Supplemental Comparative Billing Report for Hospices
October 17, 2013 12:50 PM
SafeGuard Services released Supplemental Report for CBR027: Hospice Services Findings from a Retrospective Cohort Study. For this report, the claims data of 15,797 hospice patients who died over a seven day period in May 2013 was analyzed for the type of services utilized, the diagnosis at time of death and the length of stay.
In June 2013, a Comparative Billing Report (CBR) was disseminated to 3,459 hospice agencies in the country. The report compared individual hospice utilization data to regional and national utilization measures. The CBR study, however, did not provide data on overall length of stay in hospice per beneficiary or the top diagnoses among hospice patients. Moreover, according to the report, Centers for Medicare & Medicaid Services (CMS) hospice subject matter experts (SMEs) indicated that General Inpatient Care (GIP) might be insufficiently offered by hospice agencies. This supplemental report takes a look at these areas of hospice care delivered to Medicare patients.
The report compared the average number of days a patient is receiving hospice care to the average number of days between the first date a patient ever enrolled in hospice to the time of death while enrolled in hospice. The supplemental report found that, on average, a hospice patient utilized hospice services for 80.34 days and, on average, the lapsed time between first enrolling in hospice to dying while enrolled in hospice was 110.21 days.
There was a significant difference of almost 30 days between these two measures of length of stay meaning that, on average, a patient received hospice care for 80.34 consecutive days prior to the date of death but due to a previous enrollment and subsequent revocation/discharge a total of 110.21 days lapsed between the patient’s initial enrollment in hospice care to the day of death and the patient almost 30 days of non-hospice care over the course of the 110.21days.
The report cites CMS data indicating that the primary diagnosis at time of enrollment in hospice and at time of death remained the same and is consistent with other reported data on diagnosis at time of death. The top 20 diagnoses at time of death continue to move toward more neurological diseases and less cancer diseases. In accordance with this shift, the average number of days in hospice has also increased. The supplemental report data specifically shows an average length of stay for “debility” to be 117 days while CMS’ data for debility in 2009 was 83 days.
Of the 1,294,480 hospice days of service for the 15,797 hospice patients reviewed, the majority of services were billed under the Routine Home Care revenue code. The next largest revenue code used was General Inpatient Care at only 1.95% of all revenue codes used. The site of service for the majority of the patients (70.1%) was within their home (private and assisted living). Almost 20% of all hospice days occurred in a long term nursing facility followed by 6.83% in a skilled nursing facility. Over 50% of all hospice days are devoted to the care of “Debility”, “Dementia”, “Alzheimer’s” and “Adult failure to thrive”. The average length of stay in hospice for all diagnoses was 160.64 days, but overall hospice patients in this cohort had Alzheimer’s as a primary diagnosis for 181.96 days on average.
SafeGuard Services indicated in this report that it has been implied that GIP care is not sufficiently available for hospice patients. The data showed that only 25,276 (1.95%) hospice days were delivered to this group of hospice patients and the majority of these occurred in an inpatient hospice facility (70.22%).
To be clear, this is a supplemental report and hospices will not be receiving an additional CBR comparing their performance in the areas studied in this report. It is interesting to note that in gathering data for the report, SafeGuard Services found that one fifth of hospices agencies active in 1999 had closed by 2009.