Last Visit First

CMS released the CY 2027 Home Health final rule, and the headline is a 2.4% payment increase. But the 3% temporary adjustment is still here, there's no new permanent cut, and the OASIS submission deadline drops from four and a half months to 45 days.

Tom Maxwell brings back Jay Duty, COO of Maxwell TEC, and walks through the free interactive tool he built to make the 490+ page rule easier to digest, with plain-language explanations, page citations, a glossary and rate calculators. Section by section, Jay adds what operators need to know: what the 2.4% really means for your agency, the $4.9 billion PDGM recoupment, outlier and LUPA changes, palliative care under the home health benefit, and the provider enrollment and change-of-ownership rules that could put every license you hold at risk.

Enjoying the show? Please rate and review Last Visit First on Apple Podcasts (https://podcasts.apple.com/us/podcast/last-visit-first/id1830051182) and follow us on Spotify (https://open.spotify.com/show/3iSKGRvHC9Bk3iq7l8UPxs). It takes 10 seconds and helps more home health and hospice leaders find these conversations.

Topics covered:

• Why you shouldn't add the 3% cut, or the full 2.4%, straight into your budget
• No permanent adjustment, the outlier ratio drops to 0.29, and LUPA thresholds move
• The new 45-day OASIS deadline and the 2% penalty for missing it
• Palliative care: homebound status and a skilled need are still required
• Retroactive revocation, change of ownership, 855A and fingerprinting risks

Explore the 2027 Final Rule interactive tool: https://hhfinalrule27.lovable.app

Connect with Maxwell TEC: https://www.maxwelltec.com

Chapters:

• 0:00 Intro: Jay Duty on the 2027 final rule
• 1:11 The free interactive final rule tool
• 2:22 The 2.4% increase and the 3% temporary cut
• 5:40 No permanent adjustment, outliers and payment update
• 9:20 PDGM, the $4.9B recoupment and behavioral adjustment
• 11:37 Case-mix, LUPA thresholds and wage index
• 15:08 Palliative care, OASIS deadline and quality reporting
• 19:54 Value-based purchasing and DME
• 21:32 Enrollment risk: revocation, ownership and 855A
• 28:41 Hospice changes and the agency impact calculator
• 30:44 How to reach Jay and Maxwell TEC

Check out Last Visit First on other platforms:

• Apple Podcasts: https://podcasts.apple.com/us/podcast/last-visit-first/id1830051182
• Spotify: https://open.spotify.com/show/3iSKGRvHC9Bk3iq7l8UPxs
• Website: https://lastvisitfirst.com
• YouTube: https://www.youtube.com/@lastvisitfirstpodcast
• LinkedIn: https://www.linkedin.com/company/last-visit-first

Sponsors:

• Maxwell TEC: https://www.maxwelltec.com

Paul Kusserow took over Amedisys when it was under a Corporate Integrity Agreement, carrying heavy debt, fighting activist shareholders and trading at a low. He spent about a week a month in the field, scrapped a nearly $100 million in-house software build, cut nurse turnover from the 40s to 15%, raised quality to 4.8 stars, and grew Amedisys into the third-largest hospice provider before UnitedHealth's Optum acquired it.

Now Executive Chairman and CEO of Careforth, Paul sits down with Tom Maxwell to talk about what actually fixes home health and hospice: why payers bought the industry's biggest home health companies, how Careforth cares for nursing-home-eligible patients at home for $45 to $60 a day, the ESRD and dialysis rule that keeps patients out of hospice, what Medicare Advantage gets wrong about care in the home, and why he believes healthcare will change more in the next five years than in the last hundred.

Topics covered:

• The Amedisys turnaround: people first, turnover and quality
• The $100M software mistake and letting employees choose the EMR
• The economics of the golden rule
• Family caregiving, Medicare Advantage and the hospice rules that need to change
• AI, administrative waste and the $5.8 trillion US healthcare economy

Connect with Paul:

• Careforth: https://careforth.com
• Unified Women's Healthcare: https://unifiedwomenshealthcare.com/
• Website: https://www.paul-kusserow.com/

Chapters:

