Last Visit First

Tom Maxwell
  • 5.0 (2)
  • Business
  • Updated Semiweekly

Most care stories in home healthcare end with the last visit. Last Visit First podcast starts there. Hosted by Tom Maxwell — a nationally respected healthcare veteran with over three decades of experience, Co-Founder and Chairman of Maxwell TEC, Maxwell Investment Partners, and Maxwell Advisory Group — this podcast features honest, unfiltered conversations with the founders, CEOs, clinicians, and innovators shaping the future of home health, hospice, palliative, and post-acute care. If you lead, operate, or believe in the power of care in the home, this is your podcast. Subscribe to listen.

  1. 3d ago

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

    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-robsonChapters: 0:00 Meet Dr. Chet Robson1:40 His journey into medicine and EMRs5:02 EMRs he's worked with: Cerner, NextGen, Epic6:19 What clinical practice taught him about leadership9:18 AI translation and patient communication10:06 Physician leader vs. clinical leader13:10 Why patients fill out the same form five times15:09 The Netherlands' single EMR system16:47 Why can't EMRs talk to each other19:12 A real example of a broken patient experience21:17 Why 40% of patients skip home health after discharge25:59 Ad Break28:50 Technologies with the biggest clinical impact33:01 Why home health still can't get paid for telemedicine33:56 What population health and value-based care got wrong37:01 Barriers to managing high-risk patients40:57 The cockroach ER story42:51 What Walgreens taught him about retail pharmacy47:27 Where retail pharmacy is headed49:59 Ad Break50:38 What separates great health tech startups from the rest53:50 How to evaluate AI health companies59:46 Clinical intelligence vs. artificial intelligence1:01:04 If he ran CMS for a day1:04:38 His legacy in healthcare1:06:44 Closing thanksSponsors: 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

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

  2. Aug 8

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

    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 healthcareThe mentor who changed the course of her careerWhat she found in her first 90 days as Interim's CEOWhy Interim has lasted 60 years, and what's nextCalifornia's new emergency hospice bill, explainedWhat Rexanne would change if she ran CMS for a dayWhere AI is already saving clinicians hours of workWhy negative press is hurting hospice educationAbout 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-b55b061Interim's website: https://www.interimhealthcare.com/Chapters: 0:00 Welcome to Rexanne Domico, CEO of Interim HealthCare1:37 How Rexanne got her start, from staffing to Gentiva3:07 Running a home health pharmacy business4:54 The mentor who changed everything: Ron Malone7:11 Tom's favorite Ron Malone stories8:33 Staying humble while leading a major organization11:45 What makes organizations scale successfully13:57 Ron Malone, Keith Myers, and Mark Baiada: the industry's founding icons16:39 The first 90 days as CEO of Interim20:02 60 years of Interim: what's kept it going23:17 Interim's size, scale, and the next 5 years25:55 Balancing a national brand with local entrepreneurship28:52 Inside Interim's national conference29:30 What success looks like for home-based care in 203032:25 The 79 million reason staffing matters33:23 What healthcare leaders still get wrong about home care34:32 Telehealth's role in the future of care35:42 The ESRD and hospice access gap35:53 Trends Interim is watching closely39:18 California's emergency hospice bill, explained42:12 If Rexanne ran CMS for a day46:46 Fixing recruiting and retention across the network50:41 Where technology will make the biggest impact52:15 How AI could cut hours of chart review54:38 The gap: 6 days with no nurse in the home55:44 Early adopter vs. letting tech mature59:12 Educating families about hospice1:01:34 Why negative press is hurting hospice access1:02:43 Rexanne outside of work1:04:24 Advice to her younger self1:05:53 The legacy she wants to leave1:06:56 How to reach Rexanne about franchising1:07:56 Closing thoughtsSponsors: Maxwell TEC: https://maxwelltec.com/IntellaTriage: https://intellatriage.com/ #homehealth #hospice #homecare #PostAcuteCare #InterimHealthCare #franchising #healthcareleadership #aginginplace #LastVisitFirst

