Achieving Better Homecare Value-Based Purchasing Results without Sacrificing Integrity

Episode Summary

If you want to learn how home care agencies can achieve top quality care, and maximum reimbursement, then this podcast is for you. K&K is a healthcare consulting company celebrating its 10-year anniversary of providing revenue protection strategies and education to home care agencies. This 100% woman-owned business is passionate about ensuring claims, documentation, OASIS data collection, and coding that is accurate the first time and proving Enjoy listening to our guests, K & K Health Care Solutions owner and founder, Cindy Krafft, PT, MS and Home Care Clinical Specialist, along with the CFO and co-owner of K&K, Sherry Teague.

Episode Notes

Visit the K&K website.

Episode Transcription

Title: Achieving Better Homecare value-based purchasing results without sacrificing integrity

Guests: Cindy Krafft, PT, MS and Home Care Clinical Specialist; Sherry Teague, CFO and co-owner of K&K

Host: Christine Parent, Associate Vice President, MEDITECH

Christine: Welcome to another episode of MEDITECH podcast, the leader in healthcare technology, empowering you to be a more informed healthcare consumer and provider. Hear the latest from our friends and colleagues on topics we think you should know about. 

K&K Healthcare Solutions is a healthcare consulting company providing revenue protection strategies and education to home care agencies. Celebrating its 10-year anniversary, this 100% woman-owned business is passionate about ensuring claims documentation, Oasis data collection, and coding is accurate the first time proving you can have top-quality care and maximum reimbursement. With me today are K&K Healthcare Solutions owner and founder Cindy Kraft, PTMS and Home Care Clinical Specialist along with the CFO and co-owner of K&K, Sherry Teague. Welcome, Cindy and Sherry, I'm so happy to have you here today, and congratulations again on K&K's 10-year anniversary.

Cindy and Sherry: Thank you very much. Thank you.

Christine:  So to begin, why don't you tell us what led you both to where you are today? What drives your individual passion? Cindy, why don't we start with you?

Cindy:  Well I've been in the Home Health space now for nearly 30 years and I had no intention of going into that space. I was going to work in a completely different setting and my passion was about treating neurologically impaired patients and a friend of mine basically cajoled me into, why don't you try Home Health? I had no exposure to Home Health in my academic program. It wasn’t on my radar at all and after my first couple of patients, I literally fell in love with the setting in terms of the creativity it takes to manage the patients, the complexity of the patient situation. No two homes being alike, no two days being exactly alike, but what I also learned pretty quickly is there was not a lot of structure around understanding the rules that I guess if I had to be summed up I am quite the rule follower and it really frustrated me to find out well you're not supposed to do that. Well, why and then, oh well there's this rule. Well, how come you didn't tell me that before? 

Ironically, I was working in the setting for quite some time before somebody explained home-bound status to me. Unfortunately, they did it very oddly by telling me to never document the patient walked on grass. Okay, that made no sense but over time I realized that we have really passionate people that come into this space because they want to help others through nursing, therapy aid, and social work but sometimes that passion doesn't get the right context of the setting it's in. The boundary lines with respect she thinks like the conditions of participation around regulation, around Oasis. Three terms right there that people go, oh gosh please tell me she's not going to talk about those because she's going to bore me to death but we have to. We have to have some degree of understanding of how those things work, and what the implications are. What my decisions, the decisions I make on a day-to-day basis, how they impact that so that people can be practicing at that infamous top of their license, safely. That path took me through a variety of leadership levels and within an organization that got into some consulting space and then my path started to cross with Sherry Teague. I will hand it off to you now Sherry, how we got to that intersection and where we went from there.

Sherry: I'm listening to your story and I've heard it a bunch of times and it reminds me of why I wanted the business with you. I started off as an athletic trainer. I have a master's degree in exercise support science as an athletic trainer and many of you might be shaking your head and go how's that create Home Health? How does that go to Home Health? When I got out of school, I realized that I love the rehab side of athletic training more so than I love the standing on the sideline or traveling all the time with sports medicine so I was in the clinic a lot and had the opportunity to work with people of all ages and discover that I really love the LOLs, the little old ladies, and the little old men and I love the stories that they told and I love the time either that the things that they wanted to do to get back to their activities whether it be recreational golf or you walking for fitness or any of those kinds of things just made me want to spend more time with them. 

