Hospice Clearly Lost its Way

Strange Tony,

Ira Byock, M.D. is on record that hospice needs to be blown up and started over.  When asked about regulatory solutions in a recent panel he referred to statements issued by several professional hospice associations.  Dr. Byock said the industry knew enough in 2008 to issue those guidelines.

On the panel was the Chief Medical Officer of Vitas Hospice Joseph Shega, M.D.. A Vitas piece on his promotion states:

He joined VITAS in 2013 as a regional medical director and was promoted to senior vice president and national medical director in 2016.

Vitas is owned by Chemed which is publicly traded on the NYSE.  In October 2017 Vitas settled with the Justice Department for $75 million for fraudulent billing.

The settlement resolves allegations that between 2002 and 2013 Vitas knowingly submitted or caused to be submitted false claims to Medicare for services to hospice patients who were not terminally ill.

The settlement also resolves allegations that between 2002 and 2013, Vitas knowingly submitted or caused to be submitted false claims to Medicare for continuous home care services that were not necessary, not actually provided, or not performed in accordance with Medicare requirements.

According to the complaint, the defendants set goals for the number of continuous home care days billed to Medicare and used aggressive marketing tactics and pressured staff to increase the volume of continuous home care claims, without regard to whether the patients actually required this level of crisis care. 

The interview did not mention this settlement.

 Dr. W. Edwards Deming rued the negative impact on quality arising from temporary corporate ownership with the express purpose of garnering huge returns from flipping the company.  He referred to this emerging phenomena in his Seven Deadly Diseases.

The world's quality guru, Dr. W. Edwards Deming, spoke in 1984 about an economy without takeovers, without leveraged buyouts (LBO firms).  LBO morphed into private equity before exploding the last two decades.  Greed is their constancy of purpose.

Dr. Byock noted that the hospice industry gets a bad rap for patients that get better under our care.  Our hospice got many patients better under the expert care of our founding Medical Director.  As soon as they no longer met hospice criteria he discharged them.  

Corporate structures changed that.  Our Hospice and Palliative Medicine board certified doctor had to submit a request to remove a patient from hospice care that often took weeks for the Regional Medical Director to process.  I heard our Regional Medical Director tell our IDG Team that those patients were good for six months and only needed to be discharged at the next recertification.  Our Medical Director disagreed but had no power to change corporate policy. 

Our founding Medical Director knew good managers appreciated staff.  He was repeatedly disturbed by the myriad of cuts imposed by new owners, the last two have been majority private equity.  Owners cut paid time off, reduced the number of holidays and cut holiday pay 33%.  I watched financial rapscallions institute new software that robbed employees of pay for time worked and mileage driven in the provision of care. 

Dr. Byock may want private equity owned hospices to increase their margin but he needs to look and see on whose back that occurs. 

Our founding Medical Director enjoyed telling the story of the corporate office having a special dark room, not much bigger than a closet, where they take a new manager and suck out half their brain.  I very much enjoyed watching the faces of those he told.  It generally took a few minutes for it sink in.

Thank you to Death Nurse for making me aware of the panel interview and sharing their wisdom in this arena.  "Game over" for hospice is due to the infiltration of financial rapscallions in the very fiber of American politics.  When private equity billionaires make government policy, they can do what they want.

Anonymous