More than 1.6 million individuals in the United States receive hospice care every year,1 which is provided by an increasing number of hospice agencies. What started with a few small nonprofit hospice agencies in the 1970s is now a multibillion-dollar industry comprising nonprofit and for-profit companies that have doubled in number in the last 10 years. With this growth comes concern about variability in services and the quality of care delivered by hospice agencies.