I went back and got my PTA degree after my master's, you know it's never over, education-wise for any of us, but I had the opportunity at that point to treat everybody at an acute care/outpatient facility kind of thing, and every day I was being asked to see more patients in the same 8 hours and I'm one of those risk taking individuals that I would not recommend this to the people on the podcast for sure but I take risks and when I discovered that I was being asked to see more patients and in the same hour it really floored me. I went on a search on my own to find the place where I could give that patient exactly what they deserve and Home Health was really that only place. The only place that you're only asked to see one patient at a time and there's a lot of regulations and rules around Home Health and I owned an agency for 10 years in Florida and really went to graduate school. When it came to Home Health by opening an agency and being entrepreneurial spirit, this is my third business and by far my most fun, by far my most successful, and my longest and I've been successful in three businesses but this one you hitting 10 years is a huge mark for us. 

We really believe, and Cindy and I have such a complimentary belief in things being accurate and people doing things the right way because this benefit is so crucial to folks being able to stay at home where they want to be to age in place and live their life at a high quality so that's why Home Health is important to me and that's one of the reasons why we stay in this area of care and in assisting agencies and providing this care.

Christine: Thank you, Sherry and Cindy. Your stories are a little different as have been the journey but you can certainly hear the passion for Home Care in both of your voices in your conversation with us. I'm going to pivot a little bit. We talked about the rules, the Home Health value-based purchasing model was designed to support greater quality and efficiency of care among Medicare certified Home Health agencies. What has been the impact on home care agencies and patient care? Cindy, why don't we start again with you?

Cindy: Well, I think it's important to look at some of those preliminary reports that came out during the demonstration project because right now we're in the early stages of expansion, but I think it's better to  kind of take a step back and say how did we end up here?  I had the opportunity to be a participant in one of the technical expert panels around the value-based purchasing model and in looking at those findings, I guess we all kind of went into it with this idea that this was going to be about quality, right?  Because it talks about value-based purchasing but if you look at about the end of year four, there were some changes in the quality reporting from the participating original agencies but a bigger emphasis on the cost savings. And before we immediately assume it was cost savings in the Home Health space. It was not. The spending in the Home Health space was virtually unchanged by implementation of this demonstration project. The cost savings was coming from keeping people out of the hospital and out of Skilled Nursing Facilities. 

When we look at this intent to expand, we want to keep it in its proper context. Yes, quality is a cornerstone of that, and focusing on achieving that quality in terms of what we're traditionally used to in the Home Health space about the outcome measures or the stars are compare ratings.  I don't want us to get just stuck on those because of the bigger ticket item, essentially that drove expansion was reducing rehospitalization dealing with ED use and ultimately keeping people out of skilled nursing facilities. We want to make sure that emphasis is front and center in our planning because I think some people are seeing that efficiency as oh that means Home Health needs to do less. We need to be more efficient in terms of fewer visits. We've already seen some of those implications happen with the implementation of PDGM. 

Unfortunately on this, we're going to do less and less but that demonstration project revealed that the expenditures to Home Health were not changed so these savings didn't come from agencies trying to cut further corners and narrow the amount of care they're provided.

Sherry: And I think it's really crucial that agencies also concentrate on what they're doing between the Oasis time points. What kind of care is being provided? What kind of patient engagement is happening? So they're also dedicated to the process and what kind of data is being collected and is it accurate and really putting that emphasis on clinicians to provide sound evidence-based care that will result in better outcomes.

Cindy, we see a lot of folks and in our line of business, as we audit quite a bit, we see a lot of folks that maybe are trying to massage the numbers. Is that a good word, massage the numbers on the Oasis items or the collection of that data in a way that comes out better for them in the end but ultimately it comes down to that care. It comes down to the fact that what you do in between those Oasis time points really matters the most.

Cindy: Because that's historically been one of the things that happens is that anytime we talk about outcomes that goes all the way back to when we first started seeing things publicly reported in Home Health Compare. There is an intense focus on the Oasis document that those responses need to be accurate and that's absolutely true but sometimes it could become hypervigilance so that we get very focused on the measurement tool and not on the decision-making in between, like Sherry said. And so unfortunately, we see a lot of this from time to time that agencies aren't satisfied with their current quality scores or they don't like their Stars ratings and so their number one objective then is we have to quote fix the Oasis or fix the clinicians that complete Oasis. 

