What’s Next for Hospice? Insights from Industry Leaders

The hospice industry is undergoing a pivotal transformation – driven by shifting expectations around end-of-life care and a surge of private equity interest. We recently sat down with Carla Davis, Hospice Executive, and Geoffrey Abraskin, President at Amedisys, to explore how leading providers are navigating industry changes. From redefining service excellence to integrating technology and balancing scale with human connection, their insights shed light on what is in store for the future of hospice. 

How would you describe the overall state of the hospice industry? 

Carla Davis: We’re in a great place. Circumstances in 2020 really laid the runway for hospice to continue to grow and evolve into an integral part of our healthcare system, as opposed to an alternative solution at the end of life. Today, the consumer population is more educated, more empowered, and more vocal around the type of care they desire. People want to live the last phase of their life the way they lived the rest of it – on their own terms. 

Geoffrey Abraskin: The hospice industry as a whole is very strong. For the first time since COVID, we are seeing more than 50% of Medicare deaths being served by hospice. That number had dropped significantly during and post COVID, so to see that return in utilization is very positive. 

In a crowded market, how can hospice providers truly differentiate themselves? 

Carla Davis: To differentiate in a sea of hospice providers, you don’t have to be fancy or highly technical. It is as simple as doing what you say you’re going to do, when you say you’re going to do it – with service at the heart of the care. Focusing on basic care coordination and strong communication goes a long way. Furthermore, the patient and family should define their experience – and their care plan. We have to meet people where they are.  

Geoffrey Abraskin: If you are a high-quality care provider, that sets you apart. No patients want to die alone. If you improve the frequency of visits and the time spent with patients in their last week of life, that’s a huge differentiator. Capacity is another one – the ability to provide continuity of care with very skilled, qualified nurses. If someone is making a hospice referral, whether it be a doctor’s office or a hospital, it’s not an easy decision. So, if you can arrive within minutes or hours versus days, that will set you apart. 

How has private equity changed the landscape of hospice care? 

Carla Davis: I’ve been in hospice since 1994, and the provider constituency has changed dramatically. Back then, there were maybe 1,300 hospices. Today, there are around 6,000. For-profit ownership has grown, and nonprofit and hospital-based hospices have declined. But generally, I think private equity is drawn to hospice because of its value to both the consumer and our healthcare system. Hospice has the highest customer service scores in healthcare, and patients and families who have experienced it usually wish they had started sooner. The hospice industry also has a relatively favorable image with Congress and regulators resulting in little change to date, even if reimbursement hasn’t always kept place with inflation. Finally, there is a significant opportunity for consolidation and advancement for those willing to innovate. 

Geoffry Abraskin: In addition to private equity, the biggest shift I’ve seen in the industry is consolidation from payviders. For example, Humana bought Kindred and then divested off the hospice segment. Another example, Optum bought LHC Group and is now in the process of purchasing Amedisys. Additionally, in the last five years, there has been about a 30% increase in the number of hospice care providers because hospice is an attractive business compared to other segments. Overall, hospice is a great, growing industry and we do good work, which is creating and driving new entrants into the space. 

How are providers adapting to growing regulatory demands and quality reporting? 

Carla Davis: The response has been mixed. Many providers either do not have the resources or have not prioritized investing in the infrastructure necessary to meet CMS reporting criteria. From my perspective, CMS sets the floor, not the ceiling. We go beyond   CMS requirements and capture data that can help us get better. One area I’m focused on is after-hours care. We’re paid to serve 24 hours a day, seven days a week, 365 days per year, but most care is structured Monday through Friday, nine to five. We need to be better at managing nights, weekends, and holidays – because that’s when patients and families really need us. 

Geoffry Abraskin: From a quality standpoint, HVLDL (Hospice Visits in Last Days of Life) was introduced a few years back, and more recently SIA (Service Intensity Add-on) was put into place. Under SIA, if you are able to meet the established quality metrics, you’ll receive more upside from a reimbursement standpoint. It’s pay for performance, which is positive. Another shift from CMS is HOPE, which is set to go live October 1st. HOPE will meaningfully shift the frequency and quantity of data we collect. The last time we saw CMS make a big change like this was really with the introduction of OASIS, which changed the payment model. I would not be overly surprised if we see a payment model change in the hospice space in the next few years as a result of the data collected from HOPE. One question, from a regulatory standpoint, is how do we maintain our quality amid these shifts? My advice for any provider that wants to avoid the negative implications of introducing a new tool or quality metric is to get ahead of these shifts. A little bit of lead time and information on what’s going to be measured will make it easier for clinicians to implement the shifts.  

