DEPARTMENT OF HEALT H AND HUMA.l~ SERVIC ES 

OFFICE OF INSPECTOR GENERAL 

WASHI NGTON , DC 2020 1 

MAY 0 3 2013 

TO: 	 Marilyn Tavenner 

Acting Administrator 

Centers for Medicare & Medicaid Services 

FROM: Stuart Wright: 

Deputy Inspector General 

for Evaluation and Inspections 

SUBJECT: 	 Memorandum Report: Medicare Hospice : Use ofGenerallnpatient 

Care, OEI-02-1 0-00490 

This memorandum report describes the use of hospice general inpatient care in 2011. It 

is part of ongoing work by the Office of Inspector General (OIG) on the Medicare 

hospice benefit. A companion report will look at the appropriateness ofhospice general 

inpatient care provided to beneficiaries. 

SUMMARY 

Hospice general inpatient care (GIP) is for pain control or symptom management 

provided in an inpatient facility that cannot be managed in other settings. The care is 

intended to be short-term and is the second most expensive level of hospice care. GIP 

may be provided in one of three settings: a Medicare-certified hospice inpatient unit, a 

hospital, or a skilled nursing facility (SNF). 

Centers for Medicare & Medicaid Services (CMS) staff have expressed concerns about 

possible misuse of GIP, such as care being billed for but not provided, long lengths of 

stay, and beneficiaries receiving care unnecessarily. In addition, the Federal govenunent 

recently reached a $2.7 million settlement with a hospice for allegedly billing Medicare 

for GIP when beneficiaries actually received routine home care, which has a lower 

reimbursement rate . 

1 

We found that Medicare paid $1 .1 billion for GIP in 2011, most of which was provided in 

hospice inpatient units, as opposed to hospitals or SNFs. Twenty-three percent of 

1 U .S. Department of Justice, "Hospice Home Care to Pay $2,700,000 Settlement in Medicare Fraud Case," 


December 9, 2011. Accessed at 


http: www. j usti ~~Q_y usao are news 2011/Dec;ember Hos ice quita[!Ljlf.ttle 12091l.html on April22, 


2013 . 

Page 2 – Marilyn Tavenner

Medicare Hospice: Use of General Inpatient Care (OEI-02-10-00490)

Medicare hospice beneficiaries received GIP during the year. One-third of beneficiaries’ 

GIP stays exceeded 5 days, with 11 percent lasting 10 days or more. The hospices that 

used inpatient units provided GIP to more of their beneficiaries and for longer periods of 

time than hospices that used other settings. We also found that 953 hospices, or 

27 percent of Medicare hospices, did not provide any GIP to Medicare beneficiaries in 

2011 and that 429 of these hospices did not provide any level of hospice care other than 

routine home care.

These results raise several questions about GIP. Long lengths of stay and the use of GIP 

in inpatient units need further review to ensure that hospices are using GIP as intended 

and providing the appropriate level of care. OIG is committed to looking into these 

issues further and will conduct a medical record review that will assess the 

appropriateness of GIP provided in different settings. CMS should also focus on these 

issues as it considers options for hospice payment reform and for developing hospice 

quality measures. In particular, CMS should focus on hospices that do not provide GIP 

and ensure that these hospices are providing beneficiaries access to needed levels of care 

at the end of their lives. One option is for CMS to adopt a quality measure regarding 

hospices’ ability to provide all hospice services.

 

BACKGROUND

The goals of hospice care are to help terminally ill beneficiaries continue life with 

minimal disruption and to support beneficiaries’ families and other caregivers throughout 

the process. The care may be provided to individuals and their families in various 

settings, including a hospice inpatient unit, the home, or other places of residence, such as 

a SNF or other nursing facility. In 2011, Medicare paid $13.7 billion for hospice care for 

1.2 million beneficiaries.

