2015 REPORT. Hospice Demographic and Outcome Measures

Transcription

1 2015 REPORT Hospice Demographic and Outcome Measures Updated February 8, 2016

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3 Table of Contents 1.0 Executive Summary Data Collected Outcome Measures Outcome Measure 1 (OM1) Outcome Measure 2 (OM2) Outcome Measure 2A (OM2A) Accreditation Individual Hospice Information Hospice Geographical Coverage Inpatient Facilities and Residential Units Primary Diagnosis at Time of Admission Patient Race and Ethnicity Patient Age Discharges by Disposition Type Patient Days by Location Reimbursement Additional Hospice Data Available Centers for Medicare & Medicaid Services (CMS) Quality Measures for Hospice Quality Reporting Program and Data Submission Requirements Conclusion APPENDIX A... 27

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5 1.0 Executive Summary As mandated in Section of the Florida Statutes, together with Rule 58A-2.005, Florida Administrative Code, hospices licensed in Florida are required to submit outcome measure, demographic, and diagnostic information to the Department of Elder Affairs (DOEA) each year. This report contains an analysis of the data submitted by 44 of Florida s 45 licensed hospices for and comparisons between the current year and years prior are provided in this report where trends and contrasts are noteworthy. All but one of the 44 Florida hospices that reported outcome measure data met the standards set for the three mandatory outcome measures: 50 percent or more of patients who reported severe pain on a 0-10 scale reported a reduction to five or less by the end of the fourth day or care in the hospice program (OM1); 50 percent or more of patients reported they received the right amount of medicine for his or her pain (OM2); and 50 percent or more of patients and/or family members recommended hospice services to others based on the care the patient received (OM2A). In all, hospice demographic and outcome measure results for 2014 were similar to previous reporting years. In 2014, Florida hospices individually operated as many as 17 independent facilities or residential units, and more than half of all Florida hospices were accredited organizations (57%). The typical patient is a Caucasian individual (74%) who is 65 years or older in age (85%) admitted for seven days or less (55%), three characteristics that remain constant across each year of reporting. The majority of hospice services were provided in private residences (55% of all patient days), and Medicare remains the primary source of payment (87% of all hospice reimbursements) during the reporting year. The most notable change is the steady increase in the demand for hospice services. Over the last six years, Florida hospices have experienced steady increases in patient admissions each year, culminating in a 32 percent increase in patient admissions in 2014 (50,920) compared to 2009 (34,719). 1 Compassionate Care Hospice of Lake and Sumter, Inc., admitted the first patient in quarter 4 of 2014, and, therefore, has minimal results. Unless otherwise noted, data received from Compassionate Care Hospice of Lake and Sumter, Inc., is not included in any further analysis Hospice Demographic and Outcome Measures Report Revised February, 2016

6 2.0 Data Collected Section of the Florida Statutes requires the Department of Elder Affairs (DOEA), in conjunction with the Agency for Health Care Administration (AHCA), to develop outcome measures to determine the quality and effectiveness of hospice care for hospices licensed in Florida. This statute, along with Rule 58A-2.005, Florida Administrative Code, defines the outcome measures, as well as demographic and diagnostic information hospices are required to submit annually to DOEA. Hospices are also required to conduct patient surveys using the National Hospice and Palliative Care Organization Patient/Family Satisfaction Survey or a similar survey. Calendar year 2014 is the sixth year for which results for all three outcome measures are available. A secure online form was made accessible January 1, 2010, to all hospices for the purpose of data collection. A copy of the form that lists the required information (DOEA Form H-002) is included in the Appendix. The information provided by each hospice organization includes the following: Hospice contact information; Counties served; Facility and residential unit information (including the number of beds, facility admissions, and facility patient days); Outcome Measure 1: Proportion of patients reporting a reduction of pain; Outcome Measure 2: Proportion of patients receiving the right amount of pain medicine; Outcome Measure 2A: Proportion of patients who would recommend hospice services to others; Diagnosis, age, race, and reimbursement information for patients admitted; Number of patient days by location; and Number of patient discharges by death/non-death. The majority of the required information is reported at the larger hospice organization level (not for each facility or residential unit operated by a hospice organization) Hospice Demographic and Outcome Measures Report Revised February, 2016

7 3.0 Outcome Measures Hospices are required to report three outcome measures (see Exhibit 1 below). These measures were designed to be used as a tool for evaluating hospice quality. Results from 2014 indicate that all but one hospice that reported outcome measure data met the standards set for these three measures. Exhibit 1 lists the standard set for each outcome measure and the percentage of reporting hospices that met the standard. The acceptable standard for all three outcome measures is set at 50 percent of the survey responses received by the hospice. Exhibit 1: Percentage of Florida Hospices That Met Outcome Measures for 2014 Outcome Measure Number 1 (OM1) 2 (OM2) 2A (OM2A) Description of Outcome Measure and Standard 50 percent or more of patients who reported severe pain on a 0-to-10 scale reported a reduction to five or less by the end of the fourth day of care in the hospice program. 50 percent or more of patients reported they received the right amount of medicine for their pain. 50 percent or more of patients and/or family members recommended hospice services to others based on the care the patient received. Note: Samaritan Care Hospice of Osceola, Inc., did not meet the 50% standard for OM1. Percentage of Reporting Hospices That Met Standard 97.8% 100% 100% Hospice Demographic and Outcome Measures Report Revised February, 2016

