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10/23/2011
1
Harnessing the Power of Data for Hospice Leaders, Part 1
Cordt T. Kassner, PhDPrincipal, Hospice Analytics
2011 HOPE Fall Conference
October 26, 2011
In Partnership with:
Introduction & Background
Cordt T. Kassner, PhD
Principal
Hospice Analytics
2355 Rossmere Street
Colorado Springs, CO 80919
P: 719.209.1237
E: CKassner@HospiceAnalytics.com
W: www.HospiceAnalytics.com
www.HospiceAnalytics.com 2
10/23/2011
2
Presentation Purpose
1. To connect bedside clinical hospice care to state and national policy
2. To connect national and state policy to bedside clinical hospice care
www.HospiceAnalytics.com 3
Presentation Outline
Part 1: Connecting Clinical Care to National Policy
1. In the Beginning… Early Questions & Answers
2. Data Available
3. Data Applications for Hospice Administrators
Part II: Connecting National Policy to Clinical Care
1. WFA (Nursing Facilities, Caps, Long LOS, DC Alive)
2. MedPAC (Net Margins, U-Shaped Curves)
3. Palliative Care
4. Dartmouth Atlas
www.HospiceAnalytics.com 4
10/23/2011
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Part 1: Early Questions & Answers
How many hospices are there?
How many hospice patients are there?
2009: 3,336 Medicare Certified Hospices (primary locations);
~500 Medicare certified hospice satellite locations?
~100 non-Medicare Certified Hospices?
2009: 1,079,676 U.S. Medicare Hospice Admissions;
10,567 non-U.S. Medicare Hospice Admissions
~11% non-Medicare Hospice Admissions
~5% Medicaid; ~5% Private Pay; ~1% Charity
www.HospiceAnalytics.com 5
New Development – National Hospice Locator
Currently there is no place listing all hospices in the country.
In 2 weeks there will be! www.HospiceAnalytics.com The National Hospice Locator Web page will become public Nov. 7, 2011
It includes contact information for every hospice in the country, and more
Made possible with sponsorships from:
Sangre de Cristo Hospice & Palliative Care, Pueblo, CO; Karen Ermel
VNA Hospice Care, Boston, MA; Diane Bergeron
Family LifeCare, Berne, IN; SueAnn Reynolds
HCI (Hospice of Central Iowa), West Des Moines, IA; Norene Mostkoff
www.HospiceAnalytics.com 6
10/23/2011
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Patients & Families – Hospice Compare
Providers – Access, Utilization, Competition
Quality Assurance - QIOs
Surveyors
Veteran’s Administration
Payers – CMS, MedPAC, Insurance Companies
Regulators – CMS, Program Integrity
Legislators – Local, State, and National
Everyone cares…
Data – Who Cares?
www.HospiceAnalytics.com 7
Consultants, from one-person boutiques to large corporations such as Thomson Reuters, make a business out of putting this data into an easily understandable form and answering clients' questions.
Hospice care, for example, used to be provided mostly by local, not-for-profit outfits. Now, more than half of the Medicare-licensed hospice providers are for profit, according to Cordt Kassner, whose one-man consulting firm, Colorado-based Hospice Analytics, serves a variety of hospice providers and state hospice associations. Mr. Kassner said he spends about $10,000 per year purchasing Medicare claims data.
One of his clients is Michigan-based Great Lakes Home Health & Hospice, which served about 27,000 patients last year, according to the company, including 16,500 home health-care and 1,500 hospice patients. Great Lakes CEO William Deary says he used the data to identify relatively under-served cities. In 2007, Mr. Deary's company opened an office in one such city, Lansing, and in doing so "increased our hospice revenue by 88% in 36 months," he said.
Wall Street Journal10/26/10 Front Page Story
www.HospiceAnalytics.com 8
10/23/2011
5
Presentation Outline
Part 1: Connecting Clinical Care to National Policy
1. In the Beginning… Early Questions & Answers
2. Data Available
3. Data Applications for Hospice Administrators
Part II: Connecting National Policy to Clinical Care
1. WFA (Nursing Facilities, Caps, Long LOS, DC Alive)
2. MedPAC (Net Margins, U-Shaped Curves)
3. Palliative Care
4. Dartmouth Atlas
www.HospiceAnalytics.com 9
1. Medicare datasets: Standard Analytic Files (aka, claims data), Denominator File, Provider of Service File, etc.
2. Medicare Cost Reports
3. Other national data files: Census, etc.
4. State and national hospice organization surveys
Overview of Publically Available Datasets
www.HospiceAnalytics.com 10
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Medicare Datasets 2009 Populations Comments
Denominator48,756,649 Records48,753,141 Beneficiaries
1. Claims / Payment data2. RHHI’s and surveyors check
data3. All data reported for calendar
year4. Possible to compare providers,
states, nationally, etc.
5. Strong incentives for accurate data
Hospice3,888,151 Records1,090,867 Beneficiaries
Home Health Agency7,434,625 Records3,301,579 Beneficiaries
Skilled Nursing Facility5,535,663 Records1,824,315 Beneficiaries
Hospital Inpatient12,403,865 Records6,973,132 Beneficiaries
Provider of Service File122,973 Records66,378 Active3,336 Hospices
Comparison of Publically Available Datasets, 1
www.HospiceAnalytics.com 11
Cost Reports 2008 Populations Comments
Independent Hospices 2,098 Hospice Reports 1. Self-report2. No data verification3. Reported on provider’s fiscal
