St. Croix Hospice CMO Mayo: Clinical, Medical Onboarding Critical to Growth

After seeing firsthand the person-centered multidisciplinary care that hospices provide, St. Croix Hospice’s Chief Medical Officer Dr. Andrew Mayo felt drawn to the field.

As a descendant of the Mayo Clinic’s founders, his connection to medicine runs deep. While working in family medicine, hospitals and nursing homes, he started “moonlighting” in hospice, which ultimately took his career in a new direction.

“When I saw what hospice does in that team approach to care, I really drew that correlation between what my ancestors had done in starting the Mayo Clinic,” Mayo told Hospice News. “They had taken the multi-disciplinary approach to care and brought that all under one roof to address what it is to be human in the dying process. That’s what really drew me into hospice care.”

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Mayo recently made Becker Healthcare’s list of Top 110 CMOs to Know, the only hospice executive to be included this year. St. Croix Hospice, a portfolio company of the private equity firm H.I.G. Capital, cares for nearly 4,000 patients from 60 locations in 10 Midwestern states.

Hospice News recently spoke with Mayo about the ways the CMO role has changed in an evolving industry, as well as the importance of effective medical and clinical staff integration as providers pursue growth.

St. Croix Hospice’s Dr. Andrew Mayo nationally recognized as one of 110 Chief Medical Officers to Know in 2023 by Becker’s Hospital Review.

As a chief medical officer, how have you had to adapt in the wake of the pandemic?

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While the pandemic certainly impacted all of the United States and countries all over the world, I think it really emphasized the need for our organization and hospice in general and the need for many businesses to be nimble and able to adapt to changing conditions.

It forced us to innovate the way that we deliver care. One of the ways that we really adapted was the use of telemedicine, being able to reach patients that were isolated.

In that aspect, we also recognize that some of the physicians that we contracted with were being pulled in many directions. This led us to develop a hybrid model of care where we now have full-time hospice physicians dedicated to being there for our nurses, for our patients, but who also still maintain a presence locally, so that hybrid model of both regional and local physicians.

One of the other big impacts was really recognizing the importance of culture and how to maintain that within the organization. Because culture is very important for any organization. When we were much more isolated from each other, we really kept that emphasis.

St. Croix has been on a steady growth trajectory for the past few years, through the multiple acquisitions and de novos. Where does the CMO fit in when it comes to integrating those clinicians and medical staff?

We have grown very quickly in our expansion and have been pretty much dedicated to growth in the Midwest. And in those acquisitions and de novos, it’s really important to onboard physicians and the team with an eye toward our values and culture.

As CMO, I work with our integration team to onboard the physicians and the wonderful teams that we’ve been able to partner with and grow to make sure that we are orienting them to St. Croix Hospice’s values, and culture.

Part of the process is that I deliver a talk what I call “Heart of Hospice,” and it really talks about my journey into hospice in being able to leave a full practice and come on as a chief medical officer in that journey and my experiences.

I share that with the teams because I think it really alleviates some of the fear or anxiety of becoming a new team member with St. Croix Hospice and really shows that our commitment is to the best possible care for patients.

My great-grandfather William James Mayo said that the best interest of the patient is the only interest to be considered, and we hold that very dear in St. Croix Hospice. Being able to share that message with the new teams I think is very valuable in ensuring that they feel part of the team and that they know that the heart of hospice is in the right place.

As a private equity-backed hospice could St. Croix be impacted by some of the anticipated interest rate increases? Is this a concern for the executive team?

I really don’t anticipate that any interest rate increases will impact our business or strategy here at St. Croix Hospice. We really are focused on providing the best care for patients, and from a medical perspective, I don’t see that changing.

What are some of the other top issues that are on your radar this year?

I think that this regionalization of physician coverage for our organization, the hybrid model, we’re going to continue to look at that and expand that model. I think we’re going to look at continued innovative ways via technology and relationships to benefit patient care and compliance.

We’re really largely focused on providing internal and external education about the hospice benefit itself, eligibility and best practices. That’s an ongoing effort throughout our organization.

How do you think the hospice field may change in the coming years?

I think there’s going to be a continued need to adopt technology. And I think that we’re seeing a lot of strides and innovative technology that can really help with the compliance part of things, the patient care part of things.

My great-great-grandfather, William Warroll Mayo, mortgaged his house back in the 1800s to buy a microscope. He felt that was going to be very important to ensure that his patients were getting the best care possible. And I think that in hospice those types of investments [in tools and technology] will increasingly help us to provide the best care.

With the aging population, we’re going to see more and more people coming in that will be in need of a hospice benefit. And so, I think providers, and the hospice benefit, are going to need to innovate and adapt to provide better access to care.

This needs to happen not only for patients in hard-to-reach communities, but I think also for looking at specific diagnoses for hospice and how we apply the criteria to ensure that we’re really caring for people in the best way possible, at whatever stage of the dying process that they’re in.

What thoughts do you have on how to bring more clinicians into hospice as a specialty? What are some of the obstacles to that and where do you see solutions?

There’s an ongoing need, I think we’ve started making inroads into providing continued exposure and education for those up-and-coming clinicians — all medical disciplines really having that exposure and education to what hospice is and what it can do for patients.

On an inpatient basis, we’re seeing more and more palliative teams being part of hospitals. And we are seeing some palliative teams that are in a clinic or outpatient setting. I think that exposure is going to help people see that it’s there and that it’s available. But I think we need greater educational awareness for those clinicians who are already practicing, because there are still a lot of misconceptions about what the hospice benefit is and how it can be incorporated as part of the continuum of care.

I think hospice providers are in a significantly powerful position to help educate not only patients and families, but also providers and clinicians about the true nature of hospice care. I think we have a lot of work to do in dispelling the myths and misinformation that’s been spread about hospice.

I just want to bring attention to Jimmy Carter, the former president, of course, and his choice in pursuing hospice. I think that that makes a huge statement to the general public and to health care providers that hospice care is truly a choice for people. It helps to break down the barriers for patients and families to be able to make a choice that’s right for them at the end of life. And it’s just to me very encouraging to see how this public figure can bring a well-deserved positive light to hospice.

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