Section 8: Health Care Providers and Service Availability
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Transcript of Section 8: Health Care Providers and Service Availability
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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
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HOSPITAL SYSTEM AND CAPACITY
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Hospital Capacity in Minnesota, 2011
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*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
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Minnesota Geographic Regions: Definition
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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
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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
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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%
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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
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Minnesota Hospital Outpatient Visits and Inpatient Admissions, 2001 to 2011
Source: MDH Health Economics Program analysis of hospital annual reports
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
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Ou
tpa
tien
t vi
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Outpatient visits
Inpatient admissions
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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
Source: MDH Health Economics Program analysis of hospital annual reports
Ave
rag
e le
ng
th o
f st
ay
(da
ys)
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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
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th o
f st
ay
(da
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Minnesota Hospital Utilization by Region, 2011
Source: MDH Health Economics Program analysis of hospital annual reports
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
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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%
Source: MDH Health Economics Program analysis of hospital annual reports
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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
Source: MDH Health Economics Program analysis of hospital annual reports
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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
Source: MDH Health Economics Program analysis of hospital annual reports
Em
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in T
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s
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HOSPITAL FINANCIAL TRENDS
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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
Source: MDH Health Economics Program analysis of hospital annual reports
Mill
ion
s o
f d
olla
rs
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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
Source: MDH Health Economics Program analysis of hospital annual reports
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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%
Source: MDH Health Economics Program analysis of hospital annual reports
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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%
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HOSPITAL CAPITAL EXPENDITURES
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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
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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%
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Source: MDH Health Economics Program analysis of hospital annual reports
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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
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COMMUNITY BENEFIT
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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%
Source: MDH Health Economics Program analysis of hospital annual reports
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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)
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AVAILABILITY OF SPECIFIC HOSPITAL SERVICES
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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
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PHYSICIAN SERVICES
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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
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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
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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
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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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