Hospice Sales Talk

Strange Tony,

A Kindred Hospice employee wrote on "Indeed":

The hospice division is up for sale and yet another transition, more corporate speeches, more of the same.

Cue the key employee retention bonuses and promises of no changes.  Those no changes turned into massive hospice staff layoffs, reduced holidays, cuts in holiday pay and worse health insurance.

The July 2018 hope of receiving Humana level benefits never materialized for my coworkers.  Humana decided the hospice division was disposable for capital raising purposes.

Kindred Hospice executives David Causby and Larry Graham won't say how many millions they made when Humana bought the rest of Kindred at Home from its financial rapscallion partners.  

We will be sold to the next round of money changers.  Expect more abuse.

Anonymous

PE Stakeholder Project Confuses Kindreds

 

Strange Tony,

In searching for any information on the Senate Finance Committee's review of hospice company private equity ownership I ran across a report from the Private Equity Stakeholder Project.  

Generic Hospice readers know my disdain for financial rapscallions, who along with Humana trashed our once great hospice (nationally recognized).  However, I also value accuracy  in reporting and I found a error in their report table.  

July 2018 saw the take private split up of Kindred Healthcare.  Humana, TPG Capital and Welsh, Carson, Anderson and Stowe (WCAS) bought out the home health, hospice and community care parts of Kindred, now known at Kindred at Home.  TPG and WCAS took the hospital portions of Kindred Healthcare, long term acute care and rehabilitation hospitals, as well as outpatient rehab services.  

Humana purchased the rest of Kindred at Home from its financial rapscallion partners in August 2021.  WCAS and TPG monetized the post acute hospital division (Kindred Healthcare) to LifePoint in December 2021.  These were distinctly different deals. 

I looked for a way to submit this information so they could consider correcting their report but found no contact information.  

Last year I wrote:

How did Humana and Kindred at Home executives treat employees after the buyout?  They reduced headcount from 56.000 to 43,000.  They cut the number of holidays by 33% and holiday pay by 50%.  

After buying the rest of Kindred at Home Humana increased its employment number by 40,000.  That is why I submitted that number as a possible correction.  I hope the U.S. Senate report is more accurate in this regard.

 Anonymous 

Humana's CEO Earned 687 Times Hospice CNA

Strange Tony,

I just heard a guest on CNBC say the average worker will continue to fall further behind financially.  Humana released a report yesterday indicating how much it paid its board of directors and executive team.  

CEO Bruce Broussard made nearly $8,000 an hour with a total compensation of $16.5 million.  That does not include his board pay from HP ($190,000 in 2021) or KeyCorp, the parent company of KeyBank ($220.000 in 2020).  

Former CFO Brian Kane made nearly $5.6 million for working half a year.  CFO and the head of Humana's Home Division Susan Diamond took home $4 million.

They can't take it with them when they leave this earth and have to answer for the harm they caused hospice patients.

Anonymous

Crappy Corporate Hospices Change Hands for Executive Profit

Strange Tony,

Something odd happened while waiting for Humana to dump our hospice remnants to yet another financial rapscallion.  Jerry at the Death Nurse blog pondered if private equity firm Advent International might make a bid.  Advent owns AccentCare.  

I countered with an ironic alternative buyer, Bain Capital's Aveanna Healthcare headed by our former CEO Tony Strange.  

Those two names made a recent news report on Encompass' sale of its Enhabit home health/hospice division.

Private equity firms including Advent International and companies including Aveanna Healthcare Holdings Inc  have expressed interest in acquiring the home health and hospice business of Encompass Health Corp, people familiar with the matter said.

Jerry writes about crappy corporate hospice, a frequent topic at this blog.  DeathNurse linked to a September 2019 story about Caris Hospice firing a nurse while she was undergoing treatment for breast cancer. 

A Nolensville hospice care nurse was fired from her job after she was diagnosed and began treatment for breast cancer.

Chrissy Ballard worked for Caris Healthcare, a hospice care company headquartered in Knoxville but with offices in Middle Tennessee.

