2015 State Hospice Report 2013 Medicare Information 1/1/15

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Noah Gibbs
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1 2015 State Hospice Report 2013 Medicare Information 1/1/15

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3 2013 Demographics & Hospice Utilization National Population 316,022,508 Total Deaths 2,529,792 Medicare Beneficiaries 53,838,457 Medicare Beneficiary Deaths 2,081,847 Medicare Hospice Beneficiary Admissions Medicare Hospice Beneficiary Deaths Medicare Hospice Total Days of Care Medicare Hospice Mean Days / Beneficiary Medicare Hospice Median Days / Beneficiary Medicare Hospice Total Payments Medicare Hospice Mean Payment / Beneficiary 1,304,994 63% of Medicare deaths 946, % of Medicare deaths 91,044,459 Days 70 Days 24 Days $14,917,921,218 $11,

4 2013 Hospice Utilization (Medicare Hospice Deaths / Total Medicare Deaths) 70% 45.5% 45.5% 45.4% 45.4% 44.9% 43.9% 43.6% 43.3% 43.3% 43.2% 42.8% 42.6% 42.5% 42.1% 42.1% 41.8% 40.9% 40.4% 40.2% 40.1% 38.1% 37.7% 37.5% 34.8% 32.1% 31.5% 30.2% 29.7% 28.4% 25.1% 58.7% 56.1% 55.8% 54.3% 53.7% 53.3% 52.3% 52.1% 51.5% 51.1% 49.3% 48.8% 48.8% 47.6% 47.6% 47.3% 47.0% 47.0% 46.9% 46.7% 45.7% 45.7% 60% 50% 40% 30% National: 45.4% 20% 10% 0% Arizona 1 Utah 2 Florida 3 Iowa 4 Delaware 5 Oregon 6 Rhode Island 7 Ohio 8 Colorado 9 Michigan 10 Texas 11 Georgia 12 Wisconsin 13 Idaho 14 South Carolina 15 Nebraska 16 Kansas 17 Missouri 18 New Mexico 19 Minnesota 20 Oklahoma 21 Pennsylvania 22 Louisiana 23 Nevada 24 North Carolina 25 National Illinois 26 Alabama 27 Arkansas 28 Indiana 29 New Hampshire 30 Washington 31 Connecticut 32 Maine 33 Massachusetts 34 California 35 Maryland 36 New Jersey 37 Virginia 38 Hawaii 39 Montana 40 Tennessee 41 West Virginia 42 Kentucky 43 Mississippi 44 South Dakota 45 District of Columbia 46 Vermont 47 Wyoming 48 New York 49 North Dakota 50 Alaska

5 Change in Hospice Utilization (Medicare Hospice Deaths / Total Medicare Deaths) -1.9% -0.2% -0.6% -0.8% -1.1% 2.4% 2.2% 2.1% 2.1% 2.1% 2.1% 2.0% 1.9% 1.9% 1.9% 1.8% 1.7% 1.6% 1.6% 1.5% 1.5% 1.3% 1.2% 1.2% 1.2% 1.1% 1.1% 1.1% 1.1% 1.0% 1.0% 0.9% 0.9% 0.8% 0.8% 0.8% 0.7% 0.7% 0.6% 0.6% 0.5% 0.5% 0.5% 0.3% 0.3% 0.2% 0.2% 0.2% 0.1% 0.0% 0.0% 5.4% 6% 5% 4% National: +1.0% 3% 2% 1% 0% -1% -2% -3% Alaska 1 Indiana 2 North Carolina 3 Arkansas 4 Hawaii 5 Kentucky 6 Ohio 7 Mississippi 8 Alabama 9 Nevada 10 Virginia 11 Wyoming 12 Maryland 13 Oklahoma 14 South Carolina 15 Pennsylvania 16 Wisconsin 17 Texas 18 Vermont 19 Idaho 20 New Mexico 21 Connecticut 22 District of Columbia 23 Florida 24 Louisiana 25 National New York 26 Georgia 27 Missouri 28 California 29 Minnesota 30 Tennessee 31 New Hampshire 32 South Dakota 33 Illinois 34 Utah 35 West Virginia 36 Nebraska 37 North Dakota 38 Massachusetts 39 Kansas 40 Michigan 41 New Jersey 41 Rhode Island 43 Oregon 44 Maine 45 Washington 46 Arizona 47 Colorado 48 Iowa 49 Delaware 50 Montana

