Literature Review

Pursuit of quick profits makes hospice care worse, new research says Ohio Capital Journal; by Marty Schladen; 11/20/24 Private equity firms — high-dollar investors known for aggressively seeking profit — and publicly traded health conglomerates have been buying up businesses that provide hospice care. But when it comes to caring for patients facing the end of their lives, those businesses perform worst, according to a research letter published Monday in the Journal of the American Medical Association. ...  Publicly traded behemoths such as UnitedHealth Group and CVS Health are already the subject of investigations and lawsuits by federal and state government over allegedly anticompetitive actions as drug middlemen. At the same time, both provide hospice care. Meanwhile, the business practices of private equity groups have been coming under increasing scrutiny over the past decade. They often buy businesses in deals structured so they can quickly recoup their investment, identify the most profitable assets, sell them and then sell the resulting business or declare bankruptcy. ... The firms also have been accused of being predatory toward consumers.

For-profit hospices increasing despite poor performance EurekAlert!, Weill Cornell Medicine; Peer-reviewed publication; 11/18/24 Hospices are increasingly owned by private equity firms and publicly traded companies, but recently Weill Cornell Medicine researchers found that they performed substantially worse than hospices owned by not-for-profit agencies. This is concerning as nearly 75% of hospice programs, which care for patients in their last stage of life, are for-profit. The study, published Nov. 18 in JAMA, highlights the need for policy interventions that focus on increasing transparency and accountability in hospice ownership. ... The researchers analyzed Consumer Assessment of Health Care Providers and Systems (CAHPS) data from January 2021 through December 2022. CAHPS, the national standard for assessing the quality of patient care, surveyed the caregivers of those who passed away in hospice by telephone and mail. The researchers compared measures for communication, timely care, treating family members with respect, emotional and religious support, help for symptoms, hospice care training, hospice rating and willingness to recommend. ... Of the 2,676 hospices included in the final analysis, approximately 25% were owned by private equity and publicly traded companies and 40% were other types of privately owned for-profit hospices. Though only 25% of the hospices surveyed were not-for-profit, they provided the highest-rated quality care including focus on managing pain, comfort, dignity and quality of life.

Inside the Justice Department’s Amedisys-Optum lawsuit Hospice News; by Jim Parker; 11/18/24 ... 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. The deal would expand Optum’s home health and hospice footprint to five additional states, allowing the company to gain nearly 500 locations in 32 states. “UnitedHealth Group Incorporated and Amedisys, Inc. are two of the largest home health and hospice service providers in the country,” DOJ indicated in the complaint. “Today, competition between UnitedHealth and Amedisys benefits millions of Americans who need home health or hospice services. But the proposed merger between UnitedHealth and Amedisys would forever eliminate that competition.”

Dr. Andrew Mayo: Hospice leaders face ‘delicate balance’ in today’s regulatory, workforce climateHospice News; by Holly Vossel; 11/12/24Today’s hospice leaders need to take a wide view into the range of challenges facing their interdisciplinary care teams, according to Dr. Andrew Mayo, chief medical officer at St. Croix Hospice. ... The Minnesota-headquartered hospice provider is a portfolio company of the private equity firm H.I.G. Capital. ...He recently sat down in a Hospice News Elevate podcast to discuss what pulls workers towards the end-of-life care space — and the factors that are leading them away. While competitive compensation and work-life balance are important priorities for hospice workers, organizational culture is one of the most significant retention factors, Mayo stated. ... “One of the most important things is culture. As you grow as a hospice, I think [it’s about] paying particular attention to culture, because people want to work for an entity, a health care provider that has their heart in the right place. That goes a long way for retaining employees … Maintaining that culture is an easy thing to say, but a very difficult thing to do.”

DOJ preps lawsuit to block UnitedHealth-Amedisys deal Modern Healthcare; by Josh Sisco, Bloomberg; 11/12/24 The US Justice Department is moving to block UnitedHealth Group Inc.’s $3.3 billion purchase of Amedisys Inc. over concerns the deal would harm competition in the market for home-health services, according to people familiar with the matter.  Justice Department antitrust officials have signed off on a lawsuit to be filed in federal court as soon as this week to stop the deal, according to the people, who asked not to be named discussing a nonpublic matter. The move follows a meeting last week between company executives and the Justice Department in a last-ditch effort to ease the government’s concerns, the people said. 

Startup Guaranteed looks to improve end-of-life care Healthcare Brew; by Cassie McGrath; 11/6/24 After losing her father, Jessica McGlory founded a startup to improve end-of-life care. In August 2019, Jessica McGlory got a call that her father had had a double heart attack and was admitted to a hospital in Chicago. As his health declined, McGlory became his caregiver and healthcare proxy. But she said she never got the opportunity to discuss her father’s end-of-life care or his wishes. “I thought it was going to be an opportunity to really focus on my loved one, but instead, [I] had to focus on everything else and really didn’t get the support [I] expected from the hospice,” she told Healthcare Brew. Hospice is palliative care that typically includes counseling, physical care, medicine, and equipment for patients with terminal illnesses. Two years later, despite having no previous experience in healthcare, McGlory decided to take action. In 2022, she launched Guaranteed, a New York-based hybrid end-of-life care startup that works to support people with terminal illness as well as their loved ones and caregivers. ... Guaranteed has raised $10 million to date and is looking to expand into three more states next year, she said.

