Welcome everyone, thanks so much for joining us today. We'll go ahead and get started and let people in as they come. So my name is Gina Parisi and I serve as the executive director for HMDCB. And I'm really excited for us to host this session today, physician onboarding, getting physicians ready for the job. Before we get started, I just want to share a few HMDCB updates with everyone. A few reminders, if your certification does expire next year, you'll be able to quit starting January 13th. And then if you have any non-certified colleagues, they can apply for the initial exam starting January 27th. And just noticing just a quick reminder to everyone to please just stay on mute if you're not speaking, that will just help to eliminate any background noise. And then a few other reminders, we have our final coffee chat of the year coming up on December 10th at 11 a.m. central. And then we also have the Hospice Super Forum coming up. So we're really excited to co-host this with AHPM. It's going to be the first ever virtual mini conference that's going to be focused solely on hospice content. And so we encourage everyone to attend. And if you aren't a member of AHPM, you can receive the member rate by using the code on the screen, Forum 2024. And just a thank you to our sponsors, GenSiva Hospice and Heartland Hospice. Without their support, we wouldn't be able to provide these webinars for free for our certificants. So we greatly appreciate GenSiva and Heartland sponsoring the webinar series. If you're interested in learning more about this organization, we definitely encourage you to visit their website. And I want to introduce our speakers for today, Dr. Brian Bell and Dr. Bridget Hiller. So I'm going to read their bios for everyone just to give you a better understanding of their background and who they are. And so Brian Bell is a board certified in family medicine and hospice and palliative medicine. He is also a fellow of the American Academy of Hospice and Palliative Medicine and has worked in hospice care since 2006. He joined Arkansas Hospice and Palliative Care in 2016 and is currently on the faculty at the University of Arkansas for Medical Sciences, where he teaches hospice and palliative medicine fellows. Previous, he started a hospice and palliative medicine fellowship at Spartanburg, South Carolina, and served as the program director. And he currently serves on the education committee for the National Hospice and Palliative Care Organization and NHPCO. So Dr. Bell, thank you so much for being here with us today. And our other speaker is Dr. Bridget Hiller. And Dr. Bridget Hiller is the chief medical officer for Via Health Partners, which is a large nationally recognized nonprofit hospice and palliative care organization in the Carolinas. As a compassionate, inspirational, and engaging leader, her impact is focused on transforming the care for patients and families living with a serious illness to have a meaningful end-of-life experience. She has accomplished this through innovative partnerships, community education, and engagements. As an agent of change, her career in leadership started when she was elected as chief resident in internal medicine at North Shore University Hospital in 2005. Initially starting off as a hospitalist, it was her experience that served as a catalyst for her passion to improve the outcomes of patients living with a serious illness. And she completed her fellowship in hospice and palliative medicine in 2012. Dr. Hiller became a fellow of the American Academy of Hospice and Palliative Medicine and passed her hospice medical director certification board, both in 2019. In 2021, she was chosen as one of 50 women physician as a woman's wellness through equity and leadership scholar from the American Hospital Association. It was during this time she served on key strategic health system committees, state associations to create standards for care of patients living with a serious illness, initiated a quality award-winning direct emergency department to hospice program, and spearheaded community-based palliative care, including a designated care plan for various disease-specific states, including heart failure. So, Dr. Bridget, thank you so much for being here with us today and presenting. And I will now hand it over to you and Dr. Bell to start our webinar. All right. Well, thank you very much. I'm really happy to be here and to speak to you on physician onboarding, getting your practitioners ready for the job. Next slide, please, Gina. Dr. Bell and I do not have anything to disclose. So, we're going to really hit really five main areas. I'll start by talking about why physician onboarding is so important, kind of dip into the adult learning theory in terms of medical education and education as physicians get older. Dr. Bell will take over and talk about the hospice medical director, kind of unlocking that. Then we'll talk about the hospice medical director blueprint. And then Dr. Bell and I will go through four examples and ultimately just leave you with some great resources to really take with you back home so that you can really work on focusing on onboarding your own physicians when they start your organization. Next slide. So, let's start by talking about, like, why is this so important? And so, you know, one in every three physicians receive no formal orientation upon starting a new job. And that is quite compelling because how many of us, I know there's probably a few on this line that have really gotten in there and said, oh my gosh, all I've gotten was just a general orientation in three days and nothing else. And what's so interesting about that is that when they actually surveyed nationally physicians, only 29% of them said that their employer provided them an actually individualized orientation program. The remainder only received that general orientation, which really does not set us as physicians up for success. Because when we're starting a new job, I mean, we're afraid we have so much to really get acclimated to the organization. And we truly want to really do our best. So, a thorough onboarding can really change and improve retention within an organization. And then finally, it actually also helps with job satisfaction and also burnout. Because those first few months of getting onboard to an organization can clearly be overwhelming because you do feel overwhelmed when you get the job to start the job. And if that onboarding isn't there to match that, it definitely can feel quite overwhelming. Next slide for me. So, I really wanted to leave you with