Curo's Hospice Staffing Model

StrangeTony,

Our local hospice branch manager mentioned the new Curo staffing model.  They've provided no details thus far but prior Curo employees weighed in around the web. 

The staffing model is very lean, leaving the team over worked and under paid.

Management does not care about overworking employees and their mantra is “everybody is replaceable, leave if you don’t like it”.

All the good experienced employees are being forced out to be replaced with uneducated employee's, to allow low dollar hourly pay rate. 

Management is poor and not a good environment. All they focus on is the numbers and not the patients.

The people in charge are incompetent and dishonest. More drama within company than a teenage school dance.

There are too many patients, and not enough staff. 

The management was ungrateful and disrespectful. Never satisfied and always adding more to the nurses weekly. Nothing was ever good enough. They were all about the numbers and not the patients.

Those who do good work are rewarded, those who do not will not be.  

Census is all that matters and expect all staff to work non-stop. Until burn-out happens, retention is not important to them. 

Nurses are the ants of this operation where they make you work 70 hrs, average a week and salary you for 40. They pay you $2 for on call and don't pay you for your time to do you visit. They expect you to work all day, all night, all weekend, and of course, be happy about it.

If you question anything you become a target and soon be goon, seen it too many times with co workers.    

Management drinking on the job. Management covering for one another. If you question what is going on you become their target.    

Management has no respect for employees, they will replace you at any time for no reason.

Management encourages cutting cost to pad their bonus structure and turns a deaf ear to complaints from patients/families about needs not being met.  

Leaders who don't listen will ultimately be surrounded by people who have nothing to say.

They don't care one iota about their employees. All they care about is twisting the numbers as they report "adjusted" EBITDA. They will make the numbers say anything they want.

Lies lies lies! Bad employee morale. Leadership act as if they are children at school. Constant drama. 

Employees are over worked with poor compensation. Expectations are unrealistic. 

Small changes turned into firing half our staff and taking away everything that set us apart from other hospices.

Three TOTAL staff in the office if you have less than 100 patients, this is including the DOO, DCS, and one other person.       

Our hospice has way more staff than some of these comments.  Our branch manager displayed some of the listed characteristics under Kindred.  I expect those will be magnified soon.

Reductions can come from honesty/fair severances or from bad leaders psychologically breaking people and kicking their carcasses out the door.  Our hospice saw enough psychological torture under Kindred and prior owners.  Our team does not need or want any more.  If positions need to be reduced Curo's management should be adult about it.  

Anonymous  (from New KAHtivacare-plus Hospice)

Toad Now Curo Level Executive

Strange Tony,

Executives held a conference call on Kindred at Home's progress in splitting from mother ship Kindred Healthcare.  Kindred bought Gentiva in February 2015.  Hospice, home health and community care were strategic post-acute care services until December 2017 when Kindred executives and the board decided to cash in, lever up the subsequent companies and roll the dice that they could make yet another fortune in a few years time by partnering with financial rapscallions.

Thirty four and a half months of integrating companies had to be undone.  Executives planned the split with change in control compensation and new equity positions swimming through their greedy heads.

KAH President David Causby updated the hospice division by introducing new senior executives, all from Curo Health Services.   After a few moments of technical difficulties hospice employees heard the voice of our new chief, Larry Graham.  He shared a lot of words about people he's worked with a long time and trusts, i.e. not Kindred.  Graham and his predecessor made two different financial rapscallions big money, Thomas H. Lee Partners and GTCR Golder Ranuer.  Larry enters the new arrangement with outsized pay, an equity stake not available to employees and massive incentive compensation. 

Regional positions have both Kindred Hospice and Curo Health executives sharing roles.  I expect the Curo people will mine the unbalanced brains of Kindred Hospice executives before sending Kindred leaders packing.  Gentiva-Harden and Kindred-Gentiva employed a similar strategy of milking knowledge then jettisoning excess leadership.

Nearly every executive spoke about the importance of our people but not one mentioned fair pay, competitive benefits or the possibility of a raise.  Fellow hospice employees at our site have gone years without a raise.

