Literature Review

What's keeping CFOs up at night? Becker's Hospital CFO Report; by Alan Condon; 2/14/25 As health system CFOs chart their course for 2025, they face an increasingly complex financial landscape marked by mounting labor costs, tightening margins, shifting payer dynamics and an evolving regulatory environment. ... [Several] CFOs recently joined the “Becker's CFO and Revenue Cycle Podcast” to discuss the trends they're watching most closely — and the strategies they're deploying to stay ahead. [Key items include the following: labor shortages (key theme); major investments in ambulatory care facilities; AI to support operations and service; physician partnerships; shift from fee for service to value-based care; clinical labor; malpractice litigation; growth of Medicare Advantage programs; staffing shortages; inflation; reimbursements; providing care to undersinsured patients; Medicaid supplemental funding programs; "disruptors' by private equity and "other nontraditional players"; uncertainty of federal and state regulation changes.]

Hospice leaders applaud CMS’s decision to reevaluate Special Focus Program, call for meaningful reforms National Alliance for Care at Home, Washington, DC and Alexandria, VA; Press Release; 2/14/25 Effective February 14, 2025, the Centers for Medicare & Medicaid Services (CMS) has ceased the implementation of the Hospice Special Focus Program (SFP) so that CMS may further evaluate the program. This decision is a positive move acknowledging that the current approach is not working as intended. The hospice community has long advocated for strong oversight and patient protections, but the SFP, as implemented, was deeply flawed, unlawful, and harmful to the very patients it was meant to protect. A multi-state coalition of hospices and hospice associations took legal action in January to challenge the program, citing its misrepresentation of hospice compliance records, misleading data, and jeopardized access to high-quality end-of-life care. The flawed algorithm behind the SFP failed to distinguish fraudulent providers from reputable ones, disproportionately penalized well-established hospices, and ignored repeated warnings from congressional leaders and industry stakeholders. ... Now that CMS is reassessing its approach, there is an opportunity to ensure that oversight efforts truly enhance patient protections without restricting access to trusted hospice providers. The National Alliance for Care at Home (the Alliance) and the National Partnership for Healthcare and Hospice Innovation (NPHI) remain committed to protecting access to high-quality hospice care and ensuring that regulatory oversight is fair, transparent, and aligned with congressional intent. ... [Click on the title's link to continue reading.] 

How the DOJ-UnitedHealth Group lawsuit could change hospice M&A Hospice News; by Jim Parker; 2/11/25 A U.S. Justice Department (DOJ) victory in its lawsuit to block UnitedHealth Group’s (NYSE: UNH) acquisition of Amedisys is unlikely to have a cooling effect on hospice M&A, according to some experts. The UnitedHealth Group subsidiary Optum in June 2023 agreed to acquire Amedisys in a $3.3 billion deal. Optum in February 2023 also acquired the home health and hospice provider LHC Group for $5.4 billion. DOJ in December 2024 filed the lawsuit to kill the deal. The state attorneys general of Maryland, Illinois, New Jersey, and New York are also plaintiffs in the suit. ... DOJ’s chief concern is that the combination of the two companies would dampen competition in the hospice and home health space. Should the transaction proceed, Optum would control 30% or more of the home health or hospice services in eight states, according to the Justice Department’s complaint.

Kroger partners with Express Scripts to expand pharmacy services Becker's Hospital Review; by Alexandra Murphy; 2/6/25 Cincinnati-based Kroger Health has reached a new agreement with Express Scripts, the pharmacy benefit services arm of Evernorth, to provide access to prescription medications and health services at the Kroger Family of Pharmacies for Express Scripts Customers. Under the new agreement, the Kroger Family of Pharmacies will resume serving customers in Express Scripts' Medicare Part D and Tricare/Department of Defense plans, according to a Feb. 5 Kroger news release. This comes after Kroger ended its contract with Express Scripts in September of 2022, after months of unsuccessful negotiations over a new agreement. 

Bristol Hospice acquires St. Agatha Comfort Care Hospice News; by Jim Parker; 2/6/25 Bristol Hospice has acquired St. Agatha Comfort Care in Las Vegas for an undisclosed amount. ... Bristol is a portfolio company of the private equity firm Webster Equity Partners. The company operates 64 locations across 25 states, employing more than 3,000 professionals. The hospice provider has indeed been on a growth trajectory. In June 2024, Bristol Hospice acquired Mississippi-based Mid-Delta Hospice, a move that marked its entry into that state. Bristol has been a prolific buyer in the M&A market during the past five years, but more recently it has leaned harder into its de novo strategy. In August of last year, Bristol Hospice opened four new locations within a single week in three different states.

