Working Together to Build Census

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                                                                                                      FA L L 2 0 0 5

Working Together
to Build Census
What Has Your Therapy Department Done for You Lately?
Put a Tiger in Your Tank
A Wide-Open Door of Opportunity

                                           S p e cial ad ver t ising s e c t io n sp o ns o re d by
R E H A B             P E R S P E C T I V E S                                         WORKING TOGETHER TO BUILD CENSUS

Are You Chasing Census
or Building Census?
     nursing facility administra-
      tor once confided to me his
recurring nightmare: He arrives
at the facility one morning to
find every single bed empty.
Panicked, he rounds up the staff.
They fan across town, running
up and down streets trying to
entice people to come to the facility. The people
can’t seem to see or hear them.
   Maintaining census is an ongoing challenge
for nursing facilities. Fluctuation between pau-
city and plenty is a common occurrence. A full
complement of beds brings everyone a contented
sigh. But when beds go begging, the alarm bells
sound; the marketing team rushes off to woo
the nearest referral source, and the facility hurls
a flurry of dollars at an ad campaign.
   Chasing census is an adrenaline-fueled roller-
                                                      03 What Has Your Therapy Department Done
                                                         for You Lately?
coaster ride—and unfortunately it’s not all that               Six value-added components to look for from rehab
effective. Building census, on the other hand, is
a rock solid, ongoing strategy. In that process,
a facility can have no better partner than its
rehab team.                                           05 A Therapist on Your Marketing Team is a
                                                         Tiger in Your Tank
   Building census is really about building rela-
tionships and designing carefully thought-out                  Make rehab your marketing partner
programs that fill a community need. Your rehab

                                                      07 A Wide-Open Door of Opportunity
company can bring its expertise and technology
to assess market need and design appropriate
                                                               CMS’s rule change could be a boon to SNF census
programs. Therapists are a natural marketing
partner because they can tell the facility’s story
in a dialogue with physicians, hospitals, discharge
planners, and even families in a way that provides
knowledge and builds trust.
   The rehab company that can communicate
outcomes establishes its credibility with referral
sources. By profiling those referral sources and
providing an overview of their needs, the rehab
company can help the facility pinpoint where             For more information on these articles, contact Aegis Therapies at:
its marketing efforts might have the greatest            Aegis Therapies
success.                                                 3960 Hillside Drive, Suite #204
   We hope you enjoy this issue of Rehab Perspec-        Delafield, WI 53018
tives and the exploration of how the partnership         Toll Free: (877) 877-9889
between rehab and your nursing facility can work.        Phone: (262) 646-1760
                                                         Fax: (262) 646-5634
Aegis is your rehab resource.
Best regards,
                                                         Produced by the Nursing Homes/Long Term Care Management special projects team:
                                                         K.T. Anders, Editor and Writer
                                                         Richard Peck, Managing Editor
Martha Schram                                            Eric E. Collander, Art Director/Designer
President                                                Mary McCarthy, Production Manager
Aegis Therapies

R E H A B              P E R S P E C T I V E S                                              WORKING TOGETHER TO BUILD CENSUS

            What Has Your
          Therapy Department
          Done for You Lately?           Six value-added components to look for from rehab

