Reg's Blog

Senior and Post-Acute Healthcare News and Topics

CMS Releases Hospice Stats

Within the past two weeks, CMS released data from 1998 to 2008 for length of stay and diagnosis trends.  What is interesting to note is the utilization trends (length of stay and numbers) over the period as well as the diagnosis correlated to utilization.  For CMS and in particular MedPAC, the prevailing concern has been programmatic growth (additional spending) correlated to diagnoses once rarely encountered.  A secondary concern that arises from the first is length of stay.  In summary, as diagnoses such as Dementia and Failure to Thrive and Debility become more common and frequent, length of stay has crept up (longer).  Reading between the lines, CMS and MedPAC have raised the issue of unjustifiable diagnosis and unwarranted lengths of stay, particularly as connected to hospice patients in SNF settings and now provided the data publicly to support or reinforce their conclusions.  Data being what data is, it neither wholly supports or refutes but if you are CMS or MedPAC, you could clearly use the data to reinforce the case that lengths of stay are up (justifiably perhaps) and the typical terminal diagnoses once predominant in Hospice are no longer quite so typical.

I’ve provided a link to the CMS reports below.  A brief sample or highlights for those that don’t wish to download the reports follows.

  • In 1998, the number one diagnosis (most patients) was Lung Cancer with an average length of stay of 43 days.  In 2008, the number one diagnosis was Non-Alzheimer’s Dementia with an average length of stay of 89 days.
  • In 1998, Alzheimer’s was ranked number 12 with an average length of stay of 57 days.  In 2008, Alzheimer’s had moved to a ranking of 8 with an average length of stay of 105 days.
  • In 1998, the second most prominent diagnosis was CHF with an average length of stay of 52 days.  In 2008, the second most prominent diagnosis was Debility/NOS  with an average length of stay of 83 days.
  • In 1998, the average hospice length of stay was 48 days and in 2008, the average length of stay was 71 days.
  • Failure to Thrive didn’t appear as a top 20 diagnosis until 2001 when the average length of stay was 52 days.  By 2008, the average length of stay had jumped to 82 days. 
  • The top five diagnoses with an increase in length of stay greater than 50% since 1998 are (greatest to least): Failure to Thrive at 64.2%; Debility/NOS at 62.7%; Alzheimer’s at 56.7%;  Non-Alzheimer’s Dementia at 56.1%; Parkinson’s at 55.2%.  The diagnoses with the smallest percentage of increase or that decreased all were cancer related except pneumonia and chronic liver disease.

The data can be found and accessed at http://www.cms.hhs.gov/center/hospice.asp

 

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November 4, 2009 - Posted by | Hospice, Policy and Politics - Federal | , , , , ,

1 Comment »

  1. You give excellent insight into what is going on in the hospice industry. What should be coupled with the facts noted is the reversal between nonprofit and for-profit hospice corporation involvement. Years ago, almost all hospices were nonprofit, now for-profit hospices are taking over, and studies show that services provided are fewer in for-profit hospices. They view hospice as a money-maker.

    Whenever hospice is “making money,” there is fraud involved as the reimbursement arrangement is frugal. When a hospice with integrity provides all required services, they just break even, they do not “make money,” as so many for-profit hospice corporations are doing.

    Comment by Ron Panzer, Pres., Hospice Patients Alliance | December 29, 2010 | Reply


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