Last Visit First

Keep the Family Close: Anne Karber on Grief, Sobriety and Leaving Nothing Unsaid

Tom Maxwell — Sat, 31 Oct 2026 16:53:00 GMT

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:

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:

Sponsors:

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

How He Built a Hospice From 50 to 8,000 Patients: Heath Bartness of St. Croix Hospice

Tom Maxwell — Wed, 21 Oct 2026 13:15:00 GMT

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:

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:

Sponsors:

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

AI That Actually Helps Clinicians: Homecare Homebase President Luke Rutledge

Tom Maxwell — Thu, 15 Oct 2026 13:00:00 GMT

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.

The Best Healthcare Is Local: The Pennant Group's Alicia Bowman on AI & the Hospice Addendum

Tom Maxwell — Thu, 15 Oct 2026 13:00:00 GMT

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?

The Most Exciting Thing HCHB Has Done: VitalCaring CEO April Anthony on Curate: Scribe

Tom Maxwell — Thu, 15 Oct 2026 13:00:00 GMT

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?

Hiring 300 Nurses a Year: IntellaTriage CEO Daniel Reese on After-Hours Care & AI

Tom Maxwell — Thu, 15 Oct 2026 13:00:00 GMT

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?

Copilot, Not Autopilot: Steno Health's Dr. Alex Milani on Curate: Scribe

Tom Maxwell — Thu, 15 Oct 2026 13:00:00 GMT

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?

"You Can't Rationalize With an Irrational Brain" | Debbie Compton of The Purple Vine

Tom Maxwell — Sun, 11 Oct 2026 13:30:00 GMT

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:

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:

Sponsors:

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

Who's Winning in Home Health and Hospice? New 2026 Data + Trella Health's AI First Look

Tom Maxwell — Thu, 01 Oct 2026 13:15:00 GMT

Medicare Advantage growth stalled for the first time in a decade. Hospice admissions are growing faster every year. And in some states, patients wait nearly a week after hospital discharge for their first home health visit.

Trella Health CEO Scott Tapp and Senior Consultant of Data & Analytics Carter Bakkum join Tom Maxwell once again, this time to walk through Trella's new Post-Acute Market Intelligence Report: 2026 Edition, live on screen. This year the report is fully interactive, so you can drill into your own state and market instead of relying only on national benchmarks.

We cover why payers are pulling Medicare Advantage out of rural markets like Vermont, what accelerating hospice growth means after the moratorium, the time-to-start-of-care gap that's driving hospital readmissions, and why the TEAM model is a sales opportunity most home health agencies aren't using yet.

We also get a first look at Ask Trella AI, a new tool that answers market questions in plain language: who's gaining and losing share in your market, which physicians refer the most, where you can compete, and much more.

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:

The new interactive 2026 Post-Acute Market Intelligence Report
Medicare Advantage penetration stalls at 55.4%
Payer exits and the rural Medicare Advantage pullback
Accelerating hospice admissions and length of stay trends
Time to start of care and its impact on readmissions
First look at Ask Trella AI

Connect with the guests:

Chapters:

00:00 Welcome: Scott Tapp and Carter Bakkum of Trella Health
01:12 What's new in the 2026 Market Intelligence Report
04:23 The data behind the report
07:10 Medicare Advantage growth stalls
08:51 Vermont and the rural MA pullback
15:55 What MA shifts mean for providers
17:21 Hospice growth is accelerating
21:32 Discharge instructions and adherence
24:45 Time to start of care by state
29:13 The TEAM model and the Indiana opportunity
36:21 First look: Ask Trella AI
41:07 Who's gaining and losing market share
46:45 Where Trella AI is headed
53:53 When you can get it and wrap-up

Sponsors:

Presented by Last Visit First's Premier Sponsor, Trella Health.
Check out Trella Health's new 2026 Post-Acute Market Intelligence Report here.

Check out Last Visit First on other platforms:

Investing in People, Elevating Care: A Conversation with Tracy Dent

Tom Maxwell — Wed, 05 Nov 2025 14:15:00 GMT

Tom sits down with Tracy Dent, Senior Vice President of Clinical Operations at AccentCare and the first nurse to join Last Visit First. Tracy’s story runs from LVN in rural Texas to leading national teams. She opens up about the patient who “gave her the bug,” what rate cuts really mean for access in rural America, why leaders retain people better than bosses, and how AI, telehealth, and practical quality work can free clinicians to spend more time with patients. You will hear a clear case for home as the lowest-cost, highest-outcome setting and what it takes to get there.

Keywords:

home health, hospice care, care at home, AccentCare, nursing leadership, clinical operations, workforce retention, healthcare leadership, value-based care, AI in home health, telehealth, quality outcomes, rural access to care, healthcare policy, hospital at home, palliative care, home-based care, Last Visit First podcast, Tom Maxwell, Tracy Dent.

People of the Episode:

Guest: Tracy Dent, Senior Vice President of Clinical Operations
Host: Tom Maxwell
Producer: Cole Sorensen

Be Sure to Check Out Our Sponsors:

Premier Sponsor: Homecare Homebase: https://hchb.com/
Maxwell TEC: https://maxwelltec.com/
StenoHealth: https://www.stenohealth.com/

Last Visit First Podcast Links:

Apple Podcasts: ⁠⁠https://podcasts.apple.com/us/podcast/last-visit-first/id1830051182⁠

Spotify: ⁠⁠https://open.spotify.com/show/3iSKGRvHC9Bk3iq7l8UPxs?si=fc219a6e1a504861⁠
YouTube: ⁠⁠www.youtube.com/@lastvisitfirstpodcast⁠
Website: ⁠⁠https://www.lastvisitfirst.com⁠ ⁠
LinkedIn:⁠ ⁠linkedin.com/company/last-visit-first⁠

Mentioned in the Episode:

Gene Metcalfe book - Left for Dead at Nijmegen: The True Story of an American Paratrooper in World War II: https://www.amazon.com/Left-Dead-Nijmegen-American-Paratrooper/dp/1612006965
AccentCare: https://www.accentcare.com/

Contact the Last Visit First Team:

Producer: csorensen@lastvisitfirst.com
Host: tom@lastvisitfirst.com

Chapters:

00:00 – HCHB Premier Sponsor Ad Read

00:48 – Welcome and intro
01:30 – How Tom and Tracy first met
02:48 – Tracy’s start in nursing and home health
06:05 – Joining AccentCare
08:45 – Rate cuts and rural impact
12:21 – The patient who inspired her
16:07 – WWII veteran story and book mention
18:36 – Building strong teams and leaders
22:29 – AI and the clinician’s role
25:38 – Telehealth and access to care
28:03 – Driving quality at the bedside
31:29 – Rural length-of-stay challenges
32:38 – The future of care at home
35:02 – Transitions and hospice coordination
38:28 – ESRD and hospice eligibility
39:57 – Behavioral health and homebound rules
43:28 – Waivers, policy, and workforce outlook
46:58 – Tracy’s legacy
49:27 – Staying connected to the field
50:00 – Closing
50:54 – Sponsor Ad Reads

Kathy Ford (Trella Health) | The Democratization of Healthcare Data

Tom Maxwell — Mon, 02 Feb 2026 15:00:00 GMT

Live from Day 2 of Home Care 100 in Scottsdale, Tom Maxwell sits down with Kathy Ford, Chief Product Officer at Trella Health.

As a premier sponsor of Last Visit First, Trella Health is at the forefront of the "data revolution." In this interview, Kathy discusses Trella’s evolution from a Medicare-dominant platform to a comprehensive data suite covering Commercial and Medicare Advantage markets. She breaks down the recent acquisition of Repisodic, explaining how integrating discharge workflows into Epic and Cerner is solving the "length of stay" puzzle for health systems. Kathy also shares her "plea to fellow vendors" on why data must be democratized for the sake of the patient.

Chapters:

01:10 – Beyond Medicare: Trella’s expansion into Commercial and Medicare Advantage data sets.
02:30 – Solving the Discharge Gap: How the Repisodic acquisition embeds Trella into acute care workflows.
03:50 – Signal in the Noise: Contextualizing thousands of data sources into meaningful executive insights.
05:20 – The 30-EHR Integration: Leveraging data across the entire post-acute landscape.
06:40 – A Call to Action: Why data democratization is better for patients and providers alike.

Connect with Trella Health and Kathy:

Website: https://www.trellahealth.com/
LinkedIn: https://www.linkedin.com/company/trellahealth/
Kathy's LinkedIn: https://www.linkedin.com/in/kathy-dalton-ford-7657367

Special thanks to our sponsors:

Premier Sponsor:⁠⁠⁠⁠⁠ Trella Health⁠⁠⁠⁠⁠
Premier Sponsor: ⁠⁠⁠⁠⁠Homecare Homebase⁠⁠⁠⁠⁠
Premier Sponsor: ⁠⁠⁠⁠⁠Maxwell TEC⁠⁠⁠⁠⁠
Premier Sponsor: ⁠⁠⁠⁠⁠Lincoln Healthcare Leadership⁠

#HomeHealth #Hospice #TrellaHealth #HC100 #DataAnalytics #HealthcareIT #Interoperability #LastVisitFirst #PostAcuteCare

"It's All About Money": Why Healthcare Systems Won't Talk to Each Other | Dr. Chet Robson

Tom Maxwell — Tue, 18 Aug 2026 13:30:00 GMT

Dr. Chet Robson has held Chief Medical Officer and Chief Clinical Officer roles at Adventist Health Partners, Walgreens, and Your BioHealth. In this conversation he walks through his journey from paper charts to EMRs to AI, and why the biggest problems in healthcare still come down to systems that won't talk to each other.

Tom and Dr. Robson get into why 30 to 50 percent of patients never follow through on prescriptions or home health referrals after discharge, what a single national EMR system looks like in the Netherlands, and why retail pharmacy might be the most underused platform in American healthcare. They also cover what separates great health tech startups from the rest, how to evaluate AI companies, and what Dr. Robson would change if he ran CMS for a day.

Connect with Dr. Chet Robson:

https://linkedin.com/in/chet-robson

Chapters:

0:00 Meet Dr. Chet Robson
1:40 His journey into medicine and EMRs
5:02 EMRs he's worked with: Cerner, NextGen, Epic
6:19 What clinical practice taught him about leadership
9:18 AI translation and patient communication
10:06 Physician leader vs. clinical leader
13:10 Why patients fill out the same form five times
15:09 The Netherlands' single EMR system
16:47 Why can't EMRs talk to each other
19:12 A real example of a broken patient experience
21:17 Why 40% of patients skip home health after discharge
25:59 Ad Break
28:50 Technologies with the biggest clinical impact
33:01 Why home health still can't get paid for telemedicine
33:56 What population health and value-based care got wrong
37:01 Barriers to managing high-risk patients
40:57 The cockroach ER story
42:51 What Walgreens taught him about retail pharmacy
47:27 Where retail pharmacy is headed
49:59 Ad Break
50:38 What separates great health tech startups from the rest
53:50 How to evaluate AI health companies
59:46 Clinical intelligence vs. artificial intelligence
1:01:04 If he ran CMS for a day
1:04:38 His legacy in healthcare
1:06:44 Closing thanks

Sponsors:

Premier Sponsor: Trella Health: https://trellahealth.com/
Maxwell TEC: https://maxwelltec.com/
IntellaTriage: https://intellatriage.com/

#homehealthcare #hospice #PostAcuteCare #valuebasedcare #healthtech #digitalhealth #interoperability #aiinhealthcare #populationhealth #healthcareleadership

CMS 2027 Proposed Rule Explained: What the 2.4% Increase Actually Means

Tom Maxwell — Thu, 09 Jul 2026 13:30:00 GMT

CMS just proposed a 2.4% payment increase for home health in 2027. If that's the only number you take away, you're missing a lot.

Tom Maxwell sits down with Jay Duty, COO at Maxwell TEC, to unpack what's actually happening underneath the headline: a temporary rate cut, a nearly $5 billion recoupment, a full case-mix recalibration, and provider enrollment changes that could put your Medicare billing privileges at risk.

Jay spent his first ten years in the hospital business at HCA before moving into post-acute care strategy, eventually landing at Maxwell TEC. In this conversation, he and Tom walk through what CFOs need to know before they finalize next year's budget, why the "behavioral adjustment" methodology has the industry pushing back, and what a home health specific wage index could mean for high-cost and rural markets.

Topics Include:

The real math behind the 2.4% headline number and where it actually comes from
Why the temporary 3% clawback matters more than the payment increase
How to model your 2027 budget before the final rule drops in November
The CMS wage index proposal and its impact on rural and high-cost markets
What CMS's expanded provider enrollment authority means for your Medicare billing risk

The comment period for this rule runs through August 31, 2026. If you're a home health agency owner, operator, or CFO, this episode gives you the framework to build your comment letter and your budget at the same time.

Connect with Jay Duty:

jay@maxwelltec.com or https://www.maxwelltec.com

Chapters:

0:00 Intro: the 2.4% headline everyone's getting wrong
1:26 Jay Duty's path from HCA to home health strategy
1:53 The first thing Jay checks in a new CMS rule
2:21 What's actually driving the 2.4% number
3:55 The one sentence every CFO needs to remember
4:49 The behavioral adjustment, explained
6:26 Real example: therapy-only cases and the 30-day billing trap
7:44 The $4.9 billion recoupment breakdown
9:54 Is CMS's data methodology actually flawed?
12:15 What a strong industry comment letter argues
13:33 Why this rule always lands mid-budget cycle
14:46 How to model your 2027 budget starting now
17:01 Why visits per period keep falling
19:45 What investors and lenders should hear from you now
21:28 The case for a home health specific wage index
24:00 CMS's expanded power to deny or revoke enrollment
25:34 Can industry comments actually move the needle?
28:16 What makes a comment letter valuable to CMS
29:48 Will this adjustment mechanism still exist in five years?
31:51 What to do this week if you run an agency
33:08 How to reach Jay Duty

Sponsors:

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

Building Better Jobs for Clinicians with Jason Yu

Tom Maxwell — Fri, 14 Nov 2025 14:15:00 GMT

Jason Yu started his career as a teacher, became a management consultant, and eventually found himself running a home care agency during the start of the pandemic. That experience shaped everything that would become Levo, a clinician retention platform helping agencies reduce turnover and improve patient outcomes.

In this conversation, Jason explains why the real causes of turnover are often quiet, gradual, and preventable. He talks through how data reveals patterns that agencies miss, how to give clinicians back time, and why solving staffing challenges starts with leadership and culture.

Tom and Jason also dive into the future of home health and hospice, AI in recruiting, how to build teams that last, regulatory pressures, and the mindset needed to run a growing company today.

