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What a hospice live-discharge rate tells you

Hospice is for people expected to die within six months. When patients leave alive in unusual numbers, it is sometimes good news and sometimes a warning. The published data lets you tell the difference — if you read it alongside the rest.

Why patients leave hospice alive

Several reasons, and they are not equivalent:

  • The patient improved and no longer meets the prognosis. This is a legitimate, intended outcome.
  • The patient revoked the election — often to pursue treatment, or after a hospitalisation.
  • The patient transferred to another hospice.
  • The hospice discharged them for cause, or because they moved out of the service area.

Only the aggregate rate is published, not the reason mix. That is why the number is a question, not a verdict.

The two rates CMS publishes

Both are components of the Hospice Care Index, and both appear on every hospice page on this site:

  • Early live discharges — patients discharged alive within the first days of enrolment, as a share of live discharges. A high figure raises the question of whether patients were enrolled who did not qualify.
  • Late live discharges — patients discharged alive after a long stay. A high figure raises a different question: whether patients were kept enrolled while stable and inexpensive, then discharged as their care needs — and costs — rose.

Of the 5,326 hospices with a published early live-discharge rate, 234 report 20% or higher. That is a starting point for questions, not an accusation against any of them.

Read it with three other numbers

A live-discharge rate on its own explains very little. Put it beside:

  1. The Hospice Care Index overall score — out of 10, built from ten indicators. A high discharge rate in an otherwise strong index reads differently from one in a weak index.
  2. Visits in the last days of life — whether the team shows up when it matters most.
  3. The family survey — caregivers answering after the death are the least sentimental judges available.

Then look at burdensome transitions: patients moved between hospice, hospital and nursing facility near the end of life. Those transfers are hard on patients and are measured for that reason.

Ownership is part of the picture

Hospice has drawn regulatory and journalistic attention partly because of who has been buying providers. CMS asks owners to classify themselves on enrolment forms, and those checkboxes are public. Among hospice ownership groups running two or more providers, 82 include an owner that identified as a private equity company; the equivalent figure for home health is 86.

That is a disclosure, not a finding — plenty of well-run providers have institutional owners. But an owner's record across every provider it runs is more informative than any single location, and Medicare's Care Compare does not present it that way. Ownership group records are here.

If you think something is wrong

Concerns about a specific hospice go to the state survey agency, which investigates complaints and whose findings become public record. Suspected billing fraud goes to the HHS Office of Inspector General hotline. Both are free, and both generate records that help the next family.

For choosing rather than reporting, start with the provider records by state.

Common questions

Is a high live-discharge rate proof of fraud?

No. Patients legitimately leave hospice alive when they improve or choose to resume treatment. A high rate is a reason to ask the provider how its enrolment and discharge decisions are made, not a finding of wrongdoing.

What is a normal live-discharge rate?

There is no official threshold that separates acceptable from unacceptable. CMS scores each hospice against national distributions inside the Hospice Care Index. Compare a provider with others in the same state rather than against an absolute number.

Where does this data come from?

Medicare claims, published by CMS in the Hospice Provider Data file as components of the Hospice Care Index. Every figure on our provider pages is reproduced from that file with the release date shown.

Does the data say why patients were discharged?

No. CMS publishes the rates, not the reason mix behind them. That limitation is why we present the number as a question to ask the provider.

Check a specific provider

Records for 14,690 nursing homes, 5,597 assisted living facilities and 28,152 hospice, home health, dialysis and rehabilitation providers: search by name or city · nursing homes · hospice · home health · dialysis · inpatient rehab · nursing home groups · other ownership groups.

This guide is general information from public sources, not medical, legal, or financial advice. Program rules and dollar figures change annually and vary by state — verify with Medicare.gov, your state Medicaid agency, or a certified elder law attorney before acting.