october 20, 2016 - oregon hospital guide 2016 utilization report.pdf · q2 2016 hospital...

Q2 2016 HOSPITAL UTILIZATION AND FINANCIAL ANALYSIS

© 2016 Apprise Health Insights

October 20, 2016

4000 Kruse Way Place • Suite 100 • Lake Oswego, OR 97035 • Tel: (503) 479-6021 • www.apprisehealthinsights.comAPPRISE HEALTH INSIGHTS IS A SUBSIDIARY OF THE OREGON ASSOCIATION OF HOSPITALS AND HEALTH SYSTEMS


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ABOUT THIS REPORT

This report aims to provide a quarterly analysis of the utilization and financial data submitted by Oregon’s hospi-tals to the DATABANK program.

DATABANK is a state-mandated monthly hospital data program administered by Apprise Health Insights in collaboration with the Office for Oregon Health Policy and Research (OHPR). Please note that all DATABANK data are self-reported by the hospital and represent a twelve-month calendar year. Accuracy is the responsibility of the reporting hospitals.

Because this report’s objective is to provide a complex dive into the data, the graphs and methods will likely change between reports. This forces only the most compelling stories to be exhibited. The determination of which graphs and stories to focus on is evaluated by hospital finance and data experts at Apprise. While reading this, if you would like a different view of the data in any section, please reach out to Apprise and a custom view will be generated for you.

Note: Kaiser Sunnyside and Kaiser Westside hospitals are excluded from this analysis due to the lack of financial data available in DATABANK.

NOTES FOR THIS QUARTER

• In the DATABANK reporting system there are four payer categories: Medicaid, Medicare, Self Pay, and Oth-er. Traditionally, the ‘Other’ category has been reported as ‘Commercial’ because the largest component of that category is commercial insurance. However, recently Apprise was made aware that the “Other” category includes up to 30% of true other payers–such as worker’s compensation and auto insurance. For that reason, we will now be reporting Commercial Payer Mix as Commercial & Other Payer Mix.

• Coquille Valley hospital did not have June 2016 data available at the time of report generation.


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TABLE OF CONTENTS

Operating Margin..........................................................................................................................................................Page 4

Net Patient Revenue......................................................................................................................................................Page 4

Payer Mix........................................................................................................................................................................Page 5

Charity Care...................................................................................................................................................................Page 6

Bad Debt.........................................................................................................................................................................Page 6

Inpatient Discharges......................................................................................................................................................Page 7

Ambulatory Surgery Visits...........................................................................................................................................Page 7

Emergency Department Visits.....................................................................................................................................Page 8

Total Outpatient Visits..................................................................................................................................................Page 8

Appendix A: Regions....................................................................................................................................................Page 9

Appendix B: Hospital Types.......................................................................................................................................Page 10

Appendix C: Definitions.............................................................................................................................................Page 11


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OPERATING MARGIN

2013 Q4 2014 Q2 2014 Q4 2015 Q2 2015 Q4 2016 Q2-1.0..

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

3.06%2.61%

3.33%

2.26%

3.63%

-0.73%

3.80%

-0.52%

6.04%5.69%

4.80%

0.79%

Operating Margin Percentage(Median)

2013 Q4 2014 Q2 2014 Q4 2015 Q2 2015 Q4 2016 Q2

-6.0%

-4.0%

-2.0%

0.0%

2.0%

4.0%

6.0%

8.0%

-5.81%

-0.03%

1.73%

8.71%

Operating Margin Percentage(Median by CAH Status)

Non-CAH HospitalsCAH Hospitals

Figure 1

Median Operating Margin percentage (Figure 1) was much higher in Q2 2016 than other quarters, in-line with the previous two Q2’s. However, critical access hospitals have had much worse operating margins than non-crit-ical access hospitals over the past three years (Figure 2).