I learned after the call VP Toad is Curo material and been promoted.  His new title is Senior Assistant Executive Vice President of Market Finance Compliance.  Toad will hop in and inflate himself in any situation that threatens the future financial success of our Senior Executive Team, be it severe competitive disadvantage, financial peril from paying employees fairly or legal jeopardy from admitting and keeping patients that do not qualify for hospice.

How did an executive with poor people skills and unbalanced priorities get promoted?  Apparently Toad's father-in-law works for one of the financial rapscallions intent on making a fortune from flipping Kindred at Home and the Kindred Hospital company. Greed is all in the family and our hospice is square in the middle of it.

A few long term employees are determined to keep hospice service levels up but it gets harder with each new hire.  Experience out, question mark in.  I wish I could identify the criteria for bringing new people in but at this stage it is not discernible.

With Toad's promotion our hospice will get a new Vice President.  Unfortunately they can be worse.  It seems improbable with Toad's multiple failings but Glassdoor comments indicate Larry Graham is up to the task of appointing someone less appealing.

Anonymous (at Southern KAHtivacare Hospice)

Broussard Talks Hospice in Humana's Q2 Earnings Call

Strange Tony,

Humana owns 40% of our hospice alongside two financial rapscallions.  CEO Bruce Broussard spoke of Humana's interest in caring for patients with terminal illness in the recent earnings call.

Over the last year, we've continued to make significant advances in our enterprise strategy, particularly in the past few months as demonstrated by our recent investments in both Kindred at Home and Curo Health Services. With a continued focus on helping seniors achieves their best health, we are striving to reshape healthcare by expanding access to high-quality, value-based care in both primary care and home health. 

Humana's CFO said the company used approximately $1.1 billion in parent cash to buy the 40% stake in Kindred at Home and Curo.  Parent cash could've bought 100% of Kindred at Home and had two divisions to spin off, LTAC hospitals and RebabCare.  Humana would've had $280 million leftover to invest in Curo.  Instead Humana did a squirrely deal with Welsh, Carson, Anderson and Stowe (WCAS) and TPG Capital, the employer of a Kindred board member.

In the call Humana's CFO added "we expect reasonable adjusted EBITDA growth in our healthcare services segment, as the Kindred results are annualized and our other businesses in the segment, particularly our own clinics, improve."

Broussard stated in his prepared remarks.

Turning to home, we recently announced the completion of the acquisition of a 40% interest in each of Kindred at Home and Curo Health Services, collectively the largest home health and hospice operator in the nation. As we previously indicated, we are striving to do something that has never been done before in home health -- transform the payment model into one that is value-based, encouraging a transition for maximizing volume to focusing on managing health and chronic conditions, such as COPD, congestive heart failure, and diabetes to prevent or slow disease progression. This movement to value-based care and aware from a predominantly therapy-based methodology, is aligned with the recent CMS proposal for changes to the home health payment methodology, which was anticipated when we entered into the transaction.

Broussard partnered with leveraged buyout firm WCAS, which employs ex-Medicare Chief Tom Scully.  WCAS is also Broussard's former employer and sponsor of his first fortune.

In that regard, we appreciate the model proposed by CMS and welcome change that aligns home health with pay-per-value and improved clinical outcomes, reducing preventable events. While the ultimate transformation will take many years, upon closing of the transaction, we immediately launched test-and-learn pilots aimed at both operational and clinical improvements in four markets: Richmond, Virginia; Charlotte, North Carolina; Virginia Beach, Virginia; and Dallas, Texas. These pilots incorporate a pay-per-value mechanism in addition to the traditional fee-for-service payment based on four quality measures: hospital admissions, hospital readmissions within 30 days, emergency room visits without hospitalization, and timely initiation of home care specifically within 48 hours of referral or an M.D. order.

In addition, in order to create differentiated home health model, we had the opportunity to weave the richness of Humana at Home telephonic and in-home engagements, as well as Humana pharmacy resources, into the skilled nursing provided by Kindred at Home clinicians. Over the next year, we plan to leverage Humana predictive modeling to identify additional clinical interventions, integrate Humana pharmacy resources to conduct comprehensive medication reviews, and extend our care management best practices from Humana at Home into the Kindred at Home homecare environment.

