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Harnessing the Power of Data for Hospice Leaders, Part 1
Cordt T. Kassner, PhDPrincipal, Hospice Analytics
2011 Carolina’s Center for Hospice & End-of-Life Care Annual Meeting
September 26, 2011
In Partnership with:
Introduction & Background
www.HospiceAnalytics.com 2
Cordt T. Kassner, PhD
Principal
Hospice Analytics
2355 Rossmere Street
Colorado Springs, CO 80919
P: 719.209.1237
W: www.HospiceAnalytics.com
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Presentation Outline
Part 1:1. In the Beginning… Early Questions & Answers2. Data Available3. Data Applications for Hospice Administrators
Part II:1. Death Service Ratio2. Length of Service3. Hospice in Nursing Facilities4. Hospice Caps5. Data Driven Advocacy6. U-Shaped Curves7. Disaster Preparedness & Misc.
www.HospiceAnalytics.com 3
Part 1: Early Questions & Answers
How many hospices are there?
How many hospice patients are there?
2009: 3,336 Medicare Certified Hospices (primary locations);
~500 Medicare certified hospice satellite locations?
~100 non-Medicare Certified Hospices?
2009: 1,079,676 U.S. Medicare Hospice Admissions;
10,567 non-U.S. Medicare Hospice Admissions
~11% non-Medicare Hospice Admissions
~5% Medicaid; ~5% Private Pay; ~1% Charity
www.HospiceAnalytics.com 4
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Patients & Families – Hospice Compare
Providers – Access, Utilization, Competition
Quality Assurance - QIOs
Surveyors
Veteran’s Administration
Payers – CMS, MedPAC, Insurance Companies
Regulators – CMS, Program Integrity
Legislators – Local, State, and National
Everyone cares…
Data – Who Cares?
www.HospiceAnalytics.com 5
Consultants, from one-person boutiques to large corporations such as Thomson Reuters, make a business out of putting this data into an easily understandable form and answering clients' questions.
Hospice care, for example, used to be provided mostly by local, not-for-profit outfits. Now, more than half of the Medicare-licensed hospice providers are for profit, according to Cordt Kassner, whose one-man consulting firm, Colorado-based Hospice Analytics, serves a variety of hospice providers and state hospice associations. Mr. Kassner said he spends about $10,000 per year purchasing Medicare claims data.
One of his clients is Michigan-based Great Lakes Home Health & Hospice, which served about 27,000 patients last year, according to the company, including 16,500 home health-care and 1,500 hospice patients. Great Lakes CEO William Deary says he used the data to identify relatively under-served cities. In 2007, Mr. Deary's company opened an office in one such city, Lansing, and in doing so "increased our hospice revenue by 88% in 36 months," he said.
Wall Street Journal10/26/10 Front Page Story
www.HospiceAnalytics.com 6
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Presentation Outline
Part 1:1. In the Beginning… Early Questions & Answers2. Data Available3. Data Applications for Hospice Administrators
Part II:1. Death Service Ratio2. Length of Service3. Hospice in Nursing Facilities4. Hospice Caps5. Data Driven Advocacy6. U-Shaped Curves7. Disaster Preparedness & Misc.
www.HospiceAnalytics.com 7
1. Medicare datasets: Standard Analytic Files (aka, claims data), Denominator File, Provider of Service File, etc.
2. Medicare Cost Reports
3. Other national data files: Census, etc.
4. State and national hospice organization surveys
Overview of Publically Available Datasets
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Medicare datasets
Denominator File
Standard Analytic Files (aka, claims data): Research Identifiable Files (RIF) and Limited Data Sets (LDS) Hospice
Home Health Agencies
Skilled Nursing Facilities Hospital Inpatient
Hospital Outpatient
Carrier File: Physician, Laboratory, and other suppliers Durable Medical Equipment
Explanation of Publically Available Datasets
www.HospiceAnalytics.com 9
Medicare Datasets, continued:
Provider of Service File
Cost Reports
Medicare Provider Analysis & Review (MedPAR) File
Hospital Inpatient
Skilled Nursing Facilities
Other datasets:
Census: population, mortality
County Files: SSA & FIPS
State Medicaid Files
State & National Hospice Organization Surveys
Hospice QAPI and other information
Explanation of Publically Available Datasets, 2
www.HospiceAnalytics.com 10
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Medicare Datasets 2009 Populations Comments
Denominator48,756,649 Records48,753,141 Beneficiaries
1. Claims / Payment data2. RHHI’s and surveyors check
data3. All data reported for calendar
year4. Possible to compare providers,
states, nationally, etc.
5. Strong incentives for accurate data
Hospice3,888,151 Records1,090,867 Beneficiaries
Home Health Agency7,434,625 Records3,301,579 Beneficiaries
Skilled Nursing Facility5,535,663 Records1,824,315 Beneficiaries
Hospital Inpatient12,403,865 Records6,973,132 Beneficiaries
Provider of Service File122,973 Records66,378 Active3,336 Hospices
Comparison of Publically Available Datasets, 1
www.HospiceAnalytics.com 11
Cost Reports 2008 Populations Comments
Independent Hospices 2,098 Hospice Reports 1. Self-report2. No data verification3. Reported on provider’s fiscal
year (inconsistent timeframes)4. Difficult to compare providers,
states, nationally, etc.5. Cost reports collect different
information
6. No incentive for accurate data
Home Health Agency-based Hospices
597 Hospice Reports
Hospital-based Hospices
544 Hospice Reports
Skilled Nursing Facility-based Hospices
19 Hospice Reports
Total3,258 Hospice Reports
98% POS Matches
Comparison of Publically Available Datasets, 2
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Other Datasets 2009 Sample Comments
