Medicare Payment Policy

tABLe
12–5
Characteristic
insurers are experimenting with this approach among
the commercially insured, working-age, managed care
population. One insurer reported that its concurrent care
program resulted in greater hospice enrollment, less use
of intensive services, and lower costs (Krakauer et al.
2009). It is uncertain whether this type of approach would
yield savings in a Medicare FFS environment, with the
absence of health plan utilization management and an
elderly population with a greater prevalence of noncancer
diagnoses, which tend to result in longer hospice stays.
Length of stay varies by observable patient characteristics,
such as patient diagnosis and location, which makes it
possible for providers to focus on more profitable patients
Hospice average length of stay among decedents
by beneficiary and hospice characteristics, selected years
Average length of stay among decedents (in days)
2000 2009 2010 2011
Beneficiary
Diagnosis
Cancer 50 53 53 52
Neurological conditions 63 132 134 137
Heart/circulatory 46 76 76 74
Debility 49 98 97 97
COPD 69 107 110 107
Other
Main location of care
48 85 88 86
Home N/A 87 87 88
Nursing facility N/A 107 111 111
Assisted living facility N/A 143 148 149
Hospice facility or hospital N/A 14 14 15
Hospice
Hospice ownership
For profit 59 100 101 102
Nonprofit 49 69 70 69
Type of hospice
Freestanding 55 87 89 89
Home health based 46 70 69 68
Hospital based 49 62 62 61
Note: COPD (chronic obstructive pulmonary disease), N/A (not available). Average length of stay is calculated for Medicare beneficiaries who died in a given year and
used hospice that year and reflects the total number of days the decedent was enrolled in the Medicare hospice benefit during his/her lifetime. Main location is
defined as the location where the beneficiary spent the largest share of his/her hospice days in a given year.
Source: MedPAC analysis of 100 percent hospice claims standard analytical file data, Medicare Beneficiary Database, Medicare hospice cost reports, Provider of Services
file data from CMS.
(Table 12-5). For example, Medicare decedents in 2011
with neurological conditions and chronic obstructive
pulmonary disease had substantially higher average
lengths of stay (137 days and 107 days, respectively)
than those with cancer (52 days) and heart or circulatory
conditions (74 days). While length of stay changed little
for most diagnosis groups in the last three years, length of
stay for decedents with neurological conditions increased
five days between 2009 and 2011—from 132 days to 137
days.
Differences in length of stay by diagnosis are reflected
in the percentile distribution of length of stay (Table 12-
6, p. 274). Length of stay is similar for patients with the
Report to the Congress: Medicare Payment Policy | March 2013
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