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

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: PE acquisition of hospices is consistently associated with deterioration in multiple domains of family caregivers' experience.