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Changes in Diagnoses and Site of Care for Patients Receiving Hospice Care From Agencies Acquired by Private Equity Firms and Publicly Traded Companies

IMPORTANCE: Private equity firms and publicly traded companies have been acquiring US hospice agencies; an estimated 16% of US hospice agencies are owned by private equity (PE) firms or publicly traded companies (PTC). OBJECTIVE: To examine the association of PE and PTC acquisitions of hospices with...

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Autores principales: Braun, Robert Tyler, Unruh, Mark A., Stevenson, David G., Prigerson, Holly G., Fernandez, Rahul, Yao, Leah Z., Casalino, Lawrence P.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10520742/
https://www.ncbi.nlm.nih.gov/pubmed/37747735
http://dx.doi.org/10.1001/jamanetworkopen.2023.34582
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author Braun, Robert Tyler
Unruh, Mark A.
Stevenson, David G.
Prigerson, Holly G.
Fernandez, Rahul
Yao, Leah Z.
Casalino, Lawrence P.
author_facet Braun, Robert Tyler
Unruh, Mark A.
Stevenson, David G.
Prigerson, Holly G.
Fernandez, Rahul
Yao, Leah Z.
Casalino, Lawrence P.
author_sort Braun, Robert Tyler
collection PubMed
description IMPORTANCE: Private equity firms and publicly traded companies have been acquiring US hospice agencies; an estimated 16% of US hospice agencies are owned by private equity (PE) firms or publicly traded companies (PTC). OBJECTIVE: To examine the association of PE and PTC acquisitions of hospices with Medicare patients’ site of care and clinical diagnoses. DESIGN, SETTING, AND PARTICIPANTS: This cohort study of US hospice agencies used a novel national database of acquisitions merged with the Medicare Post–Acute Care and Hospice Public Use File for 2013 to 2020. Changes in sites of care and patient characteristics for hospice agencies acquired by PE or PTCs were compared with changes for patients in nonacquired for-profit hospice agencies. EXPOSURE: Private equity and publicly traded company acquisitions. MAIN OUTCOMES AND MEASURES: This study used a difference-in-differences approach within an event-study framework to examine the association of PE and PTC acquisitions of hospice agencies with changes in patient diagnoses and sites of care. Dependent variables were annual hospice-level measures of the Hierarchical Condition Category (HCC) score and proportion of patients diagnosed with cancer or dementia. Sites of care included the proportion of patients receiving hospice care in their personal home, nursing home, or assisted living facility. RESULTS: A total of 158 hospice agencies acquired by PEs, 250 acquired by PTCs, and 1559 other for-profit hospice agencies were included. Preacquisition, hospice agencies that would later be acquired by PE or PTC served a mean (IQR) 30.1% (12.0%-44.0%) and 29.4% (13.0%-43.0%) of their patients in nursing homes respectively, a greater proportion compared with the 27.1% (8.0%-43.8%) served by for-profit hospices that were never acquired. Agencies acquired by PE between 2014 and 2019 saw a significant relative increase of 5.98% in dementia patients (1.38 percentage points; 95% CI, 0.35-2.40 percentage points; P = .008). In PTC-owned hospices, the proportion of patients receiving care at home increased by 5.26% (2.98 percentage points; 95% CI, 1.46-4.51 percentage points; P < .001), the proportion of dementia patients rose by 13.49% (3.11 percentage points; 95% CI, 2.14-4.09 percentage points; P < .001), and the HCC score decreased by 1.37% (−3.19 percentage points; 95% CI, −5.92 to −0.47 percentage points; P = .02). CONCLUSIONS AND RELEVANCE: These findings suggest that PE and PTCs select patients and sites of care to maximize profits.
