K.I.S.S. PLAN FOR HEALTH CARE
(Keep It Simple Stupid)
NOT THE PUBLIC OPTION, THE SELF-INSURED OPTION
WITH DEFINED CONTRIBUTIONS FROM GOVERNMENT & BUSINESS
A VISION FOR THE FUTURE OF
RI & US HEALTH CARE
IMPROVE ACCESS, FINANCE & COST
“MOVE TO DE FACTO SINGLE PAYER AS NEW FED. EXCHANGE IN RI”
SIMILAR TO BEACON IN WORKER COMP., FED. 330 CLINICS, AND RI PSEUBA (2011-H5901)
www.ribetter.org
April, 2013
ribetter@gmail.com.
SUMMARY & CONTENTS
PART 1: RI HEALTH
SLIDE 8 TO 25: Brief overview of how $8 billion is spent on health care in RI each year. A proposal to create
a single buyer’s co-op (RI Life & Health Trust) to act as a market counter-weight to providers, achieve 100%
financial & geographic access and re-orient care away from fee-for-service & hospitals and toward prevention
& primary care. Use life insurance to fund cost. Business & Government contribute to the Co-Op on a fixed
per person, % of payroll and/or % of revenue, etc basis at their current level. Future increases are capped at
inflation under 5 to 10 year contracts with the Co-Op. Business & Government have no vote in Co-Op, only
individual patients & working families vote. Co-Op negotiates agreements with providers in a public process,
any costs not covered by Business & Government contributions are paid for by patients & working families
who vote to support or reject the agreements/plans proposed annually. Maximize transparent “arms-length”
market transaction between paying patient & provider. Minimize lobbying, politics, and unsustainable
growth. All stakeholders have clear transparency what resources are available & the customer can say “NO”.
SLIDE 26 TO 42: Primary Care requirements in RI. Pay Parity, no Fee-for-Service, Prevention.
SLIDE 43 TO 49: Hospital costs in RI. Shrink & Focus. No Fee-for-Service.
SLIDE 50 TO 78: Appendix A-D detail data tables on RI.
PART 2: GOING NATIONAL
SLIDE 79 TO 247: Appendix E-L Taking the above RI example and applying it to the national health care
market. Effectively reducing the number of health care customers in the country to 185 buyer Co-Op’s (each 1
to 2 mil people, 1 to 2 RI’s) and looking at how we spend $2.3 trillion on health. As in RI, reduce hospital costs
and drug costs to fund added nursing homes & home care (2x increase in +65 pop.). Limit cost to inflation.
HOW WE SPEND $2.3T
SAVE $360B 15%
(re-invest in Nursing Homes & Home Care)
CURRENT COSTS:
MOVE TO
(see appendix A & B)
MD/Other fees
$484B 21%
Dental
$ 115B 5%
Hosp-546m OP other $285B 12%
MD FEEs (slide 80):
135k Surgeons
$68b
25k Psychiatrists
$10b
118k Medical
$73b
Hosp-138m OP ER $ 95B 4%
Hosp-25m OP Surg. $ 30B 1%
Hosp-39m inpatient $402B 18%
Drugs
Nursing Homes
Non-Durables
Home Care
Other
TOTAL
$ 270B 12%
$ 135B 6%
$ 137B 6%
$ 74B 3%
$ 273B 12%
$2,300B
MD PRIMARY CARE:
122k Gen. Practices $146b
50k Geriatric
$61b
49k Pediatric
$59b
47k Ob/Gyn
$56b
101k Dentists
$95b
52k Optometrists $33b
111k Diet/Nutri
$8b
39k Ath. Trainers
$3b
TOTAL
$461b
Also, this population
will double 10-20 yrs
see A5/A6, global waiver
Hospitals
$527b
Drugs
Nursing Homes
Non-Durables
Home Care
Other
TOTAL
$185b
$135b
$137b
$74b
$273b
$1,943b
Primary Care is 660m 1/2hr MD visits & 1B 1hr nurse visits per year. Should include
routine lab, imaging, etc. 100% access. Shrink & focus hospitals to ER, Surgery & Inpatient.
COST INCREASE 31% + INFLATION OVER NEXT 20 YEARS, +65 THEN STABLE
2010 POP: 309 mil (+65 40 mil)
2030 POP: 364 mil (+65 72 mil) +17%, (+180%)
2050 POP: 439 mil (+65 89 mil) +21%, (+24%)
MD PRIMARY CARE:
122k Gen. Practices
$146b
50k Geriatric
$61b
49k Pediatric
$59b
47k Ob/Gyn
$56b
101k Dentists
$95b
52k Optometrists
$33b
111k Diet/Nutri
$8b
39k Ath. Trainers
$3b
TOTAL
$461b
MD PRIMARY CARE:
129k Gen. Practices
$155b +6%
90k Geriatric
$108b +180%
56k Pediatric
$68b +15%
49k Ob/Gyn
$58b +4%
118k Dentists
$111b +17%
61k Optometrists
$39b +18%
130k Diet/Nutri
$9b +17%
46k Ath. Trainers
$4b +17%
TOTAL
$552b +20%
MD FEEs:
135k Surgeons
58k Psychiatrists
281k Medical
MD FEEs :
159k Surgeons
68k Psychiatrists
332k Medical
$68b
$15b
$68b
$80b +18%
$18b +18%
$80b +18%
Hospitals +65 (15m dchg) $200b
Hospitals <65 (24m dchg) $327b
Hospitals +65
Hospitals <65
$360b +180%
$353b +8%
Drugs +65 (40mil pop)
$55b
Drugs <65 (270 m pop) $130b
Nursing Homes (1.7m)
$135b
Non-Durables
$137b
Home Care (1.1b days)
$74b
Other
$273b
TOTAL
$1,943b
Drugs +65 (72mil)
$100b +180%
Drugs <65 ( 292 m)
$140b +8%
Nursing Homes
$243b +180%
Non-Durables
$160b +17%
Home Care
$135b +180%
Other
$320b +17%
TOTAL
$2,541b +31%
TURN HEALTH CARE ON IT’S HEAD

