Comments Wanted! Financial Rapscallion Hospice Ownership

Strange Tony,

You are well aware that financial rapscallions have overrun various aspects of our healthcare delivery system.  The Federal Trade Commission is taking public comment on the impact of private equity ownership in healthcare.  There are over 1,400 comments to date.

I have perused a few of them.  Numerous emergency room physicians detail the damage done by private equity firms in their ceaseless pursuit of outsized returns.  Dentists, radiologists, dermatologists and nurses detail the specific ways financial rapscallions have harmed staff and patients.

There are a few comments that mention hospice as an area of consolidation by financial rapscallions.  I offered a comment detailing the harm done to our hospice after being majority acquired by WCAS and TPG Capital.  I encouraged the FTC to look at the real time harm being done as Gentiva "integrates" Heartland Hospices, once owned by Promedica.

Private equity industry insiders with a conscience have commented, well aware of the possibility of targeted retaliation.  Hats off to these people.

The door is open for anyone to comment.  Any comments must be submitted by May 6th.  

Healthcare workers have the opportunity to share their thoughts, experiences and recommendations on healthcare buyouts, the majority of which are done by private equity.  Please do so, as inspired.  

Anonymous

If you are interested in commenting:

Click on this link and look for the Navy Blue box that says "Comment."

If you are interested in reading the comments, click on the link above and look for the box that says "Browse Posted Comments"

Heartland Hospice Employee Calls Gentiva Heartless

Strange Tony,

Another Heartland Hospice staffer noted Gentiva's reducing staff, vacation and miserly approach to supplies.

A Gentiva employee noted executive management not listening to people in the field.

I'm sure Gentiva's Human Abuse Department will work overtime to identify and current employees raising legitimate concerns and target them for elimination.  It's the Causby way.

Anonymous

Gentiva: Indeed vs. Glassdoor

Strange Tony,

Gentiva executives are courting hospice clinicians on their Indeed site with promises of good work/life balance.  Glassdoor's Gentiva reviews reveal a broader picture, one less flattering to equity holding executives.  

 

A hospice nurse in Georgia said:  

"The corporate level cares little about the staff and will not hesitate to lay you off if the profit margin shifts for a quarter. They call you back to try to rehire you (saving on training a new person). Ridiculous. Job security is non existent even for top level branch management." 11-24-23

A North Carolina nurse offered in her pro statement "everyone is so ridiculously overworked."  Her con reply included:

This is a company that cares about profit, and little, if anything else. Just like with their patients-they will say anything to get you in the door, then leave you high and dry. Require you to care for patients over a huge service area, manage a ridiculous and unsafe number of patients, force you to work overtime, on call, do admissions. There is zero recognition for hard work and dedicated staff. Will lie to your face and cover for employees not doing their job. Benefits are a joke-worst coverage/highest cost I have ever paid for health insurance. Covers primary care preventative only unless you reach entire out of pocket deductible. No urgent cares “in network” within an hour of me. No one near me takes their dental-not even any of the people listed on their site.  6-6-23

Financial rapscallion Clayton, Dubilier and Rice closed on its majority Gentiva stake in August 2022.  They completed the Promedica Hospice buyout in November 2023.  New employees are often gobsmacked by things existing employee have been trained to accept (numbed).   

An employee new to Gentiva offered:

Recently bought out from Promedica Heartland. We we're told that nothing will change, however at least 10% of the staff have been laid off.  We are told we will never get a raise.  Our phones were taken away and basically everything is changing.  2-29-24

That has a familiar refrain.  When TPG/WCAS became our majority owners many dedicated employees lost their jobs.  The work did not go away.  We had to do it under new, crappy, unreliable technology and yes, they took away company provided phones, overtime pay and three holidays.  The new comprehensive hospice software stole hours and mileage from employees.    

Don't worry Promedica people, IT is there to supply you with hours of background music while you wait for a representative.  You might be lucky and reach an actual person.  HR is there to back management at every turn.  That generally works out poorly for clinicians.

A Pennsylvania hospice nurse wrote:

Salary position, no increases, no bonuses. Not paid for extra hours you work. No availability for nurses to work part time. It’s FT only. The work is independent which can be a bad thing if you need support or your superior to back you up on a decision you made.  You are promised one thing then management does the opposite, acting like that conversation never happened

Over and over I saw HR work against employees with legitimate concerns.

Under financial rapscallion ownership our clinicians learned that patients only became ineligible for hospice as a new certification period approached.  Area Medical Directors indicated there was no need to discharge a patient who no longer met hospice criteria because of our good care.  They said the certification is still good for however long.  Our hospice medical director disagreed but had no power. The TPG/WCAS/Humana way meant weeks of fraudulent billing.  

Promedica employees should know accessing the Compliance Department generally involves a quick exit from Gentiva.  Principled people are not appreciated.  

Gentiva cares for its clinicians?  Indeed, they don't and haven't for quite some time.

Anonymous

Gentiva Debt, Humana Trophy Office: Not Cheap

Strange Tony,

Gentiva Hospice's debt has several tiers.  Its first lien senior secured debt pays holders 10.1% annual interest, while the second lien senior secured debt pays 13.08%.  Both are floating rate and mature in 2028.  

This debt is far more expensive than prior issuances.  Interest expenses are up by 50 to 80% from prior debt offerings.  That means less money for staff or more important, patient care.

Humana and financial rapscallion Clayton, Dubilier and Rice issued Gentiva's debt via another corporate entity, Charlotte Buyer.  It's address is 500 W. Main Street in downtown Louisville.  Founder David Jones felt strongly about Louisville and built Humana's distinctive headquarters building in 1980's at that very address.

