tag:blogger.com,1999:blog-91879631318367490262024-03-06T07:39:23.213-08:00Death NurseBecause this is a blog about living and dying, and because I'm a nurse.Jerryhttp://www.blogger.com/profile/01241842671993239496noreply@blogger.comBlogger236125tag:blogger.com,1999:blog-9187963131836749026.post-22272282150656758362024-01-19T07:54:00.000-08:002024-01-19T07:54:39.160-08:00Dr G and Me - Together Again! How to find your best option for hospice - Part 2, The Demo-ing<p> </p><iframe allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" allowfullscreen="" frameborder="0" height="315" src="https://www.youtube.com/embed/K9XNnARH5-A?si=imYQxSZwxolKEpQl" title="YouTube video player" width="560"></iframe><div><br /></div><div><b><span style="font-family: courier;">You can do it - you absolutely can in 5 simple steps</span></b></div>Jerryhttp://www.blogger.com/profile/01241842671993239496noreply@blogger.comtag:blogger.com,1999:blog-9187963131836749026.post-35171461603624158872024-01-19T07:51:00.000-08:002024-01-19T07:51:56.406-08:00Dr G and Me - Together Again! How to find your best option for hospice - Part 1 of 2<p> </p><iframe allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" allowfullscreen="" frameborder="0" height="315" src="https://www.youtube.com/embed/k7xIezN47sM?si=DgHubs0RqMgMlYeI" title="YouTube video player" width="560"></iframe><div><br /></div><div><span style="font-family: courier;"><b>How do you even start? Here's how</b></span></div>Jerryhttp://www.blogger.com/profile/01241842671993239496noreply@blogger.comtag:blogger.com,1999:blog-9187963131836749026.post-43758827339718514062023-08-14T10:24:00.002-07:002023-08-14T10:24:10.018-07:00See me on TV with Dr G!<p style="text-align: center;"><iframe allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" allowfullscreen="" frameborder="0" height="315" src="https://www.youtube.com/embed/s5Q-P9Vze5s" title="YouTube video player" width="560"></iframe></p><p style="text-align: center;"><span style="font-family: courier;"><b>"That's me in the spot-light... trying to keep up with you"<br />(REM - 'Losing my Religion')</b></span></p><p style="text-align: left;"><span style="font-family: courier;">I'm grateful to Dr G for the chance to talk about what it was like trying to keep up with Jeanne</span></p><p style="text-align: left;"><span style="font-family: courier;">See more by Kaishauna Guidry,MD,HMDC and Mourning Dove Medical</span></p><p style="text-align: left;"></p><ul style="text-align: left;"><li><span style="font-family: courier;"><b><a href="https://www.youtube.com/@MourningDoveMed" target="_blank">YouTube</a></b></span></li><li><span style="font-family: courier;"><b><a href="https://twitter.com/DrMamaKai" target="_blank">Dr G on Twitter</a></b> </span></li><li><span style="font-family: courier;"><b><a href="https://mourningdovemedical.com/" target="_blank">Mourning Dove Medical</a></b></span></li></ul><p></p><p style="text-align: left;"><span style="font-family: courier;">Here are a few related posts about Jeanne </span></p><p style="text-align: left;"></p><ul style="text-align: left;"><li><span style="font-family: courier;"><a href="http://www.deathnurse.com/2017/05/a-death-i-nursed.html" target="_blank"><b>A Death I Nursed</b></a></span></li><li><span style="font-family: courier;"><b><a href="http://www.deathnurse.com/2017/08/david-bowie-is-helping-me-grieve.html" target="_blank">David Bowie is helping me grieve</a></b></span></li><li><span style="font-family: courier;"><b><a href="http://www.deathnurse.com/2017/12/unconditional-love.html" target="_blank">Unconditional love</a></b></span></li><li><span style="font-family: courier;"><b><a href="http://www.deathnurse.com/2018/01/remembering-jeanne-today.html" target="_blank">Remembering Jeanne today</a></b></span></li><li><span style="font-family: courier;"><b><a href="http://www.deathnurse.com/2018/02/story-time-nutrition-and-end-of-life.html" target="_blank">Ice Cream, a Love Story</a></b></span></li><li><span style="font-family: courier;"><b><a href="http://www.deathnurse.com/2018/03/things-that-went-badly-part-1.html" target="_blank">Things that went badly... Part 1</a></b></span></li><li><span style="font-family: courier;"><b><a href="http://www.deathnurse.com/2018/03/things-that-went-badly-part-2.html" target="_blank">Things that went badly... Part 2</a></b></span></li><li><span style="font-family: courier;"><b><a href="http://www.deathnurse.com/2018/11/options-for-final-disposition-of-dead.html" target="_blank">Options for the final disposition of a dead body</a></b></span></li><li><span style="font-family: courier;"><b><a href="http://www.deathnurse.com/2019/01/understanding-alzheimers-decline-and.html" target="_blank">Understanding Alzheimer's - decline and prognosis</a></b></span></li><li><span style="font-family: courier;"><b><a href="http://www.deathnurse.com/2019/07/i-remember-day.html" target="_blank">I remember the day</a></b></span></li><li><span style="font-family: courier;"><b><a href="http://www.deathnurse.com/2019/09/death-nurse-film-fest-v-12-2019-ice.html" target="_blank">Death Nurse Film Fest V-1.2 (2019) - Ice Cream, a Love Story</a></b></span></li><li><span style="font-family: courier;"><b><a href="http://www.deathnurse.com/2021/01/life-on-mars.html" target="_blank">Life on Mars?</a></b></span></li><li><a href="http://www.deathnurse.com/2023/01/jeanne-m-soucy.html" style="font-family: courier; font-weight: bold;" target="_blank">Jeanne M. Soucy</a></li></ul>Jerryhttp://www.blogger.com/profile/01241842671993239496noreply@blogger.comtag:blogger.com,1999:blog-9187963131836749026.post-58572809451085426442023-04-11T15:28:00.000-07:002023-04-11T15:28:00.636-07:00New! Update for Updated Update: Game Over Updated<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhO9jHDHnYvUKgdaGEbnHpo56VrQX4vRkBa-LOyPp_ICz9-8YnjxykqVlhGCHPakW9_kHCT8_vFuxemcCMqgCj--_Nj7YL0XViqVo5KcnCeFkKo9ubge5_jXyXVcvY6gYKnOmwHOk9vMVQ4GWcWESMfteEKPDnVa9DmMsah0ZikVtrpHcSidztBNnw0YA/s1920/Screenshot%202023-04-11%206.15.57%20PM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1080" data-original-width="1920" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhO9jHDHnYvUKgdaGEbnHpo56VrQX4vRkBa-LOyPp_ICz9-8YnjxykqVlhGCHPakW9_kHCT8_vFuxemcCMqgCj--_Nj7YL0XViqVo5KcnCeFkKo9ubge5_jXyXVcvY6gYKnOmwHOk9vMVQ4GWcWESMfteEKPDnVa9DmMsah0ZikVtrpHcSidztBNnw0YA/s320/Screenshot%202023-04-11%206.15.57%20PM.png" width="320" /></a></div><div class="separator" style="clear: both; text-align: center;"><b><span style="font-family: courier;">Four white dudes doing what they do</span></b></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;">I returned to <b><a href="https://youtu.be/ClV04OGF50A" target="_blank">The Ira and VITAS! Show</a></b> today for the first time since the 6th, and managed to follow along for another four (4!) of the episode's fifty-one (51!) minutes</span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;">Here's what I said in the comments this time...</span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><div class="separator" style="clear: both;"><span style="font-family: courier;">OK so today I could handle about 4 minutes</span></div><div class="separator" style="clear: both;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: courier;">I got re-oriented with Ira tossing out some nightmare clinical scenarios like bowel infarct, seizures and status epilepticus, though he didn't mention my personal favorite - massive sudden arterial bleed for tumor and tissue damage in head and neck cancer (dark towels?) - to emphasize the need for hospices to provide crisis levels of care (via continuous care in the home or general inpatient care at a licensed staffed facility)</span></div><div class="separator" style="clear: both;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: courier;">Sure absolutely the IDT has to be prepared for the worst - part of every plan of care should be to ask: what's the worst that could happen? Then make sure to assess monitor prevent and intervene if needed because you were prepared</span></div><div class="separator" style="clear: both;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: courier;">Now THAT's a great quality indicator</span></div><div class="separator" style="clear: both;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: courier;">OK, now Ira's jabbering about "kind of have our hair on fire" - kind of? - then goes on to point out the many lost opportunities and failures by the professional orgs (oops) to do anything as it all happened under your nose and under your watch [ref above Christian admitting y'all haven't don't squat about it for 20 years]</span></div><div class="separator" style="clear: both;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: courier;">I need to be honest with you here: you've been captured, the war is over and VITAS! dude's side won it all</span></div><div class="separator" style="clear: both;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: courier;">Seriously, consider yourselves captives owned by the financial rapscallions who have taken over hospice, and they're just getting started, so really from here on out your jobs are all about harm reduction and keeping your heads down in order to survive in the current environment</span></div><div class="separator" style="clear: both;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: courier;">Also too the orgs AAHPM RacistHPNA, of course the trade groups most notably NHPCO and org of orgs NCHPC (Ginger's new gig), etc - they're not just responsible for lots of the problems we're all in, but now also central to whatever "solutions" creep out of this mess or more specifically exploit it</span></div><div class="separator" style="clear: both;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: courier;">Consider their whacky idea that one indicator of quality should be the number of nurses on staff who are certified CHPN etc via RacistHPNA - which is an excellent idea for RacistHPNA because dues + certification test prep and testing are pretty much the main revenue channels for orgs like RacistHPNA that still follow the model</span></div><div class="separator" style="clear: both;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: courier;">I'm sure AAHPM is making that same play because orgs are platforms for commerce and careers and that's it</span></div><div class="separator" style="clear: both;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: courier;">So, to repeat the obvious - you've lost everything at what''s likely the biggest board game most of you have ever played - your battleships are sunk, your king is surrounded etc etc etc</span></div><div class="separator" style="clear: both;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: courier;">Your jobs are now harm reduction and keeping your head down in order to survive in the current environment</span></div><div class="separator" style="clear: both;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: courier;">So Lauren has her hair on fire because there's no reason for 1,000 hospices in LA County (Ira says 800 so of course he does), then there's some chuckling about scammers and inside info because VITAS! dude knows where they live</span></div><div class="separator" style="clear: both;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: courier;">Anyway Lauren asks the burning question - how do we regulate hospice to assure quality BUT! don't make regulations (?)