Top hospitals by Medicaid and Medicare payor mix
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By Maggy Tieche
Revenue sources for U.S. hospitals play an important role in an organization’s financial health and performance. This payor mix, or payer mix, refers to the percentage of hospital revenue from healthcare insurance companies versus government insurance programs like Medicare and Medicaid.
How is payor mix calculated?
In the Definitive Healthcare HospitalView product, payor mix data represents the breakdown of revenues, charges, discharges, and patient days that come from different medical insurance claims payors. The proprietary calculation is based on a facility’s charge and revenue measures in the Medicare Cost Report.
Results in the following analysis are aggregated from the most recent 12-month interval tracked in our database. The most recent full calendar year of data available at the time of publishing is for 2021.
Why is payor mix important in healthcare?
Payor mix is an important metric to track because self-paying patients and healthcare insurance companies compensate hospitals at a higher rate than government programs like Medicare. Government programs may pay hospitals less than the actual cost of patient treatment, impacting hospital revenue.
Facilities that serve primarily Medicare and/or Medicaid beneficiaries, such as safety-net hospitals, rely far more heavily on government 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 balance the scales.
What is the average payor mix at U.S. hospitals?
On average, payor mix between Medicare, Medicaid and private/self-pay at U.S. hospitals is estimated at:
Average payor mix based on net patient revenue
Fig. 1 Data is from the Definitive Healthcare HospitalView product and derived from the Medicare Cost Report. Accessed June 2023.
How is payor mix changing?
The percentage of the total payor mix from private/self-pay revenue increased from 66.5% in 2018 to 68.9% in 2021. The Medicare percentage decreased from 21.8% to 18.9%.
In addition, the percentage of patient days covered by private/self-payors has increased from 42.7% in 2011 to 56.5% in 2021 while the percentage of Medicare patient days decreased by about 10 percentage points to 35.6%. This trend points towards the increase in Medicare Advantage enrollment, or the Medicare Part C plans offered by private payors approved by Medicare.
The payor mix percentage for Medicaid revenue increased slightly from 12.8% to 13.5% 2018 to 2021. Medicaid enrollment has been increasing with the expansion of the Affordable Care Act (ACA) and during the COVID-19 pandemic.
Which hospitals have the highest and lowest Medicare payor mix?
Below are the top hospitals with the highest and lowest payor mix days for Medicare. For this analysis, only hospitals with more than 50 discharges in the previous year and more than 50 beds are included to minimize outliers.
U.S. hospitals by highest Medicare payor mix
| Rank | Definitive ID | Hospital name | Hospital type | Location | Payor mix: Medicare days |
| 1 | 6194 | Whittier Rehabilitation Hospital - Westborough | Long-term acute care hospital | Westborough, MA | 91.3% |
| 2 | 585562 | Ridgeview Behavioral Hospital | Psychiatric hospital | Middle Point, OH | 86.1% |
| 3 | 6273 | Encompass Health Rehabilitation Hospital of Wichita Falls | Rehabilitation hospital | Wichita Falls, TX | 85.9% |
| 4 | 5653 | Deers Head Hospital Center | Long-term acute care hospital | Salisbury, MD | 82.9% |
| 5 | 274169 | AnMed Health Rehabilitation Hospital | Rehabilitation hospital | Anderson, SC | 82.4% |
| 6 | 981256 | Tidelands Health Rehabilitation Hospital - Murrells Inlet | Rehabilitation hospital | Murrells Inlet, SC | 82.3% |
| 7 | 1012378 | Encompass Health Rehabilitation Hospital of Cumming | Rehabilitation hospital | Cumming, GA | 80.7% |
| 8 | 5295 | Encompass Health Rehabilitation Hospital of Salisbury | Rehabilitation hospital | Salisbury, MD | 80.5% |
| 9 | 976111 | The Blackberry Center | Psychiatric hospital | Saint Cloud, FL | 80.3% |
| 10 | 1046223 | Encompass Health Rehabilitation Hospital of Lakeland | Rehabilitation hospital | Lakeland, FL | 77.4% |
Fig. 2 Data is from the Definitive Healthcare HospitalView product and derived from the Medicare Cost Report. Accessed June 2023.
Whittier Rehabilitation Hospital - Westborough in Massachusetts, a long-term acute care hospital, has the highest Medicare payor mix at 91.3%. Second, Ridgeview Behavioral Hospital, a psychiatric hospital in Middle Point, Ohio has a Medicare payor mix of over 86.1%.
