Characteristics of hospice enrollees and nonenrollees in Green Ribbon Health's Medicare Health Support program

Medicare Health Support (MHS) is the first large-scale chronic care improvement initiative under traditional, fee-for-service Medicare. Green Ribbon Health (GRH) provides MHS services to beneficiaries with diabetes and heart failure residing in Central Florida. Some studies of Medicare fee-for-service have found that costs are lower for Hospice enrollees with a cancer diagnosis compared to nonenrollees but higher for persons with dementia and other non-cancer diagnoses. This study compared FFS Medicare expenditures for Hospice enrollees and nonenrollees identified as having CHF or Diabetes in GRHs MHS program. We analyzed a retrospective cohort of 4,319 beneficiaries who died between 1/1/2004 and 7/31/2006. First, demographic and primary diagnoses were compared between Hospice enrollees and nonenrollees. Secondly, a series of linear regression models were used to estimate mean Medicare payments in the last year of life within a cohort of Hospice enrollees and nonenrollees defined by age, and diagnosis of primary conditions, adjusting for illness duration, length-of-time in hospice, gender, race, enrollment in Medicaid, nursing home residence, urban setting, comorbidities, and risk based on the CMS-HCC score. Preliminary findings indicate that enrollees were twice as likely to have dementia and 4 times more likely to have cancer than nonenrollees, while nonenrollees were 5 times more likely to have a diagnosis of cardiac arrest. Expenditures were on average 3% higher for hospice enrollees compared to nonenrollees, but inpatient expenditures were 24% lower than nonenrollees. This presentation is intended to inform researchers, program developers and policy-makers who are interested in program costs and the hospice benefit.