Home Health & Hospice Week

LOS ticks upward.

You have only a matter of days left to give Medicare your two cents on its proposed rule for hospice payment for next year. Consider these 2017 statistics revealed in the 2019 rule when formulating your feedback:

• The average length of stay was 79.7 days, increasing slightly from 79.2 days in FY 2016 and 78.1 days in FY 2015.
• The lifetime LOS has remained steady in the 96-day range over the past several years.
• The median LOS at 18 days has also remained steady over the past several years.
• About 98 percent of hospice days were for Routine Home Care, with 1.4 percent General Inpatient care, 0.3 percent Continuous Home Care, and 0.3 percent Inpatient Respite Care.
• The group of diagnoses with the longest LOS were neuro (Alzheimer’s, Dementia, and Parkinson’s) with 191 days, while the shortest was Chronic Kidney Disease with 61 days.
• About 16.7 percent of hospice beneficiaries were discharged alive in 2017, with beneficiary revocations representing 44 percent, determinations the patient was no longer terminally ill 45 percent, and transfers to other hospices 9 percent.
• The live discharge rate declined from 21.9 percent in 2007 to 16.4 percent in 2015, then rose again to 17.0 percent in 2016 and is back down to 16.7 percent.
• About 22 percent of live discharges occurred within 30 days of the start of hospice care, 10 percent between 31 to 60 days, 14 percent between 61 to 90 days, 20 percent between 91 to 180 days, and 35 percent after a more than 180 days.
• The number of beneficiaries using hospice was nearly 1.5 million, compared to 513,000 in 2000.
• Medicare spent about $17.5 billion, compared to $2.8 billion in 2000.
• Alzheimer’s Disease (G30.9) was the top diagnosis in 2017, compared to lung cancer in 2002.
• The next-most-common diagnoses, in order, were COPD (J44.9), heart failure (I50.9), and Senile degeneration of brain (G31.1), with lung cancer (C34.90) now in fifth place.
• In 2017, 100 percent of hospices reported more than one diagnosis on claims, 89 percent submitted at least two diagnoses, and 81 percent included at least three diagnoses.

Note: The rule, including instructions for commenting, is at www.gpo.gov/fdsys/pkg/FR-2018-05-08/pdf/2018-08773.pdf.