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60thingstoknowaboutthehospitalindustry|
2016
WrittenbyErinDietsche(Twitter|Google+)|January14,2016|Print|Email

872
HospitalsandhealthsystemsintheU.S.areundergoingadramaticshiftintheirbusiness
modelsduetoanumberofforcesfromprovidersconcernedwiththevolumeofservicesthey
Share provide,toproviderswhofocusonofferinghighvalueservicesthatemphasizekeeping
populationshealthy.Forthoseunfamiliarwiththisshiftingindustry,orthosewhosimplywantto
Tweet
knowmore,hereare60factsandstatisticsaboutthehospitalindustryin2016.
104
Share
1.Thereare5,686hospitalsintheU.S.,accordingtotheAmericanHospitalAssociation.1

2.Ofthese,2,904hospitalsarenonprofitand1,060areforprofit.Additionally,1,010areowned
bystateorlocal(county,hospitaldistrict)governmententities.1

3.OfallhospitalsintheU.S.,1,971serveruralcommunitiesandareconsideredruralhospitals.1

4.Ofruralhospitals,1,332aredesignatedasCriticalAccessHospitalsbyCMS.2CAHsareruralhospitals
withnomorethan25bedsandareatleast35miles(15milesinareaswithmountainousterrainoronly
secondaryroads)awayfromanotherhospital.CAHsarepaiddifferentlybyCMSthantraditionalacute
carehospitalstheirpaymentsreflecttheiroperatingcosts,ratherthanvolumes.

5.Despitethehighnumberofruralhospitals,manyofthemareatriskofclosing.AccordingtoSeptember
2015data,57ruralhospitalshadclosedsince2010.AnanalyticsfirmcallediVantagecreatedanda
hospitalstrengthindexbasedonfinancialstability,patientsandqualityindicatorsfor2,224ruralhospitals
acrossthecountry.iVantagedetermined283,ornearly13percent,werevulnerabletoclosure.The
vulnerablehospitalsarelocatedacross39states.
6.Althoughhospitalclosuresimmediatelyraiseconcernaboutaccesstocare,thegenerallinkbetweena
closedhospitalandratesofpatientmortalityratesmaybeunfounded,accordingtostudypublished
inHealthAffairs.Researchersidentified195hospitalclosuresintheU.S.between2003and2011and
comparedtheannualpatientmortalityratesinhospitalserviceareaswithoneormoreclosurewithHSAs
thatdidn'texperienceanyhospitalclosures.Theyfoundnosignificantdifferencebetweenthemortality
rates.InHSAsthatexperiencedatleastonehospitalclosure,themortalityratedroppedfrom5.5percent
to5.2percentfrom2003to2011.InHSAsthatdidnotexperienceahospitalclosure,themortalityrate
remainedthesameat5.4percentfrom2003to2011.

7.Academicmedicalcentersarehospitalsandhealthsystemswithacloseaffiliationwithamedical
school.AMCsfeatureresidencyandoftenfellowshiptrainingprogramsandpursueclinicalresearchin
additiontodirectpatientcare.Theyalsooftenareconsideredtertiarycarecenters,becauseoftheirability
totreatafullrangeofcomplexconditionsandaccesstosubspecialists.In2013,thelatestyearforwhich
dataisavailable,approximately400U.S.hospitalswereaffiliatedwithamedicalschool.Thereare145
accreditedmedicalschoolsinthecountry,accordingtotheAssociationofAmericanMedicalColleges.3

8.Safetynethospitalsareacategoryofhospitalsthatprovideadisproportionatelevelofcharitycare
comparedtootherfacilities.4ThesehospitalsreceiveHospitalDisproportionateSharePaymentsfrom
CMStohelpoffsetthecostofcaringforlargenumbersofMedicaid,Medicareanduninsuredpatientswho
resultinuncompensatedcare.TheAffordableCareActcallsforDSHpaymentstobesignificantlyreduced
overaperiodofyears.DSHfundingbeganin2014.

