New Research Shows Hospice Care Reduces Medicare Costs

For Immediate Release
March 22, 2023  

New Research Shows Hospice Care Reduces Medicare Costs 

Hospice Care Contributed to $3.5 Billion in Medicare Savings in One Year  

Better Outcomes Together with Medicare Savings Demonstrate Hospice’s Value  

(Alexandria, VA and Washington, DC) – New research shows that patients’ use of hospice care contributed to $3.5 billion in savings for Medicare in 2019, while providing multiple benefits to patients, families, and caregivers. The study, conducted by NORC at the University of Chicago, is one of the most comprehensive analyses of enrollment and administrative claims data for Medicare patients covered by Medicare Advantage and Traditional Medicare. The study was funded by the National Association for Home Care & Hospice (NAHC) and the National Hospice and Palliative Care Organization (NHPCO).  

Key findings from the study include the following:   

      • NORC estimates that Medicare spending for those who received hospice care was $3.5 billion less than it would have been had they not received hospice care 
      • In the last year of life, the total costs of care to Medicare for beneficiaries who used hospice was 3.1 percent lower than for beneficiaries who did not use hospice.  
      • Hospice is associated with lower Medicare end-of-life expenditures when hospice lengths of stay are longer than 10 days. In other words, earlier enrollment in hospice reduces Medicare spending even further. 
      • Hospice stays of six months or more result in savings for Medicare. For those who spent at least six months in hospice in the last year of their lives, spending was on average 11 percent lower than the adjusted spending of beneficiaries who did not use hospice.  
      • At any length of stay, hospice care benefits patients, family members, and caregivers, including increased satisfaction and quality of life, improved pain control, reduced physical and emotional distress, and reduced prolonged grief and other emotional distress. 

“Multiple studies over many years have confirmed what hospice providers know: hospice care improves the end-of-life journey for patients and families. This new NORC study shows that in addition to improving care, hospice saves tax dollars,” said NHPCO COO and Interim CEO, Ben Marcantonio. “With questions about the future of the Medicare Trust Fund, policymakers and healthcare leaders are working to make changes that increase value and reduce costs, while putting patients at the center and delivering more care at home. That’s what hospice has done for more than 40 years. This research, along with American’s growing demand for hospice care, shows that any effort to save money by reducing hospice expenses will backfire. In fact, we should increase the investment in hospice, both to save money and to increase the quality of end-of-life care.”  

“One important finding of this research is that generally as hospice lengths of stay increased, so did Medicare savings. One of the main points of feedback we hear from families of hospice patients is ‘We only wish we had chosen hospice earlier.’ Hospice stays of less than 15 days don’t give enough time for patients and families to benefit fully from the person-centered care that hospice provides. Yet, 50 percent of hospice patients receive 17 days or less of hospice care,” added NAHC President, William A. Dombi. “Policymakers, health systems, and healthcare payers reading this groundbreaking research should see an opportunity to support patient interests and family wellbeing, while also driving savings for Medicare, by ensuring timely patient access to hospice care.”  

Our research shows that hospice is an essential component of end-of-life care and is relevant in any discussion about the future of Medicare solvency,” said Dianne Munevar, Vice President of Health Care Strategy at NORC. “For patients and families, our research provides one more reason to have conversations about end-of-life care before it is needed and to seriously consider hospice so that when the time comes their wishes and preferences are respected.
 Methodology
NORC compared the utilization of health services and costs of care for the last 12 months of life of more than 500,000 Medicare beneficiaries who died in 2019 and had a hospice stay immediately prior to death to more than 457,000 Medicare decedents who had similar risk profiles but did not have a hospice stay. The findings were jointly published by NAHC and NHPCO. 

More information
To access the full report and related materials, see nahc.org/hospiceworks or nhpco.org/hospiceworks  

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About NAHC 

The National Association for Home Care & Hospice (NAHC) is the voice of home care and hospice. NAHC represents the nation’s 33,000 home care and hospice providers, along with the more than two million nurses, therapists, and aides they employ. These caregivers provide vital services to Americans who are aged, disabled, and ill. Some 12 million patients depend on home care and hospice providers, who depend on NAHC for the best in advocacy, education, and information. NAHC is a nonprofit organization that helps its members maintain the highest standards of care. To learn more, visit nahc.org  

About NHPCO 

The National Hospice and Palliative Care Organization (NHPCO) is the nation’s largest and oldest membership association for providers who care for people affected by serious and life-limiting illness. Our members deliver and expand access to high-quality, person-centered interdisciplinary care to millions of Americans. NHPCO provides education and resources to support that mission. Together with our advocacy partner, the Hospice Action Network (HAN), we serve as the leading voice advancing public policy to improve serious-illness and end-of-life care, while our CaringInfo program provides free resources to educate and empower patients and caregivers. nhpco.org  

