What Is the Hospice Care Index (HCI)?

The Hospice Care Index (HCI) is a single CMS measure that summarizes 10 indicators of how a hospice delivers care across a patient's whole stay — from how often nurses visit to how many patients leave the hospice alive. It is published on Medicare's Care Compare to help you spot patterns that family surveys alone might miss.

What the HCI is built from

Unlike the CAHPS family survey, which captures experience, the HCI is built from a hospice's own claims data. CMS combines 10 separate indicators into one index. They are designed to flag care patterns that, taken together, may signal lower-quality or potentially problematic care. The indicators include things like:

• How often the hospice provides nursing and skilled visits, including near the end of life.
• The share of patients who get higher levels of care (such as general inpatient care) when symptoms escalate.
• The rate of live discharges — patients leaving hospice alive, which can be appropriate but, at high rates, can signal enrollment of patients who weren't truly eligible.
• Patterns in very long stays and gaps in visits.

Each indicator is scored, and a hospice earns a point for meeting the expected standard on each. The points add up to a single HCI value, so a higher index reflects more of the desired care patterns.

The kinds of patterns the indicators capture

You do not need to memorize all ten indicators, but it helps to know the categories they fall into, because each tells you something different about how an agency operates. Broadly, the HCI looks at:

Category	What it hints at
Visit frequency and timing	Whether the agency shows up consistently, including in the last days of life
Use of higher care levels	Whether the agency escalates to crisis or inpatient care when symptoms flare
Live-discharge patterns	Whether the agency may be enrolling patients who were not truly eligible
Length-of-stay patterns	Whether very long or very short stays cluster in unusual ways
Continuity and gaps in care	Whether patients experience stretches with no visits

No single category is decisive. The point of bundling them is that a problem agency often looks unusual on several at once.

How to use the HCI when comparing hospices

Think of the HCI as a screening tool. A high index suggests the agency's overall care patterns look reasonable across many dimensions; a low index is a prompt to dig deeper, not an automatic disqualification. Because it is built from claims rather than surveys, the HCI complements the CAHPS family-survey scores — one tells you what families felt, the other tells you what the agency actually did. Read them together. A hospice with strong family ratings but a weak HCI, or vice versa, deserves direct questions before you enroll.

HCI versus the family survey: two different lenses

It is worth being explicit about how these two public measures differ, because using them together is the whole point.

Feature	Hospice Care Index (HCI)	CAHPS Family Survey
Source	The agency's Medicare claims	Surveys of bereaved caregivers
Measures	What the agency actually did	How families experienced the care
Hard to game?	Yes — based on billing data	Depends on who responds
Best for	Spotting unusual care patterns	Gauging communication and respect

When both point the same direction, you can have more confidence. When they disagree, that gap is your cue to ask sharper questions.

Why a claims-based measure is useful

The HCI's value is that it's hard to game with marketing. Family surveys depend on who responds and how they felt; the HCI is computed from what the agency actually billed Medicare across all its patients. That makes it a helpful counterweight — especially for spotting patterns a single family wouldn't see, like an agency that rarely provides skilled visits in the final days, or one whose live-discharge rate is far outside the norm. None of these patterns proves wrongdoing, but together they sketch how the agency tends to operate over many cases rather than one.

Turning the index into questions

If a hospice's index looks low or an underlying indicator stands out, ask about it directly. Useful questions include: Your live-discharge rate looks high — why? or How often do your nurses visit in a patient's last days? A confident agency will explain its numbers; evasiveness is itself informative. Pair the HCI with the red flags of a low-quality hospice so you know which patterns warrant the most concern.

The misconception, corrected

Some families treat the HCI as a star rating or a pass/fail grade. It is neither. It is a composite of 10 process indicators, and a single low component can pull the index down even when overall care is sound; conversely, a decent index doesn't guarantee a good fit for your specific situation. Use it to generate questions — "Your live-discharge rate looks high; can you explain it?" — rather than as a final verdict. Pair it with quality measures and your own interview, and remember you can switch providers once per benefit period if a choice isn't working.

Frequently asked questions

Where do I find a hospice's HCI?

On Medicare's Care Compare website, in the hospice's quality information. Our guide to using Medicare Care Compare for hospice walks through where to look and how to read what you find.

Is a higher HCI always better?

A higher index reflects more of the desired care patterns, so in general it is reassuring. But it is a screening summary, not a guarantee. A high HCI does not promise the agency is the right fit for your loved one's specific needs, and a moderate HCI is a reason to ask questions rather than to rule an agency out.

What is a "live discharge" and why does it matter to the HCI?

A live discharge is when a patient leaves hospice alive — sometimes appropriately, because they stabilized or improved and no longer meet the prognosis standard, and sometimes because they were never truly eligible. A normal rate is expected; a rate far above the norm can signal over-enrollment, which is why the HCI tracks it.

Can the HCI tell me a hospice is committing fraud?

No. The HCI flags unusual patterns, not wrongdoing. An outlier indicator is a reason to ask questions and look closer, not proof of anything. Combine it with family-survey scores, an interview, and the red-flag checklist before drawing conclusions.

Should the HCI override family-survey scores?

Neither should override the other. They measure different things — what the agency did versus how families felt. Read them side by side and treat disagreements between them as a prompt for direct questions to the provider.

Practical next steps

• Find the HCI on Care Compare — see how to use Medicare Care Compare for hospice.
• Read it alongside the family survey and what hospice quality measures actually tell you.
• Watch for outliers using red flags of a low-quality hospice, and ask the agency to explain any.
• Compare locally — compare hospices near you and review each one's index.

Bottom line: the HCI is a useful, claims-based summary of how a hospice delivers care. Treat it as a flag for further questions, weigh it with family-survey scores, and never let one number make the decision for you.