To be eligible for Medicare hospice care, a beneficiary must be entitled to Part A of 

Medicare and be certified as having a terminal illness with a life expectancy of 6 months 

or less if the disease runs its normal course.2

 Upon a beneficiary’s election of hospice 

care, the hospice agency assumes the responsibility for medical care related to the 

beneficiary’s terminal illness and related conditions. This care is palliative, rather than 

curative. It includes, among other things, nursing care, medical social services, hospice 

aide services (sometimes referred to as home health aide services), medical supplies 

(including drugs and biologicals), and physician services. The beneficiary waives all 

rights to Medicare payment for services related to the curative treatment of the terminal 

condition or related conditions but retains rights to Medicare payment for services to treat 

conditions unrelated to the terminal illness.3

 Beneficiaries may revoke their election of 

hospice care and return to standard Medicare coverage at any time.4

2 Social Security Act, §§ 1814(a)(7)(A) and 1861(dd)(3)(A), 42 U.S.C. §§ 1395f(a)(7)(A) and 

1395x(dd)(3)(A); 42 CFR §§ 418.20 and 418.22. Certification is based on the physician’s or medical 

director’s clinical judgment regarding the normal course of the individual’s illness. 3 Social Security Act, §§ 1812(d)(2)(A) and 1861(dd)(1), 42 U.S.C. §§ 1395d(d)(2)(A) and 1395x(dd)(1); 

42 CFR § 418.24(d). 4 Social Security Act, § 1812(d)(2)(B), 42 U.S.C. § 1395d(d)(2)(B); 42 CFR § 418.28.
Page 3 – Marilyn Tavenner

Medicare Hospice: Use of General Inpatient Care (OEI-02-10-00490)

Beneficiaries are entitled to receive hospice care for two 90-day periods, followed by an 

unlimited number of 60-day periods.5 The periods need not be consecutive. At the start 

of each period of care, an attending physician must certify that the beneficiary is 

terminally ill and has a life expectancy of 6 months or less. For care to be covered under 

Part A, hospices must be certified by Medicare.6 In 2011, there were 3,585 Medicare 

hospices. Of these, 2,071 were for-profit, 1,237 were nonprofit, and 185 were

government owned.7 

The Medicare hospice benefit is currently undergoing some changes. Per the Patient 

Protection and Affordable Care Act (ACA), CMS must reform the hospice payment 

system.8 Also, CMS must develop quality measures for hospices and hospices must 

report quality data. CMS is currently using two quality measures. The first relates to 

pain management and the second relates to how hospices track patient care. Beginning in 

2014, hospices must report these measures or face reduced Medicare payments.9 

Hospice General Inpatient Care

The Medicare hospice benefit has four levels of care.10 Each level has an all-inclusive 

daily rate that is paid through Part A. The rate is paid to the hospice for each day that a 

beneficiary is in hospice care, regardless of the number of services furnished. The rates 

are adjusted based on the beneficiary’s geographic location.

GIP is the second most expensive level of hospice care. As with all covered hospice 

services, hospices are required to provide GIP if the beneficiary needs it.

11 GIP is for 

pain control or symptom management that cannot be managed in other settings, such as 

the beneficiary’s home.12 GIP is intended to be short-term and may be provided in one of 

three settings: a Medicare-certified hospice inpatient unit, a hospital, or SNF.13 A 

Medicare-certified hospice inpatient unit can be freestanding or in space shared with 

another health care facility. Medicare-certified hospices with inpatient units must comply 

with a number of Federal regulations, ranging from staffing to the dispensing of drugs.14

The other three levels of care are routine home care, continuous home care, and inpatient 

respite care. Routine home care is the most common. Medicare reimburses the hospice 

at this rate for each day that the beneficiary is under the care of the hospice and is not 

receiving one of the other levels of care. Continuous home care is allowed only during 

5 Social Security Act, § 1812(a)(4), 42 U.S.C. § 1395d(a)(4). Prior to 1990, Medicare provided hospice 

coverage for a maximum of 210 days.

