originally presented april 2009 - healthcare market resources · to compare and contrast various...
TRANSCRIPT
PURPOSE
To utilize hospice penetration as a metric for access to care
To identify those states with high and low levels, on a relative basis, of hospice penetration
To compare and contrast various market factors, at the state level, to understand differences between high and low penetration states
AGENDA
Background
Identification of High and Low Penetration States
Market Factors Influencing Penetration
Conclusions
SPEAKER BACKGROUND BA Lehigh University Mathematics, MBA MIT Sloan
School
Marketing and planning positions with Fortune 100 companies, with emphasis of consumer products
20+ years in all aspects of home care with for-profit and non-profit organizations
President, Healthcare Market Resources, a local market competitive intelligence firm
DATA SOURCES
Medicare hospice claims files
Medicare reports
Center for Disease Control publications
Department of Commerce, Census Bureau
State Departments of Health websites
RESEACH APPROACH
Regression Analysis See if hospice penetration is dependent on a given
variable
Utilizes entire set of state data
Very high or very low correlation can be relied upon
High/Low Penetration Identify high and low penetration states & see if these
groups’ results mirror top 10 or bottom 10 performers for that indicator
Better able to identify factors that enhance or inhibit penetration
PENETRATION BY STATE 2006
0.00%
0.50%
1.00%
1.50%
2.00%
2.50%
3.00%
3.50%
4.00%
AL AK AZ AR CA CO CT DE DC FL GA HI ID
PENETRATION BY STATE 2007
0.00%
0.50%
1.00%
1.50%
2.00%
2.50%
3.00%
3.50%
4.00%
AL AK AZ AR CA CO CT DE DC FL GA HI ID
PENETRATION BY STATE 2006
0.00%
0.50%
1.00%
1.50%
2.00%
2.50%
3.00%
3.50%
IL IN IA KS KY LA ME MD MA MI MN MS MO
PENETRATION BY STATE 2007
0.00%
0.50%
1.00%
1.50%
2.00%
2.50%
3.00%
3.50%
4.00%
IL IN IA KS KY LA ME MD MA MI MN MS MO
PENETRATION BY STATE 2006
0.00%
0.50%
1.00%
1.50%
2.00%
2.50%
3.00%
3.50%
4.00%
MT NE NV NH NJ NM NY NC ND OH OK OR PA PR US
PENETRATION BY STATE 2007
0.00%
0.50%
1.00%
1.50%
2.00%
2.50%
3.00%
3.50%
4.00%
MT NE NV NH NJ NM NY NC ND OH OK OR PA
PENETRATION BY STATE 2006
0.00%
0.50%
1.00%
1.50%
2.00%
2.50%
3.00%
3.50%
4.00%
RI SC SD TN TX UT VT VA WA WV WI WY US
PENETRATION BY STATE 2007
0.00%
0.50%
1.00%
1.50%
2.00%
2.50%
3.00%
3.50%
4.00%
RI SC SD TN TX UT VT VA WA WV WI WY US
HIGH PENETRATION STATES 2006 •OKLAHOMA •ARIZONA
•ALABAMA •UTAH
•MISSISSIPPI •FLORIDA
•IOWA •GEORGIA
•NEW MEXICO •TEXAS
HIGH PENETRATION STATES 2007
•ARIZONA •FLORIDA
•UTAH •IOWA
•OKLAHOMA •DELAWARE
•ARIZONA •TEXAS
•MISSISSIPPI •MISSOURI
LOW PENETRATION STATES 2006 ALASKA HAWAII
WYOMING NEW YORK
DISTRICT OF
COLUMBIA
PUERTO RICO
VERMONT SOUTH DAKOTA
MAINE WEST VIRGINA
LOW PENETRATION STATES 2007
ALASKA WYOMING
HAWAII NEW YORK
DISTRICT OF
COLUMBIA
VERMONT
SOUTH DAKOTA KENTUCKY
WEST VIRGINA MAINE
PENETRATION GROWTH 2006
48.00%
98.20%
51.20%
40.00%
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
HIGH LOW LOW w/o AK AVG
PENETRATION GROWTH 2007
56.38%
97.26%
55.21%
47.56%
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
HIGH LOW LOW w/o AK AVG
HIGH GROWTH STATES 2006 •ALASKA •MAINE
•DELAWARE •RHODE ISLAND
•SOUTH DAKOTA •IDAHO
•MISSISSIPPI •ALABAMA
•KANSAS •TENNESSEE
High Penetration-Bold; Low
Penetration-Italics
