NHPCO Facts and Figures
2020 EDITION

Published August 20, 2020

Section 2: Who Receives
Hospice Care

Section 4: How Does Medicare
Pay for Hospicez H ow many Medicare beneficiariesz

Spending per Patientz

Spending by Days of Carez

Spending by Diagnosisz

Spending by Level of Carereceived care?
z W hat proportion of Medicare

decedents were served by hospice?
z W hat % of hospice patients wereenrolled in Medicare Advantage?
z W
 hat are the characteristics ofMedicare beneficiaries who received

Table of Contents
at the end of this report for details
on the data sources used within thisoperation in 2018

• GenderzProvider Size

• Age

z

Tax Status• Racez

Patient Volume• Principal Diagnosisz

Admissionsz

Deathspublication.

Section 3: How Much Carewas Receivedz

About this reportzWhat is hospice care?

z

Length of Servicez

How is hospice care delivered?

zDays of Carez

What services are provided?

z

Deathsz

Location of Carez

DischargeszLevels of Carez

Level of Carez

Volunteer Servicesz

Location of Carez

Bereavement Services

Facts and Figures | 2020 EDITION rganizationz H ow many hospices were in

hospice care?

Please see the Data Sources Section

Section 1: Introduction

Section 5: Who Provides Care

Reference: Data Sources
and Methodology

1Introduction
About this Report
NHPCO Facts and Figures: Hospice Care in America provides anannual overview of hospice care delivery. This overview provides
specific information on:z Hospice patient characteristics
z Location and level of carez Medicare hospice spendingz Hospice provider characteristicsz Volunteer and bereavement services
Currently, most hospice patients have their costs covered by Medicare,through the Medicare Hospice Benefit. The findings in this report reflect
only those patients who received care through 2018, provided by the
Medicare Hospice Benefit by the hospices certified by the Centers for
Medicare and Medicaid Services (CMS) to care for them.

Facts and Figures | 2020 EDITION rganization

What is hospice care?
Considered the model for quality compassionate care for people facing alife-limiting illness, hospice provides expert medical care, pain management,
and emotional and spiritual support expressly tailored to the patient’s
needs and wishes. Support is provided to the patient’s family as well.
Hospice focuses on caring, not curing. In most cases, care is provided in
the patient’s home but may also be provided in freestanding hospicefacilities, hospitals, and nursing homes and other long-term care facilities.
Hospice services are available to patients with any terminal illness or of
any age, religion, or race.
Consideration for discussion around differences in numbers reported byother authorities like MedPAC: This report presents metrics that may
differ from other reporting sources eventhough the data sources arefrom CMS. This is a result in differing approaches and/or rules being
applied such as use of fiscal vs calendar years, ICD Codes, and otherhistorical lookback models. Please be aware of this when using the data
for analysis and comparison between analytic vendors.

2

Introduction (continued)
How is hospice care delivered?
Typically, a family member serves as the primary caregiver and, when appropriate, helps
make decisions for the terminally ill individual. Members of the hospice staff make regular
visits to assess the patient and provide additional care or other services. Hospice staff is
on-call 24 hours a day, seven days a week.
The hospice team develops a care plan that meets each patient’s individual needs for pain
management and symptom control. This interdisciplinary team, as illustrated in Figure 1,
usually consists of the patient’s personal physician, hospice physician or medical director,
nurses, hospice aides, social workers, bereavement counselors, clergy or other spiritual
counselors, trained volunteers, and speech, physical, and occupational therapists, if needed.

&

What services are provided?
The interdisciplinary hospice team:z Manages the patient’s pain and other symptoms;z Assists the patient and family members with the emotional, psychosocial, and spiritual aspects of dying;z Provides medications and medical equipment;z Instructs the family on how to care for the patient;z Provides grief support and counseling;z Makes short-term inpatient care available when pain or symptoms become too difficult to manage at home,or the caregiver needs respite time;z Delivers special services like speech and physical therapy when needed;z Provides grief support and counseling to surviving family and friends.