About NORC at the University of Chicago  

NORC at the University of Chicago conducts research and analysis that decision-makers trust. As a nonpartisan research organization and a pioneer in measuring and understanding the world, we have studied almost every aspect of the human experience and every major news event for more than eight decades. Today, we partner with government, corporate, and nonprofit clients around the world to provide the objectivity and expertise necessary to inform the critical decisions facing society. www.norc.org  

NAHC and NHPCO Exploring Collaboration Opportunities

For Immediate Release
March 8, 2023

(Washington, DC and Alexandria, VA) – For many years, the National Association for Home Care & Hospice (NAHC) and the National Hospice and Palliative Care Organization (NHPCO) have often worked together to advance projects and initiatives in our common interest. The Boards of Directors of both NAHC and NHPCO believe the time is right to explore how a stronger, unified, and more intentional approach to collaboration could accelerate the impact of work around our respective missions and on behalf of our members. To that end, the organizations have formed a joint exploratory committee to assess how to best enhance collaboration, partnership, efficiency, and effectiveness between our two organizations.

These discussions follow naturally from our history of collaboration and are rooted in our shared belief that the more united our voices and actions are, the more we will serve and benefit our respective members and the patients and families they serve. Leadership of both NAHC and NHPCO are enthusiastic about the possibilities afforded by these conversations and are fully supportive of exploring options that strengthen impact and alignment across the sector.

While these discussions are taking place, both organizations are evaluating key positions and the timing for hiring and/or replacement. Both organizations have agreed to suspend their executive recruitment and succession planning for the duration of these discussions.

The NAHC and NHPCO boards have great confidence in their respective leadership teams and their ability to meet the needs of members as we explore this unique and exciting opportunity.

NAHC and NHPCO have jointly retained the association consulting firm McKinley Advisors to help support the process and provide an objective analysis of potential opportunities to strengthen the ties between the two organizations. As part of this evaluation, McKinley will be conducting in-depth interviews with industry stakeholders over the next several weeks and will report findings and recommendations to the Boards of both organizations. The exploratory committee expects to issue additional communications about these findings and our collective next steps regarding the collaboration opportunities in May.

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Media Contacts
Caleb Tiller
NHPCO Communications
571-412-4032

Thomas Threlkeld
NAHC Communications
202-547-7424

Meeting Readout: Four National Hospice Organizations Met with CMS Administrator Chiquita Brooks-LaSure

For Immediate Release
February 15, 2023

Organizations Voiced Concerns About Hospice Program Integrity

(Alexandria, VA and Washington, DC) – LeadingAge, the National Association for Home Care & Hospice (NAHC), the National Hospice and Palliative Care Organization (NHPCO), and the National Partnership for Healthcare and Hospice Innovation (NPHI) met with Centers for Medicare and Medicaid Services’ (CMS) Administrator, Chiquita Brooks-LaSure today to share concerns and recommendations to address the rampant growth in the number of Medicare certified hospices in some states and how CMS can protect Medicare beneficiaries receiving hospice care. The discussion also suggested that additional oversight is needed to address hospice program integrity concerns and to ensure that Medicare beneficiaries receive quality hospice care when it is needed at the end of life. Based on the discussion, it is clear that CMS is deeply engaged on this issue and committed to taking action.

Topics discussed in the meeting included:

      • The alarming recent growth of the number of Medicare certified hospices in California, Arizona, Nevada, and Texas, many of which are found at the same address or with the same administrator or other key staff and with a concern for possible fraudulent activity.
      • A discussion of some of the 34 recommendations made by the four national hospice organizations as they collaborated to share legislative and regulatory changes to strengthen hospice oversight and program integrity with CMS and key Congressional stakeholders.
      • Our strong support of a targeted, temporary moratorium on new Medicare certified hospices in counties with troubling trends in the growth of Medicare certified hospices.
      • Our recommendation that CMS develop a list of red flag criteria in the Medicare certification application process, which would trigger additional oversight by the accrediting organization or state survey agency before Medicare certification could be approved. Red flags should include concerns such as: co-location of multiple hospices at single address, a single hospice administrator overseeing multiple hospices, and a patient care manager or other hospice leadership staff serving multiple hospices.
      • Additional regulatory requirements, including additions to the Medicare Hospice Conditions of Participation, such as an education or experience requirement for a hospice administrator or patient care manager and more frequent surveys for new hospices, which would strengthen the ability of a newly certified hospice to be compliant and provide quality hospice care.

LeadingAge, NAHC, NHPCO, and NPHI expressed our appreciation for Administrator Brooks-LaSure’s time and our collective commitment to working alongside lawmakers and regulatory bodies to ensure that Medicare beneficiaries get the end-of-life care they want and deserve.

