title: Medicare's hospice benefit: analysis of utilization and resource use.
abstract: OBJECTIVE
  This work provides descriptive statistics on hospice users. It also explores the magnitude of relative resource use during hospice episodes and whether such patterns vary by episode length for patients who only use routine home care as compared to those who use multiple levels of hospice care. Examining resource use for hospice users who require different hospice levels of care within an episode versus solely routine home care provides insight to the varied resource use associated with the different patient populations (i.e., those who may require steady routine home care across the entire episode versus those who require varied levels of care across the episode).
  
  
  METHODS
  The analyses were based on a longitudinal analytic file that was constructed from 100% of Medicare claims for hospice users with completed episodes spanning September 1, 2008 through the end of calendar year 2011. In examining resource use for routine home care users and all levels of hospice care, the analyses were restricted to single episode decedents who began their hospice episode on or after April 1, 2010 and whose date of death was on or before December 31, 2011. Daily wage-weighted visit units (WWVUs) were calculated for each patient during their hospice stay. In order to compute a WWVU, one-fourth of the Bureau of Labor Statistics hourly wage rate for each visit discipline (i.e., skilled nursing, medical social services, home health aide, and an average for therapies) was multiplied by the corresponding number of visit units reported on hospice claims.
  
  
  RESULTS
  Using enhanced data on the intensity of service use, the results confirm previous research that suggested a curved pattern to service use during a hospice episode. For several measures of resource intensity, service use is more intensive during the initial days in the episode and for the last few days prior to death relative to the middle days of the episode. The pattern becomes more pronounced as episodes increase in length, but is otherwise a similar curve when compared by diagnosis. Thus, the results provide useful information for potential policy discussions about Medicare hospice reform.
authors.affiliation: Department of Health and Human Services-Office of the Assistant Secretary for Planning and Evaluation.
authors.forename: Susan
authors.initials: S
authors.lastname: Bogasky
authors.affiliation: Department of Health and Human Services-Office of the Assistant Secretary for Planning and Evaluation.
authors.forename: Steven
authors.initials: S
authors.lastname: Sheingold
authors.affiliation: The University of North Carolina at Chapel Hill-Gillings School of Global Public Health.
authors.forename: Sally C
authors.initials: SC
authors.lastname: Stearns
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000628:therapy; D003704:Dementia / Q000628:therapy; D017051:Hospice Care / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage; D008137:Longitudinal Studies; D008297:Male; D006278:Medicare / Q000458:organization & administration / Q000706:statistics & numerical data; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy; D014481:United States / Q000453:epidemiology
keywords: Medicare; Medicare hospice; hospice benefit; hospice resource use; hospice utilization
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