Section 8: Health Care Providers and Service Availability Hospital system and capacity Utilization of hospital services Hospital financial trends Hospital

Section 8: Health Care Providers and Service Availability

• Hospital system and capacity• Utilization of hospital services• Hospital financial trends• Hospital capital expenditures• Hospital community benefit• Availability of specific health care services at hospitals (e.g., imaging, surgery)

• Physician services

1

HOSPITAL SYSTEM AND CAPACITY

Hospital Capacity in Minnesota, 2011

3

*Available beds is defined as the number of acute care beds that are immediately available for use or could be brought online within a short period of time. **Licensed beds is defined as the number of beds licensed by the Department of Health, under Minnesota Statutes, sections 144.50 to 144.58.Source: MDH Health Economics Program analysis of hospital annual reports, U.S. Census Bureau

Number of Hospitals

Available Beds*

Occupancy Rate Based on Available

BedsLicensed Beds**

Occupancy Rate Based on Licensed

Beds

Available Beds Per

1,000 Population

133 11,724 56.5% 16,415 40.4% 2.2

Minnesota Geographic Regions: Definition

4

Regional Hospital Capacity in Minnesota, 2011

Number of

HospitalsAvailable

Beds*

Occupancy Rate Based on Available

BedsLicensed

Beds**

Occupancy Rate Based on Licensed

Beds

Available Beds Per

1,000 Population

Central 19 1,145 49.5% 1,377 41.2% 1.6

Metro 26 5,939 67.0% 8,484 46.9% 2.1

Northeast 17 1,170 46.3% 1,410 38.4% 3.6

Northwest 13 390 35.9% 578 24.2% 1.9

South Central 15 557 39.5% 779 28.2% 1.9

Southeast 12 1,604 59.4% 2,640 36.1% 3.2

Southwest 23 591 20.1% 725 16.4% 2.7

West Central 8 328 32.7% 422 25.4% 1.7

Total 133 11,724 56.5% 16,415 40.4% 2.2

*Available beds is defined as the number of acute care beds that are immediately available for use or could be brought online within a short period of time. **Licensed beds is defined as the number of beds licensed by the Department of Health, under Minnesota Statutes, sections 144.50 to 144.58.Source: MDH Health Economics Program analysis of hospital annual reports

5

Distribution of Minnesota’s Hospitals by Size and Region, 2011

Source: MDH Health Economics Program analysis of hospital annual reports

Under 25 Beds

25-49 Beds

50-99 Beds

100-199 Beds

200 or More Beds

Total

Central 10.5% 68.4% 10.5% 5.3% 5.3% 100.0%

Metro 3.8% 11.5% 26.9% 11.5% 46.2% 100.0%

Northeast 47.1% 17.6% 17.6% 5.9% 11.8% 100.0%

Northwest 46.2% 46.2% 0.0% 7.7% 0.0% 100.0%

South Central 53.3% 26.7% 13.3% 6.7% 0.0% 100.0%

Southeast 25.0% 25.0% 33.3% 0.0% 16.7% 100.0%

Southwest 39.1% 56.5% 4.3% 0.0% 0.0% 100.0%

West Central 37.5% 37.5% 12.5% 12.5% 0.0% 100.0%

Statewide 30.1% 36.1% 15.0% 6.0% 12.8% 100.0%

By Number of Available Beds

6

Ownership of Minnesota Hospitals, 2011

Religiously Affiliated, 10,

7.5%

Private Non-Profit, 84,

63.2%

For Profit, 1, 0.8%

*District hospitals are nonfederal government sponsored hospitals organized at a level other than city or countySource: MDH Health Economics Program analysis of hospital annual reports

Government: 28.6%

City: 9.8% County: 6.8%City and County: 1.5%District*: 10.5%

7

Composition of Minnesota’s Hospital Workforce, 2011

Physical and Occupational

Therapists1.8%

Pharmacist1.5%

Registered Nurse29.3%

X-Ray Technician3.3%

Lab Technician3.1%

Nursing Assistant/Aide

5.1%

Licensed Practical Nurse2.7%

Physician2.3%

Mid Level Practitoner1.5%

Other49.4%

*Includes nurse anesthetists, nurse practitioners, and physician assistantsSource: MDH Health Economics Program analysis of hospital annual reports

