200 Hospital Benchmarks

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Comparative data is remarkably valuable in healthcare, as hospitals strive to master quality outcomes and deliver an experience that meets patients' expectations while remaining fiscally sound. Becker's Hospital Review has collected 200 benchmarks related to each of these demands from various healthcare organizations for hospitals to measure their performance and better assess their strengths and weaknesses.

Quality of care

30-day readmissions and mortality1

The following data is based on metrics included in the Hospital Consumer Assessment of Healthcare Providers and Systems.

1. Heart attack mortality rate
(Based on 4,351 hospitals)
25th percentile: 14.50
Median: 15.40
Average: 15.45
75th percentile: 16.40

2. Heart attack readmission rate
(Based on 4,287 hospitals)
25th percentile: 18.70
Median: 19.60
Average: 19.71
75th percentile: 20.60

3. Heart failure mortality rate
(Based on 4,494 hospitals)
25th percentile: 10.70
Median: 11.60
Average: 11.65
75th percentile: 12.60

4. Heart failure readmission rate
(Based on 4,493 hospitals)
25th percentile: 23.50
Median: 24.60
Average: 24.78
75th percentile: 25.90

5. Pneumonia 30-day mortality rate
(Based on 4,505 hospitals)
25th percentile: 10.90
Median: 11.90
Average: 12.10
75th percentile: 13.20

6. Pneumonia readmission rate
(Based on 4,510 hospitals)
25th percentile: 17.40
Median: 18.40
Average: 18.53
75th percentile: 19.50

Timeliness of care2

Figures reflect national averages.

7. Number of minutes before outpatients with chest pain or possible heart attack who needed specialized care were transferred to another hospital: 60
8. Number of minutes before outpatients with chest pain or possible heart attack received an ECG: 8
9. Outpatients with chest pain or possible heart attack who received medication to break up blood clots within 30 minutes of arrival:
59 percent
10. Outpatients with chest pain or possible heart attack who received aspirin within 24 hours of arrival: 96 percent
Pneumonia patients who received initial antibiotics within six hours after arrival: 96 percent
11. Outpatients having surgery who received an antibiotic at the right time, within one hour before surgery: 96 percent
12. Surgery patients who received an antibiotic at the right time, within one hour before surgery, to help prevent infection: 98
percent
13. Surgery patients whose preventive antibiotics were stopped at the right time, within 24 hours after surgery: 97 percent
14. Patients who received treatment at the right time, within 24 hours before or after their surgery, to help prevent blood clots after certain types of procedures: 96 percent
15. Surgery patients whose urinary catheters were removed on the first or second day after surgery: 93 percent

Imaging3

Figures reflect national averages.

16. Outpatients with low back pain who underwent an MRI without trying recommended treatments first, such as physical therapy: 36.8 percent
17. Outpatients who had a follow-up mammogram or ultrasound within 45 days after a screening mammogram: 8.5 percent4
18. Outpatients who received cardiac imaging stress tests before low-risk outpatient surgery: 5.6 percent
19. Outpatients who received brain CT scans and simultaneously received a sinus CT scan: 2.7 percent
20. Outpatient CT scans of the chest that were combination or double scans: 0.0445
21. Outpatient CT scans of the abdomen that were combination or double scans: 0.1496

Hospital-acquired conditions

Figures reflect the national average rate per 1,000 discharges.7
22. Falls and injuries: 0.527
23. Mismatched blood types: 0.001
24. Severe pressure or bed sores: 0.136
25. Air bubble in the bloodstream: 0.003
26. Infection from a urinary catheter: 0.358
27. Signs of uncontrolled blood sugar: 0.058
28. Blood infection from a catheter in a large vein: 0.372
29. Objects accidentally left in the body after surgery: 0.028

Length of stay8

Figures reflect national averages.

