How He Built a Hospice From 50 to 8,000 Patients: Heath Bartness of St. Croix Hospice

About This Episode

Transcript

Tom Maxwell (00:15)

All right, welcome to the next episode of the Last Visit First Podcast. Today I have a special guest. Heath Bartness is the founder and chief executive officer at St. Croix Hospice, one of the Midwest leading hospice organizations and one of the nation's largest. He's founded St. Croix in two thousand and nine with a simple, but ambitious idea. People facing the end of life deserve exceptional care, and that care should be available regardless of where they live. But Heath's past to hospice, didn't just start in hospice.

He began his career working with the Iowa Department of Public Health and later served as secretary for the Iowa Senate Business and Labor Committee. Have no clue what that is, but he'll tell us here in a minute. From there, he moved directly into healthcare operations, serving as an administrator with care initiatives and later leading Arbor Springs, a long-term care center in West Des Moines. Since its founding, St. Croix Hospice has expanded extensively across the Midwest.

While maintaining a strong emphasis on the local clinical teams, hospice access, quality, and organization of culture. We're going to dig hard into his culture. Heath has been particularly focused on bringing hospice into the role in underserved communities and reaching patients earlier in their end of life journey. His leadership philosophy centers on the behalf of the culture isn't created by words on a wall. It's created by decisions leaders and employees make every day, and ultimately by how the organization treats its patients, families, that they serve most.

Today we're going to talk about St. Croix's building scale, leading hospice without losing the mission, leadership, culture, technology, and the future of Medicare hospice benefit and what Heath has learned in the last two decades building one of the top companies in the United States. Welcome to the podcast, buddy.

Heath (01:50)

Well look, thanks for having me and I gotta say that's the nicest thing anyone's ever said about me, especially coming from this side of the river here. So I appreciate I appreciate the kind words, Tom.

Tom Maxwell (02:01)

Yeah, first and foremost, most people ask me when when you talk about Saint Croix hospice, they think you're talking about an island. So where did St. Croix come by and what does that mean? And how'd you get the name?

Heath (02:10)

Well Saint Croix is it's actually a river that separates Minnesota from Wisconsin. But in Latin, Saint Croix is also, you know, the Holy Cross or Holy Crossing. And so there was kind of a double entendre meaning

Why we pick that name. One again, just from my personal belief of the crossing from one life to a next. And then secondarily, obviously, the the geography that we had ambition to someday serve. You know, perhaps at some point we would serve both the the Minnesota side of the St. Croix River and the Wisconsin side. And and today, today we serve well beyond those borders.

Tom Maxwell (02:49)

That's awesome. All So let's go back to the beginning. Take me back to 2009. What did you see at Hospice made you think I can build something bigger than that or better than that?

Heath (02:57)

Well when you

were when you were speaking so kindly about my my past, I was a nursing home administrator and and I tell ya I I loved my residence. it was it was the greatest. you know, I was I was twenty three, twenty four years old, running a nursing home down in Iowa. And you know, my buddies that I lived with at the time, we lived in a house together in in Des Moines and you know, one of them was smart enough to to buy a house and then make us pay the mortgage by

by renting from him. and you know, I got into the into senior health care and and and started writing this nursing home. And they'd say, man, you know, how do you do it every day, right? I mean, how do you go? Isn't it just this dark, depressing place? And I said, look, fellas,

When you guys are sitting at your cubicles, you know, working on spreadsheets, I'm I'm making macaroni art and watching the NCAA basketball tournament with my residence. I have the greatest gig in the world. You know, I mean I'm th this is fantastic. The only thing I didn't like is the building itself, right? There was always some nuance, whether it was HVAC or or

leaks in the roof or you know something with water temperatures, and then the you know housekeeping, laundry and maintenance, there was always nits that just were frustrating that that did not allow us to fully focus on our residents and their families. And so how this came to evolution is is that you know I I would see these hospice programs come into our

into our building and look they they were good. I mean they they were not bad hospice programs. but I would oftentimes think, boy, if we could do this ourselves, we can do this better. You know, we would check in and check out every single visit. You know, I would make sure that people knew who we were and when we're coming back. You know, I'm the nurse. I'm not a family member you haven't met yet or whatever it might be. And and so, you know, I started talking to the owners of the nursing home.

that was operating, I said, look, you know, I I really think we can do this different. And I think we can do this better. and and really be, you know, a bit of a you know

addition to the the care that we're providing as you know as opposed to a supplement, right? I mean which we can't be, but how can we help add value? And they said, okay, well, look, we're sick of either hearing you talk about this or they really believed in it. I'm not quite sure, but they said we will fund you to go do this, but you can't do this in Iowa in case you fail. Go back home to Minnesota and do it up there. And you have two years. And in two years, if you're successful, great.

If not, then any nursing home we have open, you're coming back and you're running a nursing home for us. So look for me it was almost a win-win because it was something I was very passionate about. and I also knew I had a a bit of a safety net and that, you know, these these owners of the facility had trusted me and had seen the the the value of what I did as a nursing home administrator.

But I've not moved back to Iowa since so so I I here we are in Minnesota and and this is where we stand. At the time, our goal was to to someday

have 50 patients. We thought if we had 50 patients, we made the big time. And there was a there was a health system in the Twin Cities. It was called Health East and it was an East kind of St. Paul area health system. And they were kind of the dominant program in in the East Metro. We thought, well if we could just be second to them, you know, this this would be this would be a success.

And today, Tom, we serve nearly 8,000 patients in 10 states, and that healthy system doesn't even exist anymore. and so we certainly have gone above and beyond any of the wildest expectations I could have ever had. If you would have told me even three years ago that we'd be doing what we're doing today and I'd be on the horn with you talking about this, I would have said you're crazy. Like they're they're just

Every single blessing we've had has just been hit hitting us like a ton of bricks. And and we just kind of shake our heads sometimes and say, How did we get here? And you start off by really talking about culture. and that's a success. It a hundred percent is. I am not the smartest person in the room. I'd like to think I'm the smartest person on this podcast, but but but perhaps

Tom Maxwell (07:16)

Ha ha ha.

Heath (07:17)

I'm not even that. but but I will say that.

One thing that I learned early on is that as good as I may have thought I was, right, at sports or or anything,

I wasn't probably that good. I probably thought of myself as better than what I perhaps was, or maybe what I strove to be. And so surrounding yourselves with talented folks that could do things you could not do, that's what the focus was. And to this date, our chief clinical officer, someone that's been with me for you know 15 years, our our chief commercial officer, who's had multiple roles in business development and in HR and chief administrative officer titles, he's been with me for

Almost 15 years. Our chief medical officer, Dr. Andrew Mayo, you know, he's been with us for over a decade. I mean, the talent just continues to be here and to continue to kind of take that same sentiment forward that we need to continue to add talent to the team and talent that does things differently than us.

Tom Maxwell (08:20)

Amazing. All right. So do you remember back to that first hospice patient you had in St. Croix?

Heath (08:25)

Never forget. I could tell you the patient's name right now. I went and visited him the day of the admission and

Tom Maxwell (08:32)

Okay.

Heath (08:32)

I was scared to death of what we were walking into. But yeah, absolutely remember it like it was yesterday. Yeah.

Tom Maxwell (08:39)

That's amazing. Most people don't

remember the first patient, but I'm glad you do. Is there one patient

Heath (08:43)

I

Tom Maxwell (08:44)

that really got you that the the one that you really remember?

Heath (08:48)

Well, I don't know there's one that that I really remember outside of the fact that you know we we've cared for yeah, I've we've cared for family members of mine. My grandmother, my grandfather, we cared for a very close friend of mine who who who works with us, his wife who was a patient. there there's so many. we just cared

Over this last weekend, we we lost a high school classmate of mine that was a patient of ours and had chosen St. Croix Hospice without even knowing my involvement with it. And so every time I look at the obituary and the towns that that I grew up in, you know, on the Iowa-Minnesota border, a town of 400 people, the the the town closest to there in Iowa is is is where you know that has a funeral home.

