Hospice Utilization: Is Hospice Stuck in a Rut?

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It seems that hospice is stuck in a rut.  We recently took an 11-year snapshot of hospice utilization, only to find that while hospice utilization was growing at the beginning of the period, that utilization seems to have plateaued. Apparently, doing things the ways that they have historically been done has only gotten hospices so much growth.  Add to that increased regulatory scrutiny and pressure, and hospices are finding growth harder to come by as they become even more conservative about who they accept and keep on service.  And, yet our data shows that the opportunity for growth is there.

The 11-Year Snapshot 

  • Across the 11-year period, there is a wide variation in average hospice utilization growth rates among states. For example, utilization growth rates were as low as 17% for Colorado but as high as 849% for Alaska.
  • Generally speaking, while the first 6 years were characterized by robust growth and increased utilization, in year seven that growth plateaued, then picked up modestly in 2009 only to plateau again in 2013.
  • Some states, such as Arizona, Florida and Kansas, are already seeing hospice utilization declines, rather than growth for the last three years.
  • Other are in decline for the last two years: New Jersey, Delaware, Iowa and South Dakota.
  • Only a few have been able to turn 2012 declines into modest 2013 growth: Oklahoma, Rhode Island and Wyoming.
HealthMR Hospice Utilization 2002 - 2013 Averages

2013 Breakdown

  • The 2013 national average hospice utilization rate is 2.46%.
  • There is a wide variation in 2013 hospice utilization rates among states, ranging from Alaska with the lowest rate of 1.16% to Utah with the highest rate of 3.6%.
  • For 2013, the states in the top quartile of hospice penetration rates use hospice 75% more often as states in the bottom quartile: 3.23% (on average) versus 1.85% (on average).

HealthMR 2013 Hospice UtilizationWhat does the future hold for hospice utilization nationally and in your local market? Obviously, hospice utilization gains are becoming more difficult and securing hospice growth significantly more complicated. Once upon a time, geographic expansion held the key to solid growth. Not so, today when some markets are over-saturated and others are leveling off on their utilization rates.

And, yet the opportunity is there.  Our research has shown that that 7% of the Medicare patients who are discharged alive from a hospital die within 30 days.  Too many patients, who die in LTAC’s or SNF’s, are hospice candidates.  This is compounded by the fact that hospice median length-of-stay has barely budged in the past several years.  Innovative programs like the Medicare Care Choices Model may help jumpstart hospice utilization. And, rather than spinning their wheels, hospices can learn some new moves.

If you would like to see our analysis at the individual state level, we can send you the free, state-by-state chart of hospice utilization.  Just e-mail Rich at rchesney@nullhealthmr.com to request it.


  • hospice utilization rates are measured by dividing the number of hospice patients served by the total Medicare eligible population for each state.
  • for the most accurate benchmarking, you should look at utilization at the county level, which is included in the Hospice Market Profile Report Set.