Cardiovascular and cerebrovascular conditions

Acute myocardial infarction
30. 2010: 5.3 days
31. Projected LOS in 2012: 4.8 days

Coronary artery disease and coronary atherosclerosis
32. 2010: 3.9 days
33. Projected LOS in 2012: 3.9 days

Congestive heart failure
34. 2010: 5.6 days
35. Projected LOS in 2012: 5.3 days

Stroke and acute cerebrovascular disease
36. 2010: 6.1 days
37. Projected LOS in 2012: 5.8 days

Atrial fibrillation
38. 2010: 3.7 days
39. Projected LOS in 2012: 3.5 days

Cardiovascular and cerebrovascular procedures

Coronary artery bypass graft
40. 2010: 10.1 days
41. Projected LOS in 2012: 10.1 days

Percutaneous transluminal coronary angioplasty without stents
42. 2010: 5.2 days
43. Projected LOS in 2012: 5.4 days

Percutaneous transluminal coronary angioplasty with stents
44. 2010: 3.4 days
45. Projected LOS in 2012: 3.4 days

Aortic resection
46. 2010: 6.2 days
47. Projected LOS in 2012: 5.8 days

Carotid endarterectomy
48. 2010: 3.0 days
49. Projected LOS in 2012: 2.9 days

Patient satisfaction

The following data is based on metrics included in the Hospital Consumer Assessment of Healthcare Providers and Systems.9

50. Patients who gave the hospital a rating of nine or 10
Note: A rating of 10 is the highest. Based on 3,857 hospitals.
25th percentile: 63 percent
Median: 68 percent
Average: 68.42 percent
75th percentile: 74 percent

51. Patients who gave the hospital a rating of seven or eight
Note: A rating of 10 is the highest. Based on 3,857 hospitals.
25th percentile: 20 percent
Median: 23 percent
Average: 22.91 percent
75th percentile: 27 percent

52. Patients who gave the hospital a rating of six or lower
Note: A rating of 10 is the highest. Based on 3,857 hospitals.
25th percentile: 6 percent
Median: 8 percent
Average: 8.67 percent
75th percentile: 11 percent

53. Patients who said, yes, they would definitely recommend the hospital to friends and family
Based on 3,858 hospitals.
25th percentile: 64 percent
Median: 70 percent  
Average: 69.93 percent  
75th percentile: 77 percent

54. Patients who said, yes, they would probably recommend the hospital to friends and family
Based on 3,858 hospitals.
25th percentile: 20 percent
Median: 25 percent
Average: 24.83 percent
75th percentile: 30 percent

55. Patients who said, no, they probably or definitely would not recommend the hospital to friends and family
Based on 3,858 hospitals.
25th percentile: 3 percent
Median: 5 percent
Average: 5.24 percent
75th percentile: 7 percent

56. Patients who said their room and bathroom was 'always' clean
Based on 3,858 hospitals.
25th percentile: 67 percent
Median: 71 percent
Average: 71.92 percent
75th percentile: 77 percent

57. Patients who said the area around their room was 'always' quiet at night
Based on 3,858 hospitals.
25th percentile: 52 percent
Median: 58 percent
Average: 59.02 percent
75th percentile: 66 percent

58. Patients who said their nurses 'always' communicated well
Based on 3,858 hospitals.
25th percentile: 74 percent
Median: 77 percent
Average: 76.90 percent
75th percentile: 80 percent

59. Patients who said their physicians 'always' communicated well
Based on 3,858 hospitals.
25th percentile: 77 percent
Median: 80 percent
Average: 80.61 percent
75th percentile: 84 percent

60. Patients who said they 'always' received help as soon as soon as they wanted
Based on 3,858 hospitals.
25th percentile: 59 percent
Median: 64 percent
Average: 64.93 percent
75th percentile: 70 percent

61. Patients who said their pain was 'always' well controlled
Based on 3,857 hospitals.
25th percentile: 67 percent
Median: 70 percent
Average: 69.70 percent
75th percentile: 73 percent

62. Patients who said staff 'always' explained medicines before administering
Based on 3,855 hospitals.
25th percentile: 58 percent
Median: 61 percent
Average: 61.63 percent
75th percentile: 65 percent

63. Patients who said staff provided information about what to do during their recovery at home
Based on 3,857 hospitals.
25th percentile: 80 percent
Median: 83 percent
Average: 82.98 percent
75th percentile: 86 percent

