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