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UTILIZATION OF HOSPITAL SERVICES

Minnesota Hospital Outpatient Visits and Inpatient Admissions, 2001 to 2011


0

2,000,000

4,000,000

6,000,000

8,000,000

10,000,000

12,000,000

0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Adm

issi

ons

Ou

tpa

tien

t vi

sits

Outpatient visits

Inpatient admissions

10

Average Length of Stay in Minnesota Hospitals, 2001 to 2011

4.4 4.3 4.3 4.2 4.2 4.2 4.2 4.3 4.2 4.2 4.3

0

1

2

3

4

5

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011


Ave

rag

e le

ng

th o

f st

ay

(da

ys)

11

Average Length of Stay: Rural and Urban Minnesota Hospitals, 2001 to 2011

3.63.4 3.3

4.6 4.4 4.4

0.0

1.0

2.0

3.0

4.0

5.0

2001 2006 2011

Rural Urban

A hospital is defined as rural if it is located in a county that is not part of a metropolitan statistical area.Source: MDH Health Economics Program analysis of hospital annual reports

Ave

rag

e le

ng

th o

f st

ay

(da

ys)

12

Minnesota Hospital Utilization by Region, 2011


Inpatient Admissions

Inpatient Days

Average Length of Stay

(days)

Outpatient Visits

Central 57,459 206,834 3.6 1,513,330

Metro 327,589 1,452,007 4.4 3,990,619

Northeast 45,950 197,702 4.3 939,738

Northwest 14,715 51,131 3.5 489,704

South Central 22,213 80,279 3.6 718,540

Southeast 75,664 347,761 4.6 1,697,574

Southwest 13,440 43,413 3.2 537,549

West Central 11,029 39,185 3.6 444,913

Statewide 568,059 2,418,312 4.3 10,331,967

13

Distribution of Hospital Admissions and Inpatient Days by Type of Service, 2011

Percent of

AdmissionsPercent of

Inpatient Days

Medical & surgical care 33.6% 34.9%

Cardiac care 12.1% 10.5%

Obstetric care 12.6% 7.6%

Orthopedic care 12.4% 9.8%

Psychiatric care 6.2% 11.1%

Neurology care 5.7% 5.9%

Neonatal care (excluding births) 3.8% 4.8%

Chemical dependency care 1.6% 2.0%

Rehabilitation 1.1% 3.0%

Other acute care 10.9% 10.4%

Total acute care 100% 100%


14

Trend in Outpatient Surgeries at Minnesota Hospitals, 2001 to 2011

0

50

100

150

200

250

300

350

400

450

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Ou

tpa

tien

t Su

rge

rie

s in

Th

ou

san

ds


15

Trend in Emergency Room Visits at Minnesota Hospitals, 2001 to 2011

0

200

400

600

800

1,000

1,200

1,400

1,600

1,800

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011


Em

erg

en

cy R

oo

m V

isits

in T

ho

usa

nd

s

16

HOSPITAL FINANCIAL TRENDS

Net Income of Minnesota Hospitals, 2001 to 2011

$309

$400 $454

$615

$705

$616

$872

$344

$983

$1,104 $1,150

$0

$200

$400

$600

$800

$1,000

$1,200

$1,400

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011


Mill

ion

s o

f d

olla

rs

18

Minnesota Hospitals' Net Income as a Percent of Revenue, 2001 to 2011

4.4%

5.1% 5.3%

6.6%6.9%

5.6%

7.3%

2.7%

7.3%7.7% 7.6%

0%

1%

2%

3%

4%

5%

6%

7%

8%

9%

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011


19

Hospital Financial Indicators by Region, 2011

Net Income

(Million Dollars)Net Income as a

% of Revenue

Central $195.7 12.3%

Metro $406.2 5.1%

Northeast $134.4 9.2%

Northwest $35.4 9.1%

South Central $47.8 7.5%

Southeast $284.1 12.8%

Southwest $29.3 6.8%

West Central $17.1 5.5%

Statewide $1,150.1 7.6%


20

Hospital Financial Indicators by Hospital Size, 2011

Number of available beds. PPS stands for Prospective Payment System, a method of reimbursing hospitals based on a predetermined, fixed amount. Most acute care, non-Critical Access facilities are so called PPS hospitals.Source: MDH Health Economics Program analysis of hospital annual reports