Operational

Average full-time staff10
Data organized by hospital bed count
64. Bed size 6 to 24: 90
65. Bed size 25 to 49:     160
66. Bed size 50 to 99:     264
67. Bed size 100 to 199: 597
68. Bed size 200 to 299: 1,112
69. Bed size 300 to 399: 1,613
70. Bed size 400 to 499: 2,375
71. Bed size 500+: 4,405

Average part-time staff11
Data organized by hospital bed count
72. Bed size 6 to 24: 42
73. Bed size 25 to 49: 70
74. Bed size 50 to 99: 118
75. Bed size 100 to 199: 257
76. Bed size 200 to 299: 425
77. Bed size 300 to 399: 593
78. Bed size 400 to 499: 787
79. Bed size 500+: 1,198

Average length of stay12
Data organized by hospital bed count
80. Bed size 6 to 24: 4.2
81. Bed size 25 to 49: 4.8
82. Bed size 50 to 99: 5.2
83. Bed size 100 to 199: 4.6
84. Bed size 200 to 299: 4.7
85. Bed size 300 to 399: 4.8
86. Bed size 400 to 499: 5.1
87. Bed size 500+: 5.4

Full-time equivalent and facility benchmarks13

88. Full-time equivalent staff per adjusted occupied bed, all hospitals
1st Quartile — 3.45 FTE
2nd Quartile — 4.37 FTE
3rd Quartile — 5.12 FTE
4th Quartile — 6.48 FTE

89. Full-time equivalent staff per adjusted occupied bed, investor-owned hospitals
1st Quartile — 3.21 FTE
2nd Quartile — 3.93 FTE
3rd Quartile — 4.51 FTE
4th Quartile — 5.76 FTE

90. Full-time equivalent staff per adjusted occupied bed, non-profit hospitals
1st Quartile — 3.61 FTE
2nd Quartile — 4.55 FTE
3rd Quartile — 5.27 FTE
4th Quartile — 6.55 FTE

91. Average age of plant, all hospitals
1st Quartile — 3.63 years
2nd Quartile — 7.70 years
3rd Quartile — 10.59 years
4th Quartile — 15.39 years

92. Average age of plant, investor-owned hospitals
1st Quartile — 2.12 years
2nd Quartile — 4.83 years
3rd Quartile — 8.23 years
4th Quartile — 12.96 years

93. Average age of plant, non-profit hospitals
1st Quartile — 4.90 years
2nd Quartile — 8.65 years
3rd Quartile — 11.28 years
4th Quartile — 15.75 years

Financial

Average costs per inpatient day

United States
Data is reflective of averages in 2010, the latest data available.14
94. State/local government hospitals — $1,625
95. Non-profit hospitals — $2,025
96. For-profit hospitals — $1,629

Charity care

Figures reflect average percent of total hospital expense.15 Data based on hospitals' 2009 Schedule H forms, filed with the Internal Revenue Service.

Total charity care
Means-tested government programs and other benefits.
97. Small hospitals (less than $100 million expense): 7.3 percent
98. Medium hospitals ($100 million to $299 million expense): 8.0 percent
99. Large hospitals ($300 million or more expense): 9.8 percent
100. Systems (more than one licensed hospital): 9.3 percent

Medicare shortfall
101. Small hospitals:  2.0 percent
102. Medium hospitals: 3.6 percent
103. Large hospitals: 2.6 percent
104. Systems: 3.8 percent

Bad debt expense attributable to charity care
105. Small hospitals: 0.5 percent
106. Medium hospitals: 0.5 percent
107. Large hospitals: 0.3 percent
108. Systems: 0.5 percent

Community building activities
109. Small hospitals: 0.1 percent
110. Medium hospitals: 0.2 percent
111. Large hospitals: 0.2 percent
112. Systems: 0.1 percent

Total benefits to the community
113. Small hospitals: 9.9 percent
114. Medium hospitals: 12.3 percent
115. Large hospitals: 12.8 percent
116. Systems: 13.7 percent