Whenever I see the name St. Cro Hospice in those obituaries, I think, you know, this is just incredible. You know, like th there's there's there's no reason that they'd choose us. You know, I don't go there and and and and try to tell people what we do or anything like that. They choose us because of the reputation of our team that services that area. You know, it has nothing to do with me. When we've seen patients that we've taken care of that are of celebrity status or or patients that, you know, have some

connection to us. and I think, you know, look, it this is because of the team itself. We had a an incredible story. that was not even the best story, but this happened right right right around the COVID era where we had a patient

you know, in in their eighties or or so, and her and her husband had been married for a number of years. I I believe it was somewhere around you know sixty years they'd been married. And they never got to have an actual wedding because they got married at the Justice of the Peace right before the husband went off to World War Two. And our staff members had heard about this and so they went and they were able to work with the family on on finding a wedding dress and there was some

amateur photographer that they were able to find and they actually held a ceremony in this patient and her husband's backyard. Okay. Something that happens more frequently than you could even ever imagine.

Well, if this happened on a on a Wednesday or Thursday, I I couldn't tell you, but on Saturday morning I got a call from the Washington Post and they wanted to know they wanted to comment about this story that had happened with this marriage. And I said, Geez, you know, I I didn't know anything about it. You know, this is nothing. No one ran this up the flagpole. I mean this is just what happens, you know, and and and for every one amazing story that goes viral, which which this story did, it was in the largest media outlets in in

you know, UK and Spain and France and Italy and and I mean this this thing just went viral and it was all done by the team. I mean there was there was zero engagement, zero involvement from me whatsoever. And I told the the reporter of the Washington Post, I said, look,

This just happens. And and I wish, I only wish you could capture all the times this happens against none of the fanfare that this one did. And it's look, it's not just our program. I mean, the other hospices that do these things, they're they're they're beyond amazing. I mean, they're incredible.

Tom Maxwell (12:04)

All right. So Heath, when did you stop feeling that the that you were running a startup and that holy crap, this is gonna be something great.

Heath (12:13)

Well look that I don't know if I've ever felt that way, to be honest with you. I mean, I still, you know, put my pants on the same way I did back in two thousand eight, two thousand nine. I make a priority about, you know, engaging with our new hires and sending handwritten notes to every employee upon their anniversary date. although we are much bigger in terms of size and scale,

This is the only thing that I know. I you know, again, I ran nursing homes for four years and and I loved it. And and then I immediately went into into the world of hospice care. And so it I

Look, I don't ever even see myself as a CEO. I mean, a CEO is supposed to be someone that wears a suit and a tie. Cry me snakes. The only suits and ties I own are from you, Tom, because you lost all that weight and you've given me your your your hand-me-downs, hand-me-ups, whatever you want to call

Tom Maxwell (13:01)

It's true. That's a true factor, yeah.

Heath (13:05)

so so so no, I mean, look, it we we've just kind of always been the same. And again, even though

You know, perhaps we have some some better negotiating power with some of our tremendous partners out there from a pharmacy or medical equipment or supply perspective. you know, that's about it. otherwise, you know, the model has stayed largely the same. Certainly the depth of the team members is different. You know, you you hit these different cliffs where

all of sudden, you know, a a more sophisticated EMR system is required. You know, getting real HR. Right. At the time, I was the founder, I was the HR, I was a salesperson, I was the office manager, I was the the kind of the pseudo-biller. Right. I mean you had to kind of do it all. And now there's people that do it that are, you know, much more skilled than what what I ever was at those different functions.

But nothing's really changed in in terms of how we act or function or anything like that. and I think that's that's perhaps part of the the culture that you know continues to endure and something that, you know, if if I did show up in a suit, I hope it'd be at my funeral.

Tom Maxwell (14:18)

I remember the first time I met you, or one of the first times I met you and interacted a lot. You were still sharing an office with Mayo and Nate and Brian and you, and you all had four cubes in an office. And that was that was the CEO's office at this company. I walk in, I'm like, What in the world?

Heath (14:32)

Yeah.

Tom Maxwell (14:32)

I that I mean that was that's the real Heath though. That's what we all know and and remember. And I don't think I've ever seen you in a real suit either. I think I've seen you with the jacket on, but no no real suit. Which is great.

Heath (14:41)

Yeah.

Tom Maxwell (14:42)

I d I don't like suits either anymore.

what was harder? Getting from zero to a first scale meaningful or scaling the organization to where your momentum is today?

Heath (16:20)

I think that they both had significant challenges, right? I mean, getting to a hundred patients was something that was phenomenal and exciting and something that, you know, the the buildup to it was just it was just incredible. It it really was. going from 7,800 to 7900 patients, right? That that's something that it just it just happened, right? I mean, it it was it was very different feeling. I would say though that

You know, those early days when we were all learning together and and and making mistakes and learning from those mistakes and and and whatnot is what has allowed us

To grow from 78 to 79, 79 to 8,000 and and not and not have to think about it, right? Because it's just it's it's innately built into our DNA now, how things ultimately work. And and you know, there's still challenges, there's still hiccups, there's still footfalls. You know, one thing that I've shared with our team is the only thing that we can promise a patient or a family is at some point something that we plan will not go as planned. Right? That that's an absolute promise that we can keep. Beyond that.

There's so many unknowns, there's so many what-ifs that we could try to hypothesize and plan out. And we could have a whiteboard that looks like hieroglyphics saying if this happens and that. But we know that at some point a nurse is going to have a sick kid and they're not going to be able to make that visit at 10 o'clock and someone else might make that visit at noon. We know that a nursing assistant may have a flat tire and and that visit at nine o'clock in the morning with that bath that that patient needs and wants may have to wait until 10 30, right? We know that we live in the Midwest and there's there's

There's snow and there's ice and there's things that happen. But as long as we have relationships and we're honest and we're sincere and and and and we really do communicate well, all those things can be overcome. And I think that's the one thing that a lot of programs who strive for perfection that can never be achieved get really anxious about.

It it it it's it's the unknowns. And and look, I'm that way by nature. I mean I've got a plan if I win the Powerball tonight. I've got a plan of how I'm gonna spend it.

But I don't really expect it to happen. But if it does, I'm ready, you know? And and

Tom Maxwell (18:33)

Ha ha ha.

Heath (18:35)

and I think that I think it's hard to do that when you're dealing always with people, right? I mean, our only asset is our team. We we have no other asset. Our brand might be worth something just because that's what someone says that it is. But in terms of reality, it's our people. And it and I'll tell you, every nursing assistant we have, I would be more more than grateful to have them take care of my mother, my grandmother, my father, whomever it is, myself.

every social worker every chaplain every nurse every nurse practitioner our music massage therapist every mddo that we have they're tremendous people that really do care i don't think people typically go into hospice because they want to make money

That's not why people do this. People truly feel that this is a calling. And I look, I I have heard people talk about it as a ministry, and I actually fundamentally believe that that's what it is. We have an opportunity to impact someone when they take that final breath of their life. Now, some people, that's really impactful.

Other people, it's not for them. That doesn't mean you're a bad person. That doesn't mean you're inept or or or unable to be kind and caring. It's just not for you. That's okay. You're probably not gonna work in a hospice, and that's okay. You should go work somewhere else. But for those that have that, for whatever the reason, that hole in their gut to help impact someone when they take the last breath of their life, once you get in hospice, it's your home. Now you might leave for a for a brief respite, and a lot of people need that, right? It's very emotional.

Tom Maxwell (20:07)

That's right. They say people birth souls or they birth babies, you know, and there's a difference between the two, but they're both nurses doing something. And so that's really interesting. All

Heath (20:14)

Yeah, yeah.

Tom Maxwell (20:16)

right, you talked about all the roles you had there. Which one of those roles, you know, you were the janitor, you were the I'm sure you were the guy that s you know, scoop scraped the snow off the sidewalks and all that for the people that 'cause you're always the first guy in the office. But what responsibility was the most hard for you personally to give up as you've expanded and grown and grown?

Heath (20:35)

Well, again, I I I would say this. If if if there is a desire to be a problem solver, which is which is what I would say is largely what the role of a CEO in my world has been.

