Proportion and Patterns of Hospice Discharges in Medicare Advantage Compared to Medicare Fee-for-Service

Joan M. Teno, Thomas J. Christian, Pedro Gozalo, Michael Plotzke

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


Background: When Medicare Advantage (MA) patients elect hospice, all covered services are reimbursed under the Medicare fee-for-service (FFS) program. This financial arrangement may incentivize MA plans to refer persons to hospice near end of life when costs of care typically rise. Objective: To characterize hospice discharge patterns for MA versus FFS patients and examine whether patterns differ by MA concentration across hospital referral regions (HRRs). Design and Measurement: The rate and pattern of live discharges and length of stay (LOS) between FFS and MA patients were examined. A multivariate mixed-effects model examined whether hospice patients in MA versus FFS had differential patterns of discharges. In addition, we tested whether concentrations of MA hospice patients in a patient's HRR were associated with different patterns of discharges. Results: In fiscal year 2014, there were 1,199,533 hospice discharges with 331,142 MA patients having a slightly higher live discharge rate (15.8%) compared to 868,391 FFS hospice discharges (15.4%). After controlling for patient characteristics, the adjusted odds ratio (AOR) was 1.01 (95% CI 0.99-1.02). MA patients were less likely to have early live discharges (AOR 0.87 95% CI 0.84-0.91) and burdensome transitions (AOR 0.61 95% CI 0.58-0.64) but did not differ in live discharges post 210 days. Among hospice deaths, MA hospice patients were less likely to have a three-day or less LOS (AOR 0.95 95% 0.94-0.96) and a LOS exceeding 180 days (AOR 0.97 95% 0.96-0.99). The concentration of MA patients in a HRR had minimal impact. Conclusion: MA hospice patients' discharge patterns raised less concerns than FFS.

Original languageEnglish (US)
Pages (from-to)302-306
Number of pages5
JournalJournal of palliative medicine
Issue number3
StatePublished - Mar 2018


  • Medicare Advantage
  • fee-for-service
  • hospice
  • live discharge

ASJC Scopus subject areas

  • Nursing(all)
  • Anesthesiology and Pain Medicine


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