this and tell you that we spend such a significant amount of time prior to a person starting. We spend so much time with recruitment. We look for that right candidate. And by the time we hire that candidate, that candidate will put in their resignation and start with us. Honestly, that takes time. So, I think we need to learn how to balance that, not only just spending the same time on recruitment, but also taking that same time to spend on onboarding. Because that's where onboarding truly starts. It starts when you hire that new candidate to start the job. Next slide. And ultimately, as we go through the key elements of onboarding a physician, I want you to really kind of take home three things. And Dr. Bell will really go into this more specifically. You really have to connect them with colleagues. Studies have shown that a physician that has a mentor in their onboarding actually are going to be more productive. And they're also going to feel more welcomed and part of the group. The next thing is to really create a structured plan. And we'll, again, talk about that. And what I mean by a plan is being so clear about what does the first 30 days look like? What do the first 60 days look like? What do the first 90 days look like? And ultimately, what does the year look like? Because a longer onboarding actually shows that patients, not patients, excuse me, I'm thinking about patients, that physicians will actually stay with an organization if they have a longer, more thorough onboarding. And last but not least is communicate information. But I want to leave you with this. When you're thinking about commuting the information, think about commuting to that candidate prior to them starting. So having a call with that candidate that one week or two weeks before just to really relieve that anxiety and set them up for success is really important. So on the next slide, I'm just going to walk you through, if I have some GME people on the line that do a lot of resident education, a lot of this foundation from Malcolm Knowles is really key in terms of those three key elements that we've talked about before for onboarding. So I want to talk to you about the adult learning theory. Next slide. What this really kind of informs us is, listen, I mean, as physicians get older and we get older, how we learn typically changes as opposed to younger learners. So I want you to just realize that training a new physician for hospice is clearly overwhelming because I'm not going to lie. When I think about someone starting with me, I want them to be ready yesterday because typically I'm short staffed. Physicians have options. And as we know, in a recent CAHPSI survey, one of the big thing is really hiring qualified candidates. So we don't want to overwhelm anyone when they start. We want them to truly be successful. And we don't have to provide all the information for them at the same time. And the goal of the adult learning theory, it really helps the learner help themselves and learn in the entire process. Next slide. So there are a couple of like key areas in the adult learning process that I just want to point out to you. So the first is the working memory. And that's the amount of space that we as individuals have to learn. And as we get older, we really don't have the space for that working memory. And what are some of the key reasons why? I mean, one is because we have family and we have other job commitments because as you probably all know, in the hospice space, some of the doctors that are going to come on board are going to be contract doctors. And Dr. Bell is actually going to talk about one of those examples. So the next thing is that in that working memory, in that space, you're also going to think about learning a total new specialty. Some of the docs are coming to me from internal medicine, from emergency department. Some are just coming from retirement thinking that this is a job to slow down. But guess what? It's not. It's really a job of learning key areas that are really going to be important to become a very highly qualified functional hospice physician. Next slide. So I'll quickly touch on interference, right? And this is the concept that one's brain becomes too full of information to adequately process new information, right? And this is something that we want to avoid. Why? It's because the amount of information to learn to be a hospice medical director, that does take some time to take that in. And I really try to work with my docs just to pace them. So you'll see what my 30 and 60 and 90 days looks like. But I'm just saying to you to take it slow, set the expectation that this is going to take some time. Because becoming a hospice medical director takes patient's commitment and really learning on the job, but learning from mentorship. And we'll talk about mentorship too. Next slide. So ultimately, I want to just kind of have you have these key takeaways. And I'm going to start with the key takeaways. I want to just kind of have you have these key takeaways. And the heart of this is because we really want to make the learner that comes to us for hospice to feel aroused, engaged, and also not to feel stressed out or burned out. So here's some of the takeaways that we'll kind of expand on. So one is milestone education landmarks. Setting clear landmarks of where you'd like that employee to be in the orientation and the onboarding for, again, the 30, 60, 90. But I'm going to extend and say even to the year mark, OK? Have a support system for them. And we'll talk about mentorship, because they want to feel part of the team, really engaged in the organizational culture. And then last but not least, provide constant feedback, because the right doc for hospice is important. Sometimes it might not be the right fit. But providing feedback for that learner to actually grow is going to be really important and to support them to be successful. Next slide. I think I turn it over to Dr. Bell now. Yeah. All right, Gina. That's where I'm starting off at. So Gina, go to the next slide. So the days where the hospice vision, I'm not going to read these to you. You can read them yourself. But when the physician just came in, did some paperwork, left, was not very involved with the IDP team, those days are over. Really, CMS is really pushing more physician involvement. And I think that's important. I think they can be a great asset to your hospice team as you're developing them, bringing them on. You know, I think they can be a great team member. You just kind of got to know how to do that. So next slide. So what I