Do Acquisitions of Hospice Agencies by Private Equity Firms and Publicly Traded Corporations Impact End-of-Life Quality and Cost of Care?

PROJECT SUMMARY/ABSTRACT
This is a K01 Mentored Research Scientist Development Award submitted to the National
Institute on Aging by Robert Tyler Braun, an Instructor in the Department of Population Health Sciences
at Weill Cornell Medical College (WCMC). Dr. Braun's career goal is to become an independent
researcher on improving end-of-life care for the elderly by assessing various policy interventions and
delivery models of hospice care. This K01 application will provide Dr. Braun with the necessary training
1) to gain expertise in aging and hospice research; 2) to understand clinical care for hospice patients;
and 3) to gain methodological skills to conduct qualitative studies related to hospice delivery and care.
Dr. Braun has assembled a mentor team of accomplished researchers from WCMS and
Vanderbilt University School of Medicine (VUSM): Dr. Lawrence Casalino (primary mentor) who is the
Livingston Farrand Professor of Public Health at WCMC and an expert on health care organization and
behavior, and qualitative methods; Dr. Holly Prigerson (co-mentor) who is the Irving Sherwood Wrights
Professor of Geriatrics at WCMC and an expert on end-of-life care; Dr. David Stevenson (co-mentor) who
is a professor and the holder of the Endowed Directorship in Health Policy Education at VUMC and an
expert in the delivery of hospice care; and Dr. Mark Unruh (co-mentor) who is an Associate Professor in
the Department of Population Health Sciences at WCMC with expertise in long-term care and Medicare
claims data.
Over the past couple of decades, the hospice industry has moved from largely a not-for-profit
sector to predominately for-profit. Facilitated by relatively easy market entry and generous Medicare
payments, PE firms and PTCs have been acquiring hospices (many of them non-profit), with the goal to
deliver short-term, above market returns to their investors. Despite this emergence, little is known of its
effect on hospice care. Building on his previous research and training on assessing this phenomenon in
physician practices, Dr. Braun will identify the organizational, staffing, patient, and quality
characteristics associated with PE and PTC acquisitions using publicly available hospice data from Center
for Medicare and Medicaid Services (CMS) (Aim 1), use rigorous econometric methods to assess the
effect PE and PTC acquisition on hospice care using patient-level Medicare claims (Aim 2), and use
qualitative methods to assess organizational, cultural, and delivery aspects of hospices post-acquisition
integration (Aim 3). This research will be a foundation for an R01 grant application and will incorporate
the new skills acquired through his training, which inform opportunities for improvement in hospice
delivery of care.

Grant Number: 5K01AG075246-05
NIH Institute/Center: NIH
Principal Investigator: Robert Braun