Harnessing the Power of Data for Hospice Leaders, Part 1€¦ · Harnessing the Power of Data for Hospice Leaders, Part 1 Cordt T. Kassner, PhD Principal, Hospice Analytics 2011 Carolina’s

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Harnessing the Power of Data for Hospice Leaders, Part 1

Cordt T. Kassner, PhDPrincipal, Hospice Analytics

2011 Carolina’s Center for Hospice & End-of-Life Care Annual Meeting

September 26, 2011

In Partnership with:

Introduction & Background

www.HospiceAnalytics.com 2

Cordt T. Kassner, PhD

Principal

Hospice Analytics

2355 Rossmere Street

Colorado Springs, CO 80919

P: 719.209.1237

E: [email protected]

W: www.HospiceAnalytics.com

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Presentation Outline

Part 1:1. In the Beginning… Early Questions & Answers2. Data Available3. Data Applications for Hospice Administrators

Part II:1. Death Service Ratio2. Length of Service3. Hospice in Nursing Facilities4. Hospice Caps5. Data Driven Advocacy6. U-Shaped Curves7. Disaster Preparedness & Misc.


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


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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?


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


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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


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Medicare datasets

Denominator File

Standard Analytic Files (aka, claims data): Research Identifiable Files (RIF) and Limited Data Sets (LDS) Hospice

Home Health Agencies

Skilled Nursing Facilities Hospital Inpatient

Hospital Outpatient

Carrier File: Physician, Laboratory, and other suppliers Durable Medical Equipment

Explanation of Publically Available Datasets


Medicare Datasets, continued:

Provider of Service File

Cost Reports

Medicare Provider Analysis & Review (MedPAR) File

Hospital Inpatient

Skilled Nursing Facilities

Other datasets:

Census: population, mortality

County Files: SSA & FIPS

State Medicaid Files

State & National Hospice Organization Surveys

Hospice QAPI and other information

Explanation of Publically Available Datasets, 2


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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


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



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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. 2007 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



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?

?



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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.


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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.


2009 Demographics & Hospice Utilization

North Carolina South Carolina National

Population 9,380,884 4,561,242 307,006,550

Total Deaths78,306

0.8% of population42,027

0.9% of population2,486,097

0.8% of population

Medicare Beneficiaries 1,518,347 785,374 47,645,019

Medicare Beneficiary Deaths60,741

78% of total deaths31,038

74% of total deaths1,899,969

76% of total deaths

Medicare Hospice Beneficiary Admissions33,938

43% of total deaths56% of Medicare deaths

20,20748% of total deaths

65% of Medicare deaths

1,079,67643% of total deaths


Medicare Hospice Beneficiary Deaths23,315

30% of total deaths38.4% of Medicare deaths


39.1% of Medicare deaths


39.6% of Medicare deaths

Medicare Hospice Total Days of Care 2,483,846 Days 1,754,424 Days 76,724,901 Days

Medicare Hospice Mean Days / BeneficiaryMedicare Hospice Median Days / Beneficiary

73 Days28 Days

87 Days37 Days

71 Days24 Days

Medicare Hospice Total PaymentsMedicare Hospice Mean Payment / Beneficiary

$381,409,125$11,238

$260,143,849$12,874

$12,064,905,206$11,175


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State Average 38%National Average 40%


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SC #24:39.1%

National:39.6%

NC #27:38.4%


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2009 Total Number of Hospices by StateNational= 3,336 Hospices; NC= 81 (#15); SC= 82 (#14)

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174

133

131

126

121

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2009 Total Number of Hospice Closures by StateNational= 29; NC= 0 (#5); SC= 1 (#14)

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2009 Total Number of Hospice Closure Reasons by StateVoluntary Merger or Closure: National= 27; NC= 0; SC= 1Voluntary Other: National= 2; NC= 0; SC= 0

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2009 Total Hospice PatientsNational= 1,079,676

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NC #9:33,938


SC #20:20,207

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Executive Summary- 1

Hospice2009

Beneficiaries

Mean LOS

(days)

