Per-Beneficiary Medicare Spending

Identifying Attributes

Care Settings
Palliative Care
Country
United States of America
Publishing Organisation
Centers for Medicare & Medicaid Services (CMS): Hospice Quality Reporting Program
Type of Quality Indicator
Outcome
IOM Quality Dimension
Efficiency
Domain
Ethical and Legal Aspects of Care

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
No
Risk Adjustments

None

Stratifications

None

Data Attributes

Type of Data Collection
Administrative data
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
Continuous
Frequency of Data Collection in Days
1
Reporting Methods

Public reporting.

Reporting Frequency
Annually
Reporting Frequency in Days
365
Indicator Has Recommended Targets
Yes

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.

Link to Measurement Tools

This measure is linked to the Hospice Care Index (HCI) measure.

Quality Indicator Confirmed to be Part of a Program Used to Monitor Quality and Safety of Care Among Older People at a Population-Level between 2012-2022
Yes
Assessed by the Australian Consortium for Aged Care Collaborators as Generally Containing Good Properties (Importance and Scientific Acceptability)
Yes
Australian Consortium for Aged Care Endorsed
No
Identified by PHARMA-Care Project
No
Upload Date
12 March 2025