200 hospital benchmarks

With the shift from fee-for-service to value-based care, physicians and hospital executives have an increased interest in using comparative data as a tool to help improve quality of care. Healthcare is a data rich industry, and healthcare executives can use the comparative information to benchmark themselves against competitors as well as national leaders. 

For the third year, Becker's Hospital Review has collected 200 benchmarks related to some of the most important day-to-day areas hospital executives oversee: quality, patient satisfaction, operations, utilization and finance.

 Quality and process of care

Source: Hospital Compare, Department of Health & Human Services, Timely and Effective Care Measures - National Averages September 2013, the latest available data for these measures.

Hospital-acquired conditions

The following represent the average percentage of patients who experienced the conditions.

Collapsed lung due to medical treatment: 0.32 percent
A wound that splits open on the abdomen or pelvis after surgery: 0.92 percent
Accidental cuts and tears from medical treatment: 1.83 percent
Serious blood clots after surgery: 4.14 percent
Serious complications: 0.61 percent 

Heart attack patients

Who were given fibrinolytic medication within 30 minutes of arrival: 54 percent
Who were given angioplasty within 90 minutes of arrival: 96 percent 
Who were given aspirin at discharge: 99 percent
Who were given a prescription for a statin at discharge: 98 percent
Outpatients with chest pain or possible heart attack who got drugs to break up blood clots within 30 minutes of arrival: 58 percent
Outpatients with chest pain or possible heart attack who got aspirin within 24 hours of arrival: 96 percent
Average number of minutes before outpatients with chest pain or possible heart attack who needed specialized care were transferred to another hospital: 60 minutes
Average number of minutes before outpatients with chest pain or possible heart attack got an ECG: 7 minutes
Median time to fibrinolysis: 28 minutes

Heart failure patients

Who were given discharge instructions: 94 percent
Who were given an evaluation of left ventricular systolic function: 99 percent
Who were given ACE inhibitor or ARB for left ventricular systolic dysfunction: 97 percent

Pneumonia patients

Whose initial emergency room blood culture was performed prior to the administration of the first hospital dose of antibiotics: 98 percent
Who were given the most appropriate initial antibiotic(s): 95 percent

Surgery patients

Who were given an antibiotic within one hour before surgery to help prevent infection: 98 percent
Whose preventive antibiotics were stopped within 24 hours after surgery: 98 percent
Who got treatment within 24 hours before or after their surgery to help prevent blood clots after certain types of surgery: 98 percent
Who were taking beta blockers before coming to the hospital and who were kept on the beta blockers during the period just before and after their surgery: 98 percent
Who were given the appropriate kind of antibiotic to help prevent infection: 99 percent
Heart surgery patients whose blood sugar is kept under control in the days right after surgery: 97 percent
Whose urinary catheters were removed on the first or second day after surgery: 97 percent
Who were actively warmed in the operating room or whose body temperate was near normal by the end of the surgery: 100 percent
Whose physicians ordered treatments to prevent blood clots after certain types of surgeries: 98 percent
Outpatients having surgery who got an antibiotic at the right time (within one hour before surgery): 98 percent
Outpatients having surgery who got the right kind of antibiotic: 98 percent

Emergency department patients

Average time spent in the ED before patients were admitted to the hospital as an inpatient: 274 minutes
Average time patients spent in the ED after the physician decided to admit them as an inpatient but before leaving the ED for their inpatient room: 98 minutes
Average time patients spent in the ED before being sent home: 134 minutes
Average time patients spent in the ED before they were seen by a healthcare professional: 26 minutes
Average time patients who came to the ED with broken bones had to wait before receiving pain medication: 57 minutes
Percentage of patients who came to the ED with stroke symptoms who received brain scan results within 45 minutes of arrival: 57 percent

Preventive care patients

Who were assessed and given flu vaccination: 90 percent
Who were assessed and given pneumonia vaccination: 92 percent

Stroke patients

Who were evaluated for rehabilitation services: 97 percent
Who received a prescription for medicine known to prevent complications caused by blood clots before discharge: 99 percent
Who were given a prescription for a blood thinner at discharge: 95 percent
Who got treatment to prevent blood clots on the day of or day after hospital admission or surgery: 85 percent
Who got treatment to prevent blood clots on the day of or day after being admitted to the intensive care unit: 92 percent

Children's asthma patients

Who received reliever medication while hospitalized for asthma: 100 percent
Who received systemic corticosteroid medication that reduces inflammation and controls symptoms while hospitalized for asthma: 100 percent
And their caregivers who received a home management plan of care while hospitalized for asthma: 88 percent

Patient satisfaction

Source: Hospital Compare, Department of Health & Human Services, HCAHPS survey results September 2013, the latest available data for these measures.

