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Users, LOS, and more are down, however.

You may agree with the famous Mark Twain quote 鈥渢here are three types of lies 鈥� lies, damn lies, and statistics.鈥� But your elected representatives may not 鈥� and that could lead to lowered hospice payment before you know it.

The Medicare Payment Advisory Commission offers up its latest batch of hospice stats in its annual report to Congress released on March 15.

Foremost among the stats is the 2020 Medicare aggregate profit margin at 14.2 percent, up from 13.4 percent in 2019. Expect law- and policymakers to latch onto this figure as proof that hospice payments could use an adjustment 鈥� and not an upward one.

The latest margin compares to 12.4 percent in 2018, 12.5 percent in 2017, 10.9 percent in 2016, 9.9 percent in 2015, 8.2 percent in 2014, and a 7.4 percent margin back in 2010. 鈥淗ospice margins are presented [only] through 2020 because of the data lag required to calculate cap overpayment amounts,鈥� MedPAC reminds in the report.

Including COVID relief funds, hospices鈥� average 2020 margin was about 16 percent.

While the hospice margin might be the highest in over a decade, at least it isn鈥檛 as high as home health agencies, which clocked in at a wince-inducing 24.9 percent for 2021, according to the Commission.

MedPAC didn鈥檛 calculate an all-payer margin. 鈥淚rregularities in the way some hospices report their total revenue and total expense data on cost reports prevent us from calculating a reliable estimate of all-payer total margins for hospices,鈥� MedPAC says.

Other statistics in MedPAC鈥檚 report include:

• In 2021, Medicare spent $23.1 billion on hospice services, compared to $22.4 billion in 2020 and $12.9 billion in 2010.
• In 2021, 1.71 million Medicare beneficiaries received hospice services. That鈥檚 down slightly from 1.72 the year before.
• The number of hospice days also fell slightly in that period, from 127.8 million to 127.6 million.
• The number of hospices in 2021 increased 6 percent to 5,358. 鈥淢arket entry of for-profit, freestanding providers drove the growth in supply,鈥� MedPAC notes. 鈥淔or-profit hospices accounted for all of the net increase 鈥� an over 8 percent increase 鈥� while the number of nonprofit and government hospices declined by about 2 percent.鈥�
• Also down in that period were the number of Medicare decedents who used hospice (1.29 million, down from 1.31 million); the average lifetime length of stay among decedents (92.1 days, down from 97.0); and median lifetime LOS among decedents (17 days, down from 18).
• Nearly 60 percent of Medicare hospice spending in 2021, $13.6 billion, was for patients with stays exceeding 180 days.
• Hospice visits increased from an average of 3.6 per patient per week in 2020 to 3.8 in 2021. But that鈥檚 still down markedly from pre-COVID years (4.3 in 2019 and 4.4 in 2018).
• Above-cap hospices have fewer patients per year, on average, than below-cap hospices and are more likely to be for-profit, freestanding, recent entrants to the Medicare program and located in urban areas. v

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