Hospice Care: Purpose, Financial Dynamics, and Evolving Challenges

16 January 2024
Hospice Care Purpose, Financial Dynamics, and Evolving Challenges (1)

In the realm of healthcare, the costs associated with hospice care have been on the rise, but there’s more to the story than just the increasing expenses. Why has there been a surge in the number of organizations offering hospice care? Why are we seeing a shift from nonprofit to for-profit entities, some of which are backed by private equity firms? These questions are swirling around the domain of hospice care in the U.S., a service intended to provide comfort and solace to patients and their families as they approach the end of life. However, the delivery of this vital care has evolved beyond its fundamental purpose.

Purpose and Mechanism

Hospice care is designed for individuals with a terminal illness and a life expectancy of six months or less. It falls under Medicare Part A and involves two doctors and a hospice director concurring on the terminal prognosis. Upon admission, the hospice assumes medical care responsibility in exchange for a daily fee. However, as hospice care is palliative, it excludes life-saving or curative treatments.

Financial Dynamics and Challenges

Hospice providers are remunerated based on four care levels and location, with an average daily fee encompassing routine home care, continuous home care (crisis care), general inpatient care, and inpatient respite care. Notably, this fee remains unchanged regardless of the services provided on a given day. This pricing structure poses financial challenges for hospice agencies, particularly when patients stay for shorter durations than expected.

Ethical Dilemmas and Patient Care

The expansion of for-profit hospice care has paralleled an increase in conversations surrounding ethical dilemmas. The economic drive has increased concerns about access to care for non-paying patients in underserved areas and compromised quality of care due to cost containment measures. There are many commendable for-profit providers in the market, however, profitability can potentially overshadow the provision of top-notch care, affecting patient outcomes.

As the landscape of hospice care evolves, striking a balance between quality care and financial viability becomes increasingly crucial. The ever-evolving dynamics underscore the need to uphold a delicate equilibrium between profitability and ensuring patients receive the compassionate care they deserve.

At Inszone Insurance, we understand the risks associated with your healthcare practice. We will assist you in securing proper Insurance coverage. Reach out to us today to explore our tailored Insurance options.

Amy Hieatt

Executive VP – North American Health Care Practice Leader

Amy Hieatt is an Executive VP – North American Health Care Practice Leader at Inszone Insurance Services, joining Inszone in September 2023. In her role, Amy is responsible for overseeing the strategic direction and day-to-day operations of Inszone’s national healthcare liability vertical, with a strong emphasis on maintaining a customer-centric approach.

Over the past 20+ years, Amy has dedicated her career to the property and casualty insurance sector, focusing extensively on the Medical Professional Liability and Professional Liability sectors. Prior to her role at Inszone, she served as the Managing Director at Connected Risk Solutions (formerly ABRisk Solutions), a national wholesale brokerage. Before that, Amy led Business Development efforts for NORCAL Group’s Admitted and E&S business lines, managing teams across four regional offices nationwide. She initially entered the insurance field on the retail side, holding the position of Executive Vice President at a regional retail agency that specialized in healthcare liability insurance.


Amy’s remarkable journey in insurance, spanning over two decades, is marked by her commitment to servant leadership, her impressive track record of achieving growth and retention, and her dedication to mentoring high-performing collaborative teams. Her expertise in the medical professional liability sector has earned her the admiration of her peers, recognizing her as a visionary leader and expert in the field.


In her time off, Amy is passionate about outdoor activities, advocating for animal rights, and finds joy in traveling and reading.

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