Episode Chapters:

00:00 Homecare Homebase Sponsored ad

00:48 Jason Yu introduction and backstory
11:52 The biggest gaps and opportunities in home health and hospice
18:21 Why clinicians leave and what Levo is solving
22:28 Maxwell TEC ad
23:27 How Levo uses AI in recruiting and retention
33:47 What turnover costs and how agencies can reduce it
38:33 The future of home based care
45:43 Steno ad
46:13 Personal stories, leadership lessons, and building Levo
59:16 Jason’s legacy and what drives him
1:05:49 Why Levo moved into a new office
1:10:25 What is next for Last Visit First
1:14:05 Last Visit First outro

Guest Links:

Levo website: https://www.hellolevo.com/
Jason Yu on LinkedIn: linkedin.com/in/jasonhxyu
Contact information for Jason: jason@hellolevo.com

Special Thank You to Our Sponsors:

Premier Sponsor: Homecare Homebase: ⁠https://hchb.com/
Maxwell TEC: ⁠https://maxwelltec.com/⁠
StenoHealth: ⁠https://www.stenohealth.com/⁠

Listen to Last Visit First:

Apple Podcasts: ⁠https://podcasts.apple.com/us/podcast/last-visit-first/id1830051182
Spotify: ⁠https://open.spotify.com/show/3iSKGRvHC9Bk3iq7l8UPxs?si=fc219a6e1a504861
YouTube: ⁠www.youtube.com/@lastvisitfirstpodcast
Website: ⁠https://www.lastvisitfirst.com⁠
LinkedIn: ⁠linkedin.com/company/last-visit-first

Show Notes and Resources:

JAMA article referenced on Medicare Advantage: https://jamanetwork.com/journals/jama-health-forum/fullarticle/2815745
Joe Rogan and Guy Fieri hospice segment: https://youtu.be/NzBNVGNY_FA?si=JDjfwf39zyKzOCaU

About Last Visit First:

Last Visit First shares real conversations with leaders shaping the future of home based care. Hosted by Tom Maxwell, Chairman of Maxwell TEC. Subscribe for more episodes on home health, hospice, leadership, and the future of care at home.

Subscribe to the channel, leave a comment, and share this episode with someone in the home health or hospice community.

#LastVisitFirst #HomeHealth #Hospice

Leading Hospice at Scale with Alex Mauricio

Tom Maxwell — Mon, 24 Nov 2025 14:15:00 GMT

In episode #6, Tom sits down with Alex Mauricio, President and CEO of Bristol Hospice, for an in depth conversation about leadership, culture, and the future of hospice care. Alex shares how growing up as “free labor” in his mom’s home health agency shaped his career, how he entered hospice, and how he now leads one of the largest and fastest growing hospice organizations in the country.

They talk about Bristol’s 20 year story, including their major expansion through organic growth and De Novos, their specialty programs like Breathe Easy, Bristol Palliative, and pediatric hospice, and their commitment to the We Honor Veterans program. Alex also shares his personal patient story that changed his life and why he believes culture and people are the core drivers of growth.

You will also hear Tom and Alex explore:

• How to balance mission and margin

• Why hospice leaders must be intentional about culture

• How Bristol supports clinician grief and burnout

• What HOPE means for the future of care

• How technology, AI, and innovation will shape clinical work

• Why ESRD patients and behavioral health patients need better access to end of life care

• The importance of collaboration across the industry

• What legacy means to Alex and how he hopes to be remembered

Guest Links:

-Bristol Hospice: https://bristolhospice.com/

-Alex on LinkedIn: https://www.linkedin.com/in/alex-mauricio-189b3a33

Sponsors:

-Premier Sponsor: Homecare Homebase: https://hchb.com/

-Episode Sponsor: Levo: https://hellolevo.com/

-Maxwell TEC: https://maxwelltec.com/

-StenoHealth: https://www.stenohealth.com/

Listen to 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

Resources Mentioned:

-We Honor Veterans Program: https://www.wehonorveterans.org/

About the Show:

Last Visit First shares real conversations with leaders shaping the future of home based care. Hosted by Tom Maxwell, Chairman of Maxwell TEC.#Home Health, #Hospice, #Leadership, #CareAtHome

Jennifer Maxwell (Maxwell TEC) | People, Processes, and Technology

Tom Maxwell — Fri, 30 Jan 2026 15:00:00 GMT

Live from Home Care 100 in Scottsdale, host Tom Maxwell sits down with Jennifer Maxwell, CEO and Co-Founder of Maxwell TEC.

As a tech-enabled strategic consulting leader and prolific investor in the space (Mosai, Element 5, Levo), Jennifer shares why she believes "tchotchkes and booths" don't move the needle—meaningful, intimate networking does. She breaks down the "three-legged stool" of successful agency management and reveals how simple, text-based communication via the nanaCONNECT platform is solving the communication breakdowns that lead to poor star ratings and patient frustration.

Chapters:

01:05 – Why HC100 is the catalyst for Maxwell TEC’s yearly innovation.
01:50 – Staying focused: Why Jennifer only invests in the post-acute care "catcher's mitt."
02:30 – The Three-Legged Stool: Why technology fails without people and process.
03:20 – nanaCONNECT: Why text-based outreach wins over clunky apps and logins.
05:05 – The REACH Product: How to stay "top of mind" for the 20% of patients who naturally return to home health.

Connect with the Maxwell TEC team:

Special thanks to our sponsors:

Premier Sponsor: ⁠⁠⁠Trella Health⁠⁠⁠
Premier Sponsor: ⁠⁠⁠Homecare Homebase⁠⁠⁠
Premier Sponsor: ⁠⁠⁠Maxwell TEC⁠⁠⁠
Premier Sponsor: ⁠⁠⁠Lincoln Healthcare Leadership

#Hospice #MaxwellTEC #nanaCONNECT #HC100 #PostAcuteCare #LastVisitFirst

Tarrah Lowry (Empath Health) | The "One Hospice" Model & Disaster-Proofing Care

Tom Maxwell — Fri, 30 Jan 2026 15:00:00 GMT

Live from Home Care 100 in Scottsdale, Tom Maxwell sits down with Tarrah Lowry, Chief Operating Officer of Empath Health.

Tarrah oversees one of the largest non-profit hospice and home health mergers in the country—the recent affiliation between Empath and Trustbridge. In this conversation, she reveals the "One Hospice Model," a strategy designed to unify different electronic health records and cultures without losing the personal community touch. She also shares a fascinating "hurricane-proof" benefit of their scale: how having teams on both Florida coasts allows for seamless care even when disaster strikes.

Chapters:

01:10 – The "Full Life Care" model: PACE, Physician Practices, and I-SNPs.
01:45 – Scale matters: Managing a daily census of 5,500 hospice patients.
02:20 – The Empath & Trustbridge Merger: Lessons from a "merger of equals."
03:05 – The Hurricane Plan: Why standardized software is a safety net for Florida patients.
04:30 – Whoop & Wearables: Why even the busiest COOs are tracking their sleep (and the "HC100 sleep deficit").

Connect with Empath Health:

Special thanks to our sponsors:

Premier Sponsor: ⁠⁠⁠⁠Trella Health⁠⁠⁠⁠
Premier Sponsor: ⁠⁠⁠⁠Homecare Homebase⁠⁠⁠⁠
Premier Sponsor: ⁠⁠⁠⁠Maxwell TEC⁠⁠⁠⁠
Premier Sponsor: ⁠⁠⁠⁠Lincoln Healthcare Leadership

#HomeHealth #EmpathHealth #Trustbridge #HC100 #DisasterRecovery #OneHospice #LastVisitFirst

The Logistics of a Calling and Rich Johnson’s Journey to Healthcare CEO

Tom Maxwell — Fri, 13 Mar 2026 13:30:00 GMT

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: Rich.Johnson@ViaQuestInc.com
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

The Fragmented System Keeping Grandma in the Hospital (And How to Fix It)

Tom Maxwell — Tue, 09 Jun 2026 13:30:00 GMT

Brian Lobley spent more than 20 years inside one of the country's largest health insurers before crossing the aisle to fix the problem he "helped create." Now as CEO of tango, he is building the infrastructure that gets patients home faster, keeps them out of the hospital, and actually rewards the agencies doing the work.

Tom Maxwell sits down with Brian to break down why the post-acute system is broken, what value-based care looks like when it actually works at the episode level, and how tango is using AI to transform clinical workflows without replacing the clinician.

He explains:

Why Medicare Advantage networks are broken and what payers keep getting wrong
How Tango eliminates the referral-to-authorization gap that delays care in the critical first 48 hours after discharge
What value-based care actually looks like at the episode level and how providers get rewarded for it
Why 10 to 12 percent of SNF admissions do not need to happen and what fixing that requires
How AI is cutting 22-minute case reviews to five to eight minutes without replacing the clinician

CHAPTERS

0:00 Introduction and Brian Lobley's background
1:53 Brian's career path from IT consulting to Independence Blue Cross
4:48 Building the tango leadership team
8:02 What tango does and how the model works
12:09 How home health providers can join the tango network
17:33 The interoperability challenge and where the industry stands
21:14 Why delays in home health hurt patients, payers, and hospitals
27:57 [Ads]
30:21 Value-based care: what's actually working vs. theoretical
34:49 Expanding beyond home health: hospice and personal care
37:24 What Medicare Advantage plans are getting right and wrong
43:26 Why payer networks keep failing home health agencies
45:06 [Ads]
46:10 How tango is using AI in clinical and operational workflows
54:43 Hiring at tango and how to join the network
56:31 The story behind the name change from PHCN to tango
57:39 Closing thoughts

Learn more about tango: https://tangocare.com/

Connect with Brian Lobley: https://linkedin.com/in/brian-lobley-339b2a4

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.

From the DOJ to the Defense Table: What Hospice Operators Need to Hear

Tom Maxwell — Wed, 20 May 2026 12:45:00 GMT

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:

jonathan.porter@huschblackwell.com

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.

The $1.5B Home-Based Care CEO Getting Honest About the Future of Healthcare | Mike Asselta

Tom Maxwell — Mon, 04 May 2026 14:13:18 GMT

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.

From Valuation to Close: Inside the Deal Process for Home Health and Hospice Owners

Tom Maxwell — Mon, 29 Jun 2026 14:00:00 GMT

What does it actually take to sell a home health or hospice agency, and how do you make sure you walk away with what your business is worth?

Alex Veach, Partner at Agenda Health, joins Last Visit First for a conversation that covers the full arc of the healthcare M&A process, from the moment you start thinking about an exit to the day you close a deal. Agenda Health advised on roughly 25% of all home-based care transactions in 2025 alone, and Alex brings a decade of deal reps and hard-won market knowledge to every answer.

This is not a theoretical conversation. It is a practical, direct look at how buyers evaluate agencies, what kills deals, how to time an exit around regulatory cycles, and why the emotional side of selling a business you built from nothing is just as important as the financial side.

Topics include:

What the current healthcare M&A market actually looks like for home health and hospice owners and where the opportunity is headed
The three things buyers prioritize above everything else in smaller agency deals and why compliance now leads the list
How Agenda's buyer profiling process matches sellers with the right capital partners, not just the highest bid
What the full deal process looks like step by step, from valuation call to signed LOI, for an owner who has never done this before
The emotional reality of selling a business you built from nothing and how good advisors help owners through it

Chapters:

00:00 Introduction to Alex Veach and Agenda Health
01:29 Alex's Background and Path to Agenda
02:45 What Agenda Health Does and Who They Serve
05:14 The Current M&A Market for Home Health and Hospice
07:43 What Most Owners Get Wrong About Valuation
09:18 Valuation Ranges Across Home Health, Hospice, and Personal Care
12:15 What a Platform Deal Actually Means
14:22 Buyer's Market or Seller's Market Right Now
17:34 How Large Platform Deals Create Add-On Opportunity for Smaller Agencies
19:05 Acquisition vs. Recapitalization: What's the Difference
21:37 The Top Three Things Buyers Look for in Smaller Agencies
25:12 The Role of Team and Key Man Risk in a Deal
26:39 How Regulatory Timing and Rate Changes Affect Deal Process
29:22 Ads
31:59 Building Relationships and Teaching the Business
36:47 How Long the Seller Relationship Takes to Develop
39:33 Begin With the End in Mind: Prepping 24 Months Out
42:01 EMR Data, Financial Readiness, and What Buyers Are Testing
45:42 Walking Through a Real Deal: 250-Patient Hospice in Houston
46:27 Valuation Presentation and Process Strategy
49:46 Ads
50:51 The Data Room: How It Works and Why It Matters
53:03 Keeping Census Up While Your Deal Is in Process
56:46 Managing Team Distraction and Confidentiality During a Sale
58:01 Legacy, Impact, and What Alex and Agenda Want to Be Known For
1:03:39 The Emotional Reality of Selling Your Business
1:04:37 How to Reach Alex Veach and Agenda Health
1:05:46 Closing Thoughts

Connect with Alex Veach and Agenda Health:

Agenda Health's Website: https://www.agendahealth.com
Agenda Health's LinkedIn: https://www.linkedin.com/company/agenda-business-services/
Alex's LinkedIn: https://www.linkedin.com/in/alex-veach

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

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/

How 1 Million Texts Are Reconnecting Hospice & Home Health Families | nanaCONNECT

Tom Maxwell — Thu, 04 Jun 2026 13:30:00 GMT

Last Visit First sponsor Maxwell TEC just hit a massive milestone: their nanaCONNECT platform reached 1 million messages sent across home health and hospice. With a 31% engagement rate and a 1.3% opt-out rate, this is patient communication that actually works.

In this special bonus episode, Andy O'Connell (Director of Product) and Desiree Ardoin (Senior Consultant, Product Adoption) of Maxwell TEC join the podcast to unpack what 1 million connections really means for patients, families, caregivers, and the agencies that serve them.

This is what proactive, compassionate, scalable patient communication looks like.

What we get into:

The numbers behind the milestone, including a 31% engagement rate (6% is considered excellent) and roughly $436,000 a month in savings versus traditional mail
The bereavement stories families are sending back, and why Maxwell TEC is rethinking the traditional 13-month cutoff
How real-time caregiver feedback through text is helping agencies catch problems long before an HCAHPS survey ever shows up
A quick look at how it all works across NOTIFY, ENGAGE, REACH, and BEREAVE: no app, no logins, just a text from a number families already recognize

Chapters:

00:00 Celebrating Milestones in Healthcare Communication
02:48 The Impact of NanoConnect on Patient Care
06:01 Engagement Metrics and Cost Efficiency
08:35 Cultural Sensitivity and Regional Adaptation
11:17 Real-Time Feedback and Continuous Improvement
14:22 Future of Communication in Home Health and Hospice
16:39 Extending Bereavement Support Beyond Traditional Limits
19:38 The Human Element in Healthcare Communication

Sponsors:

Maxwell TEC: Learn more or schedule a demo at https://www.maxwelltec.com

Subscribe to Last Visit First for new episodes every 10 days with the leaders shaping home health, hospice, palliative care and the future of healthcare.

