To search out essentially the most memorable quotes from house care executives of 2023, Dwelling Well being Care Information used a technique that's half artwork, half science.

Finally, the quotes chosen resonated most with HHCN workers and readers. They have been prescient, controversial, important and extremely related to suppliers' issues and alternatives.

They mentioned house care cost charges from the Facilities for Medicare & Medicaid Providers (CMS), Medicare Benefit (MA) plans, operational realities, and the way forward for house care within the US.

“My concern is the sport we’re taking part in with CMS. It's a protracted, tiring recreation. They provide you with a proposal for important cuts. The whole business is anxious about it and flees to Washington. I did this, and everybody in our firm did. We foyer, foyer, they get a variety of strain, after which they arrive again with one thing that’s simply mediocre. It's not sufficient if we make Congress all about passing laws. But it surely's sufficient to maintain us in purgatory. We should overcome this rippling feeling of insufficient compensation.”

– Paul Kusserow, former CEO and present Chairman of Amedisys (January 24)

Kusserow advised HHCN this in January when he reassigned the function of CEO. And once more, that recreation between business and CMS passed off in 2023.

CMS proposed a 2.2% internet minimize to house well being funds for the 12 months 2024 in June, then finalized a 0.8% improve in November that also included everlasting cuts.

Kusserow was proper that CMS's skill to come back again with a “higher” model of the proposed rule will assist soften the momentum the business is constructing in DC as members of Congress need to focus their consideration elsewhere.

Only a few months after his quote, UnitedHealth Group (NYSE: UNH) introduced it needed to agree to accumulate Amedisys Inc. (Nasdaq: AMED) – an indication of issues to come back.

“As an operator you instantly really feel a sigh of aid, simply because we anticipated the complete proposed minimize. However the additional you learn, you assume, 'That is rubbish. I'm not going to just accept this till 2025 and past. It's not occurring. ''

– Summer time Napier, the CEO of Therapeutic Arms Healthcare (November 15)

Napier advised HHCN that in a November webinar highlighting the supplier's response to the ultimate rule.

However for Kusserow, Napier urged different suppliers to not purchase into CMS's “recreation” and to proceed combating in opposition to long-term charge cuts in house care.

“One of many issues we're actually making an attempt to construct out is a complicated palliative care mannequin. Palliative care may be very tough as of late. It’s primarily based on the physician's schedule Half B. It’s a loss chief. There's simply no good compensation. However we personally really feel that this is among the biggest wants. One of many largest bills in as we speak's well being care system is for these sufferers within the center bucket who don’t qualify for house care and don’t qualify for hospice. That's actually the place palliative care must be.”

– David Causby, CEO of Gentiva (4 October)

Gentiva actually began to take form in 2023. This recognizable identify in house care, this model of the corporate, was based when Humana Inc. (NYSE: HUM) exited the hospice and residential care property of Kindred at Dwelling (now CenterWell Dwelling Well being). ).

Causby was keen to speak in regards to the firm's palliative care program at HHCN's FUTURE occasion. As he stated, palliative care has lengthy been seen as a useful service for sufferers – however not essentially for companies.

At Gentiva, Causby believes the corporate can change that stigma.

“If it continues at 80%, you will notice a big majority of small mothers and dads go bankrupt. They'll most likely do properly in states like Illinois, and possibly in New York and Washington since you're already there. In these different states, particularly the southwestern states the place you pay a minimal wage of $7.25 an hour, you're going to have issues.”

Dirk Allison, the CEO of Addus (June 7)

Exterior of the house care cost rule, the rule that the majority dominated headlines in 2023 was Medicaid's proposed Dwelling and Neighborhood Providers (HCBS) rule that might require 80% of all reimbursements to be spent on workers.

As one of many largest suppliers of HCBS, Addus has been one of many loudest voices advocating in opposition to the rule, which the corporate says will adversely and unfairly have an effect on smaller suppliers – and suppliers in sure markets.

One of many greatest objections from suppliers to the rule is the sensation that different investments – equivalent to coaching – must be counted as investments in direction of workers, even when they don’t seem to be particularly about wages.

“Dwelling care is a sustainable enterprise. It goes by means of cycles. We will likely be right here for a very long time.”

