Medicare pays hospice a flat per diem. The same daily rate whether your team makes one visit or five.
That means the margin in hospice does not come from better care. It comes from two things: enrolling patients who need the least care, and holding service intensity below the per diem. Longer stays of low-acuity patients are the most profitable, which is exactly why the aggregate cap exists, because providers were enrolling people too early and keeping them too long.
For-profit hospices already select less resource-intensive patients than nonprofits. That pattern is documented going back years.
Now read a DOGE-bros “Special” pitch against that. They say they will “root out waste” using AI “efficiencies” to “increase nurse pay.”
One needs to look no further than childcare learning centers in Minnesota or hospice businesses in California to find immense waste at the state level from businesses that benefit from taxpayer dollars.
Targets named. The method to generate margin they are promising investors is delivering less care per reimbursed dollar, then optimizing patient selection toward the cheapest bodies to serve.
They are literally describing undertreatment of dying people and calling it efficiency.
The DOGE-bros believe care is waste.
Notice also how they move to “open source all billing claims”. They mean the claims that show what they collected from Medicare. They do not want to show who was enrolled, whether those patients were actually terminal, what care was withheld, or how anyone died. Publishing the money is not accountability for the care. It displays the one number they want celebrated, while they make “proprietary” every number that would convict them.