Hospice was used by 1.72 million Medicare beneficiaries who died in calendar year (CY) 2022. That represented 50.0% of Medicare decedents, or about half of the approximately 2.6 million Medicare beneficiaries who died that year. The figures below describe hospice utilization, patient and provider patterns, length of stay, payments, quality reporting, and veterans’ hospice care. Unless noted otherwise, the Medicare figures are for CY 2022 and are reported in NHPCO Facts and Figures 2024.
Contents
- Medicare hospice use
- Who is represented in the data
- Diagnoses and length of stay
- Hospice settings and payment
- Hospice providers and geography
- Quality reporting and caregiver experience
- Veterans’ hospice care
Medicare hospice use
The 2022 utilization rate varied by sex. Hospice was used by 54.3% of female Medicare decedents and 43.8% of male Medicare decedents. Medicare had 67,990,335 enrolled beneficiaries in total that year, including 36,902,396 women and 31,087,927 men.
The number of Medicare decedents who used hospice has risen over the longer period shown in NHPCO Facts and Figures 2024: 0.87 million in 2010, 1.20 million in 2019, 1.29 million in 2021, and 1.30 million in 2022. These are reported historical values, and the 2022 utilization summary separately reports 1.72 million beneficiaries who elected hospice care; the measures should not be treated as interchangeable without knowing the underlying table definitions.
Hospice use also differed by community classification. Urban Medicare decedents had a 50.2% hospice utilization rate. The rate was 47.2% in micropolitan areas, 47.8% in rural areas adjacent to urban locations, 42.1% in rural areas nonadjacent to urban locations, and 35.2% in frontier areas.
Who is represented in the data
The 2022 Medicare decedent counts by age were 234,301 people under age 65; 672,663 ages 65–74; 834,527 ages 75–84; 735,523 ages 85–94; and 172,226 ages 95 and over. These counts describe Medicare decedents, not all deaths in the United States.
The enrollment profile reported for the same year included 52,870,608 non-Hispanic White beneficiaries, 7,333,277 Black beneficiaries, 1,930,681 Asian/Pacific Islander beneficiaries, 2,346,723 Hispanic beneficiaries, 266,193 American Indian/Alaska Native beneficiaries, and 1,425,135 beneficiaries categorized as other race. These enrollment counts provide population context; they are not hospice utilization rates for each racial or ethnic group.
Diagnoses and length of stay
The largest principal hospice diagnosis category was Alzheimer’s, nervous system disorders, and organic psychosis, accounting for 25% of hospice beneficiary diagnoses in 2022. Among individual reported principal diagnoses, senile degeneration of brain (ICD-10 G311) accounted for 132,665 beneficiaries, or 7.7%. Alzheimer’s disease, unspecified (G309), accounted for 115,336 beneficiaries, or 6.7%.
Other leading individual diagnoses included chronic obstructive pulmonary disease (COPD), unspecified (J449), with 74,178 beneficiaries and 4.3%; Alzheimer’s disease with late onset (G301), with 61,097 and 3.5%; Parkinson’s disease (G20), with 50,977 and 2.9%; and heart failure, unspecified (I509), with 46,806 and 2.7%.
The remaining diagnoses in the reported top group were atherosclerotic heart disease of the native coronary artery without angina pectoris (I2510), with 43,159 beneficiaries and 2.5%; cerebral atherosclerosis (I672), with 42,583 and 2.5%; and malignant neoplasm of an unspecified part of an unspecified bronchus or lung (C3490), with 40,948 and 2.4%.
Length of stay varied substantially by diagnosis in CY 2021–2022. The average was 159 days for COPD, 135 days for neurological disease, 106 days for heart or circulatory disease, 52 days for cancer, and 55 days for other diagnoses. These diagnosis-specific averages are reported by NHPCO Facts and Figures 2024 and the MedPAC July 2024 Data Book.
