have our fingers on the pulse. 00:04:41.000 --> 00:04:46.000 What are the issues? What are the concerns? What are the wins happening in the field? 00:04:46.000 --> 00:04:49.000 And what we asked you was, How are you doing. 00:04:49.000 --> 00:04:55.000 How are your teams doing? What are you concerned about? And what can we, Cap see to help. 00:04:55.000 --> 00:04:58.000 So next slide, please. Chelsea. 00:04:58.000 --> 00:05:00.000 And what gets me excited about. 00:05:00.000 --> 00:05:05.000 The pulse is the idea that this is meant to be as close as possible to real time. 00:05:05.000 --> 00:05:10.000 Rachel is our guru of research at Kapsie, but, as we all know, research can be slow. 00:05:10.000 --> 00:05:15.000 You submit the results of a survey or an investigation for peer review. 00:05:15.000 --> 00:05:25.000 And many months later you understand what happened and what we intend for the palliative for this to be more real time. And we want to hear from you, and we want to respond to what you told us. 00:05:25.000 --> 00:05:30.000 In that same year. So I'm warning you. This is the 1st annual pulse survey. 00:05:30.000 --> 00:05:39.000 You will be seeing this in the future, and what I keep thinking about is the Npr. Fundraising drives every year where you get a toe bag. 00:05:39.000 --> 00:05:44.000 We're not asking you for money, but we are asking for your time to tell us what's going on with your programs. 00:05:44.000 --> 00:05:51.000 And we aim to do this every year one, so that we we know what are your concerns each year but 2, so that over time. 00:05:51.000 --> 00:05:56.000 We can start understanding what trends we're seeing. And again, so that share those back with you. 00:05:56.000 --> 00:05:58.000 So I'll pass back to Rachel to talk about. 00:05:58.000 --> 00:06:01.000 What we found. 00:06:01.000 --> 00:06:08.000 Should say, we also don't have eggs. But okay, next slide, please. Chelsea. 00:06:08.000 --> 00:06:10.000 Okay. So down to the survey itself. 00:06:10.000 --> 00:06:19.000 Some of the questions were adopted from previous Capsi had sent out during the pandemic. I'm sure some of you probably participated in those. 00:06:19.000 --> 00:06:30.000 We tested the survey with several people, including at least one doctor, one nurse, practitioner, one social worker, and we also tested it with people who were not capsi members to get that point of view as well. 00:06:30.000 --> 00:06:35.000 The survey was open from mid-march to beginning of May of this year. 00:06:35.000 --> 00:06:38.000 Feels like it was so long ago. But it was just this year. 00:06:38.000 --> 00:06:44.000 And the survey contained 29 questions, the majority of which were multiple choice. 00:06:44.000 --> 00:06:50.000 Any member of a specialty. Palliative care team, whether clinical or administrative, was welcome to join. 00:06:50.000 --> 00:06:56.000 And all of the data that we're gonna share on the following slides are based on the participant self report. 00:06:56.000 --> 00:06:59.000 Next slide, please. 00:06:59.000 --> 00:07:10.000 Our final sample included 759 survey respondents. And I just want to say, on the behalf of the 3 of us, as well as all of caps. 00:07:10.000 --> 00:07:17.000 To everyone who participated. We were extremely surprised and delighted to get that many participants. 00:07:17.000 --> 00:07:19.000 So thank you very much. 00:07:19.000 --> 00:07:24.000 Here are some of the demographics of the respondents, about 2 thirds. 00:07:24.000 --> 00:07:28.000 Of the respondents were team members, and about 1 3rd were team leaders. 00:07:28.000 --> 00:07:33.000 Also, the majority of the respondents were capsi members, about 84%. 00:07:33.000 --> 00:07:35.000 We did want to point out. 00:07:35.000 --> 00:07:37.000 Oh, can you hit it? One more time. 00:07:37.000 --> 00:08:01.000 We did want to point out, the only 4% of the respondents were from programs that saw pediatric patients. Only we wanted to point that out today to hopefully increase participation next time. And in the years that follow, because we wanna make sure that the survey and its findings and the content that we build because of it is applicable and helpful to many people as possible. 00:08:01.000 --> 00:08:04.000 Next slide. 00:08:04.000 --> 00:08:15.000 Some additional patient respondent. Demographics excuse me. About 1 3rd of the survey respondents. Each said that their palliative care teams were administered by health systems or hospitals. 00:08:15.000 --> 00:08:24.000 And it was a pretty even split between the 4 Us. Regions. With slightly higher participation in the South. 00:08:24.000 --> 00:08:27.000 Next slide. 00:08:27.000 --> 00:08:32.000 Now we'll move on to some of the overall findings from the survey questions next slide. 00:08:32.000 --> 00:08:41.000 One of the 1st questions you would have seen if you participated was, we asked you to name 3 top concerns for your palliative care team in the coming year. 00:08:41.000 --> 00:08:46.000 Overall, the topics included in the most respondents. Top 3. 00:08:46.000 --> 00:08:49.000 We're team morale and well-being at 40%. 00:08:49.000 --> 00:08:52.000 The ability to meet patient demand at 37%. 00:08:52.000 --> 00:08:56.000 And support from organizational leadership. At 34. 00:08:56.000 --> 00:09:05.000 When looking at the responses for team leaders, specifically access to qualified hires was also frequently at the top. 00:09:05.000 --> 00:09:11.000 For pediatric programs, the top also included expanding to new patient populations. 00:09:11.000 --> 00:09:13.000 And access to qualified hires. 00:09:13.000 --> 00:09:17.000 And if you looked at programs operated by hospices and home health agencies. 00:09:17.000 --> 00:09:20.000 Their top included billing and documentation. 00:09:20.000 --> 00:09:25.000 An alternative payment models in addition to ability to meet current demand. 00:09:25.000 --> 00:09:29.000 Next slide. 00:09:29.000 --> 00:09:37.000 So one of the questions we were most interested in was what teams felt was going on with their consult volumes. So we asked compared to last year. 00:09:37.000 --> 00:09:42.000 73% of respondents said that their consult volumes had increased. 00:09:42.000 --> 00:09:44.000 Either slightly or quite a bit. 00:09:44.000 --> 00:09:49.000 22 said they stayed the same, and only 5% said that they had decreased. 00:09:49.000 --> 00:09:55.000 The percentage that increased slightly by patient population. It was the highest for those. 00:09:55.000 --> 00:10:02.000 From programs to solve both adult and pediatric patients, while it was lowest from those from pediatric only programs. 00:10:02.000 --> 00:10:08.000 There was, however, not very much variation if you looked at it by Us. Region. 00:10:08.000 --> 00:10:12.000 Next slide. 00:10:12.000 --> 00:10:16.000 We also asked team leaders about their team staffing levels. 00:10:16.000 --> 00:10:18.000 34% said that their staff. 00:10:18.000 --> 00:10:20.000 Increased in size. 00:10:20.000 --> 00:10:28.000 38% said that it hadn't changed, and 28 said that their staff had actually decreased in size over the last year. 00:10:28.000 --> 00:10:39.000 There was slight variation in staffing by the administering organization. So, for example, only 20% of respondents from hospitals said that they had a staffing increase. 00:10:39.000 --> 00:10:43.000 Compared to 27% of respondents from hospices and home health agencies. 00:10:43.000 --> 00:10:48.000 Similar. Similarly there was slight variation across the Us. Regions. 00:10:48.000 --> 00:10:53.000 So, for example, here, 25% of the respondents in the Midwest. 00:10:53.000 --> 00:11:03.000 Said that they had a decrease in staffing or increase. Excuse me, compared to 36% from the West. Next slide. 00:11:03.000 --> 00:11:10.000 So this is actually one of our favorites. I really like this visualization. We wanted to look at the responses. 