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F INANCIALS
HOSPITALS/SYSTEMS DIGEST 2015
SANOFI / MANAGED CARE DIGEST SERIES
®
/
WHERE INFORMATION BECOMES INTELLIGENCE
.
™
30
HOSPI TALS IN MULT IHOSPI TAL SYSTEMS
Data source: IMS Health © 2015
Key Takeaway
Many new payment models incentivize disease management and preventive, outpatient-focused
care over more costly inpatient care. MHS hospitals that own plans could be leveraging their close
relationships with them to facilitate appropriate use of outpatient facilities by members and primary
care physicians. Their non-HMO-owning counterparts may be narrowing the outpatient revenue gap
by adopting some of the same practices in response to new payment methodologies.
Total Revenue Edges Down Among MHS Hospitals With HMOs
• From 2012 to 2013, total revenue shrank
1.7% (to $482.7 million from $491.0 million)
at hospitals in MHSs that owned HMOs and
0.2% (to $464.9 million from $465.8 million)
in hospitals that did not own HMOs.
• At the same time, inpatient revenue slipped
2.3% (to $270.2 million from $276.6 million)
in hospitals in MHSs that owned HMOs and
0.8% (to $260.1 million from $262.3 million)
in those that did not own HMOs.
$193.9
$208.6
$216.6
$209.4
$214.4
$212.5
$159.0
$177.3
$186.5
$197.5
$203.6
$204.8
$122.9
$135.7
$144.8
$146.7
$154.4
$158.3
2008
2009
2010
2011
2012
2013
$100
$135
$170
$205
$240
Outpatient Revenue (Millions)
Hospitals in MHSs Owning HMOs
Hospitals in MHSs Not Owning HMOs
All Hospitals
AVERAGE OUTPATIENT REVENUE, 2008–2013
HOSPITAL UTILIZATION FINANCIAL STATISTICS
Average # of
Discharges
per Year
Total Revenue
(Millions)
Inpatient
Revenue
(Millions)
Inpatient
Revenue as
% of Total
Revenue
Outpatient
Revenue
(Millions)
Outpatient
Revenue as
% of Total
Revenue
HOSPITAL TYPE
2012 2013 2012 2013 2012 2013 2012 2013 2012 2013 2012 2013
Hospitals in MHSs
Owning HMOs
9,928 9,783 $491.0 $482.7 $276.6 $270.2 56.3% 56.0% $214.4 $212.5 43.7% 44.0%
Hospitals in MHSs
Not Owning HMOs
9,785 9,695 465.8 464.9 262.3 260.1 56.3 55.9 203.6 204.8 43.7 44.1
ALL HOSPITALS
7,148 7,190 $344.7 $351.8 $190.3 $193.5 55.2% 55.0% $154.4 $158.3 44.8% 45.0%
Outpatient Revenue Grows Faster in MHS Hospitals Without HMOs
• In 2008, average outpatient revenue in
MHS hospitals with HMOs was 21.9% higher
than that of MHS hospitals without HMOs.
In 2013, this margin contracted to 3.8%.
• From 2008 to 2013, average outpatient revenue
at hospitals in MHSs that did not own HMOs
climbed 28.8% versus 9.6% at MHS hospitals that
owned HMOs. The measure rose 28.8% overall.
LONG-TERM TREND