Median LOS

(days)County

Hospice Utilization

Died Without Hospice

Mountain Hospice 1,622 52 17 Aspen 44% 787

Moose Hospice 1,018 49 17 Blue Sky 47% 2,627

Blue Sky Hospice 693 44 16 Moose 37% 5,656

Lake Hospice 682 79 37 Mountain 38% 1,457

Plains Hospice 611 70 27 Lake 45% 914

Aspen Hospice 498 41 14 Peak 47% 365

Peak Hospice 490 39 9 TOTAL 41% 11,806

Scout Hospice 467 40 14 Compare: Colorado 37% 26,975

Whitewater Hospice 421 56 28 Compare: National 40% 1,178,425

Tree Line Hospice 366 93 36

All Others (N=25) 4,970 62 26

TOTAL 11,838 58 21

Compare: Colorado 21,805 63 23

Compare: National 1,090,862 72 24

Aggregate Cap Estimate= 39%-59% Last CMS Survey (years ago): 1.8 See Slide 4 note

Inpatient Cap Estimate= ~12% State CMS Survey Average (years) 3.2


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2009 Settings In Which Medicare Beneficiaries Died – N (%)

CountyTotal Beneficiary

DeathsHospice Deaths Hospital Deaths SNF Deaths HHA Deaths Other Deaths

Aspen 1,414 627 (44%) 192 (14%) 73 (5%) 22 (2%) 500 (35%)

Blue Sky 4,955 2,328 (47%) 856 (17%) 395 (8%) 200 (4%) 1,176 (24%)

Moose 8,972 3,316 (37%) 1,757 (20%) 673 (8%) 310 (3%) 2,916 (33%)

Mountain 2,342 885 (38%) 586 (25%) 257 (11%) 34 (1%) 580 (25%)

Lake 1,663 749 (45%) 247 (15%) 92 (6%) 39 (2%) 536 (32%)

Peak 691 326 (47%) 121 (18%) 42 (6%) 31 (4%) 171 (25%)

TOTAL 20,037 8,231 (41%) 3,759 (19%) 1,532 (8%) 636 (3%) 5,879 (29%)

Compare: Colorado 42,923 15,948 (37%) 9,468 (22%) 3,664 (9%) 943 (2%) 12,900 (30%)

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 near 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. Mountain 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. Mountain county is unusually high.4. Home Health Agency deaths are higher than the national average in most counties. Blue Sky and Peak counties are unusually high.5. Other Deaths (i.e., outside of these four Medicare provider types; e.g., Medicare Advantage, Medicaid, private insurance, no payer, etc.) are lower

than the national average across most counties. Aspen county is unusually high.



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 1.8 years ago, and the state survey average is 3.2 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.


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Hospice Utilization:

24,917 2009 Total Deaths in the selected counties

20,037 Medicare Deaths in the selected counties

Therefore, 80% 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.

8,231 2009 Medicare Hospice Deaths

An accepted “maximum hospice utilization rate” is 65% of deaths, or 13,025 Medicare hospice deaths in the selected counties – 4,794 more patients than died in hospice in 2009. This is a good target for potential growth. (Slide 18)




Hospice utilization in the selected counties ranges from 37% in Moose to 47% in Blue Sky County. Peak county, where your hospice is located, averaged 47%. Most of these percentages are above the national average of 40% and near your state’s average of 37%. This is positive in terms of current increasing trends in hospice utilization (with a goal of 65%), and there appears to be opportunity for additional hospice utilization increased for several years ahead. (Slide 18)


9/2/2011

20



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)


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.


