Total Revenue

+7.5% (from $276.4M in Q4 2023 to $297.18M in Q4 2024)

Overall revenue growth was driven by strong performances in core segments. Personal Care (up 7.8%) and Hospice (up ~7.7%) contributed significantly, while a modest rise in Home Health (up 4.1%) added to the growth. These increases build on previous period improvements such as higher revenues per billable hour and the impact of targeted acquisitions, which have now been reflected in Q4 2024 results. " " " "

Personal Care Segment

+7.8% (from $204.5M in Q4 2023 to $220.38M in Q4 2024)

The segment experienced robust growth largely due to increased revenues per billable hour—a trend that continued from prior periods—supported by favorable rate increases and solid demand. The ongoing organic growth, building on previously reported improvements in service delivery and reimbursement trends, further reinforces this upward trajectory. " " " "

Hospice

~+7.7% (from $54.77M in Q4 2023 to $58.97M in Q4 2024)

The Hospice segment’s rise reflects the successful integration of acquisitions and organic growth strategies. Improved Medicare reimbursement rates and cost management that began in previous periods have continued to bolster revenues despite higher associated service costs, leading to a stable yet growing operating environment. " " " "

Home Health

+4.1% (from $17.13M in Q4 2023 to $17.83M in Q4 2024)

Modest revenue growth in Home Health is primarily linked to the positive effects of recent acquisitions and operational improvements—such as more efficient intake and scheduling processes seen in Q3 2024—which are now contributing to higher total visit volumes. This builds on the prior period’s enhancements in contract pricing and payer mix adjustments. " " " "

Geographic – New York

~-85% (from $23.75M in Q4 2023 to $3.52M in Q4 2024)

The dramatic drop in New York revenue is due to the divestiture of New York Personal Care operations, a decision driven by strategic misalignment and the high management effort required in the state. Previously, New York had contributed significantly given resumed admissions under CDPAP, but the divestiture (now excluding $21.2M in prior same-store revenue) allows the company to concentrate efforts in markets that support its integrated care model. " " "

Geographic – Ohio

+23% (from $18.17M in Q4 2023 to $22.41M in Q4 2024)

Ohio’s strong performance is linked to a combination of organic growth and acquisition impacts—with rising hospice service revenues, which in earlier periods were boosted by a solid payer mix and operational efficiency improvements. The significant 23% increase reflects both the momentum from prior growth trends and focused market efforts in this state. " " "

Gross Margin

Q1 2025

no prior guidance

Expected to decline by approximately 200 basis points sequentially from Q4 2024 due to annual merit increases, normal annual payroll tax resets, and a mix shift toward personal care "

no prior guidance

Revenue

Q1 2025

no prior guidance

Q1 2025 is expected to benefit from the Illinois rate increase and two additional months of Gentiva revenue, partially offset by one less business day in Personal Care and some seasonal impact from winter storms "

no prior guidance

Seasonality

Q1 2025

no prior guidance

Normal seasonality in margins is anticipated: Q1 2025 – low watermark due to payroll tax resets and merit increases; Q2 2025 – slight lift (typically 30–40 basis points); Q3 2025 – flat margins; Q4 2025 – best quarter due to the hospice rate increase and relief on payroll tax caps "

no prior guidance

Tax Rate

FY 2025

Effective tax rate for calendar 2024 is expected to remain in the mid‑20% range, with a favorable impact of approximately 50–60 basis points starting in Q4 2024 "

Expected to remain in the mid‑20% range for FY 2025 "

no change

Gentiva Acquisition Integration

In Q3, the focus was on synergy potential with expectations of EPS accretion and system conversion benefits. " " " Q2 discussions emphasized its strategic fit and integration planning without mentioning margin pressure. " " " Q1 had no mention of this topic [Q1].

In Q4, integration was discussed with an increased emphasis on margin pressure from a 200 basis point expected decline due to a mix shift and integration costs, even as synergy potential remained part of the narrative. " " "

Increased focus on margin impact and execution risk relative to the previously balanced outlook.

Regulatory Environment

Q1 focused on the Medicaid access rule and the 80-20 rule with uncertainty over implementation. " " Q2 mentioned the Medicaid redetermination process, detailed 80-20 rule impacts, and approval delays. " " " Q3 highlighted favorable reimbursement trends and improvements in redetermination outcomes. " "

In Q4, the call highlighted potential Medicaid spending cuts, legislative proposals, and federal funding uncertainties alongside bipartisan support and value-based care trends. " " " "

Greater emphasis on uncertainty and potential policy risks in Q4 while still acknowledging favorable elements.