HEALTH CARE, LIKE MANY MARKETS IN THE US, IS SO DOMINATED BY SELLERS &
GOV’T LOBBYING AS TO NOT BE A MARKET AT ALL.

BY REDUCING CUSTOMERS TO 185 SELF-INSURED BUYING GROUPS (CO-OPs), THIS
DYNAMIC IS COMPLETELY CHANGED.

CUSTOMER WOULD BE KNOWLEDGEABLE, FINANCIALLY STRONG AND HAVE THE
ABILITY TO SAY “NO” TO SELLERS AND MAKE OTHER ARRANGEMENTS. THAT’S THE
DEFINITION OF A MARKET. THAT’S WHAT “PATIENT-DRIVEN” REALLY LOOKS LIKES.

LIMITING BUSINESS & GOVERNMENT TO DEFINED CONTRIBUTIONS, AND INSURERS
TO BENEFIT MANAGERS, GIVES THEM CERTAINTY & SHIFTS RISK TO THE DIRECT
“BUYER-SELLER RELATIONSHIP” COST REDUCTION WILL RESULT.

USING LIFE INSURANCE REDUCES FINANCING TO A “CASH FLOW TIMING” EXERCISE.
DEATH BENEFITS FROM BOOMERS WHO DO NOT MAKE OLD AGE, WILL PAY HEALTH
COST OF THOSE BOOMERS WHO DO. IN 30 YEARS DEATH BENEFITS WILL EXCEED
HEALTH COSTS AS THE +65 POPULATION BECOMES STABLE THEREAFTER.

CO-OPs WOULD REPORT AS PUBLIC COMPANIES DO TODAY ON A QUARTERLY OR
BIANNUAL BASIS. INCREASED FINANCIAL & HEALTH INFO WILL FURTHER REDUCE
COST & IMPROVE HEALTH AWARENESS... a completely changed dynamic in the health market.

NOT A ONE SIZE FITS ALL. THERE IS ONLY A LIMITED AMOUNT OF MONEY
AVALABLE IN EACH OF THE 185 CO-OP MARKETS (SEE APPENDIX F). ALTHOUGH
THERE WILL BE COMMON COVERAGES & PLANS AVAILABLE NATIONWIDE, LOCAL
SOLUTIONS WILL DIFFER. LOCAL BUYERS (CO-OP) & SELLERS IN AGREEMENT.

