This transcript has been auto-generated and may contain technological errors.
00;00;05;00 - 00;00;33;29
Meg Pekarske
Hello and welcome to Hospice Insights, The Law and Beyond, where we connect you to what matters in the ever changing world of hospice and palliative care. A Fond Farewell: Musings on the End of the Medicare Advantage Hospice Carve-In Demonstration. Chris Comeaux, I'm so happy you're here. You were the first person I wanted to call when this happened. I said, I want to talk about this with Chris. And you said, okay, I'm game. So thank you for being here.
00;00;34;09 - 00;00;36;22
Chris Comeaux
Anytime I get a chance to talk to you, Meg is a blessing.
00;00;37;19 - 00;01;01;07
Meg Pekarske
I don't know about you, but, you know, at least when we're recording this in time, it's about a week since the news is out, and I'm still, like, flabbergasted a bit. I mean, both like, this is I feel like the right resolved, but I'm still sort of surprised because it seems very abrupt. But I guess where you blown away or what was your reaction?
00;01;01;14 - 00;01;34;23
Chris Comeaux
Yeah, I think definitely the timing being blown away. And then I've talked to so many people afterwards, so it makes sense now. But I think I've not talked to one person like, yes, totally expected the abruptness. I haven't met one person. So I think the announcement when it occurred back, they even went back last week to try to go to the State of the Union cause. So we're kind of trying to understand why that Monday you did have the State of the Union later. But there's nothing that makes sense about the timing of it. But certainly now look in the rearview mirror why they're sunsetting it. I've got some stuff I'll be able to share with you.
00;01;34;24 - 00;01;50;25
Meg Pekarske
Yeah, well, well, let's jump in, because minds may be more conspiracy thinking, but you seem like you have hard facts. So let's start with what you think. Why? Why did they. They end this as it is right now.
00;01;50;29 - 00;02;51;21
Chris Comeaux
What are. Yeah. So I think what it comes down to is so the whole demonstration right. Is you got enough people to run the experiment with enough data. We know that, you know the, the major payers and you could probably guess who are amongst those top three and four. Their number one payer was in, you know, how they have to put in their bids. So there's no there's out of those top two, there's a major one that did partake for 2025 and that's the main reason why they're not kind of going forward. The demonstration, they just didn't have enough emails to actually take part going forward. Now, what does that mean as I'm sure where you and I are going to go forward, Does that mean they've got enough data and they're just going to carve us in? And I find they're kind of three schools of thought of what it means. But I think that, yeah, number one, the abruptness didn't make sense to anyone. But now that you can understand this, that they just don't have enough people. They're going to be participating in 2025 to make it worth the while to keep running the demonstration program, which makes sense if you think about it.
00;02;52;03 - 00;05;21;14
Meg Pekarske
Yeah. Well, so one of my concerns because everything you said makes total sense to me and then like, is this dad, Dad or is this just like the pause? And then we get carved in I mean, I think right now Medicare Advantage in general is under a lot of scrutiny. I mean, just in terms of from a fraud and abuse perspective. And if we think we hospices have it bad in terms of auditing, the Department of Justice has focused a lot on Medicare Advantage plans. And, you know, because of how they're paid and, you know, their rate setting and all that stuff and is there is some gamesmanship about that. And I think that right when you think about Medicare Advantage in general, it was supposed to save the government money. And that's sort of when I thought that this was the foregone conclusion, was like, of course we're going to end up being carved in because you may pay these Medicare Advantage plans. It's capitated. You know, right now, fee for service. It could go on forever, you know, super more expensive, more expensive. And now when you look at the data, the cost that the government is paying for Medicare Advantage is now I think I read somewhere more than traditional Medicare. Yes. And so the idea and motivation behind like putting more services in to maybe a less cost effective program and that has some fraud abuse concerns, Is that sort of where we want to go? And again, that's like Meg's music. It's not anything. It just sort of from a legal perspective, there is just, I think, a lot of concerns with Medicare Advantage. But then you talk to my colleague Norine, and she came from the insurance world and she said it's so hard for Medicare Advantage plans to make money because there's a lot of regulation. And so it's not really attractive business model. So you have made plans that have paid at least one settlement last year, like $170 million back to the government. But then you also have people that are giving up their Medicare Advantage business because it's like this is not the profitable business for me. So there's something else maybe going on again. Maybe it's just my conspiracy theory or whatever, but I don't know if you have thoughts about that.