year (inconsistent timeframes)4. Difficult to compare providers,
states, nationally, etc.5. Cost reports collect different
information
6. No incentive for accurate data
Home Health Agency-based Hospices
597 Hospice Reports
Hospital-based Hospices
544 Hospice Reports
Skilled Nursing Facility-based Hospices
19 Hospice Reports
Total3,258 Hospice Reports
98% POS Matches
Comparison of Publically Available Datasets, 2
www.HospiceAnalytics.com 12
10/23/2011
7
Other Datasets 2009 Sample Comments
Census 307,006,550 Residents1. Actual census every decade,
estimates for other years
County Files3,549 SSA Counties3,457 FIPS Counties
1. Different types of counties, CBSA’s, “rural”, etc.
State Medicaid Medicaid Analytic eXtract (MAX)
1. 2008 data recently becameavailable
2. DUA and IRB approval required (RIF files)
3. Several challenges
State Hospice Organization Surveys ~12 States
1. Collect data on various surveys outside of basic membership dues calculations. Not generalizable across states, nationally
Comparison of Publically Available Datasets, 3
www.HospiceAnalytics.com 13
NHPCO Surveys Sample Comments
National Data Set (NDS)2009: 991 Hospices (30%)
plus supplemental materials
1. Similar comments as cost reports.
2. “This type of convenience sample is prone to unknown selection biases; therefore results may not be generalizable beyond the survey participants.” From EROM
3. Consistent data collection and reporting of results?
4. Hope for the future…
Family Evaluation of Hospice Care (FEHC)
2009: 1,297 Hospices (39%)40% of surveys completed
End Result Outcome Measures (EROM)
2010 1-3Q: 87 Hospices (3%)
Family Evaluation of Bereavement Services (FEBS)
No public results
Family Evaluation of Palliative Care (FEPC)
No public results
Survey of Team Attitudes and Relationships (STAR)
No public resultsPurchase results online
Patient Evaluation of Hospice Care? ?
Hospice Compare / other publicly reported quality measures?
?
Comparison of Publically Available Datasets, 4
www.HospiceAnalytics.com 14
10/23/2011
8
Presentation Outline
Part 1: Connecting Clinical Care to National Policy
1. In the Beginning… Early Questions & Answers
2. Data Available
3. Data Applications for Hospice Administrators
Part II: Connecting National Policy to Clinical Care
1. WFA (Nursing Facilities, Caps, Long LOS, DC Alive)
2. MedPAC (Net Margins, U-Shaped Curves)
3. Palliative Care
4. Dartmouth Atlas
www.HospiceAnalytics.com 15
The Breadth of Medicare Information Available
Hospice Provider Characteristics: number of (Medicare Certified) hospices, address, date of certification, date / reason of ownership change, date / reason of closure, date / reason of last survey, type of control (13 categories of non-profit, proprietary, and government), type of facility (freestanding, hospital-based, HHA-based, SNF-based), etc.
Hospice Patient Characteristics: number of patients served, age, sex, race, diagnoses, length of stay, level of care, Medicare reimbursement, patient status at discharge, location of care (2007), discipline providing care (2008), duration of visits (2010), etc.
www.HospiceAnalytics.com 16
10/23/2011
9
The Depth of Information Available
In addition to descriptive analyses (above), Medicare datasets can be combined in innovative ways to increase access to and utilization of hospice services, for example:
1. Calculations within the hospice file – cap calculations, surveys, net margins, etc.
2. Combining Medicare files – hospice utilization, detail provider and beneficiary characteristics, etc.
www.HospiceAnalytics.com 17
2009 Demographics & Hospice Utilization
Wisconsin National
Population 5,654,774 307,006,550
Total Deaths46,508
0.8% of population2,486,097
0.8% of population
Medicare Beneficiaries 933,761 47,645,019
Medicare Beneficiary Deaths27,207
80% of total deaths1,899,969
76% of total deaths
Medicare Hospice Beneficiary Admissions21,097
45% of total deaths57% of Medicare deaths
1,079,67643% of total deaths
57% of Medicare deaths
Medicare Hospice Beneficiary Deaths15,323
33% of total deaths41.2% of Medicare deaths
752,94330% of total deaths
39.6% of Medicare deaths
Medicare Hospice Total Days of Care 1,438,360 Days 76,724,901 Days
Medicare Hospice Mean Days / BeneficiaryMedicare Hospice Median Days / Beneficiary
68 Days24 Days
71 Days24 Days
Medicare Hospice Total PaymentsMedicare Hospice Mean Payment / Beneficiary
$222,735,595$10,118
$12,064,905,206$11,175
www.HospiceAnalytics.com 18
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www.HospiceAnalytics.com 19
www.HospiceAnalytics.com 20
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www.HospiceAnalytics.com 21
