Home Nursing Provider for Elderly Seeks Out Place in Health Reform

AccentCare, a privately owned, venture capital-backed company, provides skilled nursing and non-medical services such as dressing, bathing and bathroom help to seniors in their homes.

The company operates in California, New York, Arizona, Ohio and Washington and employs 9,500 workers in all, including about 70 at its Irvine Spectrum headquarters.

For the 12 months ended March, AccentCare did about $200 million in revenue. The business is profitable, according to Chief Executive William “Biff” Comte.

AccentCare’s services are paid for by government healthcare programs Medi-care and Medicaid, long-term care insurance or by clients themselves or their adult children.

It also has contracts with the Department of Veterans Affairs and other government agencies. Health maintenance organizations and other insurers make up the rest of the business, part of what AccentCare refers to as its private pay business.

“If the economy’s hurting and the private pay business gets reduced, our other (government) business may be doing just fine,” Comte said. “It always works out that when one business is up, the other business is down.”

AccentCare has shifted its business through the years. Early on, it was primarily involved with non-medical services for seniors. Now skilled nursing makes up about half of AccentCare’s business, Comte said.

“In California, for sure, we’re one of the largest providers of home health Medicare services,” Comte said.

Comte has done his share of work with Medicare and other health-related government programs. His background includes 20 years as a hospital executive and serving as chief operating officer at Concentra Inc., a Dallas-based company that helps businesses and insurance companies manage workers’ compensation claims.

“I’m certainly familiar with Medicare and the twists and turns it can take you on,” he said.

AccentCare’s clients come from various sources, including referrals from health-care agencies and word of mouth, Comte said.

The company isn’t looking to go public or be bought anytime soon, according to Comte.

“At $200 million (in yearly revenue), we still believe we’re too small,” he said. “(The) venture guys continue to cover us. Some day, there will be some sort of exit.”

Early on, AccentCare received $25 million in funding from a group led by Three Arch Partners of Menlo Park and Boston-based Highland Capital Partners LLC.

AccentCare hasn’t had to “pull any money down from the venture guys in about three or four years,” Comte said.

It recently got a $35 million loan from CapitalSource Inc., a Chevy Chase, Md.-based financing company known locally for its 2008 acquisition of branches from failed Brea-based Fremont General Corp.

AccentCare is using the loan money for operations, to refinance its debt and possibly to buy smaller companies.

Beyond possible acquisitions, AccentCare is looking for growth with a rebound in its private pay business.

Growth also will “somewhat depend” on whether home health payments are cut from Medicare through ongoing healthcare reform in Congress, Comte said.

Healthcare Reform

As Congress continues to debate healthcare reform, AccentCare argues that it and other home healthcare companies can play a part in reducing costs.

According to AccentCare, studies have shown that people who receive healthcare in their homes are less likely to have repeat hospitalizations or visit the emergency room—two major factors in increasing costs.

Lawmakers “are going to see that people want to be in their homes and be taken care of in their homes,” said Comte, who’s been AccentCare’s chief executive for nearly seven years.

Competitors include Amedisys Inc. of Baton Rouge, La., Atlanta-based Gentiva Health Services Inc., National Healthcare Corp. of Murfreesboro, Tenn.,

and Almost Family Inc., based in Louisville, Ky.

Apria Healthcare Group Inc., a Lake Forest-based home healthcare provider, is different from AccentCare in that it primarily provides breathing treatments to patients in their homes, Comte said.

“They’re oxygen. They don’t do what we do in home health,” Comte said.

AccentCare last year got out of providing intravenous drug treatments to patients in their homes, another Apria specialty.