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NHPCO’s New Facts and Figures Report Shows Changes in Hospice Patient Diagnoses

For Immediate Release:
October 28, 2021

Data Show Growing Number of People Choosing Hospice and Decreasing Number of Cancer Diagnoses

(Alexandria, Va) – The National Hospice and Palliative Care Organization (NHPCO) today published the 2021 edition of NHPCO Facts and Figures (PDF), a report produced annually to provide an overview of hospice care delivery in the U.S., with specific information on hospice patient characteristics, location and level of care, Medicare hospice spending, hospice provider characteristics, and more.

“In the nearly forty years that the Medicare hospice benefit has been in place, we’ve seen a significant shift in the primary diagnoses, how communities access care, length of service, and how hospice is made available,” said NHPCO President and CEO Edo Banach. “Next year we mark the 40th anniversary of the passage of the Medicare hospice benefit legislation, and we must be actively planning for the next 40 years. The latest NHPCO Facts and Figures report is a resource for policymakers and healthcare leaders nationwide who are mapping the future of patient-centered, interdisciplinary care to help patients live life to its fullest right up to the end.”

NHPCO published Facts and Figures just prior to the start of National Hospice and Palliative Care Month, marked each year in November. On Friday, November 5, NHPCO is encouraging all hospice providers and supporters to participate in the annual Social Media Action Day to increase visibility of hospice and palliative care and share the benefits.

Key points from the report include the following:

Changing Primary Diagnoses

In 2019 we saw continued growth in the number of Medicare hospice patients with non-cancer diagnoses, including a principal diagnosis of Alzheimer’s, dementia, or Parkinson’s, which represented more than four times the number of patients who had cancer. For several decades, hospices primarily served people with cancer diagnoses. As recently as 2007, cancer continued to be the leading principal diagnosis of those receiving care. However, that has shifted dramatically over the last decade.

Reaching Diverse Communities

In 2019, almost 54 percent of white Medicare beneficiary decedents used hospice care (53.8 percent). Nearly 43 percent (42.7) of Hispanic Medicare beneficiary decedents and almost 41 percent (40.8) of Black Medicare beneficiary decedents enrolled in hospice in 2019. For the hospice community, which is committed to equity and access, these figures show significant progress over the last two decades as well as a need for continued improvement.

Late Hospice Access

Hospice professionals continue to be concerned about the number of people accessing hospice care late in the course of an illness. The NHPCO report indicates that 10 percent of Medicare decedents received hospice care for two days or less in 2019. Twenty-five percent of beneficiaries received care for five days or less, and 50 percent received care for 18 days or less. These very short stays in hospice are considered too short a period for patients to fully benefit from the unique person-centered, interdisciplinary care provided by hospice.

Growth in Hospice Utilization

1.61 million Medicare beneficiaries received hospice care in 2019, an increase of 3.9 percent from the previous year. Utilization of the hospice benefit remains slightly higher among individuals enrolled in Medicare Advantage (MA) plans than among traditional Medicare users, while the trendline for hospice usage continues to increase in both groups. MA enrollees who utilized the hospice benefit rose from 51.1 percent in 2015 to 53.2 percent in 2019. During the same period, traditional Medicare beneficiaries utilizing the hospice benefit rose from 47.6 percent of Medicare decedents in 2015 to 50.7 percent in 2019.

Additional Data Points

      • 51.6 percent of all Medicare decedents were enrolled in hospice at the time of death in 2019.
      • The average Lifelong Length of Stay (LLOS) for Medicare patients enrolled in hospice in 2019 was 92.6 days. The Median Length of Service (MLOS) was 18 days, which has changed little in the last fifteen years.
      • Routine Home Care accounted for 98.3 percent of days of care provided. This includes care provided in the patient’s own home, an assisted living facility, nursing home, or other congregate living facility.
      • Over the course of 2019, there were 4,840 Medicare certified hospices in operation based on claims data. This represents an increase of 18.3 percent since 2014.

“This annual report provides a valuable snapshot of hospice access and care provision, but we never forget that behind the data points are people,” added Banach. “That’s why the hospices across the country work tirelessly to provide person- and family-centered, interdisciplinary care to help them during a time of great need.”

Download the new report, NHPCO Facts and Figures (PDF).

To learn more about hospice and care for those coping with serious illness, please visit NHPCO’s CaringInfo.org website.

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Contact:
Jon Radulovic
Communications, Director
Ph: 571-412-3973