Geographic Access to Hospices with High Quality Ratings

Area of Science:

• Health Services Research
• Public Health
• Gerontology

Background:

• Growing hospice utilization raises concerns regarding equitable access and consistent quality of care across the United States.
• Variability in hospice provider presence and quality may disproportionately affect vulnerable populations.

Purpose of the Study:

• To investigate the geographical distribution and quality of hospice providers at the U.S. county level.
• To identify sociodemographic factors associated with the presence of high-quality hospice care.

Main Methods:

• Hospice provider quality data was sourced from the 2023 Centers for Medicare & Medicaid Services (CMS) Hospice Survey Star Ratings.
• County-level sociodemographic information was obtained from the U.S. Census Bureau's American Community Survey (2023, 5-year sample).

Main Results:

• Only 29.2% of 7024 hospice providers had available quality ratings, with 55.3% of those rated as high-quality (>3 stars).
• Hospice care was available in 41.4% of U.S. counties, while high-quality hospice was present in only 23.6%.
• High-quality hospice providers were more prevalent in urban counties with higher incomes, larger populations, higher education levels, and lower rates of poverty and uninsurance.

Conclusions:

• A significant number of U.S. counties lack any hospice providers, indicating substantial gaps in access.
• The availability of high-quality hospice care is significantly lower in rural and socioeconomically disadvantaged counties.
• The absence of star ratings for many hospice providers impedes the use of public quality data for patient and family decision-making.