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spelling pubmed-105207422023-09-27 Changes in Diagnoses and Site of Care for Patients Receiving Hospice Care From Agencies Acquired by Private Equity Firms and Publicly Traded Companies Braun, Robert Tyler Unruh, Mark A. Stevenson, David G. Prigerson, Holly G. Fernandez, Rahul Yao, Leah Z. Casalino, Lawrence P. JAMA Netw Open Original Investigation IMPORTANCE: Private equity firms and publicly traded companies have been acquiring US hospice agencies; an estimated 16% of US hospice agencies are owned by private equity (PE) firms or publicly traded companies (PTC). OBJECTIVE: To examine the association of PE and PTC acquisitions of hospices with Medicare patients’ site of care and clinical diagnoses. DESIGN, SETTING, AND PARTICIPANTS: This cohort study of US hospice agencies used a novel national database of acquisitions merged with the Medicare Post–Acute Care and Hospice Public Use File for 2013 to 2020. Changes in sites of care and patient characteristics for hospice agencies acquired by PE or PTCs were compared with changes for patients in nonacquired for-profit hospice agencies. EXPOSURE: Private equity and publicly traded company acquisitions. MAIN OUTCOMES AND MEASURES: This study used a difference-in-differences approach within an event-study framework to examine the association of PE and PTC acquisitions of hospice agencies with changes in patient diagnoses and sites of care. Dependent variables were annual hospice-level measures of the Hierarchical Condition Category (HCC) score and proportion of patients diagnosed with cancer or dementia. Sites of care included the proportion of patients receiving hospice care in their personal home, nursing home, or assisted living facility. RESULTS: A total of 158 hospice agencies acquired by PEs, 250 acquired by PTCs, and 1559 other for-profit hospice agencies were included. Preacquisition, hospice agencies that would later be acquired by PE or PTC served a mean (IQR) 30.1% (12.0%-44.0%) and 29.4% (13.0%-43.0%) of their patients in nursing homes respectively, a greater proportion compared with the 27.1% (8.0%-43.8%) served by for-profit hospices that were never acquired. Agencies acquired by PE between 2014 and 2019 saw a significant relative increase of 5.98% in dementia patients (1.38 percentage points; 95% CI, 0.35-2.40 percentage points; P = .008). In PTC-owned hospices, the proportion of patients receiving care at home increased by 5.26% (2.98 percentage points; 95% CI, 1.46-4.51 percentage points; P < .001), the proportion of dementia patients rose by 13.49% (3.11 percentage points; 95% CI, 2.14-4.09 percentage points; P < .001), and the HCC score decreased by 1.37% (−3.19 percentage points; 95% CI, −5.92 to −0.47 percentage points; P = .02). CONCLUSIONS AND RELEVANCE: These findings suggest that PE and PTCs select patients and sites of care to maximize profits. American Medical Association 2023-09-25 /pmc/articles/PMC10520742/ /pubmed/37747735 http://dx.doi.org/10.1001/jamanetworkopen.2023.34582 Text en Copyright 2023 Braun RT et al. JAMA Network Open. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Braun, Robert Tyler
Unruh, Mark A.
Stevenson, David G.
Prigerson, Holly G.
Fernandez, Rahul
Yao, Leah Z.
Casalino, Lawrence P.
Changes in Diagnoses and Site of Care for Patients Receiving Hospice Care From Agencies Acquired by Private Equity Firms and Publicly Traded Companies
title Changes in Diagnoses and Site of Care for Patients Receiving Hospice Care From Agencies Acquired by Private Equity Firms and Publicly Traded Companies
title_full Changes in Diagnoses and Site of Care for Patients Receiving Hospice Care From Agencies Acquired by Private Equity Firms and Publicly Traded Companies
title_fullStr Changes in Diagnoses and Site of Care for Patients Receiving Hospice Care From Agencies Acquired by Private Equity Firms and Publicly Traded Companies
title_full_unstemmed Changes in Diagnoses and Site of Care for Patients Receiving Hospice Care From Agencies Acquired by Private Equity Firms and Publicly Traded Companies
title_short Changes in Diagnoses and Site of Care for Patients Receiving Hospice Care From Agencies Acquired by Private Equity Firms and Publicly Traded Companies
title_sort changes in diagnoses and site of care for patients receiving hospice care from agencies acquired by private equity firms and publicly traded companies
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10520742/
https://www.ncbi.nlm.nih.gov/pubmed/37747735
http://dx.doi.org/10.1001/jamanetworkopen.2023.34582
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