They provide little or no care at the hospices, because hospices by design provide only palliative care, and once they hit the $32,000.00 Medicare limit, they are kicked loose.
They then have to put their lives back together, including restarting Medicare coverage, because they were removed because they were declared to be dying by HCA:
It's not that conservatives aren't sometimes right – it's that even when they're right, they're highly selective
about it. Take the hoary chestnut that "incentives matter," trotted out
to deny humane benefits to poor people on the grounds that "free money"
makes people "workshy."
There's a whole body of conservative economic orthodoxy, Public
Choice Theory, that concerns itself with the motives of callow, easily
corrupted regulators, legislators and civil servants, and how they might
be tempted to distort markets.
But the same people who obsess over our fallible public institutions
are convinced that private institutions will never yield to temptation,
because the fear of competition keeps temptation at bay. It's this
belief that leads the right to embrace monopolies as "efficient": "A
company's dominance is evidence of its quality. Customers flock to it,
and competitors fail to lure them away, therefore monopolies are the
public's best friend."
………
Wealth-based health-care rationing is bad enough, but when it's combined with the public purse, a bad system becomes a nightmare.
Take #HospiceCare: private equity funds have rolled up huge numbers of
hospices across the USA and turned them into rigged – and lethal –
games:
https://pluralistic.net/2023/04/26/death-panels/#what-the-heck-is-going-on-with-CMS
Medicare will pay a hospice $203-$1,462 to care for a dying person,
amounting to $22.4b/year in public funds transfered to the private
sector. Incentives matter: the less a hospice does for their patients,
the more profits they reap. And the private hospice system is
administered with the lightest of touches: at the $203/day level, a
private hospice has no mandatory duties to their patients.
You can set up a California hospice for the price of a $3,000 filing
fee (which is mostly optional, since it's never checked). You will have a
facility inspection, but don't worry, there's no followup to make sure
you remediate any failing elements. And no one at the Centers for
Medicare & Medicaid Services tracks complaints.
So PE-owned hospices pressure largely healthy people to go into "hospice care" – from home. Then they do nothing
for them, including continuing whatever medical care they were
depending on. After the patient generates $32,000 in billings for the PE
company, they hit the cap and are "live discharged" and must go through
a bureaucratic nightmare to re-establish their Medicare eligibility,
because once you go into hospice, Medicare assumes you are dying and
halts your care.
PE-owned hospices bribe doctors to refer patients to them. Sometimes,
these sham hospices deliberately induce overdoses in their patients in a
bid to make it look like they're actually in the business of caring for
the dying. Incentives matter:
https://www.newyorker.com/magazine/2022/12/05/how-hospice-became-a-for-profit-hustle
………
The paperclip-maximizing, grandparent-devouring transhuman colony
organism that calls itself a Private Equity fund is endlessly inventive
in finding ways to increase its profits by harming the rest of us. It's
not just hospices – it's also palliative care.
Writing for NBC News, Gretchen Morgenson describes how HCA Healthcare
– the nation's largest hospital chain – outsourced its death panels to
IBM Watson, whose algorithmic determinations override MDs' judgment to
send patients to palliative care, withdrawing their care and leaving
them to die:
https://www.nbcnews.com/health/health-care/doctors-say-hca-hospitals-push-patients-hospice-care-rcna81599
Incentives matter. When HCA hospitals send patients to die somewhere
else to die, it jukes their stats, reducing the average length of stay
for patients, a key metric used by HCA that has the twin benefits of
making the hospital seem like a place where people get well quickly,
while freeing up beds for more profitable patients.
………
Only one of HCA's doctors was willing to go on record about its death
panels: Ghasan Tabel of Riverside Community Hospital (motto: "Above all
else, we are committed to the care and improvement of human life").
Tabel sued Riverside after the hospital retaliated against him when he
refused to follow the algorithm's orders to send his patients for
palliative care.
Tabel is the only doc on record willing to discuss this, but 26 other
doctors talked to Morgenson on background about the practice, asking
for anonymity out of fear of retaliation from the nation's largest
hospital chain, a "Wall Street darling" with $5.6b in earnings in 2022.
………
But while cutting staff and leaving hospitals to crumble are
inarguable malpractice, the palliative care scam is harder to pin down.
By using "AI" to decide when patients are beyond help, HCA can employ
empiricism-washing, declaring the matter to be the factual – and
unquestionable – conclusion of a mathematical process, not mere
profit-seeking:
https://pluralistic.net/2023/07/26/dictators-dilemma/ggarbage-in-garbage-out-garbage-back-in
But this empirical facewash evaporates when confronted with
whistleblower accounts of hospital administrators who have no medical
credentials berating doctors for a "missed hospice opportunity" when a
physician opts to keep a patient under their care despite the
algorithm's determination.
This is the true "AI Safety" risk. It's not that a chatbot will
become sentient and take over the world – it's that the original
artificial lifeform, the limited liability company, will use "AI" to
accelerate its murderous shell-game until we can't spot the trick:
https://pluralistic.net/2023/06/10/in-the-dumps-2/
The risk is real. A 2020 study in the Journal of Healthcare Management
concluded that the cash incentives for shipping patients to palliatve
care "may induce deceiving changes in mortality reporting in several
high-volume hospital diagnoses":
https://journals.lww.com/jhmonline/Fulltext/2020/04000/The_Association_of_Increasing_Hospice_Use_With.7.aspx
Incentives matter. In a private market, it's always more
profitable to deny care than to provide it, and any metric we bolt onto
that system to prevent cheating will immediately become a target.
For-profit healthcare is an oxymoron, a prelude to death panels that
will kill you for a nickel.