Ari Stawis, Director of Professional Services & Development, Zimmet Healthcare Group

Episode Transcript

David Pardo (00:01)
What’s up Ari, welcome to the long game.

Ari Stawis (00:04)
How are you? Nice to see you.

David Pardo (00:06)
Yeah, likewise. It’s so awkward that we showed up with like the same same outfit almost.

Ari Stawis (00:12)
I know I got the email before I listened, I put on pants, you know.

David Pardo (00:15)
I thought the zip -up was like my private move. Now I gotta find something else.

Ari Stawis (00:22)
Uh, well you have a shirt under there. I just, this is all I got.

David Pardo (00:26)
Yeah, I’m sorry, you know, and I guess a ploy of more professional dictates a big amount of me. So I appreciate you coming on. I like to I want to start with with you and your professional background. But before we jump to your professional background, you’re at Zimmet, you’re at the Zimmet Healthcare Group, I think is the full name. So for people who live under a rock.

Ari Stawis (00:33)
Heheheheh

Correct. Zimmet and Healthcare Services Group. Yep.

David Pardo (00:54)
who are listening to this podcast because they’re in the industry but don’t know Zimmet, please tell me in like a sentence or two.

Ari Stawis (01:03)
Well, it’s going to take a little bit longer than a sentence or two for Zimmet Healthcare, but yeah, fair enough. You know, Zimmet Healthcare Services Group, we have a multitude of consulting services that we provide to the nursing home industry, primarily focused on reimbursement, whether that is ensuring that operators are capturing all of the reimbursement that is due to them, whether that is advising,

David Pardo (01:06)
You get five. You get five.

Ari Stawis (01:32)
banks or other transaction type services, including REITs, brokers in regards to landscape of Medicaid structure and reimbursement structure for the industry in general. There’s various other consulting services, including quality and data analytics, as well as our technology division, which is, you know, as time’s gone on, been a big focus of ours, which is called ZPACs, which has

many different applications in it. So we’ve been, you know, focused on the technology component, but sticking to our guns of, you know, reimbursement consultant for the industry. And on a yearly basis, we touch around 4 ,000 nursing homes. So a nice number.

David Pardo (02:17)
Wow. So sticking to your bread and butter and the consulting, the technology is always like an ever emerging, interesting, evolving story, which I’d love to jump in on another, another podcast. You came though to Zimmet already, I think with 10 years in to your, your career in healthcare with the title director of professional services and development. So.

Ari Stawis (02:36)
Yeah.

David Pardo (02:43)
When does a young boy, when does a young Ari wake up and say when I grow up I want to be like what’s what’s the what is that? What does that do? I know I like I see you at all the shows so I assume it has something to do with shows.

Ari Stawis (02:53)
Yeah.

Ironically, your guess is as good as mine to be completely transparent. You know, it’s a nice, it’s a dream job. It’s a nice generic title. I can tell you what I focus on, you know, at Zimmet. But, you know, titles has never been something that’s been that important to me, but definitely something to put on there. So I’d like to say that I have my hands in a few different things.

David Pardo (03:04)
It’s a dream job.

Ari Stawis (03:24)
and shows being one of them, but that’s not the main one. But it’s always nice to see people at shows.

David Pardo (03:33)
So you’re involved in shows, but, and like, forget titles. I’m more curious about sort of the scope of your activities. Definitely sounds like a suitable role for someone with ADHD. You get to run around and get involved in a lot of things. What’s the full scope? Yeah, it’s an advantage.

Ari Stawis (03:46)
I’m not going to disagree with that.

Yeah, so it’s an advantage. It doesn’t hurt. So my primary focus is one of our subsidiary companies is called Z -AIMS, which stands for Z Ancillary Innovation Management Services. So I’m officially the COO of that sub -entity. What that focuses on, we’ve started for multiple clients who have asked us to start.

