“It doesn’t seem right,’’ said Stubbs, who had Appling’s power of attorney to make medical decisions. “What incentive did the doctor have to put my aunt on hospice? How much was she being paid?’’
Harden Healthcare, the hospice’s current owner, said medical directors received no incentive pay. Appling’s doctor, Donna Ewy, did not return four calls seeking comment.
Hospice care, once chiefly a charitable cause, has become a growth industry, with $14 billion in revenues, 1,800 for-profit providers and a base of Medicare-covered patients that doubled to 1.1 million from 2000 to 2009.
Compensation based on enrollment numbers, pay to nursing-home doctors who double as hospice medical directors and gifts to the nursing facilities have helped fuel the boom, according to an examination of 1,000 pages of court documents and interviews with more than 45 current and former hospice employees, patients, and family members.
“They wanted us to admit, admit, admit,’’ said Joyce White, a former marketer for Vitas Healthcare, a Chemed Corp. unit that is the nation’s largest hospice chain. “All of us competed against each other to make our numbers. You lived or died by your numbers.’’
Publicly traded companies such as Chemed and Gentiva Health Services have created hospice chains through serial takeovers in the last decade. Hospice buyouts and investments by private-equity firms have also led to boosted enrollments.
Funding from Kohlberg Kravis Roberts enabled closely- held Harden’s acquisition of Hospice Care of Kansas’s parent last year. The seller: private-equity investor Apax Partners, of London and New York.
“There was always pressure to get the patient census up, any way we could, to sell the company,’’ said Rae Ann Angelo, a Wichita salesperson for the Kansas hospice from 2003 to 2009, including most of the time when Apax owned it. “You can’t sell unless you show big growth.’’
