Eli's Hospice Insider

Live discharges grow from 13% to 18% over decade.

The Centers for Medicare & Medicaid Services is using this data compiled and analyzed by contractor Abt Associates to help decide the future of your payment rates:

• In 2012, 28.9 percent of beneficiaries had no skilled visit in the last day of care, when the last day was billed as Routine Home Care.

• In 2012, 14.4 percent of beneficiaries had no skilled visit in the last two days of care, when those days were billed as RHC. The figure dropped to 9.1 percent for three days and 6.2 percent for four days.

• When the patient’s day of death was a Sunday, 23.4 percent had no skilled visits during the last two days of life. For Monday 17.1 percent had no skilled visits during the last two days of life, for Tuesday 9.1 percent, Wednesday 11.9 percent, Thursday 12.2 percent, Friday 11.8 percent, Saturday 14.6 percent.

• States with the lowest percentage of beneficiaries with no visits on the last two days of life were Wisconsin (5.7 percent), North Dakota (7.3 percent), Vermont (7.5 percent), Tennessee (7.5 percent), and Kansas (8.7 percent).

• States with the highest percentage of beneficiaries with no visits on the last two days of life were

• New Jersey (23.0 percent), Massachusetts (22.9 percent), Oregon (21.2 percent), Washington (21.0 percent), and Minnesota (19.4 percent).

• The Medicare Payment Advisory Commission noted that in 2009, hospices above their cap had a 48 percent live discharge rate compared to 16 percent in below-cap hospices.

• The average live discharge rate grew from 13.2 percent in 2000 to 18.2 percent in 2010.

• Twenty-five percent of beneficiaries in 2011 had stays of five days or less.

• Rebasing using current cost information would result in a reduction in the FY 2014 Routine Home Care payment rate of 10.1 percent.

• Of the $16.3 billion Medicare spent on hospice beneficiaries in 2012, $15 billion was for hospice services and $1.3 billion for non-hospice services.

• Ninety-five percent of hospices days billed are for RHC.

• Hospice patients in a nursing facility receive more visits than patients in the home after controlling for patient and provider characteristics.

Source: Abt Associates slides and presentation at Jan. 16 Open Door Forum for home care providers.