9.U.S.healthspendingincreasedby5.3percentin2014toatotalof$3trillion,accordingtoCMS'Office
oftheActuary.

10.In2014,100mergersoracquisitionstookplaceinthehospitalindustry,worthadollarvalueof$62
billion,accordingtoIrvingLevinAssociates.Thenumberofhealthcaresectormergersandacquisitions
reached"recordbreakingproportions,"accordingtoareportfromthecompany.5

11.Ofthe100mergersandacquisitions,65involvednonprofithospitalbuyers,while35involvedforprofit
hospitalbuyers.5

12.Thefivelargestforprofithospitaloperatorsinclude:

CommunityHealthSystems(Brentwood,Tenn.)196
HospitalCorporationofAmerica(Nashville,Tenn.)165
TenetHealthcare(Dallas)84
LifePointHealth(Brentwood,Tenn.)70,whichincludesacutecarefacilitieswithinBrentwood,
Tenn.basedDukeLifePointHealth
PrimeHealthcareServices(Ontario,Calif.)386

13.Thefivelargestnonprofithospitalsystemsinclude:

AscensionHealth(St.Louis)129
CatholicHealthInitiatives(Englewood,Colo.)102
TrinityHealth(Livonia,Mich.)91
DignityHealth(SanFrancisco)39
KaiserPermanente(Oakland,Calif.)386

14.ThefivelargestnonprofithospitalsinAmerica(bybedcount)are:

NewYorkPresbyterianHospital/WeillCornellMedicalCenter(NewYorkCity)2,508
FloridaHospitalOrlando2,350
BaptistMedicalCenter(SanAntonio)1,563
UPMCPresbyterian(Pittsburgh)1,548
Orlando(Fla.)RegionalMedicalCenter1,5256

15.ThelargestforprofithospitalsinAmerica(bybedcount)are:
MethodistHospital(SanAntonio)(affiliatedwithMethodistHealthcareSystem)1,561
Edinburg(Texas)RegionalMedicalCenter(affiliatedwithSouthTexasHealthSystem)816
ChippenhamHospital(Richmond,Va.)(affiliatedwithHCA)793
NorthShoreMedicalCenter(Miami)771
HenricoDoctors'Hospital(Richmond,Va.)(affiliatedwithHCA)7336

16.Hospitalsvarygreatlyissize,fromsmallruralfacilitieswithjustafewkeyservicelinestolarge,tertiary
carefacilities.HereisabreakoutofU.S.hospitalsbybedcountin2012,thelatestyearforwhichdatais
publiclyavailable.7

624bed462
2529beds1,192
5099bed954
100199beds1,012
200299beds570
300399beds348
400499beds189
500bedsormore272

17.Therewasanaverageof104inpatienthospitalsadmissionsper1,000peoplein2014,downfroman
averageof111.8daysin2011.Thisdatasuggestsonongoingshiftfrominpatienttooutpatientcare,which
hasbeendrivenlargelybyadvancesinminimallyinvasivesurgicaltechniquesaswellasadvanced
anesthesiatechniquesthatallowpatientstorecovermorequicklyfromsurgicalprocedures.8

18.In2012,thelatestyearforwhichdataisavailable,theaveragelengthofstayforanacutecare
hospitaladmissionwas4.5days.9

19.Theaveragecostperinpatientdayin2014was$2,346fornonprofithospitalsand$1,798forforprofit
hospitals.Atnonprofithospitals,theaveragecostperinpatientdaywashighestinCalifornia($3,533)and
lowestinSouthDakota($1,321).Amongforprofithospitals,theaveragecostperinpatientdaywas
highestinNewJersey($4,656)andlowestinSouthDakota($434).10

20.Therewasanaverageof2,145outpatientvisitsper1,000peoplein2013,upfromanaverageof
2,105.6daysin2011,furthersupportingthetrendofinpatientsurgeriesmovingtotheoutpatientsetting.10

21.Emergencydepartmentsarecriticalunitswithinhospitalsastheyaccountforthemajorityofinpatient
admissions.In2011,thelatestyearforwhichdataisavailable,therewere44.5EDvisitsper100persons
intheU.S.,accordingtotheCDC.Thistranslatestoroughly136.3millionvisitstotalthatyear.

