Hospice Burden Estimate

January 29, 2021

Exhibit A – Hospice Item Set Burden Calculation Worksheet

PART 1. TIME BURDEN

Estimated number of hospice admissions and Hospice Item Set record submissions

Total number of Medicare-participating hospices = 3,742

Total number of admissions to all hospices per year = 1,089,719¹

Estimated number of admissions to each hospice per year

1,089,719 admissions to all hospices / 3,742 hospices = 291

Estimated number of admissions to each hospice per month

1,089,719 admissions to all hospices / 3,742 hospices / 12 months per year = 24

Estimated number of Hospice Item Set records submitted by all hospices per year

1,089,719 admissions to all hospices per year x 2 Hospice Item Set records (1 Admission Record and 1 Discharge Record) per patient = 2,179,438

Estimated number of Hospice Item Set records submitted by each hospice per year

2,179,438 Hospice Item Set records per all hospices / 3,742 hospices = 582

Estimated average number of Hospice Item Set records submitted by each hospice per month

2,179,438 Hospice Item Set records per all hospices / 3,742 hospices / 12 months per year = 49

Estimated average number of Hospice Item Set records submitted by all hospices per month

2,179,438 Hospice Item Set records per all hospices per year / 12 months per year = 181,620

PART 2. Cost/Wage Calculation

Time required to complete each Hospice Item Set record

14 minutes nursing/clinical staff time to abstract data for Admission Record – paid @ $33.23/hr.²

5 minutes nursing/clinical staff time to abstract data for Discharge Record – paid @ $33.23/hr.

5 minutes administrative/clerical staff time to upload Assessment Record data – paid @ $15.59/hr.³

5 minutes administrative/clerical staff time to upload Discharge Record data – paid @ $15.59/hr.

Nursing Time:

19 minutes x 291 Hospice Item Sets per each hospice per year = 5,529 minutes per each hospice per year

5,529 minutes per each hospice per year / 60 minutes per hour = 92.15 hours per each hospice per year

92.15 hours per year x $33.23 per hour = $3,062.14 nursing wages per each hospice per year

$3,062.14 x 3,742 hospice providers = $11,458,528 per all hospices per year

Administrative Assistant Time:

10 minutes x 291 Hospice Item Sets per each hospice per year = 2,910 minutes per hospice per year

2,910 minutes per provider per year / 60 minutes per hour = 48.50 hours per each hospice year

48.50 hours per year x $15.59 per hour = $756.12 administrative/clerical wages per each hospice per year

$756.12 x 3,742 hospice providers = $2,829,401 per all hospices per year

Total annualized cost to each hospice provider:

$3,062.14 Nursing wages per each hospice per year

$756.12 Administrative assistant wages per each hospice per year

$3,818.26 Total

Total annualized cost to all hospice providers:

$11,458,528 Nursing wages per all hospice providers per year

$2,829,401 Administrative assistant wages per all hospice providers per year

$14,287,929 Total;

PART 3. Additional Calculations:

Average yearly cost to each individual hospice provider:

$14,287,929 – cost for all hospices per year / 3,742 hospices = $3,818.26

Average monthly cost to each individual hospice provider:

$14,287,929 – cost for all Hospices per year / 3,742 hospices / 12 months per year = $318.19

Cost to provider per each individual hospice patient:

$14,287,929 – cost for all hospices per year / 1,089,719 Hospice Item Sets per year = $13.11

Appendix 1: Hourly Time and Wage Burden Calculation Detail

Hospice Quality Reporting Program

Time and Wage Burden Itemization

Record Type	Number of Questions	Time Required To Complete Questions	Staff Wages for Questions
Admission Record	45	14 min – Nursing/Clinical time 0.3 min. per item x 45 items	14 min. x $33.23/hr.= $7.75
		5 min – Admin/Clerical time (to upload data)	5 min. x $15.59/hr. = $1.30
Discharge Record	15	5 min– Nursing/Clinical time (0.3 min. per item x 15 items)	5 min. x $33.23/hr. = $2.77
		5 min – Admin/Clerical time (to upload data)	5 min. x $15.59/hr. = $1.30
Totals	60	29 minutes	Total cost per patient $13.12

