Originally presented April 2009 - Healthcare Market Resources · To compare and contrast various...

Originally presented April 2009

PURPOSE

To utilize hospice penetration as a metric for access to care

To identify those states with high and low levels, on a relative basis, of hospice penetration

To compare and contrast various market factors, at the state level, to understand differences between high and low penetration states

AGENDA

Background

Identification of High and Low Penetration States

Market Factors Influencing Penetration

Conclusions

SPEAKER BACKGROUND BA Lehigh University Mathematics, MBA MIT Sloan

School

Marketing and planning positions with Fortune 100 companies, with emphasis of consumer products

20+ years in all aspects of home care with for-profit and non-profit organizations

President, Healthcare Market Resources, a local market competitive intelligence firm

DATA SOURCES

Medicare hospice claims files

Medicare reports

Center for Disease Control publications

Department of Commerce, Census Bureau

State Departments of Health websites

RESEACH APPROACH

Regression Analysis See if hospice penetration is dependent on a given

variable

Utilizes entire set of state data

Very high or very low correlation can be relied upon

High/Low Penetration Identify high and low penetration states & see if these

groups’ results mirror top 10 or bottom 10 performers for that indicator

Better able to identify factors that enhance or inhibit penetration

HOSPICE PENETRATION METRIC

Patients Served

Medicare Eligible = Hospice Penetration

PENETRATION BY STATE 2006

0.00%

0.50%

1.00%

1.50%

2.00%

2.50%

3.00%

3.50%

4.00%

AL AK AZ AR CA CO CT DE DC FL GA HI ID


0.00%

0.50%

1.00%

1.50%

2.00%

2.50%

3.00%

3.50%

4.00%

AL AK AZ AR CA CO CT DE DC FL GA HI ID


0.00%

0.50%

1.00%

1.50%

2.00%

2.50%

3.00%

3.50%

IL IN IA KS KY LA ME MD MA MI MN MS MO


0.00%

0.50%

1.00%

1.50%

2.00%

2.50%

3.00%

3.50%

4.00%

IL IN IA KS KY LA ME MD MA MI MN MS MO


0.00%

0.50%

1.00%

1.50%

2.00%

2.50%

3.00%

3.50%

4.00%

MT NE NV NH NJ NM NY NC ND OH OK OR PA PR US


0.00%

0.50%

1.00%

1.50%

2.00%

2.50%

3.00%

3.50%

4.00%

MT NE NV NH NJ NM NY NC ND OH OK OR PA


0.00%

0.50%

1.00%

1.50%

2.00%

2.50%

3.00%

3.50%

4.00%

RI SC SD TN TX UT VT VA WA WV WI WY US

HIGH PENETRATION STATES 2006 •OKLAHOMA •ARIZONA

•ALABAMA •UTAH

•MISSISSIPPI •FLORIDA

•IOWA •GEORGIA

•NEW MEXICO •TEXAS

HIGH PENETRATION STATES 2007

•ARIZONA •FLORIDA

•UTAH •IOWA

•OKLAHOMA •DELAWARE

•ARIZONA •TEXAS

•MISSISSIPPI •MISSOURI

LOW PENETRATION STATES 2006 ALASKA HAWAII

WYOMING NEW YORK

DISTRICT OF

COLUMBIA

PUERTO RICO

VERMONT SOUTH DAKOTA

MAINE WEST VIRGINA

LOW PENETRATION STATES 2007

ALASKA WYOMING

HAWAII NEW YORK

DISTRICT OF

COLUMBIA

VERMONT

SOUTH DAKOTA KENTUCKY

WEST VIRGINA MAINE

PENETRATION GROWTH 2006

48.00%

98.20%

51.20%

40.00%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

HIGH LOW LOW w/o AK AVG

PENETRATION GROWTH 2007

56.38%

97.26%

55.21%

47.56%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

