1
Section 8: Health Care Providers and Service
Availability
• Hospital system and capacity
• Utilization of hospital services
• Hospital financial trends
• Hospital capital expenditures
• Hospital community benefit
• Availability of specific health care services at
hospitals (e.g., imaging, surgery)
• Physician services
HOSPITAL SYSTEM AND CAPACITY
3
Hospital Capacity in Minnesota, 2011
Number of
Hospitals
Available
Beds*
Occupancy
Rate Based
on Available
Beds
133
11,724
56.5%
Licensed
Beds**
Occupancy
Rate Based
on Licensed
Beds
Available
Beds Per
1,000
Population
16,415
40.4%
2.2
*Available beds is defined as the number of acute care beds that are immediately available for use or could be
brought online within a short period of time.
**Licensed beds is defined as the number of beds licensed by the Department of Health, under Minnesota
Statutes, sections 144.50 to 144.58.
Source: MDH Health Economics Program analysis of hospital annual reports, U.S. Census Bureau
4
Minnesota Geographic Regions:
Definition
5
Regional Hospital Capacity in Minnesota, 2011
Number
of
Hospitals
Available
Beds*
Occupancy
Rate Based
on Available
Beds
Central
19
1,145
49.5%
1,377
41.2%
1.6
Metro
26
5,939
67.0%
8,484
46.9%
2.1
Northeast
17
1,170
46.3%
1,410
38.4%
3.6
Northwest
13
390
35.9%
578
24.2%
1.9
South Central
15
557
39.5%
779
28.2%
1.9
Southeast
12
1,604
59.4%
2,640
36.1%
3.2
Southwest
23
591
20.1%
725
16.4%
2.7
West Central
8
328
32.7%
422
25.4%
1.7
133
11,724
56.5%
16,415
40.4%
2.2
Total
Licensed
Beds**
Occupancy
Rate Based
on Licensed
Beds
Available
Beds Per
1,000
Population
*Available beds is defined as the number of acute care beds that are immediately available for use or could be
brought online within a short period of time.
**Licensed beds is defined as the number of beds licensed by the Department of Health, under Minnesota
Statutes, sections 144.50 to 144.58.
Source: MDH Health Economics Program analysis of hospital annual reports
6
Distribution of Minnesota’s Hospitals by Size and
Region, 2011
By Number of Available Beds
Under
25 Beds
25-49
Beds
50-99
Beds
100-199
Beds
200 or More
Beds
Total
Central
10.5%
68.4%
10.5%
5.3%
5.3%
100.0%
Metro
3.8%
11.5%
26.9%
11.5%
46.2%
100.0%
Northeast
47.1%
17.6%
17.6%
5.9%
11.8%
100.0%
Northwest
46.2%
46.2%
0.0%
7.7%
0.0%
100.0%
South Central
53.3%
26.7%
13.3%
6.7%
0.0%
100.0%
Southeast
25.0%
25.0%
33.3%
0.0%
16.7%
100.0%
Southwest
39.1%
56.5%
4.3%
0.0%
0.0%
100.0%
West Central
37.5%
37.5%
12.5%
12.5%
0.0%
100.0%
Statewide
30.1%
36.1%
15.0%
6.0%
12.8%
100.0%
Source: MDH Health Economics Program analysis of hospital annual reports
7
Ownership of Minnesota Hospitals, 2011
For Profit, 1,
0.8%
Government:
28.6%
City:
9.8%
County:
6.8%
City and County: 1.5%
District*:
10.5%
Private NonProfit, 84,
63.2%
Religiously
Affiliated, 10,
7.5%
*District hospitals are nonfederal government sponsored hospitals organized at a level other than city or county
Source: MDH Health Economics Program analysis of hospital annual reports
8
Composition of Minnesota’s Hospital Workforce, 2011
Physical and
Occupational
Therapists
1.8%
Pharmacist
1.5%
Registered Nurse
29.3%
Other
49.4%
X-Ray Technician
3.3%
Lab Technician
3.1%
Nursing
Assistant/Aide
5.1%
Mid Level Practitoner
1.5%
*Includes nurse anesthetists, nurse practitioners, and physician assistants
Source: MDH Health Economics Program analysis of hospital annual reports
Physician
2.3%
Licensed Practical
Nurse
2.7%
UTILIZATION OF HOSPITAL
SERVICES
10
Minnesota Hospital Outpatient Visits and Inpatient
Admissions, 2001 to 2011
Outpatient visits
700,000
12,000,000
Inpatient admissions
600,000
10,000,000
500,000
400,000
6,000,000
300,000
4,000,000
200,000
2,000,000
100,000
0
0
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Source: MDH Health Economics Program analysis of hospital annual reports
Outpatient visits
Admissions
8,000,000
11
Average Length of Stay in Minnesota Hospitals,
2001 to 2011
Average length of stay (days)
5
4.4
4.3
4.3
4.2
4.2
4.2
4.2
4.3
4.2
4.2
4.3
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
4
3
2
1
0
Source: MDH Health Economics Program analysis of hospital annual reports
12
Average Length of Stay: Rural and Urban Minnesota
Hospitals, 2001 to 2011
Average length of stay (days)
5.0
4.0
4.6
3.6
4.4
4.4
3.4
3.3
3.0
2.0
1.0
0.0
2006
2001
Rural
Urban
A hospital is defined as rural if it is located in a county that is not part of a metropolitan statistical area.
