1. In Partnership with: The ONLY Hospice report including Hospital, SNF & Home Health Info!

2.  This is a State Hospice Organization Report completed for the Texas & New Mexico Hospice Organization.  This report is created from the most current 100% publically available data files from CMS, U.S. Census, CDC, and others. It is organized by county-specific information followed service area (i.e., all requested counties), state, and national aggregated information.  Medicare Data Year= 2009.  Questions or comments, please contact: Hospice Analytics, Inc. Cordt T. Kassner, PhD, Principal 2355 Rossmere Street Colorado Springs, CO 80919 P: 719-209-1237 E: CKassner@HospiceAnalytics.com W: www.HospiceAnalytics.com Texas & New Mexico Hospice Organization 2

3. Suggestions on applying information in this report: 1.Understand current trends regarding access to and utilization of hospice services in your area – and how that compares to state and national trends. 2.How can access to and utilization of hospice services be strengthened in your area and across your state? 3.Using this information, is it possible to identify target populations as a starting place (e.g., target specific diagnoses with low hospice utilization, or outreach to hospital or skilled nursing facility providers caring for dying patients, etc.)? 4.Identify areas of high hospice access and utilization in your state (or perhaps a nearby state) – what can be learned from them? How might partnerships be formed and best practices shared? How can your state hospice organization help? 5.How might this information be used in statewide advocacy, regulatory, and education efforts? 6.What other questions do you have? How can information in the Medicare claims data, cost reports, etc., help provide an evidence- base for decision-making? How can your state hospice organization help? Texas & New Mexico Hospice Organization 3

4. 1. State Information 2. Who Was Missed? 3. County Information 4. National Information 5. Hospitals, SNFs, and HHAs Texas & New Mexico Hospice Organization 4

5. TexasNew Mexico Population24,782,3022,009,671 Total Deaths 163,758 0.7% of population 15,562 0.8% of population Medicare Beneficiaries3,051,891318,375 Medicare Beneficiary Deaths 121,653 74% of total deaths 11,619 75% of total deaths Medicare Hospice Patient Admissions 79,557 49% of total deaths 65% of Medicare deaths 7,785 50% of total deaths 67% of Medicare deaths Medicare Hospice Patient Deaths 53,114 32% of total deaths 43.7% of Medicare deaths 4,943 32% of total deaths 42.5% of Medicare deaths Texas & New Mexico Hospice Organization 5

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11. Perhaps billing errors Texas & New Mexico Hospice Organization 11

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15. TX #3: 79,557 Texas & New Mexico Hospice Organization 15 NM #37: 7,875

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17. TX #2: 6,391,782 Texas & New Mexico Hospice Organization 17 NM #34: 677,755

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19. TX #11: 80 National: 71 Texas & New Mexico Hospice Organization 19 NM #6: 87

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21. National: 24 TX #15: 27 Texas & New Mexico Hospice Organization 21 NM #8: 36

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23. NM #35 $100,104,518 Texas & New Mexico Hospice Organization 23 TX #3 $954,727,454

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25. TX #11: $12,001 Texas & New Mexico Hospice Organization 25 NM #9: $12,859

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38.  Please refer to the Excel spreadsheet enclosed with this report for additional information.  Also, additional detailed county-level information is available through Market Reports for your hospice provider members. Texas & New Mexico Hospice Organization 38

39. 1. State Information 2. Who Was Missed? 3. County Information 4. National Information 5. Hospitals, SNFs, and HHAs Texas & New Mexico Hospice Organization 39

40.  This section highlights what information is available for Medicare beneficiaries who died outside of hospice care. Texas & New Mexico Hospice Organization 40

41. County-Specific InformationMedicare Beneficiaries Who Died Medicare Beneficiaries Who Died With Hospice Medicare Beneficiaries Who Died Without Hospice Compare: Texas3,051,891121,65353,11468,539 Compare: New Mexico318,37511,6194,9436,676 Compare: National48,753,1411,936,900758,4751,178,425 Texas & New Mexico Hospice Organization 41

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45. 1. State Information 2. Who Was Missed? 3. County Information 4. National Information 5. Hospitals, SNFs, and HHAs Texas & New Mexico Hospice Organization 45