Eden Health acquires A Plus Hospice Care Hospice News; by Jim Parker; 11/11/24 Eden Health of Northern Nevada, dba Eden Hospice, has acquired A Plus Hospice Care in its home state. Financial terms were undisclosed. Through the transaction, A Plus Hospice Care patients will have access to Eden Health’s additional services, including home health, home care and palliative care. The M&A advisory firm Agenda Health consulted on the deal. Cultural alignment, proximity to its existing footprint and the seller’s strong track record on compliance were factors in Eden’s decision to acquire, Jamie Brown, the company’s COO, told Hospice News in an email. ... Eden Health is a 100% employee-owned company operating in Washington state, Nevada, California, Idaho, Montana, Wyoming and Arizona.

Quality hospice researchers seek to untangle possible relationships between tax status and outcomes Hospice News; by Holly Vossel; 11/8/24 ... More private equity (PE) investors have stepped into the hospice and home health space in recent years. This trend extends across the broader health care continuum, as certain types of owners — notably private equity entities — have come under scrutiny from lawmakers. Providers’ tax status may be among the potential risk factors of fraudulent hospice spending. For-profit business and operational infrastructures can differ from nonprofit hospices, which have historically represented much of the providers in the industry. But research has found that the tide is shifting. Private equity transactions represented half of all home health and hospice deals in 2018 and 2019, resulting in a 300% increase in patients enrolled under PE-backed providers, according to research published in the Journal of Palliative Medicine. ... Live discharges occur in less than 10% of patients at nonprofit hospices, study author Lauren Hunt indicated. This compared to an overall 20% of live discharge rates among patients of for-profit hospices. 

Aveanna revs hospice, home health M&A engine Hospice News; by Holly Vossel; 11/7/24 Aveanna Healthcare Holdings (Nasdaq: AVAH) is ramping up its merger and acquisition activity in the home health and hospice space heading into next year. The Atlanta-headquartered company has set its strategic sights on both private duty nursing and hospice and home health, according to Aveanna CEO Jeff Shaner. The company has been quiet on the M&A front in recent years, taking a cautious approach to growth, Shaner said during an earnings call on Thursday. Aveanna is in the process of reviewing a few potential acquisitions, which could close in 2025, he indicated.

Payers push into home health: 5 things to know Becker's Payer Issues; by Rylee Wilson; 11/4/24 Payers are expanding their reach into home healthcare. In October, Elevance Health said it plans to acquire CareBridge, a Nashville-based home and community care provider. Elevance will pay $2.7 billion for the company, according to the Nashville Business Journal. Elevance CEO Gail Boudreaux told investors on an Oct. 17 call the acquisition will serve as the foundation for Carelon's home health business. Here are five more things to know about payers' ventures into home health:

Addus leaders dive further into Gentiva deal, ‘historically low’ turnover rates Home Health Care News; by Joyce Famakinwa; 11/5/24 Completing the acquisition of Gentiva’s personal care operations is still top of mind at Addus HomeCare Corp. (Nasdaq: ADUS). The $350 million transaction was first announced in June. Addus Chairman and CEO Dirk Allison explained how he believes the deal will better position the company for the impacts of the “Ensuring Access to Medicaid Services” rule. “We believe our personal care segment benefits from both scale and broad geographic coverage in the states where we operate,” Allison said Tuesday during the company’s third-quarter earnings call. ..."

VITAS touts significant Q3 success, projects future growth McKnights Home Care; by Adam Healy; 10/31/24 VITAS, the home care and hospice subsidiary of Chemed, achieved robust financial results in the third quarter of 2024 and is poised for continued growth, company leadership said Wednesday during an earnings-related conference call. “We are excited about the continued strong results of VITAS,” Kevin McNamara, president and chief executive officer of Chemed, said, according to a transcript. “We are very bullish on the prospects for VITAS for the remainder of 2024 and beyond.” In the quarter ended Sept. 31, VITAS generated $53.4 million in profits, a 20.6% increase compared with the prior year quarter. Revenues rose 17.2% to $391.4 million. Chemed as a whole produced $75.7 million in net profit, a 1% increase year-over-year, behind revenues that increased nearly 7.4% to $606.1 million, according to an earnings report.

BrightSpring CEO: Home health, hospice acquisitions offer ‘high return on investment’ Home Health Care News; by Audrie Martin; 11/1/24 The newest home-based care face on the public market, BrightSpring Health Services (Nasdaq: BTSG), is making strides. The company announced a successful third quarter during its earnings call Friday. Leaders reported an overall increase in business and raised 2024 revenue and adjusted EBITDA guidance. Provider service segment revenue grew across service lines for the Louisville, Kentucky-based company. This was primarily attributed to billable hours growth and its Rehab in Motion program supporting Medicare Part B outpatient rehab patients. ... “From an acquisition strategy perspective, I think it’s going to be consistent with what we’ve done over the past couple of years,” he said. “On the provider side, it’s been rehab, home health and hospice, and then home-based primary care as well. We currently have three or four very small tuck-ins for home health and hospice, which are high returns on investment. On the de novo side, it’s really on home health, hospice and rehab.”