Cash-to-debt ratios

Figures reflect fiscal year 2011 for non-profit hospitals.16

117. Overall median cash-to-debt ratio: 117.7 percent
118. Overall mean cash-to-debt ratio: 141.4 percent

119. Maximum recorded cash-to-debt ratio in Moody's sample: 936.8 percent
120. Minimum recorded cash-to-debt ratio in Moody's sample: 12 percent

121. Median cash-to-debt ratio for "Aa2"-rated hospitals: 214.5 percent
122. Median cash-to-debt ratio for "Aa3"-rated hospitals: 185.8 percent
123. Median cash-to-debt ratio for "A1"-rated hospitals: 146.9 percent
124. Median cash-to-debt ratio for "A2"-rated hospitals: 143 percent
125. Median cash-to-debt ratio for "A3"-rated hospitals: 104 percent

126. Median cash-to-debt ratio for "Baa1"-rated hospitals: 91.6 percent
127. Median cash-to-debt ratio for "Baa2"-rated hospitals: 74.6 percent
128. Median cash-to-debt ratio for "Baa3"-rated hospitals: 93 percent
129. Median cash-to-debt ratio for hospitals with ratings below "Baa": 107 percent

Median ratios

Figures reflect fiscal year 2011 for non-profit hospitals.17

130. Operating margin: 2.5 percent
131. Excess margin: 4.9 percent
132. Operating cash flow margin: 9.3 percent
133. Return on assets: 4.5 percent
134. Annual debt service coverage: 4.4x
135. Maximum annual debt service coverage: 4.2x
136. Current ratio: 1.9x
137. Cash on hand: 165 days
138. Cushion ratio: 14.9x
139. Cash-to-debt ratio: 117.7 percent
140. Accounts receivable: 45.1 days
141. Average payment period: 58.6 days
142. Debt-to-capitalization ratio: 40.4 percent
143. Debt-to-cash flow: 3.5x
144. Bad debt as a percent of net patient revenue: 6.1 percent
145. Capital spending ratio: 1.2x
146. Debt-to-total revenue: 36.1 percent
147. Three-year operating revenue compounded annual growth rate: 5.4 percent
148. Cash-to-total comprehensive debt: 88 percent
149. Monthly liquidity to demand debt: 340.4 percent
150. Annual liquidity to demand debt: 373.7 percent
151. Puttable debt as a percent of total debt: 35.1 percent
152. Cash-to-demand debt: 384 percent
153. Monthly liquidity to total cash/investments: 98 percent

Investments

Figures reflect averages across 86 non-profit healthcare organizations.
154. Average investable assets in fixed income strategies: 36 percent18
155. Average investable assets in alternative strategies: 21 percent19

Average payor mix by region20

United States
156. Medicare: 40.9 percent
157. Medicaid: 17.2 percent
158. Worker's compensation and other government programs: 2 percent
159. HMO or PPO: 14 percent
160. Blue Cross Blue Shield, other private insurance: 16.5 percent
161. Self-pay: 4.9 percent

Northeast
162. Medicare: 42.9 percent
163. Medicaid: 15.7 percent
164. Worker's compensation and other government programs: 1.2 percent
165. HMO or PPO: 16.6 percent
166. Blue Cross Blue Shield, other private insurance: 16.6 percent
167. Self-pay: 3.2 percent

Midwest
168. Medicare: 44.5 percent
169. Medicaid: 16 percent                                        
Worker's compensation and other government programs: n/a
HMO or PPO: n/a
170. Blue Cross Blue Shield, other private insurance: 19.2 percent
171. Self-pay: 4.5 percent

South
172. Medicare: 41.7 percent
173. Medicaid: 16 percent
174. Worker's compensation and other government programs: 3 percent
175. HMO or PPO: 11.3 percent
176. Blue Cross Blue Shield, other private insurance: 15.8 percent
177. Self-pay: 6.2 percent

West
178. Medicare: 32.9 percent
Medicaid: n/a
Worker's compensation and other government programs: n/a
179. HMO or PPO: 18.4 percent
Blue Cross Blue Shield, other private insurance: n/a
Self-pay: n/a

