title: Nearly half of all Medicare hospice enrollees received care from agencies owned by regional or national chains.
abstract: Analyses of ownership in the US hospice sector have focused on the growth of for-profit hospice care and on aggregate differences in patient populations and service use patterns between for-profit and not-for-profit agencies. Such comparisons, although useful, do not offer insights about the types of organizations within the hospice sector, including the emergence of multiagency chains. Using Medicare cost report data for the period 2000-11, we tracked the evolution of the US hospice industry. We not only describe the market's composition by profit status but also provide new information about the roles of regional and national chains. Almost half of all Medicare hospice enrollees in 2011 received hospice services from a multiagency chain. A handful of companies play a prominent role, although the presence of smaller for-profit and not-for-profit hospice chains also has grown in recent years. By focusing on the role of the diverse organizations that provide hospice care, our analyses can help inform efforts to monitor and assure quality of care, to assess payment adequacy and options for reform, and to facilitate greater transparency and accountability within the hospice marketplace.
authors.affiliation: David G. Stevenson (david.stevenson@vanderbilt.edu) is an associate professor in the Department of Health Policy at Vanderbilt University, in Nashville, Tennessee.
authors.forename: David G
authors.initials: DG
authors.lastname: Stevenson
authors.affiliation: Jesse B. Dalton is a research analyst in the Department of Health Care Policy at Harvard Medical School, in Boston, Massachusetts.
authors.forename: Jesse B
authors.initials: JB
authors.lastname: Dalton
authors.affiliation: David C. Grabowski is a professor of health care policy at Harvard Medical School.
authors.forename: David C
authors.initials: DC
authors.lastname: Grabowski
authors.affiliation: Haiden A. Huskamp is a professor of health care policy at Harvard Medical School.
authors.forename: Haiden A
authors.initials: HA
authors.lastname: Huskamp
mesh_terms: D000368:Aged; D003695:Delivery of Health Care / Q000706:statistics & numerical data* / Q000639:trends; D005544:Forecasting; D019981:Health Care Sector / Q000639:trends; D018574:Home Care Agencies / Q000706:statistics & numerical data*; D017051:Hospice Care / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D008389:Marketing of Health Services / Q000706:statistics & numerical data; D006278:Medicare / Q000706:statistics & numerical data* / Q000639:trends; D010067:Ownership / Q000706:statistics & numerical data / Q000639:trends; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data / Q000639:trends; D014481:United States; D014600:Utilization Review / Q000706:statistics & numerical data / Q000639:trends
keywords: Medicare; chain; hospice; ownership; profit