HIGH LOW LOW w/o AK AVG

HIGH GROWTH STATES 2006 •ALASKA •MAINE

•DELAWARE •RHODE ISLAND

•SOUTH DAKOTA •IDAHO

•MISSISSIPPI •ALABAMA

•KANSAS •TENNESSEE

High Penetration-Bold; Low

Penetration-Italics

High Penetration-Bold

Low Penetration-Italics

HIGH GROWTH STATES 2007

•ALASKA •MAINE

•DELAWARE •RHODE ISLAND

•IDAHO •SOUTH DAKOTA

•SOUTH CAROLINA •NORTH DAKOTA

•TENNESSEE •IOWA

LOW GROWTH STATES 2006

KENTUCKY COLORADO

HAWAII NEVADA

ILLINOIS MICHIGAN

FLORIDA OREGON

WASHINGTON MARYLAND





LOW GROWTH STATES 2007

KENTUCKY COLORADO

NEVADA ILLINOIS

OREGON HAWAII

WYOMING MARYLAND

NEW YORK FLORIDA

CON STATES PENETRATION 2006

1.82%1.71%

2.25% 2.29%2.19%

0.00%

0.50%

1.00%

1.50%

2.00%

2.50%

CON

States

CON

States w/o

FL

Non-CON

States

Nat'l Wght

Avg

Nat'l

Unwght

Avg

CON States - 25% of Total

CON STATES PENETRATION 2007

1.92%1.82%

2.43% 2.41%2.30%

0.00%

0.50%

1.00%

1.50%

2.00%

2.50%

3.00%

CON States CON States

w/o FL

Non-CON

States

Nat'l Wght

Avg

Nat'l Unwght

Avg

ACCESS IN CON STATES 2006 (Hospices per Counties)

0.68

3

0.63

1.4

0.23

1.17

0.82 0.8

1.28

0.60.71

0.82

0.33

0.950.79

0

0.5

1

1.5

2

2.5

3

AR DC FL HI KY MD NY NC SC TN VT WA WV US AVG

ACCESS IN CON STATES 2007 (Hospices per Counties)

0.65

3.00

0.64

1.60

0.23

1.17

0.81 0.82

1.48

0.600.71

0.82

0.33

1.02

0.68

-

0.50

1.00

1.50

2.00

2.50

3.00

3.50

AR DC FL HI KY MD NY NC SC TN VT WA WV US AVG

HIGH PENETRATION STATES 2006 CON STATES IN BOLD

•OKLAHOMA •ARIZONA

•ALABAMA •UTAH

•MISSISSIPPI •FLORIDA

•IOWA •GEORGIA

•NEW MEXICO •TEXAS

HIGH PENETRATION STATES 2007 CON STATES IN BOLD

•ARIZONA •FLORIDA

•UTAH •IOWA

•OKLAHOMA •DELAWARE

•ARIZONA •TEXAS

•MISSISSIPPI •MISSOURI

LOW PENETRATION STATE 2006 CON STATES IN BOLD

ALASKA HAWAII

WYOMING NEW YORK

DISTRICT OF

COLUMBIA

PUERTO RICO

VERMONT SOUTH DAKOTA

MAINE WEST VIRGINA

ALASKA WYOMING

HAWAII NEW YORK

DISTRICT OF

COLUMBIA

VERMONT

SOUTH DAKOTA KENTUCKY

WEST VIRGINA MAINE

LOW PENETRATION STATE 2007 CON STATES IN BOLD

LOW GROWTH STATES 2006 CON STATES IN BOLD

KENTUCKY COLORADO

HAWAII NEVADA

ILLINOIS MICHIGAN

FLORIDA OREGON

WASHINGTON MARYLAND

KENTUCKY COLORADO

NEVADA ILLINOIS

OREGON HAWAII

WYOMING MARYLAND

NEW YORK FLORIDA

LOW GROWTH STATES 2007 CON STATES IN BOLD

HOSPICE PENETRATION (Hospice Deaths as % of Anticipated Deaths)

45.3% 44.4%

20.1% 20.4%

33.6%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

50.0%

Top 10 High Pent Bottom 10 Low Pent Nat'l Avg

METRIC COMPARISON BY STATE High Death % High Penetration % Low Death % Low Penetration %

Arizona Oklahoma Alaska Alaska

Utah Arizona Dist of Columbia Hawaii

Alabama Alabama Hawaii Wyoming

Florida Utah Wyoming New York

Mississippi Mississippi Puerto Rico Dist of Columbia

Colorado Florida New York Puerto Rico

New Mexico Iowa Vermont Vermont

Oklahoma Georgia South Dakota South Dakota

Oregon New Mexico North Dakota Maine

Iowa Texas Maine West Virginia

HOSPICE GROWTH (% Change in Hospice Penetration % 2002-6)

