Humana Gave Kindred Hospice Cost Controls During Pandemic

 

Strange Tony,

Under COVID-19 Humana has been making money hand over fist.  CFO Brian Kane was the only executive to mention Kindred at Home in the Q3 earnings call.  Kane said:

Regarding Kindred at Home, you'll recall we mentioned on our first quarter earnings call that new home health admissions have been adversely impacted by COVID. As the year has progressed, volumes have stabilized and early signs of a rebound in demand are beginning to materialize. Further, the Company has been able to offset these initial challenges with strong clinical and overhead cost controls across the organization.

On Home Health Humana CEO Bruce Broussard offered:

We do continue to also want to grow the value base from us building our clinics and our home health side. So, you see with the primary care -- the partners in primary care product and the Conviva product, along with some of our home solutions, moving more and more to value-based payment models that are really oriented to the ability to do it, whether we do it internally with our providers or externally through our partnerships there.

There was no mention of hospice on the call even though Americans are dying from COVID-19 in droves.

Oddly, Broussard mentioned a program Papa that provides support to lonely Medicare Advantage patients.  

While registering Otis for the Papa program, the case manager noticed it was Otis' birthday and began singing happy birthday to him over the phone. Otis was overcome with emotion, noting it had been years since someone had even wished him a happy birthday. His reaction impacted his case managers so much that she reached out to Papa's corporate team and Humana, who immediately took action and had a birthday cake delivered to Otis' home. Sometimes, the smallest action can make a big difference in someone's life. Programs like Papa now are important element in addressing the holistic needs of our members.  

Our hospice did this very thing for years for our patients.  It ended when Humana and its financial rapscallion partners bought Kindred at Home and forced our hospice into Curo's penny pinching operating model.

Curo does not allow a color printer in the office.  Thus we stopped making personalized birthday cards for patients.  We could no longer print custom certificates honoring veterans for their military service.  These cost our hospice pennies to produce.  For years patients and their families expressed heartfelt appreciation for birthday celebrations (often with cake) and military service recognition (with veterans pins and balloons).

Management said "Ink is expensive."  Our Medical Directors offered to pay for the ink.  Management declined.  Our office just installed new cartridges which would last a year.  We asked if we could just use up the ink in the printer.  Management said "that is forbidden." 

Our office paid over $2 a page for veterans certificates at an outside vendor.  Add staff time and mileage reimbursement and each certificate cost over $12.  Before Humana we produced those for pennies in a fraction of the time.

I recall a meeting with Jeff Shaner, Senior VP of the Hospice Division under Gentiva.  Shaner told a story about a chaplain who'd gotten "employee of the year" for his region.  The chaplain stayed with the patient and family all night because it felt like the right thing to do.  

After Shaner finished his story our hospice chaplain said he would've been fired for doing that very thing.  The award winning chaplain was salaried, thus his extended hours of service had no additional cost to Gentiva.  Our chaplain was hourly and would've been fired for working overtime without permission.  I know he regularly stayed with patients and families off the clock.  That too could have gotten him fired.

Humana's CEO bragged about Papa to Wall Street analysts.   Our hospice did the same thing for years and Broussard's managers nixed it, doing so with contempt and disdain.   

Humana contracts for Papa's services.  Our celebratory work with patients was done by hospice volunteers, i.e. for free by people with big hearts and love to share.  Contrast that with Humana's executive team which has to be motivated by complex reward schemes to do their job.

The spoils of this earth lies in the hands of Broussard and his executive team.  Hospice angels get their rewards by doing God's work on this earth.   Humana cut our once award winning hospice service levels.  During the pandemic Broussard et al gave us cost controls.  Kindred at Home owners and executives are loath to share.

Anonymous 

Destroyer Leaving

 

Strange Tony,

To resounding applause Regional-Local Assistant Vice President of Operations Minus Marketing Savanna Heartless Banshee announced her acceptance of a job with another hospice company so she could make more money.  