</span></div><div class="separator" style="clear: both;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: courier;">Or what she's really saying is don't keep dumping everything on the nurses, which is a universal complaint and valid - but seriously Lauren of course rules etc will have lots of implications that need to be figured out and whatever else you want they're not going to be "free," especially the way VITAS! dude's handlers need them to be free or as close to zero as possible, divided by 2</span></div><div class="separator" style="clear: both;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: courier;">You just negotiated against yourself - you were advocating for something then immediately advocated against it with the other side's own argument</span></div><div class="separator" style="clear: both;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: courier;">Anyway, Ira droned on and on about three great policy recommendations from some in-group but after he ran out of breath and stopped talking we still have no idea what these great things are in even the most general sense, which at this point we can all just chuckle and say oh Ira... and move on</span></div><div class="separator" style="clear: both;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: courier;">Eric tosses out another fat slow juicy grapefruit of a pitch to VITAS! dude - hey so I don't suppose you and your bosses like regulations all that much do you? </span></div><div class="separator" style="clear: both;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: courier;">And with a mighty swing VITAS! dude smashes a really slow roller down the first base line until it stops at about halfway no he thinks self-regulation is definitely the way to go, then he and Ira fist pump and hug because it's all about quality</span></div><div class="separator" style="clear: both;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: courier;">Then there's quibbling and second guessing and more negotiating against themselves in an incoherent mess until at one point Eric brings up amyloid eaters the Alz Assoc/pharma scam - and since he's a bright guy of course he sees the connection and the irony of it all before he says let's not bring that up (which was Ira's point a moment ago that the orgs just don't even want to talk about these topics let alone look at them with a critical eye and basic understanding of financial concepts (making money with money)</span></div><div class="separator" style="clear: both;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: courier;">Then I stopped watching at about 34:00 - thanks, until next time</span></div></div>Jerryhttp://www.blogger.com/profile/01241842671993239496noreply@blogger.comtag:blogger.com,1999:blog-9187963131836749026.post-58987680859511630292023-04-04T09:34:00.002-07:002023-04-04T09:46:47.320-07:00UPDATED! Updated Game Over Update<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYIZ8k53aWnuU-wvitg698Mji0UXmBeKbVGg3Frk8s1WBqj9LGtJ4VY9VxA0eTHjRndTZtQufd9R_8FRSrDml1LjvhjKzxC8ljCoP0W1caFppUD1J-KPTKDCfQpeyxsvkSytXgyMAfd4WIp27aIawcGPHHcw5C2wCk_U_xwhSkyStQua_YFF3kSxj07w/s1096/Screenshot%202023-04-04%2011.57.08%20AM.png" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: courier;"><img border="0" data-original-height="613" data-original-width="1096" height="179" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYIZ8k53aWnuU-wvitg698Mji0UXmBeKbVGg3Frk8s1WBqj9LGtJ4VY9VxA0eTHjRndTZtQufd9R_8FRSrDml1LjvhjKzxC8ljCoP0W1caFppUD1J-KPTKDCfQpeyxsvkSytXgyMAfd4WIp27aIawcGPHHcw5C2wCk_U_xwhSkyStQua_YFF3kSxj07w/s320/Screenshot%202023-04-04%2011.57.08%20AM.png" width="320" /></span></a></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: courier;"><b>Rare shot of Ira with mouth closed</b></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;">Today I celebrated the halfway point of my journey to listen and annotate the <b><a href="https://youtu.be/ClV04OGF50A" target="_blank">GeriPal podcast video talkapalooza from Montreal</a></b> - this is not a trip for the fainthearted, especially when it comes to air</span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;">It's not that the air gets thinner with altitude - it's the combination of naivety, bullshit, willful ignorance and detached indifference </span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;">Sure, this is a 'professional conference' so the voices of patients and families are notably absent...</span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;">Which is the whole freaking problem with the same old models we see here, so as long as y'all keep doing this please don't expect anything different, and none of us should expect y'all to find a way through this mess with the same old models </span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;">You can check out all of my comments at YouTube, here are today's annotations - </span></div><p></p><div class="separator" style="clear: both;"><span style="font-family: courier;"><b>April 4 </b>- OK today I was able to tolerate 2-3 more minutes plus some rewind of Ira's waxing poetic about how great things used to be when the for-profit owners were satisfied with "reasonable" ROI (reasonable to who?) operating "efficiently" (we'll hear that one again) which sounds nice when you're talking about an assembly line but we're talking about patients and families facing serious illness and end of life - oh, wait </span></div><div class="separator" style="clear: both;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both;"><div class="separator" style="clear: both;"><span style="font-family: courier;">Ira wraps up his monologue with the insistence that "our field has a role to play," and probably means himself more than anything because someone so un-self-aware isn't going to realize it's time to STFD and STFU</span></div><div class="separator" style="clear: both;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: courier;">Eric steps up again and before you know it launches into an upbeat commercial for VITAS, and the punchline is a physician even cleaned the house! he's never seen another hospice do THAT before!!! </span></div><div class="separator" style="clear: both;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: courier;">So Eric there's this role in the IDT called 'hospice aide' where a person goes into the home and provides personal care including light housekeeping and meal preparation if that's part of the individualized plan of care - <b><a href="https://www.vitas.com/careers/vitas-hospice-career-insights/2018/march/should-you-be-a-hospice-aide" target="_blank">check it out</a> (warning - irony ahead) </b></span></div><div class="separator" style="clear: both;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: courier;">Anyway after stepping all over what should have been his main question to VITAS dude (what do YOU think of the tension (conflict) between 'excellent hospice care' and 'making lots of money, as much as possible but always more than last time') ...</span></div><div class="separator" style="clear: both;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: courier;">VITAS dude takes a swing - and there's a slow roller to third, it's not a bunt just really weak contact</span></div><div class="separator" style="clear: both;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: courier;">Something something Chicago (economics?), then he's in Florida to join a parent facing serious illness</span></div><div class="separator" style="clear: both;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: courier;">Now he reports to the CEO and is held to metrics so of course he always asks what's best? (for?)</span></div><div class="separator" style="clear: both;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: courier;">Then he name drops <b>RacistHPNA</b> Board Member Ab '6-Pac' Brody and I'm not sure if he's talking about having or not having an EMR, something about paper and pharmacy and knowing everything and VITAS is great (gonna start writing VITAS!)</span></div><div class="separator" style="clear: both;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: courier;">Funny story about me and '6-Pac' - he expressed righteous indignation as <b><a href="https://www.advancingexpertcare.org/about-hpna/hpna-board-of-directors/" target="_blank">RacistHPNA BOD</a></b> member when y'all announced plans to hold in-person in pandemic in freaking Nashville Tenne-freaking-See racist homophobic transphobic Confederate hotbed and thus a risky unsafe place for big swaths of memberships (well, not so big really), and I responded nah - y'all will be there because commerce and careers are more important than caring</span></div><div class="separator" style="clear: both;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: courier;">How did he respond to that? Let's just say you don't have to be a cishet abled white woman to be a brittle white feminist - in a world of problematic nursing orgs <b><a href="http://www.deathnurse.com/2018/07/hpna-wont-speak-out-against-genocide.html" target="_blank">RacistHPNA pretty much heads the list</a></b></span></div><div class="separator" style="clear: both;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: courier;">Anyway VITAS! dude's main point is that his factories are the best - he and Ira high-five chest bump yell 'EFFICIENT!!' - and the only question he asks himself every morning is how many terminally ill people can he help today? HOW MANY?! don't forget he reports to the CEO who reports to the BOD etc</span></div><div class="separator" style="clear: both;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: courier;">QUANTITY is the only thing that really matters - comps, same store sales - get them to sign on the line that is dotted because even if we have to send a physician over to clean the toilets we'll do whatever it takes, we don't make money on every admission but when you have lots and lots of admissions you can make lots and lots of money</span></div><div class="separator" style="clear: both;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: courier;">That's the simplest most uncomplicated part of this whole thang</span></div><div class="separator" style="clear: both;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: courier;">Peace out until next time</span></div><div><br /></div></div><p></p><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;"> </div><br /><p></p>Jerryhttp://www.blogger.com/profile/01241842671993239496noreply@blogger.comtag:blogger.com,1999:blog-9187963131836749026.post-68447554103764024052023-03-30T10:41:00.000-07:002023-03-30T10:41:10.993-07:00Updated Game Over Updated<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiYUx-rryggj10z1BMPMF3lwjaIKZuiZNHsQv04isCw0aX05s5OedSCUoaZHnK_Kns6LaI8WUCtVFVu_szUZxwV6jxOFgYUqRwRTnVCmDIFoHvFBjJF9t6BYOqhOLYNEYVyEm-qxjnLgBe2TnvR096VJGegSrS8XQAQtkGzTHOj0kQyn_9wlfP6KOfxrg/s1920/Screenshot%202023-03-30%201.02.55%20PM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1080" data-original-width="1920" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiYUx-rryggj10z1BMPMF3lwjaIKZuiZNHsQv04isCw0aX05s5OedSCUoaZHnK_Kns6LaI8WUCtVFVu_szUZxwV6jxOFgYUqRwRTnVCmDIFoHvFBjJF9t6BYOqhOLYNEYVyEm-qxjnLgBe2TnvR096VJGegSrS8XQAQtkGzTHOj0kQyn_9wlfP6KOfxrg/s320/Screenshot%202023-03-30%201.02.55%20PM.png" width="320" /></a></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: courier;">Don't piss off the puppeteers</span></div><span style="font-family: courier;"><br /></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYl2Gin3kMReC9T72UpyWQS2rns1IdJD1iDv6v0RcuSv9w3FMGrHQCnZBe37Ft43xqgXlhGBOQBnYVBQmAZ3x_-VkoTwNXNrevxjie09I9IfsapJyOKcMeGR8QCDHAJ1F1zJwp6oTW149ZTYm60ziL2lcxq5BLGlo1RU-mow4edF3RfmVrIgiHbTtn4A/s1920/Screenshot%202023-03-30%201.02.47%20PM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: courier;"><img border="0" data-original-height="1080" data-original-width="1920" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYl2Gin3kMReC9T72UpyWQS2rns1IdJD1iDv6v0RcuSv9w3FMGrHQCnZBe37Ft43xqgXlhGBOQBnYVBQmAZ3x_-VkoTwNXNrevxjie09I9IfsapJyOKcMeGR8QCDHAJ1F1zJwp6oTW149ZTYm60ziL2lcxq5BLGlo1RU-mow4edF3RfmVrIgiHbTtn4A/s320/Screenshot%202023-03-30%201.02.47%20PM.png" width="320" /></span></a></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: courier;">Time to throw this baby out</span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;">So I've been <b><a href="http://www.deathnurse.com/2023/03/game-over.html" target="_blank">slowly making my way through this podcast</a></b>, 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?