Some would argue that it's a need to be in control as opposed to just being a problem solver. not that my wife has ever said that, but perhaps she has. I would say that's it. I would say that it's, you know, I just had our super talented director of marketing communications that came in and said, hey, you know, we're changing our name badges, right? We just have a very simple name badge, right? Everyone has to have a name badge with a picture, your name, your title on it.

She says we're changing the design. Would you like to, you know, have some input in it? And it took everything in my power to say no.

you know, you certainly can make that decision. But I know that if I say yes, then I'm putting a lid on her ability to be as successful as she can be. And that's one thing that that I learned early on is that you know we oftentimes want people to you know to grow and to develop and evolve, right? I mean like we all want that. But sometimes we unknowingly put lids on these folks and then we don't give them that opportunity. And if it's a mistake, if it's a design that doesn't work out, guess what? We'll change it, right?

She'll change it. I'm certain of that. but I would say that was probably the the number one thing, Tom, is that

you know being involved in every single decision is something that definitely impacted impacted me probably the most i mean to the point where at one time and this is very i guess self-disclosing and i'm kind of embarrassed to say that but hopefully it may it may impact others out there but i was counting paper clips i early on i would i would say why do we have staff members that have boxes of paper clips in their office desk drawers i mean you only need one paper

Clip typically at a time. Like, why can't we share a box of paper clips? Instead, everyone has a box of paper clips in their in their desk drawer. Well, what a foolish thing to be nickel and diming and worried about, right? And again, it wasn't necessarily about money in terms of margin or anything like that. It was, well, one, we had no money at the time, but it was more about how can we be most efficient and effective of what with what we're doing.

And that was a terrible thought process to have right. It was give give the team members the tools for them to be successful and then stay the heck out of their way. and so I was actually encouraged by our our chief clinical officer at the time and our CFO, Brian, you mentioned, and and another gentleman's name was Gary Corbin. Heath, you need to spend a week at home. Do not come to the office, do not think about work. We actually are banning you from being here. And it was so hard, it was so hard for me to.

do but but it was really good and look the company ran perfectly fine without me for one week there was no issues no challenges and if there were issues or challenges it got resolved right and so look as with most things and Tom I'm certain that it happens in your world as well we learn early on

That although we were the founder or although our title is what it is, it's so much bigger than any one person. It it just is. And and ego aside, it's really important that we just acknowledge that, I think, and we say, look, we got great people that can do great things. And they're probably gonna they're probably doing things that are greater than anything I could have done.

Tom Maxwell (24:07)

Yeah. It's a it's funny that I remember the paper clip story. I think you've shown me that before, but I I remember also having that same conversation of why do they put bags in this box of paper clips? Why do you need a box? Why can't you just get a bag? And so we're just cycling and cycling, cycling order and order, and we're just crazy. it's right. All right, what did you refuse to change from the early days of St. Croix? There's still something there and people say culture, all that, but I what's the real thing? Like do you you d you're never gonna change this? St. Croix can be

Heath (24:34)

Yeah.

Tom Maxwell (24:35)

five thousand bigger.

ten thousand bigger than you are today and you're never gonna

Heath (24:38)

Yep.

Tom Maxwell (24:38)

change this one thing.

Heath (24:40)

I do town halls, Tom. I go to every office once every year, year and a half. And I walk in and I say, Look, this is your meeting. You can talk to me about whatever you want to talk to me about. Five foot eleven, two hundred and sixty-five pounds, right? I mean, I'm not afraid to answer any question you have. If I don't know the answer, I'm not gonna make it up. I'm not a good politician, I can't spin things very well, I'm gonna be blunt and direct. But the only thing I care about, the only thing

Is it worth the best?

You have to live it, you have to believe it, you have to know it. We have to be the best. We have one opportunity to give a patient and family a positive end-of-life experience. There's no do-overs, there's no second chances. We have to be the best. And I hope and I pray that every single hospice program feels the exact same way. And I hope they'd unapologetically say that, because I unapologetically would say that to any of the cop competitors that are listening to this right now. We are the best. And I hope that they'd say the exact same thing. No, we're

The best, right? Because if we're not the best, then what are we doing? Right? What are we even doing here? So that is the one single underlying factor. Our team members have to know it, they have to believe it, but most importantly, they have to live it. That means that if there's an order of mouth swaps, something very simple that sometimes you dip in seven up just to keep your mouth, your mouth moist, that if they were concerned that a family member may not know how to deploy these.

That on their way home, they would make a stop just to make sure, right? Like that's being the best. It means checking in and checking out with community providers. That means showing up when we say we're gonna show up. Look, things happen. We know that things happen. But if we're gonna be late, what's the responsible thing to do? The responsible thing is to call that patient or that family member and say, look, this is Heath.

Gonna be seeing your mom this afternoon. My visit prior took a bit longer than I had anticipated. I'm not gonna make it at 10 o'clock. I'll be there at 10:30, right? Like it's so simple. Instead, what we oftentimes do is you come in, you apologize. I'm sorry I'm late and whatnot. No, like like there's just simple things. And so by doing those things, lots of things can change. So being the best, that is a hundred percent the only absolute that we have at St. Croix Hospice.

Tom Maxwell (26:56)

Your your example of being there thirty minutes late and you know the patient's sitting there waiting on you and they're nervous about it and all that. It's so it's so important. I mean, if you just take that to a Home Depot, like I ordered a wine fridge for our downstairs basement and I got a message that in the night before that we'll be there sometime between eight AM and six PM. Well, you said you were coming tomorrow, so I know you're c give me a you know, thirty minutes advance forty five minutes. Can you call ahead? No, just gotta somebody's gotta be there. And you're like, Are you kidding me? It's just terrible. That same concept happens to patients all the time.

All right, what's one decision during the growth of St. Croix that you thought was wrong at the time you made it, but turned out to be the best decision? Can you think of one of those?

Heath (27:32)

Well, look, music and massage therapy is something that immediately comes to mind, and and I say that because I truly believed that music therapy in particular was absolute hocus pocus. I thought people did this because it was a marketing agenda that that that was, you know, trying to get a leg up and an opportunity that perhaps you wouldn't have without until I saw it work.

And and look, my story is a little bit different than probably most hospice folks' stories. My story with music therapy actually has nothing to do with hospice. I had a very, very close friend who was in a very severe car accident down in Iowa coming back from an Iowa State football game.

And he was found a day after his accident happened, kind of in a drainage ditch, and you know, in really, really bad shape. And he was fortunate enough to have the care from the world famous Mayo clinic. And one thing that happened was while he was there

subsequent to him you know getting you know getting back kind of on track a bit and and you know he was in coma and things like that was he was getting a rehab and this rehab person had a music therapist there and the music therapist individual they would when they played the music when they played these different beats his step count would increase based on the beats that they were playing. And and I

I didn't understand it at first until they they kind of the the physical therapist kept going back to the music therapist saying, Well, you know, let's let's go one more, right? One one more beat or whatever, beat a second. However, how I don't know music, but however it works. And and it kept getting faster. His his his cadence kept getting faster. Like he kept going more, you know, he'd go a further distance in and all that.

And I was enamored by it. I thought, geez, I mean the psychology of this, how music can really impact someone to get a result, to get a result that they're looking for. I had never thought about it that way. And so music therapist therapy is one of those things that I would have said, we're never gonna do this. I mean, this just doesn't make sense to me.

And now we see it almost as core to our program, right? Just the impact that it can have. And again, not from entertainment. If it entertains someone as well, great, right? There, what's wrong with that? But the the actual non-pharmacological intervention to palliate a symptom that music therapy can provide, who would have thought, right? But and again, music therapists obviously knew it, but I certainly did see the light until I had that experience. So yeah.

Tom Maxwell (30:07)

That's awesome. Yeah.

That's it's interesting. we had a lady on the podcast here a couple weeks ago that's gonna come out and she was talking about the one thing that made her mother in law who she was taking care of happy was singing. And she's like, We sing all the time and she's like it would just bring a smile to her face. Even she had, you know, dementia and and Alzheimer's and all that. Couldn't understand anything she'd say, but she could sing and it was the the one thing. So yeah, that's cool. I didn't know that story Peter.

