Thursday, March 30, 2023

Updated Game Over Updated

Don't piss off the puppeteers

Time to throw this baby out

So I've been slowly making my way through this podcast, because like any good journal article there's a reason (need?) to stop at about every 6th word - either to check out a footnote that turns into a multi-day  rabbit hole, think about what you just read and read it again, or just mutter quietly WTAF?

Anyway, the only thing I can manage today is to reflect back on a phrase VITAS dude leaned into right out of the gate - "tax status" 


I just remembered something VITAS dude said in his first 10 seconds of the podcast - "tax status" - that's an important rhetorical misdirection on his part even if clumsy shallow Weaselspeak

Sure, one difference between not-for-profit and for-profit hospices is that the not-for-profit hospices are exempt from paying the IRS  because they're recognized as charitable entities, like your favorite local church

They have to state their case and show evidence - most notably by filing IRS Form 990 every year to report on their finances and operations, including how much the highest earners get paid

It's all very transparent - orgs have to make their filings open and available for public inspection, and legit orgs like Doctors Without Borders and Partners in Health make theirs available right from their websites

For whatever reason I haven't found any hospices that do the same, but online resources like Guidestar provide access independent of the orgs - though they may not be too recent

Plenty of non-profit hospices have reason to be hinky about their finances (exec comp and bonuses in particular), but at least with a little digging it's possible to get some idea

Here's the problem with VITAS dude's memorized propaganda - if the issue is simply one of "tax status," can you seriously imagine this conversion between VITAS godfather Don Gaetz (yeah, he's the dad) and his financial backers in 1984 when non-profit Hospice Care, Inc. became for-profit Hospice Care, Inc:

Don Don - We haven't been paying taxes since 1978, even though we've done a ton of business and now we're looking at even more business paid for by the federal government, the freaking sky is the limit!

Financial Rapscallions (in unison) - What should we do, Don Don?

Don Don - We should definitely start paying taxes!
Financial Rapscallions (in unison) - What a great idea, Don Don!! Yes, let's start paying taxes!!!

You guys crack me up. Please push back on the nonsense, it's literally the least you can do.


Note - I have deep respect for the GeriPal dudes that goes all the way back to the early days of blogging about this stuff, and even wrote a thang for them back in the day, as well as a thang about their thang in tribute

I'm glad they did this podcast, and also very sad because it shows how bleak the future of hospice is

Imagine yourselves as energetic go-getters from Toys R Us completely convinced that those dudes at Bain Capital will have a complete change of heart once they listen to what you have to say 

Sunday, March 26, 2023

Game Over - UPDATED!


why are these white dudes smiling?

So the latest GeriPal thang took place just a few days ago during the annual AAHPM corporate lovefest and awards ceremony with HPNA tagalong - that's a whole other story

I'm taking in this video slowly, in bites - there's a lot to chew on, like a long obituary for a beloved figure who's not quite dead yet

I made it 10 minutes in on this first go - we'll see when I have an appetite for more - my first comment:

"this is worth line by line analysis, nobody can hide (even though there's abundant Weaselspeak right out of the gate). 

VITAS dude is unhappy about the investigative report on hunger in America because it didn't mention his favorite restaurant. 

Only a hit dog howls and they do it every time

Every nurse working at a for-profit with their eyes open sees the ugliest of corporate greed, fraud and malpractice as a matter of routine. 

"I'm not against for-profit hospice- private equity - publicly  traded..." 

Ira just negotiated against himself and walked away from the table empty handed. 

Nice work, doc. Check your pockets.

It's over, folks.

The financial rapscallions have won, they've captured hospice including the trade groups and professional orgs.

There's nothing for them to do besides mop up, and you've got no choices besides keep on dancing to their tune or step away to make all  things new. 

This discussion was over just 10 minutes in.