Now obviously the measurement device for an outcome has to be trusted. We have to be confident that that answer is the best possible answer following the most current guidance whether it's the start of care, a resumption of care or recertification, or discharge. But I think what we've done is we've created this pressure on it that makes clinicians resent this tool more often than not to the point where I get stuck in training. I have to do all of this. I have to do all this extra work to humor Medicare and my goal is an individual clinician ends up being, can I turn it in and not get a phone call or an email or a correction? 

Okay, so my goal is very much get it off my plate and then hopefully I don't have to deal with it anymore over the course of care. Maybe somebody else will end up with the discharge and I never have to deal with it again but if we're really talking about quality and outcomes, it's what we are intentionally doing between those visits and we being well beyond the one individual tasked with completing the measurement device in Oasis. It is the LPN, the PT, the PTA, the OT, the code of the aid, the social worker, some of those are currently not even allowed to touch the document but the decisions they make on an individual visit either get us closer to the objective for this individual. Whether it is we're going to improve certain things that they can do or we're going to keep them out of the hospital or if we're not really paying attention to those things. We're getting tasks done on a visit, no, because that's what somebody put on a plan but may fall short of that measurable outcome because of lack of purpose,

Christine:  Let's expand upon quality and outcomes and I love what you stated specifically, Sherry, around that patient engagement, the data in those points in between those visits, so expanding upon that, where does technology fit into that larger puzzle?

Sherry:  I think that leaning into the tech is so crucial right now. The one positive thing that came out of the pandemic was that we had to use technologies that before we were somewhat resistant to use, and part of that was Telehealth. Part of that was patient remote monitoring. Part of that was simply Zoom visits between your doctor and you or between clinicians and the patient, much of that was stuff that was available prior to the pandemic but we were hesitant to use it.  

I think that we need to go ahead and decide and know as an industry that that stuff isn't going away. And in our patients, as they, as we age through our population, our patients are becoming much more fluent in this technology and my 80-year-old dad is literally on Facebook all the time and and wants to know more about Instagram and just got rid of this flip phone and so they're learning even though they might be older, they're learning this Tech as it comes along and the ones coming behind them, the generation is coming behind them are, this is part of their being. They've been around it their entire life. 

I mean, Cindy and I are of the age group, not to out you in your age, Cindy, we are of the age group that we remember memography and smelling when they come across and I can remember them taking my first Scantron test. We don't come from, we're immigrants to this technology.  I'm quoting de Cornetti when I say that. We didn't come to this as children, whereas kids you know that the Generation Z and the Millennials, they don't know a world without technology. I think that it's a little bit short-sighted if we try and hesitate or go slowly into this new tech revolution because it's here. It's already happened.

Cindy:  I'd like to poke the bear a little bit with Sherry right here because she's talking about that hesitancy to use it. The technology was there before the pandemic but the elephant in the room is people aren't using it because their argument and I'll just play devil's advocate here, Sherry, we weren’t getting paid for it. So if we weren’t getting paid for it then I'm not going to do it. I’m going to wait until CMS creates a specific dollar value for these things and then once they do that then I'm willing to do that but that speaks to an industry that is still very much tied to the idea of a visit, so what say you about that, Sherry?

Sherry:  I say we are no longer in a fee for service and we need to get over it and I hate to be so blunt but we don’t get paid for every service we provide. We get paid episodically in Home Health and also in skilled nursing. We get paid by the number of days and the amount of care that we provide in those number of days. It has to do with what the patient presents with and how we record that on the available documentation which is the Oasis, and coding, and the answers we give to that data. That is so crucial that it be accurate and reflective of what that patient needs so thinking of a beeper service. I get paid for every single thing I do is really passe’ antiquated.  

Cindy:  And if I could share a very specific example about that, it has to do with the idea of Tele-rehab. Tele-rehab is not new. That has been around for a very long time, particularly in the outpatient space about remote monitoring, activity, interactions with patients, remote home exercise programs, all of those things. The irony to me wasn't going to some of those conferences and watching demonstrations of this technology. You would never find one of those vendors at a Home Health conference, whether it was the state one or a national one. They simply weren't there. Now why not? Because prior to PDGM, the number of therapy visits after the year 2000 directly influenced reimbursement. So more therapy meant more money and I always argued, yes, let's not forget that also means more cost of putting somebody out there more but more visits meant more money so fewer visits meant less money so you don't want Tele-rehab. We don’t want to discuss that option. We don’t want a technology that could substitute for some of these in-person therapy visits because it's going to lower our revenue.

