The Top 10 Hospice News Stories of 2021

This year was transformational for the hospice space. The industry took its first steps towards value-based payment through the hospice component of the value-based insurance design model, or Medicare Advantage hospice carve-in. Providers also saw an overhaul of the U.S. Centers for Medicare & Medicaid Services’ (CMS) survey process, all while contending with COVID-19 headwinds and worsening labor pressures.

Nevertheless, two themes dominated in terms of the information providers sought from Hospice News: COVID-19 vaccines and massive acquisitions as industry consolidation continues to accelerate.

The following are the most-read Hospice News articles of 2021.

1. Brookdale to Sell Majority Hospice, Home Health Stake to HCA Healthcare in $400 Million Deal (Feb. 24)

Early in the year, a struggling Brookdale Senior Living Inc. (NYSE: BKD) sold an 80% stake in its hospice, home health and outpatient therapy business to hospital system HCA Healthcare (NYSE: HCA). Brookdale retained a 20% interest through a joint venture with HCA.

The hospice M&A market has been hot for several years, and that trend is not abating. This deal was among the largest of 2021, and it marked the entry of a large hospital industry player into the hospice and home health arena.

But the story didn’t end there. In September, LHC Group (NASDAQ: LHCG) purchased the former Brookdale home health and hospice locations that lie outside HCA’s service area, which is concentrated in the Florida market. The transaction included 11 hospice, 23 home health and 13 therapy locations in 22 states. LHC Group expects these assets to generate nearly $146 million annually, but the sale price was not disclosed.

2. Top 10 Largest Hospice Providers of 2020 (Feb. 11)

The annual listing from LexisNexis of the largest hospices by market share typically attracts a good number of readers who are eager to size up their top competitors on a national scale.

VITAS Healthcare, a subsidiary of Chemed Corp. (NYSE: CHE), remained the largest provider in the United States last year, with 4.42% of market share. Kindred Healthcare ranked second nationwide with 2.86%, followed by HCR Manorcare at 2.16%, Amedisys Inc. (NASDAQ: AMED) at 2.09%, and Seasons Hospice & Palliative Care (1.62%) in the top five.

The report does not reflect the 2019 acquisition of Compassionate Care Hospice by Amedisys, as it lists these organizations as two separate companies. According to LexisNexis, this will be updated in next year’s report and could influence the company’s rankings.

3. Top Hospice Trends to Watch in 2021 (Jan. 1)

This annual editorial is designed to give providers a heads up on the most significant forces that will influence the hospice space in the coming year. For 2021, Hospice News identified growth in telehealth, a drive towards upstream care, more movement in to the hospice space by non-traditional investors, a rise in community-based palliative care, and an emerging movement to change the national conversation about death and dying as key trends.

For 2022, Hospice News called out pandemic-related uncertainty, private equity investment (with greater regulation), the growing importance of Medicare Advantage, the staffing shortage, and diversity, equity and inclusion.

4. CMS, OSHA Issue Vaccine Mandate for All Health Care Workers
(Nov. 4)

Hospice providers were thirsty for information about the complex matter of COVID-19 vaccine mandates. Many providers welcomed the additional layer of protection for employees and patients and families, while also wringing their hands about the potential of losing more staff. They also had to weigh the question of their employees’ personal choices and where and how employers could step in.

As expected, the mandates have been challenged in the courts, and the ultimate outcome remains uncertain. Most likely, the U.S. Supreme Court will have to weigh in, while hospices and other health care organizations wait in limbo.

5. Humana Set to Make Bank on Kindred at Home Hospice Spin Off, Sale (June 22)

Humana Inc.’s (NYSE: HUM) deal to acquire 100% ownership of home health and hospice company Kindred at Home was one of the largest transactions in the sector during 2021. The insurance giant has plans to spin off and sell the hospice segment of the business, which stands to be quite lucrative in light of the record-high valuations in the space. Humana also expects to see substantial cost savings through reduced hospitalizations and skilled nursing admissions as more care moves into the home.

Humana had acquired a 40% stake in Kindred at home in 2018, with private equity firms Welsh, Carson, Anderson & Stowe and TPG Capital holding the remaining 60%. The company bought out its partners this year for a total consideration of $8.1 billion. This includes Humana’s existing equity value of $2.4 billion from its existing 40% ownership of the business.

6. BrightSpring Moves Into Hospice Space with Abode Healthcare Acquisition (Feb. 24)

The hospice market saw a substantial new player enter the space with Louisville, Ky.-based BrightSpring’s purchase of Abode Healthcare from Summit Partners with a reported valuation of $775 million. The transaction is projected to bring the combined company roughly $6 billion in annual revenue.

BrightSpring’s total value currently rests at approximately $10 billion. Brightspring is a portfolio company of the global investment and private equity firm KKR & Co., which purchased the company in 2018 for approximately $1.32 billion.

In October, the company announced that it would soon go public and begin trading on the NASDAQ.

7. HCA Healthcare to ‘Aggressively Grow’ Brookdale Hospice, Home Health Post-Sale (Feb. 25)

The sale of Brookdale’s home health and hospice assets to HCA Healthcare was Hospice News’ most-read story of 2021. This follow up went into more detail about what the hospital system planned to do with its new purchase.

Brookdale and HCA pledged significant health care services expansion both within facility walls and among the larger community-based patient population. The joint venture between these two companies later sold many of the former Brookdale locations to LHC Group, but nevertheless plans for growth in markets within the HCA service region.

8. California Passes Major Hospice Reform Laws (Oct. 5)

The California legislature passed two bills in October designed to strengthen regulatory oversight of hospices. State legislators began pursuing these bills — Senate Bill 664 and Assembly Bill 1280 — following a Los Angeles Times investigation into alleged misconduct among California hospice providers.

The Times reported that the number of providers operating in the state has ballooned during the past several years, particularly among for-profit companies. This rapid expansion has contributed to rising instances of fraud and negligence, according to the Times, which also cited a “cottage industry” of kickbacks and deceptive practices.

The new laws include a moratorium on new hospice provider licenses as well as an extensive audit of California’s licensing and oversight processes.

9. Federal Judge Suspends CMS Vaccine Mandate Nationwide (Nov. 30)

The potential federal vaccine mandate for health care workers is one of the most-watched and most contentious issues that Hospice News covered in 2021. The U.S. Supreme Court today set dates for oral arguments to decide the ultimate fate of these requirements. The outcome of these cases will have a substantial impact on every single hospice provider in the nation — for better or worse.

10. Film ‘The Elephant in the Room’ Shines a Light on Palliative Care (Jan. 3)

Rounding out the Top 10 is this atypical story by reporter Holly Vossel from the first week of the year. The article features conversations with the filmmakers behind “The Elephant in the Room,” which is based on true stories of palliative care providers. 

In turns heartwarming and heartbreaking, the film gave viewers an inside view into the benefits that palliative care offers patients and the emotional toll that it can have on those who provide it. Hospices News typically does not cover film or entertainment, but given that public misperception is among the largest barriers standing between patients and palliative care, anything that can help people better understand these services merits attention.