Appendix 2: Alternative Method of Calculating Burden for the Hospice Data Item Set

Burden Estimate Based on Hospice Size

Estimated annual time burden per each hospice based on hospice size

• 100 annual admissions x 29 minutes per Hospice Item Set = 2900 minutes / 60 minutes per hour = 48 hours per each hospice with 100 annual admissions

• 500 annual admissions x 29 minutes per Hospice Item Set = 14,500 minutes / 60 minutes per hour = 242 hours per each hospice with 500 annual admissions

• 2,500 annual admissions x 29 minutes per Hospice Item Set = 72,500 minutes / 60 minutes per hour = 1,208 hours per each hospice with 2,500 annual admissions

Estimated average annual cost to each hospice provider for reporting quality data based on hospice size

• 100 annual admissions x $6.56 per each Hospice Item Set record submission x 2 record submissions = $1,312 per each hospice with 100 annual admissions

• 500 annual admissions x $6.56 per each Hospice Item Set submission x 2 record submissions = $6,560 per each hospice with 500 annual admissions

• 2,500 annual admissions x $6.56 per each Hospice Item Set submission x 2 record submissions = $32,800 per each hospice with 2,500 annual admissions

Appendix 3: Burden Information Obtained From Limited Pilot Testing In Various Sizes and Types of Hospices

Itemized Time and Wage/Cost Burden Estimate for the Hospice Item Set Records:

• The Hospice Item Set consists of 2 different types of records.

• A hospice is required to complete and submit an Admission Record within 30 days after the patient is admitted.

• A hospice must also complete and submit a Discharge Record within 30 days after the patient is discharged.

Hospice Item Set Pilot Time Estimates – Admission Record

Hospice	TE01	TE02	TE03	TE04	TE05	TE06	TE07	TE08	Total
A	2.5	2.7	4.2	3.0	3.0	1.4	1.0	0.6	18.3
B	4.3	3.8	3.4	2.9	2.9	2.3	1.2	1.7	22.5
C	1.0	1.0	1.0	1.0	1.0	1.0	1.0	0.6	7.6
D	1.4	1.2	1.8	1.4	1.2	1.3	0.6	0.4	9.3
E	2.8	2.2	2.9	2.5	3.8	1.4	1.7	0.3	17.7
F	5.2	3.9	3.5	2.3	1.9	1.9	1.4	1.2	21.5
G	1.8	2.0	3.1	1.8	1.7	2.2	1.0	0.8	14.4
H	1.1	0.8	1.2	1.2	1.1	1.0	0.8	0.4	7.6
J	1.3	1.1	1.9	1.1	1.7	1.0	1.0	0.3	9.3
Total	2.3	2.0	2.5	1.9	2.1	1.5	1.1	0.7	14.1

Top 5% removed as outliers.

Blank TE08’s recoded as 0.

Admission Record

(Alternate Method of Calculation)

Number of Questions: 45 @ 0.3 minutes each = 13.5 minutes

Discharge Record

Number of Questions: 15 @0.3 minutes each = 4.5 minutes

Appendix 4: Change in Burden Table

Change In Burden From Prior 2012 PRA Package Burden Estimate

& the Current Hospice Item Set PRA Package Burden Estimate

Type of Calculation	Prior 2012 Hospice PRA Package	Current Hospice Item Set PRA Package	Change in Burden
Per Each Hospice	$3,038	$3,818	+ $780
Per All Hospices	$11,034,016	$14,287,929	+ $3,253,913

1The admissions number, 1,089,719, was calculated using 2011 Medicare hospice claims data. MedPAC listed the number of beneficiaries in hospice as 1,159,000 in their 2012 “Data Book.” However, MedPAC’s numbers are not restricted to admissions and are based on 2010 claims data.

2 The mean hourly wage of $33.23 per hour for a Registered Nurse was obtained from the U.S. Bureau of Labor Statistics. See

http://www.bls.gov/oes/current/oes291111.htm

3 The mean hourly wage of $15.59 per hour for a Medical Secretary was obtained from the U.S. Bureau of Labor Statistics. See http://www.bls.gov/oes/current/oes436013.htm

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