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Facility Demographics

  • Updated

Facility Demographics Overview + Video

This report contains high level information about the facility including a map with the location of the facility pinned. This information comes from the Medicare Cost Report submitted annually by the facility itself. We import this data into our system monthly, so that within one month of a new submission the update will appear in our system. 

Facility Metrics

The information summarized about the facility includes:

  • Number of beds
  • Total employees
  • Type of ownership
  • Fiscal Year
  • Number of discharges
  • Total inpatient days
  • Average length of stay
  • Total revenue
  • System affiliation
  • Network
  • GPO (Group Purchasing Organization)
  • Number of operating rooms
  • Number of endoscopy procedure rooms
  • Number of cardiac catheterization procedure rooms

Use this report to better understand the size of the hospital as measured by a variety of metrics such as revenue, number of beds, employees, procedure rooms, and inpatient days.

This report is also useful to understand how the facility relates to other organizations. Facility affiliations show whether the facility is owned or aligned with a bigger organization such as a health system or integrated delivery network. For example, if the targeted facility is owned by a corporate or for-profit entity (such as HCA or Tenet), you may need to consider how the broader corporate structure fits into purchasing decisions and technology acquisitions.

A facility’s affiliation with a Group Purchasing Organization (GPO) may significantly impact your ability to sell direct to the facility administrators or even physicians who are affiliated with the facility. If a facility is contracted with a GPO, your product or service may need to go through a vetting and approval process negotiated through the GPO rather than through facility employees.

 

Payer and Discharge Mix

 

Use this part of the Facility Demographics report to understand the different sources of revenue for the facility. Payer mix is an important metric monitored very closely facility administrators. Different types of payers or insurance companies reimburse facilities at different rates for the same procedure or service. Reimbursement rates depend on the underlying contracts negotiated between the payer (i.e. insurance company) and the facility.

 

In general, private pay sources of revenue will reimburse the facility at higher rates than government or public sources of revenue. For example, a facility will expect to earn more revenue per service or procedure if the patient is insured by Aetna, BlueCross Blue Shield, Cigna, and other commercial insurers as compared to if the patient is insured by Medicare or Medicaid.

The first part of the payer mix table breaks down the facility’s revenue by the three major sources of reimbursement: Medicaid, Medicare and Private Pay. Total revenue, revenue per discharge, and charges are broken down by each payer category.

Each facility must maintain a single uniform list price for each service, referred to as the service charge. The hospital's standard price list is also referred to as the charge master. Viewing the sum of charges (or list prices) for all services delivered by each payer gives you a uniform comparison of the services consumed by patients covered by each insurance type.

In contrast, revenue refers to the amount actually reimbursed or received from each payer category, after contractual adjustments and other discounts are applied. Revenue per discharge divides the amount reimbursed by the number of discharges according to each to each payer category.

The second part of the payer mix table breaks down discharges, inpatient days, and the average length of stays by each payer category.

In general, an average facility will receive approximately half their total revenue from private pay and other sources and approximately 25% from Medicaid and 25% from Medicare. These averages do not apply uniformly across facilities and can be impacted by geography, patient demographics, degree of competition, and other factors.

Knowing if the targeted facility diverges greatly from an average payer mix may uncover insights about the facility’s financial performance. For example, if a facility’s payer mix skews toward government or public sources of reimbursement (as measured by either the charges, revenue, discharges, or inpatient days), then the facility may have an even greater focus on controlling costs or improving operational efficiency.

Keep in mind that even if a facility receives a disproportionate share of their total revenue from private pay sources, the facility may wind up treating a higher volume of Medicare patients. Investigate discharges and inpatient days by payer category to help understand the sources of the facility’s inpatient volume (which drives many of the hospital’s costs) as compared to the sources of the facility’s total revenue.

Average length of stay by payer category shows differences, at a high level, of the acuity of the underlying patient population. You may uncover that the hospital’s sickest and longest-to-treat patients are covered by insurance sources with relatively lower levels of reimbursement.

 

 

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