Location of Care
The majority of hospice care is provided in the place the patient calls home. In addition to private residences, this includes
nursing homes and residential facilities. Hospice care may also be provided in freestanding hospice facilities and hospitals(see Levels of Care).

Facts and Figures | 2020 EDITION rganization

3

Introduction (continued)
Levels of Care
Hospice patients may require differing intensities of care during the course of their disease.
While hospice patients may be admitted at any level of care, changes in their status may requirea change in their level of care.
The Medicare Hospice Benefit affords patients four levels of care to meet their clinical needs:
Routine Home Care, General Inpatient Care, Continuous Home Care, and Inpatient Respite Care.
Payment for each covers all aspects of the patient’s care related to the terminal illness, including
all services delivered by the interdisciplinary team, medication, medical equipment and supplies.
z Routine Hospice Care (RHC) is the most common level of hospice care. With this type of care,an individual has elected to receive hospice care at their residence.
z Continuous Home Care (CHC) is care provided for between 8 and 24 hours a day to manage
pain and other acute medical symptoms. CHC services must be predominately nursing
care, supplemented with caregiver and hospice aide services and are intended to maintain theterminally ill patient at home during a pain or symptom crisis.
z Inpatient Respite Care (IRC) is available to provide temporary relief to the patient’s primary
caregiver. Respite care can be provided in a hospital, hospice facility, or a long-term care facility
that has sufficient 24 hour nursing personnel present.
z General Inpatient Care (GIP) is provided for pain control or other acute symptom managementthat cannot feasibly be provided in any other setting. GIP begins when other efforts to manage
symptoms are not sufficient. GIP can be provided in a Medicare certified hospital, hospiceinpatient facility, or nursing facility that has a registered nursing available 24 hours a day toprovide direct patient care.

Facts and Figures | 2020 EDITION rganization

4

Introduction (continued)
Volunteer Services

Bereavement Services

The U.S. hospice movement was founded by volunteers and continues

Counseling or grief support for the patient and loved ones is an essential

to play an important and valuable role in hospice care and operations.

part of hospice care. After the patient’s death, bereavement support

Moreover, hospice is unique in that it is the only provider with Medicare

is offered to families for at least one year. These services can take a

Conditions of Participation (CoPs) requiring volunteers to provide atvariety of forms, including telephone calls, visits, written materials about

least 5% of total patient care hours.

grieving, and support groups. Individual counseling may be offered by thehospice or the hospice may make a referral to a community resource.

Hospice volunteers provide service in three general areas:z S pending time with patients and families (“direct support”)
z P roviding clerical and other services that support patient care andSome hospices also provide bereavement services to the community atlarge.

clinical services (“clinical support”)
z E
 ngaging in a variety of activities such as fundraising, outreach andeducation, and serving on a board of directors (general support).

Facts and Figures | 2020 EDITION rganization

See page 26 for details on methodology and data sources including citedreferences within the report.

5Who Receives Hospice CareHow many Medicare beneficiaries received hospice care in 2018?
1.55 million Medicare beneficiaries, a 4% increase from prior year, were enrolled in
hospice care for one day or more in 2018*. This includes patients who:z Died while enrolled in hospicez Were enrolled in hospice in 2017 and continued to receive care in 2018z Left hospice care alive during 2018 (live discharges)*includes all states, Washington, D.C., U.S. territories, and Other.

Figure 1: Medicare Beneficiaries

1.32M

2014

1.38M

2015

1.43M

2016

1.49M

2017

1.55M

2018

Source: MedPAC March Report to Congress, Table 12-4, Various years

Facts and Figures | 2020 EDITION rganization

6

Who Receives Hospice Care (continued)
What proportion of Medicare
decedents were served byhospice in 2018?
Of all Medicare decedents in 2018, 50.7%
received one day or more of hospice care

Figure 2: Medicare Decedents Receiving 1 or moreDays of Hospice Care
47.8%

48.6%

49.7%

50.0%

50.7%

2014

2015

2016

2017

2018

and were enrolled in hospice at the timeof death.

