Last Visit First

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
• Connect with Scott Tapp: https://linkedin.com/in/scotttapp
• Connect with Carter Bakkum: 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.

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

Connect with Jonathan Porter:

• [email protected]

Sponsors:

• Premier Sponsor: Trella Health: ⁠https://trellahealth.com/⁠
• Premier Sponsor: Homecare Homebase: ⁠https://hchb.com/⁠
• Maxwell TEC: ⁠https://maxwelltec.com/⁠
• StenoHealth: ⁠https://www.stenohealth.com/⁠
• IntellaTriage: ⁠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.

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

Careers at Compassus:

• https://www.compassus.com/careers

Sponsors:

• Premier Sponsor: Trella Health: https://trellahealth.com/
• Premier Sponsor: Homecare Homebase: https://hchb.com/
• Maxwell TEC: https://maxwelltec.com/
• StenoHealth: https://www.stenohealth.com/
• IntellaTriage: 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.

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
• Spotify: https://open.spotify.com/show/3iSKGRvHC9Bk3iq7l8UPxs
• YouTube: https://www.youtube.com/@lastvisitfirstpodcast
• Website: https://www.lastvisitfirst.com
• LinkedIn: https://linkedin.com/company/last-visit-first

Check out our sponsors:

• Premier Sponsor: Trella Health: https://trellahealth.com/
• Premier Sponsor: Homecare Homebase: https://hchb.com/
• Maxwell TEC: https://maxwelltec.com/
• StenoHealth: https://www.stenohealth.com/
• IntellaTriage: https://intellatriage.com/

Connect with David and The Vistria Group:

• https://vistria.com/contact/

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
• Spotify: https://open.spotify.com/show/3iSKGRvHC9Bk3iq7l8UPxs
• YouTube: https://www.youtube.com/@lastvisitfirstpodcast
• Website: https://www.lastvisitfirst.com
• LinkedIn: https://linkedin.com/company/last-visit-first

Check out our sponsors:

• Premier Sponsor: Trella Health: https://trellahealth.com/
• Premier Sponsor: Homecare Homebase: https://hchb.com/
• Maxwell TEC: https://maxwelltec.com/
• StenoHealth: https://www.stenohealth.com/
• IntellaTriage: https://intellatriage.com/

Connect with Dr. Lanz:

• LinkedIn: https://www.linkedin.com/in/katylanz/
• LifePlans: https://www.ourlifeplans.com/

"It is not a transparency tool, it is a targeting system."

On April 2, 2026, CMS released the FY 2027 Hospice Proposed Rule, and the message is clear: the days of flying under the radar are over. While many are focusing on the 2.4% payment increase, Tom Maxwell reveals why that "raise" is actually just a break even point against inflation.. More importantly, he explains why the new SSVI (Service and Spending Variation Index) is the real story you need to be watching.

In this episode, we connect the dots between the new 16 point "report card" and "Operation Never Say Die", which was the FBI’s massive fraud takedown that landed the same week as this rule. If your hospice scores high on the SSVI, you aren't just getting a grade; you’re getting a target on your back for audits and revocations.

What you’ll learn in this breakdown:

• The 16 Point Grading Scale: Learn why Measure 9 (non hospice spending) carries half the total weight and how to audit your patterns before CMS does.
• The FBI Factor: Understand the details behind the $60 million fraud scheme in LA and why CMS is expanding oversight to Georgia, Ohio, Arizona, and beyond.
• The "Red X" Penalty: See how failing to submit quality data in 2026 will lead to a public non compliance icon on Medicare.gov by 2028.
• October 2026 Deadlines: Discover the mandatory workflow changes you must implement for the new Election Statement Addendum.

Chapters:

• 00:00 Overview of the 2027 Hospice Proposed Rule
• 02:47 Payment Increase and Its Implications
• 05:15 Introduction of the SSVI Report Card
• 08:13 Impact of Fraud and Enforcement Actions
• 10:38 Operational Changes and Compliance Requirements
• 13:30 Preparing for Future Changes and Public Comments
• 16:31 Outro

Don't wait for the final rule in August to start adjusting your intake and clinical documentation. Watch now to learn how to protect your PTN and keep your hospice out of the "DANGER ZONE."

Get Involved:

• The public comment period is open until June 1, 2026. Tom shares how you can collaborate with Maxwell TEC and your peers to impact the final ruling.