6 Social Security Act, §§ 1814(a) and 1866, 42 U.S.C. §§ 1395f(a) and 1395cc; 42 CFR § 418.116(a). 7 We did not have information on ownership status for 92 hospices.

8 Patient Protection and Affordable Care Act (ACA), P.L. 111-148 § 3132. 9 ACA, P.L. 111-148 § 3004; 76 Fed. Reg. 47302, 47325–26 (Aug. 4, 2011). 10 42 CFR § 418.302. 11 Social Security Act, § 1861(dd)(2)(A)(i), 42 U.S.C. § 1395x(dd)(2)(A)(i). 12 42 CFR § 418.302(b)(4). 13 42 CFR § 418.108(a) and (b). For GIP, Medicare regulations do not specify what is meant by “short 

term.”

14 42 CFR § 418.110.
Page 4 – Marilyn Tavenner

Medicare Hospice: Use of General Inpatient Care (OEI-02-10-00490)

brief periods of crisis in which a beneficiary requires continuous care to achieve 

palliation or management of acute medical symptoms. Inpatient respite care is short-term 

inpatient care provided to the beneficiary when necessary to relieve the beneficiary’s 

caregiver(s). It may not be provided consecutively for more than 5 days at a time.15 See 

Table 1 for the unadjusted payment rates for each level of care in fiscal year (FY) 2011.

Table 1: Unadjusted Daily Medicare Hospice Payment 

Rates by Level of Care, FY 2011

Level of Care Unadjusted 

FY 2011 Rate

Routine Home Care $146.63

Continuous Home Care $855.79

General Inpatient Care $652.27

Inpatient Respite Care $151.67

Source: CMS, “Update to Hospice Payment Rates, Hospice Cap, Hospice Wage 

Index, and the Hospice Pricer for FY 2011,” Change Request 7077, July 23, 2010.

Inpatient care is subject to an annual cap. Medicare limits the total number of days of 

inpatient care (the sum of GIP and inpatient respite care days) for which a hospice may 

be reimbursed. The cap is set at 20 percent of the hospice’s total patient care days.16

Related Work

This report is part of OIG’s continuing work related to Medicare hospice care. Another 

study involving a medical record review of general inpatient claims from 2012 will 

follow this memorandum report. In 2011, OIG issued a report that found that hospices 

with a high percentage of their Medicare beneficiaries residing in nursing facilities 

received more Medicare payments per beneficiary and served beneficiaries who spent 

more time in hospice care.17 Another report determined that Medicare paid an average of 

$960 per week for hospice care for each beneficiary in a nursing facility.18 This care 

most commonly included nursing, home health aide, and medical social services. 

Hospices provided an average of 4.2 visits per week for these 3 services combined. 

OIG also has conducted several studies identifying inappropriate Medicare payments in 

hospice. OIG found that 82 percent of hospice claims for beneficiaries in nursing 

facilities did not meet Medicare coverage requirements.19 In addition, OIG identified a 

number of cases in which the use of inpatient respite care for beneficiaries in nursing 

facilities may have been inappropriate.20 OIG also found instances in which Medicare 

15 42 CFR § 418.302(e)(5). 16 Social Security Act, § 1861(dd)(2)(A)(iii), 42 U.S.C. § 1395x(dd)(2)(A)(iii); 42 CFR § 418.302(f). 

Excess inpatient care days are reimbursed at the routine home care rate. 

17 OIG, Medicare Hospices That Focus on Nursing Facility Residents, OEI-02-10-00070, July 2011. 18 OIG, Medicare Hospice Care: Services Provided to Beneficiaries Residing in Nursing Facilities, 

OEI-02-06-00223, September 2009. Payment for physician services was not included in the analysis. 