Source: MedPAC March Report to Congress, Table 12-3, Various years

The number of individuals who enrolled in a
Medicare Advantage plan within the same
year that they utilized the hospice benefit
rose from from 30.2% of Medicare hospicepatients in 2014 to 36.9% in 2018. The
increase in hospice beneficiaries with MA
enrollment is consistent with the overall
increase in MA enrollment over this period.

Figure 3: Growth of Medicare Advantage Hospice Patients% of Total Hospice Patients

What % of Hospice Patients
Enrolled in Medicare Advantage
within the Year?

100%
80%
60%

69.8%

68.3%

67.4%

65.3%

63.1%

30.2%

31.8%

32.6%

34.7%

36.9%

2014

2015

2016

2017

2018

40%
20%
0%

Non-Medicare Advantage Hospice Patients

Medicare Advantage PatientsCMS Data sourced by HCCI for NHPCO

Facts and Figures | 2020 EDITION rganization

7

Who Receives Hospice Care (continued)

Figure 5: Medicare Decedent
Enrollment % for 2018
Rank

State

1

Utah

60.5%

2

Delaware59.4%

death varied from a low of 14.3% (other) to a high of 60.5% (UT). Vermont and Wyoming had the3

Arizona58.8%

4

Florida57.9%

greatest % increase since 2014 at 22.26% and 22.13% respectively. Alaska was the lowest with -10.88%.

5

Rhode Island

57.5%

6

Ohio

56.7%

7

Iowa

56.2%

8

Wisconsin

55.1%

9

Idaho

53.9%

10

Michigan

53.8%

11

Minnesota

53.5%

12

Kansas53.3%

13

Colorado

53.2%

14

Oregon

53.2%

15

Texax

52.8%

16

Maine

51.4%

17

Indiana51.2%

18

Georgia

51.0%

19

Nebraska

50.9%

20

Arkansas

50.9%

21

South Carolina

50.8%

22

Oklahoma

50.4%

23

Illinois

50.3%

24

Missouri

50.2%

25

Louisiana

50.0%

26

New Mexico

49.6%

27

Pennsylvania

49.3%

28

Alabama

49.2%

29

North Carolina

49.2%

30

Connecticut

48.6%

31

Nevada48.5%

32

Massachusetts

47.8%

33

New Hampshire

47.7%

34

Maryland

47.6%

35

Virginia

46.7%

36

California

46.1%

37

Washington

46.0%

38

New Jersey

45.6%

39

Montana

45.6%

40

Hawaii

45.4%

41

Mississippi

45.2%

42

Tennessee

44.9%

43

West Virginia

43.6%

44

Kentucky

43.5%

45

South Dakota

43.2%

46

Vermont

42.9%

47

Wyoming

33.4%

48

District of Columbia

33.2%

49

North Dakota

31.0%

50

New York

30.0%

51

Alaska

22.8%

52

Other

14.3%

As illustrated on this page, the proportion of Medicare decedents enrolled in hospice at the time of

Figure 4: % of Medicare Decedents Served by Hospice by state (Aligns with Figure 5)

Source: CMS Data sourced by HCCI for NHPCO

Figure 6: 5 Year Change in Medicare
Decedents by State

Source: CMS Data sourced by
HCCI for NHPCO

2014

Facts and Figures | 2020 EDITION rganization

2015

2016

2017

2018

8

Who Receives Hospice Care (continued)
What are the characteristics of Medicare beneficiaries who received hospice care in 2018?

55.1%

Patient Gender
In 2018, more than halfof hospice Medicare

were female

beneficiaries were female.

46.1%
were male

Source: MedPAC March 2020 Reportto Congress, Table 12-3

Patient Age
In 2018, about 61.4% of Medicare hospicepatients were 75 years of age or older.

Figure 8: % Change over 5 Years

The 85 and older age category has
increased the most since 2014 at 9.6%.