Connect with Tom Maxwell:

• Email: [email protected]
• Podcast Website: www.lastvisitfirst.com

Connect with Maxwell TEC:

• Website: www.maxwelltec.com
• Email: [email protected]

#hospicecare #HospiceUpdate #cms #hospice #SSVI #lastvisitfirst #HospiceLeadership #HospiceOperations #HospiceCompliance #medicarefraud #OperationNeverSayDie #HospiceOversight #healthcarefraud #postacutecare #palliativecare #homehealthcare #healthpolicy #MaxwellTEC #healthcareinnovation #audits #droz #houseoversightcommittee #medicaid #medicare #healthcarepodcast

Is the ER where healthcare begins to fail, or just where chronic disease finally runs out of time? In this episode of the Last Visit First podcast, host Tom Maxwell sits down with Dr. Danielle Kelvas—a physician entrepreneur, medical marketing leader, and the Chief Medical Marketing Officer for Credential Network.

Dr. Kelvas brings her frontline experience from emergency medicine, family medicine, and concierge clinics to discuss the massive disconnect between the "business" of healthcare and actual patient care. Tom and Dr. Kelvas dive deep into the unseen bottlenecks crippling the industry, from the absurdly inefficient credentialing process keeping nurses and doctors off the floor, to the crushing student loan debt reshaping the future of medical professionals.

Plus, expect some wild, laugh-out-loud ER stories (yes, there is a cockroach involved), a candid look at why "loneliness" is treated as a medical emergency, and a fascinating breakdown of how AI is already transforming patient outcomes in speech pathology, ultrasound interpretation, and rural prescribing.

Whether you work in home health, hospice, or are just curious about the future of medicine, this episode is packed with unfiltered truths and actionable insights.

What you’ll learn in this episode:

• How a global medical mission trip shaped Dr. Kelvas’s communication skills.
• The massive inefficiencies in medical credentialing and how Credential Network is fixing it.
• Why the shift in graduate loan policies is a double-edged sword for mid-level providers.
• Why the USMLE Step 1 going pass/fail is controversial among program directors.
• The reality of the ER: Why it's a catch-all for systemic healthcare failures.
• How home health and hospice agencies can better prevent avoidable hospital readmissions.
• The real-world impact of AI in healthcare, from Doctronic to AI-assisted ultrasounds.

Chapters:

• 00:00 Introduction to Dr. Danielle Kelvas
• 05:25 Transitioning from Medicine to Medical Marketing
• 11:16 The Healthcare Credentialing Crisis
• 20:41 The Financial Hemorrhage of Medical Student Debt
• 25:03 The Pass/Fail Dilemma in Medical Training
• 36:48 Health Literacy & Crazy ER Stories
• 45:23 Why Loneliness Presents as a Medical Emergency
• 49:14 Keeping Patients Out of the ER (Assessing Stability)
• 54:41 Why Continuity of Care is Broken
• 01:06:20 AI in Healthcare: A Tool for Progress, Not Fear
• 01:14:28 Building a Medical Consulting Firm
• 01:21:03 The Legacy of a Physician

Connect with Dr. Danielle Kelvas:

• LinkedIn: https://linkedin.com/in/danielle-kelvas-md-488936186
• Email: [email protected]
• DKMD Consulting: https://dkmdconsulting.com/
• Credential Network: https://credentialnetwork.com/

Special thank you to our sponsors:

• Premier Sponsor: Trella Health: https://trellahealth.com/
• Premier Sponsor: Homecare Homebase: https://hchb.com/
• Maxwell TEC: https://maxwelltec.com/
• StenoHealth: https://www.stenohealth.com/
• IntellaTriage: https://intellatriage.com/

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
• YouTube: https://www.youtube.com/@lastvisitfirstpodcast
• Website: https://www.lastvisitfirst.com
• LinkedIn: https://linkedin.com/company/last-visit-first

#lastvisitfirst #healthcareai #clinicaldocumentation #hospicecare #homehealthcare #emergencyroom #nursing #physician #healthtechnologyinnovator #healthtech #innovation #podcast #healthcarepodcast #emergencymedicine #medicalmarketing #medicalpodcast

This episode is a deep dive into the biggest technical shift in the history of home-based care. Tom Maxwell sits down with Dr. Alex Milani, the MD/MBA power-player behind Steno Health, to break down their massive new integration with HomeCare HomeBase.

Documentation is the #1 reason for clinician burnout. Between the rigidity of OASIS and the hours spent "pajama documenting" at night, the industry is losing its best people. Dr. Milani explains how ambient "clinical intelligence" is changing the game—acting as a co-pilot that listens in the background, pre-populates complex forms, and gives nurses up to 50% of their time back.