</span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;">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" </span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;">****</span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><div class="separator" style="clear: both;"><span style="font-family: courier;">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</span></div><div class="separator" style="clear: both;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: courier;">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</span></div><div class="separator" style="clear: both;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: courier;">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</span></div><div class="separator" style="clear: both;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: courier;">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</span></div><div class="separator" style="clear: both;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: courier;">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</span></div><div class="separator" style="clear: both;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: courier;">Plenty of non-profit hospices have reason to be hinky about their finances (<b><a href="http://www.deathnurse.com/2019/07/one-year-two-ceos-and-lots-of-money.html" target="_blank">exec comp and bonuses in particular</a></b>), but at least with a little digging it's possible to get some idea</span></div><div class="separator" style="clear: both;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: courier;">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:</span></div><div class="separator" style="clear: both;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: courier;">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!</span></div><div class="separator" style="clear: both;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: courier;">Financial Rapscallions (in unison) - What should we do, Don Don?</span></div><div class="separator" style="clear: both;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: courier;">Don Don - We should definitely start paying taxes!</span></div><div class="separator" style="clear: both;"><span style="font-family: courier;">.</span></div><div class="separator" style="clear: both;"><span style="font-family: courier;">.</span></div><div class="separator" style="clear: both;"><span style="font-family: courier;">.</span></div><div class="separator" style="clear: both;"><span style="font-family: courier;">Financial Rapscallions (in unison) - What a great idea, Don Don!! Yes, let's start paying taxes!!!</span></div><div class="separator" style="clear: both;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: courier;">You guys crack me up. Please push back on the nonsense, it's literally the least you can do.</span></div><div class="separator" style="clear: both;"><span style="font-family: courier;"><br /></span></div></div><span style="font-family: courier;">****</span><p></p><div><span style="font-family: courier;">Note - I have deep respect for the GeriPal dudes that goes all the way back to the <b><a href="http://deathclubforcuties.blogspot.com/2009/12/palliative-care-grand-rounds-111_01.html" target="_blank">early days of blogging about this stuff</a></b>, and even <b><a href="https://geripal.org/cops-obstacle-or-inspiration_3/" target="_blank">wrote a thang for them</a></b> back in the day, as well as <b><a href="http://www.deathnurse.com/2018/04/and-final-number-was-zero.html" target="_blank">a thang about their thang</a></b> in tribute</span></div><div><span style="font-family: courier;"><br /></span></div><div><span style="font-family: courier;"><b><a href="http://www.deathnurse.com/2019/03/4-panel-cartoon-of-four-panel-cartoon.html" target="_blank">And again</a></b></span></div><div><span style="font-family: courier;"><br /></span></div><div><span style="font-family: courier;">I'm glad they did this podcast, and also very sad because it shows how bleak the future of hospice is</span></div><div><span style="font-family: courier;"><br /></span></div><div><span style="font-family: courier;">Imagine yourselves as energetic go-getters from Toys R Us completely convinced that <b><a href="https://pitchbook.com/news/articles/toys-r-us-creditors-sue-former-bain-capital-kkr-execs" target="_blank">those dudes at Bain Capital</a></b> will have a complete change of heart once they listen to what you have to say </span></div><div><span style="font-family: courier;"><br /></span></div><div><span style="font-family: courier;"><b><a href="https://sadlyno.com/" target="_blank">Sadly, no</a></b></span></div><div><span style="font-family: courier;"><br /></span></div><div><span style="font-family: courier;"><b><a href="https://www.pallimed.org/2009/12/palliative-care-grand-rounds-is-up.html" target="_blank">Hi, Christian!</a></b></span></div>Jerryhttp://www.blogger.com/profile/01241842671993239496noreply@blogger.comtag:blogger.com,1999:blog-9187963131836749026.post-61508161305491482052023-03-26T12:16:00.001-07:002023-03-27T13:20:14.392-07:00Game Over - UPDATED!<p> </p><div class="separator" style="clear: both; text-align: center;"><iframe allowfullscreen="" class="BLOG_video_class" height="266" src="https://www.youtube.com/embed/ClV04OGF50A" width="320" youtube-src-id="ClV04OGF50A"></iframe></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: courier;"><b>why are these white dudes smiling?</b></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;">So the latest <b><a href="https://geripal.org/is-hospice-losing-its-way-a-podcast-with-ira-byock-and-joseph-shega/" target="_blank">GeriPal thang</a></b> took place just a few days ago during the annual <b><a href="https://aahpm.org/meetings/assembly" target="_blank">AAHPM corporate lovefest and awards ceremony with HPNA tagalong</a></b> - that's a whole other story</span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;">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</span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;">I made it 10 minutes in on this first go - we'll see when I have an appetite for more - my first comment:</span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;">"this is worth line by line analysis, nobody can hide (even though there's abundant Weaselspeak right out of the gate). </span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;">VITAS dude is unhappy about the investigative report on hunger in America because it didn't mention his favorite restaurant. </span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;">Only a hit dog howls and they do it every time</span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;">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. </span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;">"I'm not against for-profit hospice- private equity - publicly traded..." </span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;">Ira just negotiated against himself and walked away from the table empty handed. </span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;">Nice work, doc. Check your pockets.</span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;">It's over, folks.</span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;">The financial rapscallions have won, they've captured hospice including the trade groups and professional orgs.</span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;">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. </span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;">This discussion was over just 10 minutes in.</span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;">#RacistHPNA #CorporateShillsAAHPM #hapc #hapc23 #hapc2023</span></div><p></p><div class="separator" style="clear: both;"><div class="separator" style="clear: both;"><span style="font-family: courier;">Also too - <b><a href="http://generichospice.blogspot.com/ " target="_blank">Strange Tony has been reporting on this for ten years</a></b></span></div><div class="separator" style="clear: both;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: courier;"><b>*************************</b></span></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: courier;"><b>UPDATED 3/27/2023 4PM+/-</b></span></div><div class="separator" style="clear: both;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: courier;">Let's call everything up there <b>1 - Intro</b></span></div><div class="separator" style="clear: both;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: courier;"><div class="separator" style="clear: both;"><b>2 - physician cheers business without understanding business</b></div><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both;">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. </div><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both;">That's always been the bottleneck even in the best times, which these are not.</div><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both;">It's money that matters, <b><a href="https://homehealthcarenews.com/2022/12/amedisys-ceo-paul-kusserow-we-havent-hit-earnings-thats-why-im-back/" target="_blank">Paul Kusserow</a></b> came back to make sure they'd meet their numbers - and BEAT their numbers, especially in the short-term</div><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both;">You can want whatever you want - they just want ROI that meets expectations and BEATS expectations!</div><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both;">It's the only success</div><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both;"><b>3 - yeah we’ve been blowing it for 25 years but this time we’re serious </b></div><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both;">Ira's against bad hospice - good position to take</div><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both;">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</div><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both;">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?</div><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both;">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 <b><a href="https://www.nationalcoalitionhpc.org/coalition-pledges-to-work-together-to-improve-hospice-program-integrity/" target="_blank">stop talking and go sit over there</a></b></div><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both;"><b>4 - “get big or get out” Earl Butz - USAgSec, racist and stand up comic</b></div><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both;">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. </div><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both;">In his way of thinking, small community-based agencies are the real problem</div><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both;">I guess he's correct in a way - they couldn't pay <b><a href="https://oig.hhs.gov/fraud/enforcement/chemed-corp-and-vitas-hospice-services-agree-to-pay-75-million-to-resolve-false-claims-act-allegations-relating-to-billing-for-ineligible-patients-and-inflated-levels-of-care/" target="_blank">$75 million to DOJ</a></b> in a settlement for <b><a href="https://www.tampabay.com/news/politics/legislature/senate-president-don-gaetzs-former-company-sued-for-medicaid-fraud/2120026/" target="_blank">fraudulent practices over an 11 year period</a></b> as easily as <b>VITAS</b> (Chemed, <b>NYSE CHE</b> - a holding company whose other division is <b><a href="https://en.wikipedia.org/wiki/Roto-Rooter#" target="_blank">Roto-Rooter</a></b> the jokes write themselves)</div><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both;">The sanctimony is palpable</div><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both;">I'm curious if any women will be allowed to speak</div><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both;">On to the next few minutes or as much as I can stand in one sitting</div><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both;"><b>5 - that’s what trade orgs and biz groups and prof orgs are for</b></div><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both;">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)</div><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both;">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</div><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both;">Please consider opening your eyes</div><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both;"><b>6 - i’m not afraid to say when someone’s right</b></div><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both;">Ira says "it's not complex" and y'know he's right</div><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both;">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</div><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both;">FWIW the most important indicator of quality are the answers to these questions:</div><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both;">- do you have enough staff?