Census 307,006,550 Residents1. Actual census every decade,
estimates for other years
County Files3,549 SSA Counties3,457 FIPS Counties
1. Different types of counties, CBSA’s, “rural”, etc.
State Medicaid Medicaid Analytic eXtract (MAX)
1. 2007 data recently becameavailable
2. DUA and IRB approval required (RIF files)
3. Several challenges
State Hospice Organization Surveys ~12 States
1. Collect data on various surveys outside of basic membership dues calculations. Not generalizable across states, nationally
Comparison of Publically Available Datasets, 3
www.HospiceAnalytics.com 13
NHPCO Surveys Sample Comments
National Data Set (NDS)2009: 991 Hospices (30%)
plus supplemental materials
1. Similar comments as cost reports.
2. “This type of convenience sample is prone to unknown selection biases; therefore results may not be generalizable beyond the survey participants.” From EROM
3. Consistent data collection and reporting of results?
4. Hope for the future…
Family Evaluation of Hospice Care (FEHC)
2009: 1,297 Hospices (39%)40% of surveys completed
End Result Outcome Measures (EROM)
2010 1-3Q: 87 Hospices (3%)
Family Evaluation of Bereavement Services (FEBS)
No public results
Family Evaluation of Palliative Care (FEPC)
No public results
Survey of Team Attitudes and Relationships (STAR)
No public resultsPurchase results online
Patient Evaluation of Hospice Care? ?
Hospice Compare / other publicly reported quality measures?
?
Comparison of Publically Available Datasets, 4
www.HospiceAnalytics.com 14
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Presentation Outline
Part 1:1. In the Beginning… Early Questions & Answers2. Data Available3. Data Applications for Hospice Administrators
Part II:1. Death Service Ratio2. Length of Service3. Hospice in Nursing Facilities4. Hospice Caps5. Data Driven Advocacy6. U-Shaped Curves7. Disaster Preparedness & Misc.
www.HospiceAnalytics.com 15
The Breadth of Medicare Information Available
Hospice Provider Characteristics: number of (Medicare Certified) hospices, address, date of certification, date / reason of ownership change, date / reason of closure, date / reason of last survey, type of control (13 categories of non-profit, proprietary, and government), type of facility (freestanding, hospital-based, HHA-based, SNF-based), etc.
Hospice Patient Characteristics: number of patients served, age, sex, race, diagnoses, length of stay, level of care, Medicare reimbursement, patient status at discharge, location of care (2007), discipline providing care (2008), duration of visits (2010), etc.
www.HospiceAnalytics.com 16
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The Depth of Information Available
In addition to descriptive analyses (above), Medicare datasets can be combined in innovative ways to increase access to and utilization of hospice services, for example:
1. Calculations within the hospice file – cap calculations, surveys, net margins, etc.
2. Combining Medicare files – hospice utilization, detail provider and beneficiary characteristics, etc.
www.HospiceAnalytics.com 17
2009 Demographics & Hospice Utilization
North Carolina South Carolina National
Population 9,380,884 4,561,242 307,006,550
Total Deaths78,306
0.8% of population42,027
0.9% of population2,486,097
0.8% of population
Medicare Beneficiaries 1,518,347 785,374 47,645,019
Medicare Beneficiary Deaths60,741
78% of total deaths31,038
74% of total deaths1,899,969
76% of total deaths
Medicare Hospice Beneficiary Admissions33,938
43% of total deaths56% of Medicare deaths
20,20748% of total deaths
65% of Medicare deaths
1,079,67643% of total deaths
57% of Medicare deaths
Medicare Hospice Beneficiary Deaths23,315
30% of total deaths38.4% of Medicare deaths
12,12629% of total deaths
39.1% of Medicare deaths
752,94330% of total deaths
39.6% of Medicare deaths
Medicare Hospice Total Days of Care 2,483,846 Days 1,754,424 Days 76,724,901 Days
Medicare Hospice Mean Days / BeneficiaryMedicare Hospice Median Days / Beneficiary
73 Days28 Days
87 Days37 Days
71 Days24 Days
Medicare Hospice Total PaymentsMedicare Hospice Mean Payment / Beneficiary
$381,409,125$11,238
$260,143,849$12,874
$12,064,905,206$11,175
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North Carolina County-Level Hospice UtilizationTop 30 Counties (slide 1 of 3)Hospice Utilization= Medicare Hospice Deaths / Medicare Total Deaths
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North Carolina County-Level Hospice UtilizationCounties 31-60 (slide 2 of 3)Hospice Utilization= Medicare Hospice Deaths / Medicare Total Deaths
State Average 38%National Average 40%
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32%
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North Carolina County-Level Hospice UtilizationCounties 61-100 (slide 3 of 3)Hospice Utilization= Medicare Hospice Deaths / Medicare Total Deaths
Perhaps billing errors
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48%
48%
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42%
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South Carolina County-Level Hospice UtilizationTop 20 Counties (slide 1 of 2)Hospice Utilization= Medicare Hospice Deaths / Medicare Total Deaths
State Average 39%National Average 40%
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38%
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37%
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South Carolina County-Level Hospice UtilizationCounties 21-46 (slide 2 of 2)Hospice Utilization= Medicare Hospice Deaths / Medicare Total Deaths
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2009 Hospice Utilization(Medicare Hospice Deaths / Total Medicare Deaths)
0%
10%
20%
30%
40%
50%
60%
Ariz
ona
1U
tah
2Fl
orid
a 3
Del
awar
e 4
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a 5
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gon
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rgia