THIS PLAN SHOULD KEEP HEALTH COST AT $2.5 TRILLION +INFLATION OVER THE
NEXT 20 YEARS AND CUT IT IN HALF AS % OF GDP. 100% ACCESS.
BUS. & GOV’T FUND AT CURRENT LEVEL + POP. & INFLATION. NO CO-OP VOTE
FUNDING
FEDERAL PAYMENTS ($1.1 TRIL.)
NOW:
2030:
Medicare: $515B
$600B +17%
Medicaid: $365B
$430B +17%
All Other: $220B
$260B +17%
(APPENDIX E4, E7, E8, E9, I, J, K)
(funding & spending below are ex-inflation)
MD PRIMARY CARE
NOW:
2030:
$461B
$552B
185 BUYER
CO-OP’S
HOSP: IP, OP-ER & Surg.
NOW:
2030:
$527B
$713B
(self-insured)
STATE & LOCAL ($300B)
NOW:
2030:
Medicaid: $127B
$150B +17%
All Other: $200B
$235B +17%
(APPENDIX E4, E7, E8, E9, J, L)
(Appendix F)
each 1 to 2.5 MIL
PEOPLE
$8B to $20B
SPEND
BUSINESS/ EMPLOYERS ($700B.)
NOW:
2030:
$743B
$870B +17%
(APPENDIX E4, E7, E8, E9)
Patients & Working Families
NOW:
2030:
$220B
$260B +17%
POP: 310m
364m +17%
HLDs 140m
165m +17%
(APPENDIX E4 & E6)
Local Markets
within states
LIFE
INSURANCE
$54T Benefits
(A4, A5, E2)
SPENDING
NOW: $1,943B
2030: $2,541B
+INFLATION
MD FEES- Specialists
NOW:
2030:
$151B
$178B
Nurs. Homes & Home Care.
NOW:
2030:
$209B
$378B
DRUGS
NOW:
2030:
$185B
$240B
Non-Durables & Other.
NOW:
2030:
$410B
$480B
“PATIENT-DRIVEN” ANY OTHER INCREASE IS BORNE BY PAYING & CO-OP VOTING PATIENTS
TABLE OF CONTENTS
PART 1- RI HEALTH CARE:
RI Trust:
Fin Access:
Geo Access:
Primary:
Hospital:
MD Fees:
Appendix A:
Appendix B:
Appendix C:
Appendix D:
RI OVERVIEW (CO-OP, Life Ins, etc)
FINANCIAL ACCESS IN RI
GEOGRAPHIC ACCESS IN RI
PRIMARY CARE IN RI
HOSPITAL COSTS IN RI
MD FEES IN RI (Specialists- not PC or Hosp EE’s)
REVIEW OF RI HEALTH COSTS (by pop., service, cash flow, etc.)
HOSPITAL COSTS IN RI (Detailed Activities)
25 MOST PROFITABLE HOSPITALS IN THE USA
OUTPATIENT PRICING- HOSP. VS MD OFFICE IN RI
PART 2- GOING NATIONAL:
Appendix E1-12: EXPANDING RI MODEL NATIONALLY
(maps) Appendix E13-21: POPULATION BY AGE (185 CO-OP’s DEFINED & MAP Links)
Appendix E22-34: PRIMARY CARE COSTS BY CO-OP (# practices, etc)
Appendix E35-44: HOSP. INPATIENT COSTS BY CO-OP (# beds, discharges, etc)
Appendix E45-54: HOSP. OUTPATIENT ER & SURG. COSTS BY CO-OP
Appendix E55-64: HOSP. OUTPATIENT OTHER COSTS BY CO-OP
Appendix E65-70: HOSP. UTILIZATION RATES & EXCESS BEDS BY STATE & REGION
Appendix E71-80: NURSING HOME BEDS & HOME CARE DAYS BY CO-OP
Appendix E81-90: PRESCRIPTION DRUGS BY CO-OP
Appendix E91-103: DOCTOR FEES (not Hosp. EE’s or Primary Care)
Appendix E104-113: NON-DURABLES & OTHER
(maps) Appendix F: TOTAL FUNDING & SPENDING by CO-OP (MAP Links)
Appendix G: REIMBURSEMENT RATES & GEOGRAPHIC COLA’S
(maps) Appendix H: ECON. & DEMO. DIFFERENCES (185 CO-OP’s DEFINED & MAP Links)
Appendix I: FED. MEDICARE FUNDING BY STATE
Appendix J: FED. & STATE MEDICAID FUNDING BY STATE
Appendix K: OTHER FED. HEALTH FUNDING BY STATE
Appendix L: STATE & LOCAL GOVERNMENT
PART 1: RI HEALTH COSTS
NOW LET’S LOOK AT RHODE ISLAND
HEALTH IN DETAIL.
A “1 MILLION PERSON MICROCOSM” OF
THE NATIONAL HEALTH SYSTEM
“PATIENT-DRIVEN” CHANGING THE DELIVERY SYSTEM: CHEAPER, BETTER
RI HEALTH CARE COSTS