want to say here is realizing how much of what the physician's impact is on your hospice. You think about it. They affect admissions, your medication, symptom management, the ALJ hearings, QAPI, education. They touch a big, big portion of your hospice program. And so probably of all the IDP members, they may be the one that actually is in more areas than some of the other interdisciplinary team members. And making sure we get this right, especially from the beginning, is truly, truly very important. Next slide. So let's talk about it. You know, I think the first step that I'm going to go through is how we're going to onboard. First of all, just finding the right doc. And sometimes I think what I look for when I'm hiring a doc is the right heart. You know, we kind of call it the hospice heart. So we always want that. I think, you know, I don't always get that. I do have a lot of contract workers, but we're trying to look for that. And a lot of the doctors that we hire, time, make sure they have enough time. And that's, like I said, sometimes more with the contract workers. Obviously, if you're hiring a full-time doc, you know, they're working 40, probably more than 40 hours a week. They got plenty of time. But I think if you're not, then you also got to look at that as well. Having the right attitude. I've had doctors who, you know, have the right heart, but not the right attitude. You know, they're not, you know, it's like doctors like to be cowboys. Sometimes they want to, you know, don't want to be a part of the team, right? I'm the doc. It's going my way or the highway. So their heart is right. They want to help patients. But maybe their attitude, they're not, they don't fit in with the team. So getting the right attitude, somebody is a team player. And then incentivizing, you know, making sure we put the right incentives. When I've dealt contracts, you know, their CTI quality, that they get CTIs done in time. And, you know, they're showing up at meetings on time and cap scores. And so I always want to make sure when we're hiring docs, like you, I need you to understand these are the responsibilities and I'm going to incentivize them in their contract structure contract structure when I hire them. Next slide. So next is educate. And I think it's very important. It's part of making sure we get them the right education, the knowledge, you know. And there's a lot of different ways to do that. And I, you know, once again, you can hand out books. I give everyone the hospice medical manual, director manual. They all get that. They also get a symptom management manual. Also make videos, individualized videos. I probably have about 10 of those that I do for my hospice physicians. And I really make them before they come on, try to watch it before they even come on board with us. If not, they can watch it later. But I think it's important, you know, making sure you have other resources, you know, websites, things like that, that they can turn to. You know, we have a kind of a little app on our phone for our hospice. You can go on with all the locations, you know, there's different other apps out there that I think would be great on the phone that you can use. And then obviously there's a hospice medical director certification. There's also an HPCO and CAPC. Those are another organizations where I could go on and have them watch some videos from those organizations. And then I do require them to continue in mediation, which is not that difficult, right? Because most everybody here is board certified in something, so they have to do it anyway. But we also want to make sure it's in some hospice or palliative care education that we want to provide. Next slide. Next slide. So with that education, I think these are the basics. I don't think this is, you know, everything. I think there's a lot more. But, you know, I'm always really big about getting good quality CTIs, making sure we're educating what we consider good quality CTIs. Deprescribing, medication management, what is your formulary, right? You know, most hospices have a formulary. We don't want to be prescribing some very expensive medicines when we got some great alternatives out there. And, you know, sometimes my docs, they love a certain medicine, you know, and they want to stay with it. But, you know, they have to understand, you know, hospice is different. We're paying for that medication now, right? It's not just their Part B or Part D plan that's paying for that or their insurance plan. We're actually responsible. Relatedness, I think we go into a lot on relatedness and what's related, what diagnosis and medications related. Hospice regulations kind of hit the big ones, kind of, you know, there's a lot of regulations out there, so we try to hit the one, right? And then admissions and discharge, you know, what are we looking for for GIP? Making sure they know the LCDs, you know, what we need to do. And then in the end, what is their role? What is their responsibility? Kind of give them, as we're talking here today, a little bit of a blueprint of what does it look like to be a hospice physician on the IDTT? You know, what does that role look like? Okay, next. And then as we talked earlier, as Dr. Hiller talked earlier, mentoring. And I think this is really important that you give someone a mentor. Just don't throw them out there and tell them to swim because they're going to sink a lot of times and we don't want to do that. And so for me, either myself or someone else, I get them to attend their interdisciplinary meetings, at least two or three. Lately, it seems like we're doing four or five. We're even doing more than we used to. Making sure they're shadowing us, you know, going with us on visits or shadowing us, you know, just in our own IDT meeting, seeing how we run our meetings when we do that. Also just making sure you're available 24-7 because as you know, hospice is around the clock, right? And we may get an admission at 10 o'clock at night and maybe they're having a difficulty coming up with a diagnosis or what's related or not related. So we need to be able to make sure that they can call someone 24-7. And then regularly scheduled one-on-ones. I always tell, you know, the doctors, we're going to do this, this time, this time. And it's not just going to be when you're in trouble or when you're having problems. We're going to be here to, you know, support you, celebrate your successes. But if we see a problem, we can go ahead and address those at those regular one-on-one meetings. And then I'd say review their CTIs and advise, you