harnessing the power of data for hospice leaders, … 1 harnessing the power of data for hospice...

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Harnessing the Power of Data for Hospice Leaders, Part 1

Cordt T. Kassner, PhDPrincipal, Hospice Analytics

2011 HOPE Fall Conference

October 26, 2011

In Partnership with:

Introduction & Background

Cordt T. Kassner, PhD

Principal

Hospice Analytics

2355 Rossmere Street

Colorado Springs, CO 80919

P: 719.209.1237

E: [email protected]

W: www.HospiceAnalytics.com

www.HospiceAnalytics.com 2

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Presentation Purpose

1. To connect bedside clinical hospice care to state and national policy

2. To connect national and state policy to bedside clinical hospice care


Presentation Outline

Part 1: Connecting Clinical Care to National Policy

1. In the Beginning… Early Questions & Answers

2. Data Available

3. Data Applications for Hospice Administrators

Part II: Connecting National Policy to Clinical Care

1. WFA (Nursing Facilities, Caps, Long LOS, DC Alive)

2. MedPAC (Net Margins, U-Shaped Curves)

3. Palliative Care

4. Dartmouth Atlas


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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


New Development – National Hospice Locator

Currently there is no place listing all hospices in the country.

In 2 weeks there will be! www.HospiceAnalytics.com The National Hospice Locator Web page will become public Nov. 7, 2011

It includes contact information for every hospice in the country, and more

Made possible with sponsorships from:

Sangre de Cristo Hospice & Palliative Care, Pueblo, CO; Karen Ermel

VNA Hospice Care, Boston, MA; Diane Bergeron

Family LifeCare, Berne, IN; SueAnn Reynolds

HCI (Hospice of Central Iowa), West Des Moines, IA; Norene Mostkoff


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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?


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


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2. Data Available





3. Palliative Care

4. Dartmouth Atlas


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 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


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



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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. 2008 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



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?

?



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2. Data Available





3. Palliative Care

4. Dartmouth Atlas


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.


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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.


2009 Demographics & Hospice Utilization

Wisconsin National

Population 5,654,774 307,006,550

Total Deaths46,508

0.8% of population2,486,097

0.8% of population

Medicare Beneficiaries 933,761 47,645,019

Medicare Beneficiary Deaths27,207

80% of total deaths1,899,969

76% of total deaths

Medicare Hospice Beneficiary Admissions21,097

45% of total deaths57% of Medicare deaths

1,079,67643% of total deaths

57% of Medicare deaths

Medicare Hospice Beneficiary Deaths15,323

33% of total deaths41.2% of Medicare deaths

752,94330% of total deaths

39.6% of Medicare deaths

Medicare Hospice Total Days of Care 1,438,360 Days 76,724,901 Days

Medicare Hospice Mean Days / BeneficiaryMedicare Hospice Median Days / Beneficiary

68 Days24 Days

71 Days24 Days

Medicare Hospice Total PaymentsMedicare Hospice Mean Payment / Beneficiary

$222,735,595$10,118

$12,064,905,206$11,175


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Wisconsin County-Level Hospice UtilizationTop 35 Counties (Slide 1 of 2)Hospice Utilization= Medicare Hospice Deaths / Medicare Total Deaths

National AverageState Average


36%

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Wisconsin County-Level Hospice UtilizationAll Remaining Counties (Slide 2 of 2)Hospice Utilization= Medicare Hospice Deaths / Medicare Total Deaths


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2009 Hospice Utilization(Slide 1/2; Medicare Hospice Deaths / Total Medicare Deaths)