19 OIG, Medicare Hospice Care for Beneficiaries in Nursing Facilities: Compliance With Medicare 

Coverage Requirements, OEI-02-06-00221, September 2009. 20 OIG, Hospice Beneficiaries’ Use of Respite Care, OEI-02-06-00222, March 2008.
Page 5 – Marilyn Tavenner

Medicare Hospice: Use of General Inpatient Care (OEI-02-10-00490)

paid physicians for services related to a beneficiary’s terminal illness under Part B, while 

also paying for physicians’ services for the terminal illness under Part A.21

In addition, OIG is conducting a study that focuses on discharges from acute care 

hospitals to hospice care.22 It will address how a hospital transfer payment policy for 

early discharges to hospice care would financially affect the Medicare Part A program 

and hospitals.

METHODOLOGY

We based this memorandum report on an analysis of Medicare Part A hospice claims. 

To conduct this analysis, we extracted all Medicare Part A hospice claims from CMS’s 

National Claims History file that included service dates for hospice care in 2011 and 

2010. Part A hospice claims typically cover a 1-month period but could be for shorter 

periods of time. The level of hospice care, such as GIP, was indicated by a code on the 

claim.

We analyzed the claims data to identify the hospice beneficiaries who received GIP

during 2011, the number of days that each beneficiary received this care, and the setting 

in which the care was provided. We also determined from the claims data the terminal 

illness of each beneficiary. For beneficiaries receiving care at the beginning of 2011, we 

used hospice claims from 2010 to determine the level of care they received when they 

started hospice care.

In addition, we identified all of the Medicare-certified hospices that provided hospice 

care in 2011. For each hospice, we determined the number of Medicare hospice 

beneficiaries it served, the number of hospice beneficiaries for whom it provided GIP, 

the settings in which it provided GIP, the number of beneficiaries for whom it provided 

other levels of hospice care, and the reimbursements it received for GIP and for all 

hospice care. We determined each hospice’s profit status by using Certification and 

Survey Provider Enhanced Reports (CASPER). If CASPER did not show a 

classification of for-profit, nonprofit, or government owned for a hospice, we used 

information available in the Healthcare Cost Report Information System to determine the 

hospice’s status.

We grouped hospices according to the number of Medicare beneficiaries each hospice 

served during the year. We considered a hospice to be large if it provided care to more 

than 320 Medicare beneficiaries in 2011. We considered a hospice to be small if it 

provided care to 90 or fewer beneficiaries.23

21 OIG, Questionable Billing for Physician Services for Hospice Beneficiaries, OEI-02-06-00224, 

September 2010.

22 OIG, Medicare Could Save Millions by Implementing a Hospital Transfer Payment Policy for Early 

Discharges to Hospice Care, A-01-12-00507, (forthcoming). 23 Large hospices were those in the top 30th percentile, whereas small hospices were in the bottom 30th 

percentile.
Page 6 – Marilyn Tavenner

Medicare Hospice: Use of General Inpatient Care (OEI-02-10-00490)

For the purposes of this memorandum, we use the term “GIP stay” to refer to the 

continuous days in which a beneficiary received GIP from the same hospice in the same 

setting. To determine the continuous days a beneficiary received care, we combined 

claims for GIP when they were for the same beneficiary in the same setting, from the 

same hospice, and the start date of a subsequent claim was the same day or the next day 

as the ending date of the previous claim.

Standards

This study was conducted in accordance with the Quality Standards for Inspection and 

Evaluation issued by the Council of the Inspectors General on Integrity and Efficiency.

Limitations

We based this memorandum report on an analysis of Medicare hospice claims. We did 

not conduct a medical record review and did not determine whether services provided 

were medically necessary.
Page 7 – Marilyn Tavenner

Medicare Hospice: Use of General Inpatient Care (OEI-02-10-00490) 

RESULTS

Medicare Paid More Than $1 Billion for Hospice General Inpatient Care in 2011, 

Most of Which Was Provided in Hospices’ Inpatient Units, as Opposed to Hospitals 

or SNFs

Medicare paid $1.1 billion for GIP in 2011. This is 8 percent of the total $13.7 billion 

that Medicare spent for all hospice care during the year. 