00;05;22;13 - 00;06;49;01
Chris Comeaux
Yeah, a couple of thoughts. You know, we do our Talks podcast with Mark Cohen every month, the market idea, the top news stories of the month mag and why I love doing that show is it kind of gives me a catbird seat of TRIA. And starting in the fall I have seen more negative press on the May plans and I have seen and I've talked to other consultants and they're like, Well, this is indicative of the eighties when HMO's started to be scrutinized. I was in high school that but yeah, my my career 30 year career this is the most scrutiny in yeah I think that there's a lot more scrutiny but also I'm not sure that we're going to see the trend reversed. Like, you know, if you look at Kaiser fact, there's many people just projecting 55, 60% of all Medicare will be at Medicare Advantage. We know the government has said by 2030 100% of Medicare, it needs to be in some type of value based arrangement, which would tell you you're going to see probably more AMA type plans in the future, or at least the bigger will probably continue to get bigger. But also to your point, it's not an easy business, but yet they do cost more than traditional Medicare. So there's lots of interesting like, well, how do you make sense of all this? I'm I'm not sure if that's exactly what kind of boat into as far as the hospice. CARVIN What I'm finding, Meg, is there kind of three themes of the kind of the way people are reacting. One theme is we dodged the bullet. We could go back to the way things were. Not so not so fast. Mr. or. Mrs...
00;06;49;01 - 00;06;49;28
Meg Pekarske
Yeah, yeah.
00;06;50;04 - 00;07;54;00
Chris Comeaux
That's the first with the other. Is that we still need to innovate that. Yes, in fact I would put a sub bullet on that one. We did this incredible study amongst our telehealth collaborative network and we came up with eight major challenges that we're facing into the future. It may Carvin was a sub bullet under one of those, so there is still eight major challenges that we're navigating. And M.A. Carve-In was only one sliver of a much bigger pie. And then the third kind of theme is, okay, they're sunsetting the demo, but are they brewing something else? Kind of like you're saying, your conspiracy theory. Are they do they have enough data that they're just going to carve this in or they got enough data and they're going to do something else related to? M-A That's the three kind of themes I'm seeing. I think probably there's a little bit of all three that we need to kind of unpack with each other. And probably the one that's the most dangerous is you dodged the bullet. It's all going to be okay. We don't need to change that. That is probably the riskiest kind of response from anyone.
00;07;54;07 - 00;10;39;25
Meg Pekarske
I agree, because there are many challenges our industry faces, regardless of whether or not we're we're carved in into Medicare Advantage. But I guess before we we move on to what's next and what should we be advocating for because, like, right, all of this should be that's where do we want things to go instead of being so reactionary to what the government is doing, what can we advance? But just before we leave, that one other thing were talking about Emma plans. And again, I feel like I read so much stuff. It's like hard to keep track of where you read stuff, but like the quality of people in Medicare Advantage plans, like the outcomes. I think it was for some particular diagnosis just weren't. Oh, I think it was about home health and like the outcomes of people on home health. It's not Medicare Advantage or something and otherwise because and I think when we look at this administration's focused on equity and I think a lot on quality and all those other things like those things do matter. And I think that was something that was just real frustrating when we were working with clients and negotiating their very bad contracts and this hopefulness around like, oh, this palliative care benefits in there and, you know, yeah, you're taking a haircut on rates, but you know you're going to meet it in volume and none of that stuff panned out. Like, I don't know, a single provider that we worked with had said they made it up in volume or that palliative care component was meaningful or that other, or there was like a respite thing too. And then there was like, you can build a ramp or there was like some other small benefit so underutilized, which I think was also very evident in the comments back recently that people had to know what's working, what's not, because I think there were some nuggets in there that were the possibility for excitement, right? Like increasing utilization, appropriate utilization, of course, but like increase in utilization, getting people on earlier so we can be most impactful and and thinking that if you're in a and a plan, maybe there would be more levers there to, you know, get people there and it just didn't pan out. But those we still need to make that happen, right? Like we should be increasing utilization in this country because I think while there are many flaws in the hospice benefit, it is, I think far and apart the best and most compassionate way we can care for people with advanced illness and those that are dying, which is an interdisciplinary model that I don't need to tell you. I mean, we're all.
