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Selling Hospice

Published online by Cambridge University Press:  01 January 2021

Extract

Hospice care in the United States has undergone a remarkable transformation since it assumed its modern form in the late 1960s. It began as a movement driven by small organizations staffed with many volunteer providers focusing on comprehensive spiritual, palliative, and mental health services for a relatively small number of terminally ill patients, typically suffering from cancer. The idea behind hospice during its early days was that a terminally patient and his or her family made a decision to focus on easing a patient’s pain and anxiety, making him or her more comfortable, rather than pursuing additional curative treatment. Because these objectives required a wide range of professional and non-professional skills, hospice care involved not only physicians and nurses, but clergy, social workers, volunteer caretakers, homemakers, and, of course, family members. The process of decision-making by the patient and his or her family was never uniform and never systematically studied.

Type
Symposium
Copyright
Copyright © American Society of Law, Medicine and Ethics 2014

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References

Wales, J. Kane, R. Robbins, S. Bernstein, L. Krasnow, R., “UCLA Hospice Evaluation Study: Methodology and Instrumentation,” Medical Care 21, no. 7 (1983): 734744.CrossRefGoogle Scholar
Wilson, B. P. Blossé, R. W. Tucker, J. L. Spector, K. K., “Hospice Care: Perspectives on a Blue Cross Plan's Community Pilot Program,” Inquiry 20, no. 4 (1983): 322327.Google Scholar
Smith, D. H. Granbois, J. A., “The American Way of Hospice,” Hastings Center Report 12, no. 2 (April 1982): 810 (“Typically, [hospices] are small, with 75 percent admitting fewer than 100 patient/family units in 1980, and only 2 percent admitting more than 250. The average current caseload was sixteen patient/family units. Sixty percent of the programs reported annual budgets under $75,000; only 10 percent had budgets over $300,000. The hospice patient can be autonomous in an important sense of that word; dignity and thinking for himself do matter. But the overwhelming fact of his life, and of the lives of those who provide him with care, is his dependence on or relatedness to others. Debilitating illness makes it impossible not to come to terms with this fact.CrossRefGoogle Scholar
See Wilson, et al, supra note 2.Google Scholar
Conner, S. R., “Development of Hospice and Palliative Care in the United States,” Omega – Journal of Death and Dying 56, no. 1 (2007): 8999, at 89–90.CrossRefGoogle Scholar
Editorial, “The Debate in Hospice Care,” Journal of Oncology Practice 4 (2008): 153157, at 153;Aldridge, M. D.et al, “Hospices' Enrollment Policies May Contribute to Underuse of Hospice Care in the United States,” Health Affairs 31, no. 12 (2012): 2690–2698, at 2693. In 2013, the Centers for Medicare and Medicaid Services issued a final rule disfavoring “debility” and “adult failure to thrive” as hospice eligibility diagnoses. Department of Health and Human Services Medicare Program, “FY 2014 Hospice Wage Index and Payment Rate Update; Hospice Quality Reporting Requirements; and Updates on Payment Reform; Final Rule,” Federal Register 78 (to be codified at 42 CFR pt. 418): 48234.Google Scholar
National Hospice and Palliative Care Organization, NHPCO Facts and Figures 2012 Edition, available at <http://www.nhpco.org/sites/default/files/public/Statistics_Research/2012_Facts_Figures.pdf>(last visited November 4, 2014).(last+visited+November+4,+2014).>Google Scholar
Jennings, R., “A Federal Role in Hospice Care?” American Psychologist 37, no. 11 (1982): 1249, 1251 (“The hospice concept begins when the patients themselves are encouraged to give families and doctors the cue that they have had enough: Of chemotherapy that makes them even sicker, of medical procedures that cause them even more pain, of tests that are mostly experimental in nature and not really expected to help.”).Google Scholar
Lorenz, K.et al, “Cash and Compassion: Profit Status and the Delivery of Hospice Services,” Journal of Palliative Medicine 5, no. 4 (2002): 507514, at 508.CrossRefGoogle Scholar