9/2/2011

21


2009 Demographics and Medicare Hospice Utilization

County-Specific Information Aspen Blue Sky Moose Mountain Lake Peak Total

Total Population 201,876 742,582 1,505,006 405,906 299,276 123,589 3,278,235

Total Deaths 1,724 6,305 11,083 2,829 2,059 917 24,917

Medicare Beneficiaries 37,732 126,426 228,424 59,333 45,909 18,524 516,348

Medicare Beneficiary Deaths 1,414 4,955 8,972 2,342 1,663 691 20,037

Medicare Hospice Beneficiary Admits% of Medicare Deaths

83959%

3,14363%

4,54351%

1,13949%

1,02161%

41460%

11,09955%

Medicare Hospice Beneficiary DeathsUtilization= % of Medicare Deaths

62744.3%

2,32847.0%

3,31637.0%

88537.8%

74945.0%

32647.2%

8,23141.1%


9/2/2011

22

2009 Demographic and Medicare Hospice Utilization Comparisons

24,917

20,037

11,099

8,231

0

5,000

10,000

15,000

20,000

25,000

30,000

Total Deaths Medicare Deaths Hospice Admissions Hospice Deaths


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

Aspen 861 51,668 60 23 142

Blue Sky 3,218 196,439 61 22 538

Moose 4,699 278,323 59 21 763

Mountain 1,172 65,500 56 21 179

Lake 1,057 63,557 60 25 174

Peak 424 19,547 46 14 54

TOTAL 11,431 675,034 59 22 1,849

Compare: Colorado 21,805 1,365,446 63 23 3,741

Compare: National 1,090,862 78,203,910 72 24 214,257


9/2/2011

23

2009 Which Hospices Serve Beneficiaries Residing in the Counties Selected for this Report?

Hospice Aspen Blue Sky Moose Mountain Lake Peak Total

Mountain Hospice * 1,313 164 * * * 1,490

Moose Hospice * 632 216 19 107 * 975

Blue Sky Hospice * 288 221 * 15 * 532

Lake Hospice 58 * * * 196 196 462

Plains Hospice * * 12 393 27 * 438

Aspen Hospice * 61 352 * * * 416

Peak Hospice * 137 251 * * * 388

Scout Hospice * 71 298 * * * 375

Whitewater Hospice * 207 156 * * * 365

Tree Line Hospice * 12 320 * * * 334

All Others (N=289) 795 489 2,705 747 696 224 5,656

TOTAL 861 3,218 4,699 1,172 1,057 424 11,431

* Indicates CMS protected fields where cell size <11

See Excel spreadsheet for additional detail.


2009 Comparison of Hospices Serving Beneficiaries Residing in the Counties Selected for this Report

1,49

0

975

532

462

438

416

388

375

365

334

0

200

400

600

800

1,000

1,200

1,400

1,600


9/2/2011

24

2009 Which Hospices Serve Beneficiaries Residing in the Counties Selected for this Report?

0 0 0

58

0 0 0 0 0 0

795861

1,313

632

288

0

0

61

137

71

207

12

4893,218

164

216 221

0

12

352

251

298

156

320

2,705

4,699

0

19

0

0

393

0 0 0 0 0

747

1,172

0

10715

196

270 0 0 0 0

696 1,057

0 0 0

196

0 0 0 0 0 0224 424

0%

20%

40%

60%

80%

100%

MountainHospice

MooseHospice

Blue SkyHospice

LakeHospice

PlainsHospice

AspenHospice

PeakHospice

ScoutHospice

WhitewaterHospice

Tree LineHospice

All Others(N=289)

TOTAL

Peak

Lake

Mountain

Moose

Blue Sky

Aspen


2009 Admissions by Quarter in Selected CountiesSee Excel spreadsheet for additional detail

334

218

130

118

99 98 96

68

84

65

348

197

101

121

92 87 89 87

54

76

301

219

70

78

106

97

88

74

85

62

318

222

100

83

104

100

78

68

85

71

0

50

100

150

200

250

300

350

400

MountainHospice

Moose Hospice Blue SkyHospice

Lake Hospice Plains Hospice Aspen Hospice Peak Hospice Scout Hospice WhitewaterHospice

Tree LineHospice

1st Quarter2nd Quarter3rd Quarter4th Quarter


9/2/2011

25

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, 96% of Medicare beneficiaries served by your hospice reside in the counties selected for this report; 4% 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

