A joint venture between home-based care provider Compassus and the Providence health system has been delayed due an ongoing state review in Oregon.

Compassus in October formed a joint venture with Providence to assume management of its home-based care business lines, with each company owning a 50% stake. Branded as Providence at Home with Compassus, the JV includes 17 hospice and palliative care locations in Alaska, California, Oregon, Texas and Washington state.

The JV is currently undergoing a state review in Oregon following concerns raised by the Oregon Nurses Association, which cited challenges to employment and working conditions, costs of care and patient access in a local news report.

“We respect the regulatory processes in all the communities we seek to enter, and the state of Oregon has a clear process for review of proposed health care transactions,” a Compassus spokesperson told Hospice News in an email. “We are prepared and committed to ensuring any questions or concerns are addressed.”

In addition to hospice and palliative care, the JV also includes home health and private duty nursing. The deal includes 24 of Providence’s home health locations in four states as well as private duty services in southern California.

Compassus, a portfolio company of the private equity firm Towerbrook Capital Partners and the health system Ascension Health, provides home health, home infusion, palliative and hospice care across 30 states. The home-based provider also offers advanced care management and skilled nursing facility-at-home services. Compassus’ 7,000 employees care for more than 120,000 patients annually.

The Oregon Nurses Association recently penned a letter to the Oregon Health Authority following public concerns raised by patients and family members of Providence regarding a lack of continuity of care due to the joint venture with Compassus.

The main concerns are about the potential loss of specialty care services and rural access, according to Myrna Jensen, communication specialist at the Oregon Nurses Association.

“In terms of specialty care, pediatric care has already been cut and we provide services beyond the federally required minimums such as mental health nursing and Augmentative and Alternative Communication (AAC),” Jensen told Hospice News in an email. “Compassus does not provide these services in other areas, and we are concerned with them being eliminated in Oregon after the joint venture. Similarly, rural care is more expensive due to the longer distances our caregivers need to travel to get to patients.”

The nonprofit faith-based Providence health system employs roughly 38,000 nurses, 34,000 physicians and 122,000 caregivers. The health system operates 51 hospitals and 1,000 clinics across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington.

Among other workforce concerns is the potential that Providence employees would no longer be eligible to participate in student-loan forgiveness programs because their new employer is not a nonprofit entity.

The new JV also establishes a new reimbursement system for Providence, which could impact staff wages. The change in reimbursement may also pose limitations in the availability of certain services, and potentially impact retention as well, according to the Oregon Nurses Association.

“Compassus has a pay-per-visit model in most of their other ventures, and these disincentivize rural care.” Oregon Nurses Association representatives said. “[The JV] could lead to reduced services as well as caregiver burnout if they force our members to move to a pay-per-visit model. While pay-per-visit is illegal in the nursing field in Oregon, Oregon law is silent on this model for other specialties like physical therapy, occupational therapy and social work. This is a real concern for our membership.”

Compassus in November notified the Oregon Health Authority about the Providence transaction to seek guidance on its review process, a company spokesperson indicated.

“The joint venture has no plans to discontinue pediatrics in any programs where it is already established. Compassus also provides pediatric care in many of our existing home health markets,” the Compassus spokesperson told Hospice News in an email. “Providence caregivers will retain their current pay practices after the transition to the joint venture. There are no plans to change pay practices for caregivers who are not already on a pay-per-visit schedule.”

The company has taken into consideration that regulatory reviews could extend its anticipated transition timeline, which passed on December 27, the spokesperson stated. 

“Ensuring the well-being of patients and their families, as well as the smooth transition of Providence caregivers to our team, are our top priorities,” the Compassus spokesperson said. “We look forward to a resolution that supports delivering exceptional [care] where patients feel most comfortable — at home.”