Section 8 - Minnesota Department of Health

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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, 2012
Number of
Hospitals
Available
Beds*
Occupancy
Rate Based
on Available
Beds
133
11,721
56.9%
Licensed
Beds**
Occupancy
Rate Based
on Licensed
Beds
Available
Beds Per
1,000
Population
16,412
40.6%
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
Unless otherwise noted, all data is this section is for each hospital’s fiscal year.
4
Minnesota Geographic Regions:
Definition
5
Regional Hospital Capacity in Minnesota, 2012
Number
of
Hospitals
Available
Beds*
Occupancy
Rate Based
on Available
Beds
Licensed
Beds**
Occupancy
Rate Based
on Licensed
Beds
Available
Beds Per
1,000
Population
Central
19
1,189
47.2%
1,377
40.7%
1.6
Metro
26
5,883
69.0%
8,484
47.9%
2.0
Northeast
17
1,165
45.5%
1,411
37.6%
3.6
Northwest
13
390
35.8%
578
24.2%
1.9
South Central
15
559
37.0%
779
26.5%
1.9
Southeast
12
1,622
58.6%
2,640
36.0%
3.3
Southwest
23
585
18.6%
725
15.0%
2.7
West Central
8
328
32.0%
418
25.1%
1.7
Total
133
11,721
56.9%
16,412
40.6%
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.
6
Distribution of Minnesota’s Hospitals by Size and
Region, 2012
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
41.2%
23.5%
17.6%
5.9%
11.8%
100.0%
Northwest
46.2%
46.2%
0.0%
7.7%
0.0%
100.0%
South Central
46.7%
33.3%
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
28.6%
37.6%
15.0%
6.0%
12.8%
100.0%
Source: MDH Health Economics Program analysis of hospital annual reports.
7
Ownership of Minnesota Hospitals, 2012
For Profit, 1,
0.8%
Government, 34,
25.6%
City:
County:
City and County:
District:
Private NonProfit, 89,
66.9%
Source: MDH Health Economics Program analysis of hospital annual reports.
Religiously
Affiliated, 9,
6.8%
7.5%
5.3%
1.5%
11.3%
8
Affiliation of Minnesota Community Hospitals, 19922012
100
90
Number of Hospitals
80
70
60
50
40
30
20
10
0
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Affiliated
Source: MDH Health Economics Program analysis of hospital annual reports.
No Affiliation
9
Largest Minnesota Hospital Systems, 2002-2012
16
Sanford Health*
14
Mayo Clinic
Number of Hospitals
12
Allina Hospitals and Clinics
10
Essentia Community Hospitals
and Clinics**
8
Fairview Health Services
6
Catholic Health Initiatives
4
2
0
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
*Previously known as Sioux Valley. Changes in the number of hospital affiliations impact trend lines over time.
**Essentia represents the merger of Benedictine and SMDC systems and includes both systems over time.
Source: MDH Health Economics Program analysis of hospital annual reports.
10
Minnesota Hospital System Ownership, 2012
Hospital System
Allina Hospitals and Clinics
Owned
Managed Leased Total
Available Beds
10
1
0
11
1,857
Avera Health
1
2
0
3
99
Catholic Health Initiatives
5
0
0
5
107
CentraCare Health System
2
0
1
3
515
Children's Hospitals and Clinics
Essentia Community Hospitals and Clinics
(ECHC)
Fairview Health Services
1
0
0
1
279
9
1
0
10
773
7
0
0
7
1,414
HealthEast Care System
4
0
0
4
630
HealthPartners, Inc.
2
0
0
2
502
13
0
0
13
1,748
Ministry Health Care
1
0
0
1
23
North Memorial Health Care
2
0
0
2
440
Park Nicollet Health Services
2
1
0
3
433
Paynesville Area Health Care System
1
0
0
1
30
Quorum Health Resources
0
1
0
1
25
Rice Memorial Hospital
1
0
0
1
18
Sanford Health
5
6
4
15
430
Select Medical Corporation
1
0
0
1
92
St. Luke's Hospital, Duluth
0
2
0
2
284
67
14
5
86*
9,699
49
2,022
Mayo Clinic
Total
Unaffiliated Hospitals
Source: MDH Health Economics Program analysis of hospital annual reports.
*Hospitals with multiple affiliations are counted under each affiliation; for hospitals with multiple
affiliations available beds are divided across systems equally.
11
Composition of Minnesota’s Hospital Workforce,
2012
Physical and
Occupational
Therapists
1.8%
Pharmacist
1.5%
Registered Nurse
29.0%
X-Ray Technician
3.0%
Other**
49.8%
Lab Technician
3.1%
Nursing
Assistant/Aide
4.9%
Mid Level
Practitoner*
1.6%
*Includes nurse anesthetists, nurse practitioners, and physician assistants.
**Other is reported as a grouped category of positions.
Source: MDH Health Economics Program analysis of hospital annual reports.
