Burden Calculation Worksheet

EXHIBIT A – BURDEN CALCULATION WORKSHEET
PART 1. Time Burden

Estimated number of hospice admissions and Hospice Item Set record submissions
Total number of Medicare-participating hospices = 4,259 1
Total number of admissions to all hospices per year = 1,248,419 2
Total number of admissions to all hospices over three years = 3,745,257

Estimated average number of admissions to each hospice:
•
•
•

per year: 1,248,419 admissions to all hospices / 4,259 hospices = 293 admissions per hospice per year
per month: 1,248,419 admissions to all hospices / 4,259 hospices / 12 months per year = 24 per month
over 3 years: 3,745,257 admissions to all hospices over 3 years / 4,259 hospices = 879 per 3 years

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

per year: 1,248,419 admissions to all hospices per year x 2 Hospice Item Set records (1 Admission Record
and 1 Discharge Record) per patient = 2,496,838 records per year
per month: 2,496,838 Hospice Item Set records per all hospices per year / 12 months per year = 208,070 per
month
over 3 years: 2,496,838 Hospice Item Set records per all hospices per year x 3 years = 7,490,514 per 3 years

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

per year: 2,496,838 Hospice Item Set records per all hospices / 4,259 hospices = 586 records per hospice per
year
per month: 208,070 Hospice Item Set records per all hospices per month / 4,259 hospices = 49 per month
over 3 years: 7,490,514 Hospice Item Set records per all hospices per 3 years / 4,259 hospices = 1,759 per 3
years

1 Quality Improvement and Evaluation System (QIES) List of Hospice Providers, January 2016
2 The discharge number was calculated using the number of HIS discharge assessments submitted October 1, 2014 – September 30,

2015.

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EXHIBIT A –BURDEN CALCULATION WORKSHEET

PART 2. Cost/Wage Calculation
Note that this worksheet presents rounded inputs for each calculation. The actual calculations were performed using
unrounded inputs, so the outputs of each equation below may vary slightly from what would be expected from the
rounded inputs.
Time required to complete each Hospice Item Set record
14 minutes nursing/clinical staff time to abstract data for Admission Record – paid @ $67.10/hr. 3
9 minutes nursing/clinical staff time to abstract data for Discharge Record – paid @ $67.10/hr.
5 minutes administrative/clerical staff time to upload Assessment Record data – paid @ $32.24/hr. 4
5 minutes administrative/clerical staff time to upload Discharge Record data – paid @ $32.24/hr.

Nursing Time:
•
•
•
•
•

23 minutes x 293 Hospice Item Sets per each hospice per year / 60 minutes per hour = 112.36 nursing hours
per each hospice per year
112.36 hours per year x $67.10 per hour = $7,539.66 nursing wages per each hospice per year
$7,539.66 per each hospice per year x 4,259 hospice providers = $32,111,417.38 nursing wages per all
hospices per year
$7,539.66 per each hospice per year x 3 years = $22,618.98 nursing wages per each hospice over 3 years
$32,111,417.38 per all hospices per year x 3 years = $96,334,252.13 nursing wages for all hospices over 3
years

Administrative Assistant Time:
•
•
•
•
•

10 minutes x 293 Hospice Item Sets per each hospice per year / 60 minutes per hour = 48.85
administrative/clerical hours per each hospice year
48.85 hours per year x $32.24 per hour = $1,575.06 administrative/clerical wages per each hospice per year
$1,575.06 per each hospice per year x 4,259 hospice providers = $6,708,171.43 administrative/clerical wages
per all hospices per year
$1,575.06 per each hospice per year x 3 years = $4,725.17 administrative/clerical wages per each hospice
over 3 years
$6,708,171.43 per all hospices per year x 3 years = $20,124,514.28 administrative/clerical wages per each
hospice over 3 years

3 The adjusted hourly wage of $67.10 per hour for a Registered Nurse was obtained using the mean hourly wage from the U.S. Bureau

of Labor Statistics, $33.55. This mean hourly wage is adjusted by a factor of 100 percent to include fringe benefits. See
http://www.bls.gov/oes/current/oes291141.htm
4 The adjusted hourly wage of $32.24 per hour for a Medical Secretary was obtained using the mean hourly wage from the U.S.