The four national organizations will continue to collaborate, in addition to working with our respective memberships, to refine solutions; understand their implications for patients, families, and providers; and amplify our advocacy activity.

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Press Contacts:

Colleen Knudsen
Manager, Media Relations
cknudsen@leadingage.org
202-508-1215
LeadingAge

Thomas Threlkeld
Tom@nahc.org
Director of Communications, NAHC
202-547-7424

Madison Summers
NHPCO Communications
Ph: 571-412-3973

Debbie McCarron
Dmccarron@hospiceinnovations.org
NPHI Communications

NHPCO Celebrates Hospice and Palliative Care Providers in Nationwide Quality Connections Program

For Immediate Release
February 14, 2023

22 participating organizations achieved “four ring” status for Program Year 2022

(Alexandria, Va) – The National Hospice and Palliative Care Organization (NHPCO) recognizes the achievements of participating member organizations who have earned rings in the second program year of NHPCO’s Quality Connections program. First launched in January 2021, Quality Connections is the only national program designed to support hospice and palliative care provider delivery of high-quality, person-centered care. The program is structured around four fundamental pillars which are represented by four rings: Education, Application, Measurement, and Innovation.

QC participants are required to achieve milestones within defined timeframes by participating in activities such as quarterly data reporting and benchmarking, educational courses, case studies, and engagement on emerging issues such as diversity, access, and inclusion, all of which serve to promote high quality care delivery and service excellence. Achievement in the program is measured by completing activities within each of the four foundational areas, culminating in the closure of up to four rings.

For program year 2022, over 300 organizations embarked on a continuous quality improvement journey with a total of 85 earned rings reflecting their success in Quality Connections. Among those programs, 22 organizations earned top recognition as a “four rings” program. The provider groups who have reached this milestone are as follows:

Participating QC Organization
State
AuthoraCare Collective (formerly known as Hospice and Palliative Care of Greensboro and
North Carolina
Bluegrass Care Navigators
Kentucky
Calvert Hospice, Inc.
Maryland
Delaware Hospice – Dover Office
Delaware
Delaware Hospice, Inc. – Delaware Office
Delaware
Delaware Hospice – Milford Office
Delaware
Delaware Hospice – Pennsylvania Location
Pennsylvania
Hope Healthcare
Florida
Hospice of Hilo dba Hawaii Care Choices
Hawaii
Hospice of the Chesapeake
Maryland
Hospice & Palliative Care Buffalo, Inc.
New York
Lightways Hospice and Serious Illness Care (formerly Joliet Area Community Hospice)
Illinois
Life Touch Hospice
Arkansas
St. Croix Hospice
Minnesota
Trustbridge, Inc.
Florida
VITAS Healthcare
Pennsylvania
VITAS Healthcare
Texas
VITAS Healthcare
Connecticut
VITAS Healthcare
Florida
VITAS Healthcare
California
VITAS Healthcare Chicago South
Illinois
Circle of Life Hospice
Arizona

“Delivering high-quality care is the cornerstone of any successful hospice or palliative care program, and NHPCO is the leader in supporting providers for continuous quality improvement. Quality Connections continues to grow exponentially to include broader content and learning opportunities. Providers will find the structure of the program highly interactive, yet simple and flexible to best meet the needs of every hospice and palliative care organization striving to build and sustain a culture of quality,” said NHPCO Vice President of Quality, Aparna Gupta.

QC is an exclusive NHPCO member benefit. The program cycle resets each year to ensure focused and effective continuous quality improvement. The launch of program year 2023 for QC begins on Wednesday, February 15. Organizations interested in enrolling in the program can find more information on the Quality Connections webpage to start their quality improvement journey.

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Media Contact
Madison Summers
NHPCO Communications
Ph: 571-412-3973

National Hospice Leaders Urge CMS and Congress to Advance Program Integrity in Hospice Care through Effective Oversight

For Immediate Release
January 19, 2023

Concerned by Growth of Unscrupulous Operators, Organizations Outline Areas of Focus, Key Steps 

(Alexandria, VA and Washington, D.C.) – The four national hospice provider organizations: LeadingAge, the National Association for Home Care & Hospice (NAHC), the National Hospice and Palliative Care Organization (NHPCO), and the National Partnership for Healthcare and Hospice Innovation (NPHI), provided the Centers for Medicare and Medicaid Services (CMS) and key Congressional stakeholders with recommended legislative and regulatory changes to strengthen hospice program integrity.  

The recent entry of large numbers of newly created hospice organizations in several states has heightened long-standing concerns among hospice leaders (as shared with CMS in November 2022) about the adequacy of Medicare certification, accreditation, and enforcement processes. Today, the four national hospice organizations are joining forces to urge Congress and CMS to act expeditiously to ensure that only well-qualified advanced illness care providers are permitted to care for and support beneficiaries and their families at the end of life. 