</div><div class="separator" style="clear: both;">- can you keep your staff?</div><div class="separator" style="clear: both;">- who is your staff?</div><div class="separator" style="clear: both;">- are they any good? </div><div class="separator" style="clear: both;">- who owns you?</div><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both;">...</div><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both;">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?) </div><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both;">Also too see above wrt staff</div><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both;">I once <b><a href="https://www.caredimensions.org/index.cfm" target="_blank">asked a hospice</a></b> how many full time RN Case Managers they had on staff to support a census of 850+/= and about their average case loads</div><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both;">Long story short - none of your business!</div><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both;">Story behind the story - not nearly enough</div></span><span style="font-family: courier;"><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both;"><b>7 - ugh ok that's enough for now</b> </div><div class="separator" style="clear: both;"><ul style="text-align: left;"><li>the financial rapscallions have won, it's over, nothing left to do but some mopping up</li><li>four white dudes talk talk talk talk while Vanna White holds a mic</li><li>what I anticipate moving forward</li><ul><li>best case - "If we get a seat at the table with captains of industry and masters of the universe, surely they'll listen"</li><li>worst case - everyone except Ira and VITAS dude just put everything down and walk away in disgust</li><li>most likely - "oooo Curo's looking for a new medical director in Norman, Oklahoma!"</li></ul></ul><div>Thanks for reading! See you next time!</div><div> </div></div><div class="separator" style="clear: both; text-align: center;"><b>*************************</b></div><div style="text-align: center;"><br /></div></span></div><div class="separator" style="clear: both;"><br /></div></div>Jerryhttp://www.blogger.com/profile/01241842671993239496noreply@blogger.comtag:blogger.com,1999:blog-9187963131836749026.post-15861944138688900162023-03-17T11:59:00.000-07:002023-03-17T11:59:29.224-07:00Private equity and public corps capture hospice - How it begins<p> </p><div class="separator" style="clear: both; text-align: center;"><iframe allowfullscreen="" class="BLOG_video_class" height="266" src="https://www.youtube.com/embed/0NaxdWG6gTM" width="320" youtube-src-id="0NaxdWG6gTM"></iframe></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;">This 10-minute clip is from a project I call, <b>"How to find the best hospice? How to <u><i>make money</i></u> in hospice!"</b> It's a working document, the story and pictures are set but the unscripted narration is awkward.</span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;">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**</span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;">I'm working on it***</span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;">* know more</span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;">** demand better</span></div><span style="font-family: courier;">*** nobody is coming to save us</span><p></p>Jerryhttp://www.blogger.com/profile/01241842671993239496noreply@blogger.comtag:blogger.com,1999:blog-9187963131836749026.post-17971888163785706322023-02-28T09:10:00.002-08:002023-02-28T09:10:16.967-08:00Masters of the universe playing in the hospice sandbox<p> </p><div class="separator" style="clear: both; text-align: center;"><br /></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg8fLkOSzUzGEACYRFeAfRsAMSmBD6iaG8v1cGdNHXU-2ubB5wbcEkMiKPvrJAckLAOx-wDRa2uyQV2g0cchxOIozTqF6VYIX8dlPGHcNSx7TVsfIZou5t93mIoU13K9ATLX2gxS1WebSd_23Um_ZGRRBme0KbS6uW4rW9nyFuqU8QeLO2ntkL4v_8d4g/s1920/Screenshot%202023-02-28%2011.59.05%20AM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="screenshot headline from Home Healthcare News: [Updated] CD&R-Backed Gentiva Agrees To Acquire ProMedica’s Home Care, Hospice Assets For $710M By Andrew Donlan | February 27, 2023" border="0" data-original-height="1080" data-original-width="1920" height="181" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg8fLkOSzUzGEACYRFeAfRsAMSmBD6iaG8v1cGdNHXU-2ubB5wbcEkMiKPvrJAckLAOx-wDRa2uyQV2g0cchxOIozTqF6VYIX8dlPGHcNSx7TVsfIZou5t93mIoU13K9ATLX2gxS1WebSd_23Um_ZGRRBme0KbS6uW4rW9nyFuqU8QeLO2ntkL4v_8d4g/w320-h181/Screenshot%202023-02-28%2011.59.05%20AM.png" width="320" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgoZzUGqka_kkj7h0xlogrWloMGpRE1j-IqErHaG8GkgC4ys5MJjs44eLRn-6X28c1zXpzycC1dUQXvktJM0MThfovwI5Ftvhn1YaOm-yS--tuXjbq9XvNMwRHb-aGNITu6hgFsHrL-gHSSTEkivBkAF3rlmc2zBe5fYCbmLUE2UiDC4ngJ3f-2gFoykA/s1920/Screenshot%202023-02-28%2011.59.07%20AM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="white text on black background reads: “Gentiva – the company comprised of the hospice and personal home care assets of what was formerly Kindred at Home* – has agreed to acquire ProMedica’s Heartland home health and hospice assets for $710 million.** Led by the former CEO of Kindred, David Causby, Gentiva is backed by both Humana Inc. (NYSE: HUM) and the private equity firm Clayton, Dubilier & Rice (CD&R). Specifically, CD&R owns 60% of the business, with Humana holding onto a 40% stake post-divestiture. CD&R paid $2.8 billion*** for the ownership stake last year.” * don’t forget Curo is also in that stew ** seems cheap, place must have been in shambles *** for those keeping track at home" border="0" data-original-height="1080" data-original-width="1920" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgoZzUGqka_kkj7h0xlogrWloMGpRE1j-IqErHaG8GkgC4ys5MJjs44eLRn-6X28c1zXpzycC1dUQXvktJM0MThfovwI5Ftvhn1YaOm-yS--tuXjbq9XvNMwRHb-aGNITu6hgFsHrL-gHSSTEkivBkAF3rlmc2zBe5fYCbmLUE2UiDC4ngJ3f-2gFoykA/w320-h180/Screenshot%202023-02-28%2011.59.07%20AM.png" width="320" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgSCKL1AiXgmL_8H0N_V4B3TmaH1YF9wpxNS5BSCihFFaaFMfAJF35E2igyN9s3VqSW_auemc8kW8Il3VeVjtybxA9h3sZbG1o7u8j7_zDY054dzdlYNCkYSGIVDU4SV2XQzRz6vAI5wT0yTy4kD2vbUl-_0M2bgnO9WbkpIpJX2L7iQVzY4DJzCMoPpQ/s1920/Screenshot%202023-02-28%2011.59.10%20AM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="screenshot of lexisnexis table - top ten hospices by market share, it's annotated and a real mess from all the M&A activity, shows Gentiva leaps ahead of Vitas to grab #1 spot now with 6.4% share while Vitas has 4%+" border="0" data-original-height="1080" data-original-width="1920" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgSCKL1AiXgmL_8H0N_V4B3TmaH1YF9wpxNS5BSCihFFaaFMfAJF35E2igyN9s3VqSW_auemc8kW8Il3VeVjtybxA9h3sZbG1o7u8j7_zDY054dzdlYNCkYSGIVDU4SV2XQzRz6vAI5wT0yTy4kD2vbUl-_0M2bgnO9WbkpIpJX2L7iQVzY4DJzCMoPpQ/w320-h180/Screenshot%202023-02-28%2011.59.10%20AM.png" width="320" /></a></div><br /><div class="separator" style="clear: both; text-align: left;"><b><span style="font-family: courier;"><a href="https://homehealthcarenews.com/2023/02/cdr-backed-gentiva-agrees-to-acquire-promedicas-home-care-hospice-assets-for-710m/" target="_blank">Press release and stenography here</a></span></b></div><br /><p></p>Jerryhttp://www.blogger.com/profile/01241842671993239496noreply@blogger.comtag:blogger.com,1999:blog-9187963131836749026.post-79014227770112792512023-02-22T06:18:00.001-08:002023-02-22T06:20:32.124-08:00How to make BIG money in hospice - financial engineering<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEinTngwqsJoiR0ShFo9e9mTltP51DakJdIrFBEKfpUk995NEYzAI7cFcHEGRdBnpWm3HscKtonQD9Yl8cEVZYrFRJ1Qs2qs1Js50EGVahe3BaAfGbyrN415WmVB5RsKXyC_4rUd4tQLAcfT8beoTGbXfUIXa5tmmrkEFa-_YVXbTgkWmgtcUhdi2pMAGg/s1920/Screenshot%202023-02-22%209.07.00%20AM.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1080" data-original-width="1920" height="181" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEinTngwqsJoiR0ShFo9e9mTltP51DakJdIrFBEKfpUk995NEYzAI7cFcHEGRdBnpWm3HscKtonQD9Yl8cEVZYrFRJ1Qs2qs1Js50EGVahe3BaAfGbyrN415WmVB5RsKXyC_4rUd4tQLAcfT8beoTGbXfUIXa5tmmrkEFa-_YVXbTgkWmgtcUhdi2pMAGg/w320-h181/Screenshot%202023-02-22%209.07.00%20AM.png" width="320" /></a></div><div class="separator" style="clear: both; text-align: center;"><b><span style="font-family: courier;">Park Place?</span></b></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;"><b><a href="https://seekingalpha.com/news/3939023-lhc-group-merger-with-unitedhealth-formally-closes" target="_blank">LHC Group merger with UnitedHealth formally closes</a></b></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;"><br /></span></div><span style="font-family: courier;">"The largest Louisiana transaction announced in 2022 was LHC Group’s pending merger with Optum, a subsidiary of UnitedHealth Group, in a deal valued at $5.4 billion. Approximately 70% of LHC’s revenue is derived from home health care services. UnitedHealth positioned the move as helping to advance value-based care and said it would accelerate the combined companies’ ability to deliver integrated care, leading to improved outcomes. The merger follows the larger trend of healthcare moving toward hospital-at-home services which provide both patient care and economic benefits. LHC expects the deal to close during the first quarter of 2023, after completion of an FTC review."</span><p></p><p><span style="font-family: courier;"><b><a href="https://neworleanscitybusiness.com/blog/2023/01/26/louisiana-experienced-206-merger-or-acquistions-in-2022/" target="_blank">Louisiana experienced 206 mergers or acquisitions in 2022</a></b></span></p>Jerryhttp://www.blogger.com/profile/01241842671993239496noreply@blogger.comtag:blogger.com,1999:blog-9187963131836749026.post-34326391626087322542023-02-16T07:12:00.001-08:002023-02-16T07:36:23.350-08:00To find and choose the best hospice, first separate the useful grain from the useless chaff<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiFSV1ceM5hOtHlMUAS9mpBvoyOGMvHM4k_Bj9UJCKIJiKy8gmZ4sIpxEIj0Qbt6ldbPSqB1CJ1Oh_zpxj749CO5RcrMsmiQHHhA-0wQkl_y4dPtq7c0T18n7Mimkxt0jV0J47pjDQF1Xm9Ke1ST44wyI72lisdOH4PMg66rHgfsqtVuYiBBVeBF2sELQ/s1920/Screenshot%202023-02-16%209.52.21%20AM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="2 contrasting images of a woman The image on the left is from the Medicare.gov website, it’s a contemporary straight-on photo closeup of a smiling woman including her upper chest shoulders and head, wearing a light blue denim button shirt open at the neck, with long wavy reddish hair flowing, her face is turned up and to the left as she smiles broadly The image on the right is an antique engraving illustration of Italian woman wind winnowing in Roman countryside, published on Magasin Pittoresque, Paris, 1845 This woman is standing at a basket in an open field with her arms outstretched in front of her as she holds threshed grain in her hands, letting it slowly pour down to the basket as the wind separates the useful grain from the chaff" border="0" data-original-height="1080" data-original-width="1920" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiFSV1ceM5hOtHlMUAS9mpBvoyOGMvHM4k_Bj9UJCKIJiKy8gmZ4sIpxEIj0Qbt6ldbPSqB1CJ1Oh_zpxj749CO5RcrMsmiQHHhA-0wQkl_y4dPtq7c0T18n7Mimkxt0jV0J47pjDQF1Xm9Ke1ST44wyI72lisdOH4PMg66rHgfsqtVuYiBBVeBF2sELQ/w320-h180/Screenshot%202023-02-16%209.52.21%20AM.png" width="320" /></a></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: courier;"><b>Now THAT's Italian!