Hospice Crapification Hits Federal Government

Strange Tony,

Financial rapscallion majority ownership turned our nationally recognized hospice into a shell of its former self.  

• Office headcount reductions of 50%
• Over-reliance on "new" (but unreliable and incapable) technology that wasted staff time
• Cutting the number of holidays and holiday pay 
• Not giving raises for years
• Reducing office square footage (to meet C-suite spreadsheet expectations)
• Put in phone system that enabled calls to be overheard without worker knowledge
• Hospice office/clinical system robbed staff of fair reimbursement for miles driven
• Made nurses salaried, then overworked them horribly
• Reduced work to 30 hours for some positions - 25% pay cut

Training on these new systems was poor to nonexistent.  Dedicated hospice staff did not have the time to properly care for patients and do the checking needed to make sure they were paid fairly for hours worked and miles driven.  The company effectively stole hours and mileage from workers.

These very things are occurring in the federal government under Elon Musk.  Musk's henchpeople are rapidly seeking headcount reductions, square foot eliminations and implementing crappy technology.  It's not clear if Musk's henchpeople have multiple full time, well paying gigs (like many insiders in our Age of Sponsorship).

Financial rapscallions have no problem ordering physicians around, negatively impacting the practice of medicine with hard spreadsheet targets.  This has been seen across multiple medical specialties.  

The greed imposed on our hospice resulted in significant and immediate disintegration.  Our census never returned to pre-rapscallion levels.  I expect that very thing is happening across the federal government as Musk's team crapifies operations.  Dang. it sure brings back bad memories.

Anonymous

Gentiva vs. Bristol Hospice: Glove Up

Strange Tony,

Clayton, Dubilier and Rice's Gentiva Hospice sued Webster Equity Partner's Bristol Hospice and a former Gentiva nurse administrator for damages resulting from the nurse violating a non-compete agreement and revealing Gentiva trade secrets.  

Bristol Hospice entered the Brewer, Maine market, hired Gentiva's nurse administrator who then tried to hire other Gentiva employees.  

Gentiva requested a jury trial.  I would love for Gentiva CEO David Causby to testify under oath as to the company's practices when they enter a new market.  I'd love to hear which Gentiva trade secrets the nurse administrator spilled to Bristol.  It it's to rob fair pay for hours worked by making nurses salaried or having a crappy software product that shorts staff for miles travelled, then I hope someone from the Department of Labor is in the courtroom for the whole trial.

I'm sure Bristol is just as abusive to staff as Gentiva.  Financial rapscallions require their numbers be met and that excrement flows downhill and downhill and further downhill. 

I expect a settlement as neither rapscallion wants to reveal their trade secrets in a public court of law.

Anonymous

Egregious Breaches at Vital Cheating

Strange Tony,

A judge ruled against two financial rapscallions and April Anthony, the former founder of Encompass Health, for "egregious breaches" of fiduciary duty.   As a CPA Mrs. Anthony clearly knew about fiduciary duties.  As a Christian she is supposed to have a basic moral code, one above "earthly desires."

April's partners in crime?  Vistria Group and Nautic Partners.  I imagine these firms are similar to the financial rapscallions that denigrated our once great hospice.

Welsh, Carson, Anderson & Stowe

TPG Group

Clayton, Dubilier & Rice

Anthony and her greedy co-conspirators did the following in their "building" of VitalCaring.  

At first she tried to buy the company (Encompass), in secret partnership with Nautic and Vistria, and then later chose to form a new, competitive company (VitalCaring) with her new PE partners.

Anthony served on the board of First Financial Bankshares, a regional bank based in Abilene, Texas.  Her board bio states:

... as a certified public accountant, Ms. Anthony brings strong accounting, management, strategic planning, technology and financial skills important to the oversight of our financial reporting, enterprise and operational risk management.

Her board bio indicates that she founded Homecare Homebase, the crappy hospice software WCAS and TPG pushed on us after their summer 2018 takeover.  Homecare Homebase made it nearly impossible for our hospice staff to receive fair pay for hours worked and miles driven.  April made $422 million from selling her equity in Homecare Homebase over a number of years.

