Why Hospice Utilization Rates Have Fallen

National hospice utilization rates have fallen since 2020, though the total number of patients served remains consistent.

About 47.3% of all Medicare decedents received one day or more of hospice care and were enrolled in hospice at the time of death during calendar year 2021, the most recent year for which data are available, according to Alix Ware, director of health policy for the National Hospice and Palliative Care Organization (NHPCO). This utilization rate is similar to what was seen in calendar year 2020.

Mathematically, the percentage declined in part because of continually changing demographics.


“The aging population continues to increase, so even as the percentage of patients served decreases, the total number of patients served increases,” Ware told Hospice News.

In 2021, 1.71 million Medicare beneficiaries were enrolled in hospice care for one day or more, compared to 1.72 million Medicare beneficiaries in 2020. NHPCO publishes utilization and other data annually in its Facts and Figures report.

Also, because these are 2021 data, they reflect the impact of the COVID-19 pandemic, which reduced utilization rates due to a number of factors.


One of those factors was the relatively short trajectory of the virus, particularly for vulnerable seniors and facility residents. Many patients died before they were able to elect the hospice benefit. Also, many who would have eventually entered hospice care due to other potentially terminal conditions instead lost their lives to COVID.

Some hospice providers also saw a drop in admissions as a result of disruptions in the larger health care space during the coronavirus pandemic, but expect to see numbers trend upwards as the system stabilizes.

Hospitals and health systems, for example, experienced disruptions in providing routine services as they shifted their focus towards their response to the outbreak. Many patients also decided to forego or delay some medical care as states began to implement stay-at-home orders and restrictive social distancing measures.

“In this period, COVID-19 continued to influence the downward trend in hospice utilization, a continuation of what we saw in 2020. Deaths increased overall therefore outpacing the growth in hospice,” Patrick Harrison, senior director of regulatory and compliance for NHPCO, previously told Hospice News. “We expect it will take some time for utilization to bounce back, as even though the public health emergency has ended, COVID-19 continues to impact our communities.” 

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