$7.7B HEADED TO $9B, UNSUSTAINABLE
THINGS WE CAN INFLUENCE:

FINANCE & ACCESS: USE LIFE INS TO REDUCE IN-STATE BURDEN PAID
BY RI FAMILIES, EMPLOYERS & GOV’T 40% NOW DURING BOOMER
YEARS, 100% THEREAFTER. AVOID $2.4B PER YR & 100% ACCESS

COST: REVERSE TREND OF HOSPITALS BUYING PRIMARY CARE
PRACTICES AS “LOSS LEADER” TO DRIVE UP OUTPATIENT VOLUME AT
2X THE COST. 3 VISITS/YR FOR EVERY PERSON IN RI ($1.5B)? SAVE $.5B
DRAMATICALLY IMPROVE CARE & 100% ACCESS.

COST: 15M SCRIPTS $1B ($60/EA). LESS RETAIL , MORE NEGOTIATED
PRICE PLAN. SAME COMPANIES NOW ANYWAY.

COST: IT’S ESTIMATED THAT 1/3 OF INS PREMIUM IS CONSUMED BY
INSURER AS ADMIN, RESERVE & PROFIT. NO HEALTH BENEFIT.
LESS INSURER MORE BENEFIT MANAGER FOR A FEE. INS PROFIT
WOULD IMPROVE AND MORE CARE FOR THE $. THE INS MODEL
CONSUMES TOO MANY DOLLARS, WE NEED A BETTER CONDUIT.
CREATE THE RI LIFE & HEALTH TRUST (RI L&HT)
CREATE A DE FACTO
SINGLE PAYER PLAN
(IN ADDITION TO MEDICAID, MEDICARE & FED EE’s)
RI LIFE & HEALTH TRUST
TRUST IS PRIMARILY A BUYER’S CO-OP SEEKING VALUE AND ACCESS. SIMILAR
TO FED. 330 CLINICS. AN EFFECTIVE COUNTER-WEIGHT TO PROVIDERS.
ALSO SIMILAR TO BEACON IN WORKER’S. COMP. &
RI PSEUBA (Public School Employee Universal Benefit Act)
RI LIFE & HEALTH TRUST

EMPLOYERS & GOV.’T CONTRIBUTE CURRENT PREMIUMS TO
TRUST FOR SIMILAR PLAN RECEIVE A 40% REBATE/REFUND (see
A7 for detail).

COVERAGE IS NOT DEPENDEND ON EMPLOYMENT

ALL SMALL / UN-INSURED EMPLOYERS MUST CONTRIBUTE
SOMETHING: (EX: $500/EE/YR, 3 YR PHASE-IN)

FAMILIES PAY BASED ON ABILITY (AGI)
INSURERS (Blue Cross) BECOME BENEFIT MANAGERS
100% ACCESS/COVERAGE


PATIENTS are free to purchase added coverage with their own funds
through the TRUST or in the open market. TRUST focus is on health
care as a “public utility” for all in the area.
USE LIFE INS TO FINANCE