Hospice companies as an example, which I know we’re going to get into, as well as other startups that are connected to the SNF ecosystem, right? So anything that connects to the nursing home industry, Mark Simmons likes to use the word incubator that, you know, we’re really the incubator that everyone has these ideas or thoughts or comments. It comes to us. It comes to me. Hey, is this something we should do? How can I get involved in this in some capacity? You know, as the years have gone on, operators have really

expanded the horizons of what they’re involved in. And so the Z Ames division of ancillary management services is one that I oversee. In addition to that, on the technology side, one of our platforms is called ECAP Intel, which is focused on transactions. We take various different data sources in the industry and put it in one place and contextualize the data with our own proprietary spin.

And so we have a lot of clients on that end, both on the operator side, on the bank side, on the lender side. So the day -to -day involvement, sales, operations of that are two of my primary focuses. The third one being helping for the Zimmet conference that we do, as well as trying to assist all the other divisions, whether it’s business development or understanding it from an operator’s perspective, which is my background.

David Pardo (05:47)
Interesting. And then at some point Zimmet decided or you decided or someone decided like we should go into hospices, which is I think for a lot of people listening is a like a step step sibling of the more traditional sniffs. So tell me like what that decision was or how that was.

Ari Stawis (06:09)
Yeah, it sort of fell into our lap. We had an operator, the first one, even before my time was one in Mississippi. And then in Oklahoma, I remember when I started at Zimmet, it was around six years ago. And, you know, Zimmet started a hospice for, you know, a nursing home operator who was looking to expand their services, everything from application, hiring.

Medicare certification, state certification, accreditation, which is a whole process that is complicated and time consuming for sure. And when I was getting involved, sure.

David Pardo (06:47)
Wait, hold on. Sorry. Just to clarify, you have an operator in Missouri who’s a client for various consulting services and they said to Zimmet, hey, Oklahoma, sorry, I want to open in addition to my sniff and ciliary to a hospice, please set the whole thing up for me.

Ari Stawis (06:55)
Oklahoma.

Yeah. Yep.

David Pardo (07:07)
And that was brand new for the group.

Ari Stawis (07:09)
that at the time, you know, there was some hospice experience that the firm had and, you know, but yes, that was sort of a new incubator, right, that came in in regards to is this something that someone can help out with? And so that organically grew and then went through a merger specifically over there. And as the years have gone on, that question of startup hospices has sort of been our forte. Currently we’re involved between 10 and 15 hospices across the country in different capacities, some as the entire bells and whistles of a startup process, others just as consulting services for hospice providers. But it was something that sort of fell into our lap and then as time went on, it was one of the things that stuck. So we’ve been going at it.

David Pardo (08:03)
So you’re involved in 10 to 15 hospice centers that are owned by clients. But Ari Stawis is also involved in hospices it but not hospice centers out of Zimmet. Can you tell me about those two things are those two things separate things.

Ari Stawis (08:08)
Mm -hmm.

No, all of the hospice affiliations that Ari Stowell has is through, you know, Zimmet and the subsidiary. So, you know, we are able to handle full back office services, which is, you know, what some clients want. Other clients, they will handle all that. Just help us get started from the operations end and then taking it from there. So it really depends on the client and what they’re looking for. You know, so we can either scale up or scale down depending on what the needs are.

David Pardo (08:54)
How much, what percentage of this are hospice centers versus hospice home healthcare?

Ari Stawis (09:00)
So all of what we do is hospice at home. So again, hospice at home could either be in the nursing home, at assisted living, at home, in a hospital. I think what you’re talking about of a hospice center can either be GIP, which is general inpatient, which is a level higher. We currently are not involved in any of those, even though we work on some strategic relationship and partnerships with hospitals to lease out a certain amount of beds.

specifically for our hospices. So none of our hospices have, let’s call it brick and mortar hospice locations. You know, we service patients in their home, wherever that home may be.

David Pardo (09:43)
Okay. And in SNFs.

Ari Stawis
That might be their home. Yeah.

David Pardo
So there’s, there’s a, there’s some, that might be their home. So there’s two points where, um, where someone in a sniff might overlap with or encounter, um, someone operating hospice either as bringing them into the facility and allowing them to do hospice for a specific patient in facility and, or to release them to a hospice at home.