Heartless Banshee (aka Mean Girl #1) destroyed our once great hospice with her arrogant, disconnected and arbitrary decisions that hurt patient care but gave her bosses what they wanted, buckets of cash and high staff turnover.  There is no institutional memory at our hospice, not that Banshee respected it when it existed.  

Heartless Banshee is executive material in a world where the spoils go to the top and nothing trickles down to hard working staff.

I suggest her new company consider Banshee's real resume:

• Stole pay from nurse case managers by making them salaried and requiring they take call in addition to their regular hours.
• Implemented Homecare-Homebase, a garbage in-garbage out software suite that claims to automate all hospice operations but does nothing well.  
• Stole mileage reimbursement from staff by having HCHB automatically include mileage to the patient's home but not add the return trip.
• Caused turnover of at least 30% per year at our hospice location, over 100% in the nursing area over her tenure
  
• Treated employees like they were inferior in intellect and/or personality.  Extremely dismissive of legitimate concerns expressed by employees. This behavior was emboldened by Humana/Curo.
  
• Fired qualified, hard working staff simply because she did not like them
• Leader of Mean Girl executive group that tormented the most outstanding areas of our hospice 

I had the displeasure of Banshee doing my performance review as we had no Branch Manager at the time.  She did not acknowledge any of the outstanding outcomes achieved in the prior year.  When I tried to raise them Banshee said "I are evaluating you, not your job."  Heartless Banshee told me the many reasons she did not like me.  I burned her evaluation after using it for toilet paper.

RLAVPOOMM Savanna Heartless Banshee may make more money but she cannot take it with her when she leaves this world.  She will face her maker and answer for her earthly deeds.  .Hospice taught me to say, "Lord, it's in your hands now.  Thy will be done."

While there might be hope that Banshee's replacement will be better, Humana/Curo repeatedly showed me that is not likely.  Change benefits those at the top.  The rest of us patiently wait for crumbs to fall from their table.

 Anonymous

Management review on Indeed showed Savanna's dastardly deeds at Abode:

• Corporate management is the worst. They treat everyone as disposable. Corporate management treat local staff like they are elementary students but want them to perform like big company executives. Stay away from this employer to avoid regrets
• Pros--Free coffee, lunch room, free parking
• Cons--Treat staff poorly. Just another overhead cost that can be easily replaced

Kindred Healthcare's Disintegration Nears Completion

 

Strange Tony,

Financial rapscallions continue to tear apart an already gutted Kindred Healthcare in the pursuit of profits.  Their latest move is to sell the RehabCare divsion to Select Rehabilitation.  

 

"Select shares many of our core values and is led by a senior management team whose number one priority is doing what is best for the patients entrusted to their care," Benjamin Breier, Kindred’s president and chief executive officer, said in a prepared statement.

Breier described the RehabCare sale as building "on Kindred’s record of innovation and intentional disruption in its core businesses."  

 

Select Rehabilition is also owned by financial rapscallion Flexpoint Ford.  That means senior management's number one focus is generating return for their owners, not doing what's best for patients.  Breier knows this as that's his charge under TPG Capital and WCAS.  

Kindred Healthcare envisioned itself as a one stop continuum of care shop for patient's leaving the hospital.  Kindred bought Integracare Home Health and Hospice from Flexpoint Ford in 2012.  At the time Kindred CEO Paul Diaz said:

 

“We believe that the continued expansion of our continuum of post-acute care services in our key cluster markets supports the growing interest among patients, physicians, hospital systems and public and private payors for high-quality, patient-centered integrated care.”

 

Diaz took a $6 million bonus for closing the Gentiva deal and landed jobs with two financial rapscallions, Cressey & Company and Guidon Partners. 

Ben Breier blew up the one stop post acute care strategy to enrich himself and his greedy bosses.  Rehabcare employees received a 10% pay cut in April while other employers added hazard pay due to the pandemic.  The pay cut came after years with no raises.

