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A study of for-profit hospices acquired by private equity firms found that Medicare spending rose by 5.9% per hospice stay after acquisition, compared with similar for-profit hospices that weren't acquired. The increase was driven mainly by longer stays, with the average length of stay rising by 6.3 days. This was likely related to shifts toward patients who use less daily care, including a significant increase in the share of patients with dementia, consistent with a larger share of patients discharged from hospice alive.

Medicare pays hospices a set daily fee regardless of how much care a patient needs. The researchers found no increase in services at private equity–acquired hospices, and instead fewer social work visits. Specifically, there were no increases in physician, nurse or home health visits that may have kept patients alive longer. This suggests the increased length of stay and live discharges may be partly due to a shift toward patients who need less ongoing care, beyond what other for-profit hospices were already doing, the researchers said.

The findings are published in the November issue of Health Affairs.

"The goal of hospice is to provide respectful, person-centered care that helps terminally ill people approach end of life with dignity, while minimizing pain and suffering," said senior author Zirui Song, associate professor of health care policy in the Blavatnik Institute at Harvard Medical School and HMS associate professor of medicine at Massachusetts General Hospital, where he is a general internist.

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