These recommendations are the culmination of a year-long effort by each of these organizations to assess various options for improving program integrity in hospice care. The 34 recommendations are grouped into 11 core issue areas; five key points are listed below: 

      • Limit enrollment of new providers with a targeted moratorium on new hospices: Use existing CMS moratorium authority to limit enrollment of new hospice providers in counties with troubling rates of explosive licensure and Medicare certification growth. 
      • Enforce against non-operational hospices by revoking Medicare enrollment and increasing site visits: Investigate Medicare provider numbers that show aberrant gaps in Medicare billing. Revoking enrollment of non-operational hospices prevents them from being sold to inexperienced providers for a profit.
      • Develop hospice “red flag” criteria: Identify Medicare certification application “triggers” related to specific areas of concern that would prompt CMS to investigate an applicant before certification could be approved. Red flags should include: 
          • Co-location of multiple hospices at single address 
          • A single hospice administrator overseeing multiple hospices 
          • A patient care manager or other hospice leadership staff serving multiple hospices 
          • A hospice company that appears to be hidden behind a shell company 
      • Require surveyors to confirm ability of hospices to provide all four levels of care:  Surveyors must ensure hospices have the ability to provide all four levels of care, including General Inpatient Care (GIP) and respite contracts, as well as provision for continuous home care (CHC) and afterhours care.
      • Add hospice administrator and patient care manager qualifications to Medicare hospice Conditions of Participation (CoPs): Add education and/or qualifications to the hospice CoPs for these key personnel, including minimum years of experience or a combination of education and experience. 

“Good hospice care, because of its holistic, patient-and family-centered compassionate approach to the dying, is a godsend. Bad care and true fraud in this valuable benefit are intolerable. It’s time to take action. America’s population is aging, and high-quality services are needed now more than ever before. Reform must promote high-quality care, including the right services in the right quantity, and eliminate opportunity for misdeeds. Our goal in collaborating with other hospice provider groups, with Congress, and with CMS, is to ensure necessary change. Yet it is only part of the solution; our work will not be complete until we address the desperate need for a system of long-term services and supports that is responsive to how older adults live and die now,” said Katie Smith Sloan, president and CEO, LeadingAge, the association of nonprofit providers of aging services, including hospice. 

“NAHC believes strongly that improved hospice program integrity will benefit patients, families, providers, and the Medicare program, and that it is an essential element in ensuring quality of care. Historically NAHC has strongly supported meaningful solutions to problems as they have arisen within hospice and other programs. The series of recommendations that we are putting forth in conjunction with other national hospice organizations clearly communicate our continued commitment to designing and supporting effective regulations, processes, and operational standards in hospice. We look forward to working with Congress and the Administration to move these recommendations forward,” stated NAHC President William A. Dombi.  

“Ensuring program integrity is essential to enabling good hospice care. That’s why NHPCO has worked for more than 40 years to engage government officials and other partners to shape policy that supports effective oversight of hospices. These recommendations are the latest such effort and are especially topical given the alarming recent growth of Medicare certified hospices in California, Arizona, Nevada, and Texas which are fraudulent actors. NHPCO and national partner organizations must be proactive in our response and intolerance toward deceptive hospice care that does not live up to the standards of high-quality care we expect from members of our community,” said NHPCO COO and interim CEO, Ben Marcantonio. 

“End-of-life care providers have an obligation to support and care for patients and their loved ones with dignity and respect at this most vulnerable time in their lives. Providers who manipulate the Medicare benefit solely to profit at the expense of their patients have no place in the hospice program,” said NPHI CEO Tom Koutsoumpas. “To curb the entry of bad actors into hospice, NPHI is pleased to put forth, in conjunction with our national partners, robust program integrity reform recommendations. We look forward to working with our partner organizations, Congress, and CMS to advance meaningful change that will better protect those receiving hospice care at the end-of-life.” 

The full list of recommendations is available on each organization’s website.  

These four national hospice organizations will continue to work together and with other partners to drive solutions to stop the growth of fraudulent hospices and strengthen the hospice Medicare certification and the survey process. 

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Press Contacts: 

Lisa Sanders 
Director, Media Relations
Lsanders@leadingage.org
202-508-9407
LeadingAge 

Thomas Threlkeld
Tom@nahc.org 
Director of Communications, NAHC
202-547-7424

Madison Summers
NHPCO Communications
Ph: 571-412-3973 

Debbie McCarron
Dmccarron@hospiceinnovations.org
NPHI Communications 

NHPCO Announces 2023 Project ECHO Offerings Focused on Health Equity

For Immediate Release
January 04, 2023

(Alexandria, VA) – The National Hospice and Palliative Care Organization (NHPCO) announced the launch of the Project ECHO (Extension for Community Healthcare Outcomes) tele-mentoring program, Equity Where It Matters. The first virtual session, “Advancing Equity in Serious Illness and End-of-Life Care: An Analysis of Data” will take place on Thursday, January 5, kicking off the year-long series.

