Medicare
Medicare spending per hospice stay rose 5.9% after private equity purchases, Harvard study finds
Hospices bought by private equity firms saw longer stays and more patients discharged alive, without more visits, a Harvard study of 191 acquisitions found. Researchers say Medicare's flat daily payment may need changes.
Key facts
- Medicare spending per stay rose 5.9% after private equity purchases.
- Average stays grew by 6.3 days.
- Visits did not increase.
What happened
A study from Harvard Medical School, published in the November issue of Health Affairs and released November 2, compared 191 for-profit hospices bought by private equity firms between 2018 and 2022 with 1,305 similar for-profit hospices that were not. The researchers used Medicare claims from two years before and two years after each purchase.
After acquisition, Medicare spending per hospice stay rose 5.9% compared with the other hospices. The main reason was longer stays: the average stay grew by 6.3 days. Fewer patients had stays of under a week, more stayed longer than six months, and more were discharged from hospice alive. The share of patients with dementia rose from 22.6% to 23.8%.
The researchers found no increase in physician, nurse or home health visits, and somewhat fewer social work visits. Because Medicare pays hospices the same daily rate no matter how much care a patient needs, the authors said the changes likely reflect a shift toward patients who need less daily care. They suggested Medicare consider adjusting payments based on patients' needs.
What it means for families
Hospice ownership varies widely, and the study looked at averages, not any one provider. Families choosing hospice can still ask direct questions about how care is delivered: how often nurses and aides visit, whether a social worker is part of the team, and who answers the phone at night.
For example: ask a hospice how many nurse visits a week your father can expect and how quickly someone comes out during a crisis.
New York families can compare hospice quality measures and family survey results on Medicare's Care Compare website before choosing a provider.
What to do this week
- Compare hospices on Medicare Care Compare.
- Ask how often nurses, aides and social workers will visit.
- Ask who responds after hours and how fast.
Sources
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