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o 1
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and
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tana
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Virg
inia
39
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40
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41
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ucky
42
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Nor
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7Ve
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New
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k 4
9W
yom
ing
50
Alas
ka 5
1
SC #24:39.1%
National:39.6%
NC #27:38.4%
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2009 Total Number of Hospices by StateNational= 3,336 Hospices; NC= 81 (#15); SC= 82 (#14)
316
231
174
133
131
126
121
112
112
103
98 9785 82 81 78 75 70 67 65 64 63 55 54 54 50 49 48 46 39 39 37 33 31 31 28 27 24 22 20 19 17 17 15 14 10 9 8 8 5 3
0
50
100
150
200
250
300
350Te
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Penn
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Neb
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and
37
Kent
ucky
38
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9W
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aine
41
Nev
ada
42
Wyo
min
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44
Nor
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Del
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2009 Total Number of Hospice Closures by StateNational= 29; NC= 0 (#5); SC= 1 (#14)
0
1
2
3
4
5
6
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2009 Total Number of Hospice Closure Reasons by StateVoluntary Merger or Closure: National= 27; NC= 0; SC= 1Voluntary Other: National= 2; NC= 0; SC= 0
0
1
2
3
4
5
6Voluntary Other
Voluntary Merger or Closure
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2009 Total Hospice PatientsNational= 1,079,676
010,00020,00030,00040,00050,00060,00070,00080,00090,000
100,000
Flor
ida
1C
alifo
rnia
2
Texa
s 3
Penn
sylv
ania
4
Ohi
o 5
Mic
higa
n 6
Illin
ois
7N
ew Y
ork
8N
orth
Car
olin
a 9
Geo
rgia
10
Ariz
ona
11
New
Jer
sey
12
Mis
sour
i 13
Alab
ama
14
Virg
inia
15
Indi
ana
16
Tenn
esse
e 1
7M
assa
chus
etts
18
Wis
cons
in 1
9So
uth
Car
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a 2
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ashi
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n 2
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klah
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22
Loui
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a 2
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n 2
4M
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25
Col
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o 2
6Io
wa
27
Mar
ylan
d 2
8M
issi
ssip
pi 2
9Ke
ntuc
ky 3
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nsas
31
Arka
nsas
32
Con
nect
icut
33
Uta
h 3
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evad
a 3
5W
est V
irgin
ia 3
6N
ew M
exic
o 3
7N
ebra
ska
38
Idah
o 3
9M
aine
40
Rho
de Is
land
41
Del
awar
e 4
2N
ew H
amps
hire
43
Mon
tana
44
Haw
aii
45So
uth
Dak
ota
46
Nor
th D
akot
a 4
7Ve
rmon
t 48
Dis
trict
of C
olum
bia
49
Wyo
min
g 5
0Al
aska
51
NC #9:33,938
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SC #20:20,207
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Executive Summary- 1
Hospice2009
Beneficiaries
Mean LOS
(days)
Median LOS
(days)County
Hospice Utilization
Died Without Hospice
Mountain Hospice 1,622 52 17 Aspen 44% 787
Moose Hospice 1,018 49 17 Blue Sky 47% 2,627
Blue Sky Hospice 693 44 16 Moose 37% 5,656
Lake Hospice 682 79 37 Mountain 38% 1,457
Plains Hospice 611 70 27 Lake 45% 914
Aspen Hospice 498 41 14 Peak 47% 365
Peak Hospice 490 39 9 TOTAL 41% 11,806
Scout Hospice 467 40 14 Compare: Colorado 37% 26,975
Whitewater Hospice 421 56 28 Compare: National 40% 1,178,425
Tree Line Hospice 366 93 36
All Others (N=25) 4,970 62 26
TOTAL 11,838 58 21
Compare: Colorado 21,805 63 23
Compare: National 1,090,862 72 24
Aggregate Cap Estimate= 39%-59% Last CMS Survey (years ago): 1.8 See Slide 4 note
Inpatient Cap Estimate= ~12% State CMS Survey Average (years) 3.2
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Executive Summary- 2
2009 Settings In Which Medicare Beneficiaries Died – N (%)
CountyTotal Beneficiary
DeathsHospice Deaths Hospital Deaths SNF Deaths HHA Deaths Other Deaths
Aspen 1,414 627 (44%) 192 (14%) 73 (5%) 22 (2%) 500 (35%)
Blue Sky 4,955 2,328 (47%) 856 (17%) 395 (8%) 200 (4%) 1,176 (24%)
Moose 8,972 3,316 (37%) 1,757 (20%) 673 (8%) 310 (3%) 2,916 (33%)
Mountain 2,342 885 (38%) 586 (25%) 257 (11%) 34 (1%) 580 (25%)
Lake 1,663 749 (45%) 247 (15%) 92 (6%) 39 (2%) 536 (32%)
Peak 691 326 (47%) 121 (18%) 42 (6%) 31 (4%) 171 (25%)
TOTAL 20,037 8,231 (41%) 3,759 (19%) 1,532 (8%) 636 (3%) 5,879 (29%)
Compare: Colorado 42,923 15,948 (37%) 9,468 (22%) 3,664 (9%) 943 (2%) 12,900 (30%)
Compare: National 1,936,900 758,475 (40%) 408,986 (22%) 102,651 (5%) 44,938 (2%) 584,919 (31%)
* Indicates CMS protected fields where cell size <11
Observations:1. Hospice Utilization is near the national average across most selected counties, although lower than an “accepted maximum” of 65%.2. Hospital deaths are lower than the national average in most counties. Mountain county is unusually high, perhaps due to the number of specialty
beds and academic medical centers in this county.3. Skilled Nursing Facility deaths are higher than the national average in most counties. Mountain county is unusually high.4. Home Health Agency deaths are higher than the national average in most counties. Blue Sky and Peak counties are unusually high.5. Other Deaths (i.e., outside of these four Medicare provider types; e.g., Medicare Advantage, Medicaid, private insurance, no payer, etc.) are lower
than the national average across most counties. Aspen county is unusually high.
