Trends in Hospital Financing - AHA CHARTBOOK 2016 Trends in Hospital Financing. Chart 4.1:...
Transcript of Trends in Hospital Financing - AHA CHARTBOOK 2016 Trends in Hospital Financing. Chart 4.1:...
-
TRENDWATCH CHARTBOOK 2016Trends in Hospital Financing
Chart 4.1: Percentage of Hospitals with Negative Total and Operating Margins, 1995 2014
Source: Analysis of American Hospital Association Annual Survey data, 2014, for community hospitals.
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14
Negative Operating Margin
Negative Total Margin
-
TRENDWATCH CHARTBOOK 2016Trends in Hospital Financing
Chart 4.2: Aggregate Total Hospital Margins(1) and Operating Margins,(2)1994 2014
Total Margin
Operating Margin
0%
2%
4%
6%
8%
10%
94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14
Source: Analysis of American Hospital Association Annual Survey data, 2014, for community hospitals. (1) Total Hospital Margin is calculated as the difference between total net revenue and total expenses divided by total net revenue.(2) Operating Margin is calculated as the difference between operating revenue and total expenses divided by operating revenue.
Chart1
0.0480.033594
0.0560.038895
0.0670.045596
0.0670.040497
0.0580.030898
0.0460.020899
0.0460.020300
0.0420.026901
0.0440.03702
0.0480.03303
0.0520.03604
0.0530.03705
0.060.0406
0.0690.04307
0.0260.03308
0.050.04409
0.07242493730.05529733610
0.07042893430.055080771811
0.0784060520.065204249212
0.0791986060.057258702913
0.0832010.0644114
Total Margin
Operating Margin
Sheet1
949596979899000102030405060708091011121314
Total Margin4.8%5.6%6.7%6.7%5.8%4.6%4.6%4.2%4.4%4.8%5.2%5.3%6.0%6.9%2.6%5.0%7.2%7.0%7.8%7.9%8.3%
Operating Margin3.4%3.9%4.6%4.0%3.1%2.1%2.0%2.7%3.7%3.3%3.6%3.7%4.0%4.3%3.3%4.4%5.5%5.5%6.5%5.7%6.4%
-
TRENDWATCH CHARTBOOK 2016Trends in Hospital Financing
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14
Per
cent
age
of R
even
ue
Chart 4.3: Distribution of Outpatient vs. Inpatient Revenues, 1994 2014
Source: Analysis of American Hospital Association Annual Survey data, 2014, for community hospitals.
Gross Inpatient Revenue
Gross Outpatient Revenue
Chart1
0.280.72
0.30.7
0.310.69
0.330.67
0.330.67
0.340.66
0.350.65
0.350.65
0.350.65
0.350.65
0.36025422040.6397457796
0.36996701730.6300329827
0.380.62
0.3840.615
0.390.605
0.410.59
0.420.58
0.43164496850.5683550315
0.440.56
0.450.55
0.460.54
Gross Outpatient Revenue
Gross Inpatient Revenue
Percentage of Revenue
Sheet1
92949596979899000102030405060708091011121314
Gross Outpatient Revenue25%28%30%31%33%33%34%35%35%35%35%36%37%38%38%39%41%42%43%44%45%46%
Gross Inpatient Revenue75%72%70%69%67%67%66%65%65%65%65%64%63%62%62%61%59%58%57%56%55%54%
-
TRENDWATCH CHARTBOOK 2016Trends in Hospital Financing
Chart 4.4: Annual Change in Hospital Operating Revenue and Expenses per Adjusted Admission,(1) 1994 2014
-2%
0%
2%
4%
6%
8%
10%
94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14
Change in Total Expenses Change in Operating Revenue
Source: Analysis of American Hospital Association Annual Survey data, 2014, for community hospitals. (1) An aggregate measure of workload reflecting the number of inpatient admissions, plus an estimate of the volume of outpatient services,
expressed in units equivalent to an inpatient admission in terms of level of effort.
