Private equity and publicly traded hospices show lower caregiver satisfaction compared to not-for-profits

A new study published in JAMA highlights significant disparities in caregiver-reported hospice quality based on ownership models, with hospices owned by private equity firms (PEF) or publicly traded companies (PTC) showing the lowest performance scores. Researchers say the findings, drawn from data collected through the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey between January 2021 and December 2022, raise critical concerns about the implications of profit-driven ownership in end-of-life care.

Researchers analyzed 2,676 hospices across three ownership categories: private equity/publicly traded company-owned for-profits, non-PEF/PTC for-profits, and not-for-profits. Government-owned and other hospices were excluded. The CAHPS survey measures caregiver satisfaction on various aspects of hospice care, including communication, timeliness, emotional and religious support, symptom management, and overall quality.

The study found that not-for-profit hospices consistently outperformed for-profit models, particularly those owned by private equity firms and publicly traded companies. Adjusted regression models showed that:

- PEF/PTC-owned hospices scored an average of 2.86 percentage points lower than not-for-profits and 1.68 points lower than non-PEF/PTC for-profits on a composite measure of caregiver satisfaction.

- Not-for-profit hospices achieved the highest scores across all survey metrics, while PEF/PTC-owned hospices demonstrated the lowest performance.

Ownership and quality disparities

According to the research, ownership by PEFs and PTCs has unique characteristics that may impact care quality. Unlike traditional for-profit models, PEFs and PTCs are designed to maximize short-term, above-market returns for investors. This focus on rapid financial gain may contribute to diminished investment in caregiving resources and quality improvement, the authors suggest.

Among the individual CAHPS measures, the disparities were most pronounced in areas like communication, emotional and religious support, and overall ratings of hospice care. Researchers say these gaps underscore the potential challenges faced by PEF/PTC-owned hospices in meeting the emotional and relational needs of patients and caregivers. For clinicians referring patients to hospice care, these findings highlight the importance of considering ownership models when evaluating hospice quality. While for-profit ownership has been associated with lower quality in previous studies, the uniquely poor performance of PEF/PTC-owned hospices suggests that this category warrants particular scrutiny.

The study's authors call for increased transparency in hospice ownership structures and greater accountability for PEF/PTC-owned agencies. They suggest that policy interventions may be necessary to ensure that financial objectives do not overshadow the mission of providing high-quality, compassionate care at the end of life.