www.HospiceAnalytics.com 35
Executive Summary- 3
Caps: Always be mindful of both the Hospice Overall Cap and Inpatient Care Cap. If you are not already monitoring your cap on a monthly basis, you might consider it. (Slides 13-14)
Surveys: According to CMS records, your last hospice survey (as of 12/31/09) was 1.8 years ago, and the state survey average is 3.2 years. If this is accurate, then your hospice has been surveyed more recently than most other hospices in the state. Your state surveys more often than the national hospice survey average of 3.7 years. (Slide 15)
Note: This data accounts for Medicare surveys only – only exceptions to these survey dates have involved deemed status accreditation surveys. If your hospice is accredited, it is possible that your accreditation survey has been more recent than what is posted in the CMS file.
www.HospiceAnalytics.com 36
9/2/2011
19
Executive Summary- 4
Hospice Utilization:
24,917 2009 Total Deaths in the selected counties
20,037 Medicare Deaths in the selected counties
Therefore, 80% of Total Deaths are Medicare Deaths in the selected counties; the national average is 80%. So while the Medicare population accounts for the vast majority of deaths, also consider Medicaid, private insurance, and other potential sources for expanding hospice utilization.
8,231 2009 Medicare Hospice Deaths
An accepted “maximum hospice utilization rate” is 65% of deaths, or 13,025 Medicare hospice deaths in the selected counties – 4,794 more patients than died in hospice in 2009. This is a good target for potential growth. (Slide 18)
www.HospiceAnalytics.com 37
Executive Summary- 5
Hospice Utilization:
Hospice utilization in the selected counties ranges from 37% in Moose to 47% in Blue Sky County. Peak county, where your hospice is located, averaged 47%. Most of these percentages are above the national average of 40% and near your state’s average of 37%. This is positive in terms of current increasing trends in hospice utilization (with a goal of 65%), and there appears to be opportunity for additional hospice utilization increased for several years ahead. (Slide 18)
www.HospiceAnalytics.com 38
9/2/2011
20
Executive Summary- 6
Hospice Utilization:
There is opportunity for growth and expansion when considering Medicare beneficiaries who died outside of hospice care. (Slides 45-49).
Age: Medicare beneficiaries who died outside of hospice tend to be slightly older in the selected counties for this report. (Slide 47)
Sex: Consider that hospices serve 60% females / 40% males, while Medicare beneficiaries who die outside of hospice are 50% females / 50% males. (Slides 40 and 48)
Race:Typically there are opportunities to expand hospice access across various racial groups, particularly with African Americans, Asians, and Hispanics. Always consider these possibilities both within and outside of Medicare populations. (Slide 49)
www.HospiceAnalytics.com 39
Report Sections:
1. Executive Summary (slides 1-7)
2. Hospice Local Information (slides 8-49)
3. Hospice State Information (slides 50-59)
4. Hospice National Information (slides 60-62)
5. Hospital Information (slides 63-72)
6. SNF Information (slides 73-82)
7. Home Health Information (slides 83-93)
* This PowerPoint presentation provides a summary of information. Please see Excel Spreadsheet for additional detail, including hospice comparisons by county and quarter.
www.HospiceAnalytics.com 40
9/2/2011
21
www.HospiceAnalytics.com 41
2009 Demographics and Medicare Hospice Utilization
County-Specific Information Aspen Blue Sky Moose Mountain Lake Peak Total
Total Population 201,876 742,582 1,505,006 405,906 299,276 123,589 3,278,235
Total Deaths 1,724 6,305 11,083 2,829 2,059 917 24,917
Medicare Beneficiaries 37,732 126,426 228,424 59,333 45,909 18,524 516,348
Medicare Beneficiary Deaths 1,414 4,955 8,972 2,342 1,663 691 20,037
Medicare Hospice Beneficiary Admits% of Medicare Deaths
83959%
3,14363%
4,54351%
1,13949%
1,02161%
41460%
11,09955%
Medicare Hospice Beneficiary DeathsUtilization= % of Medicare Deaths
62744.3%
2,32847.0%
3,31637.0%
88537.8%
74945.0%
32647.2%
8,23141.1%
www.HospiceAnalytics.com 42
9/2/2011
22
2009 Demographic and Medicare Hospice Utilization Comparisons
24,917
20,037
11,099
8,231
0
5,000
10,000
15,000
20,000
25,000
30,000
Total Deaths Medicare Deaths Hospice Admissions Hospice Deaths
www.HospiceAnalytics.com 43
2009 Medicare Hospice Beneficiaries Residing in theCounties Selected for this Report
County-Specific Information Beneficiaries Utilization DaysMean Days / Beneficiary
Median Days / Beneficiary
Mean Daily Census
Aspen 861 51,668 60 23 142
Blue Sky 3,218 196,439 61 22 538
Moose 4,699 278,323 59 21 763
Mountain 1,172 65,500 56 21 179
Lake 1,057 63,557 60 25 174
Peak 424 19,547 46 14 54
TOTAL 11,431 675,034 59 22 1,849
Compare: Colorado 21,805 1,365,446 63 23 3,741
Compare: National 1,090,862 78,203,910 72 24 214,257
www.HospiceAnalytics.com 44
9/2/2011
23
2009 Which Hospices Serve Beneficiaries Residing in the Counties Selected for this Report?
Hospice Aspen Blue Sky Moose Mountain Lake Peak Total
Mountain Hospice * 1,313 164 * * * 1,490
Moose Hospice * 632 216 19 107 * 975
Blue Sky Hospice * 288 221 * 15 * 532
Lake Hospice 58 * * * 196 196 462
Plains Hospice * * 12 393 27 * 438
Aspen Hospice * 61 352 * * * 416
Peak Hospice * 137 251 * * * 388
Scout Hospice * 71 298 * * * 375
Whitewater Hospice * 207 156 * * * 365
Tree Line Hospice * 12 320 * * * 334
All Others (N=289) 795 489 2,705 747 696 224 5,656
TOTAL 861 3,218 4,699 1,172 1,057 424 11,431
* Indicates CMS protected fields where cell size <11
See Excel spreadsheet for additional detail.
