Pleased to be joined today by Mike Witzeman, Chief Financial Officer of Chemed Corporation, and Joel Wherley, Chief Executive Officer of VITAS Healthcare. Thank you guys both for being here today.
Thanks, Ben.
Thanks, Ben.
Just wanted to kick off with a little bit of discussion about admission mix rebalancing cadence and for the quarter in 1Q 2026, VITAS had over 19,000 admissions. It was up about 7%. Hospital-directed admissions were up almost 14%. All other pre-admissions, up about 8.5% in the Florida program. You described the hospital admission range as appropriate balance for sustained long-term stability. With Florida at about 44%, how quickly are you experiencing a push to non-hospital admissions to become the dominant growth driver for the remainder of this year?
Yeah. Spoke about in the fourth quarter of the calendar year of 2025, first quarter of the Medicare CAP year, that we needed to see how that quarter went before we could think about responsible, thoughtful growth back into that Medicare CCN. We established key metrics that we measure on a daily basis, specific to the percentage and split out of where our business comes from. We can't control average length of stay. What we can control is where we focus our resources and our efforts into referral environments that we know typically generate a short length of stay, medium length of stay, long length of stay type patient. As we purposely refocused where our resources went in response to our CAP mitigation strategy, we came out of that fourth quarter extremely strong, very pleased with our execution, and feel like we're in a really good position.
I know we put out there, we want to keep our hospital free environment in that 42%-45% of our total admissions. That's on an annualized basis. There's going to be fluctuations up and down. There is a little seasonality in Florida as well. That's going to fluctuate monthly. We feel really good about where we're at with that number. In all honesty, we look to the back half of 2026 really as an opportunity to now thoughtfully begin to grow back that census. Actually, we're already doing that, and we're ahead of our expected growth trajectory.
Yes. As far as cadence goes, Ben, as you well know, I'm sure, we had projected in the first quarter having ADC flat during the period where Joel and his team were sort of rebalancing that portfolio, and it actually grew to a 2.2% in the first quarter. We're ahead of the curve. Joel's team did a great job in accelerating the return to a more balanced patient mix, and that adds to itself, right? It's cumulative as you go along. We really, as Joel said, expect the second, particularly the second half of the year, to really show some significant growth for us.
Yeah. From a CAP perspective, $32.5 million of CAP cushion Florida combined program in the 1st quarter alone. No CAP liability accrued for in the quarter. How are you thinking about that developing, just the dynamics of Manatee County opening and knowing that all of those are going to be short stay to begin with?
Yeah. We want to ensure the pendulum doesn't swing too far one way or the other. We really like the balance where we're at. Yes, to your point, Manatee, if you look at Manatee as a statistical opportunity, in fiscal year 2024, about 61% of the Medicare deaths that occurred benefit from hospice benefit. Okay. They were exercising their right to the benefit very late in their disease trajectory. We feel strongly through our educational efforts that we'll be able to work with the healthcare community, improving education and expand that, allowing that patient and their family to access that benefit earlier.
To your point, for the rest of 2026, all of those new patients are essentially going to be a short length of stay patient, given the timeframe of the Medicare calendar year, which ends September thirtieth. They're going to come online mid-June, and they'll continue to help contribute to our CAP mitigation. As starts, Pasco, Marion, Pinellas specifically, we've already seen that we've received their short length of stay benefits from becoming a new start, but now they're building census. Now they're starting to contribute and essentially we're able to then to monetize the value of that CAP mitigation strategy in those new start markets.
The new starts are really what has allowed us to really start taking in those longer stay patients in a quicker timeframe. They've given us that runway to be able to do that.
Maybe we can stay on the whole Marion, Pasco, and Pinellas discussion here. Obviously, as you mentioned, exceeding expectations on the pace ramp-up. Anything in particular driving that outperformance relative to the 500 admissions you had expected from those markets? In your internal model, any referral source relationships, community awareness dynamics in those markets that are developing that faster new start benchmark?
While I won't talk about specific referral sources, the opportunity that we've been presented in those communities where there clearly was a need to be met. Increased educational opportunities and our approach to a new start market. We go all in. We don't come in with a skeleton staff, pay as you go, advance your team as you grow census. We come in, all in, fully loaded and are able to hit the ground running, and it's been extremely well-received. Florida does such an incredible job managing the CON environment. They identify the need through a very long-tested algorithmic approach, and so when they see that high growth in deaths that are not being met, they open up the CON opportunity. In those markets specifically, we've seen it be received extremely well.
It's exceeded our expectations, but that's contributable to our team, being able to come into the community, present who we are, the value proposition that we present, and the referral sources have responded.