Most GIP was provided in hospice inpatient units. Fifty-eight percent of GIP stays were 

in hospice inpatient units, compared to 33 percent in hospitals and 8 percent in SNFs.24 

In addition, GIP stays in hospice inpatient units accounted for more than two-thirds of the 

total amount Medicare spent on GIP during the year. In 2011, Medicare paid 

$738 million for GIP provided in hospice inpatient units, $280 million for GIP provided 

in hospitals, and $86 million for this care in SNFs. These amounts accounted for 

67 percent, 25 percent, and 8 percent of all GIP spending, respectively. See Figure 1.

Figure 1: Percentages of GIP Stays and Medicare Spending on GIP 

by Setting, Calendar Year 2011

58%

67%

33%

25%

8% 8%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

GIP Stays Dollars Spent on GIP

Percentage of GIP Stays and Spending

Hospice Inpatient Units Hospitals SNFs

Source: OIG analysis of CMS data, 2012.

Twenty-three percent of Medicare hospice beneficiaries received GIP in 2011. 

Seventy-one percent of these beneficiaries received GIP at the start of their time in 

hospice care. The most common terminal illnesses of beneficiaries who received GIP 

were cancer, circulatory disease, respiratory disease, ill-defined conditions, and mental 

disorders. These terminal illnesses were also the most common in the general hospice 

population. 

24 Because of rounding, these figures do not add to 100 percent.
Page 8 – Marilyn Tavenner

Medicare Hospice: Use of General Inpatient Care (OEI-02-10-00490) 

One-Third of GIP Stays Lasted Longer Than 5 Days 

Thirty-three percent of GIP stays in 2011 were longer than 5 days, with some lasting 

much longer than 5 days. More specifically, 11 percent of all GIP stays were 10 days or 

more. Two percent of all GIP stays continued for over 3 weeks. See Figure 2. Medicare 

policy does not specify a limit on the number of days GIP is allowed, although it is 

intended to be short-term. The other level of hospice care intended to be short-term, 

inpatient respite care is limited to 5 consecutive days. Inpatient respite care is used to 

relieve the beneficiary’s caregiver(s).

Figure 2: Percentage of GIP Stays Lasting More Than 5, 10, or 21 Days, 

Calendar Year 2011

33%

11%

2%

0%

5%

10%

15%

20%

25%

30%

35%

More than 5 days More than 10 days More than 21 days

Percentage of All GIP Stays

Length of Stay

Source: OIG analysis of CMS data, 2012.

GIP stays were much less likely to begin on Sunday or Saturday than on a weekday. 

Eight percent of all GIP stays started on Sundays and 11 percent started on Saturdays, 

whereas at least 16 percent of GIP stays started on each of the other days of the week. 

Because GIP is meant for pain control or symptom management that cannot be managed 

in other settings, we would expect that the percentages of GIP starts during weekend days 

and those during weekdays to be similar.

25 In each of the three settings, the lowest 

percentage of GIP stays started on Sundays. The difference between Sunday and other 

days was greatest in SNFs, where 5 percent of GIP stays started on Sundays and 

19 percent started on Fridays. See Appendix A. 

Unlike the starts of GIP stays, the ends of GIP stays were generally steady throughout the 

week. Fourteen percent of GIP stays ended on Sundays and 13 percent on Saturdays. 

Thirteen to 16 percent of GIP stays ended on each of the other days of the week. 

