Last Visit First

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.

Last Visit First is a business podcast hosted by Tom Maxwell, with 48 episodes on record and a Required Pod Score of 80. PitchCentric scores this show on Booking Probability, Listen Score, and live audience signals refreshed every 24 hours.

Tom Maxwell hosts Last Visit First, a business show with 48 episodes published.

Our AI reads these to draft pitches. Use them as grounding for a pitch that cites a real guest and a specific topic.

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  Episode #10

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

  Aug 18, 20261h 8mS2

  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-robson Chapters : 0:00 Meet Dr. Chet Robson 1:40 His journey into medicine and EMRs 5:02 EMRs he's worked with: Cerner, NextGen, Epic 6:19 What clinical practice taught him about leadership 9:18 AI translation and patient communication 10:06 Physician leader vs. clinical leader 13:10 Why patients fill out the same form five times 15:09 The Netherlands' single EMR system 16:47 Why can't EMRs talk to each other 19:12 A real example of a broken patient experience 21:17 Why 40% of patients skip home health after discharge 25:59 Ad Break 28:50 Technologies with the biggest clinical impact 33:01 Why home health still can't get paid for telemedicine 33:56 What population health and value-based care got wrong 37:01 Barriers to managing high-risk patients 40:57 The cockroach ER story 42:51 What Walgreens taught him about retail pharmacy 47:27 Where retail pharmacy is headed 49:59 Ad Break 50:38 What separates great health tech startups from the rest 53:50 How to evaluate AI health companies 59:46 Clinical intelligence vs. artificial intelligence 1:01:04 If he ran CMS for a day 1:04:38 His legacy in healthcare 1:06:44 Closing thanks Sponsors: 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

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  Episode #8

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

  Jul 29, 202653 minS2

  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 CEO Turning a broken, bankrupt agency into Mission Healthcare California's hospice fraud crackdown and the PPEO audit process How Mission uses Muse data and technology to stay compliant What makes a great leader and a culture people stay in for life Chapters: 00:00 Intro 00:16 Welcome to Last Visit First & Meet Mark Kimsey 01:06 A Teenage Hospital Job That Sparked a Career in Healthcare 05:50 Breaking Into Sales at Medline 07:00 Returning to Care South and Building Toward Mission 08:16 The Broken Agency That Became Mission Healthcare 09:29 Why San Diego? The Origin Story 11:21 Mission Healthcare Today: 34 Locations and the Traditions Acquisition 12:54 Running a Company With Your Spouse and Best Friend 15:51 California's Hospice Fraud Crackdown and PPEO Audits 19:41 Helping Patients and Physicians Identify a Compliant Provider 20:55 Technology, Muse Data, and AI Adoption 22:42 The Secret to Recruiting Great People 25:55 Building a Culture People Never Want to Leave 27:56 What's Next: Growth, Acquisitions, and Hiring Plans 29:46 Ads 34:15 What Makes a Great Leader at Mission 35:59 Hustle, Culture, and Having Fun at Work 37:57 A Letter That Showed the True Impact of Hospice Care 40:19 The Nana Upstairs, Nana Downstairs Story 42:53 Family Home Health and Hospice in Georgia 44:32 How a Napkin Sketch Led Jack Drawn Into Home Health 47:39 Meet the Mission Healthcare Leadership Team 51:37 Reflecting on the Mission Healthcare Journey 53:13 Outro Sponsors: Premier Sponsor: Homecare Homebase: https://hchb.com/ Maxwell TEC: https://maxwelltec.com/ IntellaTriage: https://intellatriage.com/ #hospice #homehealthcare #endoflifecare #hospicecare #medicare #healthcarepolicy #healthcareleadership #healthcarepodcast

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  Episode #7

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

  Jul 19, 20261h 9mS2

  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 today How AI is helping nurses track and document patient decline more accurately Why licensed practical nurse visits aren't reimbursed the same as registered nurse visits during a crisis, and why that's a problem How respite and continuous home care are two of the most underused hospice benefits Why bereavement care might be the most overlooked part of the entire hospice benefit Tom 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 Intro 01:04 Philip's path into the family hospice business 03:38 About Saad Healthcare 04:50 A day in the life of a VP of Hospice 07:21 Inpatient hospice units: freestanding vs. hospital-based 09:50 Hospice under scrutiny in the national press 12:38 The 27% of hospices not submitting CMS data 17:21 Long length of stay and the SSVI framework 20:23 Using AI to track and document patient decline 23:10 Favorite AI tools in hospice care 24:01 Building a "hospice brain" to catch patients earlier 26:13 The $1.9 billion cost of choosing hospice late 28:20 De-prescribing medications near end of life 31:41 What respite care actually is 34:36 Continuous care in the home 37:01 Ad Break 39:25 The LPN vs. RN reimbursement problem 41:11 Why aides and chaplains don't count in CMS metrics 42:21 EMTs, paramedics, and the hospice workforce shortage 42:53 RN licensing caps and compact state frustrations 46:22 CMS's proposed rule and Medicare spending buckets 47:55 PTANs and the nursing home referral cap 51:36 Inside Saad's bereavement program 56:00 Text-based bereavement and community outreach 1:02:06 How to connect with Philip and Saad Healthcare 1:03:15 The legacy question Sponsors: Premier Sponsor: Homecare Homebase: https://hchb.com/ Maxwell TEC: https://maxwelltec.com/ IntellaTriage: https://intellatriage.com/ #hospice #homehealthcare #endoflifecare #hospicecare #medicare #HealthcarePolicy