Bureau of Labor Statistics, $16.12. This mean hourly wage is adjusted by a factor of 100 percent to include fringe benefits. See
http://www.bls.gov/oes/current/oes436013.htm

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EXHIBIT A –BURDEN CALCULATION WORKSHEET

Total annualized cost to each hospice provider:
$7,539.66
$1,575.06

Nursing wages per each hospice per year
Administrative assistant wages per each hospice per year

$9,114.72

Total

Total annualized cost to all hospice providers:
$32,111,417 Nursing wages per all hospice providers per year
$6,708,171

Administrative assistant wages per all hospice providers per year

$38,819,589

Total

Total 3-year cost to each hospice provider:
$22,618.98
$4,725.17

Nursing wages per each hospice over 3 years
Administrative assistant wages per each hospice over 3 years

$27,344.16

Total

Total 3-year cost to all hospice providers:
$96,334,252
$20,124,514

Nursing wages per all hospice providers over 3 years
Administrative assistant wages per all hospice providers over 3 years

$116,458,766 Total

PART 3. Additional Calculations:

Average monthly cost to each individual hospice provider:
•

$38,819,589 for all Hospices per year / 4,259 hospices / 12 months per year = $759.56

Cost to provider per each individual hospice patient:
•

$38,819,589 for all hospices per year / 1,248,419 Hospice Item Sets per year = $31.10

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EXHIBIT A –BURDEN CALCULATION WORKSHEET

Appendix 1: Hourly Time and Wage Burden Calculation Detail
Hospice Quality Reporting Program
Time and Wage Burden Itemization
Number of
Time Required To Complete
Record Type
Questions
Questions
Admission
48
14 min – Nursing/Clinical time
Record
0.3 min. per item x 48 items
5 min – Admin/Clerical time
(to upload data)
Discharge
29
9 min– Nursing/Clinical time
Record
(0.3 min. per item x 29 items)
5 min – Admin/Clerical time
(to upload data)
Totals
77
33 minutes

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Staff Wages for
Questions
14 min. x $67.10/hr.=
$15.66
5 min. x $32.24/hr. =
$2.69
9 min. x $67.10/hr. =
$10.07
5 min. x $32.24/hr.
=$2.69
Total cost per patient =
$31.10

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EXHIBIT A –BURDEN CALCULATION WORKSHEET

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 33 minutes per Hospice Item Set = 3300 minutes / 60 minutes per hour = 55
hours per each hospice with 100 annual admissions
500 annual admissions x 33 minutes per Hospice Item Set = 16,500 minutes / 60 minutes per hour = 275
hours per each hospice with 500 annual admissions
2,500 annual admissions x 33 minutes per Hospice Item Set = 82,500 minutes / 60 minutes per hour = 1,375
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 $31.10 per each Hospice Item Set record submission = $3,110 per each hospice with
100 annual admissions
500 annual admissions x $31.10 per each Hospice Item Set submission = $15,550 per each hospice with 500
annual admissions
2,500 annual admissions x $31.10 per each Hospice Item Set submission = $77,750 per each hospice with
2,500 annual admissions

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EXHIBIT A –BURDEN CALCULATION WORKSHEET

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.

Admission
•

•

A hospice is required to complete and submit an Admission Record within 14 days after the patient is
admitted.
The following Admission Record time estimates are taken from the 2012 HIS pilot of HIS v1.00.0. HIS
v2.00.0 includes 3 additional items, and time estimates for these items was not collected for these new items
during the 2015 HIS pilot.

Hospice Item Set Pilot Time Estimates – Admission Record
Hospice
Total (minutes)
A
B
C
D

18.3
22.5
7.6
9.3

E

17.7

F

21.5

G
H
J
Total

14.4
7.6
9.3
14.1

Top 5% removed as outliers.
•

Using an estimate of 0.3 minutes per item, the total time for HIS v2.00.0 is estimated to be:
14.1 minutes + (3 items * 0.3 minutes) = 15 minutes for HIS Admission Record

Discharge
•
•

A hospice must also complete and submit a Discharge Record within 7 days after the patient is discharged.
The following Discharge Record time estimates are taken from the 2015 HIS pilot, which included versions
of the HIS v2.00.0 items.

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EXHIBIT A –BURDEN CALCULATION WORKSHEET

Hospice Item Set Pilot Time Estimates – Discharge Record
Hospice
Total (minutes)
A
4.6
B
13.7
C
4.3
E
10.2
F
8.7
G
4.8
H
8.9
J
17.5
K
13.5
L
7.7
M
14.6
Total
9.5
Top 5% removed as outliers.
•

Using these Admission and Discharge record time estimates, the total time burden per patient is 24.5 minutes
of Nursing/Clinical time.

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EXHIBIT A –BURDEN CALCULATION WORKSHEET

Appendix 4: Change in Burden Table
Change In Burden From Prior 2013 PRA Package Burden Estimate & the Current Hospice Item Set PRA Package
Burden Estimate
Prior
Current
Type of
2013 Hospice PRA
Hospice Item Set
Calculation
Package
PRA Package
Change in Burden
Per Each Hospice
$3,818.26
$9,114.72
+ $5,296.46
Per All Hospices
$14,287,929
$38,819,589
+ $24,531,660

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