22.Ofthattotal,approximately40.2millionEDvisitswereinjuryrelated.Thepercentageofemergency
departmentvisitsresultinginhospitaladmissionwas11.9percent,andthepercentageofemergency
departmentvisitsresultinginatransfertoadifferenthospitalwas2.1percent.11

23.Theterm"hospitalacquiredconditions"includesadversedrugevents,catheterassociatedurinary
tractdefects,centrallineassociatedbloodstreaminfections,pressureulcersandsurgicalsiteinfections,
amongothers.HHSestimateda17percentdeclineinHACratesfrom2010to2014,or2.1millionfewer
recordedHACcases.HHSreported87,000fewerpatientdeathsinhospitalsandnearly$20billionincare
costsavingsasaresultofHACdecreaseoverthisperiod.

24."Lowvolumehospitals"becameatalkingpointin2015.Whensurgeonsatahospitalperformalow
volumeofcasesofcertainprocedures,patientsareatahigherriskofsufferingdeathorserious
complicationsthanifthesurgeonsandhospitalshavemoreexperience,analysisfromU.S.News&World
Reportfound.Lastspring,threemajoracademichealthsystemsDartmouthHitchcockMedicalCenter
inLebanon,N.H.,BaltimorebasedJohnsHopkinsMedicineandAnnArborbasedUniversityofMichigan
sharedplanstobarmemberhospitalsfromperformingcertainlowvolumeprocedures.

25.TheAmericanHospitalAssociationistheleadingassociationrepresentingU.S.hospitals.Itisledby
PresidentandCEORichard(Rick)Pollack.
26.TheFederationofAmericanHospitalsrepresentsforprofit,investorownedhospitals.Itwasfounded
in1966andisledbyPresidentandCEOCharles(Chip)Kahn.

27.America'sEssentialHospitalsrepresentssafetynethospitals,includingmanylarge,urbanfacilities.It
isledbyPresidentandCEOBruceSiegel,MD,MPH.

28.Avarietyoffactorshavepressuredhospitalfinancesoverthelastseveralyears,andtheseforcesare
unlikelytoletup.Inadditiontothevolumeshiftfrominpatienttooutpatientvisits,thegrowthinhigh
deductibleheathplansandotherhealthinsurancebenefitdesignelementsthatincreasecostsfor
consumershasresultedinsomepatientsdelayingorwithholdingmedicalcare.For2012,thelatestdata
available,theaverageoperatingmarginforanonprofithospitalwas2.6percent,accordingtoMoody's
InvestorsService.

29.In2013,hospitalswereunderpaidformedicalservicesby$51billion,accordingtotheAmerican
HospitalAssociation.Thistotalincludesshortfallsof$37.9billionforMedicareand$13.2billionfor
Medicaid.Thatyear,underMedicare,hospitalsreceivedpaymentof88centsforeverydollarspentcaring
forMedicarepatients.UnderMedicaid,hospitalsreceivedpaymentof90centsforeverydollarspent
caringforMedicaidpatients.

30.In2014,theaveragenonprofithospitalhad205.8dayscashonhandandacashtodebtpercentage
of141.8.However,cashtodebtratiosvarywidelyintheindustry:

Mediancashtodebtpercentagefor"AAratedhospitals:201.7
Mediancashtodebtpercentagefor"A"ratedhospitals:143.7
Mediancashtodebtpercentagefor"BBB"ratedhospitals:89.5
Mediancashtodebtpercentageforhospitalsratedbelow"BBB":52.212

31.Thepaymentahospitalreceivesfortheserviceitprovidesvariesbasedonthepayer.Governmental
payers,includingMedicareandMedicaid,setrates,andnearlyeveryhospitalchoosestoacceptthemin
ordertohaveaccesstothesepatients.Withcommercialpayers,hospitalscannegotiateratesbasedon
expectedvolumeandotherfactorshowevermanycommercialratesaresetbasedonapercentof
MedicareorsomeotherformulathatusesMedicareratesasabaselinefigure.Therefore,cutsto
MedicareratesmayhavealargerimpactonhospitalfinancesthanjustamongMedicarepatients.

