Literature Review

Large systems outsource home care to focus on 'core business' Becker's Hospital CFO Report; by Alan Condon; 10/25/24 A growing number of health systems are outsourcing home health and hospice operations to third-party specialists with broader geographic reach to reduce cost and administrative burdens and focus on core services. The regulatory environment for home health and hospice is complex, with stringent requirements for reimbursement, reporting and patient care standards. Partnering with an outsourced provider also helps systems mitigate the risks associated with non-compliance and operational issues. Here are four health systems that have outsourced or plan to outsource home health and hospicare care:

New FTC regulations could create obstacles for hospice M&A Hospice News; by Jim Parker; 10/24/24 Changes to federal rules governing mergers and acquisitions could have sweeping effects on hospice and other health care transactions. The Federal Trade Commission (FTC) recently finalized a rule that will implement changes to required pre-merger notification forms. Pursuant to the Hart-Scott-Rodino Act, parties to certain transactions must submit these documents to the FTC and other regulatory agencies to help identify and address potential antitrust concerns. The law requires that transactions exceeding $120 million must submit the form, which agencies will use to conduct a 30-day premerger assessment, according to Luke Smith, member at the law firm Bass, Berry and Sims. The final rule will likely complicate the closing of some hospice acquisitions.

Duke Health CFOs' plan to reach 1 in 4 North Carolinians Becker's Hospital CFO Report; by Madeline Ashley; 10/21/24 Since Lisa Goodlett was named senior vice president, CFO and treasurer of Durham, N.C.-based Duke University Health System in March, one of the health system's main goals has been to increase access to the health system from 8% of North Carolina's population to more than 25%. To achieve this, the health system is leveraging technology and looking at expanding partnerships to ensure services are more widely available. ... As Duke Health continues to push expanded care access, the health system has also been in contract negotiations with UnitedHealthcare for the last few weeks regarding 172,000 of its patients.  ... If the parties cannot come to an agreement by Nov. 1, Duke Health's hospitals, facilities and physicians would be out of network for employer-sponsored commercial plans, including UMR and Medicare Advantage plans, including a group retiree and dual special-needs plans.

Providence, Compassus form home care joint ventureModern Healthcare; by Diane Eastabrook; 10/22/24Home care provider Compassus will take over management of Providence’s home-based care services through a joint venture the two companies announced Tuesday. Under the arrangement, Brentwood, Texas-based Compassus would manage and jointly own Providence’s home health, hospice, community-based palliative care and private duty nursing services under the name Providence at Home with Compassus, the companies said in a news release. Neither company would disclose financial terms of the deal, which is subject to approval by state and federal regulators.Publisher's note: This joint venture is different from other recent Compassus joint ventures with Mercy Health, OhioHealth, and Bon Secours.

Martis Capital rumored to purchase Three Oaks Hospice’s in $150m deal Hospice News; by Holly Vossel; 10/18/24 The private equity firm Martis Capital may soon acquire Dallas-based Three Oaks Hospice for a price tag ranging from $150 million to $160 million. Rumors of the potential sale appeared today in an Axios report, in which unnamed sources reportedly confirmed the deal. The Nashville-based investment and management company Petra Capital currently owns Three Oaks Hospice, which reportedly generates between $10 and $13 million in EBITDA, Axios indicated. Rumors that the hospice was considering a potential sale were first reported last month by the website Ion Analytics. The private-equity backed company provides hospice, palliative care and bereavement services across 28 locations in seven states. 

How physicians can navigate ethical conflicts when caring for patients Physician's Weekly; 10/14/24 ... According to the president of The Physicians Foundation, Gary Price, MD, ethics in medical care are particularly complicated regarding end-of-life choices. While decades ago, a patient’s primary care provider (PCP) would have been involved in that patient’s hospitalized care and their end-of-life decisions within the hospital, the fragmented nature of today’s healthcare system has all but eliminated PCPs from involvement in hospitalized patient care. As such, patients often make end-of-life decisions based on the guidance of doctors with whom they have no pre-existing relationship. Other factors that blur ethical lines in healthcare, adds Dr. Price, are the new state of healthcare ownership and financing. Dr. Price mentions, for instance, conflicts of interest due to the US’s biggest employer of physicians, Optum, being a subsidiary of the same company that owns UnitedHealthcare. This situation allows for an insurer who controls reimbursement and who could, as the physician’s employer, influence decisions made regarding patient care. Sadly, this influence largely comes from financial concern instead of concern for the patient’s best health outcomes. 