</b></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;">I'm out here trying to put together something that could actually be useful for patients and families, while "industry stakeholders" just keep doing their thing, because hospice is captive to profiteers </span></div><br /><p></p>Jerryhttp://www.blogger.com/profile/01241842671993239496noreply@blogger.comtag:blogger.com,1999:blog-9187963131836749026.post-27601152589841010632023-02-15T08:41:00.004-08:002023-02-15T08:41:55.356-08:00The most important questions to ask a hospice<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhCWGTkTjFNv0zTvS1-cG7lvbDvTetWJi5qTPdw23Dgm8U8RqqP1wjFGFuxcMeu6yM3zSxGDXU_yYid5WeqOSZd3pTWjr45-DFhjhpbkDEvrV-7M9YqWE6kckC6P9Eoot440RBNfe2Hv_1O5Xbhme1xdJ1u3DCxumFUcuH70uZIL8LWgsZAURqvYOp7iw/s1920/Screenshot%202023-02-15%2011.29.51%20AM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1080" data-original-width="1920" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhCWGTkTjFNv0zTvS1-cG7lvbDvTetWJi5qTPdw23Dgm8U8RqqP1wjFGFuxcMeu6yM3zSxGDXU_yYid5WeqOSZd3pTWjr45-DFhjhpbkDEvrV-7M9YqWE6kckC6P9Eoot440RBNfe2Hv_1O5Xbhme1xdJ1u3DCxumFUcuH70uZIL8LWgsZAURqvYOp7iw/w320-h180/Screenshot%202023-02-15%2011.29.51%20AM.png" width="320" /></a></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: courier;"><b>Got staff?<br /></b></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;">Awkward graphic from a presentation in progress, as we cut to the nut about what really matters when you're trying to find and choose your best options for hospice</span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;"><br /></span></div><p></p><div class="separator" style="clear: both;"><a href="https://archive.nytimes.com/newoldage.blogs.nytimes.com/2014/06/17/how-to-choose-a-hospice/" target="_blank"><span style="font-family: courier;">How to Choose a Hospice</span></a></div><div class="separator" style="clear: both;"><div class="separator" style="clear: both;"><a href="https://archive.nytimes.com/newoldage.blogs.nytimes.com/2014/06/17/how-to-choose-a-hospice/" target="_blank"><span style="font-family: courier;">By Paula Span June 17, 2014</span></a></div></div><p><a href="https://www.medicare.gov/care-compare/resources/resources-and-information" target="_blank"><span style="font-family: courier;">Medicare Care Compare - Resources and information for patients and caregivers</span></a></p><p><a href="https://www.propublica.org/article/hospice-healthcare-aseracare-medicare" target="_blank"><span style="font-family: courier;">Endgame: How the Visionary Hospice Movement Became a For-Profit Hustle<br />By Ava Kofman November 28, 2022 </span></a></p>Jerryhttp://www.blogger.com/profile/01241842671993239496noreply@blogger.comtag:blogger.com,1999:blog-9187963131836749026.post-42992161152244322892023-02-09T11:28:00.002-08:002023-02-09T11:28:44.614-08:00Shocked and mortified<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgKQ6Mi2xXEnW9ek6CwHcdv-5xGEqwDpV3AlXypEjzb0XPVcbc1BGfeufLxzo4BuHXeU9EaWV-GJ9aDBe93ccI2IV7nsQJHFwQHH8I-77tGcgwe5P6QJYChCYf5IzGiRAWx85OfaMuSHEw1T6LU_KIuIUhetWa3xrgcgcrjKnedjYnXqqTERXQIfIM4zg/s1920/Screenshot%202023-02-09%202.22.22%20PM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1080" data-original-width="1920" height="181" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgKQ6Mi2xXEnW9ek6CwHcdv-5xGEqwDpV3AlXypEjzb0XPVcbc1BGfeufLxzo4BuHXeU9EaWV-GJ9aDBe93ccI2IV7nsQJHFwQHH8I-77tGcgwe5P6QJYChCYf5IzGiRAWx85OfaMuSHEw1T6LU_KIuIUhetWa3xrgcgcrjKnedjYnXqqTERXQIfIM4zg/w320-h181/Screenshot%202023-02-09%202.22.22%20PM.png" width="320" /></a></div><div><br /></div><span style="font-family: courier;">The nice white ladies are positively apoplectic in this run-on sentence:</span><p></p><div><span style="font-family: courier;">"This type of behavior is antithetical to all standards and guidelines within the hospice and palliative care profession and does not represent the majority of hospice professionals, the nurses, physicians, physician assistants, social workers, chaplains, pharmacists, and other members of the inter-disciplinary team who deliver care to patients (and their caregivers) that focuses on quality of life for people who are experiencing a life-limiting illness."</span></div><div><span style="font-family: courier;"><br /></span></div><div><a href="https://www.nationalcoalitionhpc.org/coalition-pledges-to-work-together-to-improve-hospice-program-integrity/" target="_blank"><span style="font-family: courier;"><b>Read more here</b></span></a></div>Jerryhttp://www.blogger.com/profile/01241842671993239496noreply@blogger.comtag:blogger.com,1999:blog-9187963131836749026.post-11353972244937003532023-01-31T12:52:00.002-08:002023-01-31T12:52:40.805-08:00NHPCO CEO Clutches Pearls, 2014 Edition<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj1zFg4b78d27riW9mBDQKWr4kZeFkbaDxBt4OASF6n6YNMgLmXIaO8EHBfg9W1hfPMxDPgfU264J0HhGFHxIxQDGa7k7wmCxyWbSwayFAM-z7BQRIJugc8imgKYik28qPaga2phPMdB38w7KI9VnwsFewUuz9kItFIoJq3YJ5KDn7EZ0e5thjMXE9ENg/s1920/Screenshot%202023-01-31%203.45.04%20PM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1080" data-original-width="1920" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj1zFg4b78d27riW9mBDQKWr4kZeFkbaDxBt4OASF6n6YNMgLmXIaO8EHBfg9W1hfPMxDPgfU264J0HhGFHxIxQDGa7k7wmCxyWbSwayFAM-z7BQRIJugc8imgKYik28qPaga2phPMdB38w7KI9VnwsFewUuz9kItFIoJq3YJ5KDn7EZ0e5thjMXE9ENg/w400-h225/Screenshot%202023-01-31%203.45.04%20PM.png" width="400" /></a></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: courier;"><b><a href="https://www.ahpco.org/news/214469/NHPCO-Responds-to-Latest-Washington-Post-Article.htm" target="_blank">yeop, he really said all that</a></b></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;">This is what so badly bothered J. Donald:</span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;">"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."</span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: courier;"><a href="https://www.washingtonpost.com/business/economy/2014/12/26/a7d90438-692f-11e4-b053-65cea7903f2e_story.html" target="_blank"><b>WaPo - Dying and profits: The evolution of hospice</b></a><br /></span></div><br /><p></p>Jerryhttp://www.blogger.com/profile/01241842671993239496noreply@blogger.comtag:blogger.com,1999:blog-9187963131836749026.post-10564307538145758892023-01-29T11:43:00.005-08:002023-01-29T12:53:15.708-08:00Preview Presentation: How to Make Money in Hospice - Spin-off Stock Price Wipeout!!<p style="text-align: center;"> <iframe allowfullscreen="true" frameborder="0" height="299" mozallowfullscreen="true" src="https://docs.google.com/presentation/d/e/2PACX-1vQWP-6txHz2RKRPInYOnTsKSwOg07vNXPRPSJQipyBTNQ7MhDVg5AQupYYhmecp8BVviWV7ro39CSmG/embed?start=false&loop=false&delayms=3000" webkitallowfullscreen="true" width="360"></iframe></p><p style="text-align: center;"><span style="font-family: courier;">It's a slide show, you can maximize screen size, advance the slides or auto loop</span></p><p><span style="font-family: courier;">This is an excerpt from a work in progress - How to find the best hospice? | How to <u><i>make money</i></u> in Hopsice!! and specifically an excerpt that takes a look at the way to make the BIG money in hospice: financial engineering</span></p><p><span style="font-family: courier;">Inspired by the reporting of journalist <b><a href="https://www.propublica.org/people/ava-kofman" target="_blank">Ava Kofman</a></b></span></p><p><span style="font-family: courier;"><b><a href="https://www.propublica.org/article/hospice-healthcare-aseracare-medicare" target="_blank">How Hospice Became a For-Profit Hustle</a></b></span></p><p><span style="font-family: courier;">The final(?) version(s) will be video(s) with scripted narration</span></p><p><span style="font-family: courier;">This is just some of the storyboard that</span><span style="font-family: courier;"> takes a look at one form of financial engineering - </span><b style="font-family: courier;"><a href="https://blog.encompasshealth.com/press-releases/encompass-health-corporation-board-of-directors-declares-distribution-of-enhabit-home-health-hospice/" target="_blank">the spin-off special dividend</a></b><span style="font-family: courier;"> - and how it's turned out so far in the case of </span><b style="font-family: courier;"><a href="https://encompasshealth.com/" target="_blank">Encompass</a></b><span style="font-family: courier;"> | </span><b style="font-family: courier;"><a href="https://www.ehab.com/" target="_blank">Enhabit</a></b></p><p><span style="font-family: courier;">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</span></p><p><span style="font-family: courier;">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</span></p><p><span style="font-family: courier;">Boomers are getting old, sick and dying - it's a demographic wave </span></p><p><span style="font-family: courier;">Surf's up!</span></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg9ZMSxUtQhoYxwgMAMjeVpq3t5YvQBUiPsVdktpSsydPNgULQeNTo3nsZVv6ocpQn-hYGffbGJP1oTdpWUZ-N_lgFo_tDdebpzhc9syP7b1AvSsmBzTcA8JYaHrR6f7-2kNIH5tazFrNt8u1YZkrI2DQeOqHlcLqI4mCwbM1gkvsCOIqlyOvN9kqyAnw/s1920/Screenshot%202023-01-29%202.41.12%20PM.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1080" data-original-width="1920" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg9ZMSxUtQhoYxwgMAMjeVpq3t5YvQBUiPsVdktpSsydPNgULQeNTo3nsZVv6ocpQn-hYGffbGJP1oTdpWUZ-N_lgFo_tDdebpzhc9syP7b1AvSsmBzTcA8JYaHrR6f7-2kNIH5tazFrNt8u1YZkrI2DQeOqHlcLqI4mCwbM1gkvsCOIqlyOvN9kqyAnw/w400-h225/Screenshot%202023-01-29%202.41.12%20PM.png" width="400" /></a></div><span style="font-family: courier;">In their own words:</span><p></p><p><span style="font-family: courier;">"Investment to strengthen and scale... leadership in a fast-growing and fragmented market"</span></p><p><a href="https://www.adventinternational.com/advent-international-acquires-accentcare/" target="_blank"><b><span style="font-family: courier;">Advent International Acquires AccentCare</span></b></a></p><p><b><a href="https://sixfeetunder.fandom.com/wiki/Matthew_Gilardi" target="_blank"><span style="font-family: courier;">Inside Joke</span></a></b></p><p><span style="font-family: courier;">Thanks for reading, see you next time!</span></p>Jerryhttp://www.blogger.com/profile/01241842671993239496noreply@blogger.comtag:blogger.com,1999:blog-9187963131836749026.post-92122751649855384682023-01-22T12:15:00.001-08:002023-01-22T12:16:42.043-08:00More on the dangers of for-profit corporate hospice<p><span style="font-family: courier;">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</span></p><p><span style="font-family: courier;"><a href="https://www.propublica.org/article/hospice-healthcare-aseracare-medicare" target="_blank"><b>Ava Kofman’s recent piece</b></a> 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</span></p><p><span style="font-family: courier;">There are so many rabbit holes in the space, as just one example:</span></p><p></p><ul style="text-align: left;"><li><span style="font-family: courier;">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</span></li><li><span style="font-family: courier;">2014 second PE firm buys Curo $730 million, first PE exit strategy</span></li><li><span style="font-family: courier;">2018 third PE firm buys Curo $1.4 billion, second PE exit strategy</span></li><li><span style="font-family: courier;">2022 fourth PE firm buys 60% of Curo + remains of Kindred Hospice for $2.4 billion, third PE exit strategy</span></li><li><span style="font-family: courier;">Humana owns other 40% (they also love Medicare Advantage)</span></li></ul><p></p><p><span style="font-family: courier;">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</span></p><p><span style="font-family: courier;">Surf’s up!