Figure 7: % of Patients by Age for 2018
<65
65-74

16.3%
22.3%

75-84
85 and older

28.0%
33.4%

Source: MedPAC March 2020 Report to Congress,
MedPac analysis of the denominator file and the Medicare
Beneficiary Database (Applies to both Figure 7 & 8)

Facts and Figures | 2020 EDITION rganization

9

Who Receives Hospice Care (continued)
What are the characteristics of Medicare beneficiaries who received hospice care in 2018?
Patient Race
In 2018 a substantial majority of Medicare hospice patients were Caucasian. However, since 2014, patients identified
as Asian/Pacific Islander and Hispanic have increased by 45% and 33% respectively.

Figure 9: % of Patients by Race for 2018
Caucasian 82.0%
African American 8.2%
Hispanic 6.7%
Asian/Pacific Islander 1.8%
Other 0.5%
Native American 0.4%
Unknown 0.4%

Source: CMS Data sourced by HCCI for NHPCO

Facts and Figures | 2020 EDITION rganization

10

Who Receives Hospice Care (continued)
What are the characteristics of Medicare beneficiaries who received hospice care in 2018?
Principal Diagnosis
The principal hospice diagnosis is the diagnosis that has been determined to be the most contributory to the patient’s
terminal prognosis. 2018 continued to show that more Medicare hospice patients had a principal diagnosis of cancer thanany other disease.
Principal diagnosis categories of Stroke, Other, Respiratory, and Circulatory/Heart have grown the most since 2014.

Figure 10: % of Hospice Decedents by Principal Diagnosis for 2017 & 2018
ICD-9/10 Classification
CancerCirculatory/Heart
Dementia
Other
Respiratory
StrokeChronic Kidney Disease

2017
30.1%
17.6%
15.6%
13.9%
11.0%
9.4%
2.3%

2018
29.6%
17.4%
15.6%
14.7%
11.0%
9.5%
2.2%

Figure 11: No. of Hospice Decedents by Principal Diagnosis for 2017 & 2018
ICD-9/10 Classification
CancerCirculatory/Heart
Dementia
Other
Respiratory
StrokeChronic Kidney Disease2017332,718
194,512
172,643
153,963
122,004
103,684
24,953

2018
336,307
196,971
177,490
166,848
124,407
107,439
25,221

Source: CMS Data sourced by HCCI for NHPCO

Facts and Figures | 2020 EDITION rganization

11

How Much Care Is Received?
Lifetime Length of Stay

Days of Care

The average Lifetime Length of Stay (LLOS) for

In 2018 hospice patients received a total of 114.0 million days

Medicare patients enrolled in hospice in 2018 wasof care paid for by Medicare.

89.6 days. The median length of service (MLOS) was
18 days.

A greater proportion of Medicare patients (27.9%) were enrolled inTable 1: Average Lifetime Length of Stayof service categories. Forty percent of hospice beneficiaries in

hospice a total of seven days or fewer compared to all other length

Year Patients

Total Days

Avg. Days
of Care

2014

1.32M

91.9M

88.2

2015

1.38M

95.9M

86.7

2018 were served 14 days or less.

Figure 12: % of Patients by Days of Care for 2018*
27.9%

1-7

12.5%

2016

1.43M

101.2M

87.0

2017

1.49M

106.3M

88.1

2018

1.55M

113.5M

89.6

Source: MedPAC March Report to Congress, Various years

Day Stratifications

8-14
15-30

13.4%

31-60

12.4%

61-90
91-180

7.7%
12.1%

>180

14.1%

*These values are computed using only days of care that occurred in 2018. Days ofcare occurring in other years are not included. Days of care have been combined forpatients who had multiple episodes of care in 2018.
Source: CMS Data sourced by HCCI for NHPCO

Facts and Figures | 2020 EDITION rganization

12

How Much Care Is Received (continued)
Days of Care

Days of Care

In 2018 over half (53.8%)

Days of care over multiple years by percentage of patients*of patients were enrolled in
hospice for 30 or fewer days.

