Upswing in Hospice Utilization, Length of Stay

An upward trend in hospice utilization during 2018 brought a record number of patients into hospice for longer periods of time, according to a report from Atlanta-based research firm Excel Health.

Hospice utilization among Medicare beneficiaries climbed above 50 percent during 2018, the highest rate since the 1983 inception of the Medicare Hospice Benefit. Meanwhile the average length of stay rose to 75 days in Q2 2018  from 74 in full-year 2017, the report indicated.

“Hospice admissions continue to grow steadily with quarterly fluctuations that are established and predictable. The first quarter typically shows greater growth that tapers off until the start of the fourth quarter each year,” the report indicated.


The report’s developer, cloud-based data solutions firm Excel Health Group, based its findings on Medicare Part A and Part B data for Q1 2017 through Q2 2018.

Though utilization continues to rise, the rate of growth slowed from 5.6 percent in Q2 2017 to 3.5 percent in the second quarter of 2018.

“When we examine the bottom 10 states in hospice utilization for Q2 2018, it is interesting that we find four on the list of top 10 gaining states in the previous quarter,” the report said. “This suggests that at least some of the shift may have less to do with actual volume of utilization and more to do with timing, as utilization statistics are measured only among decedents.”


In addition to higher utilization, length of stay in increasing, likely due to shifting trends in terminal diagnoses. Though cancer remains the most frequently occurring terminal diagnosis among hospice patients, advances in treatment are reducing the rate of cancer deaths while cases of dementia cases are on the rise. Patients with congestive heart failure and chronic obstructive pulmonary disease also see higher lengths of stay, according to the National Hospice & Palliative Care Organization.

“Average length of stay for hospice has been steadily creeping up due to the change in the nature of terminal diagnoses of hospice patients, with more dementia patients who typically experience longer lengths of stay due to a longer trajectory of decline,” according to the report.

On the state level, Utah claimed the highest hospice utilization rate among all states and has the highest average length of stay at close to 99 days. In Q2 2018 the Total U.S. average was 75 days with 19 states above that level.

Alaska saw the most significant growth in the number of hospices operating in the state, but this is likely due to the scarcity of hospice in the nation’s largest state. Only five hospice organizations are located in Alaska.

In payor trends, the number of beneficiaries enrolled in Medicare Advantage plans was double the growth of Medicare beneficiaries at large, accounting for 35 percent of all Medicare participants in 2018. The U.S. Centers for Medicare & Medicare Services in 2021 will begin a demonstration of hospice coverage through Medicare Advantage.

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