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

License to FRoperate

Strange Tony,

Gentiva's press release on its closing the buyout of Promedica's hospice and home health operations had a strange name at the bottom.  Contact information was not for a Gentiva PR person but H/Advisors Abernathy.

At first I thought it might be another affiliate of Clayton, Dubilier and Rice given financial rapscallion's propensity to cross sell across their corporate holdings.  Then I found H/Advisors Abernathy had been helping private equity for 40 years.  No financial rapscallion holds onto an asset that long.

H/Advisors Abernathy "thinks like private equity", helps with add-on acquisitions can reach stakeholders who can impact private equity firms' license to operate, i.e. throw off huge amounts of cash to sponsors while shafting employees.

H/Advisors announced a new healthcare public policy influence effort (lobbying), bought Tinkle in Spain (our hospice physicians make us say urinate), and opened their first office in the Middle East (Dubai).  

Oddly the press release on the Gentiva Promedica purchase made no mention of CDR or the $500 million in added debt that will increase interest expense.  My bowels can feel more cost reduction efforts on the way.

H/Advisors knows financial rapscallions like to stay hidden from public view and they clearly did their job.  The CDR team appreciates it.

Anonymous

Gentiva Closes on Promedica Hospices

Strange Tony,

Gentiva announced it closed on Promedica's hospices giving CEO David Causby another shot at managing an integration.  Moody's said the "$500 million first lien term loan add-on will not impact the company's ratings or outlook."

Proceeds from the term loan add-on, along with new equity from the private equity sponsor, will be used to fund the acquisition of Heartland from ProMedica.  

Clayton, Dubilier and Rice did not issue a press release on the deal, however Gentiva did.  Just as Kindred Hospice dug into its name history to produce Gentiva, Causby is going retro with Promedica's hospices.

Most of ProMedica’s hospice locations will rebrand to the Heartland Hospice brand by the end of 2023. Home Health locations will rebrand to Heartland Home Health in early 2024.

Causby butchered the Harden Hospice integration while COO at Gentiva (under CEO Tony Strange).  He eviscerated any goodwill by putting Harden's hospices with their mish-mash of brand names into Gentiva's.  Our hospice took on a number of Harden patients, got a temporary bump and then it was business as usual.  Causby's integration lost over $100 million in expected combined revenue.

Our hospice remains highly leveraged.  That means stiffing workers on pay, benefits and mileage reimbursement.  The pressure to admit patients on the edge of qualifying for hospice care is ever present but will ramp up.   

Our financial rapscallion owners addressed "delivering value in the shift to value based care" in a keynote interview.  Gentiva board member Ravi  Sachdev participated in the interview but made no mention of Gentiva.  Neither did the other two CDR executives.  

Welcome to the Promedica folks.  Hope you guys last.

Anonymous

 

The CDR Players at Our Hospice

Strange Tony,

Our hospice waits for government approval of Gentiva's planned buyout of Heartland Hospice.  Once approval is given the deal will close and integration will begin.  Our majority owners for the last fourteen months are financial rapscallions, Clayton, Dubilier and Rice (CDR).  

CDR expected the Heartland acquisition to close in the second quarter.  It's now the fourth quarter and the deal has a mid December complete by date.  Should it go through here are the CDR staffers who will shape the combined companies:

I don't expect anything good to come out of New York, especially from a financial rapscallion.  I think these people have a game plan and it involves harvesting cash from our hospice team's hard work.

These people hate to share.  Not very hospice like, is it?   Taker's owning a company full of givers, it's the financial rapscallion way.

Anonymous

HBO's John Oliver Torches McKinsey

Strange Tony,

Comedian John Oliver blasted McKinsey and Co., a giant consulting firm in a darkly comedic piece.  It's well worth the watch. 

McKinsey featured Kindred Healthcare on a podcast two weeks before CEO Ben Breier sold us down the river to financial rapscallions TPG and Welsh, Carson, Anderson and Stowe.

 

In January 2022 McKinsey mentioned Kindred at Home again in a Medicare segment, when Humana briefly owned 100% of the company. 

It's not clear how many podcasts McKinsey does for non-clients, but our hospice owner made two of them.

John Oliver summed up our experience under financial rapscallion and Humana ownership.

Job loss and wage theft at the hospice level, major financial gains at the top.  Thanks McKinsey....

Anonymous

Gentiva May Soon Close on ProMedica Hospices

Strange Tony,

The Toledo Blade reported on the delayed closing of Gentiva's purchase of ProMedica's hospice division due to antitrust concerns in certain markets.

The article said ProMedica's pushed back a debt repayment by several weeks as a result of the delay.  That means the closing could be imminent.

Anonymous