To find the most memorable home-based care executive quotes in 2023, Home Health Care News employed a strategy that is part art, part science.
Ultimately, the quotes chosen resonated the most with HHCN’s staff and readers. They were prescient, controversial, telling and highly relevant to provider struggles and opportunities.
They touched on the Centers for Medicare & Medicaid Services’ (CMS) home health payment rates, Medicare Advantage (MA) plans, operational realities and the future of home-based care in the U.S.
“My concern is the game that we play with CMS. It’s a long, exhausting game. They come up with a proposed significant cut. The whole industry gets all worked up about it and runs to Washington. I’ve done this, and everybody in our business has. We lobby, lobby lobby, they get a lot of pressure, and then they come back with something that is just mediocre. It’s not enough for us to get Congress all worked up about it to pass legislation. But it’s enough to keep us in purgatory. We have to get through this dribbling sense of inadequate reimbursement.”
– Paul Kusserow, former CEO and current chairman of Amedisys (Jan. 24)
Kusserow told this to HHCN in January as he was handing off the CEO role once again. And, yet again, that game between the industry and CMS took place in 2023.
CMS proposed a net 2.2% reduction to CY 2024 home health payments in June, then finalized a 0.8% increase in November that still included permanent cuts.
Kusserow was right that CMS’ ability to come back with a “better” version of its proposed rule helps mitigate momentum the industry builds up in D.C., as Congress members have to turn their attention elsewhere.
Just a few months after his quote, UnitedHealth Group (NYSE: UNH) announced that it had to agreed to acquire Amedisys Inc. (Nasdaq: AMED) – a sign of things to come.
“Immediately, you feel a little sigh of relief as an operator just because we were expecting the full proposed cut. But then the further you read, you’re like, ‘This is trash. I’m not going to accept this for 2025 and beyond. It’s not happening.’”
– Summer Napier, the CEO of Healing Hands Healthcare (Nov. 15)
Napier told HHCN that on a November webinar highlighting the provider reaction to the final rule.
To Kusserow’s point, though, Napier urged other providers to not accept CMS’ “game,” and to continue fighting against long-term rate cuts in home health care.
“One of the things that we’re really trying to build out is an advanced palliative care model. Palliative care is very difficult today. It’s built on the physician Part B schedule. It’s a loss leader. There’s just not very good reimbursement. But we personally feel that’s one of the greatest needs. One of the biggest spends in the health care system today are those patients that sit in that middle bucket that don’t qualify for home health and don’t qualify for hospice. That’s really where palliative should sit.”
– David Causby, the CEO of Gentiva (Oct. 4)
Gentiva really began taking shape in 2023. A very recognizable name in home-based care, this iteration of the company was formed when Humana Inc. (NYSE: HUM) divested the hospice and home care assets of Kindred at Home (now CenterWell Home Health).
Causby, at HHCN’s FUTURE event, was most eager to chat about the company’s palliative care program. As he mentioned, palliative care has long been viewed as a valuable service for patients – but not necessarily for businesses.
At Gentiva, Causby believes the company can change that stigma.
“If it goes through at 80%, you’re going to see a vast majority of the small mom and pops go out of business. In states like Illinois, they’ll probably do OK, and maybe New York and Washington because you’re already there. In these other states, mainly the Southwestern states where you’re paying $7.25 an hour minimum wage, that’s where you’re going to have difficulty.”
Dirk Allison, the CEO of Addus (June 7)
Outside of the home health payment rule, the regulatory storyline that dominated headlines the most in 2023 was the Medicaid home- and community-based services (HCBS) proposed rule that would mandate 80% of all reimbursement be directed to workers.
As one of the largest providers of HCBS, Addus has been one of the loudest voices advocating against the rule, which it believes will affect smaller providers – and providers in certain markets – adversely and unfairly.
One of the biggest gripes providers have with the rule is the feeling that other investments – such as training – should be counted as investments toward workers, even if they’re not specifically wages.