A Caris LPN included this in a 2020 review:

...over a million profit not enough, projecting more for this yr and stupid enough to tell us

A June 2021 story noted Caris' complete sellout to publicly traded NHC.

NHC acquired the remaining interest in Caris from its founder and managing director, Norman McRae, and McRae Investment Company. NHC already owned a majority stake in Caris prior to the purchase.

Caris CEO Norman McRae serves as Chair of the National Hospice and Palliative Care Organization's board of directors.  He also served as Chairman of Hospice Action Network, the lobbying arm of NHPCO.

NHPCO described the cancer-stricken nurse firing CEO as combining "a heart for mission-driven, community-based hospice with an entrepreneur’s drive for developing and nurturing outstanding teams, running efficient operations, differentiating on quality outcomes, and identifying and meeting community need."

Chrissy Ballard's husband Matt noted:

"The hypocrisy of being a company whose mission statement is Hospice with Compassion, Hospice with Grace," said Matt. "When you are on the flip side of that and you are an employee who is fired after their cancer diagnosis, it is devastating."

Heartless for sure.  There are over a million reasons.

Anonymous 

Humana Launches CenterHell in Seven States

 

Strange Tony,

Humana announced it would rebrand Kindred at Home Home Health offices in seven states to the CenterWell brand.  States where Humana will make the name change include Washington, Oregon, Idaho, Nevada, Arizona, New Mexico and North Carolina.

Months ago I offered the CenterHell name, complete with the green H often used by Humana.  I based this on how Humana tortured our once great hospice, turning it into a heartless cash machine for executives.  

When Humana et al purchased us in July 2018 my coworkers believed they were going to improve pay and benefits.  That did not happen.  Humana made nurse salaried and then overworked them terribly under sparse staffing guidelines.  They reduced the number of holidays and cut holiday pay rates 33%. 

Horrible technology added significant work hours and purposefully underpaid staff for miles driven and hours worked.   Talented, dedicated hospice staff were either fired or fled.  All these executive changes harmed patient care and as a result reduced our census over 50%.  

Executives sold us out on the cheap in 2018.  Their deal ensured they would make a 44% return on the stock they alone were allowed to buy.  However, that wasn't enough for David Causby and his C Suite companions.  Staff firings and pay/benefit reductions ensured they would get an additional 22% return.  How many regular employees received a 66% increase in take home pay over the last three and a half years?  Senior executives got just that from their exclusive stock holdings. 

Profit obsessed Humana will garner a big bolus of cash when it sells our hospice, yet again, to a financial rapscallion or group of greedy financiers.  Lord, hear our prayer for relief from the never-ending quest for profit.  Deliver us from the profiteers.

Anonymous

Goldman Sachs Shopping Our Hospice for Humana

Strange Tony,

Insiders leaked the status of Humana's planned sale of Kindred Hospice/Community Care.  "Axios" wrote:

A Goldman Sachs-run divestiture process aimed at private equity is underway, three sources tell Axios. The company last year explored a strategic sale of the hospice arm shortly after buying out its private equity JV partners, two people add.

• The company generates approximately $300 million in EBITDA, sources say.
• The sale aims to fetch 12x EBITDA for the assets, one person adds, which suggests a deal could be valued in the upper $3 billion range if that EBITDA is applied.

Between the lines: 12x is lower than recent private market trades for scale hospice companies. 

It appears our hospice will be once again saddled with financial rapscallion owners.  CEO Bruce Broussard's promise of a public listing turned out to be hollow.  

Humana will spin off Kindred Hospice/Community Care for 12x EBITDA, essentially the same price it paid TPG Capital and WCAS (11.5X EBITDA).

Debt rating agency Moody's rates Kindred at Home's debt under "Gentiva New":

Any divestiture of the hospice/ community care assets would trigger the requirement within the credit agreement to repay the debt and as a consequence could result in a different rating outcome. 

 The report indicates:

....at June 30, 2021, the company had a large cash position at around $200 million dollars, and consistently positive free cash flow. 

Moody's also notes that KAH has been paying down debt of roughly $125 million per quarter, which we expect would continue.