The Man Who Rewrote Medicare Home Health Law | Bill Dombi on 50 Years of Fighting for Home Care

Tom Maxwell — Tue, 08 Sep 2026 13:30:00 GMT

For nearly five decades, Bill Dombi has shaped almost every major law, regulation, and legal battle behind home health and hospice care in America. As former President and CEO of the National Association for Home Care & Hospice (NAHC) and now senior counsel at Arnall Golden Gregory, Bill has argued in front of Congress, CMS, and the courts to protect access to care at home.

In this episode, Bill sits down with Tom Maxwell to reveal the untold history of the industry, including the landmark Duggan v. Bowen lawsuit that rewrote Medicare home health coverage, the last-minute decision that almost kept home health out of Medicare entirely, and the uphill battle to create the Medicare Hospice Benefit in 1983.

Topics covered:

The origin story of Medicare home health coverage
Duggan v. Bowen and the fight to expand home health eligibility
Creating the Medicare Hospice Benefit
Operation Restore Trust and hospice fraud today
Medicare Advantage's impact on home health and hospice providers
The future of value-based care
AI's role in clinical and operational efficiency
Advice for the next generation of home care and hospice leaders

About the guest:

William "Bill" Dombi served as President and CEO of the National Association for Home Care & Hospice (NAHC) from 2018 until its merger with NHPCO, forming the National Alliance for Care at Home. Prior to that, he spent decades as NAHC's Vice President for Law. He was lead counsel in landmark litigation expanding Medicare home health coverage and helped shape the Medicare Hospice Benefit. He now serves as senior counsel at Arnall Golden Gregory LLP and sits on the board of advisors for New Day Healthcare.

Connect with Bill:

Chapters:

0:00 Welcome Bill Dombi to the show
1:44 What first drew Bill to home care advocacy
4:05 Bill's proudest career accomplishments
9:08 Bill Dombi outside of Washington
11:09 The patient story that defines his mission
12:43 Sponsor Break
13:42 The hardest battle: creating the hospice benefit
18:49 What almost happened: home health nearly left out of Medicare
21:31 Why healthcare fraud keeps happening
23:41 Sponsor Break
24:55 The biggest threat to home health: stagnation
28:09 Is hospice at a crossroads?
35:24 Medicare Advantage: is it really an advantage?
42:32 Where AI actually helps in home-based care
48:41 If Bill could rewrite one regulation
52:53 Sponsor Break
54:45 Einstein the hospice therapy dog
56:11 How Bill stayed optimistic for 50 years
59:35 What Bill is doing today
1:04:37 How to reach Bill Dombi

Check out Last Visit First on other platforms:

Sponsors:

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

The Nursing Home Myth That Ruins Families' Decisions

Tom Maxwell — Fri, 28 Aug 2026 13:30:00 GMT

Dave Devereaux has spent more than 40 years inside America's nursing homes, from teenage housekeeper to CEO, board member, and investor, and he's channeled all that knowledge into his book, "Beyond Bedrails and Bingo: Myths, Truths and the Future of America's Nursing Homes."

In this episode, Dave joins the podcast to break down the biggest myths families believe about nursing homes, including the misconception that admission of a loved one means they're there forever (in reality, that's not usually the case). Dave explains the real differences between a skilled nursing facility, assisted living, and memory care, and what separates a top notch facility from the average ones.

The conversation covers the growing dementia and Alzheimer's care crisis, including the staggering new data showing nearly 800,000 additional direct care workers will be needed by 2034, and Dave's controversial take on why the healthcare industry waits too long to develop caregivers. They also dig into whether nursing home staffing shortages are a workforce problem, a reimbursement problem, or a leadership problem, the role of AI (or as Tom calls it, clinical intelligence) in senior care, and when families should start planning for aging parents before a crisis forces the decision.

Dave also shares a deeply personal story, from caring for his mother through six and a half years of memory care to a near-death accident earlier this year that reshaped how he thinks about the time he has left.

Topics covered:

The biggest myth families believe about nursing homes
Skilled nursing facility vs assisted living vs memory care, explained
What makes a memory care program world-class
The dementia and Alzheimer's caregiver shortage
Why nursing home staffing is a leadership issue, not just a workforce issue
AI's role and risks in senior care
How and when to start planning for aging parents
Dave's personal story of loss, caregiving, and survival

Learn more about Dave and his book, "Beyond Bedrails and Bingo":

https://www.davedevereaux.com/

If you're caring for an aging parent, working in senior care, or just trying to figure out where you or a loved one should spend the years ahead, this episode is for you.

Chapters:

0:00 Dave Devereaux's introduction
0:18 Meet Dave — 40+ years in senior care, from housekeeper to CEO
4:44 The story behind "Beyond Bedrails and Bingo"
6:55 Biggest nursing home myth: debunking the "forever" assumption
8:47 Skilled nursing vs. assisted living vs. memory care, explained
10:10 Memory care up close: Dave's mother's story
14:09 The dementia caregiver crisis: 800K workers needed by 2034
18:19 Why schools and nursing homes aren't partnering to build the workforce
22:23 Nurse classification and licensing hurdles
24:24 What separates great memory care from average
26:32 Helping families navigate dementia visits and behavior changes
32:36 Ads
33:45 Are nursing homes becoming higher-acuity?
38:00 Clinical intelligence, not artificial: AI's role in senior care
43:10 Ads
45:06 Is staffing a workforce, reimbursement, or leadership problem?
50:39 Where should someone spend their last five years?
52:49 When to start planning for aging parents
56:21 What aging has taught Dave about living, and his near-fatal accident
1:02:10 Where to find the book and closing thoughts
1:03:36 Outro

Sponsors:

Last Visit First:

Amee Devani (WellBeam) | Killing the Fax Machine: 13-Hour Order Signatures

Tom Maxwell — Fri, 30 Jan 2026 15:00:00 GMT

Live from Home Care 100 in Scottsdale, host Tom Maxwell sits down with Amee Devani, CEO and Co-Founder of WellBeam.

Born out of physician frustration with the "black box" of post-acute care, WellBeam has built the infrastructure to replace faxes and phone tag with true EMR interoperability. Amee breaks down how they serve as the "epic pipe" (or universal adapter) that allows clinicians to share wound images, medication adjustments, and orders directly within their existing EMRs—without ever having to log out or pick up a fax.

Chapters:

01:15 – Why AI is useless if you can't move data: The interoperability reality check.
02:15 – Southern California to the East Coast: WellBeam's expansion with Stanford, Cedars-Sinai, and Advocate Atrium.
03:05 – The 21-Day Problem: How WellBeam cut the time to signature down to 13 hours.
03:45 – Revenue Recapture: Why health systems are missing out on billing codes by using analog faxes.
05:10 – The "Hardest Name to Spell" Award: A funny story about branding and character limits.

Connect with WellBeam and Amee:

Website: https://https://well-beam.com/
LinkedIn: linkedin.com/company/wellbeam-inc/
Amee Devani: linkedin.com/in/amee-devani-a2418812

Special thanks to our sponsors:

Premier Sponsor: Trella Health
Premier Sponsor: Homecare Homebase
Premier Sponsor: Maxwell TEC
Premier Sponsor: Lincoln Healthcare Leadership

#HomeHealth #Hospice #WellBeam #Interoperability #HC100 #HealthTech #Epic #LastVisitFirst

Joe Randesi (Element5) | Building the Next Workforce for Post-Acute

Tom Maxwell — Mon, 02 Feb 2026 15:00:00 GMT

Live from the Woodpecker Room for Day 2 of the Last Visit First podcast at Home Care 100, Tom Maxwell welcomes a true post-acute tech pioneer: Joe Randesi, CEO and Co-Founder of Element5.

Joe explains why the world is moving beyond simple SaaS toward Agentic AI—digital workers that autonomously navigate EHRs, verify eligibility, and manage authorizations. He breaks down the "swivel chair" problem and how Element5’s vertical-specific agents are designed to eliminate the "paper cuts" of back-office operations. Joe also shares his perspective on why the industry is finally "leveling up" through collective innovation.

Chapters:

01:10 – The DeVero Journey: How co-founding an EHR led to the automation revolution.
01:45 – What is an "Agent"? Defining the digital worker that automates the financial journey.
02:45 – No Smoke Breaks, No COVID: Why agents are an OpEx solution for back-office bottlenecks.
03:30 – Building Blocks: How Element5’s vertical platform allows for rapid, at-scale innovation.
05:10 – "Fail Fast": Joe’s advice for agencies looking to adopt disruptive technology.
05:50 – The Value of Face-to-Face: Why Home Care 100 remains the preeminent "deal-making" venue.

Connect with Element5 and Joe:

Website: https://www.E5.ai
LinkedIn: https://www.https://www.linkedin.com/company/e5ai/
Joe's LinkedIn: https://www.linkedin.com/in/joerandesi

Special thanks to our sponsors:

Premier Sponsor:⁠⁠⁠⁠⁠⁠⁠ Trella Health⁠⁠⁠⁠⁠⁠⁠
Premier Sponsor: ⁠⁠⁠⁠⁠⁠⁠Homecare Homebase⁠⁠⁠⁠⁠⁠⁠
Premier Sponsor: ⁠⁠⁠⁠⁠⁠⁠Maxwell TEC⁠⁠⁠⁠⁠⁠⁠
Premier Sponsor: ⁠⁠⁠⁠⁠⁠⁠Lincoln Healthcare Leadership⁠

#HomeHealth #Hospice #Element5 #HC100 #AgenticAI #WorkflowAutomation #PostAcuteCare #RCM #LastVisitFirst #JoeRandesi

What Families Get Wrong About Dementia Care - Dr. Shadi Gholizadeh

Tom Maxwell — Fri, 19 Jun 2026 13:30:00 GMT

Dementia is one of the most feared diagnoses in aging. But most of what families, caregivers, and even healthcare professionals think they know about it is incomplete.

Dr. Shadi Gholizadeh, Chief Quality and Innovation Officer at TheKey, joins Tom Maxwell for a conversation that covers dementia from every angle. Prevention, care, behavior change, the one symptom our aging population is not paying attention to, and what it actually looks like to build a meaningful life after a diagnosis.

Dr. Gholizadeh is a clinical psychologist with training from Stanford, the London School of Economics, and UC San Diego. She has spent over a decade building science-backed, scalable care models at TheKey, the largest privately owned premium home care provider in North America, and she brings that experience into a conversation that is practical, personal, and long overdue.

Topics include:

The study that found 45% of dementias can be prevented or delayed through lifestyle changes
The Balanced Care Method and TheKey's six pillars of health in action
Anosognosia: the misunderstood symptom that changes how families should respond
Why labeling dementia patients as "resistant to care" is the wrong frame entirely and what to use instead
Engagement erosion: how decline happens quietly before anyone notices
The caregiver-as-change-agent model and why it works in the home
Where AI and wearables are headed in home care
A story about a son who almost stopped visiting his mom with dementia and what changed

Chapters

00:00 Introduction to Dr. Shadi Golizada and The Key
02:54 Dr. Golizada's Journey in Clinical Psychology
05:35 Understanding The Key's Home Care Services
08:48 The Six Pillars of Health and Wellness
11:33 Personalized Care and Hydration Strategies
14:38 The Importance of Caregiver Stories
17:28 Navigating Dementia and Family Dynamics
20:21 Education and Awareness in Dementia Care
23:23 Hope and Lifestyle Changes for Dementia Patients
26:05 Ads
29:06 Resources for Aging and Care Coordination
31:45 Technology in Home Care Services
35:59 AI in Caregiving: Enhancing Relationships and Documentation
40:49 The Importance of User-Centric Technology
44:28 Engagement and Joy in Care: The Role of AI
49:19 Health Behavior Change: A Balanced Approach
51:20 Ads
57:28 Long-Term Care: Building Meaningful Relationships
01:03:50 Transformative Stories: Changing Perspectives on Caregiving

Dr. Gholizadeh is the author of three books, all available on Amazon:

TheKey Essentials: Navigating Cognitive Change: A New Kind of Dementia Guide for Families by the Leaders in Home-Based Cognitive Support: https://a.co/d/0aLuKhf3
TheKey Essentials: The Balanced Path: Six Lifestyle Pillars That Shape How We Age: https://a.co/d/0iHbxSKr
TheKey Essentials: Aging with Confidence: Your Guide to Care, Safety, and Living Fully Wherever You Call Home: https://a.co/d/0dovA0iy

Connect with Dr. Shadi Gholizadeh and TheKey:

Website: https://www.thekey.com
Email: shadi@thekey.com
LinkedIn: https://www.linkedin.com/in/shadig

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

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/

Building a Hospice Company Around Family, Not Fraud: Phillip Fulgham

Tom Maxwell — Sun, 19 Jul 2026 13:30:00 GMT

The biggest problem in hospice isn't fraud, it's patients waiting too long to choose it.

Tom sits down with Phillip Fulgham, Vice President of Hospice at Saad Healthcare, a family owned home health and hospice company based in Mobile, Alabama serving the state's southern counties and coastal Mississippi. Phillip has led Saad's hospice service line since 2017, continuing a business his grandparents started over 50 years ago.

He explains:

Why short length of stay, not fraud, is the real crisis facing hospice today
How AI is helping nurses track and document patient decline more accurately
Why licensed practical nurse visits aren't reimbursed the same as registered nurse visits during a crisis, and why that's a problem
How respite and continuous home care are two of the most underused hospice benefits
Why bereavement care might be the most overlooked part of the entire hospice benefit

Tom and Phillip also get into the CMS Hospice Care Index, the serving and spending variation index oversight framework, nursing home referral practices, de-prescribing medications near end of life, and what it's like building a family legacy in home health and hospice.

Chapters:

00:16 Intro
01:04 Philip's path into the family hospice business
03:38 About Saad Healthcare
04:50 A day in the life of a VP of Hospice
07:21 Inpatient hospice units: freestanding vs. hospital-based
09:50 Hospice under scrutiny in the national press
12:38 The 27% of hospices not submitting CMS data
17:21 Long length of stay and the SSVI framework
20:23 Using AI to track and document patient decline
23:10 Favorite AI tools in hospice care
24:01 Building a "hospice brain" to catch patients earlier
26:13 The $1.9 billion cost of choosing hospice late
28:20 De-prescribing medications near end of life
31:41 What respite care actually is
34:36 Continuous care in the home
37:01 Ad Break
39:25 The LPN vs. RN reimbursement problem
41:11 Why aides and chaplains don't count in CMS metrics
42:21 EMTs, paramedics, and the hospice workforce shortage
42:53 RN licensing caps and compact state frustrations
46:22 CMS's proposed rule and Medicare spending buckets
47:55 PTANs and the nursing home referral cap
51:36 Inside Saad's bereavement program
56:00 Text-based bereavement and community outreach
1:02:06 How to connect with Philip and Saad Healthcare
1:03:15 The legacy question

Sponsors:

Premier Sponsor: Homecare Homebase: https://hchb.com/
Maxwell TEC: https://maxwelltec.com/
IntellaTriage: https://intellatriage.com/

#hospice #homehealthcare #endoflifecare #hospicecare #medicare #HealthcarePolicy

Laura Brinkoetter (Mosai) | Automating the Home Health Workflow

Tom Maxwell — Mon, 02 Feb 2026 15:00:00 GMT

Live from the Woodpecker Room at Home Care 100, Tom Maxwell welcomes a familiar face and industry star: Laura Brinkoetter, Chief Product Officer at Mosai.