46. Texas & New Mexico Hospice Organization 46

47. National Population307,006,550 Total Deaths 2,486,097 0.8% of population Medicare Beneficiaries47,645,019 Medicare Beneficiary Deaths 1,899,969 76% of total deaths Medicare Hospice Patients 1,079,676 43% of total deaths 57% of Medicare deaths Medicare Hospice Patient Deaths 752,943 30% of total deaths 39.6% of Medicare deaths Total Days of Hospice Care76,724,901 Days Mean Days / Patient of Hospice Care71 Days Median Days / Patient of Hospice Care24 Days Total Medicare Hospice Payments$12,064,905,206 Texas & New Mexico Hospice Organization 47

48. 1. State Information 2. Who Was Missed? 3. County Information 4. National Information 5. Hospitals, SNFs, and HHAs Texas & New Mexico Hospice Organization 48

49. 2009 Settings In Which Medicare Beneficiaries Died – N (%) County Total Beneficiary Deaths Hospice DeathsHospital DeathsSNF DeathsHHA DeathsOther Deaths Compare: Texas121,65353,114 (44%)28,836 (24%)5,421 (4%)5,006 (4%)29,276 (24%) Compare: New Mexico11,6194,943 (42%)2,031 (17%)445 (4%)298 (2%)3,902 (34%) Compare: National1,899,969758,475 (40%)408,986 (22%)102,651 (5%)44,938 (2%)584,919 (31%) Texas & New Mexico Hospice Organization 49

50. The 2009 Medicare Data Was Recently Released: Who Provides Healthcare at the End of Life?Snapshots 1/19/11 Note: Information reflects Medicare beneficiaries only; categories are not mutually exclusive. Texas & New Mexico Hospice Organization 50

51. Summary:  Inpatient Hospitals in Texas cared for 480,298 Medicare beneficiaries, of whom 72,786 died (15%). (Compare national=15%.)  Of those who died: ◦ 28,836 (40%) died in a Inpatient Hospital (compare national=40%) ◦ 42,869 (59%) were admitted to a hospice (compare national=51%) ◦ 30,550 (42%) died under hospice care (compare national=37%)  Of those admitted to hospice: ◦ 50% died within 14 days of admission (compare national=14 days) ◦ Hospice mean length of stay=51 days (compare national=46 days) Texas & New Mexico Hospice Organization 51

52. Summary:  Inpatient Hospitals in New Mexico cared for 36,723 Medicare beneficiaries, of whom 5,327 died (14%). (Compare national=15%.)  Of those who died: ◦ 2,031 (38%) died in a Inpatient Hospital (compare national=40%) ◦ 3,032 (57%) were admitted to a hospice (compare national=51%) ◦ 2,034 (38%) died under hospice care (compare national=37%)  Of those admitted to hospice: ◦ 50% died within 15 days of admission (compare national=14 days) ◦ Hospice mean length of stay=53 days (compare national=46 days) Texas & New Mexico Hospice Organization 52

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54. TexasNew MexicoNational Population24,782,3022,009,671307,006,550 Total Deaths 163,758 0.7% of population 15,562 0.8% of population 2,486,097 0.8% of population Medicare Beneficiaries3,051,891318,37547,645,019 Medicare Beneficiary Deaths 121,653 74% of total deaths 11,619 75% of total deaths 1,899,969 76% of total deaths Medicare Inpatient Hospital Patients 480,29836,7236,938,545 Medicare Inpatient Hospital Patient Deaths 28,836 18% of total deaths 24% of Medicare deaths 2,031 13% of total deaths 17% of Medicare deaths 408,986 16% of total deaths 22% of Medicare deaths Total Days of Inpatient Hospital Care 5,123,919 Days308,652 Days63,792,525 Days Mean Days / Patient of Inpatient Hospital Care 11 Days8 Days9 Days Median Days / Patient of Inpatient Hospital Care 5 Days4 Days5 Days Total Medicare Inpatient Hospital Payments$8,502,411,681$582,071,099$116,664,490,101 Texas & New Mexico Hospice Organization 54

55. Summary:  Skilled Nursing Facilities in Texas cared for 109,602 Medicare beneficiaries, of whom 26,892 died (24%). (Compare national=23%.)  Of those who died: ◦ 5,421 (20%) died in a SNF (compare national=24%) ◦ 19,134 (71%) were admitted to a hospice (compare national=54%) ◦ 12,919 (48%) died under hospice care (compare national=37%)  Of those admitted to hospice: ◦ 50% died within 17 days of admission (compare national=15 days) ◦ Hospice mean length of stay=54 days (compare national=48 days) Texas & New Mexico Hospice Organization 55

