Tuesday, January 31, 2023

NHPCO CEO Clutches Pearls, 2014 Edition


This is what so badly bothered J. Donald:

"the data analysis, based on hundreds of thousands of Medicare patient and hospice records from 2013, shows that the gap between the for-profits as a whole and nonprofits is striking and consistent, regardless of hospice size."

Sunday, January 29, 2023

Preview Presentation: How to Make Money in Hospice - Spin-off Stock Price Wipeout!!


It's a slide show, you can maximize screen size, advance the slides or auto loop

This is an excerpt from a work in progress - How to find the best hospice? | How to make money in Hopsice!! and specifically an excerpt that takes a look at the way to make the BIG money in hospice: financial engineering

Inspired by the reporting of journalist Ava Kofman

How Hospice Became a For-Profit Hustle

The final(?) version(s) will be video(s) with scripted narration

This is just some of the storyboard that takes a look at one form of financial engineering - the spin-off special dividend - and how it's turned out so far in the case of Encompass | Enhabit

I believe it's essential that patients and families, caregivers, clinicians and the community understand what's happening with hospice from every perspective - especially including the investors' point of view

They see the business opportunity as plain as you should be able to see the nose on your face in a mirror in broad daylight

Boomers are getting old, sick and dying - it's a demographic wave 

Surf's up!

In their own words:

"Investment to strengthen and scale... leadership in a fast-growing and fragmented market"

Advent International Acquires AccentCare

Inside Joke

Thanks for reading, see you next time!

Sunday, January 22, 2023

More on the dangers of for-profit corporate hospice

I’ve been observing for-profit-corporate hospice for a while, and have long believed it’s the single greatest threat to a patient and family’s opportunity to achieve a peaceful death

Ava Kofman’s recent piece emphasized yet again the need to develop ways to help people negotiate the minefield that for-profit corps have made of hospice, and to help patients, families, caregivers, clinicians and the community understand the difference between good hospice and predatory crappy hospice

There are so many rabbit holes in the space, as just one example:

  • Curo Health Services didn’t exist until 2010, when it was founded by some hospice sharpies and a private equity firm to acquire other hospices - classic rollup small players
  • 2014 second PE firm buys Curo $730 million, first PE exit strategy
  • 2018 third PE firm buys Curo $1.4 billion, second PE exit strategy
  • 2022 fourth PE firm buys 60% of Curo + remains of Kindred Hospice for $2.4 billion, third PE exit strategy
  • Humana owns other 40% (they also love Medicare Advantage)

Like I said, that’s just one story there’s so much M&A going on because Boomers are getting old sick and dying - it’s a demographic wave

Surf’s up!

Working on the material also leads to the questions - so what? What can we do?

Here's what I think:

We need easy access to reliable information that supports informed decision making

“WE” = patients, families, caregivers, clinicians and the community

  • Every hospice must be required to post and update the following information daily, prominently on their websites, transmit it daily to the hospice compare section at medicare.gov, and be prepared to convey by phone when requested:
  • Post ownership 
  • For-Profit must include parent corp, whether public/private, list PE & major shareholders, and post links to investor info 
  • Not-for-Profit must post links to past 5 years IRS 990
  • Post ADC (total, home, LTC, ALF, other) 
  • Post staff #’s (FT - RNCM, MSW, SC, HCA, NP/PA, MD, Other; PT - RN, MSW, SC, HCA, NP/PA, MD, Other) 
  • Post actual case load # and average case load calcs @ NHPCO 2010 workload guidelines
  • Post staff #’s open positions 
  • Post current quality scores
  • Post notice deficiencies & complaints
  • Post all staff bios

FWIW I have also assembled links to my previous blog posts on the topic

Appendix B

Death Nurse: Boo Boo talks about hospice

Death Nurse: Boo Boo talks $$ and non-profit hospice


Death Nurse: When your hospice medical director is a useless idiot…


Hospice 101 - Part 1: Meet your nurse

Death Nurse: This could be the start of something big

Death Nurse: Another point about suffering

http://www.deathnurse.com/2018/12/searching-for-hospice-at-place-in.html Part 1

http://www.deathnurse.com/2019/01/searching-for-hospice-at-place-in.html Part 2

Death Nurse: Peeking up from the rabbit hole…

Death Nurse: At least it's not a meat grinder

Death Nurse: This is not financial or investment advice

Death Nurse: Failing CMM-101

Death Nurse: This is not financial advice, continued

Death Nurse: This is not financial advice, continued (different one)

Death Nurse: Orange Crate Update Number 1



Death Nurse: Quick Taste of an Upcoming Post - What's News in Corporate Hospice? 