8 Percent of Patients 3.1 Outcome Measure 1 (OM1) As required in Section of the Florida Statutes, Outcome Measure 1 measures the percentage of patients who had severe pain (seven or higher on the 0-10 scale) at admission and whose pain was reduced to a level of five or lower by the end of the fourth day of care in the hospice program. Of the 44 hospices that reported data on this measure in 2014, 43 hospices met or exceeded the 50 percent standard for decreasing pain to a level of five or less by the end of the fourth day. 2 As shown in Exhibit 2 below, 17 hospices reported they reduced the pain level to five or lower by the end of the fourth day for 87 to 100 percent of their patients (compared to 16 hospices in 2013) and 16 hospices reported they reduced the pain level to five or lower by the end of the fourth day for 75 to 86 percent of their patients (compared to 22 hospices in 2013). Exhibit 2: The Number of Hospices Whose Percentage of Patients With Severe Pain Was Reduced to a Level 5 or Lower % % % 50-62% % Standard % 1 Number of Reporting Hospice Organizations Data provided by individual hospice organizations, n = 44; 2014 The number of hospices that did not meet the standard for minimum pain reduction by the fourth day ranged from one hospice in 2009 to two hospices in Between 2011 and 2013, all hospices met the standard. In 2014, one hospice did not meet the standard for minimum pain reduction by the fourth day. See Exhibit 9 on page 9 for a list of the names of the hospices and the percentage of their patients who met this outcome measure. 2 Number reporting reduction in pain level to 5 or less Number reporting reduction in pain level to 5 or less + Number reporting continued pain level 6 or higher Hospice Demographic and Outcome Measures Report Revised February, 2016

9 Statewide, hospices reported pain level data for 57,857 patients at the time of admission. Sixteen percent of these patients (9,360) reported having severe pain at admission (see Exhibit 3 below). Exhibit 3: Florida Hospices Pain Level at Time of Admission Patients With Severe Pain 16% (9,360) Patients With No, Mild, or Moderate Pain 84% (48,497) Data provided by individual hospice organizations, n=57,857; 2014 Of those patients reporting severe pain at the time of admission, 58 percent reported a reduction in pain to a level of five or lower by the end of the fourth day of care, 9 percent reported their pain level was a six or higher by the end of the fourth day of care, and 33 percent were unable to report their pain level by the fourth day (see Exhibit 4 below). These totals may include patients who chose not to receive pain medicine. Exhibit 4: Status of Florida Hospice Patients at End of Fourth Day of Care for Those Who Had Severe Pain at Admission 60% 50% 40% Reduced Pain, Level 5 or Lower 58% Patient Unable to Report 33% 30% 20% Continued Pain, Level 6 or Higher 9% 10% 0% Data provided by individual hospice organizations, n=9,360; Hospice Demographic and Outcome Measures Report Revised February, 2016

10 Inconsistencies in the data collection for this outcome measure were identified. Namely, not all hospices reported the level of pain on the fourth day after admission. Furthermore, the first day on which pain measures are collected varies by hospice, as some hospices start reporting pain on the day of admission while others start on the first day of care received. In addition, when multiple pain scores were reported on the fourth day, the score selected varies; some hospices use the first pain score reported, some use the lowest pain score reported, and others use the highest pain score reported. The Centers for Medicare & Medicaid Services (CMS) reported similar challenges in the reporting of the National Quality Forum (NQF) pain measure in its effort to implement this measure nationwide (see section 15.0 for more information). 3.2 Outcome Measure 2 (OM2) The inconsistencies in data collection for the pain management outcome measure that were identified in Florida were similar to those recognized by CMS as an industry-wide challenge in the National Quality Forum. Outcome Measure 2 measures the percentage of patients/families who indicated the patient received the right amount of pain medicine. All 44 hospices exceeded the standard that at least 50 percent of their patients received the right amount of medicine for their pain. Hospice organizations reported that 84,689 surveys were initiated during the reporting period asking whether or not the patient received the right amount of medicine for his or her pain. The total number of surveys received by the hospice organizations was 23,805 or 28 percent of the initiated surveys. Of these, 19,370 (81%) answered the question for Outcome Measure 2. Ninetysix percent of patients/families who answered the question for Outcome Measure 2 said the patient received the right amount of medicine for his/her pain (see Exhibit 5 below). 3 This proportion has not changed over the past six years of reporting. Exhibit 5: Florida Hospice Patients Outcome Measure 2 Results Did the patient receive the right amount of medicine for his or her pain? Number of survey responses received during reporting period indicating the patient received the right amount of medicine for his or her pain. Number of survey responses received during the reporting period indicating the patient did not receive the right amount of medicine for his or her pain. Total survey responses received indicating whether or not the right amount of medicine was received. Data provided by individual hospice organizations, n = 19,370; 2014 Number of Patients Percentage of Patients 18,528 96% 842 4% 19, % 3 Number that received right amount of medicine for pain Number that received right amount of medicine + Number that did not receive right amount of medicine Hospice Demographic and Outcome Measures Report Revised February, 2016

11 3.3 Outcome Measure 2A (OM2A) Outcome Measure 2A measures the percentage of patients who would recommend hospice services to others. All 44 hospices exceeded the standard that at least 50 percent of their patients and/or family members would recommend hospice services to others based on the care the patient received. Hospice organizations reported that 84,754 surveys were initiated during the reporting period asking whether or not the patient or responsible party would recommend hospice services to others. The total number of surveys received by the hospice organizations was 25,118 (30% of the initiated surveys) and 23,873 of these (95%) answered the question for Outcome Measure 2A. Ninety-seven percent of all patients/families who responded to this question said the patient or responsible party would recommend hospice services to others (see Exhibit 6 below). 4 This proportion has not changed between 2010 and 2014, though it decreased slightly from reporting year 2009, when 98 percent of patients and/or family members said they would recommend hospice services to others. Exhibit 6: 2014 Florida Hospice Patients Outcome Measure 2A Results Based on the care the patient received, would the patient and/or responsible party recommend hospice services to others? Number of Patients Percent of Patients Number of survey responses received during the reporting period answering yes to this survey question. Number of survey responses received during the reporting period answering no to this survey question. Total survey responses received indicating whether or not hospice services would be recommended to others. Data provided by individual hospice organizations, n = 23,873; ,144 97% 729 3% 23, % 4 Number would recommend hospice services Number would recommend hospice services+ Number would not recommend hospice services Hospice Demographic and Outcome Measures Report Revised February, 2016