It's never enough for the greedy.  All that knowledge, money and deep faith did not prevent April Anthony from acting unethically in the pursuit of even more money than the $740 million she had accumulated as of 2023.

I'm afraid this is the state of hospice, healthcare and more.  It is sad as it is a form of death, the extinction of ethical leaders.

Anonymous

Gentiva Settles False Claim Suits for $20 million

Strange Tony,

Having lots of names came in handy for Gentiva/Kindred/Curo in its settlement with the Justice Department for fraudulent billing.  The nearly $20 million settlement involved mostly Curo branded hospices.  The bad behavior began in early 2010 and went on until year end 2023 over various individual hospices.  The settlement agreement has the specific breakdowns.

That Curo hospices behaved unethically is no surprise and calls into question the judgement of Humana and its financial rapscallion partners (TPG and WCAS) as they chose to impose the Curo model on Kindred's hospices (which were generally much larger and greater in number than Curo's brands).

That decision destroyed our once nationally ranked hospice.  We went from a Kindred sized hospice of over 100 hospice patient census to half that (Curo sized).  It turns out referral sources expect someone to answer the phone and show up when needed.  Curo's technology and staffing model did not enable this level of service delivery.

Left out of this settlement were any of the company's owners whose financial practices encouraged, almost demanded, unethical behavior.  If the company can steal pay and mileage from employees, surely an enterprising branch manager can steal from Medicare/Medicaid/Tricare.  

Humana, TPG, CDR and WCAS  take a bow.  Bad behavior from June 2018 to December 2023 rests on your shoulders.  

I wonder how far Humana CEO Bruce Broussard's Washington, D.C. office is from the Justice Department and how many trips he made to Capital Hill to put this issue to bed.  Surely he and the boys from CDR/TPG/WCAS put a bug in someone's ear.

The latest Gentiva/Kindred settlement makes me realize how our legendary Medical Director kept the ethical wolves at bay for so long.  Our census stayed high due to his care and concern for patients and their families.  Money flow kept regional and national corporate parasites in check.  

He loved to tell our corporate visitors about the special closet in the national office where new recruits were taken in and had half their brains sucked out.  Their facial expressions were priceless.  Thank heaven he retired before Humana/TPG?WCAS trashed his baby.  Our legend was a hospice doc to the very end.  God rest his soul and God help those suffering under greedy fools.

 Anonymous

Greed Drives Hospice De-evolution

Strange Tony,

Financial rapscallions have caused widespread harm in healthcare.  Only a sycophant could refer to their impact as "elevate."  

Private equity and venture capital are the business version of iatrogenic disease.  

"...a state of ill health or adverse effect caused by" management greed

Obscenely wealthy principals partner with executives to shovel money into their pockets from the work of hospice multidisciplinary teams.  Strict staffing models, combined with bad technology and high turnover, mean salaried nurses often work 70 hours a week for 40 hours pay.

That's a win for greedy management.  It's cheating and overworking staff.  

Elevate happened yesterday in Washington, D.C.  Did any members of the Federal Trade Commission attend?  I hope so.  They should be much smarter after months of public comment on healthcare consolidation (mostly by private equity).

Anonymous

CDR Monetizes Gentiva Personal Care

Strange Tony,

It took twenty months for Clayton, Dubilier and Rice to sell off Gentiva's personal care division to Addus for $350 million.  

Ownership genealogy for this division went from Kindred to Humana/WCAS/TPG to Humana to Humana/CDR.  It's now going to Addus with its $280 million in annual revenues.

Moody's is yet to weigh in on the impact of the deal on Gentiva's debt rating, if any.  The press release states Addus agreed to "acquire the personal care operations of Gentiva."  That reads 100%.  Currently Humana owns 40% of Gentiva and CDR 60%.  

How might the parties split the $350 million?  That's a financial rapscallion trade secret.  Charlotte Buyer-Gentiva debt holders should pay close attention.  Moving prize assets away from the parent company (debt issuer) is all the rage for financial tricksters.  

