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The role of the Hospice Medical Director is changing. For years, the industry relied on contracted physicians primarily for administrative oversight—but with new regulations like the HOPE assessment and rising acuity in patients, the "paperwork doctor" model is no longer enough. In this episode, Tom sits down with two of the most respected clinical leaders in the country: Dr. Andrew Mayo (Chief Medical Officer, St. Croix Hospice) and Dr. Tiffany Richter (Chief Medical Officer, Agape Care Group). They break down the debate between full-time vs. contracted physicians, the "hybrid" model that is winning, and the heartbreaking regulatory gaps preventing dialysis patients from accessing hospice care. Plus, they share deeply personal stories that remind us why we do this work. What We Cover: 00:00 – HCHB Premier Sponsor Spot 00:48 – Intro: Tom welcomes Dr. Mayo (St. Croix Hospice) & Dr. Richter (Agape Care). 01:41 – Dr. Richter’s Journey: From Family Med to Chief Medical Officer. 04:02 – The Mayo Legacy: Dr. Mayo’s path from "small town doctor" to Hospice CMO. 14:37 – The Great Debate: Contracted vs. Full-Time Hospice Physicians. 21:22 – Sponsor Spotlight: Maxwell TEC (Jennifer Maxwell, CEO) 22:30 – The HOPE Assessment: Will it actually improve patient care? 25:18 – The ESRD Conflict: Why dialysis patients are being blocked from hospice. 29:31 – Staffing & Burnout: How to keep clinicians from walking away. 34:51 – "High Tech vs. High Touch": The role of AI in hospice. 39:02 – Sponsor Spotlight: Steno Health (Alex Milani, CEO) 39:33 – Solving the Documentation Crisis: Why paperwork is the enemy of care. 46:49 – "It wasn't your job to fix it": Dr. Richter’s defining patient story. 51:06 – "I have 15 minutes left": Dr. Mayo’s deeply personal encounter with hospice. 59:10 – Advice for new Hospice Medical Directors. About Our Guests: Dr. Andrew Mayo is the Chief Medical Officer at St. Croix Hospice, serving 10 states in the Midwest. He is a fifth-generation physician with a lineage tracing back to the founders of the Mayo Clinic. -LinkedIn: linkedin.com/in/andrew-mayo-546a4b10b -St. Croix Hospice: https://www.stcroixhospice.com/ Dr. Tiffany Richter is the Chief Medical Officer at Agape Care Group, a leading hospice and palliative care provider across the Southeast. She oversees clinical quality and the pediatric palliative care program, "Hands of Hope." -LinkedIn: linkedin.com/in/tiffany-richter-a397857 -Agape Care Group: https://agapecaregroup.com/ Special Thank You To Our Sponsors: -Premier Sponsor: Homecare Homebase: https://hchb.com/ -Maxwell TEC: https://maxwelltec.com/ -StenoHealth: https://www.stenohealth.com/ Listen to Last Visit First: -Apple Podcasts: https://podcasts.apple.com/us/podcast... -Spotify: https://open.spotify.com/show/3iSKGRv... -YouTube: / @lastvisitfirstpodcast -Website: https://www.lastvisitfirst.com -LinkedIn: / last-visit-first About Last Visit First: In home health and hospice, the start of care usually begins with the final visit in mind—because every decision becomes a memory. 'Last Visit First' challenges the industry to prioritize quality, connection, outcomes, and dignity right from the start. Hosted by industry veteran Tom Maxwell, we sit down with the CEOs, innovators, and clinical leaders shaping the future of Care at Home. We bring you the conversations that drive change, from leadership strategies to the innovations redefining patient care. Join the Conversation: If you enjoyed this episode, please Subscribe and leave a comment below. It helps us bring more incredible guests to the show.