BUY LIFE INS FOR 45-54 AGE GROUP
$1M 30YR TERM INS POLICIES
$2K PER PERSON PER YR COST
CREATES $180B DEATH BENEFIT STREAM
ASSIGN TO INVESTORS FOR $30B NOW
$30B GENERATES $2B INCOME FOR REBATES
5% -10% OF DEATH BEN. TO FAMILY
USE RI LIFE & HEALTH TRUST AS VEHICLE
(SEE APPENDIX A4 FOR DETAILED DATA)
OPPOSE THE
LIFESPAN-CARE NE MERGER
(will add cost, low volume procedures, more outpatient, like MA)
(it costs $26k for 5 day stay at RI Hosp vs $16k at Kent)
SUPPORT A
BLUE CROSS-CARE NE MERGER
(provider & payer focused on high volume inpatient procedures & true ER)
(A market counter-weight to LifeSpan)
B/C & others become benefit managers to the large self-insured CO-OP. Ins capital is not at risk.
BECOME PART OF RI LIFE & HEALTH TRUST.
RI LIFE & HEALTH TRUST
PRIMARY TRUST FOCUS:
FINANCE & ACCESS (SINGLE PAYER, LIFE INS, 100% COVERAGE)
PRIMARY CARE (PAY PARITY, LOWER COST, BETTER HEALTH STATS)
HIGH VOLUME LOW COST IN-PATIENT & TRUE ER
(BLUE CROSS – CARE NE MERGER) (SHRINK & FOCUS HOSPITALS)
END FEE-FOR-SERVICE (As described herein for Hosp & Primary Care)
DRUG COST REDUCTION (MORE NEGOTIATED MAIL ORDER LESS RETAIL)
STATE WIDE WEB-BASED MED. RECORDS
REQUIRE DIET & EXERCISE IN K-12. LEVERAGE PE.
100% FINANCIAL ACCCESS
FAMILIES PAY BASED ON ABILITY
EMPLOYERS PAY CURRENT RATE LESS TRUST REBATE
ALL BUSINESSES MUST CONTRIBUTE NOT JUST EMPLOYERS & NEED NOT BE PAYROLL BASED
(see A7 for added details, payroll based example)
INSURERS BECOME BENEFIT MANAGERS
SHRINK & FOCUS HOSPITAL/ BULK DRUG SAVE 1/3
RI LIFE & HEALTH TRUST
Table of Contents
WHO PAYS? 100% ACCESS
TOTAL HEALTH COSTS
FED. MEDICARE/MEDICAID
FED. EE PLANS
IN-STATE COSTS
STATE- MEDICAID
STATE- EE/OTHER
STATE- TRUST REFUND
MUNI- EE/OTHER
MUNI- TRUST REFUND
FAMILIES/EE (based on $)
EMPLOYERS/ OTHER
ER TRUST REFUND
TRUST PAYS
BUSINESS FRIENDLY!
NOW
$7.7B
($2.3B)
($0.2B)
$5.2B
$.8B
$.3B
$0
$.4B
$0
$1.0B
$2.7B
$0
$5.2B
NEW
$7.7B
($2.3B)
($0.2B)
$5.2B
$1.0B
$.3B
($.6B)
$.4B
($.2B)
$.8B
$2.7B
($1.1B)
$3.3B -46%
$1.9B
$5.2B
From
investing
Life Ins
assign $30B
BAL. STATE BUDGET!
RI FAMILY’S PAYROLL DEDUCT (see A7)
PEOPLE (EXEMPTS)
RATE
TOTAL
PREM.
$3.0B
2.0% < $20k
$60M
290k/235k
$11.2B
4.0%
$445M
418k/198k
AGI
RANGE
AGI (B$)
TOTAL
< $30K
$30- $100K
HOUSEHOLDS
(RETURNS)
$100- $200K $6.1B
4.0% $100/wk max $230M
132k/46k
+$200K
4.0% $100/wk max $65M
37k/13k
$7.1B
NO TAX RETURN
MEDICARE/
MEDICAID
TOTAL
193k/??
$27.4B
$1B today
$800M
1,070k/492k
$19K PAYS $7/ WK, $40K PAYS $30/ WK, $80K PAYS $60/ WK, $100K PAYS $77/WK, $200K PAYS $100/ WK
Coverage is based on living or working in RI not employment and includes a life insurance benefit..
RI EMPLOYER’S CONTRIBUTION (see A7)
(Jobs < $20k would pay avg. of $125/mo/ee, Jobs > $20k would pay avg. $750/mo/ee. Scaled- $1k max)
# OF
EE’S
# OF
FIRMS
TOTAL
JOBS
1 to 19
23,000
100,000 $2B
$150M
1st $10k wages 5%, next $10k 10%
100,000 $4.8B
$900M
> $30k-$60k , 20% of all wages
20 to 99 2,500
TOTAL
WAGES
PREMIUMS
TO PAY
($3.6B X 20% + 15k jobs >$60k X $12k/ea.)
+100
500
180,000 $8.7B
$1,650M
> $20k-$60k , 20% of all wages
($6.7B X 20% + 25k jobs >$60k X $12k/ea.)
Gov’t
Total
62,000
26,000
$3.5B
442,000 $19B
$950M
approx. same as today (in Fed EE)
$3,650M
+ $150m than today, small co’s