56. Summary:  Skilled Nursing Facilities in New Mexico cared for 6,959 Medicare beneficiaries, of whom 1,713 died (25%). (Compare national=23%.)  Of those who died: ◦ 445 (26%) died in a SNF (compare national=24%) ◦ 1,098 (64%) were admitted to a hospice (compare national=54%) ◦ 656 (38%) died under hospice care (compare national=37%)  Of those admitted to hospice: ◦ 50% died within 21 days of admission (compare national=15 days) ◦ Hospice mean length of stay=62 days (compare national=48 days) Texas & New Mexico Hospice Organization 56

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58. TexasNew MexicoNational Population24,782,3022,009,671307,006,550 Total Deaths 163,758 0.7% of population 15,562 0.8% of population 2,486,097 0.8% of population Medicare Beneficiaries3,051,891318,37547,645,019 Medicare Beneficiary Deaths 121,653 74% of total deaths 11,619 75% of total deaths 1,899,969 76% of total deaths Medicare SNF Patients109,6026,9591,822,074 Medicare SNF Patient Deaths 5,421 3% of total deaths 4% of Medicare deaths 445 3% of total deaths 4% of Medicare deaths 102,651 4% of total deaths 5% of Medicare deaths Total Days of SNF Care4,702,557 Days247,453 Days67,514,523 Days Mean Days / Patient of SNF Care31 Days36 Days37 Days Median Days / Patient of SNF Care43 Days25 Days27 Days Total Medicare SNF Payments $1,521,348,459$85,174,671$24,476,518,870 Texas & New Mexico Hospice Organization 58

59. Summary:  Home Health Agencies in the selected Texas counties cared for 351,248 Medicare beneficiaries, of whom 36,471 died (10%). (Compare national=12%.)  Of those who died: ◦ 5,006 (14%) died in a HHA (compare national=11%) ◦ 24,834 (68%) were admitted to a hospice (compare national=64%) ◦ 16,338 (45%) died under hospice care (compare national=43%)  Of those admitted to hospice: ◦ 50% died within 20 days of admission (compare national=18 days) ◦ Hospice mean length of stay=57 days (compare national=51 days) Texas & New Mexico Hospice Organization 59

60. Summary:  Home Health Agencies in the selected New Mexico counties cared for 16,155 Medicare beneficiaries, of whom 2,167 died (13%). (Compare national=12%.)  Of those who died: ◦ 298 (14%) died in a HHA (compare national=11%) ◦ 1,620 (75%) were admitted to a hospice (compare national=64%) ◦ 972 (45%) died under hospice care (compare national=43%)  Of those admitted to hospice: ◦ 50% died within 25 days of admission (compare national=18 days) ◦ Hospice mean length of stay=57 days (compare national=51 days) Texas & New Mexico Hospice Organization 60

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62. TexasNew Mexico National Population24,782,3022,009,671307,006,550 Total Deaths 163,758 0.7% of population 15,562 0.8% of population 2,486,097 0.8% of population Medicare Beneficiaries3,051,891318,37547,645,019 Medicare Beneficiary Deaths 121,653 74% of total deaths 11,619 75% of total deaths 1,899,969 76% of total deaths Medicare HHA Patients351,24816,1553,288,479 Medicare HHA Patient Deaths 5,006 3% of total deaths 4% of Medicare deaths 298 2% of total deaths 2% of Medicare deaths 44,938 2% of total deaths 2% of Medicare deaths Total HHA Visits39,841,484 Visits711,306 Visits207,308,047 Visits Mean Visits / HHA Patient113 Visits44 Visits63 Visits Median Visits / HHA Patient36 Visits21 Visits20 Visits Total Medicare HHA Payments $4,270,780,195$96,151,270$24,903,480,624 Texas & New Mexico Hospice Organization 62

63. Please contact Hospice Analytics with any questions, comments, feedback, or for additional information: W: www.HospiceAnalytics.com P: 719-209-1237 E: Info@HospiceAnalytics.com Texas & New Mexico Hospice Organization 63