News: Not-for-profit hospices outperform for-profit in care experiences, study finds

CDI Strategies - Volume 17, Issue 9

In a new research article published by JAMA Internal Medicine, data showed that family caregivers report worse care experiences at for-profit hospices than at not-for-profit hospices. Earlier research has shown similar trends that for-profit hospices do not perform as well as not-for-profit, with higher rates of hospitalizations and emergency department visits and a narrower range of services. Despite this, the number of for-profit hospices has increased from 30% of hospices in 2000 to 73% in 2020, HealthLeaders reported.

The study collected data from a Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey, which collected responses from April 2017 to March 2019 on 1,761 for-profit hospices and 906 not-for-profit hospices. The survey includes eight measures of hospice care experiences by family caregivers:

  1. Hospice team communication
  2. Getting timely care
  3. Treating family members with respect
  4. Getting emotional and religious support
  5. Getting help for symptoms
  6. Getting hospice care training
  7. Rating of hospice
  8. Willingness to recommend a hospice

For all measures, family caregivers reported worse care experiences at for-profit hospices than at not-for-profit hospices.  Not-for-profit hospices scored better on overall performance, with 12.5% of not-for-profit hospices scoring three or more points below the national average, and 33.7% of not-for-profit hospices scoring three or more points above the national average. For-profit hospice performance showed an opposite trend, however, with 31.1% of for-profit hospices scoring three or more points below the national hospice average of overall performance, and 21.9% scoring three or more points above the national average.

Family caregivers with patients who received care in for-profit state, regional, or national hospice chains reported the worst care experiences.

“Chains may be particularly attentive to their profit margins, and as such, they may look to reduce the number and cost of staff, since staffing is the main expense for a hospice,” said Rebecca Anhang Price, PhD, senior policy researcher at RAND Corporation and lead author of the study, in a comment to HealthLeaders. “But high-quality staff are key to a hospice's ability to provide high-quality care, so understaffing—in terms of either number of staff or the skills and training of that staff—can have negative effects on patient and family care experiences.”

This new study combined with prior research raises serious concerns about for-profit hospices, the co-authors wrote. “In the hospice context, poor quality care has been associated with complicated family grief and poorer bereavement adjustment, so this quality gap, combined with the growing dominance of for-profit hospices, is of particular concern,” they said.

The authors still recommended family caregivers research both not-for-profit and for-profit hospices when making decisions for their family member, considering the still noticeable variation in quality among both types of hospices.

“Because both for-profit and not-for-profit hospices are represented among the highest-performing and lowest-performing hospices, reporting of quality results for individual hospices is critical,” the co-authors said. “Publicly reported survey measure scores provide important information to guide selection of a hospice.”

Editor’s note: To read HealthLeaders’ coverage of this story, click here. To read the JAMA study, click here.

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