Mountain Hospice 1,490 1,622 92%

Moose Hospice 975 1,018 96%

Blue Sky Hospice 278 693 40%

Lake Hospice 375 682 55%

Plains Hospice 334 611 55%

Aspen Hospice 462 498 93%

Peak Hospice 416 490 85%

Scout Hospice 438 467 94%

Whitewater Hospice 365 421 87%

Tree Line Hospice 107 366 29%

All Others (N=25) 6,191 4,970 125%

TOTAL 11,431 11,838 97%


2009 Medicare Hospice Providers & Beneficiaries

Hospice Beneficiaries Utilization DaysMean Days / Beneficiary

Median Days / Beneficiary

Average Daily Census

Mountain Hospice 1,622 83,772 52 17 230

Moose Hospice 1,018 49,780 49 17 136

Blue Sky Hospice 693 30,346 44 16 83

Lake Hospice 682 54,172 79 37 148

Plains Hospice 611 42,924 70 27 118

Aspen Hospice 498 20,406 41 14 56

Peak Hospice 490 19,156 39 9 52

Scout Hospice 467 18,801 40 14 52

Whitewater Hospice 421 23,541 56 28 64

Tree Line Hospice 366 34,056 93 36 93

All Others (N=25) 4,970 307,538 62 26 843

TOTAL 11,838 684,492 58 21 1,875

Compare: Colorado 21,805 1,365,446 63 23 3,741

Compare: National 1,090,862 78,203,910 72 24 214,257


9/2/2011

26

2009 Medicare Beneficiaries Served by Hospice

1,622

1,018

693 682611

498 490 467421

366

0

200

400

600

800

1,000

1,200

1,400

1,600

1,800

MountainHospice



Tree LineHospice


2009 Medicare Total Days of Care by Hospice

83,772

49,780

30,346

54,172

42,924

20,406 19,156 18,801

23,541

34,056

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

MountainHospice



Tree LineHospice


9/2/2011

27

2009 Medicare Mean Days of Care / Beneficiaryby Hospice

5249

44

79

70

4139 40

56

93

6258

63

72

0

10

20

30

40

50

60

70

80

90

100

MountainHospice

MooseHospice

Blue SkyHospice

LakeHospice

PlainsHospice

AspenHospice

PeakHospice

ScoutHospice

WhitewaterHospice

Tree LineHospice

All Others(N=25)

TOTAL Compare:Colorado

Compare:National


2009 Medicare Median Days of Care / Beneficiaryby Hospice

17 1716

37

27

14

9

14

28

36

26

21

2324

0

5

10

15

20

25

30

35

40

MountainHospice

MooseHospice

Blue SkyHospice

LakeHospice

PlainsHospice

AspenHospice

PeakHospice

ScoutHospice

WhitewaterHospice

Tree LineHospice

All Others(N=25)

