Evaluate Hospice Payments and Utilization

The Centers for Medicare & Medicaid Services (CMS) released two useful data files that can be used by hospice providers to evaluate their payments and utilization. These tools could be a resource for your administrative, operational, financial and marketing staff to use, even though it is important to note that the data is from 2014, and will not reflect the changes that will probably occur from the implementation of the new hospice reimbursement methodology and regulations.

The Hospice Utilization and Payment Public Use File, or “Hospice PUF,” which contains:

• Information on services hospice providers administered to Medicare beneficiaries, specifically, information on more than 1.3 million hospice beneficiaries, 4,025 hospice providers and more than $15 billion in Medicare payments for 2014. 
• State-by-state differences in total standardized payments per hospice beneficiary in 2014. South Carolina recorded the highest hospice spending per beneficiary and Wyoming ($7,132), and South Dakota had the lowest in total standardized payments per hospice beneficiary. 
• Total number of days of care that that hospice provided, the distinct number of beneficiaries that hospice served, the hospice’s total charges, the hospice’s total Medicare payments, and the hospice’s total Medicare standardized payments. 
• The sites of service, primary diagnoses and the demographics of hospice beneficiaries.

For the first time, CMS released an update to the Market Saturation and Utilization Data Tool that includes hospice. This tool includes interactive maps and supporting data sets that show national-, state-, and county-level provider services and utilization data for three reference periods and health service areas including Home Health, Skilled Nursing Facilities, and Hospice. Provider services and utilization data by geographic regions are easily compared using the interactive map. This data will be useful for hospice providers in making informed decisions about their service locations and the beneficiary populations they serve.

The Market Saturation and Utilization Data Tool can be used by CMS to monitor market saturation as a means to prevent fraud, waste, and abuse.  In 2014, Medicare spent an average of $11,393 per hospice beneficiary for an average of 70 days of hospice care. 33% of hospice beneficiaries had more than 60 days of hospice care, 13% had more than 180 days of hospice care and 11% experienced a live discharge from hospice care. The data can also be used to reveal the degree to which use of a service is related to the number of providers servicing a geographic region.

It is important to use multiple sources of data when making informed decisions on the operation of your organization's hospice, home health and Skilled Nursing Facilities. There have been critics that say some of CMS data can be misleading. A September 2016 General Accounting Office (GAO) report that focused on SNF data  said. “CMS does little to ensure the accuracy and completeness of the data.” LeadingAge appreciates CMS’ commitment to greater data transparency, but encourages CMS to move towards a more accurate, comprehensive report on provider data.