For all Medicare decedents, the average lifetime hospice length of stay was 95.3 days in 2022, while the median was 18 days. The distribution was uneven: 10% of hospice patients were enrolled for 2 days or less, 25% for 5 days or less, half for 18 days or less, and 75% for 84 days or less. The top 10% were enrolled for more than 275 days.
| Measure | 2010 | 2019 | 2021 | 2022 |
|---|---|---|---|---|
| Average lifetime length of stay | 87.0 days | 92.5 days | 92.1 days | 95.3 days |
| Median lifetime length of stay | 18 days | 18 days | 17 days | 18 days |
The average lifetime length of stay increased from 87.0 days in 2010 to 95.3 days in 2022, while the median was 18 days in both years. That contrast shows why an average alone does not describe the experience of a typical hospice patient.
Hospice settings and payment
The average and median length of stay differed by the setting where hospice care was delivered. At a private residence, the average was 98 days and the median was 25 days. In nursing facilities, the average was 109 days and the median was 22 days. In assisted living facilities, the average was 165 days and the median was 55 days.
Medicare paid hospice providers $20.9 billion in 2019, $23.1 billion in 2021, and $23.7 billion in 2022. In 2022, routine home care represented $21.55 billion, or 93.78% of hospice payment dollars. General inpatient care represented $1.14 billion, or 4.96%; inpatient respite care represented $0.15 billion, or 0.67%; and continuous home care represented $0.14 billion, or 0.60%.
The distribution of hospice days was even more concentrated in routine home care. Routine home care accounted for 128.32 million days, or 98.78% of hospice days. General inpatient care accounted for 1.14 million days, or 0.88%; inpatient respite care for 0.35 million days, or 0.27%; and continuous home care for 0.09 million days, or 0.07%.
Hospice providers and geography
There were 5,899 Medicare-certified hospices in operation in 2022. For-profit hospices increased from 4,008 in 2021 to 4,414 in 2022, a 10.1% year-over-year increase. Nonprofit hospices declined from 1,195 to 1,169, a 2.2% decrease, while government hospices declined from 143 to 141, a 1.4% decrease.
Freestanding hospices increased from 4,511 in 2021 to 4,919 in 2022, a 9.0% increase. Hospital-based hospices declined from 396 to 383, a 3.3% decrease. Home health-based hospices declined from 434 to 421, a 3.0% decrease, and skilled nursing facility-based hospices remained at 17 in both years.
The reported urban-rural provider counts moved in different directions. Urban hospices increased from 4,505 in 2021 to 5,006 in 2022, an 11.1% increase. Rural hospices declined from 845 to 827, a 2.1% decrease. These provider counts sit alongside the lower hospice utilization rates reported for rural, nonadjacent, and frontier Medicare decedents.
Quality reporting and caregiver experience
Publicly reported hospice quality measures identified 15% of providers as outliers on three or more measures and 2% as outliers on five or more measures. For Hospice Visits in Last Days of Life, the 25th percentile score was 40% and the 75th percentile score was 75% among providers with public reporting data.
For the January 2021–December 2022 CAHPS Hospice Survey reporting period, 50.0% of participating providers received four or five stars. Star Ratings were available for fewer than half of hospice providers, specifically 2,046 providers. In the same reporting period, 81% of caregivers rated the hospice 9 or 10 out of 10, and 84% said they would definitely recommend the hospice.
The star-rating availability figure and the caregiver-response figures describe different parts of the reporting system. The former concerns the number of providers with available ratings; the latter concerns caregiver survey responses during the stated reporting period.
Veterans’ hospice care
The Department of Veterans Affairs (VA) paid for 48,194 veterans to receive home hospice care from VA-contracted providers in fiscal year (FY) 2023 and for 13,316 veterans to receive home hospice care from community providers. VA hospice payments for home hospice care totaled $165.795 million in FY 2023, compared with $21.521 million in FY 2022.
VA clinical encounters or visits for hospice totaled 727,350 in FY 2023 and 460,876 in FY 2022. The reported VA cost per clinic stop or procedure for hospice was $227.94 in FY 2023, $46.70 in FY 2022, and $53.62 in FY 2021. These are fiscal-year VA measures, so they should not be directly compared with the calendar-year Medicare measures above without accounting for the different programs and reporting periods.
In FY 2023, 5% of U.S. veterans died in Veterans Health Administration facilities, while 95% did not die in a Veterans Health Administration facility. This statistic describes location relative to VHA facilities and is not itself a measure of hospice enrollment.