A Hospital In Your Home

By Ryan Goldberg Dec 01, 2008 8:15 am
Home healthcare companies look to capitalize on aging Boomers.
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As Baby Boomers become senior citizens, a number of investment opportunities will come to light. One that few have yet to realize: Home nursing.

When patients recover from injury or illness at home instead of the hospital, they can actually save money. This is surely an attractive option today, with reports of cash-strapped consumers postponing or waiving medical care because they lack -- or simply can’t afford   -- health insurance. 

With home healthcare, services provided to the aged and those with chronic illnesses are considered non-discretionary and are reimbursed by Medicare and Medicaid. A Democratic government is unlikely to curb these entrenched social programs.

The landscape for home nursing is dominated by many small fiefdoms. The top 4 publicly traded companies -- Amedisys (AMED), Almost Family (AFAM), Gentiva Health Services (GTIV) and LHC Group (LHCG) -- only control 15% of the entire market. So these companies have been hunting for smaller grabs.

Almost Family is the smallest of the bunch, but it’s aggressively challenging those bigger guns. It also has the most soothing name. Almost Family, based in Louisville, Kentucky, provides home healthcare in 11 states - all concentrated in the eastern half of the US. Earlier this month, the company reported an 84% rise in third-quarter revenue. And in October, Forbes magazine ranked Almost Family twenty-fourth in its list of the 200 Best Small Companies in America.

At the beginning of August, Almost Family completed its biggest buyout ever: The $45 million purchase of Patient Care. That deal will bring in $47 million in annual revenue for a company that earned less than 3 times that in 2007. It also allowed Almost Family to add locations in Connecticut, New Jersey and Pennsylvania. The last 2 states are new frontiers for the company. 

A big macro trend helping Almost Family and its competitors is the nationwide shortage of nurses. The American Association of Colleges of Nursing estimates the shortage of registered nurses could reach half a million by 2025. Home healthcare operators will be able to charge more for their services because of this scarcity.

Visiting nurses help patients ease their way back to independence over a finite period. The other business, for the debilitated, is long-term custodial care. Until recently, these 2 segments were roughly the same in size and revenue for Almost Family. But visiting nursing now comprises 80% of its revenue.

Visiting nursing has another major selling point over hospital stays: Patients aren't confined to 4 channels and lousy food.

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(5)
2008-12-01 13:29:24
What is the matter with Americans? Nurses have job security and make upwards of $100,000 a year. Have we abandoned all useful pursuits? Have feminists convinced young women that they are not complete unless they can wear a suit and make mortgage committments? Do young men think nursing is effeminate?

Or is it the fact that a good nurse actually has to be able to think and have an adequate knowledge base?

We are really going to go down the tubes if Americans reject careers that cannot be outsourced. I'm afraid that we are going to require a good deal more slapping up the side of the head before we get it things straight.
2008-12-01 16:29:25
Reimbursement
The author states that the nursing shortage will allow home health agencies to charge more "because of this scarcity." Nearly every home health agency contracts with insurance companies, and these companies have fee schedules with maximum allowed amounts for any service. So regardless of the amount agencies charge, insurance companies will only pay so much and the agency will have to take a contractual adjustment for the remainder. The nursing shortage will not help home health providers regarding reimbursements, but it will definitely limit the services they can provide if they can't fill vacancies.
2008-12-01 19:10:49
Reimbursement
Exactly, when a patient can't afford the HH nurse then they cut back on hours and employ HH AIDS at 1/2 the price.

Our rate is in the $27-30 per hour and at this rate it doesn't take long to drain savings.

Assisted care = ward of the state!!

they can have the house as it is full encumbered
2008-12-01 20:08:23
Have you seen nursing close up?
My Mother was a nurse and it looks like a crappy job.

The world of RNs consist of pushing a lot of papers, checking meds and making sure overworked doctors don't kill patients. The "lower ranks" (LPNS and assistances) do much more of the gratifying (and also crappy) hands on work.

Basically, RNs have all of the immediate responsibility to make sure no one dies or gets worse on their watch but none of the power to change meds, etc. There's death and constant stress. In addition, most sick people appear to be way grumpy. :) I'd pick something easier, too, for lower pay.
2008-12-01 21:24:36
Have you seen nursing close up?
Hi Amy.

Unfortunately I have and I have the utmost respect for those nurses who, in spite of the paperwork, etc., manage to do an outstanding and very necessary service. Perhaps, as the rest of our Cinderella economy implodes, there will be a new interest in the profession of nursing.
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