Chart1
0.0160.025
-0.0020.003
0.0020.009
0.0060.001
0.020.01
0.0190.009
0.0250.024
0.0470.054
0.0540.065
0.060.056
0.0470.05
0.0450.047
0.0510.054
0.0450.048
0.04383925120.0333573591
0.02624586630.037484685
0.02670777410.0394336509
0.02124221740.0210081609
0.0653387930.0769052737
0.03834006280.0295608112
0.0310.039
Change in Total Expenses
Change in Operating Revenue
Sheet1
9293949596979899000102030405060708091011121314
Change in Total Expenses8.1%5.8%1.6%-0.2%0.2%0.6%2.0%1.9%2.5%4.7%5.4%6.0%4.7%4.5%5.10%4.5%4.4%2.6%2.7%2.1%6.5%3.8%3.10%
Change in Operating Revenue8.7%5.6%2.5%0.3%0.9%0.1%1.0%0.9%2.4%5.4%6.5%5.6%5.0%4.7%5.40%4.8%3.3%3.7%3.9%2.1%7.7%3.0%3.9%
-
TRENDWATCH CHARTBOOK 2016Trends in Hospital Financing
Medicare, 34.6% Medicare, 38.3% Medicare, 40.2%
Medicaid, 9.6%Medicaid, 12.8%
Medicaid, 17.6%Other Government,
6.1%
Other Government, 1.4%
Other Government, 1.7%
Private Payer, 41.8% Private Payer, 38.7%Private Payer,(3) 33.1%
Uncompensated Care,(2) 5.1%
Uncompensated Care,(2) 6.0%
Uncompensated Care,(2) 5.3%
Non-patient,(1) 2.7% Non-patient,(1) 2.8% Non-patient,(1) 2.1%
1980 2000 2014
Chart 4.5: Distribution of Hospital Cost by Payer Type, 1980, 2000, and 2014
Source: Analysis of American Hospital Association Annual Survey data, 2014, for community hospitals.(1) Non-patient represents costs for cafeterias, parking lots, gift shops and other non-patient care operating services and
are not attributed to any one payer.(2) Uncompensated care represents bad debt expense and charity care, at cost.(3) Private payer formulas were updated in 2014 to account for the change in bad debt calculations,
which is now reported as a deduction from revenue rather than a expense. (4) Percentages were rounded, so they do not add to 100 percent in all years.
(4) (4) (4)
Chart1
0.34640.09570.06140.41810.0510.0274
0.3830.1280.0140.3870.060.028
0.40222007510.17576247560.01667460840.3314577870.05293278610.0209522679
Medicare
Medicaid
Other Government
Private Payer
Uncompensated Care(2)
Non-patient(1)
Medicaid, 12.8%
Medicaid, 17.6%
Other Government,6.1%
Other Government, 1.4%
Other Government, 1.7%
Private Payer, 41.8%
Private Payer, 38.7%
Private Payer,(3) 33.1%
Uncompensated Care,(2) 5.1%
Uncompensated Care,(2) 6.0%
Uncompensated Care,(2) 5.3%
Non-patient,(1) 2.7%
Non-patient,(1) 2.8%
Non-patient,(1) 2.1%
Sheet1
198020002014
Medicare34.6%38.3%40.2%
Medicaid9.6%12.8%17.6%
Other Government6.1%1.4%1.7%
Private Payer41.8%38.7%33.1%
Uncompensated Care(2)5.1%6.0%5.3%
Non-patient(1)2.7%2.8%2.1%
-
TRENDWATCH CHARTBOOK 2016Trends in Hospital Financing
Chart 4.6: Aggregate Hospital Payment-to-cost Ratios for Private Payers, Medicare, and Medicaid, 1994 2014
Source: Analysis of American Hospital Association Annual Survey data, 2014, for community hospitals. (1) Includes Medicaid Disproportionate Share payments.(2) Includes Medicare Disproportionate Share payments.
70%
80%
90%
100%
110%
120%
130%
140%
150%
94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14
Private Payer
Medicaid(1)
Medicare(2)
Chart1
0.9690.9371.244
0.99410.94011.2401
1.02440.94931.2163
1.03650.95971.1749
1.01860.96641.158
0.99950.95651.1511
0.99070.94471.1569
0.98440.9581.1648
0.9790.9611.19
0.9530.9231.223
0.9190.8991.289
0.9230.8711.294
0.9130.8581.303
0.9060.8791.322
0.9090.8871.283
0.9010.891.341
0.92400426450.92816132921.3352167621
0.91362335970.94729374911.3452241687
0.85916437130.88881649621.4885531956
0.87944416060.89814375191.4361059108
0.885480.900461.43657
Medicare
Medicaid(1)
Private Payer
Sheet1
9293949596979899000102030405060708091011121314
Medicare89.0%89.9%96.9%99.4%102.4%103.7%101.9%100.0%99.1%98.4%97.9%95.3%91.9%92.3%91.30%90.60%90.90%90.10%92.40%91.36%85.92%87.94%88.55%
Medicaid(1)89.5%89.6%93.7%94.0%94.9%96.0%96.6%95.7%94.5%95.8%96.1%92.3%89.9%87.1%85.80%87.90%88.70%89.00%92.82%94.73%88.88%89.81%90.05%
Private Payer131.8%130.1%124.4%124.0%121.6%117.5%115.8%115.1%115.7%116.5%119.0%122.3%128.9%129.4%130.30%132.20%128.30%134.10%133.52%134.52%148.86%143.61%143.66%
-
TRENDWATCH CHARTBOOK 2016Trends in Hospital Financing
-$60-$55-$50-$45-$40-$35-$30-$25-$20-$15-$10-$5$0$5
97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14
Billi
ons
Chart 4.7: Hospital Payment Shortfall Relative to Costs for Medicare, Medicaid and Other Government, 1997 2014(1)
Medicare
MedicaidOther Government
Source: Analysis of American Hospital Association Annual Survey data, 2014, for community hospitals. (1) Costs reflect a cap of 1.0 on the cost-to-charge ratio.