A PDGM stepped in and said okay that last vestige of a specific discipline or set of disciplines, their mere existence affecting reimbursement now we're leveling the playing field and say what does this patient need? We've watched therapy visits drop since PDGF, so all of a sudden that's well, there's these technologies we can do remote monitoring and we could have looked at that this entire time because Sherry's right, we get a budget. A dollar amount for X number of days, what we do with that as minimum requirements around the looper because they don't want us to do one visit and try to cash a check for 30 days for the care but at the same time, this idea that I don't get paid to make phone calls, I don't get paid for all my follow-up, but all of that can factor into better patient management which goes back to efficiency of care. And I think that's where that door was open before and the pandemic kind of pushed us through and now we see that the development of G code, specifically in this space to track use of some of those technologies and again, Sherry, what happened with the issue of reporting supplies on claims?

Sherry: I mean many years ago CMS allowed you the opportunity to report supplies and there was a supply add-on payment added to that and agencies just simply did not report them for years. They didn't report the supplies and collect the supply add-on so that's actually gone now. It rolled into PDGN, but I'm going to kind of echo what Cindy said. When we have the opportunity to use the technologies, CMS is going to very slowly, snail-like glacially potentially because of the amount of red tape that they have to deal with to get towards paying for that care once they see the value. We have to report those G Codes appropriately and we have to show CMS in a very real way how much time we're spending in Telehealth or virtual care and how it's benefiting the patient. We have to document that appropriately and we have to be really intentional in doing that if we expect to ever be paid for these kinds of things and just as a side Cindy, in the outpatient space, they are paying for remote patient monitoring now and that did not exist pre-pandemic. It does now because they see the value in that so we have to as an industry in Home Health, we have to show the value of the things we do for patients that do not require us to do a visit. 

And Cindy knows, and she can bear the bear further. I hate the word visit anymore because visits just going to a person's house has no value whatsoever. You have to actually do things to move that patient along their path of care. You have to do things to improve their situation or stabilize their situation so that they can stay in that home and not have to go to a higher level of care. Simply that, how you get there is going to be multifactorial. We have to use that technology and use it in a real way and I'm reminded of a piece of technology we saw, I think it was four years ago Cindy, at CSM. They were trying to get some folks, it was from the West Coast so they were trying to get some folks east of the Mississippi to trial this and they went to the boards of these hospitals and it was about remote patient monitoring and it was basically giving that iPad to the patient and then allowing virtual care to take place and if the patient had a question, all they had to do is click a button and an attendant would show up and it was usually an LPN or something along those lines and they gave the demonstration. This patient had been hospitalized several times for CHF over the last year and they were complaining because they were swollen again. Their legs were swollen again so while they're on the iPad with this patient, this is how they show the hospital the value of this, they asked the patient to flip the camera on the iPad so that they could see the environment that the patient was living in and look at how they're the legs raised on their chair. Well, inadvertently they saw several bags of highly salty chips right next to the chair. It gave them an insight into what was going on and why this patient kept being a revolving door back to the hospital for CHF exacerbations and two of them and according to the gentleman we met, they all adopted this when the capability and that's simply an iPad. We have more available to us in the tech arena that can help to get to what the root cause of some of these exacerbations and unneeded hospitalizations are because our job in Home Health Cindy is what?

Cindy: To keep people out of the hospital.

Sherry:  And sometimes they do a very good job, Christine, of hiding those chips that once or twice a week I come to the house. It's about not that we're trying to spy on the people but it really is to be consistent in reinforcing those decisions you make as a patient, as an individual, can have these kinds of consequences but you are part of this conversation. We can't throw ourselves in front of you to keep you out of the hospital. We need you involved in the process.

Christine: I love it and using technology as a tool really to better advance the health of your patients is really what it's all about. Let's go ahead and let's look forward. Which home care trends coming in the future do you personally feel are the most valuable out there? Cindy, why don't we start with you?

