Caregiver and Employee Experience Among Big Hospices—Ranking of the Largest US Hospices by Three Quality Indicators

Abstract

Background

Several studies chronicle profit-making negatively impacting US hospice care quality. However, no study has reported on caregiver satisfaction expressed online by hospice.

Objectives

Assess the relationship between online caregiver sentiment, market share, profit status, and Consumer Assessment of Healthcare Providers and Systems (CAHPS®) scores among the 50 largest US hospices.

Methods

Retrospective mixed methods of sentiment and multivariate regression analysis. Data sources were online caregiver reviews, provider CAHPS hospice survey data.

Results

Being a larger, for-profit predicted diminished caregiver and employee satisfaction. Caregiver Sentiment and CAHPS Composite were so highly associated (r = .862, P < .001), that they are converging on overall caregiver satisfaction. With large effect, CAHPS Star Rating was significantly higher than Review Star Rating. For-profits had significantly higher overall Emotional Intensity than non-profit hospices, again with large effect. Caregiver Sentiment, Review Star Rating, and Glassdoor Composite each predicted CAHPS Composite. Lack of staffing was more frequent among for-profits (13%) than non-profits (6%). Out-of-scope expectations prevalence was 9%.

Conclusion

Caregiver and employees had better experiences with non-profits than for-profits. Anger and frustration was expressed toward large, for-profit providers more focused on admissions, profiteering, and paying dividends than actual care. The CAHPS appears to draw more satisfied caregivers. Whereas, online reviewing provides open-ended, real-time voicing of care quality concerns. Even with distinct methods, CAHPS survey and review sentiment analysis converge on caregiver satisfaction, yet CAHPS paints a much rosier picture of hospice quality than online reviews. Future research should explore sentiments by topic and hospice to increase customer advocacy.

Keywords

consumer assessment of healthcare providers and systems hospice quality hospice size profit status

Get full access to this article

View all access options for this article.

References

Mor

Teno

. Regulating and paying for hospice and palliative care: reflections on the medicare hospice benefit. J Health Polit Policy Law. 2016;41(4):697-716. doi:10.1215/03616878-3620893.

Stevenson

. Growing pains for the medicare hospice benefit. N Engl J Med. 2012;367(18):1683-1685. doi: 10.1056/NEJMp1208465.

Hotchkiss

Jason

. Vivid Depictions of Big Hospice Quality: User Insights and Recommendations for the 50 Largest Hospices in the United States. Amazon Publishing; 2023.

Kofman

. How hospice became a for-profit hustle. The New Yorker. December 5, 2022. https://www.newyorker.com/magazine/2022/12/05/how-hospice-became-a-for-profit-hustle.

Teno

Plotzke

Christian

Gozalo

. Examining variation in hospice visits by professional staff in the last 2 Days of life. JAMA Intern Med. 2016;176(3):364-370. doi:10.1001/jamainternmed.2015.7479.

Perry

Stone

. In the business of dying: questioning the commercialization of hospice. J Law Med Ethics. 2011;39(2):224-234. doi:10.1111/j.1748-720X.2011.00591.x.

Report to the congress: medicare payment policy, chapter 10: hospice services (MedPac) (2023).

Appelbaum

Batt

Curchin

. Preying on the Dying: Private Equity Gets Rich in Hospice Care. London: CEPR. vol. 2023; 2023. https://cepr.net/report/preying-on-the-dying-private-equity-gets-rich-in-hospice-care/.

March 2022 report to the congress: medicare payment policy – MedPAC (MedPac) (2022).

10.

Teno

. Hospice—the time is now for additional integrity oversight. JAMA Health Forum. 2023;4(5):e232045. doi:10.1001/jamahealthforum.2023.2045.

11.

Hotchkiss

HJT

. Hospice glassdoor and CAHPS® scores—glassdoor scores and hospice financial characteristics predict hospice consumer assessment of healthcare providers and systems scores. Am J Hospice Palliat Med. 2022;40(3):311-321. doi:10.1177/10499091221099475.

12.

Anhang Price

Tolpadi

Schlang

, et al. Characteristics of hospices providing high-quality care. J Palliat Med. 2020;23(12):1639.

13.

Price

Parast

Elliott

, et al. Association of hospice profit status with family caregivers' reported care experiences. JAMA Intern Med. 2023;183(4):311. doi:10.1001/jamainternmed.2022.7076.

14.

Davlyatov

Orewa

Weech-Maldonado

. Are hospice Google ratings correlated with patient experience scores? Evidence from a national hospice study. Am J Hospice Palliat Med 2023;Feb 22:10499091231160186. doi:10.1177/10499091231160186.

15.