We will also reduce friction in the authorization process to ensure Kindred professionals are in the home within 48 hours of a referral or supplement the ordering physician through telehealth with a virtual M.D. to expedite the delivery of care. We expect the changes we are making in the home health space will not only benefit our Medicare Advantage members, but also our Medicaid members over time.

The continued development of our in-home capabilities, together with our demonstrated clinical capabilities in Medicare Advantage uniquely position us to serve the Medicaid population, giving us confidence that we'll be successful in growing our Medicare platform through procurements. Under our recent statewide award in Florida, we expect to serve an additional 141,000 members, an increase of 44% from our existing Medicaid membership.

The Florida contract was awarded based upon the ability of plans to achieve the Medicaid agency's goals. These goals included creating enhanced provider and member experience, the ability to reduce preventable inpatient and outpatient events, high-quality scores, innovative and effective methods to deliver integrated care, and integration with the community and support of Medicaid beneficiaries.

We've been successful in achieving strong results across these areas by leveraging the capabilities that have positioned us as a top Medicare Advantage plan, including our capabilities in chronic condition management, integrated care delivery, value-based provider relationships, and community programs designed to address social determinants of health, such as food and security, and social isolation. While we are confident in our capabilities and expect to be successful in the procurement process, consistent with our previous remarks, we will continue to assess length of time to scale and potential barriers to entry at the state level, while considering potential M&A opportunities in the Medicaid space. In that regard, we appreciate the model proposed by CMS and welcome change that aligns home health with pay-per-value and improved clinical outcomes, reducing preventable events.

Broussard's excitement over home health is clear in his remarks.  What about hospice?

David Windley -- Jefferies -- Analyst
Good morning. Thanks for taking my question. Going back to Kindred and Curo, and understood those are investments not full acquisitions. Integration is maybe not the right word, but how do you think about optimizing or harmonizing your workflow between those entities and your internal home health initiatives to drive more cost savings for the member base? I'm thinking about what could manifest as a trend-bender as we think into 2019 and what has to happen to make that a reality?

Bruce D. Broussard -- President and Chief Executive Officer 
At the time of close and pre-close, we had a lot of planning of what would be our top priorities in engaging with Kindred. I'll wrap around a few things. First is we're going to test and learn in a number of markets and be able to really focus more on just not about bringing our home health business over to Kindred, but more importantly, bringing the ability to prevent preventable events from happening. We have a number of things going on that are focused more on nursing-oriented patients that have chronic conditions that can be managed in the home.

First, we're just rerouting more effort nursing area as opposed to the therapy area. That's the first thing. As you mentioned, the trend-bender out of this is reduced admissions, readmission, our rates going down, ER visits going down. That's our measurement of success there, by focusing on these chronic conditions.

Part of that test will also be how we bring telehealth into the home. The telehealth platform will not only allow us to be more convenient in bringing care into the home, but the second thing is it also will help us with our star scores and other preventative measurements that that we can get into the home quicker, both in being able to do it more convenient as a result of not having to get people transported there and, in addition, working through the appointment schedule. So, we see two combinations here in our test-and-learn. One is around how do we reduce the preventable events from happening and then secondarily, how do we continue to increase our performance on our quality measurements.

David Windley -- Jefferies -- Analyst
Thank you. 

The following interchange showed CEO Bruce Broussard soft pedaling Humana's vision of being the largest hospice operator in the U.S.  Humana paid a huge premium for Curo relative to Kindred deal pricing.

Frank Morgan -- RBC Capital Markets -- Analyst
My second question, obviously with the Curo acquisition, you must like the hospice business. So, my question is, with hospice being carved out of the MA benefit today, what's your short term and your longer term view there and also just any thoughts in the context of the future for value-based purposing for hospice? Thanks.

Bruce D. Broussard -- President and Chief Executive Officer
Hospice for us is really, we look at that as a service we are participating in and providing to the healthcare community, and we leave it ultimately up to the caregiver, the family, and the physician to decide where is the proper place for an individual.

But once that decide that it moves from a restorative to pain management kind of treatment, then we are there to serve them and integrate that into offerings we have. In regard to is it in or outside of Medicare Advantage, we really look at it more is it the right thing to do for the family member and then ultimately be able to help them with the transition of quality of life.

