The Business of Dying - Physicians for a National Health Program

The Business of Dying
The Corporatization of Hospice
All Souls Day, 2013
Woody Allen
“More than any other
time in history, mankind
faces a crossroads. One
path leads to despair
and utter hopelessness.
The other, to total extinction.
Let us pray we have the wisdom to choose
Questions to Consider
• How are hospice services reimbursed,
and therefore, how to game the
• How have for-profit entities changed
the “hospice industry”?
• Are non-profit hospices any better?
In the Business of Dying: Questioning the
Commercialization of Hospice
Joshua E. Perry and Robert C. Stone
“ In our society, some aspects of life are off-limits to
commerce. We prohibit the selling of children and the buying
of wives, juries, and kidneys. Tainted blood is an inevitable
consequence of paying blood donors; even sophisticated
laboratory tests cannot supplant the gift-giving relationship
as a safeguard of the purity of blood. Like blood, health care
is too precious, intimate, and corruptible to entrust to the
- Woolhandler and Himmelstein NEJM 1999
journal of law, medicine & ethics
cost and end-of-life care • summer 2011
Hospice Basics
Reimbursed by Medicare and all others
6 month life expectancy
Forgo life-prolonging treatments
Focus on comfort care and family support
Basics II
• Began in US in 70’s –
volunteer/charity/community based
• Medicare benefit 1982
• Transformation to for-profit in the 90’s
(just like the health insurance industry)
• Over 50% of hospices now for-profit*
• Medicare hospice spending $13 billion*
*MedPAC 2010
Hospice: Capitation Lives
• Hospice assumes (almost) the total cost of
care of the dying patient
• Reimbursed on per diem
• Costs are high at admission and death, low
in between
Hospice: Capitalism Lives
• Recruiting patients who live long pays well
(for-profit LOS 45% > than non-profit*)
• High patient/staff ratios are profitable
• Nursing home patients fit both criteria
• Pizza and pens give way to:
“House brand” hospice –
part of
SNF chain
*MedPAC 2008
Office of Public Affairs FOR IMMEDIATE RELEASE
Tuesday, January 3, 2012
US Files Complaint Against National Chain of
Hospice Providers Alleging False Claims on the
Medicare Program
“For-profit hospice companies like AseraCare
are entitled to receive Medicare dollars only for
Medicare recipients who are terminally ill.”
Hospice is a Profit Center
#1, 4.9% market
HealthCare Partners =
#2, Market Cap 366M
market share 4.6%
Includes VistaCare
and Odyssey Hospice
= Healthcare Partners
Community Hospice
Purchase price > $400 million. Gentiva becomes the “preferred
hospice provider” for 49 Texas nursing homes.
AAHPM Board of Directors
AAHPM Board of Directors
Peter Brunnick, CEO, Hospice & Palliative Care Charlotte Region
How will the ACA affect your
business model?
Charlotte Business Journal 9/30/13
“The Affordable Care Act has clearly shifted the focus of a hospice
and palliative care provider towards the alignment and
coordination of care throughout the community’s continuum of
care. Historically, hospice providers were often siloed from other
health-care providers, but health-care reform has clearly
broadened our outlook and has identified that having a seat at the
table is now an imperative. We remain clearly focused on the
patient, but understanding our role in managing the health of an
entire population has heightened our awareness and has identified
the importance of reaching out from our traditional domain to
dialogue and understand the roles and requirements of other
You can’t make this stuff up. From a non-profit CEO

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