In Pinellas, for instance, I think we had market development people on the ground a month before we started operations. As a result, on the first day, we took five patients in, the first day. That's an impressive development for Joel and his team.
Yeah. To that point, Mike, specifically, if you think about Pinellas, geographically, where it's at, if you think about Manatee, geographically, where it's at, and there are other CON, Pasco. We all surround Tampa, Hillsborough County. Our ability to market in the metro Tampa area is benefiting those other markets, and it's going to benefit Manatee because our brand awareness is already out there.
Great. It sounds like from these ramp up, the trends that we're seeing, I think that I just wanted to come back to the CAP issue because we still have some clients who are asking us or treating the CAP issue as kind of a show-me story.
Absolutely.
Just giving the 2025 headwinds. It sounds like just given the ramp up of the new markets, that there's not too much to worry about, at least as trends are trending now in 2026. As I look ahead to 2027 in the rate update, I believe you guys have previously communicated to the market that Florida, you're going to see about a 1% rate update in that state versus a 2.4% CAP set up. Do we have anything to worry about next year?
No. We believe we have put in place guardrails that will protect us and help us manage against a CAP liability long into the future. You have to understand how we got there. This has not been a historical issue for VITAS, and it does speak to the archaic reimbursement environment on how CAP is established. Essentially, an inpatient, by the federal government, is set at the same level in Florida as they are in Sacramento, California, where there is significant reimbursement differences. All of that plays out to you have to manage to what the government says. You have to present in first-time Medicare admissions versus your total billed Medicare revenue. We feel with the guardrails maintained, that range of hospitals which typically are going to generate a shorter length of stay patient will be able to then effectively balance that.
I think the key strategies is taking that hospital relationship, which is a healthcare system, and expanding from just a hospital-based referral to perhaps their insurance product, their physician community, and all the other relationships that they have, whether it's home health, palliative, or pace. The opportunity to then become the preferred provider across all of that genre.
To further Joel's point on the sort of the KPIs, as he said, we had a 20-year track record of not having an issue. We used the data from those 20 years to see what guardrails need to be in place to make sure this didn't happen again. We don't need to go through the whole, you know the story very well, we don't need to go through the whole story of how it occurred from the pandemic and all that. We just got out of position a little bit. We have better tools, better measurables to make sure we don't early indicator warnings to make sure we don't get out of position again.
Got you. As we kind of look to the back half of 2026, how are we thinking about the ALOS trajectory through the back half and kind of as a lever to get to that 18%-18.5% margin that you targeted?
We've already expanded through our strategic initiatives, the focus on growing non-hospital pre-admit environments, not reducing down the volume of hospital admissions, but growing and expanding non-hospitals. We've already seen that shift in a responsible way that will help us then continue to add census, which longer length of stay, driving a less complex patient.
Greater margin associated with it.
Yeah, the new starts obviously helped early in the year, but the other thing I think that Joel has done that's very smart is continue to keep the hospital admissions high. Right? When we got out of position last year, it was because, I wouldn't say we ignored hospital admissions or anything like that, but we devoted more resources to the longer length of stay. Devoting equal resources now to both, and so the faster you grow hospital admissions, you can also grow longer length of stay admissions at the same time.
Got you. In your new Tampa Bay area market, where there's obviously a lot of discharges from the short length of stay, and that's a great balancing lever to have for the state, but as we get into 2027, where it appears there might be less of an even worry about CAP, are your ability to attract those longer-stay patients in that specific market, for example, as robust as the rest of the state?
Yeah. Throughout the state, we are by far the largest provider in the state, the most trusted and well-respected brand across the state. We've done a really good job historically of balancing the benefit and the opportunity that a community may have. Again, the hospice benefit was lifted up in 1983. It was primarily intended to be a cancer service environment. That has shifted significantly. So there is so much more opportunity from other disease states that typically will come on a little sooner and have a longer trajectory.
That's one of the reasons, maybe the big reason why we, probably 15 years ago, consolidated Florida into one provider number, because then it's not so dependent on a location-by-location basis. If Joel sees an opportunity in Dade County to improve a relationship with a SNF or an ALF or whatever, he can do that and use the cushion created in Manatee to offset that. That's one of the benefits of having Florida as one provider number.
I'll add strategically, if you look forward to 2027, 2028, as we responsibly balance where we're spending our time and grow that non-hospital environment, we're also bringing on new opportunities from a higher acuity, short length of stay patient. We just did a groundbreaking on a new freestanding inpatient unit, in the Treasure Coast, Port St. Lucie area that will come online in 2027. We just signed a new relationship in the Fort Myers area for a new inpatient facility there. We're adding to the portfolio to ensure that down the road, we have a great mix and balance to be able to effectively grow, and in turn, drop that to the bottom line.