TOTAL Compare:Colorado

Compare:National


9/2/2011

28

2009 Medicare Average Daily Census by Hospice

230

136

83

148

118

56 52 52

64

93

0

50

100

150

200

250

MountainHospice



Tree LineHospice


2009 Medicare Reimbursement / Hospice

Hospice BeneficiariesTotal MedicareReimbursement

Mean MedicareReimbursement /

Beneficiary

Mountain Hospice 1,622 $15,484,819 $9,547

Moose Hospice 1,018 $8,279,079 $8,133

Blue Sky Hospice 693 $5,342,149 $7,709

Lake Hospice 682 $9,068,357 $13,297

Plains Hospice 611 $7,142,242 $11,689

Aspen Hospice 498 $3,407,379 $6,842

Peak Hospice 490 $3,833,975 $7,824

Scout Hospice 467 $3,595,394 $7,699

Whitewater Hospice 421 $3,836,517 $9,113

Tree Line Hospice 366 $5,795,797 $15,836

All Others (N=25) 4,970 $49,249,148 $9,893

TOTAL 11,838 $115,034,857 $9,717

Compare: Colorado 21,805 $230,195,947 $10,557

Compare: National 1,090,862 $12,210,869,288 $11,194


9/2/2011

29

2009 Total Medicare Reimbursement by Hospice

$15,484,819

$8,279,079

$5,342,149

$9,068,357

$7,142,242

$3,407,379 $3,833,975 $3,595,394 $3,836,517

$5,795,797

$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

$18,000,000

MountainHospice

MooseHospice

Blue SkyHospice

Lake Hospice PlainsHospice

AspenHospice

Peak Hospice ScoutHospice

WhitewaterHospice

Tree LineHospice


2009 Mean Medicare Hospice Reimbursement / Beneficiary

$9,547

$8,133 $7,709

$13,297

$11,689

$6,842

$7,824 $7,699

$9,113

$15,836

$9,893 $9,717 $10,557

$11,194

$0

$2,000

$4,000

$6,000

$8,000

$10,000

$12,000

$14,000

$16,000

$18,000


9/2/2011

30

2009 Medicare Hospice BeneficiariesCancer / Non-Cancer

1,040601

347

555

336

334289 276

269269 3,450 7,766 14,008 743,180

582417

346

127

275

164201 191

15297 1,520 4,072 7,797 347,682

0%

20%

40%

60%

80%

100%

Cancer

Non-Cancer


2009 Medicare Hospice BeneficiariesTop Six ICD-9 Diagnostic Categories (out of 19)

522413

346

125

274

164 167189

127 94 1,430 3,8517,797 344,811

230

133

121

46

118

80 6155

53 48635

1,580

6,993301,000

25378

43

229

73

63

2813

30

64 5501,424 4,364

152,457

113 67

45

33

38

39

3039

25

33

352814 3,384

142,144

13656

42

50

55

32

25

47

51

50

4951,039

3,591137,457

239204

22

135

28

93

143104

116

27

949 2,0604,328 134,995

0%

20%

40%

60%

80%

100%

Ill-defined

Nervous

Respiratory

Mental

Circulatory

Cancers


9/2/2011

31

2009 Medicare Hospice BeneficiariesStatus at Discharge

1,274746 496

434 397

391 387 374303

2243,473 8,499 15,948 758,473

137144 116

99110

66 41 3158

54

639 1,495 2,378131,389

211 128 81149

10441

62 62 6088

858 1,844 3,479 201,000

0%

20%

40%

60%

80%

100%

Still PT

DC Alive

DC Deceased


2009 Medicare Hospice BeneficiariesAge Categories

64 65 5016

53 23 15 22 15 21 173 517 921 56,208107

88 77

23

5646

1839

2628

282 790 1,471 89,957126

9375

44

6350

36

58

2830

389992 1,810

109,316

203

150

117

85

8176

64

77

6544

6431,605 2,879

155,716

328

194

135

157

93 94

113

83

92 61 9902,340 4,391

216,582

794428

239

357265 209

244188

195 182 2,493 5,594 10,333463,083

0%

20%

40%

60%

80%

100%

>84

80-84

75-79

70-74

64-69

<64


9/2/2011

32

2009 Medicare Hospice BeneficiariesSex

606 403309

212236 206 207 187 178

126 1,778 4,448 8,271 439,903

1,016 615384

470375 292 283 280 243

240 3,192 7,390 13,534 650,959

0%

20%

40%

60%

80%

100%

Female

Male


2009 Medicare Hospice BeneficiariesRace

1,590976

608

659

524

494 480 456

398

320

4,83211,337 20,744

960,848

17

58

13

55

14

33

56263 595

87,651

1511 23 78 144

20,126

11 14 51 1168,6183,503

37 86 163 8,343

80%

85%

90%

95%

100%

Other

North Amer Native

Asian

Hispanic

Black

White


9/2/2011

33

2009 Medicare Hospice BeneficiariesLevels of Care (days)

79,292

48,929 30,14953,762

42,510

19,548

17,56917,470

23,320 33,931 300,470

666,9501,343,839

75,313,071

4,415

1,107 702794

348

747

1,4321,379

221409 2,669

14,22322,557

1,590,715

44 26 18 15179

28 14815 248 731 1,244

165,401

90%

92%

94%

96%

98%

100%

Cont. Home Care

Respite Care

General Inpt

Routine Home Care


2009 Medicare Hospice BeneficiariesLocations of Care (days, new in 2007)

35,876

37,437

28,141

4,559

34,233

11,693

15,140

9,016

14,496

13,721122,910

327,222 635,100

45,887,608

39,445

21,161

9,477

47,616

4,624

11,651

4,789

7,719

7,968

15,412175,452 345,314

702,92514,701,238

9,876 7571,159 2,386

3,694

2,515

15 991 1,048 25,08047,521

70,822

9,361,433

2,9143,801

12

14,069

2,043

554 23,396 9,693

8,509,253

421 1,259 978 305 273 832 102 272 462 1,170 6,076 11,594 3,529,112

0%

20%

40%

60%

80%

100%

All Other Settings

Inpatient Hospice

Assisted LivingFacility

Skilled / Non-SkillNrsng Fac

Home


9/2/2011

34

2009 Medicare Hospice BeneficiariesVisits by Discipline (new in 2008)

41,54728,780

8,172

31,159

17,54111,723

8,0099,332

10,777137,657 304,697 504,451

29,766,570

23,83620,089

9,417

5,819

15,30216,476 8,670

14,127

10,39298,959 212,087 361,669

28,754,434

3,803 4,421 1,607 4,771 2,741 1,131 1,338 1,7561,595 21,031 44,194 76,170 4,622,109