www.HospiceAnalytics.com 22
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12
55%
53%
53%
52%
51%
50%
49%
49%
49%
48%
48%
47%
46%
46%
45%
45%
44%
44%
44%
44%
43%
43%
42%
42%
42%
40%
40%
40%
39%
38%
38%
37%
36%
36%
36%
0%
10%
20%
30%
40%
50%
60%Sh
eboy
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hing
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auke
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ette
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ood
Wisconsin County-Level Hospice UtilizationTop 35 Counties (Slide 1 of 2)Hospice Utilization= Medicare Hospice Deaths / Medicare Total Deaths
National AverageState Average
www.HospiceAnalytics.com 23
36%
36%
35%
34%
32%
32%
31%
31%
31%
30%
30%
29%
28%
28%
28%
27%
27%
27%
27%
27%
27%
26%
26%
25%
25%
24%
23%
23%
23%
22%
22%
21%
19%
18%
17%
17%
12%
0%
10%
20%
30%
40%
50%
60%
Cal
umet
Wau
shar
aG
reen
Lak
eG
rant
Bayf
ield
Chi
ppew
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onro
eSa
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laire
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ffalo
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ett
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pin
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kFl
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ce
Wisconsin County-Level Hospice UtilizationAll Remaining Counties (Slide 2 of 2)Hospice Utilization= Medicare Hospice Deaths / Medicare Total Deaths
www.HospiceAnalytics.com 24
10/23/2011
13
2009 Hospice Utilization(Slide 1/2; Medicare Hospice Deaths / Total Medicare Deaths)
56.1
%
52.2
%
51.9
%
51.3
%
50.1
%
49.3
%
49.2
%
47.1
%
46.0
%
44.1
%
43.9
%
43.7
%
42.6
%
42.5
%
42.2
%
41.4
%
41.2
%
41.0
%
40.6
%
39.9
%
39.6
%
39.5
%
39.5
%
39.3
%
39.1
%
38.6
%
0%
10%
20%
30%
40%
50%
60%Ar
izon
a 1
Uta
h 2
Flor
ida
3
Del
awar
e 4
Iow
a 5
Ore
gon
6
Col
orad
o 7
Rho
de Is
land
8
Mic
higa
n 9
Kans
as 1
0
Ohi
o 1
1
Texa
s 1
2
Geo
rgia
13
New
Mex
ico
14
Neb
rask
a 1
5
Nev
ada
16
Wis
cons
in 1
7
Idah
o 1
8
Mis
sour
i 19
Min
neso
ta 2
0
Nat
iona
l
Was
hing
ton
21
Penn
slyv
ania
22
Illin
ois
23
Sout
h C
arol
ina
24
New
Jer
sey
25
WI #17:41.2%
National:39.6%
www.HospiceAnalytics.com 25
2009 Hospice Utilization(Slide 2/2; Medicare Hospice Deaths / Total Medicare Deaths)
38.5
%
38.4
%
37.8
%
37.5
%
37.4
%
37.2
%
36.8
%
36.5
%
35.9
%
35.2
%
35.0
%
34.3
%
34.2
%
33.8
%
32.8
%
32.3
%
31.6
%
29.7
%
29.4
%
27.8
%
26.8
%
25.8
%
25.6
%
25.2
%
23.4
%
15.5
%
0%
10%
20%
30%
40%
50%
60%
New
Ham
shire
26
Nor
th C
arol
ina
27
Mai
ne 2
8
Loui
sian
a 2
9
Alab
ama
30
Mas
sach
uset
ts 3
1
Cal
iforn
ia 3
2
Con
nect
icut
33
Indi
ana
34
Okl
ahom
a 3
5
Tenn
esse
e 3
6
Mar
ylan
d 3
7
Mon
tana
38
Virg
inia
39
Wes
t Virg
inia
40
Arka
nsas
41
Kent
ucky
42
Sout
h D
akot
a 4
3
Mis
siss
ippi
44
Haw
aii
45
Dis
trict
of C
olum
bia
46
Nor
th D
akot
a 4
7
Verm
ont
48
New
Yor
k 4
9
Wyo
min
g 5
0
Alas
ka 5
1
www.HospiceAnalytics.com 26
10/23/2011
14
2009 Total Number of Hospices by StateSlide 1/2; National= 3,336 Hospices; WI= 65 (#20)
316
231
174
133
131
126
121
112
112
103
98 97
85 82 81 78 75 70 67 65 64 63
55 54 54
0
50
100
150
200
250
300
350Te
xas
1
Cal
iforn
ia
2
Penn
sylv
ania
3
Geo
rgia
4
Okl
ahom
a 5
Loui
sian
a 6
Alab
ama
7
Mis
siss
ippi
8
Ohi
o 9
Mis
sour
i 10
Illin
ois
11
Mic
higa
n 1
2
Indi
ana
13
Sout
h C
arol
ina
14
Nor
th C
arol
ina
15
Iow
a 1
6
Virg
inia
17
Mas
sach
uset
ts 1
8
Uta
h 1
9
Wis
cons
in 2
0
Min
neso
ta 2
1
Ariz
ona
22
Tenn
esse
e 2
3
Kans
as 2
4
New
Jer
sey
25
WI #20:65
www.HospiceAnalytics.com 27
2009 Total Number of Hospices by StateSlide 2/2; National= 3,336 Hospices; WI= 65 (#20)
50 49 48 46 39 39 37 33 31 31 28 27 24 22 20 19 17 17 15 14 10 9 8 8 5 3
0
50
100
150
200
250
300
350
Arka
nsas
26
New
Yor
k 2
7
Col
orad
o 2
8
Ore
gon
29
Flor
ida
30
Idah
o 3
1
New
Mex
ico
32
Neb
rask
a 3
3
Con
nect
icut
34
Was
hing
ton
35
Mon
tana
36
Mar
ylan
d 3
7
Kent
ucky
38
New
Ham
pshi
re 3
9
Wes
t Virg
inia
40
Mai
ne 4
1
Nev
ada
42
Wyo
min
g 4
3
Sout
h D
akot
a 4
4
Nor
th D
akot
a 4
5
Verm
ont
46
Del
awar
e 4
7
Haw
aii
48
Rho
de Is
land
49
Alas
ka 5
0
Dis
trict
of C
olum
bia
51
www.HospiceAnalytics.com 28
10/23/2011
15
2009 Total Number of Hospice Closure Reasons by StateVoluntary Merger or Closure: National= 27; WI= 0Voluntary Other: National= 2; WI= 0
0
1
2
3
4
5
6Al
abam
a 1
Penn
sylv
ania
2
Ariz
ona
3
Cal
iforn
ia
4
Indi
ana
5
Loui
sian
a 6
Mis
siss
ippi
7
Ohi
o 8
Texa
s 9
Idah
o 1
0
Mic
higa
n 1
1
Mis
sour
i 12
Okl
ahom
a 1
3
Sout
h C
arol
ina
14
Virg
inia
15
Voluntary Other
Voluntary Merger or Closure
www.HospiceAnalytics.com 29