Employers who currently offer insurance would continue to contribute the same amount on a % of payroll or per
Employee basis during a transitional period of several years to the above. New employers or those not offering
insurance now would Contribute based on the above. Rebates from Trust income could be skewed to smaller
employers to defray cost. Net cost to Employers after rebates could be 40% less than today, a true competitive
advantage for the state. DEFINED CONTRIBUTION FOR BUSINESS 5-10 years. Cost risk shifts to TRUST.
Coverage is based on living or working in RI not employment and includes a life insurance benefit. .
RI EMPLOYER’S CONTRIBUTION (see A7)
(Jobs < $20k would pay avg. of $125/mo/ee, Jobs > $20k would pay avg. $750/mo/ee. Scaled- $1k max)
INDUSTRY
HEALTH CARE & SOCIAL ASSISTANCE
RETAIL TRADE
MANUFACTURING
ACCOMMODATION & FOOD SERVICE
FINANCE & INSURANCE
ADMINISTRATIVE & WASTE SERVICES
PROFESSIONAL & TECHNICAL SERVICES
CONSTRUCTION
EDUCATIONAL SERVICES
OTHER SERVICES
WHOLESALE TRADE
INFORMATION
TRANSPORTATION & WAREHOUSING
MANAGEMENT OF COMPANIES
ART, ENTERTAINMENT & RECREATION
REAL ESTATE & RENTAL & LEASING
UTILITIES
AGRICULTURE, FISHING, HUNTING
MINING
TOTAL PRIVATE SECTOR
GOVERNMENT EMPLOYMENT
GRAND TOTAL
TOTAL
JOBS
AVG TOTAL WAGES TOTAL PREMIUM
WAGE
($ MIL)
($ MIL)
77,000
46,000
44,000
39,000
23,000
21,000
19,000
18,000
17,000
16,500
15,000
10,000
9,000
9,000
8,000
6,500
1,100
700
200
380,000
39,000
26,000
46,000
16,000
68,000
29,000
62,000
50,000
44,000
26,000
60,000
57,000
35,000
104,000
23,000
37,000
79,000
26,000
47,000
40,900
3,003
1,196
2,024
624
1,564
609
1,178
900
748
429
900
570
315
936
184
241
87
18
9
15,535
600
120
405
50
250
115
225
180
150
50
180
115
63
108
24
48
13
2
2
2,700
62,000
56,000
3,472
950
442,000
43,000
19,007
3,650
AVG. PREM
PER EE/ MO
649
217
767
107
906
456
987
833
735
253
1,000
958
583
1,000
250
615
1,000
238
833
592
most pt , < $20k
most pt , < $20k
most pt , < $20k
max $1k/ mo
most pt , < $20k
max $1k/ mo
most pt , < $20k
1,277 same as today
688
Premiums would be 5% on 1st $10k in wages, 10% on next $10k, 15% on next $10k. From $30k to $60k its 20% of all wages.
Rebates from Trust income could be skewed to smaller employers to defray cost. Net cost to Employers after rebates
could be 40% less than what is shown above (which is today’s cost) , a true competitive advantage for the state.
DEFINED CONTRIBUTION FOR BUSINESS 5-10 years. Cost risk shifts to TRUST.
Coverage is based on living or working in RI not employment and includes a life insurance benefit.
SAVE $1.3B 15%
(re-invest in Nursing Homes & Home Care)
RI CURRENT COSTS:
MOVE TO
(see appendix A & B)
MD/Other fees
$1.7B 22%
Dental
$ .3B 4%
Hosp-2.2m OP other $1.1B 14%
MD FEEs:
450 Surgeons
195 Psychiatrists
935 Medical
Hosp-440k OP ER
$ .3B 4%
Hosp-82k OP Surg. $ .1B 1%
Hosp-127k inpatient $1.3B 17%
Drugs
Nursing Homes
Non-Durables
Home Care
Other
TOTAL
$ .9B 12%
$ .7B 9%
$ .3B 4%
$ .2B 3%
$ .8B 10%
$7.7B
PRIMARY CARE:
425 Gen. Practices
195 Geriatric
160 Pediatric
160 Ob/Gyn
350 Dentists
180 Optometrists
370 Diet/Nutri
130 Ath. Trainers
TOTAL
Also, this population
will double 10-20 yrs
see A5/A6, global waiver
$510m
$235m
$190m
$190m
$330m
$115m
$ 25m
$ 8m
$1,603
