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*Updated as of May 14, 2019
Patients seeking affordable, convenient care facilities are molding the outpatient care industry. This demand has led to innovation in the field of telehealth, and encouraged the growth of retail clinics, outpatient surgery centers, and freestanding imaging centers. Patients no longer rely solely on hospitals to receive preventative care and treatment.
The rise in popularity of outpatient care facilities has caused speculation about fragmented care and increased healthcare costs among industry experts, leading hospital leaders to acquire or partner with outpatient care centers - including physician groups - to prevent patient leakage and revenue loss.
When most people picture a hospital, they think of a short-term acute care (STAC) hospital. For outpatient visits or short inpatient visits not requiring rehabilitation, that is where most patients seek care first. Now, with the popularization of outpatient care centers, patients are choosing short-term care facilities less often—however, outpatient centers cannot always provide the kind of integrated, connected care a hospital can, particularly when it comes to inpatient care.
|Rank||Hospital Name||Net Patient Revenue||Staffed Beds|
|1.||New York-Presbyterian Hospital at Weill Cornell Medical Center (NY)||$5,340,902,266||862|
|2.||Cleveland Clinic Main Campus (OH)||$4,858,709,504||1,266|
|3.||Stanford Hospital (CA)||$4,132,132,686||447|
|4.||NYU Langone Tisch Hospital (NY)||$4,101,296,000||725|
|5.||UCSF Helen Diller Medical Center at Parnassus Heights (CA)||$3,620,962,130||782|
|6.||University of Texas MD Anderson Cancer Center (TX)||$3,480,505,919||674|
|7.||Vanderbilt University Medical Center (TN)||$3,442,776,569||626|
|8.||AdventHealth Orlando (FL)||$3,432,794,596||2,626|
|9.||University of Michigan - University Hospital (MI)||$3,296,778,854||931|
|10.||Cedars-Sinai Medical Center (CA)||$3,140,742,831||880|
Fig 1 Data from Definitive Healthcare’s hospital & IDN platform
STAC hospitals are by far the most prolific hospital type in the United States, making up just under half of all U.S. hospitals. However, STAC facilities are vastly outnumbered by urgent care clinics and outpatient surgery centers – where there are roughly 3,900 active STAC hospitals, there are more than 9,900 urgent care clinics and 9,400 ambulatory surgery centers (ASCs) in the U.S. according to Definitive Healthcare data.
Currently, three of the top ten STAC hospitals by net patient revenue are based in California and two are in New York. This is likely due to high patient volumes that come with locations in or near major metropolitan areas. Although Stanford Hospital (CA) ranks third for highest net patient revenue, it has the fewest staffed beds on the list with 447. Interestingly, the hospitals with the greatest number of staffed beds are in Florida and Ohio, ranking second and eighth by net patient revenue, respectively.
|Rank||Hospital Name||Net Patient Revenue||Staffed Beds|
|1.||AdventHealth Orlando (FL)||$3,432,794,596||2,626|
|2.||Methodist Hospital (TX)||$1,499,642,523||1,548|
|3.||Jackson Memorial Hospital (FL)||$1,166,828,685||1,457|
|4.||Montefiore Hospital - Moses Campus (NY)||$2,728,344,000||1,449|
|5.||Baptist Medical Center (TX)||$1,034,929,360||1,405|
Fig 2 Data from Definitive Healthcare’s hospital & IDN platform
As you can see from the tables above, a greater number of staffed beds does not necessarily correlate with higher net patient revenue. Of the top 5 STAC hospitals with the most staffed beds, only one is on the list of facilities with the highest net patient revenue.
The short-term acute care model differs from long-term acute care hospitals in several ways. Long-term acute care (LTAC) hospitals operate in a similar manner to short-term but focus on patients staying more than 25 days. Long-term acute care hospitals generally offer comprehensive rehabilitation, respiratory therapy, treatment for head trauma, and pain management services in addition to short-term services. Currently the Definitive Healthcare database contains clinical and financial intelligence on more than 460 long-term acute care hospitals.
|Rank||Hospital Name||Net Patient Revenue||Avg LoS|
|1.||Piedmont Geriatric Hospital (VA)||$24,208,951||577.2|
|2.||McLeod Darlington (SC)||$10,824,579||209.4|
|3.||Texas Center for Infectious Disease (TX)||$18,944,100||169.8|
|4.||Jasper General Hospital (MS)||$14,116,247||129.6|
|5.||Eastern State Hospital (VA)||$5,580,799||44|
Fig 3 Data from Definitive Healthcare’s hospital & IDN platform. Length of stay is measured in days. Does not include Anderson Regional Medical Center – South, as it is an extreme outlier.
One challenge facing short-term acute care hospitals is patient length of stay. Longer lengths of stay have been linked to higher readmission rates, particularly for cardiovascular issues. Patients are also more likely to contract hospital-acquired infections (HAIs) or other hospital-acquired conditions (HACs) the longer their hospital stay.
For facilities like Piedmont Geriatric Hospital, with an average stay length of 82 weeks, patients are more likely to develop HACs during their stay. High rates of HACs hurt a hospital’s net revenue, and likely increases the hospital’s risk of receiving penalties from the Centers for Medicare and Medicaid Services (CMS). Longer lengths of stay also decrease patient turnover, as there are fewer unoccupied beds, reducing the number of patients a hospital can hold for treatment. This could lead to patient transfers to other facilities, resulting in greater revenue loss.
Though there are a variety of challenges facing short-term acute care hospitals, they still dominate the short-term care industry. Given their history of providing comprehensive, reliable care, it will be difficult to unseat them.
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