MD Home Health expands services with in-clinic, virtual care, remote patient monitoring, house calls and hospice Longview News-Journal, Phoenix, AZ; by MD Home Health; 10/15/24 Leading Home Health Agency in Arizona launches comprehensive onmnichannel healthcare approach. MD Home Health, a privately-held leading Arizona-based home health agency, today announced the expansion of its healthcare services to include in-clinic care, virtual care, remote patient monitoring, house calls, and hospice, making it one of the first privately-held home health agencies in Arizona to offer a full and comprehensive omnichannel healthcare approach. This expansion allows the firm to broaden its healthcare offering to significantly increase access to comprehensive, quality and convenient healthcare for residents across the Phoenix metro area. "Our new and comprehensive services are designed to ensure that patients have convenient and flexible options to access quality healthcare how, when and where they need it," said David P. Tusa, President and Chief Executive Officer of MD Home Health. 

Optum’s home-based care arm propelling growth at UnitedHealth Group Hospice News; by Jim Parker; 10/15/24 UnitedHealth Group’s subsidiary OptumHealth is a growth engine for the massive health care and insurance company. In addition to other services OptumHealth holds a substantial home health and hospice business. Optum is in the process of acquiring the home health and hospice provider Amedisys (NASDAQ: AMED), with closing expected before the end of the year, pending some regulatory hurdles. Optum last June penned its agreement to acquire Amedisys in an all-cash transaction of $101 per share, or about $3.3 billion. The Amedisys deal is among a slew of large acquisitions by Optum, which include the home health and hospice provider LHC Group and the health care tech company Change Healthcare. Optum closed its $5.4 billion acquisition of LHC Group in February 2023. 

National Health Investors announces $121.3 million acquisition, largest deal since 2020; pipeline at $305 million McKnights Senior Living; by Lois A. Bowers; 10/10/24 National Health Investors is acquiring a portfolio of 10 assisted living and memory care communities in North Carolina for $121.3 million in what the real estate investment trust says is its largest deal since 2020, the year the COVID-19 pandemic started. The Murfreesboro, TN, REIT announced the transaction Thursday morning in a business update. The properties, which have a combined 522 units, will continue to be managed by Spring Arbor. NHI says that the portfolio bears “no material impact” from Hurricane Helene.

Private equity in senior living an increasing focus of federal, state government McKnights Senior Living; by Kimberly Bonvissuto, Lois A. Bowers and Kathleen Steele Gaivin; 10/7/24 At press time [10/7], a bill that would require private equity firms and hedge fund organizations in California to give prior notice of acquisitions or changes in control to the state’s attorney general was sitting on the governor’s desk, to become effective Jan. 1 if he signed it into law. It is just one example of legislation recently put forth at the state or national level focused on the private equity and real estate investment trust funding sometimes used in senior living and in other industries. ... The legislation calls for greater transparency for private equity firms and for-profit companies that own healthcare entities, including nursing homes, hospitals, and mental or behavioral health facilities. ...

Private equity’s role in US healthcare remains unchecked after California veto The Guardian; by Jessica Glenza; 10/7/24 Hopes to rein in private equity investment in healthcare died in California last weekend, as a nationally watched bill was vetoed by the Democratic governor, Gavin Newsom. The bill was the nation’s most high-profile legislative effort to regulate such investments in healthcare, and would have given the state attorney general discretion to deny mergers.Its demise comes amid US Senate hearings over mismanagement at Steward Health, a chain of more than 30 private equity-backed hospitals in Massachusetts whose CEO and investors siphoned “hundreds of millions” of dollars from community hospitals even as they developed one of the worst patient care records in the country. 

Podcast: Melissa Aldridge on Private Equity Acquisitions Of HospicesHealth Affairs; 9/24/24Health Affairs' Editor-in-Chief Alan Weil interviews Melissa Aldridge of Icahn School of Medicine at Mount Sinai and James J. Peters Bronx Veterans Affairs Medical Center about her recent paper exploring the increasing trend of private equity acquisitions of hospices and how ownership structures still remain complex and opaque.

Fighting ‘phantoms’: How fraud skews competition in the hospice market Hospice News; by Holly Vossel; 9/26/24 Fraudulent operators’ marketing strategies are morphing the competitive landscape, making it difficult for legitimate hospice providers to maintain visibility among patients and families. A mounting concern is that fraudsters stepping into the hospice industry have been implementing marketing and outreach practices that at times mirror strategies utilized by quality providers, according to Jeanne Chirico, president and CEO of the Hospice & Palliative Care Association of New York State (HPCANYS). This makes it difficult for referrals, patients and their families to discern the best end-of-life care option. Another significant concern is that the fraudulent actors may have deeper pockets compared to smaller or nonprofit hospices, allowing them to invest more heavily and saturate the market with their messaging.