From the DOJ to the Defense Table: What Hospice Operators Need to Hear

The Home Health Data Reckoning: Fraud, Moratoriums & the Future of Post-Acute Care

The numbers are in — and home health care is at a turning point. In this data-packed episode of Last Visit First, host Tom Maxwell sits down with Scott Tapp (CEO, Trella Health) and Carter Bakkum (Senior Data Scientist, Trella Health) for a quarterly deep dive into what the Medicare claims data is actually telling us about the state of home health and hospice in America. Key Stats from This Episode: * Home health market: $162B in 2024 → projected $380B * 94% of U.S. counties saw a reduction in home health agencies (2019–2023) * 2,201 new hospice NPIs enumerated in LA County since Jan 2020 * Average patient risk score increased from 2.3 → 2.5 (2021–2024) * Readmission rates dropped from 11.9% → 11.8% * Time to start of care: 4.8 days → 3.12 days * 724 hospitals participating in the TEAM model * $11.8B in annual Medicare reimbursements tied to 3 TEAM categories Chapters: * 00:00 - Introduction & Guest Welcome * 00:59 - Who Is Carter Bakkum? Scott Explains * 01:45 - Why We're Doing Quarterly Data Deep Dives * 02:04 - Big News: Trella's Monthly CMS Data Access * 03:19 - How Trella Combines Billions of Claims * 04:43 - The Lag Problem with Finalized CMS Claims * 05:39 - CMS Moratorium on New Home Health & Hospice Licenses * 05:59 - The $162B Home Health Market & Home Infusion Surge * 07:10 - Shocking Stat: 94% of Counties Lost Home Health Agencies * 07:53 - Carter Explains the County Reduction Data * 09:10 - Trella's New Interactive NPI County Map Tool * 11:20 - 2,200+ New Hospice NPIs in LA County Alone * 12:30 - The Fraud Hotspots: Clark County, Franklin County & Miami-Dade * 12:54 - Does the Map Include Change of Ownership (CHOW)? * 13:35 - What the Moratorium Means for De Novo vs. Acquisition Strategy * 14:33 - The 36-Month Rule & Who's Actually Acquirable Right Now * 15:10 - Is This Essentially a National Certificate of Need? * 15:32 - What Comes After the Moratorium? New CMS Rules Explained * 16:22 - Real Impact: Access to Care Is Already Being Restricted * 17:09 - Tom's Story: No Home Health Available in Upstate New York * 18:30 - The PR Problem: Seniors Seeing Home Health as "All Fraud" * 19:49 - Adherence to Home Health Discharge Instructions Is Rising * 21:02 - Should We Look at Adherence by Rural vs. Urban Classification? * 21:26 - Home Health Is Treating Sicker Patients — And Doing It Better * 22:22 - Patient Risk Scores: Up from 2.3 to 2.5 (What That Really Means) * 25:00 - Readmission Rates Down Despite Higher Complexity * 25:38 - Why Patients Are Being Discharged So Much Faster Now * 27:03 - Time to Start of Care Dropped from 4.8 to 3.1 Days * 27:47 - Introducing the TEAM Model: What It Is & Who's Affected * 29:43 - Carter's TEAM Data: 724 Hospitals, Upside/Downside Risk Explained * 32:15 - $11.8 Billion in Medicare Reimbursements at Stake * 33:20 - Why CMS Chose These 5 Episode Categories * 34:10 - The $36,000 Variance in CABG Costs Across the Country * 34:39 - 39% of TEAM DRGs Are Discharged to Post-Acute — The Opportunity * 35:41 - What This Means for Home Health Agencies RIGHT NOW * 37:10 - Call to Action: Submit Your Data Questions for Next Quarter * 37:40 - Closing Thoughts from Scott & Carter * 38:51 - Goodbye & Happy Memorial Day Have a topic for next quarter's data deep dive? Drop it in the comments below. Sponsored by Trella Health: * Learn more Trella Health: https://www.trellahealth.com [https://www.trellahealth.com] * Connect with Scott Tapp: https://linkedin.com/in/scotttapp [https://linkedin.com/in/scotttapp] * Connect with Carter Bakkum: https://linkedin.com/in/carterbakkum [https://linkedin.com/in/carterbakkum] Subscribe to Last Visit First for new episodes every week with the leaders shaping home health, hospice, palliative care and the future of healthcare.