In this briefing, Laura discusses the evolution of Mosai—the strategic merger of Medalogix and Forcura—and how they are marrying interoperability with clinical analytics. She breaks down the "Mosai Review" product and how "hands-free" automation is changing the game for coding and OASIS reconciliation. Plus, Tom and Laura reminisce about their days at Enclara and the legendary Maxwell pre-kickoff party in Scottsdale.

Chapters:

00:54 – Technology as a Force Multiplier: How technology enables strategy.
01:50 – The Power of the Merger: Marrying Forcura’s interoperability with Medalogix’s clinical analytics.
02:15 – Mosaic Review: Automating the referral flow and OASIS reconciliation.
03:15 – Summarizing Patient Care: Using tech to save clinicians from "reading every part of the chart."
05:30 – From Industrial Supply to Hospice: Laura’s journey from Grainger to the Enclara board.

Connect with Mosai and Laura:

Website: https://www.mosai.com/
LinkedIn: https://www.linkedin.com/company/mosai-intelligent-care/posts/?feedView=all
Laura's LinkedIn: linkedin.com/in/laura-brinkoetter-5b371216

Special thanks to our sponsors:

Premier Sponsor:⁠ Trella Health⁠
Premier Sponsor: ⁠Homecare Homebase⁠
Premier Sponsor: ⁠Maxwell TEC⁠
Premier Sponsor: ⁠Lincoln Healthcare Leadership⁠

#HomeHealth #Hospice #HomeCare100 #HC100 #HealthcareLeadership #LincolnHealthcare #LastVisitFirst

Is Your Hospice A Target? The 2027 CMS "Report Card" Explained

Tom Maxwell — Fri, 10 Apr 2026 22:56:51 GMT

"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: tom@maxwelltec.com
Podcast Website: www.lastvisitfirst.com

Connect with Maxwell TEC:

Website: www.maxwelltec.com
Email: sales@maxwelltec.com

#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

Stephen Phenneger (St. Croix Hospice) | The Reality of AI & "Co-op-etition"

Tom Maxwell — Mon, 02 Feb 2026 15:00:00 GMT

Live from HC100 in Scottsdale, Tom Maxwell sits down with longtime friend Stephen Phenneger, President and CFO of St. Croix Hospice.

Stephen offers a candid look at the state of the hospice industry, from the "dot-com" energy surrounding AI to the "co-op-etition" that defines the sector. With 7,000 patients across 10 states, St. Croix remains committed to a single-vertical delivery model. Stephen explains why he brings a full "cache" of clinical and financial leaders to HC100 and why the most important industry insights still happen when the "guards are down" at dinner.

Chapters:

01:20 – Target Rich Environment: Accomplishing 25 meetings in 3 days.
02:00 – Single-Vertical Strategy: Why St. Croix stays hospice-only across 100 offices.
02:30 – The AI Reality Check: Why today’s tech landscape feels like the "dot-com" era.
03:20 – M&A Outlook: Predicting the next 18 months of market activity.
04:30 – Co-op-etition: Why your competitors are your best teachers.

Connect with St. Croix Hospice and Stephen:

Website: https://StCroixHospice.com
LinkedIn: https://www.linkedin.com/company/st-croix-hospice/
Stephen's LinkedIn: linkedin.com/in/stephen-phenneger

Special thanks to our sponsors:

Premier Sponsor:⁠⁠ Trella Health⁠⁠
Premier Sponsor: ⁠⁠Homecare Homebase⁠⁠
Premier Sponsor: ⁠⁠Maxwell TEC⁠⁠
Premier Sponsor: ⁠⁠Lincoln Healthcare Leadership⁠

#Hospice #StCroixHospice #HC100 #HealthcareCFO #HospiceLeadership #LastVisitFirst #AIinHealthcare #HealthcareMA #HomeCare100

Unleashing Creative Genius in Home Health & Hospice with Dr. Heather Hodges

Tom Maxwell — Wed, 11 Feb 2026 15:00:00 GMT

Is leadership in home health a calling or just a job? In this episode of Last Visit First, Tom Maxwell sits down with Dr. Heather Hodges, organizational psychologist and CEO of Hodges Group International, to discuss the "Heart Work" required to lead frontline teams in the care at home industry.

Dr. Heather Hodges shares her journey from a creative professional to a leadership strategist within the home care industry. She introduces her groundbreaking framework, The 12 Types of Creative Genius, and explains why innovation isn't just for scientists—it’s the engine that allows clinicians to solve complex problems at the bedside.

Key Takeaways:

The 11-Second Rule: Why listening just a few seconds longer leads to better patient outcomes.
The Hero’s Journey of Leadership: Moving from a "weak" hero to a "strong" guide (the Yoda vs. Luke Skywalker analogy).
Culture as Retention: Why people don't leave organizations; they leave supervisors—and how to build a culture people won't want to leave.
Creative Genius: Identifying whether your leadership style is driven by the Head (Cognitive), Heart (Relational), or Hands (Functional).

Chapters:

00:00 – Meet Dr. Heather Hodges: Leadership Strategist
02:03 – The Career Shift: From Creative to Home Health Executive
05:47 – Personality Science: Using the Enneagram to Lead Diverse Teams
08:38 – The 12 Types of Creative Genius (Head, Heart, and Hands)
14:52 – Cultivating Culture: Tapping into Frontline Innovation
20:08 – Heart Work: Bridging the Gap Between Nursing and Management
28:05 – Communication Secrets: The 11-Second Rule for Clinicians
32:36 – The Future of Care: Balancing AI Tech with Human Empathy
45:57 – Self-Reflection & The Hero’s Journey of Leadership
50:31 – How to Connect with Dr. Hodges & Final Thoughts

Connect with Dr. Heather Hodges:

Special thank you to our sponsors:

Check out Last Visit First on other platforms:

About Last Visit First:

In home health and hospice, the start of care usually begins with the final visit in mind—because every decision becomes a memory.

'Last Visit First' challenges the industry to prioritize quality, connection, outcomes, and dignity right from the start. Hosted by industry veteran Tom Maxwell, we sit down with the CEOs, innovators, and clinical leaders shaping the future of Care at Home. We bring you the conversations that drive change, from leadership strategies to the innovations redefining patient care.

Join the Conversation: If you enjoyed this episode, please Subscribe and leave a comment below. It helps us bring more incredible guests to the show.

Plugging the Leak: Mastering After-Hours Care in a Value-Based World

Tom Maxwell — Sat, 21 Feb 2026 19:05:59 GMT

When the high-stakes discipline of a Navy submarine officer meets the fragmentation of hospice and home health, the result is a radical "Nurse-First" philosophy that challenges every industry norm. Daniel Reese, CEO of IntellaTriage, joins Tom Maxwell to expose why the current healthcare system is failing clinicians and how to survive the coming workforce redesign.

Inside the Episode:

The "Submarine Effect" on Leadership: Why servant leadership isn't just a buzzword—it’s a tactical requirement for mission-driven organizations.
Solving the After-Hours Black Hole: How immediate access to a US-based nurse (not an answering service) transforms patient outcomes and stabilizes the home environment.
AI & Clinical Intelligence: A skeptical look at the "AI hype train" and why technology must be used to automate the "maintenance" of documentation so clinicians can focus on "hugging the patient."
Personal stakes in ESRD: A raw discussion on why the current Medicare hospice benefit is fundamentally broken for end-stage renal disease patients and how we can advocate for change.

Chapters:

0:09 - Introduction of Daniel Reese, CEO of IntellaTriage
0:32 - Discussion about Daniel's background as a Navy submarine officer
0:40 - Daniel's journey through the Naval Academy and active duty
3:31 - Leadership lessons learned from military service
5:14 - Daniel's transition from the Navy to business school and family business
7:09 - The path to becoming CEO of IntellaTriage
9:23 - Explanation of IntellaTriage's mission and services
10:53 - Discussion on the importance of telephone nursing and after-hours care
13:14 - Issues with interoperability and after-hours care
16:56 - Staffing shortages and recruitment strategies
20:00 - Homecare Homebase premier sponsored ad
20:48 - Predictions for the next five years in the industry
23:34 - The impact of Medicare Advantage and value-based care
28:59 - Discussion on the role of AI in healthcare
32:35 - Potential benefits and risks of AI implementation
40:27 - Maxwell TEC sponsored ad
45:29 - Daniel's personal interests and family life
55:48 - His vision for the future of IntellaTriage and personal legacy

Connect with Daniel and IntellaTriage:

Daniel's LinkedIn: https://www.linkedin.com/in/dreesemba
Daniel's email: dreese@intellatriage.com
IntellaTriage LinkedIn: https://www.linkedin.com/company/intellatriage/
IntellaTriage website: https://intellatriage.com/

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:

About Last Visit First:

In home health and hospice, the start of care usually begins with the final visit in mind—because every decision becomes a memory.'Last Visit First' challenges the industry to prioritize quality, connection, outcomes, and dignity right from the start.

Hosted by industry veteran Tom Maxwell, we sit down with the CEOs, innovators, and clinical leaders shaping the future of Care at Home. We bring you the conversations that drive change, from leadership strategies to the innovations redefining patient care.

Join the Conversation:

If you enjoyed this episode, please Subscribe and leave a comment below. It helps us bring more incredible guests to the show.

10 BILLION in Investments Later: David Schuppan on Scaling Healthcare Winners

Tom Maxwell — Thu, 23 Apr 2026 12:30:00 GMT

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/

Partners, Not Competitors: QAPIplus on Building a Better Home Health Ecosystem

Tom Maxwell — Thu, 17 Sep 2026 14:00:00 GMT

QAPIplus Co-Founder and CEO Armine Khudanyan, Co-founder and CTO Lara Koraian, and Chief Growth Officer Jared Robey join Last Visit First, with guest host Jennifer Maxwell filling in for Tom this episode, to talk about how QAPIplus is transforming quality improvement and compliance for home health and hospice organizations.

The team explains how QAPIplus helps agencies operationalize the flood of data coming in from documentation and CMS quality compliance, shifting time and effort away from manual reporting and toward real, measurable performance improvement. They also share their take on the industry's ongoing AI conversation, and why partnership, not competition, between vendors is the key to building a more holistic experience for home health and hospice providers.

Chapters:

0:00 Welcome & Guest Host Jennifer Maxwell
0:18 Meet the QAPIplus Team
0:52 What QAPIplus Does
1:32 The Biggest Problem QAPIplus Solves
2:59 Why Vendor Partnership Matters More Than Competition
4:32 Reflecting on the Conference

Connect with QAPIplus

Connect with Armine

Connect with Lara

Connect with Jared

Sponsors:

Brought to you as a Premier Sponsor collaboration with Homecare Homebase (HCHB), a leading home health and hospice software and EMR platform. Learn more at https://lastvisitfirst.com/go/hchb

Want to level up your team's HCHB skills? Check out HCHB University for virtual live and on-demand training designed to help your team deliver exceptional care. Creating an account is easy—simply click Sign Up in the top right corner of the homepage to get started. Use the code uc2026 when you checkout for 35% off any course if you purchase before 9/30/26: https://lastvisitfirst.com/go/hchb-university

Building a Culture People Never Want to Leave | Mark Kimsey, CEO of Mission Healthcare

Tom Maxwell — Wed, 29 Jul 2026 13:30:00 GMT

Mark Kimsey got his start in healthcare at 13 years old, fetching sandwiches and Diet Cokes in a hospital administrative office. A few years later, an afternoon observing ICU care hooked him for good. Today he is CEO and co-founder of Mission Healthcare, one of the largest home health and hospice providers on the West Coast.

Tom Maxwell sits down with Mark to trace that whole journey, from a broken, bankrupt single-location agency called Genesis Care to a 34-location organization spanning home health, hospice, palliative, and transitional care. Along the way, Mark opens up about building a company with his wife and best friend, California's aggressive hospice fraud crackdown and what it means for good providers, the technology stack keeping Mission compliant, and the leadership philosophy that keeps people at the company for decades.

Topics Include:

Mark's path from teenage hospital intern to CEO
Turning a broken, bankrupt agency into Mission Healthcare
California's hospice fraud crackdown and the PPEO audit process
How Mission uses Muse data and technology to stay compliant
What makes a great leader and a culture people stay in for life

Chapters:

00:00 Intro
00:16 Welcome to Last Visit First & Meet Mark Kimsey
01:06 A Teenage Hospital Job That Sparked a Career in Healthcare
05:50 Breaking Into Sales at Medline
07:00 Returning to Care South and Building Toward Mission
08:16 The Broken Agency That Became Mission Healthcare
09:29 Why San Diego? The Origin Story
11:21 Mission Healthcare Today: 34 Locations and the Traditions Acquisition
12:54 Running a Company With Your Spouse and Best Friend
15:51 California's Hospice Fraud Crackdown and PPEO Audits
19:41 Helping Patients and Physicians Identify a Compliant Provider
20:55 Technology, Muse Data, and AI Adoption
22:42 The Secret to Recruiting Great People
25:55 Building a Culture People Never Want to Leave
27:56 What's Next: Growth, Acquisitions, and Hiring Plans
29:46 Ads
34:15 What Makes a Great Leader at Mission
35:59 Hustle, Culture, and Having Fun at Work
37:57 A Letter That Showed the True Impact of Hospice Care
40:19 The Nana Upstairs, Nana Downstairs Story
42:53 Family Home Health and Hospice in Georgia
44:32 How a Napkin Sketch Led Jack Drawn Into Home Health
47:39 Meet the Mission Healthcare Leadership Team
51:37 Reflecting on the Mission Healthcare Journey
53:13 Outro

Sponsors:

Premier Sponsor: Homecare Homebase: https://hchb.com/
Maxwell TEC: https://maxwelltec.com/
IntellaTriage: https://intellatriage.com/

#hospice #homehealthcare #endoflifecare #hospicecare #medicare #healthcarepolicy #healthcareleadership #healthcarepodcast

From Static Screens to AI Agents: The Future of Home Health Software with Elliott Wood

Tom Maxwell — Tue, 15 Sep 2026 14:30:00 GMT

Mosai CEO Elliott Wood joins Last Visit First once again to talk AI, software, and where home-based care technology is headed next. Eighteen months after the merger of Forcura and Medalogix into Mosai, Elliott shares how the company is reimagining software delivery from the ground up, from consolidating cluttered multi-screen clinician workflows into a single AI-assisted interface, to using AI agents to gather information and surface decisions for clinicians rather than requiring them to dig for it themselves.

