» Vitas Healthcare, Miami
Background: Operating 53 hospice programs in 16 states, Vitas is one of the nation's largest providers of end-of-life care. It admitted 17,782 patients in Florida last year and has eight Florida locations. It is one of two divisions of Cincinnati-based Chemed, which also owns Roto-Rooter.

Financials: Vitas had revenue of $926 million in 2010, up 8% over 2009. Medicare and Medicaid represented 88% of revenue. Vitas had a profit of $79.8 million last year.

» Odyssey Healthcare, Dallas
Background: The firm operates 150 for-profit hospice programs in 30 states. In Florida, it operates in south and central Florida.

Financials: Acquired by Gentiva Health Services last fall, Odyssey remains an independent subsidiary. Gentiva's hospice revenue in 2010 was $351.5 million, up from $74.4 million in 2009. The increase reflects the company's acquisition of Odyssey as well as growth from its hospice business. About 97% of total hospice revenue was from Medicare and Medicaid. Hospice gross profits were $160 million.

Home Grown

The company now known as Vitas Healthcare was founded as a non-profit, Hospice Care Inc., in Miami in early 1978 by hospice pioneers Hugh Westbrook, Esther Colliflower and Don Gaetz. The same year, Gaetz and Westbrook helped pass Florida's hospice licensure law.

Don Gaetz helped give his hospice a 20-year head start over for-profit competitors.

Florida's hospice act, the first such law in the nation, went on to become the basis of the federal Medicare/Medicaid hospice benefit, passed by Congress in 1982. Helping spread hospice throughout Florida and the nation "is the most important thing I've ever done in my career," says Gaetz, now a Florida senator. (Colliflower, of North Carolina, and Westbrook, of Miami, are now retired.)

The law also created a profitable future for Vitas and its founders. Language in the law required Florida hospices to operate as non-profits unless they were incorporated before July 1, 1978 — after Vitas was founded. That gave the company a two-decade head start before the Legislature allowed other for-profits to operate in the state. Hospice Care became a for-profit company in 1984; the name changed to Vitas Healthcare in 1992. Cincinnati-based Chemed, best known as the owner of Roto-Rooter, purchased Vitas for $406 million in 2004. The sale helped make Gaetz the richest senator in Florida, with an estimated net worth of $22 million. He no longer has any shares or affiliation with the company.

"Our vision was always that hospice should take its rightful place in the mainstream of American healthcare," says Gaetz. "But we never would have believed that Vitas would become the dominant hospice provider in this state, much less the dominant hospice provider in the world."