65 things to know about US hospitals and health systems

Here are 65 statistics, benchmarks and facts about America's hospitals and health systems.


1. According to the American Hospital Association's Hospital Statistics 2015 edition, which uses data collected in 2013, there are 5,686 registered hospitals in the U.S., including nonprofit, for-profit, federal government, state and local government, psychiatric, and long-term hospitals as well as hospital units in institutions (i.e. prison hospitals, college infirmaries, etc.). Registered hospitals include those that meet the AHA's criteria for registration as a hospital facility.

2. The AHA Hospital Statistics 2015 edition also reports there are 914,153 total staffed beds, 35,416,020 admissions and $859 billion in total expenses in all U.S. registered hospitals.

3. Pennsylvania Hospital in Philadelphia is the country's oldest hospital, founded in 1751, even before the United States won its independence from England. The hospital was founded by Benjamin Franklin and a physician named Thomas Bond. During the Revolution, both Continental and British soldiers received treatment from Pennsylvania Hospital. The hospital is now part of Penn Medicine, the University of Pennsylvania health system.

4. The following nonprofit hospital systems are the largest in the U.S., based on number of short-term, acute-care hospitals:

Note: The following two lists are based on data from the American Hospital Directory, which contains information from hospital cost reports submitted to CMS. Hospital cost reports are submitted to fiscal intermediaries approximately three months after the end of a hospital's fiscal year, and the most common fiscal year ending dates are Dec. 31, June 30 and Sept. 30.  

Systems are listed in descending order based on the number of acute-care hospitals. The company rankings total 10, although the list includes ties, which means there are more than 10 individual systems listed.

  • Ascension Health (St. Louis) — 75
  • Trinity Health (Livonia, Mich.) — 44
  • Catholic Health Initiatives (Denver) — 39
  • Kaiser Permanente (Oakland, Calif.) — 37
  • Adventist Health System (Winter Park, Fla.) — 35
  • Dignity Health (San Francisco) — 39 [Dignity Health's latest reported number for acute care hospitals, as of 7/14/15]
  • Sutter Health (Sacramento, Calif.) — 26
  • Providence Health and Services (Seattle) — 26
  • CHRISTUS Health (Irving, Texas) — 20
  • Banner Health (Phoenix) — 19
  • Baylor Scott & White Health (Dallas) — 19
  • Mercy Health (Cincinnati)* — 17
  • UPMC (Pittsburgh) — 17
  • SSM Health Care (St. Louis) — 17
  • ntermountain Health Care (Salt Lake City) — 17
  • New York-Presbyterian Healthcare System (New York City) — 16
  • Adventist Health (Roseville, Calif.) — 16

*Formerly Catholic Healthcare Partners

5. The following for-profit hospital systems are the largest in the U.S., based on number of acute-care hospitals.

  • Community Health Systems (Brentwood, Tenn.) — 188
  • Hospital Corporation of America (Nashville, Tenn.) — 166
  • Tenet Healthcare (Dallas) — 74
  • LifePoint Health (Brentwood, Tenn.)* — 56
  • Prime Healthcare Services (Ontario, Calif.) — 32
  • Universal Health Services (King of Prussia, Pa.) — 28
  • IASIS Healthcare (Franklin, Tenn.) — 18
  • Ardent Health Services (Nashville, Tenn.) — 12
  • Capella Healthcare (Franklin, Tenn.) — 9
  • Steward Health Care System (Boston) — 9
  • National Surgical Hospitals (Chicago) — 8

*Figure includes acute-care facilities within Brentwood, Tenn.-based Duke LifePoint Healthcare

Financial statistics
Source: Moody's Investors Service, "Preliminary U.S. Not-for-Profit and Public Hospital 2014 Medians: Growth in Hospital Revenue Edges Ahead of Expenses in 2014," May 2015.

Note: The preliminary medians are based on FY 2014 audited financial statements representing 48 percent of Moody's rated portfolio. These medians primarily reflect audit year ends of Sept. 30, 2014 and prior.

6. Annual median revenue. The preliminary fiscal year 2014 U.S. nonprofit and public hospital medians show a rise in annual median revenue growth to 4.7 percent, up from the all-time low of 3.9 percent in FY 2013, with total operating revenue at $679.9 million.

"Revenue growth was supported by continued consolidation in the nonprofit hospital sector and the initial influence of the Affordable Care Act as benefits of the exchanges and Medicaid expansion were realized," said Beth Wexler, Moody's vice president and senior credit officer.

