Hospice Metrics Using Medicare Data to Measure Access and Performance for Hospice and Palliative Care

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1 Hospice Metrics Using Medicare Data to Measure Access and Performance for Hospice and Palliative Care 1

2 Outline What are the Medicare data? What are the important metrics? Why hospitals matter so much Avoiding the unnecessary hospital stay Palliative Care 2

3 What are Medicare Data? Publicly available Medicare Data Include 1. Claims Data for fee-for-service enrollees 2. Medicare Cost Reports 3. Quality Reporting Programs 4. Value Based Purchasing Results All contain Provider Level Data Claims data contain Patient Level Data 3

4 What are Medicare Claims? Medicare Claims - the Limited Data Set 1. Hospice Care 2. Hospital Inpatient Care 3. Outpatient Care 4. Skilled Nursing Care 5. Home Health Care 6. Durable Medical Equipment 7. Carrier Physicians and Other Suppliers 8. Master Beneficiary Summary File 4

5 What is in Medicare Claims? Provider Identifier Patient Identifier Patient Demographics Age, Gender, Ethnicity, State, County, Dual Eligibility, HMO Service Dimensions Units, Payments, Time, Place Service Dispositions Discharge, Death, Status 5

6 Limitations of Claims Data Medicare Only Medicare Fee-for-Service Only Hospice exception, for now Part B claims sampled at 5% 6

7 Important Metrics Death Rate = Total Deaths / Population Death Service Ratio = Hospice Deaths / Total Deaths Hospice Length of Stay = Total Days / Total Patients Served Market Share = Program Patients / Total Patients 7

8 Other Metrics Live Discharge Rates Levels of Care and Visits near End-of-Life Hospitalizations at End-of-Life Patient Flows near End-of-Life Hospital Readmission Rates Palliative Care Rates 8

9 Death Rate for Medicare Enrollees 9

10 Death Rate Projection 10

11 Deaths Projection 11

12 Death Service Ratio Hospice Deaths / Total Deaths 12

13 Death Service Ratio TOP 10 BOTTOM 10 State Death Service Ratio Rank Arizona Utah Florida Delaware Iowa Ohio Rhode Island Wisconsin Michigan Oregon State Death Service Ratio Rank Montana New Jersey Vermont Kentucky South Dakota Wyoming District of Columbia New York North Dakota Alaska

14 Death Service Ratio Hospice Deaths / Total Deaths 14

15 Death Service Ratio Other CON States 15

16 Death Service Ratio Oregon Counties 16

17 Oregon 17

18 Death Service Ratio Washington Counties 18

19 Washington 19

20 Average Length of Stay Hospice Days / Hospice Patients 20

21 Hospice Length of Stay TOP 10 BOTTOM 10 State Days per Patient (ALOS) Rank Alabama Utah Texas South Carolina Idaho Georgia Mississippi Oklahoma New Mexico Louisiana State Days per Patient (ALOS) Rank New Jersey Nebraska Montana Iowa New York North Dakota Connecticut Kentucky South Dakota Wyoming

22 Hospice Length of Stay 22

23 Live Discharges WA OR 23

24 Inpatient Hospice Care 24

25 Inpatient Hospice Care 25

26 US Levels of Care at End of Life FL OR WA 26

27 US Visits at End of Life FL OR WA 27

28 Hospitals and Hospice 28

29 Service before Hospice Admission 29

30 Service before Hospice Admission & ALOS 30

31 Hospitalizations Near End of Life 31

32 Hospitalizations Near End of Life 32

33 Hospitalizations Near End of Life 33

34 Services in 6 Months Before Hospice Admission 20 MOST COMMON SERVICE SEQUENCES IN SIX MONTHS BEFORE ADMISSION TO HOSPICE FOR PHY PHY HPL PHY OUT HPL No Services PHY OUT OUT HPL SNF OUT HPL PHY OUT OUT OUT HPL PHY OUT HPL HPL PHY OUT OUT OUT OUT HPL PHY OUT OUT HPL PHY HPL HPL SNF HPL PHY OUT OUT OUT PHY OUT OUT OUT OUT OUT HPL OUT PHY OUT OUT OUT OUT PHY HHA 34

35 Physicians often Begin the Sequence 20 MOST COMMON SERVICE SEQUENCES IN SIX MONTHS BEFORE ADMISSION TO HOSPICE FOR PHY PHY HPL PHY OUT HPL No Services PHY OUT OUT HPL SNF OUT HPL PHY OUT OUT OUT HPL PHY OUT HPL HPL PHY OUT OUT OUT OUT HPL PHY OUT OUT HPL PHY HPL HPL SNF HPL PHY OUT OUT OUT PHY OUT OUT OUT OUT OUT HPL OUT PHY OUT OUT OUT OUT PHY HHA 35

36 Hospitals often End the Sequence 20 MOST COMMON SERVICE SEQUENCES IN SIX MONTHS BEFORE ADMISSION TO HOSPICE FOR PHY PHY HPL PHY OUT HPL No Services PHY OUT OUT HPL SNF OUT HPL PHY OUT OUT OUT HPL PHY OUT HPL HPL PHY OUT OUT OUT OUT HPL PHY OUT OUT HPL PHY HPL HPL SNF HPL PHY OUT OUT OUT PHY OUT OUT OUT OUT OUT HPL OUT PHY OUT OUT OUT OUT PHY HHA 36