Heath (30:33)

Well, and you know what, Tom,

it's it's it's it's also interesting because we have a daughter. My wife and I have four children and are fostering two newborn babies as well. So we have a house a houseful right now. But we have a daughter that that's a senior in high school, and so she's pursuing she wants to pursue nursing. Now I hope she really wants to be a nurse, and it's not just because her dad has said nursing's the best career you could ever have. but if she's listened to me

Tom Maxwell (31:00)

Right. And y you need another employee.

Heath (31:02)

Yeah, yeah. But if she's listened to me for that, that I'll take that too.

Tom Maxwell (31:06)

Yeah.

Heath (31:07)

But I was sharing with her, I said, here's why nursing is so incredible, right? One, you can do it anywhere in the world. You want to be a nurse in France, guess what? It's a different language, a different EMR, probably. But look, the same practice is in place, right? You want to go to California, you want to go to Hawaii, you want to go anywhere. Like you can do this. You want to, you, if you're really big into like in the Midwest, if you're into hunting and fishing, right? You can work three, four, 10-hour days, 12 hour days, whatever it's like. There's so much flexibility when it comes to being a clinician.

And you know, it's it's a role that AI, robotics, and machine learning will never be able to replace, right? The value of human-human interaction can never be replicated by AI, robotics, or machine learning, right? It can't just it just can't be. You know, robotics, machine learning, it can never touch and smell the things that you can when you're a nurse, right? I mean, there's just so many value, so much value to that. So I had a conversation the other day with a social worker.

And we're talking about caseload, which is something that obviously happens quite often. and and we serve, as you mentioned on the onset of this podcast, Tom, that you know, we we really serve a rural and tertiary market. We we we have operations in and around cities, but it you know, it it it's we're not downtown Chicago.

per se we can serve there, but most of our patients are suburban, rural. You know, we have an office in a town of of you know 980 people and you know we serve a hundred patients out there. Well we don't serve as just that town obviously it's it's you know two or three counties you know in circumference but you know that that that's just who we are. And so when I was talking to her about the social worker about

about her visit for frequency and whatnot. I said, well, you know, look, 85% of our patients have some diagnosis of dementia. Now it's not the primary diagnosis, but they have some form of dementia. What's the value of you going to a patient that has dementia every other week or once a week? And she kind of looked at me like I was like I was from outer space and she said, Heath, when I go see Ethel,

She smiles.

Well you got me there. I I can't argue that, right? I mean how

Tom Maxwell (33:23)

You can't.

Heath (33:24)

how how can you argue that? And so I think that as much of what we do from a medicinal, from a from a non-pharmacological or you know, again, perspective, sometimes we forget the value that that human-to-human interaction really does provide and how grossly impactful that can be.

Especially in some of these rural communities where their sons and daughters and grandchildren are living in the Twin Cities. They're living in a more suburban metropolitan area. And that visit is the visit they're looking forward to. That might be the last visit that anyone ever has is that visit by that social worker. So who the heck am I to challenge a show social worker and say, well, what value are you providing?

That's not really my call. That social worker and that IDG group, they're the ones that need to say what is the value of that visit. And I think that's really important. And so oftentimes, people with titles such as you and I, we get in the way of that because we we think, I guess logically, or

algorithmically almost to it, and we're wrong. We're wrong so often because we don't know what's going on. We don't know how impactful that is. Yet here we are thinking or looking at a spreadsheet or trying to do some analysis or trying to defend a decision that we made, like in this case with a caseload. and here, you know, again, one word, you know, one one quick response. But she smiles at me. Yep, can't beat that.

Tom Maxwell (34:59)

might be the best

best best thing that happened to that patient all day long. The social worker showed up, you know?

Heath (35:03)

Could be. Could very well be. Yeah.

Tom Maxwell (37:15)

All right, flip that around. What decision would you absolutely make different if you could do it again?

Heath (37:20)

Boy, that's that's a tough one because I I'm certain there are a number of decisions that I regret making.

I would have probably done things sooner. I would have, you know, probably looked at implementing our fleet vehicle program for employees sooner. I think I would have probably done something in the form of an ESOP for our employment employees. I think that would have been really impactful. I really wish that we would have done that early on when we had an opportunity to to do something like that.

you know we set a minimum wage coming out of covet i wish i could have i wish we would have had that in place prior to we set a minimum wage coming out of COVID and and here's what happened and we had it we had great partners at the time that supported this philosophy but it was something that i was nervous we we couldn't get across the finish line there's a convenience store chain in in the midwest it's called quick trip

They're based in La Crosse, Wisconsin. And I believe, I'm in fact, I'm almost certain that their that their CEO is a physician. his family started and he was a practicing physician of some kind, maybe even a surgeon. And he he left medicine and and is now running Quick Trip. And look, I don't know Cook Trip, I I've never met the guy. so so I there's there's no

No benefit in me saying this, other than I was at a quick trip, which I enjoy going to too often for lunch. They have great pork rib sandwiches. and sometimes they're on sale for

Tom Maxwell (38:46)

Disgusting.

Heath (38:47)

two bucks. Yeah, but no, they're great. They're great. a little barbecue sauce, some honey mustard. Anyway, there was a there was a sign on the on the door. this is right after COVID that said overnight shift, 19 to $20 an hour. Okay.

I remember looking at that and I came back to the office and I told our our current CFO, Stephen Phenneger I said, Steven, what we do has to matter more than the overnight cashier at Quick Trip. Again, I love Quick Trip, right? Nothing to be not no intent to offend Cook Trip. But we we have to have a minimum wage higher than this. Like we have to make sure that every single employee is making at least $20 an hour. And he said, geez, you know.

At time, some of nursing assistants, especially in rural, rural markets and Missouri and Iowa and Nebraska, you know, 20 bucks an hour was not a number that we were hitting. I said, we need to do this. And we we we we Steven and the rest of the finance team were able to figure out how to make this happen. We got approval from our board and we roll out this $20 an hour minimum wage.

Within 24 hours of announcing this, we were post, we had a post by the Minnesota Nurses Association, a very prominent labor, organized labor group here in Minnesota, that gave us a kudos, right? Like of anything, like I was scared to death that we were tagged somehow with with Minnesota Nurses Association.

a kudos, right? They and they were they were congratulating us on stepping forward and announcing this. I had calls from countless employees of ours. One I'll never forget. It was a nursing assistant down in Missouri. It was an acquisition we had just done. And it was it was a small acquisition. But this nursing assistant had called me and said, You're on speaker phone with my son and my husband. I want to let you know that you have changed our life.

You have changed our life. I said, how you know how because of what? Twenty dollars an hour is something that I never dreamt I could be making. You gave me an eight dollar an hour raise. Now I didn't realize that we had that big of a delta, but again, it was an acquisition, all fairness. She said, You have changed our lives. And I thought, geez, you know, if if if we can do this, not that that's my goal, not that that was my intent. My intent was to try to ensure that.

people knew we appreciated them and to try to help get the price point up. not to not to have people call me and say you changed our lives. And so that was just something that again, I'll never forget. And but if there was something at you that I would answer again your question.

what would I have done differently? We would have done that sooner, right? I I mean I think that that I think that there was an opportunity to to do that sooner and and and maybe that twenty dollar an hour minimum wage would have been twenty two, you know.

Tom Maxwell (41:46)

It's awesome. And it's awesome that she picked up the phone and called you with her husband and son on the phone. That's even better.

Heath (41:51)

What

Tom, I've been told that I am by almost every H R person we have that I'm too approachable. And I take that as a g with great deal of pride, that I'm too approachable. So yeah.

Tom Maxwell (42:02)

Yeah, that's good

though. If they wanna yeah, but if you want to know what's going on in the field, what's something that

Heath (42:06)

Yeah, exactly.

Tom Maxwell (42:07)

you tolerated as a younger CEO that you simply won't tolerate today though?

