WSHPCO Annual Conference, Session 5C 1

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Payer Medicare Hospice Benefit87.2%83.7% Managed Care or Private Insurance6.2%7.6% Medicaid Hospice Benefit3.8%5.5% Uncompensated or Charity Care0.9%1.2% Self Pay0.8%0.9% Other Payment Source1.2% NHPCO Facts and Figures on Hospice Care

Payer Medicare Hospice Benefit91.2%89.0% Managed Care or Private Insurance4.0%4.4% Medicaid Hospice Benefit3.1%4.3% Uncompensated or Charity Care0.6%0.8% Self Pay0.5%0.6% Other Payment Source0.6%0.9% NHPCO Facts and Figures on Hospice Care

WashingtonNational Total Deaths51,0522,529,792 Medicare Beneficiary Deaths41,5602,081,847 Medicare Hospice Beneficiary Admissions 24,021 58% of Medicare deaths 1,304,994 63% of Medicare deaths Medicare Hospice Beneficiary Deaths 17, % of Medicare deaths 946, % of Medicare deaths Medicare Hospice Total Days of Care1,385,256 days91,044,459 days Medicare Hospice Mean Days/Beneficiary Medicare Hospice Median Days/Beneficiary 58 days 23 days 70 days 24 days Medicare Hospice Total Payments Medicare Hospice Mean Payment/Beneficiary $240,695,096 $10,021 $14,917,921,218 $11,444 6www.HospiceAnalytics.com

2013 Hospice Utilization (Medicare Hospice Deaths / Total Medicare Deaths) 7

2013 Medicare Hospice Mean Days of Care / Beneficiary WA #40: 58 National:

2013 Medicare Hospice Median Days of Care / Beneficiary National: 24 WA #28:

2013 Medicare Hospice Beneficiaries Levels of Care (days) 10

2013 Mean Medicare Hospice Payments/Beneficiary WA #31: $10,021 National: $11,

BNAF ACA Prod Adjustment Sequestration Quality Reporting Penalty 2 Tier RHC + SIA

MEDICARE PAYMENT: HISTORICAL REVIEW

Show me the money…

15 8/6/15:

16www.HospiceAnalytics.com

17 MEDICARE PAYMENT

18www.HospiceAnalytics.com

19www.HospiceAnalytics.com

20 Type of CareNew RateVersus Continuous Home Care (CHC)$944.79$ Inpatient Respite Care (IRC)$167.45$ General Inpatient Care (GIP)$720.11$ Wage Index Adjustments Market Basket Increase 1.6% Final Year BNAF Phase Out Adjustment Factor 1.018% -2% for Hospice Agencies that DO NOT Submit Required Quality Data

Revenue Modeling Dec January * * 31Days $501, $467, $479, $492, Census = $504, $517, $529, $541, DeathsSIA: 2 hrs x 2 days DeathsSIA: 3 hrs x 3 days DeathsSIA: 3 hrs x 4 days14173

Revenue Modeling Dec-15 January $34, * * 31Days $501, $467, $479, $492, $504, Census = $517, $529, $541, DeathsSIA: 2 hrs x 2 days DeathsSIA: 3 hrs x 3 days DeathsSIA: 3 hrs x 4 days14173

Revenue Modeling Dec-15 January * * 31Days $501, $467, $479, $492, $504, Census = $517, $529, $541, DeathsSIA: 2 hrs x 2 days $40, DeathsSIA: 3 hrs x 3 days DeathsSIA: 3 hrs x 4 days14173

Revenue Modeling Dec-15 January * * 31Days $501, $467, $479, $492, Census = $504, $517, $529, $541, DeathsSIA: 2 hrs x 2 days DeathsSIA: 3 hrs x 3 days DeathsSIA: 3 hrs x 4 days14173

Revenue Modeling Dec-15 January * * 31Days $501, $467, $479, $492, Census = $504, $517, $529, $541, DeathsSIA: 2 hrs x 2 days DeathsSIA: 3 hrs x 3 days DeathsSIA: 3 hrs x 4 days14173