We do believe, over time, that hospice and palliative care will continue to be more and more important parts of the care model as we see the need for it. We see people living longer and at the same time, treatment options at end of life become more intense or there are fewer of them and people make this choice that is probably one of the less used area of healthcare today that probably have a large, positive impact on people's life as they think about where they are in their stage of life.

 For us, we are more a recipient of it. We are believer it's the right thing to do and we are a believer that we will provide that service to our members if they choose to.\

The payment model is less of an issue for us and insignificant in our decision making.

Frank Morgan -- RBC Capital Markets -- Analyst
Thank you.

 
Broussard provided mixed messages to hospices in his call.  It's an important service for families and the payment model isn't important.  However, as people have less treatment options hospice has a role to play.  What if insurance denials result in more insureds having few to no treatment options?  In that case hospice would be a cost saving measure for Humana.

If payment were insignificant why would Humana's CFO talk about Kindred's contribution to reasonable EBDITA growth for the second half of 2018?  He went past EBDITA as a measure saying the company would only report adjusted EBDITA for Kindred at Home/Curo.  Adjusted EBDITA is a financial rapscallion measure. 

Cost control measures have already begun at our hospice.  WCAS, TPG and Humana have set clear financial performance expectations.  The only window into these is Humana's SEC filings.  Financial rapscallions don't disclose.  

Anonymous (from KAHtivacare Hospice managed by Curo Executives)

Pushing Kindred Hospices into Curo's Management Structure

Strange Tony,

Kindred at Home (KAH) President David Causby welcomed a new hospice division executive in Curo Health's Larry Graham.  Together they are integrating Kindred's 178 hospices into Curo's 245.  Kindred at Home's hospices are much larger than Curo's, over twice the size on an average revenue basis.   Significant overlap exists in a number of hospice markets..

Kindred at Home's new owners, TPG, WCAS and Humana, expect significant cost reductions in the hospice arena from combining Curo and Kindred at Home.  Causby oversaw the integration of Harden Hospice into Gentiva as a newly promoted Executive Vice President-Chief Operating Officer.  That integration came up $150 million short of revenue expectations.   That's a lot of business to drive away.

Moving Forward communications have avoided personnel reductions to date.  Early casualties can be found in the medical director arena.  Kindred's former Hospice National Medical Director now fills a regional position.

Cost control is the mantra under KAH's new National Medical Director.  Insurance like approvals are needed for a number of hospice interventions.  Board certified hospice physicians have to ask management for approval for certain medications or treatments to treat symptoms and/or manage pain.  It's not clear how this process might delay needed care for hospice patients or deny it altogether.  That will play out over time.

Very little has been shared locally about changes but our hospice managers seem distracted, even disconnected.  They may be trying to wrap their minds around new targets to meet, possibly Curo's staffing model.

The way work is done is important.  Hospice was founded on compassion, teamwork and collaboration.  Respect, integrity and openness are in short supply at the moment.  Win/lose competition has reared its ugly head at our site.  Management fomented chaos since the double KAH-Curo buyouts were executed.  

Gratitude, appreciation and raises disappeared long ago.  There are no signs of a pay increase.  Hospice has its own intrinsic rewards but the work carries an emotional toll.  Bad management adds an additional unnecessary burden that can drive employees away.

Financial rapscallions prefer a lower average wage.  This emphasis discounts the value of seasoned, experienced employees, something critical in the hospice arena.  Seasoned staff are integral to quality patient care/customer service and are necessary for mentoring/training new employees..

Massive change is underway.  It's mostly subterranean at this point.  To date leaders have been massively enriched while employees wrestle with stagnant pay and deteriorating benefits.  I'll write as more information arrives that illuminates executive priorities for our hospice. Hopefully it won't be years before my hospice co-workers get a real raise.

Anonymous (from KAHtivacare Hospice)  

Kindred Sold Cheap, Curo Went for Far More

Strange Tony,

Brigade Capital sued to stop Kindred's breakup sellout to two private equity firms and Humana.  The investor claimed the deal severely undervalued Kindred. The court ruled in Kindred's favor on March 27, 2018.  Kindred shareholders voted March 29, 2018 to sell out.

Humana and its financial rapscallion partners announced the deal to buy hospice provider Curo Health on April 23, 2018. 