32.For2009,thelatestyearforwhichdataisavailable,themajorityofpatientstreatedbyhospitalsare
coveredbyMedicare(40.9percentofpatientstreatedinU.S.hospitals).TheaveragepayermixofaU.S.
hospitalisasfollows:

Medicare:40.9percent
Medicaid:17.2percent
BlueCrossBlueShield,otherprivateinsurance:16.5percent
HMOorPPO:14percent
Selfpay:4.9percent
Worker'scompensationandothergovernmentprograms:2percent13

33.Nonprofithealthsystemsreceivetaxexemptstatusbecauseofthebenefitstheyprovidetotheir
communities.However,therehasbeengreaterscrutinybylawmakersandthepublicinthepastfiveyears
astowhetherthetaxbreaksareequivalenttothelevelofcharitycareorotherbenefitsprovidedbythe
hospitals.AspartoftheACA,theIRShasimplementedstricterreportingrequirements,andmanystate
andlocalgovernmentsarecurrentlyevaluatinghospitaltaxbreaks.(See:"HospitalTaxExemptionsUnder
FireinIllinois"and"NJBillApprovedto'Tax'NonprofitHospitals.")

34.AspartoftheACA,hospitalsagreedtoroughly$155billioninpaymentcutsfromMedicareand
Medicaidover10years.Further,theAmericanTaxpayerReliefActof2012,betterknownasthefiscalcliff
deal,broughtonfurthercutstohospitalpaymentrates.Together,theseadjustmentswillslowthegrowth
ofMedicarespending.However,hospitalsarenotreimbursedalowerrateyeartoyear.Instead,growthin
Medicarepaymentsareslowed.UnderCMS'proposedrulefor2016payments,acutecarehospitalsthat
reportqualitydataandaremeaningfulusersofEHRswillreceivea0.9percentincreaseinMedicare
operatingrates.
35.VariousreformsundertheACAhaveincreasedthepercentageofMedicarepaymentrates,underthe
formulaCMSuses,thataretiedtohospitalperformance.TheACAimplementedthehospitalValueBased
Purchasingprogram,andin2012,CMSintroducedtheHospitalReadmissionsReductionprogram.Asthe
adagegoes:"whereMedicaregoes,sogoprivatepayers."Manyprivatepayershaveenteredintovarious
typesofvaluebasedcontractswithproviders.(SeeNo.33.)

36.Thefinancialimpactofthesevaluebasedreformswasexpectedtohaveasignificantimpact,
particularlyonlowperforminghospitals.However,inanOctober2015report,theUnitedStates
GovernmentAccountabilityOfficefoundtheValueBasedPurchasingProgramhad"modesteffectson
Medicarepaymentsandnoapparentchangeinqualityofcaretrends."14

37.Theimpetusforvaluebasedcareisdrivenbytwocoreforces:1)therisingcostofmedicalcareand
2)thelackofpredictablequality.Regardingthelatterforce,medicalerrorsandhealthcareassociated
infectionscontinuetooccuratalarmingratesinU.S.hospitals,thoughtheyhavedecreasedoverthepast
decade.Accordingtoa2013studybytheCDC15thatexaminedhospitaldatafrom2011,approximately
721,800HAIsoccurannually.ThenumberofestimateddeathsassociatedwithHAIsinU.S.hospitalswas
75,000.Ofthese,157,500wereforpneumonia,71,900forbloodstreaminfections,123,100for
gastrointestinalillness,93,300forurinarytractinfections,157,500forsurgicalsiteinfectionsand118,500
forinfectionsofothersites.