00:11:10.000 --> 00:11:15.000 For consult volumes and compare those to the responses for staffing levels. 00:11:15.000 --> 00:11:19.000 So the figure and the visualization has both. 00:11:19.000 --> 00:11:25.000 Questions on it, so on the left are responses to consult volume. When they said it had gone up. 00:11:25.000 --> 00:11:30.000 And on the right is what those people responded as their staffing. 00:11:30.000 --> 00:11:38.000 So the key takeaway for you here is that palliative care teams are often trying to handle increases in console volumes. 00:11:38.000 --> 00:11:44.000 When they're staffing, has stayed the same, or in some instances even decreased. 00:11:44.000 --> 00:11:50.000 So you can see of the team leaders who reported that they had had an increase in console volumes. 00:11:50.000 --> 00:11:56.000 36% of them. So over a 3rd said that their team had stayed the same size while the volume had gone up. 00:11:56.000 --> 00:12:03.000 And then, similarly, 27% of those said that they had actually lost staffing, even though the volumes had gone up. 00:12:03.000 --> 00:12:07.000 So some people are trying to care for these patients with less. 00:12:07.000 --> 00:12:12.000 Next slide. 00:12:12.000 --> 00:12:19.000 This was another question specifically for team leaders. We asked how concerned they were for the well-being of their team. 00:12:19.000 --> 00:12:23.000 And almost all of the team leader said they were concerned to some extent. 00:12:23.000 --> 00:12:32.000 Levels of concern were slightly lower in programs operated by hospices and home health agencies or independent palliative care organizations. 00:12:32.000 --> 00:12:43.000 The number was also slightly lower for programs who only saw pediatric patients, but overall they were very high, most often in the 90. In the nineties. 00:12:43.000 --> 00:12:47.000 Next slide. 00:12:47.000 --> 00:12:54.000 So, as you heard a little earlier in the survey, we also had some open end questions where we asked if you all could. 00:12:54.000 --> 00:13:01.000 Write in and tell us how you were feeling, what gives you joy, but what also can give you frustration, or keep you up at night? 00:13:01.000 --> 00:13:06.000 And that's where the quotations from the 1st couple of slides came from that we used. 00:13:06.000 --> 00:13:14.000 So we wanted to include one here, too, because we thought this one spoke to several of the topics that I've touched on so faring. 00:13:14.000 --> 00:13:17.000 Demand for consults and emotional well-being. 00:13:17.000 --> 00:13:25.000 So it says, I'm concerned that I'm not doing enough to keep the team's morale up, and this may result in people leaving their positions. 00:13:25.000 --> 00:13:30.000 The high clinical demand makes the thought of losing team members nerve racking. 00:13:30.000 --> 00:13:35.000 Quotations like this actually help us quite a lot. In addition to the quantitative data. 00:13:35.000 --> 00:13:51.000 Because it takes topics that may seem disparate when we're talking about them, and puts them together to give us a really well rounded picture of what people are actually feeling on a day to day basis. The numbers tell us what thing one thing your words tell us something else. 00:13:51.000 --> 00:13:55.000 Next slide. 00:13:55.000 --> 00:14:01.000 The next question asked respondents about their own personal team. 00:14:01.000 --> 00:14:08.000 So 45% of all of the respondents reported that their personal or very good. 00:14:08.000 --> 00:14:15.000 This varied a little bit with team leaders. It was a little lower 37 and team members. It was a little higher at 50. 00:14:15.000 --> 00:14:21.000 There was very little variation based on the Patient age group and a little bit of variation in the regions. 00:14:21.000 --> 00:14:27.000 With it being a little bit higher in the northeast, and a little bit lower in the midwest. 00:14:27.000 --> 00:14:30.000 Next slide. 00:14:30.000 --> 00:14:38.000 So one question we've been talked about, and this has been a Capsi topic for a very long time is the sustainability of the palliative care program. 00:14:38.000 --> 00:14:45.000 So we asked if team leaders were concerned about the sustainability of their program, and almost all of them 92%. 00:14:45.000 --> 00:14:51.000 Said that they were worried to some extent about the continued viability of their palliative care programs. 00:14:51.000 --> 00:14:55.000 There was slight variation in numbers. When you look at the demographics. 00:14:55.000 --> 00:15:02.000 But they all stayed quite high again, like the previous question, all up in the in the nineties. 00:15:02.000 --> 00:15:06.000 Next question. Excuse me next slide. 00:15:06.000 --> 00:15:10.000 And can you add the little one below it? Thank you. 00:15:10.000 --> 00:15:20.000 So we also included a question where we asked people to tell us if they were working on any initiatives around health, equity, health equity has been a very important. 00:15:20.000 --> 00:15:25.000 Aspect, Cap. See, it's part of our strategic plan. And we wanted to make sure that we were talking to people about this as well. 00:15:25.000 --> 00:15:29.000 So this table includes the counts of. 00:15:29.000 --> 00:15:33.000 How many respondents have selected each of these. 00:15:33.000 --> 00:15:50.000 In their survey. So the real takeaway from this table for me is the best variety of populations that have been identified. You have specific racial groups. You have rural areas, you have veterans, you have patients with or people with developmental disabilities. 00:15:50.000 --> 00:15:58.000 All of these categories had some people say they were working on them, and additionally we had 38 of. 00:15:58.000 --> 00:16:09.000 Team leaders say that even though they weren't working with one particular patient population group, they did feel that they were working generally to improve health, equity for their patients. 00:16:09.000 --> 00:16:13.000 And next slide. 00:16:13.000 --> 00:16:19.000 So here we asked what you, as our audience, would need from us. 00:16:19.000 --> 00:16:27.000 What future content people would want to see from Cape, and, as you can see from this, everyone has different needs. 00:16:27.000 --> 00:16:36.000 Overall. The top interest for respondents were clinical training Ppe and mental health and the dynamics of high functioning teams. 00:16:36.000 --> 00:16:44.000 For team leaders. The top areas of interest were operating a community program and program measurement and metrics. 00:16:44.000 --> 00:16:50.000 For team members. Some of the top interests were clinical training and emotional Ppe which matches the overall. 00:16:50.000 --> 00:16:55.000 And for pediatric programs. Some of the top areas of interest where leadership skills. 00:16:55.000 --> 00:16:59.000 And dynamics, of high functioning teams. 00:16:59.000 --> 00:17:02.000 Chelsea. Could we go on to the next slide. 00:17:02.000 --> 00:17:09.000 So one of the things that occurred to us as we were looking at the pulse results, and seeing, you know, the. 00:17:09.000 --> 00:17:26.000 The high percentage that responded to clinical training. We wanted to ask a poll question because we realized we weren't really clear on what we were asking when we asked about clinical training. So I guess just for just some clarity, if folks on the call here could on the zoom here could respond to this question. 00:17:26.000 --> 00:17:44.000 What if you were one of the people? Or if you're thinking about clinical training, would you be looking for continuing education for palliative care teams, education for palliative care team members who are not certified. Or were you thinking clinical education for colleagues outside of palliative care? And we'll. 00:17:44.000 --> 00:17:50.000 We'll give a minute for at least 30 seconds for for folks to respond to this. 00:17:50.000 --> 00:17:55.000 Before we move on and thank you for doing. This helps us a lot. Clarify. 