In 2014, Medicare paid for 87.3% of hospice services in the U.S.
Hospice utilization in the U.S has increased, yet fewer than half of eligible Medicare beneficiaries use hospice care and most only for a short period of time. (MCCM)
In 2014, more than 1.3 million Medicare beneficiaries received hospice services, at a total cost of about $15.1 billion. (Medpac 2016)
Currently, Medicare beneficiaries are required to forgo curative care in order to receive access to hospice services.
Beginning in 2016, certain patients will be allowed to continue curative treatment while receiving hospice services at selected hospice providers through the Medicare Care Choices Model. (MCCM)
To be eligible for MCCM:
patients must be eligible for Medicare hospice services
patients must not have elected the hospice services within 30 days
patient diagnosis must include: advanced cancers, chronic obstructive pulmonary disease, congestive heart failure or human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS).
MCCM hospice services must be provided at one of the 141 select facilities.
The intent of the MCCM demonstration program is to increase hospice access and improve the quality of life for beneficiaries.
Medicare pays for four levels of hospice care distinguished by the location and intensity of the services provided.
Routine home care is care provided on a typical day, 97.7% occurs in the home
2016 FY Medicare payment is $187/day for days 1-60
2016 FY Medicare payment is $147/day for days 60+
General inpatient care to treat symptoms that cannot be managed in another setting
2016 FY Medicare payment is $720/day
Continuous home care provided during periods of patient crisis.
2016 FY Medicare payment is $39/hour
Inpatient respite care for a short period to provide respite for primary caregiver
2016 FY Medicare payment is $167 per day.(Medpac 2016)
Profit margin varies between nonprofit and for-profit providers of services.
For-profit 2013 profit margin was 14.7%
Nonprofit 2013 profit margin was 1.2%(Medpac 2016)
Of the Medicare beneficiaries who died in 2014, 47.8 percent used hospice, up from 47.3 percent in 2013 and 22.9 percent in 2000.(Medpac 2016)
In 2014, about 25 percent of providers had a live discharge rate greater than 30 percent, and 10 percent of providers had live discharge rates greater than 50 percent. The most frequent reasons include:
beneficiary moved out of hospice provider’s services area (5 percent)
provider discharged beneficiary for cause (2 percent) (Medpac 2016)
2014 hospice beneficiary characteristics
Age - utilization is lowest for beneficiaries <65 and highest for those >85
Gender - Female beneficiaries were more likely than male beneficiaries to use hospice, partly due to a longer average life span for women and greater hospice use among older beneficiaries.
Race - hospice use was highest among White decedents, followed by Hispanic, African American, North American Native, and Asian American decedents, in that order. Disparity may be due to cultural or religious beliefs, preferences for end-of-life care, socioeconomic factors, disparities in access to care or information about hospice, and mistrust of the medical system.
Location - Hospice use is higher for urban than rural beneficiaries.
The average length of stay among decedents remained at about 88 days in 2014, about the same level as the prior two years. The median length of stay for hospice decedents was 17 days in 2014 and has remained stable at approximately 17 or 18 days for more than a decade.(Medpac 2016)
Centers for Medicare and Medicaid Services, Chronic Condition Warehouse. FY 2010 Hospice beneficiaries matched with FY 2010 Part D claims.
Centers for Medicare and Medicaid Services, Medicare Care Choices Model. Accessed 5/9/2016.
Medicare Payment Advisory Commision (Medpac) 2016. REPORT TO THE CONGRESS Medicare Payment Policy. Accessed 5/9/2016
National Hospice and Palliative Care Organization (2014) NHPCO Facts and Figures on Hospice Care in America 2014 Edition. Accessed 5/9/2016 http://www.nhpco.org/sites/default/files/public/Statistics_Research/2014_Facts_Figures.pdf