Financial rapscallions and senior executives plan to make a king's ransom from their equity stakes.  They will offer nice sounding words but nothing substantive to employees.  Nearly two weeks ago the EEOC sued Kindred at Home for disability discrimination and retaliation.

Gentiva Health Services, Inc. d/b/a Kindred at Home (“Kindred”), a provider of home health services, including nursing and rehabilitation assistance, violated federal law when it failed to accommodate an employee in its purchasing department and instead placed her on involuntary unpaid leave because of her disability, the U.S. Equal Employment Opportunity Commission (EEOC) charged in a lawsuit it filed today.

According to the EEOC’s suit, Kindred learned that one of its employees suffered from Morton’s Neuroma and capsulitis of the metatarsophalangeal joint of both feet. The employee initially asked to telecommute for three weeks in accordance with her doctor’s recommendation to stay off her feet, as an accommodation for her disability. Kindred originally allowed her to telework for a week but then reversed its decision and unilaterally placed her on unpaid leave without benefits for four months, the EEOC said.

“In the absence of undue hardship, an employer’s refusal to accommodate its employee with a limited period of telework where the employee has demonstrated the ability to perform the essential functions of the position from home violates the law,” said Robert Weisberg, acting regional attorney for the EEOC's Atlanta District Office. “The EEOC is committed to seeking relief for workers who are harmed by such discriminatory practices.”

 

Kindred at Home contracted out most HR functions after their Human Abuse department became strategic.

Patients will experience ever deteriorating care due to greed and purposeful service reductions in both quantity and quality.  Such pressures will grow when Humana begins treating hospice as a carve in benefit under their Medicare Advantage plans in 2021.  Our hospice will become a cost center for Humana, no longer a source of revenue.

Ben Breier sold our hospice to Humana and the same two financial rapscallions pulling his strings.  They've decimated our once great hospice.  Innovation is supposed to make things better.  

 

Disruptors think less like “stewards” of God’s creation and more like sovereign “masters.”

 

Humana CEO Bruce Broussard, CFO Brian Kane, Paul Diaz, Ben Breier, KAH President David Causby and Hospice President Larry Graham will meet their maker one day and have to account for their actions on this earth.  They can't take their ever increasing, abundant wealth with them and God could school them on those harmed from their management edicts. 

Anonymous

Living Under Humana's Wolves

Strange Tony,

I ran across something you gave me after I joined our hospice and began to be confused by Gentiva management.  I found your message as our office prepares to move locations under Humana.  They are:

 "It is no measure of health to be well adjusted to a profoundly sick society." - J. Krishnamurti

If we were in a healthy, functional situation, with wise, experienced leaders, it would probably make sense to speak our mind with total confidence, and share our honest feeling-reactions, and appeal to common sense, and point sincerely to what is fair and just, and to what is most likely to fix what is broken.

But sadly, the current society does seem to be very dysfunctional.  I can't help thinking that this means we have to be, as Jesus put it, "as clever as snakes".  We can't fight the frequent battles all dressed up in our brightly colored uniforms, out in the open field, standing in neat, disciplined rows.  We have to do as some did in the Revolution, crouching in the forests, wearing deerskin and soft-soled moccasins, and learning to strike and flee with stealth.  

Some of the situations confronting us seem so patently absurd!  The motives given of course sound very noble and saintly, but we can't help seeing and sensing a lot of hidden agendas, power games, paranoia, and all of the "games people play".  It's lamentable, but it's the present climate we find ourselves in.  

It seems to call for a day-by-day discernment.  Is today calling for simple honesty?  Or is it calling for slow, cautious, deliberate, snake-like cleverness.  More and more these days, it seems to call for saying less instead of more, for going with the flow, even though the flow is not a sensible one.

There is one bit of good news in this crazy atmosphere.  Very many of the kooky decisions and plans simply don't last long!  The fanfare and boasting quickly fade.  Three or four weeks after the loud display of grandiosity, it all just goes away.