Source: MDH Health Economics Program analysis of hospital annual reports
2011
13
Minnesota Hospital Utilization by Region, 2011
Inpatient
Admissions
Central
Inpatient
Days
Average
Length of Stay
(days)
Outpatient
Visits
57,459
206,834
3.6
1,513,330
327,589
1,452,007
4.4
3,990,619
Northeast
45,950
197,702
4.3
939,738
Northwest
14,715
51,131
3.5
489,704
South Central
22,213
80,279
3.6
718,540
Southeast
75,664
347,761
4.6
1,697,574
Southwest
13,440
43,413
3.2
537,549
West Central
11,029
39,185
3.6
444,913
568,059
2,418,312
4.3
10,331,967
Metro
Statewide
Source: MDH Health Economics Program analysis of hospital annual reports
14
Distribution of Hospital Admissions and
Inpatient Days by Type of Service, 2011
Percent of
Admissions
Percent of
Inpatient Days
Medical & surgical care
33.6%
34.9%
Cardiac care
12.1%
10.5%
Obstetric care
12.6%
7.6%
Orthopedic care
12.4%
9.8%
Psychiatric care
6.2%
11.1%
Neurology care
5.7%
5.9%
Neonatal care (excluding births)
3.8%
4.8%
Chemical dependency care
1.6%
2.0%
Rehabilitation
1.1%
3.0%
Other acute care
10.9%
10.4%
100%
100%
Total acute care
Source: MDH Health Economics Program analysis of hospital annual reports
15
Trend in Outpatient Surgeries at Minnesota
Hospitals, 2001 to 2011
Outpatient Surgeries in Thousands
450
400
350
300
250
200
150
100
50
0
2001
2002
2003
2004
2005
Source: MDH Health Economics Program analysis of hospital annual reports
2006
2007
2008
2009
2010
2011
16
Trend in Emergency Room Visits at Minnesota
Hospitals, 2001 to 2011
Emergency Room Visits in Thousands
1,800
1,600
1,400
1,200
1,000
800
600
400
200
0
2001
2002
2003
2004
2005
Source: MDH Health Economics Program analysis of hospital annual reports
2006
2007
2008
2009
2010
2011
HOSPITAL FINANCIAL TRENDS
18
Net Income of Minnesota Hospitals, 2001 to 2011
$1,400
Millions of dollars
$1,200
$1,104
$1,150
$983
$1,000
$872
$800
$705
$615
$616
$600
$400
$400
$454
$309
$344
$200
$0
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Source: MDH Health Economics Program analysis of hospital annual reports
19
Minnesota Hospitals' Net Income as a Percent of
Revenue, 2001 to 2011
9%
8%
6.6%
7%
6%
5.1%
5%
7.3%
6.9%
7.3%
7.7%
7.6%
2010
2011
5.6%
5.3%
4.4%
4%
2.7%
3%
2%
1%
0%
2001
2002
2003
2004
2005
Source: MDH Health Economics Program analysis of hospital annual reports
2006
2007
2008
2009
20
Hospital Financial Indicators by Region, 2011
Net Income
(Million Dollars)
Net Income as a
% of Revenue
Central
$195.7
12.3%
Metro
$406.2
5.1%
Northeast
$134.4
9.2%
Northwest
$35.4
9.1%
South Central
$47.8
7.5%
Southeast
$284.1
12.8%
Southwest
$29.3
6.8%
West Central
$17.1
5.5%
$1,150.1
7.6%
Statewide
Source: MDH Health Economics Program analysis of hospital annual reports
21
Hospital Financial Indicators by Hospital Size,
2011
Net Income
(in mill $)
Net Income as a
% of Revenue
Under 25 Beds
$28.3
5.2%
25 to 49 Beds
$173.2
9.4%
50 to 99 Beds
$105.1
5.4%
100 to 199 Beds
$92.0
6.4%
200 Beds or More
$751.5
8.1%
Critical Access
$137.6
7.8%
$1,008.5
7.6%
$4.0
3.9%
$1,150.1
7.6%
PPS
Other
All Hospitals
Number of available beds.