00;10;39;27 - 00;12;41;25
Chris Comeaux
Industry data that shows it saves money. I mean, there's great data in our in our study, the neighbor study, Those are great studies that show that even with the long tail, which is not really indicative of the type of programs that I work with, you still save money that if you get a great you know, I'm a little partial community based mission minded nonprofit programs, you also, because they do a great job keeping them in the home place and you're not getting that rehospitalization. So there's good data. Say that you think about Meg, there's a Edward Deming quote that every system is perfectly designed to produce the results it produces. Insurance companies are designed to save money. Think about, you know, recently it was an article that United Health Care deploying an algorithm that literally denied care within seconds of the actual claim. So and I'm not dissing on all the insurance companies but the systems, all the processes, how that whole machine is built, end of life care is different. And so getting getting that referral, which is why I think the future is the innovative space, is that whole serious illness space, whether it's powered care or advanced illness management, there's going to be all sorts of different flavors. And I think this year, so in a space and that is where I think hospices need to go to go further upstream. So that way you can get that patient into hospice at the appropriate time. I do think in the future long let this stay for multiple reasons. If we get carved in some kind of way that optimal length of stay, there's enough data to show that 60 to 90 days, anything beyond that, there's many disincentives and how they look at total cost of care, etc.. So for writing a prescription of the future, it would seem to be how do you go upstream and get really good care models and partner with other people? And that's maybe where you tie into plans and then have a good continuum of care where you can transition to hospice at the right place. Right time is probably where we need to go. And if folks are thinking, well, dodged a bullet there, don't go there, I think that probably be foolhardy.
00;12;42;09 - 00;14;45;13
Meg Pekarske
Yeah, I completely agree because I think that one thing that over the last couple of years as we've been doing with the Carven was I think AMA plans and commercial payers in general are a lot more interested in having fairly open ended conversations about help me solve this problem of high cost patients, complex illness, you know, and if you're offering solutions that can manage care better and produce better outcomes, like I think there's conversation that's happening that ten years ago. Well, I mean, it always still feels like pushing up a boulder, but I think there is actually people are getting to the table and, you know, people getting, you know, per per patient per month, you know, amounts to managed care. And I still don't know that it's like the model that we want. But I think it's starting to get into what's the role of case management in keeping people out of the hospital? Because I feel sometimes we do more than sort of the simple things that actually make a meaningful difference, like someone calling you and asking you to take your medications, you know, because I think when we look at lower level professionals and the level and the important role that they can play, I mean, I think you talk to a lot of hospices and people value that CNS service tremendously. Right. So, you know, but maybe that's when we created the benefit, not what we thought was the most important thing to patients, but I guess when we create this, what should we be advocating for? I mean, it's been I feel like a number of years trying to, you know, talk about this community based palliative care benefit. And I guess what from a national perspective, do you think we should be advocating for?
00;14;45;13 - 00;15;11;18
Chris Comeaux
Yeah, we've actually been working amongst our group, and I love their framing of enhancing their benefit because if you look at the benefit, it is a brilliant model of care. You know, model of care that believes that people are body, mind, spirit, social, emotional component, and then building a team around that, making the care plan, the center of what's most important to that patient and family. So that team, all of that is brilliant. And so I think we should just.