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

  3. Jul 29

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

    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 CEOTurning a broken, bankrupt agency into Mission HealthcareCalifornia's hospice fraud crackdown and the PPEO audit processHow Mission uses Muse data and technology to stay compliantWhat makes a great leader and a culture people stay in for lifeChapters: 00:00 Intro00:16 Welcome to Last Visit First & Meet Mark Kimsey01:06 A Teenage Hospital Job That Sparked a Career in Healthcare05:50 Breaking Into Sales at Medline07:00 Returning to Care South and Building Toward Mission08:16 The Broken Agency That Became Mission Healthcare09:29 Why San Diego? The Origin Story11:21 Mission Healthcare Today: 34 Locations and the Traditions Acquisition12:54 Running a Company With Your Spouse and Best Friend15:51 California's Hospice Fraud Crackdown and PPEO Audits19:41 Helping Patients and Physicians Identify a Compliant Provider20:55 Technology, Muse Data, and AI Adoption22:42 The Secret to Recruiting Great People25:55 Building a Culture People Never Want to Leave27:56 What's Next: Growth, Acquisitions, and Hiring Plans29:46 Ads34:15 What Makes a Great Leader at Mission35:59 Hustle, Culture, and Having Fun at Work37:57 A Letter That Showed the True Impact of Hospice Care40:19 The Nana Upstairs, Nana Downstairs Story42:53 Family Home Health and Hospice in Georgia44:32 How a Napkin Sketch Led Jack Drawn Into Home Health47:39 Meet the Mission Healthcare Leadership Team51:37 Reflecting on the Mission Healthcare Journey53:13 OutroSponsors: Premier Sponsor: Homecare Homebase: https://hchb.com/Maxwell TEC: https://maxwelltec.com/IntellaTriage: https://intellatriage.com/#hospice #homehealthcare #endoflifecare #hospicecare #medicare #healthcarepolicy #healthcareleadership #healthcarepodcast

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

  4. Jul 19

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

    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 todayHow AI is helping nurses track and document patient decline more accuratelyWhy licensed practical nurse visits aren't reimbursed the same as registered nurse visits during a crisis, and why that's a problemHow respite and continuous home care are two of the most underused hospice benefitsWhy bereavement care might be the most overlooked part of the entire hospice benefitTom 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 Intro01:04 Philip's path into the family hospice business03:38 About Saad Healthcare04:50 A day in the life of a VP of Hospice07:21 Inpatient hospice units: freestanding vs. hospital-based09:50 Hospice under scrutiny in the national press12:38 The 27% of hospices not submitting CMS data17:21 Long length of stay and the SSVI framework20:23 Using AI to track and document patient decline23:10 Favorite AI tools in hospice care24:01 Building a "hospice brain" to catch patients earlier26:13 The $1.9 billion cost of choosing hospice late28:20 De-prescribing medications near end of life31:41 What respite care actually is34:36 Continuous care in the home37:01 Ad Break39:25 The LPN vs. RN reimbursement problem41:11 Why aides and chaplains don't count in CMS metrics42:21 EMTs, paramedics, and the hospice workforce shortage42:53 RN licensing caps and compact state frustrations46:22 CMS's proposed rule and Medicare spending buckets47:55 PTANs and the nursing home referral cap51:36 Inside Saad's bereavement program56:00 Text-based bereavement and community outreach1:02:06 How to connect with Philip and Saad Healthcare1:03:15 The legacy questionSponsors: Premier Sponsor: Homecare Homebase: https://hchb.com/Maxwell TEC: https://maxwelltec.com/IntellaTriage: https://intellatriage.com/#hospice #homehealthcare #endoflifecare #hospicecare #medicare #HealthcarePolicy

