Home Health & Hospice Week

CMS puts long LOS, high live discharge rates under its microscope.

Medicare is analyzing the hospice data you are now submitting via claims and cost reports, and officials aren’t liking everything they see.

At the National Association for Home Care & Hospice’s March on Washington conference, the Centers for Medicare & Medicaid Services revealed a long list of new statistics it has gleaned from hospices’ newly collected data.

Among the revelations from CMS’s Hillary Loeffler in a March 24 session at the conference:

• Medicare’s non-hospice-benefit spending on beneficiaries who have elected the benefit varies widely. For the bottom 10 percent of hospices (equaling 373 agencies), Medicare spent an average of only
$197 per beneficiary outside of the benefit. On the other end of the spectrum, for the highest 10 percent of hospice agencies, CMS spent $1,289 per beneficiary.

• Patients with primary diagnoses of Debility and Adult Failure to Thrive had the highest Medicare spending.

• About 20 percent of hospices never billed a single General Inpatient (GIP) day in the period CMS reviewed. On the other hand, 46 hospices billed 10 percent or more of their days as GIP.

• Hospices also varied widely on length of stay, although the national average was 95 days. At the extreme end, nine hospices had an average LOS of more than 540 days, Loeffler reported. “Who are these
people?” exclaimed one attendee in the audience of the packed session.

• Another incredible figure was that 71 hospices had live discharges on 100 percent of patients. Those hospices had an average LOS of 193 days.

• Hospice agencies averaged live discharges of 10.89 percent of their patients in 2013.

• Based on 2012 claims data, 10 percent of hospice beneficiaries did not receive a skilled visit in their last 48 hours of life. The claims data wouldn’t reflect non-skilled visits such as aides or chaplains,
though, Loeffler noted.

• In 2006, 9 percent of hospices exceeded the aggregate per beneficiary cap. In 2009, that figure was 13 percent. In 2013, CMS is expecting that the figure dropped to about 11 percent.

• Hospices that exceed their per bene caps tend to have long LOS, high profit margins, and a high live discharge rate, Loeffler told attendees.

• Hospices’ average cost for drugs was $20 in 2004 and $10 in 2012.

What now? One attendee asked why CMS doesn’t go after the hospices with extreme statistics. Loeffler responded that CMS may turn over the data to its contractors for further investigation.