Does private equity acquisition impact the quality of care provided in US hospices?

The impact of private equity (PE) acquisition on the quality of care provided in hospices is unknown, despite the growing presence of PEs in the hospice sector.

Hospices acquired by PE during 2018-2020 were identified through mergers and acquisitions data. Difference-in-differences estimation was conducted to evaluate the impact of PE acquisition on Consumer Assessment of Healthcare Providers & Systems (CAHPS) Hospice Survey results. A total of 80 PE-acquired hospices were identified. These hospices were matched to 480 controls, using exact matching on state, ownership status, year, and nearest-neighbor matching on hospice size. The CAHPS Hospice Survey scores were pre-processed into top-box and bottom-box scores, representing percentages of respondents who selected the most and the least favorable response options in each survey domain.

In the main analysis including 80 PE-acquired facilities and 480 controls, the top-box score for Communication with Family, Getting Timely Care, and Hospice Rating decreased in the treatment group by 0.81 (95% CI, -1.49 to -0.14; P < 0.05), 2.01 (95% CI, -2.94 to -1.08; P < 0.001), and 0.88 (95% CI, -1.73 to -0.02; P < 0.05) respectively. In a sensitivity analysis incorporating a two-year post-PE acquisition washout period, there was a significant decrease in the top-box score across all the domains except for Emotional and Spiritual Support, and an increase in the bottom-box scores across all the domains except for Emotional and Spiritual Support, Help with Pain and Symptoms, Training Family to Care for Patient, and Hospice Rating.

PE acquisition of hospices is consistently associated with deterioration in multiple domains of family caregivers' experience.