00;15;11;27 - 00;15;37;11
Meg Pekarske
Like pause there and say that was radical. This was like late seventies. Like this is amazing. And like, I still look at it and it's like really revolutionary and you have to have volunteer your hours and you have to I mean, it's just so a shout out to the hospice benefit and that maybe today it never would have passed but like it did 40 years ago. So but yeah but back to the story.
00;15;37;14 - 00;17;44;20
Chris Comeaux
Yeah so, so all of that is great. So you don't want to mess with that. I think the challenge has been right. How do we get further upstream? So do you create a powdered care type benefit that is further upstream that might be able to utilize? And I do think that probably in the future, like a 60 to 90 day length of stay is probably ideal. But how do you get in that patient's disease, trajectory care trajectory where you are getting a maybe on winding some of those competencies, bringing them further upstream, whether that's called to care, home based primary care, serious illness, advanced illness. However, its package is further upstream. If you had some type of pmpm, maybe that patient during the stay could say, you know what, we want to go back to the trajectory of let's say, chemo and radiation. So you get maybe weave it in. It doesn't have to be kind of like hard stop and then all end and then you can't discharge the patient. I think that's a when we look at a lot of the gamesmanship, once you're in, you cannot discharge that patient, which is going to really force us to get really good at. When do you then get the right care at the right place at the right time. So that's the general flavor of what I think the broad aspects need to be. I think there are several different groups advocating for pieces of parts of that. As a person that you and I both know that actually I love the way he framed it. He actually calls it a hospice special needs plan as a framing. And I love that framing as a as a as an alternative to the Medicare Advantage. Carvin is really is how he was framing it. I love that actual framing because let's say something is still being brewed. That's a once you're if it was a hospital, a special needs plan, you're fully at risk for that patient's kind of like pace without walls. Yeah, So I like that, actually. To me, that's a really smart way to frame what we're focused on. You can't discharge the patient. And then again, maybe there's something like a lighter model upstream. And if you're modeling that, what's in there may plan, but then also shopping that as maybe the future enhancement of this beautiful benefit that's been 40 years, I think that something like that may be really wise.
00;17;44;23 - 00;19;51;12
Meg Pekarske
Yeah. Which gets to how should people react after we're both like everyone's like Hogarth's like, what just happened? I think the momentum that has been building, especially I think in the not for profit community, you know, are we've worked and we've talked on the podcast a lot about a lot of the different affiliations. And several years ago we did the chart from messenger model to member substitution all the staff and, you know, doing a lot of work in the space. And I'm just wondering like, well, that chill a little bit because people are in me like, well, they need to affiliate because I thought I was going to, you know, have to be the one of five hospices to contract with Medicare Advantage, you know, geographic reach, service reach, you know, cost of care, like those kinds of things. I don't have to answer to anyone. I can still direct market to patients. And there's total freedom of choice and all that. And I don't know, because I've been down the road with many nonprofit boards and deals have died and I think that there are folks that maybe I mean, including myself, like I do think that was a driver to get bigger. But I do think there's regardless of what happens here, I think we need to find ways to do what we're doing differently because it's not really working. And this whole reacting always to what the government's doing as opposed to like solving the problem and like and the fact now that we have payers because we've got to find some way to get paid for all these great ideas that we have. And I do think there's a lot of momentum, but I think you still need to have scale to have to get to the table, right? I mean, if you're a tiny provider that says, I could do this for 50 patients, that's not really going to be exciting to a large payor, so...