Physician
2.7%
Licensed Practical
Nurse
2.6%
UTILIZATION OF HOSPITAL
SERVICES
13
Minnesota Hospital Outpatient Visits and Inpatient
Admissions, 2002 to 2012
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
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Source: MDH Health Economics Program analysis of hospital annual reports.
Outpatient visits
Admissions
8,000,000
14
Average Length of Stay in Minnesota Hospitals,
2002 to 2012
Average length of stay (days)
5
4.3
4.3
4.2
4.2
4.2
4.2
4.3
4.2
4.2
4.3
4.3
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
4
3
2
1
0
Source: MDH Health Economics Program analysis of hospital annual reports.
Average length of stay grew by 1.9% in 2012 but due to rounding it appears constant.
15
Average Length of Stay: Rural and Urban Minnesota
Hospitals, 2002 to 2012
Average length of stay (days)
5.0
4.0
4.5
3.5
4.5
4.4
3.4
3.4
3.0
2.0
1.0
0.0
2002
2007
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.
2012
16
Minnesota Hospital Utilization by Region, 2012
Inpatient
Admissions
Central
Inpatient
Days
Average
Length of Stay
(days)
Outpatient
Visits
56,477
204,641
3.6
1,602,863
326,203
1,482,413
4.5
4,290,921
Northeast
43,984
193,404
4.4
949,749
Northwest
14,985
51,031
3.4
647,816
South Central
21,217
75,472
3.6
724,323
Southeast
74,919
347,180
4.6
1,804,865
Southwest
12,416
39,714
3.2
557,534
West Central
10,478
38,343
3.7
554,025
560,679
2,432,198
4.3
11,132,096
Metro
Statewide
Source: MDH Health Economics Program analysis of hospital annual reports.
17
Distribution of Hospital Admissions and
Inpatient Days by Type of Service, 2012
Percent of
Admissions
Percent of
Inpatient Days
Medical & surgical care
30.5%
31.4%
Cardiac care
11.4%
9.6%
Obstetric care
11.6%
6.9%
Orthopedic care
11.5%
8.9%
Psychiatric care
5.9%
10.4%
Neurology care
5.2%
5.4%
Neonatal care (excluding births)
3.6%
4.4%
Chemical dependency care
1.4%
1.8%
Rehabilitation
1.0%
2.7%
Other acute care
17.8%
18.4%
Total acute care
100.0%
100.0%
Source: MDH Health Economics Program analysis of hospital annual reports.
18
Trend in Outpatient Surgeries at Minnesota
Hospitals, 2002 to 2012
Outpatient Surgeries in Thousands
450
400
350
300
250
200
150
100
50
0
2002
2003
2004
2005
2006
Source: MDH Health Economics Program analysis of hospital annual reports.
2007
2008
2009
2010
2011
2012
19
Trend in Emergency Room Visits at Minnesota
Hospitals, 2002 to 2012
Emergency Room Visits in Thousands
1,800
1,600
1,400
1,200
1,000
800
600
400
200
0
2002
2003
2004
2005
2006
Source: MDH Health Economics Program analysis of hospital annual reports.
2007
2008
2009
2010
2011
2012
HOSPITAL FINANCIAL TRENDS
21
Net Assets of Minnesota Hospitals, 2002 to 2012
$14
$11.6
$12
Billions of dollars
$10.1
$10
$8.4
$7.7
$8
$6.8
$5.6
$6
$4.6
$8.6
$7.3
$6.0
$4.9
$4
$2
$0
2002
2003 2004 2005
2006 2007 2008
2009 2010 2011
Source: MDH Health Economics Program analysis of hospital annual reports.
Net assets is an accounting term defining the total assets minus the total liabilities, and describes the hospital’s
financial position.
2012
22
Net Income of Minnesota Hospitals, 2002 to 2012
$1,400
Millions of dollars
$1,200
$1,104
$1,150
$1,159
2011
2012
$983
$1,000
$872
$800
$705
$616
$615
$600
$400
$400
$454
$344
$200
$0
2002
2003
2004
2005
2006
Source: MDH Health Economics Program analysis of hospital annual reports.
2007
2008
2009
2010
23
Minnesota Hospitals' Net Income as a Percent of
Revenue, 2002 to 2012
9%
8%
6.6%
7%
6%
5.1%
7.3%
6.9%
7.3%
7.7%
7.6%
2010
2011
7.3%
5.6%
5.3%
5%
4%
2.7%
3%
2%
1%
0%
2002
2003
2004
2005
2006
2007
Source: MDH Health Economics Program analysis of hospital annual reports.
2008
2009
2012
24
Hospital Financial Indicators by Region, 2012
Net Income
(Million Dollars)
Net Income as a
% of Revenue
Central
$85.0
5.2%
Metro
$556.1
6.4%
Northeast
$86.0
5.9%
Northwest
$42.7
9.9%
South Central
$50.1
7.5%
Southeast
$298.4
12.8%
Southwest
$26.8
5.9%
West Central
$14.2
4.0%
$1,159.2
7.3%
Statewide
Source: MDH Health Economics Program analysis of hospital annual reports.
