Anyone who has had to deal with Hospice for a loved one has to been impressed with the level of compassion and concern and caring they bring.

But they are not all the same, and a paper in JAMA Internal Medicine finds a way to create a little bit of class warfare about that.

In 2011,  51 percent of hospices were for-profit. That's much different that the 5 percent that were for-profit in 1990. What does that really mean? The biggest misconception among the public is that for-profit is bad and not-for-profit must be good. They both have to make a profit. United Way does not pay its CEO $700,000 a year because it loses money. A non-profit simply does not pay a dividend to shareholders the way a public corporation does. More Baby Boomers have started to die and that means more hospice.

A non-profit also has access to funding that a for-profit won't have, primarily government. As a result, the new paper found that the tax status of a hospice (for-profit vs. nonprofit) affected community benefits, the population served and community outreach. All areas that are outside service delivery, but worth writing about.

The authors examined the association between hospice profit status and the provision of community benefits (charity care, research and serving as training sites), populations served and community outreach in 591 Medicare-certified hospices around the country. They found that compared to nonprofit hospices, for-profit hospices:

- Were less likely to provide community benefits, including serving as training sites (55 percent vs. 82 percent), conducting research (18 percent vs. 23 percent) and providing charity care (80 percent vs. 82 percent)

- Cared for a larger proportion of patients with longer expected hospice stays, including those in nursing homes (30 percent vs. 25 percent)

- Had higher patient disenrollment rates (10 percent vs. 6 percent, patients who don’t remain in hospice until their death)

- Were more likely to exceed Medicare’s aggregate annual cap, which is a regulatory measure to control hospice length of stay and constrain Medicare hospice expenditures, (22 percent vs. 4 percent)

- Were more likely to do outreach to low-income communities (61 percent vs. 46 percent) and minority communities (59 percent to 48 percent), suggesting that the growth of the for-profit sector may increase the use of hospice by these groups and address disparities in hospice use.

- Were less likely to partner with oncology centers (25 percent vs. 33 percent)

“Ownership-related differences are apparent among hospices in community benefits, population served and community outreach. Although Medicare’s aggregate annual cap may curb the incentive to focus on long-stay hospice patients, additional regulatory measures such as public reporting of hospice disenrollment rates should be considered as the share of for-profit hospices in the United States continues to increase,” they conclude.

JAMA Intern Med. February 24, 2014. doi:10.1001/jamainternmed.2014.3.