Net Patient Revenue, Discharges, and Outpatient Visits by Payer and Facility
In 2021, Private/Other Third-Party payers were the largest source of net patient revenue for California healthcare facilities (41.2 percent), while Medicare covered the largest share of inpatient discharges (38.6 percent). Outpatient visits were almost evenly split between Medicare, Medi-Cal, and Private/Other Third-Party payers.
Introduction
This report was created to help assess the financial status and service volume of healthcare facilities in California to advance healthcare cost transparency. The comparison of net patient revenue (i.e., the amount of money generated from patient services, regardless of the payer), the number of discharges, and the number of outpatient visits by payer category allows users to better understand the relationship between revenue and utilization. For example, users could identify differences between the payer type that generates the most money (net patient revenue) and the payer type whose payments covered the most patients served (discharges and outpatient services). The filters allow users to analyze and compare these data points of interest.
Key Findings
- Private/Other Third-Party payers make up a smaller proportion of net patient revenue (29.3 percent), discharges (16.7 percent), and outpatient visits (26.0 percent) in Primary Care Health Professional Shortage Areas than elsewhere (43.8 percent, 25.6 percent, and 34.7 percent, respectively).
- Rural/Frontier and Urban facilities have very similar Medi-Cal discharges (35.6 percent and 34.9 percent, respectively).
- Teaching Facilities have a higher proportion of Medi-Cal discharges (42 percent), compared to non-teaching facilities (33.1 percent).
Net Patient Revenue, Discharges and Outpatient Visits by Payer Category
This dashboard displays the total annual net patient revenue and the number of discharges and outpatient visits for a set of hospitals, as defined by the filter selections, with breakdowns by payer category.
Note: The facility-level data reported is based on the parent facility, which could include satellite facility-level data.
Facility Comparison Tool
Users can make selections below to compare net patient revenue and the number of discharges and outpatient visits between two hospitals.
Note: The facility-level data reported is based on the parent facility, which could include satellite facility-level data.
How HCAI Created This Product
The Net Patient Revenue, Discharges, and Outpatient Visits by Payer and Facility, 2021 report was built using HCAI’s Hospital Annual Financial Data, which consists of annual financial and utilization data that all California hospitals and hospital systems are required to submit to HCAI. Specifically, the audited Hospital Annual Financial Selected File for calendar year 2021 was used for this report. For more information about the data, see the Hospital Annual Selected File – Documentation.
Non-comparable facilities (i.e. facilities that are not required to submit all data by statute or because a reporting modification has been granted) were removed to create this product. Kaiser, state, and psychiatric health facilities are not included, as they submit data differently than other facilities. Per SB 343, Kaiser Permanente began submitting annual financial files for the 2022 fiscal year by individual facility, similar to other hospital systems. Data for the year 2022 and subsequent years will reflect this change. The facility-level data reported is based on the parent facility which could include satellite facility-level data.
The number of patient discharges reported in Hospital Annual Financial Data may be similar to the number of discharges reported in other data collected by HCAI, such as the Patient-Level Administrative Data, but the two are collected in different ways under different statutes.
Glossary
Payer Categories
Payer categories used in this report are based on the standard regulatory definitions used in Hospital Annual Financial Data reporting, sourced from the HCAI Accounting and Reporting Manual for California Hospitals.
- County Indigent Programs: Programs that cover indigent patients under Welfare and Institutions Code Section 17000 and those funded in whole or in part by County Medical Services Program (CMSP), California Health Care for Indigents Program (CHIP) and/or Realignment Funds. Includes traditional (fee-for-service), managed care, and other indigent programs.
- Medi-Cal: A public health insurance program that provides free or low-cost medical services and healthcare benefits to low-income individuals, financed from state and federal funds; California’s version of Medicaid. Includes Medi-Cal Managed Care and Medi-Cal Fee-for-Service.
- Medicare: A federal health insurance program funded by the Centers for Medicare & Medicaid Services (CMS) under the Social Security Amendments of 1965 that provides healthcare benefits to those aged 65 years and over and to disabled beneficiaries of any age. Includes Medicare Advantage and Medicare Fee-for-Service (traditional Medicare).
- Private / Other Third-Party: This payer category includes product types for which the coverage premium is paid by a private party –also called Commercial in most other HCAI data sources– and other payers such as Workers’ Compensation and Short-Doyle. Includes both traditional (fee-for-service) and managed care products.
- All Other: Includes all payers who do not belong in any of the other categories, including uninsured patients and self-paid patients.
Additional Information
Topic: Cost Transparency
Source Link: Hospital Financials
Citation: Hospital Annual Financial Data – Selected Data & Pivot Tables, 2021
Temporal Coverage: 2021
Spatial/Geographic Coverage: Statewide, County
Frequency: Annually