The 69% of California hospice providers have failed to download, review, and analyze their Program for Evaluating Payment Patterns Electronic Report (PEPPER) data which can result in inability to compare claims data over time and identify potential areas of payment vulnerability. The PEPPER Report is intended to serve as an “educational tool”; however, very few hospices know how to analyze the 11 target areas and other PEPPER Report elements to self-identify and self-correct any areas of payment vulnerability. 

National Target Area Analysis – Hospices

Provides national-level statistics for areas identified as at risk for improper Medicare payments in hospices. The data include the number of Medicare beneficiary episodes of service/days for the numerator and denominator for each target area, proportion for each target area, average length of stay for the numerator episodes of service/days (where applicable) and the average Medicare payment and the sum of total Medicare payments (where applicable) for the numerator episodes of service/days for each target area for all hospices in the nation for fiscal years 2016, 2017 and 2018. For more information on the areas identified as at risk for improper payments, please see the Hospice PEPPER User’s Guide (PDF, 8th Edition).

National Top Terminal Diagnoses

A listing of the top terminal clinical classification system (CCS) diagnosis categories by total number of Medicare decedents for all hospices in the nation. The data are aggregated at the national level. The data include the number of decedents, proportion of decedents for the terminal CCS diagnosis category to total decedents and the national average length of stay for each terminal diagnosis category. The data represent fiscal year 2018 (October 1, 2017 – September 30, 2018). For more information on the terminal diagnoses, please see the Hospice PEPPER User’s Guide (PDF, 8th Edition).

National Live Discharges by Type

Provides national-level statistics for beneficiaries discharged from hospice care alive. The data include, for each live discharge category, the number of Medicare beneficiary episodes, the proportion of all live discharges and the average length of stay for the most recent three fiscal years (2016, 2017 and 2018). The overall live discharge rate is also presented. For more information on the types of live discharges, please see the Hospice PEPPER User’s Guide (PDF, 8th Edition).

State Target Area Analysis – Hospices

Provides statistics for areas identified as at risk for improper Medicare payments for hospices in each state/territory. The data include the number of Medicare beneficiary episodes of service/days for the numerator and denominator for each target area, proportion for each target area, average length of stay for the numerator episodes of service/days (where applicable) and the average Medicare payment and the sum of total Medicare payments for the numerator episodes of service/days (where applicable) for each target area for all hospices in each state/territory for fiscal years 2016, 2017 and 2018. For more information on the areas identified as at risk for improper payments, please see the Hospice PEPPER User’s Guide (PDF, 8th Edition).

State Top Terminal Diagnoses

A listing of the top terminal clinical classification system (CCS) diagnosis categories by total number of Medicare decedents for each state/territory. The data are aggregated at the state level. The data include the number of decedents, proportion of decedents for the terminal CCS diagnosis category to total decedents and the state average length of stay for each terminal diagnosis category. The data represent fiscal year 2018 (October 1, 2017 – September 30, 2018). For more information on the terminal diagnoses, please see the Hospice PEPPER User’s Guide (PDF, 8th Edition).

State Live Discharges by Type

Provides state-level statistics for beneficiaries discharged from hospice care alive. The data include, for each live discharge category, the number of Medicare beneficiary episodes, the proportion of all live discharges and the average length of stay for the most recent three fiscal years (2016, 2017 and 2018) for each state. The overall state live discharge rate is also presented. For more information on the types of live discharges, please see the Hospice PEPPER User’s Guide (PDF, 8th Edition).

Peer Group Bar Charts

Charts displaying, for each of the areas identified as potentially at risk for improper Medicare payments, the target area percents that are at the 80th, 50th and 20th percentiles for hospices in three categories: total number of episodes, location and ownership type. The statistics were calculated for hospice episodes ending in fiscal year 2018 (October 1, 2017 – September 30, 2018). For details on how these charts were developed please see the Hospice Peer Group Methodology document (PDF, updated 5/2/19). For a listing of all hospices and their peer group classification please see the hospices by peer group file