know, hey, you're doing a good job here. Make sure we add this here. And so just keeping up with that and going over their CTIs as they're doing those. Next slide. Here's the thing. You got to reevaluate. You just can't let them go into the wild and you got to follow up on things on a regular basis. And so usually I, after we kind of spend a couple months training and then I go back and circle around and I'll attend an IDT meeting at least once a year, sometimes twice a year. I'll actually do a 360 review in a couple months and see how the team is grading them on how well they're fitting into the team, how good a job they're doing. Obviously, we're going to be doing routine CTI audits. So that's important. And I also look at their admissions and non-admissions and discharges, right? So the docs not admitting appropriately, you know, the hospice Medicare benefits really important. It's a benefit. We want to make sure every patient who deserves hospice gets it. But also not, you know, if they're not admitted, making sure, well, maybe we should have admitted that patient or on the flip side, on the admissions, maybe we shouldn't have admitted that patient. And then obviously the patients that are being discharged from hospice, we want to look at those as they're making those decisions. So when that's all done, next slide, when that's all done, we'll put it together, you know, and, you know, hopefully over this time period, we're going to, you know, have us a great doc that we got out there working for our hospice, contributing, you know, making an impact. Next slide. So the next one is just a little timeline. Here's my timeline. You know, a lot of times prior to hire, you know, I'll ask them, especially my contract doctors, I'll go ahead and bring them into an IDT meeting. So they just kind of understand what the job they're signing on to do, because this is really pretty foreign to them in a lot of ways. They don't always understand kind of what their role is because it is a little different than just being a regular physician sometimes. You know, I make sure if they can to review all the videos, give them the hospice medical director handbook. Unfortunately, I don't know how much they read that thing. It may just be a paperweight, which is okay, but at least they have a resource that they can turn to on their desk and look up something if they have it. And then obviously provide education and material aids. Like I have a little relatedness grid that I give them and I tell them to bring it to every hospice meeting and I make sure they have a formulary that on their phone or sitting there. And so then we bring them on and from day one to, you know, the first month, you know, we're attending those IDT meetings. We're reviewing those CTIs, all the things we've already talked about in doing those types of things, but also just informally talking to the team. Well, you know, how's Dr. Shaw doing? Is everything going well? Any problems? So, you know, kind of just going around, making sure everything's going okay from the team members aspect as well. And then in a couple months, I like to do is a 360 review where I send it out to all the IDT members and they get to kind of grade the doctor and say, hey, you know, these are the areas where he's being very, or she's being very successful. We think it's doing well. This is the area we feel like it's not going as well. And so it gives us a little time to start working on the things we need to kind of tweak in the next couple months and obviously continue to review those CTIs. And then in a year, circle back around and keep doing the same thing. The 360, attending the IDT, reviewing all the things. And so one of the concepts that I have is, and I see this so often, is a lot of times I'll send that doc out and even here when I got here, I sent the doc out and they kind of, nobody's really followed up with them in two or three years. And it looks completely different from what they were taught. And I call this drift. Next slide. I call this a drift. There's an educational drift. And go ahead and push the next one that they're going quite along. And then all of a sudden over time, they kind of get off the path, off the road that we sent them on. And they're down a place like, how did we get here? How did we get to this place? Because I know we trained this way. And then it's two years later, we're going to a new place. And, you know, and I think part of that is when I got into hospice, a lot of the nurses had been there for years. You know, you had really nurses, you know, when I started training, been there 15, 20 years. It seems now our nurses are turning over. They may only have done hospice a year. So they don't have that institutional knowledge to say when it starts drifting, that they don't know how, they don't even know what the norm is to get us back in line, to get us back on track. So always pay close attention to that drift. Next slide. I think that's my last one. All right. Thanks, Dr. Bell. So, you know, I really think that it's really important that the foundation of our hospice medical directors is really based off of the blueprint that's been put together by the Hospice Medical Director Certification Board. So what I'm going to talk with you guys about are really these key five pillars that are important for our hospice medical directors to know, which is patient and family care, medical knowledge, medical leadership and communication, professionalism, regulatory compliance, and quality improvement. Again, very overwhelming, and they learn it over time. But this surely comes directly from the Hospice Medical Director Certification website. So we've left the link for you guys there so you can click on it to be able to access this after the presentation. But I'll go through very briefly each one and just kind of end it with just showing you how my onboarding will look like. So if we go to the next couple of slides, we'll expand on what is in the patient and family care. And that's really being able to provide your practitioners with really being able to understand medical direction, family meetings, and goals of care, advanced care planning. And as Dr. Bell talked about, deprescribing. And you can read the rest. But what I find with this is really being able to find key areas in their onboarding to make sure that this happens. And so just so you know, for me, I partner with the neighboring health system here. They provide a course on advanced care planning and goals of care and family meetings. And I send every single physician and our nurse practitioner