Figure 14: Days of Care Between 2016-2018 by % of Patients

Figure 13: % of Patientsby Days of Care for 2018
Day Stratifications

53.8%
30 days or less

46.2%

>30 days

1-7

26.3%

8-14

11.5%

15-30

12.1%

31-60

11.0%

61-90

7.0%

91-180

11.4%

>180

20.8%

*These values are computed using all days of care that occurred between 2016 through2018 highlighting extended care beyond 180 days that covered multiple years vs just 2018.
Source: CMS Data sourced by HCCI for NHPCO

Source: CMS Data sourced by HCCI
for NHPCO

Facts and Figures | 2020 EDITION rganization

13

How Much Care Is Received? (continued)
Days of Care
Patients with a principal diagnosis of dementia had the largest number of days of care on average in 2018.

Figure 15: Days of Care by Principal Diagnosis for 2018
Alzheimer’s, Dementia,
and Parkinson’s			
Mdn: 26

StrokeMdn: 55				

Avg: 82.1

Mdn: 31.0

Circulatory/Heart

Avg: 80.2

Mdn: 21

Respiratory
Other

Mdn: 19

Cancer

Mdn: 18

Chronic Kidney Disease

Mdn: 80

20

Avg: 105.2

				

Avg: 71.8
Avg: 64.3
Avg: 45.6
Avg: 38.1

40

60

80

100

120

Days of Care

*These values are computed using only days of care that occurred in 2018. Days of care have been combined for patients who had
multiple episodes of care in 2018. Days of care occurring in other years are not included.
Source: CMS Data sourced by HCCI for NHPCO

Facts and Figures | 2020 EDITION rganization

14

How Much Care Is Received? (continued)
DeathsIn 2018, 1.1 million Medicare beneficiaries died while enrolled in
hospice care. 51.5 % of deaths occurred in the home, andFigure 16: Decedent % by Location of Death

Other 2.0%

Nursing Facility* 17.4%

Home 51.5%

facilities have grown the most over 5 years by over 40%.

Assisted Living Facility 12.3%

facilities, and assisted living facilities. However, assisted living

Hospice In-Patient Facility 12.8%

more than a third between nursing facilities, hospice in-patient* Includes skilled nursing facilities, nursing facilities, and long-term carefacilities.

Source: CMS Data sourced by HCCI for NHPCO

Facts and Figures | 2020 EDITION rganization

15

How Much Care Is Received? (continued)
Discharges and Transfers

Level of Care

In 2018, there were 1.3M discharges. Live discharges comprised 17%

In 2018, the vast majority of days of care were at the Routine Homecareof all Medicare hospice discharges with patient and hospice initiated(RHC) level.

discharges being about equal.

Table 3: Level of Care by % of Days of Care

Table 2: Discharge by Type for 2018
DeathsPatient Initiated-Live
Discharges

Hospice Initiated-Live
Discharges

Decedents

83%

Revocations

6.6%

Transfers

2.2%

No Longer Terminally Ill

6.3%

Moved Out of the Service Area

1.6%

Discharges for Cause

0.3%

LOC Metrics

2014

2015

2016

2017

2018

RHC Days

97.7%

97.9%

98.0%

98.0%

98.2%

CHC Days

0.3%

0.3%

0.3%

0.2%

0.2%

IRC Days

0.3%

0.3%

0.3%

0.3%

0.3%

GIP Days

1.7%

1.6%

1.6%

1.3%

1.2%

Source: MedPAC March Report to Congress, Various years*Calculations are based on total number of discharges which includes patients who
were discharged more than one time in 2018.
Source: CMS Data sourced by HCCI for NHPCO

Facts and Figures | 2020 EDITION rganization

16

How Much Care Is Received? (continued)
Location of Care
In 2018, most of days of care were

Figure 17: Average Days by Location of Careprovided at a private residence
followed by assisted living facilities
and nursing facilities.