56.1

%

52.2

%

51.9

%

51.3

%

50.1

%

49.3

%

49.2

%

47.1

%

46.0

%

44.1

%

43.9

%

43.7

%

42.6

%

42.5

%

42.2

%

41.4

%

41.2

%

41.0

%

40.6

%

39.9

%

39.6

%

39.5

%

39.5

%

39.3

%

39.1

%

38.6

%

0%

10%

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40%

50%

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izon

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ida

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WI #17:41.2%

National:39.6%


2009 Hospice Utilization(Slide 2/2; Medicare Hospice Deaths / Total Medicare Deaths)

38.5

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38.4

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37.8

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37.5

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37.4

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37.2

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36.8

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36.5

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35.9

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35.2

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35.0

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34.3

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34.2

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33.8

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32.8

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32.3

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31.6

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29.7

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29.4

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27.8

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26.8

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25.8

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25.2

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23.4

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15.5

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shire

26

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2009 Total Number of Hospices by StateSlide 1/2; National= 3,336 Hospices; WI= 65 (#20)

316

231

174

133

131

126

121

112

112

103

98 97

85 82 81 78 75 70 67 65 64 63

55 54 54

0

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8

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Illin

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13

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22

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WI #20:65


2009 Total Number of Hospices by StateSlide 2/2; National= 3,336 Hospices; WI= 65 (#20)

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

350

Arka

nsas

26

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29

Flor

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30

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34

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51


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2009 Total Number of Hospice Closure Reasons by StateVoluntary Merger or Closure: National= 27; WI= 0Voluntary Other: National= 2; WI= 0

0

1

2

3

4

5

6Al

abam

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Cal

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Ohi

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Texa

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Okl

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15

Voluntary Other

Voluntary Merger or Closure



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2009 Total Hospice PatientsSlide 1/2; National= 1,079,676

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

100,000Fl

orid

a 1

Cal

iforn

ia

2

Texa

s 3

Penn

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ania

4

Ohi

o 5

Mic

higa

n 6

Illin

ois

7

New

Yor

k 8

Nor

th C

arol

ina

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

7

Mas

sach

uset

ts 1

8

Wis

cons

in 1

9

Sout

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20

Was

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21

Okl

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a 2

2

Loui

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3

Ore

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24

Min

neso

ta 2

5

WI #19:21,097


2009 Total Hospice PatientsSlide 2/2; National= 1,079,676

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

100,000

Col

orad

o 2

6

Iow

a 2

7

Mar

ylan

d 2

8

Mis

siss

ippi

29

Kent

ucky

30

Kans

as 3

1

Arka

nsas

32

Con

nect

icut

33

Uta

h 3

4

Nev

ada

35

Wes

t Virg

inia

36

New

Mex

ico

37

Neb

rask

a 3

8

Idah

o 3

9

Mai

ne 4

0

Rho

de Is

land

41

Del

awar

e 4

2

New

Ham

pshi

re 4

3

Mon

tana

44

Haw

aii

45

Sout

h D

akot

a 4

6

Nor

th D

akot

a 4

7

Verm

ont

48

Dis

trict

of C

olum

bia

49

Wyo

min

g 5

0

Alas

ka 5

1


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Sample Market Report

What kind of information is included in a Market Report? How might I use this information?

So, let’s take a closer look at 2009 county data for: Kenosha Milwaukee Racine Waukesha


Executive Summary- 1

Hospice2009

Beneficiaries

Mean LOS

(days)

Median LOS

(days)County

Hospice Utilization

Died Without Hospice

VITAS – WAUWATOSA 1,220 74 28 Kenosha 40% 549

AURORA VNA 1,214 48 15 Milwaukee 44% 3,385

ODYSSEY - MILWAUKEE 659 96 51 Racine 42% 760

HOSPICE ALLIANCE 647 69 24 Waukesha 49% 1,336

HORIZON HC & HOSPICE 622 37 13 TOTAL 44% 6,030

WHEATON FRANCISCAN HOSPICE 613 28 7 Compare: Wisconsin 41% 21,884

SEASONS HOSPICE PALLIATIVE CARE 490 70 28 Compare: National 40% 1,178,425

ASERACARE – WEST ALLIS 449 80 39

HEARTLAND – BROOKFIELD 440 96 50

RUTH HOSPICE 435 14 6

All Others (N=5) 1,191 73 36

TOTAL 7,980 63 20

Compare: Wisconsin 21,097 68 24

Compare: National 1,090,862 72 24

Aggregate Cap Estimate= xxx% Last CMS Survey (years ago): xxx See Slide 4 note

Inpatient Cap Estimate= xxx% State CMS Survey Average (years) 3.4


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2009 Settings In Which Medicare Beneficiaries Died – N (%)