to that course when they come on board. Next slide. So the next pillar is medical knowledge. And it's really kind of focusing on pain, those symptomatology that we have at end of life. And also the medical knowledge that's just for chronic and serious illness. Because a lot of you, when you're onboarding your hospice medical directors, a lot of hospices now are going into primary care. They're doing community-based palliative care. So it's really being able to encompass and make sure that that medical education is comprehensive. Some will come from fellowships, some will not. So it's reprogramming them and helping them realize that they have to know these essential features to be a hospice medical director. And we actually will provide you with some key links. So we always give out Fast Facts. They can get the app on the phone. We talked about CAHPSI, where they do have various type of onboarding and modules. And I do give pretty much a outline from CAHPSI, what they recommend as all of the key onboarding and modules that should be completed by our physicians and our nurse practitioners. Next slide. I think we might even go to the next two, which really kind of just talks really about that medical knowledge. And then the next pillar that we talk about is medical leadership and communication. So, I mean, I'll tell you, I learned nothing about leadership. I learned about it by just being put in my first leadership position as saying, oh, policies. Okay. No idea. So what I think you'll really find is that with medical leadership and communication, I mean, this is really a key area where you're really going to have to invest the time and intentionality about helping your medical directors learn about the features of medical leadership. And I do, we did put together, Dr. Bell and I, some key resources on leadership towards the end. So all of my physicians will do, they'll actually give them the link for that Brene Brown Dare to Lead. I tell them all to do that just because I want to see kind of where they are. And then all of my docs, we do together strength finders. So that's kind of just something that I do for them for medical leadership. And then communication I talked about a little bit earlier, but then it's also communication with the hospice staff. You know, a lot of these physicians come on board thinking and not really understanding what hospice is. And some of it is a little bit more nurse driven. You're going to have to deal with the interdisciplinary team. And so that's something that I do think you really have to keep that eye on and those mini check-ins and that mentor will help them through that. Next slide. Oh, professionalism, one of my favorites. So I'll tell you, professionalism. I'll tell you, this one comes from a lot of receiving feedback from the various people that they rotate with just to kind of see how are they doing? The next thing that I always think about is how do we really handle self-care fatigue and burnout? And that's something I think with those mini check-ins that you have with that practitioner as they're getting on board, whether it's a new physician contract, it's really kind of seeing how are they really dealing with the principles and the foundation of hospice because a lot of docs that really need to be reprogrammed, and I'll talk about that, that's really something that's really, really tough for them. So just kind of really outlining the professionalism here as well. And then last but not least, oh boy, regulatory and compliance. So I ensure that each of the docs will have a list of all of the, now the Alliance, documents that are key to their success. So I make sure like on the first day, they have an outline of what they needed. Every time we have that check-in, I kind of check off for them. I want you to read this one. I want you to do this lecture from NHPCO because I do want to match their learning as we talked about adult learning theory so they can learn themselves. And I really have them match that as they go along. And then when I review their CTIs, I kind of go in there and kind of see like what did they write? What did they say? And then I kind of talk through it with them on those types of things. And so I find that that really helps a lot. And then you'll see some key things in there, but I do give like the key policies for them. So they have that when they start in the organization, because some of the processes might be a little bit different. And then I will tell you this, when it comes to the audits, I would find that that I typically do towards a little bit towards the later end, just because I need them really in their first 30 to 60 days, 90 days, to really just get acclimated to the organization, really kind of understand like those key compliance areas. And then when it comes to audits, I do a lot of that towards the end and towards when they get to a year, because I actually have every physician meet with our VP of compliance and VP of quality. So they're well acclimated when they get emails from them. And then ultimately, I think my next slide breaks it down. I just wanted you guys just to really see what I give out to my physicians. I'm typically on that first meeting I have with them just to set the expectation. So I do give them a list of resources for my new docs. And I'm not going to lie, this is literally probably like 10 pages, but it really kind of encompasses and has everything for them, the key compliance, your organizational policies and procedures, how does it compare to the other doc, and then policies and procedures, how was the patient admitted, they might not know that process. And you're going to laugh, but I also like show them the org chart, because you know, sometimes they don't know who's who. So that's like one of my key like first months. And then Dr. Bell mentioned, you know, letting them recognize that they need to look at the right LCDs, because that's definitely happened to me a couple times I brought a doc on and they were using the wrong one. So just ensure that they have the right one when they're coming to you. And I think my next slide just breaks down for me, similar to Dr. Bell, kind of what my 90 day timeline looks like. So the first 30 days expectations we talked about getting to know the organization, they're assigned a physician mentor, and their physician mentor is typically some actually assigned to, but they have one main physician mentor, and that person is with them, and they meet with them weekly for the first 90 days, and they meet with them monthly for the rest of the year. And the