Noe, K. Smith, P. C., “Quality Measures for the U.S. Hospice System,” Ageing International 37, no. 2 (2012): 165180, at 168.CrossRefGoogle Scholar
Thompson, J. W. Carlson, M. D. A. Bradley, E. H., “US Hospice Industry Experienced Considerable Turbulence from Changes in Ownership, Growth, and Shift To For-Profit Status,” Health Affairs 31, no. 6 (2012): 12861293, at 1286.CrossRefGoogle Scholar
Perry, J. Stone, R. C., “In the Business of Dying: Questioning the Commercialization of Hospice,” Journal of Law, Medicine & Ethics 39, no. 2 (2011): 224234, at 227.CrossRefGoogle Scholar
See Lorenz, et al, supra note 9, at 511.Google Scholar
Abramson, M.et al, “The Continuing Evolution of Medicare Hospice Policy,” Public Administration Review 67, no. 1 (2007): 127134, at 130.Google Scholar
See NHPCO, supra note 7, at 5.Google Scholar
Cherlin, E.et al “Interdisciplinary Staffing Patterns: Do For-Profit and Nonprofit Hospices Differ?” Journal of Palliative Medicine 13, no. 4 (2010): 389394, at 393.CrossRefGoogle Scholar
McCue, M. Thompson, J., “Operational and Financial Performance of Publicly Traded Hospice Companies,” Journal of Palliative Medicine 8, no. 6 (2005): 11961206, at 1205.CrossRefGoogle Scholar
Lindrooth, R. C. Weisbrod, B. A., “Do Religious Non-Profit and For-Profit Organizations Respond Differently to Financial Incentives? The Hospice Industry,” Journal of Health Economics 26, no. 2 (2007): 342357, at 354.CrossRefGoogle Scholar
See Noe, Smith, , supra note 10, at 168.Google Scholar
Casarett, D.et al, “Making Difficult Decisions about Hospice Enrollment: What Do Patients and Families Want to Know?” Journal of the American Geriatric Society 53, no. 2 (2005): 249254, at 250.Google Scholar
Waldrop, D. P. Meeker, M. A., “Hospice Decision-Making: Diagnosis Makes a Difference,” Gerontologist 52, no. 5 (2012): 686–97, at 686.CrossRefGoogle Scholar
42 CFR §418.52(c)(4); Federal Register 73, no. 109 (2008): 32146.Google Scholar
IBM Case Studies, “Vitas Innovative Hospice Care Keeps Its Business Healthy,” June 22, 2012, available at <http://www-01.ibm.com/software/success/cssdb.nsf/CS/STRD-8VFJX7?OpenDocument&Site=corp&cty=en_us>(last visited November 4, 2014).(last+visited+November+4,+2014).>Google Scholar
Waldman, P., “Preparing Americans for Death Lets Hospices Neglect End of Life,” Bloomberg News, July 21, 2011, available at <http://www.bloomberg.com/news/2011-07-22/preparingamericans-for-death-lets-for-profit-hospices-neglect-end-of-life.html>(last visited November 4, 2014).(last+visited+November+4,+2014).>Google Scholar
U.S. v. Vitas Hospice Servs., L.L.C., No. 4:13-cv-00449-BCW (W.D. Mo. filed May 2, 2013), at 58.Google Scholar
See Thompson, Carlson, Bradley, , supra note 11, at 1291.Google Scholar
Statement of Representative Carrie Meek, Congressional Record Volume 141, Number 39, Thursday, March 2, 1995, available at <http://www.gpo.gov/fdsys/pkg/CREC-1995-03-02/html/CREC-1995-03-02-pt1-PgE495.htm>(last visited November 4, 2014);Pettit, P., “Esther Colliflower Is Still Looking Forward,” South Florida Hospital News and Healthcare Report 2, no. 9 (2006) available at <http://southfloridahospitalnews.com/page/Esther_Colliflower_Is_Still_Looking_Forward/887/1/> <http://caringfoundations.org/content/revhugh-westbrook>(both last visited November 4, 2014).Google Scholar
DeFede, J., “Death and Profits,” Miami New Times, June 6, 1993, available at <http://www.miaminewtimes.com/1993-06-16/news/death-and-profits/full/>(last visited November 4, 2014).Google Scholar
Vitas Innovative Hospice Care, Vitas Story, available at <http://www.vitas.com/about-us/history/vitas-story>(last visited November 26, 2014).(last+visited+November+26,+2014).>Google Scholar
See Pettit, , supra note 20DeFede, , supra note 22 “The company I created is worth a lot of money, and so on paper I created a lot of wealth. That was sort of not the intended result of what I set out to do. It is something that sort of happened along the way.”).Google Scholar
Colavecchio-Van Sickler, S., “GOP lawmaker Don Gaetz Is Rising Fast as a State Senate Leader,” Tampa Bay Times, March 30, 2008, available at <http://www.tampabay.com/news/politics/state/gop-lawmaker-don-gaetz-is-rising-fast-as-a-state-senate-leader/436807>(last visited November 4, 2014).(last+visited+November+4,+2014).>Google Scholar