</span></p><p><span style="font-family: courier;">Working on the material also leads to the questions - so what? What can we do?</span></p><p><b><span style="font-family: courier;">Here's what I think:</span></b></p><p><span style="font-family: courier;">We need easy access to reliable information that supports informed decision making</span></p><p><span style="font-family: courier;">“WE” = patients, families, caregivers, clinicians and the community</span></p><p></p><ul style="text-align: left;"><li><span style="font-family: courier;">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:</span></li><li><span style="font-family: courier;">Post ownership </span></li><li><span style="font-family: courier;">For-Profit must include parent corp, whether public/private, list PE & major shareholders, and post links to investor info </span></li><li><span style="font-family: courier;">Not-for-Profit must post links to past 5 years IRS 990</span></li><li><span style="font-family: courier;">Post ADC (total, home, LTC, ALF, other) </span></li><li><span style="font-family: courier;">Post staff #’s (FT - RNCM, MSW, SC, HCA, NP/PA, MD, Other; PT - RN, MSW, SC, HCA, NP/PA, MD, Other) </span></li><li><span style="font-family: courier;">Post actual case load # and average case load calcs @ NHPCO 2010 workload guidelines</span></li><li><span style="font-family: courier;">Post staff #’s open positions </span></li><li><span style="font-family: courier;">Post current quality scores</span></li><li><span style="font-family: courier;">Post notice deficiencies & complaints</span></li><li><span style="font-family: courier;">Post all staff bios</span></li></ul><p></p><div><span style="font-family: courier;">FWIW I have also assembled links to my previous blog posts on the topic</span></div><div><span style="font-family: courier;"><br /></span></div><span id="docs-internal-guid-4c0bcd87-7fff-7fc9-d43c-e6edb28463f8"><span style="font-family: courier;"><p dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">Appendix B</span></p><p dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><a href="http://www.deathnurse.com/2017/08/boo-boo-talks-about-hospice.html" style="text-decoration-line: none;"><span style="color: #1155cc; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; text-decoration-line: underline; text-decoration-skip-ink: none; vertical-align: baseline; white-space: pre-wrap;">Death Nurse: Boo Boo talks about hospice</span></a></p><p dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><a href="http://www.deathnurse.com/2017/08/boo-boo-talks-and-non-profit-hospice.html" style="text-decoration-line: none;"><span style="color: #1155cc; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; text-decoration-line: underline; text-decoration-skip-ink: none; vertical-align: baseline; white-space: pre-wrap;">Death Nurse: Boo Boo talks $$ and non-profit hospice</span></a></p><p dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><a href="http://www.deathnurse.com/2017/09/whats-point-good-question.html" style="text-decoration-line: none;"><span style="color: #1155cc; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; text-decoration-line: underline; text-decoration-skip-ink: none; vertical-align: baseline; white-space: pre-wrap;">http://www.deathnurse.com/2017/09/whats-point-good-question.html</span></a><span style="font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"> </span></p><p dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><a href="http://www.deathnurse.com/2017/10/when-your-hospice-medical-director-is.html" style="text-decoration-line: none;"><span style="color: #1155cc; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; text-decoration-line: underline; text-decoration-skip-ink: none; vertical-align: baseline; white-space: pre-wrap;">Death Nurse: When your hospice medical director is a useless idiot…</span></a></p><p dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><a href="http://www.deathnurse.com/2018/01/sadly-not-rare-hospicefail.html" style="text-decoration-line: none;"><span style="color: #1155cc; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; text-decoration-line: underline; text-decoration-skip-ink: none; vertical-align: baseline; white-space: pre-wrap;">http://www.deathnurse.com/2018/01/sadly-not-rare-hospicefail.html</span></a><span style="font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"> </span></p><p dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><a href="http://www.deathnurse.com/2018/01/hospice-101-part-1-meet-your-nurse.html" style="text-decoration-line: none;"><span style="color: #1155cc; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; text-decoration-line: underline; text-decoration-skip-ink: none; vertical-align: baseline; white-space: pre-wrap;">Hospice 101 - Part 1: Meet your nurse</span></a></p><p dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><a href="http://www.deathnurse.com/2018/10/this-could-be-start-of-something-big.html" style="text-decoration-line: none;"><span style="color: #1155cc; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; text-decoration-line: underline; text-decoration-skip-ink: none; vertical-align: baseline; white-space: pre-wrap;">Death Nurse: This could be the start of something big</span></a></p><p dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><a href="http://www.deathnurse.com/2018/10/another-point-about-suffering.html" style="text-decoration-line: none;"><span style="color: #1155cc; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; text-decoration-line: underline; text-decoration-skip-ink: none; vertical-align: baseline; white-space: pre-wrap;">Death Nurse: Another point about suffering</span></a></p><p dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><a href="http://www.deathnurse.com/2018/12/searching-for-hospice-at-place-in.html" style="text-decoration-line: none;"><span style="color: #1155cc; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; text-decoration-line: underline; text-decoration-skip-ink: none; vertical-align: baseline; white-space: pre-wrap;">http://www.deathnurse.com/2018/12/searching-for-hospice-at-place-in.html</span></a><span style="font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"> Part 1</span></p><p dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><a href="http://www.deathnurse.com/2019/01/searching-for-hospice-at-place-in.html" style="text-decoration-line: none;"><span style="color: #1155cc; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; text-decoration-line: underline; text-decoration-skip-ink: none; vertical-align: baseline; white-space: pre-wrap;">http://www.deathnurse.com/2019/01/searching-for-hospice-at-place-in.html</span></a><span style="font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"> Part 2</span></p><p dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><a href="http://www.deathnurse.com/2019/02/peeking-up-from-rabbit-hole_20.html" style="text-decoration-line: none;"><span style="color: #1155cc; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; text-decoration-line: underline; text-decoration-skip-ink: none; vertical-align: baseline; white-space: pre-wrap;">Death Nurse: Peeking up from the rabbit hole…</span></a></p><p dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><a href="http://www.deathnurse.com/2019/02/at-least-its-not-meat-grinder.html" style="text-decoration-line: none;"><span style="color: #1155cc; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; text-decoration-line: underline; text-decoration-skip-ink: none; vertical-align: baseline; white-space: pre-wrap;">Death Nurse: At least it's not a meat grinder</span></a></p><p dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><a href="http://www.deathnurse.com/2019/02/this-is-not-financial-or-investment.html" style="text-decoration-line: none;"><span style="color: #1155cc; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; text-decoration-line: underline; text-decoration-skip-ink: none; vertical-align: baseline; white-space: pre-wrap;">Death Nurse: This is not financial or investment advice</span></a></p><p dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><a href="http://www.deathnurse.com/2019/02/failing-cmm-101.html" style="text-decoration-line: none;"><span style="color: #1155cc; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; text-decoration-line: underline; text-decoration-skip-ink: none; vertical-align: baseline; white-space: pre-wrap;">Death Nurse: Failing CMM-101</span></a></p><p dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><a href="http://www.deathnurse.com/2019/02/this-is-not-financial-advice-continued.html" style="text-decoration-line: none;"><span style="color: #1155cc; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; text-decoration-line: underline; text-decoration-skip-ink: none; vertical-align: baseline; white-space: pre-wrap;">Death Nurse: This is not financial advice, continued</span></a></p><p dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><a href="http://www.deathnurse.com/2019/03/this-is-not-advice-continued.html" style="text-decoration-line: none;"><span style="color: #1155cc; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; text-decoration-line: underline; text-decoration-skip-ink: none; vertical-align: baseline; white-space: pre-wrap;">Death Nurse: This is not financial advice, continued</span></a><span style="font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"> (different one)</span></p><p dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><a href="http://www.deathnurse.com/2019/03/orange-crate-update-number-1.html" style="text-decoration-line: none;"><span style="color: #1155cc; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; text-decoration-line: underline; text-decoration-skip-ink: none; vertical-align: baseline; white-space: pre-wrap;">Death Nurse: Orange Crate Update Number 1</span></a></p><p dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><a href="http://www.deathnurse.com/2019/04/orange-crate-update-number-2.html" style="text-decoration-line: none;"><span style="color: #1155cc; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; text-decoration-line: underline; text-decoration-skip-ink: none; vertical-align: baseline; white-space: pre-wrap;">http://www.deathnurse.com/2019/04/orange-crate-update-number-2.html</span></a><span style="font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"> </span></p><p dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><a href="http://www.deathnurse.com/2019/08/orange-crate-update-3.html" style="text-decoration-line: none;"><span style="color: #1155cc; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; text-decoration-line: underline; text-decoration-skip-ink: none; vertical-align: baseline; white-space: pre-wrap;">http://www.deathnurse.com/2019/08/orange-crate-update-3.html</span></a><span style="font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"> </span></p><p dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><a href="http://www.deathnurse.com/2019/10/quick-taste-of-upcoming-post-whats-news.html" style="text-decoration-line: none;"><span style="color: #1155cc; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; text-decoration-line: underline; text-decoration-skip-ink: none; vertical-align: baseline; white-space: pre-wrap;">Death Nurse: Quick Taste of an Upcoming Post - What's News in Corporate Hospice?</span></a><span style="font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"> </span></p><p dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><a href="http://www.deathnurse.com/2019/11/november-is-hospice-month-so-whats-news.html" style="text-decoration-line: none;"><span style="color: #1155cc; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; text-decoration-line: underline; text-decoration-skip-ink: none; vertical-align: baseline; white-space: pre-wrap;">Death Nurse: November is Hospice Month! So, what's news in corporate hospice? A story told mostly in pictures.