PPS stands for Prospective Payment System, a method of reimbursing hospitals based on a predetermined,
fixed amount. Most acute care, non-Critical Access facilities are so called PPS hospitals.
Source: MDH Health Economics Program analysis of hospital annual reports
22
Sources of Patient Revenue for Minnesota
Hospitals, 2011
Percent of Hospital Patient Revenue
Rural
Facilities
Urban
Facilities
Facilities
Statewide
Medicare
38.5%
28.5%
30.5%
State Public Programs*
11.3%
12.8%
12.5%
Private Insurance
44.1%
53.4%
51.5%
Self-Pay
4.2%
3.5%
3.6%
Other Payers
1.9%
1.8%
1.8%
100.0%
100.0%
100.0%
All Payers
*Includes Medical Assistance and MinnesotaCare
A hospital is defined as rural if it is located in a county that is not part of a metropolitan statistical area.
Source: MDH Health Economics Program analysis of hospital annual reports
HOSPITAL CAPITAL EXPENDITURES
24
Capital Expenditure Commitments by
Minnesota Hospitals, Calendar Year 2011
Percent of Minnesota hospitals reporting major capital
expenditure commitment
Total number of capital expenditure commitments reported
Value of major capital expenditure commitments reported
(Millions)
Major spending commitments that are reportable under 62J.17 include expenditures in excess of $ 1 million.
A small portion of capital expenditure data may belong to earlier reporting periods.
Source: MDH Health Economics Program analysis of hospital annual reports
2010
2011
29.6%
26.3%
103
81
$668.3
$380.3
25
Minnesota Hospital Capital Expenditure
Commitments by Type, 2011
Capital Expenditure
Commitments
(Millions)
Percent of Total
Capital Expenditure
Commitments
Medical equipment
$80.7
21.2%
Building and space
$270.1
71.0%
Other
$29.5
7.7%
All Major Capital Expenditure Commitments
$380.3
100%
Source: MDH Health Economics Program analysis of hospital annual reports
26
Minnesota Hospital Capital Expenditure Commitment
by Category, 2011
Capital Expenditure
Commitments
(Millions)
Percent of Total
Capital Expenditure
Commitment
Other Patient Care Services
$104.5
27.5%
General Infrastructure
$80.2
21.1%
Surgery
$69.3
18.2%
Diagnostic Imaging
$39.5
10.4%
Mental Health
$36.7
9.6%
Emergency Care
$35.3
9.3%
Cardiac Care
$13.2
3.5%
Obstetrics
$1.7
0.4%
$380.3
100.0%
All Major Capital Projects
Major spending commitments that are reportable under 62J.17 include expenditures in excess of $ 1 million.