Ari Stawis
Correct. So again, you can have a patient who is in a hospital who is admitting to a nursing home on hospice. You can have a nursing home patient who’s been in the nursing home for a long time and is now going on to hospice, or you can have a patient who is discharging from a nursing home, going home to hospice. So again, you can have a few different, a few different variations.

David Pardo (10:38)
At what point would a person be referred to hospice?

Ari Stawis (10:44)
Great question. And it’s one that we tackle every day. I think a common misconception for hospice is, OK, I’m about to die. Let me go on hospice, right? Which is not really the case. There’s a lot of other benefits of being on hospice. I’m not sure if you’ve seen Jimmy Carter. President Jimmy Carter’s been on hospice for around a year at this point. National average for hospice is around three months, right? Give or take. So.

How it works with hospices, the diagnosis that’s required is you need to have less than six months to live. So as long as you have that diagnosis, you are eligible for hospice. So again, six months or less is the diagnosis. Three months is around the average length of stay in a nation. So it really is beneficial to refer to hospice a little bit earlier because of the services that can be provided.

But just because you’re eligible for hospice earlier than people normally do. Again, there are some times in some of our referral sources that our average length of stay might be 10, 15 days, right? Because they’re really just referring them at the end. We have some patients, I know we had a patient over the weekend that was admitted at two o ‘clock and died at 11 o ‘clock, right? So I mean, sometimes you can have it really short.

David Pardo (11:44)
earlier than the six month mark or earlier than people normally do.

Wow.

Ari Stawis (12:10)
But the question of when they should be referred is a great educational point of discussion. And again, the average length of stay should probably be around three months.

David Pardo (12:23)
So I know a lot of SNF operators, listen, people also die in nursing homes. They don’t exclusively die in hospices. A lot of SNF operators say, my staff can take care of somebody at the end of life, even though we know that we’re, my understanding is people say hospices for palliative and after you’ve abandoned curative. But let’s say, you know, a SNF operator is listening right now, my staff can take care. We can do the billing.

What do I need to strike up a relationship with a hospice for?

Ari Stawis (12:57)
Yeah, so first of all, one thing you said, palliative and hospice are actually two different things. Again, that’s what I would say another misconception, you know, to no problem. No problem. I’m right. I’m writing them all down so I can, you know, test you in six months to see if you’ve gotten any better at that. But yeah, difference between palliative and hospice. But, you know, to answer your question of, you know, what’s the benefit?

David Pardo (13:03)
Okay. Ooh, good. I’m going to bring as many misconceptions as I can, but they’re all going to be for me. I’m not reading them. My own private misconceptions. Yeah, not palliative.

Yeah, heck yeah.

Ari Stawis (13:26)
of a nursing home provider, of having a relationship with a hospice, there’s many of them. First of all, from a staffing perspective, staffing challenges, as we know in the SNF market, is difficult as it is. Anytime you can have, let’s call it, an extra hand, providing care to your patients, I think, is important. So the fact that someone’s on hospice, then the hospice is the one who’s coming in and assisting with certain items. So that’s…

you know, one reason that could be beneficial. And also, it’s just, it’s a little bit different care, right? You’re providing different care. It’s more comfort care. Um, and a hospice nurse is different than a nursing home nurse, not necessarily better or worse. I like to say that a hospice nurse is probably the most special one out there, but they’re just providing a little bit different care, right? If you have an ER nurse is going to be different than a, you know, than a maternity ward nurse is going to be different than a nursing home nurse.

could be different than in a doctor’s office nurse, right? Doesn’t mean that they’re not all nurses. It just means that they understand how to provide care a little bit differently. And the same is true by a hospice nurse.

David Pardo (14:34)
Okay, but get jump back to the part where I’m wrong, meaning I said my my assumption was hospices about palliative care over curative, you’re no longer treating the underlying disease, you’re just provide like in your language comfort. So but you said that’s all wrong, the palliative part. So how’s that wrong?

