1. Do Live Discharge Rates Increase as Hospices Approach Their Medicare Aggregate Payment Caps? 
Rachel Dolin, PhD, Pam Silberman, JD, DrPH, Denise A. Kirk, MS, Sally C. Stearns, PhD, Laura C. Hanson, MD, MPH, Donald H. Taylor, PhD, MPA, G. Mark Holmes, PhD 
Journal of Pain and Symptom Management 
Volume 55, Issue 3, Pages (March 2018)
DOI: /j.jpainsymman
Copyright © 2017 American Academy of Hospice and Palliative Medicine Terms and Conditions

2. Fig. 1 Enrollee deaths and live discharges, by month.
Author analysis of Medicare claims, 2012–2013; data set without washout period.
Journal of Pain and Symptom Management  , DOI: ( /j.jpainsymman )
Copyright © 2017 American Academy of Hospice and Palliative Medicine Terms and Conditions

3. Fig. 2
Monthly facility-level cap risk, 2013 cap year. Facility-level cap risk was calculated as the median LOS, aggregated with each successive month in the cap year (i.e., beginning November 2012). LOS = length of stay.
Author analysis of Medicare claims, 2012–2013; data set without washout period.
Journal of Pain and Symptom Management  , DOI: ( /j.jpainsymman )
Copyright © 2017 American Academy of Hospice and Palliative Medicine Terms and Conditions

4. Fig. 3
Predictive probability of being discharged dead vs. alive based on facility cap risk. Models were clustered at the beneficiary level and controlled for beneficiary age, beneficiary gender, beneficiary primary diagnosis, beneficiary RUCA group, facility type, facility profit status, facility years in operation, facility census division, facility rural/urban status, facility size, HHI, month in the cap year. Model also included interactions between facility census division and rural/urban status, facility profit status and cap risk, and facility years in operation and cap risk. Model referent group: Still a patient; models should be interpreted as unconditional probabilities where probabilities of being discharged alive, discharged dead, and remaining a patient sum to 1 for each patient type at each cap risk level. Characteristics of Patient no. 1 (high likelihood of being discharged alive): 85 years old, African American, female, with dementia, living in an urban area. Receiving care at a for-profit, freestanding, nonchain, medium-sized hospice, operating in an urban area in the South Atlantic for five years in a market with an HHI of 0.02 in the month of July Characteristics of Patient no. 2 (high likelihood of being discharged dead): 70 years old, white, male, with cancer, living in a large rural area. Receiving care at a nonprofit, hospital-based, large, nonchain hospice, operating in a rural area in New England for 25 years in a market with an HHI of in the month of July Characteristics of Patient no. 3 (average patient): 82 years old, white, female, with congestive heart failure, living in an urban area. Receiving care at a nonprofit, freestanding, nonchain, large hospice operating in an urban area in the East North Central region for 18 years in a market with an HHI of in the month of July HHI = Herfindahl-Hirschman index; RUCA = Rural-Urban Commuting Area.
Author analysis of Medicare claims, 2012–2013; data set without washout period.
Journal of Pain and Symptom Management  , DOI: ( /j.jpainsymman )
Copyright © 2017 American Academy of Hospice and Palliative Medicine Terms and Conditions