Heath (42:11)

Well, I still struggle with this immensely. and I have been told by many, including many that have been on my board, that I have I'm loyal to a fault. And I really struggle with moving on or moving away from team members.

That have impacted us in significant times of need. And then perhaps their world, our world has just grown apart. And perhaps they're not as strong of a player, or their their their skill set has changed or evolved even. and and and I have been reluctant to accept perhaps that they're not the next in line to be the next whatever. Or

that you know that it's not going to be a a good long term fit. and so that that I'd say is is probably is probably number one. Number two would be I st it, you know, if we get one complaint out of every 100, to me it's like a hundred are complaints, right? I mean we we get 99 glowing compliments and one person's frustrated about the delivery of something.

Or about the inconsistency because people have to take days off, right? And and they were upset that it wasn't the same nurse, even though they had the same nurse for the last eight visits, the ninth visit was the on-call person or whatever it might be. that irritates me still to this day. And and I know it's it's it I know that it's normal. I know that it's it's something that is not possible per se to even be corrected because again, things, things happen and and and whatnot. But

I have a hard time accepting a negative as not something that I should not overreact to, right? I I probably overreact to a lot of the the negative that we get. Now again, fortunately it's ninety-nine positive and one, you know, one negative. Yeah, but but nevertheless it still is something that I truly take to heart. And when I do look at those obituaries in my hometown that I mentioned.

And they didn't choose our hospice or they didn't have hospice at all. I mean, I want to call my buddies whose grandmother it was and say, Why didn't you talk to me? Why, why I mean, jeepers creepers. I mean, we we could have we could have been there. We could have provided so much value and service, in particular when they don't choose hospice. You know, that that's what's really still tough, right? I mean, we still have, you know, fifty percent or less of persons in the markets that we're in that elect this benefit. You know, I mean it it it's it's just

It's just bewildering to me that that the concept of hospice is still as immature as it is to the general public. You know, they still think it's, you know, days, not six months, right? Which which is what the ideal scenario is. When I tell them Jimmy Carter was on hospice for over a year. You know, like things happen. Now his wife, she was on hospice for, you know, less than a month. I mean, I think it was weeks, maybe even less than a week. you know, it it it

You got we gotta get more of those stories out.

Tom Maxwell (45:25)

Yeah, I think it's and we've talked about this a lot on this podcast. I think a lot of it was historically a hospice was a hospice house. It was a an area of the hospital they moved you to that you went there to die. And that's

Heath (45:32)

Yeah. Yeah.

Tom Maxwell (45:34)

what most people think as hospices. They they don't know that it's in home hospice and the story's getting better and better and better. And the more more times that people experience a g you know, a great hospice outcome, the better off they are. But you're right. Still fifty percent of the people go to the hospital to die. And they don't they

Heath (45:48)

Well and you know

Tom Maxwell (45:49)

don't die in their own home with their own cat and their own remote control and their all the spiritual care and

you know, social workers coming out and help you do family planning and end-of-life planning and all that. None of that happens. They just they go to the hospital and die.

Heath (46:01)

If I ruled the

world, my number one target would be primary care. We have tremendous primary care in this country. They're tremendous people. But when you see someone with a terminal diagnosis, certainly not with a life expectancy of six months or less at this time, but a patient that has a terminal diagnosis, CHF, C O P D, you name it, and they're seeing their primary care provider, you know, every six months.

Now it's once a quarter, right? Now they're coming in every three weeks, right? And and it's chronic conditions, right? It's chronic management of symptoms. It's med management. It's it may be vertigo or things like that, right? And on a Monday morning, that primary care physician sees a patient panel and notices that on Friday, patient Heath went to the ER. Well, I had just seen Heath and his wife not long ago.

Huh, well he's in the hospital. They're talking about discharge planning to hospice. well, that's really not good. Like this is not what we what I had expected or anticipated, but it doesn't really surprise me. Right? This this is the story you hear from these primary care providers. And if only when Heath was going in every quarter, there could have been some opportunity to educate.

some opportunity to communicate, some opportunity just to engage about this thing called hospice that Heath doesn't have to go on a Friday night in February.

With a foot of snow on the ground and ice buried underneath it into an ER that has people with pneumonia, people with flu, all these different elements that are happening. Heath probably has some form of dementia. And so he's confused. Heath's wife is trying to lift him and pull him. And again, 265 pounds, it's not easy, especially the size of my wife, to move me around in and out of bed or out

Tom Maxwell (48:03)

Ha ha ha.

Heath (48:04)

of a house. And it all could have been prevented.

And and look, it's good for not just Heath and his spouse and his family, it's good for the provider, it's great for the hospital not to have that bed, you know, used by me, and it's great for the Medicare benefit, just in general. And so if I was if I had any control of how to impact things, it's not that our primary care providers are uneducated or are not intelligent enough.

It's just that it's not nomenclature. It's just not how it typically happens. And they have patient panels of a thousand patients or more, and they're trying to just keep up. And so again, somehow that that nut is going to be cracked. And I don't know how, Tom, that's going to happen. I don't know when that's going to happen, but that needs to happen. So often, 60% of our patients are on our service for 30 days or less.

We get we get referrals on Fridays that are emergent admission referrals. We have nurses that go out to these patients' homes or to the hospital and they say, I don't even know if this patient's eligible for hospice. This was an emergent referral? How is this possible?

Well, it's not my team calling an emergent. It's the health system saying we need to get this patient out of the hospital. And again, the social worker, the discharge buyer that's doing it, it's not their fault. It's not the fault of the physician, the hospitalist that's making rounds. It's not their fault. And quite honestly, I don't even think it's a fault of the administration. I think it's just a system that's become so just repetitive that this is just what happens. And and we if we could just nip it sooner, you know, it would be good, it would be good for everyone.

Tom Maxwell (49:51)

True. we see tons of patients that are, you know, one,

Heath (49:54)

Okay.

Tom Maxwell (49:54)

two days on hospice and they've they've paid for that benefit their whole lives and working through the Medicare benefit that you pay in and they get none of it because some doctor didn't say it's time for you to go to hospice. My father's in that boat right now. It's super sad.

Heath (50:06)

Or the or yeah. Or or the family

was was spooked about what this thing called hospice is, or to your point, well when do they have to move in? Well it's not a place. Hospice isn't a place. We've taken care of patients that have lived under bridges. I mean we you know, you you do everything you can to find them a place of safety and whatnot, but at some point it's it's their personal preference as to where they where they call home, and home might be

you know, under Grand Avenue and and I thirty five E in in the Twin Cities. And as much as we don't like it for them, that's where their home is and that's where they want to be.

Tom Maxwell (50:43)

Right. That's

right. All right. Let's talk about the people that have influenced you. So who's really influenced you over your career? made you a better CEO or made Saint Croix Hospice more successful?

Heath (50:54)

Well, let me start off early on. there was a the the first nursing home administrator that I trained under. Her name was Mert Stefan, Muriel Stefan, but we called her Mert. And she was down in Iowa, Marshalltown, Iowa, that has the best sandwiches in in the world in my opinion, Taylor's made rights. no, no, no, no, no.

Tom Maxwell (51:14)

I thought you were gonna say they were in the quick trip.

Heath (51:20)

No, I don't know if they had a quick trip there. Casey's is kind of the convenience searching down there.

Tom Maxwell (51:23)

Yeah.

Heath (51:25)

But day one, I walk into this nursing home and Mert says, Get a hairnet on, we're serving breakfast. Okay, geez. D did what she said. So I put a hairnet on and and I had hair at the time. and and and I'm

Tom Maxwell (51:40)

I was going, what do you need an internet for?

Heath (51:43)

and I'm you know bringing bringing trays out to residents, right? It is in the in the dining room.

And after we bring them out, right, we're starting to pick up, right? And I'm picking up things. And I'm like, you know, you get some mechanically soft diet, you know, ground up sausage on your finger or whatever. And it's like, gosh, this is a little tough. and she says, you can always wash your hands, Heath. You can always wash your hands. Yeah, I think she she was right, you know, you can always wash your hands.