The upcoming session, the first in a planned 2023 series, will focus on the recently published Hospice Through the DEI Lens report created by NHPCO’s Diversity and Advisory Council with the support of the Transcend Strategy Group to better understand perceptions of hospice and barriers to access within Black, Hispanic/Latino, and LGBTQ+ populations. The discussion will include a real-life case study and highlight the opportunities and challenges of delivering culturally competent care across the continuum of serious illness in an equitable, inclusive, and person-led manner.

Project ECHO is an innovative program designed to create virtual groups of learners by bringing together healthcare providers, subject matter experts, and the wider community using case-based learning and fostering an “all teach, all learn” approach. Recognizing that diversity expands across many dimensions of our identity, the 2023 Project ECHO curriculum focuses on inclusive topics addressing various aspects of diversity and cultural competence in healthcare. Satisfactory completion of the curriculum also offers participants the option to earn a certificate in Diversity, Equity, and Inclusion for Hospice and Palliative care.

NHPCO recently earned recognition as an official “Superhub” of Project ECHO, joining the ranks of more than 25 organizations with the designation worldwide. As a Superhub, NHPCO facilitators are authorized to train new ECHO partners (called “hubs”) and provide technical assistance and support as the hubs continue to grow and develop their own programs.

“Project ECHO empowers providers and communities through access to knowledge. Health equity and cultural competency are at the core of high-quality care experiences and NHPCO is committed to supporting knowledge sharing with the goal of improving hospice and palliative care experiences for all. Health equity is imperative in all care but especially care during serious illness and at the end of life,” said Aparna Gupta, VP of Quality at NHPCO.

Registration for the program is free and open to the public. Register for the upcoming sessions, including the first in the series on January 5 at 3 p.m. ET, by visiting the Project ECHO page for more information.

Questions can be addressed by reaching out to innovation@nhpco.org.

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Press Contact:
Madison Summers
NHPCO Communications
Ph: 571-412-3973

Government Funding Bill Extends Telehealth Flexibilities, Averts Cap Cut

For Immediate Release
December 20, 2022 

(Alexandria, VA) Congress has released the text of the Consolidated Appropriations Act, 2023, an omnibus funding package that will fund the government through Fiscal Year 2023. As NHPCO advised its members in a Member Alert this morning, the legislation contains measures that will affect hospices positively and negatively. We expect the legislation to pass and be signed into law later this week.  

Key developments in this legislation include the following.  

      • Telehealth extension: The legislation extends hospice telehealth flexibilities through the end of 2024, which were initially enacted as part of the CARES Act in 2020. This allows hospice patients and providers to continue to use telehealth for low touch, face-to-face visits prior to recertification for the hospice benefit. Patients will also be able to continue to participate in telehealth visits from home. 
      • Continued slowdown of hospice caps: The legislation extends the cap calculation methodology implemented by the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014. For years that measure has slowed the growth of the hospice aggregate cap, reducing the total amount a hospice can be reimbursed for care provided to patients, as compared to the rates set prior to the IMPACT Act. The FY23 omnibus extends that IMPACT Act aggregate cap methodology by another year to 2032, meaning that for the next decade many hospices will have to do more with less to continue providing patient care. 
      • Cap cut avoided: Beyond extension of the IMPACT Act methodology, there was some consideration to MedPAC’s recommendation to outright decrease the hospice aggregate cap by 20 percent. That cut was averted, protecting hospice patients and providers.
      • Expanded definition of the IDT: The legislation will allow hospices, starting in 2024, to use marriage and family therapists (MFTs) and mental health counselors (MHCs) as part of the hospice interdisciplinary team. There is no requirement for hospices to use MFTs or MHCs and a social worker is still required if needed under a patient’s plan of care.
      • Focus on Grief and Bereavement: Noting that more Americans are experiencing grief due to COVID-19 losses, the bill designates $1,000,000 for assessing the feasibility of developing consensus-based quality standards for high-quality bereavement and grief care. It also directs the U.S. Department of Health and Human Services (HHS) Office of the Assistant Secretary for Planning and Evaluation (ASPE) to collaborate with other health officials to evaluate and report on the scope of need for high-quality bereavement and grief services, including a focus on the role of hospices in community services. 