Inpatient units are important for CAP because they take in the sickest patients.
Sickest of the sick.
Directly from hospitals, generally, taking the sickest patients in. They have a pretty short length of stay generally, which provides CAP cushion for other things.
I want to shift over to labor capacity. I know that this has been a core competency of you guys since the pandemic. We came through first quarter about 100 FTEs understaffed. I know you accelerated hiring. Maybe you can kind of talk about your plans. Where are your targets versus your steady state hiring and how that's progressing in the second quarter?
Yeah. It really was responding to our growth in census. We purposely had that employee base brought down based on what we were doing from a CAP mitigation strategy. We managed that census responsibly down, and then as we have started growing that back up, program by program, we identified the specific needs, and we're having no concerns whatsoever in meeting the labor demands and adding care in all those programs. We're also managing it appropriately to the census growth, so it's not additional marginal compression.
We had budgeted originally about 30-35 FTEs a month that we would add during 2026. We started 100 below where we thought we were going to start. We increased for the last nine months of the year to about 50-60 FTEs. As Joel said, that's just responding to the more accelerated increase in the ADC to respond to the volume.
Got you. Want to shift over to some of the regulatory and policy environment a little bit. A lot of scrutiny in California that we've heard recently about the concentration of operators in that state. Can you maybe talk a little bit about your exposure in California, ADC concentration, and then active CMS state-level reviews that are impacting your platform?
Yeah.
California is 15%-ish of our business. Joel can talk about the regulatory environment, certainly.
We're the largest provider in the state. We've been very actively involved with Washington, with Dr. Oz, who attended his very public meeting in California. We've provided guidance because in reality, we believe that scale, transparency, and clinical expertise is going to be a tremendous advantage. We have no concern whatsoever of the increased oversight and the steps that they've taken. I'm going to separate out the California circumstance from the national moratorium that was just announced, and I'll address that specifically. In California, in L.A. County alone, and we are very vocal about our concerns about this.
L.A. County alone grew from the high 400 providers to nearly 1,800 providers in a two-year period. They got their license somehow. That starts at the state. That's not the federal government. However, that oversight also comes from the state, and it didn't happen. We welcome the fact, and Dr. Oz has publicly communicated last week in the press conference, that they have suspended the billing privileges of 800 providers in L.A. County, of which more than a handful reached out to the government to say, "What is going on?" The others are just moving on. We have no issue whatsoever in the additional scrutiny to weed out the fraudsters, because it only takes away from the incredible benefit that the hospice In 1983, the hospice benefit was created, and the need it was there to meet. This is the most vulnerable time of life, and yet there's individuals taking advantage of that.
There's fraud in every aspect of healthcare. You only have one shot at this in hospice, and you've got to do it right. Our stance and position in working with Dr. Oz and their group is we are extremely supportive. What we were disappointed in is the broad brush approach they decided to take nationally in announcing the hospice moratorium last Wednesday. We would much more prefer a targeted, specific approach where they've identified areas of fraud and work specifically then with local state government to weed out that fraud. Our concern is this: the broad brush approach on a national basis impacts everyone nationwide. From the business case, doesn't impact us as a clinically competent regulatory, following, organization in every state we serve.
We have no concern about the oversight. What we're concerned about is what it does to states that have no fraud. If you think about North Carolina, if you think about Florida, that have longstanding, fantastic oversight through their CON process. This moratorium applies to them. Through increased deaths in that community, how does someone expand into that community to help meet that need? There's think eventually it's going to be modified and be more target specific. For right now, the broad brush is concerning, recognizing that only about 51% of the individuals who pass away in our country today who could have benefited from the hospice benefit access that benefit.
There's so much more opportunity and there are studies that support the fact that, the longer the patient is on hospice, the more money they save the Medicare trust fund, not the opposite. Get rid of fraud, weed them out, focus specifically on where those areas of concern are. Let's look at improving education and expanding that benefit to those in need. The misconception is the fact that hospice is about death. In 1983, when it was lifted up and focused on cancer, it was. Today, hospice is about life. It's about infusing as much life as possible into whatever journey that patient and their loved ones have left. That is a tremendous responsibility.
It's not a blood test. It's not a chest X-ray. It's everything associated with the terminal prognosis for that patient. It's a powerful charge, and one we take very seriously. We work with the government, and in fact, yesterday, to ensure that there are appropriate guardrails put in place, that we have targeted specific focus to identify fraud and weed it out, and the opportunity to expand the benefit to those patients and families in need.
Great, I think that brings us right to time. I really appreciate it. Joel, it's great to have you for the first time at the event, and we always like hearing from you guys. Thank you very much.
Thanks, Ben.
Thanks, Ben