And so away we went, right? Got the breakfast service all done. The residents all you know were taken care of. They all went back to their rooms or to the activity area. And she said, We're going on the roof. If you're gonna run a nursing home, you better know what your building's like. We're going on the roof. Well, this woman weighed, you know, weighed a hundred pounds. She was five foot three. And she and I are up on the roof of this nursing home. Day one. Day one. I I'd never I'd been in nursing homes before.

But only because I visited grandparents or or things like that. I'd never, this was my first, like day one of my internship, how to be a nursing administrator.

Tom Maxwell (52:51)

Yeah.

Heath (52:51)

And and I'll never forget kind of her tenacity about things. And she said, your number one job is to not be seen and not be heard, but just to do whatever needs to be done. If there's a piece of paper on the ground, you pick it up and you throw it away.

If there's someone that needs help with something, you just go, don't ask questions. And that's kind of how we've functioned here too, is you just do the things because the right thing to do, right? You don't ask questions, you just do it. You don't look for praise or adoration. You don't do things because you want your staff to give you respect because you cleaned out the dirty linens and the soiled utility, you know, hopper. You just do it. and that's how she did it. And she led you know, just just tremendously.

So again, that really set the tone about how you function as a professional, right? It doesn't mean you wear have to wear a suit and a tie to do things the right way. It just means you have to do things, right? Just don't don't get in the way. You don't need to be seen. You don't need to be heard. You just need to do. then I had a mentor as well, someone that you know, Tom, who was one of the biggest curmudgeons I had ever met. Just a curmudgeon. Grumpy kind of

Bossy, almost even condescending. and his name was Ron Malone. And

Tom Maxwell (54:11)

Uncle Ron.

Heath (54:12)

the more I got to know Mr. Malone, the more I understood what he was trying to do for me. He had a belief in me that I didn't have. I did not think I'd ever run a hospice of a thousand patients. I didn't think I was capable. I didn't think I was capable of leading a team with talented people.

that we were starting to bring on. And and it was his style more than anything that that got me finally to understand what he was doing. because he would say things not aggressively, not mean. He wasn't mean ever, but he would say things in a way that was so just matter of fact. And he would encourage me to say, well, you know, to to just do what I felt needed to be done.

and and and to not look back. And so he was someone that the first time I met him, I I would have never I was quite honestly I was fearful of him. I would have never thought that I'd ever refer to him as a tremendous mentor to me. But I don't know if he's ever known the impact that he had on me. and one of those things that, you know, I probably should have told him. and and and I never did. Yeah.

Not that there's not time to still do it, but yeah, he was a tremendous mentor as well. And then, you know, there there's so many other people in the field. I mean, you, for example, Tom, getting to know you o over time and and understanding that you know it it's about as much as who you know as opposed to what you know, and I'm not suggesting you don't know anything, but you have such a wide net of of friends and connections that

It's good to bounce ideas off of people. It's it's good to have people bounce ideas and thoughts off of you, things that perhaps you're not even thinking about.

Tom Maxwell (56:06)

For sure.

Heath (56:07)

just to hear where other people are are kind of at with things. And so I I I would say that there's th truly, I I'm leaving so many amazing people out that have certainly impacted me and others that have have helped get us to where we're at. You know, there was another board member that we had, an individual named Sheridan Deary, that that quite honestly

ruffled my feathers at times, but she she only helped us, right? I mean, the benefit was was immense, you know, just just having certain discipline and and thinking about things in a way that that I could have never anticipated. I never ran a hospice the size of the hospice she ran. So she'd already been there and done that. And she was beyond open with sharing her opinions about things, of which sometimes I didn't agree with.

But she at least shared them with me. And it was up to me to to ascertain if I'm gonna take her thoughts and her opinions and run with them, or if I'm gonna go a different direction. But without people like that that are not, you know, that they're willing to not be yes people, but that are willing to even engage in constructive conflict. And again, n none of it was ever negative or ill. It was all but it was constructive. you know, we would never be the program we are today.

And we we just never would be.

Tom Maxwell (57:28)

You know, something I remember about you and I was on Heath's board for many years. back in the day when he was learning. But one of the things that you always did at the executive session that I always loved is you would ask that question, what can I do better? And most CEOs can't ask that question. And we give you real feedback. I mean, we'd I mean, I remember Ron. Ron would let you have it. And and I I've done ten podcasts where people knew Ron Malone and they all talk about him as a mentor and Rexanne was that way. She worked for him way back in the day in Gentiva and

Heath (57:55)

Yeah.

Tom Maxwell (57:56)

And before that and and I was with you. I was scared to death of Ron. And but he is he's an absolute

Heath (58:01)

Mm-hmm.

Tom Maxwell (58:02)

great I when he was at Gentiva and we were trying to sell software to him, and that guy would walk around this like posse of people, and we would like get out the way and like you know, try not to get in Ron's way and and and I've I've known him now for ten years very closely and one of the greatest guys and one of the greatest. But you're right, he he'll never give you the answer. He'll he'll he'll make you think about how to get to the answer. Like he's not gonna tell

Heath (58:20)

Yeah. Yep.

Tom Maxwell (58:21)

you, go make this decision, but he'll give you all the pros and cons and now you're gonna make your decision, Heath and

By the way, maybe the right one or maybe the wrong way. Let's go. He he's got a

Heath (58:29)

Yeah.

Tom Maxwell (58:29)

unique way of doing that. I think he learned it all from Tammy, his wife. I've met her a couple of times. She's she's an angel too. So Tammy's taught Ron well. And I hope he listens to this.

Heath (58:33)

Yeah. Well, to to be

married to him, she'd have to be an angel. But no,

Tom Maxwell (58:40)

She is.

Heath (58:41)

he's he's he just tremendous, right? A tremendous human being and someone that someone that cares. You know, one other thing you mentioned at board meetings, you know, we oftentimes get caught up in the discussion about the operations and the performance, right? I mean, like that that that it's inevitable you have to do that.

But one thing that I'm I'm really proud of every board that we've ever had has never challenged me or has never moved me along from from saying something along the lines of, but what we're doing is really meaningful. Like what we're doing really matters.

Right. I mean, the impact that we're having for these patients, these families, the the grandchildren, generational impact, it really matters. And we've been so fortunate that the boards that we've had, they it's it's not lip service. They they believe it too. I mean, they see it. and again, it's not just about financial you know, metrics or or you know, some opportunity that that that's out there. It it's really about

Are we better than we were yesterday? And you can't ask for anything better when you have board members that think about things from that perspective.

Tom Maxwell (1:00:00)

Yeah, and you have a I mean, there there's there's a lot of press around private equity buying into hospitals or hospitals or home health or all these and you know, that they do disservice to and I I I struggle with that because I see the amount of investments that are being made and you know, growing, doing small rule acquisitions, buying technology, making sure we have all the right compliance in place, making sure we have HR,

Heath (1:00:20)

Yeah.

Tom Maxwell (1:00:21)

making sure recruiting processes are right, making sure we checked all the boxes, making sure we're billing correctly, all those things that that are that you guys have built and I mean never once is

A PE company gonna say, No, skimp on that. We don't want compliance or we don't want more people or we don't want more locations or technologies. It's always been investment, investment, investment. And so it it gets a negative press and it's unfortunate, but that's true.

Heath (1:00:43)

Well,

and look, I I mean I've only worked with private equity in hospice, right? I mean, I don't know anyone else private equity. I mean, may maybe I've I've met other people that do private equity, but I I don't know what they really do. I don't know how they function. But every private equity partner that we've had, you're spot on, Tom. I'll never forget the first the first private equity partner we had.

We were looking at a new EMR and we were going to go with a different EMR than what we chose. Okay. And and it was it was price prohibitive, we thought, from choosing the EMR that we ultimately chose that we currently have today. And they said, Why would you choose the non-Cadillac? Well, it's too expensive. I mean, you know.

