National / International News
Conventional wisdom has been that hospice care at the end of life will improve someone’s final days and save money. It’s certainly cheaper to have a team of caregivers check on someone a few times a day compared to stays in intensive care units.
But it turns out that was wrong, according to a New England Journal of Medicine report out Wednesday.
In fact, for patients in nursing homes, spending went up by nearly $6,800 per patient due to increased hospice care.
Here’s the first thing you need to know about hospice care: between 2000 and 2012, the number of people enrolling doubled — which is great, says Pedro Gozalo, a healthcare economist at Brown.
“Hospice does seem to bring value by decreasing services like ICU unitization and feed tube insertion,” he says.
Gozalo, who wrote the report, found hospice is doing what it’s supposed to do; lower visits to intensive care, hospitalizations, the expensive stuff. But here’s the problem: at least for nursing home patients, those savings get gobbled up because people are spending longer and longer in hospice.
In part, that’s because more complicated patients are being enrolled, like folks with Alzheimer’s, Gozalo says, and it’s hard to know how much time they have left.
“Some person may appear frail,” he says. “Then after a few weeks go by, then they perk up again and then they seem to be stable for two, three more years. It’s just not easy to do.”
More than complex cases though are driving these longer hospice stays, which brings me to the second thing you need to know about hospice care: spending has exploded from $2.9 billion in 2000 to $15 billion in 2012.
Some people worry hospice companies are taking advantage of long-standing payment policies, basically bilking the federal government. Nancy Harrison works for the Office of the Inspector General at Health and Human Services, and filed a report on the issue.
"We found patterns that show that companies target patients with long lengths of stay and medically uncomplicated conditions who may offer the greatest financial gain,” she says.
Regulators in Washington have responded and hope to clamp down on this practice by changing how hospice companies get paid.
EU officials announced they are moving to regulate U.S. tech companies like Google, Amazon and Facebook when they do business in Europe.
Marketplace’s Molly Wood has been looking at possible outcomes of increased scrutiny of U.S. tech companies in Europe.
“I would imagine that any regulation isn’t going to be so strong that it actually damages a U.S. company’s ability to do business in Europe,” Wood says. “I’d be surprised if they actually went that far because consumers already know what they can get and they’re gonna be mad if they can’t get it anymore.”
Hear the full conversation using the audio player above.
For the 10-year anniversary of their book, "Freakonomics," economist Steven Levitt and journalist Stephen Dubner have a new book called "When To Rob A Bank…and 131 More Warped Suggestions and Well-Intended Rants."
The pair have published over 8,000 blog posts on the Freakonomics website, and the book compiles some of their favorites, covering topics as diverse as gas prices, terrorism, the benefits of a "sex tax," cheating, and of course, robbing banks.
"There are all the big things you study, big important questions. And then there are the little things that don’t add up to an academic paper, that don’t add up to a chapter of a book, but for 400 words, you really want to say something about them," Levitt says. "And that‘s what I love about the blog posts."
Listen to the full interview using the audio player above, and read an excerpt from the book below.
Chapter 4: Contested
Every time we write a book, our publisher prints up a bunch of swag — T-shirts, posters, etc. — to use as promotion. They send us a few boxes, which inevitably wind up in a closet. One day we were thinking: How can we give this stuff away to people who might actually want it? That’s when we decided to run our first blog contest, with the winner getting a piece of swag. These contests were so much fun — our blog readers are extraordinarily ingenious — that we held dozens of them. Here are a few of our favorites.
What Is the Most Addictive Thing in the World?
I was talking with my colleague and friend Gary Becker a while back about addiction. Among his many other accomplishments, for which he has won a Nobel, Becker introduced the idea of rational addiction.
When he told me his opinion as to the most addictive good, I was initially surprised and skeptical. On further reflection, I believe he is right.
So here is the quiz: What does Gary Becker think is the most addictive thing on earth?
The following day...
More than six hundred readers took a shot at guessing what Gary Becker thinks is the most addictive thing on earth.
Lots of folks said things like crack and caffeine, but do you really think I’m going to offer a blog quiz with an obvious answer?
While not the answer I was looking for, there was some- thing poetic about Deb’s guess:
"A yawn. A smile. Salt."
Before I give the answer, it is worth thinking about what it means for a good to be addictive. At least the way I think about it, an addictive thing has the following characteristics:
- Once you start consuming it, you want to consume more and more of it.
- Over time you build up a tolerance to it; i.e., you get less enjoyment out of consuming a fixed amount of it.
- Pursuit of that good leads you to sacrifice every- thing else in your life to get it, potentially leading you to do ridiculous things to try to get the good.