Chart1
4.3-1.6-0.7
2.3-1.4-0.6
-0.1-1.9-0.4
-1.4-2.6-0.5
-2.4-2.1-0.7
-3.4-2.3-0.6
-8.1-5-0.5
-15.020740674-7.104942217-0.5333465482
-15.488219078-9.759570839-0.369350714
-18.6-11.321.11
-21.5-10.41.4
-21.9-10.51.2
-25.165715037-11.3310405620.391038581
-20.117165973-7.8242323110.384813384
-23.839257562-6.024064649-0.03
-42.263478706-13.734444838-1.27
-37.865393464-13.167262348-1.45
-37.245554999-14.145872176-1.08
Medicare
Medicaid
Other Government
Billions
Sheet1
979899000102030405060708091011121314
Medicare4.32.3-0.1-1.4-2.4-3.4-8.1-15.0-$15.49-$18.60-$21.50-$21.90-$25.17-$20.12-$23.84-$42.26-$37.87-$37.25
Medicaid-1.6-1.4-1.9-2.6-2.1-2.3-5-7.1-$9.76-$11.32-$10.40-$10.50-$11.33-$7.82-$6.02-$13.73-$13.17-$14.15
Other Government-0.7-0.6-0.4-0.5-0.7-0.6-0.5-0.5-$0.37$1.11$1.40$1.20$0.39$0.38-$0.03-$1.27-$1.45-$1.08
-
TRENDWATCH CHARTBOOK 2016Trends in Hospital Financing
Chart 4.8: Income from Investments and Other Non-operating Gains(1) as a Percentage of Total Net Revenue, 1994 2014
-1.0%
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14
Per
cent
age
of T
otal
Net
Rev
enue
Source: Analysis of American Hospital Association Annual Survey data, 2014, for community hospitals. (1) Non-operating gains include income from non-operating activities, including investments, endowments and
extraordinary gains, as well as the value of non-realized gains from investments.
Chart1
0.0146443613
0.0181661092
0.0229904813
0.0274555055
0.0275561852
0.0261920223
0.0258294887
0.0158556635
0.0076482891
0.0150078904
0.0165502502
0.0165088665
0.0207342186
0.0271417164
-0.0069192292
0.006469662
0.0181301504
0.0162428301
0.0141222671
0.0232724536
0.0200844727
Ratios
Percentage of Total Net Revenue
Sheet1
9293949596979899000102030405060708091011121314
Ratios1.9%1.8%1.5%1.8%2.3%2.7%2.8%2.6%2.6%1.6%0.8%1.5%1.7%1.7%2.1%2.7%-0.7%0.6%1.8%1.6%1.4%2.3%2.0%
-
TRENDWATCH CHARTBOOK 2016Trends in Hospital Financing
Chart 4.9: Number of Bond Rating Upgrades and Downgrades, Not-for-profit Health Care, 1995 2015
Source: Email correspondence with Moodys Investors Services.
-70
-50
-30
-10
10
30
50
70
95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15
Upgrades
Downgrades
-
TRENDWATCH CHARTBOOK 2016Trends in Hospital Financing
Chart 4.10: Median Average Age of Plant, 1994 2014
8.6 8.8 8.99.2 9.3 9.2 9.4
9.7 9.8 9.8 9.8 9.9 9.8 9.8 9.6 9.810.110.310.1 10.2
10.9
0
2
4
6
8
10
12
94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14
Year
s
Source: Optum, Almanac of Hospital Financial and Operating Indicators, 2005, 2008, 2009, 2010, 2011, 2013, 2014, 2015 and 2016 and CHIPS, The Almanac of Hospital and Financial Operating Indicators, 1994 and 1996-7.
Chart1
8.6
8.8
8.9
9.2
9.3
9.2
9.4
9.67
9.76
9.83
9.83
9.9
9.78
9.8
9.56
9.75
10.1
10.32
10.14
10.17
10.91
Age
Years
8.8
Sheet1
949596979899000102030405060708091011121314
Age8.68.88.99.29.39.29.49.79.89.89.89.99.89.89.69.810.110.310.110.210.9
-
TRENDWATCH CHARTBOOK 2016Trends in Hospital Financing
Chart 4.11: Percent Change in Employment Cost Index,(1) All Private Service Industries, All Health Services and Hospitals, 2006 2015(2)
Source: Bureau of Labor Statistics, Employment Cost Index, 12 months ending December 2015. Link: www.bls.gov.(1) Total compensation.(2) Data represent annualized 12 month percent change.
0%
1%
2%
3%
4%
5%
06 07 08 09 10 11 12 13 14 15
All Private Service Industries
Hospitals All Health Services
Slide Number 1Slide Number 2Slide Number 3Slide Number 4Slide Number 5Slide Number 6Slide Number 7Slide Number 8Slide Number 9Slide Number 10Slide Number 11Slide Number 12