12 4.0 Accreditation While all hospices in the state of Florida have to be licensed (Section , Florida Statutes), accreditation is a voluntary process that requires a hospice organization to submit to an extensive on-site evaluation that covers several areas of patient care and patient safety. Many see accreditation as a tool for measuring the quality of an organization. Although the percentage of accredited hospices dropped from 51 percent in 2011 to 44 percent in 2012, the percentage of accredited hospices increased to 49 percent in 2013 and to a six-year high of 57 percent in 2014 (see Exhibit 7 below). Exhibit 7: Number and Percentage of Accredited Hospices Number of Accredited Hospices Number of Hospices Percentage of Accredited Hospices 44% 41% 51% 44% 49% 57% Data provided by individual hospice organizations, n=44; 2014 The hospices that have been accredited are identified in Exhibit 9 along with the name of the accrediting agency. The Accrediting Entity column in Exhibit 9 shows that the majority of hospices were accredited by The Joint Commission (TJC; 13), followed by the Community Health Accreditation Program (CHAP; 11), and the American Commission for Healthcare (ACHC; 1). 5.0 Individual Hospice Information Hospice agencies are organized into three tax status categories: not-for-profit hospice organizations, which are subject to 501(c)3 tax provisions; for-profit hospice organizations, which can be privately owned or publicly held entities; and not-for-profit government hospices, which are owned and operated by federal, state, or local municipalities. Both not-for-profit private and government hospices are categorized as non-profit. The majority of hospices in 2014 (31 or 70.5%) had non-profit status. The number of for-profit hospices increased from 2013 to 2014 (12 and 13, respectively), after remaining constant from 2011 to 2013, with 12 for-profit hospices each year (see Exhibit 8 below). Overall, the percentage of for-profit hospices in Florida has nearly doubled over the past six reporting years, from 17 percent in 2009 to 30 percent in Exhibit 8: Number and Percentage of For-Profit Hospices Number of For-Profit Hospices Percent of Hospices 17% 22% 28% 28% 28% 30% Data provided by individual hospice organizations, n=44; Hospice Demographic and Outcome Measures Report Revised February, 2016

13 Exhibit 9 on the following three pages lists the city in which the hospice organization is located, the number of patients admitted, the profit status, the accrediting status and accrediting entity, and the outcome measures results, for each of the 44 hospices licensed in Florida. The Profit Status column in Exhibit 9 contains FP if the hospice is a for-profit hospice (the field is blank for non-profit hospices). Exhibit 9: Outcome Measure (OM) Results, Accrediting Entity, Profit Status, and Number of Patients, by Hospice Hospice Name City OM 1 OM 2 OM 2A Accrediting Entity Profit Status Number Patients Avow Hospice, Inc. Naples 86% 93% 98% TJC 1,898 Big Bend Hospice, Inc. Tallahassee 57% 100% 100% CHAP 1,351 Catholic Hospice, Inc. Miami Lakes 92% 99% 99% 2,751 Community Hospice of Northeast Florida, Inc. Jacksonville 94% 97% 98% 5,673 Compassionate Care Hospice of Central Florida, Inc. Compassionate Care Hospice of Miami-Dade and the Florida Keys, Inc. Cornerstone Hospice & Palliative Care Lakeland 100% 80% 97% CHAP FP 599 Hialeah 75% 94% 100% CHAP FP 38 Tavares 82% 94% 97% 5,138 Covenant Hospice, Inc. Pensacola 77% 96% 96% TJC 4,331 Florida Hospital Hospice Care Good Shepherd Hospice Ormond Beach Temple Terrace 92% 95% 98% TJC 1,311 91% 94% 97% TJC 2,941 Gulfside Hospice and Pasco Palliative Care 5 Land O' Lakes 95% 98% 97% 1,796 Halifax Hospice, Inc. Port Orange 95% 94% 99% 2,903 Haven Hospice Gainesville 98% 96% 87% ACHC 3,919 5 Formerly known as Gulfside Regional Hospice, Inc Hospice Demographic and Outcome Measures Report Revised February, 2016

14 Exhibit 9: Outcome Measure (OM) Results, Accrediting Entity, Profit Status, and Number of Patients, by Hospice (continued) Hospice Name City OM 1 OM 2 OM 2A Accrediting Entity Profit Status Number Patients Heartland Home Health Care and Hospice Jacksonville 53% 91% 85% CHAP FP 212 HCR Manor Care Services of Florida III, Inc. 6 HCR Manor Care Services of Florida II, Inc. 7 Hope Hospice and Community Services, Plantation 63% 60% 100% CHAP FP 422 Palmetto Bay 95% 100% 100% CHAP FP 527 Fort Myers 80% 94% 99% CHAP 4,773 Hospice by the Sea, Inc. Boca Raton 81% 100% 94% TJC 3,912 Hospice Care of South Florida Hospice of Citrus and the Nature Coast Hospice of the Emerald Coast, Inc. 8 Hospice of Gold Coast Home Health Services Hospice of Health First Hospice of Marion County, Inc. Hospice of Okeechobee, Inc. Hospice of Palm Beach County, Inc. Hospice of St Francis, Inc. Hospice of the Comforter, Inc. Miami 100% 100% 100% 127 Beverly Hills 74% 98% 99% TJC 3,306 Panama City 78% 92% 94% 1,852 Fort Lauderdale West Melbourne 93% 99% 100% CHAP % 95% 100% TJC 1,149 Ocala 95% 100% 98% TJC 3,027 Okeechobee 88% 98% 86% 220 West Palm 83% 100% 98% TJC 7,258 Beach Titusville 63% 96% 97% CHAP 905 Altamonte Springs 78% 93% 94% 2,399 6 Formerly known as Heartland Hospice 7 Formerly known as Heartland Hospice Services II 8 Formerly known as Emerald Coast Hospice Hospice Demographic and Outcome Measures Report Revised February, 2016