Overall hospital rating

Patients who gave the hospital a rating of nine or 10: 71 percent
Patients who gave the hospital a rating of seven or eight: 21 percent
Patients who gave the hospital a rating of six or lower: 8 percent

Patient recommendation

Patients who said, yes, they would definitely recommend the hospital to friends and family: 71 percent
Patients who said, yes, they would probably recommend the hospital to friends and family: 24 percent
Patients who said, no, they probably or definitely would not recommend the hospital to friends and family: 5 percent

Cleanliness

Patients who said their room and bathroom was "always" clean: 73 percent
Patients who said their room and bathroom was "usually" clean: 19 percent
Patients who said their room and bathroom was "sometimes" or "never" clean: 8 percent

Noise

Patients who said the area around their room was "always" quiet at night: 61 percent
Patients who said the area around their room was "usually" quiet at night: 29 percent
Patients who said the area around their room was "sometimes" or "never" quiet at night: 10 percent

Physician and nurse communication

Patients who said their nurses "always" communicated well: 79 percent
Patients who said their nurses "usually" communicated well: 17 percent
Patients who said their nurses "sometimes" or "never" communicated well: 4 percent
Patients who said their physicians "always" communicated well: 82 percent
Patients who said their physicians "usually" communicated well: 14 percent
Patients who said their physicians "sometimes" or "never" communicated well: 4 percent

Pain control

Patients who said their pain was "always" well controlled: 71 percent
Patients who said their pain was "usually" well controlled: 22 percent
Patients who said their pain was "sometimes" or "never" well controlled: 7 percent

Staff explanations

Patients who said staff "always" explained medicines before administering: 64 percent
Patients who said staff "usually" explained medicines before administering: 18 percent
Patients who said staff "sometimes" or "never" explained medicines before administering: 18 percent

Staff help

Patients who said they "always" received help as soon as they wanted: 68 percent
Patients who said they "usually" received help as soon as they wanted: 23 percent
Patients who said they "sometimes" or "never" received help as soon as they wanted: 9 percent

Recovery information

Patients who said staff provided information about what to do during their recovery at home: 85 percent
Patients who said staff did not provide information about what to do during their recovery at home: 15 percent

Staffing

 Source: American Hospital Association, AHA Hospital Statistics Report, 2014 Edition.

Average full-time staff

Hospitals with 6 to 24 beds: 93
Hospitals with 25 to 49 beds: 169
Hospitals with 50 to 99 beds: 274
Hospitals with 100 to 199 beds: 615
Hospitals with 200 to 299 beds: 1,148
Hospitals with 300 to 399 beds: 1,703
Hospitals with 400 to 499 beds: 2,447
Hospitals with 500 or more beds: 4,660

Average part-time staff

Hospitals with 6 to 24 beds: 45
Hospitals with 25 to 49 beds: 74
Hospitals with 50 to 99 beds: 128
Hospitals with 100 to 199 beds: 262
Hospitals with 200 to 299 beds: 451
Hospitals with 300 to 399 beds: 606
Hospitals with 400 to 499 beds: 843
Hospitals with 500 or more beds: 1,277

Patient Volume

 Source: American Hospital Association, AHA Hospital Statistics Report, 2014 Edition.

Average admissions per year

Hospitals with 6 to 24 beds: 427
Hospitals with 25 to 49 beds: 947
Hospitals with 50 to 99 beds: 2,115
Hospitals with 100 to 199 beds: 5,850
Hospitals with 200 to 299 beds: 11,049
Hospitals with 300 to 399 beds: 16,263
Hospitals with 400 to 499 beds: 20,984
Hospitals with 500 or more beds: 33,953

Average inpatient surgeries per year

Hospitals with 6 to 24 beds: 89
Hospitals with 25 to 49 beds: 198
Hospitals with 50 to 99 beds: 501
Hospitals with 100 to 199 beds: 1,528
Hospitals with 200 to 299 beds: 3,033
Hospitals with 300 to 399 beds: 4,326
Hospitals with 400 to 499 beds: 6,018
Hospitals with 500 or more beds: 10,442

Average outpatient surgeries per year

Hospitals with 6 to 24 beds: 619
Hospitals with 25 to 49 beds: 963
Hospitals with 50 to 99 beds: 1,580
Hospitals with 100 to 199 beds: 3,381
Hospitals with 200 to 299 beds: 5,200
Hospitals with 300 to 399 beds: 6,953
Hospitals with 400 to 499 beds: 8,834
Hospitals with 500 or more beds: 14,273

Finance

Hospital adjusted expenses per inpatient day

 Source: Kaiser State Health Facts, accessed 2014 and based on 2011 data.