From the DOJ to the Defense Table: What Hospice Operators Need to Hear

Former DOJ prosecutor Jonathan Porter joins Tom Maxwell for the Season 2 premiere of Last Visit First, and the timing could not be more critical. With CMS announcing a nationwide enrollment moratorium on hospice and home health agencies and over 440 providers already suspended, every operator in the industry needs to understand what is actually happening and what to do about it. Jonathan spent years at the Department of Justice taking down healthcare fraud schemes involving billions in billings. Now, as a partner at Husch Blackwell, he defends the hospices, home health agencies, and healthcare executives caught in the crossfire. He knows exactly how this machine works from both sides of the table, and he is not holding back. He explains: * Why legitimate agencies are getting swept up in enforcement actions designed to catch bad actors * How the whistleblower incentive system is structurally built to go after the good guys with deep pockets rather than the fraudsters who already moved their money offshore * What actually triggers a federal investigation for a compliant hospice or home health agency * The real difference between a compliance program that protects you and binders collecting dust on a shelf * How AI is creating brand new enforcement risks that most operators have not thought about yet * When self-disclosure to CMS or DOJ makes sense and when it does not * What to do the moment an agent shows up at your door CHAPTERS * 0:00 Introduction — Meet Jonathan Porter, Former DOJ Prosecutor and Partner at Husch Blackwell * 1:07 Jonathan's Path: From Capitol Hill to the DOJ to Healthcare Law * 4:09 Prosecuting Doctors, Executives and a Pastor: What It Taught Him About Human Behavior * 7:39 Why He Left DOJ to Defend the People He Used to Investigate * 8:59 The CMS Crackdown: 447 Hospices and 23 Home Health Agencies Suspended in LA Alone * 12:35 Why the Government Keeps Lumping the Good Guys In With the Bad * 13:30 The Whistleblower Incentive Problem: Why Relator Lawyers Target Deep Pockets * 15:51 Payment Suspensions: What Happens to Legitimate Agencies Caught in the Crossfire * 19:42 What Actually Triggers a Federal Investigation for a Compliant Agency * 24:33 Ads * 25:52 Husch Blackwell, the Anti-Kickback Statute and How It Applies to Hospice and Home Health * 33:15 Real Examples: When Giving Something of Value Crosses the Line * 34:59 Home Health Enforcement: What DOJ Is Actually Watching in the Data * 38:41 Whistleblowers: Disgruntled Employees, Wired Informants and Data Mining Companies * 41:43 Ads * 44:08 AI Enforcement Risks, Self-Disclosure and Where the Line Is in Clinical Documentation * 51:44 The Three Things Every Compliance Officer Needs to Address Immediately * 54:43 Binders on a Shelf vs. a Compliance Program That Actually Protects You * 58:21 If Jonathan Could Change One Thing About Government Enforcement * 59:58 Don't Panic: What Every Operator Needs to Hear Before It Gets to That Point * 1:01:44 How to Reach Jonathan Porter and the Husch Blackwell Team Learn more about Husch Blackwell: * https://www.huschblackwell.com [https://www.huschblackwell.com] Connect with Jonathan Porter: * jonathan.porter@huschblackwell.com [jonathan.porter@huschblackwell.com] Sponsors: * Premier Sponsor: Trella Health: ⁠https://trellahealth.com/⁠ [https://trellahealth.com/] * Premier Sponsor: Homecare Homebase: ⁠https://hchb.com/⁠ [https://hchb.com/] * Maxwell TEC: ⁠https://maxwelltec.com/⁠ [https://maxwelltec.com/] * StenoHealth: ⁠https://www.stenohealth.com/⁠ [https://www.stenohealth.com/] * IntellaTriage: ⁠https://intellatriage.com/⁠ [https://intellatriage.com/] Subscribe to Last Visit First for new episodes every week with the leaders shaping home health, hospice, palliative care and the future of healthcare.