Margin Dynamics

Across Q1–Q3, discussions balanced expansion opportunities (from rate increases, divestitures, and hospice improvements) with compression risks such as payroll tax resets and implicit price concessions. " " " "

Q4 emphasized a 200 basis point margin decline expected in Q1 2025 due to factors such as Gentiva’s lower margins, merit increases, and mix shifts; however, opportunities from rate increases (Illinois and Medicare hospice) were also noted. " " " " "

Short‑term margin compression is more pronounced in Q4 compared to the more balanced trend in earlier periods.

Operational Efficiency and Technology Utilization

Q1 and Q2 stressed improvements in hiring metrics, streamlined scheduling processes, IT system enhancements, and effective use of ARPA funds. " " " " Q3 continued to highlight scheduling process improvements and positive hiring trends. " "

In Q4, the rollout of a new caregiver scheduling app, enhanced IT initiatives, and a strong focus on workforce optimization were emphasized to drive improved scheduling efficiency and retention. " " " "

Consistent focus with steady, positive improvements; technology remains a key enabler.

Market Expansion Opportunities

Q1 mentioned a general acquisition-based expansion strategy into new states when achieving scale. " " Q2 and Q3 focused on the Gentiva acquisition’s role in expanding market presence—especially in Texas—with strategic entry into multiple states. " " " "

Q4 put a strong spotlight on Texas as a high-growth region. The discussion underscored plans to leverage legislative developments, M&A opportunities, and a focus on Personal Care Services to capture increased market share. " " " "

Increasing emphasis on Texas as a key growth market, reflecting a clearer strategic focus compared to earlier, broader expansion strategies.

Reimbursement Dynamics

In Q1, there were mentions of modest rate increases in Medicare hospice (3.1%) and challenges in home health rates impacting margins. " " Q2 and Q3 addressed rate increases (e.g., Illinois 5.5% increase, Medicare hospice, and modest home health adjustments) with continuing challenges from lower reimbursement profiles, especially in Texas. " "

In Q4, while rate increases in Illinois (5.5%) and Medicare hospice (2.9%) were highlighted positively, there was notable concern over the lower reimbursement profile in Texas—bringing the effective revenue per hour down and impacting the overall mix. " " " "

Mixed sentiment remains, with consistent rate increases partly offset by increased pressure from lower reimbursement segments, particularly in Texas, in Q4.

M&A Pipeline and Strategic Acquisitions

Q1 highlighted acquisitions as central to growth with a focus on markets where personal care might be expanded by adding clinical services. " " " Q2 and Q3 continued to emphasize a robust acquisition strategy—especially regarding Gentiva—and noted a strong financial position to support deals, though integration risks were not as pronounced. " " " "

Q4 discussed the active M&A pipeline with an emphasis on executing the Gentiva acquisition. The call stressed the integration challenges (e.g., billing system conversion taking 18 months) and overall execution risks, while still affirming strategic intent in targeted markets. " " "

Evolving focus toward managing integration complexities and execution challenges as acquisitions near closure, building on prior strategic emphasis.

Emerging Concerns Over Clinical Labor Shortages

Q1 contained no notable mention of clinical labor challenges; Q2 reported strong hiring metrics in Personal Care and normalized clinical hiring; Q3 reflected improved hiring trends and a stable clinical labor environment. " " " " "

In Q4, emerging concerns were raised about shortages in the clinical labor segment, with particular emphasis on challenges in recruiting nurses amid competition from institutional providers despite efforts like enhanced scheduling and ARPA-funded initiatives. " " "

A new concern surfaces in Q4 regarding clinical labor shortages, contrasting with the previously stable or improving environment.

Value‑Based Care Expansion

Q1 and Q2 described active expansion, new contracts, and IT system rollouts to support value‑based care, with several contracts now in effect despite immaterial revenue impact. " " " Q3 linked the Gentiva acquisition and Texas market as catalysts for advancing VBC, claiming it as a strategic growth lever. "

In Q4, while the strategy remains in place, there was less emphasis on actively expanding VBC initiatives. The discussion noted that the focus on VBC has been part of the company’s approach for several years but is now less highlighted compared with other immediate priorities. " "

Continued strategic importance but with reduced emphasis in Q4 relative to previous periods, suggesting a shift in focus toward near-term integration and market expansion initiatives.