Source: MDH Health Economics Program analysis of hospital annual reports
COMMUNITY BENEFIT
28
Community Benefit Provided by Minnesota Hospitals,
2011
Community Benefit
(Millions)
Percent of Total
Operating Expenses
Community Care
$152.0
1.1%
State Health Care Programs Underpayment
$427.2
3.1%
Operating Subsidized Services
$98.2
0.7%
Education
$188.0
1.4%
Research
$14.3
0.1%
Community Health Services
$38.7
0.3%
Financial and In-Kind Contributions
$13.0
0.1%
Community Building Activities
$7.5
0.1%
Community Benefit Operation
$12.3
0.1%
Total
$951.1
6.9%
Source: MDH Health Economics Program analysis of hospital annual reports
29
Distribution of Minnesota Hospitals’ Community
Benefit by Category, 2011
Financial and In-Kind
Contributions
1.4%
Research
1.5%
Community Benefit
Operation
1.3%
Community Building
Activities
0.8%
Community Health
Services
4.1%
Operating Subsidized
Services
10.3%
State Health Care
Programs
Underpayment
44.9%
Education
19.8%
Community Care
16.0%
Source: MDH Health Economics Program analysis of hospital annual reports
For definitions see: MDH/Health Economics Program, “Community Benefit Provided by Minnesota
Hospitals in 2011,” forthcoming (www.health.state.mn.us/healtheconomics)
AVAILABILITY OF SPECIFIC HOSPITAL
SERVICES
31
Services Available in Minnesota Hospitals, 2011
Number of Hospitals
Services
Available*
Services Not
Available
Surgery
Inpatient Surgery
Outpatient Surgery
Open-Heart Surgery Services
Organ Transplant Services
128
131
18
6
5
2
115
127
61
26
72
108
132
130
8
1
3
125
40
93
42
25
91
108
Mental Health/Chemical Dependency Services
Outpatient Psychiatric Services
Detoxification Services
Diagnostic Radiology
Computer Tomography (CT) Scanning Services
Magnetic Resonance Imaging (MRI) Services
Positron Emission Tomography (PET) Services
Single Photon Emission Computerized
Tomography (SPECT) Services
Other Services
Renal Dialysis Services
Cardiac Catheterization Services
*Services are considered “available” when they are provided on site by hospital staff, on site through contracted
services, or off site through shared services agreement.
Source: MDH Health Economics Program analysis of hospital annual reports
PHYSICIAN SERVICES
33
Number of Physicians Practicing in Minnesota, 2011
Number of Physicians:
15,523
Primary Care Physicians
4,937
Specialty Care Physicians
7,532
No Certification
3,054
Physicians per 100,000 Population:
Primary Care Physicians
Specialty Care Physicians
Primary Care includes: General Family Medicine, General Internal Medicine, General Pediatrics.
No Certification means there were no board certifications on the record received from the Minnesota Board of
Medical Practice.
Source: Minnesota Board of Medical Practices, analysis of MDH, Office of Rural Health & Primary Care
290
92
141
34
Number of Physicians Practicing in Minnesota
by MSA and Non-MSA Counties, 2011
Rural
Number of Physicians:
Micropolitan
Urban
Statewide
572
1,136
13,815
15,523
Primary Care Physicians
341
528
4,068
4,937
Specialty Care Physicians
100
418
7,014
7,532
88
168
364
290
Primary Care Physicians
52
78
101
92
Specialty Care Physicians
15
62
175
141
Physicians per 100,000 Population:
MSA Defintions, OMB 2008
Note: Due to methodology changes, past Chartbook data should not be used for comparison.
Source: Minnesota Board of Medical Practices, analysis by MDH, Office of Rural Health & Primary Care
35
Distribution of Number of Physicians Practicing
in Minnesota by Location and Specialty, 2011
Rural
Micropolitan
Urban
Statewide
Primary Care Physicians
59.6%
46.5%
29.4%
31.8%
Internal Medicine Subspecialty
Physicians
0.9%
2.7%
10.4%
9.5%
Surgeons
9.8%
19.0%
13.7%
13.9%
6.8%
15.1%
26.7%
25.1%
No Certification
22.9%
16.7%
19.8%
19.7%
All Specialties
100%
100%
100%
100%
Other Specialty Physicians
MSA Defintions, OMB 2008
Note: Due to methodology changes, past Chartbook data should not be used for comparison.
Source: Minnesota Board of Medical Practices, analysis by MDH, Office of Rural Health & Primary Care
36
Additional Information from the Health
Economics Program Available Online
• Health Economics Program Home Page
• www.health.state.mn.us/divs/hpsc/hep/index.html
• Publications
• www.health.state.mn.us/divs/hpsc/hep/publications/yearly/2010.html
• Health Care Market Statistics (Chartbook Updates)
• www.health.state.mn.us/divs/hpsc/hep/chartbook/index.html
• Interactive Health Insurance Statistics
• https://pqc.health.state.mn.us/mnha/Welcome.action