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

  5. Jul 9

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

    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 fromWhy the temporary 3% clawback matters more than the payment increaseHow to model your 2027 budget before the final rule drops in NovemberThe CMS wage index proposal and its impact on rural and high-cost marketsWhat 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 wrong1:26 Jay Duty's path from HCA to home health strategy1:53 The first thing Jay checks in a new CMS rule2:21 What's actually driving the 2.4% number3:55 The one sentence every CFO needs to remember4:49 The behavioral adjustment, explained6:26 Real example: therapy-only cases and the 30-day billing trap7:44 The $4.9 billion recoupment breakdown9:54 Is CMS's data methodology actually flawed?12:15 What a strong industry comment letter argues13:33 Why this rule always lands mid-budget cycle14:46 How to model your 2027 budget starting now17:01 Why visits per period keep falling19:45 What investors and lenders should hear from you now21:28 The case for a home health specific wage index24:00 CMS's expanded power to deny or revoke enrollment25:34 Can industry comments actually move the needle?28:16 What makes a comment letter valuable to CMS29:48 Will this adjustment mechanism still exist in five years?31:51 What to do this week if you run an agency33:08 How to reach Jay Duty Sponsors: Maxwell TEC: https://www.maxwelltec.com

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

  6. Jun 29

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

    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 headedThe three things buyers prioritize above everything else in smaller agency deals and why compliance now leads the listHow Agenda's buyer profiling process matches sellers with the right capital partners, not just the highest bidWhat the full deal process looks like step by step, from valuation call to signed LOI, for an owner who has never done this beforeThe emotional reality of selling a business you built from nothing and how good advisors help owners through itChapters: 00:00 Introduction to Alex Veach and Agenda Health01:29 Alex's Background and Path to Agenda02:45 What Agenda Health Does and Who They Serve05:14 The Current M&A Market for Home Health and Hospice07:43 What Most Owners Get Wrong About Valuation09:18 Valuation Ranges Across Home Health, Hospice, and Personal Care12:15 What a Platform Deal Actually Means14:22 Buyer's Market or Seller's Market Right Now17:34 How Large Platform Deals Create Add-On Opportunity for Smaller Agencies19:05 Acquisition vs. Recapitalization: What's the Difference21:37 The Top Three Things Buyers Look for in Smaller Agencies25:12 The Role of Team and Key Man Risk in a Deal26:39 How Regulatory Timing and Rate Changes Affect Deal Process29:22 Ads31:59 Building Relationships and Teaching the Business36:47 How Long the Seller Relationship Takes to Develop39:33 Begin With the End in Mind: Prepping 24 Months Out42:01 EMR Data, Financial Readiness, and What Buyers Are Testing45:42 Walking Through a Real Deal: 250-Patient Hospice in Houston46:27 Valuation Presentation and Process Strategy49:46 Ads50:51 The Data Room: How It Works and Why It Matters53:03 Keeping Census Up While Your Deal Is in Process56:46 Managing Team Distraction and Confidentiality During a Sale58:01 Legacy, Impact, and What Alex and Agenda Want to Be Known For1:03:39 The Emotional Reality of Selling Your Business1:04:37 How to Reach Alex Veach and Agenda Health1:05:46 Closing ThoughtsConnect with Alex Veach and Agenda Health: Agenda Health's Website: https://www.agendahealth.comAgenda Health's LinkedIn: https://www.linkedin.com/company/agenda-business-services/Alex's LinkedIn: https://www.linkedin.com/in/alex-veachLast Visit First: Apple Podcasts: https://podcasts.apple.com/us/podcast/last-visit-first/id1830051182Spotify: https://open.spotify.com/show/3iSKGRvHC9Bk3iq7l8UPxsYouTube: https://www.youtube.com/@lastvisitfirstpodcastWebsite: https://www.lastvisitfirst.comLinkedIn: https://linkedin.com/company/last-visit-firstSponsors: 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/