Elliott and Tom also dig into how AI is transforming software development speed itself, cutting build timelines from weeks to hours, and what that means for the future of home health and hospice technology more broadly.

Chapters:

0:00 An Update from Mosai
0:08 What Is Mosai? Forcura + Medalogix
1:23 Conference Buzz: Reset & Realign Keynote
2:43 18 Months Into the Merger
2:59 AI's Impact on Software's Future
3:59 From Multiple Screens to One AI-Assisted View
6:01 Speed to Software: Building Faster with AI
7:18 A Golf Scoring App Built with Claude
9:32 Software People Want to Use, Not Have To

Connect with Mosai

Connect with Elliott

Sponsors:

Brought to you as a Premier Sponsor collaboration with Homecare Homebase (HCHB), a leading home health and hospice software and EMR platform. Learn more at https://lastvisitfirst.com/go/hchb

Want to level up your team's HCHB skills? Check out HCHB University for virtual live and on-demand training designed to help your team deliver exceptional care. Creating an account is easy—simply click Sign Up in the top right corner of the homepage to get started. Use the code uc2026 when you checkout for 35% off any course if you purchase before 9/30/26: https://lastvisitfirst.com/go/hchb-university

Hannah Pearson (HCHB) | Meaningful Connections & Industry Survival

Tom Maxwell — Wed, 28 Jan 2026 15:59:34 GMT

We are kicking off our "Live from HC100 Scottsdale" series with a very special guest: Hannah Pearson, Chief Revenue Officer at Homecare Homebase.In this short, candid conversation with Tom Maxwell, she breaks down the shift from the "negative" industry outlooks to the power of meaningful, in-person connections at the Phoenician.

Key Highlights:

00:55 – Why the "Failure Panel" doesn't tell the whole story of home health.
01:40 – The intensity of HC100: Why meetings start at 7:00 AM.
02:50 – Hot off the presses: The return of Martha Stewart Williams to the HCHB team.
04:10 – How to connect with the Homecare Homebase team.

Special thanks to our sponsors:

Premier Sponsor: Trella Health
Premier Sponsor: Homecare Homebase
Premier Sponsor: Maxwell TEC
Premier Sponsor: Lincoln Healthcare Leadership

#HomeHealth #Hospice #PostAcuteCare #HC100 #LastVisitFirst

Si Luo (CareXM) | Unlocking Clinician Capacity via EMR Interoperability

Tom Maxwell — Fri, 30 Jan 2026 15:00:00 GMT

Live from Home Care 100 in Scottsdale, host Tom Maxwell is joined by Si Luo, CEO of CareXM.

As agencies face increasing "growth constraints" and clinical capacity issues, Si breaks down CareXM's unique "overlay stack" approach—a bidirectional integration with major EMRs like Homecare Homebase and MatrixCare. This allows a centralized nursing workforce to manage after-hours triage without the need for multiple, disparate logins, preserving both security and clinician sanity.

Key Highlights:

01:05 – Turning agencies 24/7: The clinical triage impact on the HOPE assessment.
01:45 – Why Si L. Luo’s team built an "Overlay Stack" to bypass the EMR login nightmare.
02:20 – The "No More EMR" airplane stunt: A debate on the lifeblood of revenue cycle.
03:40 – Growth Constraints vs. Demand: Strategies for the "AI Curious" era of 2026.
04:30 – Interoperability: Capturing "tribal clinician knowledge" to scale without compromise.

Connect with Si Luo & CareXM:

Website: https://CareXM.com
LinkedIn: https://linkedin.com/in/siluo

Special thanks to our sponsors:

Premier Sponsor: ⁠⁠⁠⁠⁠Trella Health⁠⁠⁠⁠⁠
Premier Sponsor: ⁠⁠⁠⁠⁠Homecare Homebase⁠⁠⁠⁠⁠
Premier Sponsor: ⁠⁠⁠⁠⁠Maxwell TEC⁠⁠⁠⁠⁠
Premier Sponsor: ⁠⁠⁠⁠⁠Lincoln Healthcare Leadership

#Hospice #CareXM #Interoperability #HC100 #Triage #HealthcareTech #LastVisitFirst

Inside CareXM's AI Transformation Journey with Si Luo

Tom Maxwell — Thu, 17 Sep 2026 14:00:00 GMT

CareXM CEO Si Luo returns to Last Visit First to share how the company's AI triage assistant is changing the way nurses handle patient calls. Si explains how CareXM rolled the tool out to 100% of its internal users, with early external adoption from agencies like Amedisys and LHC, resulting in more than a 25% improvement in the number of triage encounters each nurse can handle.

Si also breaks down how the tool works, clinically summarizing calls so triage nurses can stay fully present with patients while the software connects back to protocol for large-scale QA review, and shares what's next for CareXM's integration roadmap alongside Homecare Homebase, including smart scheduling and point-of-care tools.

Chapters:

0:00 Welcome Back: Si Luo, CEO of CareXM
0:53 What's New at CareXM
1:44 The AI Triage Assistant Rollout
2:54 What's Next: Aligning with HCHB's Roadmap

Connect with Si

Sponsors:

Brought to you as a Premier Sponsor collaboration with Homecare Homebase (HCHB), a leading home health and hospice software and EMR platform. Learn more at https://lastvisitfirst.com/go/hchb

Want to level up your team's HCHB skills? Check out HCHB University for virtual live and on-demand training designed to help your team deliver exceptional care. Creating an account is easy—simply click Sign Up in the top right corner of the homepage to get started. Use the code uc2026 when you checkout for 35% off any course if you purchase before 9/30/26: https://lastvisitfirst.com/go/hchb-university

Innovation, Legacy, and Mission: April Anthony’s Impact on Care at Home

Tom Maxwell — Wed, 08 Oct 2025 13:00:00 GMT

In this episode of Last Visit First, Tom Maxwell sits down with April Anthony — CEO of VitalCaring, founder of Encompass Home Health, and creator of Homecare Homebase. April shares her remarkable journey from unexpectedly buying her first home health agency at 25 to building some of the most influential organizations in care at home. Her story highlights the power of resilience, innovation, and culture in shaping not just businesses, but the future of home health and hospice.

People of the Episode:
Guest: April Anthony
Host: Tom Maxwell
Producer: Cole Sorensen

Sponsors:
Maxwell TEC
Steno Health
Levo

Companies Founded by April Anthony:
VitalCaring
Homecare Homebase
Encompass Health

Listen & Follow Last Visit First:
Apple Podcasts
Spotify
YouTube
Website
LinkedIn

Reference:
Medicare Advantage Article

Contact:
csorensen@lastvisitfirst.com

Keywords:
home health leadership, homecare homebase, April Anthony, VitalCaring, hospice innovation, care at home future, healthcare technology, Medicare Advantage, clinician retention, healthcare culture

Outline:
00:00 – Sponsor Ad Reads
02:16 – Introduction and April’s Career Overview
03:48 – How Tom and April First Met
04:18 – April’s Start in Home Health
08:21 – Buying Her First Agency at 25
10:36 – Learning the Business Through Ride-Alongs
13:45 – Philosophy: Take Care of Employees First
15:55 – Founding Homecare Homebase
20:49 – Growth of HCHB (2001–2007)
27:32 – Patient Story: Owen Perry
39:27 – Technology and AI in Home Health
50:00 – The Rise of Medicare Advantage
57:27 – April’s Legacy and Motivation
01:05:15 – Closing Reflections

20 Years Strong: Inside HCHB's Biggest Users Conference Yet | Hannah Pearson

Tom Maxwell — Tue, 15 Sep 2026 14:30:00 GMT

Homecare Homebase kicked off its 20th anniversary Users Conference in Orlando, Florida, and Last Visit First was there to capture it. Chief Revenue Officer Hannah Pearson joins host Tom Maxwell to set the stage for this milestone home health and hospice conference, from the keynote and executive track sessions to a jam-packed vendor marketplace with hundreds of home care industry exhibitors.

With nearly 500 attendees and around 50 executives in the room, this year's HCHB Users Conference brought together home health and hospice leaders for education, networking, and a look at what's next for the industry, plus a little fun along the way, including a bourbon and wine night and a glow party at SeaWorld.

Hannah also shares what's ahead for HCHB's Users Conference, including upcoming stops in Washington, D.C., Chicago, and Nashville in the years to come.

Chapters:

0:00 Welcome to HCHB's 20th Anniversary Conference
0:40 Conference Events & Vendor Marketplace
1:30 What's Next: Future Conference Locations

Connect with Hannah: https://www.linkedin.com/in/pearsonhannahm

Sponsors:

Brought to you as a Premier Sponsor collaboration with Homecare Homebase (HCHB), a leading home health and hospice software and EMR platform. Learn more at https://lastvisitfirst.com/go/hchb

Want to level up your team's HCHB skills? Check out HCHB University for virtual live and on-demand training designed to help your team deliver exceptional care. Creating an account is easy—simply click Sign Up in the top right corner of the homepage to get started. Use the code uc2026 when you checkout for 35% off any course if you purchase before 9/30/26: https://lastvisitfirst.com/go/hchb-university

Rexanne Domico, CEO of Interim HealthCare, on Leading a 60-Year-Old Franchise Network

Tom Maxwell — Sat, 08 Aug 2026 13:30:00 GMT

Rexanne Domico is the President and CEO of Interim HealthCare, one of the nation's largest network of home care, home health, hospice, and medical staffing franchises. She stepped into the CEO role in January 2025 after more than two decades in post-acute care, including leadership roles at Gentiva, LHC Group, BrightSpring, and HomeFree Pharmacy Services.

In this conversation, Rexanne joins the podcast to talk about the mentors who shaped her career (including care at home industry icon Ron Malone and Keith Myers), what surprised her most in her first 90 days as CEO, how Interim has stayed at the forefront of care at home for 60 years, and where she sees the biggest opportunities and gaps in home-based care today. They also dig into the hospice care access gaps, California's new emergency hospice regulations, and how AI is starting to change the day-to-day work of clinicians and back-office teams.

What's covered in the episode:

How Rexanne got her start in the staffing industry and moved into healthcare
The mentor who changed the course of her career
What she found in her first 90 days as Interim's CEO
Why Interim has lasted 60 years, and what's next
California's new emergency hospice bill, explained
What Rexanne would change if she ran CMS for a day
Where AI is already saving clinicians hours of work
Why negative press is hurting hospice education

About Interim HealthCare:

Founded in 1966, Interim HealthCare is a national network of locally owned home care, home health, hospice, and medical staffing franchises, serving roughly 190,000 people a year across more than 300 care centers.

Connect with Rexanne and Interim HealthCare:

Rexanne's LinkedIn: https://www.linkedin.com/in/rexanne-domico-b55b061
Interim's website: https://www.interimhealthcare.com/

Chapters:

0:00 Welcome to Rexanne Domico, CEO of Interim HealthCare
1:37 How Rexanne got her start, from staffing to Gentiva
3:07 Running a home health pharmacy business
4:54 The mentor who changed everything: Ron Malone
7:11 Tom's favorite Ron Malone stories
8:33 Staying humble while leading a major organization
11:45 What makes organizations scale successfully
13:57 Ron Malone, Keith Myers, and Mark Baiada: the industry's founding icons
16:39 The first 90 days as CEO of Interim
20:02 60 years of Interim: what's kept it going
23:17 Interim's size, scale, and the next 5 years
25:55 Balancing a national brand with local entrepreneurship
28:52 Inside Interim's national conference
29:30 What success looks like for home-based care in 2030
32:25 The 79 million reason staffing matters
33:23 What healthcare leaders still get wrong about home care
34:32 Telehealth's role in the future of care
35:42 The ESRD and hospice access gap
35:53 Trends Interim is watching closely
39:18 California's emergency hospice bill, explained
42:12 If Rexanne ran CMS for a day
46:46 Fixing recruiting and retention across the network
50:41 Where technology will make the biggest impact
52:15 How AI could cut hours of chart review
54:38 The gap: 6 days with no nurse in the home
55:44 Early adopter vs. letting tech mature
59:12 Educating families about hospice
1:01:34 Why negative press is hurting hospice access
1:02:43 Rexanne outside of work
1:04:24 Advice to her younger self
1:05:53 The legacy she wants to leave
1:06:56 How to reach Rexanne about franchising
1:07:56 Closing thoughts

Sponsors:

Maxwell TEC: https://maxwelltec.com/
IntellaTriage: https://intellatriage.com/

#homehealth #hospice #homecare #PostAcuteCare #InterimHealthCare #franchising #healthcareleadership #aginginplace #LastVisitFirst

Scott Levy (The Alliance) | The 2026 Policy Roadmap & Washington Outlook

Tom Maxwell — Mon, 02 Feb 2026 15:00:00 GMT

Live from Home Care 100 in Scottsdale, Tom Maxwell sits down with Scott Levy, the Chief Government Affairs Officer for the National Alliance for Home Care at Home.In this interview, Scott pulls back the curtain on the Alliance’s unified advocacy mission following the historic NACH and NHPCO merger.

He discusses the reality of "divided government" following the 2026 elections, the implementation of HOPE, and the industry’s proactive stance against fraud, waste, and abuse. Scott also shares a personal perspective on "continuity of care" and why educating new members of Congress on the difference between home health and hospice is the industry’s biggest hurdle.

Chapters:

01:15 – One Voice: How the Alliance merger is strengthening the industry’s messaging.
02:40 – The Patient’s Lens: Why "familiar faces" are the most important metric for family caregivers.
05:40 – D.C. Calendar: Key dates for the Financial & Tech Conference and the Washington Fly-In.
06:20 – Fraud & Abuse: Working with CMS to stop "bad actors" before they enter the program.
09:30 – Dr. Oz & CMS: Why the administration is reaching out to the Alliance for provider insights.
11:45 – Election Forecast: What a shifting House and Senate means for reimbursement in 2027.

Connect with The Alliance and Scott:

Website: https://allianceforcareathome.org/
LinkedIn: https://www.linkedin.com/company/thealliancehome/posts/
Scott's LinkedIn: linkedin.com/in/scott-levy-09a8829b

Special thanks to our sponsors:

Premier Sponsor:⁠⁠⁠ Trella Health⁠⁠⁠
Premier Sponsor: ⁠⁠⁠Homecare Homebase⁠⁠⁠
Premier Sponsor: ⁠⁠⁠Maxwell TEC⁠⁠⁠
Premier Sponsor: ⁠⁠⁠Lincoln Healthcare Leadership⁠

#HomeHealth #Hospice #TheAlliance #HC100 #HealthcarePolicy #WashingtonDC #Lobbying #LastVisitFirst #Medicare

Kurt Baumgartel (CareRing Health) | Ambient AI and the Future of Dual-Eligible Care

Tom Maxwell — Mon, 02 Feb 2026 15:00:00 GMT

We’re closing out our "Live From HC100" series with a true industry veteran, Kurt Baumgartel, CEO of CareRing Health.