00:17:55.000 --> 00:18:10.000 That particular aspect of the the survey. 00:18:10.000 --> 00:18:19.000 Alright pretty, even across the board. I'm not sure that really clarified a whole lot, but it is helpful to know that all of those are things that people are thinking about. 00:18:19.000 --> 00:18:23.000 Because that will go into informing our programming. 00:18:23.000 --> 00:18:31.000 Going forward Chelsea. Next slide. 00:18:31.000 --> 00:18:35.000 So, you know. We took a step back, and we looked at both the numbers, and, as Rachel said. 00:18:35.000 --> 00:18:41.000 All of the personal thoughts that you all shared, and the the right responses. 00:18:41.000 --> 00:18:43.000 And the picture that emerges is. 00:18:43.000 --> 00:18:46.000 Okay, so consults have gone up. 00:18:46.000 --> 00:18:50.000 For a great many of the programs across the country who answered the survey. 00:18:50.000 --> 00:18:55.000 That increased demand isn't always translating to more resources for the program. 00:18:55.000 --> 00:18:59.000 To to hire staff numbers. 00:18:59.000 --> 00:19:06.000 We are a field that's growing fast, and our programs cannot always find people to hire for their teams. 00:19:06.000 --> 00:19:12.000 And so are needing to to educate folks as they are onboarded to the team. 00:19:12.000 --> 00:19:22.000 Our program leaders are concerned about the well-being of the people working on their teams. Although, you know, when we ask individual palliative care professionals. 00:19:22.000 --> 00:19:26.000 The picture looks a little bit better. Folks are reporting that. 00:19:26.000 --> 00:19:34.000 I'm feeling pretty good, though. I have concerns about the future for our program and how we sort of navigate these challenges. 00:19:34.000 --> 00:19:38.000 And then, you know, one of the last slides that Rachel presented. 00:19:38.000 --> 00:19:45.000 Made me, and I think all of us on the team really excited, which is, we are a field that is really committed to health, equity. 00:19:45.000 --> 00:19:49.000 I was kind of blown away by how many. 00:19:49.000 --> 00:19:57.000 Of our survey respondents reported, not just. Yes, we care about health equity, and we talk about it. But we are actually doing work. 00:19:57.000 --> 00:20:01.000 To achieve more equitable care, so that. 00:20:01.000 --> 00:20:03.000 I think, just filled us with a lot of pride. 00:20:03.000 --> 00:20:06.000 For where the values of this field sit. 00:20:06.000 --> 00:20:11.000 But what do we? So what do we make of all this information? And and Chelsea, if you could go to the next slide. 00:20:11.000 --> 00:20:21.000 What struck me is like all of us looking at this is boy. Has the conversation, and our field changed? Over the last decade and 2 decades. 00:20:21.000 --> 00:20:26.000 15 years ago. What we were focused on is how to make the case. 00:20:26.000 --> 00:20:29.000 Through numbers, through stories, through example. 00:20:29.000 --> 00:20:40.000 To make those that we're working with leadership in our organizations understand what palliative care is, why it could be a benefit to them to patients. 00:20:40.000 --> 00:20:42.000 That looks different today. 00:20:42.000 --> 00:21:01.000 When you look at these responses, there's not a question of palliative care. Do we have a program? Whatnot for a large number of programs. It's a question of how do we navigate resource challenges. How do we navigate strategic opportunities. 00:21:01.000 --> 00:21:13.000 In the context of scarce resources to make sure that our program can sustain, and to make sure that we're growing in a direction that ensures that we are delivering high quality care, and that we are reaching the patients who need us most. 00:21:13.000 --> 00:21:17.000 So that's a different conversation. 00:21:17.000 --> 00:21:20.000 And as we look towards the future, I think the question then becomes. 00:21:20.000 --> 00:21:40.000 How do we ensure consistently high quality care as a field in a way that is sustainable for our programs and our organizations? And how can we really, as a Us. Health system, as all of our organizations, as all of our teams ensure accountability for access to palliative care and accountability. 00:21:40.000 --> 00:21:49.000 Palliative care. We can imagine the future in which every health system is required to demonstrate that they can provide palliative care. 00:21:49.000 --> 00:21:56.000 4 people with serious illness across care settings. So that's the vision that we're that we look towards. 00:21:56.000 --> 00:21:59.000 So next slide, Chelsea. 00:21:59.000 --> 00:22:06.000 So what we, what we thought would be really interesting to do was to look back at. 00:22:06.000 --> 00:22:09.000 Searching our emails, searching old 00:22:09.000 --> 00:22:12.000 Old seminar 00:22:12.000 --> 00:22:24.000 Cord brochures and and data that we had collected to see who came and what they went to, and I think to demonstrate how far we come. We took some examples of. 00:22:24.000 --> 00:22:32.000 These were the top 4 topics that we were talking about in our seminar like a decade ago. So. 00:22:32.000 --> 00:22:36.000 You know, how are we targeting and identifying patients? We are out there looking for patience. 00:22:36.000 --> 00:22:40.000 We were working through discussing prognosis. 00:22:40.000 --> 00:22:44.000 We tend to talk about the program. People were interested in that. 00:22:44.000 --> 00:22:51.000 And advanced care planning was just sort of coming into our focus as a central component of what we did. 00:22:51.000 --> 00:22:59.000 And when we look at the pulse results for 24, you can see that there's really kind of a shift. You know. We're no longer worried about. 00:22:59.000 --> 00:23:02.000 Targeting and identifying patients as much. 00:23:02.000 --> 00:23:07.000 We're worried about. What do we do with all the volume? Well, how is that? Affected our team? Well, being. 00:23:07.000 --> 00:23:09.000 Are we able to meet the demand now. 00:23:09.000 --> 00:23:14.000 Are we getting the support from our organizational leadership to meet that demand. 00:23:14.000 --> 00:23:18.000 And how? How are we functioning as teams like just. 00:23:18.000 --> 00:23:25.000 Are we healthy teams? Are we working together? Are we putting the right people in the right rooms at the right time? Those sorts of things so. 00:23:25.000 --> 00:23:31.000 It's. It's really a Testament to the growth of the field, and the the field has grown on the. 00:23:31.000 --> 00:23:34.000 Backs of all the hard work of folks like you on this call. 00:23:34.000 --> 00:23:37.000 And it really is kind of. 00:23:37.000 --> 00:23:40.000 Even though we're struggling. I think this points to. 00:23:40.000 --> 00:23:46.000 Success as a field and success to us as individual clinicians, that we've moved the needle. 00:23:46.000 --> 00:23:51.000 And Chelsea. With that maybe we can head to the next slide. So. 00:23:51.000 --> 00:23:56.000 One of the things I found really interesting when I've talked about this. 00:23:56.000 --> 00:24:02.000 Pulse survey with my colleagues from other disciplines, and I even went, and I looked at what. 00:24:02.000 --> 00:24:05.000 Other disciplines we're talking about in their research. So. 00:24:05.000 --> 00:24:08.000 One of the things that really struck me is, are we. 00:24:08.000 --> 00:24:14.000 Really having too much demand? Or is this just a symptom of our success like we have made it? Now, you know, like. 00:24:14.000 --> 00:24:21.000 Growth creates new challenges and new opportunities. And we're struggling with those. And our problems. 00:24:21.000 --> 00:24:38.000 I think what has been most evident to me are not specific to palliative care. You know one of the things there was some write Ins. Actually, quite a few write ins in the pulse survey about, you know, doing paperwork at 10 or 11 at night. Our cardiologist colleagues are doing that our oncology colleagues are doing that like people are. 00:24:38.000 --> 00:24:44.000 You know, doing ehr work after hours. So these aren't exclusive to us. But we're now. 00:24:44.000 --> 00:24:47.000 Experiencing the things that were unique. 