Home

90 Avg.

89 Avg.

90 Avg.

91 Avg.

93 Avg.

26 Mdn.

26 Mdn.

26 Mdn.

26 Mdn.

26 Mdn.

110 Avg.

105 Avg.

106 Avg.

105 Avg.

106 Avg.

20 Mdn.

21 Mdn.

155 Avg.

Average days by location of care asshown in figure 22 were 93 days at
Home, 106 days in Nursing Facilities,
and 155 days with Assisted Living
Facilities. Avg Days at Home grewby 3.3 % since 2014 while Nursing

Nursing
Facility

Facilities declined by 3.6% over thesame period.
31 Mdn.

Table 4: Location of Care by% of Days of Care for 2018
Home

55.6%

Assisted Living Facility

19.74%

Nursing Facility*

17.27%

Other

6.6%

Hospice In-Patient Facility

0.8%* Includes skilled nursing facilities, nursing facilities,
and RHC days in a hospice inpatient facility.

Assisted
LivingFacility

20Mdn.

30 Mdn.

154 Avg.

152 Avg.

152 Avg.

153 Avg.

51 Mdn.

51 Mdn.

51 Mdn.

51 Mdn.

2014

2015

2016

2017

54 Mdn.

2018

Source: CMS Data sourced by HCCI for NHPCO
Source: MedPAC March 2020 Report to Congress, Table 12-5

Facts and Figures | 2020 EDITION rganization

17

How Does Medicare Pay for Hospice?
Medicare paid hospice providers a total of $19.2 billion dollars

Spending Per Patientfor care provided in 2018, representing an increase of 7.2% over

The average spending per Medicare hospice patient was $12,200.

the previous year.

Figure 19: Average Medicare Spending Per Patient

Figure 18: Medicare Spending
Average:$12,411$15.1B2014$15.9B2015$16.8B2016$17.9B2017$19.2B2018

Source: MedPAC March Report to Congress, Various Years

Spending by Days of Care
In 2018, only 27.9% of Medicare spending for hospice care
was for patients who had received 180 or fewer days ofcare.* (See Table 5)

Average:$12,284

Median$4,760Median$4,7772014

2015

Average:$12,502

Average:$12,722

Average:$12,200

Median$5,389Median$5,443

Median$5,475

2016

2017

2018

Source: CMS Data sourced by HCCI for NHPCO

Table 5: Medicare Payments by Days of Care Stratified
from 2012-2018
Day Stratifications

2014

2015

2016

2017

2018

1-7

3.12%

3.04%

3.1%

1.85%

1.90%

8-14

2.80%

2.68%

2.73%

1.66%

1.69%

15-30

4.18%

4.02%

4.20%

2.79%

2.79%

31-60

5.95%

5.80%

6.19%

4.61%

4.61%

61-90

5.38%

5.31%

5.54%

4.67%

4.67%

91-18012.78%

12.58%

12.46%

11.06%

12.23%>180

65.79%

66.58%

65.79%

73.75%

72.10%* Includes days of care that spanned between the years of 2012 through 2017.
Source: CMS Data sourced by HCCI for NHPCO

Facts and Figures | 2020 EDITION rganization

18

How Does Medicare Pay for Hospice? (continued)
Spending by Diagnosis

Spending by Level of Care

In 2018, patients with a principal diagnosis of dementia continued to

In 2018, the vast majority of Medicare spending for hospice carelead Medicare hospice spending at 25.3%. Stroke, circulatory/heart,

was for care at the routine home care level. This has grown 17.8%

and respiratory related medicare spending grew the most since 2014.

since 2014.

Table 6: % of Medicare Spending by Principal Diagnosis

Table 7: Spending by Level of Care

CCS

2018

Level of Care

Dementia

25.3%

Routine Home Care

89.81%

Circulatory/Heart

20.2%

General Inpatient Care

6.44%

Cancer

17.7%

Inpatient Respite Care

1.95%

Other

13.3%

Continuous Home Care

1.79%

Respiratory

10.9%

Source: CMS Data sourced by HCCI for NHPCO

Stroke11.5%

Chronic Kidney Disease

1.1%

2018

Source: CMS Data sourced by HCCI for NHPCO

Facts and Figures | 2020 EDITION rganization

19

Who Provides Care?
How many hospices were in operation in 2018?