Having run divisions for some of the biggest names in the space, Kurt is now focusing on perfecting the "care coordination" model for dual-eligibles in the Mid-Atlantic. In this briefing, he and Tom dive deep into the technology that has everyone at HC100 buzzing: Ambient AI. Kurt discusses his success using ambient listening in the clinic and how this "game-changer" is poised to transform the home health start of care visit. We also explore CareRing Health’s sophisticated use of Snowflake and Health Cloud to drive cross-service admissions and better patient outcomes.

Chapters:

01:05 – Ambient AI in the Clinic: How "ambient listening" is already saving clinicians from hours of documentation.
02:30 – Solving the Start of Care: Why reducing the documentation burden will make nurses want to do admissions again.
03:50 – CareRing Health’s Model: Managing 5,000 lives across the Mid-Atlantic with a focus on personal care.
04:20 – The Data Stack: Leveraging Snowflake and Salesforce Health Cloud for intelligent care coordination.
05:00 – Proving the Value: Using a Philadelphia-based pilot to show payers the cost savings for dual-eligibles.

Connect with CareRing Health and Kurt:

Website: https://careringhealth.com/
LinkedIn: https://www.linkedin.com/company/carering-health/
Kurt's LinkedIn: https://www.linkedin.com/in/kurt-baumgartel

Special thanks to our sponsors:

Premier Sponsor: Trella Health
Premier Sponsor: Homecare Homebase
Premier Sponsor: Maxwell TEC
Premier Sponsor: Lincoln Healthcare Leadership

#HomeHealth #Hospice #PersonalCare #AmbientAI #HealthcareAI #DualEligibles #HC100 #CareRingHealth #LastVisitFirst #Podcast #TomMaxwell HomeCare100

Brian Lobley (Tango) | The End of the "Referral Jump Ball" in Home Health

Tom Maxwell — Fri, 30 Jan 2026 15:00:00 GMT

What if you never had to "chase" a referral again? In this episode of Last Visit First, live from HC100 in Scottsdale, Tom Maxwell sits down with Brian Lobley, President and CEO of tango.

Brian breaks down tango’s pivot from PHCN to a value-based MSO that acts as an "enablement platform" for home health providers. He shares a staggering success story from Pennsylvania where 100% of qualified referrals were successfully placed because the administrative burden—eligibility, orders, and patient contact—was handled before the agency even received the ping.

Key Highlights:

01:10 – Moving the market to value-based care: Why all stakeholders are finally aligned.
02:05 – Scaling to 900,000+ new lives in Michigan, Tennessee, and Oregon.
03:45 – "Land and Expand": How tango levels the playing field between small agencies and national payers.
04:55 – The 100% Placement Metric: Eliminating the "Jump Ball" at discharge.
06:20 – Why Home Health spend is only 2% of the dollar, but controls 100% of the outcome.

Connect with tango:

Website: https://tangocare.com
LinkedIn: https://www.linkedin.com/company/tangocare/

Special thanks to our sponsors:

Premier Sponsor: ⁠⁠Trella Health⁠⁠
Premier Sponsor: ⁠⁠Homecare Homebase⁠⁠
Premier Sponsor: ⁠⁠Maxwell TEC⁠⁠
Premier Sponsor: ⁠⁠Lincoln Healthcare Leadership

#ValueBasedCare #HC100 #tango #PostAcuteCare #LastVisitFirst #Podcast #LeadershipConference

Navigating the Gray: The Role of Hospice Pharmacy with Dr. Jason Kimbrel

Tom Maxwell — Sat, 17 Jan 2026 15:00:00 GMT

From clinical rotations in Maine to guiding strategy at a national scale, Dr. Jason Kimbrel has defined his career by "living in the gray." As the COO of Yellow Leaf Consulting and a former NHPCO section leader, Jason bridges the gap between rigid medical rules and the compassionate, complex reality of end-of-life care.

In this episode, Jason joins Tom to dismantle the industry's biggest medication myths—from the fear that "morphine kills" to the regulatory nightmares of Medicare Part D leakage. They dive deep into the origins of the hospice pharmacy movement, the history of liquid morphine (Roxanol), and the heartbreaking "Vitamin Story" that exposed a massive gap in how clinicians handle de-prescribing.

Plus, Jason breaks down the "BUILD Model" for difficult conversations and advises CEOs on when it makes financial sense to bring a pharmacist in-house.

In this episode, we cover:

The "Gray Area" of Hospice Pharmacy: Why success in end-of-life care requires moving beyond black-and-white hospital protocols to focus on comfort.
The Art of De-prescribing: How to stop unnecessary medications without making families feel abandoned—preventing the "cereal bowl" effect of too many pills.
Debunking the "Morphine Myth": Addressing the deep-seated fear that hospice opioids are meant to hasten death rather than manage pain.
The Crisis of Experience: How the decline in nurse tenure (from 10 years to 2) is creating a knowledge gap in pharmacology that leaders must address.
Pharmacy Access Danger: The growing risk of "pharmacy deserts" as 24-hour community pharmacies disappear, threatening 3 AM crisis management.
The Pharmacist in the IDG: The critical need to integrate pharmacy expertise into the Interdisciplinary Group to improve HOPE scores and outcomes.

Timestamps:

00:09 Introduction to Dr. Jason Kimbrel
01:20 The Superpower of "Living in the Gray"
05:00 The History: Phyllis Grauer & Roxane Labs
08:52 The M&A Journey: From PCCG to Optum
10:37 The Meaning Behind "Yellow Leaf"
12:54 What Makes Hospice Pharmacy Unique?
16:47 Addressing the "Morphine Kills" Myth
21:16 The Vitamin Story: A Failure in De-prescribing
28:00 The BUILD Model Explained
34:06 Misunderstood Meds: Haloperidol & Methadone
43:30 Medicare Part D Leakage & "Call Letters"
44:00 Regulatory History: CR 8358 & 10573
51:47 CEO Advice: Managing Formularies & PBMs
59:06 Drug Shortages & Sub-Q Administration
01:02:18 The HOPE Assessment & Symptom Management
01:07:26 The Pharmacist's Role in the IDG
01:17:29 When to Hire an In-House Pharmacist (1,000 ADC)
01:24:40 The Crisis of Community Pharmacy Access
01:33:00 The "Billy" Story: Ewing's Sarcoma & Legacy

Resources Mentioned:

Book: Palliative Care Consultant: Guidelines for Effective Management of Symptoms (The "PCC")
Model: The BUILD Model (Build, Understand, Inform, Listen, Develop)
Regulation: CR 8358 (NDC Reporting Requirement)
Regulation: CR 10573 (Two-Tier Payment System)
Person: Phyllis Grauer (Industry Pioneer)

Special thank you to our sponsors:

Check out Last Visit First on other platforms:

About Last Visit First:

In home health and hospice, the start of care usually begins with the final visit in mind—because every decision becomes a memory.

Join the Conversation: If you enjoyed this episode, please Subscribe and leave a comment below. It helps us bring more incredible guests to the show.

Jason Gerard (Agape Care Group) | The M&A Playbook for Regional Scale

Tom Maxwell — Mon, 02 Feb 2026 15:00:00 GMT

Live from the Woodpecker Room at HC100, Tom Maxwell welcomes Jason Gerard, CFO of Agape Care Group.

Jason shares the remarkable growth story of Agape Care, which expanded from a single-state provider in South Carolina to serving over 6,500 patients across 10 states in just a few years. He breaks down the strategic decision to remain "hospice-only," the importance of their pediatric program ("Hands of Hope"), and the unique integration playbook that ensures one plus one actually equals two in an acquisition. Plus, a shoutout to integration star Carrie Vanden Magdenberg and her journey from Maxwell TEC consultant to Agape Care leader.

Chapters:

01:10 – The Growth Engine: Scaling from 700 to 6,500+ patients since 2018.
01:55 – Partnership with Linden: Why Agape Care Group recapped with Linden Capital Partners.
02:25 – Tight Geography: Why staying close to the "flagpole" in the Southeast is a strategic win.
03:00 – Hands of Hope: Serving the unique needs of nearly 200 pediatric hospice patients.
04:35 – The Niche Advantage: Why Agape chose to double down on hospice rather than diversify into home health.
05:40 – The Integration Secret: How a customized integration plan keeps employees engaged and assets protected.

Connect with Agape Care Group and Jason:

Website: https://agapecaregroup.com/
LinkedIn: https://www.linkedin.com/company/agapecaregroup/
Jason's LinkedIn: linkedin.com/in/jason-gerard-tx

Special thanks to our sponsors:

Premier Sponsor:⁠⁠⁠⁠ Trella Health⁠⁠⁠⁠
Premier Sponsor: ⁠⁠⁠⁠Homecare Homebase⁠⁠⁠⁠
Premier Sponsor: ⁠⁠⁠⁠Maxwell TEC⁠⁠⁠⁠
Premier Sponsor: ⁠⁠⁠⁠Lincoln Healthcare Leadership⁠

#Hospice #AgapeCare #HC100 #HomeCare100 #HealthcareM&A #HealthcareCFO #LastVisitFirst #PediatricHospice #HandsOfHope #HospiceGrowth

Centralization & The "Dream EMR" with Beau Sorensen

Tom Maxwell — Wed, 07 Jan 2026 14:00:00 GMT

From working front desk tasks in high school to leading as CEO, Beau Sorensen has built First Choice Home Health & Hospice into a powerhouse of culture and operational discipline.

In this episode, Beau joins Tom to discuss how he is navigating the industry's biggest headwinds—from Medicare Advantage rate pressures to the "ProPublica hangover." They dive deep into the future of technology, debating why today’s EMRs aren’t enough, the shift from "Ambient Listening" to "Ambient Watching," and how First Choice uses individual scorecards to gamify clinical outcomes.

Plus, Beau shares the unique challenges of scaling a Pediatric Home Health division and his "Leadership by Wandering Around" philosophy.

In this episode, we cover:

The "Dream EMR": Why Beau would pay a premium for a single "pane of glass" platform.
Ambient Intelligence: Moving beyond voice dictation to cameras that detect tremors and gait changes.
Gamifying Quality: How individual clinician scorecards drastically improved patient outcomes.
Centralization Strategy: Why First Choice centralizes functions, not just people.
Pediatric Home Health: The business case for 24/7 care vs. intermittent visits.

Timestamps:

00:00 Introduction to Home Health and Hospice Leadership
01:06 Bo Sorensen's Journey in Home Health
04:47 Core Leadership Principles at First Choice
09:36 Embracing Technology and AI in Home Health
17:05 Addressing Challenges in Home Health Care
24:42 Vision for the Future of EMR and AI Integration
28:08 The Bi-Directional Relationship in EMRs
29:51 The Rise of Ambient Listening in Healthcare
32:37 The Future of Ambient Watching
34:53 Rapid Changes in Healthcare Technology
36:36 Improving Outcomes through Individual Scorecards
40:56 Preparing for Value-Based Care
42:44 Post-Discharge Patient Management
45:02 Expanding into Pediatric Care
49:48 Challenges in Hospice Care
58:28 Empowering Athletes with Disabilities
58:52 Challenges of Medicare Advantage
01:00:40 Negotiating with Payers
01:03:41 Quality of Care in Medicare Advantage
01:05:46 Holistic Healthcare Solutions
01:07:37 Legacy and Industry Advancement
01:09:43 Leadership and Trust
01:11:49 Influences and Mentorship
01:16:43 Grounding Practices for CEOs
01:19:39 Closing Thoughts and Future Engagements

Resources Mentioned:

Special thank you to our sponsors:

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

Check out Last Visit First on other platforms:

About Last Visit First:

In home health and hospice, the start of care usually begins with the final visit in mind—because every decision becomes a memory.

Join the Conversation: If you enjoyed this episode, please Subscribe and leave a comment below. It helps us bring more incredible guests to the show.

Charles McDonough (Delaware Hospice) | Ripping Down Barriers in Post-Acute Care

Tom Maxwell — Mon, 02 Feb 2026 15:00:00 GMT

Live from Day 2 of the Last Visit First podcast at the 2026 Home Care 100 Leadership Conference in Scottsdale, Charles McDonough, President and CEO of Delaware Hospice, joins the podcast to discuss the evolving definition of "community care."

As the leader of the nation's first hospice in the first state, Charles isn't just leaning on legacy—he’s leaning into disruption. In this briefing, he explores how Delaware Hospice is leveraging the GUIDE model to redefine dementia care and why "upskilling" internally is the only sustainable answer to the national nursing crisis. Charles and Tom also dive into a provocative discussion on state licensure laws: are they protecting quality, or are they artificially suppressing the workforce?

Chapters:

02:15 – The Dementia Mandate: Why specialized cognitive care is the next industry frontier.
04:45 – Scaling Through Partnership: Expanding into Pennsylvania and Maryland via non-profit collaboration.
06:30 – The Licensure Bottleneck: Is it time for a universal clinical license?
08:50 – Virtual-First Care: Connecting rural patients to elite clinical resources.

Connect with Charles and Delaware Hospice:

Website: https://www.DelawareHospice.org
LinkedIn: https://www.linkedin.com/company/delaware-hospice-inc../
Charles's LinkedIn: https://www.linkedin.com/in/charlesmcdonough

Special thanks to our sponsors:

Premier Sponsor:⁠⁠⁠⁠⁠⁠ Trella Health⁠⁠⁠⁠⁠⁠
Premier Sponsor: ⁠⁠⁠⁠⁠⁠Homecare Homebase⁠⁠⁠⁠⁠⁠
Premier Sponsor: ⁠⁠⁠⁠⁠⁠Maxwell TEC⁠⁠⁠⁠⁠⁠
Premier Sponsor: ⁠⁠⁠⁠⁠⁠Lincoln Healthcare Leadership⁠

#Hospice #DelawareHospice #HC100 #NonProfitHospice #DementiaCare #GUIDEModel #NursingShortage #HealthcareInnovation #LastVisitFirst #Podcast #HealthcarePodcast

The 90% Rule: Element5 CEO Joe Randesi on AI, Automation & the Human in the Loop

Tom Maxwell — Thu, 17 Sep 2026 14:00:00 GMT

Element5 Co-founder and CEO Joe Randesi joins Last Visit First once again, with guest host Jennifer Maxwell, Co-Founder and CEO of Maxwell TEC and wife of Tom Maxwell, to talk about how AI agents are automating revenue cycle management and back-office operations for the home health and hospice community. Joe explains Element5's approach to "touchless rate," the percentage of financial and administrative tasks handled entirely without human intervention, and why the company aims for a high touchless rate around 90%, rather than chasing full automation.