Key discussion points:

• The HCHB Integration: How Steno Health is being deployed at scale to 195,000 clinicians.
• Ending "Pajama Documentation": Moving from 2005-era "click-click-click" charting to real-time clinical capture.
• The "Angel on the Shoulder": How AI serves as a safety net for high-risk cases like CHF and fall prevention.
• Patient Literacy: Breaking communication barriers with support for 80+ languages.
• The Future of the Role: Why AI won't replace clinicians, but will replace those who refuse to use it.

Chapters:

• 00:00 Introduction to Steno Health and AI in Home Care
• 01:57 Reducing Documentation Burden with AI
• 04:32 Enhancing Clinical Documentation Efficiency
• 07:45 The Future of Clinical Intelligence
• 13:26 Alex Milani's Journey: From Medicine to Entrepreneurship
• 15:35 Steno Health's Unique Position in the Market
• 19:03 Addressing Language Barriers in Home Health
• 20:59 Popular Features and Overcoming Skepticism
• 24:45 Combating Burnout in Healthcare Professionals
• 26:08 Future Roadmap and Innovations
• 26:53 The Role of AI in Healthcare Documentation
• 28:19 AI's Impact on Radiology and Job Dynamics
• 31:28 Building a High-Performance Team
• 33:47 Navigating the Rapid Evolution of AI Tools
• 38:12 The Importance of Effective Onboarding in Home Health
• 41:57 Service Codes and Flexibility in Home Health Documentation
• 45:15 Enhancing Patient Care Through Better Communication
• 49:25 Future Prospects and Industry Changes

Special thank you to our sponsors:

• Premier Sponsor: Trella Health: https://trellahealth.com/
• Premier Sponsor: Homecare Homebase: https://hchb.com/
• Maxwell TEC: https://maxwelltec.com/
• StenoHealth: https://www.stenohealth.com/
• IntellaTriage: https://intellatriage.com/

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
• YouTube: https://www.youtube.com/@lastvisitfirstpodcast
• Website: https://www.lastvisitfirst.com
• LinkedIn: https://linkedin.com/company/last-visit-first

DISCLAIMER

The investment or stock-related information discussed or referenced in this podcast is provided for informational and educational purposes only and should not be considered financial, investment, or trading advice. The views and opinions expressed by participants are their own and may not reflect the views of any affiliated organizations.

Content discussed may not be suitable for all investors. Each participant may or may not hold positions in securities referenced during the discussion. Individuals and organizations associated with the participants may serve different clients with varying objectives, risk tolerances, investment horizons, and strategies.

As a result, such entities may maintain positions or viewpoints regarding specific securities, markets, or sectors that differ from those expressed in the discussion. Viewers and listeners should conduct their own research and consult appropriate financial professionals before making any investment decisions.

#lastvisitfirst #StenoHealth #HomeCareHomeBase #healthcareai #clinicaldocumentation #hospicecare #homehealthcare #nursing #healthtechnologyinnovator #healthtech #innovation #podcast #healthcarepodcast

Rich Johnson’s path to becoming a healthcare CEO began in a juvenile courtroom where a judge gave him two choices: jail or the service. Choosing the Air Force didn't just change his life; it gave him the logistical blueprint to manage a $90 million appropriation by age 18 and eventually build ViaQuest, Inc. into an integrated healthcare powerhouse. Today, Rich oversees 4,500 employees providing a "Circle of Care" that spans hospice, behavioral health, and services for the IDD community.

This discussion pulls back the curtain on how military discipline translates to healthcare culture and why the integration of mental health is the missing piece in the modern hospice puzzle. We also dive into the technical "headwinds" facing the industry, ranging from the regulatory shift of Section 504 to the potential for AI agents to solve the hiring crisis for home health and hospice agencies.

In this episode, we cover:

• The Military Mindset — Why accountability and shared values are the only way to lead 4,500 "heroes" in the home.
• The Integrated Model — How ViaQuest leverages behavioral health to support grieving families and terminal IDD patients.
• The AI Revolution — Real-world applications for Perplexity Computer and autonomous agents in nurse recruiting and clinical workflows.
• The Pediatric Paradox — Examining the data that proves concurrent curative treatment actually improves quality of life while lowering costs.

