Monday, July 31, 2017

Official Death Nurse Blog Re-launch Day Post!


Sant' Apollinare Nuovo (Ravenna), Mosaik"Auferweckung des Lazarus"

It's time to get serious. More serious? To stop taking this so seriously?

Anyway, today is the official re-launch of this blog!

All content here is based on a simple goal - to help people know more and demand better for care in serious illness and at end of life.

I'm committed to 3 posts each week, M-W-F. Each day has a theme.

Monday's theme is "Some things about hospice," and explores the topic from several perspectives: as a philosophy of care, a clinical discipline, an insurance benefit, and a business.

Others have written about the contemporary history of hospice in the U.S. Let's talk about the business side of things for a few minutes.

There are two basic business approaches to providing care for patients and families facing serious illness and end of life.

The first is to operate a hospice with the primary goal of making money. We'll call these, "For Profit Hospices." As any honest capitalist will admit, there is no secondary goal.

The second is to operate a hospice with the primary goal of providing care, and a secondary goal to avoid losing money. We'll call these, "Not for Profit Hospices."

That's a fundamental distinction and, to me, the most important one when it comes to picking a hospice to work with, either as a clinician or as a patient, family member, or caregiver.

I don't think for-profit hospices should exist. Period.

I've heard others argue there's no objective data to support the idea that for profit hospice = bad care at end of life, etc. but to me the logic explains itself:

1. People are dying.
2. ????
3. Profit!

Those question marks bother me.

Which brings us to the blog's first rule: A business model is not a health care model.

I've learned that making money in hospice requires at least one, and ideally more than one, of the following: aggressive sales, Medicare fraud, and relentless cost-cutting.

It's also possible to play games with real estate and executive compensation, but let's just focus on the operating basics.

An aggressive sales force trolls for patients, no matter who they are, where they are, or what they need. The only point is to, "get them to sign on the line that is dotted."

Fraud comes from admitting patients when a hospice plan of care isn't really appropriate, i.e. they aren't dying; and billing for a more expensive level of care than they require, i.e. GIP or Continuous Care instead of Routine.

Relentless cost-cutting also includes monumental resource wasting. It's mostly sporadic and reactive, not strategic.

The bottom line: there's no room to even consider quality of care in a For-Profit Hospice. I'd love to hear from anybody who thinks they can explain this better, or point out where I'm wrong.

Picks of the Week


As luck would have it, I stumbled on a new blog while preparing this post. It looks like Generic Hospice has been around for a while, and I appreciate its subjective insider's look at the latest workings of the publicly-traded Kindred Healthcare, Inc. (stock symbol KND).

I also like his/her attitude: "When hospice reverts to the lowest common denominator and leaders obsess about metrics."

FWIW, Kindred acquired rival Gentiva in 2015 for $1.8 billion. Also, too: remember the blog's first rule.

I'm also very glad to have found Frances Shani Parker's most excellent Hospice and Nursing Homes Blog. She's been at this for a while. Her deep expertise is evident in the blog's breadth, depth, and substance. Check out her July 10 post on managing pain.

Thanks for reading. See you on Wednesday.


Notes

Disclosure: I own shares of CareTrust REIT (stock symbol CTRE), but they don't own me ;^)


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5 comments:

  1. I'm in complete agreement w/you re for-profit Hospice.

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  2. I agree with your sentiments, any public corporation is charged with the fiduciary obligation to maximize shareholder value, profit being a huge driver of that. Not a good fit for Hospice or Healthcare in general. But a not-for-profit entity isn't immune either, generally (top) salaries, benefits, time off and overhead are pumped up well beyond the free market levels. It's usually limited to far fewer people instead of every shareholder. PBS stations cry poverty non-stop but as an auditor of them, its simple not true...

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    Replies
    1. I agree. An upcoming post will explore how to find and assess a non-profit's IRS Form 990.

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