NPHI to Host Dr. Robert Braun: Economic Outlook and Strategies for Hospice Agencies Given Acquisitions by Private Equity and Public Companies
Over the past 3 decades, the hospice industry has transitioned from a mostly not-for-profit sector to one where nearly two-thirds of all agencies operate on a for-profit basis. A substantial driver of this trend has been the growth of large for-profit hospice chains, many of which are part of publicly traded corporations. In general, for-profit hospice agencies have been associated with higher rates of live discharge, lower levels of skilled staffing, and provision of a narrower range of clinical services than not-for-profit agencies.
An understudied and less visible factor is the more recent entry of private equity (PE) investment into the sector. Facilitated by relatively easy market entry and the prospect of stable Medicare payments, PE firms and PTCs have made strategic hospice investments in recent years, raising quality concerns among some policymakers and patient advocates.
To see how NPHI members fit into the emerging end-of-life (EOL) landscape, the NPHI team will host Dr. Robert Tyler Braun for a deep dive on strategies for navigating this increasingly complex landscape.
About Dr. Braun:
Dr. Robert “Tyler” Braun is a health services researcher and Instructor in the Division of Health Policy and Economics, Department of Population Health Sciences at Weill Cornell Medical College. His research is focused on the organization of the health care system with a particular interest in the evolution of changes in the organization and financing of long-term care and physician practices and how it influences patient quality and cost of care.
Before joining Weill Cornell Medical College, Dr. Braun received his master’s degree in health and medical policy at George Mason University. During his master’s degree Dr. Braun worked in the Center for Health Policy Research and Ethics with the health economist Dr. Len Nichols where they consulted with top state officials in Virginia that implemented the Virginia Health Innovation Plan and assisted in writing a grant proposal to the Center for Medicare and Medicaid Innovation to design and implement new models of payment and care coordination for the Commonwealth of Virginia.
After completing his master’s degree Dr. Braun enrolled in the PhD Program in Healthcare Policy and Research at Virginia Commonwealth University—Medical College of Virginia. Supported by an internal four-year department scholarship and a pre-doctoral award from the Department of Medical Assistance Services (Virginia Medicaid), he was able to gain research experience throughout his graduate studies using various types of secondary datasets, including Medicaid claims and the State Inpatient Database from AHRQ’s Healthcare Cost and Utilization Project. Throughout Dr. Braun’s doctoral training he investigated several aspects of social determinants of health such as the tradeoffs that food-insecure low-income people make, such as forgoing health care services. In related work, he led the data analysis for a project examining the prevalence, severity, and health care costs of co-occurring chronic and behavioral health conditions among low-income people. Furthermore, he led several population health research initiatives in the Office of Data Analytics at Virginia Medicaid. He provided guidance to key Medicaid leadership in the evaluation of the Governor’s Access Plan to give access to mental health services to low-income, severely mentally ill Medicaid recipients. He also led an evaluation that assessed the quality-of-care disabled Medicaid patients received in nursing homes.
Dr. Braun joined the Division of Health Policy and Economics, Department of Healthcare Policy and Research (now the Department of Population Health Sciences) at WCMC as a Postdoctoral Associate in 2018. He was promoted to faculty Instructor in July 2020. Presently, his primary research interest is investigating how supply-side and structural factors of the health care system—such as variation in the financing and delivery of health care—affect health access and cost, and ultimately health outcomes. His current research is focused on the organization of the health care system with a particular interest in the evolution of changes in the organization of long-term care facilities and physician practices and how they influence patient quality of care and cost. In particular, his main research to date investigates the effects of physician practice and hospice consolidation by private equity firms. During the past 3 years he have developed a unique methodology that links Medicare and commercial claims to physician practice and long-term care organization private equity acquisitions within the U.S. Dr. Braun directs and manages Cornell’s database of private equity mergers and acquisitions of physician practices and long-term care facilities within the U.S through a $4 million dollar grant from the Physicians Foundation. Dr. Braun also recently received a grant from the Arnold Foundation examining how Real Estate Investment Trusts acquisition of nursing home facilities effect staffing, finances, quality, and cost of short- and long-stay residents in nursing homes. His pioneering methods have led to over $1 million dollars in funding for the Division of Health Policy and Economics related to the corporatization of medicine and its effects on U.S. health care system.
Dr. Braun is published in several highly respected peer reviewed journals such as JAMA Internal Medicine, JAMA Open, JAMDA, Medical Care, and Health Affairs. He has consulted with MedPac, Government Accountability Office, and the Senate HELP Committee on matters related to private equity in healthcare. His work has been inquired and written about by The New York Times, CBS Morning News, USA Today, and MedScape.