00;19;51;17 - 00;22;49;22
Chris Comeaux
Well, I think first off, big Medicare Advantage carved in was a really sticky talking point to help people understand and just the broad, you know, 25 different flavors of change are coming down the pike. It was just you know, I was I presented to many boards and it's one that sticks in people's minds because of how much the Medicare percentage of their reimbursement is today. But the reality is I mean, there are two again, I said there's we have eight challenges that we roadmap. And that whole presentation is like an hour and a half presentation unpacking what those eight things mean. And they Carvin has literally one bullet under one of those slides. Melissa's take two broad things, and these two things are two sub bullets. Under those a medicare is looming insolvency 2030 Medicare is predicted to be insolvent. Think of what they did last time during sequestration when, you know, politicians want to be elected so they can't do the adult thing and tell us things that we don't want to hear. Yeah, so last time they just basically cut everybody 2% across the board. So what are they going to do to solve that should make us all concerned. Number two, think about by 2030, which is also the same year, Medicare recipients, albeit 100% of Medicare, are supposed to be in some value based arrangement. How we get referrals today is going to shift, certainly because of at least one of those things as more primary care practices go at risk, etc.. So there's all of these things and I believe in the mission of hospice, but I'm going to use business language. If you picture hospice at the tail end in health care and this kind of pipeline by which we get referrals today, there's all this disruption that Medicare Advantage carbon was only one flavor of disruption. There are many, many more flavors. And so how we work with the rest of health care to make sure we get access to patients is going to be challenged. Whether Medicare Advantage carbon happen or not, that is all that change is going to go forward. So I think that's where the folks are thinking dodged a bullet like I'm all for deep red. Let's be thoughtful because you don't want to be frenetic and like, I'm worried and and then you make rash decisions. You can be thoughtful, but you can't step back and go, Well, we're just not going to do anything. You've got to realize what's happening throughout the rest of health care. And one of my early mentors used to use this analogy that I never forgot because when my kids were small, they would take the jump rope and they would do like that. And the end of the jump rope is flailing about. Yeah, well, hospice is that the tail end health care. And there's all this other change happening. We would be foolhardy to think that change is not going to reverberate at the tail end of health care. We have to be thoughtful about what that means. And then how do you then partner with the rest of health care? And does that mean I need to be part of something bigger for scale, for innovation? And more than likely, the answer for a lot of people is yes, you're probably going to have to. So then be thoughtful. Which flavor that you look at or partner with.
00;22;50;11 - 00;23;24;08
Meg Pekarske
Yeah, I think that the why should be the world is changing. I need to change to not like well only this particular thing because I mean it is clear that there is a growing patient population with the baby boomers. But like, I think you're exactly right. Like how those patients may come to us if they come to us. And then I think, you know, there's other people that can compete in the space with when we talk about the non hospice kind of stuff and I know...
00;23;24;14 - 00;23;26;07
Chris Comeaux
There's substitution competitions.
00;23;26;07 - 00;24;30;09
Meg Pekarske
Yeah, we just think of our competition as other hospices, but there are other people that are going to try. I mean, look at the rest of health care like Amazon's now doing pharmaceuticals. I mean, you have all of these disruptors going into health care to find new ways to deliver something or fight. And so you know who is going to try because we have a very needy population, baby boomers. I can't remember when that's going to peak. I'm sure you know that off the top of your head. But like, yeah, one that is going to peak. And so there is a lot of opportunity to be innovative to solve problems and and I think meet people where they are, which is patients don't want to leave their home. And so like I mean we have the whole hospital at home, you know, thing which we thought was a COVID thing that sort of sticking around. And I mean, there's just going to be different people trying to meet the needs of patients and. Well.
00;24;30;28 - 00;25;11;29
Chris Comeaux
Yeah, to two key points there, Meg. If you look at the baby boomers as they have aged, they're out there, their demographic I've heard it call before the pig in a blanket, because if you look at distribution, it's such a broad population segment, things that we take for granted today, SUV, suburbia, vacation homes, they have transformed every part of our economy as they've aged to the different parts of their life the thirties, the forties, the fifties, and now they're coming into health care and they have traditionally been a much more demanding customer, like the whole concept of customer service and have it your way and it came out of the baby boomers. Now I think we have a beautiful chassis and hospice that was designed for patient centered care.
