Good hospice can be immensely valuable. But there are predators.
A wise friend referred me to this New Yorker article last month about a Pro Publica investigation. I skimmed it then, and today I read it in full. It’s appalling. If anyone you know is considering hospice, or has been “invited” by a company to consider it, beware. Here’s what the friend basically said – and they were right:
For-profit hospice is a vast crime scene,
and private equity is holding the knife
Note, I’m talking (and the article talks) about for-profit hospice companies. For-profit hospice chains bill the government four times more per patient than not-for-profits, and focus on both maximizing admissions and cutting costs (i.e. cutting back on services), all the while gaming the system to barely squeak under the wire before Medicare makes them give back the money.
Numerous lawsuits have unearthed company emails and dialogs emphasizing sales “or else” (and actual firings for low sales numbers), and some patients have discovered they’d been enrolled in hospice without their knowledge–which in some cases made them ineligible for the treatment they’d already been getting.
There can be abuses in any for-profit company (or non-profit), but it gets worst when the investors are private equity, which is known for identifying the bare minimum they must do to get paid. Read and you’ll see. (It’s the same as they’ve done to local newspapers (NPR) and this Richmond nursing home (New Yorker).)
If this subject touches your life (which it will, someday) please read the New Yorker article and spread the word: How Hospice Became a For-Profit Hustle.
I have nothing against capitalism per se. But it has to be regulated and enforced, which can be hard, and sometimes they get away with absurd and cruel things and just cashing in. Government enforcers can be outfoxed by high-paid hospice lawyers; as one attorney says in the article, “When a case settles for $1 million where the [questionable insurance filings] have been for over $200 million, I think that speaks for itself.”
Informed consumers (that’s you and me) are our only recourse.
I’m intentionally posting this without telling you all the cruel, cynical things these companies’ employees have done, as described in the article. Please, read it, and spread the word.
And don’t just spread the word in your personal circles: as you’ll see from the very beginning of the article, some of these companies actively seek out vulnerable people to sell to. And they get away with it. (One of them describes wearing scrubs to the door, though she has no medical background, so “I would automatically be seen as a help.”)
Stop them: tell relevant people in your communities to watch out. Good hospice is truly wonderful, but there are predatory companies.
Thank you for this, Dave.
Hi, Erika – anything in particular, or just everything in general?
Never in my wildest dreams did I imagine, when I coined the descriptor Opaque Dying Marketplace that (a) it would apply as completely to hospice as to hospital, and (b) that it would involve such detail, nor sinister aspects. Ay yai yai.
Bart, I hope you have (or had) a chance to read the article. Astoundingly, these predatory business people are looking for people who are NOT dying, and registering THEM into hospice … and then sometimes medicating them into submission so they shut up and stay billable!
Here on your site it’s (relatively) safe to say that I hate the **ckers. (I did read the article).
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Dave, Yikes! This article reveals that any of us could easily have similar experiences, e.g. hit close to home. Thanks for sharing.
So, Bart, the big lesson (I believe) is that when shopping for a hospice provider, pay close attention to whether they’re incorporated for profit. There can be abuse in non-profits, too, but when the whole corporation’s purpose *by law* is to make money for the owners *and regulations are hard to enforce*, the door is wide open for heartless abuse.
Hi Dave,
I would encourage you and others to read this article with discusses the claims made in the New Yorker Article. While there is fraud in hospice, and all of healthcare as well, it is dangerous to paint with such a broad brush.
https://hospicenews.com/2022/12/02/for-profit-or-nonprofit-hospice-is-not-a-hustle/
Hi Brian! Did I see on LinkedIn and Facebook that you work in the hospice industry?
I haven’t read the article yet (I will) – too late here – just asking. Good night for now.
Yes, I do work in hospice and for a for-profit agency. I will say that whether a hospice agency, hospital, physician group, specialist, et al are in on the healthcare “hustle” largely depends on leadership, not on tax status.
Thanks for the dialogue, Brian. I totally agree that leadership, which of course can start with the owners, is the key factor. That’s why I asked the questions about how a family in need can tell whether it’s a good one or a bad one. “Tax status” is one crude filter – I’d love to learn how better to do it!
That’s why I asked if there is a code of ethics or anything like that in the hospice industry.
It sounds like you might be a good person to call on the industry to create one! What are your personal standards?
Or heck, you don’t need to wait for anyone – you could write your own code of conduct, e.g.
“We are committed to truly being of service.”
“We will never aggressively sell people on starting hospice too soon.”
“We ….”
And you could talk with other good, ethical hospice providers to adopt something similar.
Honestly, as the New Yorker article says, your industry started with the best possible intentions, and it appears to have been invaded by these horrible predatory companies – truly a den of thieves. Is there a way for you good ones to cast them out?
By the way, again without me having read the article: you say it’s dangerous to paint the whole industry with a broad brush because of some bad actors. Can you tell us what the industry is doing to detect and root out those bad actors? If not, are you saying that potential customers of the industry should just go ahead and take their chances, because even you can’t tell who is a crook?
Does the hospice industry have a code of conduct specifying what is acceptable behavior?
The hospice industry itself does not, but there are regulations and metrics set forth by Medicare which dictates how hospice operates (98% of all hospice benefits fall under medicare as a primary payor, therefore they get to set the rules).
I have been in the industry for 10 years in both for profit and non profit. I have been witness to predatory practices from both, as well as amazing end of life care by both. There are now key metrics that consumers are not aware of when selecting a hospice, that include CAHP survey scores (a questionnaire sent to all hospice discharged fam, regardless of whether the patient was a live discharge or a death).
The “willingness to recommend” is a vital question and consumers should ask to see the SHP report that can be printed to see the number for themselves.
The other is the EOL (end of life) metric, whereas the patient would have been seen at least 2x by a RN or Social worker in the last 3 days of life.
I am passionate about educating anyone who will listen on how to choose a hospice. I found this researching for my book on hospice by the way.
I’ll reply tonight – I want to know more about your book
Stephanie, I took the liberty of breaking your reply into paragraphs — I know it’s hard to do during input but easy for the moderator to do later. So helpful!
I’m very grateful to you for posting about this – I never heard about it. Please link to your book here.