00:24:47.000 --> 00:24:53.000 To palliative care. Sort of the the pains of being a palliative care provider. 00:24:53.000 --> 00:25:01.000 And now we're also dealing with all the other things that people in our dysfunctional healthcare system are are struggling with. So the question becomes. 00:25:01.000 --> 00:25:08.000 How do we? How do we navigate these growing realities? And we can go to the next slide? Chelsea. 00:25:08.000 --> 00:25:11.000 So you know. 00:25:11.000 --> 00:25:15.000 The top challenges facing all healthcare workers. And I think this slide just. 00:25:15.000 --> 00:25:22.000 Puts a fine point on the things that we're experiencing are what everybody across healthcare is experiencing. 00:25:22.000 --> 00:25:26.000 You know, burnout like our emotional wellbe. 00:25:26.000 --> 00:25:34.000 High turnover rates. Long work hours was mentioned in the pulse survey, as I alluded to earlier. Like the the workforce shortages. 00:25:34.000 --> 00:25:37.000 The financial pressures, I mean. 00:25:37.000 --> 00:25:42.000 We're we're a lot of programs now are under Rvu. 00:25:42.000 --> 00:25:50.000 Sort of benchmarking, and that that creates pressure on on clinicians. And I think historically. 00:25:50.000 --> 00:25:59.000 We've always struggled with time. You know, time has always been the thing that we brought to our patients and families. We've we've used time to give them the space to open up to us. 00:25:59.000 --> 00:26:02.000 And for us to understand what their needs are. 00:26:02.000 --> 00:26:10.000 But as volumes go up, and as financial pressures and Rvu benchmarks start creeping into our. 00:26:10.000 --> 00:26:21.000 Our reality. That's that's putting a pinch on what has always been of such great value and palliative care. Which is this patient and provider time. 00:26:21.000 --> 00:26:24.000 We can go to the next slide. Chelsea. 00:26:24.000 --> 00:26:28.000 So what are the options for? For programs with high volumes. 00:26:28.000 --> 00:26:30.000 You know it. It's not. 00:26:30.000 --> 00:26:35.000 It's not it's not nuanced. I mean, you either increase revenue. 00:26:35.000 --> 00:26:37.000 Which is you build better, or bill more. 00:26:37.000 --> 00:26:40.000 Or you renegotiate contracts. 00:26:40.000 --> 00:26:43.000 You make a case to leadership about. 00:26:43.000 --> 00:26:49.000 What we're what's happening with us. You know. We don't have the resources. We need to meet the demand. We're we're dealing with. 00:26:49.000 --> 00:26:57.000 What do we do when the organizations come to us? Because we are successful, and how we've built the field and built our programs. 00:26:57.000 --> 00:26:59.000 They ask us to do more, so. 00:26:59.000 --> 00:27:01.000 How do we do more. 00:27:01.000 --> 00:27:07.000 With what the earlier slides that Rachel presented showed us that most programs are not growing. 00:27:07.000 --> 00:27:15.000 So our volumes are growing. But we're not growing with the number of people to meet the demand. So that creates a situation where we have to balance trade off. 00:27:15.000 --> 00:27:17.000 And analyzing, you know. 00:27:17.000 --> 00:27:23.000 Our service and our staffing design. And again this words coming into the picture which is. 00:27:23.000 --> 00:27:26.000 Do we do? We pivot and become a hybrid model with telehealth. 00:27:26.000 --> 00:27:30.000 Do we start becoming more restrictive about the patients that we do see. 00:27:30.000 --> 00:27:35.000 Are we hanging on to patients too long? Once the consults completed, should we be. 00:27:35.000 --> 00:27:39.000 Be signing off things like that like these are all. 00:27:39.000 --> 00:27:47.000 So all things we're struggling with. And so every growth strategy, every single one of these top, 3 bullets and other ways to think about. 00:27:47.000 --> 00:27:50.000 Our options for high volumes. 00:27:50.000 --> 00:27:54.000 Come with trade offs, and really. 00:27:54.000 --> 00:28:02.000 As much as that's not comfortable, and we like to be everything to everyone. The trade offs are important and becoming. 00:28:02.000 --> 00:28:05.000 A really sort of in tune with. 00:28:05.000 --> 00:28:10.000 What is going to help us sustain the program. Long term super important because. 00:28:10.000 --> 00:28:14.000 If the programs fold because we're UN, we're unwilling to. 00:28:14.000 --> 00:28:32.000 To increase revenue through trade offs, or make the case to leadership and trade one thing off for another. If we don't do that, the program doesn't survive. And if the programs don't survive, then the patients and the caregivers ultimately suffer. And that's that's an endpoint. None of us want to get at. So this becomes a really pivotal time for us. 00:28:32.000 --> 00:28:35.000 When we start thinking about strategies to to deal with. 00:28:35.000 --> 00:28:37.000 Our success. 00:28:37.000 --> 00:28:50.000 I want to jump in and add a little bit here, too, because this is the slide is really where the rubber meets the road. It seems kind of tongue in cheek to have a 1st bullet, says increase revenue like a great idea. 00:28:50.000 --> 00:28:53.000 But you know I. 00:28:53.000 --> 00:28:56.000 For example, in the last couple of years there are. 00:28:56.000 --> 00:29:09.000 Number of new billing opportunities that apply to work that most palliative care teams are doing. And it's Andy himself who builds the the tools and the technical assistance on our website that would help you think about. 00:29:09.000 --> 00:29:14.000 You know whether those new codes are applicable for what your program is doing, and how to build them. 00:29:14.000 --> 00:29:20.000 What kind of documentation you need. This is really worth leading into and spending time on. 00:29:20.000 --> 00:29:29.000 Because it can make the difference between 50 of your program costs with billing and covering 70 of your program costs with billing. 00:29:29.000 --> 00:29:32.000 It can make the difference between your leadership. 00:29:32.000 --> 00:29:35.000 Seen. You know that that. 00:29:35.000 --> 00:29:38.000 That you have been. 00:29:38.000 --> 00:30:01.000 A careful steward of those resources, and that even increase the percentage of your budget by billing. So this is, you know, these are opportunities that that we need to take advantage of. We're talking about the new case to leadership. I saw Maria's comment in the chat, and it's a valid one, which is, it seems, like, maybe, based on these results from the survey. Things are getting the same or worse in terms of perceptions and palliative care. 00:30:01.000 --> 00:30:07.000 And I want to pick up something that we saw in the pulse responses that speaks to this. 00:30:07.000 --> 00:30:12.000 We asked during the pandemic, and then we asked again in the Poll Survey. 00:30:12.000 --> 00:30:17.000 About perceptions of palliative care by leadership. So that's the perceived value. 00:30:17.000 --> 00:30:24.000 Of the palliative care team or the palliative care service, and that has gone up, and that really went up during the pandemic. 00:30:24.000 --> 00:30:30.000 Perceived value of palliative care among leadership, and among referring. 00:30:30.000 --> 00:30:33.000 What hasn't been happened is. 00:30:33.000 --> 00:30:35.000 The resources that go with that. 00:30:35.000 --> 00:30:47.000 You can say that part of that is what we need to do as leaders of palliative care programs is continue to make a sophisticated case about the value of palliative care, and that is part of it. 00:30:47.000 --> 00:30:49.000 There's also the context that. 00:30:49.000 --> 00:30:56.000 That we're in right now and broader Us. Healthcare, which is that it's been a rough couple of financial years out there. 