By NextBestFitRequire non-profit hospice
Only non-profit or public organizations may provide hospice.
Draft decision:RejectedConfidence: medium · not yet reviewed
Oversight first; capacity loss risk.
Review ledgerHow this path connects
This path
Require non-profit hospice
Concrete changes if chosen
What would actually have to change in law, agencies, payment rules, or systems.
- Require non-profit or public hospice providers
Effects
Each effect has its own page: the evidence, the case that it is or isn't a real cost, and whom it affects.
What it fixes
- Hospice growth, for-profit entry, and fraud
Restricting hospice provision to nonprofit or public organizations removes the profit motive and follows the approach of peer countries.
What it creates or worsens
- Providers leave, retire, or go cash-only if pay drops
Restricting hospice provision to nonprofit or public organizations can reduce capacity when for-profit providers exit.
3 paths soften this
Phase rate changes in over several yearsProviders leave, retire, or go cash-only if pay dropsChosenStrict opt-out rules for cash-only practiceProviders leave, retire, or go cash-only if pay dropsChosenLower costs for clinicians, not only payProviders leave, retire, or go cash-only if pay dropsChosen - Takes years, or money up front, before it pays off
Buying out for-profit hospice providers is costly.
Who's affected
Who gains
- People with ongoing or specialist care needs
- Hospice growth, for-profit entry, and fraud: Inappropriate hospice enrollment can remove access to curative treatment.
- Taxpayers and public budgets
- Hospice growth, for-profit entry, and fraud: Hospice fraud concerns threaten public spending.
- Cash-pay and private care practices
- Providers leave, retire, or go cash-only if pay drops: Payment cuts can shift providers toward cash-only care.
Who loses
- Hospitals, clinics, and care organizations
- Hospice growth, for-profit entry, and fraud: Hospices benefit from long-stay patients.
- People with ongoing or specialist care needs
- Providers leave, retire, or go cash-only if pay drops: Provider retirements, opt-outs, and closures reduce access in affected specialties and regions.
- Residents of areas with too few health professionals
- Providers leave, retire, or go cash-only if pay drops: Provider retirements, opt-outs, and closures reduce access in affected specialties and regions.
Other ways to soften the losses
- Buyout or conversion
Where it has been tried
- Most peer countries: In 2021, the Medicare aggregate profit margin was 19.2% for for-profit hospices compared to 5.2% for non-profit hospices (and -15.6% for hospital-based hospices), according to MedPAC.