Thursday, March 28, 2019

Orange Crate Update Number 1

Earlier this month I announced the Death Nurse Orange Crate of Publicly-Traded Hospice Companies*. Timing is everything, because now is when these guys tell the world how much money they've made and/or try to explain why they didn't make enough.

I'm sifting through their assorted filings and reports, dense with legal disclaimers, marketing braggadocio, and accounting. I'm not going to tell you that I understand it all, because I don't. I'm not a lawyer, accountant, of Master of the Universe.

However, my bullshit detectors are finely tuned, and there's plenty of that kind of stuff in these reports, and in the associated materials that make up your typical investor road show.

My detectors quickly sniffed out two examples from Humana's (NYSE:HUM) latest, courtesy of my new friends at Seeking Alpha. They're not the only ones, but ya gotta start somewhere. 

Before we do, a quick review of the fundamental premise behind every company in the Orange Crate*:

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

Number one is fact. Number three is the goal. Number two? A combination of magical thinking and messy details. Do you see what I'm saying? Good, let's begin.

HUM's base business is selling health insurance, an industry where making money depends entirely on nickle-and-diming vulnerable patients, denying their claims, and squeezing their providers. 

They're doubling down on the whole Medicare Advantage thing because it's their direct pipeline to seniors, and we all know about seniors and health care dollars.

It's like when someone asked Willie Sutton why he robbed banks - you go where the money is. For our friends at HUM, that means the United States Department of Health and Human Services. The Centers for Medicare & Medicaid Services is its drive-up teller window.

So, right now they can pick the pockets of about 4 million people over age 65. Of course they want more, but it's enough to get started on exploiting the opportunity (People are dying).

Since we've already identified the final objective (Profit!!), the only thing that remains is replacing the question marks with... a circle and two pieces of the world's easiest puzzle. 

Wasn't that easy? Who says healthcare is hard? Next slide, please.

I previously posted about HUM's entry into corporate hospice through their minority (40%) partnership with two leveraged buyout firms (they'd rather we say "private equity") in the $5.4 billion blender called, "Kindred at Home." (smoothie still in progress) It's key to their "success" - $$ from the dying.

You'd think that HUM, which can arguably claim to be in the healthcare business, would insist on running the show. Surprise! 

Thanks for reading. See you next time.

Also too: Get thee to Generic Hospice Blog.

*For education only. This is not financial advice.

Tuesday, March 19, 2019

World Premiere - Death Nurse Cartoons!

A student film

I chose the name 'Death Nurse' without fully thinking through what it meant, but this is how it's evolving - as a character in a cartoon world that touches on contemporary life, serious illness, death and everything associated as frequently and in as many different ways as six seasons of the Sopranos (plus every episode of Deadwood, Six Feet Under, The Wire...). 

Aim high. Keep swinging.

Friday, March 15, 2019

Ceci n'est pas un robot

Index card version

Simple is different than easy

I'm still working on the video, but wanted to show my cards.

Tuesday, March 12, 2019

Manifesto Tuesday - 4 admonitions

It's pretty simple, which is not the same as easy.

I had it all planned - 'Manifesto Monday' has a nice ring to it. But it's Tuesday. Better late than never.

The biggest challenges for developing the blogging portion of my practice have been consistency and reliability. That's a problem, because if posting useful content is Blogging Rule #1, then #2 is being consistent in posting that useful content. Daily, weekly, or whatever matters less than following the schedule.

So, I'm going to start observing that rule by scheduling content based on the day of the week. I plan to build up to posting a different theme on each weekday.

I'm starting with a commitment to post every Tuesday because that's what day it is today, and I'm starting with Death Nurse Manifesto as Tuesday's focus... because. 

I announced the Manifesto back in early December, though the idea has been rattling around my skull for much longer. 

What is Death Nurse Manifesto?

It's fortune cookie wisdom, Burma Shave haiku, bumper sticker philosophy, short attention span theater, earworm verse chorus verse, card catalog entry, ticker tape data, distilled and filtered, essence of knowledge, cheat sheet, quick reference guide, the right tool for the right job, solemn advice, half-baked fantasies, rules for living, a reason to tweet, a reason to block, an invitation, a doorway, a bridge, a chasm, an obstacle, completely meaningless and without merit, helpful, funny, offensive and repugnant, a cry for help, the beginning of a longer conversation, a cry in the wilderness, a plea to consider what really matters.

What is "this mess" you're talking about?

It's the overall heath care system in general, and more specifically the many ways we fail with advance care planning, making informed decisions about treatment options in serious illness, goals for care at end of life, caring for the dead and bereaved.

Why four (4) parties? Why not three (3), or eleven (11)? 

Because that's how it shakes out. The number is four (4). Who am I to argue? Each party is essential, but if you're wondering if any party is more important than the rest, think you already know, or simply want to know, just ask this question: Whose needs are being met?


C'mon, just give it a try.

Thanks for reading. More soon - next Tuesday at the latest.

Saturday, March 9, 2019

Captain Obvious wants to know

Which approach is better for talking with patients and families about prognosis and options for treatment in serious illness, and goals for care at end of life?

A: Nurse and Social Worker, live and in person
B: Remote talking doctor head on video screen riding a robot trolley

Bonus: WTAF is this even a question?

AP Story here

Monday, March 4, 2019

This is not financial advice, continued

power tie + magic pen

Last week I wrote about my goal to purchase one (1) share of stock in each of six (6) publicly-traded hospice corporations.

Willing Buyer met Willing Seller with the help of our good friend The Invisible Hand, and I've collected my shares in an orange crate for safe keeping. 

Actually, there's just an electronic record of the whole mess 'o transactions somewhere out in space. No physical money was exchanged, and I don't know if anyone still even issues stock certificates.

Anywhoozle, it's done.

Why did I do this? 

I didn't do it to get rich. One share won't cut it. 

And it's not an 'investment' in the sense of my wanting to end up with more money in my pocket because of this particular decision.

Also, too: this is not financial or investment advice.

I'm interested in what's going on in the hospice space, and these folks are messing in it. I'd rather learn about them from this perspective. They're in charge, and I get to pester them with questions, opinions, and advice.

Thanks for reading. See you next time.

Saturday, March 2, 2019

4 panel cartoon of a four panel cartoon, with links

how many ways can we access the same information?

I'm just starting to learn Twitter. 

I got a re-Tweet by Diane Meier (@DianeEMeier) of a Tweet by PallMedEd (@PallMedEdof an article that appeared over 4 years ago in McKinght's Long-Term Care News, "Tomorrow’s nursing homes must integrate palliative care."

I don't know if today is the tomorrow they were talking about, but I was immediately reminded of a blog post I'm still fond of, featuring a video cartoon based on a terrific podcast I heard about a year ago - an interview with Caroline Stephens, a nurse on faculty at UCSF, by Eric Widera and Alex Smith, two physicians also at UCSF, about her current research which had recently been published in an issue of JAMA concerning the use of palliative care for nursing home residents.

2014, 2019.....

Thanks for reading. See you next time.