Selling Hospice

Americans are increasingly turning to hospice services to provide them with medical care, pain management, and emotional support at the end of life. The increase in the rates of hospice utilization is explained by a number of factors including a “hospice movement” dating to the 1970s which emphasized hospice as a tool to promote dignity for the terminally ill; coverage of hospice services by Medicare beginning in 1983; and, the market for hospice services provision, sustained almost entirely by governmental reimbursement. On the one hand, the growing acceptance of hospice may be seen as a sign of trends giving substance to the death-with-dignity movement and the growing strength of end-of-life decision-makers and planners who integrate medical, community, family and spiritual networks. On the other hand, the precise relationship between the death-with-dignity and commercial processes driving hospice utilization rates are not well understood. On May 2, 2013, the U.S. Government intervened in a lawsuit brought by former hospice employees alleging that behind Vitas Innovative Hospice Care, the largest for-profit hospice service provider in the United States, lie an intricate web of incentives for patient intake nurses, physicians and marketers which not only drove hospice patients to use more expensive (and medically unnecessary) crisis care services, but influenced patient and family decisions as to whether or not to discontinue curative treatment. The corporate, investment, and regulatory history behind Vitas provides an important insight into the market realities behind Americans\u27 embrace of hospice care and the risks to patient autonomy and health that accompany the commercialization of this ethically and morally complex health care service

Developing a Business Case for the Care Coordination and Transition Management Model: Need, Metrics, and Measures

In this descriptive qualitative study, nurse and healthcare leaders\u27 experiences, perceptions of care coordination and transition management (CCTM®), and insights as to how to foster adoption of the CCTM RN role in nursing education, practice across the continuum, and policy were explored. Twenty-five barriers to recognition and adoption of CCTM RN practice across the continuum were identified and categorized. Implications of these findings, recommendations for adoption of CCTM RN practice across the care continuum, and strategies for reimbursement policies are discussed

Quality of Life for Patients and Caregivers: Palliative Care Funding Opportunities

Development of the field of palliative care, which was nourished through extensive private foundation funding over more than a decade, has to some extent been stalled because of sharply reduced private funding, a lack of understanding by the general population, and the inaction of major institutions. This study investigated the current state of palliative care funding efforts in the San Francisco Bay Area (the Bay Area ) and across the U.S. The individuals that participated in the research component of this study included palliative care experts and palliative care funders. Through two separate surveys and two interview groups their perceptions and opinions were recorded. Three Bay Area counties were used for the purpose of considering how palliative care might be advanced across one specific finite region - with the hope that resulting information would be applicable to other regions in the U.S. Research data indicated that Bay Area patients and their families, in the opinion of survey respondents and interview informants, would benefit from the advancement of palliative care, and that existing organizational priorities, capacity, and mission statements are congruent with the advancement of palliative care. This research revealed that most Bay Area funders are not knowledgeable about palliative care or of its capacity to improve quality of life, and that they do not plan to make related grants. Expert opinions from around the U.S. indicated that this is also the case among funders in general. Yet despite these findings the field continues to develop, if not at a rate that matches the ability of palliative care to impact positively the quality of life for patients and their caregivers. The study revealed that where palliative care is not advancing there are individual professionals, organizations, systems, and policies that continue to impede its development. lV Study findings suggest that there is an ongoing need among the general public, healthcare professionals, healthcare organizations and healthcare funders to understand the emotional, spiritual, and psychological barriers to dealing with chronic illness and death. Interview informant data suggests that America\u27s ageist society, its general inability to deal with death in holistic and healthy ways, and its medical culture that equates death with failure, regardless of quality of life, are all part of a complicated situation that makes funding in this field less than attractive and less than a top priority

Managing Medicaid Pharmacy Benefits: Current Issues and Options

Examines issues and considerations for state reforms of Medicaid prescription drug reimbursement, pharmacy management, and cost sharing and other best practices for realizing savings

Access to Hospice Care: Expanding Boundaries, Overcoming Barriers

This report looks at issues of social justice, access, and public policy in hospice and palliative care. As it examines the issues from the perspectives of social justice and fairness, it also recommends ways in which the definition of hospice can be expanded to include more Americans for a longer period of time than simply the days or months shortly before death

Executive Authority to Reform Health: Options and Limitations

Presidential power has provoked increasingly vigorous debate since the turn of this century. In recent years, scholars and lawyers have been grappling with how Congress\u27s dictates may limit the President\u27s Commander-in-Chief power to detain enemy combatants at Guantanamo Bay, to fight wars abroad, and to conduct intelligence activities at home. But policymakers have not yet explored the many possibilities for invoking the President\u27s Take Care power to change health care policy. This paper explores the scope and limits of President Barack Obama\u27s ability to invoke his executive authority to reform health care. Specifically, it identifies ways the Obama Administration can use directives to: (1) expand Medicaid and SCHIP coverage through section 1115 waivers; (2) test quality initiatives through Medicare demonstration authority; (3) expand health information technology; (4) allow drug reimportation and experiment with contracting power under Medicare; (5) enhance patient protections and private coverage requirements; (6) lift coverage restrictions on Medicaid and SCHIP; and (7) build on the health insurance program for federal employees. Consistent with the mission of the Legal Solutions in Health Reform project, this paper does not endorse a particular policy. Instead of recommending what, it explains how

What Happens to a Nursing Home Chain When Private Equity Takes Over? A Longitudinal Case Study.

We analyzed what happens to a nursing home chain when private equity takes over, with regard to strategy, financial performance, and resident well-being. We conducted a longitudinal (2000-2012) case study of a large nursing home chain that triangulated qualitative and quantitative data from 5 different data sources. Results show that private equity owners continued and reinforced several strategies that were already put in place before the takeover, including a focus on keeping staffing levels low; the new owners added restructuring, rebranding, and investment strategies such as establishing new companies, where the nursing home chain served as an essential "launch customer.

Collective Corporate Knowledge, the Federal False Claims Act, and the Future of Federal Health Programs

While recent U.S. Supreme Court decisions have drawn focus to whether what corporations “say” is protected by the First Amendment or what they “believe” is protected by the federal Religious Freedom Restoration Act, the more relevant inquiry for a wide range of statutory and regulatory regimes is what corporations “know.” At the core of that question is what guides information relevant for legal compliance (including product safety, employee welfare, and material risks considered by investors) from its source to any given point in the firm, including decision-makers. This Article analyzes the federal False Claims Act as an underexploited resource in developing answers to how and why corporations “know” or fail to “know” relevant information. That law provides for monetary sanctions against an individual or firm that “knowingly presents, or causes to be presented, a false or fraudulent claim for payment or approval” by the U.S. federal government. In the context of business entities, attribution of “knowledge” has generated disagreement between federal courts. Some courts reason that liability only attaches if a single individual, no matter how large the enterprise, knew the claim to be false. Others have determined that firms are responsible for the entire universe of knowledge obtained by employees and agents in the course and scope of their employment or agency. Finally, others have created a system of rebuttable presumptions about what firms are deemed to know or not know for purposes of the law. This article concludes that the False Claims Act’s design and legislative history strongly suggest that it was intended to hold firms accountable for the collective knowledge agents and employees possess about compliance with government payment programs, even where it appears that information channels between employees, agents and decision-makers are disaggregated and violations of payment program terms cannot be traced to a single individual. The article explains the significance of this conclusion both in the context of federal health programs, where the application of a “collective corporate knowledge” doctrine will play a vital role in ensuring the financial viability of Medicare, Medicaid and the Affordable Care Act as well as in the broader literature on organizational behavior approached by economists, psychologists, and sociologists