October 25, 2014

Special Report

Hospices in Florida: From Cause to Commerce

A look at how hospices in Florida are transitioning as revenue - and need - increase.

Cynthia Barnett | 8/1/2011
Hospice room
Florida is home to some of the largest non-profit and for-profit hospices. While the number of non-profits held steady from 2000-07, for-profit hospices more than doubled. [Photo: Jon M. Fletcher]

BY THE NUMBERS


The Medicare Factor

$2.9 billion — Medicare payments to hospices nationally in 2000

$11 billion — Medicare payments to hospices nationally in 2008

$1.2 billion — Medicare payments to Florida hospices in 2008

87% — Hospice patients on Medicare

49% — Medicare enrollees in Florida who die in hospice care

In the 1970s, hospices began to grow in the United States as a grassroots effort by those who believed that terminally ill people should be able to die with dignity.

Advocates set up non-profit organizations called hospices on shoestring budgets to care for the emotional, social and spiritual needs of dying people and their families. The programs relied almost entirely on charitable contributions and volunteers. Florida became the first state to set standards for care, enacting a hospice licensure law in 1978.

In 1983, the federal government validated the approach when Congress approved Medicare reimbursement for hospice services aimed at cancer patients, then expanded coverage to other terminal illnesses.

Medicare reimbursement also began transforming hospice from righteous cause to a multibillion-dollar industry. Once Medicare began paying, demand for hospice services surged. In 2008 alone, Florida hospices provided care to nearly 100,000 Medicare recipients with terminal illnesses at an estimated cost of $1.2 billion, far more than any other state in the nation.

Florida's Largest Non-Profit Hospices

» Tidewell Hospice: Admitted 7,500 patients in Florida last year. The community hospice launched in 1979 to provide services at Sarasota Memorial Hospital and now covers Sarasota, Manatee, Charlotte and DeSoto counties.

» Suncoast Hospice: Admitted 7,388 patients in Florida last year. Founded in 1977, Suncoast serves Pinellas County and for many years has been one of the nation's largest non-profit providers of community hospice care; its daily patient census is usually the largest in Florida.

» Hospice of Palm Beach County: Admitted 6,449 patients in Florida last year. Launched as a grassroots movement by a group of women volunteers in 1978, Hospice of Palm Beach County now operates six in-patient units throughout the county, but more than 90% of patients are cared for at home. The hospice plans to begin operations in Broward County this month.

» Hope HealthCare: Admitted 4,536 patients in Florida last year. Based in Fort Myers, Hope was founded in 1979 and now operates in nine Florida counties, from the southwest coast to rural Hendry and Glades.

Sources: Agency for Health Care Administration and individual hospices. Rankings based on patient admissions from July 2009 through June 2010.

Providers of hospice services grew to meet the demand. Many non-profits got bigger, but the Medicare reimbursement system was generous enough to attract for-profit providers, too. Recent growth has been noticeably uneven. Between 2000 and 2007, the number of non-profit hospices nationally has remained at around 1,200, while the number of for-profit hospices more than doubled, from 725 to 1,660.

In Florida, Vitas Healthcare, founded in Miami ["Homegrown Profits"], was the only for-profit hospice firm that operated in the state until out-of-state for-profit firms convinced the Legislature to let them do business here in 2006. Since then, the number of for-profit hospices operating in Florida has doubled, and for-profit companies have challenged non-profits' market share in almost every region of Florida.

"Hospice began as a tiny seed of an idea rooted in the belief that dying could be more humanistic, and that concept has grown into a massive web of corporate entities," says Kathy Cerminara, law professor and end-of-life-care expert at Nova Southeastern University.

Today, Florida is home to some of the largest non-profit U.S. hospice organizations, including Suncoast Hospice of Pinellas County and its $131-million annual budget, and some of the biggest for-profits companies, including Vitas Healthcare, which in 2010 posted revenue of $926 million. About a third of Vitas' business last year was in Florida.

Just as it spurred the expansion of the industry, the Medicare reimbursement system continues to shape its evolution and the tension that has emerged between the for-profits and non-profits. Non-profit executives, for example, rejoice at the overall acceptance of hospice while lamenting what they see as the loss of a sense of mission implicit in the emergence of so many for-profit providers. Susan Ponder-Stansel, CEO and president of Community Hospice of Northeast Florida, calls it the "best of times, worst of times" for the hospice approach.

Tags: Healthcare

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