Headwinds Mount as Encompass Health Nears ‘Enhabit Home Health & Hospice’ Launch

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The long road that was Encompass Health Corporation’s (NYSE: EHC) journey to finding the right “strategic alternative” for its home health and hospice segment is nearing its end.

And while the segment is about to undergo a $13 million to $18 million rebranding as it spins off as Enhabit Home Health & Hospice onto the public market, there’s plenty of other aspects of the business that deserve equal and immediate attention.

Since that road was initially set out on, multiple alternatives were considered – a private or public spinoff, a sale and a merger. Ultimately, a spinoff was decided on by the Encompass Health board in December, a decision that received some pushback. It was reiterated in January, and now, a definitive plan seems to be in place.

Meanwhile, Barb Jacobsmeyer, the previous head of Encompass Health’s in-patient rehab business, took over as CEO. She replaced the longtime leader and original founder of the home health and hospice segment, April Anthony.

“In anticipation of the spinoff, our home health and hospice business will begin rebranding as Enhabit,” Encompass Health CFO Doug Coltharp said on the company’s fourth quarter earnings call Wednesday. “Rebranding will begin in the Dallas home office this month. Branch locations will begin rebranding in mid-April.”

Birmingham, Alabama-based Encompass Health’s footprint includes 145 hospitals, 251 home health locations and 96 hospice locations in 42 states and Puerto Rico.

Coltharp also added that the rebranding should be largely completed by the time the spinoff comes to fruition. It’s expected to take place at some point in the first half of this year – likely in the second quarter.

All the while, Encompass Health is dealing with mounting pressures on its business overall, as well as with its departing home health and hospice segment.

Like nearly all home health providers at this point, Encompass Health is not facing a lack of home health demand, but instead, it’s lacking the ability to meet that demand. And even when it can meet that demand, it costs more to do so.

“The biggest thing for us is that the volumes are there, but the staffing has been the challenge,” Jacobsmeyer said on the call. “So [we want to] not only be successful in recruitment, but also in retention, so that we can get fully staffed and can accept all of these referrals.”

The segment lost a “minimum” of 1,700 admissions in the fourth quarter due to staffing constraints.

The referral sources are there, though, and Jacobsmeyer said that the company’s seeing more of them wanting to offload the majority of their patients to one provider. For instance, it has seen an increase in the amount of non-episodic admissions coming from referral sources that generally send episodic admissions.

Non-episodic admissions increased by nearly 68% in the fourth quarter and by 28% overall in 2021. Overall, home health total admissions increased 4.7% in Q4 and increased by 3.3% in 2021.

Episodic admissions declined 7.2% in Q4, but about 50% of that decline is related to the conversion of admissions to non-episodic under a “large managed care contract” initiated in February 2021, the company noted.

Encompass Health’s revenue totaled $1.3 billion in Q4, an 8.6% increase year over year. Home health brought in $224 million in the quarter, a 1.6% decrease year over year, while hospice brought in $52 million, a 2.8% decrease.

Full-year revenues totaled $5.1 billion in 2021, an over 10% increase compared to the $4.6 billion brought in last year.

“I would say right now the most difficult part would be that, as we’re growing both the episodic and non-episodic [admissions], the focus for us is on productivity and optimization to try to mitigate that margin compression,” Jacobsmeyer said. “But that’s been really difficult to do in this current environment we’re in.”

The glass as half full

The transfer from Encompass Health’s home health and hospice segment to Enhabit Home Health & Hospice is taking place during turbulent times. Its current problems with staffing – and in part, admissions – reflect that.

But its leaders are hoping those problems are temporary. There’s evidence to suggest that could be the case.

For instance, there’s no doubt that staffing pressure is an indefinite headwind for home health providers. But the strength of that headwind is irregular right now.

The Omicron-fueled surge in COVID-19 cases among staff was significant for the company, far higher than it was during the Delta wave, which is consistent with the general population’s experience with the two variants.

“The home health segment had as many as 1,300 staff members out one week in quarantine in the month of January, which surpassed the previous year’s high under Delta,” Encompass Health CEO Mark Tarr said on the call.

But cases in the U.S. are down 44% compared to just two weeks ago, according to The New York Times, which suggests that the peak has been reached.

There will likely be another variant, but Coltharp acknowledged that the U.S. Centers for Disease Control and Prevention (CDC) guidance that reduced quarantine time from 10 to five days has helped.

Plus, Encompass Health has significantly gained ground on its vaccination rate. It’s now in the “mid-90s”, percent wise, in terms of overall employees that have been vaccinated. That has resulted in the majority of its cases being asymptomatic or mildly symptomatic ones.

Jacobsmeyer is getting help on the staffing front, too, in the form of additional leadership.

“To ensure an increased focus on recruiting new clinical talent and reducing turnover, Barb has added a chief human resources officer and a vice president of talent acquisition to her leadership team,” Tarr said. “These roles did not previously exist in our home health and hospice segment, and these hires round out and solidify the senior management team for this business.”

Prospects for growth

The home health and hospice business still sees the potential to grow amid staffing woes.

“We closed on approximately $102 million of home health and hospice acquisitions and opened three de novo locations,” Tarr said. “We’ll continue to pursue home health and hospice acquisitions and currently have an active pipeline of potential deals. We’ll also plan to open 10 additional de novo locations.”

While it isn’t entirely clear whether the de novo locations or acquisitions will be completed before or after the spinoff is completed, both Tarr and Jacobsmeyer made it clear that growth won’t take a backseat to any contemporary headwinds.

In addition to de novo and acquired locations, the segment also expects further growth from contracts with managed care providers as well as Medicare Advantage plans.

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