        ou’ve heard it many times: Two heads are better than one. That’s
        why smart skilled nursing facilities are looking at their therapy
        departments in a new light when it comes to the task of building
census. “Therapy is the right arm of the nursing home,” says Patrick
Sulzberger, managing consultant for BKD, a large certified public ac-
counting and consulting firm. “It’s a big, big piece, a key partner in
obtaining admissions.”
   Since the start of PPS in 1998, many skilled nursing facilities around
the country have seen a 10% drop in census, according to Leo LaCroix,
vice-president of sales for Aegis Therapies. “The trend affects the entire
industry,” he says. “It demands proactive solutions.”
   A skilled facility’s rehab department can play a big role in those solu-
tions by offering a variety of value-added services to expand the facility’s
market. “Therapy can’t own a skilled facility’s census development,”
says LaCroix, “but it can help facilitate it and support it.”
   “The value-added side of therapy is important,” adds Faith Lessig
Ott, marketing consultant at LW Consulting, Inc. “More than simply
specifically providing rehab, we have to think outside the box. A really
great rehab partner has to be creative.”                                           involving rehab. It was excellent. The feedback was very good, and it
   If your therapy department isn’t offering its expertise to help fill those       increased awareness among administrators.”
empty beds, the big question is: Why not? “You need the expertise of                  LaCroix’s popular sales-referral program, “Unlocking the Mysteries
the therapy team to grow your business,” says Vickie Shoopman, RN,                 of Census Development,” is geared toward marketing departments
CRRN, CCM, owner of Rx Healthcare Management and Consulting,                       and executive directors. “It’s important that the organization speaks
LLC. “If the therapy department says it can’t do it because it’s not bill-         the same language as it relates to sales so they can understand why
able time, that’s a problem.”                                                      they are getting admissions and why they are losing admissions to
   “Look for a rehab company that provides more than therapy,” advises             the competition,” explains LaCroix. “We talk about identifying need
Fran Fowler, president of Fowler Healthcare Affiliates, Inc. “The rehab             and matching services to need, building relationships, validating our
company can bring market development expertise to the table.”                      promises, working out obstacles, and closing the sale.”
   Here are six ways in which your therapy department can reach out                   2. Ramp up relationships with referrals. “We have found that fa-
to help your SNF build census.                                                     cilities with Medicare censuses below their target levels oftentimes are
                                                                                   not proactive about going to the hospital discharge planning team and
   1. Boost marketing skills. Mark Tellier, healthcare consultant and              identifying candidates for skilled care,” says Sulzberger. He suggests that
principal with Tellier & Associates, LLC, recalls his experience when              the therapy director meet with the hospital to identify Medicare skilled
he was involved with Covenant Health Network, a group of some of the               criteria and talk about the outcomes the skilled facility can provide.
largest not-for-profit long-term care facilities in Arizona: “Leo LaCroix              Relationships that therapists forge with physicians can lead to
from Aegis Therapies provided an in-service on how to grow census by               customized care for the physicians’ patients. “Therapists understand
R E H A B             P E R S P E C T I V E S                                              WORKING TOGETHER TO BUILD CENSUS