CountyTotal Beneficiary

DeathsHospice Deaths Hospital Deaths SNF Deaths HHA Deaths Other Deaths

Kenosha 909 360 (40%) 200 (22%) 109 (12%) * (*%) 233 (26%)

Milwaukee 6,032 2,647 (44%) 1,487 (25%) 300 (5%) 99 (2%) 1,499 (25%)

Racine 1,301 541 (42%) 174 (13%) 67 (5%) * (*%) 519 (40%)

Waukesha 2,615 1,279 (49%) 514 (20%) 159 (6%) * (*%) 653 (25%)

TOTAL 10,857 4,827 (44%) 2,375 (22%) 635 (6%) 116 (1%) 2,904 (27%)

Compare: Wisconsin 37,207 15,323 (41%) 6,560 (18%) 2,610 (7%) 348 (1%) 12,366 (33%)

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 above 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. Milwaukee 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. Kenosha county is unusually high.4. Home Health Agency deaths are lower than the national average in most counties.5. Other Deaths (i.e., outside of these four Medicare provider types; e.g., Medicare Advantage, Medicaid, private insurance, no payer, etc.) are higher

than the national average across most counties. Racine county is unusually high.



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 xxx years ago, and the state survey average is 3.4 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.

WI average surveys= 3.4 years

National average surveys= 3.7 years


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Hospice Utilization:

13,878 2009 Total Deaths in the selected counties

10,857 Medicare Deaths in the selected counties

Therefore, 78% 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.

4,827 2009 Medicare Hospice Deaths

An accepted “maximum hospice utilization rate” is 67% of deaths, or 7,275 Medicare hospice deaths in the selected counties – 2,448 more patients than died in hospice in 2009. This is a good target for potential growth. (Slide 18)



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)


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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.



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21

2009 Demographics and Medicare Hospice Utilization

County-Specific Information Kenosha Milwaukee Racine Waukesha Total

Total Population 165,382 959,521 200,601 383,154 1,708,658

Total Deaths 1,218 8,108 1,563 2,989 13,878

Medicare Beneficiaries 22,148 138,443 33,662 64,731 258,984

Medicare Beneficiary Deaths 909 6,032 1,301 2,615 10,857

Medicare Hospice Beneficiary Admits% of Medicare Deaths

52558%

3,43757%

76659%

1,72066%

6,44859%

Medicare Hospice Beneficiary DeathsUtilization= % of Medicare Deaths

36039.6%

2,64743.9%

54141.6%

1,27948.9%

4,82744.5%


2009 Demographic and Medicare Hospice Utilization Comparisons

13,878

10,857

6,448

4,827

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

Total Deaths Medicare Deaths Hospice Admissions Hospice Deaths


10/23/2011

22

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

Kenosha 545 39,613 73 27 109

Milwaukee 3,592 205,627 57 17 563

Racine 793 50,195 63 20 138

Waukesha 1,802 119,620 66 21 328

TOTAL 6,732 415,055 62 19 1,137

Compare: Wisconsin 21,097 1,438,360 68 24 3,941

Compare: National 1,090,862 78,203,910 72 24 214,257


2009 Which Hospices Serve Beneficiaries Residing in the Counties Selected for this Report?

Hospice Kenosha Milwaukee Racine Waukesha Total

VITAS – WAUWATOSA * 657 61 244 967

AURORA VNA 26 597 94 121 838

HOSPICE ALLIANCE 368 * 204 * 585

WHEATON FRANCISCAN HOSPICE * 280 159 132 573

ODYSSEY – MILWAUKEE 25 295 84 127 531

HORIZON HC & HOSPICE * 385 * 87 472

RUTH HOSPICE * 333 * 61 403

SEASONS HOSPICE PALL CARE 26 133 51 179 389

ASERACARE – WEST ALLIS 15 226 22 81 344

ALLAY HOME & HOSPICE * 215 * 93 317

All Others (N=140) 76 464 102 671 1,313

TOTAL 545 3,592 793 1,802 6,732

* Indicates CMS protected fields where cell size <11

See Excel spreadsheet for additional detail.