Figure 2

NET PATIENT REVENUE

Q1 Q2 Q3 Q4

2014 2015 2016 2014 2015 2016 2013 2014 2015 2013 2014 2015$0.0B

$0.5B

$1.0B

$1.5B

$2.0B

$2.5B

$3.0B

$2.36B$2.57B

$2.77B

$2.46B$2.65B

$2.81B

$2.27B$2.46B

$2.63B

$2.36B$2.55B

$2.76B

Net Patient Revenue(Aggregate Quarter Comparison)

Aggregate Net Patient Revenue (NPR) continued to increase, controlled for seasonal variation (Figure 3).

Net Patient Revenue as a percentage of Oregon’s Gross Domestic Product has increased significantly since 1997. Figure 4 helps to show the increasing impact patient care at hospitals has had on Oregon’s economy in the past 18 years. The AHA listed hospital care as 5.6% of the national GDP in 2014.

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

NPR

/ G

DP

2.89%

4.93%

Hospital NPR as a Percentage of OR GDP(OR Hospital Net Patient Revenue / OR State Gross Domestic Product)

Oregon Gross Domestic Product Source: US. Bureau of Economic Analysis, Total Gross Domestic Product for Oregon [ORNGSP], retrieved from FRED, Federal Reserve Bank of St. Louis; https://fred.stlouisfed.org/series/ORNGSP, September 27, 2016.American Hospital Association Source: AHA Trendwatch Chartbook 2016, The Economic Contribution of Hospitals, http://www.aha.org/research/reports/tw/chartbook/2016/2016chartbook.pdf, Page 57

Figure 3 Figure 4


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PAYER MIX

2013 Q4 2014 Q2 2014 Q4 2015 Q2 2015 Q4 2016 Q20.0%

5.0%

10.0%

15.0%

20.0%

14.79%

15.18%

22.01%20.46%

22.31%

22.37%

22.49%22.89%

23.30%23.33%23.35%

23.35%

Medicaid Payer Mix(Aggregate)

Aggregate Medicaid Payer Mix seems to have stabilized around 22-23% across the state (Figure 5).

Aggregate Medicare Payer Mix has looked extremely stable at 42-43% for the past three years (Figure 6).

Figure 5

2013 Q4 2014 Q2 2014 Q4 2015 Q2 2015 Q4 2016 Q20.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0% 42.73%

41.89%

42.64%

42.79% 42.06%42.49% 43.34%

42.94%

42.45%

42.97% 42.98%43.12%

Medicare Payer Mix(Aggregate)

Figure 6

Aggregate Commercial & Other Payer Mix is stabilizing around 32% after a slow decrease through 2014-2015 (Figure 7).

Aggregate Self Pay Payer Mix increased slightly in Q2 2016 for the first time in three years, compared to similar quarters of previous years (Figure 8). This may mean it is starting to stabilize at around 1.6-1.8%.

2013 Q4 2014 Q2 2014 Q4 2015 Q2 2015 Q4 2016 Q20.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%35.83%

33.09%

33.09%33.43% 33.48%35.27%

33.79%

32.36%

32.26%

31.54%

32.04%

32.03%

Commercial & Other Payer Mix(Aggregate)

Figure 7

Q1 Q2 Q3 Q4

2014 2015 2016 2014 2015 2016 2013 2014 2015 2013 2014 20150.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

3.32%

1.83% 1.65% 1.78% 1.68% 1.87%

7.05%

2.33%1.85%

6.26%

2.15%1.80%

Self Pay Payer Mix(Aggregate Quarter Comparison)

Figure 8


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CHARITY CARE PERCENTAGE

Median Charity Care as a percentage of Total Charges seems to be stablizing at around 1% after the ACA drop (Figure 9).

2013 Q4 2014 Q2 2014 Q4 2015 Q2 2015 Q4 2016 Q20.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

3.5%

4.0% 3.86%

3.65%

1.66%1.50%

1.38%

1.37%

2.20%

1.28%

1.18% 1.10%

1.09%

1.00%

Charity Care Percentage(Median)

Figure 9

BAD DEBT

Median Bad Debt as a percentage of total charges seems to be stabilizing around 0.7 - 0.9% (Figure 10). CAH hospitals have a much higher rate of bad debt than non-CAH hospitals (Figure 11).

