Hospice Facts and Stats

In 2014, more than 1.3 million Medicare beneficiaries received hospice services, at a total cost of about $15.1 billion (Medpac, 2016). Medicare paid for 87.3% of hospice services in the U.S. (Medpac, 2016).

Some private insurers have a hospice care provision in their policies for individuals under 65. They frequently follow standards and procedures established by Medicare.

Medicare does not prohibit patient private pay for hospice care, if they are financially able to do so. Also under Medicare law, no person can be refused hospice care. Funds from donations, gifts, and other community resources are often used for individuals who have not hospice coverage.

• Medicare pays for four levels of hospice care distinguished by the location and intensity of the services provided.

• Routine home care (nursing visits, social worker, volunteer, home health aides for up to 4 hours) 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 hospice services.
  • For-profit 2013 profit margin was 14.7%
  • Nonprofit 2013 profit margin was 1.2% (Medpac, 2016).
• 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).
• Non-death discharge rate in 2014 - about 25 percent of providers had a non-death discharge rate greater than 30 percent, and 10 percent of providers had non-death discharge rates greater than 50 percent. The most frequent reasons include:
  • no longer terminally ill (43 percent)
  • beneficiary revoked hospice election (39 percent)
  • beneficiary transferred hospice providers (12 percent)
  • beneficiary moved out of hospice provider’s services area (5 percent)
  • provider discharged beneficiary for cause (2 percent) (Medpac, 2016).
• Hospice beneficiary characteristics, in 2014
  • 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, native North American Indians, 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

New Hospice Model being tested

Hospice utilization in the U.S has increased, yet just under half of eligible Medicare beneficiaries use hospice care and most only for a short period of time (MCCM, 2015).

• Currently, Medicare beneficiaries are required to forgo curative care to receive access to hospice services.
  • Beginning in 2016, patients at 141 hospice programs throughout the US were allowed to continue curative treatment while receiving hospice services 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.

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References

• Centers for Medicare and Medicaid Services, Chronic Condition Warehouse. FY 2010 Hospice beneficiaries matched with FY 2010 Part D claims.
• Medicare Care Choices Model (MCCM) awards (2015) Centers for Medicare and Medicaid Services. https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-07-20.html
• Medicare Hospice Transparency Data (CY2014)(2016). Centers for Medicare and Medicaid Services, Newsroom, 2016 Fact sheet item. Accessed 2/20/2017
  https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-10-06.html
• Medicare Payment Advisory Commision (Medpac) 2016. REPORT TO THE CONGRESS Medicare Payment Policy. Accessed 5/9/2016
  http://192.168.1.1:8181/http://www.medpac.gov/documents/reports/march-2016-report-to-the-congress-medicare-payment-policy.pdf
• 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

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