Cindy:  The technology to a certain extent looking beyond just what we think now is a substitute visit. I'm sorry, I use the word again, Sherry, but I think some of it still kind of feeling like I'm making a substitute electronic visit. I think it's more about patient engagement and some of those things one of our colleagues, Dr. Jason Valve has done research in the Home Health space and has been able to identify a specific number of steps per day that if an older adult coming home from the hospital regardless of diagnosis, 4,600 and some odd steps, yes it is that specific, if they do that per day when they first come home there's a significantly better chance of them not being rehospitalized. If they're under it, it's significantly higher. So I think sometimes we think about that. The iPads are the big devices. I think it's exciting to think about the risk devices, the more simple things that many of us already have to say how am I engaging that in patient management because I think patients do want to be more involved in their healthcare. They're just not really sure how and I think some of our kind of well verbalized understanding teach back, it might capture a moment in time where they understood what I said just now but are they able to retain it and incorporate it into their daily routines and I think you know by looking at this whole, how are we keeping people out of the hospital from my multifaceted issue. It is an exciting trend. I think one of the challenges though to go with that is the higher acuity of patients we're seeing in this setting.

It's undeniable that it's a combination of people just being sicker. We saw that trend prior to the pandemic. People coming home with a higher degree of involvement and functional impairments, medical status, and so on but the pandemic kicked that up a notch and I think we're going to see that continue because based on how things went in the Skilled Nursing Facility environment, there are many more patients and their families that are saying I'm not putting them there. I'm not going there, I'm going home and so that raises that challenge as well about how are we going to manage a hierarchy patient effectively and I think sometimes we throw our hands up and say my outcomes look the same because my outcomes are horrible because my individual agency gets the worst patients in the state. Everybody says that, so that's not possible but if everybody's getting the same kind of patient, it kind of levels the playing field.

Yeah, there's like occasional cherry picking but I think it's it's exciting and it may sound like you said like look forward to, and half of what you said sounds unexciting or overwhelming but I think it's an opportunity to rejuvenate how we've approached care not stick to the here's the paper hand out and I go to three times a week and we talk about the same thing but how can I approach this differently and engage you differently and I think that is exciting to clinicians more so than we're going to make a new CHF protocol. Now we have to go to four meetings and we have to stare at this list and then I have to put this protocol on my EMR and I have to check the box every time I go. We could do better than that and I think you as our EMRS are an active participant in this to say you put all this information in here let's see what we can do with it and make good decisions going forward. 

Sherry:  I promise we didn't rehearse this, it is going to sound like we rehearse this because I'm going to go to the social determinants of health. I think that we as an industry for a really long time have ignored the inequities that occur in the way that the healthcare dollar is spent and now there are some ways that we can collect that data to make sure that the people are getting what they need, how they need it, when they need it, and I think that that data collection has gotten to a point where it's again the lids off the data fountain. Everybody can see the data. Everybody can see the numbers. Everybody can see how many times, how much money you spend in care in that 30 or 60, 30-day episode that 60-day episode of care. They can absolutely see it in real-time. 

I think that having the ability to pay caregivers, to pay family caregivers, and some of the legislation that's been proposed in order to be able to have caregivers that could be trained to take care of someone in their home that goes to what Cindy said about the higher acuity patients coming home. Many of them need more care than what Home Health is able to provide so having three or four caregivers, family caregivers that don't have to lose their income to take care of their loved one just makes sense and it looks like it's progressing through legislation so that's going to be interesting. 

The last thing I’m going to say, going into technology doesn't just mean computers and data and all that. There are some really cool mobility tech things going on right now. The biggest mobility check that I had last time, I saw a patient in the house was a Hoyer lift and that's going to make me, well people are like what? How long has it been since you’ve seen a home visit? It's been a little while and the Hoyer lift was very valuable to get patients from the bed to a chair and to prevent pressure ulcers but some of the transfer devices that they have right now and some of the things that they have to keep people independent and safe are kind of amazing and it's a lot of robotic technology and things that I think that we need to look for ways to make sure that's covered for patients so that we can keep people moving as much as possible. 

I said that was the last thing but this is the last thing, is the way communities are being planned. At this point in time, we are watching a revolution where, like Dr. Jason Valve said, the way the community is planned and what's accessible for people as they age is super important: the ability to get back and forth to their doctor's appointment, the ability to walk around their neighborhood and be safe. Those kinds of things are being considered in new community development and I think that's fascinating. 