Ari Stawis (14:51)
No, so the palliative part, palliative is different. It’s really even before hospice, right? So in a, let’s call it an ideal situation, you’d have someone, let’s say in a nursing home setting who would then go to palliative care. Palliative care is billable, but there are people who have palliative care programs that are set up as non -billable because typically palliative care in itself is a loss leader as a referral source for hospice. So palliative is sort of initially or earlier on in the stage. And then,

comes hospice a little bit later when they’re eligible for hospice. So again, it’s all just different care that you’re providing. Now, could it be done in a nursing home? Yes. But again, there are advantages of a nursing home giving hospice care based on staffing, based on education. On the nursing home end, it can actually impact your quality measures by having stronger hospice care and increase your quality measures, which has an impact on your star rating, which can have an impact on various other things on the sniff market.

So there is value of having a strong relationship with a hospice provider, even in a nursing home setting.

David Pardo (16:00)
I’m probably late to the game. Your relationship with your hospice care impacts your CMS rating?

Ari Stawis (16:06)
Indirectly so the quality measures in a nursing home. Yeah a quality measure in the nursing home You know the rehospitalization rates and those in a few of the components Hospice has a direct impact on so if hospice is able to improve those metrics for the nursing home Then the nursing home has better metrics when we’re talking about you know what the quality measures are and then you know the overall five -star rate?

David Pardo (16:08)
Indirectly.

So, okay, that makes sense. You mentioned Jimmy Carter has been on hospice for a year. I didn’t know that. I also know that a year is double six months, which is the, I know, I’m doing well today. So I assume Jimmy Carter can get whatever the heck Jimmy Carter wants.

Ari Stawis (16:39)
Yep. Yep.

Yep, look at you. You’re getting there, you’re getting there.

Hahaha!

David Pardo (16:57)
But for people who aren’t Jimmy Carter, how typical is it to outlast six months? Do you run out of benefits? Do you get cut off if you’re outperforming, first of all, your initial diagnosis, and then if you get better?

Ari Stawis (17:10)
So hospice is very interesting where you really have to self -regulate yourself. Again, there’s something called a CAP and that gets into a really detailed conversation. But the six month diagnosis can continue if you get an additional terminal diagnosis, right? So you could be on for six months and then a physician will come in and this is what’s due every six months and say, are you still eligible? And then they’ll basically say, yes, you still only have

less than six months to live, right? So if someone has dementia or someone has, you know, terminal cancer, they can live for longer than that period. So you can get another election period, right? Again, I don’t want to get too detailed into how the cap works and payment and repayment and all that, but yes, it is possible to have more than one six month benefit period for hospice.

Hopefully that answers your question. Yeah, so you had…

David Pardo (18:06)
Does reevaluation happen at the six month mark? Yeah, it does. I definitely respect the idea of not overloading on details, but yeah, sorry. The six month mark you’re saying?

Ari Stawis (18:15)
Yeah, no, I was going to say you have the six month mark. There are check ins before then, but yeah, the six month mark is really the, you know, again, making sure and, and, you know, again, talk about misconceptions. Another misconception is someone cannot graduate from hospice. And the answer is, is you can, right? You can have the example that, you know, we’re sort of out, you know, laying out right here is that you can be on for six months and then say, or even three months or even a day and say, you know what?

you’re not terminally ill anymore. Your diagnosis is not less than six months. We are going to graduate you and live discharge you from hospice. That does happen.

David Pardo (18:53)
Fascinating and then they usually go back to the nursing home or back home or I guess it depends where they came from.

Ari Stawis (18:57)
Yeah, it depends where they came from or what they’re sending us.

David Pardo (19:03)
People can graduate. Interesting. So I had like a list of terms here.

Ari Stawis (19:04)
Yep.

Uh oh, all right, is this like rapid Spitfire over here? Okay, yeah, I guess it is. Yeah. Yeah, exactly.

David Pardo (19:14)
Community -based palliative care. No. Yeah, time for your quiz. All right, no. One of the terms that came up while I was Googling around was community -based palliative care as something that’s on the rise. What is that in relation to?

