Hospice Facts and Stats

In 2018, more than 1.5 million Medicare beneficiaries received hospice services, at a total cost of about $19.2 billion (Medpac, 2020). 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 no 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
    • 2020 FY Medicare payment is $195/day for days 1-60
    • 2020 FY Medicare payment is $154/day for days 60+
  • General inpatient care to treat symptoms that cannot be managed in another setting
    • 2020 FY Medicare payment is $1,021/day
  • Continuous home care provided during periods of patient crisis.
    • 2020 FY Medicare payment is $58/hour
  • Inpatient respite care for a short period to provide respite for primary caregiver
    • 2020 FY Medicare payment is $450 per day. (Medpac, 2020).
• Medicare beneficiaries who died in 2017, 48.2% used hospice, but 40.5% of those patients received care for 14 days or less (NHPCO,2019).
• Non-death discharge rate in 2017 - about 17% of hospice patients under Medicare had a live discharge. The most frequent reasons include:
  • no longer terminally ill (6.7%)
    
  • beneficiary revoked hospice election (6.5%)
    
  • beneficiary transferred hospice providers (2.1%)
    
  • beneficiary moved out of hospice provider’s services area (1.4%)
    
  • provider discharged beneficiary for cause (0.3%) (NHPCO, 2018).

Hospice beneficiary characteristics, in 2018

For more detailed information go to the NHPCO facts and Figures, 2018 edition at https://39k5cm1a9u1968hg74aj3x51-wpengine.netdna-ssl.com/wp-content/uploads/2019/07/2018_NHPCO_Facts_Figures.pdf.

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 (CMS, 2017).

Currently, Medicare beneficiaries are required to forgo curative care to receive access to hospice services.

• Beginning in 2016, patients in select hospice programs throughout the US were allowed to continue curative treatment while receiving hospice services through the Medicare Care Choices Model. (MCCM). MCCM tests whether eligible Medicare and dually eligible beneficiaries would choose to receive hospice support services, if they could also continue to receive treatment for their terminal condition.

Current eligibility criteria are:              

• Having Medicare Part A and Part B as their primary health insurance for 12 months prior to enrollment in MCCM
• Being diagnosed with: 1) advanced cancers; 2) chronic obstructive pulmonary disease; 3) congestive heart failure or 4) human immunodeficiency virus/acquired immune deficiency syndrome
  
• Having at least one hospital-based encounter in the last 12 months (emergency department visit, observation stay or admission)
  
• Having at least three office visits (with a Medicare-certified provider for any reason)
• Being eligible for the Medicare or Medicaid hospice benefit;
  
• Not having elected the Medicare or Medicaid hospice benefit within the last 30 days prior to enrolling in the MCCM
  
• Living in a traditional home for at least 30 days prior to MCCM enrollment (CMS, 2017).

The intent of the MCCM demonstration program is to increase hospice access and improve the quality of life for beneficiaries.