00;25;12;06 - 00;25;12;17
Meg Pekarske
Yeah.
00;25;13;00 - 00;26;13;10
Chris Comeaux
But how we package that into the future, again, I think that they're not going to want their mom and their dad's hospice or how we package what we do for the baby boomer is going to be so important. And to your point, yeah, we actually brought a guy in Meg, He used to do all this interesting research for Chambers of Commerce and he did a lot of death research. The trend line for our hospice. And I know folks are listening, but they can't see that the trend line was overwhelming and it is to about 2035 and then it starts to level out. But even then, it is actually still a pretty it's still an upward trend. So these next ten years, the volume of people we have to care for, at the same time, you've got Medicare looming insolvency, you've got also more value based thought processes occurring throughout our referral sources and all that is coming upon us the next ten or 15 years. I've got 30 years now and this amazing hospice and palliative care thing. Maggie I know these next ten or 15 are going to be much more fascinating. The 30 years that I've had today.
00;26;13;10 - 00;28;46;15
Meg Pekarske
Oh, yeah, that's that's really interesting. I think that I remember because you were one of the guests on my first one of my first podcast episodes back. I don't know if that's seven years now or whatever. I was reminiscing as we were preparing for this, and when I was doing these innovation like CEO discussions, the last question I always asked was, Are we ever going to evolve beyond like the need for humans to care for humans at the end? And I just when I reflect on that question now is seven years and now we have AI and then like we just got through COVID and how do you know there are things we can do via telehealth and technology that I think can aid in the goals of patients? So it was just striking when you were saying that and suddenly was popped into my head is, you know, how are we going to have enough staff to care for people? Because it is I mean, right now and you say 2035 is going to be like the peak. I mean, it is a staffing crisis now. And so there's been innovation, actually. And I don't see how we're going to get more people to go to medical school and nursing school and all the stuff. And it's like I think when we talk about innovation, it's also like how we deliver care, because I do think we and I'm sure you know, there is not like COVID care had it, you know, there weren't things that didn't work during COVID, but we did find different ways to meet people's goals and use technology and be more efficient and how we deploy our staff and all the staff. So I guess and those things cost money to to innovate, like to to have more of a state of the art call center and like how you map you know, UPS has their little they map out I'm sure the most efficient route like they don't take left hand turns I guess because that's like delays timing like they map their around and like, do we do that with staff so they're most efficient and how we're deploying people and I don't know. It just I think as I'm listening to talk, the role of humans caring for humans remains very important, but I just don't know how we solve this.
00;28;46;26 - 00;30;16;16
Chris Comeaux
Yeah, that was my takeaway. So that was again, that's why I always love being around you. And that wasn't a prepared line. It was just me and you kind of breaking with each other. I just remember saying out loud, the folks that figure out how to blend technology with people are going to be the key to the future because and now we know, because now we have the data that they just won't be enough humans. And I mean, they're going to need things. They're going to have to push our thinking. My son is actually working in hospice now. My second son. And what I love about his generation is they're their view on technology is just they're just so much it's just been part of their life from the get go. He was showing me this weekend you've seen like Primus Teslas robot, like the actual feel. It feels like a human, looks like a human. And you go, I would never put a robot. Someone's home. Well, we may have to in the future. Now, what I think we're saying is we've delivered this today, this amazing sacred work, and it's mostly via humans. So how do we not lose that? But then blend technology is probably going to be some robots, but is probably also more than likely going to be a lot of different technology tools. Or our people can be at the right place at the right time so we can spread those people over the patients and families that need us. And I've seen lots of applications of that coming up, you know, finding the money for that. I mean, all of those reasons why people need to be having thought partners and like, okay, I hear these concepts or what do I do about it should be part of a group who's doing something about these things.
