Amedisys(AMED) - 2022 Q4 - Annual Report

Business Operations and Scale - Amedisys operates 532 care centers in 37 states and the District of Columbia, with approximately 20,000 employees delivering over 11.2 million visits annually to more than 465,000 patients[10] - As of February 10, 2023, Amedisys employed approximately 20,000 people throughout the United States[30] - The company operates 231 home health care centers and 47 hospice care centers in states requiring Certificates of Need (CON) or Permits of Approval (POA)[55] - Home health care centers are required to obtain CON or POA in 17 states and the District of Columbia, while hospice care centers require CON in 12 states and the District of Columbia[52] Revenue and Payment Models - Medicare accounts for approximately 74% to 75% of Amedisys' net service revenue over the last three years[11] - Medicare home health payments are bundled into 60-day episodes of care, with a recertification assessment required if treatment continues beyond 60 days[35] - CMS implemented the Patient-Driven Groupings Model (PDGM) in 2020, shifting to a 30-day payment period and eliminating therapy visit counts as a payment determinant[35] - The 30-day base payment rate for Medicare home health services increased from $1,864 in 2020 to$ 2,032 in 2022, but decreased to $2,011 in 2023[36] - CMS estimates a 0.7% increase in Medicare home health payments for 2023, resulting from a 4.0% payment update and a -3.5% permanent adjustment[36] - Medicare hospice payments are based on daily rates, with two routine care rates: one for the first 60 days and another for care beyond 60 days, plus a service intensity add-on (SIA) for visits in the last seven days of life[42] - Hospice providers are subject to two payment caps: an inpatient cap limiting inpatient care to 20% of total patient care days and an overall payment cap limiting average annual payments per beneficiary[42] - High acuity care contracts with health insurance plans provide fixed payment rates for 30-day or 60-day episodes, indexed to patient diagnoses, with episodic stop-loss insurance for certain contracts[47][48] - Approximately 30% of non-Medicare managed care contracts allow for additional payments based on quality or process metrics, such as star ratings and acute-care hospitalization rates[40] - Rural add-on payments for home health services vary by county classification, with percentages ranging from 1.5% to 4.0% in 2019, phasing out by 2022[81][82] Quality and Patient Satisfaction - Amedisys' Quality of Patient Care star average across all providers was 4.49, with 99% of care centers rated 4+ stars and 46 care centers achieving 5 stars[16] - The Patient Satisfaction star average for Amedisys was 3.57, outperforming the industry average by 1%[16] - Amedisys' home-based recovery services have consistently achieved patient satisfaction scores exceeding 85% and reduced hospital and skilled nursing readmission rates[23] - The company's care centers must comply with Medicare Conditions of Participation (COPs) to receive Medicare payments, focusing on quality care and patient outcomes[56] Acquisitions and Divestitures - Amedisys signed a definitive agreement to sell its personal care business (excluding Florida operations) on February 10, 2023, with the divestment expected to close in Q2 2023[21] - Amedisys acquired Contessa Health on August 1, 2021, establishing its high acuity care segment, which delivers inpatient hospital, SNF care, and palliative care to patients in their homes[22] - Amedisys acquired 15 home health care centers from Evolution Health and two home health locations from AssistedCare on April 1, 2022[28] Regulatory Compliance and Risks - The company maintains controls over coding, clinical operations, billing, and patient recertification to ensure compliance with Medicare requirements and accurate billing[49] - Medicare can reopen and deny previously filed claims, requiring repayment of overcharges and deductions from future payments, with the company appealing denials it deems inappropriate[39] - Non-compliance with Medicare COPs can result in temporary management, payment suspensions, and civil monetary penalties up to$ 112,131 per violation[57][68] - Violations of the federal Anti-Kickback Statute can lead to civil fines up to $25,076 per violation and penalties up to$ 112,131 plus three times the amount of improper remuneration[62] - The Stark Law imposes penalties up to $27,750 per violation and up to$ 185,009 for schemes to circumvent its restrictions[63] - The False Claims Act imposes penalties ranging from $23,607 to$ 25,076 per claim for false or fraudulent claims submitted to federal programs[64] - The company must report and return Medicare and Medicaid overpayments within 60 days of identification, with a six-year lookback period[66] - HIPAA compliance is mandatory, with violations punishable by civil and criminal penalties for breaches of privacy, security, and breach notification regulations[70] - The company is subject to state anti-fraud and abuse laws, which may be stricter than federal laws in some cases[69] - HIPAA violations can result in fines ranging from $127 per violation to a maximum of$ 1.919 million for multiple violations in a calendar year, with the largest penalty to date being $16 million[71] - Recent changes to HIPAA have increased enforcement activity, with periodic audits required to ensure compliance, raising the likelihood of financial penalties for violations[72] - All 50 states and the District of Columbia have data breach notification laws, with some imposing significant monetary penalties for violations, including private litigation risks under laws like the California Consumer Privacy Act[73] - The IMPACT Act requires post-acute care providers to report standardized patient assessment data, with a 2% reduction in market basket prices for non-compliance[75] Value-Based Purchasing and Payment Reforms - The Home Health Value-Based Purchasing (HHVBP) model adjusts payments by up to ±8% based on performance, with expansion to all 50 states starting January 2023 and a proposed maximum adjustment of ±5% by 2025[78] - The Home Health Prospective Payment System (HHPPS) reform introduced a 30-day payment system in 2020, with a 4.36% reimbursement reduction due to behavioral changes, and a 0.7% payment increase estimated for 2023[79] - CMS is considering a temporary adjustment of approximately$ 2 billion to offset overpayments in 2020 and 2021, though it will not apply to 2023[80] Environmental and Competitive Landscape - The company has committed to reducing greenhouse gas (GHG) emissions, with interim targets for Scope 1 and 2 emissions aligned with the Paris Agreement's 1.5°C goal, and plans to establish Scope 3 targets by December 2023[83] - The company faces competition from local healthcare providers, non-profit organizations, and hospital-owned entities, competing on service quality, personnel availability, and pricing[84] Financial and Interest Rate Risks - Total outstanding debt subject to interest rate fluctuations as of December 31, 2022, was $435.9 million[265] - A 1.0% interest rate change would cause interest expense to change by approximately$ 4.4 million annually[265] - The company's Term Loan and Revolving Credit Facility are tied to the Eurodollar rate (LIBOR) and the Prime Rate[265] - The Second Amended Credit Agreement provides for the replacement of LIBOR with the daily or term secured overnight financing rate (SOFR) whenever LIBOR is discontinued[265] Hospice Care Focus - Amedisys' hospice care teams focus on non-cancer diagnoses, such as heart disease, lung disease, and dementia, to address historical underrepresentation[20]