25 Hospices must make physician and nursing services available (as needed) on a 24-hour basis. Social 

Security Act, § 1861(dd)(2)(A)(i), 42 U.S.C. § 1395x(dd)(2)(A)(i). 
Page 9 – Marilyn Tavenner

Medicare Hospice: Use of General Inpatient Care (OEI-02-10-00490) 

Hospices That Used Inpatient Units Provided GIP to More of Their Beneficiaries 

and for Longer Periods of Time Than Hospices That Used Other Settings

Twenty-three percent of all Medicare hospices (809 hospices) provided GIP in inpatient 

units. Sixty percent of all Medicare hospices (2,163 hospices) provided GIP in hospitals, 

and 27 percent (978 hospices) provided GIP in SNFs.26

The 23 percent of hospices that used inpatient units were more likely than other hospices 

to provide GIP to their beneficiaries. Hospices that used inpatient units provided GIP to 

35 percent of their beneficiaries. In contrast, hospices that did not use inpatient units and 

provided GIP in hospitals or SNFs did so for 12 percent of their beneficiaries. Hospices 

that used inpatient units were also more dependent on GIP dollars. GIP represented 

13 percent of the total Medicare dollars of hospices that used hospice inpatient units. In 

contrast, GIP represented 4 percent of the total Medicare dollars of hospices that did not 

use inpatient units and provided GIP in hospitals or SNFs. 

GIP stays in inpatient units were typically longer than GIP stays in other settings. On 

average, GIP stays in inpatient units were 50 percent longer than GIP stays in hospitals 

and 29 percent longer than GIP stays in SNFs. The average GIP length of stay in an 

inpatient unit lasted 6.1 days, whereas the average GIP length of stay in a hospital was 

4.1 days and the average in a SNF was 4.8 days. See Figure 3. GIP stays in inpatient 

units were much more likely than GIP stays in other settings to exceed 5 days. Forty 

percent of all GIP stays in an inpatient unit exceeded 5 days, compared to 22 percent in 

hospitals and 27 percent in SNFs. 

Figure 3: Average Length of GIP Stays by Setting, Calendar Year 2011

6.1

4.1

4.8

0

1

2

3

4

5

6

7

Inpatient Units Hospitals SNFs

Days of GIP Stay

GIP Setting

Source: OIG analysis of CMS data, 2012. 

Hospices that provided GIP in inpatient units were more likely to be large than were

other hospices that provided GIP. We considered a hospice to be large if it provided 

26 Some hospices provided GIP in more than one setting.
Page 10 – Marilyn Tavenner

Medicare Hospice: Use of General Inpatient Care (OEI-02-10-00490) 

hospice care to more than 320 Medicare beneficiaries in 2011. Sixty-two percent of 

hospices that used inpatient units were large, compared to 29 percent of other hospices. 

Hospices that provided GIP in inpatient units served an average of 774 Medicare 

beneficiaries in 2011. Other hospices that provided GIP served an average of 

292 Medicare beneficiaries. 

More Than One Quarter of Hospices Did Not Provide Any General Inpatient Care 

in 2011 

A total of 953 hospices did not provide GIP in 2011. This represents 27 percent of the 

3,585 Medicare hospices in 2011. These 953 hospices served 92,803 Medicare hospice 

beneficiaries, but did not provide GIP to any of them during the year. As with all 

covered hospice services, hospices are required to provide GIP if the beneficiary needs it. 

In general, the beneficiaries served by hospices that did not provide GIP had the same 

terminal illnesses as beneficiaries served by hospices that provided GIP.27 

Hospices that did not provide GIP often did not provide other levels of hospice care to 

beneficiaries. Sixty-eight percent of hospices that did not provide GIP also did not 

provide continuous care, which is a level of hospice care that manages acute medical 

symptoms while the beneficiary remains at home. Sixty-two percent of hospices that did 

not provide GIP did not provide inpatient respite care, which is short-term inpatient care 

provided to the beneficiary when necessary to relieve the beneficiary’s caregiver(s). Like 

GIP, continuous care and inpatient respite care are covered by Medicare and must be 

provided if needed. In total, 45 percent of hospices that did not provide GIP also did not 

provide continuous care or inpatient respite care during the year. These 429 hospices 

provided only routine hospice care to all their beneficiaries throughout 2011. 

The hospices that did not provide GIP were more likely than other hospices to be 

for-profit. In 2011, 69 percent of the hospices that did not provide GIP were for-profit, as 

opposed to 54 percent of hospices that provided GIP. 

