VistaCare hospice rides out of the West
Latest gunslinger to seek national hospice presence
Although hospice's for-profit sector continues to grow faster than the industry as a whole, the trail is littered with the bones of numerous investor-owned hospices and diversified national health companies that once unveiled bold plans for large-scale national hospice operations, but failed to deliver at the promised pace. Perhaps wringing profit out of hospice care is not as easy as it first appears.
The newest entrant to create a buzz in the hospice sweepstakes is VistaCare of Scottsdale, AZ, founded in 1995 by Barry Smith, former CEO of the pharmacy management company ValueRX. Smith has been cutting a high profile in the hospice world recently, attending the invitation-only organizing meeting for the end-of-life policy initiative called MediCaring (see related story in Hospice Management Advisor, February 1998, p. 24), and hobnobbing with the Hospice Work Group, an informal group of a dozen of the country's leading nonprofit hospice executives.
Vista's hospice operations in the states of Arizona, Nevada, Texas, and Utah now total a modest cumulative census of about 400 patients, but the company plans to expand by at least 30 sites in the next 12 months, reports Steven L. Bodhaine, chief operating officer, West. A major multi-site hospice acquisition is said to be imminent, and the company is rumored to have plans to go public, despite the omen presented by Miami-based Vitas Healthcare Corporation, which tried and failed to launch a huge sale of common stock last fall.
Vista's latest coup was to hire Carolyn J. Cassin, the founding executive of the statewide, nonprofit Hospice of Michigan, as its chief operating officer, East. The company is also expected to announce that David Rehm, ACSW, former CEO of Hospice Care of Rhode Island and one of the hospice industry's leading proponents of vertical integration, is coming on board.
VistaCare also boasts an impressive National Advisory Board, which includes Balfour M. Mount, MD, CM, OQ, director of the Palliative Care Service of Royal Victoria Hospital in Montreal, Canada; author and hospice physician Ira Byock, MD; Arthur G. Lipman, PharmD, professor of clinical pharmacy at the University of Utah, Salt Lake City; and Betty R. Ferrell, RN, PhD, nursing research scientist at City of Hope National Medical Center in Duarte, CA.
But is Vista really different from previous, largely unsuccessful attempts to establish a major national, proprietary hospice presence? One hospice insider who prefers not to be named describes Vista as a "major contender," and says that in contrast with who have gone before, experience, capital, and leadership will make a big difference."
A somewhat more cynical view is offered by another nationally prominent nonprofit hospice director. "I don't know what Vista really is about. Here's a man [Smith] with a lot of bucks who has caught the hospice bug," but will his interest last? "People think there are big bucks to be made in hospice from the efficiency of a national network, but it remains to be seen how true that is. I just don't see a great demand for a national hospice network," the executive says.
Is VistaCare the real deal?
Bodhaine explains that one of Vista's goals is "to move the hospice concept further upstream, to take the philosophy and move it into areas where it hasn't always been welcomed." The six-months-or-less requirement of the Medicare hospice benefit remains a major impediment to the industry's further growth, and Vista intends to experiment with other end-of-life approaches, he says.
"We only do hospice, and we're very focused on doing it based on the foundation of what has gone before, while adding a level of managerial, technological, and clinical sophistication whose time has come for this industry," Bodhaine asserts. He adds that the company's leaders all bring experience running large corporations. "In the name of compassion, hospice has often lacked discipline. It needs to act like an industry, which means a different degree of discipline, responsibility and vision."
Bodhaine also emphasizes the company's commitment to advancing the art of "evidence-based care," conducting meta-analyses of existing research, publishing evidence-based guidelines, and funding palliative care research at the Uni ver sity of Utah Health Sciences Center and elsewhere. "Part of the challenge facing hospice is that our evidence up to now has been very anecdotal. Part of our mission at Vista is to establish a firmer scientific basis for what we do."
Perhaps Vista's biggest innovation lies in partnering with specialty care providers in the hazy new realm of disease management. Vista is now developing such a partnership with Community Cancer Care of Indianapolis, and will soon open a certified hospice program in Indiana to work closely with that disease management company. "By tracking their data, doing research and analysis, we can start to identify when active curative [cancer] care begins to look futile," and utilize hospice supportive skills to help patients and families make the transition away from such care, Bodhaine says.
"Our advisory board members view us as a tool that can really drive change in the hospice industry because we are better structured financially, with capital from management and venture capital, and because we put our money where our mouth is," he proclaims, adding that the industry can expect more big announcements about the company's plans within the next few months. Only time will tell if VistaCare can live up to its grand plans.
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