“Home health is an enduring business. It goes through cycles. We’re going to be here for a long time.”
– David Schuppan, senior partner and co-head of health care at The Vistria Group (Sept. 18)
Private equity dealmaking has been way down in 2023, but the reality is that its been down across health care, and across all industries. That’s due to macroeconomic factors.
At points, though, it was hard to believe that certain PE firms weren’t shying away from home health care because of rate cuts and staffing concerns.
Schuppan – a part of The Vistria Group, one of the most active firms in home-based care – quelled some of those concerns in his sitdown with HHCN in September.
“I don’t see the rate of rejection going down in the short term. Those staffing challenges are going to take some time to address. I do think what’s interesting, though, is that when we go out and talk to providers, we’re starting to see providers really [honing in on] making their staff more efficient. They’re starting to reduce the administrative pieces of jobs so that those workers can focus more on clinical care.”
– Lissy Hu, the president of connected networks at WellSky (April 21)
Referral rejection rates were one of the most evident resulting issues from staffing shortages and rate cuts in home health care over the last year.
The rates reached all-time highs, all while CMS seemed to dismiss those rates as unalarming.
As a result, providers have had to find ways to make their staff more efficient. They’ve done so through technology, but also through allocating resources to payer partners that reimburse at a fair rate in Medicare Advantage (MA).
“This is the generational battle. The battle we’re having today with PDGM and the payment rates pales in comparison to what needs to be done as the plans continue to grow.”
– William A. Dombi, the president of the National Association for Home Care & Hospice (Oct. 6)
Over the past few years, tensions between MA plans and home health providers has steadily risen.
As CMS cuts payments in fee-for-service, and as MA penetration grows, providers are having to fight for fair rates from plans.
Their survival, long term, depends on that fight.
“To just say it directly, we want to partner with you. I love your feedback. … How do we get this right? How do we have a home health system … that partners with Medicare Advantage plans, both United and others, to really have a value-based system in home health?”
– Patrick Conway, the former CEO of Care Solutions at Optum, and current CEO of Optum Rx (June 15)
Conway was speaking directly to home-based care providers in the audience at a summer conference.
Providers listened closely, as Optum is set to become the largest provider of home health care in the country. It currently owns LHC Group, and is in the process of acquiring Amedisys Inc. (Nasdaq: AMED).
UnitedHealth Group owns Optum, but also owns UnitedHealthcare, one of the largest insurers in the country. Home health providers deal with UnitedHealthcare in MA on a regular basis, and now, on the other side of its house, Optum is about to own about 10% of the home health market.
Providers remain split on what that means for the home health industry – whether it’s good, bad, or doesn’t matter.
“While they may look like they’re there to advocate for the home health benefit, they’re also there to advocate – more so – for Medicare Advantage, and around how Medicare Advantage plans can benefit over just one part of the home health benefit. I don’t think that it is great for us that they’re in this space at the level that they are. I think, in fact, it’s probably just the opposite.”
– Anonymous CEO (Aug. 28)
The above quote from a home health executive gets to the question above, which is: What does Optum becoming such a big player in home health care mean for the rest of the industry?
Multiple executives throughout the year told HHCN that they believed Optum may be beneficial in the fight in D.C. for better fee-for-service rates.
This executive disagreed, and pulled at some of the themes that have been giving other provider executives pause about Optum’s entrance.
“[Back in the ‘90s], when we’d make our rounds talking to people, and telling them that we were in the home care business, we were explaining to people that we weren’t repairing houses. To think where LHC has gone, and where the industry has gone, from then to now.”
Keith Myers, senior advisor, Optum; chairman & CEO Emeritus, LHC Group (Sept. 27)
While most of the quotes included here have an eye toward the future, this quote from Keith Myers – also at HHCN’s FUTURE event – draws back to the past.
There’s rate cuts, staffing shortages and a bevy of other concerns in the home health and home care spaces right now. But it’s worth considering just how far home-based care has come – since the 90s, and even since 2019.
