For-Profit Hospices Underperform Compared to Not-for-Profit Agencies, Study Finds

The growing dominance of for-profit hospices, particularly those owned by private equity firms and publicly traded companies, is raising significant concerns about end-of-life care quality, according to new research from Weill Cornell Medicine. Published in JAMA, the study reveals that not-for-profit hospices provide substantially better care compared to their for-profit counterparts, which now account for nearly 75% of all hospice programs.

The study’s findings highlight the need for increased transparency and stricter oversight in hospice ownership to ensure quality care for patients in their final stages of life.

Key Findings: Care Quality and Ownership Structures

Researchers analyzed Consumer Assessment of Health Care Providers and Systems (CAHPS) data from 2021 to 2022, focusing on caregiver-reported metrics such as communication, timely care, emotional and religious support, and hospice training. The study encompassed 2,676 hospices, representing 87% of all Medicare hospice users.

While not-for-profit hospices represented only 25% of those surveyed, they consistently delivered the highest-rated care, emphasizing pain management, dignity, and quality of life. In contrast, hospices owned by private equity and publicly traded companies scored the lowest across all CAHPS measures. These facilities were linked to poorer caregiver experiences, higher rates of hospitalizations, and a troubling pattern of live discharges, where patients are removed from hospice care prematurely only to be re-enrolled later. This practice not only disrupts patient care but also imposes undue stress on families.

Why This Matters: Policy Implications and Patient Care

The shift toward for-profit hospice ownership has profound implications for vulnerable patients. The study underscores the risk of financial incentives undermining the quality of care, as private equity and market-driven models prioritize returns over patient well-being. “Greater ownership transparency would allow regulators and families to make informed decisions, safeguarding care quality and helping hold hospices accountable when ownership shifts occur,” noted senior author Dr. Robert Tyler Braun.

The findings call for urgent policy interventions, including stricter reporting requirements for ownership changes and enhanced regulatory oversight. Such measures could help mitigate the risks associated with profit-driven care models and protect the dignity and comfort of patients in hospice.