physicians,” says Fowler. “Long-term care providers don’t. So therapists           or disease,” says Violet Parker, director of customer care and account
could work with physicians in the community to build a rehab program               management for Aegis Therapies. “Our therapists take part in health
that is tailored to physicians’ specific protocols. The rehab component             fairs and speak at assisted living facilities and other senior centers about
is the number one issue most orthopods are concerned with. Using a                 fall prevention, how to prevent back pain, and other wellness topics.”
seasoned team of therapists and a company that can point to outcomes,              When the need for rehab or skilled services arises, the facility has already
with a mechanism for training and updating therapists, gives a facility            generated goodwill and name recognition.
an advantage in obtaining referrals.”                                                 The rehab department can strengthen the awareness of the rehab
   3. Manage care for maximum census. The 2005 work plan for the                   component within the facility itself, according to Dolores Reidenbach,
HHS Office of Inspector General includes a focus on recidivism and                  senior director of LW Consulting. She advocates including therapy
concern about how effectively patient care is being managed. Because               goals in care planning at all levels, not simply among RNs and thera-
therapists are familiar with the intricacies of the Medicare program and           pists. “For example, if the CNA understands that Mr. Jones doesn’t
are experts at managing therapy minutes, they can be a valuable source             only need help to get to the bathroom, but needs to ambulate 150 feet,
of information for the facility. “Rehab can educate both the facility and          then the CNA might include a walk down to the nurses’ station.” That
the hospital staff so they can build a coalition that moves the patient            kind of knowledge fosters faster resident improvement and increases
through the continuum of care at the right time,” says Sulzberger.                 patient and family satisfaction—which enhances the buzz about good
“When length of stay is managed effectively, a facility might be able to           therapy in the facility.
increase its Medicare patients by 10% or more.”                                       In addition, such integrated care is a selling point for referral sources.
   4. Generate business and outcomes information. The rehab com-                   “It shows that the facility is focused on the total outcome after the patient
pany that can deliver knowledge about its business gives the facility an           leaves the therapy room,” says LW Consulting’s Lessig Ott.
advantage over its competition. Useful outcomes data, denials tracking,
documentation procedures, e-billing, and technology to capture, analyze,              If your therapists are stuck in the gym, it may be time to ask for a
and report data in a variety of ways all make the rehab company an                 helping hand in taking your message to the outside world. Rehab is
invaluable asset. For example, Aegis offers a state-of-the-art program             more than a group of therapists who treat patients; it is your partner in
that demonstrates the benefits of therapy. “Our information system                  building census. “Rehab can strengthen the market position of a nursing
helps the facility understand its business,” says Mike Beckwith, Aegis’s           home,” says Fowler. “It improves reimbursement, enhances reputation,
senior sales manager. “We can tell the facility where its discharges are           and aligns facilities better with physicians. For a skilled facility, that’s
coming from, the length of patients’ stays, where they are discharged,             a significant step up in the community.”
and exactly how much progress they made. That’s money in the bank
for the facility.”
   5. Create a market niche. Creating a rehab specialty is an effective             The Case for Demographics
method of building census. By analyzing market data and tracking                    Rehab/facility partnership success story
referrals and discharges, a good rehab company can identify a niche
in the marketplace and help the facility fill that unmet community                   A rehab company that can collect demographic information is a
need. “If we see a lot of stroke discharges, for example, then we can               valuable partner. Leo LaCroix, vice-president of sales for Aegis
put together a stroke recovery program that is unique to the facility to
                                                                                    Therapies, tells of a facility in Wisconsin that was worried about
capture those patients,” says Beckwith. “The rehab company can be a
leader in positioning the facility in a specialty.”                                 low census, although it was located within a six-mile radius of
   Tellier suggests that specialty programs are an excellent way for skilled        three hospitals—one two miles away, one four miles, and one six.
facilities to differentiate themselves from their competition. “I’m a big           “The facility only called on the hospital two miles away,” reports
believer in marketing by product line. You’re not marketing a nursing
home, you’re marketing a stroke rehab program or an orthopedic rehab                LaCroix. “They had no demographic information.”
program,” he explains. “This positions the                                                       When Aegis began working with the facility to obtain
SNF as an expert in the area. It becomes                                                      demographic information, it turned out that the hospital
more than a generic rehab provider—in
                                                                                              the facility used for referral had 420 discharges to a SNF a
essence it has a new identity.”
   Tellier cites the case of Springdale West,                                                 year. The big surprise was that the hospital four miles away
in Mesa, Arizona, where he helped develop                                                     had 860, and the hospital six miles away had 1,000.
a vent unit. “Our successes with the vent
                                                                                                 The demographics opened up a whole new market for
program changed the image of Springdale
West in the community,” he says. “Rehab                                                       the facility. “To be successful, you have to have demo-
brought a lot of life to a traditional nursing                                                graphic information so you know the number of discharges
home setting by marketing a specialty.”
                                                                                              from a hospital, the number of discharges to a SNF, the
  6. Reach out to educate the facility and
the community. One of the key value-added                                                     diagnosis at discharge, and who the referring physicians
contributions from rehab is outreach edu-                                                     are,” says LaCroix. “A rehab company with the capability
cation. “We have an obligation to educate                                                     to collect such information can be a big help.”
the community in how to prevent injury

R E H A B              P E R S P E C T I V E S                                             WORKING TOGETHER TO BUILD CENSUS

          A Therapist on Your
          Marketing Team is a
          Tiger in Your Tank                        Make rehab your marketing partner