www.HospiceAnalytics.com 30
10/23/2011
16
2009 Total Hospice PatientsSlide 1/2; National= 1,079,676
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000
90,000
100,000Fl
orid
a 1
Cal
iforn
ia
2
Texa
s 3
Penn
sylv
ania
4
Ohi
o 5
Mic
higa
n 6
Illin
ois
7
New
Yor
k 8
Nor
th C
arol
ina
9
Geo
rgia
10
Ariz
ona
11
New
Jer
sey
12
Mis
sour
i 13
Alab
ama
14
Virg
inia
15
Indi
ana
16
Tenn
esse
e 1
7
Mas
sach
uset
ts 1
8
Wis
cons
in 1
9
Sout
h C
arol
ina
20
Was
hing
ton
21
Okl
ahom
a 2
2
Loui
sian
a 2
3
Ore
gon
24
Min
neso
ta 2
5
WI #19:21,097
www.HospiceAnalytics.com 31
2009 Total Hospice PatientsSlide 2/2; National= 1,079,676
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000
90,000
100,000
Col
orad
o 2
6
Iow
a 2
7
Mar
ylan
d 2
8
Mis
siss
ippi
29
Kent
ucky
30
Kans
as 3
1
Arka
nsas
32
Con
nect
icut
33
Uta
h 3
4
Nev
ada
35
Wes
t Virg
inia
36
New
Mex
ico
37
Neb
rask
a 3
8
Idah
o 3
9
Mai
ne 4
0
Rho
de Is
land
41
Del
awar
e 4
2
New
Ham
pshi
re 4
3
Mon
tana
44
Haw
aii
45
Sout
h D
akot
a 4
6
Nor
th D
akot
a 4
7
Verm
ont
48
Dis
trict
of C
olum
bia
49
Wyo
min
g 5
0
Alas
ka 5
1
www.HospiceAnalytics.com 32
10/23/2011
17
Sample Market Report
What kind of information is included in a Market Report? How might I use this information?
So, let’s take a closer look at 2009 county data for: Kenosha Milwaukee Racine Waukesha
www.HospiceAnalytics.com 33
Executive Summary- 1
Hospice2009
Beneficiaries
Mean LOS
(days)
Median LOS
(days)County
Hospice Utilization
Died Without Hospice
VITAS – WAUWATOSA 1,220 74 28 Kenosha 40% 549
AURORA VNA 1,214 48 15 Milwaukee 44% 3,385
ODYSSEY - MILWAUKEE 659 96 51 Racine 42% 760
HOSPICE ALLIANCE 647 69 24 Waukesha 49% 1,336
HORIZON HC & HOSPICE 622 37 13 TOTAL 44% 6,030
WHEATON FRANCISCAN HOSPICE 613 28 7 Compare: Wisconsin 41% 21,884
SEASONS HOSPICE PALLIATIVE CARE 490 70 28 Compare: National 40% 1,178,425
ASERACARE – WEST ALLIS 449 80 39
HEARTLAND – BROOKFIELD 440 96 50
RUTH HOSPICE 435 14 6
All Others (N=5) 1,191 73 36
TOTAL 7,980 63 20
Compare: Wisconsin 21,097 68 24
Compare: National 1,090,862 72 24
Aggregate Cap Estimate= xxx% Last CMS Survey (years ago): xxx See Slide 4 note
Inpatient Cap Estimate= xxx% State CMS Survey Average (years) 3.4
www.HospiceAnalytics.com 34
10/23/2011
18
Executive Summary- 2
2009 Settings In Which Medicare Beneficiaries Died – N (%)
CountyTotal Beneficiary
DeathsHospice Deaths Hospital Deaths SNF Deaths HHA Deaths Other Deaths
Kenosha 909 360 (40%) 200 (22%) 109 (12%) * (*%) 233 (26%)
Milwaukee 6,032 2,647 (44%) 1,487 (25%) 300 (5%) 99 (2%) 1,499 (25%)
Racine 1,301 541 (42%) 174 (13%) 67 (5%) * (*%) 519 (40%)
Waukesha 2,615 1,279 (49%) 514 (20%) 159 (6%) * (*%) 653 (25%)
TOTAL 10,857 4,827 (44%) 2,375 (22%) 635 (6%) 116 (1%) 2,904 (27%)
Compare: Wisconsin 37,207 15,323 (41%) 6,560 (18%) 2,610 (7%) 348 (1%) 12,366 (33%)
Compare: National 1,936,900 758,475 (40%) 408,986 (22%) 102,651 (5%) 44,938 (2%) 584,919 (31%)
* Indicates CMS protected fields where cell size <11
Observations:1. Hospice Utilization is above the national average across most selected counties, although lower than an “accepted maximum” of 65%.2. Hospital deaths are lower than the national average in most counties. Milwaukee county is unusually high, perhaps due to the number of specialty
beds and academic medical centers in this county.3. Skilled Nursing Facility deaths are higher than the national average in most counties. Kenosha county is unusually high.4. Home Health Agency deaths are lower than the national average in most counties.5. Other Deaths (i.e., outside of these four Medicare provider types; e.g., Medicare Advantage, Medicaid, private insurance, no payer, etc.) are higher
than the national average across most counties. Racine county is unusually high.
www.HospiceAnalytics.com 35
Executive Summary- 3
Caps: Always be mindful of both the Hospice Overall Cap and Inpatient Care Cap. If you are not already monitoring your cap on a monthly basis, you might consider it. (Slides 13-14)
Surveys: According to CMS records, your last hospice survey (as of 12/31/09) was xxx years ago, and the state survey average is 3.4 years. If this is accurate, then your hospice has been surveyed more recently than most other hospices in the state. Your state surveys more often than the national hospice survey average of 3.7 years. (Slide 15)
Note: This data accounts for Medicare surveys only – only exceptions to these survey dates have involved deemed status accreditation surveys. If your hospice is accredited, it is possible that your accreditation survey has been more recent than what is posted in the CMS file.