High Penetration-Bold
Low Penetration-Italics
HIGH GROWTH STATES 2007
•ALASKA •MAINE
•DELAWARE •RHODE ISLAND
•IDAHO •SOUTH DAKOTA
•SOUTH CAROLINA •NORTH DAKOTA
•TENNESSEE •IOWA
LOW GROWTH STATES 2006
KENTUCKY COLORADO
HAWAII NEVADA
ILLINOIS MICHIGAN
FLORIDA OREGON
WASHINGTON MARYLAND
High Penetration-Bold
Low Penetration-Italics
High Penetration-Bold
Low Penetration-Italics
LOW GROWTH STATES 2007
KENTUCKY COLORADO
NEVADA ILLINOIS
OREGON HAWAII
WYOMING MARYLAND
NEW YORK FLORIDA
CON STATES PENETRATION 2006
1.82%1.71%
2.25% 2.29%2.19%
0.00%
0.50%
1.00%
1.50%
2.00%
2.50%
CON
States
CON
States w/o
FL
Non-CON
States
Nat'l Wght
Avg
Nat'l
Unwght
Avg
CON States - 25% of Total
CON STATES PENETRATION 2007
1.92%1.82%
2.43% 2.41%2.30%
0.00%
0.50%
1.00%
1.50%
2.00%
2.50%
3.00%
CON States CON States
w/o FL
Non-CON
States
Nat'l Wght
Avg
Nat'l Unwght
Avg
ACCESS IN CON STATES 2006 (Hospices per Counties)
0.68
3
0.63
1.4
0.23
1.17
0.82 0.8
1.28
0.60.71
0.82
0.33
0.950.79
0
0.5
1
1.5
2
2.5
3
AR DC FL HI KY MD NY NC SC TN VT WA WV US AVG
ACCESS IN CON STATES 2007 (Hospices per Counties)
0.65
3.00
0.64
1.60
0.23
1.17
0.81 0.82
1.48
0.600.71
0.82
0.33
1.02
0.68
-
0.50
1.00
1.50
2.00
2.50
3.00
3.50
AR DC FL HI KY MD NY NC SC TN VT WA WV US AVG
HIGH PENETRATION STATES 2006 CON STATES IN BOLD
•OKLAHOMA •ARIZONA
•ALABAMA •UTAH
•MISSISSIPPI •FLORIDA
•IOWA •GEORGIA
•NEW MEXICO •TEXAS
HIGH PENETRATION STATES 2007 CON STATES IN BOLD
•ARIZONA •FLORIDA
•UTAH •IOWA
•OKLAHOMA •DELAWARE
•ARIZONA •TEXAS
•MISSISSIPPI •MISSOURI
LOW PENETRATION STATE 2006 CON STATES IN BOLD
ALASKA HAWAII
WYOMING NEW YORK
DISTRICT OF
COLUMBIA
PUERTO RICO
VERMONT SOUTH DAKOTA
MAINE WEST VIRGINA
ALASKA WYOMING
HAWAII NEW YORK
DISTRICT OF
COLUMBIA
VERMONT
SOUTH DAKOTA KENTUCKY
WEST VIRGINA MAINE
LOW PENETRATION STATE 2007 CON STATES IN BOLD
LOW GROWTH STATES 2006 CON STATES IN BOLD
KENTUCKY COLORADO
HAWAII NEVADA
ILLINOIS MICHIGAN
FLORIDA OREGON
WASHINGTON MARYLAND
KENTUCKY COLORADO
NEVADA ILLINOIS
OREGON HAWAII
WYOMING MARYLAND
NEW YORK FLORIDA
LOW GROWTH STATES 2007 CON STATES IN BOLD
HOSPICE PENETRATION (Hospice Deaths as % of Anticipated Deaths)
45.3% 44.4%
20.1% 20.4%
33.6%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
50.0%
Top 10 High Pent Bottom 10 Low Pent Nat'l Avg
METRIC COMPARISON BY STATE High Death % High Penetration % Low Death % Low Penetration %
Arizona Oklahoma Alaska Alaska
Utah Arizona Dist of Columbia Hawaii
Alabama Alabama Hawaii Wyoming
Florida Utah Wyoming New York
Mississippi Mississippi Puerto Rico Dist of Columbia
Colorado Florida New York Puerto Rico
New Mexico Iowa Vermont Vermont
Oklahoma Georgia South Dakota South Dakota
Oregon New Mexico North Dakota Maine
Iowa Texas Maine West Virginia
HOSPICE GROWTH (% Change in Hospice Penetration % 2002-6)
79.9%
51.0%
23.1%
48.0%
40.0%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
Top 10
w/o AK
High Pent Bottom 10 Low Pent
w/o AK
Nat'l Avg
HOSPICE GROWTH (% Change in Hospice Penetration % 2002-7)
92.6%
56.4%
27.3%
55.2%
47.6%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Top 10 w/o
AK
High Pent Bottom 10 Low Pent
w/o AK
Nat'l Avg
POPULATION DENSITY Population per Square Mile
604.57
92.9
14
90.2 83.8
0
100
200
300
400
500
600
700
Top 10
w/o DC
High Pent Bottom 10 Low Pent
w/o DC
Nat'l Avg
ACCESS TO CARE (Hospices /10K Medicare Eligible)