• 0:00 Welcome Paul Kusserow, former Amedisys CEO
• 1:44 From a Vermont farm to McKinsey, Tenet and Humana
• 5:19 Inside the Amedisys turnaround
• 7:20 Cutting nurse turnover from the 40s to 15%
• 10:20 The $100M software mistake and choosing HCHB
• 14:58 The economics of the golden rule
• 17:43 Careforth: nursing-home-level care at home for $45-$60 a day
• 19:46 Sponsor Break
• 21:43 The hidden cost of family caregiving
• 24:03 Dialysis, ESRD and the hospice rule that makes no sense
• 27:20 Fraud, the look-back rule and consolidation
• 31:18 Why home health hasn't used EMTs and paramedics
• 34:43 What Medicare Advantage gets wrong about home care
• 42:15 Sponsor Break
• 44:55 Late hospice referrals and dementia live discharges
• 46:57 AI, admin waste and the $5.8 trillion healthcare economy
• 51:30 How healthcare gets fixed, and a 30-year life expectancy gap
• 54:01 Food is medicine: PurFoods
• 56:28 Paul's legacy and why home care's best days are ahead

Check out Last Visit First on other platforms:

• Apple Podcasts
• Spotify
• YouTube
• Website
• LinkedIn

Sponsors:

• Premier Sponsor: Homecare Homebase
• Premier Sponsor: Trella Health
• StenoHealth
• Maxwell TEC
• IntellaTriage

Anne Karber grew up poor in South Dakota and spent years chasing freedom through money. She helped build a multi-million dollar construction company and got the big house and the Mercedes, and she says she had never been more miserable. When her sister died giving birth to her fourth child, Anne had no idea how to carry the grief. She spent the next 18 months numbing it with alcohol before she went looking for help. Ten years sober, she's now an author, mentor and the host of the Let's Get Naked podcast.

In this episode, Anne sits down with Tom Maxwell to talk about the conversations most families avoid. She explains why she tells people to "keep death close," why forgiveness is for you and not the other person, and how to leave nothing unsaid. She also shares her Skittles theory of energy, why caregivers can't give from an empty tank, and the one-word trick that stops judgment in its tracks.

Enjoying the show? Please rate and review Last Visit First on Apple Podcasts and follow us on Spotify. It takes 10 seconds and helps more home health and hospice leaders find these conversations.

Topics covered:

• Why money and success didn't bring happiness
• Losing her sister, and what grief taught her about emotional intelligence
• "Keep death close" and having the hard conversations now
• The Skittles theory: energy, burnout and caregivers
• Forgiveness, unfinished business and legacy

Connect with Anne:

• Website
• Let's Get Naked Podcast
• The Life Hack Playbook

Chapters:

• 0:00 Welcome Anne Karber, author and host of Let's Get Naked
• 1:38 From construction to podcasting
• 6:53 Why money doesn't equal happiness
• 9:30 Losing her sister and 18 months of numbing the grief
• 16:40 "Keep death close": leaving nothing unsaid
• 19:38 Sponsor Break
• 21:55 Wellness and "show me the receipts"
• 25:46 How to stop judging people: the "tree" trick
• 30:06 Why she named it Let's Get Naked
• 31:48 Why everyone struggles to talk about death
• 34:43 Aging parents and the "cheerleader from Arizona"
• 35:56 Hospice, and a good death versus a bad death
• 38:03 Grief, the "granddaddy" of emotions
• 40:41 Sponsor Break
• 42:31 The Skittles theory and caregiver burnout
• 48:52 Unfinished business: forgiveness and the hot brick
• 53:36 Anne's legacy and what's next
• 59:41 How to find Anne and her book

Last Visit First on other platforms:

• Apple Podcasts
• Spotify
• YouTube
• Website
• LinkedIn

Sponsors:

• Premier Sponsor: Homecare Homebase
• Premier Sponsor: Trella Health
• Maxwell TEC
• IntellaTriage

In 2009, Heath Bartness was a 20-something nursing home administrator with an idea: hospice could be done better. His owners agreed to fund it, with one condition. He had two years to succeed, and if it didn't work out, he'd come back and run a nursing home for them. The goal was 50 patients. Today, St. Croix Hospice serves nearly 8,000 patients across 10 states and more than 100 locations, making it one of the largest hospice organizations in the country.

In this episode, Heath sits down with Tom Maxwell to talk about how St. Croix grew without losing what made it work. He tells the story of the $20 minimum wage that gave one nursing assistant an $8 raise and "changed our life." He also explains why he once called music therapy "hocus pocus," what a social worker taught him about the value of a visit, why so many families still call hospice too late, and what he'd tell CMS if he had them in a room with no lobbyists.

Enjoying the show? Please rate and review Last Visit First on Apple Podcasts and follow us on Spotify. It takes 10 seconds and helps more home health and hospice leaders find these conversations.