Net Income

(in mill $)Net Income as a % of Revenue

Under 25 Beds $28.3 5.2%

25 to 49 Beds $173.2 9.4%

50 to 99 Beds $105.1 5.4%

100 to 199 Beds $92.0 6.4%

200 Beds or More $751.5 8.1%

Critical Access $137.6 7.8%

PPS $1,008.5 7.6%

Other $4.0 3.9%

All Hospitals $1,150.1 7.6%

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Sources of Patient Revenue for Minnesota Hospitals, 2011

*Includes Medical Assistance and MinnesotaCareA hospital is defined as rural if it is located in a county that is not part of a metropolitan statistical area.Source: MDH Health Economics Program analysis of hospital annual reports

Percent of Hospital Patient Revenue

Rural Facilities

Urban Facilities

Facilities Statewide

Medicare 38.5% 28.5% 30.5%

State Public Programs* 11.3% 12.8% 12.5%

Private Insurance 44.1% 53.4% 51.5%

Self-Pay 4.2% 3.5% 3.6%

Other Payers 1.9% 1.8% 1.8%

All Payers 100.0% 100.0% 100.0%

22

HOSPITAL CAPITAL EXPENDITURES

Capital Expenditure Commitments by Minnesota Hospitals, Calendar Year 2011

2010 2011

Percent of Minnesota hospitals reporting major capital expenditure commitment

29.6% 26.3%

Total number of capital expenditure commitments reported 103 81

Value of major capital expenditure commitments reported (Millions)

$668.3 $380.3

Major spending commitments that are reportable under 62J.17 include expenditures in excess of $ 1 million.A small portion of capital expenditure data may belong to earlier reporting periods.Source: MDH Health Economics Program analysis of hospital annual reports

24

Minnesota Hospital Capital Expenditure Commitments by Type, 2011

Capital Expenditure Commitments

(Millions)

Percent of Total Capital Expenditure

Commitments

Medical equipment $80.7 21.2%

Building and space $270.1 71.0%

Other $29.5 7.7%

All Major Capital Expenditure Commitments $380.3 100%

25


Minnesota Hospital Capital Expenditure Commitment by Category, 2011

Capital Expenditure Commitments

(Millions)

Percent of Total Capital Expenditure

Commitment

Other Patient Care Services $104.5 27.5%

General Infrastructure $80.2 21.1%

Surgery $69.3 18.2%

Diagnostic Imaging $39.5 10.4%

Mental Health $36.7 9.6%

Emergency Care $35.3 9.3%

Cardiac Care $13.2 3.5%

Obstetrics $1.7 0.4%

All Major Capital Projects $380.3 100.0%

Major spending commitments that are reportable under 62J.17 include expenditures in excess of $ 1 million. Source: MDH Health Economics Program analysis of hospital annual reports

26

COMMUNITY BENEFIT

Community Benefit Provided by Minnesota Hospitals, 2011

Community Benefit (Millions)

Percent of Total Operating Expenses

Community Care $152.0 1.1%

State Health Care Programs Underpayment $427.2 3.1%

Operating Subsidized Services $98.2 0.7%

Education $188.0 1.4%

Research $14.3 0.1%

Community Health Services $38.7 0.3%

Financial and In-Kind Contributions $13.0 0.1%

Community Building Activities $7.5 0.1%

Community Benefit Operation $12.3 0.1%

Total $951.1 6.9%


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Distribution of Minnesota Hospitals’ Community Benefit by Category, 2011