Hospice Size

Over the course of 2018, there were 4,639 Medicare certified hospices

One indicator of hospice size is the average daily census (ADC) orin operation based on claims data. This represents an increase of

more specifically the number of patients cared for by a hospice on

13.4% since 2014.

average each day.

Figure 20: Number of Operating Hospices

In 2018, the mean ADC for all hospices was 66.9 with a median of 31.8

4,092

4,382

4,199

4,488

4,639

patients. 63% of all hospices had an ADC of less than 50 patients.

Figure 21: Hospice Average Daily Census for 201830.5%

50-199 Patients63%< 50 Patients

13.4

2014

2015

2016

2017

5.5%

2018

200-499 Patients

Source: MedPAC March Report to Congress, Various Years

1.0%>= 500Source: CMS Data sourced by HCCI for NHPCO

Table 8: ADC Support StatsYear

Mean Census

Median Census

10th Percentile
Census25th Percentile
Census75th Percentile
Census90th Percentile
Census

2014

66.9

33.5

4.1

12.8

75.3

150.3

2015

66.3

33.2

4.0

13.2

74.5

146.5

2016

67.3

33.1

3.1

12.1

75.9

153.5

2017

68.9

33.2

3.6

12.2

78.3

157.6

2018

66.9

31.8

4.0

12.5

75.5

154.2

Source: CMS Data sourced by HCCI for NHPCO

Facts and Figures | 2020 EDITION rganization

20

Who Provides Care? (continued)
Tax Status
As shown in figure 22, 69.7%

Figure 22: Providers by Typeof active Medicare provider
numbers were assigned tohospice providers with forprofit tax status and 26.9%
with not-for-profit status.
For-profit hospice providers
grew by 24.7 % since 2014
while non-profit hospiceproviders retracted 4.4%.
Government-owned hospiceproviders comprised only
3.4% and has also declinedby more than 20% since 2014.

Source: MedPAC March Report to Congress, Various Years

Facts and Figures | 2020 EDITION rganization

21

Who Provides Care? (continued)
Patient Volume First Admissions

Volume of Deaths

In 2018 hospice providers performed a total 1.48 million unduplicated

In 2018, the highest number of hospice providers served 50 or fewer

admissions* of Medicare hospice patients representing a 23.9%

patients who died while enrolled in hospice care.

increase since 2014.

Figure 24: % of Hospice Providers by Decedent Count

Figure 23: First Admissions
1.25M

1.29M

1.35M

1.48M

2016
32.48%<=50
No of Deaths

1.19M

2015
51-10017.21%

51-10017.56%

101-200

19.19%

101-200

18.20%

201-500

18.77%

201-500

18.79%

501-1000>1000

501-1000

8.14%
4.20%

>1000

33.93%

2015

2016

2017

2018

*Unduplicated admissions include patients who were part of the census at the endof 2017, carried over into 2018, discharged in 2017 and readmitted within the year.
Source: CMS Data sourced by HCCI for NHPCO

No of Deaths<=50
51-10017.01%

51-10018.34%

101-200

201-500

18.29%

201-500

>1000

4.20%

8.04%
4.39%

34.55%<=50

101-200
501-1000

8.00%

2018

2017

2014

33.24%<=50

501-1000
>1000

16.5%
18.53%
17.89%
8.14%
4.39%

Source: CMS Data sourced by HCCI for NHPCO

Facts and Figures | 2020 EDITION rganization

22

Who Provides Care? (continued)
Provider Medicare Certification
More than 55% of all providers have been certified for 10 or more years, highlighting the maturity of the industry.
The biggest growth of provider certification since 2014 has been on newer providers certified for 2-5 years,
highlighting new entrants within the industry.