Buck, J., “Nursing the Borderlands of Life: Hospice and the Politics of Health Care Reform,” in D'Antonio, Patricia Lewenson, Sandra, eds., Nursing Interventions Through Time: History as Evidence (New York: Springer, 2010): At 212.Google Scholar
Buck, J., “Policy and the Re-Formation of Hospice: Lessons from the Past for the Future of Palliative Care,” Journal of Hospice & Palliative Nursing 13, no. 6 (2011): S35S43.CrossRefGoogle Scholar
42 C.F.R. § 418.22(b) (2013).CrossRefGoogle Scholar
See infra note 101 and accompanying text.Google Scholar
42 C.F.R. §418.204(a).Google Scholar
Records obtained from the Florida Secretary of State designate January 12, 1984 as the date that Hospice Care Incorporated – the entity now part of Chemed – was formed. Records obtained from the Delaware Secretary of State show that Vitas Healthcare Corporation was formed on August 24, 1983. Hospice Inc. was formed in June 1978.Google Scholar
Rich, S., “Two Hospice Pioneers Starting a Business,” Washington Post, February 22, 1984;Vitas Healthcare Corporation, Form S-1 Registration Statement under the Securities Act of 1933, at 32 [hereinafter “S-1”].Google Scholar
See DeFede, supra note 29.Google Scholar
Associated Press, “Top Lawmakers Heed Givers' Likes and Dislikes,” Chicago Tribune, September 10, 1998 (citing Charles Lewis, The Buying of Congress, Center for Public Integrity 1998) (“Senate Minority Leader Tom Daschle (D-S.D.) co-sponsored legislation to provide federally funded hospice care for terminally ill veterans, a bill cheered by Vitas Healthcare Corp. of Miami, which hoped to tap that new source of funds in addition to its Medicare money. The company contributed $23,000 to Daschle as his third-most-generous contributor.”).Google Scholar
Modern Healthcare, HHS Issues Guidelines for Hospice Care, October 4, 1999.Google Scholar
Vitas Innovative Hospice Care, “Social Responsibility,” available at <http://www.vitas.com/wi/milwaukee-hospice/about-us/social-responsibility>(last visited November 25, 2014).(last+visited+November+25,+2014).>Google Scholar
Westbrook, H., “Saving the Medicare Hospice Benefit from Certain Failure,” Testimony and Recommendations to the Health Subcommittee of the U.S. Senate Finance Committee, September 17, 1984 (“We convinced a group of investors to capitalize our company based on certain assumptions of financial viability…The proportion of the reimbursement dollar devoted to indirect costs, as opposed to direct patient care, could be minimized by…spreading those indirect costs over an atypically large patient population…”).Google Scholar
Latz Griffin, J. Stein, S., “Hospice Firm Uses Nurses to Recruit Patients,” Chicago Tribune, August 26, 1990;Stein, S. Griffin, J. L., “Hospice's Patient Recruiting under Fire,” Chicago Tribune, September 9, 1990.Google Scholar
See DeFede, , supra note 29.Google Scholar
Investor Agreement dated December 17, 1991 between Hospice Care Incorporated, Chemed Corporation, and OCR Holding Company.Google Scholar
Hospice Pharmacia, VITAS Healthcare Corporation and Hospice Pharmacia Enter into Agreement to Provide Patients with High-Quality Medication Management, February 21, 2013, available at <http://www.vitas.com/about-us/newsroom/2013/february/21/vitas-hospice-and-hospice-pharmacias-enter-into-agreement>(last visited November 25, 2014).(last+visited+November+25,+2014).>Google Scholar
See DeFede, , supra note 29.Google Scholar
Investor Agreement dated December 17, 1991 between Hospice Care Incorporated, Chemed Corporation, and OCR Holding Company.Google Scholar
See S-1, supra note 40, at 60.Google Scholar
Id., at 4 (“Prior to fiscal year 1995, Vitas had attempted to diversify its operations to include non-hospice services, such as chronic disease management, through the development of large multi-functional service teams at the local program level with regional support capabilities.”).Google Scholar
Id., at 2.Google Scholar
Id., at 23.Google Scholar
Id., at 25.Google Scholar
Chemed Corporation, Annual Report 1999, at 33, available at <http://media.corporate-ir.net/media_files/irol/72/72704/anrpt99.pdf>(last visited November 5, 2014).(last+visited+November+5,+2014).>Google Scholar