In addition, hospices that did not provide GIP were more likely than other hospices to be 

small. We considered a hospice to be small if it provided hospice care to 90 or fewer 

Medicare beneficiaries in 2011. Sixty-three percent of hospices that did not provide GIP 

were small while 18 percent of hospices that provided GIP were small. 

27 There were small differences in two terminal illnesses. Twenty-four percent of beneficiaries from 

hospices that did not provide GIP had cancer, compared to 28 percent of beneficiaries from hospices that 

provided GIP. Eight percent of beneficiaries from hospices that did not provide GIP had Alzheimer’s 

disease, compared to 5 percent from the other hospices. See Appendix A.
Page 11 – Marilyn Tavenner

Medicare Hospice: Use of General Inpatient Care (OEI-02-10-00490) 

CONCLUSION

GIP is an important level of care for hospice beneficiaries. We found that Medicare paid 

$1.1 billion for GIP in 2011, most of which was provided in hospice inpatient units, as 

opposed to hospitals or SNFs. Twenty-three percent of Medicare hospice beneficiaries 

received GIP during the year. One-third of beneficiaries’ GIP stays exceeded 5 days, 

with 11 percent lasting 10 days or more. The hospices that used inpatient units provided 

GIP to more of their beneficiaries and for longer periods of time than hospices that used 

other settings. We also found that 953 hospices, or 27 percent of Medicare hospices, did 

not provide any GIP to Medicare beneficiaries in 2011 and that 429 of these hospices did 

not provide any level of hospice care other than routine home care. 

These results raise several questions about GIP. Long lengths of stay and the use of GIP 

in inpatient units need further review to ensure that hospices are using GIP as intended 

and providing the appropriate level of care. OIG is committed to looking into these 

issues further and will conduct a medical record review that will assess the 

appropriateness of GIP provided in different settings. CMS should also focus on these 

issues as it considers options for hospice payment reform and for developing hospice 

quality measures. In particular, CMS should focus on hospices that do not provide GIP 

and ensure that these hospices are providing beneficiaries access to needed levels of care 

at the end of their lives. One option is for CMS to adopt a quality measure regarding 

hospices’ ability to provide all hospice services. 

This report is being issued directly in final form because it contains no recommendations. 

We anticipate making recommendations regarding the use of GIP in a separate report 

after we have completed our medical record review. If you have comments or questions 

about this report, please provide them within 60 days. Please refer to report number 

OEI-02-10-00490 in all correspondence. 
Page 12 – Marilyn Tavenner

Medicare Hospice: Use of General Inpatient Care (OEI-02-10-00490) 

APPENDIX A 

Figure A-1: Percentage of Hospice General Inpatient Care (GIP) Stays That Started on 

Each Day of the Week by Setting, Calendar Year 2011

0%

5%

10%

15%

20%

25%

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Percentage of All GIP Stays

Starting Day of the GIP Stay

Hospice Inpatient Units Hospitals Skilled Nursing Facilities

Source: Office of Inspector General analysis of Centers for Medicare & Medicaid Services data, 2012.
Page 13 – Marilyn Tavenner

Medicare Hospice: Use of General Inpatient Care (OEI-02-10-00490) 

APPENDIX B 

Figure B-1: Beneficiary Diagnoses in Hospices That Provided Hospice General Inpatient 

Care (GIP) and in Hospices That Provided No GIP, Calendar Year 2011

0%

5%

10%

15%

20%

25%

30%

35%

Cancers Circulatory

Diseases

Respiratory

Diseases

Ill-Defined

Conditions

Mental

Disorders

Alzheimer's

Disease

Percentage of Beneficiaries

Diagnosis Category of the Terminal Illness

Hospices that provided no GIP Hospices that provided GIP

Source: Office of Inspector General analysis of Centers for Medicare & Medicaid Services data, 2012.