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.”