Net Patient Revenue, Discharges, and Outpatient Visits by Payer and Facility
In 2019, Private/Other Third Party payers were the largest source of net patient revenue for California health care facilities (41.0 percent), but Medicare covered the largest share of inpatient discharges (39.8 percent). Outpatient visits were evenly split between Medicare, Medi-Cal, and Private/Other Third Party payer types.
Why publish Net Patient Revenues, Discharges and Outpatient Visits?
These visualizations were created to help assess facility financial status and service volume 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), discharges, and outpatient visits by payer type allows users to better understand the relationship among revenue and utilization. For example, the user could identify differences between the payer that generates the most money (net patient revenue) and the payer that is serves for the most patients served (discharges and outpatient services). The filters (e.g., bed size, county and/or health professional shortage areas) allow users to analyze and compare these data points of interest.
The visualizations in this series specifically include comparable facilities for the data reporting period. Kaiser, state, and psychiatric health facilities are not included, as they submit data differently than the other facilities. Per SB 343, Kaiser Permanente began submitting annual financial files for the 2022 fiscal year end.
Key Findings
- Private/Other Third Party payer types make up a smaller proportion of net patient revenue (28.7 percent), discharges (15.5 percent), and outpatient visits (24.8 percent) in Primary Care Health Professional Shortage Areas than elsewhere (43.7 percent, 25.2 percent, and 32.7 percent, respectively).
- Rural/Frontier and Urban facilities have very similar Medicare net patient revenue (29.6 percent and 28.4 percent, respectively).
- Teaching Facilities have a higher proportion of Medi-Cal discharges (41.1 percent), compared to non-teaching facilities (32.5 percent).
How Payer Categories are Defined
- Medicare includes: Medicare Advantage, traditional Medicare.
- Medi-Cal includes: Medi-Cal managed care, fee-for-service Medi-Cal.
- Private Coverage includes: employer group coverage, individual coverage (including coverage purchased through Covered California), organized charity payers (e.g., March of Dimes, Shriners).
- Self-Pay includes: uninsured patients, as well as instances when insurance does not cover the treatment, or the patient would like to keep the medical procedure private.
- Other Payer includes: Workers’ Compensation, County Indigent Programs, any third-party payment not included in any other category, stays for which no payment will be required by the facility (e.g. courtesy patients), and stays for which no valid expected payer was reported to HCAI.
Note: This visualization displays the total annual net patient revenue, discharges and outpatient visits per filter selection with breakdowns by payer category. Facility level information is based on the parent facility which could include the satellite facility level information. In addition, the number of discharges in this product may be similar to the number of patient discharges from other HCAI products, but the two are collected in different ways under different statutes. The Medicare, Medi-Cal, and Private/Other Third Party payer categories include both traditional (fee-for-service) and managed care. The County Indigent Programs payer category includes traditional (fee-for-service), managed care, and Other Indigent encounters. This dashboard contains data relevant to all comparable hospitals in California.
Facility Comparison Tool
Users can make selections below to compare net patient revenue, discharges, and outpatient visits between two hospitals.
Note: This visualization displays the total annual net patient revenue, discharges and outpatient visits per filter selection with breakdowns by payer category. Facility level information is based on the parent facility which could include the satellite facility level information. In addition, the number of discharges in this product may be similar to the number of patient discharges from other HCAI products, but the two are collected in different ways under different statutes. The Medicare, Medi-Cal, and Private/Other Third Party payer categories include both traditional (fee-for-service) and managed care. The County Indigent Programs payer category includes traditional (fee-for-service), managed care, and Other Indigent encounters. This dashboard contains data relevant to all comparable hospitals in California.
How HCAI Created This Product
The Net Patient Revenue, Discharges, and Outpatient Visits by Payer and Facility, 2019 visualization was built from the financial reports which all California facilities are required to submit annually to HCAI.
The Audited Selected Financial Data was used, and the non-comparable facilities were removed to create this product.
Additional Information
Topic: Cost Transparency
Source Link: Hospital Financials
Citation: Hospital Annual Financial Data – Selected Data & Pivot Tables, 2019
Temporal Coverage: 2019
Spatial/Geographic Coverage: Statewide, County
Frequency: Annually