Death Nurse: November is Hospice Month! So, what's news in corporate hospice? A story told mostly in pictures.


Death Nurse: Orange Crate Update #4 - Welcome Our New Robot Brain Friends to the Hospice Team


Death Nurse: November is hospice month! Hospice Fraud Wall of Shame Update

Death Nurse: November is Hospice Month! BREAKING!! Amedisys continues to acquire and disrupt

Death Nurse: Ending the year with a look back at a hospice service failure

Death Nurse: Sneak peek magnum opus - how to find the best hospice    

Death Nurse: How to choose a hospice





Death Nurse: The problem is crappy corporate hospice 

Thanks for reading, more to come

Friday, January 20, 2023

FWIW - New Yorker/ProPublica piece isn’t the first one, by far

 WaPo 2014 - “... data analysis, based on hundreds of thousands of Medicare patient and hospice records from 2013, shows that the gap between the for-profits as a whole and nonprofits is striking and consistent, regardless of hospice size

“Unfortunately, a lot of people have come into the business for the wrong reasons,” said Michael Girard, who with his wife Deb owns the Circle of Life for-profit hospice in Reno, Nev. “A lot of the problems we have in hospice today have happened with the entry of what I call the ‘vulture capitalists.’ ”

WaPo 'Business of Dying'

NHPCO 2014 - “In an article appearing in today’s Washington Post, “Dying and profits: The evolution of hospice,” examination of federal hospice cost report data points out differences among provider types. It may be inferred that tax status influences the quality of care a hospice provider delivers to patients and their families. The National Hospice and Palliative Care Organization is concerned that this article –  like others in the Post’s “The Business of Dying” series – may confuse the public seeking care at the end of life. Assessing quality is not as simple as identifying whether a hospice provider is a non-profit or for-profit organization or looking at a single statistic.”

“As the need for hospice and the awareness of the services hospice provides has increased, the number of both non-profit and for-profit providers has grown.”

NHPCO is simply mortified

**NOTE: The statement above is not correct - the total number of not-for-profit hospices reached a peak of 1,400+/- in 1998 and has declined to about 1,200 in 2022, while between 1998 and 2022 the number of for-profit hospices has increased from 700+/- to over 3,600.

“Between 2000 and 2013, the number of Medicare beneficiaries served by chain hospices more than quadrupled, and FP chain agencies are now the largest category of hospice agencies nationally… Our results highlight the value of more detailed analyses of hospice ownership to offer a more nuanced assessment concerning the role of structural and organizational dimensions in care delivery. Such a focus will help guarantee that clinicians, patients, researchers, and policymakers have the tools necessary to assess care provided by particular companies and to ensure greater transparency in the hospice marketplace.”

Tracking ownership changes in hospice - HHS

“In this longitudinal study of hospices active in Medicare during 1999–2009, we analyzed Provider of Services files to understand key shifts in the industry. We found evidence of substantial turbulence. One-fifth of Medicare-certified hospices active in 1999 had closed or withdrawn from the program by 2009, and more than 40 percent had experienced one or more changes in ownership. The most prominent trend was the shift in ownership type from nonprofit to for-profit ownership. Four out of five Medicare-certified hospices that entered the marketplace between 2000 and 2009 were for-profit. Hospices also became larger, as the proportion with 100 or more full-time employees doubled to 5 percent from 1999 to 2009.”

Hospice industry turbulence in shift to for-profit

“We… physicians haven’t been bold in the past TWO decades during multiple OIG & news reports of fraud in hospice. We should be bold now.” 

Christian Sinclair, MD via Twitter

HPNA via email - “ I hope that you read our advocacy update in Friday’s HPNA Happenings newsletter on this topic. We were mindful to update the entire membership with the work we have done to this point on the Ava Kofman article.  The national office staff has also been monitoring the community message boards and may distribute a similar advocacy update message in the days ahead.  As HPNA continues to work with its Coalition partners on this issue, which has a high-level of complexity, the national office staff will be sure to share additional information when it becomes available.  Our staff looks forward to continuing to highlight the significant role hospice nurses play in providing care to patients and families throughout the process.”

Sunday, January 15, 2023