University of Alabama at Birmingham, United States
Background: Hospice patients and families often lack information about the quality of care of hospices when selecting hospices. Given the lack of quality information on hospice care and the critical role of hospice to patients and families, the Centers for Medicare and Medicaid Services (CMS) implemented the Consumer Assessment CAHPS® Hospice Survey. The CAHPS® Hospice Survey is a national survey of family caregivers for hospice patients. The quality of care delivered by hospices has become intricately intertwined with their financial performance.
Purpose: This study addresses the gap in the literature by examining the association between the quality of care of hospices and their financial performance using Donabedian’s Structure - Process and Outcome (SPO) framework.
Methods: Descriptive statistics were calculated to summarize the characteristics of hospice facilities included in the study. Mixed-effects models were employed to account for the hierarchical structure of the data, with observations nested within facilities and states across multiple years.
Results: Composite Process Measure was positively associated with total margin (ß=0.062, p<0.05). Among facility-level characteristics, total hospice days were positively related to total margin (ß=0.017, p<0.05) in Model 1, operating margin in Model 3 (ß=0.001, p<0.05) and Model 4 (ß=0.014, p<0.05). Compared to the for-profit status of hospice facilities, not-for-profit status was associated with negative financial measures (-3,581, -3,724, -6,188, and -6.531) in Models 1-4, respectively. Practice Implications: The lack of a strong correlation between quality and financial performance has important implications for practice and policy. Hospice providers may need to explore strategies that balance quality improvements with financial sustainability, ensuring quality measures align more closely with operational goals.