WI average surveys= 3.4 years
National average surveys= 3.7 years
www.HospiceAnalytics.com 36
10/23/2011
19
Executive Summary- 4
Hospice Utilization:
13,878 2009 Total Deaths in the selected counties
10,857 Medicare Deaths in the selected counties
Therefore, 78% of Total Deaths are Medicare Deaths in the selected counties; the national average is 80%. So while the Medicare population accounts for the vast majority of deaths, also consider Medicaid, private insurance, and other potential sources for expanding hospice utilization.
4,827 2009 Medicare Hospice Deaths
An accepted “maximum hospice utilization rate” is 67% of deaths, or 7,275 Medicare hospice deaths in the selected counties – 2,448 more patients than died in hospice in 2009. This is a good target for potential growth. (Slide 18)
www.HospiceAnalytics.com 37
Executive Summary- 6
Hospice Utilization:
There is opportunity for growth and expansion when considering Medicare beneficiaries who died outside of hospice care. (Slides 45-49).
Age: Medicare beneficiaries who died outside of hospice tend to be slightly older in the selected counties for this report. (Slide 47)
Sex: Consider that hospices serve 60% females / 40% males, while Medicare beneficiaries who die outside of hospice are 50% females / 50% males. (Slides 40 and 48)
Race:Typically there are opportunities to expand hospice access across various racial groups, particularly with African Americans, Asians, and Hispanics. Always consider these possibilities both within and outside of Medicare populations. (Slide 49)
www.HospiceAnalytics.com 38
10/23/2011
20
Report Sections:
1. Executive Summary (slides 1-7)
2. Hospice Local Information (slides 8-49)
3. Hospice State Information (slides 50-59)
4. Hospice National Information (slides 60-62)
5. Hospital Information (slides 63-72)
6. SNF Information (slides 73-82)
7. Home Health Information (slides 83-93)
* This PowerPoint presentation provides a summary of information. Please see Excel Spreadsheet for additional detail, including hospice comparisons by county and quarter.
www.HospiceAnalytics.com 39
www.HospiceAnalytics.com 40
10/23/2011
21
2009 Demographics and Medicare Hospice Utilization
County-Specific Information Kenosha Milwaukee Racine Waukesha Total
Total Population 165,382 959,521 200,601 383,154 1,708,658
Total Deaths 1,218 8,108 1,563 2,989 13,878
Medicare Beneficiaries 22,148 138,443 33,662 64,731 258,984
Medicare Beneficiary Deaths 909 6,032 1,301 2,615 10,857
Medicare Hospice Beneficiary Admits% of Medicare Deaths
52558%
3,43757%
76659%
1,72066%
6,44859%
Medicare Hospice Beneficiary DeathsUtilization= % of Medicare Deaths
36039.6%
2,64743.9%
54141.6%
1,27948.9%
4,82744.5%
www.HospiceAnalytics.com 41
2009 Demographic and Medicare Hospice Utilization Comparisons
13,878
10,857
6,448
4,827
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
Total Deaths Medicare Deaths Hospice Admissions Hospice Deaths
www.HospiceAnalytics.com 42
10/23/2011
22
2009 Medicare Hospice Beneficiaries Residing in theCounties Selected for this Report
County-Specific Information Beneficiaries Utilization DaysMean Days / Beneficiary
Median Days / Beneficiary
Mean Daily Census
Kenosha 545 39,613 73 27 109
Milwaukee 3,592 205,627 57 17 563
Racine 793 50,195 63 20 138
Waukesha 1,802 119,620 66 21 328
TOTAL 6,732 415,055 62 19 1,137
Compare: Wisconsin 21,097 1,438,360 68 24 3,941
Compare: National 1,090,862 78,203,910 72 24 214,257
www.HospiceAnalytics.com 43
2009 Which Hospices Serve Beneficiaries Residing in the Counties Selected for this Report?
Hospice Kenosha Milwaukee Racine Waukesha Total
VITAS – WAUWATOSA * 657 61 244 967
AURORA VNA 26 597 94 121 838
HOSPICE ALLIANCE 368 * 204 * 585
WHEATON FRANCISCAN HOSPICE * 280 159 132 573
ODYSSEY – MILWAUKEE 25 295 84 127 531
HORIZON HC & HOSPICE * 385 * 87 472
RUTH HOSPICE * 333 * 61 403
SEASONS HOSPICE PALL CARE 26 133 51 179 389
ASERACARE – WEST ALLIS 15 226 22 81 344
ALLAY HOME & HOSPICE * 215 * 93 317
All Others (N=140) 76 464 102 671 1,313
TOTAL 545 3,592 793 1,802 6,732
* Indicates CMS protected fields where cell size <11
See Excel spreadsheet for additional detail.
www.HospiceAnalytics.com 44
10/23/2011
23
2009 Comparison of Hospices Serving Beneficiaries Residing in the Counties Selected for this Report
967
838
585
573
531
472
403
389
344
317
0
200
400
600
800
1,000
1,200
www.HospiceAnalytics.com 45
2009 Which Hospices Serve Beneficiaries Residing in the Counties Selected for this Report?
0 26
368
0 25 0 026 15 0
76 545
657597
0
280
295
385 333
133
226 215
464
3,592
61
94 204
15984
00
51
220
102
793
244121
0
132 12787 61
179
8193
671
1,802
0%
20%
40%
60%
80%
100%
Waukesha
Racine
Milwaukee
Kenosha
www.HospiceAnalytics.com 46
10/23/2011
24
2009 Admissions by Quarter in Selected CountiesSee Excel spreadsheet for additional detail
188 20
0
114
155
100
127
92
83
63 62
216
189
119 12
6
98 100
91
80
65 62
189
179
120 12
6
116
97 95 92
59 61
181
178
128 13
2
97 101 104
88
66 65
0
50
100
150
200
250
VITAS –WAUWATOSA
AURORA VNA HOSPICEALLIANCE
WHEATONFRANCISCAN
HOSPICE
ODYSSEY –MILWAUKEE
HORIZON HC &HOSPICE
RUTHHOSPICE
SEASONSHOSPICE PALL
CARE
ASERACARE –WEST ALLIS
ALLAY HOME& HOSPICE
1st Quarter
2nd Quarter
3rd Quarter
4th Quarter
www.HospiceAnalytics.com 47
2009: Explain the Difference Between theLast Section and This Section…
• The last section highlighted Medicare beneficiaries residing in counties selected for this report; this section highlights providers in counties selected for this report.