38.HospitalsandhealthsystemsareenteringintoavarietyofvaluebasedpaymentmodelswithCMS
andprivatepayers.ManyvaluebasedagreementswithprivatepayersaresimilartoCMS'VBPprogram
wherethereareincentivesforprovidinghighqualitycarethatmeetscertainbenchmarks.Othersaremore
complexandmayincludeaccountablecareorganizationarrangements,capitatedpaymentsforapatient
overasetperiodoftime,orbundledpaymentsforcertainmedicalandsurgicalservices.

39.Hospitalsfacearelentlesspushtoimprovethepatientexperienceandsupportpatientsasactive
participantsinthecareprocess,whenpossible,versuspassiverecipientsofcare.Since2006,CMSand
thefederalgovernmenthasusedHospitalConsumerAssessmentofHealthcareProvidersandSystems
(HCAHPS)asastandardizedsurveytomeasurepatientperceptionofthequalityofcarereceived.The
HCAHPSsurveyasksdischargedpatients27questionsabouttheirrecenthospitalstay.TheACA
includesHCAHPSamongthemeasurestobeusedtocalculatevaluebasedincentivepaymentsinthe
HospitalValueBasedPurchasingprogram,whichbeganwithdischargesinOctober2012.In2015,
CMSlaunchedstarratingsonitsHospitalComparewebsiteasawaytostreamlinehospitalratingsfor
patientstryingtomakehealthcaredecisions.CMSwillpublish12differentstarratingsontheHospital
Comparewebsiteforeachfacility:11oftheratingswillbebasedonindividualHCAHPSmeasuresand
the12thisacompositestarrating.

40.Accountablecareorganizationshaveprovenapopularvaluebasedmodel,atleastintermsof
systemswillingtotesttheirviability.ACOsareoneofseveralprogramscreatedbytheCenterfor
Medicare&MedicaidInnovation,whichwascreatedandfundedbytheACAtopilotnewpatientcare
modelsintendedtoreducecostsandimprovequality.CMScreatedseveralmodelsforACOs,including
theMedicareSharedSavingsProgram,thePioneerACOprogramandtheNextGenerationACOmodel.
The21newNextGenACOswhichwereannouncedearlythisyearwilltakeonmoreperformance
riskthanACOsinothermodels,buttheyalsohavethepotentialtoshareingreatersavings.TheCMMI
alsolaunchedtheBundledPaymentsforCareImprovementProgram,whichwillpayhospitalsabundled
rateforcertainhospitalbasedandoutpatientservicesassociatedwithselectedDRGs.

41.ACOswillcontinuetogrow.AccordingtoareportfromconsultingfirmOliverWyman,therewere522
ACOsintheU.S.in2014.AsofJanuary2015,thenumberofACOsroseto585.

42.Becauseofdemandstolowercosts,improvequality,coordinatecareandimprovepopulationhealth,
hospitalsareconcernedwiththeiralignmentwithphysicians.Physicians,afterall,controlmosttestingand
treatmentdecisions,andtheirgoalsmustbealignedwiththoseofthehealthsystemforsuccess.To
achievethis,healthsystemslooktoclinicallyintegratewithphysicians,whichcanbeachievedthrougha
varietyofmodelsrangingfromemploymenttooperatingamanagementserviceorganizationfor
independentphysicians.

43.Despitethevarietyofmodelsavailabletoachieveclinicalintegration,physicianemploymenthasrisen
inpopularity,likelybecauseiteliminatesmanylegalhurdlesassociatedwithhospitalphysician
relationships.AccordingtoMedscape's2015PhysicianCompensationReport,63percentofphysicians
areemployed.