See S-1, supra note 39, at 23.Google Scholar
Id., at 12, F-21.Google Scholar
Amended and Restated Investor Agreement dated April 27, 2001 between Vitas Healthcare Corporation, Chemed Corporation, and OCR Holding Company.Google Scholar
See Boyer, , supra note 53.Google Scholar
Department of Health and Human Services, Centers for Medicare and Medicaid Services, Medicare and Medicaid Programs: Hospice Conditions of Participation;Final Rule, Federal Register 73 (to be codified at 42 CFR pt. 418): 32090;Iglehart, J. K., “A New Era of For-Profit Hospice Care – the Medicare Benefit,” New England Journal of Medicine 360, no. 26 (2009): 27012703, at 2701 (“MedPAC, for its part, has recommended substantial changes designed to improve the accuracy of Medicare payments to hospices, increase hospice organizations' accountability, and ensure greater involvement by physicians in end-of-life care. A recent study showed that physicians often end all contact with patients once they refer them for hospice care.”).CrossRefGoogle Scholar
Id., at 32095.Google Scholar
See S-1, supra note 40, at 23.Google Scholar
Id., at 23.Google Scholar
Id., at 38.Google Scholar
Id., at 3637.Google Scholar
Roto-Rooter, Inc., Form 10-K, Annual Report Pursuant to Section 13 or 15(d) of the Securities Exchange Act of 1984, at v, available at <http://www.sec.gov/Archives/edgardata/19584/000095015204001868/l05867ae10vk.txt>(last visited November 5, 2014).(last+visited+November+5,+2014).>Google Scholar
Chemed, Inc., Form 10-K, Annual Report Pursuant to Section 13 or 15(d) of the Securities Exchange Act of 1984, at 20, available at <https://wwwsec.gov/Archives/edgar/data/19584/000095015206002164/l18258ae10vk.txt>(last visited April 8, 2014).(last+visited+April+8,+2014).>Google Scholar
See S-1, supra note 40, at 38.Google Scholar
Roto-Rooter, Inc., Form 10-K, Annual Report Pursuant to Section 13 or 15(d) of the Securities Exchange Act of 1984, at 5, available at <http://www.sec.gov/Archives/edgar/data/19584/000095015204001868/l05867ae10vk.txt>(last visited November 5, 2014).(last+visited+November+5,+2014).>Google Scholar
U.S. v. Vitas Hospice Servs., L.L.C., No. 4:13-cv-00449-BCW (W.D. Mo. filed May 2, 2013), at 3747.Google Scholar
Id., at 13.Google Scholar
Id., at 14.Google Scholar
Id., at 1332;see also Complaint at 16–26, U.S. ex rel Urick v. Vitas HME Solutions, Inc., No. SA08CA0663 (W.D. Tex. filed August 8, 2008); Complaint at 9-16, U.S. ex rel Gonzales v. Vitas Healthcare Corp., No. CV12–0761 (C.D. Cal. docketed Jan. 27, 2012); Complaint at 6–9, Spottiswood ex rel. U.S. v. Chemed Corp., No. 4:13-cv-005050-BCW (N.D. Ill. filed August 14, 2007).Google Scholar
See U.S. v. Vitas Hospice Servs., L.L.C., supra note 67, at 15.Google Scholar
Id., at 1415 (Procedures provided to medical staff were inconsistent with Medicare regulations, and a former medical director believed he could bill Medicare for CHC if the patient was “Actively dying.”).Google Scholar
Id., at 34.Google Scholar
Id., at 35.Google Scholar
Id., at 34.Google Scholar
Id., at 35.Google Scholar
Blum, J., “Informed Consent in the Hospice Setting: A Discussion of the Legal Doctrine and Its Impact on Hopsice Programs,” American Journal of Hospice Care 3, no. 4 (1986): 1922, at 19;Jandre v. Wis. Injured Patients & Families Comp. Fund, 813 N.W.2d 627, 640 (Wis. 2012).CrossRefGoogle Scholar
42 CFR ch iv. part 418 Sec. 418.62.Google Scholar
See Churchill, L. R., “The Ethics of Hospice Care?” in Davidson, G. W., ed., Hospice: Development and Administration (Hemisphere Publishing Company, 1985): At 163179 (identifying a range of relevant medical practices and communication relationships challenged and even upended in the hospice care setting).Google Scholar
Kusserow, R. P., A Program Inspection on Hospice Care, September 10, 1984, at 55, available at <https://archive.org/stream/medicarehospiceb00unit_3/medicarehospiceb00unit_3_djvu.txt>(last visited November 26, 2014).(last+visited+November+26,+2014).>Google Scholar
See U.S. v. Vitas Hospice Servs., L.L.C., supra note 67, at 3435.Google Scholar
CMS, “Medicare Care Choices Model,” available at <http://innovation.cms.gov/initiatives/Medicare-Care-Choices/>(last visited November 5, 2014).(last+visited+November+5,+2014).>Google Scholar