Joe also shares his take on why AI adoption, not new technology itself, will be the biggest driver of change in post-acute care over the next few years, and why keeping a human in the loop remains essential even as automation and ambient listening tools continue to advance.

Chapters:

0:00 Welcome: Joe Randesi, CEO of Element5
0:31 What Element5 Does: Automating RCM & Back Office
1:17 Most Successful Moment at the Conference
2:36 Why a Human in the Loop Still Matters
3:04 Looking Ahead: The Next 3-5 Years of AI Adoption

Connect with Joe: https://www.linkedin.com/in/joerandesi

Connect with Element5: https://www.e5.ai/

Sponsors:

Brought to you as a Premier Sponsor collaboration with Homecare Homebase (HCHB), a leading home health and hospice software and EMR platform. Learn more at https://lastvisitfirst.com/go/hchb

Want to level up your team's HCHB skills? Check out HCHB University for virtual live and on-demand training designed to help your team deliver exceptional care. Creating an account is easy—simply click Sign Up in the top right corner of the homepage to get started. Use the code uc2026 when you checkout for 35% off any course if you purchase before 9/30/26: https://lastvisitfirst.com/go/hchb-university

The Future of the Hospice Physician: HOPE, Staffing & Technology | Dr. Mayo & Dr. Richter

Tom Maxwell — Sun, 14 Dec 2025 23:06:05 GMT

The role of the Hospice Medical Director is changing. For years, the industry relied on contracted physicians primarily for administrative oversight—but with new regulations like the HOPE assessment and rising acuity in patients, the "paperwork doctor" model is no longer enough.

In this episode, Tom sits down with two of the most respected clinical leaders in the country: Dr. Andrew Mayo (Chief Medical Officer, St. Croix Hospice) and Dr. Tiffany Richter (Chief Medical Officer, Agape Care Group).

They break down the debate between full-time vs. contracted physicians, the "hybrid" model that is winning, and the heartbreaking regulatory gaps preventing dialysis patients from accessing hospice care. Plus, they share deeply personal stories that remind us why we do this work.

What We Cover:

00:00 – HCHB Premier Sponsor Spot
00:48 – Intro: Tom welcomes Dr. Mayo (St. Croix Hospice) & Dr. Richter (Agape Care).
01:41 – Dr. Richter’s Journey: From Family Med to Chief Medical Officer.
04:02 – The Mayo Legacy: Dr. Mayo’s path from "small town doctor" to Hospice CMO.
14:37 – The Great Debate: Contracted vs. Full-Time Hospice Physicians.
21:22 – Sponsor Spotlight: Maxwell TEC (Jennifer Maxwell, CEO)
22:30 – The HOPE Assessment: Will it actually improve patient care?
25:18 – The ESRD Conflict: Why dialysis patients are being blocked from hospice.
29:31 – Staffing & Burnout: How to keep clinicians from walking away.
34:51 – "High Tech vs. High Touch": The role of AI in hospice.
39:02 – Sponsor Spotlight: Steno Health (Alex Milani, CEO)
39:33 – Solving the Documentation Crisis: Why paperwork is the enemy of care.
46:49 – "It wasn't your job to fix it": Dr. Richter’s defining patient story.
51:06 – "I have 15 minutes left": Dr. Mayo’s deeply personal encounter with hospice.
59:10 – Advice for new Hospice Medical Directors.

About Our Guests: Dr. Andrew Mayo is the Chief Medical Officer at St. Croix Hospice, serving 10 states in the Midwest. He is a fifth-generation physician with a lineage tracing back to the founders of the Mayo Clinic.

-LinkedIn: linkedin.com/in/andrew-mayo-546a4b10b

-St. Croix Hospice: https://www.stcroixhospice.com/

Dr. Tiffany Richter is the Chief Medical Officer at Agape Care Group, a leading hospice and palliative care provider across the Southeast. She oversees clinical quality and the pediatric palliative care program, "Hands of Hope."

-LinkedIn: linkedin.com/in/tiffany-richter-a397857

-Agape Care Group: https://agapecaregroup.com/

Special Thank You To Our Sponsors:

-Premier Sponsor: Homecare Homebase: https://hchb.com/

-Maxwell TEC: https://maxwelltec.com/

-StenoHealth: https://www.stenohealth.com/

Listen to 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

Hosted by industry veteran Tom Maxwell, we sit down with the CEOs, innovators, and clinical leaders shaping the future of Care at Home. We bring you the conversations that drive change, from leadership strategies to the innovations redefining patient care.

Join the Conversation: If you enjoyed this episode, please Subscribe and leave a comment below. It helps us bring more incredible guests to the show.

Jeanette Lynn (Home Care 100) | The Architecture of Visionary Leadership

Tom Maxwell — Fri, 30 Jan 2026 15:00:01 GMT

Live from the Phoenician in Scottsdale, Tom Maxwell sits down with the woman who makes it all happen: Jeanette Lynn, President and Managing Director of Home Care 100.

Jeanette pulls back the curtain on what makes Home Care 100 the premier perch for healthcare operators. She breaks down the three pillars of the Lincoln Healthcare Leadership mission: Visionary Intelligence, Purposeful Connections, and an Exceptional Experience. From the legendary "Cocktail Book" to the highly-regarded Spouse Program, Jeanette explains how they set the table for the intimacy and trust required to move the industry forward.

Chapters:

01:10 – Beyond the Day-to-Day: Why executives need a "minute to stop and think" about the future.
02:05 – Strategic Matchmaking: Moving away from transactional networking to purposeful partnerships.
04:15 – The Power of the Spouse Program: Building trust beyond the business meeting.
06:00 – Bench Strength: How Lincoln has built an internal "intelligence group" to predict industry hurdles.
08:50 – Requesting an Invitation: The specific criteria for joining the top 100 innovators.
11:45 – AI & The Cocktail Book: Using tech to navigate 400 pages of strategic insights.

Connect with Home Care 100, Lincoln, and Jeanette:

Home Care 100 Website: https://homecare100.com/
Home Care 100 LinkedIn: linkedin.com/company/home-care-100/
Lincoln Healthcare Leadership Website: https://www.lincolnhc.com/
Lincoln Healthcare Leadership LinkedIn: linkedin.com/company/lincoln-healthcare-events/
Jeanette LinkedIn: linkedin.com/in/jeanette-lynn-3105104

Special thanks to our sponsors:

Premier Sponsor: Trella Health
Premier Sponsor: Homecare Homebase
Premier Sponsor: Maxwell TEC
Premier Sponsor: Lincoln Healthcare Leadership

#HomeHealth #Hospice #HomeCare100 #HC100 #HealthcareLeadership #LincolnHealthcare #LastVisitFirst

Zero-Cost Pharmacy Care for Home Health Patients: AnewHealth's Roman Fry

Tom Maxwell — Tue, 15 Sep 2026 14:30:00 GMT

AnewHealth Chief Growth Officer Roman Fry joins Last Visit First to explain how the company's pharmacy care model helps home health agencies manage their most complex, high-medication patients, at no added cost to the agency. Roman breaks down how AnewHealth, the only integrated pharmacy partner with Homecare Homebase, works directly inside the EMR to identify patients with high medication burden, deliver pre-packaged pill strips, and provide virtual pharmacist support, all while reporting a 78 net promoter score among patients.

Roman also shares how referrals work, why speed matters most in the critical first 72 hours after a patient transition, and what's behind AnewHealth's broader portfolio, including Tabula Rasa's leadership in PACE pharmacy and SafeDose's work supporting individuals with intellectual and developmental disabilities.

Chapters:

0:00 Welcome: Roman Fry, Chief Growth Officer of AnewHealth
1:12 The Pharmacy Model: No Cost to Home Health Agencies
2:38 Pill Packs vs. Pill Sorters
3:12 The Caregiver Burden AnewHealth Takes Away
4:03 What Happens If a Patient Has a Crisis Later
4:58 How Nurses Make a Referral
6:17 Inside Tabula Rasa & PACE Pharmacy
7:16 SafeDose & Serving Dual-Eligible Patients

Connect with AnewHealth

Connect with Roman

Sponsors:

Brought to you as a Premier Sponsor collaboration with Homecare Homebase (HCHB), a leading home health and hospice software and EMR platform. Learn more at https://lastvisitfirst.com/go/hchb

Want to level up your team's HCHB skills? Check out HCHB University for virtual live and on-demand training designed to help your team deliver exceptional care. Creating an account is easy—simply click Sign Up in the top right corner of the homepage to get started. Use the code uc2026 when you checkout for 35% off any course if you purchase before 9/30/26: https://lastvisitfirst.com/go/hchb-university

Crazy ER Stories, Crushing Student Loans, & The Real Reason Doctors Burn Out | Dr. Danielle Kelvas

Tom Maxwell — Fri, 03 Apr 2026 13:30:00 GMT

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: danielle@credentialnetwork.com
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

How to Build a Serious Illness Ecosystem: Lessons from AuthoraCare CEO Kristen Yntema

Tom Maxwell — Tue, 03 Mar 2026 14:30:00 GMT

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:

Check out Last Visit First on other platforms:

BONUS EPISODE: Exploring Mosai with CEO Elliott Wood

Tom Maxwell — Wed, 29 Oct 2025 20:00:00 GMT

In this special bonus episode, Tom Maxwell sits down with Elliott Wood, CEO of MOSAI, to discuss the merger of Forcura and Medalogix into one unified company. Together, they unpack how two strong cultures came together under a shared mission to simplify care through connected intelligence.

Elliott shares how MOSAI is reimagining technology’s role in home health and hospice—using AI, automation, and data to help clinicians focus on what matters most: the patient. He reflects on leadership lessons, understanding customer needs, and how partnerships drive innovation in care delivery.

The episode closes with a look ahead at MOSAI’s future and what it means for the evolving landscape of home-based care. You won't want to miss this one.

Keywords:

Elliott Wood, Tom Maxwell, MOSAI, Medalogix, Forcura, home health, hospice, care at home, healthcare technology, AI in healthcare, predictive modeling, leadership, mergers and acquisitions, clinical analytics, interoperability, automation, clinician efficiency, patient outcomes, connected intelligence, healthcare innovation

People of the Episode:

Guest: Elliott Wood, CEO of MOSAI

Host: Tom Maxwell

Producer: Cole Sorensen

A Special Thank You to Our Premier Sponsor — Mosai

Mosai brings a new level of connected intelligence to every stage of post-acute care. To learn more, visit mosai.com.

Last Visit First Podcast Links:

Mentioned in the Episode:

Being Mortal by Atul Gawande

Compassus Home Health Care

The Vistria Group

Berkshire Partners

Homecare Homebase

Contact the Last Visit First Team

csorensen@lastvisitfirst.com

Outline:

(00:00) – Tom introduces Elliott Wood and teases the reveal of a new company identity

(00:40) – Last Visit First intro video

(00:48) – Welcome and guest introduction

(01:03) – Tom asks Elliott to reveal the new name

(01:07) – Elliott announces MOSAI and showcases the logo

(01:15) – MOSAI sponsor ad read

(02:53) – Meaning behind the name MOSAI

(04:26) – Why now: The Forcura and Medalogix merger

(06:32) – Shared mission and product synergy

(08:19) – Elliott and Craig Mandeville’s longstanding relationship

(10:30) – Importance of listening to customers and EMR innovation

(11:01) – Lessons from the Muse and Medalogix merger

(13:31) – Board alignment with Vistria and Berkshire

(15:52) – Customer and employee reactions

(16:50) – Cultural integration into one company

(19:21) – Why a new brand identity was essential

(20:31) – Elliott’s career journey from data entry to CEO

(24:23) – Early Medalogix startup years

(27:01) – Building tech that solves clinician problems

(29:06) – The “Dancing Nana” story

(32:45) – How Being Mortal inspired MOSAI’s mission

(35:17) – Partnership with Compassus and patient outcomes

(36:04) – Lessons from scaling both companies

(40:04) – MOSAI’s vision for connecting clinicians, physicians, and payers

(41:21) – Overview of MOSAI’s three product families

(47:10) – Hands-free referral automation

(49:21) – The Circle platform for order signing

(50:44) – Real-world inefficiencies and hand-delivered orders

(52:20) – Interoperability and EMR data exchange

(53:55) – Proving ROI through measurable outcomes

(57:27) – Differentiating BI, predictive modeling, and generative AI

(1:02:34) – Using AI to summarize records and justify decisions

(1:05:00) – Improving efficiency and compliance

(1:07:54) – Expected outcomes for agencies using MOSAI

(1:11:35) – Future partnerships and consolidation

(1:13:13) – Elliott’s legacy and long-term vision for MOSAI

(1:15:20) – Reflections on leadership and culture

(1:16:11) – Tom’s closing thoughts and congratulations

(1:17:08) – Last Visit First outro video

Female Founders in Healthcare: WellBeam CEO Amee Devani on Building WellBeam

Tom Maxwell — Thu, 17 Sep 2026 14:00:00 GMT

WellBeam CEO and Co-Founder Amee Devani returns to Last Visit First, this time with guest host Jennifer Maxwell filling in for Tom, to talk about how WellBeam is eliminating one of home health's most outdated workflows: getting physicians to sign care plans and orders. Amee explains how WellBeam brings this process directly into physician EMRs like Epic, Cerner, and eClinicalWorks, mapping everything back into Homecare Homebase, cutting order turnaround from an industry average of 21 days down to as little as half a day.

Amee also shares WellBeam's vision for using AI to surface clinical decline earlier, helping care teams coordinate before a patient crashes rather than after, along with candid reflections on building a healthcare startup as a female founder and balancing entrepreneurship with family life.

Chapters:

0:00 Welcome Back: Amee Devani, CEO of WellBeam
0:55 What WellBeam Solves: Ending the Fax Machine Workflow
1:59 From 21 Days to Half a Day
2:29 The Biggest AI Hurdle for Agencies Right Now
3:19 Using AI to Predict Decline Before a Crisis
4:04 WellBeam's First Users Conference: Key Takeaways
5:07 On Being a Female Founder in Healthcare

Connect with WellBeam

Connect with Amee

Sponsors:

Brought to you as a Premier Sponsor collaboration with Homecare Homebase (HCHB), a leading home health and hospice software and EMR platform. Learn more at https://lastvisitfirst.com/go/hchb

Want to level up your team's HCHB skills? Check out HCHB University for virtual live and on-demand training designed to help your team deliver exceptional care. Creating an account is easy—simply click Sign Up in the top right corner of the homepage to get started. Use the code uc2026 when you checkout for 35% off any course if you purchase before 9/30/26: https://lastvisitfirst.com/go/hchb-university

From Call Centers to CEO: Luke Rutledge's Inspiring Path

Tom Maxwell — Wed, 22 Oct 2025 13:00:00 GMT

In this episode of Last Visit First, Tom Maxwell sits down with Luke Rutledge, President of Homecare Homebase (HCHB)—one of the most impactful technology platforms in post-acute care and the company where Tom once served as Chief Strategy Officer. What began as a friendship between mentor and mentee has evolved into a story of leadership, innovation, and purpose-driven growth.