6 2012 Hospice Utilization 9-Year Trends 50% 45% 40% 35% 31.6% 34.1% 36.0% 37.5% 39.6% 41.1% 42.9% 44.4% 45.4% National +13.8% 30% 25% 20% 15% 10% 5% 0% Note: Hospice Utilization= Medicare Hospice Deaths / Total Medicare Deaths. 6

7 2013 Medicare Hospice Admissions National= 1,303, ,000 50,311 48,077 47,592 42,054 41,831 33,983 32,689 30,411 28,233 27,975 27,323 27,113 27,047 26,938 26,544 24,020 21,379 21,112 19,991 19,368 19,284 18,530 17,203 16,659 15,305 14,184 13,480 13,321 10,714 10,697 9,230 8,937 7,992 7,167 6,502 5,620 5,298 4,659 4,630 4,027 2,658 2,014 1,855 1,654 1, ,759 64,076 98, , , , ,000 80,000 60,000 40,000 20,000 - California 1 Florida 2 Texas 3 Pennsylvania 4 Ohio 5 Michigan 6 Illinois 7 New York 8 Georgia 9 North Carolina 10 Arizona 11 New Jersey 12 Missouri 13 Virginia 14 Alabama 15 Indiana 16 Wisconsin 17 South Carolina 18 Tennessee 19 Massachusetts 20 Washington 21 Louisiana 22 Minnesota 23 Oklahoma 24 Oregon 25 Maryland 26 Colorado 27 Iowa 28 Kentucky 29 Mississippi 30 Arkansas 31 Connecticut 32 Kansas 33 Utah 34 Nevada 35 West Virginia 36 New Mexico 37 Nebraska 38 Idaho 39 Maine 40 Rhode Island 41 New Hampshire 42 Delaware 43 Hawaii 44 Montana 45 South Dakota 46 Vermont 47 North Dakota 48 District of Columbia 49 Wyoming 50 Alaska

8 2013 Medicare Total Days of Hospice Care National= 91,044,459 Days 10,000,000 4,555,920 4,238,080 3,594,402 3,223,203 2,944,139 2,905,808 2,697,790 2,555,924 2,463,446 2,422,035 2,205,155 2,061,727 1,905,203 1,853,058 1,811,024 1,741,770 1,721,500 1,708,139 1,688,700 1,385,256 1,333,435 1,326,093 1,311,697 1,132,213 1,079, , , , , , , , , , , , , , , , , , , , ,205 99,809 64,408 43,001 8,297,944 8,080,259 7,760,337 9,000,000 8,000,000 7,000,000 6,000,000 5,000,000 4,000,000 3,000,000 2,000,000 1,000,000 0 California 1 Texas 2 Florida 3 Ohio 4 Pennsylvania 5 Georgia 6 Michigan 7 Illinois 8 North Carolina 9 Arizona 10 Alabama 11 New York 12 South Carolina 13 Missouri 14 New Jersey 15 Virginia 16 Wisconsin 17 Tennessee 18 Indiana 19 Massachusetts 20 Louisiana 21 Oklahoma 22 Washington 23 Mississippi 24 Minnesota 25 Colorado 26 Oregon 27 Maryland 28 Iowa 29 Kentucky 30 Utah 31 Nevada 32 Kansas 33 Arkansas 34 New Mexico 35 Connecticut 36 Idaho 37 West Virginia 38 Nebraska 39 Maine 40 Rhode Island 41 Delaware 42 Hawaii 43 New Hampshire 44 Montana 45 South Dakota 46 Vermont 47 District of Columbia 48 North Dakota 49 Wyoming 50 Alaska