15 Exhibit 9: Outcome Measure (OM) Results, Accrediting Entity, Profit Status, and Number of Patients, by Hospice (continued) Hospice Name City OM 1 OM 2 OM 2A Accrediting Entity Profit Status Number Patients Hospice of the Florida Keys Key West 73% 92% 95% 261 Hospice of the Treasure Coast Incorporated HPH Hospice LifePath Hospice Odyssey Healthcare of Marion County, Inc. (dba Gentiva Health Services) Regency Hospice of Northwest Florida Samaritan Care Hospice of Osceola, Inc. Seasons Hospice and Palliative Care of Southern Florida Stuart 67% 95% 98% 2,003 Temple Terrace Temple Terrace 74% 97% 97% 3,701 80% 93% 94% TJC 5,690 Miami 90% 95% 96% CHAP FP 1,217 Pensacola 87% 94% 100% FP 315 Orlando 33% 100% 77% FP 309 Miami Did not Report 100% 100% TJC FP 1,421 Suncoast Hospice Clearwater 97% 94% 98% TJC 7,184 The Hospice of Martin and St. Stuart 78% 98% 98% 1,577 Lucie Inc. Tidewell Hospice Inc. Sarasota 85% 95% 97% CHAP 7,342 Vitas Healthcare Corporation of FL Vitas Healthcare Corporation of FL Vitas Healthcare Corporation of FL VNA Hospice of Indian River County Inc. Wuesthoff Brevard Hospice and Palliative Care Average outcomes; Total number & average of patients Melbourne 83% 94% 97% FP 7,533 Boynton Beach 88% 94% 97% FP 7,465 North Miami 79% 96% 97% FP 6,753 Beach Vero Beach 81% 98% 98% TJC 1,187 Viera 64% 97% 96% FP % 95% 96% - - Total: 120,155 Average: 2,730 ACHC = American Commission for Healthcare, Medicare Deeming Authority for Home, Health, Hospice, and Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) accrediting CHAP = Community Health Accreditation Program TJC = The Joint Commission, formerly the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) FP = For-Profit Hospice Demographic and Outcome Measures Report Revised February, 2016

16 6.0 Hospice Geographical Coverage As in the prior years of reporting, each of Florida s 67 counties was served by at least one hospice organization in The number of hospice organizations serving each county is listed in Exhibit 10 below. Exhibit 10: Geographical Coverage of Florida Hospices, 2014 County Number of Hospice Organizations Serving County County Number of Hospice Organizations Serving County County Number of Hospice Organizations Serving County Alachua 2 Hardee 4 Okeechobee 3 Baker 4 Hendry 1 Orange 4 Bay 2 Hernando 1 Osceola 4 Bradford 2 Highlands 4 Palm Beach 3 Brevard 4 Hillsborough 1 Pasco 2 Broward 6 Holmes 2 Pinellas 1 Calhoun 2 Indian River 1 Polk 4 Charlotte 1 Jackson 2 Putnam 2 Citrus 2 Jefferson 2 Saint Johns 4 Clay 4 Lafayette 2 Saint Lucie 3 Collier 2 Lake 1 Santa Rosa 3 Columbia 2 Lee 1 Sarasota 1 Desoto 1 Leon 2 Seminole 2 Dixie 2 Levy 2 Sumter 1 Duval 4 Liberty 2 Suwannee 2 Escambia 3 Madison 2 Taylor 2 Flagler 5 Manatee 1 Union 2 Franklin 2 Marion 2 Volusia 5 Gadsden 2 Martin 3 Wakulla 2 Gilchrist 2 Miami-Dade 8 Walton 3 Glades 1 Monroe 5 Washington 2 Gulf 2 Nassau 4 Hamilton 2 Okaloosa 3 Data provided by individual hospice organizations, n = 44; Hospice Demographic and Outcome Measures Report Revised February, 2016

17 Number of Admissions 7.0 Inpatient Facilities and Residential Units During 2014, Florida hospice organizations operated 105 inpatient facilities and residential units, increasing from 87 in These include inpatient wings or rooms within a hospital or skilled nursing facility that were operated by the hospice as well as freestanding hospice inpatient facilities and residential units that appear on the hospice license. Each facility/unit must meet the following criteria: (1) Consist of one or more beds that are owned or leased by the hospice, (2) Be staffed by the hospice organization, and (3) Have policies and procedures set by the hospice. In 2014, Florida hospice organizations individually operated as many as 17 independent facilities or residential units. The 12 hospice organizations that did not have facilities in 2013 and 2014 provided inpatient care and services to individuals in private residences. The number of hospices with one or two facilities/residential units dropped to 14 hospices in 2014 (compared to 15 hospices in 2013) while the number of hospices with three to eight facilities/residential units increased to 15 hospices (compared to 14 hospices in 2013). Overall, the number of facilities/residential units operated by Florida hospice organizations has remained stable over the past six reporting years. In 2014, there were 50,920 patient admissions to Florida hospices, and hospices provided 1,551 beds in their facilities/residential units. As shown in Exhibit 11 below, the number of admissions to hospice facilities and residential units has steadily increased each year, from 34,719 in 2009 to 50,920 in Subsequently, the number of beds provided by Florida hospices also continues to increase, from 1,329 in 2009 to 1,551 in 2014 (see Exhibit 12 on the next page). Exhibit 11: Patient Admissions to Florida Hospices, ,000 50,920 50,000 47,938 45,000 40,000 38,469 39,799 41,878 35,000 34,719 30, Data provided by individual hospice organizations, n=50,920; Hospice Demographic and Outcome Measures Report Revised February, 2016