Luke shares his journey from leading call centers at AT&T to being hired by Tom Maxwell in 2013 and climbing the ranks within HCHB to now lead the company as President. Together, they discuss how Homecare Homebase has grown from serving just 15 percent of the market to empowering more than 300,000 clinicians and processing $27 billion in annual claims across home health and hospice.

Keywords:

- Luke Rutledge, Tom Maxwell, Homecare Homebase, HCHB, care at home, home health, hospice, healthcare technology, leadership, innovation, clinician empowerment, AI in healthcare, post-acute care, purpose-driven leadership, patient outcomes.

People of the Episode:

-Guest: Luke Rutledge

-Host: Tom Maxwell

-Producer: Cole Sorensen

Sponsors of the Episode:

-PREMIER SPONSOR - Homecare Homebase: https://hchb.com/

-Maxwell TEC: https://maxwelltec.com/

-Steno Health: https://www.stenohealth.com/

-Levo: https://www.hellolevo.com/

Last Visit First Podcast Links:

-Apple Podcasts: https://podcasts.apple.com/us/podcast/last-visit-first/id1830051182

-Spotify: https://open.spotify.com/show/3iSKGRvHC9Bk3iq7l8UPxs

-YouTube: https://www.youtube.com/channel/UCvBv-nOIuI4fAFqsejKwfgQ

-Website: https://www.lastvisitfirst.com

-LinkedIn: https://www.linkedin.com/company/last-visit-first

Make a Difference in Care At Home—Check Out the Alliance:

-National Alliance for Care at Home: https://allianceforcareathome.org/

Contact the Last Visit First Team:

-csorensen@lastvisitfirst.com

-tom@lastvisitfirst.com

Outline:

(00:00) – Premier Sponsor Ad: Homecare Homebase (HCHB)

(00:48) – Last Visit First Intro Video

(00:56) – Welcome and Guest Introduction

(01:22) – How Tom and Luke First Met and the 2013 Hiring Story

(03:37) – Luke’s Career Journey: Logistics, Finance, AT&T, and Joining HCHB

(04:42) – Climbing the Ladder: From Client Services to President

(05:36) – Growth of HCHB: From 15% to 47% Market Share

(07:03) – Industry Impact: 300,000 Clinicians, $27B in Claims

(07:37) – Personal Story: Luke’s Family and Connection to Home-Based Care

(10:38) – Leadership Philosophy: Staying Close to Customers and Employees

(12:28) – Company Culture and Mentorship at HCHB

(13:09) – The Role of AI and Innovation in Reducing Clinician Burden

(17:22) – Retaining and Empowering Clinicians in Home Health

(19:24) – Mid-Roll Sponsor Ad Reads

(21:29) – Policy Discussion: CMS, Outcomes, and Payer Partnerships

(23:57) – Growth of Medicare Advantage and Industry Trends

(26:19) – Unified Payment Models and Blended Care Settings

(31:34) – Advocacy and Data-Driven Storytelling for Home Health

(35:22) – Grassroots Action: The Alliance and Clinician Involvement

(36:52) – Legacy and Mentorship: Training the Next Generation

(38:07) – Tom Reflects on Luke’s Leadership Journey

(39:35) – Tom’s Closing Remarks and Thanks to Listeners

(39:59) – Last Visit First Outro Video / Credits

Tom & Tapp: From Navy Flight Decks to Solving the Healthcare Data Puzzle

Tom Maxwell — Mon, 22 Dec 2025 14:30:00 GMT

What do aircraft carrier flight decks teach you about running the industry's leading healthcare analytics platform?

In this episode of Last Visit First, host Tom Maxwell sits down with Scott Tapp, CEO of Trella Health, for a conversation that spans from the discipline of military service to the cutting edge of healthcare AI.

The post-acute care market is facing a massive "data puzzle"—from the "black hole" of patient discharge to the complexities of Value-Based Care (VBC). Scott breaks down how Trella is solving these problems by combining 100% of Medicare and Commercial claims data with intelligent CRM workflows.

We go deep on the reality of the market: why "quality" is the new currency for referrals, how AI is actually being used (beyond the hype), and why vulnerability is a CEO’s greatest strength.

Chapters & Timestamps:

(00:00) Introduction: Scott Tapp and the evolution of Trella Health.
(04:45) Navy Roots: Stories from the flight deck, the Marine Corps, and military discipline.
(12:50) Leadership Lessons: How service influences decision-making and "The Why."
(19:15) Market Watch: Consolidation, Private Equity, and the shift to Value-Based Care.
(24:30) Product Roadmap: Moving from insights to intelligent workflows (CRM).
(30:00) Solving the "Black Hole": Automating the discharge process to improve adherence.
(38:20) The Data Advantage: How to use claims data to win referrals and prove quality.
(46:00) The Ecosystem: Integrating 100% of Medicare and Commercial claims data.
(52:00) AI & Innovation: Balancing human judgment with machine learning in healthcare.
(59:00) The Consumer Shift: Patients taking ownership of their own healthcare data.
(1:05:00) The "Magic Wand" Question: Fixing care coordination and interoperability.
(1:15:00) Legacy & Culture: Why vulnerability is a superpower for CEOs.
(1:21:00) Rapid Fire: Favorite podcasts, coffee habits, and closing thoughts.

About Our Guest: Scott Tapp is the Chief Executive Officer of Trella Health, the leading source of market intelligence and CRM solutions for the post-acute care industry. A US Navy Veteran with over 20 years of executive leadership experience, Scott has guided multiple high-growth companies to successful exits, including roles as CEO of Software Brands and Managing Director at SBI. At Trella, he is dedicated to empowering meaningful change in healthcare by providing the data and insights providers need to improve patient outcomes and reduce the cost of care.

Scott's LinkedIn: ⁠linkedin.com/in/scotttapp⁠
Trella Health: ⁠https://trellahealth.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/⁠

Listen to 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

About Last Visit First: In home health and hospice, the start of care usually begins with the final visit in mind—because every decision becomes a memory.'Last Visit First' challenges the industry to prioritize quality, connection, outcomes, and dignity right from the start. Hosted by industry veteran Tom Maxwell, we sit down with the CEOs, innovators, and clinical leaders shaping the future of Care at Home. We bring you the conversations that drive change, from leadership strategies to the innovations redefining patient care.Join the Conversation: If you enjoyed this episode, please Subscribe and leave a comment below. It helps us bring more incredible guests to the show.

CMS Policy Insider: 80% Of Healthcare Is Missing The Point! Why You Need A "Family Operating System"

Tom Maxwell — Mon, 13 Apr 2026 13:30:00 GMT

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/

Building and Leading in Care at Home with David Curtis

Tom Maxwell — Wed, 24 Sep 2025 13:15:00 GMT

In the very first episode of Last Visit First, Tom Maxwell sits down with longtime friend and industry leader David Curtis, Founder and CEO of Graham Healthcare Group and a pioneer in home health and hospice.

Together, they unpack:

-David’s journey from Princeton rower to turning around struggling agencies and building one of the nation’s largest care-at-home providers.

-The leadership practices that have helped him retain teams for decades in an industry known for high turnover.

-How technology and AI—from Homecare Homebase to predictive tools—are reshaping clinical workflows and patient outcomes.

-The personal story of his son’s early health challenges and how that experience shaped his perspective on caregiving.

-What the future of home health, hospice, and Medicare Advantage looks like in the next 5–10 years.

This conversation goes beyond strategy. It’s about culture, legacy, and the very real impact leaders can have on patients, families, and the teams that serve them.

People of the Episode:

-Guest: David Curtis

-Host: Tom Maxwell

-Producer: Cole Sorensen

Learn More About Our Sponsors:

-Maxwell TEC: https://maxwelltec.com/

-Steno Health: https://www.stenohealth.com/

-Levo: https://www.hellolevo.com/

Last Visit First Podcast Links:

-Apple Podcasts: https://podcasts.apple.com/us/podcast/last-visit-first/id1830051182

-Spotify: https://open.spotify.com/show/3iSKGRvHC9Bk3iq7l8UPxs

-YouTube: https://www.youtube.com/channel/UCvBv-nOIuI4fAFqsejKwfgQ

-Website: https://www.lastvisitfirst.com

-LinkedIn: https://www.linkedin.com/company/last-visit-first

Contact the Last Visit First Team:

-csorensen@lastvisitfirst.com

Keywords:

home health, hospice, care at home, Medicare Advantage, healthcare leadership, patient outcomes, healthcare innovation, AI in healthcare, OASIS documentation, nurse retention, team culture, David Curtis, Tom Maxwell, Residential Healthcare, Last Visit First podcast, home healthcare technology, hospice benefit, recruiting nurses, future of care at home, care transitions, healthcare podcasts

Outline:

00:00 Introduction and Background of David Curtis

04:52 Career Journey and Home Health Agency Growth

09:56 Leadership and Employee Retention Strategies

15:51 The Role of Technology and AI in Home Health

22:07 Patient Advocacy and Caregiver Challenges

27:16 Future of Home Health and Hospice Care

31:29 Future of Post-Acute Care Payment Models

31:55 Collaboration in Home Health and Joint Ventures

32:52 Understanding Hospital at Home vs. SNF at Home

35:11 The Rise of Medicare Advantage in Home Health

36:39 Patient Preferences and Cost-Effectiveness of Home Health

37:42 The Value of Hospice Care

40:29 Recruitment and Retention Strategies in Home Health

44:06 Adapting to Industry Changes and Growth

48:31 Legacy and Impact in Home Health and Hospice

59:00 Thanks for listening!

The Home Health Data Reckoning: Fraud, Moratoriums & the Future of Post-Acute Care

Tom Maxwell — Sat, 30 May 2026 17:30:00 GMT

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.

Breaking Down the 2026 Home Health Final Rule with Scott Levy and Luke James

Tom Maxwell — Thu, 04 Dec 2025 14:30:00 GMT

Scott Levy of the National Alliance for Care at Home and Luke James, President of VitalCaring Group, join Tom Maxwell on Last Visit First to break down CMS's Calendar Year 2026 Home Health Final Rule. This conversation is timely, detailed, and one of the most important episodes we have recorded for leaders in home based care.

Tom sits down with Scott and Luke to explain how CMS reached the final 1.3 percent cut, why the permanent adjustment shift matters, what changed in PDGM, and how the rule affects payments, operations, visit patterns, and staffing across the country. They also cover wage index swings, VBP changes, outlier policy, advocacy wins, financial planning, and what all of this means for the future of home health and hospice.

If you want a clear and practical breakdown of the Final Rule from two of the most trusted policy and operations voices in the industry, this episode is for you.

Mentioned in the Episode:

CMS 2026 Home Health Final Rule
PDGM recalibration and payment updates
Wage index shifts and FDL changes
Value Based Purchasing updates
Telehealth limits in home health
Recruiting and retention challenges
National Alliance for Care at Home advocacy efforts
VitalCaring operational insights

Timestamps:

00:00 HCHB featured commercial
00:48 Introduction to the 2026 Final Rule
03:06 Dissecting the Payment Structure
10:53 Understanding the Impact of Cuts
16:53 Maxwell TEC sponsor (nanaCONNECT and REACH)
18:08 PDGM Recalibration and Cost Reports
23:13 Clinical and Operational Changes
29:35 Value Based Payments and Quality Metrics
32:00 Challenges in Rural Healthcare Access
33:13 Episode sponsor Levo
33:54 Revisiting Visit Patterns Amid Rate Pressures
36:16 The Impact of Telehealth on Home Health
41:06 Understanding Fixed Dollar Loss Ratio
44:26 StenoHealth sponsor
45:24 Budgeting Strategies for Home Health Agencies
49:31 The Future of Smaller Agencies in Home Health
53:10 Recruitment and Retention in Home Health
56:39 Reflections on Last Visit First
01:01:05 Thank You and Reach Out if Needed

Guest Links:

National Alliance for Care at Home: https://allianceforcareathome.org/
Scott Levy on LinkedIn: https://linkedin.com/in/scott-levy-09a8829b
VitalCaring Group: https://www.vitalcaring.com/
Luke James on LinkedIn: https://linkedin.com/in/luke-james-9bb93821

Special Thank You to Our Sponsors:

Premier Sponsor: Homecare Homebase: https://hchb.com/
Maxwell TEC: https://maxwelltec.com/
Episode Sponsor: Levo: https://www.hellolevo.com/
StenoHealth: https://www.stenohealth.com/

Listen to 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

About Last Visit First:

Last Visit First brings real conversations with leaders shaping home based care. Hosted by Tom Maxwell, Chairman of Maxwell TEC. Subscribe for more episodes on home health, hospice, policy, leadership, and the future of care at home.#LastVisitFirst #HomeHealth #Hospice #CareAtHome #Leadership #Innovation #Policy #FinalRule

50% Documentation Time Savings? The AI Revolution Hitting Post-Acute Care

Tom Maxwell — Tue, 24 Mar 2026 13:30:00 GMT

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

AI, Automation & the New Hospice Amendment: Maxwell TEC's Jay Duty

Tom Maxwell — Tue, 15 Sep 2026 14:30:00 GMT

Maxwell TEC COO Jay Duty joins Last Visit First to unpack the biggest themes on the show floor at HCHB's Users Conference, including AI and automation in home health and hospice, ambient listening technology for clinicians, and the industry buzz around the new hospice amendment regulation.

Jay breaks down the fast-approaching hospice amendment deadline, the challenge of getting signed amendments back from patients within five days of start of care, and why traditional tools like DocuSign may not be a realistic fix. He also shares what's happening at Maxwell TEC right now, from rising M&A activity in home health and hospice to the growing adoption of their nanaCONNECT platform for automating patient communication, intake, and bereavement outreach.

Chapters:

0:00 Welcome & Why Jay's at the Conference
0:23 Top Themes: People, Process & Technology
0:47 AI, Automation & Ambient Listening for Clinicians
1:32 The New Hospice Amendment Deadline
2:42 The DocuSign Problem: Getting Signatures from Patients
3:02 What's New at Maxwell TEC: M&A Trends
3:13 nanaCONNECT & Automating Patient Communication
4:05 Who's at the Conference with Jay

Connect with Maxwell TEC

Connect with Jay

Sponsors:

Brought to you as a Premier Sponsor collaboration with Homecare Homebase (HCHB), a leading home health and hospice software and EMR platform. Learn more at https://lastvisitfirst.com/go/hchb

Want to level up your team's HCHB skills? Check out HCHB University for virtual live and on-demand training designed to help your team deliver exceptional care. Creating an account is easy—simply click Sign Up in the top right corner of the homepage to get started. Use the code uc2026 when you checkout for 35% off any course if you purchase before 9/30/26: https://lastvisitfirst.com/go/hchb-university