2,113 287 50 165 612

338

347 3,912 6,039 1,223,418

0%

20%

40%

60%

80%

100%

Physician and NP

Social Services

Skilled Nursing

Hospice Aide


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.


9/2/2011

35

2009 Counties & Medicare Hospice Beneficiaries

County-Specific Information Medicare BeneficiariesMedicare Beneficiaries

Who Died

Medicare BeneficiariesWho Died

With Hospice


Without Hospice

Aspen 37,732 1,414 627 787

Blue Sky 126,426 4,955 2,328 2,627

Moose 228,424 8,972 3,316 5,656

Mountain 59,333 2,342 885 1,457

Lake 45,909 1,663 749 914

Peak 18,524 691 326 365

TOTAL 516,348 20,037 8,231 11,806

Compare: Colorado 1,087,158 42,923 15,948 26,975

Compare: National 48,753,141 1,936,900 758,475 1,178,425


2009 Medicare Hospice BeneficiariesWho Died Without Hospice: Age Categories

88 250 476 164 98 501,126 2,449 133,169

79243 530

152 10742

1,153 2,575142,544

88234 562

149 10841

1,182 2,601

142,044

130

374 849200

12453

1,730 3,809

173,799

122

523 1,032281 161

59

2,178 5,017

211,401

284 1,013 2,229516 320 120

4,482 10,611383,664

0%

20%

40%

60%

80%

100%

Aspen Blue Sky Moose Mountain Lake Peak TOTAL Compare:Colorado

Compare:National

>84

80-84

75-79

70-74

64-69

<64


9/2/2011

36

2009 Medicare Hospice BeneficiariesWho Died Without Hospice: Sex

395 1,242 2,640 696 463 172 5,608 12,663 586,916

396 1,395 3,038 766 455 193 6,243 14,399 599,705

0%

20%

40%

60%

80%

100%


Compare:National

Female

Male


2009 Medicare Hospice BeneficiariesWho Died Without Hospice: Race

780

2,492 5,365

1,429 903 360

11,32925,146

977,736

45 133199

1,042

134,972

2261

12

110 304

16,481

1984 113 269

20,189

5127 83 231

29,155

15 6,223

70%

75%

80%

85%

90%

95%

100%


Compare:National

N. Amer Native

Hispanic

Asian

Other

Black

White


9/2/2011

37

County-Specific Information Medicare BeneficiariesMedicare Beneficiaries

Who Died


With Hospice


Without Hospice

Compare: North Carolina 1,518,347 60,741 23,315 37,426

Compare: South Carolina 785,374 31,038 12,126 18,912

Compare: National 48,753,141 1,936,900 758,475 1,178,425

2009 Counties & Hospice Patients


5,233 2,901133,169

4,8102,704

142,544

4,7262,466

142,044

5,4952,806

173,799

6,2813,080

211,401

11,017 5,055383,664

0%

20%

40%

60%

80%

100%

Compare: North Carolina Compare: South Carolina Compare: National

>84

80-84

75-79

70-74

64-69

<64

2009 Medicare Beneficiaries Who Died Without Hospice: Age Categories


9/2/2011

38

18,181 9,502 586,916

19,381 9,510 599,705

0%

20%

40%

60%

80%

100%


Female

Male

2009 Medicare Beneficiaries Who Died Without Hospice: Sex


28,919

13,675

977,736

8,049

5,171

134,972

208 65

16,481

116 48

20,189

82 22

29,155

146 13 6,223

65%

70%

75%

80%

85%

90%

95%

100%


North American Native

Hispanic

Asian

Other

Black

White

2009 Medicare Beneficiaries Who Died Without Hospice: Race


9/2/2011

39

2009 Summary of Health Care Providers forMedicare Beneficiaries at the End of Life

2009 Settings In Which Medicare Beneficiaries Died – N (%)

CountyTotal Beneficiary

DeathsHospice Deaths Hospital Deaths SNF Deaths HHA Deaths Other Deaths

Compare: North Carolina 60,741 23,315 (38%) 14,535 (24%) 3,583 (6%) 1,178 (2%) 18,130 (30%)