• For example, 79% of Medicare beneficiaries served by Vitas - Wauwatosa reside in the counties selected for this report; 21% come from outside these counties.
• Percentages exceeding 100% indicate beneficiaries residing in selected counties receiving hospice services outside of the selected counties.
2009 HospiceBeneficiaries Residing in
Selected Counties -Last Section
Total Beneficiaries -This Section
% Total Beneficiaries Residing in Selected
Counties
VITAS – WAUWATOSA 967 1,220 79%
AURORA VNA 838 1,214 69%
ODYSSEY - MILWAUKEE 531 659 81%
HOSPICE ALLIANCE 585 647 90%
HORIZON HC & HOSPICE 472 622 76%
WHEATON FRANCISCAN HOSPICE 573 613 93%
SEASONS HOSPICE PALLIATIVE CARE 389 490 79%
ASERACARE – WEST ALLIS 344 449 77%
HEARTLAND – BROOKFIELD 311 440 71%
RUTH HOSPICE 403 435 93%
All Others (N=5) 1,319 1,191 111%
TOTAL 6,732 7,980 84%
www.HospiceAnalytics.com 48
10/23/2011
25
2009 Medicare Hospice Providers & Beneficiaries
Hospice Beneficiaries Utilization DaysMean Days / Beneficiary
Median Days / Beneficiary
Average Daily Census
VITAS – WAUWATOSA 1,220 89,922 74 28 246
AURORA VNA 1,214 57,729 48 15 158
ODYSSEY - MILWAUKEE 659 63,233 96 51 173
HOSPICE ALLIANCE 647 44,531 69 24 122
HORIZON HC & HOSPICE 622 22,808 37 13 62
WHEATON FRANCISCAN HOSPICE 613 17,390 28 7 48
SEASONS HOSPICE PALLIATIVE CARE 490 34,151 70 28 94
ASERACARE – WEST ALLIS 449 36,010 80 39 99
HEARTLAND – BROOKFIELD 440 42,197 96 50 116
RUTH HOSPICE 435 6,110 14 6 17
All Others (N=5) 1,191 85,769 73 36 235
TOTAL 7,980 499,850 63 20 1,369
Compare: Wisconsin 21,097 1,438,360 68 24 3,941
Compare: National 1,090,862 78,203,910 72 24 214,257
www.HospiceAnalytics.com 49
2009 Medicare Beneficiaries Served by Hospice
1,220 1,214
659 647 622 613
490449 440 435
1,191
0
200
400
600
800
1,000
1,200
1,400
www.HospiceAnalytics.com 50
10/23/2011
26
2009 Medicare Total Days of Care by Hospice
89,922
57,72963,233
44,531
22,80817,390
34,151 36,01042,197
6,110
85,769
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000
90,000
100,000
www.HospiceAnalytics.com 51
2009 Medicare Mean Days of Care / Beneficiaryby Hospice
74
48
96
69
37
28
70
80
96
14
73
6368
72
0
20
40
60
80
100
120
www.HospiceAnalytics.com 52
10/23/2011
27
2009 Medicare Median Days of Care / Beneficiaryby Hospice
28
15
51
24
13
7
28
39
50
6
36
20
24 24
0
10
20
30
40
50
60
www.HospiceAnalytics.com 53
2009 Medicare Average Daily Census by Hospice
246
158173
122
6248
94 99116
17
235
0
50
100
150
200
250
300
www.HospiceAnalytics.com 54
10/23/2011
28
2009 Medicare Reimbursement / Hospice
Hospice BeneficiariesTotal MedicareReimbursement
Mean MedicareReimbursement /
Beneficiary
VITAS – WAUWATOSA 1,220 $14,987,930 $12,285
AURORA VNA 1,214 $10,155,526 $8,365
ODYSSEY - MILWAUKEE 659 $9,342,450 $14,177
HOSPICE ALLIANCE 647 $6,725,244 $10,395
HORIZON HC & HOSPICE 622 $3,877,594 $6,234
WHEATON FRANCISCAN HOSPICE 613 $3,230,139 $5,269
SEASONS HOSPICE PALLIATIVE CARE 490 $5,431,044 $11,084
ASERACARE – WEST ALLIS 449 $5,320,773 $11,850
HEARTLAND – BROOKFIELD 440 $6,374,330 $14,487
RUTH HOSPICE 435 $1,235,428 $2,840
All Others (N=5) 1,191 $12,993,051 $11,019
TOTAL 7,980 $79,673,509 $9,984
Compare: Wisconsin 21,097 $222,735,595 $10,558
Compare: National 1,090,862 $12,210,869,288 $11,194
www.HospiceAnalytics.com 55
2009 Total Medicare Reimbursement by Hospice
$14,987,930
$10,155,526 $9,342,450
$6,725,244
$3,877,594 $3,230,139
$5,431,044 $5,320,773
$6,374,330
$1,235,428
$12,993,051
$0
$2,000,000
$4,000,000
$6,000,000
$8,000,000
$10,000,000
$12,000,000
$14,000,000
$16,000,000
www.HospiceAnalytics.com 56
10/23/2011
29
2009 Mean Medicare Hospice Reimbursement / Beneficiary
$12,285
$8,365
$14,177
$10,395
$6,234 $5,269
$11,084 $11,850
$14,487
$2,840
$11,019 $9,984
$10,558 $11,194
$0
$2,000
$4,000
$6,000
$8,000
$10,000
$12,000
$14,000
$16,000
www.HospiceAnalytics.com 57