#RacistHPNA #CorporateShillsAAHPM #hapc #hapc23 #hapc2023


UPDATED 3/27/2023 4PM+/-

Let's call everything up there 1 - Intro

2 - physician cheers business without understanding business

Ira wants for-profit hospice to succeed by providing excellent care, but since that requires supporting proficient staff and safe staffing, they gotta cough up for both and that's just too expensive. 

That's always been the bottleneck even in the best times, which these are not.

It's money that matters, Paul Kusserow came back to make sure they'd meet their numbers - and BEAT their numbers, especially in the short-term

You can want whatever you want - they just want ROI that meets expectations and BEATS expectations!

It's the only success

3 - yeah we’ve been blowing it for 25 years but this time we’re serious  

Ira's against bad hospice - good position to take

He also admits that y'all in the awards club he helped found and guide have just been looking on for the past 25 years - though not really just looking, since y'all have to work somewhere so you've participated

Here's a question - how do you expect the people and the structures like AAHPM and bastard stepchild HPNA who have been on the scene throughout the theft to have any role or credibility in figuring out how to clean up the mess this has become?

I think this is a hint that whatever you've done is wrong, and that your best contribution to the discussion moving forward is to just stop talking and go sit over there

4 - “get big or get out” Earl Butz - USAgSec, racist and stand up comic

Now VITAS dude makes a pitch for scale in hospice, which is great for factories like theirs because they can meet their numbers and BEAT their numbers the same way McDonald's churns out whatever it is they churn out, some call it food. 

In his way of thinking, small community-based agencies are the real problem

I guess he's correct in a way - they couldn't pay $75 million to DOJ in a settlement for fraudulent practices over an 11 year period as easily as VITAS (Chemed, NYSE CHE - a holding company whose other division is Roto-Rooter the jokes write themselves)

The sanctimony is palpable

I'm curious if any women will be allowed to speak

On to the next few minutes or as much as I can stand in one sitting

5 - that’s what trade orgs and biz groups and prof orgs are for

Since corporate has captured hospice and that includes their trade group, don't be surprised to see them pushing hard for crap like this that favors their business interests which are NEVER the same as the interests of patients and families (and most clinicians)

Yeah they'll jabber on about how that's not true - but always ask yourselves who really benefits and 10/10 it's money that matters

Please consider opening your eyes

6 - i’m not afraid to say when someone’s right

Ira says "it's not complex" and y'know he's right

I'll listen more to what he thinks is important but I expect it'll be hugely physician biased since y'all have a hard time thinking about others besides yourselves

FWIW the most important indicator of quality are the answers to these questions:

- do you have enough staff?
- can you keep your staff?
- who is your staff?
- are they any good? 
- who owns you?


Yeah his advice was marginally helpful, of course physicians figure prominently; lots of features features (useless when you're trying to sell something); but he legit earned a cookie repeating Medicare's most useful questions (How many other patients does my hospice nurse see? Who comes for a nighttime emergency?) 

Also too see above wrt staff

I once asked a hospice how many full time RN Case Managers they had on staff to support a census of 850+/= and about their average case loads

Long story short - none of your business!

Story behind the story - not nearly enough

7 - ugh ok that's enough for now 
  • the financial rapscallions have won, it's over, nothing left to do but some mopping up
  • four white dudes talk talk talk talk while Vanna White holds a mic
  • what I anticipate moving forward
    • best case - "If we get a seat at the table with captains of industry and masters of the universe, surely they'll listen"
    • worst case - everyone except Ira and VITAS dude just put everything down and walk away in disgust
    • most likely - "oooo Curo's looking for a new medical director in Norman, Oklahoma!"
Thanks for reading! See you next time!

Friday, March 17, 2023

Private equity and public corps capture hospice - How it begins


This 10-minute clip is from a project I call, "How to find the best hospice? How to make money in hospice!" It's a working document, the story and pictures are set but the unscripted narration is awkward.
There's lots more to the story, including what we can do about the current hospice mess* and how patients, families, caregivers, clinicians and the community can best separate those rare grains of wheat from the overwhelmingly crappy chafe**

I'm working on it***

* know more
** demand better
*** nobody is coming to save us