Summary of the 8/6/15 Hospice Final Rule 26

Hospice Reimbursement Modeling (based on levels of care only, no SIA or wage index adjustment) 27

28www.HospiceAnalytics.com

29www.HospiceAnalytics.com

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Routine Home Care 31

32 5Cost Reporting Period (mm/dd/yyyy) From:01/01/2013To:12/31/2013 6Provider Identification Number 6National Provider Identifier (NPI) Number 7Type of Control (see instructions) 1 PART II Title XVIIITitle XIXTitle XVIIITitle XIX Unduplicated Enrollment DaysUnduplicated Skilled NursingNursingOtherTotal Medicare DaysMedicaid DaysFacility Days UnduplicatedUnduplicated Days Continuous Home Care 27 9Routine Home Care 144,0545,22927,075 17,946167,229 10Inpatient Respite Care Inpatient General Care Total Hospice Days 144,5845,33427,201 18,131168,049 PART III Title XVIIITitle XIX Skilled NursingNursing Title XVIIITitle XIXFacility OtherTotal Number of Patients Receiving Hospice Care ,773 Total Number of Unduplicated Countinuous 14 Care Hours Billable to Medicare 15Average Length of Stay Unduplicated Census Count ,633

33 CON- RECLAS- EMPLOYEE TRACTED SIFICATION SALARIESBENEFITSTRANSPOR-SERVICES (Increase/ COST CENTER DESCRIPTIONS(From TATION(From TOTALDecrease) Wkst A-1)Wkst A-2)(See inst.)Wkst A-3)OTHER(col. 1-5)(Fr Wkst A-6)SUBTOTAL GENERAL SERVICE COST CENTERS 10100Capital Related Costs-Bldg and Fixtures 691, Capital Related Costs-Movable Equipment 235, Plant Operation and Maintenance 17, Transportation - Staff 50500Volunteer Service Coordination125,14656,4921,296 66,334249, Administrative and General1,232,703556,4556,0012,962,3512,847,5107,605,020 INPATIENT CARE SERVICE Inpatient - General Care Inpatient - Respite Care VISITING SERVICES Physician Services116,71452, , , Nursing Care7,474,4773,374,055516,33387,970256,55311,709,388-2,079,1859,630,203 ####1620Nursing Care -- Continuous Home Care Physical Therapy Occupational Therapy 213, Speech/ Language Pathology Medical Social Services 1,340, Spiritual Counseling 525, Dietary Counseling Counseling - Other152,14668,68010,8821, , Home Health Aide and Homemaker476,637215,15927,14335,03455,581809,554 ####2420HH Aide & Homemaker -- Cont Home Care 25 Other 36,758

34 CONT- RECLAS- EMPLOYEE RACTED SIFICATION SALARIESBENEFITSTRANSPOR-SERVICES (Increase/ COST CENTER DESCRIPTIONS(From TATION(From TOTALDecrease) Wkst A-1)Wkst A-2)(See inst.)Wkst A-3)OTHER(col. 1-5)(Fr Wkst A-6)SUBTOTAL OTHER HOSPICE SERVICE COSTS Drugs, Biological and Infusion Therapy 1,411,342 ####3030Analgesics ####3031Sedatives / Hypnotics ####3032Other -- Specify Durable Medical Equipment/Oxygen 1,429, Patient Transportation Imaging Services 3, Labs and Diagnostics 23, Medical Supplies 202, Outpatient Services (incl. E/R Dept.) 722, Radiation Therapy Chemotherapy 39 Other HOSPICE NONREIMBURSABLE SERV Bereavement Program Costs487,292219,96917, ,890774, Volunteer Program Costs Fundraising 53 Other Program Costs209,88894,7463, ,388490, Total11,309,6015,105,270583,0783,443,0458,230,70328,671,697

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