2009 Medicare Hospice BeneficiariesCancer / Non-Cancer
914
672
566
416
315369
414 393339
260851 5,509 14,084 743,180
306
542
93
231
307244
76 56101
175340 2,471 7,013 347,682
0%
20%
40%
60%
80%
100%
Cancer
Non-Cancer
www.HospiceAnalytics.com 58
10/23/2011
30
2009 Medicare Hospice BeneficiariesTop Six ICD-9 Diagnostic Categories (out of 19)
306
525
93
214
304
214
76 55101
175
326 2,3897,013 344,811
204
220
81
110
59
136
122
52
68
66
1601,278
6,275 301,000
30
66
49
28
95
65
32
26
147549 2,868 152,457
86
138
51
77
41
8041
21
32
33
86 6862,970 142,144
114
96
101
80
32
2539
37
47
17
64652
2,575 137,457432
21
192
73 44 43
13595 267
1,305 3,549 134,995
0%
20%
40%
60%
80%
100%
Ill-defined
Nervous
Respiratory
Mental
Circulatory
Cancers
www.HospiceAnalytics.com 59
2009 Medicare Hospice BeneficiariesStatus at Discharge
875 925
416 432454
532
327 278244
410
7685,661 15,323 758,473
118136
8175
110
42
68 85
80
182984 1,917 131,389
227153
162 14058 39
95 86116
18
241 1,335 3,857 201,000
0%
20%
40%
60%
80%
100%
Still PT
DC Alive
DC Deceased
None 25%+ DC Alive
www.HospiceAnalytics.com 60
10/23/2011
31
2009 Medicare Hospice BeneficiariesAge Categories
30 64 25 40 45 41 21 25 31 339 908 56,2086488
3046 58 47
13 2126 30
69 492 1,571 89,95780
137
26
5583
59
2326
2535
86 635 1,863 109,316122
199
81
93
101
88
5652
6276
1561,086 2,876
155,716217
282
127
133
130
130
10097
101
90
2521,659 4,212
216,582
707
444
370280
205248
290 244205
179597 3,769 9,667 463,083
0%
20%
40%
60%
80%
100%
>84
80-84
75-79
70-74
64-69
<64
www.HospiceAnalytics.com 61
2009 Medicare Hospice BeneficiariesSex
443561
205256 278 288
150 145 154178 474 3,132 8,694 439,903
777653
454391 344 325
340 304 286257 717 4,848 12,403 650,959
0%
20%
40%
60%
80%
100%
Female
Male
www.HospiceAnalytics.com 62
10/23/2011
32
2009 Medicare Hospice BeneficiariesRace
1,139 1,134604
615
491
516
477
395401
391
1,126
7,289
20,209
960,848
64 6046
21
124
8149
3441
47
576
601
87,651
51 66
20,126
17 448,618
86 3,50327 51 8,343
75%
80%
85%
90%
95%
100%
Other
North Amer Native
Asian
Hispanic
Black
White
www.HospiceAnalytics.com 63
2009 Medicare Hospice BeneficiariesLevels of Care (days)
86,728
53,928
63,142 44,393
21,925
16,213
33,417
36,07241,767 85,174
487,9631,407,30275,313,071
1,658
2,830
40 121
954
1,344
252
0
57
668
430
8,354 20,5711,590,715
129
266 0 20 73 41
26
12215
0 126 908 3,873 165,401
90%
92%
94%
96%
98%
100%
Cont. Home Care
Respite Care
General Inpt
Routine Home Care
www.HospiceAnalytics.com 64
10/23/2011
33
2009 Medicare Hospice BeneficiariesLocations of Care (days, new in 2007)
30,628
46,756
6,628
20,165
22,021
12,819
8,1629,615
25,030
4,320
24,204210,348
669,72745,887,608
56,145
942
40,442
14,117
45
3,444
20,756
18,202
15,379
872
43,365
213,709 440,826
14,701,238
25,7972,018
18,047 10,075
47
14,1038,409 7,600
17,233 103,329344,118
9,361,433
2,4133,308 1,875 46 11
6734,116 12,442 41,125
8,509,253
678 619 42 303 882 1,428108 960 5,021 32,618 3,529,112
0%
20%
40%
60%
80%
100%
All Other Settings
Inpatient Hospice
Assisted LivingFacility
Skilled / Non-SkillNrsng Fac
Home
www.HospiceAnalytics.com 65
2009 Medicare Hospice BeneficiariesVisits by Discipline (new in 2008)
35,042 38,77822,383
28,385
6,1814,977
11,756 14,78213,702
15,422 57,903 249,311 532,47529,766,570
48,201 43,66615,993
10,718
7,2707,296
7,786 11,12711,637
10,98845,951 220,633
558,22728,754,434
5,019 4,743 3,481 3,676 1,170 1,401 1,685 1,5633,423
574 7,348 34,083 102,096 4,622,1091,264 2,450 18 116 12 116 30 238 658 4,909 12,541 1,223,418
0%
20%
40%
60%
80%
100%
Physician and NP
Social Services
Skilled Nursing
Hospice Aide
www.HospiceAnalytics.com 66
10/23/2011
34
Who was missed?That is, who died without hospice care?
There is little information available regarding Medicare beneficiaries who died outside of hospice care.
This section highlights what information is available in the counties selected for this report.