10/23/2011

23

2009 Comparison of Hospices Serving Beneficiaries Residing in the Counties Selected for this Report

967

838

585

573

531

472

403

389

344

317

0

200

400

600

800

1,000

1,200


2009 Which Hospices Serve Beneficiaries Residing in the Counties Selected for this Report?

0 26

368

0 25 0 026 15 0

76 545

657597

0

280

295

385 333

133

226 215

464

3,592

61

94 204

15984

00

51

220

102

793

244121

0

132 12787 61

179

8193

671

1,802

0%

20%

40%

60%

80%

100%

Waukesha

Racine

Milwaukee

Kenosha


10/23/2011

24

2009 Admissions by Quarter in Selected CountiesSee Excel spreadsheet for additional detail

188 20

0

114

155

100

127

92

83

63 62

216

189

119 12

6

98 100

91

80

65 62

189

179

120 12

6

116

97 95 92

59 61

181

178

128 13

2

97 101 104

88

66 65

0

50

100

150

200

250

VITAS –WAUWATOSA

AURORA VNA HOSPICEALLIANCE

WHEATONFRANCISCAN

HOSPICE

ODYSSEY –MILWAUKEE

HORIZON HC &HOSPICE

RUTHHOSPICE

SEASONSHOSPICE PALL

CARE

ASERACARE –WEST ALLIS

ALLAY HOME& HOSPICE

1st Quarter

2nd Quarter

3rd Quarter

4th Quarter


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, 79% of Medicare beneficiaries served by Vitas - Wauwatosa reside in the counties selected for this report; 21% 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

