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Title page 1

Contents 3

Highlights 2

Letter 6

Background 10

Hospice Eligibility, Coverage, and Requirements 10

Trends in Hospice 12

Hospice Payment Reform 18

Low-Visit Hospices Delivered Half as Many Visits to Medicare Beneficiaries on Average as High-Visit Hospices 20

Hospice Routine Home Care Payments Exceeded What Would Be Paid Using Home Health Per-Visit Payment Rates 23

Medicare Effectively Paid Low-Visit Hospices More Than Double Per Visit Compared to High-Visit Hospices and to Home Health Per-Visit Rates 23

Medicare's Daily Hospice Payment Structure and Rates Resulted in Higher Spending Compared to Home Health Per-Visit Rates 27

Conclusions 28

Matter for Congressional Consideration 29

Agency Comments 29

Appendix I: Objectives, Scope, and Methodology 30

Appendix II: Medicare Hospice and Non-Hospice Spending 37

Appendix III: Medicare Hospice Visits and Care by Terminal Illness 39

Appendix IV: Beneficiary Characteristics, Patterns of Hospice Care, and Hospice Characteristics 41

Appendix V: GAO Contact and Staff Acknowledgments 49

Tables 3

Table 1. Medicare Payment Rates for Hospice Routine Home Care, Fiscal Year 2026 16

Table 2. Medicare Hospice Daily Rates Before and After Rebasing in Fiscal Year 2020 19

Table 3. Medicare Payments for Hospice Using Hospice Payment Rates and Estimated Home Health Per-Visit Rates for Selected Beneficiaries... 27

Table 4. Home Health Low Utilization Payment Adjustment Per-Visit Rates, 2024 32

Table 5. Average Minutes Per Visit for Home Health and Hospice for Selected Medicare Beneficiaries Discharged from Hospice in 2024 35

Table 6. Medicare Hospice and Non-Hospice (Part A and B) Spending per Week of Routine Home Care for Selected Beneficiaries Discharged... 38

Table 7. Average Number and Type of Hospice Visits per Week for Routine Home Care, by Terminal Illness for Selected Medicare Beneficiaries... 39

Table 8. Average Number of Hospice Days in Routine Home Care by Type of Terminal Illness for Selected Medicare Beneficiaries Discharged... 40

Table 9. Proportion of Beneficiaries Treated and Average Visits per Week for Routine Home Care Days in Low-Visit and High-Visit Hospices... 41

Table 10. Average Percentage of Medicare Hospice Live Discharges for Selected Beneficiaries Discharged in 2024, by Low- to High-Visit Hospices 42

Table 11. Average Number of Days in Routine Home Care per Medicare Hospice Stay for Selected Beneficiaries Discharged in 2024, by Low- to... 43

Table 12. Average Percentage of Medicare Hospice Beneficiaries Served for Selected Beneficiaries Discharged in 2024 by Hospice Ownership,... 43

Table 13. Distribution of Low-Visit Hospices (20 Percent of Hospices with the Fewest Average Routine Home Care Visits per Week) by State, 2024 44

Table 14. Distribution of Small Hospices (with Fewer Than 30 Selected Beneficiaries) That Delivered Fewer Than 2.5 Average Routine Home Care... 46

Figures 4

Figure 1. Medicare Spending for Hospice Beneficiaries Under Parts A and B, Fiscal Years 2015 Through 2024 13

Figure 2. Average Length of Medicare Hospice Stay, 2015 Through 2024 14

Figure 3. Percentage Change in Length of Medicare Hospice Stay on Average, by Terminal Illness Category, 2015 Through 2023 15

Figure 4. Medicare Hospice Routine Home Care Visits and Daily Payments 17

Figure 5. Average Number of Routine Home Care Hospice Visits for Selected Medicare Beneficiaries Discharged in 2024, by Low- to High-Visit... 20

Figure 6. Number of Low-Visit Hospices by State for Selected Medicare Beneficiaries Discharged in 2024 22

Figure 7. Hypothetical Examples of Weekly Routine Home Care Visits and Estimated Payments per Visit for Low- and High-Visit Hospices 24

Figure 8. Average Estimated Per-Visit Hospice Payment Compared to Home Health Per-Visit Rates for Low- and High-Visit Hospices for Selected... 26

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