Medicare Home Health Agency Growth

{"type":"Bar","table":[["Year","Number of Medicare-Certified HHAs"],["2004",7651],["2008",9787],["2012",12311],["2014",12461],["2015",12346]],"options":{}}
{"type":"Table","table":[["Year","Number of Medicare-Certified HHAs"],["2004",7651],["2008",9787],["2012",12311],["2014",12461],["2015",12346]],"options":{}}

Sources: MedPAC March 2015; MedPAC June 2015 and 2016.

Medicare Hospice Agency Growth

{"type":"Bar","table":[["Year","Number of Medicare-Certified Hospices"],["2002",2323],["2008",3346],["2010",3509],["2012",3727],["2014",4092],["2015",4199]],"options":{}}
{"type":"Table","table":[["Year","Number of Medicare-Certified Hospices"],["2002",2323],["2008",3346],["2010",3509],["2012",3727],["2014",4092],["2015",4199]],"options":{}}

Sources: Medicare & Medicaid Research Review, 2013 Statistical Supplement and CMS/OIS/HCIS, Data from the Standard Analytical Files. Table 8.1; MedPAC June 2015. Table 12-3; MedPAC March 2017.

Home Health Medicare Margin

Home Health Margins and Volume Quintile
Quintile 2012 2013 2014 2015
First (Smallest) 7.1 6.1 4.0 7.4
Second 8.1 7.8 5.4 9.6
Third 10.1 8.9 7.6 12.4
Fourth 13.2 11.2 10.0 13.8
Fifth (Largest) 16.8 14.8 12.5 17.6
Sources: MedPAC Report to the Congress: Medicare Payment Policy, March 2014, 2016, and 2017, and MedPAC June 2014 and June 2015 Data Book.
Medicare Margin 2015
All Freestanding HHAs 15.6%
Majority urban 16.0%
Majority rural 13.2%
For profit 16.7%
Nonprofit 12.1%
Freestanding home health agencies had an aggregate margin of 15.6 percent in 2015. MedPAC estimates the marginal profit of HHAs to be 18.1 percent in 2015, higher than the overall Medicare margin.Sources: MedPAC Report to the Congress: Medicare Payment Policy, March 2014, 2016, and 2017 and MedPAC June 2014 and June 2015 Data Book.

Hospice Medicare Margin

Hospice Margins and Volume Quintile
Quintile 2011 2012 2013 2014
First (Smallest) -3.8 -2.3 -0.4 -4.7
Second 2.7 5.8 5.9 2.3
Third 7.6 9.7 9.3 9.6
Fourth 9.3 11.1 10.6 10.0
Fifth (Largest) 9.6 10.5 8.2 8.4
Source: MedPAC Report to the Congress: Medicare Payment Policy. March 2016.

In 2014, the average hospice Medicare margin was 8.2%. Freestanding hospices had higher margins (11.5%), while home health based hospices averaged 3.8% and hospital-based -20.3%.

Source: MedPAC Report to the Congress: Medicare Payment Policy March 2017.

Medicare Hospice Average Length of Stay

Diagnosis 2015 LOS (in days)
Cancer 53
Neurological conditions 147
Heart/circulatory 91
COPD 116
Other 51
Main location of care 2015 LOS (in days)
Home 89
Nursing facility 105
Assisted living facility 152
Source: MedPAC Report to the Congress: Medicare Payment Policy, March 2017.

Home Health Service Use

Home Health Service Use
Measure 2006 2014 2015
Home Heath users (millions) 3.0 3.4 3.5
Episodes (millions) 5.5 6.6 6.6
Per Home Health user 1.8 1.9 1.9
Payments (billions) $14.0 $17.7 $18.1
Per Home Health user $4,606 $5,156 $5,225

The average episode per home health user has decreased from 2.0 in 2010 to 1.9 in 2015. Payment per home health user decreased in the same period from $5,679 to $5,225. Source: MedPAC March 2015, 2016, and 2017; MedPAC December 2015 meeting presentation: Assessing payment adequacy and updating payments: home health care services.

Home Health Visits per Episode

Type of Visit Visits per Episode (2015)
Skilled Nursing 9.6
Therapy 7.1
Home Health Aide 2.0
Medical Social Services 0.1
Source: MedPAC Report to the Congress: Medicare Payment Policy, March 2017.

Medicare Advantage Enrollment Growth

Source: MedPAC Data Book 2016

Medicare Enrollment Growth

Medicare enrollment increased from 20 million in 1970 to 48 million in 2010, and is projected to reach 114 million in 2080.

Source: Medicare Trustees Report 2015: Medicare Enrollment by Part and in Total. Actual data through 2014.

Average Case Mix by State

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{"type":"Table","table":[["State","CMW"],["Alabama",1.072],["Alaska",1.04],["Arizona",1.076],["Arkansas",1.035],["California",0.96],["Colorado",1.144],["Connecticut",1.031],["Delaware",1.036],["District of Columbia",1.092],["Florida",1.182],["Georgia",1.103],["Hawaii",1.12],["Idaho",1.156],["Illinois",0.978],["Indiana",1.103],["Iowa",1.013],["Kansas",1.074],["Kentucky",1.064],["Louisiana",0.955],["Maine",1.06],["Maryland",1.104],["Massachusetts",1.033],["Michigan",1.096],["Minnesota",1.083],["Mississippi",0.964],["Missouri",1.071],["Montana",1.075],["Nebraska",1.105],["Nevada",0.978],["New Hampshire",1.027],["New Jersey",1.026],["New Mexico",1.021],["New York",0.998],["North Carolina",1.1],["North Dakota",0.996],["Ohio",1.048],["Oklahoma",0.937],["Oregon",1.046],["Pennsylvania",1.051],["Puerto Rico",1.076],["Rhode Island",1.053],["South Carolina",1.115],["South Dakota",1.083],["Tennessee",1.131],["Texas",0.946],["Utah",1.108],["Vermont",0.974],["Virginia",1.096],["Washington",1.124],["West Virginia",1.123],["Wisconsin",1.037],["Wyoming",1.068]],"options":{"places":3,"colors":["#dde4e1","#99afac"]}}

Source: Fazzi analysis of Medicare 2015 home health claims.