Both Kindred and Curo had leverage around 6 times EBITDA.  The two companies shared a similar capital structure.

Had the Curo deal been announced earlier Brigade Capital would have had a stronger case.  Kindred at Home sold for 0.78 times 2017 revenues while Curo went for 3.03 times 2017 revenues.  Buyers paid nearly four times more for Curo than they did for Kindred at Home.

Long term Kindred investors did not make out well.  Kindred's last 10-K showed a mere 1.87% return over a five year period for long term shareholders.

The end result is Kindred at Home will have $3 billion in revenues.  It will also have $3 billion in debt, a massive increase from pre-buyout levels of $1.1 billion.

This is the new face of Kindred at Home.  Despite buyout after buyout, legacy employees have never been in this precarious a position.  Pray for coworkers as management gets marching orders from executives and owners who vastly overpaid for Curo relative to Kindred..

Just as Brigade Capital received short shrift, so may Kindred Hospice employees under Curo's executive rule.

Anonymous (from KAHtivacareplus Hospice)

Humana, Financial Rapscallion Partners Close on Curo

Strange Tony,

The second leg of our hospice buyout happened today.  The first leg had Humana and two financial rapscallions purchase Kindred at Home.  That occurred on July 2nd.  Nine days later the same owners closed on Curo Health Services, another hospice provider with 245 locations.  Prior news reports indicated Curo's management would lead Kindred at Home's hospice division.

Curo settled with the Justice Department in April 2017 for $12.2 million to make an investigation go away.  Curo was accused of paying kickbacks for admissions. Curo's President Larry Graham has not publicly addressed the settlement. 

Our new owners have confidence that Mr. Graham is the right man to lead the hospice segment.  Graham does have a record of growing margins at Amedisys.  Employees asserted the company manipulated patient assessments, as well as treatment plans, to maximize Medicare reimbursement.

Curo's average hospice census is 40 patients.  Kindred at Home's average hospice census is 75 patients.  Gentiva's Justice Department settlement for fraudulent billing occurred in February 2012. 

Two have become one, under the ownership of three.  The smaller will lead the larger.  The more recently unethical hospice will head the division.  Kindred at Home has 245 new little hospices with a documented history of cheating in the Dallas-Fort Worth area. 

Something is moving.  Our hospice employees will find out what soon enough.

Anonymous (from KAHtivacareplus hospice)

VP Toad to Join Curo's Dubious Executives?

Strange Tony,

It's been one week since Humana and two financial rapscallions purchased Kindred at Home, the Old Gentiva plus Integracare and Professional Medical's home health and hospice agencies.  There's a slight unease at our hospice.  We've not seen hide nor hair of VP Toad.

With the Curo Health Services buyout looming I expect Kindred hospice area/regional managers are rather nervous.  Our new owners plan to put Kindred's hospice division under Curo, despite our having nearly twice the revenue and much larger hospices by volume.  Their rationale is Curo's management is more entrepreneurial.

Curo Health Services, Inc. have agreed to pay $12.21 million to resolve allegations that they violated the False Claims Act by paying kickbacks in exchange for patient referrals.

Curo's  leaders settled for $12.2 million with the U.S. Department of Justice in April 2017.

First, from 2007 through 2012, kickbacks were allegedly paid to American Physician Housecalls, a physician housecall company, in exchange for patient referrals to these hospice companies. The alleged kickbacks took the form of sham loans, a free equity interest in another entity, stock dividends, and free rental space. 

Second, from 2007 through 2014, kickbacks were allegedly paid to medical providers, including doctors and nurses as well as hospitals and long-term care facilities, in exchange for patient referrals to these hospice companies. The alleged kickbacks took the form of cash, gift cards, and other valuable items.

Hospice employees don't have the means to offer sham loans, free equity, stock dividends or free rental space.  Those are all the auspices of management.

Curo spent years under the ownership of financial rapscallions.  Their executives are well trained in giving sponsors what they want, steady streams of cash and a huge final payday.

What changes await our hospice?  Is Toad Curo material?  I sense they share the same distorted values but only so many area/regional managers are needed in the combined company.

Anonymous (from KAHtivacare Hospice)