Hospices are increasingly owned by private equity firms and publicly traded companies, but recently Weill Cornell Medicine researchers found that they performed substantially worse than hospices owned by not-for-profit agencies. This is concerning as nearly 75% of hospice programs, which care for patients in their last stage of life, are for-profit.

The study, published Nov. 18 in JAMA, highlights the need for policy interventions that focus on increasing transparency and accountability in hospice ownership. “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,” said senior author Robert Tyler Braun, assistant professor of population health sciences at Weill Cornell Medicine. The first author was Alexander Soltoff, graduate student at Emory University.

The researchers analyzed Consumer Assessment of Health Care Providers and Systems (CAHPS) data from January 2021 through December 2022. CAHPS, the national standard for assessing the quality of patient care, surveyed the caregivers of those who died in hospice by telephone and mail. The researchers compared measures for communication, timely care, treating family members with respect, emotional and religious support, help for symptoms, hospice care training, hospice rating and willingness to recommend.

Of the 2,676 hospices included in the final analysis, approximately 25% were owned by private equity and publicly traded companies and 40% were other types of privately owned for-profit hospices. Though only 25% of the hospices surveyed were not-for-profit, they provided the highest-rated quality care including focus on managing pain, comfort, dignity and quality of life.

Hospices acquired by private equity and publicly traded companies between 2007 and 2021 were found to have the lowest performance ratings across all CAHPS measures. They had worse caregiver-reported experiences, including hospitalizations of patients and higher rates of live discharges – removing patients from hospice because they no longer meet the criteria for declining health and then re-enrolling them later. This can be distressing for the patients and create unnecessary stress for the family.

Although prior research has revealed poorer user experiences in for-profit compared to not-for-profit hospices, this study found that ownership by private equity or publicly traded companies was an especially problematic category of for-profit hospice.

The paper also noted that the facilities surveyed cared for 87% of all Medicare hospice users. The shift toward for-profit hospices has a profound effect especially on these patients, whose quality of care may suffer from the focus on profit maximization and incentives to generate market returns.

“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 said.

This study received funding support from the National Institutes of Health’s National Institute on Aging.

Gillian Giles is a freelance writer for Weill Cornell Medicine.