37 Impact of One Fewer Hospital Stays POTENTIAL HOSPICE LENGTH OF STAY INCREASES BASED ON ELIMINATING FINAL HOSPITAL STAY BEFORE HOSPICE ADMISSIONS / ALL US HOSPICES Sequence of Services before Hospice Admission Hospice Length of Stay Without Final Hospital Stay PHY HPL PHY OUT HPL PHY OUT OUT HPL OUT HPL PHY OUT OUT OUT HPL HPL HPL PHY OUT OUT OUT OUT HPL HPL PHY HPL HPL SNF HPL PHY OUT OUT OUT OUT OUT HPL OUT OUT HPL SNF OUT HPL PHY OUT OUT OUT OUT OUT OUT HPL PHY OUT HPL HPL SNF OUT OUT HPL SUBTOTAL OTHER OVERALL

38 Palliative Care in the Hospital Setting 38

39 Palliative Care in the Hospital Setting 39

40 Palliative Care in the Hospital Setting 40

41 Palliative Care in the Hospital Setting 41

42 Palliative Care in the Hospital Setting 42

43 EVERGREENHEALTH MEDICAL CENTER

44 12.0% 10.0% 8.0% 6.0% 2.9% 4.0% 2.0% 0.0% % of FFS Discharges with Palliative Encounter for EVERGREENHEALTH MEDICAL CENTER // DIAGNOSIS = ALL DIAGNOSES for % 7.7% 9.7% 8.0% 6.9% % 50% 40% 30% 20% 10% 0% % of FFS Discharges with Palliative Encounter for EVERGREENHEALTH MEDICAL CENTER // DIAGNOSIS = ALL DIAGNOSES for % Expired in Hospital 57.9% Hospice, Direct 14.5% Died < 6 months, w Hospice 4.5% 1.5% 6.9% Died < 6 months, wo Hospice All Other Discharges All Dispositions % of All Palliative Encounters for EVERGREENHEALTH MEDICAL CENTER // DIAGNOSIS = ALL DIAGNOSES for Day Hospital-Wide Readmission Rates for EVERGREENHEALTH MEDICAL CENTER // DIAGNOSIS = ALL DIAGNOSES for 2016 Died < 6 months, wo Hospice, 3% Died < 6 months, w Hospice, 18% All Other Discharges, 17% Expired in Hospital, 20% Hospice, Direct, 42% 60% 50% 40% 30% 20% 10% 0% 0% 0% 0% 0% Expired in Hospital With PCare Hospice, Direct 17% 34% Died < 6 months, w Hospice WO PCare 54% 49% Died < 6 months, wo Hospice 12% 14% 7% 3% All Other Discharges All Dispositions 44

45 GOOD SAMARITAN REGIONAL MEDICAL CENTER

46 8.0% 7.0% 6.0% 5.0% 4.0% 3.0% 2.0% 1.3% 1.0% 0.0% % of FFS Discharges with Palliative Encounter for GOOD SAMARITAN REGIONAL MEDICAL CENTER // DIAGNOSIS = ALL DIAGNOSES for % 2.5% 1.3% 4.8% 7.5% % 60% 50% 40% 30% 20% 10% 0% % of FFS Discharges with Palliative Encounter for GOOD SAMARITAN REGIONAL MEDICAL CENTER // DIAGNOSIS = ALL DIAGNOSES for % Expired in Hospital 67.1% Hospice, Direct 11.8% 11.4% Died < 6 months, w Hospice Died < 6 months, wo Hospice 1.8% 7.5% All Other Discharges All Dispositions % of All Palliative Encounters for GOOD SAMARITAN REGIONAL MEDICAL CENTER // DIAGNOSIS = ALL DIAGNOSES for Day Hospital-Wide Readmission Rates for GOOD SAMARITAN REGIONAL MEDICAL CENTER // DIAGNOSIS = ALL DIAGNOSES for 2016 Died < 6 months, wo Hospice, 7% Died < 6 months, w Hospice, 13% All Other Discharges, 19% Expired in Hospital, 15% Hospice, Direct, 47% 60% 50% 40% 30% 20% 10% 0% 0% 0% 0% Expired in Hospital With PCare 14% Hospice, Direct 7% Died < 6 months, w Hospice WO PCare 51% 52% 19% Died < 6 months, wo Hospice 15% 12% 9% 6% All Other Discharges All Dispositions 46

47 Hospice Rate vs Palliative Hospice Rate Care Rate = Discharges to Hospice (Discharges to Hospice + Hospital Deaths) Palliative Care Rate = Hospital Deaths with Palliative Care Hospital Deaths 47

48 Hospice Rate vs Palliative Care Rate for Largest 400 Hospitals in

49 Question Does an organized program of palliative care in a hospital result in a more or less coordinated system of referrals to hospice? Should the hospital or hospice run such palliative care programs? 49

50 Hospice Metrics Using Medicare Data to Measure Access and Performance 50

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