Patients receiving hospice care from for-profit providers have substantially worse care experiences than those who receive care from nonprofit hospice agencies, according to a study released Monday from the nonprofit think tank Rand Corporation.
Rand researchers analyzed surveys completed by family caregivers of patients treated by more than 3,100 hospices across the country and found family members reported worse care experiences on average from for-profit hospices. The families reported the for-profit firms fell short on a number of services, including providing help for pain and getting timely care.
The study also found family caregivers were 5% less likely to recommend a for-profit hospice than a nonprofit agency.
“Our results are not explained by the geographic regions the hospices operate in, or by the types of patients they care for,” Rebecca Anhang Price, study lead author and Rand senior policy, said in a statement.. “These findings are particularly pressing given the striking growth of for-profit hospices, which have profit incentives that have been shown to affect how they care for patients.”
More than 650,000 surveys were completed between the second quarter of 2017 and the first quarter of 2019. The study considered all types of hospice settings, including home-based care, inpatient hospices and hospice care provided in nursing homes.
Researchers calculated scores according to eight quality measures: hospice team communication, timely care, help for symptoms, respective treatment, emotional and spiritual support, training provided for in-home care, overall rating for hospice care and willingness to recommend the hospice to others. Researchers adjusted each hospice’s scores for case mix, including factors such as patient age and primary diagnosis.
A substantially higher number of for-profit hospices were in the low-performing category across all eight quality measures. Quality of care varied. While a greater proportion of for-profit hospices performed worse than the overall national average, some for-profit hospices performed better than the national average.
The National Hospice and Palliative Care Organization credited for-profit hospices in part for growth in the number of Americans choosing hospice. However, it also noted that all hospices — for-profit and nonprofit hospices — should ensure that hospice is accessible for everyone, especially Blacks, Hispanics and Native Americans.
“In the years ahead, both for-profit and nonprofit hospices have to be part of the solution for bridging those gaps,” NHPCO COO and Interim CEO Ben Marcantonio told McKnight’s Home Care Daily Pulse in a statement. “As a hospice community, we need to continue to focus relentlessly on program integrity and on quality of care.”
LeadingAge, which represents 5,000 nonprofit senior service agencies, affirmed the Rand Corporation’s findings.
“Nonprofit providers of hospice care have long been standard bearers for quality care in the sector — as this research shows,” LeadingAge President and CEO Katie Smith Sloan said in a statement. “The incredible value of mission-driven, nonprofit providers’ approach to hospice care has endured, even as the composition of the hospice sector evolves.”
Earlier this month, LeadingAge and other provider groups met with Centers for Medicare & Medicaid Administrator Chaquita Brooks-LaSure to air concerns over the rapid growth and integrity of the nation’s hospice program. The groups called for additional oversight of the program under Medicare and made 34 recommendations to improve hospice. These include a moratorium on new hospice programs and more stringent enforcement action against hospice providers who aberrant gaps in Medicare billing.
CMS recently updated survey guidance on hospices in an effort to ensure patients receive quality care.