Public hospital finances

Figures reflect averages across members of the National Association of Public Hospitals and Health Systems from 2010.21

Net revenue by payor source

180. Medicaid: 35 percent
181. Commercial: 27 percent
182. Medicare: 21 percent
183. Federal/state/local payments: 11 percent
184. Other: 4 percent
185. Uninsured: 2 percent

Sources of financing for unreimbursed care
186. Federal/state/local payments: 30 percent
187. Other: 26 percent
188. Medicaid disproportionate share hospital payments: 24 percent
189. Supplemental Medicaid payments: 11 percent
190. Medicare disproportionate share hospital payments: 5 percent
191. Medicare indirect medical education: 5 percent

Hospital operating margins (national average)
192. All hospitals: 7.2 percent
193. NAPH members: 2.3 percent
194. NAPH members without Medicaid DSH: -6.1 percent
195. NAPH members without Medicaid DSH or other supplemental payments: -10.6 percent

Hospital mergers & acquisitions

Figures reflect averages from 2011.22
196. Average price-to-EBITDA multiple: 9.5x
197. Average price-to-revenue multiple: 0.76x
198. Average price-to-revenue multiple for critical access hospitals: 0.52x
199. Average price-to-EBITDA multiple for critical access hospitals: 8.0x
200. Average price-to-revenue multiples for distressed or bankrupt hospitals: 0.3x to 0.4x


1. Source: iVantage Health Analytics, July 2012.
2. Source: Hospital Compare, U.S. Department of Health & Human Services. Last updated July 19, 2012.
3. Source: Hospital Compare, U.S. Department of Health & Human Services. Last updated July 19, 2012.
4. HHS maintains that a number lower than 8 percent may suggest "not enough follow-up, whereas a number higher than 14 percent may suggest "too much unnecessary follow-up."
5. The range for this measure is 0 to 1. A number close to 1 may mean that too many patients are being given a double scan when a single scan is all they need, according to HHS.
6. The range for this measure is 0 to 1. A number close to 1 may mean that too many patients are being given a double scan when a single scan is all they need, according to HHS.
7. Source: Hospital Compare, U.S. Department of Health & Human Services. Last updated July 19, 2012.
8. U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality. Healthcare Cost and Utilization Project, Report 2012-02.
9. Source: iVantage Health Analytics, July 2012.
10. Source: American Hospital Association Hospital Statistics, 2012 Edition.
11. Source: American Hospital Association Hospital Statistics, 2012 Edition.
12. Source: American Hospital Association Hospital Statistics, 2012 Edition.
13. Source: Healthcare Management Partners, "HMP Metrics Quarterly Report, 2010," the latest data available. Quartile rankings were assigned based on mean values calculated for the hospitals within peer groups. The first quartile contains the top 25 percent of the best performing hospitals in an applicable peer group. The fourth represents those falling below 76 percent. FTE reflects full-time equivalents.
14. Source: Kaiser State Health Facts, 2012.
15. Source: American Hospital Association, Schedule H Project Benchmark Report, January 2012.
16. Source: Moody's Investors Service, "U.S. Not-for-Profit Hospital Medians Show Operating Stability Despite Flat Inpatient Volumes and Shift to Government Payers," August 2012.
17. Source: Moody's Investors Service, "U.S. Not-for-Profit Hospital Medians Show Operating Stability Despite Flat Inpatient Volumes and Shift to Government Payers," August 2012.
18. Commonfund Institute, "2012 Commonfund Benchmarks Study® of Healthcare Organization," August 2012.
19. Commonfund Institute, "2012 Commonfund Benchmarks Study® of Healthcare Organization," August 2012.
20. Centers for Disease Control and Prevention, "National Hospital Discharge Survey." Figures reflect payor mixes from 2009, the latest year available. For categories marked "n/a," the survey had deemed those figures as not meeting a standard of reliability or precision.
21. National Association of Public Hospitals and Health Systems 2010 Characteristics Survey.
22. Irving Levin Associates, "Health Care Services Acquisition Report," 2012.

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