www.HospiceAnalytics.com 45
2009 Comparison of Hospices Serving Beneficiaries Residing in the Counties Selected for this Report
1,49
0
975
532
462
438
416
388
375
365
334
0
200
400
600
800
1,000
1,200
1,400
1,600
www.HospiceAnalytics.com 46
9/2/2011
24
2009 Which Hospices Serve Beneficiaries Residing in the Counties Selected for this Report?
0 0 0
58
0 0 0 0 0 0
795861
1,313
632
288
0
0
61
137
71
207
12
4893,218
164
216 221
0
12
352
251
298
156
320
2,705
4,699
0
19
0
0
393
0 0 0 0 0
747
1,172
0
10715
196
270 0 0 0 0
696 1,057
0 0 0
196
0 0 0 0 0 0224 424
0%
20%
40%
60%
80%
100%
MountainHospice
MooseHospice
Blue SkyHospice
LakeHospice
PlainsHospice
AspenHospice
PeakHospice
ScoutHospice
WhitewaterHospice
Tree LineHospice
All Others(N=289)
TOTAL
Peak
Lake
Mountain
Moose
Blue Sky
Aspen
www.HospiceAnalytics.com 47
2009 Admissions by Quarter in Selected CountiesSee Excel spreadsheet for additional detail
334
218
130
118
99 98 96
68
84
65
348
197
101
121
92 87 89 87
54
76
301
219
70
78
106
97
88
74
85
62
318
222
100
83
104
100
78
68
85
71
0
50
100
150
200
250
300
350
400
MountainHospice
Moose Hospice Blue SkyHospice
Lake Hospice Plains Hospice Aspen Hospice Peak Hospice Scout Hospice WhitewaterHospice
Tree LineHospice
1st Quarter2nd Quarter3rd Quarter4th Quarter
www.HospiceAnalytics.com 48
9/2/2011
25
2009: Explain the Difference Between theLast Section and This Section…
• The last section highlighted Medicare beneficiaries residing in counties selected for this report; this section highlights providers in counties selected for this report.
• For example, 96% of Medicare beneficiaries served by your hospice reside in the counties selected for this report; 4% come from outside these counties.
• Percentages exceeding 100% indicate beneficiaries residing in selected counties receiving hospice services outside of the selected counties.
2009 HospiceBeneficiaries Residing in
Selected Counties -Last Section
Total Beneficiaries -This Section
% Total Beneficiaries Residing in Selected
Counties
Mountain Hospice 1,490 1,622 92%
Moose Hospice 975 1,018 96%
Blue Sky Hospice 278 693 40%
Lake Hospice 375 682 55%
Plains Hospice 334 611 55%
Aspen Hospice 462 498 93%
Peak Hospice 416 490 85%
Scout Hospice 438 467 94%
Whitewater Hospice 365 421 87%
Tree Line Hospice 107 366 29%
All Others (N=25) 6,191 4,970 125%
TOTAL 11,431 11,838 97%
www.HospiceAnalytics.com 49
2009 Medicare Hospice Providers & Beneficiaries
Hospice Beneficiaries Utilization DaysMean Days / Beneficiary
Median Days / Beneficiary
Average Daily Census
Mountain Hospice 1,622 83,772 52 17 230
Moose Hospice 1,018 49,780 49 17 136
Blue Sky Hospice 693 30,346 44 16 83
Lake Hospice 682 54,172 79 37 148
Plains Hospice 611 42,924 70 27 118
Aspen Hospice 498 20,406 41 14 56
Peak Hospice 490 19,156 39 9 52
Scout Hospice 467 18,801 40 14 52
Whitewater Hospice 421 23,541 56 28 64
Tree Line Hospice 366 34,056 93 36 93
All Others (N=25) 4,970 307,538 62 26 843
TOTAL 11,838 684,492 58 21 1,875
Compare: Colorado 21,805 1,365,446 63 23 3,741
Compare: National 1,090,862 78,203,910 72 24 214,257
www.HospiceAnalytics.com 50
9/2/2011
26
2009 Medicare Beneficiaries Served by Hospice
1,622
1,018
693 682611
498 490 467421
366
0
200
400
600
800
1,000
1,200
1,400
1,600
1,800
MountainHospice
Moose Hospice Blue SkyHospice
Lake Hospice Plains Hospice Aspen Hospice Peak Hospice Scout Hospice WhitewaterHospice
Tree LineHospice
www.HospiceAnalytics.com 51
2009 Medicare Total Days of Care by Hospice
83,772
49,780
30,346
54,172
42,924
20,406 19,156 18,801
23,541
34,056
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000
90,000
MountainHospice
Moose Hospice Blue SkyHospice
Lake Hospice Plains Hospice Aspen Hospice Peak Hospice Scout Hospice WhitewaterHospice
Tree LineHospice
www.HospiceAnalytics.com 52
9/2/2011
27
2009 Medicare Mean Days of Care / Beneficiaryby Hospice
5249
44
79
70
4139 40
56
93
6258
63
72
0
10
20
30
40
50
60
70
80
90
100
MountainHospice
MooseHospice
Blue SkyHospice
LakeHospice
PlainsHospice
AspenHospice
PeakHospice
ScoutHospice
WhitewaterHospice
Tree LineHospice
All Others(N=25)
TOTAL Compare:Colorado
Compare:National
www.HospiceAnalytics.com 53
2009 Medicare Median Days of Care / Beneficiaryby Hospice
17 1716
37
27
14
9
14
28
36
26
21
2324
0
5
10
15
20
25
30
35
40
MountainHospice
MooseHospice
Blue SkyHospice
LakeHospice
PlainsHospice
AspenHospice
PeakHospice
ScoutHospice