Cindy: I think part of it is what are the exciting developments in the home care space. It isn't necessarily just looking at traditional Part A Home Health? We have a time and a place. We have a very important role but we're a cog and a much larger wheel in this conversation and we know that people you ask, most people, they generally are very supportive of themselves or their family members being able to stay in the home setting as much as possible so sometimes Medicare Part A is that solution or part of that solution but that's why we have to know the boundaries of that benefit because as there are rules to play for other providers with respect to the private duty area. The personal care folks that we've often struggled on the Part A side to say, well who's the viable person who can take care of this so they live alone? They don't have anybody or the person they live with they used to take care of them and now how is this going to work? How are we reaching out and connecting to those other services to help fill those gaps. 

And to what Sherry said about more planned communities, I mean the exciting things around aging in place just from what we know therapists and there's a whole area within predominantly occupational therapy that works along with contractors because there's so many things available and how you set your home up. If you're building a home or if you want to upgrade your kitchen or you're going to redo your bathroom, there's so many things that if you look for those magazines like Sherry and I have sometimes, you go wow, you could do like everything. It could be like totally tech decked and ridiculously, more than I'd be willing to spend so clinicians are getting into that space to help individuals and their families navigate those and say okay what you really could benefit was this and this that, that's nice but not really necessary and having recently moved myself, you start paying attention to things like doorway width and if I'm going to make that kind of change so a wheelchair couldn’t go through it. What's accessible there? 

So I think the home and I think all of us saw in the pandemic, home is where we got sent to and kept at our safest place to be. How are we going to ensure that that lasts us long-term as we age, as our loved ones age, and so that's why I see this motivation and support of the home. I just get concerned, if our industry gets so focused that it's about us in the Medicare A space like we are the primary focus of this. Depends on the patient's situation and we need to know when to direct them to other resources. 

Unfortunately, we still hear and witness situations where patients are just discharged, told that well Medicare doesn't cover this anymore so bye without really giving them options or facilitating. Here's your outpatient choice or I don't do Part B in the home but here or somebody who does on that connectivity I think is what we're going to need to do to be successful long-term in the home space.

Christine: That was wonderful and a lot of information. The two nuggets that I took out of that was when you talked a little bit about those home devices or personal devices through the watch or the wearables, the mobiles and we all have to remember that in healthcare really the pandemic really accelerated a lot of the adoption of technology but remember, there's a consumer at the other end of that who also has accelerated the adoption of technology through connections, through devices, etc..

I do think it's an interesting time and really puts us on a path to advance beyond what we thought we could do, you know 4 years ago. 

And then the other word I have to say and Sherry you used it. It's a revolution. So this is the perfect timing that we're seeing all these changes come together. These new communities that are being built and planned around the evolution or the assumption that you're going to be able to gracefully age at home. What does that really look like? What do these Smart Homes look like? How can you use technologies in other areas to make that a reality?

Really great conversation today, a lot of passion that I'm hearing, and some good things I can imagine you guys are looking at in the next 10 years, thinking you know how is healthcare going to change? How can K&K really help drive some of those changes forward?

Thank you very much and I usually end with a nice fun personal question and that's just for our listeners to get to know you on a personal note. I will start with asking the question to Sherry.

Sherry, do you have any hidden talents that you want to share with us?

Sherry:  That I want to share, yes, absolutely. I think one of my hidden talents and Cindy's going to probably know what I'm going to talk about is sports trivia. I know way too much about sports and can name Hall of Famers from the '60s in baseball, basketball, football, you name it. Not sure how it sticks in my head but it does so if you have or playing Trivial Pursuit and you need somebody to sports and leisure, I'm your girl

Christine: I have to say as a CFO, you're probably very much a numbers person so that there probably has an alignment there somewhere but Cindy how about you?

Cindy: I love to paint. Before anybody thinks it's like some sort of artwork, it's actually painting rooms. I don't use drop cloths. I don't get any paint on myself, my poor husband can walk by in the middle of the room and somehow end up with paint on himself. I don't know how he does it. That must be his hidden talent but I love to paint walls and I think part of it is along the lines of Sherry and CFO and the numbers for me. When you spend so much time in regulation, and discussion, it's nice to see something tangibly change because of your efforts in real-time. It was this color, now it's another color and it looks different. I find that very rewarding and therapeutic in a way to just paint a room a different color.

Christine: Thank you again, Cindy and Sherry. Great information and look forward to hearing, like I said, the next iteration of Home Care and where we could take health and outcomes and increase that quality for everyone in the community.

Thanks for listening. Stay informed and subscribe to MEDITECH Podcast and be sure to check out our Resource page for links from this episode. We'll talk to you next time.