Chapters:

• 00:00 Introduction of Rich Johnson and the ViaQuest story
• 02:02 From the courtroom to the cockpit — How the Air Force saved Rich’s life
• 04:53 Transitioning from military finance to healthcare consulting
• 06:09 The origin of ViaQuest and stepping into the CEO role at age 30
• 08:36 Creating a Circle of Care — Integrating IDD and Behavioral Health
• 11:21 The decision to pivot away from Home Health to focus on Hospice
• 13:27 Navigating the regulatory landscape and provider "flooding" in Ohio
• 15:32 The calling of healthcare — Recognizing the heroes in the IDD and Hospice space
• 18:48 Leadership lessons — Using military discipline to manage 4,500 employees
• 21:50 Boot camp stories — Learning knots and discovering "I’m short"
• 24:51 The unique challenges of recruiting for the IDD population
• 27:04 Serving the same patients for 25 years — "Three self-made men"
• 28:33 Rebranding the hospice conversation from "dying" to "living"
• 30:19 Why ViaQuest is adopting Bereavement for Life
• 32:05 AI in healthcare — Ambient listening and ending "pajama documentation"
• 34:56 Using Perplexity Computer to build autonomous recruiting agents
• 39:49 Creating automated daily intelligence reports with AI
• 41:55 The Section 504 deadline — Preparing for new ADA website compliance
• 46:50 Industry Headwinds — Facing the "Senior Tsunami" and staffing shortages
• 50:16 The role of remote monitoring and home-based surgery recovery
• 53:08 Legislative gaps in ESRD and Pediatric Concurrent Care
• 56:45 Identifying "Bad Actors" and the future of government audits
• 1:00:00 Inducting a CEO into the Ohio Veterans Hall of Fame
• 1:03:25 Changing lives — Rich’s proudest career accomplishments

Get ahold of Rich and ViaQuest:

• ViaQuest, Inc. website: https://viaquestinc.com/
• ViaQuest, Inc. LinkedIn: https://www.linkedin.com/company/viaquest/
• Rich's email: [email protected]
• Rich's LinkedIn: https://www.linkedin.com/in/richdjohnson

Special thank you to our sponsors:

• Premier Sponsor: Trella Health: https://trellahealth.com/
• Premier Sponsor: Homecare Homebase: https://hchb.com/
• Maxwell TEC: https://maxwelltec.com/
• StenoHealth: https://www.stenohealth.com/
• IntellaTriage: https://intellatriage.com/

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
• YouTube: https://www.youtube.com/@lastvisitfirstpodcast
• Website: https://www.lastvisitfirst.com
• LinkedIn: https://linkedin.com/company/last-visit-first

How do you turn two legacy hospice providers into a singular, "serious illness powerhouse"?Kristen Yntema didn’t start her career in a boardroom; she started as a 15-year-old unit secretary, cross-training as a nursing assistant and falling in love with the patient connection. Today, as the President and CEO of AuthoraCare Collective, she is redefining the architecture of end-of-life care.This conversation pulls back the curtain on the 2019 merger that created AuthoraCare and the radical "Culture First" strategy that made it successful. Kristen and Tom Maxwell dive into why traditional hospice is no longer enough and how building a "Serious Illness Ecosystem" allows patients to be the true authors of their own stories long before their final six months.

Inside the Episode:

• The "Pajama Charting" Crisis: How AI and ambient listening are being vetted to save clinicians from documentation burnout.
• Redefining Success: Why Kristen’s team ignores traditional metrics in favor of "Days in the Community."
• The Kids Path Mission: A rare look at the specialized world of pediatric hospice and the "Aarvy Aardvark" connection.
• The "Coffee with Kristen" Rule: Why the best strategic insights come from a $15 Panera treat and a small group of front-line staff.
• The Future of Palliative Care: Navigating the shift from "Routine Home Care" to high-needs ACO models.

Chapters:

• 00:00 — The "Last Visit First" Origin Story
• 02:35 — Starting at 15: From Unit Secretary to CEO
• 06:10 — The AuthoraCare Merger: Moving Beyond Hospice
• 09:30 — Why Culture Trumps Strategy in Healthcare
• 13:00 — Defining Excellence: The "2:00 AM Confidence Test"
• 22:30 — Building an "Ecosystem" Around the Patient
• 24:38 — HCHB Premier Sponsor Ad
• 30:15 — The "Pajama Charting" Crisis & AI Solutions
• 32:20 — Kids Path: The Mission of Pediatric Hospice
• 38:10 — Rethinking Metrics: "Days in the Community"
• 40:02 – Maxwell TEC Sponsored Ad
• 50:10 — Policy, Fraud, and the Future of the Industry
• 55:00 — Redefining Serious Illness Care

Connect with Kristen and AuthoraCare:

• Kristen's LinkedIn: https://www.linkedin.com/in/kristen-wither-yntema-bb7ab3b7
• AuthoraCare LinkedIn: https://www.linkedin.com/company/authoracare/
• AuthoraCare website: https://www.authoracare.org/

Special thank you to our sponsors:

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

Check out Last Visit First on other platforms:

• Apple Podcasts
• Spotify
• YouTube
• Website
• LinkedIn