WhitewaterHospice
Tree LineHospice
All Others(N=25)
TOTAL Compare:Colorado
Compare:National
www.HospiceAnalytics.com 54
9/2/2011
28
2009 Medicare Average Daily Census by Hospice
230
136
83
148
118
56 52 52
64
93
0
50
100
150
200
250
MountainHospice
Moose Hospice Blue SkyHospice
Lake Hospice Plains Hospice Aspen Hospice Peak Hospice Scout Hospice WhitewaterHospice
Tree LineHospice
www.HospiceAnalytics.com 55
2009 Medicare Reimbursement / Hospice
Hospice BeneficiariesTotal MedicareReimbursement
Mean MedicareReimbursement /
Beneficiary
Mountain Hospice 1,622 $15,484,819 $9,547
Moose Hospice 1,018 $8,279,079 $8,133
Blue Sky Hospice 693 $5,342,149 $7,709
Lake Hospice 682 $9,068,357 $13,297
Plains Hospice 611 $7,142,242 $11,689
Aspen Hospice 498 $3,407,379 $6,842
Peak Hospice 490 $3,833,975 $7,824
Scout Hospice 467 $3,595,394 $7,699
Whitewater Hospice 421 $3,836,517 $9,113
Tree Line Hospice 366 $5,795,797 $15,836
All Others (N=25) 4,970 $49,249,148 $9,893
TOTAL 11,838 $115,034,857 $9,717
Compare: Colorado 21,805 $230,195,947 $10,557
Compare: National 1,090,862 $12,210,869,288 $11,194
www.HospiceAnalytics.com 56
9/2/2011
29
2009 Total Medicare Reimbursement by Hospice
$15,484,819
$8,279,079
$5,342,149
$9,068,357
$7,142,242
$3,407,379 $3,833,975 $3,595,394 $3,836,517
$5,795,797
$0
$2,000,000
$4,000,000
$6,000,000
$8,000,000
$10,000,000
$12,000,000
$14,000,000
$16,000,000
$18,000,000
MountainHospice
MooseHospice
Blue SkyHospice
Lake Hospice PlainsHospice
AspenHospice
Peak Hospice ScoutHospice
WhitewaterHospice
Tree LineHospice
www.HospiceAnalytics.com 57
2009 Mean Medicare Hospice Reimbursement / Beneficiary
$9,547
$8,133 $7,709
$13,297
$11,689
$6,842
$7,824 $7,699
$9,113
$15,836
$9,893 $9,717 $10,557
$11,194
$0
$2,000
$4,000
$6,000
$8,000
$10,000
$12,000
$14,000
$16,000
$18,000
www.HospiceAnalytics.com 58
9/2/2011
30
2009 Medicare Hospice BeneficiariesCancer / Non-Cancer
1,040601
347
555
336
334289 276
269269 3,450 7,766 14,008 743,180
582417
346
127
275
164201 191
15297 1,520 4,072 7,797 347,682
0%
20%
40%
60%
80%
100%
Cancer
Non-Cancer
www.HospiceAnalytics.com 59
2009 Medicare Hospice BeneficiariesTop Six ICD-9 Diagnostic Categories (out of 19)
522413
346
125
274
164 167189
127 94 1,430 3,8517,797 344,811
230
133
121
46
118
80 6155
53 48635
1,580
6,993301,000
25378
43
229
73
63
2813
30
64 5501,424 4,364
152,457
113 67
45
33
38
39
3039
25
33
352814 3,384
142,144
13656
42
50
55
32
25
47
51
50
4951,039
3,591137,457
239204
22
135
28
93
143104
116
27
949 2,0604,328 134,995
0%
20%
40%
60%
80%
100%
Ill-defined
Nervous
Respiratory
Mental
Circulatory
Cancers
www.HospiceAnalytics.com 60
9/2/2011
31
2009 Medicare Hospice BeneficiariesStatus at Discharge
1,274746 496
434 397
391 387 374303
2243,473 8,499 15,948 758,473
137144 116
99110
66 41 3158
54
639 1,495 2,378131,389
211 128 81149
10441
62 62 6088
858 1,844 3,479 201,000
0%
20%
40%
60%
80%
100%
Still PT
DC Alive
DC Deceased
www.HospiceAnalytics.com 61
2009 Medicare Hospice BeneficiariesAge Categories
64 65 5016
53 23 15 22 15 21 173 517 921 56,208107
88 77
23
5646
1839
2628
282 790 1,471 89,957126
9375
44
6350
36
58
2830
389992 1,810
109,316
203
150
117
85
8176
64
77
6544
6431,605 2,879
155,716
328
194
135
157
93 94
113
83
92 61 9902,340 4,391
216,582
794428
239
357265 209
244188
195 182 2,493 5,594 10,333463,083
0%
20%
40%
60%
80%
100%
>84
80-84
75-79
70-74
64-69
<64
www.HospiceAnalytics.com 62
9/2/2011
32
2009 Medicare Hospice BeneficiariesSex
606 403309
212236 206 207 187 178
126 1,778 4,448 8,271 439,903
1,016 615384
470375 292 283 280 243
240 3,192 7,390 13,534 650,959
0%
20%
40%
60%
80%
100%
Female
Male
www.HospiceAnalytics.com 63
2009 Medicare Hospice BeneficiariesRace
1,590976
608
659
524
494 480 456
398
320
4,83211,337 20,744
960,848
17
58
13
55
14
33
56263 595
87,651
1511 23 78 144
20,126
11 14 51 1168,6183,503
37 86 163 8,343
80%
85%
90%
95%
100%
Other
North Amer Native
Asian
Hispanic
Black
White
www.HospiceAnalytics.com 64
9/2/2011
33
2009 Medicare Hospice BeneficiariesLevels of Care (days)
79,292
48,929 30,14953,762
42,510
19,548
17,56917,470
23,320 33,931 300,470
666,9501,343,839
75,313,071
4,415
1,107 702794
348
747
1,4321,379
221409 2,669
14,22322,557
1,590,715
44 26 18 15179
28 14815 248 731 1,244
165,401
90%
92%
94%
96%
98%
100%
Cont. Home Care
Respite Care
General Inpt
Routine Home Care
www.HospiceAnalytics.com 65
2009 Medicare Hospice BeneficiariesLocations of Care (days, new in 2007)
