Division of Health Policy and Economics, Weill Cornell Medical College, New York, New York.
Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee.
JAMA Netw Open. 2023 Sep 5;6(9):e2334582. doi: 10.1001/jamanetworkopen.2023.34582.
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).
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.
Private equity and publicly traded company acquisitions.
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.
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).
These findings suggest that PE and PTCs select patients and sites of care to maximize profits.
私募股权公司和上市公司一直在收购美国临终关怀机构；据估计，美国临终关怀机构中有 16% 为私募股权公司（PE）或上市公司（PTC）所有。
研究私募股权和上市公司收购临终关怀机构与医疗保险患者护理地点和临床诊断的关系。
设计、地点和参与者：本研究使用了美国临终关怀机构的新型全国收购数据库，该数据库与 2013 年至 2020 年的医疗保险后期护理和临终关怀公共使用文件合并。与非收购的营利性临终关怀机构相比，PE 或 PTC 收购的临终关怀机构的患者护理地点和患者特征的变化。
私募股权和上市公司收购。
本研究在事件研究框架内采用差异中的差异方法，研究私募股权和上市公司收购临终关怀机构与患者诊断和护理地点变化的关系。因变量为每年临终关怀水平的分层条件类别（HCC）评分和癌症或痴呆症诊断患者比例。护理地点包括在家中、疗养院或辅助生活设施接受临终关怀的患者比例。
共纳入 158 家由 PEs 收购的临终关怀机构、250 家由 PTCs 收购的临终关怀机构和 1559 家其他营利性临终关怀机构。在收购前，后来被 PE 或 PTC 收购的临终关怀机构分别为 30.1%（12.0%-44.0%）和 29.4%（13.0%-43.0%）的患者在疗养院接受护理，这一比例高于从未被收购的营利性临终关怀机构的 27.1%（8.0%-43.8%）。2014 年至 2019 年间，被 PE 收购的机构中，痴呆症患者的比例显著增加了 5.98%（1.38 个百分点；95%CI，0.35-2.40 个百分点；P=.008）。在 PTC 拥有的临终关怀机构中，在家接受护理的患者比例增加了 5.26%（2.98 个百分点；95%CI，1.46-4.51 个百分点；P<.001），痴呆症患者的比例上升了 13.49%（3.11 个百分点；95%CI，2.14-4.09 个百分点；P<.001），HCC 评分下降了 1.37%（-3.19 个百分点；95%CI，-5.92 至-0.47 个百分点；P=.02）。
这些发现表明，PE 和 PTC 选择患者和护理地点以最大化利润。