– David Schuppan, senior companion and co-head of healthcare at The Vistria Group (September 18th)

The variety of personal fairness transactions could have fallen considerably in 2023, however the actuality is that that is the case in healthcare and in all sectors. This is because of macroeconomic elements.

At some factors, nonetheless, it was laborious to imagine that some PE corporations weren't shying away from house care due to charge cuts and staffing points.

Schuppan – a part of The Vistria Group, probably the most energetic corporations within the house care area – quelled a few of these issues throughout his dialog with HHCN in September.

“I don't see the variety of rejections lowering within the brief time period. Addressing these staffing points will take a while. I believe what's fascinating, although, is that once we exit and discuss to suppliers, we're actually beginning to see suppliers [honing in on] make their workers extra environment friendly. They’re starting to cut back administrative duties in order that these workers can focus extra on scientific care.”

– Lissy Hu, the president of related networks at WellSky (April 21)

The variety of referral rejections was probably the most obvious issues ensuing from workers shortages and charge cuts in house care over the previous 12 months.

Rates of interest reached file highs, whereas CMS appeared to dismiss these charges as non-alarming.

Because of this, suppliers have needed to discover methods to make their workforces extra environment friendly. They’ve carried out this by means of know-how, but in addition by allocating sources to paying companions who present reimbursement at a good charge in Medicare Benefit (MA).

“That is the generational battle. The battle we’re having as we speak with PDGM and the cost charges pales compared to what must be carried out because the plans proceed to develop.”

– William A. Dombi, President of the Nationwide Dwelling Care & Hospice Affiliation (October 6)

Tensions between MA plans and residential well being suppliers have steadily elevated in recent times.

As CMS reduces fee-for-service funds and MA penetration grows, suppliers should battle for truthful charges on their plans.

Their long-term survival relies on that battle.

“To place it bluntly: we wish to work with you. I really like your suggestions. … How can we get this proper? How can now we have a house well being care system … that works with Medicare Benefit plans, each United and others, to essentially have a value-based house well being care system?

– Patrick Conway, the previous CEO of Care Options at Optum, and present CEO of Optum Rx (June 15)

Conway spoke on to house care suppliers within the viewers throughout a summer time convention.

The suppliers listened intently, as Optum is poised to develop into the biggest house well being care supplier within the nation. It presently owns the LHC Group and is within the technique of buying Amedisys Inc. (Nasdaq: AMED).

UnitedHealth Group owns Optum, in addition to UnitedHealthcare, one of many nation's largest insurers. Dwelling care suppliers frequently take care of UnitedHealthcare in MA, and now, on the opposite facet of the home, Optum is poised to personal about 10% of the house care market.

Suppliers stay divided on what meaning for the house care business – whether or not it's good, unhealthy or inconsequential.

“Whereas they might appear to be they’re there to advocate for the house well being profit, they’re additionally there to – much more so – advocate for Medicare Benefit, and round how Medicare Benefit plans can profit from only a portion of the house well being profit. I don't assume it's nice for us that they're on this area on the stage they’re proper now. I believe it's most likely the other.”

– Nameless CEO (August 28)

The above quote from a house care govt addresses the query above, which is: What does Optum turning into such a serious participant in house care imply for the remainder of the business?

A number of executives advised HHCN all year long that they believed Optum could possibly be helpful in DC's battle for higher reimbursement for providers.

This govt disagreed, drawing on a few of the themes that made different supplier executives doubt Optum's arrival.

“[Back in the ‘90s]Once we went round speaking to individuals and telling them we have been within the house care enterprise, we defined to folks that we didn't repair homes. To consider the place LHC has gone and the place the business has gone, from then to now.”

Keith Myers, senior advisor, Optum; chairman and CEO emeritus, LHC Group (September 27)

Whereas a lot of the quotes included right here have an eye fixed on the longer term, this quote from Keith Myers – additionally at HHCN's FUTURE occasion – ​​returns to the previous.

There are presently charge cuts, workers shortages, and a number of different issues within the house well being and residential care area. But it surely's price contemplating how far house care has come – because the Nineteen Nineties and even since 2019.