Home Health Ownership Transparency May Help Buyers Identify Targets More Easily, But Questions About Accuracy Remain

Last month, the U.S. Department of Health and Human Services (HHS) announced that — for the first time ever — it was releasing ownership data for all Medicare-certified home health and hospice agencies.

This move makes it possible for anyone to review information on the ownership of agencies participating in the Medicare program. This includes over 11,000 home health agencies, according to HHS.

The release of this data is an attempt to increase transparency for consumers looking to make decisions about their care needs. It also aids researchers and enforcement agencies in their efforts.

Home health stakeholders are thinking about the ways this may impact their businesses.

While many believe that it’s too early to tell, some believe that the data will play a role in M&A. Others reject the idea that the data will become a shopping guide for consumers looking for care services.

Home Health Care News heard from six home health stakeholders — including providers, dealmaking experts and policy experts — who weighed in on what this ownership data means for the industry at large.

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So far, it’s not clear what impact, if any, the recently announced HHS policy relating to ownership of home health agencies will have on the industry, given the large amounts of information already available through various other sources.

Anecdotally, this may just become another data point in the overall information mix. However, as the volume of mandated ownership information begins to accumulate and is analyzed, it may provide some additional insights into consolidation patterns and deal appetite in certain markets, and also serve to validate rumors or other ‘soft’ information circulating in the marketplace regarding ownership. It will also be interesting to see if the availability of this information, in the coming months, helps make acquisition activity somewhat more efficient or impacts overall transaction volume, particularly in the lower mid-market where deal flow does not get the same kind of coverage and visibility as more high-profile transactions. It will be useful to circle back on this in 9-12 months to see if, and to what extent, this data is being used in practice.

— Les Levinson, co-chair of the transactional health care practice at Robinson & Cole LLP

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Increasing ownership transparency of Medicare-certified home health agencies is an important goal. We need to be able to identify who owns home health agencies and ultimately how they are spending public dollars. Thus, these new data are a step in the right direction. Yet, given recent gaps in similar CMS nursing home ownership data, I worry about the completeness, accuracy, and usability of these planned home health ownership data.

Will these data provide regulators, researchers and patients with a more complete picture of ownership? Will patients use these data to drive business towards higher-performing owners? I hope so, but I do not think this will happen overnight. CMS will likely have lots of work to do over the coming years to ensure these data have their intended effect on promoting increased transparency.

— David Grabowski, member of the Medicare Payment Advisory Commission, and a professor of health care policy at Harvard Medical School

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The transparency and accessibility of HHA ownership data for our company, in particular, may have a greater meaning in the future than I presume that it will have initially. The complexity of our industry doesn’t easily enable or foster the success of sole proprietors.

Since LLCs and corporations are artificial bodies, by design and nature, linking home health agency ownership identities to individuals and groups makes entities more relatable and perhaps even more approachable. It will be surprising for some to see how many PE firms own home health organizations. The challenge for smaller organizations like ours is that the general expectations for value, quality, and employee perks don’t change based on size, revenue, or margins. So this personalizes your offerings and performance to an extent and either places blame or credit for outcomes either fairly or unfairly.

As for patients and families, I don’t perceive that the accessibility of ownership information will serve as a shopper’s guide. Lastly, for the industry as a whole, consolidators and M&A brokers will have a much clearer path to solicit, approach, and attract business owners to a bargaining table or position.

— Cleamon Moorer Jr., president and CEO at American Advantage Home Care

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The release of ownership data for all Medicare-certified home health agencies provides the public with greater transparency into the ownership structure. This may be useful for patients and families seeking home health services, as well as for others interested in understanding the overall ownership makeup of the industry. For Jet Health, it allows stakeholders to understand each of our agencies are high-quality providers in the markets we serve, and we are a long-standing, well-established presence.

This information could potentially lead to increased oversight and scrutiny of home health agency ownership structures and financial practices, which might create a higher level of compliance. It could also lead to more competition among agencies, as potential investors may have greater insight into the market. Overall, I believe publishing ownership data for agencies is a positive step toward increased visibility and accountability in the industry. It may also have implications for the broader health care industry, leading to more informed decision-making by patients, providers and policymakers alike.

— Stacie Bratcher, CEO of Jet Health

Editor’s Note: On Tuesday, May 23, Jet Health announced that Larry Nabb would succeed Bratcher as CEO of Jet Health, effective immediately. Bratcher had been in the role since March 2020.

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Selecting a health care provider is an important decision for all patients. Home health and hospice patients deserve the same level of transparency as patients seeking primary care, urgent care, and other health-related services.

As a home health and hospice provider, VitalCaring is constantly looking for opportunities to improve yesterday’s outcomes, and we welcome a level of transparency that allows patients, their families, and their trusted healthcare partners to make an informed decision when it comes to their healthcare. Medicare star ratings for clinical quality and patient satisfaction are good examples of where systems and processes have improved to help patients and their families more quickly and easily identify a high-quality provider. The star rating system has also served as a differentiator for providers to highlight their star rating in the communities they serve. The results have been positive.

As an active acquirer of other high-quality home health and hospice providers, the recent announcement of enhanced transparency and availability of ownership information will allow us to more quickly identify agencies that fit our partner criteria for acquisition or other means. When combined with other publicly available information and our proprietary database of agencies across the country, we can expand our current capabilities and make our efforts more efficient. Similar to the previous efforts by CMS to enhance transparency, I expect the results here will likewise be beneficial.

— Luke James, president at VitalCaring Group

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CMS’ decision to publicly disclose ownership data will have no impact on ProHealth Home Health & Hospice. We have always had to disclose that information to CMS and state regulatory agencies and have no concerns with that information being publicly available. I think it will have a more material effect on companies owned by private equity groups because industry watch groups will be able to more closely monitor and aggregate the quality scores of those companies. The aggregation of that data, depending on the trends shown, will either substantiate or disprove the notion that private equity investment in health care is bad for the public.

— David Lester, CEO of ProHealth Home Health & Hospice