7. The annual expense growth rate declined to 4.6 in FY 2014 from 5 percent in FY 2013 and 5.5 percent in FY 2012. The slowdown in the expense growth rate is attributable to the ongoing shift of patient care to lower-cost and more efficient settings, such as outpatient and ambulatory surgery centers, in addition to operating efficiencies gained from increasing size and scale.

8. The median cash on hand rose to 212 days in FY 2014. That's up from 207 days in 2013 and up from 197 days in 2012.

9. Unrestricted cash and investments were $377 million in FY 2014, up $20 million from FY 2013, mostly due to solid equity gains and restrained capital spending.

10. Profitability margins stabilized in 2014, though the 2.2 percent operating margin and 9.2 percent operating cash flow margins are down from higher levels in 2012.

11. Median net patient revenues: $588.2 million. In FY 2013, median net patient revenues were $545.5 million.

Patient revenue sources by gross revenue
12. Medicare: 44.7 percent

13. Medicaid: 13.2 percent

14. Commercial: 32.5 percent

15. Self-pay and other: 7.5 percent

Average cost per inpatient day
Source: Kaiser State Health Facts. This data reflects the year 2013, and was published May 2015.

16. State/local government hospitals: $1,878

17. Nonprofit hospitals: $2,289

18. For-profit hospitals: $1,791

19. In 2013, the average cost per inpatient day at state/local government hospitals was $1,878, according to data from Kaiser State Health Facts. The average cost per inpatient day in 2013 was $2,289 at nonprofit hospitals and $1,791 at for-profit hospitals.

20. Average daily inpatient costs at state/local government hospitals in 2013 were highest in Connecticut ($3,725) and lowest in Wisconsin ($325). Average daily inpatient costs at nonprofit hospitals were highest in California ($3,500) and lowest in South Dakota ($1,234). Average daily inpatient costs at for-profit hospitals were highest in North Dakota ($3,714) and lowest in Maine ($815).

Executive compensation
21. Total cash compensation levels for hospital executives decreased an average of 0.4 percent in 2014, according to Sullivan, Cotter and Associates' "2014 Manager and Executive Compensation in Hospitals and Health Systems Survey."

22. Compensation levels for health system executives increased by 0.9 percent in 2014 due to lower average payouts under annual incentive plans.

23. The average base salary for an independent health system CEO in 2014 was $752,800, and the average base salary for an independent hospital CEO was $425,200, according to Integrated Healthcare Strategies' "2014 National Healthcare Leadership Compensation Survey" report.*

24. The average base salary for an independent health system CFO in 2014 was $416,200, and the average base salary of an independent hospital CFO was $247,900, according to Integrated Healthcare Strategies' "2014 National Healthcare Leadership Compensation Survey" report.*

25. The average annual salary for a CIO in healthcare and medical services in 2015 is $173,941, according to CIO.com.

26. The average annual salary for a CXO in 2015 is $221,000, according to the Experience Innovation Network, part of Vocera.

27. Base salaries increased between 2013 and 2014 across the board for many C-suite positions, according to the Sullivan, Cotter and Associates survey. However, CEOs at independent hospitals saw the largest average base salary increase (6.4 percent) between 2013 and 2014.

28. The average base salary increases between 2013 and 2014 for executives of health systems are as follows:

CEO — 2.6 percent

COO — 2.9 percent

CFO — 3.5 percent

CMO — 2.5 percent

29. At independent hospitals, base salaries increased by the following percentages:

CEO — 6.4 percent

COO — 4.5 percent

CFO — 2.1 percent

CMO — 4.9 percent

30. At system-owned hospitals, base salaries increased by the following percentages:

CEO — 1.7 percent

COO — 1.7 percent

CFO — 2.5 percent

CMO — 1.7 percent

31. Health systems offered the following median target award opportunities to their executives in 2014, according to the Sullivan Cotter Associates survey:

CEO — 35 percent (up from 31 percent in 2004)

COO — 30 percent (up from 25 percent)

CFO — 28 percent (up from 24 percent)

SVP — 25 percent (up from 23 percent)

VP — 20 percent (up from 19 percent)

32. Hospitals offered their executives the following median target award opportunities in 2014:

CEO — 30 percent (up from 28 percent in 2004)

COO — 25 percent (up from 22 percent)

CFO — 25 percent (up from 22 percent)

SVP — 20 percent (down from 24 percent)

VP — 17 percent (down from 19 percent)

33. Healthcare executive compensation is adapting to new leadership competencies. According to a B.E. Smith whitepaper published in 2015, as hospitals and health systems attempt to adapt to the new leadership realities — such as increased CEO turnover and merger and acquisition activity — executive compensation in the healthcare industry rose 2 percent to 3 percent over the past year, with slightly higher pay raises for CEOs.