- There is a period of withdrawal when you stop consuming the good.
No doubt alcohol and crack cocaine fit that description well. In Becker’s view, however, there is something even more addictive than substances: people.
When he first said this, it sounded kind of crazy to me. What does it mean to say that people are addictive?
Then I thought more about it, and I think he is right. Fall- ing in love is the ultimate addiction. There is no question that in the early stages of attraction, spending a little bit of time with someone makes you desperately want more. Infatua- tion can be all-encompassing, and people will do anything to make a relationship blossom. They will risk everything and often end up looking utterly foolish. Once someone is in a relationship, however, the utility he or she derives from time with the beloved diminishes. The heady excitement of courtship gives way to something much more mundane. Even if a relationship isn’t that good, for at least one of the parties there is a painful withdrawal period.
To get the exact answer I was looking for took until comment number 343, when Bobo responded ”Other People.” Many others were close. Jeff (comment 13) said “Society or human companionship.” Laura (comment 47) said “Love.”
I’ll declare all three of them winners.
European leaders have unveiled a broad plan to reshape the digital economy on the continent.
The European Commission, the EU's governing executive body, is proposing a range of new rules to standardize everything from e-commerce to telecom among its 28 member states.
Officials say the EU's failure to create a single digital market is costing the continent about $470 billion. The proposed plan also calls for an investigation of the role of some big American online companies.
The plan is a radical rethink of how the EU does business digitally, says David Fidler, a visiting fellow at the Council on Foreign Relations.
"This is a big, bold, ambitious project," says Fidler, "The barriers, and the fragmentation, and the problems and the challenges, are very serious and numerous."
That's hurting Europe's small and medium-sized businesses, only seven percent of which are doing business outside their countries' borders, according to the EU.
And among the big companies, European firms have ceded to American tech firms.
"It is a natural instinct to go, 'Wow, need to look at this, we are concerned about this natural monopoly that has happened,'" says Heather Conley, director of the Europe Program at the Center for Strategic and International Studies.
American firms have faced several anti-trust investigations and inquiries into their business practices. The EU's new plan calls for that scrutiny to continue, while also eventually adding potential new regulations.
Those regulations are years away though, as the EU finalizes its plans, and convinces 28 members states to go along with the proposals.
This comes directly from Marketplace's "Oh-man-I-totally-knew-it" desk.
The NFL released its investigation into "Deflategate," the sad and sorry episode of the New England Patriots and deflated footballs in the AFC Championship last season.
Suffice it to say: they did it.
An investigator hired by the league says it was “more probable than not" the Pats did indeed deflate the footballs, making them easier to handle in that day’s rainy conditions. The investigation also found quarterback Tom Brady was “at least generally aware” of what was going on.
Sports fans around the Marketplace office have been guessing what punishment the league might hand down. I’ve heard everything from a $500,000 fine to Brady getting slapped with at least a six-game suspension.
You can quote me on this one, you guy, take it to the bank: there is no way Brady gets suspended for six.
Wall Street has been buzzing about the possibility of Microsoft offering to buy Salesforce.com Inc. Or maybe Oracle will bid. Or Google. Only very big outfits need apply, since the market considers Salesforce a $49 billion company.
Which raises a couple of questions: First, why would anyone pay that kind of money for a company that doesn’t make a profit? And second: What does Salesforce do, anyway?
Salesforce offers what it calls "customer relationship management" tools. Basically, a master database with all of a worker's contacts. Or a whole team’s contacts. Or all the contacts across an entire business — and the progress of every sale and contract.
The people who like Salesforce, really like it.
"I tell people it’s like a cult or a religion," says Gabe Arnold, founder of marketing-tech consultancy tEkk3. He also runs a LinkedIn group called SalesForce Power Users, with more than 30,000 members. "Salesforce users are extremely loyal," he says.
A combination of a high price tag and a big learning curve are part of what makes people loyal, Arnold says. Once a user invests the money to license it and the time to implement it, they're hooked.
The company has grown quickly, largely by buying smaller companies and integrating itself into more functions. Revenues have more than doubled since 2012, even though the company hasn't seen a profit.
In the company's dream scenario, software like Salesforce ties together sales and marketing.
Brian Wieser, an analyst at Pivotal Research, describes the "big data" world that Salesforce hopes to serve.
"At some point in the near future," he says, "the Chief Marketing Officer will control more of the technology budget than the Chief Technology Officer or the Chief Information Officer."
Wieser says that’s a potential trillion-dollar market for a company like Salesforce. He mentions IBM, Adobe and Oracle as likely competitors.