VITAS – WAUWATOSA 967 1,220 79%

AURORA VNA 838 1,214 69%

ODYSSEY - MILWAUKEE 531 659 81%

HOSPICE ALLIANCE 585 647 90%

HORIZON HC & HOSPICE 472 622 76%

WHEATON FRANCISCAN HOSPICE 573 613 93%

SEASONS HOSPICE PALLIATIVE CARE 389 490 79%

ASERACARE – WEST ALLIS 344 449 77%

HEARTLAND – BROOKFIELD 311 440 71%

RUTH HOSPICE 403 435 93%

All Others (N=5) 1,319 1,191 111%

TOTAL 6,732 7,980 84%


10/23/2011

25

2009 Medicare Hospice Providers & Beneficiaries

Hospice Beneficiaries Utilization DaysMean Days / Beneficiary

Median Days / Beneficiary

Average Daily Census

VITAS – WAUWATOSA 1,220 89,922 74 28 246

AURORA VNA 1,214 57,729 48 15 158

ODYSSEY - MILWAUKEE 659 63,233 96 51 173

HOSPICE ALLIANCE 647 44,531 69 24 122

HORIZON HC & HOSPICE 622 22,808 37 13 62

WHEATON FRANCISCAN HOSPICE 613 17,390 28 7 48

SEASONS HOSPICE PALLIATIVE CARE 490 34,151 70 28 94

ASERACARE – WEST ALLIS 449 36,010 80 39 99

HEARTLAND – BROOKFIELD 440 42,197 96 50 116

RUTH HOSPICE 435 6,110 14 6 17

All Others (N=5) 1,191 85,769 73 36 235

TOTAL 7,980 499,850 63 20 1,369

Compare: Wisconsin 21,097 1,438,360 68 24 3,941

Compare: National 1,090,862 78,203,910 72 24 214,257


2009 Medicare Beneficiaries Served by Hospice

1,220 1,214

659 647 622 613

490449 440 435

1,191

0

200

400

600

800

1,000

1,200

1,400


10/23/2011

26

2009 Medicare Total Days of Care by Hospice

89,922

57,72963,233

44,531

22,80817,390

34,151 36,01042,197

6,110

85,769

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

100,000


2009 Medicare Mean Days of Care / Beneficiaryby Hospice

74

48

96

69

37

28

70

80

96

14

73

6368

72

0

20

40

60

80

100

120


10/23/2011

27

2009 Medicare Median Days of Care / Beneficiaryby Hospice

28

15

51

24

13

7

28

39

50

6

36

20

24 24

0

10

20

30

40

50

60


2009 Medicare Average Daily Census by Hospice

246

158173

122

6248

94 99116

17

235

0

50

100

150

200

250

300


10/23/2011

28

2009 Medicare Reimbursement / Hospice

Hospice BeneficiariesTotal MedicareReimbursement

Mean MedicareReimbursement /

Beneficiary

VITAS – WAUWATOSA 1,220 $14,987,930 $12,285

AURORA VNA 1,214 $10,155,526 $8,365

ODYSSEY - MILWAUKEE 659 $9,342,450 $14,177

HOSPICE ALLIANCE 647 $6,725,244 $10,395

HORIZON HC & HOSPICE 622 $3,877,594 $6,234

WHEATON FRANCISCAN HOSPICE 613 $3,230,139 $5,269

SEASONS HOSPICE PALLIATIVE CARE 490 $5,431,044 $11,084

ASERACARE – WEST ALLIS 449 $5,320,773 $11,850

HEARTLAND – BROOKFIELD 440 $6,374,330 $14,487

RUTH HOSPICE 435 $1,235,428 $2,840

All Others (N=5) 1,191 $12,993,051 $11,019

TOTAL 7,980 $79,673,509 $9,984

Compare: Wisconsin 21,097 $222,735,595 $10,558

Compare: National 1,090,862 $12,210,869,288 $11,194


2009 Total Medicare Reimbursement by Hospice

$14,987,930

$10,155,526 $9,342,450

$6,725,244

$3,877,594 $3,230,139

$5,431,044 $5,320,773

$6,374,330

$1,235,428

$12,993,051

$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


10/23/2011

29

2009 Mean Medicare Hospice Reimbursement / Beneficiary

$12,285

$8,365

$14,177

$10,395

$6,234 $5,269

$11,084 $11,850

$14,487

$2,840

$11,019 $9,984

$10,558 $11,194

$0

$2,000

$4,000

$6,000

$8,000

$10,000

$12,000

$14,000

$16,000


2009 Medicare Hospice BeneficiariesCancer / Non-Cancer

914

672

566

416

315369

414 393339

260851 5,509 14,084 743,180

306

542

93

231

307244

76 56101

175340 2,471 7,013 347,682

0%

20%

40%

60%

80%

100%

Cancer

Non-Cancer


10/23/2011

30