00;30;17;01 - 00;32;12;00
Meg Pekarske
Well, And I just find working in collaboration is just more fun. Like it makes things feel less daunting. I'm also a verbal processor, so like my brain, I have like 100 ideas and like this and that and like, you know, I'm sure I can be really annoying for my teammates to work with sometimes, but I'm like the idea person, Right? And like, and then making connections sometimes between divergent things and like, and you know, I practice law, but it's like, I think it's energizing. And when you're doing this and living these challenges with someone else, and I think especially it is lonely and I know you're a leadership expert. I think it can be very lonely being a CEO because very much so. Like, who do I talk to about this? Everyone's looking at me and like and you and I think we need to put ego aside because I think ego gets in the way of a lot of good work is like groupthink. And I don't have the best ideas. I have ideas, but like and I always talk about it, like making jazz music. It's like you do something and then I do something and it's ad libbing and it's like, But having smart people to do that with and that people that can elevate your thinking, right? Like who just sits and types on their computer and has great ideas. I mean, that's part of the process. But so I totally think the whole groupthink and collaborative work is really important because it really does take a village to try to solve these problems and people coming at it from different perspectives. And so it is, well, I feel excited to solve these new challenges now, except my law job. I'm like always dealing with the problem so big. I need to come upstream, Chris, and come work for you.
00;32;13;09 - 00;32;20;08
Chris Comeaux
Well, my picture, Meg, as we're going on this journey, make sure that you and your team keep us out of the ditch. We've got this really interesting journey. We've got to go on.
00;32;21;27 - 00;32;41;27
Meg Pekarske
Yes, but. Well, this has been so fun. I knew it was going to be a lot of fun and I feel energized about the future opportunities. And just because you get to your solving different problems and the challenges that I'm solving. But we're on we're on the same team, right?
00;32;42;00 - 00;33;13;24
Chris Comeaux
So. Well, I was going to say something to make what I love about you, because just take one thing that you you picked on. What if we design different IT team members? Well, how does that reconcile with the cops or having an attorney who is so, like, innovative like you is going to be critical to the future because we're going to usually the regs don't you know, they're not the leading indicator, they're lagging indicator, and it's usually antithetical to innovation. So how do we reconcile those two and do the risk based thought processes? And that's why, you know, folks need a great thought partner like you.
00;33;14;07 - 00;33;30;24
Meg Pekarske
Well, thanks for saying that. But what you're doing super exciting and I'm happy to help along the way. It is. I think it is an exciting time. So here's to the next like 15 years, you say, right? Because you and I are about the same age. I'm 49. How old are you, Chris?
00;33;30;24 - 00;33;32;18
Chris Comeaux
I'm 53.
00;33;32;18 - 00;34;00;21
Meg Pekarske
53. So we're like the same age, remember? Like when you're young, like four years apart, it's like, Oh my God, they're so much older. And now it's like, you know, if you're in, I don't know, even like 15 years seems not that far. But anyway, so we're of the same generation where so the next next years are a lot of change. But yeah, don't give up on us right now.
00;34;00;21 - 00;34;19;26
Chris Comeaux
Model of care. And maybe our next 15 could be even more amazing than our first 30. Not by resting on our laurels, but how we take it. One of my favorite quotes, Meg, As I've stood the shoulders of giants. And so there are some giants who created this original benefit that we've kind of benefited from. What will they say about us 15 or 20 years from now?
00;34;19;26 - 00;34;47;15
Meg Pekarske
Yeah, exactly. Because if we don't change, I do think that it's going to dwindle and and we're going to lose something that was really important. So while this is an awesome conversation, as always like thank you for being game to, to do this and provide me with different perspectives because you know, it helps me think about what I do differently. So thank you for, for making me better.
00;34;47;18 - 00;34;51;19
Chris Comeaux
Thank you.
00;34;51;19 - 00;35;08;23
Meg Pekarske
Well, that's it for today's episode of Hospice Insights, The Law and Beyond. Thank you for joining the conversation. To subscribe to our podcast, visit our website at huschblackwell.com, or sign up wherever you get your podcasts. Till next time, may the wind be at your back.