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, 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 Part 1 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