2009 Medicare Hospice BeneficiariesTop Six ICD-9 Diagnostic Categories (out of 19)

306

525

93

214

304

214

76 55101

175

326 2,3897,013 344,811

204

220

81

110

59

136

122

52

68

66

1601,278

6,275 301,000

30

66

49

28

95

65

32

26

147549 2,868 152,457

86

138

51

77

41

8041

21

32

33

86 6862,970 142,144

114

96

101

80

32

2539

37

47

17

64652

2,575 137,457432

21

192

73 44 43

13595 267

1,305 3,549 134,995

0%

20%

40%

60%

80%

100%

Ill-defined

Nervous

Respiratory

Mental

Circulatory

Cancers


2009 Medicare Hospice BeneficiariesStatus at Discharge

875 925

416 432454

532

327 278244

410

7685,661 15,323 758,473

118136

8175

110

42

68 85

80

182984 1,917 131,389

227153

162 14058 39

95 86116

18

241 1,335 3,857 201,000

0%

20%

40%

60%

80%

100%

Still PT

DC Alive

DC Deceased

None 25%+ DC Alive


10/23/2011

31

2009 Medicare Hospice BeneficiariesAge Categories

30 64 25 40 45 41 21 25 31 339 908 56,2086488

3046 58 47

13 2126 30

69 492 1,571 89,95780

137

26

5583

59

2326

2535

86 635 1,863 109,316122

199

81

93

101

88

5652

6276

1561,086 2,876

155,716217

282

127

133

130

130

10097

101

90

2521,659 4,212

216,582

707

444

370280

205248

290 244205

179597 3,769 9,667 463,083

0%

20%

40%

60%

80%

100%

>84

80-84

75-79

70-74

64-69

<64


2009 Medicare Hospice BeneficiariesSex

443561

205256 278 288

150 145 154178 474 3,132 8,694 439,903

777653

454391 344 325

340 304 286257 717 4,848 12,403 650,959

0%

20%

40%

60%

80%

100%

Female

Male


10/23/2011

32

2009 Medicare Hospice BeneficiariesRace

1,139 1,134604

615

491

516

477

395401

391

1,126

7,289

20,209

960,848

64 6046

21

124

8149

3441

47

576

601

87,651

51 66

20,126

17 448,618

86 3,50327 51 8,343

75%

80%

85%

90%

95%

100%

Other

North Amer Native

Asian

Hispanic

Black

White


2009 Medicare Hospice BeneficiariesLevels of Care (days)

86,728

53,928

63,142 44,393

21,925

16,213

33,417

36,07241,767 85,174

487,9631,407,30275,313,071

1,658

2,830

40 121

954

1,344

252

0

57

668

430

8,354 20,5711,590,715

129

266 0 20 73 41

26

12215

0 126 908 3,873 165,401

90%

92%

94%

96%

98%

100%

Cont. Home Care

Respite Care

General Inpt

Routine Home Care


10/23/2011

33

2009 Medicare Hospice BeneficiariesLocations of Care (days, new in 2007)

30,628

46,756

6,628

20,165

22,021

12,819

8,1629,615

25,030

4,320

24,204210,348

669,72745,887,608

56,145

942

40,442

14,117

45

3,444

20,756

18,202

15,379

872

43,365

213,709 440,826

14,701,238

25,7972,018

18,047 10,075

47

14,1038,409 7,600

17,233 103,329344,118

9,361,433

2,4133,308 1,875 46 11

6734,116 12,442 41,125

8,509,253

678 619 42 303 882 1,428108 960 5,021 32,618 3,529,112

0%

20%

40%

60%

80%

100%

All Other Settings

Inpatient Hospice

Assisted LivingFacility

Skilled / Non-SkillNrsng Fac

Home


2009 Medicare Hospice BeneficiariesVisits by Discipline (new in 2008)

35,042 38,77822,383

28,385

6,1814,977

11,756 14,78213,702

15,422 57,903 249,311 532,47529,766,570

48,201 43,66615,993

10,718

7,2707,296

7,786 11,12711,637

10,98845,951 220,633

558,22728,754,434

5,019 4,743 3,481 3,676 1,170 1,401 1,685 1,5633,423

574 7,348 34,083 102,096 4,622,1091,264 2,450 18 116 12 116 30 238 658 4,909 12,541 1,223,418

0%

20%

40%

60%

80%

100%

Physician and NP

Social Services

Skilled Nursing

Hospice Aide


10/23/2011

34

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.