00:30:56.000 --> 00:30:59.000 Coming out of the pandemic when emergency funds went away. 00:30:59.000 --> 00:31:05.000 Now, it's very likely that next year looks better across the board. 00:31:05.000 --> 00:31:08.000 But we have suffered in that context the way that everybody else has. 00:31:08.000 --> 00:31:12.000 So we can, I think, be optimistic. 00:31:12.000 --> 00:31:17.000 That that environment is gonna feel a little bit less frozen next year. 00:31:17.000 --> 00:31:19.000 But we are talking about. 00:31:19.000 --> 00:31:29.000 And having real conversation with leadership about. If if you value the work of the palliative care team for different patient populations or different services across our organization or system. 00:31:29.000 --> 00:31:37.000 Which ones are you willing to do without? Because we can't be everywhere at once with the team that we have and the resources that we have. 00:31:37.000 --> 00:31:45.000 And then to service and and staffing. Trade offs like Andy said, these are. These are tough to think about, but we all know that this is part of growing pains. 00:31:45.000 --> 00:31:50.000 That thinking about again? Back to. 00:31:50.000 --> 00:32:00.000 Where is the need, the most acute? Where can you continue to demonstrate the value of the palliative care program such that you can make incremental growth such that you can make. 00:32:00.000 --> 00:32:04.000 Really optimize the use of the the team that you have, and the time that you have. 00:32:04.000 --> 00:32:08.000 These are. These are the trade offs, and these are the name of the game. 00:32:08.000 --> 00:32:10.000 So we wanted to present these as kind of. 00:32:10.000 --> 00:32:17.000 3 strategies, but then encourage everybody to to check out the resources in our toolkits. 00:32:17.000 --> 00:32:23.000 Or how to kind of think through the the details of these elements. 00:32:23.000 --> 00:32:24.000 Go ahead. Chelsea. Okay. 00:32:24.000 --> 00:32:26.000 If it's a if it's okay with with. 00:32:26.000 --> 00:32:35.000 You, Rachel and Brent. I wanted to address maybe a couple of things that came up in the chat Heather had written in 00:32:35.000 --> 00:32:42.000 She wanted to know how high volume is defined, and you know I'll I'll give my answer, and I'll I'll you know. Let Brendan Rachel. 00:32:42.000 --> 00:32:47.000 Weigh in as well. But to me high volume depends a little bit about your program. 00:32:47.000 --> 00:32:56.000 The the, the dynamics of the work environment. You work in the size, the number of people you have. But, very generically speaking, it's. 00:32:56.000 --> 00:33:19.000 When your console exceed what your staff's ability is to see them. And so for a community hospice that has one palliative care team with a nurse and maybe a social worker and a doc that helps on on some of the cases, you know, that could be a lot lower number than in a big academic medical center. So I I there's not a a absolute number in my mind, but it's just kind of a. 00:33:19.000 --> 00:33:21.000 You feel it when it's happening. 00:33:21.000 --> 00:33:23.000 I don't know, Brynner, Rachel, if you have. 00:33:23.000 --> 00:33:30.000 Well, and we did in the polls specifically, are your volumes higher than last year? Cause what we are interested in is trajectory. 00:33:30.000 --> 00:33:34.000 You know, has console volume. Stay flat, gone up or going down. 00:33:34.000 --> 00:33:39.000 And you know the summary statement is console team size. 00:33:39.000 --> 00:33:47.000 Averaged out to about flat. So Rachel made the comment that that teams are trying to do more with lesson. But that's a really hard situation to be in. 00:33:47.000 --> 00:33:49.000 That again requires thinking about. 00:33:49.000 --> 00:33:53.000 You know. What are those trade offs to make that feasible. 00:33:53.000 --> 00:33:56.000 And to help demonstrate. 00:33:56.000 --> 00:34:00.000 That that with more program resources, you could demand. 00:34:00.000 --> 00:34:01.000 Yeah. 00:34:01.000 --> 00:34:02.000 Yeah, for for us. It was. 00:34:02.000 --> 00:34:05.000 It was exactly that hard to. 00:34:05.000 --> 00:34:13.000 Quantify high volume for people, because everyone is so different, and they have different circumstances and different staffing and different. 00:34:13.000 --> 00:34:19.000 Triggers, and it's just there's so many different variables that go into that. So that was why we went with. 00:34:19.000 --> 00:34:30.000 Can you compare yourself to your own program a year ago, and see if you feel like it went up, or when it went down, because that was something we felt people were, would be more able to answer. 00:34:30.000 --> 00:34:42.000 Yeah. Then there was a there's a couple comments that I think are thematically. One was, you know, what happened to cost avoidance. Why are we talking about billing so much? And then a follow up comment was. 00:34:42.000 --> 00:34:46.000 You know so much of the work we do. 00:34:46.000 --> 00:34:50.000 Sort of falls outside. What's billable educating our colleagues? Things like that. 00:34:50.000 --> 00:34:57.000 And maybe a plea to us to, you know, double down on doing some work around those things. 00:34:57.000 --> 00:35:07.000 And I can say without our whole 2025 lineup of what's you know? What's coming from Capc? A lot of that's gonna be in there. We have. 00:35:07.000 --> 00:35:09.000 That some of our, you know. 00:35:09.000 --> 00:35:27.000 Core, palliative care, one cap. See classic type teachings around cost avoidance and around making the case in and articulating your value. That goes beyond your your billing revenue is important, and and some of that has feels a little bit. 00:35:27.000 --> 00:35:41.000 Dated to me now, given all the financial changes in healthcare. And so we we will be doing more of that program. So I wanna reassure people that's coming. But I wanna also get Brendan Rachel a chance to maybe comment on that as well. 00:35:41.000 --> 00:35:54.000 Well, actually, I was gonna toss it back to you, Andy, because I've seen several comments on. 00:35:54.000 --> 00:35:55.000 Yeah, I think. 00:35:55.000 --> 00:35:58.000 The limitations of billing. And I think if you could just briefly touch on opportunities for incident to billing for some of the new codes. That helps cover an interdisciplinary team. 00:35:58.000 --> 00:36:04.000 Yeah. And and I I didn't want, you know, billing. Sometimes I think overwhelms. 00:36:04.000 --> 00:36:10.000 Programming when you start talking about it. I wanted to avoid that. But one of the things that I think is important to. 00:36:10.000 --> 00:36:13.000 Observe is that Cms. 00:36:13.000 --> 00:36:16.000 Since 2,016 ish. 00:36:16.000 --> 00:36:18.000 With the advent of like some of the. 00:36:18.000 --> 00:36:25.000 Chronic care management codes and the advanced care planning codes. I think we're in 17. 00:36:25.000 --> 00:36:29.000 There's there's been a real sign posting from. 00:36:29.000 --> 00:36:34.000 Cms. That we do. I apologize. My dogs get ex when I talk about good. 00:36:34.000 --> 00:36:40.000 You know, there's been some interesting that they recognize that these things are important. 00:36:40.000 --> 00:36:42.000 In that. 00:36:42.000 --> 00:36:49.000 The work that we do that goes beyond what's really available is important for 00:36:49.000 --> 00:37:05.000 For for patients and caregivers. And so, you know, they've created opportunities for community principal illness, navigation, caregiver training. There's been a lot of opportunity for us to collect revenue outside the traditional billing. 00:37:05.000 --> 00:37:29.000 You know, billing provider with an Api number. So nurses counselors can do, you know, counseling. Now, there's other folks that can actually apply for and get Npi. Numbers. But what Bill was, what Brim was alluding to with billing for incident 2. Is that the people on your team could be seeing patients and doing some of the work that we've always been doing, and that that time can roll up under a billing. 