Private Equity–Owned Hospices Report Highest Profits, Lowest Patient Care Spending Compared With Other Ownership Models

Private equity (PE) firms and publicly traded companies own a growing share of US hospices, but little is known about differences in financial outcomes among for-profit hospices. Using 2022 Medicare cost reports, we compared revenue and expense data across four hospice ownership models: PE-owned, publicly traded company-owned, other for-profit, and not-for-profit. Adjusted analyses revealed that compared with for-profit models, not-for-profit hospices spent substantially more on direct patient care, driven by differences in nursing salaries. Relative to publicly traded company-owned and other for-profit hospices, PE-owned agencies reported the highest profits and lowest spending on direct patient care and nonsalary administrative services. PE-owned hospices also reported significantly greater expenses and revenues related to nursing facility room and board compared with all other ownership models. Our findings suggest that PE-owned hospices may follow distinct operational strategies, emphasizing nursing facility-based care and administrative efficiency while limiting direct patient care investments. Reduced spending on patient care may undermine hospice quality and shift costs to other areas of the health care system. To promote Medicare savings and better align payment with care delivery costs, policy makers could consider modifying the per diem model of hospice payment to reduce reimbursement when beneficiaries are co-located in nursing facilities.