35,876
37,437
28,141
4,559
34,233
11,693
15,140
9,016
14,496
13,721122,910
327,222 635,100
45,887,608
39,445
21,161
9,477
47,616
4,624
11,651
4,789
7,719
7,968
15,412175,452 345,314
702,92514,701,238
9,876 7571,159 2,386
3,694
2,515
15 991 1,048 25,08047,521
70,822
9,361,433
2,9143,801
12
14,069
2,043
554 23,396 9,693
8,509,253
421 1,259 978 305 273 832 102 272 462 1,170 6,076 11,594 3,529,112
0%
20%
40%
60%
80%
100%
All Other Settings
Inpatient Hospice
Assisted LivingFacility
Skilled / Non-SkillNrsng Fac
Home
www.HospiceAnalytics.com 66
9/2/2011
34
2009 Medicare Hospice BeneficiariesVisits by Discipline (new in 2008)
41,54728,780
8,172
31,159
17,54111,723
8,0099,332
10,777137,657 304,697 504,451
29,766,570
23,83620,089
9,417
5,819
15,30216,476 8,670
14,127
10,39298,959 212,087 361,669
28,754,434
3,803 4,421 1,607 4,771 2,741 1,131 1,338 1,7561,595 21,031 44,194 76,170 4,622,109
2,113 287 50 165 612
338
347 3,912 6,039 1,223,418
0%
20%
40%
60%
80%
100%
Physician and NP
Social Services
Skilled Nursing
Hospice Aide
www.HospiceAnalytics.com 67
Who was missed?That is, who died without hospice care?
There is little information available regarding Medicare beneficiaries who died outside of hospice care.
This section highlights what information is available in the counties selected for this report.
Specialty reports on Inpatient Hospitals, Skilled Nursing Facilities, and Home Health Agencies are available through your state hospice organization. These reports provide some additional information on Medicare beneficiaries receiving services by other provider types.
www.HospiceAnalytics.com 68
9/2/2011
35
2009 Counties & Medicare Hospice Beneficiaries
County-Specific Information Medicare BeneficiariesMedicare Beneficiaries
Who Died
Medicare BeneficiariesWho Died
With Hospice
Medicare BeneficiariesWho Died
Without Hospice
Aspen 37,732 1,414 627 787
Blue Sky 126,426 4,955 2,328 2,627
Moose 228,424 8,972 3,316 5,656
Mountain 59,333 2,342 885 1,457
Lake 45,909 1,663 749 914
Peak 18,524 691 326 365
TOTAL 516,348 20,037 8,231 11,806
Compare: Colorado 1,087,158 42,923 15,948 26,975
Compare: National 48,753,141 1,936,900 758,475 1,178,425
www.HospiceAnalytics.com 69
2009 Medicare Hospice BeneficiariesWho Died Without Hospice: Age Categories
88 250 476 164 98 501,126 2,449 133,169
79243 530
152 10742
1,153 2,575142,544
88234 562
149 10841
1,182 2,601
142,044
130
374 849200
12453
1,730 3,809
173,799
122
523 1,032281 161
59
2,178 5,017
211,401
284 1,013 2,229516 320 120
4,482 10,611383,664
0%
20%
40%
60%
80%
100%
Aspen Blue Sky Moose Mountain Lake Peak TOTAL Compare:Colorado
Compare:National
>84
80-84
75-79
70-74
64-69
<64
www.HospiceAnalytics.com 70
9/2/2011
36
2009 Medicare Hospice BeneficiariesWho Died Without Hospice: Sex
395 1,242 2,640 696 463 172 5,608 12,663 586,916
396 1,395 3,038 766 455 193 6,243 14,399 599,705
0%
20%
40%
60%
80%
100%
Aspen Blue Sky Moose Mountain Lake Peak TOTAL Compare:Colorado
Compare:National
Female
Male
www.HospiceAnalytics.com 71
2009 Medicare Hospice BeneficiariesWho Died Without Hospice: Race
780
2,492 5,365
1,429 903 360
11,32925,146
977,736
45 133199
1,042
134,972
2261
12
110 304
16,481
1984 113 269
20,189
5127 83 231
29,155
15 6,223
70%
75%
80%
85%
90%
95%
100%
Aspen Blue Sky Moose Mountain Lake Peak TOTAL Compare:Colorado
Compare:National
N. Amer Native
Hispanic
Asian
Other
Black
White
www.HospiceAnalytics.com 72
9/2/2011
37
County-Specific Information Medicare BeneficiariesMedicare Beneficiaries
Who Died
Medicare BeneficiariesWho Died
With Hospice
Medicare BeneficiariesWho Died
Without Hospice
Compare: North Carolina 1,518,347 60,741 23,315 37,426
Compare: South Carolina 785,374 31,038 12,126 18,912
Compare: National 48,753,141 1,936,900 758,475 1,178,425
2009 Counties & Hospice Patients
www.HospiceAnalytics.com 73
5,233 2,901133,169
4,8102,704
142,544
4,7262,466
142,044
5,4952,806
173,799
6,2813,080
211,401
11,017 5,055383,664
0%
20%
40%
60%
80%
100%
Compare: North Carolina Compare: South Carolina Compare: National
>84
80-84
75-79
70-74
64-69
<64
2009 Medicare Beneficiaries Who Died Without Hospice: Age Categories
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18,181 9,502 586,916
19,381 9,510 599,705
0%
20%
40%
60%
80%
100%
Compare: North Carolina Compare: South Carolina Compare: National
Female
Male
2009 Medicare Beneficiaries Who Died Without Hospice: Sex