</span></a></p><p dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><a href="http://www.deathnurse.com/2019/11/november-is-hospice-month-how-do-you.html" style="text-decoration-line: none;"><span style="color: #1155cc; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; text-decoration-line: underline; text-decoration-skip-ink: none; vertical-align: baseline; white-space: pre-wrap;">http://www.deathnurse.com/2019/11/november-is-hospice-month-how-do-you.html</span></a><span style="font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"> </span></p><p dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><a href="http://www.deathnurse.com/2019/11/orange-crate-update-4-welcome-our-new.html" style="text-decoration-line: none;"><span style="color: #1155cc; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; text-decoration-line: underline; text-decoration-skip-ink: none; vertical-align: baseline; white-space: pre-wrap;">Death Nurse: Orange Crate Update #4 - Welcome Our New Robot Brain Friends to the Hospice Team</span></a></p><p dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><a href="http://www.deathnurse.com/2019/11/november-is-hospice-month-commit-crime.html" style="text-decoration-line: none;"><span style="color: #1155cc; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; text-decoration-line: underline; text-decoration-skip-ink: none; vertical-align: baseline; white-space: pre-wrap;">http://www.deathnurse.com/2019/11/november-is-hospice-month-commit-crime.html</span></a><span style="font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"> </span></p><p dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><a href="http://www.deathnurse.com/2019/11/november-is-hospice-month-hospice-fraud.html" style="text-decoration-line: none;"><span style="color: #1155cc; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; text-decoration-line: underline; text-decoration-skip-ink: none; vertical-align: baseline; white-space: pre-wrap;">Death Nurse: November is hospice month! Hospice Fraud Wall of Shame Update</span></a></p><p dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><a href="http://www.deathnurse.com/2019/11/november-is-hospice-month-breaking.html" style="text-decoration-line: none;"><span style="color: #1155cc; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; text-decoration-line: underline; text-decoration-skip-ink: none; vertical-align: baseline; white-space: pre-wrap;">Death Nurse: November is Hospice Month! BREAKING!! Amedisys continues to acquire and disrupt</span></a></p><p dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><a href="http://www.deathnurse.com/2019/12/ending-year-with-look-back-at-hospice.html" style="text-decoration-line: none;"><span style="color: #1155cc; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; text-decoration-line: underline; text-decoration-skip-ink: none; vertical-align: baseline; white-space: pre-wrap;">Death Nurse: Ending the year with a look back at a hospice service failure</span></a></p><p dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><a href="http://www.deathnurse.com/2020/02/sneak-peek-magnum-opus-how-to-find-best.html" style="text-decoration-line: none;"><span style="color: #1155cc; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; text-decoration-line: underline; text-decoration-skip-ink: none; vertical-align: baseline; white-space: pre-wrap;">Death Nurse: Sneak peek magnum opus - how to find the best hospice</span></a><span style="font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"> </span></p><p dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><a href="http://www.deathnurse.com/2020/02/how-to-choose-hospice.html" style="text-decoration-line: none;"><span style="color: #1155cc; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; text-decoration-line: underline; text-decoration-skip-ink: none; vertical-align: baseline; white-space: pre-wrap;">Death Nurse: How to choose a hospice</span></a></p><p dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><a href="http://www.deathnurse.com/2020/02/how-to-find-good-hospice.html" style="text-decoration-line: none;"><span style="color: #1155cc; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; text-decoration-line: underline; text-decoration-skip-ink: none; vertical-align: baseline; white-space: pre-wrap;">http://www.deathnurse.com/2020/02/how-to-find-good-hospice.html</span></a><span style="font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"> </span></p><p dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><a href="http://www.deathnurse.com/2020/02/questions-to-ask-when-youre-looking-at.html" style="text-decoration-line: none;"><span style="color: #1155cc; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; text-decoration-line: underline; text-decoration-skip-ink: none; vertical-align: baseline; white-space: pre-wrap;">http://www.deathnurse.com/2020/02/questions-to-ask-when-youre-looking-at.html</span></a><span style="font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"> </span></p><p dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><a href="http://www.deathnurse.com/2020/02/is-hospice-lgbtq-inclusive.html" style="text-decoration-line: none;"><span style="color: #1155cc; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; text-decoration-line: underline; text-decoration-skip-ink: none; vertical-align: baseline; white-space: pre-wrap;">http://www.deathnurse.com/2020/02/is-hospice-lgbtq-inclusive.html</span></a><span style="font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"> </span></p><p dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><a href="http://www.deathnurse.com/2020/03/exercising-every-shareholders.html" style="text-decoration-line: none;"><span style="color: #1155cc; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; text-decoration-line: underline; text-decoration-skip-ink: none; vertical-align: baseline; white-space: pre-wrap;">http://www.deathnurse.com/2020/03/exercising-every-shareholders.html</span></a><span style="font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"> </span></p><p dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><a href="http://www.deathnurse.com/2021/05/the-problem-is-crappy-corporate-hospice.html" style="text-decoration-line: none;"><span style="color: #1155cc; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; text-decoration-line: underline; text-decoration-skip-ink: none; vertical-align: baseline; white-space: pre-wrap;">Death Nurse: The problem is crappy corporate hospice</span></a><span style="font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"> </span></p></span></span><div><span style="font-family: courier;"><br /></span></div><div><span style="font-family: courier;">Thanks for reading, more to come</span></div>Jerryhttp://www.blogger.com/profile/01241842671993239496noreply@blogger.comtag:blogger.com,1999:blog-9187963131836749026.post-43219601194902080462023-01-20T08:04:00.000-08:002023-01-20T08:04:24.217-08:00FWIW - New Yorker/ProPublica piece isn’t the first one, by far<p><b> <span style="font-family: courier;">WaPo 2014 -</span></b><span style="font-family: courier;"> “... 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</span></p><p><span style="font-family: courier;">“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.’ ”</span></p><p><span style="font-family: courier;"><a href="https://www.washingtonpost.com/business/economy/2014/12/26/a7d90438-692f-11e4-b053-65cea7903f2e_story.html " target="_blank"><b>WaPo 'Business of Dying'</b></a><br /></span></p><p><span style="font-family: courier;"><b>NHPCO 2014</b> - “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.”</span></p><p><span style="font-family: courier;">“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.”</span></p><p><span style="font-family: courier;"><a href="https://www.ahpco.org/news/214469/NHPCO-Responds-to-Latest-Washington-Post-Article.htm " target="_blank"><b>NHPCO is simply mortified</b></a><br /></span></p><p><span style="font-family: courier;"><b>**NOTE: The statement above is not correct -</b> 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.</span></p><p><span style="font-family: courier;">“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.”</span></p><p><span style="font-family: courier;"><a href="https://aspe.hhs.gov/reports/tracking-impact-ownership-changes-hospice-care-provided-medicare-beneficiaries-final-report " target="_blank"><b>Tracking ownership changes in hospice - HHS</b></a><br /></span></p><p><span style="font-family: courier;">“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.”</span></p><p><span style="font-family: courier;"><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3866916/" target="_blank"><b>Hospice industry turbulence in shift to for-profit</b></a><br /></span></p><p><span style="font-family: courier;">“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.” </span></p><p><a href="https://twitter.com/ctsinclair/status/1600702397193457665" target="_blank"><b><span style="font-family: courier;">Christian Sinclair, MD via Twitter</span></b></a></p><p><span style="font-family: courier;"><b>HPNA via email -</b> “ 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.”</span></p><div><br /></div>Jerryhttp://www.blogger.com/profile/01241842671993239496noreply@blogger.comtag:blogger.com,1999:blog-9187963131836749026.post-59657372949438282572023-01-15T08:35:00.000-08:002023-01-15T08:35:26.245-08:00Jeanne M. Soucy<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj_n_F5BusAZkTMNz6bkEgVma_XgspYJdGrX4BxDDM92xRp7JqvETv66SSzSKrXSIjIuTqkdRZuZtu6V9FiatzVQi55igmqW1PT5YfUzzVKlo9xZ-CyNTtaQwI8VlEuBKWg2yRNaAf6T4Z68IKvSsRaDPhNwWWgIhny9xrLIT3MPUe7FqyJFi8diY0l6g/s3264/jeanne%20first%20day%20portugal%20november%202013.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="3264" data-original-width="2448" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj_n_F5BusAZkTMNz6bkEgVma_XgspYJdGrX4BxDDM92xRp7JqvETv66SSzSKrXSIjIuTqkdRZuZtu6V9FiatzVQi55igmqW1PT5YfUzzVKlo9xZ-CyNTtaQwI8VlEuBKWg2yRNaAf6T4Z68IKvSsRaDPhNwWWgIhny9xrLIT3MPUe7FqyJFi8diY0l6g/w300-h400/jeanne%20first%20day%20portugal%20november%202013.jpg" width="300" /></a></div><div style="text-align: center;"><span style="font-family: courier;"><b>Cascais, Portugal</b></span></div><div style="text-align: center;"><span style="font-family: courier;"><b>November, 2013</b></span></div><p></p>Jerryhttp://www.blogger.com/profile/01241842671993239496noreply@blogger.comtag:blogger.com,1999:blog-9187963131836749026.post-5037975724759895312022-06-17T12:32:00.000-07:002022-06-17T12:32:25.498-07:00Excerpt - VSED, a short case study<div style="padding: 75% 0px 0px; position: relative; text-align: center;"><iframe allow="autoplay; fullscreen; picture-in-picture" allowfullscreen="" frameborder="0" src="https://player.vimeo.com/video/721563466?h=18458aef3e&badge=0&autopause=0&player_id=0&app_id=58479" style="height: 100%; left: 0; position: absolute; top: 0; width: 100%;" title="vsed short case study.mp4"></iframe></div><script src="https://player.vimeo.com/api/player.js"></script>Jerryhttp://www.blogger.com/profile/01241842671993239496noreply@blogger.comtag:blogger.com,1999:blog-9187963131836749026.post-41441296445778832352022-05-27T12:02:00.006-07:002022-05-27T12:02:56.739-07:00Do you have an hour?