Topics covered:

• Founding St. Croix Hospice with a two-year deadline
• Culture, and why "we have to be the best" is the only absolute
• Music therapy and the value of every visit
• Raising the minimum wage to $20 an hour
• Why families elect hospice late, and the role of primary care
• AI in hospice, and what St. Croix looks like in 2035

Connect with Heath:

• St. Croix Hospice
• Heath's LinkedIn

Chapters:

• 0:00 Welcome Heath Bartness, founder & CEO of St. Croix Hospice
• 2:01 Why "St. Croix"? The river and the holy crossing
• 2:49 From nursing home administrator to hospice founder
• 6:06 From a goal of 50 patients to 8,000 in 10 states
• 8:20 The patients and stories he'll never forget
• 14:44 Sponsor Break
• 16:12 Scaling St. Croix and hospice as a calling
• 20:16 Letting go: name badges and paper clips
• 24:07 The one thing St. Croix will never change
• 27:24 The decision he got wrong: music therapy
• 31:07 Why nursing is the best career: "When I go see Ethel, she smiles"
• 35:06 Sponsor Break
• 37:15 "You have changed our life": the $20 minimum wage
• 42:07 Why families call hospice too late
• 50:45 Mentors, boards and private equity in hospice
• 1:04:17 What Heath would tell CMS: moments of joy over comfortably numb
• 1:09:47 AI in hospice and St. Croix in 2035
• 1:13:36 Legacy, and how to reach St. Croix Hospice

Last Visit First on other platforms:

• Apple Podcasts
• Spotify
• YouTube
• Website
• LinkedIn

Sponsors:

• Premier Sponsor: Homecare Homebase
• Premier Sponsor: Trella Health
• Maxwell TEC
• IntellaTriage

Homecare Homebase President Luke Rutledge joins Last Visit First on the floor of the 2026 HCHB Users Conference in Orlando, the biggest in the event's 20-year history with about 600 attendees. Luke shares what customers are talking about most: AI that is meaningful, that improves clinicians' lives and automates back-office work, and how that drives HCHB's strategy with both its partners and its own new products.

Luke highlights Curate: Scribe, now in the hands of clinicians with three customers live and 15 more signed up, and tells the story of a pilot customer whose clinicians pushed to turn the tool back on after it was paused. He also talks about the leadership team coming together at Homecare Homebase, the conference's headline party, and how to reach him and the HCHB team.

Chapters:

• 0:00 Welcome: Luke Rutledge, President of Homecare Homebase
• 0:52 What Customers Are Talking About: AI That Matters
• 1:31 Curate: Scribe Goes Live
• 2:50 When Clinicians Pushed to Turn Curate: Scribe Back On
• 3:40 Building the HCHB Leadership Team

Connect with Luke: https://www.linkedin.com/in/luke-rutledge-19407664

Connect with Homecare Homebase: https://hchb.com/

Sponsors:

Brought to you as a Premier Sponsor collaboration with Homecare Homebase (HCHB). Homecare Homebase helps home-based care organizations prepare for what’s next.

Home-based care is changing. Is your technology keeping up?

Growing operational demands, workforce pressures, regulatory change, and emerging technology are reshaping what organizations need from their technology partners. The question isn’t only what your technology can do today. It’s whether it can help you prepare for what’s next. Explore why now may be the right time to take a fresh look at your technology strategy with HCHB at https://lastvisitfirst.com/go/hchb.

Alicia Bowman of The Pennant Group closes out Last Visit First's coverage of the 2026 HCHB Users Conference. Alicia shares what has kept Pennant busy this year, including the final wave of its LHC and Amedisys acquisitions in Tennessee, Alabama and Georgia, and how Pennant is testing Curate: Scribe with a group of clinicians ahead of a pilot this November.

Alicia also talks about why transparency is at the heart of Pennant's partnership with Homecare Homebase, how Pennant's local operating model works, and why the best healthcare is delivered locally. Plus, her take on the hospice addendum, why it will be a giant operational lift, and how agencies and clinicians can connect with Pennant.

Chapters:

• 0:00 Welcome: Alicia Bowman of The Pennant Group
• 0:17 Pennant's Final Wave of LHC and Amedisys Acquisitions
• 0:48 Testing Curate: Scribe at Pennant
• 3:54 Pennant's Local Operating Model
• 4:45 The Hospice Addendum: A Giant Operational Lift

Connect with Alicia: https://www.linkedin.com/in/alicia-bowman-37a114183

Connect with The Pennant Group: https://pennantgroup.com/

Sponsors:

Brought to you as a Premier Sponsor collaboration with Homecare Homebase (HCHB). Homecare Homebase helps home-based care organizations prepare for what’s next.

