EXAMINING THE PATTERN OF UTILIZATION OF HOSPICE SERVICES FROM THE MASSACHUSETTS ALL PAYERS CLAIMS DATA (MA APCD) Authors: Anne P. Medinus, PhD; Deborah Gray, PhD; Sylvia Hobbs, MPH August 2020 CENTER FOR HEALTH INFORMATION AND ANALYSIS
Purpose Most studies on hospice services have used the Medicare fee-for- services data and the Surveillance, Epidemiology and End Results (SEER)-Medicare data. Although these data systems serve as important research databases for understanding the utilization of hospice services, they focus on Medicare beneficiaries and therefore do not show utilization patterns among the non-Medicare population. This study used the MA APCD to examine the utilization pattern of hospice services among all payer types (Medicare, Medicaid and select commercial payers) across different sites of service. 2 Examining the Pattern of Utilization of Hospice Services from the MA APCD | Anne Medinus, PhD | August 2020
Methodology Data Source: The Massachusetts All Payers Claims Data for calendar years 2013 to 2017 – Release 7, Highestversion = 1 Identified hospice-related discharges and their corresponding sites of service and payers, using Dischargestatuscleaned, Siteofserviceonnsfcms1500claimscleaned, Insurancetypecodeproduct, and Distinct Memberlinkeid. The resultant data were stratified according to the discharge status codes 50, 51, 40, 41 and 42. Also 01, 30 and 70 where site of service is 34 3 Examining the Pattern of Utilization of Hospice Services from the MA APCD | Anne Medinus, PhD | August 2020
Methodology (continued) Stratified Payers into Government and Non-Government using the Insurance Type Code Facility-related discharges were compared with non-facility related discharges across different sites of service. 4 Examining the Pattern of Utilization of Hospice Services from the MA APCD | Anne Medinus, PhD | August 2020
Results An increase from 2013 spiked in 2015 Trend of Hospice Utilization 18000 with a sharp decrease in 2016, 16699 16314 followed by an increase in 2017. 16000 14000 This finding is attributable to the 2016 Supreme Court’s decision in Gobeille 12000 versus Liberty Mutual Insurance that 10000 the Vermont state cannot require 10187 9368 8000 ERISA protected health plans to send 8156 information that describes all health 6000 care procedures. Many ERISA 4000 protected health plans stopped 2000 sending claims data to the MA APCD 0 as a result of this decision. 2013 2014 2015 2016 2017 5 Examining the Pattern of Utilization of Hospice Services from the MA APCD | Anne Medinus, PhD | August 2020
Results Continued: Trend of Insurance Type: Government vs. Non-Government Hospice Services Insurance Status: The percent of non-government Government vs Non-Government payers spiked in 2014, followed 100.00% by a downward trend in 2015; a 89.86% 84.46% 90.00% slight increase in 2016 and a 79.97% 80.00% 82.29% decrease in 2017. In reverse, 70.00% 71.97% the percent of government 60.00% payers decreased from 2013 to 50.00% 2014, followed by an increase in 40.00% 2015 and a slight decrease in 27.16% 30.00% 2016 with a subsequent 19.63% 16.45% 14.94% 20.00% increase in 2017. 9.37% 10.00% 1.25% 0.86% 0.60% 0.40% 0.77% 0.00% 2013 2014 2015 2016 2017 Non-Govt Govt Other 6 Examining the Pattern of Utilization of Hospice Services from the MA APCD | Anne Medinus, PhD | August 2020
Results Continued: Trend of Insurance Type: Government vs. Non-Government Hospice Services Insurance Status: Non-government Payer Government vs Non-Government 100.00% includes Self-pay, Indemnity, 89.86% 84.46% 90.00% PPO, POS, HMO, and EPO. 79.97% 80.00% 82.29% Government Payer includes 70.00% 71.97% Medicaid, Medicaid Managed 60.00% Care Organization, Medicare 50.00% parts A, B, Secondary Plan, 40.00% Medicare Advantage, 27.16% 30.00% Commonwealth Care, 19.63% 16.45% 14.94% 20.00% Commonwealth Choice, VA, 9.37% 10.00% 1.25% 0.86% 0.60% & Other Federal Plan. 0.40% 0.77% 0.00% 2013 2014 2015 2016 2017 Non-Govt Govt Other 7 Examining the Pattern of Utilization of Hospice Services from the MA APCD | Anne Medinus, PhD | August 2020
Results continued: Annual Percentage of Hospice Annual Percentage of Live Hospice Deaths Discharges 80.00% 90.00% 72.19% 71.56% 82.39% 82.10% 70.00% 68.12% 66.04% 70.00% 80.00% 62.01% 60.00% 70.00% 58.18% 56.04% 60.00% 50.00% 50.00% 40.00% 34.89% 30.68% 40.00% 33.51% 31.92% 28.38% 27.78% 26.81% 26.84% 30.00% 30.00% 20.00% 14.34% 14.08% 20.00% 10.44% 6.93% 10.00% 6.07% 10.00% 3.83% 3.27% 3.50% 3.19% 3.27% 0.98% 0.65% 0.00% 0.00% 2013 2014 2015 2016 2017 2013 2014 2015 2016 2017 Non-Facility Facility Unknown Non-Facility Facility Unknown 8 Examining the Pattern of Utilization of Hospice Services from the MA APCD | Anne Medinus, PhD | August 2020
Results continued: Non-facility related live hospice discharges constituted about two thirds of discharges all five years with an average of 68.14%. On the reverse, facility-related hospice deaths constituted an average of 69.58%, more than two thirds of all hospice deaths during the five year period. Dramatic increases and decreases are seen in the live discharges in 2015 and 2016, when the percentage of non- facility discharges spiked with a corresponding decrease in facility-related discharges, and vice versa. 9 Examining the Pattern of Utilization of Hospice Services from the MA APCD | Anne Medinus, PhD | August 2020
Conclusion The use of the MA All Payers Claims Data rather than the Medicare claims data serves to study groups of patients across health care systems. Further studies should shed more light on the relationship, if any, between the proportion of deaths and the site of service. 10 Examining the Pattern of Utilization of Hospice Services from the MA APCD | Anne Medinus, PhD | August 2020
Questions? 11 Examining the Pattern of Utilization of Hospice Services from the MA APCD | Anne Medinus, PhD | August 2020
Contact Slide Anne P. Medinus, PhD Center for Health Information and Analysis 501 Boylston Street Boston, MA 02116 T. 617 701 8179 Email: Anne.Medinus@state.ma.us 12 Examining the Pattern of Utilization of Hospice Services from the MA APCD | Anne Medinus, PhD | August 2020
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