00:37:29.000 --> 00:37:40.000 Npi number and be accounted for. So you know, the reason. I think billing becomes so front and center is because of what Cms. Has done in the last decade which has. 00:37:40.000 --> 00:37:44.000 I think, a validated and recognize the the. 00:37:44.000 --> 00:37:53.000 The real in here intrinsic value of the kind of work that we do, and 2, even though it's not creating huge pots of money for us. 00:37:53.000 --> 00:38:03.000 It's something. At least, we're being recognized a little bit for the work we do. And and the other reality is like a lot of programs are under our view. 00:38:03.000 --> 00:38:18.000 You know our view benchmarking, and so, you know, we can't ignore billing, even though we are still the square peg trying to fit into a round hole when it comes to generating revenue through billing. 00:38:18.000 --> 00:38:19.000 Right. 00:38:19.000 --> 00:38:22.000 Yeah. The last great comment in the chat that I just wanted to respond to was Sarah's. 00:38:22.000 --> 00:38:26.000 Says the large Safety Net Hospital. 00:38:26.000 --> 00:38:33.000 Found that it's not able to demonstrate, and like stay or mortality or readmission numbers for the hospital. 00:38:33.000 --> 00:38:38.000 And so it's having to look at other ways to demonstrate value for the program. 00:38:38.000 --> 00:38:40.000 And you know this is the chicken and egg of. 00:38:40.000 --> 00:38:43.000 If your team is. 00:38:43.000 --> 00:38:47.000 Is oversized that it's difficult to achieve. 00:38:47.000 --> 00:38:51.000 Moving the needle on organizational measures like that. 00:38:51.000 --> 00:38:55.000 But you're being asked to do more, to really get specific about. 00:38:55.000 --> 00:39:01.000 Tests of change. You know, if you're being asked to see a different group of patients. Okay, what are the measures that you. 00:39:01.000 --> 00:39:05.000 In leadership, want to see and to. 00:39:05.000 --> 00:39:14.000 Treat those things as pilots, and to be looking at those patients rather than overall hospital numbers. Because if you are a small program, it is going to be difficult. 00:39:14.000 --> 00:39:17.000 To realize those top live changes. 00:39:17.000 --> 00:39:30.000 Yeah. And another thing that's happened in the last decade, too, that has made cost avoidance. A more difficult argument to make for palliative care is that hospitals have developed a lot of other programs that are sort of targeting the same sort of. 00:39:30.000 --> 00:39:33.000 Pain that we're feeling around. 00:39:33.000 --> 00:39:36.000 You know, meeting people's needs and having them not be. 00:39:36.000 --> 00:39:40.000 Bouncing back because of failed discharges and things like that like. 00:39:40.000 --> 00:39:46.000 Remote, patient monitoring like, how do we take credit if we did a palliative care console. 00:39:46.000 --> 00:40:10.000 How do we look at that and say, Okay, we avoided another admission when maybe that patient went on remote monitoring, too. So it's hard for us with all these other initiatives going on to really take exclusive credit for the things that do avoid additional costs. And so, you know, it's always. The story is always told in chapters, and some of those chapters are with our billing revenue. Some are with are making the case about our. 00:40:10.000 --> 00:40:13.000 Our our value to patients and families. 00:40:13.000 --> 00:40:25.000 Our relationships with our colleagues, how we, how we work pillars during Covid for our for our colleagues and other fields. So all of that is part of that story, so I always think about it as. 00:40:25.000 --> 00:40:29.000 You know, it's the the books, not about one thing. It's about everything that we do. 00:40:29.000 --> 00:40:34.000 We could go on to the next slide. 00:40:34.000 --> 00:40:42.000 So what are what are we doing at the at a national level to support this? So. 00:40:42.000 --> 00:40:44.000 You know. 00:40:44.000 --> 00:40:53.000 We work with people to make the case, and part of that case was cost avoidance. We we are now talking about sustainability and growth strategies. 00:40:53.000 --> 00:41:02.000 Optimizing the new billing strategies, still making the case for for the value we bring beyond it, all of those things are still part of what we're doing. But as we think about the future. 00:41:02.000 --> 00:41:05.000 You know, we need to think about. 00:41:05.000 --> 00:41:07.000 You know, policy and payment, advocacy. 00:41:07.000 --> 00:41:10.000 How do we provide. 00:41:10.000 --> 00:41:25.000 High quality care what is high quality care? When I look at that arrow, and I see the future sustainability, accountability. To me. Those are the fabric of what quality care looks like. And so we need to be. 00:41:25.000 --> 00:41:28.000 Really thinking about. 00:41:28.000 --> 00:41:44.000 Developing our workforce to be able to be sustainable, be consistent, and have accountability to our patients and families, and be accountable for our resources as well. So, Britt, I'm I'm guessing you probably have a lot to say on this slide as well. But I think we need to think about. 00:41:44.000 --> 00:41:56.000 Our constituents? Who's who's paying our salaries, who's referring us patients, and, most importantly, those patients and caregivers that count on us. And we need to make the case to all those audiences. 00:41:56.000 --> 00:42:01.000 Yeah, I just add that the national organizations in the field so. 00:42:01.000 --> 00:42:04.000 8 pm. HP. 00:42:04.000 --> 00:42:09.000 Swiping chat. The chaplaincy organizations. Nhpco. 00:42:09.000 --> 00:42:14.000 You know, one. All of those organizations are part of the National office and palliative care. 00:42:14.000 --> 00:42:19.000 A coalition, and what the Coalition does is think about. 00:42:19.000 --> 00:42:21.000 What is the advocacy? 00:42:21.000 --> 00:42:32.000 Again to to create incremental change on these issues, particularly payment for services and accountability requirements for access to palliative care. 00:42:32.000 --> 00:42:36.000 If palliative care requirement under. 00:42:36.000 --> 00:42:43.000 A particular Medicare program inside of a Cmi demonstration for hospital accreditation. 00:42:43.000 --> 00:42:49.000 That's where the resources have to follow. Because organizations are on the hook for that access. 00:42:49.000 --> 00:42:52.000 When we think about making the case. 00:42:52.000 --> 00:43:02.000 You know, the national organizations, and you all as as champions in the field, have been making the case for a long time, but like we've been commenting, the cases change. 00:43:02.000 --> 00:43:12.000 So not do we have palliative care. But what is adequate access for palliative care? What are adequate resources to ensure that that care is high quality. 00:43:12.000 --> 00:43:16.000 So the the case that the national organizations have been making has changed too. 00:43:16.000 --> 00:43:23.000 We saw, you know, that a large number of program leaders responding to Paul said. 00:43:23.000 --> 00:43:31.000 We have open headcount. We have actually gotten budget approved to add staff to our program, and we cannot find people who are specialty, trained, palliative care. 00:43:31.000 --> 00:43:36.000 The Workspace strategy is tough one. It's a symptom of how quickly we've grown. 00:43:36.000 --> 00:43:39.000 That our, you know, workforce development. 00:43:39.000 --> 00:43:46.000 Is is just barely, or perhaps not quite, keeping up with growth. 00:43:46.000 --> 00:43:48.000 So it. 00:43:48.000 --> 00:43:51.000 There are actions that individuals. 00:43:51.000 --> 00:44:02.000 In palliative care programs and in your organization can take to think about recruiting more folks to the workforce. But this is where I think the work of the collaboration of National Associations is really going to come into play. 00:44:02.000 --> 00:44:04.000 On the policy advocacy front. 