Worried about the budget. They said, if this is best for your staff and it will be best for our patients, why would you even consider it anything different? Spend the money. Don't be a miser, spend the money. And I thought, geez, this is not what private equity is supposed to be. I thought they were going to tell us to cut every you know thing that we possibly could cut. And so they encouraged us to spend money in places that we probably historically for sure wouldn't have spent on.

and I think the same is said when it comes to compliance or succession planning, which I hate that term, but but but it's it's needed and real, obviously, is you need to invest in talent. I you know, and and it might it may have been Ron that said this to me. I don't recall, but he said, if you find talent, you will find a place for them.

So it it was not, it was not, well, you need to have a role. You know, you gotta make sure if you know you fill these roles only. If you find talent, you will find a place for them on your team. So don't let talent leave you. And so that was also a novel kind of thought and concept. And again, something that based on what my perception, similar to probably

Others' perception of hospice was completely erroneous. You know, it it it wasn't about cost cutting, it wasn't about you know tightening the belt necessarily. It was about how can you build something that's gonna be better tomorrow than it is today. And the only way in our field to do that, the only way is by people, right? Every hospice does essentially the same thing, right? We do, we take care of patients.

That have a lifeline internal diagnosis that a physician says has a life expectancy of six months or less. And they choose to elect this benefit, right? That that's that's what we do. I'm not gonna suggest that my nurses have some skill set and some knowledge that any other hospice doesn't have, but I can tell you this: that when they're talented, we're gonna do everything we can to keep them happy and to keep them on board. And me, especially in my role.

And others in leadership are gonna stay out of their way so they can do what they're so gifted at doing. Because it's it's people again like us that we get in the way. And we're the ones, like I said earlier, that put the lid on people and whatever it may be. But there's so much talent out there and so much desire to give and to impact that I'm optimistic. I I am, I truly am optimistic about the future. And if anyone's looking to hire a nurse in hopefully four years,

My daughter's on my track, it will probably be five and a half years. I hope I hope you I hope you consider hiring her. Yeah.

Tom Maxwell (1:04:12)

I will. Send her my way. I already love her. I've I've met her many times. She's an angel. All right.

Heath (1:04:15)

Yeah. Yeah. Yeah.

Tom Maxwell (1:04:17)

So you're sitting across from CMS and this is the hard job of you as the CEO 'cause you have to deal with this every now and then. No lobbyists, lawyers, prepared talking points in the room. What would you tell them to get that they're getting right in hospice and what would you tell them to fix?

Heath (1:04:30)

Well, look, I I think by and large, CMS has been an advocate for us. Unlike our brethren on the other side of the home care spectrum, you know, we continue to see, albeit modest, increases in reimbursement. And so I I think that that's good. I think that CMS, in their affinity for building this benefit, has figured out something that I wish all of healthcare would have.

Which is hospice is the only healthcare vertical that requires three things to happen. A patient's physical well-being, psychosocial well-being, and spiritual well-meaning being must be addressed. Can you imagine how different life would be? I I shared a story a while ago with my team. I I had had a bum knee, okay? And so I went into orthopedic place and they did an x-ray.

And they asked me to come back for an MRI. Okay. I wasn't completely hobble, but my knee was really sore and it was causing problems. So I went back in. I'm sitting in the waiting room before I had this MRI on my knee. And I'm thinking to myself, if I was in hospice, here's how this would be different. The hospice team would say, What's going on today, Heath? Well, my knee hurts. Well, why is your knee hurting? Well, because I was running. Well, why were you running?

Well, look at me. That's why I'm running, right? Like I was, I was, well, well, okay, so why do you think you need to run? And and sincerely, and I've said this to my team, and this is gonna embarrass myself probably with some of these other folks, but I didn't want to be the heaviest dad at my daughter's homecoming in the pictures. Okay, very selfish. I mean very, very pre Madonna-esque, but that was that was that's why I decided at the time that I was gonna try to get into better shape.

For very vanity reasons, right? Very, very vanity.

And if it was hospice, they would have said, Well, let's talk about that more. We have a dietitian. You know, they could have built the plan for me. Instead, I think I'm gonna go out and I'm gonna start jogging something I haven't done for years because I think that this is the answer to solve the problem that I have, the the vanity problem of not being the heaviest dad in the homecoming picture. This is back in in 2026 or 2020 four.

That's how different it is, right? Like we never got to the crux. So they do an MRI, they say, take some rest. That was it. Sent me on my way. Now again, nothing was wrong. Some you know, I pulled a muscle or something, something benign, right? I mean, it was not a serious issue. But again, it didn't solve the problem. The problem was that I had anxiety. I don't know, maybe I was depressed. I have no idea. I never got diagnosed. But at self-diagnosing myself, I had this vanity complex that I wanted to.

Resolve. And the answer never came to me until I had to reflect on it and put myself, if I were hospice, what would this be? And so I think that CMS has really done a tremendous job in ensuring that those three fundamental principles are in place. Our chief medical officer, Andrew Mayo, he's a great grandson of one of the Mayo brothers. And one of the Mayo brothers, his great grandfather, actually, Charles Mayo, had said.

The best interest of the patient should be your only interest, right? And so I I kind of connect those dots too that that's really what hospice looks at, right? I we know we're not going to cure someone with terminal cancer. But what's the best interest of the patient? Is it to go in from their home and have chemo done four or five days a week? Or is it to keep the patient comfortable at home where they can have family visiting them, where they can still go on a ride.

And look at the leaves that are changing color or whatever it is, right? Hope may change. It may not be that I'm gonna run a marathon, it may be that I'm gonna be able to watch my grandson cross a finish line in a marathon, but there still is hope, right? And we don't take away hope, it just changes. I think that's hard sometimes, even for us in the general field of hospice, to kind of take a step back and say, Yeah, that that is what we.

Know we we we really do a great job at that, and I think that we in senior health care in general, and this is gonna sound really bad, but I'm gonna say it anyway. I think we do a great job at keeping people comfortably numb. I really do. I think we do an inadequate job of giving people moments of joy, and I think that when we have moments of joy on our forefront, because

Keeping people comfortable is something that just is natural for us, right? We do it for our children when they have headaches or when they have fevers or things like that. But moments of joy is something that's hard to do. And that doesn't mean you have to do a a viral video of someone, you know, renewing their vows before they pass away. It can be something as simple as just a smile by the social worker.

Tom Maxwell (1:09:47)

It's true. So true. Well said. All right. Talk about AI a little bit here. where do you think AI is going in hospice? Thoughts around it? What what's it gonna solve?

Heath (1:09:57)

Well, AI is never gonna go away. We know that. I think it's only gonna benefit clinical care. I really do. I just think that we need to acknowledge that again, it it's never gonna replace the value of that human to human interaction. It it never can. if it makes us smarter in our visits, if it if it allows us to focus on problems that

are likely to happen and we can be more proactive as opposed to reactive, tremendous. but in our in our field, I I I just don't see it having as significant of an impact as it will perhaps in other fields, right? I mean, will will our finance department all be run by AI at some at some point? Very very possibly could be. But the core of what we do is not finance. The core of what we do

is taking care of people with a lifelong internal diagnosis of six months or less. And again, AI can't AI can't do that. and the and it won't be able to

Tom Maxwell (1:10:59)

I agree with you. It'll make us more efficient. Maybe it'll allow the nurse to tr travel the right direction or make sure she racks and stacks her patients the right way or less documentation time, make her job easier from that perspective. Maybe she gets to spend more time with the patient. Maybe she gets b spend more time talking to that patient because we've taken away the documentation burden and requirements. And so I I I'm with you there. I don't think you're ever gonna have a robot in the home that's gonna take care of Nana. There may be a watching robot over there that tells you when Nana's about to fall or all that kind of stuff. But you're still gonna need a nurse to come in or a chaplain or social worker.

I don't think a robot's gonna be able pray for you.

Heath (1:11:30)

Yeah.

And and look, maybe maybe there will be robots in home, but again, it's it's it's not a it's not a and or. It's it's it's gotta be an and, right? I mean it it's gotta be an and. Yeah.

Tom Maxwell (1:11:42)

For sure, for sure. All

right. We're at St. Croix in thirty twenty thirty five. What's different about the hospice program, the care that we deliver then ten years from now?