1.98
1.49
0.36
0.840.73
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
2
Top 10 High Pent Bottom 10 Low Pent Nat'l Avg
GEOGRAPHIC ACCESS TO CARE (Hospices per 1K Sq Miles)
4.73
1.28
0.28
5.83
0.61 0.81
0
1
2
3
4
5
6
Top 10
ex DC
High
Pent
Bottom
10 ex
AK
Low
Pent
Low
Pent ex
AK, DC,
PR
Nat'l
Avg
NON-WHITE PATIENTS (% Non-White Discharges)
32.5%
14.7%
2.0%
20.1%
12.1%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
Top 10 High Pent Bottom 10 Low Pent Nat'l Avg
NON-WHITE HOSPICE PENETRATION (% Non-White Discharges/% Non-White Population)
67.5%
41.0%
18.1%
42.4%
31.3%36.5%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
Top 10 High
Pent
Bottom
10
Low
Pent
Low
Pent ex
DC, HI
Nat'l
Avg
DISEASE MIX (% Non-Cancer Hospice Deaths)
67.2%
60.0%
53.8% 54.8%
61.9%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
Top 10 High Pent Bottom 10 Low Pent Nat'l Avg
80+% Correlation between Hospice Penetration & Non-Cancer Hospice Deaths
ALZHEIMER’S IMPACT (% Alzheimer’s/Dementia Deaths of Total Deaths)
30.9%
16.9%
7.1%
14.8%
19.9%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
Top 10 High Pent Bottom 10 Low Pent Nat'l Avg
FOR-PROFIT PRESENCE (FOR-PROFIT MEDICARE REVENUES/TOTAL MEDICARE REVENUES)
77.4%
63.0%
9.7%
30.7%25.0%
49.4%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
Top 10 High
Pent
Bottom
10
Low
Pent
Low
Pent ex
AK
Nat'l
Avg
LENGTH OF STAY (Days per Discharge)
99.891.7
53.2
64.569.8
0
10
20
30
40
50
60
70
80
90
100
Top 10 High Pent Bottom 10 Low Pent Nat'l Avg
LONG STAY PATIENTS (% Patients w/LOS>180 days)
17.0%
15.4%
7.2%
9.2%
10.8%
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
16.0%
18.0%
Top 10 High Pent Bottom 10 Low Pent Nat'l Avg
LONG STAY PATIENTS (% Patients w/LOS>90 Days)
28.6%26.7%
15.1%
19.7% 20.6%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
Top 10 High Pent Bottom 10 Low Pent Nat'l Avg
NURSING HOME MARKET On currently available claims data, there is no data on
place of service; must infer
Claims data has place of death; if patient dies in a medical facility, it is either a hospital or a skilled nursing facility
If patient dies in a hospital, they were likely there to receive inpatient services
So if a patient dies in a medical facility and has no inpatient days on the last claim, we infer that they must have did in a SNF
NURSING HOME MARKET (% DIED IN MED FAC W/NO INPT DAYS)
30.9%
16.9%
7.1%
14.8%
19.9%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
Top 10 High Pent Bottom 10 Low Pent Nat'l Avg
CORRELATION SUMMARY (Hospice Penetration)
INDICATOR CORREL INDICATOR CORREL
Hospice Growth -.265 Alzheimer’s Impact .257
Population Density -.217 For-Profit Presence .477
Access to Care .372 Length of Stay .597
Geographic Access -.198 Long Stay Patients .645
Non-White Patients -.129 Long Stay Patients 90+ .583
Non-White Penetration .017 “Nursing Home” Market .124
Disease Mix .807 Hospice Death Penetration .949
CONCLUSIONS Few market factors appear to consistently influence
hospice penetration(access to care)
Those factors with the greatest influence
Non-Cancer Hospice Deaths
Length of Stay, particularly driven by 180+ day patients
Presence of For-Profits
CON appears to inhibit hospice penetration
CONTACT INFORMATION
Rich Chesney
President, Healthcare Market Resources
215.657.7373
215.657.0395(f)
www.healthmr.com