Table 9: Provider Certification
Years Certified

2014

2015

2016

2017

2018

< 2 Years

11.1%

10.3%

10.3%

10.1%

10.1%

2-5 Years

13.3%

15.5%

16.9%

17.9%

17.6%

5-10 Years

21.8%

18.8%

17.2%

16.3%

17.1%

10 + Years

53.8%

55.4%

55.6%

55.7%

55.1%

Source: CMS Data sourced by HCCI for NHPCO

Facts and Figures | 2020 EDITION rganization

23

Data Sources
The data sources primarily used for this report are from the MedPAC
March Report to Congress (various years), MedPAC Data Book, andvarious CMS claims related data sourced by the Health Care Cost
Institute (HCCI) paid for by NHPCO. See cited sources through out thereport for each table and figure. For data references provided by
MedPAC, the March Report to Congress from various years or the
FY2020 MedPAC Data Book are used. They can be found at www.
medpac.gov. For data references provided by HCCI, various sources andthe following methodology was used. The CMS Research Identifiable
Files (RIF) Medicare Fee-for-Service (FFS) claims data including 100%of Medicare Part A from 2012-2018. The CMS 2018 Provider of Service(POS) file is used to provide further information on facilities certified
to provide care to Medicare beneficiaries. The Healthcare Cost andUtilization Project (HCUP) Clinical Classification Software (CCS) wasused to classify patients into diagnosis categories based on theirprimary ICD-9 or ICD-10 diagnosis. The FY 2018 Hospice Wage Index
and Payment Rate Update and Hospice Quality Reporting
Requirements is the source for the tax status statistics.

Methodology Note
For all HCCI related references, all claims are analyzed within the calendar
year with the date assigned based on the claim through date, the lastdate on the billing statement for services covered to a beneficiary. The
methods used to aggregate hospice claims were based on those outlinedin the Centers for Medicare and Medicaid Services’ Medicare Hospice
Utilization &Payment Public Use File: A Methodological Overview. Results
may differ from other reports such as Medpac’s publications that lookwithin a fiscal year or across multiple years for patients that have lengthsof stay that cross many years. Unless otherwise specified, thedenominator is all hospice beneficiaries who had any services covered
within the calendar year, regardless of the discharge status code for thelast service rendered. This differs from other analyses that may restrict topatients who were discharged (live discharges and/or decedents).

Facts and Figures | 2020 EDITION rganization

CMS Research Identifiable Files (RIF) Data Set
The Medicare FFS RIFs used for this report contain all Medicare Part A claims
related to payment made directly towards hospice services. All beneficiaries
with at least one hospice claim paid through Medicare are included in this file
(2.5% of all Medicare beneficiaries in 2018). Selected variables within the files
are encrypted, blanked, or ranged. The RIF Medicare claims used for Facts andFigures include the following data files:z Hospice File: Hospice Fee-for-Service claims submitted by Medicare certified
hospice providers (see documentation for detailed information on hospice files)z Member Beneficiary Summary File (MBSF): Medicare beneficiary enrollment
information via Medicare Parts A, B, C, and D (see documentation for
detailed information on MBSF)

CMS 2018 Provider of Service (POS) Data Set
The POS file contains information of health care providers who are certified toprovide care to Medicare beneficiaries.

Healthcare Cost and Utilization Project (HCUP) ClinicalClassification Software (CCS)The CCS tool was used to group patients into diagnosis groups based off ICD-9
or ICD-10 diagnosis.

Questions May Be Directed To:
National Hospice and Palliative Care Organization Attention:
Research Phone: 703.837.1500
Email: communications@nhpco.org©2020 National Hospice and Palliative Care Organization.
All rights reserved, including the right to reproduce this publication or portions
thereof in any form. Public use of this report and reported data is authorized if
the National Hospice and Palliative Care Organization is clearly referenced.

Suggested Citation:2020 Edition: Hospice Facts and Figures. Alexandria, VA: National Hospiceand Palliative Care Organization. August 2020. www.nhpco.org/factsfigures.

24

NHPCO
1731 King Street
Alexandria, VA 22314
tel. 703.837.1500 | nhpco.org

AUGUST, 2020