Community Healthcare CEO Viki Jingle: Unethical Hospice Practices a ‘Heartbreaking Disservice’ to Patients

As regulators turn their eyes toward hospice program integrity, Community Healthcare of Texas CEO Viki Jingle has seen first-hand the “heartbreaking disservice” that families experience due to unethical practices.

Among the key concerns is a rash of newly licensed hospice operators in multiple states that some have associated with suspicious or unethical practices. The issue first gained attention late last year in California, but stakeholders have also raised concerns about providers in Nevada, Arizona and Texas.

To open a dialogue on these issues, Community Healthcare, a hospice provider based in the north-central region of the Lone Star State, invited Rep. Beth Van Duyne (R-Texas) to meet with its leadership.

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She and Earl Blumenauer (D-Ore.) led a group of lawmakers who wrote to Chiquita Brooks-LaSure, administrator of the U.S Centers for Medicare & Medicaid Services (CMS), asking for the agency to brief them on fraud and abuse within the hospice benefit.

Hospice News sat down with Jingle to talk about how these concerns are presenting themselves in her markets, how regulators should respond and the benefits of engaging with policymakers.

Community Healthcare of Texas
Community Healthcare of Texas Chief Strategy Officer Robin Carter (Left), o Rep. Beth Van Duyne (Center), Community Healthcare CEO Viki Jingle (Right)

Texas is one of the states that frequently comes up when people talk about program integrity issues in the space. What are you seeing in your state?

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We do see a tremendous influx of for-profit, third-party investors coming into the hospice space here in Texas. It’s mind-boggling how many are opening monthly, getting licenses and just expanding.

It is extremely concerning for us because what is happening in Texas is that the community-based hospice is becoming a thing of the past, and it’s corporate-based hospice programs that are not connected to our communities and are not providing the care that we have always associated with community-based hospice.

How do you see this affecting other hospices in those markets and their patients?

These third-party investors are keeping their hospices at a relatively smaller census because obviously, you’re going to stay under the radar for [U.S. Centers for Medicare & Medicaid Services] audits.

In our territory, there are services that are not being provided to patients by these hospices. So for instance, we have had patients who have come into our program from another who have told us that they were so surprised that we were giving them a bed or a particular drug. They had been told that those did not come with the hospice benefit.

I think there’s a lot of nuance to what has been interpreted by hospices in our territory, and perhaps throughout the nation, on what is appropriate and needed hospice care and what is just a bare minimum.

The other thing that we’re seeing is that in Texas, we have a very large, non-funded population, and there are only a select few of us that are taking care of them. The rest will take one or maybe two and then just say they provide it. So there’s a heavy burden on those of us that are community-based, that are accepting non-funded patients, and providing the same level of care.

It’s heartbreaking for our families because, for the most part, many families and patients don’t fully understand what the hospice benefit is and or what they should expect out of the hospice benefit. They don’t know if they’re not getting what they should be.

We see a high volume of patients who were recently discharged from a hospital, and we have a lot of competitors who do not do that because those are patients who are very high-acuity and cost a lot. They are cherry-picking patients.

That is such a disservice, and it overall creates a negative image of hospice.

Are you able to share any of the issues that you discussed during Congresswoman Van Duyne’s visit?

We talked a lot about the number of hospices that have come into the state of Texas and the other states that are experiencing this influx of third-party investors.

Don’t get me wrong. We all want to have a bottom line — no profit, no mission. But there is a level here that is extremely disturbing.

When you’re looking at profit margins like mine, zero to 2%, compared to my competitor — who is operating in the same territory and supposedly the exact same work, but has a profit margin of 20% — there is something seriously not aligned there. And we’re seeing some differences in the level of care that is being provided to patients.

We hear a lot of it from salespeople who will come from another hospice and be surprised that we don’t allow them to do certain things that are not ethical.

What would you like to see happen in regard to hospice program integrity?

Number one, we should have a [licensing] moratorium. I know California has implemented one. Texas desperately needs one as well. That certainly isn’t going to stop the trading of hospice licenses that are currently out there, but that would at least stop the influx.

I think step two is to really start looking at what is being provided. There are so many audits going on right now, and we are part of many of them. But those are not looking at what is being provided.

They’re all retrospective, on how long patients were in our care or in inpatient care, instead of really digging in and looking at the services. Did you provide the DME that is appropriate? Did you provide the appropriate medical supplies and drugs? Or are you letting the patient use Medicare Part D to buy them?

I know that’s a lot harder to get to, but those are the issues that are happening.

Our state is overwhelmed in trying to survey hospices, and when they do a survey it’s based on whether they are following this or that policy, rather than talking to patients and families and hearing what was actually provided.

What value do you see in hospices engaging with their policymakers as you have?

It’s so important at this time, for us to be reaching out to policymakers, for them to understand what we do and how we impact patients and families. There are still a lot of myths out there.

But more importantly, we need to help them understand that hospice done right saves money for the Medicare system. It’s important for our legislators to listen to us as to what it is that is changing and why it is so critical for us to stay on top of whether or not these changes are beneficial to our consumers.

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