reason why I do that is because I want them to get acclimated to the organization, but also to feel comfortable knowing that they have a buddy and someone that they can ask a question to if I'm not available or another doc's not available. So that's why I signed them to. And then we do weekly touch bases for the first 30, 60 and 90 days with the practice manager and myself just to really check in what is your schedule look like? Where are you going? Do you need directions? Because we are a pretty large organization between 38 counties between North and South Carolina, so sometimes I've just got to make sure people can get where they need to go. The 60 days, I'm really learning the clinical workflow of the MD. They shadow a lot of IDGs, watch a lot of videos, and I make sure that they read like probably like four key compliance documents or NHPCO that I think are the best. And then 90 days is their road to quasi-independence because I'm kind of like following them until about a year. I get feedback from their staff and from their mentor. I have our quality department audit three to five of their CTIs and also three to five of their face-to-face notes. Each of you might have a different setup. Some of your docs might not do face-to-faces, but I do really try to have my docs at least learn to do a face-to-face. I discuss any areas of opportunity. I talk about how the year will go, and then that's when I set up the monthly meetings. And typically, like I said, quasi-independent, they'll make it there. But I set up those monthly meetings for them for the end of the year. And I usually do monthlies with all my staff, the physicians. And I think the next slide is really just me kind of showing you what my yearly competency checklist look like. And I literally take this checklist directly from the hospice medical director certification board. And I'm more than happy to share it with you guys that you have my email if you guys would like some of these documents. I'll share it with you. And then the last two slides, and as we go through some examples, it's just really just realizing that this is a lot. It's really overwhelming. And the next slide just shows you how we really do not want our physicians and anyone joining us to feel overwhelmed. So as you're patient with that physician getting acclimated to the job, being patient with them and having them being patient as well, because you know, we as docs, we want to do a great job. We don't want to let anyone down. And when we switch and take a new job, we really want to be where we're going to be for a long time. So just be patient with that physician just to help them get on board. And if it takes longer, it takes longer, but the investment is worth it. And then I had to just steal Dr. Bell slide again, because I tell you, the drift is real. The drift is real. So in that onboarding, please just take from us the importance of, you know, this 30, 60, 90, and also those reviews, really towards the end of the year that they're there in the organization. So our next slides are really going to talk about some new hire examples and just talk about, I'm going to do two, Brian's going to do a couple. So I think I'm kicking this off with my two. So the first one is just kind of giving you an example about a new hospice and palliative medicine graduate. So Dr. Love is an internal medicine trained physician who has recently finished fellowship and has accepted a job with you as a hospice medical director. Dr. Love has not taken any gap times during residency and fellowship. And this is really her first job. And I put this there, you know, not all fellowship programs are erected the same. So some of the things I want you to think about are this. The first thing to think about is, I always think to myself that I'm getting older, but how I trained is not how our newer residents and fellows are coming out. They are different and the training is different and the priorities are different. So I just want you to think about this, you know, in the initial kind of meeting with them, okay, set the expectation, but then find out from then, you know, what did you do in your fellowship? How many, how many, how many weeks did you spend in your hospice rotation? I know that it's the ACGME has it clearly outlined how many weeks they should spend in hospice, but just ask that question, what did they do? Because some of them might have never completed a home visit. Maybe they've only shattered IDG or never shattered IDG, but they really don't know what the job is going to be like, or they've only been to the IPU. And I do ask them to tell me, what do you know about hospice? Right? Because that might be something for them that might be different from what hospice really is. Cause I'm not going to lie. I had to learn a lot when I took my first hospice job, discussing the expectations of the job. I do devote a lot of time to onboarding a new physician and helping them really balance a new job. And also being new to hospice and mentorship here is really, really, really, really important. So some of the red flags that we that I've kind of put here for you guys is, you know, a new physician coming out now is, is very, I would say it's very different. And a couple of things. So one is they really want to do a great job and they might be a little bit afraid of telling you that. So watch out to see if that physician in particularly stressed out. They're coming out with a lot of school loans, so they're really going to want to be working really, really, really, really hard. So just be very careful about that and about their work-life balance, because the last thing you want is for there to be any, any turnover and that difficulty acclimating to the position and the team, because, you know, you know, for this presentation, I just kind of looked and did a little bit of searching and I said, wow, you know, it's interesting, you know, new positions are not afraid to find another job if it doesn't really suit them. So I thought really kind of putting that work in for them is really important, but just be aware if they're stressed out because definitely this is very new for them. Next slide. All right. So my next example, you know, I'm telling you, these are real examples for you guys. So Mr. Dr. JP, he's an emergency medicine trained physician. He's been working for over 20 years. He's had a couple of jobs, most recently traveling overseas to do missionary work. After hearing from a friend, a really good friend over, over, over a great drink, he heard the hospice is great work and he decides to