18 Number of Days On average, there were 36 admissions per bed and 245 patient days per bed in From 2009 to 2014, the average rate of admissions per bed increased by 38 percent while the average number of patient days per bed has decreased by 4 percent. Each year, a few more beds have been added and several thousand more patients are admitted, but the time they are served has gotten shorter by about 10 days on average. The overall average length of stay per hospice admission was seven days in 2014 (compared to 10 days in 2013) and the median length of stay per hospice admission was 6 days in 2014 (compared to 7 days in 2013). 9 Exhibit 12: Admissions, Hospice Beds, and Facility Patient Days, 2009 through Percent Difference 2009 to 2014 Admissions 34,719 38,469 39,799 41,878 47,938 50,920 47% Number of Beds 1,329 1,445 1,545 1,520 1,550 1,551 17% Average Number of Admissions per Bed Average Number of Patient Days Spent per Bed Data provided by individual hospice organizations, n=44; % % Exhibit 13: Average and Median Days per Hospice Admission, Average Days per Hospice Admission Median Days per Hospice Admission Data provided by individual hospice organizations, n=44; The length of stay (number of days) per hospice admission can be reported as both an average and a median. The median, however, is considered a more meaningful measure for understanding the experience of the typical patient since it is not influenced by outliers (extreme values) Hospice Demographic and Outcome Measures Report Revised February, 2016

19 However, these short spans do not characterize all hospice use. Although approximately 55 percent of patients admitted to Florida hospice facilities/residential units stayed for an average of seven days or less in 2014, a large portion (44%) of patients admitted stayed an average of 8 days up to one month, and 1 percent of patients stayed an average of one to two months. Exhibit 14 on the next two pages presents information about number of beds, number of days, patient admissions, patients spent at a facility, and provides the averages for each, by county. Exhibit 14: Inpatient Facilities/Residential Units Operated by Florida Hospices, by County, 2014 Average Total Total Average Average Average Total Facility Days County Facility Facility Admissions Days per Occupancy Beds per Admissions Days per Bed Bed Rate Admission Alachua , % 6 Bay , % 6 Brevard 57 1,564 12, % 8 Broward 127 2,749 35, % 13 Charlotte , % 10 Citrus 38 1,200 7, % 6 Clay , % 7 Collier 23 1,405 6, % 5 Columbia , % 7 Desoto , % 16 Duval 92 2,748 20, % 8 Escambia 34 1,083 6, % 6 Flagler , % 5 Hernando , % 6 Highlands , % 5 Hillsborough 48 2,434 13, % 6 Indian River , % 9 Note: The number of admissions may not equal the number of patients since a patient can be admitted more than once during the calendar year and a person may be a patient during the calendar year but admitted prior to the start of the calendar year Hospice Demographic and Outcome Measures Report Revised February, 2016

20 Exhibit 14: Inpatient Facilities/Residential Units Operated by Florida Hospices, by County, 2014 (con.) County Total Beds Total Facility Admissions Total Facility Days Average Admissions per Bed Average Days per Bed Average Occupancy Rate Average Facility Days per Admission Lake , % 5 Lee 100 3,291 28, % 9 Leon , % 6 Levy , % 6 Manatee 26 1,141 8, % 8 Marion 56 1,292 16, % 13 Martin , % 6 Miami-Dade 101 2,062 22, % 11 Nassau % 8 Okeechobee , % 9 Orange 30 1,051 8, % 8 Palm Beach 151 6,171 31, % 5 Pasco 121 1,997 12, % 6 Pinellas 92 3,354 22, % 7 Polk , % 5 Putnam , % 6 Sarasota , % 6 Seminole , % 7 St. Johns , % 6 St. Lucie , % 5 Sumter 20 1,248 5, % 5 Volusia 60 2,308 14, % 6 Total Average 1,551 50, , % Average:7 Median: 6 Note: The number of admissions may not equal the number of patients since a patient can be admitted more than once during the calendar year and a person may be a patient during the calendar year but admitted prior to the start of the calendar year Hospice Demographic and Outcome Measures Report Revised February, 2016