00:44:04.000 --> 00:44:09.000 To establish resources to fund the workforce pipeline. 00:44:09.000 --> 00:44:14.000 On the on the recruitment and collaboration front. 00:44:14.000 --> 00:44:17.000 One great example of this is a. 00:44:17.000 --> 00:44:19.000 program. 00:44:19.000 --> 00:44:29.000 That is a mid-career competency based fellowship for palliative medicine, who are coming from other specialties, want to enter the field. 00:44:29.000 --> 00:44:45.000 And this is a waiver program through abim to make that more possible for folks in the middle of their career. But that's that's the kind of support infrastructure building the case, creating possibilities that the national organizations are focused on so that the challenges that you've been reporting. 00:44:45.000 --> 00:44:49.000 That we could start to address them. 00:44:49.000 --> 00:44:57.000 Next slide, please. Chelsea. 00:44:57.000 --> 00:44:59.000 So I I guess. 00:44:59.000 --> 00:45:07.000 Where we got to is, what are we gonna do with this? And you know Cap C. Has always been. I've I've been here almost 11 years now, and and. 00:45:07.000 --> 00:45:10.000 It. It's we've always been super responsive to. 00:45:10.000 --> 00:45:18.000 Feedback from the field. This just gave us a huge bolus of feedback, and that, you know, as someone who works in in. 00:45:18.000 --> 00:45:20.000 Our program development. 00:45:20.000 --> 00:45:23.000 Area like this is exciting because. 00:45:23.000 --> 00:45:35.000 The the responses. From this the feedback that we got is helping us design our seminar, which we just recently announced. That's returning in Philadelphia, in September of 2025. 00:45:35.000 --> 00:45:38.000 Our plan for 2025 webinars. 00:45:38.000 --> 00:45:41.000 Into professional grand rounds and blogs. 00:45:41.000 --> 00:45:45.000 In one of Rachel's earlier slide, she said, hospices. 00:45:45.000 --> 00:45:47.000 We're you know, struggling with. 00:45:47.000 --> 00:46:07.000 How to build propellant care services outside of Hospice. We're doing a interprofessional grand rounds on that in February. You know all of these things that you you saw in those early slides, about what what was on people's minds and what they were hoping we would do. You're going to see you know, placed throughout all of our content in 2025 00:46:07.000 --> 00:46:11.000 It informs our partnership work. You know we have. 00:46:11.000 --> 00:46:23.000 Really exciting partnerships with other national organizations from outside of palliative care, who are trying, who are struggling with the same thing, how to make the care better for people that are struggling with serious illness. 00:46:23.000 --> 00:46:26.000 And so 00:46:26.000 --> 00:46:35.000 You know, it's helping us identify health equity innovators to get the word out to show people what programs are capable of doing to reach. 00:46:35.000 --> 00:46:40.000 You know they're they're more vulnerable populations, more underserved populations. 00:46:40.000 --> 00:46:50.000 We're gonna use the pulse responses to try to support leaders. You know. What what were leaders saying were was they were struggling with, you know, worried about their teams, worried about team health. 00:46:50.000 --> 00:46:53.000 You know, build programming around that. And just really. 00:46:53.000 --> 00:46:55.000 In general. 00:46:55.000 --> 00:46:57.000 Trying to work with. 00:46:57.000 --> 00:47:03.000 Our members and just people doing palliative care in general about building tools. 00:47:03.000 --> 00:47:11.000 And convening the field together in a way that helps build camaraderie peer support, and and gives you sort of. 00:47:11.000 --> 00:47:23.000 So the emotional support and hopefully, some of the technical and tool support that you need to be able to meet the demands as they, as they evolve over time. 00:47:23.000 --> 00:47:28.000 We can go to the next slide. Chelsea. 00:47:28.000 --> 00:47:30.000 So, taking a step back. 00:47:30.000 --> 00:47:35.000 You know, I think we've seen that the challenges are real. 00:47:35.000 --> 00:47:38.000 Not. All of them are specific to palliative care. 00:47:38.000 --> 00:47:44.000 We have been in a challenging time for the last several years, and yet. 00:47:44.000 --> 00:47:48.000 And yeah, some of those challenges are a symptom of growth in the field. 00:47:48.000 --> 00:47:55.000 Of a deeper understanding of what we do, why we do it, how it benefits patients. Now the question is, how do we get more. 00:47:55.000 --> 00:47:57.000 Not? Can we have it at all? 00:47:57.000 --> 00:48:05.000 And I think what that says to us is we are not at base camp anymore. We are at a different stage of development in our field, and there has been. 00:48:05.000 --> 00:48:10.000 So much passion. So much for the strategy on the part of. 00:48:10.000 --> 00:48:14.000 Highly care champions all over the country that have brought us to this point. 00:48:14.000 --> 00:48:21.000 And now it's a different kind of leadership skill that we need. It is different challenges that we are facing. 00:48:21.000 --> 00:48:25.000 These are the challenges of A, of a further developed field. 00:48:25.000 --> 00:48:34.000 That is being pulled in a lot of directions. So the question that you know for all of us now is, how do we figure out how to apply scarce resources. 00:48:34.000 --> 00:48:39.000 In the highest possible impact way for our patients. 00:48:39.000 --> 00:48:43.000 Next slide, please. Chelsea. 00:48:43.000 --> 00:48:46.000 And this isn't easy. And we know that I know. 00:48:46.000 --> 00:48:54.000 Pepsi, we were able to address about 10% of the really exciting deals that we want to tackle as an organization. 00:48:54.000 --> 00:49:00.000 Cause. There's a lot of work to do, and we're not able to to tackle all of it when and how we want to. 00:49:00.000 --> 00:49:08.000 But as I think about, how do we make those strategic decisions as palliative care professionals and palliative care leaders, I think there are 3 values. 00:49:08.000 --> 00:49:11.000 That will help guide us. 00:49:11.000 --> 00:49:14.000 One is the idea of life leadership, development. 00:49:14.000 --> 00:49:23.000 That if the environment around us is changing, if the challenges that our program is struggling with and our teams are struggling with are changing. 00:49:23.000 --> 00:49:30.000 If there is really exciting innovation happening in the field and new opportunities in the field. 00:49:30.000 --> 00:49:34.000 That really requires a commitment to life, leadership, development. 00:49:34.000 --> 00:49:39.000 So that we can be the champions on behalf of our patients. 00:49:39.000 --> 00:49:41.000 That we can possibly be. 00:49:41.000 --> 00:49:43.000 And number 2. 00:49:43.000 --> 00:49:55.000 Is maintaining and and defending value of equitable care for people with serious illness. There are inequities all across us, healthcare. 00:49:55.000 --> 00:49:59.000 I think I hope, that we are familiar with them. 00:49:59.000 --> 00:50:04.000 Our patients are very vulnerable. Our patients are facing a serious illness. 00:50:04.000 --> 00:50:10.000 And those inequities can lead to so much avoidable. 00:50:10.000 --> 00:50:23.000 For our patient population. And I really think that we can be leaders in this space. I see it in the polls. I see it in the examples of health, equity interventions that that palliative care leaders are sharing with us all year long. 00:50:23.000 --> 00:50:38.000 And so making sure that as we navigate these growth decisions as we navigate, sustainability challenges, that we are holding the value of equity as a central part of that that process. So that we make sure that. 00:50:38.000 --> 00:50:47.000 Access to our services is equitable, and that we're fighting for equitable care for our patient population across our organizations, in our communities. 