Heath (1:11:53)

Well, I will be fifty

I'll I'll be fifty-five at that time. So I'll still have fifteen more years at least to to to work. hopefully I've hopefully I've figured out how to how to lose a little bit of weight like you have. But y you know yeah. Yeah.

Tom Maxwell (1:12:06)

You can go to the gym with me every day if you want. I'll I'll I'll I'll coach you.

Heath (1:12:10)

I really hope it's no different. I hope I hope our our philosophy stays the same. I hope our focus on

regional density and contiguous footprint stays the same. I hope that there's other tremendous hospice programs that come in and help us get better, you know, by doing things perhaps differently than what we're doing. I always want us to be on the next curve before everyone else is on the curve that we just passed. I want someone to push us.

And and look, I know that that could be a cliche as well. Competition is good. I really believe it though. I mean, it there there's a lot of things that we've done that has been impacted by things that other programs are doing. Now, there's some things that we certainly haven't done that our competition has done that we perhaps disagree with, whether it's related to regulatory or or truly capability,

But ultimately, yeah, I I think I think I think you're gonna see much of the same in twenty thirty-five as you are here in in twenty twenty six.

Tom Maxwell (1:13:14)

Yeah, I

remember back Heath when your goal was twenty twenty and twenty twenty. So you wanted two thousand and twenty patients. You we called it perfect vision. That was a Schuppan

Heath (1:13:23)

Yeah.

Tom Maxwell (1:13:24)

made up term, but it was perfect vision. We're gonna be twenty twenty by twenty twenty. And I was like, that's pretty amazing. And now you're at

Heath (1:13:28)

Yeah. Yeah.

Tom Maxwell (1:13:29)

eight thousand. I mean, that was not that many years ago. Six years ago? It's fast growth. Congratulations.

Heath (1:13:32)

Yeah, yeah, yeah, yeah, thank you.

Tom Maxwell (1:13:36)

what chapter eventually when this chapter eventually ends, Heath, what do you want people who built St. Croix alongside you to say about Heath Bartness?

Heath (1:13:44)

boy. Wow.

I hope they don't talk about me. that that that might be the best. That might be the best outcome. that could be the best.

Tom Maxwell (1:13:53)

We're we're gonna tell some stories for sure.

Heath (1:13:59)

I I I I just I hope that I was always fair. I hope that I'm known as someone that pushed the team to believe in the talent that they had and have.

And I hope that we have changed the hospice space in a very positive way. But I do hope that I'm forgotten. I I do. I I I think my legacy hopefully will not be St. Croix Hospice. I hope my legacy is that I raised children to be good humans and that I was kind to not just friends, but to everyone.

That that's kinda yeah. I mean look, what you see is what you get. there's nothing fancy about me. There there's there there are so many people that have intelligence that runs laps around me. and this is not to say I'm hokey or anything like that, but I I hope I hope that the program just endures and I hope that yeah, I hope I'm forgotten. That's actually what I hope.

Tom Maxwell (1:15:05)

Yeah. I yeah, yeah, one of my is I I want to be the friend I want my friends to be. And so I really focus a lot of my time right now on that because I wanna be you

Heath (1:15:14)

Yeah.

Tom Maxwell (1:15:14)

know, and I was listening to a podcast this morning on the it was the guy that created We Work and he's it it's

Heath (1:15:20)

Yeah.

Tom Maxwell (1:15:20)

on the last the diary of the CEO and I was listened to it and he had some really cool things to say, but he's like, You won't know who your friends are until you really need your friends. When you're sick and dying or when you're in a crisis situation and you look up and everybody's gone and your real friends and

It's something I'm really passionate about. I want to be the friend that my I want to be the friend I want my friends to be. And and and and say yes more often. Say yes more often, right? This

Heath (1:15:40)

Yeah. It's a great way to put it. Yeah.

Tom Maxwell (1:15:44)

is the year yes, or actually we call it the year of hell yes. When someone asks us to do something, we say yes. We said no for so long. And when it's friends, family, whatever, do you wanna have a family get together? I'm like, that's last thing I want to do. And we do it. We say yes, and we like, you know what, we never regret saying yes. Right? All right.

Heath (1:16:00)

So Tom, would would you be willing to send me a new set of golf clubs? All right, no. No, I don't. Yeah. No, yeah. Well yeah, you you know I don't I won't pass up on that. No, I'm I'm obviously teasing, but

Tom Maxwell (1:16:04)

Yes. I will. They're gonna be slightly used, new set. They'll be new to you. They'll they'll be new to you, but they'll be slightly used by me. Yeah. All right.

Heath if people want to reach you or Saint Croix Hospice because they love this podcast, they want to come to work for you 'cause what you guys are doing is amazing. And how do they find you? Where wh where's the best place to go?

Heath (1:16:26)

Yeah, stcroixhospice.com you can you can check us out. We have a hundred locations all throughout the Midwest. we have you know tremendous obviously team members that would love to welcome you to the St. Croix Hospice family. and look, we're not done. you know, I'll tell you that. I there's so many more areas, even in states that we've been in since our existence: Minnesota, Wisconsin.

Iowa others that that we're we're not servicing the entire state even. And there's there's folks that need to have the best hospice care and we want to be able to be there to provide for them. So we'd we'd welcome you to come and consider joining our team and and we certainly Tom appreciate

the advocacy that you do outside of your day-to-day job, you know, running your company and serving on boards and committees. having a friend in hospice is that that has a voice and that has the connectivity that you have. And I'm not suggesting just in hospice. You know, I've met a number of folks via you that that are in fields very different from hospice that that somehow, some way end up having an impact in what we do.

that that I I really appreciate you and your team, but there's so many more, right? There's so many more opportunities for us to to look at breaking through still this glass ceiling of

of hospice and and hopefully getting that message out even even broader and deeper than it alre already is to be able to service those folks especially in these rural and tertiary markets that you know that that that just don't know that we come to their house.

Right, we not only pay for medication supplies and medical equipment related internal diagnosis, but we send gifted and talented caregivers to your house so you don't have to go anywhere, right? I mean, what a tremendous benefit. And it's something that costs you nothing if you're a Medicare beneficiary. Nothing. There's no cost. And that's what just shocks me is that it's still such an unknown in terms of how frothy this benefit is. And not frothy for the for the providers, for us. I don't mean it that way, but I mean just

For the consumer, it is such a tremendous, tremendous benefit. So I thank you immensely and your entire team, Jenn and Cole and Hunter, and all and Maxwell and whatnot. But thanks for having me on. I I know I've got a bit long-winded today, but it's hard for me not to want to chat with you. I

Tom Maxwell (1:18:53)

No, you're awesome. I know, I love it. It was

Heath (1:18:58)

I'm surprised that we didn't talk about the fact that when we did have

when you were on our board the first time, we had one of the CEOs of the private equity company that used to get you and I confused all the time.

Tom Maxwell (1:19:08)

Still do.

Heath (1:19:08)

yeah, yeah. That but see I have facial hair now and you're a lot skinnier than I am. So maybe yeah.

Tom Maxwell (1:19:12)

Yeah. Yeah. He still does. Every time I see him, he's Hey, yeah, hey

Tom, how's St. Croix doing? And I'm like, You just call Tom and you still

Heath (1:19:19)

Yeah.

Tom Maxwell (1:19:19)

think I'm the CEO of St. Croix Hospice. Like, what what's going on? Yeah. It's cause it's the haircut, Heath. It's the haircut. Yeah. All right. Yeah. Appreciate you coming on, man. You're you're you're heck of a guy. Thanks for all you're doing. Yeah, and thanks, thanks for

Heath (1:19:21)

Yeah, right. I think so. It's good here. We got same barber. Yeah. thanks for having me. Appreciate you guys.

Tom Maxwell (1:19:32)

recognizing your team and all that. And we're super excited to see where St. Croix, you know, continues to grow and watch it continue to succeed. So congratulations.

Heath (1:19:40)

Well look, I'm very proud of them and I'm proud of you and I'm proud of I'm proud of the the field of hospice in general. So thanks for having me. Okay.

Tom Maxwell (1:19:46)

Me too. You bet. Bye bet.