“This package is a mixed bag for hospices. On the one hand, NHPCO members have been actively advocating for telehealth extension, against a 20 percent cap cut, and for national approaches to supporting grief and bereavement services. Those provisions are wins for patients, families, and communities across the country, as is the inclusion of marriage and family therapists and mental health counselors as part of the hospice interdisciplinary team,” said NHPCO COO and interim CEO, Ben Marcantonio “Thank you to everyone who has reached out to their elected officials on these issues. On the other hand, Congress has extended the slowdown of the growth of the hospice aggregate cap, even though the evidence shows that the seven percent reductions already implemented through the IMPACT Act have limited access to hospice care among patients with Alzheimer disease and other dementias.” 

Marcantonio continued, “Avoiding an across-the-board cap cut, while facing continued slowdown of cap growth is like two steps forward, one step back. Forty years after the creation of the Medicare Hospice Benefit, in bleak economic times, Congress has decided to put to the next ten years of hospice care at risk by continuing to recklessly use hospice as an ATM.” 

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Press Contact:
Madison Summers
NHPCO Communications
Ph: 571-412-3973 

NHPCO Facts and Figures Report Shows Growing Number of Hospice Patients 

For Immediate Release
December 15, 2022 

(Alexandria, Va) – The National Hospice and Palliative Care Organization (NHPCO) published the 2022 edition of NHPCO Facts and Figures, an annual report on key data points related to the delivery of hospice care, including information on patient characteristics, location and level of care, Medicare hospice spending, and hospice providers. NHPCO Facts and Figures is the premier resource for hospice providers and others interested in understanding the work of the community.  

Based on the most recent available data, which is from 2020, this is the first year in which NHPCO Facts and Figures includes information on COVID-19. Among Medicare hospice patients in 2020, 0.9% had a principal diagnosis of COVID-19. While COVID-19 may have contributed to the deaths of beneficiaries with other principal diagnoses, that would not show up in these data.  

Select findings from this year’s report include the following:  

      • Growth in number of hospice patients: 1.72 million eligible Medicare beneficiaries chose hospice care in 2020. This is a 6.8% increase from 2019, representing the largest recent year-over-year increase in the number of Americans choosing hospice care, both in absolute numbers and as a percentage.
      • Decrease in percentage of eligible patients served: In 2020, more Americans died than in any previous year on record, and the percentage change in the number of deaths was significantly higher than any time in the last decade. The number of deaths grew significantly faster than hospice enrollment, in large part because of COVID-19. After several years of growth, the percentage of Medicare decedents enrolled in hospice at the time of death (47.8% in 2020) dropped to the lowest number since 2013 (47.3%). 
      • Changes in race and ethnicity of hospice patients: White Medicare beneficiaries eligible for hospice care choose to enroll at higher rates than other Americans. Over the last two decades, there has been progress in the diversity of hospice patients, with more hospice-eligible Asian Americans, Black Americans, Hispanic Americans, and Native Americans choosing hospice care. However, the report shows that this year, fewer Asian, Black, Hispanic, and Native American chose hospice compared to the previous year.   
      • Continued trends in principal diagnoses: In the last 20 years, there has been a significant shift in the primary diagnoses of patients in hospice care. In 2002, cancer was the largest driver of hospice care. Since then, Alzheimer’s disease and other forms of dementia along with Parkinson’s disease have become the largest grouping of principal diagnoses. While the Alzheimer’s/dementias/Parkinson’s grouping declined slightly in 2020 compared to 2019, the overarching mix of diagnoses aligns to the trends of the last six years, which look different from the mix of the 2000s and early 2010s.  

NHPCO COO and interim CEO, Ben Marcantonio, said, “I know providers who rely on NHPCO Facts and Figures to benchmark their own programs and it is one of the most-cited reports about hospice care. As the hospice community marks the 40th anniversary of the hospice benefit, it’s a natural time to look ahead to what hospice can and should be over the next 40 years. Facts and Figures is an essential resource for informing those conversations as we continue to strive to provide the best care to help patients live their final days to the fullest.”  

The 2022 NHPCO Facts and Figures report is available on the NHPCO website 

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Press Contact:
Madison Summers
NHPCO Communications
Ph: 571-412-3973 

NHPCO Publishes Hospice Through the DEI Lens Research Report

For Immediate Release
December 13, 2022 

The National Hospice and Palliative Care Organization (NHPCO) Diversity Advisory Council (DAC) published the results of a first-of-its-kind research exploring perceptions of hospice care among African American/Black, Hispanic/Latino, and LGBTQ+ communities. This survey of 1,200 people is part of the NHPCO DAC’s commitment to health equity; to understanding hospice through the lens of diversity, equity, and inclusion (DEI); and to breaking down breaking down barriers to accessing hospice and palliative care through knowledge sharing, data collection, and collaborative discussion. Along with key research findings, the Hospice Through the DEI Lens report offers recommendations for hospice providers to help increase understanding of hospice care and help overcome barriers to access. In releasing the findings, the NHPCO DAC also noted its intention to expand this research in 2023 to include additional populations.  