$225m
$50m
$225m
Hospitals
$1,700m
Drugs
Nursing Homes
Non-Durables
Home Care
Other
TOTAL
$600m
$700m
$300m
$200m
$800m
$6,400
Primary Care is 2.3m 1/2hr MD visits & 3.8m 1hr nurse visits per year. Should include
routine lab, imaging, etc. 100% access. Shrink & focus hospitals to ER, Surgery & Inpatient.
100% GEOGRAPHIC ACCESS
PRIMARY CARE IN RI:
25 URBAN AREAS
25 NON-URBAN AREAS
(NEXT 4 SLIDES)
Table of Contents
PRIMARY CARE GEOGRAPHIC ACCESS: 25 URBAN AREAS
City/
Neighborhood
POP
(000)
Med. Hsld
INC ($000)
21
17
16
19
24
20
17
17
19
170
21
18
25
21
21
36
25
65
90
35
20
25
20
20
85
60
32
60
90
60
25
15
25
15
80
55
90
31
60
55
Pawtucket 1
Pawtucket 2
Pawtucket 3
TOTAL
27
20
26
73
51
32
40
41
E Providence 1
E Providence 2
TOTAL
18
30
48
52
47
50
Woonsocket 1
Woonsocket 2
TOTAL
20
23
43
50
30
40
CENTRAL FALLS
19
28
518
44
Providence
Providence
Providence
Providence
Providence
Providence
Providence
Providence
Providence
TOTAL
Warwick
Warwick
Warwick
Warwick
TOTAL
1
2
3
4
5
6
7
8
9
1
2
3
4
Cranston
Cranston
Cranston
Cranston
TOTAL
1
2
3
4
GRAND TOTAL
In each of the 25 areas the Trust would contract approx. 20 Primary Care MDs,
7 Dentists and 4 Optometrists to service a population of approx. 20k in each area.
25 URBAN AREAS DEFINED (with median household income)
POP
(000)
Med. Hsld
INC ($000)
21
17
16
19
24
20
17
17
19
170
21
18
25
21
21
36
25
65
90
35
Pilgrim HS, Wards 1&2, 02888 Edgewood, Pawtuxet, etc.
Vets HS, Wards 3,6&7, 02889 Oakland Beach, Airport
Tolgate HS, Wards 8&9, 02886 Malls, CCRI, Goddard Pk
Conimicut & Warwick Neck, Wards 4&5, 02889
Warwick Total
(poverty 6k 7%, non-english 5k 6%)
20
25
20
20
85
60
32
60
90
60
East HS: Park View, Wellington Ave, Washington 2nd Trail, Warwick Ave, Wards 1,2,3 02910/ 05
West of I-295, Wards 4 & part of 5 02921
West HS: Plainfield Pike, Budlong, Greening Ln, Atwood, Oaklawn, Phenix Wards 5/ 4 02920
Garden City, Dean Parkway, New London Ave, Pontiac Ave, ACI, Ward 6 02920
Cranston Total
(poverty 6k 7%, non-english 16k 20%)
25
15
25
15
80
55
90
31
60
55
Pawtucket 1
Pawtucket 2
Pawtucket 3
East of Geo. Bennett Hwy.
02861 tracts 155,56,57,58,59,68,69,70
Tollman HS: W. of Geo Bennett Hwy & N. of Mineral Spring 02860a tracts 150, 51,52,53,54,60
Shea HS:
W. of Geo. Bennett Hwy & S. of Mineral Spring 02860b tracts 161,63,64,65,66,67,71
Pawtucket Total
(poverty 12k 17%, non-english 24k 33%)
27
20
26
73
51
32
40
41
East Providence 1
East Providence 2
02915 South of Vets. Mem. Pkwy, Wampanoag Trail, Heaven's Gate Cem. tracts 105.02, 107.01, 106
EP HS: 02914 & 16 North of Vets Mem. Pkwy etc. tracts 101.01, 101.02, 102, 103, 104, 105.01
East Providence Total (poverty 4k 9%, non-english 11k 24%)
18
30
48
52
47
50
Woonsocket 1
Woonsocket 2
Outer Rim: WHS & NE, E. of Manville Rd, S. of Logee St, W. of w School St tracts 173,75,77,84,85
Inner Circle: SW of WHS, W.of Manville Rd, N. of Logee St, E of w School St. tracts 174,176, 178-83
Woonsocket Total (poverty 8k 19%, non-english 10k 23% all zip code 02895)
20
23
43
50
30
40
CENTRAL FALLS
CF Total (poverty 5k 26%, non-english 11k 58% all zip code 02863)
19
28
GRAND TOTAL
GRAND TOTAL
518
44
City/Town
Providence
Providence
Providence
Providence
Providence
Providence
Providence
Providence
