Another year, another rate cut. CMS trims home health payments again, and the reaction across the industry is predictable: tighten budgets, delay hires, maybe raise private-pay rates if the market allows it. All reasonable moves. All aimed at the part of the P&L everyone can see. Here's what almost nobody is looking at: the margin you're already losing to operational gaps that have nothing to do with CMS. I've reviewed enough agency operations to know this pattern well. Leade