44.Aphysician'shesitationtoacceptemploymentseemslargelydrivenbyasenseofindependence
(somethingapparentlymorecommonamongsurgeons)andanabilitytomaintainincomeinaprivate
practicesetting.Medscape'sPhysicianCompensationReportfoundemployedprimarycarephysicians
earn$189,000,whileselfemployedPCPsmake$212,000.Employedspecialistsmake$258,000ayear
andselfemployedspecialistsmake$329,000annually.

45.Anticipatedphysicianshortagesincertainareasofthecountryarealsodrivinghospitals'effortsto
alignwithphysicians.TheAssociationofAmericanMedicalCollegesestimatestheU.S.willhavea
shortageofbetween46,000and90,400physiciansby2025.

46.Whenhospitalsemployphysicians,theyoftendosotoprepareformanagedcareandotherbusiness
purposes.However,hospitalleadersshouldkeepinmindphysiciansarequiteexpensivetoemploy,and
infact,increasedregulationshavemadeoperatingphysicianpracticesmoreexpensivethaninthepast.A
recentreportfromMoody'sInvestorsServicefoundhospitalswithahighrateofphysicianemployment
showedstrongerrevenuegrowthbutlowerprofitabilitythanhospitalswithloweremploymentrates.

47.In2015,primarycarephysiciansexperiencedbiggerincreasesintotalcashcompensationthantheir
specialistpeers,accordingtoSullivan,CotterandAssociates'2015"PhysicianCompensationand
ProductivitySurvey."Forexample,primarycarephysicianssawa3.4percentmedianincreasein
compensationbetween2011and2015,whilemedicalspecialistssawa2.5percentincreaseandsurgical
specialistssawa2.3percentincrease.

48.AstudyfromMayoClinicinRochester,Minn.,andtheAmericanMedicalAssociationfoundworklife
balanceamongphysicianshasworsenedfrom2011through2014.In2011,45percentofphysicianswere
consideredburnedout,andthatnumbergrewto54percentby2014.Thefindingindicatesthistrendis
specifictothemedicalprofession,asworklifebalanceandburnoutremainedsteadyamongworkersin
otherfields.

49.Intotal,healthcareadded474,700jobsin2015,accordingtotheBureauofLaborStatistics.That's
morethan2014(309,000)and2013(159,700)combined.Healthcareaddedanaverageof40,000jobs
permonthin2015,comparedwithanaverageof26,000permonthin2014,accordingtotheBLS.

50.In2014,75percentofhospitalshadatleastabasicEHRinplace.Thisisnearlyfivetimestheamount
ofhospitalsthathadabasicEHRin2010,butthisdoesnotmeantheEHRmeetsrequirementsfor
meaningfuluse.Regardless,earlythisyear,CMSActingAdministratorAndySlavittsaidthemeaningful
useprogramwillendin2016.16

51.Hospitalsthatsuccessfullyimplementelectronichealthrecordsandareabletodemonstrate
"meaningfuluse"ofthoserecordsaccordingtoCMS'standardswillreceiveincentivepayments.The
fundingfortheseincentivepaymentswasallocatedbyCongressintheAmericanRecoveryand
ReinvestmentActof2009.

52.Sincethemeaningfuluseprogrambeganin2011,mosthospitalsacrosstheU.S.haveattestedto
Stage1.However,over60percentofhospitalsandapproximately90percentofphysicianshaven't
attestedtoStage2yet.16

53.In2014,theaveragebasesalaryforanindependenthealthsystemCEOwas$752,800.Theaverage
basesalaryforaCEOofanindependenthospitalonethatdoesn'treporttoaparentorganization
was$425,200,accordingtoIntegratedHealthcareStrategies'"2014NationalHealthcareLeadership
CompensationSurvey"report.

54.Therewasan18percentrateofturnoveramonghospitalCEOsin2014,themostrecentyearfor
whichdataisavailable,accordingtheAmericanCollegeofHealthcareExecutives.Whilelowerthanthe
recordhighof20percentreportedfor2013,itwasstillamongthehighestratesreportedinthelast15
years.

