A recent report on Hospice Monitoring by CMS presented statistics that provide a clear view of current trends and may highlight key areas for evaluation within your organization. The data is compelling and serves as a valuable resource for understanding how hospice agencies are performing across various metrics. Take a moment to reflect on how your agency measures up and where there may be opportunities for improvement.
One particularly striking data point is that the total number of unique patients receiving Hospice care has remained steady over the past few years, holding at approximately 1.8 million individuals from 2021 through 2024. However, while the patient count hasn’t changed, the total number of Hospice care days has noticeably increased. In 2023, there were around 137.8 million days of care, and by 2024, that number had grown to 147.2 million. That’s a 10 million day increase—with the same number of patients. This clearly suggests that patients are experiencing longer lengths of stay in Hospice care, which could have significant implications for planning, staffing, and care strategies.
That trend could be viewed in different ways—it may be positive, or it may raise some concerns. As many of you know, in certain communities or care settings, there can be cultural or emotional barriers that delay a patient’s decision to elect the Hospice benefit until much later than would be ideal. In some instances, hospice beneficiaries have very short lengths of stay, and longer lengths of stay are not detrimental. However, extended stays can also contribute to financial challenges for some organizations, especially when they lead to cap overages and the need to repay funds. It’s a dynamic that agencies should keep a close eye on as it continues to evolve.
Another important trend to highlight is related to live discharges in Hospice care. In 2024, a significant portion of these discharges stemmed from two primary reasons: 35% were due to patients choosing to revoke the Hospice benefit, and 32.9% were the result of patients being discharged because they were no longer considered terminally ill. Together, these two categories account for 68% of all live discharges, underscoring a substantial portion of patients either opting out of care or improving to the point where they no longer meet eligibility criteria.
This is a trend that warrants close attention: live discharges due to patients being no longer terminally ill can present a complex picture. It’s entirely possible for a patient to meet eligibility criteria at admission, experience stabilization or improvement, and no longer meet the criteria at a later point. However, when approximately 33% of all live discharges fall into this category, it raises an important question—were these patients truly eligible for the Hospice benefit at the time of admission? This level of occurrence is significant and should prompt agencies to closely evaluate their admission practices and documentation processes.
Revocations continue to be the leading cause of live discharges in Hospice care. If a patient genuinely decides to revoke the benefit, that choice must be fully respected. However, there’s growing concern around reports of hospices responding to hospitalizations by quickly seeking a revocation signature from the patient. It’s important to remember that a revocation must be initiated by the patient—not suggested or encouraged by the hospice. The patient must express their intent clearly. This is an area where extreme caution is needed to ensure compliance and protect patient rights.
If 35% of live discharges are the result of revocation, what does that really indicate? Could it suggest that patients are making decisions without fully understanding what Hospice care entails? Or does it point to a pattern of admitting individuals who may not yet be ready to commit to Hospice services? This number prompts a deeper look into admission practices, communication strategies, and how well patients and families are being educated about their options.
It’s essential to stay closely attuned to the trends within your agency. Some of the detailed data points raise broader questions about the direction of the Hospice benefit itself. They prompt reflection on whether changes to the current structure may be necessary. These patterns aren’t going unnoticed—there is active evaluation happening at the federal level regarding how the benefit is being utilized and whether adjustments are needed moving forward.
Healthcare Provider Solutions is here to support you with any Hospice-related needs—whether you’re reviewing your election processes, assessing patient eligibility, seeking staff education, or needing help with billing and compliance. Please don’t hesitate to reach out to us.
We recently hosted a two-day workshop exclusively for HPS Alliance members, and the recordings from those sessions will be available on our website within the next three weeks.
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