Specialty reports on Inpatient Hospitals, Skilled Nursing Facilities, and Home Health Agencies are available through your state hospice organization. These reports provide some additional information on Medicare beneficiaries receiving services by other provider types.
www.HospiceAnalytics.com 67
2009 Counties & Medicare Hospice Beneficiaries
County-Specific Information Medicare BeneficiariesMedicare Beneficiaries
Who Died
Medicare BeneficiariesWho Died
With Hospice
Medicare BeneficiariesWho Died
Without Hospice
Kenosha 22,148 909 360 549
Milwaukee 138,443 6,032 2,647 3,385
Racine 33,662 1,301 541 760
Waukesha 64,731 2,615 1,279 1,336
TOTAL 258,984 10,857 4,827 6,030
Compare: Wisconsin 933,761 37,207 15,323 21,884
Compare: National 48,753,141 1,936,900 758,475 1,178,425
www.HospiceAnalytics.com 68
10/23/2011
35
2009 Medicare Hospice BeneficiariesWho Died Without Hospice: Age Categories
62 477 8789
715 2,052 133,169
58356
82
146
6422,183
142,544
58379
91
161
6892,340
142,044
86514 120
204
924
3,081
173,799
99624 137
2541,114
3,971
211,401
189 1,046 246496
1,9778,398
383,664
0%
20%
40%
60%
80%
100%
Kenosha Milwaukee Racine Waukesha TOTAL Compare: Wisconsin Compare: National
>84
80-84
75-79
70-74
64-69
<64
www.HospiceAnalytics.com 69
2009 Medicare Hospice BeneficiariesWho Died Without Hospice: Sex
283 1,690 370 653 2,996 10,720 586,916
269 1,706 393 697 3,065 11,305 599,705
0%
20%
40%
60%
80%
100%
Kenosha Milwaukee Racine Waukesha TOTAL Compare: Wisconsin Compare: National
Female
Male
www.HospiceAnalytics.com 70
10/23/2011
36
2009 Medicare Hospice BeneficiariesWho Died Without Hospice: Race
524
2,636
673
1,324
5,157
20,759
977,736
20
639
67
14
740
822
134,972
2640
94
16,481
2531 84
20,189
55 68 8929,155
14 19 152 6,223
70%
75%
80%
85%
90%
95%
100%
Kenosha Milwaukee Racine Waukesha TOTAL Compare:Wisconsin
Compare: National
N. Amer Native
Hispanic
Asian
Other
Black
White
www.HospiceAnalytics.com 71
The 2009 Medicare Data Was Recently Released:Who Provides Healthcare at the End of Life? Snapshots
2/1/11
Hospice 41% Hospice 40%
Inpt Hospital 18% Inpt Hospital 22%
SNF 7% SNF 5%Home Health 1% Home Health 2%
None of These 33% None of These 31%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Wisconsin NationalNote: Information reflects Medicare beneficiaries only;
categories are not mutually exclusive.
www.HospiceAnalytics.com 72
10/23/2011
37
Summary:
Skilled Nursing Facilities in the selected Wisconsin counties cared for 13,229 Medicare beneficiaries, of whom 2,958 died (22%). (Compare WI=22%; national=23%.)
Of those who died (N=2,958):
635 (21%) died in a SNF (compare WI=31%; national=20%)
1,924 (65%) were admitted to a hospice (compare WI=52%; national=54%)
1,406 (48%) died under hospice care (compare WI=38%; national=37%)
97 (3.3%) died in the SNF with hospice care (compare WI=6.9%; national=8.3%)
Of those admitted to hospice (N=1,924):
Hospice median length of stay=15 days (compare WI=15; national=15 days)
Hospice mean length of stay=46 days (compare WI=47; national=48 days)
Note: Median / Mean LOS for all hospice beneficiaries= 20/63 days (compare WI=24/68 days; national=24/72 days).
2009 Medicare Skilled Nursing Facilities
www.HospiceAnalytics.com 73
1596
48
104
4826
926 1,289 3,830 279,198
50
41
30
13
25
554734 2,171 174,535
12101
3430
23934
374 827 2,060 147,228
16 11311 24
14
3 351 532 1,632 144,695
2222 22
18
15
23402 541 1,604 103,291
0%
20%
40%
60%
80%
100%
Nervous
Injury and Poisoning
Musculoskeletal
Respiratory
Circulatory
2009 Top 5 SNF Diagnostic Categories (out of 19)
www.HospiceAnalytics.com 74
10/23/2011
38
2009 Demographics & SNF Utilization
Wisconsin National
Population 5,654,774 307,006,550
Total Deaths46,508
0.8% of population2,486,097
0.8% of population
Medicare Beneficiaries 933,761 47,645,019
Medicare Beneficiary Deaths27,207
80% of total deaths1,899,969
76% of total deaths
Medicare SNF Patients 39,028 1,822,074
Medicare SNF Patient Deaths2,610
6% of total deaths10% of Medicare deaths
102,6514% of total deaths
5% of Medicare deaths
Total Days of SNF Care 1,336,807 Days 67,514,523 Days
Mean Days / Patient of SNF Care 34 Days 37 Days
Median Days / Patient of SNF Care 25 Days 27 Days
Total Medicare SNF Payments$482,812,638 $24,476,518,870
www.HospiceAnalytics.com 75
Presentation Outline
Part 1: Connecting Clinical Care to National Policy
1. In the Beginning… Early Questions & Answers
2. Data Available
3. Data Applications for Hospice Administrators
Part II: Connecting National Policy to Clinical Care
1. WFA (Nursing Facilities, Caps, Long LOS,
DC Alive)
1. MedPAC (Net Margins, U-Shaped Curves)
2. Palliative Care
3. Dartmouth Atlas
www.HospiceAnalytics.com 76
10/23/2011
39
Thank you
Please contact Hospice Analytics with any questions, comments, feedback, or for additional information:
W: www.HospiceAnalytics.com
P: 719-209-1237
E: Info@HospiceAnalytics.com
www.HospiceAnalytics.com 77
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