34. Although the industry is moving to align executive compensation with performance-based care models, 43 percent of executives surveyed said their organization hasn't taken steps to match incentives to values such as cost containment and clinical outcomes. However, further alignment will occur in 2015, according to the report.

35. Forty percent of survey respondents said their executive compensation packages are either slightly or seriously misaligned with their organization's strategies, according to the 2014 Executive Compensation Survey report by HealthLeaders Media Intelligence. As for incentive payments, operating margins serve as a basis for 60 percent of respondents' current team incentive payments, followed by clinical performance targets (59 percent) and staff engagement or satisfaction targets (51 percent).

*"Independent" refers to a system or hospital that does not report to a parent.

Physician compensation
Source: Medscape's 2015 Physician Compensation Report. The report includes responses from more than 19,500 physicians across 26 specialties.

36. The 10 states where physicians earn the most are:

  • North Dakota — $330,000
  • Alaska — $330,000
  • Wyoming — $312,000
  • Wisconsin — $309,000
  • Oklahoma — $304,000
  • New Hampshire — $300,000
  • Minnesota — $288,000
  • West Virginia — $287,000
  • Washington — $286,000
  • Indiana — $286,000

37. The nine states where physicians earn the least are:

  • Physicians in Washington, D.C., have the lowest annual income of $186,000.
  • Rhode Island — $217,000
  • Maryland — $237,000
  • New Mexico — $243,000
  • Massachusetts — $248,000
  • New York — $249,000
  • Delaware — $250,000
  • Virginia — $251,000
  • Utah — $251,000
  • Pennsylvania — $255,000

38. Specialists earn an average of $284,000 annually, while primary care physicians have an average annual income of $195,000.

39. The three specialties with the highest average patient care incomes are:

Orthopedists — $421,000

Cardiologists — $376,000

Gastroenterologists — $370,000

40. The three specialties with the lowest average patient care incomes are:

Pediatricians — $189,000

Family medicine— $195,000

Endocrinologists and internists — both at $196,000

41. Self-employed primary care physicians earned an average of $212,000 in 2014, significantly more than physicians employed by a medical group or hospital, who made an average of $189,000.

42. Self-employed specialists earned $329,000 on average in 2014, considerably more than their employed counterparts, who earned an average of $258,000.

43. Despite the pay disparity between employment statuses, an increasing number of physicians are seeking out employment within a group practice, according to the report. Additionally, more physicians are seeking to join accountable care organizations. Physician participation in ACOs grew dramatically from 3 percent in 2011 to 30 percent in 3014, with another 7 percent of physicians reporting that they plan to join an ACO during 2015.

Hospital costs
44. Healthcare expenditures on hospital services increased 125.5 percent from 2000 to 2013, according to a Kaiser Family Foundation report. In 2000, healthcare expenditures on hospital services totaled $415.5 billion. That number jumped to $936.9 billion in 2013.

45. Hospital list prices are growing faster than the rate of inflation. Between 2011 and 2013, hospital prices for common procedures increased by more than 10 percent. However, Medicare payments for these procedures have remained relatively static.

46. The procedures with the biggest list price increases from 2011 until 2013 include back and neck procedures minus spinal fusion (increased 22 percent to $36, 215), chest pain (increased 18.1 percent to $19,867) and medical back problems (increased 17.5 percent to $26,214), according to an analysis by the New York Times.

47. Gerard Anderson, director of the Center for Hospital Finance and Management at Johns Hopkins Bloomberg School of Public Health in Baltimore, told NYT the rising list prices are a simple way for hospitals to boost revenues. However, Caroline Steinberg, a vice president of the American Hospital Association, told NYT the rising prices reflect the costs required to run a hospital.

M&A activity
48. The health services sector saw increased merger and acquisition activity after the start of 2015. Overall healthcare deal volume increased by 25 percent in the first quarter of 2015 from the first quarter of 2014, according to PwC. Disclosed transactions grew by 19 percent in the first quarter of this year, with value up 92 percent, compared to the first quarter of 2014.

49. The managed care sector saw the biggest growth, with deal volume doubling in the first quarter of 2015 compared to the same period of 2014. Hospital M&A activity decreased slightly, with an 8 percent drop in deal volume in the first quarter of 2015 from the comparable period of 2014. Deal value, however, increased 14 percent in the first quarter of this year from $608 million to $693 million, according to PwC. The drop in volume may be partially accounted for by an uptick in nontraditional M&A, such as joint ventures and affiliations.