WDRB reported

Humana, the only Fortune 500 company headquartered in Kentucky, plans to vacate its iconic, 27-story headquarters building at 500 W. Main St. in a cost-cutting move, leaving a massive structure to fill in a downtown already struggling with a glut of empty office space.

As WDRB documented in 2022, many of Humana's top executives are based in a newer office outside Washington. And for the first time in company history, the CEO's job no longer requires living in Louisville.

It turns out Humana CEO Bruce Broussard was playing a confidential switch game, leaving Louisville for Washington, D.C., the center of power and influence.  Consider this report:

About the same time the Broussards sold their Louisville condo, Humana finished work on a new "trophy" office space for "executive leadership" in a high-rise building in the Rosslyn neighborhood of Arlington, Virginia, just across the Potomac River from the nation's capital. 

In May 2019, a trust in the name of Broussard's wife, Janine, purchased a $4.4 million home in the ritzy Kalorama neighborhood of Washington, where former President Barack Obama, Ivanka Trump and Jared Kushner, and Amazon CEO Jeff Bezos have had homes, according to public real estate records.

Humana's one-floor office in the Washington area represents a tiny fraction of its presence in Louisville, and no one close to the company knew of any plan to move its headquarters.

Humana made $1.3 billion in profit from flipping our hospice numerous times.  Those funds may have gone to Broussard's trophy office.  

Broussard is Chair of the Trust for the National Mall and Humana sponsored pickleball there in Fall 2023.  One doesn't get that opportunity from Louisville.

Douglas Edwards, Humana's senior vice president for enterprise associate and business solutions, and his wife sold their Louisville home in July and moved to Charlotte, North Carolina in summer 2022.  Is that the event that inspired the name "Charlotte Buyer?"

Only the executives know.  

Anonymous

KKR's BrightSpring IPO

Strange Tony,

Financial rapscallions hoped to get nearly $1 billion from taking BrightSpring Healthcare public.  Their take fell far short as investors were skeptical of the company's debt load, its valuation and KKR's dual role as sponsor and IPO underwriter.

The stock is yet to trade on NASDAQ.  Their website indicates bids around $12 for the stock, which IPO'd at $13.  

Abode Hospice is part of BrightSpring and former CEO Mike McMaude is the President of BrightSpring's Home Health Division.  

Working in hospice is hard enough.  Working for greedy executives and senior management jilted by the investment community adds a significant level of stress.  

BTSG will eventually trade at some market clearing price.  How low that is remains to be seen, but I expect an executive tirade to follow.  

Anonymous

Gentiva Targets Palliative Care

Strange Tony,

Gentiva CEO David Causby is targeting palliative care for service expansion.  He plans to take a low volume, loss leader program and turn it into 10,000 palliative care patients through a focused effort.  It would have to include increasing reimbursement for palliative care for that strategy to make sense.

Aveanna Healthcare took a similar approach to pediatric home services for medically complex patients.  Former CEO Tony Strange, a former boss of David Causby's, lobbied state legislatures for increased reimbursement for that service.  Aveanna's current CEO Jeff Shaner was a peer of Causby's, or should I say rival?

The U.S. Senate set up a committee to explore the impact of private equity ownership on healthcare.  Aveanna had Bain Capital as a sponsor.  Bain remains the majority shareholder for Aveanna.  Shaner may have his work cut out for him in refinancing Aveanna's billions in debt.

Gentiva is majority owned by Clayton, Dubilier and Rice and had two other financial rapscallion owners in TPG and Welsh, Carson, Anderson and Stowe.  

Senators asked Gentiva for information in 2021 but nothing has come from that inquiry to date.  WCAS, TPG and Humana already decimated our once nationally ranked hospice by 2021.  It has only gotten worse.  Regulators may finally pay attention to the damage done by financial rapscallions.

Aveanna was rated a "sell" and given a $1.50 price target by UBS.  Their report cited the company's high leverage.  I imagine Gentiva is in a similar position.  

Causby's goal is to increase the value of his equity holdings by several orders of magnitude.  I've seen the harm his greed caused at the local hospice level.  He and his financial rapscallion sponsors remain unchecked and for that we suffer.  

Anonymous

Healthcare's Neverending "More with Less" Takes Supreme Toll

Strange Tony,

I read the saddest story of a nurse taking her life and the note she'd written months before she committed suicide.  Tristin Kate Smith, a 28 year old emergency room nurse in Ohio, wrote:

"Each day, you ask me to do more with less." 

Smith’s letter also referenced that many nurses feel that hospital administrators are taking advantage of them.

"You are a narcissist," she wrote. "You use and exploit us to line your pockets, using the common citizen’s money for overpriced health care."

Substitute Regional Vice Presidents for hospital administrators and this could well be our hospice over the last decade.

Ten years ago our hospice was a public company and employees could buy stock, could actually own a stake.  That changed with buyout after buyout, the last two by financial rapscallions (the narcissists cited above).

Our nurses have been used and exploited to line their pockets.  As have other staff.  That much is crystal clear.  

Day after day Gentiva/Kindred/Gentiva robbed staff of fair pay for hours worked and reasonable reimbursement for miles driven.  Year after year the company prioritized profits over patient care and humane treatment of employees.  Human Resources turned strategic and became the Human Abuse Department.  Compliance pretends to care but raising concerns usually boomerangs into increased levels of abuse, often coached by HR.

I hope any nurse or healthcare worker in a dark place finds support.  I encourage healthcare workers to be attentive to anyone struggling.  Listening is an important first step.

I am grateful to the many coworkers who listened when challenges arose.   None were managers.

Anonymous