Ari Stawis (19:26)
Yep. So community -based.

hospice. Yeah. So community based just means again, it’s not in a nursing home setting. It’s not in a general inpatient setting, right? In the community at home. And palliative care is definitely growing as time goes on, right? Again, the objective of palliative care is to be the feeder for the hospital. Palliative care can be its own standalone. Uh, in larger hospices, you’ll see that your palliative is probably higher than your hospice number, right? Because it’s like,

You know, think about it, let’s call it from a baseball term, who’s in the bullpen, right? Palliative care is really in the bullpen and then hospice is when you’re on the field. So I think it’s a good analogy, but I guess you can tell me if that makes sense.

David Pardo (20:15)
Maybe my baseball is not good enough to… So palliative is before hospital.

Ari Stawis (20:17)
Ha ha ha ha.

before hospice. Yeah, before hospice.

David Pardo (20:28)
For hospice, it makes a lot more sense. Okay. And hospice can also be in community. It’s not the setting that’s the difference. It’s the who’s billing and who’s treating and what kind of nurses. Could it theoretically be the same nurse?

Ari Stawis (20:40)
Correct, correct. Getting back to the…

Sure, 100%, a lot of times it is. Getting back to the nursing home side of things, to the question of why would someone want to be on hospice or why would the nursing home not want someone to be on hospice? So how it works like that is that your Medicare benefits, when someone goes on hospice, you’re informing them that now hospice is responsible for those benefits, which means how does the hospice get paid?

by Medicare, right? There’s also a Medicaid component, but let’s focus on the primary. So that means if you have a patient who is in the nursing home on hospice, and then they go out to the hospital and then are readmitted back to the nursing home, if they had a three -day qualifying stay, they would not be eligible to be put on Medicare for the nursing home because they would still have hospice services. So a nursing home who has, you know,

patients who are going back and forth at a hospital and are getting new Medicare benefits and getting reimbursed that way, hospice would not necessarily be the best option, right? But if you have a long -term patient who’s obviously terminally ill and might have less than six months to live, so then you are giving that up to Medicare and giving that up to hospice. And again, the nursing home still gets paid their typical Medicaid room and board rate, so they’re not losing out.

by putting the person on hospice, but if they went to the hospital and the resident came back, they would not get their Medicare Part A billing, if that makes sense.

David Pardo (22:26)
Sure, sure. What are some common mistakes that you’ve seen people do in regards to hospice? Could be patients, could be families, could be operators.

Ari Stawis (22:36)
common mistakes.

Yeah, well, from a patient perspective, I wouldn’t necessarily call it a mistake as much as just when are you referring to hospice, right? And that people are just referring very late. And it makes it more difficult on the hospice. From a business end, the hospice is not as financially successful on shorter term length of stay patients, right? So if you have a patient on for three, four days, you’re probably not going to make money on the hospice end.

So again, I wouldn’t necessarily call that a mistake as much as re -education on when the proper time is to refer to hospice.

So I don’t necessarily have, I was gonna say, I don’t think I really have any real juicy stories. You know, the interesting thing is, you know, hospice compared to the…

David Pardo (23:20)
Um, is there something that you would call a mistake?

Do you have bad opinions? Do you have opinions when people say like, oh, hospice, blah, blah, blah, when you’re sitting down for lunch with somebody that like drives you nuts?

Ari Stawis (23:36)
My answer to that is, my answer to that is I don’t think that people are educated enough to have a proper opinion, right? Not in a negative way. They’re just not as educated on the services that hospitals provide. Right. So that’s what I would say is a mistake. Because, oh, I don’t need hospice in my nursing home, or it doesn’t really benefit me, or it doesn’t benefit my patients. I think it’s more of a…

David Pardo (23:50)
Interesting. They don’t know what they don’t know.

Ari Stawis (24:05)
misunderstanding or as you said, you know, not knowing what you don’t know rather than what I would call a mistake.

David Pardo (24:13)
Okay, I like that. So hopefully.

Ari Stawis (24:13)
The only, I guess the only mistake I would say from a nursing home end is you have a patient that shouldn’t have been on hospice and therefore you lost your Medicare dollars, right? Because they would have been eligible that that would be quote, a mistake from a financial end. But again, talking about the clinical care.