21 8.0 Primary Diagnosis at Time of Admission Hospices reported on the primary diagnosis of 120,155 patients at the time of admission. This total includes admissions to facilities and residential units. The following diagnosis categories were used: cancer, Acquired Immune Deficiency Syndrome (AIDS), pulmonary disease, renal disease, cardiovascular disease, and other. In 2014, 37 percent of patients admitted to Florida hospices had a primary diagnosis included in the other category. Thirty-three percent responded that cancer was the primary diagnosis, followed by 17 percent for cardiovascular disease and 11 percent for pulmonary disease. AIDS and renal failure represented two percent or less of patient primary diagnoses (0.3% and 2% respectively). The proportions of patients primary diagnosis at the time of admission to hospices in 2014 are similar to those in recent years. Exhibit 15: Primary Diagnosis at Time of Admission to a Florida Hospice Other 44,291 (37%) Cancer 39,995 (33%) Cardiovascular Disease 19,966 (17%) Pulmonary Disease Renal Disease 2,780 (2%) 12,728 (11%) AIDS 395 (0.3%) 0% 5% 10% 15% 20% 25% 30% 35% 40% Data provided by individual hospice organizations, n = 120,155; 2014 In 2014, the National Hospice and Palliative Care Organization (NHPCO) reported that cancer diagnosis constituted 37 percent of primary diagnoses for national hospice admissions, followed by 15 percent dementia, 13 percent cardiovascular disease, 10 percent pulmonary disease, and 3 percent renal disease. 10 Florida hospices are not instructed to report information on diagnosis related to dementia; however, this diagnosis may be contained in the relatively large proportion of other diagnoses (37%). Overall, the proportions of primary diagnoses at time of admission to Florida hospices closely resemble the national rates reported by the NHPCO. 10 NHPCO Facts and Figures: Hospice Care in America. Alexandria, VA: National Hospice and Palliative Care Organization, October Hospice Demographic and Outcome Measures Report Revised February, 2016

22 In February 2011, a study in the Journal of the American Medical Association 11 reported lower proportions of cancer patients and higher proportions of patients with dementia in for-profit hospices compared to non-profit hospices. Similarly, Florida experienced a similar and significant (p<.05) pattern of a lower percentage of patients with a cancer diagnosis in for-profit hospices compared to non-profit hospices (28% and 35%, respectively) in Unfortunately, the proportion of patients with dementia could not be directly replicated with available data, for hospices are not currently required to report the diagnoses of Alzheimer s disease, dementia, or a related disorder. However, the higher occurrence of patients diagnosed with other diagnoses in for-profit hospices compared to non-profit hospices (41% and 36% respectively; p=.09) may include a considerable number of patients with dementia. Exhibit 16: 2014 Patient Primary Diagnosis at Time of Admission to Florida Hospices, by Profit Status Cancer Heart Pulmonary Renal AIDS "Other" Total Non-Profit 34.8% 15.9% 10.8% 2.7% 0.3% 35.5% 100% For-Profit 28.3%* 18.9% 10.0% 0.9% 0.5% 41.4% 100% Data provided by individual hospice organizations, n = 120,155; 2014 * Significant at the p<0.05 level 11 Wachterman, M.W., Marcantonio, E.R., Davis, R.B., and McCarthy, E.P. Association of the Hospice Agency Profit Status With Patient Diagnosis, Location of Care, and Length of Stay, Journal of the American Medical Association, February Hospice Demographic and Outcome Measures Report Revised February, 2016

23 9.0 Patient Race and Ethnicity Hospices reported on the race and ethnicity of 120,155 patients at the time of admission. The following race and ethnicity categories were used: Caucasian, Black, Asian, Hispanic, and other. Hospices reported that a majority (74%) of their patients were Caucasian; 7 percent were Black; and 0.5 percent were Asian. Seven percent of hospice patients identified as some other race or combination of races, and 11 percent of patients identified themselves as Hispanic, regardless of race. A significantly larger percentage of patients served by non-profit hospices in 2014 identified as Caucasian (79%), compared to 57 percent of patients served by for-profit hospices who identified as Caucasian. 12 In contrast, Hispanic patients were served by for-profit hospices at a much higher rate than non-profit hospices (28% and 5%, respectively). Overall, the racial and ethnic composition of patients in hospices by profit status varied by less than 1 percent from 2013 to Exhibit 17: Percent of Caucasian Patients Served by For-Profit and Non-Profit Hospices, 2014 Data provided by individual hospice organizations, n = 88,908; Patient Age Hospices reported the age of 120,155 patients at the time of admission. Each person admitted was grouped into one of three age categories: 0-18, 19-64, or 65 and older. Eighty-five percent of all hospice patients admitted were 65 or older. Fifteen percent of hospice patients admitted were between the ages of 19 and 64 and two-tenths of a percent of hospice patients admitted were younger than 19 years old. Overall, the age distribution of patients admitted to Florida hospices has changed very little in 2014, compared to previous years. 12 Significant at the p<0.05 level Hospice Demographic and Outcome Measures Report Revised February, 2016

24 11.0 Discharges by Disposition Type Hospices reported on the disposition of discharge by patient, whereby each discharge was grouped into one of two categories: deaths and non-deaths. Individuals who died during the 2014 calendar year are included in the deaths category. As illustrated in Exhibit 18, discharge dispositions due to death were significantly higher in non-profit (85%) than in for-profit hospices (78%). 13 The proportion of discharges due to patient death in for-profit hospices has declined 5 percent from 83 percent in 2010 to 78 percent in In contrast, the proportion of discharges due to patient death in non-profit hospices has increased 4 percent from 81 percent in 2010 to 85 percent in Overall, the distribution of discharge dispositions has changed very little over the past six years. Exhibit 18: Florida Hospice Patient Discharges by Disposition and Profit Status, 2014 Deaths Non-Deaths 100% 85% 80% 60% 78% 84% 40% 20% 15% 22% 16% 0% Non-Profit For-Profit Statewide Data provided by individual hospice organizations, n =115,848; Significant at the p<0.05 level Hospice Demographic and Outcome Measures Report Revised February, 2016