50. There were 23 hospital transactions in the first quarter of 2015, consistent with 2014's quarterly average of 23.5, according to Kaufman, Hall & Associates. According to the report, of the 23 first-quarter transactions, 35 percent involved acquisitions by for-profit organizations, which is a somewhat higher percentage than in recent quarters.

51. The organizations that were acquired in the first quarter of 2015 had a total operating revenue of more than $4.8 billion, according to Kaufman, Hall & Associates.

52. Moody's Investors Service predicts merger and acquisition activity will grow and remain elevated for at least two years as financially distressed nonprofit hospitals seek solace in consolidation to avoid payment default.

53. Small hospitals with revenues of $500 million or less are most likely to be affected, according to Moody's. These providers are facing increasing regulatory and financial changes, leading to increased consolidation with larger, often for-profit hospital operators, which have been buffered from change by economies of scale.

54. Nonprofit hospitals declined from 80 percent market penetration in 1999 to 73 percent penetration in 2003, according to Moody's, and, M&A volume in the first quarter of 2015 and the fourth quarter of 2014 show the first significant transaction growth since 2012.

Biggest hospital markups
Source: Health Affairs. Researchers used Medicare cost reports to find the 50 U.S. hospitals with the largest difference between charges and Medicare-allowable cost in 2012.

55. On average, hospital charges were 3.4 times the Medicare-allowable cost in 2012. For example, when a hospital incurred $100 in cost, it charged $340, according to the Health Affairs study.

56. The 10 percent lowest-charging hospitals had ratios below 1.5 — hospitals in Maryland had markups of less than 1.5, lower than any other state. The upper 10 percent had ratios above 5.7.

57. Of the 50 hospitals with the biggest markups, 49 are for-profit and 46 are owned by for-profit hospital systems. Franklin, Tenn.-based Community Health Systems operates half of these 50 hospitals and Nashville, Tenn.-based Hospital Corporation of America operates more than 25 percent of them. Most (86 percent) of the hospitals are categorized as urban and few are teaching hospitals (18 percent). Twenty of them operate in Florida.

58. Hospital executives have suggested high charge-to-cost ratios are partially attributable to the slow rate growth in Medicare and Medicaid spending, as well as the need to have operating surpluses in order to remain in business. However, researchers noted, "This argument...cannot completely explain the wide variation in the charge-to-cost ratio...or why some hospitals are charging 10 times their own costs." The study authors attributed the high markups to a lack of price transparency and negotiating power by uninsured patients, out-of-network patients, casualty and workers' compensation insurers and in-network insurers.

EHRs and health IT
59. In 2015, 76 percent of non-federal, acute-care hospitals had adopted at least a basic EHR system, a significant increase from the 27 percent of hospitals who had done so in 2013. What's more, 97 percent of non-federal, acute-care hospitals were using an EHR certified by HHS.

60. According to May 2015 CMS data, 4,816 hospitals are currently participating in the EHR Incentive Program.

61. As of December 2014, nine out of 10 eligible hospitals had attested to meaningful use. This includes 89 percent of eligible critical access hospitals and 91 percent of all other, non-CAH eligible hospitals. Approximately 55 percent of children's hospitals had attested, which was to be expected as children's hospitals began MU attestation in the Medicaid EHR incentive program after the Medicare EHR incentive program.

62. As of December 2014, 86 percent of participating, eligible hospitals received Medicare payments for successfully attesting to meaningful use, including 94 percent of all urban hospitals with at least 50 beds, 70 percent of all urban hospitals with fewer than 50 beds, 96 percent of all rural hospitals with 50 or more beds, 91 percent of all rural hospitals with fewer than 50 beds and 68 percent of all critical access hospitals.

63. More hospitals have attested to meaningful use using MEDITECH's EHR platform than any other vendor, with 946 hospitals, according to March 2015 CMS data. Cerner's EHR is the second most-commonly used, with 931 hospitals attesting using its platform.

64. Hospitals shell out significant sums of money to implement these EHR platforms. In June, Boston-based Partners HealthCare went live on its new Epic EHR, a project costing $1.2 billion. It was the single biggest investment the system had made to date. In June, the Ventura County (Calif.) Health Care Agency reported paying $50 million for its Cerner EHR implementation, and it is expected to pay $19 million more over the next 10 years to the vendor.

65. The average healthcare organization uses 928 cloud applications to manage 6.8 terabytes of data each month, according to a report from cloud security software provider Skyhigh. Common cloud service categories include business intelligence, collaboration, content sharing and social media.

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