00:50:47.000 --> 00:50:51.000 And then, finally, is the commitment to quality. 00:50:51.000 --> 00:50:54.000 We are in a low resource environment. 00:50:54.000 --> 00:50:56.000 And the temptation. If if. 00:50:56.000 --> 00:51:03.000 In inside of that kind of environment is to figure out, how do we spread ourselves? And that can mean a risk to quality. 00:51:03.000 --> 00:51:05.000 And I. We know. 00:51:05.000 --> 00:51:15.000 That a high quality, professional palliative care service is where patients find benefit. You really realize 00:51:15.000 --> 00:51:20.000 The value of palliative care, and where our organizations realize the value of palliative care. 00:51:20.000 --> 00:51:27.000 So, although we need to understand and be working through trade offs about when and how we apply our resources. 00:51:27.000 --> 00:51:30.000 The commitment needs to always be to quality palliative care. 00:51:30.000 --> 00:51:33.000 And that is the sustainable way. 00:51:33.000 --> 00:51:38.000 To to continue to make the case for more resources, to continue to. 00:51:38.000 --> 00:51:49.000 to ensure that the the value of the palliative care services in our communities among our patients in our organizations is high and gets higher. 00:51:49.000 --> 00:51:53.000 So with that, you know we're done 00:51:53.000 --> 00:52:02.000 Sharing the the results from the polls. And I wanna welcome any questions for the 3 of us. I really appreciate that. Everybody's been responding into the chat. 00:52:02.000 --> 00:52:10.000 But curious what your reactions are to the data that that everyone in the field. 00:52:10.000 --> 00:52:15.000 Oh, Rachel, do you wanna dive in with the question about PC. 00:52:15.000 --> 00:52:18.000 I can. So a question came in. 00:52:18.000 --> 00:52:27.000 Curious what your thoughts are on PC. As the only national pad of care registry, and how caps he is working with them. So. 00:52:27.000 --> 00:52:29.000 We are 00:52:29.000 --> 00:52:38.000 PC. Qc. Came together as 3 registries, merging as one of which was ours. The national palliative care. 00:52:38.000 --> 00:52:42.000 So we helped create the program level surveys. 00:52:42.000 --> 00:52:53.000 For that registry, and they continue to use them. We work together to put out reports. In the chat. You'll find alison. 00:52:53.000 --> 00:52:55.000 Our chief. 00:52:55.000 --> 00:53:13.000 Health care transformation officer put in a link to a report we did with PC. Last year on home based palliative care. And we're hoping to do another report with them. Coming up in the future. So yes, we do work with them. We enjoy working with them because that. 00:53:13.000 --> 00:53:20.000 That information is very integral to what we do, and to give us an idea of. 00:53:20.000 --> 00:53:23.000 What the current state of palliative care looks like. 00:53:23.000 --> 00:53:29.000 So yes, we absolutely work with them. 00:53:29.000 --> 00:53:35.000 Seeing John's comments in the chat, we are thrilled that seminar is coming back next year. 00:53:35.000 --> 00:53:43.000 The announcement went out last week. We hope that everybody will join us in Philadelphia next year. 00:53:43.000 --> 00:53:49.000 And I think I also do just wanna reiterate something way at the beginning that this is. 00:53:49.000 --> 00:54:10.000 Our 1st annual palliative. So this is really something that we're hoping to continue to do over the years. I liked to look at the 1st year almost as a pilot to see if people would actually participate with us. And, boy, did you participate? So thank you again. And we wanna take that opportunity to both. 00:54:10.000 --> 00:54:15.000 Look at some data over time as we get more and more participation, but also. 00:54:15.000 --> 00:54:25.000 Edit and hone those questions to make sure we're asking the right questions and getting as much information from you all as possible. 00:54:25.000 --> 00:54:28.000 One more point about the theme of 00:54:28.000 --> 00:54:31.000 Trying to deliver quality care in the. 00:54:31.000 --> 00:54:34.000 In the context of of scarce resources. 00:54:34.000 --> 00:54:38.000 So one of the areas that we're we're looking at this year is. 00:54:38.000 --> 00:54:43.000 The programs and who are figuring out how to bridge access to palliative care in rural areas. 00:54:43.000 --> 00:54:49.000 Whether it's telehealth, whether it's through clinical education, whether it's through partnership. 00:54:49.000 --> 00:54:51.000 If this is something you're doing. 00:54:51.000 --> 00:55:02.000 And you have important lessons to share with the rest of the field about how you're pulling it off and really love to hear so please drop us a note on the capsule website. 00:55:02.000 --> 00:55:19.000 Because that you know, it's a it's a challenging environment. And and we want to figure out how to help bridge access. 00:55:19.000 --> 00:55:20.000 Hey? I'm you! 00:55:20.000 --> 00:55:28.000 Yeah, there's a bunch of comments about thanking this, thanking us for doing this and supporting the field by getting this feedback. And I think. 00:55:28.000 --> 00:55:32.000 I just hope that everybody on. 00:55:32.000 --> 00:55:35.000 Zoom spreads the word. So next year we have. 00:55:35.000 --> 00:55:39.000 More than 700 and. 00:55:39.000 --> 00:55:40.000 You know I forget the exact number, but. 00:55:40.000 --> 00:55:41.000 59. 00:55:41.000 --> 00:55:47.000 And we get even more responses, because the more feedback the better. You know. It's it's kind of. 00:55:47.000 --> 00:55:57.000 It's such a mix in the chat box with, you know, sort of feel good supportive comments. And then people that are really seeing a lot of. 00:55:57.000 --> 00:56:00.000 You know, destruction of their program, or. 00:56:00.000 --> 00:56:06.000 You know, stress on their program from the realities of the finances and healthcare. And so. 00:56:06.000 --> 00:56:12.000 You know, we we really need your feedback so that we can do the programming and. 00:56:12.000 --> 00:56:26.000 You know, make things a priority that are a priority to you. So that that's my last hope is that everybody moves forward and looks forward to next year's pulse. So we get even more data that we can that we can use. 00:56:26.000 --> 00:56:30.000 Yeah, and I'll close out, I guess, with the theme of collaboration. 00:56:30.000 --> 00:56:32.000 The. 00:56:32.000 --> 00:56:40.000 The other organizations in the field. The professional associations for different disciplines helped us get the word out about the survey. 00:56:40.000 --> 00:56:46.000 We are sharing the responses from the survey back with them, because we know. 00:56:46.000 --> 00:56:58.000 We are also resource, limited environment. And we want to make sure that we're working collaboratively according to our strengths, according to our reach. According to our expertise, so that together 00:56:58.000 --> 00:57:02.000 We are working to address the challenges that programs are facing. 00:57:02.000 --> 00:57:08.000 And together we can develop the resources that are needed, develop the advocacy agenda that is needed. 00:57:08.000 --> 00:57:11.000 So. 00:57:11.000 --> 00:57:19.000 You know, I think that's that's another way that that your voice in the form of a pulse response goes on to impact. 00:57:19.000 --> 00:57:25.000 Really the the national agenda fighting to to remove some of these barriers for programs. 00:57:25.000 --> 00:57:35.000 So just a less thank you to everybody who shared what was on your mind. 00:57:35.000 --> 00:57:39.000 Thanks, everyone. I hope you have a great rest of your day, is glad you could join us. 00:57:39.000 --> 00:57:42.000 And stay tuned. 00:57:42.000 --> 00:57:47.000 Yes, thank you, everyone, and we'd love to hear your feedback in the survey. If you have any. 00:57:47.000 --> 00:57:55.000 Comments or suggestions for future topics coming in 2025 other than that. Take care, everyone, and and thank you all so much.