The $1.5B Home-Based Care CEO Getting Honest About the Future of Healthcare | Mike Asselta

Compassus CEO Mike Asselta on clinical insights, care leadership and the future of healthcare. He leads one of the nation's largest home-based care companies, 10,000 caregivers and $1.5B in integrated services. He finally sat down with Tom and did not hold back. With 31 years of healthcare leadership behind him and a platform covering home health, hospice, palliative care, infusion and private duty services, Mike is driving healthcare innovation and the future of patient-centered care from the inside out. He explains: * How you scale a $1.5B home-based care company without losing the culture that made it great * The AI investments that are giving nurses their evenings back and cutting intake from 4 hours to 15 minutes * Why joint venture partnerships with health systems are the future and what the Providence deal taught them * The palliative care strategy, the SNF-at-home model and where the patient journey is actually heading * The nurse practitioner workforce crisis and the clinical data signals every provider should be watching * What great care leadership looks like at scale and the legacy he is building at Compassus CHAPTERS * 0:00 Introduction — Meet Mike Asselta, CEO of Compassus * 0:27 Mike's Career Journey: Lab One, Quest, Fresenius and Three Failed Retirements * 3:28 Entering Home-Based Care: The Fragmentation Shock * 5:20 Leading a Mobile Workforce: Care Leadership at Scale * 6:18 Compassus by the Numbers: $1.5B, 11,500 Caregivers and a Mission-First Culture * 8:24 The Leadership Summit in San Antonio: Leading With Heart * 12:11 Operational Excellence vs. Clinical Excellence * 14:15 The Single Biggest Strategic Decision of Mike's First Two Years * 15:19 Why Hospital-Health System JV Partnerships Are the Future of Post-Acute Care * 21:07 Inside the Providence Partnership: Values, Scale and Continuity of Care * 23:21 How Health Systems Should Be Thinking About Hospice and Palliative Care * 26:45 The Hospice Conversation Nobody Wants to Have (But Everyone Needs To) * 28:09 Industry Fragmentation, Fraud, Waste and Abuse — and Why the Real Story Isn't Being Told * 30:06 Ads * 31:45 Independent, Hospital-Owned or JV? What the Industry Looks Like in 10 Years * 32:30 Interoperability, Faxing and the $781M Problem CMS Is Finally Addressing * 33:58 Balancing Home Health, Hospice, Palliative Care and Infusion Across the Patient Journey * 35:58 SNF at Home, Nurse Practitioners and the Next Frontier of Home-Based Care * 37:52 The Nurse Practitioner Workforce Crisis and the Student Loan Reclassification Problem * 40:28 Palliative Care Volumes Up 50%: The Compassus Strategy * 44:41 Clinical Data Signals Every Home-Based Provider Should Be Tracking * 48:31 AI Is Transforming Intake: From 4 Hours to 15 Minutes * 49:37 AI at the Bedside: Reducing Start-of-Care Time by 50% and Ending Pajama Charting * 52:23 Ads * 54:37 Revenue Cycle, AI Workflows and the Art of the Possible in 2026 and 2027 * 57:17 Claude Cowork, Agentic AI and the Back Office Revolution at Compassus * 1:00:14 Real-World AI Win: A 45-Minute Fix for What Should Have Been a 3-Week Project * 1:02:03 Reducing Nurse Fear and Burnout Around AI Adoption * 1:04:47 Developing the Next Generation of Home Health and Hospice Leaders * 1:08:00 Mike's Legacy: What He Wants Compassus to Be Known For Learn more about Compassus: * https://www.compassus.com [https://www.compassus.com] Careers at Compassus: * https://www.compassus.com/careers [https://www.compassus.com/careers] Sponsors: * Premier Sponsor: Trella Health: https://trellahealth.com/ [https://trellahealth.com/] * Premier Sponsor: Homecare Homebase: https://hchb.com/ [https://hchb.com/] * Maxwell TEC: https://maxwelltec.com/ [https://maxwelltec.com/] * StenoHealth: https://www.stenohealth.com/ [https://www.stenohealth.com/] * IntellaTriage: https://intellatriage.com/ [https://intellatriage.com/] Subscribe to Last Visit First for new episodes every week with the leaders shaping home health, hospice, palliative care and the future of healthcare.

