Eli's Hospice Insider

Average LOS soars, but median LOS remains steady.

The Medicare Payment Advisory Commission, law- and policymakers are basing their decisions about Medicare hospice payment and regulation on the following facts:

• In 2009, nearly 1.1 million Medicare beneficiaries received services from 3,476 hospice providers for a total of $12 billion in expenditures. In comparison, the number of hospice users in 2000 was 513,000, hospice providers numbered 2,318, and spending was $2.9 billion.
• In 2008, 67 percent of hospices were freestanding, 17 percent HHA-based, and 16 percent hospital-based. Sixty-nine percent were urban, 31 percent rural.
• In 2000, 22.9 percent of Medicare beneficiaries used hospice services; in 2009 42.0 percent did.
• Average length of stay for hospice decedents was 54 days in 2000 and 86 days in 2009. But median length of stay has remained the same at 17 days during that time period. Growth in average LOS has slowed "somewhat" in recent years, MedPAC observes.
• Very long hospice stays have grown longer -- the 90th percentile for LOS was 141 days in 2000 and 247 days in 2009.
• In 2008, average LOS for patients served by forprofit hospices was 98 days; for non-profits, 68 days. Freestanding hospices saw an average LOS of 86 days, HHA-based 70 days, and hospitalbased 63 days.
• In 2008, 10.2 percent of hospices exceeded the hospice cap. In 2000, 2.6 percent did.