2013 Q4 2014 Q2 2014 Q4 2015 Q2 2015 Q4 2016 Q20.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0% 2.95%

1.38%1.25%

2.64%

1.08%1.07%0.94%

0.93%

1.90%

0.85%0.83%0.71%

Bad Debt Percentage(Median)

2013 Q4 2014 Q2 2014 Q4 2015 Q2 2015 Q4 2016 Q20.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

3.5%

2.69%

1.94%2.03%

0.57%

Bad Debt Percentage(Median by CAH Status)

Non-CAH HospitalsCAH Hospitals

Figure 10 Figure 11


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TOTAL DISCHARGES

Aggregate Inpatient Discharges have not trended up or down in the past three years, remaining constant at around 80,000 discharges (Figure 12). Of those discharges, approximately 88% were to DRG hospitals (Figure 13).

2013 Q4 2014 Q2 2014 Q4 2015 Q2 2015 Q4 2016 Q20K

10K

20K

30K

40K

50K

60K

70K

80K80K80K

80K80K

80K82K78K

82K79K79K79K

81K

Total Discharges(Aggregate)

89.6% (77,887 Discharges)

10.4% (9,018 Discharges)

Total Discharges(Percent by Hospital Type, Q2 2016)

A & B Hospitals

DRG Hospitals

Figure 12 Figure 13

AMBULATORY SURGERY VISITS

Aggregate Ambulatory Surgery Visits appears to be fairly stable over the past three years aside from a drop in Q1 2015 (Figure 14).

2013 Q4 2014 Q2 2014 Q4 2015 Q2 2015 Q4 2016 Q20K

10K

20K

30K

40K

50K 49K 49K

48K

44K

50K

53K

47K45K

51K

52K

47K

51K

Ambulatory Surgery Visits(Aggregate)

Figure 14


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EMERGENCY DEPARTMENT VISITS

Aggregate Emergency Department Visits have continued to increase each quarter compared to previous similar quarters (Figure 15). This increase is ubiquitous across all hospital types, systems and regions.

Q1 Q2 Q3 Q4

2014 2015 2016 2014 2015 2016 2013 2014 2015 2013 2014 20150K

50K

100K

150K

200K

250K

300K

350K

306K

334K347K

323K342K 343K

305K330K 335K

287K

315K 321K

Emergency Department Visits(Aggregate Quarter Comparison)

Figure 15

TOTAL OUTPATIENT VISITS

Aggregate Total Outpatient Visits have increased 21% from Q3 2014 - Q2 2016 (Figure 16). Southern Coast hos-pitals have shown the highest increase at over 50% during the same time period (Figure 17).

2013 Q4 2014 Q2 2014 Q4 2015 Q2 2015 Q4 2016 Q2

0%

10%

20%

30%

40%

50%

0.0%

20.7%

0.0%

50.8%

Total Outpatient Visits(Percent Change since Q3 2013 by Region)

Southern CoastOther Hospitals

2013 Q4 2014 Q2 2014 Q4 2015 Q2 2015 Q4 2016 Q20.0M

0.5M

1.0M

1.5M

2.0M

2.5M

3.0M

2.36M

2.69M

2.66M 2.71M

2.72M2.63M

2.76M

2.76M2.86M2.59M

2.83M

2.56M

Total Outpatient Visits(Aggregate)

Figure 16 Figure 17


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APPENDIX A: REGIONS

Central Oregon: Mid-Columbia Medical Center, Providence Hood River Memorial Hospital, St. Charles Bend, St. Charles Madras, St. Charles Prineville, St. Charles Redmond

Eastern Oregon: Blue Mountain Hospital, CHI St. Anthony Hospital, Good Shepherd Medical Center, Grande Ronde Hospital, Harney District Hospital, Lake District Hospital, Pioneer Memorial Hospital-Heppner, St. Alphonsus Medical Center-Baker City, St. Alphonsus Medical Center-Ontario, Wallowa Memorial Hospital

Northwest Oregon: Columbia Memorial Hospital, Providence Newberg Medical Center, Providence Seaside Hospital, Samaritan North Lincoln Hospital, Samaritan Pacific Communities Hospital, Tillamook Regional Medical Center, Willamette Valley Medical Center