9 2013 Medicare Hospice Mean Days of Care / Beneficiary National: Alabama 1 Idaho 2 South Carolina 3 Mississippi 4 Georgia 5 Utah 6 Oklahoma 7 Texas 8 Nevada 9 New Mexico 10 Louisiana 11 Arizona 12 Missouri 13 Ohio 14 District of Columbia 15 California 16 Colorado 17 Florida 18 National North Carolina 19 Delaware 20 Wisconsin 21 Virginia 22 Tennessee 23 Hawaii 24 West Virginia 25 Kansas 26 Massachusetts 27 Pennsylvania 28 Michigan 29 Indiana 30 New Jersey 31 Minnesota 32 Illinois 33 Arkansas 34 Montana 35 Nebraska 36 Vermont 37 Rhode Island 38 Oregon 39 Washington 40 New Hampshire 41 Iowa 42 Maine 43 Maryland 44 Kentucky 45 North Dakota 46 New York 47 Alaska 48 South Dakota 49 Connecticut 50 Wyoming

10 2013 Hospice Mean Days of Care 9-Year Trends National

11 2013 Medicare Hospice Median Days of Care / Beneficiary National: Idaho 1 Alabama 2 South Carolina 3 Utah 4 Mississippi 5 Georgia 6 Arizona 7 Oklahoma 8 Nevada 9 New Mexico 10 District of Columbia 11 Louisiana 12 Texas 13 California 14 Missouri 15 Colorado 16 Hawaii 17 Massachusetts 18 North Carolina 19 Virginia 20 Wisconsin 21 Minnesota 22 Delaware 23 Oregon 24 Vermont 25 West Virginia 26 National Montana 27 Washington 28 Kansas 29 Maine 30 Ohio 31 Tennessee 32 Nebraska 33 New Hampshire 34 Pennsylvania 35 Florida 36 Indiana 37 Michigan 38 Iowa 39 New Jersey 40 North Dakota 41 South Dakota 42 Maryland 43 Alaska 44 Illinois 45 Kentucky 46 New York 47 Arkansas 48 Rhode Island 49 Wyoming 50 Connecticut

12 2013 Hospice Median Days of Care 9-Year Trends National

13 2013 Medicare Hospice Total Medicare Reimbursement / Beneficiary National= $14,917,921,218 $732,053,770 $663,948,814 $560,846,461 $498,093,115 $493,465,215 $467,891,091 $465,846,326 $463,810,561 $363,985,248 $360,963,463 $352,186,816 $322,668,552 $303,743,390 $294,387,916 $291,443,678 $266,576,783 $262,239,752 $248,274,194 $240,695,096 $236,420,687 $218,985,496 $214,070,211 $191,544,733 $186,335,707 $183,781,606 $162,067,471 $149,281,119 $146,501,379 $135,723,069 $135,246,062 $131,171,102 $130,047,270 $114,460,237 $93,695,406 $90,040,362 $72,864,104 $59,584,350 $58,952,682 $56,798,434 $54,123,510 $51,933,238 $35,746,675 $20,200,850 $20,137,933 $19,546,678 $13,582,283 $10,118,871 $7,513,586 $1,598,834,537 $1,419,221,005 $1,246,270,326 2,000,000,000 1,800,000,000 1,600,000,000 1,400,000,000 1,200,000,000 1,000,000, ,000, ,000, ,000, ,000,000 - California 1 Florida 2 Texas 3 Ohio 4 Pennsylvania 5 Georgia 6 Michigan 7 Illinois 8 New York 9 North Carolina 10 Arizona 11 South Carolina 12 New Jersey 13 Alabama 14 Missouri 15 Massachusetts 16 Wisconsin 17 Virginia 18 Indiana 19 Tennessee 20 Louisiana 21 Washington 22 Oklahoma 23 Colorado 24 Minnesota 25 Oregon 26 Mississippi 27 Maryland 28 Nevada 29 Iowa 30 Kentucky 31 Connecticut 32 Utah 33 Arkansas 34 Kansas 35 New Mexico 36 Idaho 37 West Virginia 38 Nebraska 39 Rhode Island 40 Maine 41 Delaware 42 Hawaii 43 New Hampshire 44 Montana 45 South Dakota 46 District of Columbia 47 Vermont 48 North Dakota 49 Wyoming 50 Alaska