55.Forthe11thyearinarow,hospitalCEOsrankedfinancialchallengesastheNo.1issuefacingtheir
organizationsin2014.Theissuetoppedhealthcarereformimplementation(No.2),governmental
mandates(No.3)andpatientsafetyandquality(No.4).Withinthebucketoffinancialchallenges,the338
CEOspolledbytheAmericanCollegeofHealthcareExecutivesindicatedconcernamongthefollowing
subcategories:

Medicaidreimbursement(69percent)
Baddebt(67percent)
Decreasinginpatientvolume(63percent)
Medicarereimbursement(57percent)
Competitionfromotherproviders(ofanytype)55percent

56.TheaveragebasesalaryforanindependenthealthsystemCFOin2014was$416,200,whilethe
averagebasesalaryforaCFOofanindependenthospitalwas$247,900,accordingtoIntegrated
HealthcareStrategies'"2014NationalHealthcareLeadershipCompensationSurvey"report.

57.In2013,theaverageannualsalaryforaCIOinhealthcareandmedicalservicewas$173,941.

58.TheaverageannualsalaryforaCXOin2015was$221,000.

59.Thenumberofhospitalsineachstateisinfluencedbypopulation,ofcourse,butalsobyotherfactors.
Statecertificateofneedlawsareoneofthebiggestinfluencersofhospitaldevelopmentinastate.
Certificateofneedlawsrequirethatastategovernedboardreviewandapprovethedevelopmentofany
newhealthcarefacilitiesinthestate.Generally,approvalrequiresproofofneedthatis,acurrentlackof
accesstohealthcareservicesorafutureone,duetoprojectedpopulationgrowth.ForasummaryofCON
laws(orlackthereof)bystate,clickhere.

60.Thetopfivestateswiththemosthospitals,accordingtoKaiserHealthFacts,17are:

Texas424
California347
Florida212
Pennsylvania190
Illinois189

Footnotes:

1.AmericanHospitalAssociation."AHAHospitalStatistics,2015Edition,"whichisbasedonthe2013AHAAnnualSurvey.
2.RuralHealthResearchCentersattheUniversitiesofMinnesota,NorthCarolinaChapelHill,andSouthernMaine."CAHList."Availableonline
athttp://www.flexmonitoring.org/cahlistRA.cgi.
3.PWC."AcademicMedicalCenters."Availableonlineathttp://www.pwc.com/us/en/healthindustries/providers/servicessolutions/academicmedicalcenters.jhtml
4.America'sEssentialHospitals."AboutOurMembers."Availableonlineathttp://www.naph.org/MainMenuCategory/AboutNAPH/AboutOurMembers/whatisasafetynet
hospital.aspx
5.IrvingLevinAssociates."HealthCareServicesAcquisitionReport,2015."Pressreleaseavailableonlineat
http://www.businesswire.com/news/home/20150331006369/en/NewlyPublishedReport2014HealthCareServices#.VRv4sFKZsZ.
6.Figuresarebasedonindividualsystems'websitesaswellasCMScostreportdataanalyzedbyAmericanHospitalDirectory.Note:Thehospitalbedcountsreportedhere
includeallmedical/surgicalandspecialcarebedsasreportedtoCMSbythehospitalsintheirmostrecentcostreportsand,insomecases,mayincludebedcountsfromother
facilitiesthatshareaprovidernumberwiththemainhospital.
7.CentersforDiseaseControlandPrevention."Table98:Hospitals,beds,andoccupancyrates,bytypeofownershipandsizeofhospital:UnitedStates,selectedyears1975
2012."Availableonlineathttp://www.cdc.gov/nchs/data/hus/2014/098.pdf.
8.KaiserStateHealthFacts,2014.Availableonlineathttp://kff.org/other/stateindicator/admissionsbyownership/.
9.HealthcareCostandUtilizationProject."OverviewofHospitalStaysintheUnitedStates,2012."Availableonlineathttp://www.hcupus.ahrq.gov/reports/statbriefs/sb180
HospitalizationsUnitedStates2012.pdf.
10.KaiserStateHealthFacts,2013.Availableonlineathttp://kff.org/other/stateindicator/expensesperinpatientdaybyownership/andhttp://kff.org/other/state
indicator/outpatientvisitsbyownership/.
11.CentersforDiseaseControlandPrevention.2011,"NationalHospitalAmbulatoryMedicalCareSurvey."Availableonlineathttp://www.cdc.gov/nchs/fastats/emergency
department.htmandhttp://www.cdc.gov/nchs/data/ahcd/nhamcs_emergency/2011_ed_web_tables.pdf.
12.Source:FitchRatings,"2014MedianRatiosforNonprofitHospitalsandHealthcareSystems,"August2015.Moody'sInvestorsService,"U.S.NotforProfitHospital2014
Medians,"Sept.2015.
13.CentersforDiseaseControlandPrevention.2010,"NationalHospitalDischargeSurvey."Figuresreflectpayermixesfrom2009,thelatestyearavailable.
14.UnitedStatesGovernmentAccountabilityOffice.2015,"HospitalValueBasedPurchasing"report.Availableonlineathttp://www.gao.gov/assets/680/672899.pdf.
15.CentersforDiseaseControlandPrevention."EstimatingHealthCareAssociatedInfectionsandDeathsinU.S.Hospitals,2011"Availableonline
athttp://www.cdc.gov/HAI/surveillance/.
16.AmericanHospitalAssociation."GettingMeaningfulUseRight"factsheet.Availableonlineathttp://www.aha.org/content/14/fsmeaningfuluse.pdf.
17.TheHenryJ.KaiserFamilyFoundation.StateHealthFacts.Availableonlineathttp://kff.org/other/stateindicator/totalhospitals.