Compare: South Carolina 31,038 12,126 (39%) 7,699 (25%) 1,335 (4%) 589 (2%) 9,289 (30%)

Compare: National 1,899,969 758,475 (40%) 408,986 (22%) 102,651 (5%) 44,938 (2%) 584,919 (31%)


The 2009 Medicare Data Was Recently Released:Who Provides Healthcare at the End of Life? Snapshots

2/22/11

Hospice 38% Hospice 39% Hospice 40%

Inpt Hospital 24% Inpt Hospital 25% Inpt Hospital 22%

SNF 6% SNF 4% SNF 5%Home Health 2% Home Health 2% Home Health 2%

None of These 30% None of These 30% None of These 31%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

North Carolina South Carolina NationalNote: Information reflects Medicare beneficiaries only; categories are not mutually exclusive.


9/2/2011

40

Summary:

Inpatient Hospitals in North Carolina cared for 235,068 Medicare beneficiaries, of whom 35,166 died (15%). (Compare national=15%.)

Of those who died: 14,535 (41%) died in a Inpatient Hospital (compare national=40%)

17,825 (51%) were admitted to a hospice (compare national=51%)

12,625 (36%) died under hospice care (compare national=37%)

Of those admitted to hospice: Hospice median length of stay=17 days (compare national=14 days)

Hospice mean length of stay=51 days (compare national=46 days)

2009 North Carolina Medicare Inpatient Hospitals


Summary:

Inpatient Hospitals in South Carolina cared for 125,286 Medicare beneficiaries, of whom 18,322 died (15%). (Compare national=15%.)

Of those who died: 7,699 (42%) died in a Inpatient Hospital (compare national=40%)

10,533 (57%) were admitted to a hospice (compare national=51%)

6,797 (37%) died under hospice care (compare national=37%)

Of those admitted to hospice: Hospice median length of stay=21 days (compare national=14 days)

Hospice mean length of stay=59 days (compare national=46 days)

2009 South Carolina Medicare Inpatient Hospitals


9/2/2011

41

57,551 30,933 1,657,816

35,490 17,772 1,001,501

25,874 13,374 751,976

21,891 11,792 636,827

20,868 10,764 633,174

0%

20%

40%

60%

80%

100%


Injury and Poisoning

Musculoskeletal System

Digestive System

Respiratory System

Circulatory System

2009 Top 5 Inpatient Hospital Diagnostic Categories (out of 19)


2009 Demographics & Inpatient Hospital Utilization

North Carolina South Carolina National

Population 9,380,884 4,561,242 307,006,550

Total Deaths78,306

0.8% of population42,027

0.9% of population2,486,097

0.8% of population

Medicare Beneficiaries 1,518,347 785,374 47,645,019

Medicare Beneficiary Deaths60,741

78% of total deaths31,038

74% of total deaths1,899,969

76% of total deaths

Medicare Inpatient Hospital Patients 235,068 125,286 6,938,545

Medicare Inpatient Hospital Patient Deaths







Total Days of Inpatient Hospital Care 2,028,655 Days 1,176,010 Days 63,792,525 Days

Mean Days / Patient of Inpatient HospitalCare

9 Days 9 Days 9 Days

Median Days / Patient of Inpatient Hospital Care

5 Days 5 Days 5 Days

Total Medicare Inpatient HospitalPayments $3,610,744,322 $1,935,997,067 $116,664,490,101


9/2/2011

42

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Please contact Hospice Analytics with any questions, comments, feedback, or for additional information:

W: www.HospiceAnalytics.com

P: 719-209-1237

E: [email protected]


Documents

Harnessing the Power of Data for Hospice Leaders, Part 1€¦ · Harnessing the Power of Data for Hospice Leaders, Part 1 Cordt T. Kassner, PhD Principal, Hospice Analytics 2011 Carolina’s