Is this ideal?  No.  Does it tear at our sense of rightness and reason?  Absolutely.  But as someone once said (possibly the guy who came to be called the "Buddha", or awakened one) "Avoid the company of deluded people when you can.  But when you cannot, then keep your own counsel."

There is in this present situation, no good support to be found in the system.  "Like sheep without a shepherd".  But there is support here and there in individuals who are not as asleep as the crowds.  And there is support, as ever, in one's own depths, where our very Source abides, below and beneath the noise, the worry, the reacting, the rush, and the insanity of the times.  

I believe your words are even more applicable today to our hospice, even our greater society.  I am grateful for them and for you.

Anonymous

Hospice Workers Were Post Officed

Strange Tony,

Kindred Hospice isn't the only place with bad management.  Consider recent changes at the post office.

“Unfortunately, our production process within the plants was not fully aligned with this established schedule. So we had some delays in the mail, and our recovery process in this should have been a few days and it’s mounted to be a few weeks,” he said. “The only change that I made was that the trucks leave on time. Theoretically, everyone should have got their mail faster.”

Pressed by Senator Jacky Rosen, a Nevada Democrat, DeJoy declined to say what kind of analysis, if any, USPS had done before implementing the changes.

Losing the 671 mail sorting machines, in combination with other cuts, has led to mail moving more slowly through postal facilities, postal workers say,  

Management making universal decrees without analysis, input, testing or feedback.  Sound familiar?  The USPS, like Kindred Hospice, has a no overtime order.

Humana and its financial rapscallion partners trashed our one nationally recognized hospice.  They foisted Curo's myopic leadership and inadequate processes on us with no input from dedicated staff.  Curo ran a bunch of small hospices.  Our hospice was over three times the size of the average Curo site.  

Our mail sorting machines were staff.  Curo cut a big number initially saying technology would replace the work these dedicated people performed.  Curo's crappy technology created drastically more work for people who wanted to be paid fairly for hours worked and miles driven.  Staff cutting never stopped.  It was hard to see the company had any standard for new hires.  Repeatedly we got unqualified new people, usually with zero input from the "team."  

Curo gave us phone and computer systems that could spy on staff.  The phone system worked poorly making it difficult for families to reach our hospice in times of crisis.  Overworked nurses tried to document admissions and visits in Homecare Homebase's Gordian Knot software.  They would be disciplined, then fired for allowing their charts to go unfinished as this cost the company money.  Nurse eventually learned to say "no" to all rabbit trails and document their findings in one place, the clinical summary.  

Supposedly customer feedback was a critical measure.  It plummeted during all the changes with not a concern from local or regional management.  They refused to acknowledge or discuss indicators showing repeated service failure.

Staff turnover soared and has remained high.  We have very few experienced staff left.  Every quality hospice nurse resigned.  Some chose not to work 60-80 hour weeks and be paid for 40. 

Another mail sorting machine removed was our site's color printer.  We used it to create veteran certificates and other special items for patients and staff.  It had brand new ink cartridges installed.  Curo would not let us run down the ink, an expense already incurred.  The machine sat idle for a year while we paid a vendor to produce those Veteran Certificates and the company paid time and mileage for a staff member to pick those up.

Humana/Curo pulled a USPS on us.  Patients and families continue to pay the price in lesser quality service.   Like the post office hospice workers are not consulted on changes.  Rewards for good service are nonexistent.  

The management bar has fallen so low.  Why don't they open their eyes and ears?  Do they not care about workers and customers like the USPS?  They simply care about money and power.  For that the people suffer.

Anonymous

Another Humana Home Investment

Strange Tony,

Humana invested $100 million in Heal, a Los Angeles based physician house call and telemedicine company.  Humana's Home Business Segment President Susan Diamond will join Heal's board of directors.

Are Humana and Heal are a perfect fit?  Here are the most recent reviews from Indeed:

I left because they were not looking out for me.

