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Top Hospitals by Medicaid and Medicare Payor Mix

August 24, 2017 BY Alanna Moriarty

Top Hospitals by Medicaid and Medicare Payor Mix

Updated August 2019

According to a survey released by the Medical Group Management Association (MGMA), operating expenses for medical practices increased at nearly the same rate as revenue between 2015 and 2016. Practices with increased revenue primarily attribute this growth to a greater number of non-physician providers (NPP) and key support staff.

The MGMA study states that medical practices with a higher NPP-to-physician ratio earn more in net revenue than those with lower ratios while also reporting greater productivity. The study compared more than 2,900 provider organizations and over 40 practice types.

Another key point from the survey stated that primary care practices with lower percentages of government payor mixes, like Medicaid and Medicare, were more likely to have both higher operating costs and greater revenue. On average, practices with a payor mix of less than 30 percent yielded more than $159,000 more in revenue per physician than those with a mix of 50 percent or more. That number jumps to $221,000 for hospital-owned practices.

In addition, a recent study by Navigant found that 47 percent of U.S. hospitals saw lower operating margins after the expansion of Affordable Care Act coverage.

Payor mix refers to the percentage of hospital revenue coming from private insurance companies versus government insurance programs versus self-paying patients. Payor mix is an important metric to track because self-paying patients and private insurance companies compensate hospitals at a higher rate than government programs like Medicare. Government programs often pay hospitals less than the actual cost of patient treatment, causing hospitals to lose revenue.

Practices that serve primarily Medicare and Medicaid beneficiaries, such as safety-net hospitals, rely far more heavily on reimbursement levels than hospitals with a lower percentage of Medicare and Medicaid patients. Hospitals with greater numbers of Medicaid and Medicare beneficiaries can struggle to draw patients with private insurance to their practices to balance the scales.

Below are the top hospitals with the highest and lowest payor mixes for Medicaid and Medicare, as well as net patient revenue.

Top 10 Hospitals with Highest Medicare Payor Mix in 2017

Hospital Definitive ID Payor Mix # Medicare Discharges Net Patient Revenue 
Ridgeview Behavioral Hospital 585562 97.9% 1,366 $22,655,423
AnMed Health Rehabilitation Hospital 274169 88.3% 1,261 $27,871,031
NeuroPsychiatric Hospital of Indianapolis 840549 87.4% 679 $13,025,910
Encompass Health Rehabilitation Hospital of Toms River 4914 86.6% 2,155 $61,407,583
Levindale Hebrew Geriatric Center & Hospital 5112 85.1% 1,156 $80,655,072
Encompass Health Rehabilitation Hospital of Rock Hill 5891 85.0% 1,173 $22,571,770
Columbus Hospital LTACH 6098 84.7% 579 $47,184,205
Deers Head Hospital Center 5653 84.3% 63 N/A
Promise Hospital of Louisiana - Shreveport Campus 5258 84.1% 1,499 $51,032,509
Encompass Health Rehabilitation Hospital of Princeton 6284 83.9% 925 $20,775,793

Fig 1 Data from Definitive Healthcare using most recent CMS data. Only hospitals with 50 or more beds and 50 or more Medicare discharges were included to decrease variability.

Top 10 Hospitals with Lowest Medicare Payor Mix in 2017

Hospital Definitive ID Payor Mix # Medicare Discharges Net Patient Revenue
Childrens Hospital of Philadelphia 3567 0.3% 77 $5,445,842
Texas Childrens Hospital 6386 0.4% 137 $1,921,106,127
The Womans Hospital of Texas 3995 0.4% 96 $401,691,768
USA Childrens & Womens Hospital 92 0.4% 78 $152,431,090
Phoenix Childrens Hospital 192 0.4% 68 $778,119,493
Kapiolani Medical Center for Women & Children 5509 0.4% 52 $412,847,215
Cincinnati Childrens Burnet Campus 5576 0.5% 117 $1,659,809,285
Womans Hospital 1753 0.5% 90 $272,391,125
Egleston Hospital 5185 0.5% 84 $692,613,103
Cook Childrens Medical Center 4133 0.5% 62 $879,525,637

Fig 2 Data from Definitive Healthcare using most recent CMS data. Only hospitals with 50 or more beds and 50 or more Medicare discharges were included to decrease variability.

Top 10 Hospitals with Highest Medicaid Payor Mix in 2017

Hospital Definitive ID Payor Mix # Medicare Discharges Net Patient Revenue
First Hospital 5065 81.7% 2,533 $24,310,602
WoodRidge Behavioral Hospital 840550 81.4% 465 $3,885,212
Hospital for Special Care 5400 81.2% 258 $99,148,586
Hebrew SeniorLife - Hebrew Rehabilitation Center 6261 80.2% 164 $118,758,407
College Hospital Costa Mesa 474 79.6% 2,076 $54,102,361
Lake Taylor Transitional Care Hospital 5279 79.6% 85 $39,065,511
Methodist Behavioral Hospital 5754 79.4% 1,576 $11,211,372
USA Childrens & Womens Hospital 92 78.2% 7,273 $152,431,090
Tewksbury Hospital 5375 76.9% 470 N/A
College Medical Center 391 75.6% 6,180 $82,456,681

Fig 3 Data from Definitive Healthcare using most recent CMS data. Only hospitals with 50 or more beds and 50 or more Medicare discharges were included to decrease variability.

Top 10 Hospitals with Lowest Medicaid Payor Mix in 2017

Hospital Definitive ID Payor Mix # Medicare Discharges Net Patient Revenue
Spence and Becky Wilson Baptist Childrens Hospital 855022 0.0% 2,705 $63,002,072
Roane Medical Center 3806 0.0% 305 $32,635,016
Womans Hospital 1753 0.4% 59 $272,391,125
Saint Lukes South Hospital 1567 0.4% 63 $138,054,110
Augusta Health 4261 0.4% 171 $287,202,920
Adventist Health Vallejo 5152 0.5% 416 $25,621,087
East Jefferson General Hospital 1769 0.5% 53 $303,204,574
Baptist Health Lexington 1658 0.5% 90 $537,500,535
Hospital for Special Surgery 2840 0.5% 56 $940,737,144
AMITA Health Adventist Medical Center La Grange 1162 0.5% 117 $163,413,354

Fig 4 Data from Definitive Healthcare using most recent CMS data. Only hospitals with 50 or more beds and 50 or more Medicare discharges were included to decrease variability.

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