Key findings and recommendations include:  

      • Finding: Across all populations surveyed, large percentages of respondents agree that “Doctors often wait too long to talk about hospice,” leading to a “crisis decision.” That sentiment is particularly pronounced among LGBTQ+ respondents, 44% of whom strongly or somewhat agree.  
          • Recommendations: Hospice providers should offer in-services to healthcare providers on how to have conversations about hospice with patients and families and share this data set with referral partners. 
      • Finding: Compared to White (52%) respondents, Black (39%) and Hispanic (41%) respondents are less likely to be aware that hospice is a benefit covered by Medicare. 
          • Recommendations: Black and Hispanic caregivers should be advised early on of the hospice benefits offered by Medicare, as well as the typical costs of hospice for those with Medicaid or private insurance. Ensure understanding that hospice is an at-home option that is covered by their benefits. Clearly explain how the Medicare hospice benefit works. This can be on the hospice organization’s website AND printed collateral. 
      • Finding: Compared to White respondents, Black respondents are significantly more likely (21% vs 11%) to feel more comfortable with hospice workers who are the same ethnicity as their loved one. 
          • Recommendations: The desire for cultural similarity further underscores the need for diversity at all levels of hospice staff and leadership. Prioritize your organization’s commitment to culturally proficient care and give concrete examples of what you’re doing in both internal and external communications. Provide ongoing education to your staff to address cultural issues important to your community. 
      • Finding: Among Hispanic/Latino communities, language can be a significant barrier for non-native English Speakers. More than half (52%) of Hispanic respondents said that in order to feel comfortable they would need hospice workers who spoke their loved one’s language. 
          • Recommendations: Written materials (both print and digital) should be available in a variety of languages. Even if a patient and/or their loved ones can read English, offering materials in their native language, and in a culturally appropriate way, demonstrates a commitment to honoring their culture. Diversity of language is a key component to overall diversity. Hospice organizations should ensure language diversity that mirrors that of their patient population. Develop best practices for engaging with interpreters to ensure all communications maintain the qualities of care and compassion. 
      • Finding: Nearly 1/3 of LGBTQ+ respondents doubt or are unsure that hospice would respect their sexuality. 
          • Recommendations: Prospective LGBTQ+ clients need reassurance that they will be treated with respect. Consistently collect patient demographic information, including gender identity and preferred pronouns. 

NHPCO COO and Interim CEO, Ben Marcantonio, said, “Even as hospice uptake has grown nationally for the last two decades, we continue to see that White Americans chose hospice at higher rates than Hispanic, Black, Asian, and Native Americans. While national data sets are not available to get a full picture of hospice uptake by sexual or gender identity, we know anecdotally that many LGBTQ+ individuals have significant hesitancies when it comes to hospice. NHPCO members are committed to improving equitable access to care for all communities, and we are pleased to be able to provide resources like this report to help advance the national conversation.”   

NHPCO DAC Chair, Nicole McCann-Davis, said, “The Hospice Through the DEI Lens report offers fresh insights and practical advice for hospice providers to continue improving equitable access to culturally competent care in their communities. Regardless of where a provider is in their health equity journey, there are recommendations for everyone. The report also adds to a slate of resources available at nhpco.org/diversity. Out of NHPCO’s commitment to diversity, equity, and inclusion as a public good, we make the most of these resources available to both members and non-member organizations.”  

To access the report and other NHPCO DEI resources, visit nhpco.org/diversity 

Hospice Action Network Honors Congressional Champions with Angel Award

For Immediate Release
December 07, 2022 

(Alexandria, VA) – The Hospice Action Network (HAN), the advocacy affiliate group of the National Hospice and Palliative Care Organization (NHPCO), is pleased to announce its 2022 Hospice Action Network Angel Award Honorees. This award was created to recognize select members of Congress on both sides of the aisle for their ongoing efforts to amplify the voices of patients, families, providers, and those advocating for the vital mission of hospice and palliative care in supporting patients and their families facing serious or life-limiting illness.

This year’s award recipients are as follows:

Senator Tammy Baldwin (WI)
Senator John Barrasso (WY)
Senator Shelley Capito (WV)
Senator Catherine Cortez Masto (NV)
Senator Roger Marshall (KS)
Senator Lisa Murkowski (AK)
Senator Jacky Rosen (IL)
Congressman Earl Blumenauer (OR-3)
Congressman Vern Buchanan (FL-16)
Congressman Steven Horsford (NV-4)
Congresswoman Carol Miller (WV-3)
Congressman Joe Morelle (NY-25)

The honorees expressed their appreciation for the recognition.