25 12.0 Patient Days by Location Hospices provide services in many location types. The majority of patient care is provided in whatever place the patient calls home. In addition to private residences, this may include nursing homes and residential facilities. Hospice organizations are also able to operate dedicated inpatient units on or adjacent to a hospital campus, or provide services in their own freestanding facility. Most of these facilities provide a mix of general inpatient and residential care. Hospices reported the number of location days spent by type of location. In 2014, 55 percent of hospice patient days were spent in private residences (see Exhibit 19). Approximately 20 percent of hospice days were spent in an assisted living facility, and 19 percent were spent in a nursing home with contracted non-inpatient beds. Three percent of all hospice patient days were spent in a freestanding hospice inpatient facility, and less than 2 percent of all hospice days were spent in each of the other types. Exhibit 19: Patient Days by Location, 2014 Private Residence 55% Assisted Living Facility Non-Inpatient Bed 20% 19% Freestanding Facility 3% Dedicated Hospice Unit Other* 1.5% 1.5% 0% 10% 20% 30% 40% 50% 60% Percent of Patient Days Data provided by hospice organizations, days = 8,520,572; 2014 *Other category includes hospice patient days spent in the following settings: hospitals, nursing homes with contracted inpatient beds, hospice residential facilities, adult family care homes, and all other facilities not previously listed. While the percentage of hospice patient days spent in a nursing home with contracted noninpatient beds decreased by 4 percent from 2009 to 2014, the percentage of hospice patient days spent in assisted living facilities increased by 2 percent during the same time period. The total number of days patients spent at residential facilities dropped by approximately one half from 2012 to 2013 (from 58,117 to 25,702 days), but varied little between 2013 and Likewise, the total number of days in inpatient beds more than doubled from 2012 to 2013 (from 13,480 to 28,989), but varied little between 2013 and Apart from these settings, the distribution of patient days spent by type of location has changed little from previous years Hospice Demographic and Outcome Measures Report Revised February, 2016

26 13.0 Reimbursement Hospice care is covered under a variety of payment sources, including Medicare, Medicaid, and most private insurance plans, and patients receive hospice care regardless of their ability to pay. The Medicare hospice benefit, enacted by Congress in 1982, is the predominate source of payment for hospice care. Florida hospices reported the percentage of reimbursement from the following: Medicare, Medicaid, third party, self-pay, uncompensated, and other. The vast majority (87%) of hospice income came from Medicare in Additionally, Medicaid paid 5 percent of hospice reimbursement, 5 percent came from third parties, 3 percent came from private pay and other sources, and 1 percent was uncompensated. For-profit hospices received a slightly higher percentage of reimbursement from Medicare than non-profit hospices (89% compared to 86%), a similar percentage from Medicaid (5% compared to 6%), and a lower percentage from third parties (3% compared to 5%). The proportionate sources of reimbursement to hospices in 2014 were very similar to the previous reporting years Hospice Demographic and Outcome Measures Report Revised February, 2016

27 14.0 Additional Hospice Data Available Additional information about Florida s licensed hospices through March 2014 is available on Florida s Agency for Health Care Administration (AHCA) website. Included are the results of five questions asked on the Family Evaluation of Hospice Care Satisfaction Survey (FEHC) 14, a survey given to families whose friend or family member received hospice care. It asks family members about their view on the care provided to the patient, as well as their own hospice experience. In 2014, AHCA provided the results of 38 hospices that used the FEHC Survey. 15 Twenty-nine hospices (76%) received high ratings on all questions (90% to 100%), eight hospices (21%) received a rating that was below the highest score (80% to 89%), and one hospices (3%) received a rating of 70 percent to 79 percent. These lower ratings were with regard to how well the hospice provided care for the patients personal needs. AHCA issued 59 instances of Top Ten State and Federal Health Deficiency Citations to 24 hospices across the state in The majority of these deficiencies related to deficiencies in plans of care (17). Six citations were related to background screenings of hospice staff, five citations were for deficiencies in patient medical records, four citations each were issued for nursing services and hospice care teams, three citations were for deficiencies with hospice services, and two citations each were issued for deficiencies in coordination of services, staff training related to Alzheimer s disease, hospice residential care, clinical records, bereavement services, and Quality Assurance and Utilization Review (QAUR) Plan. 16 Information about inspection results and legal sanctions levied for each hospice are listed on AHCA s website Most Florida hospices survey families served to measure and assess quality. While several tools are used, the tool most commonly used in Florida is the FEHC, which is the basis for the reported results. Hospices that have not reported FEHC data may use another valid performance measurement tool, but those results are not provided here. 15 Primary use of the FEHC Survey was replaced with use of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey (see Section 15.0) Hospice Demographic and Outcome Measures Report Revised February, 2016

28 15.0 Centers for Medicare & Medicaid Services (CMS) Quality Measures for Hospice Quality Reporting Program and Data Submission Requirements In April 2014, the Centers for Medicare & Medicaid Services (CMS) met the requirements of the Privacy Act of 1974 by establishing a new System of Records titled the Hospice Item Set (HIS) System. This system will support the collection of data required for the Hospice Quality Reporting Program (HQRP). As of July 2014, hospices are required to use and submit patient-level data for the following seven measures endorsed by the National Quality Forum (NQF): NQF #1617 Patients Treated with an Opioid who are Given a Bowel Treatment, NQF #1634 Pain Screening, NQF #1637 Pain Assessment, NQF #1638 Dyspnea Treatment, NQF #1639 Dyspnea Screening, NQF #1641 Treatment Preferences, and NQF #1647 Beliefs/Values Addressed (if desired by patient). Beginning in 2015, hospices will contract with approved survey vendors to administer the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey. The standardized 47 question CAHPS Hospice Survey includes the following measures: hospice team communication, getting timely care, treating family members with respect, providing emotional support, support for religious and spiritual beliefs, getting help for symptoms, information continuity, understanding the side effects of pain medication, and getting hospice care training. 18 This survey will also allow the informal caregiver (family member or friend) to provide an overall rating of the hospice care their patient received and will ask if they would recommend this hospice to others in the future. The CAHPS Hospice Survey gives emphasis to additional in-depth aspects of hospice care experiences and focuses on the patient s perspective of the experience of care, rather than on patient satisfaction. For these reasons, the Department is pursing the use of CAHPS data in place of the current hospice quality reporting requirements for future hospice outcome measure analyses Hospice Demographic and Outcome Measures Report Revised February, 2016