Humana, as operating partner, mobilized KAH's cash toward paying down debt of $500 million per year.  Hospice staff generate revenue from their hard work, yet received little in the form of raises or improved benefits.  

The financialization of our hospice continues with staff having no opportunity to have a stake in the company.  Going from financial rapscallion ownership to financial rapscallion ownership is not the least bit inspiring.  

Executives continue looking out for themselves.  Goldman Sachs is lining up their next king's ransom via a $3.6 to $3.9 billion sale.  

Greed is as greed does.  It's extremely grating and fatiguing for dedicated hospice professionals.   Lord, hear our struggles and comfort us.

Anonymous

Humana Ready to Reorganize Hospice Business

Strange Tony,

Humana's Q4 earnings call suggested our hospice may know about our new owners by April.  CEO Bruce Broussard said:

...we are committed to advancing our plans to divest a majority interest in our hospice business as we are confident we can deliver the desired experiences and outcomes for patients transitioning for restorative care to hospice through partnership models.

We have continued to explore various alternatives for the long-term ownership structure of the business and have initiated steps to reorganize the hospice business for stand-alone operations while also making investments to improve clinician recruiting and retention to position the business for further growth. While we're not able to share details today on a specific transaction structure or timing, we expect that we will be in a position to provide a meaningful update by our first quarter call. 

That means Kindred Hospice employees will not transition to Humana's richer benefits package.  Broussard did not mention causes for clinician turnover, like not paying staff fairly for hours worked and miles driven. He omitted sorry Homecare Homebase which added hours of extra work (often done at home and off the clock), sent clinicians down senseless rabbit trails and made it exceedingly difficult to find pertinent information (as it could be in numerous places or not charted at all).   

Humana purchased our hospice in June 2018 and promised no changes.  It then cut the number of holidays by 25% and holiday pay by 33%.   They jettisoned  administrative and clinical hospice staff and instituted time eating work processes for those remaining.  Our experienced hospice nurses left long ago.

Broussard admitted Humana had difficulty retaining hospice nurses they'd just hired.

We also reduced the number of nurses who attrit (quit) in the first 90 days of employment in the second half of 2021 for the first time since the pandemic began.

Before Humana destroyed our once great hospice we had nurses leave during the first 90 days of employment, mostly due to management painting a rosy picture and then not living up to what they'd sold.  

Turnover went into the stratosphere in 2019.  2020 brought the pandemic which isolated staff from one another, making them more susceptible to torture from Mean Girl management.  

What happens when management harms the quality of service while taking advantage of employees?  Census goes down and down and down.  In the earnings call Bruce noted hospice's declining volume for the last quarter and full year:

Fourth quarter 2021 home health admissions were up slightly while hospice experienced a low single-digit decline as compared to the fourth quarter of 2020. From a full year perspective, we have seen home health admissions up low single digits with hospice admissions down low single digits year-over-year. It is important to note that hospice volumes have been impacted by the higher mortality rates driven by COVID as well as lower post-acute facility volumes.

Hospice volumes have also been impacted by nurse turnover and lack of availability.  Our hospice continued to take patients and overload the few clinical staff left but that turns into poor service and bad word of mouth.  

Referral sources got the message that Humana did not care about serving customers.  Hospice staff felt how little management cared for us.  We saw executives focusing on enriching themselves while pretending technology would ameliorate the downstream impact of their greed.

While hospice volumes went down, margins remained robust.  That's the money that does not go to employees.  Humana's CFO said:

Hospice had slightly higher margins than the home health business, and those trends continue.

Four years ago a few of my hospice peers thought Humana and its financial rapscallion partners might make our hospice better.  Some looked at Humana's retirement match and wondered how long before they would have such a benefit. 

EMPLOYER CONTRIBUTION:  125% on up to 6% of employee 401(k) contributions

Humana dashed any misplaced hope.  I expect similar treatment from our new owners.  The question is how much money did Bruce Broussard make on our backs?  We may never know.

Humana has begun a divestiture process in collaboration with Goldman Sachs, Axios reported Monday, noting that the information came from three different sources. The process is supposedly targeting private equity interests.

Lord, deliver us from evil....that I pray.

Anonymous