They treat the employees like options. They aren’t considerate of others time and they expect you to be understanding to constant changes. If you give a sliver of an opinion, they will say you’re not being a team player. They only care about producing the numbers for the insurance companies.

Quality care is very compromised due to greed of making money. 

There is no organization with this company. When you start, Everyone talks behind one another’s back. Some of the Dr’s are rude, to the point that MA’s cry. HR has no clue how to do his job. Would barely get breaks, and when we did the people on the office would contact you Just a horrible company as a WHOLE. No breaks.. 

Susan Diamond will blend nicely with Heal's board to further transform healthcare in the home.  Humana, TPG Capital and WCAS trashed our once nationally recognized hospice.  A longtime bereavement coordinator recently lamented how money changing owners ruined our hospice temple.  A retired social worker returned to our office to not find anything familiar in the way of office appearance or people.  She asked what happened?  I answered Humana, financial rapscallions and Curo.

I've watched as hospice physicians, once respected valuable partners in care delivery, become order takers from Curo's petty tyrants.  I've seen garbage in-garbage out Homecare Homebase rob employees of fair pay for hours worked and miles driven.  I've watched as local management carried out unethical orders from corporate chiefs.  Their charge now is keeping the money changing going.

Moving information around quickly may be one element of quality healthcare.  If a company cannot be in mutual, respectful relationship with its employees, I suggest it is not capable of doing the same with patients and their families.

Heal may be the perfect fit for Humana, unhealthy, even toxic.  That's the management norm in our age of greed.

Anonymous

Battered Hospice Division Holds Up Kindred at Home

Strange Tony,

Kindred Hospice executives continued cutting positions at our hospice.  I couldn't see how they could elimiate any more, given the number of people they've reduced since financial rapscallions and Humana bought us two years ago. 

Moody's had this to say about Kindred at Home (Gentiva New) in their June 2020 review of the company's debt.

KAH will continue to have elevated debt/EBITDA in 2020 due in part to volume declines from the coronavirus pandemic. Home health saw approximately 20% volume declines in the last week of March 2020, whereas hospice experienced about 15% declines.

Executives have no patience.  Volume down, headcount cut.  Moody's mentions our garbage-in/garbage-out hospice computer program, Homecare Homebase.  It underpaid staff for hours worked and miles driven.   

KAH has identified about $138 million in synergies, of which around $93 million has already been achieved. KAH has performed well since completing the spin off from Kindred and acquiring Curo in 2018, however there has been some delay in realizing the last of the synergies particularly related to cost savings benefits from procurement and the shift to Homecare Homebase. We expect the remaining $45 million synergies to be realized by the end of 2020, and will include some newly identified savings related to insourcing the call center and improvements to the IT platform. We believe that increased centralization will lead to opportunities for additional cost savings, including improvements to KAH's IT infrastructure, as well as the centralization of purchasing which will continue to provide benefits throughout 2020.

My coworkers will be disturbed to know more synergies loom.  Hospice provided the lion's share of earnings within the company for Q1 2020.

Laid off staff might be upset to learn the company took federal funds while cutting jobs.

KAH had $315 million of cash as of May 2020, which includes about $150 million of cash from the CARES ACT for grants, about $89 million of advanced accelerated payments, and about $10 million of the approximately $60 million estimated for fiscal year 2020 of deferred employer social security taxes. KAH continues to evaluate guidance from the Department of Health & Human Services with respect to the use of funds and has not made a final decision if it will be keeping any or all of the CARES Act funds. KAH plans to fully repay the accelerated payments in June of 2020, given their solid liquidity, which is 2 months ahead of schedule per federal guidelines.

Flush with federal cash Kindred Hospice jettisoned valuable, loyal co-workers.  Humana, TPG and Welsh Carson trashed a great hospice after they bought us in July 2018.  There's no end in sight to their carnage.  A giant executive payday awaits.  For that we suffer.

Anonymous