apply for the job. And he's a great fit after interviews, really like this guy, he's still with us now, actually. And so this is where I say different specialty and not trained. So you got to reprogram. So balance expectations. First, their understanding of hospice, because they're coming from a different specialty. They may understand some aspects of end of life, but still need some training. I love asking about the motivation, like, what is your why? I prioritize the training and managing expectations. I do a robust onboarding and I do a lot, I have to do a lot of shadowing with more similar docs. So his particular mentor was another EV physician that was here for a while. So I thought that that connection worked really, really well in terms of his mentorship and the mini check-ins were important. Some of the red flags I want you guys to kind of be aware of is the unrealistic expectations. Adjustment to call is unreasonable. I did have a physician once, I mean, great person. She fit in with the team, but the only problem was she'd never worked a nine to five, meaning a Monday to Friday, excuse me, ever for years. So it was really hard for her to get acclimated to the fact that she really had to work every single day, Monday to Friday. And treating IDG as a shift, it's not a shift. It's really about that multidisciplinary team working together with the team. So I'm going to turn it over to Dr. Bell to walk you through two more examples. Yeah, so I do have a lot of docs that I hire and employ, but a lot of my docs are contract docs, we're pretty big rural states. So we got some small offices. And so my first one here is Dr. Smith. Dr. Smith is a retired oncologist. He's worked for another hospice part-time for the past three years and this hospice shut down. There was some compliance issues and basically got to shut down. And so he really loves his hospice work and is eager to take over and wants to do that again. And so, you know, I think this kind of doc is coming to us with some other hospice's expectations. And so I always want to know, you know, what those expectations are and they may be different than our expectations. So that doc's going to have to relearn some new expectations. And that's different than having a doc that's never got into hospice and then kind of teaching them your expectations because they can lapse into some of their other habits that they had for the other hospice that we may not agree with. And so, you know, I usually start talking about, you know, how they ran their IDP, you know, how long was it, you know, were you involved or did you just show up and sign paperwork, you know, tell me, explain to what it is, you know, what was their expectation of their CTIs, you know, tell me, you know, how you write your CTIs, what do you feel like is important when you're writing your CTIs? And if they're going to do visits, you know, what is the expectations to do visits? You know, not all of our docs do visits, but, you know, what that looks like. And we kind of go through that. And then what are their phone call expectations? You know, you know, I have some docs that are just not going to return phone calls or they're going to return them an hour later. And that is a problem. I've had ones before who said, you know, well, I'm in the office, don't bother me. Right. You know, and I'll call you when I get at lunchtime or at five o'clock. Well, that's not the way we operate. And then maybe what their admission criteria, we may go talk about a couple of cases and go through that and say, hey, I got this case, let me go through it with you. Would you admit this patient? You know, of course, I make, I try to give them not the easy ones, a little bit, the ambiguous ones, ones that are not quite as clear. And I want to see which ones they're going to admit and not admit. So, you know, so some of my red flags, you know, they're doing an IDT that was unusually short. You know, they have 50 patients and they did all those in 20 minutes. That's a problem, right? And that's a real problem. You know, they're unable to describe their CTIs and the critical elements. You know, maybe it's never done a nursing home or home visit for a hospice patient. You know, if we're going to expect them to do that, you know, that's a little bit of a red flag sometimes for me. And once again, it's just a red flag. It doesn't mean they're going to be out when I do this. It's just kind of sends up the radar, sends up a little antennas, like watch out for this. One of the things I've had before, they just text them for admission orders for new admissions, and they're just going to text and do that. That's been a common thing that I've heard that some hospices just text that and the doc just says, OK, well, we don't that that is not our standard, right? So that's not our standard. And then also, you know, if they have the pertinent LCDs, you know, for each, you know, can they help describe, you know, what that LCD and sometimes they don't even know what an LCD is, which another maybe red flag that we have some more learning to do. So that's doc number one. The next doc, number Dr. Jones. Gene, I'm glad you changed that. It was Dr. Smith before I met you. Thank you. I wanted to change it. Thank you. I'm not very original, so sorry. So, so this is another contract doctor, but he's not just this doc's not retired. This doc actually is in a busy practice working 50 hours a week in his family physician and his partner works for another hospice and he kind of heard about, hey, you know, that sounds like a good gig for me and kind of reached out and wants to, you know, if he can cover one of our, you know, rural teams. And so, yeah, so I'll call him back. And so for that doc, I'm, you know, looking for the goals and motivations. You know, why are you wanting to do this? Is it just about money? You know, is it about, you know, you have a heart for it? You know, to kind of tell me, you know, I think Dr. Hiller said the why. Give me the why. Why are you wanting to do this? And how much time do you have to devote to it? So that's the other thing. You know, you're in a busy practice. How much time do you got to devote to it? I think it's another important issue to look at. And then I always kind of look to see if they've used our hospice before, even hospice, any hospice before. I have some software that I can look up and see who's referred. So if it's a doc that's really never referred to us, or maybe it's never referred to hospice at all, that could be an issue that maybe they're not completely on board with