How are you navigating the workforce shortage and talent management? 

Carla Davis: The workforce shortage has waxed and waned over time and hit an all-time low post-COVID. It’s not as much of an issue now. When it comes to talent, it ultimately comes down to leadership and culture. How do you structure the organization? Is it a place people want to work? Do they recruit their friends because it’s a great place to be? Do they feel connected to the mission and understand their role in fulfilling it? Are they empowered to deliver care they’re proud of? Can they help drive change and make things better? Is their voice heard? I know that sounds overly simplistic, but it’s true. Having the right leaders to create the right culture and the right environment ensures caregivers want to work, stay, and help more people. 

Geoffry Abraskin: I actually felt the nursing shortage more as we were coming out of COVID than I do today. The interesting thing about hospice is – if you want to be a hospice nurse, you want to be a hospice nurse. You don’t want to do any other type of nursing – you’re drawn to hospice. So, we’re operating in a slightly different market than most other segments.  

From a recruitment standpoint, there are always things you can do to motivate people, but I think the bigger challenge – and the better approach – is keeping the employees you already have. Two years ago, we were losing 30 to 40% of our nurses every year. Today, we’re down to around 25% turnover. We partnered with an external firm to build out an attrition model. It pulls in a wide range of data points like financial performance at care centers, referral volume and market share from our sales team that helps us assess who is at risk of turning over. We can then proactively check in and offer support, which has been extremely effective. Ultimately, when you reduce attrition, the pressure to find new talent becomes far less urgent. 

What does the future hold for hospice? 

Carla Davis: With new technology, there is a lot of opportunity and we’re just scratching the surface. For example, using voice-to-text to help staff complete documentation more efficiently, freeing them up to spend time with their families – or with patients. Leveraging AI to analyze documentation and predict care needs, allows for more effective resource allocation. Patients get what they need, when they need it.  

 In addition, I think our regulators need to give us clearer guidelines so that we don’t unintentionally cross lines as we innovate. Right now, we don’t have enough clarity. That’s risky. But I do think we’re in a period of rapid acceleration. We need to catch up with the rest of healthcare. When I think about how I interact with my doctor’s office – online scheduling, digital forms, reminders, follow-ups – with in home-based care we’re nowhere near that level of engagement. We’ve been too tied to our EMRs (Electronic Medical Records) for too long. Now, the innovation is coming from plug-and-play solutions that fill the gaps. That’s the future. 

Geoffry Abraskin: I think there’s huge potential for AI, including ambient listening tools. You’re starting to see primary care doctors ask, “Do you mind if I turn on a device to document our conversation?” That kind of tool in hospice or home health would be game-changing. Clinicians could focus fully on the patient, knowing the tool is capturing accurate, complete information for documentation. As a nurse, you might have a 30-minute conversation with a patient – plus vitals and an assessment – and remembering every detail is tough. This technology can capture it all, generate documentation, and allow the clinician to review and validate it. There’s a lot we can do with AI to ultimately improve patient care. 

Looking ahead to the future, I would remain focused on two things: your people and your patients. If you take great care of your people, they’ll take great care of your patients. We’ve seen this play out time and time again. Low employee turnover leads to happier clinicians. Happier clinicians drive better quality scores. Better quality leads to growth. And growth drives revenue. It really comes down to being a great employer. Take care of your people, and they’ll take care of everything else. 

As hospice continues its evolution from a niche end-of-life option to a critical component of the broader care continuum, providers face both challenge and opportunity. The future of hospice will be shaped not only by data and innovation, but by the enduring commitment to compassionate care. As Geoffrey Abraskin shared, “If you take great care of your people, they’ll take great care of your patients.” That philosophy may be the most powerful strategy of all.