The dataset provides a summary of hospice data from 1998 to 2009, using calendar year data from Health Care Information System (HCIS). It shows the top 20 diagnoses for each year, based on the number of Medicare hospice patients with that diagnosis; the percentage of all Medicare patients for the year which that diagnosis represents; and the average length of stay for that diagnosis. To be eligible to elect the Medicare hospice benefit, beneficiaries must be certified by their attending physician (if any) and by the hospice physician as being terminally ill with a prognosis of 6 months or less to live, should the illness run its normal course. Expenditures for the Medicare hospice benefit have increased approximately $1 billion per year. In fiscal year 1998, expenditures for the Medicare hospice benefit were $2.2 billion, while in 2009, expenditures for the Medicare hospice benefit were $12.1 billion.
The frequency of some hospice terminal diagnoses has changed over time, with relatively fewer cancer patients and relatively more non-cancer patients as a percentage of total hospice patients. Lung cancer has been recognized as the most common diagnosis among Medicare hospice patients every year since 1998. By 2006 non-Alzheimer’s dementia became the most common diagnosis among Medicare hospice patients. The percentage of Medicare hospice patients with lung cancer dropped from 16% in 1998 to 9% in 2009. In addition, there is notable increase in the number of neurologically-based diagnoses. A marked increase in non-specific diagnoses such as “Debility, Not Otherwise Specified”, and “Adult Failure to Thrive” is also noted. Along with the shift in the mix of hospice patients, there exists a significant increase in the average length of stay (LOS) for hospice patients. In 1998, the average LOS for hospice patients was 48 days, but by 2006 it had risen to 73 days (a 52% increase). Since 2006, the average LOS has begun to decline slightly, dropping to 71 days in 2009, which is a 48% increase from 1998.
The average LOS varies by diagnosis. For the top twenty diagnoses in 2009, the average LOS ranged from 27 days for chronic kidney disease to 106 days for Alzheimer’s disease and other degenerative conditions. While the average LOS from 1998–2009 for hospice patients with diagnoses such as chronic kidney disease or cancers has remained relatively stable, the average LOS rose significantly for most other diagnoses, though it has recently begun to decline slightly. In the dataset, diagnoses that show no data for specific years were not in the top 20 diagnoses in that year. If no data in 1998, change is from the first year shown where data were available.