hospice. Now, obviously, if it's a specialty that may not refer, you know, maybe they're an OB or something, which is not going to happen very regularly. But, you know, they might not refer as much as someone like a family doc or internal medicine or someone else. So, you know, I was looking at that. And then what are their other roles? You know, what else do you do? You got your practice and let's do that. And so my red flags there is if money is really their main goal, once again, it doesn't put them out of the running. It just puts my radar up, you know, is this really the right guy? If they got multiple side gigs, so they got their family practice and they go to the nursing home and they got hospice and then they got another one, they're working a lot, right? And how much of their time am I going to get? Am I going to get quality time from them, right? Or am I just going to get what's left over, you know, after they're exhausted from all doing their other jobs? And obviously I always said, you know, if they've never referred, I always looked and never referred to us. It also gives me an idea like, you know, do they believe in hospice? Is it something maybe they're not, you know, into hospice, even in their own practice, they're not referring to hospice as we think they should. And then I've had, you know, from IDT, I've had docs, you know, can we do IDT at 7 o'clock in the morning or 630 in the morning? I'm like, no, can't do it. Or can we do it at 5 o'clock in the afternoon? You know, they're trying to fit in all these other jobs and we're kind of getting what's left over. And so, you know, that's usually a red flag. And then obviously if they've got a poor reputation in the community, and I really don't want them to associate with us a lot of times because, you know, their standing in the community is also going to be reflected on us. And so if they have a poor standing in the community for whatever reason, then it's also going to affect our brand. And so making sure I know what that reputation is. So that's my two dots. So, you know, Dr. Bell and I wanted to leave you with just some examples of resources and onboarding templates. And there's actually, there's a number of them out there as well. So next slide. So here we have just a resource guide that you can easily access for getting your physicians ready for the job. CAPTC modules, fast facts, that hospice medical director content blueprint, the hospice medical director webinars. And the good thing about the webinars, they're free. The hospice medical director manual, there is a fourth edition coming out because I've been looking to order them myself. So they should be coming out relatively soon, the next edition. The Alliance, all of the compliance and regulatory documents are out there. There's also webinars that NHPCO, the Alliance has that I think you guys will find really good too. Some of them you have to pay for, but they do have some that are free. And then last but not least, well, two more, whether it be resources, I've sent a couple of my docs, so a few of these, and they have a nurse practitioner documentation for us. I've sent a couple of my MPs too as well. So I think that you'll find that they have some good resources for onboarding. And last but not least, we did talk about the LCDs and each of the governing MAC has a ton of resources and videos. So you can actually click on those and you can actually navigate finding those resources. And I'm with Palmetto, so they do like a physician's compliance course every year and it's really affordable. So that's just something to consider as well. And then next slide, we have for you just the leadership books and sites, the two that I give out to my physicians, but we did also want to point you guys in the direction that, you know, CAPC has some leadership skills as well, NHPCO, the Alliance, AHPM, I have to tell you some really good pre-conference workshops. I sent two of my lead nurse practitioners to the pre-conference workshops, was it this year? Yeah, this year, and they really said that it was really good. And then I do a lot of courses from the physicianleaders.org and you'll find that they have actually free webinars that you can access with some really good topics about leadership. And then I think we have one more slide. Oh, look at that. So thank you in questions. And the next one is the contact for myself and Dr. Bell. And I really say feel free to email both of us if you have any questions or you need any resources and more than happy to share everything that I shared in the presentation with you guys. Thank you. Thanks so much, Dr. Hiller and Dr. Bell. That was a great presentation. Appreciate you all sharing that information with us. If anyone has any questions, please feel free to put them in the chat box or come off mute. We'll keep the recording going for a little bit longer. I'm just seeing a lot of thank yous in the chat right now. There is a question there. Thanks for, you never mentioned monitoring research, but I consider CTI, CTI, you know, so the research, when I say we, I look at that, I'm looking at the new, you know, admission CTIs, but also the research that you're talking about, research CTIs, I'm assuming that's what you're talking about. We're also looking at those as well. And I can add to that, what for my, for our physicians, when quality will audit the CTIs, that would include recertification notes. And I also meet with the physicians and we do actually really work with them in terms of mitigating risk in the long-length of stay patients. So usually when I do do those meetings with them, like twice a year for the greater than two years, we look at their research certification notes just to make sure that they're maintaining that eligibility if that patient has been on for a certain amount of time. So hopefully that helps. I don't see any other questions coming through, so I think we can go ahead and end today's session. Thank you everyone so much for attending. If you do have questions, the slides with Dr. Hiller and Dr. Bell's information will be available in the Certification Center with the recording as well as the resource guide, so you'll be able to access everything in there and email them directly if you have questions. So Dr. Bell, Dr. Hiller, thank you so much for presenting today and sharing this information with us. Thanks everyone for attending.

hospice medical directors

onboarding strategies

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Hospice Medical Director Certification Board

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