In watching health care "deform" evolve, it is clear to me that govt wishes to take a chunk out of any industry it pays for services...physicians, hospitals, long term care facilities and home health/hospice. However, one must examine the demographic trend successes that will serve the home health sector for years to come to fully appreciate GTIV, et al, imo. Baby Boomers will not settle for instititutionalization vs. being cared for in their homes, making home health & hospice desirable services to be invested in for future returns. The companies who are big players have an edge over newcomers, in that their ops are streamlined, they have mature networks of referring physicians and they have the experience/track record of success to get referral/repeat business. And, if people are going to remain at home longer vs. going to facilities, they will NEED home health companies to provide the in-home care NECESSARY to remain home. Payment may decline on a per-visit basis, but overall revenues should increase as visits do. The challenge will be to increase margins, and it may mean less pay for medical care professionals, including nurses, aides, therapists and others. With unemployment up across the country, I look for this to encourage more to enter the health care field for training and job placement, so the employee pool could grow, which would allow providers to reduce their number one expense - labor. Just my two - good luck!