For-profit hospices linked to poor care quality

Hospices owned by private equity firms and publicly traded companies were linked to worsened care quality, according to a study published in JAMA by Weill Cornell Medicine researchers. Researchers found that for-profit hospice ownership was linked to higher rates of hospitalization and live discharges, as well as worse caregiver-reported experiences.

As previously reported, there were 124 private equity acquisitions of U.S. hospice facilities between 2015 and 2022. Experts have raised questions about private equity ownership in healthcare and its effects on care quality.

Weill Cornell Medicine researchers analyzed Consumer Assessment of Health Care Providers and Systems (CAHPS) data from January 2021 through December 2022 and surveyed caregivers of former hospice patients to understand hospice care quality.

"Although all for-profit ownership models are oriented toward profit maximization, [private equity firm] and [publicly traded company] ownership structures are distinct in being incentivized to generate short-term and above-market returns for investors, raising questions about the potential influence of financial objectives on quality," the study stated.

The researchers used linear regression models to compare CAHPS Hospice Survey scores among the different ownership models. The CAHPS Hospice Survey asks respondents to score hospices based on communication, timely care, help for symptoms, willingness to recommend and other metrics. The researchers analyzed data pertaining to 2,676 hospices in total.

The results showed that hospices owned by private equity firms or publicly traded companies achieved the lowest performance overall, while nonprofit hospices achieved the highest performance scores.

The study noted that prior research had highlighted poor care quality within for-profit versus nonprofit hospices, but no existing research had demonstrated problems specifically associated with hospices owned by private equity firms or publicly traded companies.

"To protect vulnerable patients, policymakers should implement stricter reporting requirements for ownership changes and enforce more rigorous oversight measures, ensuring that financial incentives don't undermine end-of-life patient care," Robert Tyler Braun, assistant professor of population health sciences at Weill Cornell Medical College and senior author of the study, said in an accompanying press release.

The study also observed that the reduced care quality associated with for-profit hospices might disproportionately affect Medicare hospice users. The facilities that were surveyed cared for 87% of all Medicare hospice users.

"Greater ownership transparency would allow regulators and families to make informed decisions, safeguarding care quality and helping hold hospices accountable when ownership shifts occur," Braun noted.

Jill McKeon has covered healthcare cybersecurity and privacy news since 2021.