Rates of Medicare Utilization During Gaps in Hospice Election (FR440D)

Abstract

•Understand how much hospice beneficiaries utilize non-hospice services during gaps in elections.•Understand provider characteristics associated with the highest rates of gap spending per beneficiary. Medicare Hospice beneficiaries may revoke hospice, utilize non-hospice Medicare, and afterwards re-elect the benefit. Little is known about how beneficiaries utilize services during such election gaps. Determine hospice beneficiaries’ gap utilization and characterize providers with high gap spending rates. Retrospective cohort analysis of Medicare hospice beneficiaries utilizing the benefit during Federal Fiscal Year 2016 (FY2016). Using 100% Medicare Standard Analytic Files and the Medicare Enrollment Database we examined rates of Medicare utilization during hospice election gaps. In FY2016, 1.3 million hospice episodes ended, of which 207,387 (16.9%) were live discharges, 107,336 (51.8%) of which had re-elections, and of these, 75,089 (70.0%) had Medicare spending during the gap with mean (median) total gap spending of $9,528.21 ($4,185.38) at a mean (median) rate of $645.90 ($217.07) per day and total gap spending exceeding $715 million. We find that hospices are more likely to be categorized in the highest quintile of per-beneficiary election gap spending if they are newer (35.6% certified in the 2010s vs. 4.5% in the 1980s; AOR 3.99, 95% CI 2.39-6.65), for-profit (28.8% for-profit vs. 16.2% non-profit; AOR 3.27, 95% CI 2.23-4.79), smaller (31.0% having 50-99 beneficiaries vs. 6.3% having 800+; AOR 2.31, 95% CI 1.73-3.09), free-standing (23.8% freestanding vs. 7.2% in the 1980s; AOR 1.62, 95% CI 1.15-2.30), and located in the south (32.6% South vs. 8.2% Northeast; AOR 3.29, 95% CI 2.17-4.99). Hospice beneficiaries utilized almost three-quarters of a billion dollars between election periods in FY2016. These rates were higher in newer, for-profit, smaller, free-standing, southern providers.