         he facility we’ll call Riverbend Nursing Home had enjoyed a              occupational therapist with me to a physician who did hand surgery
         steady stream of residents for several years. But suddenly, census       to do an in-service,” she says. “The dialogue that went back and forth
         was on the skids. The marketing department, which had grown              between the therapist and the physician gave the doctor a better comfort
comfortable with its collective feet up on the desk, snapped to attention         level because he spoke directly to the clinician who would be taking
with a gasp. Crisis! Something had to be done! “In a skilled nursing              care of his patients.”
facility when the census is high, nobody markets,” says Leo LaCroix,                 It helps if therapists are actually trained in customer service. “Our
vice-president of sales for Aegis Therapies. “When the census falls,              therapy department’s rehab coordinator is our lead person on our therapy
everyone is out there in a panic.”                                                team in the building and is trained specifically in marketing,” says Heidi
   The truth is, marketing for census development is not an “as needed”           Elliott, area director of Aegis Therapies in Minnesota. “The biggest
endeavor; it is an ongoing strategy that must be integrated into the              request we get from our customers is for the coordinator to come along
organization.                                                                     on joint site visits to the hospital to network with the hospital therapists
   Before its empty beds became a crisis, Riverbend could have made               and talk to physician groups or discharge planners.”
its rehab department its strategic marketing partner. “A discussion                  The therapy director is uniquely qualified to act as a link with the
of therapy’s role as a marketing partner needs to be included when a              hospital discharge planning team to help determine what kind of
facility contracts for therapy,” says consultant Patty Jamison, president         patients might be good candidates for skilled care. “We’ve found that
of Innisfree Healthcare Associates. She notes that she always looks               when nursing homes are a little more proactive in that regard, they reap
at the rehab component whenever she works with a client on census                 the rewards,” says Patrick Sulzberger, managing consultant at BKD, a
development.                                                                      large certified public accounting and consulting firm. “If you rely on
   Faith Lessig Ott, marketing consultant at LW Consulting, Inc., agrees.         the hospital discharge process to place patients, you will only get whom
“A lot of SNFs have no idea how much their rehab company can help                 they decide to send you when they decide to send them. Rehab can help
them market,” she says. “Facilities have overlooked this valuable source          in the education process by showing how the rehab company can move
of success stories. There is no better sales tool.”                               the patient through the continuum of care for the best outcomes. The
   The therapy department’s contribution to marketing happens on                  nursing home can do more to control its own destiny to get the right
several levels. The first level is a time commitment outside the therapy           patients at the right time.”
room. “It’s important to designate a portion of time, maybe one call a               The rehab department is also a fertile source of information on how
week, when the head of the therapy department actually goes out and               well the facility cares for patients—and that is a powerful selling tool.
makes a call on a referral source with someone from the facility,” says           “I think we miss the boat if rehab is not part of the marketing team,”
Lessig Ott. “We need to challenge the profession to do more of this.              says Shoopman. “As a marketer, I would want to work with the rehab
The name of the game today is getting out there and building those                supervisor to find out the strengths of my rehab department and what
relationships.”                                                                   we do best. Then I can go out and sell their expertise and outcomes.
   Relationship building means actually putting leather to the pavement.          Both provider and rehab join together to show how the rehab company
Physicians and hospital therapists appreciate a clinical link—someone             can be of value to the referral source.”
who talks their language. Vickie Shoopman, RN, CRRN, CCM,                            The facility therapist also can educate the hospital physicians and
owner of Rx Healthcare Management and Consulting, LLC, is an                      therapy department on the scope of practice in a long-term care setting.
ardent advocate of adding a therapist to the visiting marketing team              “There are still doctors out there who don’t realize that a nursing home
of administrator and admission staff as they hit the streets. “I took my          can provide rehab seven days a week, or whatever is program appropri-
R E H A B              P E R S P E C T I V E S                                             WORKING TOGETHER TO BUILD CENSUS

ate,” says Dolores Reidenbach, senior director of LW Consulting. “It’s                Filling empty beds is about telling a compelling story of excellence.
all about telling them what you can do.”                                           Adding the extra power of the rehab department to the marketing
   Referral development is about developing relationships. “The network-           effort is, in the words of Exxon’s famous slogan, like putting “a tiger
ing is important because the hospital therapist will feel more comfortable         in your tank”—it’s the fuel that speeds the story. “Providers should
sending patients to a facility where he or she knows the therapist,” says          look for a rehab company that asks the question, ‘How can I help you
Elliott. “The continuity of care increases patient satisfaction and gives          in your occupancy crisis?’” says Shoopman. “That’s a wow of a rehab
the hospital therapist confidence that the long-term care therapist will            company.”
follow through.”