10 BILLION in Investments Later: David Schuppan on Scaling Healthcare Winners

How do you manage a $17 billion investment firm while staying focused on meaningful clinical impact? In this episode of Last Visit First, Tom Maxwell sits down with David Schuppan, Co-President of Flagship Funds and Co-Head of Healthcare at The Vistria Group. With a career spanning over $10 billion in healthcare investments across 28 companies, David is one of the primary architects of the modern post-acute landscape. We go behind the scenes of the "Power of Three" investment model and discuss: * The History of PE: David’s early days working with industry legends Bryan Cressey and Carl Thoma. * Portfolio Strategy: Why Vistria invested in industry leaders like Homecare Homebase, Mosai (Medalogix), tango, and Anew Health. * The "Duals" Frontier: Why the intersection of Medicare and Medicaid is the next great value-based care opportunity. * AI in Healthcare: Shifting the industry from the "IQ business" (data analysis) to the "EQ business" (human-to-human care). * Scaling for Success: David’s advice for CEOs looking to scale from $50M to $500M and beyond. David also shares a personal look at his legacy and why he believes private capital is the "action engine" for improving the lives of patients and families. * 0:00 - Introduction to David Schuppan * 1:27 - From Missouri to Wall Street: David’s Origin Story * 4:30 - Meeting the Founders of Private Equity (Cressey & Thoma) * 8:07 - The Sourcing Strategy: Active Listening & B2B Healthcare * 10:43 - The Vistria Group’s "Power of Three" Model * 15:22 - The Mosai & Medalogix Story: Data-Driven Outcomes * 16:25 - Tango: Aligning Payers and Providers * 22:39 - Relationship-Driven Private Equity vs. Transactional PE * 25:42 - The Home-Based Care Ecosystem (Anew, Help at Home, PACE) * 29:27 - AI in Healthcare: Use Cases in Recruitment and Operations * 37:34 - David’s New Role as Co-President of Flagship Funds * 42:40 - The Future of Consolidation in Home Health & Hospice * 46:03 - The Toughest Investment Decisions & Lessons Learned * 49:20 - Advice for CEOs: Scaling to $500M * 54:58 - The Legacy of Patient Impact Enjoyed the episode? Let us know in the comments! Make sure to leave a like and subscribe! Last Visit First: * Apple Podcasts: https://podcasts.apple.com/us/podcast/last-visit-first/id1830051182 [https://podcasts.apple.com/us/podcast/last-visit-first/id1830051182 ] * Spotify: https://open.spotify.com/show/3iSKGRvHC9Bk3iq7l8UPxs [https://open.spotify.com/show/3iSKGRvHC9Bk3iq7l8UPxs] * YouTube: https://www.youtube.com/@lastvisitfirstpodcast [https://www.youtube.com/@lastvisitfirstpodcast ] * Website: https://www.lastvisitfirst.com [https://www.lastvisitfirst.com ] * LinkedIn: https://linkedin.com/company/last-visit-first [https://linkedin.com/company/last-visit-first] Check out our sponsors: * Premier Sponsor: Trella Health: https://trellahealth.com/ [https://trellahealth.com/ ] * Premier Sponsor: Homecare Homebase: https://hchb.com/ [https://hchb.com/ ] * Maxwell TEC: https://maxwelltec.com/ [ https://maxwelltec.com/ ] * StenoHealth: https://www.stenohealth.com/ [https://www.stenohealth.com/] * IntellaTriage: https://intellatriage.com/ [https://intellatriage.com/] Connect with David and The Vistria Group: * https://vistria.com/contact/ [https://vistria.com/contact/]