14 2013 Medicare Hospice Mean Medicare Reimbursement / Beneficiary 18,000 $11,818 $11,690 $11,613 $11,444 $11,443 $11,425 $11,136 $11,042 $10,858 $10,610 $10,602 $10,323 $10,264 $10,140 $10,097 $10,068 $10,021 $9,900 $9,890 $9,831 $9,802 $9,763 $9,756 $9,755 $9,735 $9,705 $9,530 $9,248 $9,117 $9,067 $8,988 $8,877 $8,794 $8,678 $7,600 $7,490 $7,322 $15,151 $13,648 $13,648 $13,458 $13,336 $13,073 $12,814 $12,807 $12,708 $12,623 $12,589 $12,191 $12,175 $12,175 $11,826 16,000 14,000 12,000 10,000 8,000 National: $11,444 6,000 4,000 2,000 - Nevada 1 Arizona 2 California 3 South Carolina 4 Georgia 5 Idaho 6 Florida 7 New Mexico 8 Texas 9 Utah 10 Alabama 11 Delaware 12 District of Columbia 13 Mississippi 14 Oklahoma 15 Colorado 16 Hawaii 17 Louisiana 18 National Massachusetts 19 Ohio 20 North Carolina 21 New Jersey 22 Wisconsin 23 Missouri 24 Rhode Island 25 Virginia 26 Illinois 27 Minnesota 28 Pennsylvania 29 Connecticut 30 Washington 31 Michigan 32 Oregon 33 New York 34 New Hampshire 35 Kansas 36 Indiana 37 West Virginia 38 Tennessee 39 Vermont 40 Maryland 41 Arkansas 42 Nebraska 43 Maine 44 Alaska 45 Montana 46 Kentucky 47 Iowa 48 South Dakota 49 Wyoming 50 North Dakota

15 2013 Medicare Hospice Beneficiaries Top Six ICD-9 PRIMARY Diagnoses (out of 19 categories) 100% 80% 60% 40% 20% 11% 6% 10% 11% 12% 23% 29% All Others Ill-Defined Mental Respiratory Nervous Circulatory Cancers 0% Compare: National 15

16 2013 Medicare Hospice Beneficiaries Status at Discharge 100% 12.8% 80% 60% DC Alive 40% 87.2% DC Deceased 20% 0% Compare: National 16

17 2013 Medicare Hospice Beneficiaries Race: Medicare Beneficiaries vs. Hospice Admissions 100% 1.9% 0.5% 2.1% 1.1% 0.3% 1.0% 1.8% 2.7% 90% 10.5% 8.2% Other North Amer Native Asian Hispanic Black White 80% 87.5% 81.4% 70% Compare: National Medicare Compare: National Hospice 17

18 2013 Medicare Hospice Beneficiaries Levels of Care (days) 100% 0.3% 0.3% 98% 1.8% Cont. Home Care 96% Respite Care 94% 92% 97.6% General Inpt Routine Home Care 90% Compare: National 18

19 2013 Medicare Hospice Beneficiaries Locations of Care (days) 100% 1.1% 17.1% 80% 60% 40% 20% 23.9% 56.8% All Other Settings Inpatient Hospice Assisted Living Facility Skilled / Non-Skill Nrsng Fac Home 0% Compare: National 19

20 Thank you Please contact Cordt Kassner, PhD, at Hospice Analytics with any questions, comments, feedback, or for additional information: P: E: W: * Review the new National Hospice Locator at geo-maps and detailed information on every known hospice in the United States! 20

TABLE 3c: Congressional Districts with Number and Percent of Hispanics* Living in Hard-to-Count (HTC) Census Tracts**

TABLE 3c: Congressional Districts with Number and Percent of Hispanics* Living in Hard-to-Count (HTC) Census Tracts** living Alaska 00 47,808 21,213 44.4 Alabama 01 20,661 3,288 15.9 Alabama 02 23,949 6,614 27.6 Alabama 03 20,225 3,247 16.1 Alabama 04 41,412 7,933 19.2 Alabama 05 34,388 11,863 34.5 Alabama 06 34,849 4,074