Per-Beneficiary Medicare Spending
Identifying Attributes
Care Settings
Country
Publishing Organisation
Type of Quality Indicator
IOM Quality Dimension
Domain
Defining Attributes
Definition
Average per-beneficiary Medicare payments (in U.S. dollars): the total number of payments Medicare paid to hospice providers divided by the total number of hospice beneficiaries served.
Numerator
Total Medicare hospice payments received by a hospice within a reporting period. Claims-based calculation details: Sum together all payments on hospice claims for a particular reporting year for a particular hospice. Medicare spending per beneficiary is calculated by dividing the total payments by the total number of unique beneficiaries
Denominator
Total number of beneficiaries electing hospice with the hospice within a reporting period. Claims-based calculation details: Count the number of unique beneficiaries on all hospice claims in the same period for a particular hospice.
Exclusions
Use of Risk Adjustment
Risk Adjustments
None
Stratifications
None
Data Attributes
Type of Data Collection
Data Collection Methods
Data Source: Hospice Medicare claims data. Data are obtained from provider submitted claims for the information needed to calculate the measure, so providers do not submit any additional data to CMS. CMS will use 2 years of Medicare claims data (8 quarters) to calculate the measure.
The ten indicators contribute to the HCI score as follows: Each HCI indicator has its own numerator, denominator, and resulting indicator score. A hospice's given indicator score relative to an Index Earned Point Criterion determines whether the hospice earns a point for that indicator towards the full index score; Index Earned Point Criteria were set based on CMS' statistical analysis of national hospice performance to ensure meaningful distinction between hospices; Hospices' HCI scores are calculated as the total number of Index Earned Points across the ten indicators and can range from a perfect 10 to a 0. All hospices with at least 20 claims during the sample period have indicator scores calculated.
Frequency of Data Collection
Frequency of Data Collection in Days
Reporting Methods
Public reporting
Reporting Frequency
Reporting Frequency in Days
Indicator Has Recommended Targets
Source and Reference Attributes
Evidence Source
Hospice Care Index Technical Report: www.cms.gov/files/document/hospice-care-index-hci-technical-reportjuly-2022.pdf. Date cited 12/10/23. CMS Current Measures: www.cms.gov/medicare/quality/hospice/current-measures. Date cited 12/10/23.
Technical Specifications
Link to Measurement Tools
This measure is linked to the Hospice Care Index (HCI) measure.