29 16.0 Conclusion In 2014, all but one of the 44 Florida hospices that reported outcome measure data met the standards set for the three mandatory outcome measures: 50 percent or more of patients who reported severe pain on a 0-10 scale reported a reduction to five or less by the end of the fourth day or care in the hospice program (OM1); 50 percent or more of patients reported they received the right amount of medicine for their pain (OM2); and 50 percent or more of patients and/or family members recommended hospice services to others based on the care the patient received (OM2A). As of 2014, 57 percent of Florida hospices were accredited, and 30 percent of Florida hospices were for-profit organizations. Hospice organizations in the state operated between zero and 17 facilities and residential units and experienced 50,920 patient admissions throughout the year. The majority of hospice patients admitted in 2014 were Caucasian (74%), and 85 percent of all hospice patients admitted were 65 years or older. Thirty-seven percent of patients had a primary diagnosis included in the other category at the time of admission to Florida hospices. Thirty-three percent of patients reported that cancer was the primary diagnosis, followed by 17 percent for cardiovascular disease and 11 percent for pulmonary disease. The majority of hospice patient days were spent in private residence (55%) and 87 percent of all hospice reimbursement came from Medicare. In all, hospice demographic and outcome measure results for 2014 were similar to previous reporting years Hospice Demographic and Outcome Measures Report Revised February, 2016

30 Hospice Demographic and Outcome Measures Report Revised February, 2016

31 APPENDIX A STATE OF FLORIDA DEPARTMENT OF ELDER AFFAIRS HOSPICE DEMOGRAPHIC AND OUTCOME MEASURES REPORT Reporting Period: January 1 through December 31 Report for Calendar Year Report Due no later than March 31 of the following year. SECTION A: BASIC HOSPICE AND CONTACT INFORMATION Hospice Name (as it appears on license) Telephone Number Physical Address Mailing Address (if different) City State ZIP Code Hospice Demographic and Outcome Measures Report Revised February, 2016

32 SECTION B: HOSPICE INFORMATION Facility License Number Medicaid Number Medicare Number Accreditation Status If Yes, Enter Organization Name: Yes No SECTION C: CONTACT PERSON Name Telephone Number Fax Number Address Hospice Demographic and Outcome Measures Report Revised February, 2016

33 SECTION D: COUNTIES SERVED Number of Florida counties served under this license: Check all counties served by this hospice license: Alachua Duval Holmes Miami-Dade Santa Rosa Baker Escambia Indian River Monroe Sarasota Bay Flagler Jackson Nassau Seminole Bradford Franklin Jefferson Okaloosa Sumter Brevard Gadsden Lafayette Okeechobee Suwannee Broward Gilchrist Lake Orange Taylor Calhoun Glades Lee Osceola Union Charlotte Gulf Leon Palm Beach Volusia Citrus Hamilton Levy Pasco Wakulla Clay Hardee Liberty Pinellas Walton Collier Hendry Madison Polk Washington Columbia Hernando Manatee Putnam DeSoto Highlands Marion Saint Johns Dixie Hillsborough Martin Saint Lucie Hospice Demographic and Outcome Measures Report Revised February, 2016

34 SECTION E: INPATIENT CARE AND RESIDENTIAL UNITS List the number of inpatient facilities and residential units that were operated by this hospice within the past year: This number should include inpatient wings or rooms within a hospital or skilled nursing facility that are operated by the hospice as well as the freestanding hospice inpatient facilities and residential units that appear on the hospice license. Each facility/unit should meet the following criteria: (1) Consist of one or more beds that are owned or leased by the hospice, (2) Be staffed by the hospice organization, and (3) Have policies and procedures set by the hospice. Please provide the following information for each facility/unit included in the count above. Include every admission into the facility (a patient may have more than one admission) in the Number of Facility Admissions column, and count all patient days for every admission for the Total Facility Patient Days number column. Please duplicate this page as necessary. Facility Name and Address County Beds Number of Facility Admissions Total Facility Patient Days Hospice Demographic and Outcome Measures Report Revised February, 2016

35 SECTION F: OUTCOME MEASURES- Reference: Rule 58A-2.005(4), F.A.C. OUTCOME MEASURE 1 Number 1 Total number of patients reporting pain on a 0-to-10 scale at time of admission to the hospice program. 2 Of the patients reporting pain, the number of patients who reported severe pain (7 or higher) at time of admission to the hospice program. 3 Of the number of patients reporting severe pain at admission, the number of patients who reported a reduction in pain level to 5 or less by the end of the fourth day of care in the hospice program. 4. Of the number of patients reporting severe pain at admission, the number of patients who continually reported pain level of 6 or higher by the end of the fourth day of care in the hospice program. 5. Of the number of patients reporting severe pain at admission, the number of patients who were unable to report pain level by the end of the fourth day due to death/discharge, transfer, or disease progression. OUTCOME MEASURE 2 Patient/Family Satisfaction Survey Question: Did the patient receive the right amount of medicine for his or her pain? Number Total number of surveys initiated during the reporting period. Total number of survey responses received during the reporting period. Number of survey responses received during reporting period indicating the patient received the right amount of medicine for his or her pain. Number of survey responses received during the reporting period indicating the patient did not receive the right amount of medicine for his or her pain Hospice Demographic and Outcome Measures Report Revised February, 2016