Tell Your Story With Outcomes Data
                                                                                    Take the Marketing Partner Quiz!
                                                                                    Marketing is a value-added service that all therapy departments
Outcomes are the proof of a facility’s success story. Sliced and diced by
                                                                                    should provide to a skilled facility to help build census. Use this
patient type, length of stay, diagnosis, discharge to home, and referral
                                                                                    quiz to determine the effectiveness of your therapy department as
source, outcomes data are the knock-‘em-dead tool—and one that gives                a marketing partner.
the facility a leg up on the competition. “A rehab company that can
provide outcomes data is a great resource for the facility,” says Shoopman.           1. Are therapists willing to commit to helping my facility market our
“Most rehab companies don’t use outcomes to their full benefit.”                          services?
   No referral source will send patients to a facility simply because it has                                          ____ YES         ____ NO
empty beds. “Case studies and testimonials are extremely important—                   2. Have the therapy director and staff therapists been trained in
better than any sales presentation you could ever do,” says Reidenbach.                  marketing techniques so they understand their role as partners
“It’s not just that your facility can do rehab. It’s about a life story. The             in marketing?
therapy company should be able to help the facility develop outcomes                                                  ____ YES         ____ NO
tracking, so it can say, for example, ‘Our hip fracture patients, average             3. Is the therapy company proactive in establishing relationships
age 88, are out of bed in 24 hours and ambulating 55 feet within the                     with physicians and hospitals?
first 48 hours.’ That’s very exciting to orthopods.”                                                                   ____ YES         ____ NO
   Having such hard data to document claims of excellence makes it hard               4. Are therapists committed to accompanying the facility mar-
for a referral source to say no. “Our Rehabilitation Outcomes Measure                    keting team on calls to doctors, hospitals, and other referral
[ROM] score allows us to go back to the referral source once a patient is                sources?
discharged and quantify the specific gains the patient made,” says Mike                                                ____ YES         ____ NO
Beckwith, senior sales manager for Aegis Therapies. On the other side                 5. Can I get DRG summary reports from the therapy department
                                                                                         that show who the referring hospitals are, what DRGs are com-
of the coin, aggregate ROM scores can show incoming patients how
                                                                                         ing out of the hospitals, and how many discharges to nursing
much they will improve based on the history of other patients in the
                                                                                         homes the hospitals have?
program. “Traditionally, patients fear that when they enter a nursing
                                                                                                                      ____ YES         ____ NO
home, they may never leave,” says Beckwith. “We can show them what
                                                                                      6. Does the therapy department provide outcomes information to
the average length of stay is, as well as, for example, what percentage of
                                                                                         take to referral sources to document our successes?
our normal hip fracture patients are discharged to home. This enhances                                                ____ YES         ____ NO
the facility’s image in the community and influences census.”                          7. Can outcomes be categorized by program, patient type, and
   Building census is a team effort. It requires participation from every                referral source so our presentation can be targeted to specific
member of the facility. “Rehab is part of it because we are part of the                  referral sources?
team,” notes Violet Parker, director of customer care and account man-                                                ____ YES         ____ NO
agement for Aegis Therapies. “We represent the facility and we provide                8. Will the therapy department help me generate sales brochures
good outcomes. We train and encourage our therapists to go out and                       and other marketing materials to take to referral sources?
help market the facility. We can show how good we are, and you can’t                                                  ____ YES         ____ NO
replace that kind of testimonial with a billboard.”                                   9. Can the therapy department assess community needs and tailor
                                                                                         specialty programs to fit those needs?
Turning Outcomes Into Business                                                                                        ____ YES         ____ NO
After rehab has told its story and shared successful outcomes, one                   10. Do therapists provide educational programs in the community,
step still remains. It’s a crucial one that often is ignored. “Therapists                such as in-services in senior centers on safety, exercise, etc.?
can be great educators, but often they don’t ask for the business,” says                                              ____ YES         ____ NO
Shoopman. She recommends that therapists tell their story and then
come right to the point. For example, they might say: “What would                   Scoring: Count your “yes” answers.
                                                                                    Score Interpretation
prevent you from sending us your next orthopedic patient with a knee
                                                                                    10: Bingo! Gotta love that therapy department—it’s bringing home
                                                                                    the bacon!
   That crucial step is why Aegis’s LaCroix includes training in “closing
                                                                                    7-9: OK, the machinery is in place, time for a little grease.
the sale” every time he does a sales-training presentation to a facility. “A
                                                                                    4-6: The spirit is willing, but the flesh is weak; time to ramp up
lot of marketing people are stuck in the ‘here-we-are-with-cookies-and-a-
brochure’ syndrome,” he says. “That’s different from really understanding           0-3: Yikes, that therapy department needs a shot in the arm!
the needs of the customer and then asking for the business.”