Home-based care is changing. Is your technology keeping up?

Growing operational demands, workforce pressures, regulatory change, and emerging technology are reshaping what organizations need from their technology partners. The question isn’t only what your technology can do today. It’s whether it can help you prepare for what’s next. Explore why now may be the right time to take a fresh look at your technology strategy with HCHB at https://lastvisitfirst.com/go/hchb.

April Anthony, Chairman and CEO of VitalCaring and founder of Homecare Homebase, returns to Last Visit First live from the 2026 HCHB Users Conference, her first in six years. April shares why this is such a transformative moment for home health, and how VitalCaring is rolling out Curate: Scribe carefully, working closely with HCHB and pre-training clinicians to narrate their visits before the tool even arrives.

April explains why she sees Curate: Scribe as perhaps the most exciting thing Homecare Homebase has done: bringing guidance on OASIS answers and coding to the point of care, and why VitalCaring chooses not to store visit transcripts. She also talks about VitalCaring's return to acquisitions, including Traditions Health and Carter Healthcare, looks back on 26 years of Homecare Homebase, and shares why the coming baby boomer wave makes the next 30 years the biggest opportunity home care has ever had.

Chapters:

• 0:00 Welcome: April Anthony, Chairman and CEO of VitalCaring
• 2:00 Rolling Out Curate: Scribe at VitalCaring
• 3:38 Guidance on OASIS and Coding at the Point of Care
• 5:50 Why VitalCaring Doesn't Store Transcripts
• 7:02 Back in Acquisition Mode
• 8:43 26 Years of Homecare Homebase

Connect with April: https://www.linkedin.com/in/april-anthony-95bab1213

Connect with VitalCaring: https://vitalcaring.com/

Sponsors:

Brought to you as a Premier Sponsor collaboration with Homecare Homebase (HCHB). Homecare Homebase helps home-based care organizations prepare for what’s next.

Home-based care is changing. Is your technology keeping up?

Growing operational demands, workforce pressures, regulatory change, and emerging technology are reshaping what organizations need from their technology partners. The question isn’t only what your technology can do today. It’s whether it can help you prepare for what’s next. Explore why now may be the right time to take a fresh look at your technology strategy with HCHB at https://lastvisitfirst.com/go/hchb.

IntellaTriage CEO Daniel Reese joins Last Visit First live from the 2026 HCHB Users Conference in Orlando to share what is new at IntellaTriage, including upcoming AI initiatives designed to help its nurses document more consistently and deliver higher-quality triage to patients and families. Daniel also talks about what he is hearing from agencies at the conference, from the impact of the moratorium on growth strategies to the push to use every resource as efficiently as possible.

Daniel and Tom reflect on 20 years of the Homecare Homebase Users Conference and the wave of baby boomers reaching Medicare age, and Daniel explains how IntellaTriage has grown beyond after-hours, nurse-first triage into 24/7 coverage and daytime care team coordination. With nearly 450 nurses and plans to hire about 300 more this year, IntellaTriage is on the flip side of the nursing shortage, helping providers keep up with growing workloads.

Chapters:

• 0:00 Welcome: Daniel Reese, CEO of IntellaTriage
• 0:47 What's New at IntellaTriage: Upcoming AI Initiatives
• 1:25 The Moratorium and Doing More with Less
• 4:09 What IntellaTriage Does: Nurse-First Triage, 24/7
• 4:57 Hiring 300 Nurses This Year

Connect with Daniel: https://www.linkedin.com/in/dreesemba

Connect with IntellaTriage: https://intellatriage.com/

Sponsors:

Brought to you as a Premier Sponsor collaboration with Homecare Homebase (HCHB). Homecare Homebase helps home-based care organizations prepare for what’s next.

Home-based care is changing. Is your technology keeping up?

Growing operational demands, workforce pressures, regulatory change, and emerging technology are reshaping what organizations need from their technology partners. The question isn’t only what your technology can do today. It’s whether it can help you prepare for what’s next. Explore why now may be the right time to take a fresh look at your technology strategy with HCHB at https://lastvisitfirst.com/go/hchb.