CMS Policy Insider: 80% Of Healthcare Is Missing The Point! Why You Need A "Family Operating System"

Most families are flying blind when it comes to aging. They think the system has their back, but Dr. Katy Lanz is here to tell us that the healthcare machine is actually built for billing, not for people. As a triple board-certified doctor who has advised CMS and helped lead one of the biggest palliative care providers in the country, Aspire Health, she knows where the cracks are because she’s spent her career trying to fill them. Millions of us are currently caught in the "Sandwich Generation," struggling to raise kids while simultaneously managing care for our parents. Katy reveals why these caregivers are actually the most influential force in the entire industry and how a "Family Operating System" like LifePlans can handle the logistical chaos before a crisis forces your hand. Key Takeaways: * The 80/20 Rule: 80% of stability is social, not medical, and ignoring this leads to unnecessary hospitalizations in the "ER trap". * Integrity vs. Despair: Navigating the final psychological battle that determines if aging is defined by fulfillment or regret. * Rural Healthcare Deserts: Why geography is a primary risk factor as local hospitals continue to vanish across America. * Proactive Life Planning: How moving from reactive crisis management to a centralized hub protects family relationships and prevents clinical burnout. Chapters: * 00:00 Intro * 00:09 Intro to Dr. Katy Lanz * 00:47 Katy's Journey into Serious Illness Care * 03:41 The Role of Aspire Health * 07:34 Innovations in Palliative Care * 11:51 The Intersection of Aging and Mental Health * 14:40 Navigating Healthcare Systems * 19:40 Future Policy Dynamics in Healthcare * 24:45 The "Sandwich Generation" and Caregiving * 30:25 The Evolution of Palliative Care in America * 33:10 Challenges in End-Stage Renal Disease (ESRD) Care * 35:23 Innovative Solutions for Life Planning * 40:20 The Concept of Whole Person Care * 48:13 Last Visit First: A Personal Reflection * 50:07 Legacy and Impact in Healthcare Enjoyed the episode? Let us know in the comments! Make sure to leave a like and subscribe! Last Visit First: * Apple Podcasts: https://podcasts.apple.com/us/podcast/last-visit-first/id1830051182 [https://podcasts.apple.com/us/podcast/last-visit-first/id1830051182] * Spotify: https://open.spotify.com/show/3iSKGRvHC9Bk3iq7l8UPxs [https://open.spotify.com/show/3iSKGRvHC9Bk3iq7l8UPxs ] * YouTube: https://www.youtube.com/@lastvisitfirstpodcast [https://www.youtube.com/@lastvisitfirstpodcast] * Website: https://www.lastvisitfirst.com [https://www.lastvisitfirst.com] * LinkedIn: https://linkedin.com/company/last-visit-first [https://linkedin.com/company/last-visit-first] Check out our sponsors: * Premier Sponsor: Trella Health: https://trellahealth.com/ [https://trellahealth.com/] * Premier Sponsor: Homecare Homebase: https://hchb.com/ [https://hchb.com/] * Maxwell TEC: https://maxwelltec.com/ [https://maxwelltec.com/ ] * StenoHealth: https://www.stenohealth.com/ [https://www.stenohealth.com/] * IntellaTriage: https://intellatriage.com/ [https://intellatriage.com/] Connect with Dr. Lanz: * LinkedIn: https://www.linkedin.com/in/katylanz/ [https://www.linkedin.com/in/katylanz/] * LifePlans: https://www.ourlifeplans.com/ [https://www.ourlifeplans.com/]