Brereton

Matlock

Fitzgerald

, et al. Content analysis of negative online reviews of hospice agencies in the United States. JAMA Netw Open. 2020;3(2):e1921130. doi:10.1001/jamanetworkopen.2019.21130.

16.

Hotchkiss

Ridderman

Buftin

. Development of a model and method for hospice quality assessment from natural language processing (NLP) analysis of online caregiver reviews. Palliat Support Care 2023;Jul 14:1-12. doi:10.1017/S1478951523001001.

17.

Hotchkiss

Ridderman

Buftin

. Overall US hospice quality according to decedent caregivers-natural language processing and sentiment analysis of 3389 online caregiver reviews. Am J Hosp Palliat Care 2023;June 20:10499091231185593. doi:10.1177/10499091231185593.

18.

CMS . CMS Hospice Care Data Archive. Centers for Medicare and Mediaid. https://data.cms.gov/provider-data/archived-data/hospice-care. Accessed February 14, 2022.

19.

CMS . New Hospice Compare Website: CMS Releases Hospice Compare Website to Improve Consumer Experiences, Empower Patients. CMS. https://www.medicaid.gov/about-us/messages/entry/47624. Accessed June 11, 2023.

20.

Shabbir

. LexisNexis risk Solutions Announces top U.S. Hospice, Home Health Providers. Lexis-nexis. https://risk.lexisnexis.com/about-us/press-room/press-release/20210209-hom-health-hospice. Accessed May 21, 2022.

21.

Liu

. Sentiment Analysis: Mining Opinions, Sentiments, and Emotions. Cambridge: Cambridge University Press; 2015.

22.

Quigley

Parast

Haas

Elliott

Teno

Anhang Price

. Differences in caregiver reports of the quality of hospice care across settings. J Am Geriatr Soc. 2020;68(6):1218-1225. doi:10.1111/jgs.16361.

23.

Stevenson

Sinclair

. Complaints about hospice care in the United States, 2005-2015. J Palliat Med. 2018;21(11):1580. doi:10.1089/jpm.2018.0125.

24.

Parast

Haas

Tolpadi

, et al. Effects of caregiver and decedent characteristics on CAHPS hospice survey scores. J Pain Symptom Manag. 2018;56(4):519.

25.

Castellucci

. Hospice providers earn high marks on CMS Satisfaction surveys, but do they reflect reality? Modern Healthcare. 2018;48(14):22.

26.

Hoff

Trovato

Kitsakos

. Hospice satisfaction among patients, family, and caregivers: a systematic review of the literature. Am J Hosp Palliat Care 2023;July 19:10499091231190778. doi:10.1177/10499091231190778.

27.

Poston

Christensen

. ‘Large-Scale Fraud’ and Lax Oversight Plague California’s Hospice Industry, Audit Finds. Los Angeles Times. March 29, 2022. https://www.latimes.com/california/story/2022-03-29/fraud-lax-oversight-california-end-of-life-hospice-industry-audit-finds.

28.

Byock

. Hospice care needs saving. STATNews. December 14, 2022. https://www.statnews.com/2022/12/14/hospice-care-needs-saving/.

29.

Parast

Elliott

Hambarsoomian

Teno

Anhang Price

. Effects of survey mode on consumer assessment of healthcare providers and systems (CAHPS) hospice survey scores. J Am Geriatr Soc. 2018;66(3):546-552. doi:10.1111/jgs.15265.

30.

Glassdoor . About Glassdoor. Glassdoor. https://www.glassdoor.com/about-us/. Accessed February 14, 2022.

31.

Johari

Kellogg

Vazquez

Irvine

Rahman

Enguidanos

. Ratings game: an analysis of nursing home compare and Yelp ratings. BMJ Qual Saf. 2018;27(8):619. doi:10.1136/bmjqs-2017-007301.

32.

Rahman

Cardenas

Singleton

Zhu

Kaur

Enguidanos

. What consumers say about hospices in online reviews. J Palliat Med. 2021;24(2):240. doi:10.1089/jpm.2019.0591.

33.

Ranard

Werner

Antanavicius

, et al. Yelp reviews of hospital care can supplement and inform traditional surveys of the patient experience of care. Health Aff. 2016;35(4):697-705. doi:10.1377/hlthaff.2015.1030.

34.

Raths

. The Yelp Approach to Healthcare Quality Improvement. Healthcare Innovation. https://www.hcinnovationgroup.com/home/blog/13026854/the-yelp-approach-to-healthcare-quality-improvement. Accessed April 18, 2022.

35.

Yelp’s

. Novel Approach to Healthcare Quality Improvement – Patients Review Doctors. Healthcare Innovation. https://www.pyzdekinstitute.com/blog/healthcare-quality/yelps-novel-approach-to-healthcare-quality-improvement-patients-review-doctors.html. Accessed April 18, 2022.