State Health Care Programs

Underpayment44.9%

Community Care16.0%

Education19.8%

Operating Subsidized Services10.3%

Community Health Services

4.1%

Financial and In-Kind Contributions

1.4%

Research1.5%

Community Benefit Operation

1.3%Community Building

Activities0.8%

Source: MDH Health Economics Program analysis of hospital annual reportsFor definitions see: MDH/Health Economics Program, “Community Benefit Provided by Minnesota Hospitals in 2011,” forthcoming (www.health.state.mn.us/healtheconomics)

29

AVAILABILITY OF SPECIFIC HOSPITAL SERVICES

Services Available in Minnesota Hospitals, 2011

*Services are considered “available” when they are provided on site by hospital staff, on site through contracted services, or off site through shared services agreement.Source: MDH Health Economics Program analysis of hospital annual reports

Number of Hospitals

Services Available*

Services Not Available

Surgery

Inpatient Surgery 128 5

Outpatient Surgery 131 2 Open-Heart Surgery Services 18 115 Organ Transplant Services 6 127Mental Health/Chemical Dependency Services

Outpatient Psychiatric Services 61 72 Detoxification Services 26 108Diagnostic Radiology

Computer Tomography (CT) Scanning Services 132 1 Magnetic Resonance Imaging (MRI) Services 130 3 Positron Emission Tomography (PET) Services 8 125 Single Photon Emission Computerized Tomography (SPECT) Services 40 93

Other Services

Renal Dialysis Services 42 91 Cardiac Catheterization Services 25 108

31

PHYSICIAN SERVICES

Number of Physicians Practicing in Minnesota, 2011

Primary Care includes: General Family Medicine, General Internal Medicine, General Pediatrics.No Certification means there were no board certifications on the record received from the Minnesota Board of Medical Practice.Source: Minnesota Board of Medical Practices, analysis of MDH, Office of Rural Health & Primary Care

Number of Physicians: 15,523

Primary Care Physicians 4,937

Specialty Care Physicians 7,532

No Certification 3,054

Physicians per 100,000 Population: 290

Primary Care Physicians 92

Specialty Care Physicians 141

33

Number of Physicians Practicing in Minnesota by MSA and Non-MSA Counties, 2011

MSA Defintions, OMB 2008Note: Due to methodology changes, past Chartbook data should not be used for comparison.Source: Minnesota Board of Medical Practices, analysis by MDH, Office of Rural Health & Primary Care

Rural Micropolitan Urban Statewide

Number of Physicians: 572 1,136 13,815 15,523

Primary Care Physicians 341 528 4,068 4,937

Specialty Care Physicians 100 418 7,014 7,532

Physicians per 100,000 Population: 88 168 364 290

Primary Care Physicians 52 78 101 92

Specialty Care Physicians 15 62 175 141

34

Distribution of Number of Physicians Practicing in Minnesota by Location and Specialty, 2011

Rural Micropolitan Urban Statewide

Primary Care Physicians 59.6% 46.5% 29.4% 31.8%

Internal Medicine Subspecialty Physicians

0.9% 2.7% 10.4% 9.5%

Surgeons 9.8% 19.0% 13.7% 13.9%

Other Specialty Physicians6.8% 15.1% 26.7% 25.1%

No Certification 22.9% 16.7% 19.8% 19.7%

All Specialties 100% 100% 100% 100%

MSA Defintions, OMB 2008Note: Due to methodology changes, past Chartbook data should not be used for comparison.Source: Minnesota Board of Medical Practices, analysis by MDH, Office of Rural Health & Primary Care

35

Additional Information from the Health Economics Program Available Online

• Health Economics Program Home Page• www.health.state.mn.us/divs/hpsc/hep/index.html

• Publications• www.health.state.mn.us/divs/hpsc/hep/publications/yearly/2010.htm

l

• Health Care Market Statistics (Chartbook Updates)• www.health.state.mn.us/divs/hpsc/hep/chartbook/index.html

• Interactive Health Insurance Statistics• https://pqc.health.state.mn.us/mnha/Welcome.action

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Documents

Section 8: Health Care Providers and Service Availability Hospital system and capacity Utilization of hospital services Hospital financial trends Hospital