79.9%

51.0%

23.1%

48.0%

40.0%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

Top 10

w/o AK

High Pent Bottom 10 Low Pent

w/o AK

Nat'l Avg

HOSPICE GROWTH (% Change in Hospice Penetration % 2002-7)

92.6%

56.4%

27.3%

55.2%

47.6%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Top 10 w/o

AK


w/o AK

Nat'l Avg

POPULATION DENSITY Population per Square Mile

604.57

92.9

14

90.2 83.8

0

100

200

300

400

500

600

700

Top 10

w/o DC


w/o DC

Nat'l Avg

ACCESS TO CARE (Hospices /10K Medicare Eligible)

1.98

1.49

0.36

0.840.73

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

2


GEOGRAPHIC ACCESS TO CARE (Hospices per 1K Sq Miles)

4.73

1.28

0.28

5.83

0.61 0.81

0

1

2

3

4

5

6

Top 10

ex DC

High

Pent

Bottom

10 ex

AK

Low

Pent

Low

Pent ex

AK, DC,

PR

Nat'l

Avg

NON-WHITE PATIENTS (% Non-White Discharges)

32.5%

14.7%

2.0%

20.1%

12.1%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%


NON-WHITE HOSPICE PENETRATION (% Non-White Discharges/% Non-White Population)

67.5%

41.0%

18.1%

42.4%

31.3%36.5%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

Top 10 High

Pent

Bottom

10

Low

Pent

Low

Pent ex

DC, HI

Nat'l

Avg

DISEASE MIX (% Non-Cancer Hospice Deaths)

67.2%

60.0%

53.8% 54.8%

61.9%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%


80+% Correlation between Hospice Penetration & Non-Cancer Hospice Deaths

ALZHEIMER’S IMPACT (% Alzheimer’s/Dementia Deaths of Total Deaths)

30.9%

16.9%

7.1%

14.8%

19.9%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%


FOR-PROFIT PRESENCE (FOR-PROFIT MEDICARE REVENUES/TOTAL MEDICARE REVENUES)

77.4%

63.0%

9.7%

30.7%25.0%

49.4%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

Top 10 High

Pent

Bottom

10

Low

Pent

Low

Pent ex

AK

Nat'l

Avg

LENGTH OF STAY (Days per Discharge)

99.891.7

53.2

64.569.8

0

10

20

30

40

50

60

70

80

90

100


LONG STAY PATIENTS (% Patients w/LOS>180 days)

17.0%

15.4%

7.2%

9.2%

10.8%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

18.0%


LONG STAY PATIENTS (% Patients w/LOS>90 Days)

28.6%26.7%

15.1%

19.7% 20.6%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%


NURSING HOME MARKET On currently available claims data, there is no data on

place of service; must infer

Claims data has place of death; if patient dies in a medical facility, it is either a hospital or a skilled nursing facility

If patient dies in a hospital, they were likely there to receive inpatient services

So if a patient dies in a medical facility and has no inpatient days on the last claim, we infer that they must have did in a SNF

NURSING HOME MARKET (% DIED IN MED FAC W/NO INPT DAYS)

30.9%

16.9%

7.1%

14.8%

19.9%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%


CORRELATION SUMMARY (Hospice Penetration)

INDICATOR CORREL INDICATOR CORREL

Hospice Growth -.265 Alzheimer’s Impact .257

Population Density -.217 For-Profit Presence .477

Access to Care .372 Length of Stay .597

Geographic Access -.198 Long Stay Patients .645

Non-White Patients -.129 Long Stay Patients 90+ .583

Non-White Penetration .017 “Nursing Home” Market .124

Disease Mix .807 Hospice Death Penetration .949

CONCLUSIONS Few market factors appear to consistently influence

hospice penetration(access to care)

Those factors with the greatest influence

Non-Cancer Hospice Deaths

Length of Stay, particularly driven by 180+ day patients

Presence of For-Profits

CON appears to inhibit hospice penetration

CONTACT INFORMATION

Rich Chesney

President, Healthcare Market Resources

[email protected]

215.657.7373

215.657.0395(f)

www.healthmr.com

Originally presented April 2009 - Healthcare Market Resources · To compare and contrast various...

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