Pennant Group acquires senior living communities in Idaho, Texas Markets Insider; 2/4/25Pennant Group (PNTG) announced that effective February 1, it has acquired three premier senior living facilities in Idaho and Texas. The acquisition in Idaho is subject to a triple net lease with the option to purchase, and the two Texas facilities are subject to a long-term, triple net lease. These transactions expand Pennant’s operations by 188 units, comprised of both assisted living and memory care services.

Baptist Health announces joint venture to enhance home health services Lane Report, Louisville, KY; 1/31/25 To further expand the delivery of high-quality care to a growing population, Baptist Health announced a joint venture with national home health leader Alternate Solutions Health Network (ASHN) to enhance services across Kentucky, southern Indiana and southern Illinois. Effective March 3, the joint venture will be owned by Baptist Health and ASHN and will continue operating as Baptist Health Home Care. 

Hospice rationale should be reassessed, says ethicist Medscape; by Arthur L. Caplan, PhD, Medical Ethics at NYU’s Grossman School of Medicine; 1/23/25 ... Decades ago, I first found out about the idea that came from England and a nurse, Cicely Saunders, to change the setting in which people die. ... I think that was a wonderful idea, and it has revolutionized end-of-life care. We have many excellent, superb hospice programs. ... The hospice institution is decades old, and it’s time to take another look at what’s going on there.  ... Private equity is all over this area, buying up hospice chains and home care hospice — looking to make big profits but not looking to maintain the quality requirements that ought to be there or to do more than is minimally required to set up and staff hospice. ... ... For reasons of serving the best interests of hospice patients, we should be rechecking the fairness of reimbursement, not overburdening families with care that ought to be provided by hospice programs, and making sure that those who are dying are monitored adequately and receiving checkups regularly. ...

Some wary of Providence home health joint venture with for-profit company Herald Net, Everett, WA; by Jenna Peterson; 1/23/25 Some nurses in the state say an upcoming joint venture between Providence Home and Community Care and Compassus, a for-profit company with private equity ownership, could have an adverse effect on health care. The deal, expected to be finalized in Washington early this year, ... impacts locations in five U.S. states. ... Boyle and Compassus spokesperson Dana Coleman said there will be no changes in care or staffing under the joint venture. But some nursing advocates, like Ian Mikusko, worry that a for-profit, private equity influence could be harmful for health care.“Private equity is somewhat more extractive because there’s a pressure to provide large dividend payments to investors,” said Mikusko, strategic researcher with the Washington State Nurses Association. Mikusko cited research that shows quality of care diminishes when private equity companies become involved in health care, such as a 2023 study from the Center for Economic and Policy Research.

Enclara Pharmacia announces patient record integration with FireNote Hospice EMR NCN - Nebraska News Channel; Business Wire Press Release; 1/21/25 Enclara Pharmacia, ... [a national] pharmacy solutions provider for the hospice and palliative care sectors, announces the launch of a new interface with FireNoteTM, an innovative hospice electronic medical record (EMR) platform. This integration enables patient demographics and medications to flow seamlessly from FireNote to Enclara’s E3 ProTM medication management system. The new software interface enables timely admissions and medication access for patients while reducing the administrative burden on nurses, a key priority for both Enclara and FireNote.“ 

Federal report highlights private equity, consolidation concerns Modern Healthcare; by Hayley Desliva; 1/16/25 Three federal agencies on [1/15/25] said "more effective and vigorous" enforcement is needed to protect patients harmed by healthcare's continued consolidation. In a report released just days before a new administration takes over, the Health and Human Services Department, Federal Trade Commission and Justice Department said comments they sought earlier this year on the state of the industry made clear that worries about access to services and costs have intensified as consolidation and private equity's role have grown. ... The report noted several areas of concern: 

Choice Health at Home completes acquisition of Family Tree Private Care WL US FM 98.3, Tyler, TX; Press Release, EINPresswire.com; 1/17/25 Choice Health at Home (“Choice”), a leading multi-state provider of home health, hospice, personal care, and rehabilitation services, is proud to announce the acquisition of Family Tree Private Care (“Family Tree”), one of the largest private care operators in the United States. This transaction further establishes Choice Health at Home as a premier operator offering a comprehensive continuum of care, including private care, to patients across Texas, Colorado, and the Southwestern U.S. “This is a transformative moment for Choice Health at Home,” said David Jackson, CEO of Choice. ... "The addition of Devotion Hospice allows us to expand our hospice services and reinforces our commitment to provide quality care to our nation’s 5th largest metro population (Houston, TX).” ... Daniel Gottschalk, CEO of Family Tree, shared his enthusiasm for the merger ...