2009 Counties & Medicare Hospice Beneficiaries

County-Specific Information Medicare BeneficiariesMedicare Beneficiaries

Who Died

Medicare BeneficiariesWho Died

With Hospice

Medicare BeneficiariesWho Died

Without Hospice

Kenosha 22,148 909 360 549

Milwaukee 138,443 6,032 2,647 3,385

Racine 33,662 1,301 541 760

Waukesha 64,731 2,615 1,279 1,336

TOTAL 258,984 10,857 4,827 6,030

Compare: Wisconsin 933,761 37,207 15,323 21,884

Compare: National 48,753,141 1,936,900 758,475 1,178,425


10/23/2011

35

2009 Medicare Hospice BeneficiariesWho Died Without Hospice: Age Categories

62 477 8789

715 2,052 133,169

58356

82

146

6422,183

142,544

58379

91

161

6892,340

142,044

86514 120

204

924

3,081

173,799

99624 137

2541,114

3,971

211,401

189 1,046 246496

1,9778,398

383,664

0%

20%

40%

60%

80%

100%

Kenosha Milwaukee Racine Waukesha TOTAL Compare: Wisconsin Compare: National

>84

80-84

75-79

70-74

64-69

<64


2009 Medicare Hospice BeneficiariesWho Died Without Hospice: Sex

283 1,690 370 653 2,996 10,720 586,916

269 1,706 393 697 3,065 11,305 599,705

0%

20%

40%

60%

80%

100%

Kenosha Milwaukee Racine Waukesha TOTAL Compare: Wisconsin Compare: National

Female

Male


10/23/2011

36

2009 Medicare Hospice BeneficiariesWho Died Without Hospice: Race

524

2,636

673

1,324

5,157

20,759

977,736

20

639

67

14

740

822

134,972

2640

94

16,481

2531 84

20,189

55 68 8929,155

14 19 152 6,223

70%

75%

80%

85%

90%

95%

100%

Kenosha Milwaukee Racine Waukesha TOTAL Compare:Wisconsin

Compare: National

N. Amer Native

Hispanic

Asian

Other

Black

White


The 2009 Medicare Data Was Recently Released:Who Provides Healthcare at the End of Life? Snapshots

2/1/11

Hospice 41% Hospice 40%

Inpt Hospital 18% Inpt Hospital 22%

SNF 7% SNF 5%Home Health 1% Home Health 2%

None of These 33% None of These 31%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Wisconsin NationalNote: Information reflects Medicare beneficiaries only;

categories are not mutually exclusive.


10/23/2011

37

Summary:

Skilled Nursing Facilities in the selected Wisconsin counties cared for 13,229 Medicare beneficiaries, of whom 2,958 died (22%). (Compare WI=22%; national=23%.)

Of those who died (N=2,958):

635 (21%) died in a SNF (compare WI=31%; national=20%)

1,924 (65%) were admitted to a hospice (compare WI=52%; national=54%)

1,406 (48%) died under hospice care (compare WI=38%; national=37%)

97 (3.3%) died in the SNF with hospice care (compare WI=6.9%; national=8.3%)

Of those admitted to hospice (N=1,924):

Hospice median length of stay=15 days (compare WI=15; national=15 days)

Hospice mean length of stay=46 days (compare WI=47; national=48 days)

Note: Median / Mean LOS for all hospice beneficiaries= 20/63 days (compare WI=24/68 days; national=24/72 days).

2009 Medicare Skilled Nursing Facilities


1596

48

104

4826

926 1,289 3,830 279,198

50

41

30

13

25

554734 2,171 174,535

12101

3430

23934

374 827 2,060 147,228

16 11311 24

14

3 351 532 1,632 144,695

2222 22

18

15

23402 541 1,604 103,291

0%

20%

40%

60%

80%

100%

Nervous

Injury and Poisoning

Musculoskeletal

Respiratory

Circulatory

2009 Top 5 SNF Diagnostic Categories (out of 19)


10/23/2011

38

2009 Demographics & SNF Utilization

Wisconsin National

Population 5,654,774 307,006,550

Total Deaths46,508

0.8% of population2,486,097

0.8% of population

Medicare Beneficiaries 933,761 47,645,019

Medicare Beneficiary Deaths27,207

80% of total deaths1,899,969

76% of total deaths

Medicare SNF Patients 39,028 1,822,074

Medicare SNF Patient Deaths2,610

6% of total deaths10% of Medicare deaths

102,6514% of total deaths

5% of Medicare deaths

Total Days of SNF Care 1,336,807 Days 67,514,523 Days

Mean Days / Patient of SNF Care 34 Days 37 Days

Median Days / Patient of SNF Care 25 Days 27 Days

Total Medicare SNF Payments$482,812,638 $24,476,518,870





2. Data Available



1. WFA (Nursing Facilities, Caps, Long LOS,

DC Alive)


2. Palliative Care

3. Dartmouth Atlas


10/23/2011

39

Thank you

Please contact Hospice Analytics with any questions, comments, feedback, or for additional information:

W: www.HospiceAnalytics.com

P: 719-209-1237

E: [email protected]


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