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28,919
13,675
977,736
8,049
5,171
134,972
208 65
16,481
116 48
20,189
82 22
29,155
146 13 6,223
65%
70%
75%
80%
85%
90%
95%
100%
Compare: North Carolina Compare: South Carolina Compare: National
North American Native
Hispanic
Asian
Other
Black
White
2009 Medicare Beneficiaries Who Died Without Hospice: Race
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2009 Summary of Health Care Providers forMedicare Beneficiaries at the End of Life
2009 Settings In Which Medicare Beneficiaries Died – N (%)
CountyTotal Beneficiary
DeathsHospice Deaths Hospital Deaths SNF Deaths HHA Deaths Other Deaths
Compare: North Carolina 60,741 23,315 (38%) 14,535 (24%) 3,583 (6%) 1,178 (2%) 18,130 (30%)
Compare: South Carolina 31,038 12,126 (39%) 7,699 (25%) 1,335 (4%) 589 (2%) 9,289 (30%)
Compare: National 1,899,969 758,475 (40%) 408,986 (22%) 102,651 (5%) 44,938 (2%) 584,919 (31%)
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The 2009 Medicare Data Was Recently Released:Who Provides Healthcare at the End of Life? Snapshots
2/22/11
Hospice 38% Hospice 39% Hospice 40%
Inpt Hospital 24% Inpt Hospital 25% Inpt Hospital 22%
SNF 6% SNF 4% SNF 5%Home Health 2% Home Health 2% Home Health 2%
None of These 30% None of These 30% None of These 31%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
North Carolina South Carolina NationalNote: Information reflects Medicare beneficiaries only; categories are not mutually exclusive.
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Summary:
Inpatient Hospitals in North Carolina cared for 235,068 Medicare beneficiaries, of whom 35,166 died (15%). (Compare national=15%.)
Of those who died: 14,535 (41%) died in a Inpatient Hospital (compare national=40%)
17,825 (51%) were admitted to a hospice (compare national=51%)
12,625 (36%) died under hospice care (compare national=37%)
Of those admitted to hospice: Hospice median length of stay=17 days (compare national=14 days)
Hospice mean length of stay=51 days (compare national=46 days)
2009 North Carolina Medicare Inpatient Hospitals
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Summary:
Inpatient Hospitals in South Carolina cared for 125,286 Medicare beneficiaries, of whom 18,322 died (15%). (Compare national=15%.)
Of those who died: 7,699 (42%) died in a Inpatient Hospital (compare national=40%)
10,533 (57%) were admitted to a hospice (compare national=51%)
6,797 (37%) died under hospice care (compare national=37%)
Of those admitted to hospice: Hospice median length of stay=21 days (compare national=14 days)
Hospice mean length of stay=59 days (compare national=46 days)
2009 South Carolina Medicare Inpatient Hospitals
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57,551 30,933 1,657,816
35,490 17,772 1,001,501
25,874 13,374 751,976
21,891 11,792 636,827
20,868 10,764 633,174
0%
20%
40%
60%
80%
100%
Compare: North Carolina Compare: South Carolina Compare: National
Injury and Poisoning
Musculoskeletal System
Digestive System
Respiratory System
Circulatory System
2009 Top 5 Inpatient Hospital Diagnostic Categories (out of 19)
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2009 Demographics & Inpatient Hospital Utilization
North Carolina South Carolina National
Population 9,380,884 4,561,242 307,006,550
Total Deaths78,306
0.8% of population42,027
0.9% of population2,486,097
0.8% of population
Medicare Beneficiaries 1,518,347 785,374 47,645,019
Medicare Beneficiary Deaths60,741
78% of total deaths31,038
74% of total deaths1,899,969
76% of total deaths
Medicare Inpatient Hospital Patients 235,068 125,286 6,938,545
Medicare Inpatient Hospital Patient Deaths
14,53518% of total deaths
24% of Medicare deaths
7,69918% of total deaths
25% of Medicare deaths
408,98616% of total deaths
22% of Medicare deaths
Total Days of Inpatient Hospital Care 2,028,655 Days 1,176,010 Days 63,792,525 Days
Mean Days / Patient of Inpatient HospitalCare
9 Days 9 Days 9 Days
Median Days / Patient of Inpatient Hospital Care
5 Days 5 Days 5 Days
Total Medicare Inpatient HospitalPayments $3,610,744,322 $1,935,997,067 $116,664,490,101
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Thank you
Please contact Hospice Analytics with any questions, comments, feedback, or for additional information:
W: www.HospiceAnalytics.com
P: 719-209-1237
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