<div style="text-align: center;"><iframe allow="autoplay; fullscreen" allowfullscreen="" frameborder="0" height="564" src="https://player.vimeo.com/video/714573294?h=d089fca256" width="640"></iframe></div><div style="text-align: center;"><span style="font-family: courier;"><b>It's about VSED </b></span></div>Jerryhttp://www.blogger.com/profile/01241842671993239496noreply@blogger.comtag:blogger.com,1999:blog-9187963131836749026.post-10508151209068353682022-03-15T10:43:00.001-07:002022-03-15T10:43:49.405-07:00An explanation, not an excuse<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEiQWyGTrLysw5Rv1cS6gvPw_F1mksVzfGnExKHMXjMPw1dajzFwpZL7zBZdI-nvqsix-troKnJx9g8CyVrEdXE7sTy9EshKvKjVW3bSeqcXenZ5OGSGO9PY4Nf0YTh4nxQnEBC377VHgzaKEBvCSBbmTrspWXkLuxWt8v-ZOoPOFvMauCzumJmfrFeqNQ=s1059" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="802" data-original-width="1059" height="303" src="https://blogger.googleusercontent.com/img/a/AVvXsEiQWyGTrLysw5Rv1cS6gvPw_F1mksVzfGnExKHMXjMPw1dajzFwpZL7zBZdI-nvqsix-troKnJx9g8CyVrEdXE7sTy9EshKvKjVW3bSeqcXenZ5OGSGO9PY4Nf0YTh4nxQnEBC377VHgzaKEBvCSBbmTrspWXkLuxWt8v-ZOoPOFvMauCzumJmfrFeqNQ=w400-h303" width="400" /></a></div><div style="text-align: center;"><b><span style="font-family: courier;"><a href="https://twitter.com/JerrySoucyRN/" target="_blank">I'm here - go there</a></span></b></div><p></p>Jerryhttp://www.blogger.com/profile/01241842671993239496noreply@blogger.comtag:blogger.com,1999:blog-9187963131836749026.post-91494862744384898652021-12-02T08:00:00.000-08:002021-12-02T08:00:31.256-08:00Meet Adrian Allotey, a friend and trusted colleague<div style="text-align: center;"><iframe allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture" allowfullscreen="" frameborder="0" height="315" src="https://www.youtube.com/embed/d-4pnmgVaFE" title="YouTube video player" width="560"></iframe></div><div style="text-align: center;"><br /></div><div style="text-align: left;"><span style="font-family: courier;">This terrific video is a great way for you to begin to know an amazing person, Ms Adrian Allotey</span></div><div style="text-align: left;"><span style="font-family: courier;"><br /></span></div><div style="text-align: left;"><span style="font-family: courier;">Take the introduction further at <b><a href="https://www.yanaec.com/" target="_blank">You Are Not Alone Elder Care</a></b></span></div>Jerryhttp://www.blogger.com/profile/01241842671993239496noreply@blogger.comtag:blogger.com,1999:blog-9187963131836749026.post-5763784778666087902021-09-25T14:12:00.001-07:002021-09-25T14:18:35.233-07:00The problem is crappy presentations<p><span style="font-family: courier;">I posed the following questions at the gated online community run by the national office of the specialty nursing organization to which I pay annual dues:<br /></span></p><p style="text-align: left;"><span style="font-family: courier;"></span></p><blockquote><span style="font-family: courier;">Why are continuing education units measured by quantity (time, contact hours) and not quality (learner objectives achieved)? Why should a 15-minute continuing ed program (including post test and evaluation) where learners achieve 2 or 3 meaningful objectives be valued as "less than" a one hour death by power point?</span></blockquote><p></p><p><span style="font-family: courier;">A colleague took exception to the phrase, "death by power point," and seemed to feel I was being judgmental or dismissive of educators who develop one hour power point presentations.</span></p><p><b><span style="font-family: courier;">My response</span></b></p><p><span style="font-family: courier;">Hi, Colleague</span></p><p><span style="font-family: courier;">Thanks for sharing your thoughts on this </span></p><p><span style="font-family: courier;">Learners’ time is valuable - I expect every educator to invest effort in their presentations</span></p><p><span style="font-family: courier;">Steve Jobs used this formula for his 1-hour presentations: 30/30/30<br />30 hours to brainstorm<br />30 hours to develop<br />30 hours to refine/rehearse</span></p><p><span style="font-family: courier;">I didn’t invent the term, “Death by PowerPoint,” but it’s an alternative to “crappy presentations”</span></p><p><span style="font-family: courier;">Before PowerPoint there were 35mm slides in a Carousel</span></p><p><span style="font-family: courier;">Before that we used overhead transparencies - remember those?</span></p><p><b style="text-align: center;"><span style="font-family: courier;">How to avoid death by PowerPoint<br />David JP Phillips - TEDxStockholmSalon</span></b></p><p><b style="text-align: center;"><span style="font-family: courier;"><a href="https://youtu.be/Iwpi1Lm6dFo" target="_blank">LINK IS HERE</a></span></b></p><p><span style="font-family: courier;"><a href="https://youtu.be/Iwpi1Lm6dFo" target="_blank"><b style="text-align: center;"></b></a></span></p><div class="separator" style="clear: both; text-align: center;"><span style="font-family: courier;"><b style="text-align: center;"><iframe allowfullscreen="" class="BLOG_video_class" height="266" src="https://www.youtube.com/embed/Iwpi1Lm6dFo" width="320" youtube-src-id="Iwpi1Lm6dFo"></iframe></b></span></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: courier;"><b style="text-align: center;"><br /></b></span></div><span style="font-family: courier;">Here’s a <b><a href="https://twitter.com/AANP_NEWS/status/1441787213822533636" target="_blank">good example of an awful slide</a> </b>from a presentation at the <b><a href="https://www.aanp.org/events/2021-fall" target="_blank">in-person conference</a></b> of the American Association of Nurse Practitioners (AANP) held September 23 - 26, 2021 in Florida</span><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiqFAzluXCb_eKH0f_vVoIxm2IaYBJDQ8VyDWtDdkyOcUaJ3QBB0uLf8rtYoGLnRBcZmMumoTsBg8qP1xXYRIFVPiEO7kfDPWJiflH0ON8TbYBQSaZMgp6EG78-CCE6txNxL110-njBrpkF/s1169/Screenshot+2021-09-25+4.55.29+PM.png" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: courier;"><img border="0" data-original-height="733" data-original-width="1169" height="251" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiqFAzluXCb_eKH0f_vVoIxm2IaYBJDQ8VyDWtDdkyOcUaJ3QBB0uLf8rtYoGLnRBcZmMumoTsBg8qP1xXYRIFVPiEO7kfDPWJiflH0ON8TbYBQSaZMgp6EG78-CCE6txNxL110-njBrpkF/w400-h251/Screenshot+2021-09-25+4.55.29+PM.png" width="400" /></span></a></div><p><span style="font-family: courier;">Dr Ruffin is expert, but slides like this mean important concepts get lost and people zone out. Check any other presentations at this or any other nursing conference and I guarantee you'll see the same awful slides over and over and over.</span></p><p><span style="font-family: courier;">I use Google slides and my 1 hour presentations have included anywhere from 12 +/- to close to 300 depending. The average lately has been about 150 and since I’ve only been doing remote what’s on the screen has to hold attention and drive the narrative - I’m in the little corner square</span></p><p><span style="font-family: courier;">13 slides in a blog post - <b><a href="http://deathclubforcuties.blogspot.com/2009/11/my-first-elnec-presentation.html" target="_blank">ELNEC ethics presentation</a></b></span></p><p><span style="font-family: courier;">10 slides in a blog post - <b><a href="http://www.deathnurse.com/2020/08/existential-distress-and-dignity-therapy.html" target="_blank">Existential Distress, Dignity Therapy, and Peaceful Death</a></b>, based on Keall, R. Clayton, J. Butow, P. Australian Palliative Care Nurses’ Reflections on Existential/Spiritual Interventions. J Hosp Pal Nsg 2014;16(2):105-112.</span></p><p><span style="font-family: courier;">134 slides in a presentation - <b><a href="http://www.deathnurse.com/2020/05/celebrating-nurses-again-with-free-self.html" target="_blank">Celebrating Nurses Again with Free Self-Paced Online Learning - End of Life Trajectories</a></b>, includes a chronology of my wife Jeanne’s and my experience 2010-2016 as case example</span></p><p><span style="font-family: courier;">I’ve been sitting through presentations in academic, business and clinical settings since 1973 up until minutes ago for that TEDx - in my experience the good ones are hard to find and the outstanding ones come by rarely but you know it when you see it</span></p><p><span style="font-family: courier;">I don't think I'm an outlier when I say the vast majority of presentations I've ever seen are painfully awful. </span></p><p><span style="font-family: courier;">I think it’s because an effective presentation takes time and effort - 30/30/30 for an hour seems about right if you’re looking to activate and inspire, which is what outstanding teaching is about</span></p><p><span style="font-family: courier;">Good teaching generates discussion</span></p><p><span style="font-family: courier;">Mediocre teaching conveys information</span></p><p><span style="font-family: courier;">If you’re only going to read one thing <b><a href="https://www.newyorker.com/magazine/2001/05/28/absolute-powerpoint" target="_blank">read this</a></b></span></p><p><span style="font-family: courier;">“<b><a href="https://www.robertgaskins.com/ " target="_blank">Robert Gaskins invented PowerPoint.</a></b> He led its initial design and development at a startup, where the idea attracted the first venture capital investment ever made by Apple Computer. PowerPoint was released for Macintosh in 1987, and soon afterward, it became the first significant acquisition ever made by Microsoft, who set up a new business unit in Silicon Valley to develop it further. Gaskins headed this new Microsoft unit for another five years, completing versions of the PowerPoint product which contributed to the explosive early growth of Microsoft Windows and to the dominance of Microsoft Office.”</span></p><p><span style="font-family: courier;">Excerpt from a detailed critique by Edward Tufte, <b><a href="https://www.edwardtufte.com/bboard/q-and-a-fetch-msg?msg_id=0001yB&topic_id=1" target="_blank">“PowerPoint Does Rocket Science--and Better Techniques for Technical Reports”</a></b></span></p><p><span style="font-family: courier;">That’s what I think about this, anyway</span></p><div><span style="font-family: courier;">Peace, and don't forget there's a pandemic still raging</span></div><div><br /></div>Jerryhttp://www.blogger.com/profile/01241842671993239496noreply@blogger.comtag:blogger.com,1999:blog-9187963131836749026.post-19703623203871861582021-09-18T06:44:00.000-07:002021-09-18T06:44:06.109-07:00To approach suffering<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgfcVFuorHJ8yeLIoExY4g8FEUmqpd27sWk__8Zy0FxxkBDeE4EaDU5Ihd3BR1Qaf7QL-Qrdnu1rO2AcXZs_lbNC3ViMlJ80IEKc86JjAQyjlO9-GVzlSZV0juN5W1yk_bmSX5hWvxHNUnf/s1920/Screenshot+2021-09-18+9.40.53+AM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em; text-align: center;"><img border="0" data-original-height="1080" data-original-width="1920" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgfcVFuorHJ8yeLIoExY4g8FEUmqpd27sWk__8Zy0FxxkBDeE4EaDU5Ihd3BR1Qaf7QL-Qrdnu1rO2AcXZs_lbNC3ViMlJ80IEKc86JjAQyjlO9-GVzlSZV0juN5W1yk_bmSX5hWvxHNUnf/w400-h225/Screenshot+2021-09-18+9.40.53+AM.png" width="400" /></a></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: courier;"><b>from a work in progress</b></span></div><p><br /><br /></p>Jerryhttp://www.blogger.com/profile/01241842671993239496noreply@blogger.comtag:blogger.com,1999:blog-9187963131836749026.post-29189075423274698022021-05-26T09:45:00.000-07:002021-05-26T09:45:07.365-07:00The Death Nurse Cookbook! Yogurt!<div style="text-align: center;"><iframe allowfullscreen="true" frameborder="0" height="299" mozallowfullscreen="true" src="https://docs.google.com/presentation/d/e/2PACX-1vQbF1lilEw4uxVX4aNQDxZLH6kgGY1O3L7I63XacgRbJYJZyQUb9hggDbH_eux2-rALtZLz35NN3K4B/embed?start=false&loop=false&delayms=2000" webkitallowfullscreen="true" width="480"></iframe></div><div style="text-align: center;"><b><span style="font-family: courier;">It's a presentation</span></b></div><div style="text-align: center;"><b><span style="font-family: courier;"><br /></span></b></div><div style="text-align: center;"><b><span style="font-family: courier;">Also too: </span></b><span style="font-family: courier;"><b><a href="https://www.bonappetit.com/test-kitchen/ingredients/article/what-is-yogurt-whey" target="_blank">Yes, Whey: </a></b></span></div><div style="text-align: center;"><span style="font-family: courier;"><b><a href="https://www.bonappetit.com/test-kitchen/ingredients/article/what-is-yogurt-whey" target="_blank">How Yogurt's Leftovers Are Getting a Second Life</a></b></span></div>Jerryhttp://www.blogger.com/profile/01241842671993239496noreply@blogger.com