Steno Health Co-founder and CEO Dr. Alex Milani joins Last Visit First at the 2026 HCHB Users Conference to talk about Curate: Scribe, the ambient AI documentation tool powered by Steno and embedded directly inside Homecare Homebase. Alex shares that the product is now officially live, with a waiting list of about 18 agencies set to onboard, and walks through how it works: summarizing referral documents before the visit, recording the conversation in the home, and a quick debrief in the car that fills in the chart.

Alex also explains why Curate: Scribe is a copilot, not an autopilot, how clinicians learn to narrate their visits during the first few weeks, and the time savings agencies are seeing, around 30 to 40 minutes on a start of care and 5 to 20 minutes on other visits. Plus, what is next for Steno, including ICD-10 coding, OASIS QA review and patient insights, and how AI is speeding up product development.

Chapters:

• 0:00 Welcome: Dr. Alex Milani, CEO of Steno Health
• 0:31 Curate: Scribe, Powered by Steno, Is Officially Live
• 1:31 How Curate: Scribe Works During a Home Visit
• 2:06 Copilot, Not Autopilot
• 3:33 Time Savings: 30-40 Minutes on a Start of Care
• 6:11 What's Next for Steno

Connect with Alex: https://www.linkedin.com/in/alexandermilani

Connect with Steno Health: https://www.stenohealth.com/

Sponsors:

Brought to you as a Premier Sponsor collaboration with Homecare Homebase (HCHB). Homecare Homebase helps home-based care organizations prepare for what’s next.

Home-based care is changing. Is your technology keeping up?

Growing operational demands, workforce pressures, regulatory change, and emerging technology are reshaping what organizations need from their technology partners. The question isn’t only what your technology can do today. It’s whether it can help you prepare for what’s next. Explore why now may be the right time to take a fresh look at your technology strategy with HCHB at https://lastvisitfirst.com/go/hchb.

Debbie Compton planned to retire from her corporate career. Instead, she spent 21 years as a family caregiver for three loved ones with three different diseases: her father with Parkinson's, her mother with vascular dementia, and her mother-in-law with Alzheimer's. Today she is the founder of The Purple Vine, a certified caregiving consultant and advocate, and the author of multiple international bestselling books for caregivers.

In this episode, Debbie sits down with Tom Maxwell to share the hard-won lessons nobody teaches family caregivers: why you should never argue with someone living with dementia, how music therapy can bring back precious moments, how to choose a memory care facility, and why families so often call hospice far too late.

Enjoying the show? Please rate and review Last Visit First on Apple Podcasts and follow us on Spotify. It takes 10 seconds and helps more home health and hospice leaders find these conversations.

Topics covered:

• Leaving corporate life to become a full-time caregiver
• Why you can't rationalize with an irrational brain
• Separating your loved one from the disease
• Music therapy, coloring and other tools that actually work
• Choosing memory care, and letting go of the guilt
• Why families should call hospice sooner
• Caregiver burnout, humor and gratitude

Connect with Debbie:

• Website
• LinkedIn

Chapters:

• 0:00 Welcome Debbie Compton to the show
• 1:38 From corporate career to full-time caregiver
• 5:40 The warning sign behind her mom's vascular dementia
• 7:38 Getting a stubborn parent to accept help
• 9:05 Parkinson's symptoms nobody talks about
• 14:59 Sponsor Break
• 16:28 Creating dementia-friendly coloring book
• 20:49 Dementia isn't rational: separate the person from the disease
• 22:41 Tom's dad, a wrong-way drive and a giant pizza
• 24:47 When your loved one doesn't recognize you
• 26:05 Music therapy and Johnny Cash's Ring of Fire
• 28:19 Her first book: Caregiving: How to Hold on While Letting Go
• 29:19 Handling the "loop-de-loop" of repeated questions
• 30:57 Sponsor Break
• 33:06 Certified caregiving consultant vs. caregiving advocate
• 38:03 Why arguing makes dementia progress faster
• 39:25 Choosing a memory care facility
• 42:42 Memory care let her be a daughter again
• 44:03 Why families call hospice too late
• 47:11 Social workers, chaplains and aides on the hospice team
• 49:38 The Caregiver's Advocate bestseller series
• 55:55 Where the name "The Purple Vine" comes from
• 59:28 How to reach Debbie and buy her books
• 1:04:24 What "Last Visit First" means to Debbie

Check out Last Visit First on other platforms:

• Apple Podcasts
• Spotify
• YouTube
• Website
• LinkedIn

Sponsors:

• Premier Sponsor: Homecare Homebase
• Premier Sponsor: Trella Health
• Maxwell TEC
• IntellaTriage