25
Hospital Financial Indicators by Hospital Size,
2012
Net Income
(Million Dollars)
Net Income as a
% of Revenue
Under 25 Beds
$34.6
6.9%
25 to 49 Beds
$153.7
7.6%
50 to 99 Beds
$152.6
7.2%
100 to 199 Beds
$103.4
6.7%
200 Beds or More
$714.9
7.3%
Critical Access
$133.3
7.2%
$1,016.6
7.3%
$9.4
7.9%
$1,159.2
7.3%
PPS
Other
All Hospitals
Number of available beds.
Source: MDH Health Economics Program analysis of hospital annual reports.
26
Sources of Patient Revenue for Minnesota
Hospitals, 2012
Percent of Hospital Patient Revenue
Rural
Facilities
Urban
Facilities
Facilities
Statewide
Medicare
38.8%
28.5%
30.6%
State Public Programs*
10.4%
12.7%
12.3%
Private Insurance
44.8%
53.1%
51.4%
Self-Pay
4.4%
3.5%
3.7%
Other Payers
1.6%
2.2%
2.1%
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
28
Capital Expenditure Commitments by
Minnesota Hospitals, 2012
Percent of Minnesota hospitals reporting major capital
expenditure commitment
Total number of capital expenditure commitments reported
Value of major capital expenditure commitments reported
(Millions)
2011
2012
30.8%
25.6%
91
83
$412.0
$569.9
Major spending commitments that are reportable under 62J.17 include expenditures in excess of $ 1 million.
Spending commitments are included by calendar date; 2011 figures reflect projects reported during 2012 and is a revision
over previous publications.
Source: MDH Health Economics Program analysis of hospital annual reports.
29
Minnesota Hospital Capital Expenditure
Commitments by Type, 2012
Capital Expenditure
Commitments
(Millions)
Percent of Total
Capital Expenditure
Commitments
Medical equipment
$85.4
15.0%
Building and space
$452.8
79.5%
Other
$31.7
5.6%
All Major Capital Expenditure Commitments
$569.9
100%
Source: MDH Health Economics Program analysis of hospital annual reports.
30
Minnesota Hospital Capital Expenditure Commitment
by Category, 2012
Capital Expenditure
Commitments
(Millions)
Percent of Total
Capital Expenditure
Commitment
Other Patient Care Services
$299.0
52.5%
General Infrastructure
$131.2
23.0%
Diagnostic Imaging
$35.3
6.2%
Surgery
$30.9
5.4%
Cardiac Care
$26.8
4.7%
Intensive Care (ICU or NICU)
$15.9
2.8%
Obstetrics
$9.7
1.7%
Orthopedics
$6.2
1.1%
Radiation Therapy
$5.6
1.0%
Emergency Care
$4.4
0.8%
Mental Health
$2.7
0.5%
Chemical Dependency
$2.3
0.4%
$569.9
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
32
Community Benefit Provided by Minnesota Hospitals,
2012
Community Benefit
(Millions)
Percent of Total
Operating Expenses
Community Care
$144.9
1.0%
State Health Care Programs Underpayment
$488.7
3.3%
Operating Subsidized Services
$127.3
0.9%
Education
$201.8
1.4%
Research
$16.3
0.1%
Community Health Services
$36.7
0.2%
Financial and In-Kind Contributions
$10.5
0.1%
Community Building Activities
$5.4
0.0%
Community Benefit Operation
$12.0
0.1%
$1,043.5
7.1%
Total
Source: MDH Health Economics Program analysis of hospital annual reports.
33
Distribution of Minnesota Hospitals’ Community
Benefit by Category, 2012
Financial and In-Kind
Contributions
1.0%
Research
1.6%
Community Benefit
Operation
1.1%
Community Health
Services
3.5%
Operating Subsidized
Services
12.2%
Community Building
Activities
0.5%
State Health Care
Programs
Underpayment
46.8%
Education
19.3%
Community Care
13.9%
Source: MDH Health Economics Program analysis of hospital annual reports.
For definitions see: MDH/Health Economics Program, “Community Benefit Provided by Minnesota
Hospitals in 2007, and forthcoming 2012 report,” (www.health.state.mn.us/healtheconomics).
AVAILABILITY OF SPECIFIC HOSPITAL
SERVICES
35
Services Available in Minnesota Hospitals, 2012
Number of Hospitals
Services
Available*
Services Not
Available
Surgery
Inpatient Surgery
Outpatient Surgery
Open-Heart Surgery Services
Organ Transplant Services
127
131
18
6
6
2
115
127
62
25
71
109
132
130
8
1
3
125
40
93
40
25
93
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
37
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
38
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
341
528
4,068
4,937
100
418
7,014
7,532
88
168
364
290
Primary Care Physicians
52
78
101
92
Specialty Care Physicians
15
62
175
141
Primary Care Physicians
Specialty Care Physicians
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.
39
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.
40
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
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