Hospital Financial Data Interactive Series: Hospital Average Cost and Profitability Delivering Patient Care

From 2012-2019, comparable hospitals in California saw an upward trend in total net patient revenue per adjusted discharge (an approximate 32.9 percent increase) and total operating expenses per adjusted discharge (an approximate 31.4 percent increase) statewide. Adjusting for inflation, the increase was about 18.7 percent for total net patient revenue per adjusted discharge, and about 17.3 percent for total operating expenses per adjusted discharge.

The Hospital Financial Data Interactive Series presents data visualizations built from the financial reports that all  California hospitals are required to submit annually to the Department of Health Care Access and Information (HCAI). The visualizations were created to help assess hospital financial status and service volume and to advance healthcare and cost transparency.

This is the third topic of the interactive series. These visualizations are focused on specific financial data items related to cost of delivering care collected in the annual financial data, presented per adjusted discharge. Links to each entry of this series can be found on the Hospital Financial Data Interactive Series landing page.

The HCAI Financial Data includes both inpatient and outpatient dollars to show the cost of care in various care settings and by specific episodes of care. The purpose of “adjusting” the discharges is to account for outpatient care volume. See the notes following each visualization to learn more about the adjustment for each financial data item.

The visualizations represent aggregate amounts for all California hospitals. Users may select specific hospitals to show totals related to the individual facility. Use the drop-down menus to select the data for the specific county and/or facility. 

The visualizations in this series specifically include fully audited data on comparable hospitals through calendar years 2012-2019. Kaiser, state, and psychiatric health facilities are not included, as they submit data differently than the other hospitals. Per SB 343, Kaiser Permanente began submitting annual financial files for the 2022 fiscal year end.

Gross Patient Revenue per Adjusted Discharge by Year#

The total gross patient revenue of all California hospitals by year, and those of specified counties, cities, teaching/rural designations, control types, or facilities, per adjusted discharge. An additional breakdown by payer category is provided.

Payer categories include:

• Medicare – Traditional
• Medicare – Managed
• Medi-Cal – Traditional
• Medi-Cal – Managed
• County Indigent – Combined (Traditional and Managed)
• Third Party – Traditional
• Third Party – Managed
• Other Indigent
• All Other

Note: This visualization displays the gross patient revenue per adjusted discharge by year with breakdowns by payer category. “Adjusted discharge” is a scaling factor to account for outpatient care volume and is calculated by dividing a facility’s gross patient revenue by its gross inpatient revenue and multiplying by total discharges. The “County Indigent – Combined” payer category includes both traditional and managed care. This dashboard contains data relevant to all comparable hospitals in California.

Net Patient Revenue per Adjusted Discharge by Year#

The total net patient revenue of all California hospitals by year, and those of specified counties, cities, rural/teaching designations, control types, or facilities, per adjusted discharge. An additional breakdown by payer category is provided.

• Medicare – Traditional
• Medicare – Managed
• Medi-Cal – Traditional
• Medi-Cal – Managed
• County Indigent – Combined (Traditional and Managed)
• Third Party – Traditional
• Third Party – Managed
• Other Indigent
• All Other

Note: This visualization displays total net patient revenue (gross patient revenue minus deductions from revenue) per adjusted discharge by year with breakdowns by specific payer category. “Adjusted discharge” is a scaling factor to account for outpatient care volume and is calculated by dividing a facility’s gross patient revenue by its gross inpatient revenue and multiplying by total discharges. The “County Indigent – Combined” payer category includes both traditional and managed care. This dashboard contains data relevant to all comparable hospitals in California.

Operating Revenue per Adjusted Discharge#

The total operating revenue of all California hospitals by year, and those of specified counties, cities, rural/teaching designations, control types, or facilities, per adjusted discharge.

Note: This visualization displays the total operating revenue per adjusted discharge by year based on the filter selections. The total operating revenue is obtained by adding a facility’s net patient revenue with its other operating revenue. “Adjusted discharge” is a scaling factor to account for outpatient care volume and is calculated by dividing a facility’s gross patient revenue by its gross inpatient revenue and multiplying by total discharges. This dashboard contains data relevant to all comparable hospitals in California.

Operating Expenses per Adjusted Discharge#

The total operating expenses of all California hospitals by year, and those of specified counties, cities, rural/teaching designations, control types or facilities, per adjusted discharge.

Note: This visualization displays the total operating expenses (direct expenses incurred by various cost center groups for providing patient care) per adjusted discharge by year based on the filter selections. “Adjusted discharge” is a scaling factor to account for outpatient care volume and is calculated by dividing a facility’s gross patient revenue by its gross inpatient revenue and multiplying by total discharges. This dashboard contains data relevant to all comparable hospitals in California.

Operating Income Per Adjusted Discharge#

The total operating income of all California hospitals by year, and those of specified counties, cities, rural/teaching designations, control types or facilities, per adjusted discharge.

Note: This visualization displays the total operating income per adjusted discharge by year based on the filter selections. The total operating income is obtained by subtracting a facility’s total operating expenses from its operating revenue (net patient revenue plus other operating revenue). “Adjusted discharge” is a scaling factor to account for outpatient care volume and is calculated by dividing a facility’s gross patient revenue by its gross inpatient revenue and multiplying by total discharges. This dashboard contains data relevant to all comparable hospitals in California.

For more information on the HCAI financial data products, please visit the following links:

Payer Type Descriptions#

• Medicare – Traditional: Includes patients covered under the Social Security Amendments of 1965.
• Medicare – Managed: Includes patients covered under the Social Security Amendments of 1965 enrolled in a managed care plan funded by Medicare.
• Medi-Cal – Traditional: Includes patients qualified as needy under state laws.
• Medi-Cal – Managed: Includes patients qualified as needy by state laws and covered by a managed care plan funded by Medi-Cal.
• County Indigent – Combined (Traditional and Managed)
• Traditional: Includes patients covered under Welfare and Institution (W&I) Code Section 17000, including those programs funded in whole or in part by County Medical Services Program (CMSP), California Health Care for Indigents Program (CHIP) and/or Realignment Funds.
• Managed: Includes patients covered under Welfare and Institution (W&I) Code Section 17000 who are enrolled in a managed care plan funded by a county.
• Third Party – Traditional: Includes all other forms of health coverage excluding managed care plans
• Third Party – Managed: Includes patients covered by managed care plans other than those funded by Medicare, Medi-Cal or a county.
• Other Indigent: Includes indigent patients provided with charity care by the hospital and UC teaching hospital that are provided care with Support for Clinical Teaching funds.
• All Other: Includes all other financial classes not covered above.

Additional Information#

Topic: Cost Transparency
Source Link: Hospital Financials
Citation: Hospital Annual Financial Data – Selected Data & Pivot Tables, 2019
Temporal Coverage: 2012-2019
Spatial/Geographic Coverage: Statewide, County
Frequency: Annually