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  Episode #6

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

  Jul 9, 202634 minS2

  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 from Why the temporary 3% clawback matters more than the payment increase How to model your 2027 budget before the final rule drops in November The CMS wage index proposal and its impact on rural and high-cost markets What 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 wrong 1:26 Jay Duty's path from HCA to home health strategy 1:53 The first thing Jay checks in a new CMS rule 2:21 What's actually driving the 2.4% number 3:55 The one sentence every CFO needs to remember 4:49 The behavioral adjustment, explained 6:26 Real example: therapy-only cases and the 30-day billing trap 7:44 The $4.9 billion recoupment breakdown 9:54 Is CMS's data methodology actually flawed? 12:15 What a strong industry comment letter argues 13:33 Why this rule always lands mid-budget cycle 14:46 How to model your 2027 budget starting now 17:01 Why visits per period keep falling 19:45 What investors and lenders should hear from you now 21:28 The case for a home health specific wage index 24:00 CMS's expanded power to deny or revoke enrollment 25:34 Can industry comments actually move the needle? 28:16 What makes a comment letter valuable to CMS 29:48 Will this adjustment mechanism still exist in five years? 31:51 What to do this week if you run an agency 33:08 How to reach Jay Duty Sponsors: Maxwell TEC: https://www.maxwelltec.com

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  Episode #5

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

  Jun 29, 20261h 7mS2

  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 headed The three things buyers prioritize above everything else in smaller agency deals and why compliance now leads the list How Agenda's buyer profiling process matches sellers with the right capital partners, not just the highest bid What the full deal process looks like step by step, from valuation call to signed LOI, for an owner who has never done this before The emotional reality of selling a business you built from nothing and how good advisors help owners through it Chapters: 00:00 Introduction to Alex Veach and Agenda Health 01:29 Alex's Background and Path to Agenda 02:45 What Agenda Health Does and Who They Serve 05:14 The Current M&A Market for Home Health and Hospice 07:43 What Most Owners Get Wrong About Valuation 09:18 Valuation Ranges Across Home Health, Hospice, and Personal Care 12:15 What a Platform Deal Actually Means 14:22 Buyer's Market or Seller's Market Right Now 17:34 How Large Platform Deals Create Add-On Opportunity for Smaller Agencies 19:05 Acquisition vs. Recapitalization: What's the Difference 21:37 The Top Three Things Buyers Look for in Smaller Agencies 25:12 The Role of Team and Key Man Risk in a Deal 26:39 How Regulatory Timing and Rate Changes Affect Deal Process 29:22 Ads 31:59 Building Relationships and Teaching the Business 36:47 How Long the Seller Relationship Takes to Develop 39:33 Begin With the End in Mind: Prepping 24 Months Out 42:01 EMR Data, Financial Readiness, and What Buyers Are Testing 45:42 Walking Through a Real Deal: 250-Patient Hospice in Houston 46:27 Valuation Presentation and Process Strategy 49:46 Ads 50:51 The Data Room: How It Works and Why It Matters 53:03 Keeping Census Up While Your Deal Is in Process 56:46 Managing Team Distraction and Confidentiality During a Sale 58:01 Legacy, Impact, and What Alex and Agenda Want to Be Known For 1:03:39 The Emotional Reality of Selling Your Business 1:04:37 How to Reach Alex Veach and Agenda Health 1:05:46 Closing Thoughts Connect with Alex Veach and Agenda Health: Agenda Health's Website: https://www.agendahealth.com Agenda Health's LinkedIn: https://www.linkedin.com/company/agenda-business-services/ Alex's LinkedIn: https://www.linkedin.com/in/alex-veach Last 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/@lastvisitfirstpodcast Website: https://www.lastvisitfirst.com LinkedIn: https://linkedin.com/company/last-visit-first 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/

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