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SandraTanner2yearsago
AndtheabsoluteworsthospitalIhaveeverworkedat(andIhavebeentohundreds)isYumaregionalMedicalCenter.
TheHRdepartment,lovestoreportnursestotheboardofnursing,ontrumpeduplies.!Shameonthem,youcanttrust
them,bewareofworkingatthisfacility.Itisdangerousforpatients,ayoungtravelnursediedfrompneumonia,!and
nurses,forewarned.
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MelissaPazen2yearsago
Afascinatingvolumeofinformation.
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Larryayearago
ThisisalotofinfoitconfirmswhatI'veneedsayingaboutallthehospitalsbuyingthesePhy'spracticestherevenuegoes
upbuttheprofitabilitydeceased
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EZMEDxayearago
Althoughitmaybeatoughpilltoswallow,someofthebenefitsthatphysicianpracticesmaybenefit(throughacquisition)
areguaranteedpaychecks,reducedadministrativeburden,andhigherincome.Thesefactorscaneventuallyleadto
increasedfocusoncareandamorestreamlinedexperience.
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Anewpatientengagementmodelforpayment The2actionsTrumptookonhealthcareThursday:9
collection thingstoknow
2commentsadayago 37comments4daysago
PhilSpradlinFascinating!Whatwillyoutrytoincrease benedictasum Theyneverknowwhatthey'retalking
patientrevenue? about.They'resostuckonideology.ACO'sonlyeffect
Medicarepatients,whoaresponsoredbythe

Medicaljournaleditors:7wayshealthcare TenetsellshospitaltoLoyolawitheyeonexiting
professionalscanhelppreventgunviolence Chicagomarket
4comments6daysago 4comments6daysago
cargosquid1.Seekinformationonlocalgunpolicies KDWinPlanoIstillworkhere.I'mnottryingtoabsolve
andproposalstoimprovelegislation.NOTICE...thereisno anyoneofpoorperformance,butisTenet'sperformance
mentionofwhat"improve"means.....2.Contact worseinthoseareasthantheindustryaverage,or

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