“As someone who spent time as the primary caregiver for my grandmother, I know the world of difference it makes in someone’s life to have compassionate palliative care,” said Senator Baldwin. “I’m deeply honored to receive the 2022 Hospice Action Network Angel Award and remain committed to enhancing access to palliative and hospice care services to help improve the quality of life for the millions of Americans managing serious illnesses.”

“I have experienced hospice care as both a doctor and family member.” said Senator Barrasso. “Hospice lets patients enjoy the highest quality of life when they need it most. I am proud to support all the dedicated hospice providers in Wyoming and across the country. It is an honor to once again be recognized by the hospice community and I will continue supporting efforts to improve hospice care in the years ahead.”

“I have seen firsthand the impact that hospice and palliative care can have on patients, and personally felt the support it provides as someone who cared for aging parents,” said Senator Capito. “That is why I have been, and continue to be, committed to making sure these critical services are available in communities across West Virginia, including our more rural areas. It is important that we take action now to grow, improve, and sustain the palliative and hospice care workforce, and recognize their importance and dedication. I am so honored to be recognized as a 2022 Hospice Action Network Angel, and I will continue to push for legislative solutions to help improve the well-being of Americans with life-threatening illnesses and their families.”

“Hospice and palliative care provide critical comfort to people all over the Silver State,” said Senator Cortez Masto. “I’m proud to partner with Hospice Action Network to support Nevadans facing serious illness, and I’ll continue working in the Senate to make sure all Nevadans have access to affordable, quality health care.”

“I collaborated with compassionate and talented palliative and hospice professionals during my time as both a practicing physician and hospital manager,” said Senator Roger Marshall. “I have the utmost respect for the professionals who perform this work in health care systems across the country, and it is an honor to receive NHPCO’s Hospice Action Network Award for a second time since I came to Congress in 2017.”

“Hospice and palliative care can be challenging topics to discuss as they are so personal, but the immense benefits they provide for patients and their families cannot be overstated. These services have the potential to improve quality of life, reduce physical and mental stress, and help patients better understand the best options of care for their unique circumstances—something we should all want for the people we care about,” said Senator Murkowski. “I commend all those who provide hospice and palliative care services. It’s an honor to be recognized with this award, and I look forward to continuing my work to drive policy initiatives on behalf of providers and the patients they care for.”

“I’m honored to be recognized by the National Hospice and Palliative Care Organization for my work to provide patients and families in Nevada and across the country better access to comprehensive health services, including hospice and palliative care,” said Senator Rosen. “I will continue to lead on this issue and look forward to working with the nation’s hospice and palliative care providers to make sure that patients and their families receive the best care possible.”

“Making sure that patients and families understand their choices and have their wishes respected has long been a passion of mine,” said Congressman Blumenauer. “I was the ‘death panel guy’ and the object of Sarah Palin‘s ‘Lie of the Year’ as I fought to ensure that the federal government assigned value to understanding and protecting patients’ end of life wishes. The amazing work of people who provide critical hospice and palliative care should be celebrated and protected. Our struggle to make sure that everybody understands and takes advantage of these services continues, and the federal government must keep pace.”

“Hospice and palliative care workers go above and beyond to provide compassionate care to patients and their families,” said Congressman Buchanan. “I’m honored to be recognized by the Hospice Action Network and will continue my work in Congress to support patients and promote access to quality end-of-life care.”

“I am proud to accept the 2022 Hospice Action Network Angel Award,” said Congressman Horsford. “So many families across Nevada and around the country count on hospice and palliative care providers during one of the most difficult times they will face. That is why I have made it a priority to improve training and education opportunities for the health professionals who work in the hospice and palliative care industry and have advocated for strengthening home and community-based care services as part of our nation’s caregiving infrastructure.”

“I’m honored to receive the 2022 Hospice Action Network Angel Award,” said Congresswoman Miller. “Hospice and palliative care providers play an invaluable role in our communities, and I will continue my work in Congress to support this important industry and the outstanding people who make it whole.”

“I want to thank the National Hospice and Palliative Care Organization for the honor of being named the winner of the 2022 Hospice Action Network Angel Award,” said Congressman Joe Morelle. “I’m grateful for their continued support as we’ve worked to get the GRIEF Act introduced in the House of Representatives—legislation I authored to help end the stigma around mental health and ensure families can access the essential support they deserve during challenging times. Again, thank you to everyone at the NHPCO for this award, and I look forward to our continued work together to create a culture of awareness and support for those who need it most.”

NHPCO and HAN are proud to recognize these lawmakers for their ongoing efforts.

“Thank you to our HAN Angel Recipients for their leadership and support of hospice and palliative care patients and families across our country who rely on person-centered, interdisciplinary care during their greatest time of need,” said Executive Director of HAN, Logan Hoover.

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