National- and State-Level Trends in Medicare Hospice Beneficiaries for Stroke During 2013 to 2019 in the United States.

Background: Stroke is the fifth leading cause of death in the United States, one of the leading contributors to Medicare cost, including through Medicare hospice benefits, and the rate of stroke mortality has been increasing since 2013. We hypothesized that hospice utilization among Medicare beneficiaries with stroke has increased over time and that the increase is associated with trends in stroke death rate.
Methods: Using Medicare Part A claims data and Centers for Disease Control mortality data at a national and state level from 2013 to 2019, we report the proportion and count of Medicare hospice beneficiaries with stroke as well as the stroke death rate (per 100 000) in Medicare-eligible individuals aged ≥65 years.
Results: From 2013 to 2019, the number of Medicare hospice beneficiaries with stroke as their primary diagnosis increased 104.1% from 78 812 to 160 884. The number of stroke deaths in the United States in individuals aged ≥65 years also increased from 109 602 in 2013 to 129 193 in 2019 (17.9% increase). In 2013, stroke was the sixth most common primary diagnosis for Medicare hospice, while in 2019 it was the third most common, surpassed only by cancer and dementia. The correlation between the change from 2013 to 2019 in state-level Medicare hospice for stroke and stroke death rate for Medicare-eligible adults was significant (Spearman ρ=0.5; P <0.001). In a mixed-effects model, the variance in the state-level proportion of Medicare hospice for stroke explained by the state-level stroke death rate was 48.2%.
Conclusions: From 2013 to 2019, the number of Medicare hospice beneficiaries with a primary diagnosis of stroke more than doubled and stroke jumped from the sixth most common indication for hospice to the third most common. While increases in stroke mortality in the Medicare-eligible population accounts for some of the increase of Medicare hospice beneficiaries, over half the variance remains unexplained and requires additional research.
Competing Interests: Disclosures Dr de Havenon has received investigator-initiated clinical research funding from the American Academy of Neurology, has received consultant fees from Integra and Novo Nordisk, has equity in TitinKM and Certus, and receives author fees from UpToDate. Dr Sheth reports investigator-initiated clinical research funding to Yale from Hyperfine, Biogen, and Bard, from Sense and Zoll for data and safety monitoring services, from Cerevasc, Astrocyte, CSL Behring, Certus, and Rhaeos for consultant services, and a patent pending for Stroke wearables licensed to Alva Health. Dr Burke reports employment by Ohio State University and University of Michigan and funding from the American Heart Association. Dr Creutzfeldt reports funding from the National Institutes of Health NIH-NINR. Dr Mac Grory reports employment by Duke University and funding from NIH-National Institute of Neurological Disorders and Stroke (NINDS) and the American Heart Association. Dr Skolarus reports employment by Northwestern University and funding from NIH-NINDS and the American Heart Association. The other author reports no conflicts.