That’s the dream. Andrew Bartels from Forrester Research, thinks expanding into marketing puts Salesforce up against established competitors. He lays out another possible scenario.
"At a certain point in time," he says, "Salesforce’s revenues will grow more slowly. It simply can’t sustain 38 percent revenue growth as it gets bigger and bigger."
At that point, he says, shareholders will start to want profits.
Some hospitals are using a remote command center to keep an eye on ICU patients. This brings the expertise of a major medical center to rural hospitals — and may help keep the rural centers open.
The earthquake has prompted hundreds of people to set up online campaigns. They've raised hundreds of thousands, often for groups based in Nepal. What do charity watchdogs make of all this?
Near a field of deep sea vents between Norway and Greenland, scientists discovered the DNA of microbes that seem to be primitive archaea, but with a lot more genes — typical of complicated creatures.
The crowded and fast-growing district is facing a severe teacher shortage.
Oil hit a new high for the year — closing at just under $61 a barrel. But some analysts say the global economic slowdown and the rise of alternative energy will mean less demand and lower prices.
We touch on fantasy sport every now and then, but today something just a little bit different. Instead of drafting his favorite actual players, comedian Greg Proops has put together his ideal business team for us — a CEO dream team, if you will:
Spring is here and the smell of green is in the air. Is anything more exciting than the thrill of getting in a rundown by government regulators or stealing homes from people who paid for them? Yesiree, a CEO baseball team has to be motivated, ruthless and mostly white guys. Let's play ball.
Manager: John J Rockefeller (Standard Oil)
The gold standard for robber barons, Rocky can lead this feisty group to wins over strikers, whiners and nervous Nellies. Invented PR to cover for his goons killing innocent women and children in a miners strike in Ludlow, if the crowd boos him he will make a nice gesture like buy Yellowstone or start a foundation. John J will black gold.
1st Base: Steve Jobs (Apple)
Super innovative at reaching for other people's ideas. He can cover the first base with an eye to stealing second. Fearless umpire baiter, he will yell and scream to achieve his dream.
3rd Base: Eddie Lampert (Sears)
The man who had the singular vision to sell Rolex watches at Sears. The Lamprey will hustle like no one else and if they lose. It is definitely not his fault. Nothing ever is.
Short stop: Tony Hayward (BP)
Great at cleaning up big spills he will cover loads of ground. After the BP explosion he wanted his life back. He can go into the deep hole and feel good about himself.
Left field: Dick Costolo (Twitter)
Let anyone yell whatever they like Dick can take it. The Big Twitt as we know him recognizes there is no way to keep fans from raining sexist, racist abuse and he seems cool with that. Just so they keep it under 140 characters.
Center field: Lloyd Blankfein (Goldman Sachs)
Blanksy is definitely President Obama's favorite player. When a player gets paid this much he has to be good, right? He feels he is being punished for his success BY THE JEALOUS. Untouchable and arrogant or just well protected? BLANKSY WILL DOMINATE.
Right field: Jamie Dimon (JP Morgan)
Bring him in front of the commissioner and he just laughs. The man who told Senator Warren "So hit me with a fine. We can afford it." gets the call to hold down right. Right field requires the strongest arm. The Dimon dog has got bark and bite, baby.
Catcher: Mike Jeffries (Abecombie and Fitch)
Not your old fashioned catcher, this field general will micromanage the game. He knows where everyone should play, what underwear they should wear and where his dogs sit on the private plane to the next game.
Starting pitcher: Jeff Bezos (Amazon)
Brings the mad fastball via his drone like arm. Once named, "The World's Worst Boss," he will back you off the plate with high hard ones. Hell, he will buy all the scorecards and have his minions fill them in if necessary. Fans go Crezos for Bezos.
Concessions: Charles Johnson (Owner of SF Giants)
So you shouldn't think I am am playing favorites. The owner of the team I root for the San Francisco Giants. Our ball yard features gourmet BBQ, garlic fries and cappuccino at the park. Mr. Johnson's personal worth is somewhere north of six and half billion but he makes sure the men and women who sell food and drink at the park get paid poverty wages. Keeps the costs down while providing awesome snacks. That is world class CEOing. way to hang swinging Johnson.
Equipment manager: Chip Wilson (Lululemon)
No ones gains weight on his watch. If you go up a size Chip will blame your thighs. Motivates the clubhouse with some sassy Ayn Rand quotes like To say 'I love you' one must first be able to say the 'I.' then puts you in some tight, sheer stirrup pants. Chipper puts the "I" in team.
Greg Proops new book is called: "The Smartest Book in the World: A Lexicon of Literacy, A Rancorous Reportage, A Concise Curriculum of Cool."