Portland Metro Area: Adventist Medical Center, Legacy Emanuel Medical Center, Legacy Good Samaritan Medical Center, Legacy Meridian Park Medical Center, Legacy Mount Hood Medical Center, OHSU, Provi-dence Milwaukie Medical Center, Providence Portland Medical Center, Providence St. Vincent Medical Center, Providence Willamette Falls Medical Center, Shriners Hospital-Portland, Tuality Healthcare

Southern Coast: Bay Area Hospital, Coquille Valley Hospital, Curry General Hospital, Lower Umpqua Hospi-tal, Southern Coos Hospital & Health Center

Southern Oregon: Asante Ashland Community Hospital, Asante Rogue Regional Medical Center, Asante Three Rivers Medical Center, Mercy Medical Center, Providence Medford Medical Center, Sky Lakes Medical Center

Valley: Good Samaritan Regional Medical Center, Legacy Silverton Medical Center, McKenzie-Willamette Medical Center, PeaceHealth Cottage Grove Community Hospital, PeaceHealth Peace Harbor Hospital, Peace-Health Sacred Heart Medical Center at RiverBend, PeaceHealth Sacred Heart Medical Center University Dis-trict, Salem Hospital, Samaritan Albany General Hospital, Samaritan Lebanon Community Hospital, Santiam Memorial Hospital, West Valley Hospital


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APPENDIX B: HOSPITAL TYPES

• Adventist Medical Center• Asante Rogue Regional Medical Center• Asante Three Rivers Medical Center• Bay Area Hospital• Good Samaritan Regional Medical

Center• Legacy Emanuel Medical Center• Legacy Good Samaritan Medical Center• Legacy Meridian Park Medical Center• Legacy Mount Hood Medical Center• McKenzie-Willamette Medical Center• Mercy Medical Center• OHSU Hospital• PeaceHealth Sacred Heart Medical Cen-

ter at RiverBend• PeaceHealth Sacred Heart Medical Cen-

ter University District• Providence Medford Medical Center• Providence Milwaukie Hospital• Provicence Portland Medical Center• Providence St. Vincent Medical Center• Providence Willamette Falls Medical

Center• Salem Hospital• Samaritan Albany General Hospital• Shriners Hospital-Portland• Sky Lakes Medical Center• St. Charles Bend• Tuality Healthcare• Willamette Valley Medical Center

• Blue Mountain Hospital*• CHI St. Anthony Hospital*• Curry General Hospital*• Good Shepherd Medical Center*• Grande Ronde Hospital*• Harney District Hospital*• Lake District Hospital*• Pioneer Memorial Hospital-Heppner*• St. Alphonsus Medical Center-Baker

City*• St. Alphonsus Medical Center-Ontario*• Tillamook Regional Medical Center*• Wallowa Memorial Hospital*

• Asante Ashland Community Hospital• Columbia Memorial Hospital*• Coquille Valley Hospital*• Legacy Silverton Medical Center• Lower Umpqua Hospital*• Mid-Columbia Medical Center• PeaceHealth Cottage Grove Community

Hospital*• PeaceHealth Peace Harbor Medical

Center*• Providence Hood River Memorial

Hospital*• Providence Newberg Medical Center• Providence Seaside Hospital*• Samaritan Lebanon Community Hos-

pital*• Samaritan North Lincoln Hospital*• Samaritan Pacific Communities Hospi-

tal*• Southern Coos Hospital & Health

Center*• St. Charles Prineville*• St. Charles Madras*• St. Charles Redmond• West Valley Hospital*

DRG Hospitals Type A Hospitals Type B Hospitals

Urban Rural

Type A Hospitals are small and remote and have 50 or fewer beds. Type A hospitals are located more than 30 miles from another acute care, inpatient facility.

Type B Hospitals are small and rural and have 50 or fewer beds. Type B Hospitals are located 30 miles or less from another acute care facility

*Designates a CAH facility (more information in Appendix C: Definitions)


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APPENDIX C: DEFINITIONS

Bad Debt: Bad debt is the unpaid obligation for care, based on a hospital’s full established rates, for patients who are unwilling to pay their bill. Unlike charity care, bad debt arises in situations where the patient has either not requsted financial assistance or does not qualify for financial assistance. In these cases the hospital will generate a bill for services providec. For uninsured patients, the amount of bad debt can pertain to all or any portion of the bill that is not paid. For patients with insurance, certain amounts that are the pa-tient’s responsibility—such as deductibles and coinsurance—are expsed as bad debt if not paid.