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

  7. Jun 19

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

    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 changesThe Balanced Care Method and TheKey's six pillars of health in actionAnosognosia: the misunderstood symptom that changes how families should respondWhy labeling dementia patients as "resistant to care" is the wrong frame entirely and what to use insteadEngagement erosion: how decline happens quietly before anyone noticesThe caregiver-as-change-agent model and why it works in the homeWhere AI and wearables are headed in home careA story about a son who almost stopped visiting his mom with dementia and what changedChapters 00:00 Introduction to Dr. Shadi Golizada and The Key02:54 Dr. Golizada's Journey in Clinical Psychology05:35 Understanding The Key's Home Care Services08:48 The Six Pillars of Health and Wellness11:33 Personalized Care and Hydration Strategies14:38 The Importance of Caregiver Stories17:28 Navigating Dementia and Family Dynamics20:21 Education and Awareness in Dementia Care23:23 Hope and Lifestyle Changes for Dementia Patients26:05 Ads29:06 Resources for Aging and Care Coordination31:45 Technology in Home Care Services35:59 AI in Caregiving: Enhancing Relationships and Documentation40:49 The Importance of User-Centric Technology44:28 Engagement and Joy in Care: The Role of AI49:19 Health Behavior Change: A Balanced Approach51:20 Ads57:28 Long-Term Care: Building Meaningful Relationships01:03:50 Transformative Stories: Changing Perspectives on CaregivingDr. 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/0aLuKhf3TheKey Essentials: The Balanced Path: Six Lifestyle Pillars That Shape How We Age: https://a.co/d/0iHbxSKrTheKey Essentials: Aging with Confidence: Your Guide to Care, Safety, and Living Fully Wherever You Call Home: https://a.co/d/0dovA0iyConnect with Dr. Shadi Gholizadeh and TheKey: Website: https://www.thekey.comEmail: shadi@thekey.comLinkedIn: https://www.linkedin.com/in/shadigLast 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/@lastvisitfirstpodcastWebsite: https://www.lastvisitfirst.com LinkedIn: https://linkedin.com/company/last-visit-firstSponsors: 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/

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

  8. Jun 9

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

    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 wrongHow Tango eliminates the referral-to-authorization gap that delays care in the critical first 48 hours after dischargeWhat value-based care actually looks like at the episode level and how providers get rewarded for itWhy 10 to 12 percent of SNF admissions do not need to happen and what fixing that requiresHow AI is cutting 22-minute case reviews to five to eight minutes without replacing the clinicianCHAPTERS 0:00 Introduction and Brian Lobley's background1:53 Brian's career path from IT consulting to Independence Blue Cross4:48 Building the tango leadership team8:02 What tango does and how the model works12:09 How home health providers can join the tango network17:33 The interoperability challenge and where the industry stands21:14 Why delays in home health hurt patients, payers, and hospitals27:57 [Ads]30:21 Value-based care: what's actually working vs. theoretical34:49 Expanding beyond home health: hospice and personal care37:24 What Medicare Advantage plans are getting right and wrong43:26 Why payer networks keep failing home health agencies45:06 [Ads]46:10 How tango is using AI in clinical and operational workflows54:43 Hiring at tango and how to join the network56:31 The story behind the name change from PHCN to tango57:39 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.

    The Fragmented System Keeping Grandma in the Hospital (And How to Fix It)
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5
out of 5
2 Ratings

About

Most care stories in home healthcare end with the last visit. Last Visit First podcast starts there. Hosted by Tom Maxwell — a nationally respected healthcare veteran with over three decades of experience, Co-Founder and Chairman of Maxwell TEC, Maxwell Investment Partners, and Maxwell Advisory Group — this podcast features honest, unfiltered conversations with the founders, CEOs, clinicians, and innovators shaping the future of home health, hospice, palliative, and post-acute care. If you lead, operate, or believe in the power of care in the home, this is your podcast. Subscribe to listen.

Information

  • Creator
    Tom Maxwell
  • Years Active
    2025 - 2026
  • Episodes
    49
  • Rating
    Explicit
  • Copyright
    © Tom Maxwell
  • Show Website
    Last Visit First

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