David Pardo (24:31)
That’s if they put them on hospice and shouldn’t.

Ari Stawis (24:33)
Yeah, but from the clinical care, you know, I haven’t, don’t have that many disasters and stories.

David Pardo (24:43)
All right, so the great hope is that people share this podcast episode with their friends so that they get more educated. And as people get more educated, they’ll be in a position to have bad opinions.

Ari Stawis (24:53)
Yeah, I think that’s fair to say.

David Pardo (24:56)
drive Ari crazy. All right, you heard it. Ladies and gentlemen, Ari is asking you to share this podcast episode so we can generate more bad opinions. I love this. Can we we’re we’re nearing the end of the episode. I want to jump to my favorite fun questions. Are you ready?

Ari Stawis (24:59)
Yeah.

Sure, let’s do it.

David Pardo (25:12)
Most life -changing purchase under $150.

Ari Stawis (25:18)
Ooh, most life changing. Should I say that my wife’s engagement ring was under $150? You know, because it was not. Yeah. Yeah. Yeah. Okay. Yeah. Fair enough. Fair enough. Most.

David Pardo (25:28)
This is a place for truth, R .A. Whatever you want.

We all started at the bottom, that’s all good.

Ari Stawis (25:36)
Yeah, yeah. Um, isn’t some anything that’s coming up? Oh, you know what I would say? I would say Costco pants. Those are fantastic. One that I love and have a bunch of pairs and it is a lot less than $150. Let me tell you.

David Pardo (25:56)
Fascinating. Are these like the technical pants? The like sport?

Ari Stawis (25:59)
No, I like the stretchy ones, the stretchy relaxing ones.

David Pardo (26:03)
Right. Right, right. The ones that look like they’re formal slacks or whatever, but they’re really actually made out of spandex or something.

Ari Stawis (26:13)
something like that. That has been life changing for me. Yeah, yeah. Yeah, all right. I try to be original.

David Pardo (26:18)
Cool, that’s an original. I like that. If you had…

If I gave you a billboard and I guaranteed you a million people would see it, 2 million eyeballs on average, what would you slap on that billboard?

Ari Stawis (26:38)
This, I don’t know if this is going to be original or not, but it’s just one line that just says, be a good human. That’s it. It’s not rocket science. You know, I feel like, you know, what, one of the things that I try to do and, you know, I obviously had some at healthcare as well. And what we get is just be honest, be real and just be a good person. And, and what come, you know, what goes around comes around and.

David Pardo (26:50)
solid.

Ari Stawis (27:08)
You’ll get more business that way. You’ll be more respected that way. Just be a real human. Just be real. Be nice. Be honest.

David Pardo (27:20)
Things in short supply, but we could we could all use it. That’s great. And last, where do you get your health care news? How do you get educated on what’s going on in the field?

Ari Stawis (27:22)
Yeah, yeah.

Get it from a few different places. Internally from Zim and Healthcare is a great place. Let me tell you about knowing what’s going on. You know, we always joke that we’re just walking NDAs, just knowing everything that’s going on in the industry. And we love, I always love when someone’s like, I’m going to tell you something, but you can’t tell anyone else. And I’m like, got it. Yeah. Cause we do. Yeah. Story of my life. Exactly. You know, definitely get it from the main publications, you know, skilled nursing news, McKnight’s.

David Pardo (27:50)
Enjoy my life.

Ari Stawis (27:59)
you know, try to get it from other places as well. I think it’s important like any news without trying to get too political here to get it from multiple sources instead of just getting it from one. And, you know, that’s what I would say where we get our news from. Sometimes, you know, drama and politics and just, you know, what we hear from Zimmet Healthcare is entertaining enough, let me tell you.

David Pardo (28:25)
Yeah, I’ll bet. Ari, this has been a blast. I appreciate you being here.

Ari Stawis (28:30)
Yep, sounds good. Thanks, David. I really appreciate you reaching out and taking the time.

David Pardo (28:35)
All right.