Charity Care: The dollar amount of free care, based on a hospital’s full established rates, provided to patients who are determined by the hospital to be unable to pay their bill. The determination of a patient’s ability to pay is based on the hospital’s charity care policy. Hospitals will typically determine a patient’s inability to pay by examining a variety of factors such as individual and family income, assets, employment status, or availability of alternative sources of funds. Determination of charity care status is made prior to admis-sion if the patient has requested and applied for financial assistance. Charity care status may be granted at a later date depending on the circumstances of the admission, such as an emergency admission, no request for financial assistance prior to admission, or lack of information about the patient’s financial status at the time of admission. Financial assistance provided by the hospital may pertain to all or a portion of the patient’s bill.

Critical Access Hospitals (CAHs): A designation given to certain rural hospitals by the Centers for Medicare and Medicaid Services. Created by Congress in the 1997 Balanced Budget Act, the CAH designation is designed to reduce the financial vulnerability of rural hospitals and improve access to healthcare in those areas. A CAH must have no more than 25 inpatient beds, maintain an annual aver-age length of stay of less than 96 hours, offer 24/7 emergency care, and be located at least 35 miles away from another hospital.

Emergency Department Visits: The total number of patients seen in the emergency department who are not later admitted as inpa-tients.

Net Nonoperating Gains: Amount of income or loss after expenses which result from the hospital’s peripheral or incidental transac-tions and from other events stemming from the environment that may be largely beyond the control of the reporting entity and its management. An example would be sale of investments in marketable securities.

Net Patient Revenue: The revenue the reporting entity generates from patient care.

Operating Margin Percent: Measure of profitability from the reporting entity’s operations.

Other Operating Revenue: Revenue derived from the reporting entity’s operations other than direct patient care. Examples are revenue generated from operation of the cafeteria and gift shop.

Outpatient Surgeries: A planned operation for which the patient is not expected to be admitted to the hospital.

Outpatient Visits: Total number of outpatient visits reported during the reporting period. This includes emergency room visits, ambu-latory surgery visits, observation visits, home health visits, and all other visits.

Payer Mix: The amount of total charges that were attributable to one of four payer categories: Medicaid, Medicare, commercial, and self pay.

Reporting Entity: A hospital and any additional consolidated entities that are included in the Income Statement at the front of the audited financial statement. The only exceptions are foundations that the hospital does not want included in its financial reporting.


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APPENDIX C: DEFINITIONS (CONT.)

Tax Subsidies: Tax revenues from cities, counties or special hospital districts, which assess levies to subsidize the reporting entity.

Total Charges: Amount billed for services at full established rates.

Total Contractuals: The amount of total charges that have been negotiated away by payers. This is the difference between what the hospital bills for and what it expects to receive as revenue.

Total Discharges: The termination of the granting of lodging in the hospital and the formal release of the patient (includes patients admitted and discharged the same day). When a mother and her newborn are discharged at the same time, they count as one discharge. When the baby stays beyond the mother’s discharge (boarder baby), it counts as one discharge for the mother and one discharge for the boarder baby.

Total Margin Percent: Measure of profitability from all sources of the reporting entity’s income.

Total Operating Expenses: All expenses incurred from the reporting entity. Examples are salaries and benefits, purchased services, professional fees, supplies, interest expense, depreciation, and amortization and rent and utilities.

Total Operating Revenue: All revenue derived from the reporting entity’s operations directly related to patient care. Includes net pa-tient revenue and other operating revenue.

Uncompensated Care: The total amount of health care services, based on full established rates, provided to patients who are either unable or unwilling to pay. Uncompensated care includes both charity care and bad debt.

october 20, 2016 - oregon hospital guide 2016 utilization report.pdf · q2 2016 hospital...

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