R E H A B               P E R S P E C T I V E S                                               WORKING TOGETHER TO BUILD CENSUS

                  A Wide-Open Door
                    of Opportunity
                                        CMS’s rule change could be a boon to SNF census

         ight now, skilled nursing facilities are looking at the best op-            of care are admitted.
         portunity to grow census since PPS came into being in 1998,”                   Because patients will be discharged home within 20 days, the short
         says Fran Fowler, president of Fowler Healthcare Affiliates, Inc.            stays will increase patient satisfaction and improve the perception
The reason? A CMS rule change.                                                       of the SNF in the community. “People will see that mom came into
   In May 2004, the Centers for Medicare & Medicaid Services (CMS)                   this facility and then went
changed the rule (once called the “75/25” rule) regarding what types of              home,” says Klemm. “Down
single-joint-replacement patients can be admitted into acute inpatient               the line, when mom needs
rehab facilities. Following a formula phased in over three years, the                more care, she will remem-
new rule eliminates acute inpatient rehab unless joint replacements                  ber the facility because she
are bilateral, the patient is over 85 years old, or the patient’s body mass          had good results and the
index is greater than 50.                                                            people were great.”
   “Orthopods are floundering nationwide—they don’t know what to                         As with any new venture,
do,” says Fowler. “They are looking for another venue for their patients.            the first step is for a skilled
Nursing homes that can step up to the plate will capture these popula-               facility to analyze the need
tions, and that’s where rehab comes in. It’s a golden opportunity for                within its community to
every long-term care provider.”                                                      determine what size unit
   Because historically some acute units had as high as 40 to 50% of                 would be appropriate. Arbe-
their total patient population as single-joint replacements, Mark Tellier,           laez says that Aegis can help
healthcare consultant and principal with Tellier & Associates, LLC,                  the facility perform its due
believes this is a relatively easy market for skilled facilities to step into.       diligence and align the unit
“The SNFs should be going after it,” he says. “If they have a good                   with its local hospital and at least one orthopedic group. “You have to
rehab program, and they’re marketing smart to those patients, it’s just              develop therapy protocols,” he says. “If you don’t manage the minutes
low-hanging fruit.”                                                                  carefully, then the program is not going to be successful. Because of
   The kind of good rehab program that can target these patients is                  the higher RUG categories, the SNF will get anywhere from $350 to
what newly created Aegis Acute Rehab has in mind with its Centers                    $500 a day for these patients.”
for Orthopedic Excellence. “We are taking underutilized beds in the                     Expertise is essential to success with these new units. “I think it would
skilled facility and converting them into an orthopedic unit that will               be hard for a SNF to do this on its own,” says Mary Guyot, RN, BS,
concentrate on the ultra-high and very high RUG levels for patients                  CRRN, senior consultant at Stroudwater Associates. “The SNF should
who require intensive therapy,” says Maurice Arbelaez, president of                  associate itself with people who have experience with a rehab model
Aegis Acute Rehab. “With 15 to 25 beds, we can bring in the short-term               and rehab philosophy in order to have good outcomes.”
orthopedic Medicare Part A patients and other managed care patients                     The orthopedic centers will also enhance the facility’s image, ac-
who no longer meet the acute level of care. That will be a big boost to              cording to Stroudwater’s senior consultant Susan Kreps, PT, MBA:
the SNF’s census.”                                                                   “If you have staff specially trained in orthopedics, with protocols and
   The Centers for Orthopedic Excellence would be a dedicated or-                    procedures specifically designed for the ortho population, the level of
thopedic unit in the SNF with its own separate entrance. “We don’t                   trust in the program increases. The rehab needs are not going to go
want to commingle our beds with the rest of the facility because then                away. If people can’t get rehab at the acute level, they are still going to
the efficiency of the unit falls off,” adds Bill Klemm, vice-president                need a rehab program.”
of finance for Aegis Acute Rehab. “We want all these patients in one                     The transition time for the CMS rule is ticking away and skilled
location so we can have a dedicated nursing and therapy staff.” The                  facilities must act soon. “Those that grab this opportunity will do well,
management team includes a program director, a medical director and,                 and those that don’t will miss a significant opportunity for profit,” says
in some cases, a community relations coordinator who could act as a                  Fowler. “An investment in therapy for these patients, in relation to the
liaison with the hospital to make sure all patients who require this level           return—particularly if the facility has empty beds—is a no-brainer.”