Association of Hospice Accreditation With Quality Measures

Voluntary accreditation is a prevalent structural signal of high quality in healthcare, yet its association with improved quality measures remains contested. In the U.S. hospice sector, the value of accreditation as an oversight mechanism warrants rigorous investigation, given its role in Medicare's "deemed status" program. The objective of this study is to determine the association between a hospice gaining accreditation and its performance on quality measures.

We conducted a retrospective, longitudinal study of U.S. hospices from 2016 to 2023. Using facility fixed-effects models, we estimated the change in quality measures associated with accreditation. The sample included a national panel of Medicare-certified hospices with publicly reported quality data. The primary independent variable was accreditation status. Dependent variables were four CMS quality measures: the Admission Composite Process Measure, Hospice Visits in the Last Days of Life, the Hospice Care Index, and the overall Hospice Star Rating.

Gaining accreditation was associated with divergent quality outcomes: a significant improvement in clinical service intensity at the end of life, but a significant decline in the quality of administrative processes at admission. Accreditation was not associated with star rating.

Hospice accreditation does not appear to function as a mechanism for comprehensive quality improvement. Instead, our results suggest that organizations may strategically prioritize performance on surveyor-visible metrics, sometimes at the expense of other care processes. These findings suggest accreditation should be viewed as a domain-specific signal rather than a comprehensive proxy for superior hospice quality.