A Gentiva higher up that went on to run the Personal Care Division once visited our hospice site.  They called staff concerns about our hospice a "female dog" (bitching).  

The local Personal Care manager used our office for interviews and we ran across their staff in the field.  They were often college students pursuing nursing or physical therapy.  Our least paid hospice position was a big step up in pay for these folks.

I'm sure that has not changed given the miserly nature of Gentiva executives under financial rapscallion ownership.  Let's hope Addus is a bit more generous to the little people.

Anonymous

Public Comments on Healthcare Consolidation: Over 50% Cited Financial Rapscallions

Strange Tony,

Public comment closed two days ago on the impact of health care buyouts.  Over 6,000 comments were submitted and the FTC shared 2,142 on their website.  50.5% of the public comments cited the impact of private equity, aka financial rapscallion, consolidation.  

Thirty four comments mentioned hospice.  I submitted two, one from my experience with Gentiva/Kindred/Gentiva and the other based on how financial rapscallions have harmed society's most vulnerable, children and the elderly.

The National Hospice and Palliative Care Organization submitted a letter.  It avoided the consolidation that has gutted hospice care over the last decade.  NHPCO's board has many members from financial rapscallion owned hospice organizations (the ones doing the consolidating and gutting).  One is even a limited partner with 99% percent ownership of their hospice organization. It's no surprise they avoided the elephant in the room with their recommendation:

Bad actors and poor performing hospices can come in any shape, size, or ownership status; therefore, we strongly recommend the federal government better target program integrity efforts and supporting quality hospice providers to ensure beneficiaries have access to quality, affordable hospice services while promoting and protecting competition in healthcare markets.

A physician had a different take:

Private equity only exists in its current state as a leech on healthcare, reducing quality and patient safety and extracting healthcare dollars at the expense of the American public.

Gentiva CEO David Causby led our hospice through two financial rapscallion buyouts.  He likely doubled the value of his holdings in the consecutive sales, Kindred Hospice to Humana and then Humana to Clayton, Dubilier and Rice.  Trickle down is yet to happen.  

Causby is on the Transition Board for the merger between NHPCO and the National Association for Home Care and Hospice (NAHC).    Home care and hospice have not always been friends.  Our legendary Medical Director started providing care for terminally ill patients in our area in the 1980's.  Home Health fought against the establishment of hospice and lobbied against Medicare establishing the Hospice benefit.

NAHC's letter on healthcare consolidation refers to the benefits of "private interest ownership and consolidation."  I saw no benefits from TPG Capital and WCAS owning 60% of our hospice.

 

Letter writer Leslie Norwalk works for a healthcare venture capital firm (Epsilon Health Investors) and healthcare private equity firm (Peloton Equity) in addition to serving as strategic counsel for Epstein Becker Green.  Her EBG bio states:

Attorney Leslie Norwalk serves as an advisor to private equity investors, including three private equity firms, and to those seeking investment. 

Another bio states:

She serves as an advisor to private equity firms Warburg Pincus, Peleton Equity and Enhanced Equity Fund.

This obvious conflict of interest is not mentioned in Norwalk's letter to the FTC.  That is not unusual in a world where financial rapscallions work nearly unseen in our houses of power, drawing multiple massive salaries in their many roles.  Our Hospice Nurse Aides struggle to get paid 40 hours a week.

Norwalk worked alongside Tom Scully at the Center for Medicare/Medicaid.  Scully went on to financial rapscallion Welsh, Carson, Anderson and Stowe.  WCAS owned 30% of our hospice before flipping it for massive profits to Humana.  I worked for two WCAS affiliates in my career before retiring.  This blog details the many harms our hospice endured under greedy hands.

Our climb is a steep uphill to wrestle hospices away from financial rapscallions.  The deterioration has gone on for too long, enabled by the very people who were to protect us.  

At least some of the common people got to speak up.  Now, which side is taking note?

Anonymous