Nonprofit hospitals: $2,088
State/local government hospitals: $1,667
For-profit hospitals: $1,628

Key ratios

 Source: Moody's Investors Service, "U.S. Not-for-Profit Hospital 2013 Medians" Report, August 2014.

The medians are based on an analysis of audited 2013 financial statements for 383 freestanding hospitals, single-state health systems and multi-state healthcare systems, representing 88 percent of all rated healthcare entities. Children's hospitals, hospitals for which five years of data are not available and certain specialty hospitals were not eligible to be included in the medians.

Maintained bed occupancy: 62.7 percent
Operating margin: 2 percent
Excess margin: 5.1 percent
Operating cash flow margin: 9 percent
Return on assets: 4 percent
Cash-to-direct debt ratio: 134.7 percent
Cash-to-comprehensive debt ratio: 99.9 percent
Debt-to-capitalization ratio: 35.4 percent
Debt-to-total operating revenue: 37.9 percent
Three-year operating revenue CAGR: 5 percent
Three-year operating expense CAGR: 5.1 percent
Annual operating revenue growth rate: 4.3 percent

Current ratio: 1.9x
Cushion ratio: 17.5x
Annual debt service coverage: 4.5x
Maximum annual debt service coverage: 4.2x
Debt-to-cash flow: 3.7x
Capital spending ratio: 1.2x

Cash on hand: 197.6 days
Accounts receivable: 49.8 days
Average payment period: 63.4 days
Average age of plant: 10.7 years

Patient revenue sources by gross revenue

Medicare: 44.4 percent
Medicaid: 13 percent
Commercial: 32.4 percent
Self-pay and other: 7.7 percent

Financial medians related to healthcare reform
Reimbursement methods (% of net patient revenue)

DRG: 41 percent
Percent of charges: 20.5 percent
Fee schedule: 26 percent
Per diem: 4.5 percent
Risk-based: 2.4 percent
Traditional capitation: 1.3 percent
Other: 4.8 percent

Number of covered lives
Medicare: 37,656
Medicaid: 45,000
Commercial: 108,956

Hospital utilization data
Unique patients: 151,269
Total case mix index: 1.4
Number of employed physicians: 94
Active medical staff (independent and employed): 570

Sources of revenue
Inpatient revenue: 51.2 percent
Outpatient revenue: 48.5 percent


Hospital margins by credit rating group

Source: Fitch Ratings, "2014 Median Ratios for Nonprofit Hospitals and Healthcare Systems" Report, August 2014.

Median 
Operating margin: 2.2 percent
Operating EBITDA margin: 9.2 percent
Excess margin: 3.7 percent
EBITDA margin: 10.9 percent

"AA" rating
Operating margin: 3.9 percent
Operating EBITDA margin: 11 percent
Excess margin: 7.3 percent
EBITDA margin: 13.1 percent

"A" rating
Operating margin: 2.5 percent
Operating EBITDA margin: 9.5 percent
Excess margin: 4.1percent
EBITDA margin: 11 percent

"BBB" rating
Operating margin: 1.1 percent
Operating EBITDA margin: 7.9 percent
Excess margin: 2.4 percent
EBITDA margin: 9.2 percent

Below "BBB" rating, or non-investment grade 
Operating margin: -1.4 percent
Operating EBITDA margin: 7.3 percent
Excess margin: -0.5 percent
EBITDA margin: 7.6 percent

Charity care

Source: American Hospital Association, "Schedule H Project Benchmark" Report, August 2014.
Charity care includes total unreimbursed means-tested government programs and other benefits.

Total charity care as an average percent of total expenses

Small hospitals (less than $100 million in total expenses): 8.5 percent
Medium hospitals ($100 million to $299 million in total expenses): 8.5 percent
Large hospitals ($300 million or more in total expenses): 9.8 percent
Systems (more than one licensed hospital): 9 percent

General medical/surgical hospital: 8.7 percent
Teaching hospital: 10.2 percent
Critical access hospital: 9.3 percent
Children's hospital: 15.5 percent

Urban/suburban hospital: 9.1 percent
Rural hospital: 8.4 percent

Total benefits to the community as an average percent of total expenses

Small hospitals: 11.4 percent
Medium hospitals: 12.7 percent
Large hospitals: 12.4 percent
Systems: 13.2 percent

General medical/surgical hospital: 12.5 percent
Teaching hospital: 12.3 percent
Critical access hospital: 10.4 percent
Children's hospital: 16.3 percent

Urban/suburban hospital: 12.8 percent
Rural hospital: 10.9 percent

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