U.S. hospitals by lowest Medicare payor mix
| Definitive ID | Hospital name | Hospital type | Location | Payor mix: Medicare days |
| 4941 | Austin State Hospital | Psychiatric hospital | Austin, TX | 0.0% |
| 843011 | Children’s Hospital Colorado - Colorado Springs | Children’s hospital | Colorado Springs, CO | 0.0% |
| 6343 | Children’s Scottish Rite Hospital | Children’s hospital | Atlanta, GA | 0.0% |
| 542196 | El Paso Children’s Hospital | Children’s hospital | El Paso, TX | 0.0% |
| 5579 | Eleanor Slater Hospital | Long-term acute care hospital | Cranston, RI | 0.0% |
| 7252 | Nationwide Children’s Hospital - Toledo | Children’s hospital | Toledo, OH | 0.0% |
| 6212 | Nationwide Children’s Hospital - Toledo | Psychiatric hospital | Richmond, IN | 0.0% |
Fig. 3 Data is from the Definitive Healthcare HospitalView product and derived from the Medicare Cost Report. Accessed June 2023.
Seven U.S. hospitals have zero Medicare payor mix days. Four hospitals on the list are children’s hospitals. Since Medicare supports individuals over the age of 65, it is fitting that many children’s hospitals do not receive any Medicare reimbursement.
Which hospitals have the highest and lowest Medicaid payor mix?
Seven U.S. hospitals have zero Medicare payor mix days. Four hospitals on the list are children’s hospitals. Since Medicare supports individuals over the age of 65, it is fitting that many children’s hospitals do not receive any Medicare reimbursement.
U.S. hospitals with highest Medicaid payor mix
| Rank | Definitive ID | Hospital name | Hospital type | Location | Payor mix: Medicaid days |
| 1 | 1565 | Meadowbrook Rehabilitation Hospital | Rehabilitation hospital | Gardner, KS | 85.7% |
| 2 | 5279 | Lake Taylor Transitional Care Hospital | Long-term acute care hospital | Norfolk, VA | 85.4% |
| 3 | 6252 | Brookhaven Hospital | Psychiatric hospital | Tulsa, OK | 84.5% |
| 4 | 8098 | Mohawk Valley Psychiatric Center | Psychiatric hospital | Utica, NY | 83.1% |
| 5 | 5122 | Brentwood Behavioral Healthcare | Psychiatric hospital | Flowood, MS | 82.5% |
| 6 | 840550 | Perimeter Behavioral Hospital of West Memphis | Psychiatric hospital | West Memphis, AR | 81.4% |
| 7 | 947886 | Cornerstone Behavioral Health - El Dorado | Psychiatric hospital | Tucson, AZ | 81.0% |
| 8 | 541988 | Nemours Children’s Hospital - Florida | Children’s hospital | Orlando, FL | 80.3% |
| 9 | 6261 | Hebrew SeniorLife - Hebrew Rehabilitation Center | Long-term acute care hospital | Boston, MA | 79.3% |
| 10 | 5400 | Hospital for Special Care | Long-term acute care hospital | Britain, CT | 79.0% |
Fig. 4 Data is from the Definitive Healthcare HospitalView product and derived from the Medicare Cost Report. Accessed June 2023.
Meadowbrook Rehabilitation Hospital in Gardner, Kansas and Lake Taylor Psychiatric Care Hospital in Norfolk, Virginia have the highest Medicaid payor mix days, each at more than 85%.
U.S. hospitals with lowest Medicaid payor mix
| Definitive ID | Hospital name | Hospital type | Location | Payor mix: Medicaid days |
| 5670 | Baton Rouge Rehab Hospital | Rehabilitation hospital | Baton Rouge, LA | 0.0% |
| 3916 | Baylor Scott & White Heart and Vascular Hospital - Dallas | Short term acute care hospital | Dallas, TX | 0.0% |
| 3942 | Carrollton Regional Medical Center | Short term acute care hospital | Carrollton, TX | 0.0% |
| 2548 | CHI Health Nebraska Heart | Short term acute care hospital | Lincoln, NE | 0.0% |
| 577363 | Hoag Orthopedic Institute | Short term acute care hospital | Irvine, CA | 0.0% |
| 1079 | Kuakini Medical Center | Short term acute care hospital | Honolulu, HI | 0.0% |
| 1566 | Menorah Medical Center | Short term acute care hospital | Overland Park, KS | 0.0% |
| 4910 | Sea Pines Rehabilitation Hospital | Rehabilitation hospital | Melbourne, FL | 0.0% |
| 855022 | Spence and Becky Wilson Baptist Children’s Hospital | Children’s Hospital | Memphis, TN | 0.0% |
| 5391 | Springbrook Behavioral Health | Psychiatric hospital | Travelers Rest, SC | 0.0% |
| 6093 | Terrell State Hospital | Psychiatric hospital | Terrell, TX | 0.0% |
Fig. 5 Data is from the Definitive Healthcare HospitalView product and derived from the Medicare Cost Report. Accessed June 2023.
Eleven hospitals currently have Medicaid payor mix days at 0.0%. The hospitals on the list range from a children’s hospital to psychiatric and rehabilitation hospitals. A number of the short-term acute care hospitals on the list are specialty hospitals for the heart or orthopedics.
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