Providence
Warwick
Warwick
Warwick
Warwick
Neighborhood
1
2
3
4
5
6
7
8
9
1
2
3
4
Cranston
Cranston
Cranston
Cranston
1
2
3
4
Classical HS: Down Town, Smith Hill, Federal Hill & Valley Wards 12 &13, 02903/ 08/ 09
Alvarez HS: Elmwood & Upper South Providence Wards 9 & 11, 02907/ 05/ 03
Cooley HS: S. Elmwood, Lower South Providence & Washinton Park Ward 10 & 9, 02905/ 07
Central HS: West End & Reservoir Wards 8, 11, 13, 02907/ 09
Silver Lake, Hartford, Olneyville & Manton Wards 7,15, 6, 02909
MTP HS: Elmhurst & Mount Pleasant Wards 5 & 14, 02908/ 09
E3 HS: Charles & Wanskuck Wards 4 & 14, 02904/ 08
Hope HS: Blackstone, Hope & Mount Hope Wards 3 & 2, 02904/ 06
College Hill, Wayland & Fox Point Wards 1 & 2, 02906/ 03
Providence Total (poverty: 44k 26%, non-english 75k 44%)
PRIMARY CARE GEOGRAPHIC ACCESS: 25 NON-URBAN AREAS
City/
Neighborhood
POP
(000)
Med. Hsld
INC ($000)
Barrington
Bristol
Warren
17
23
11
95
63
50
Portsmouth
Middletown
Newport
Tiverton/ L Comp.
17
17
26
19
70
61
49
61
E Greenwich
N King/Jamestown
S Kingstown
Narragansett
Westerly
13
35
27
16
23
85
89
71
61
63
Charlestown,
Hopkinton, Rich.
23
66
Cumberland
Johnston
Lincoln
N Providence
N Smithfield
Smithfield
34
30
22
33
11
21
74
54
70
50
72
69
Burillville
Coventry
Exeter/ W Green.
W Warwick
16
35
11
30
70
70
79
47
Foster,Glocester,
Scituate
24
70
1 to 15
54 NM
534
66
Block Island
GRAND TOTAL
In each of the 25 areas the Trust would contract approx. 20 Primary Care MDs,
7 Dentists and 4 Optometrists to service a population of approx. 20k in each area.
PRIMARY CARE GEOGRAPHIC ACCESS
IT IS IMPORTANT TO REITERATE THAT EVERY PRIMARY CARE
MD GENERATES APPROXIMATELY THE SAME INCOME, EVERY
DENTIST GENERATES APPROXIMATELY THE SAME INCOME
AND EVERY OPTOMETRIST GENERATES APPROXIMATELY
THE SAME INCOME AS DEFINED HEREIN.
THERE IS NO FINANCIAL ADVANTAGE TO LOCATING IN A
MORE AFFLUENT AREA VS A LESS AFFLUENT AREA.
PROVIDERS ARE COMPENSATED ON A PER PATIENT BASIS,
BASED ON PATIENT AGE & HEALTH CONDITION NOT
FEE-FOR-SERVICE BILLING EVENTS.
EMPHASIS IS ON PATIENT CARE, AND IMPROVING THE
HEALTH STATISTICS OF THE PATIENT ROSTER.
PRIMARY CARE IN RI:
MOVING BACK TO THE MD
OFFICE FROM HOSP. OUTPATIENT
(NEXT 16 SLIDES)
Table of Contents
PRIMARY CARE IN RI:
EVERYONE SEES A DOCTOR
4 TO 8 TIMES PER YEAR MIN.
PLUS 3 OB/GYN, TWO DENTIST
VISITS & AN OPTOMETRIST IS
SEEN EVERY TWO YEARS.
THE ABOVE IS REQUIRED TO KEEP COVERAGE.
PRIMARY CARE IN RI:
THIS WOULD REQUIRE 940
MD OFFICES, 350 DENTISTS,
180 OPTOMETRISTS EACH
DEFINED AS FOLLOWS
940 PRIMARY CARE PRACTICES
(1) DOCTOR $250K + BEN.
(3) NURSES $60K +BEN.
(2) RECPT/ADMIN $45K +BEN.
COST
$350K
$240K
$120K
RENT $6K/ MONTH
UTILITIES
PROPERTY. INS/TAX
LIAB. INS (REFORMED)
SUPPLIES
EQUIP. RENT ($1M/5YR)
OTHER
TOTAL
$70K
$12K
$12K
$12K
$120K
$200K
$64K
$1,200K
Includes a $50k to $100k
performance bonus
The above will support 2,400 ½ hr MD appointments per yr and 4,000 1 hr nurse appts. That’s 800
patients (+65 y/o or < 1 y/o at 8 times per year.) or 1,600 patients 4 times/ yr. PRIMARY PAY PARITY
This leaves 700 hrs per year for MD professional development & Admin.
350 DENTAL PRACTICES
(1) DENTIST $160K + BEN.
(3) HYGIENISTS $70K +BEN.
(1) RECPT/ADMIN $45K +BEN.
COST
$215K
$280K
$60K
RENT $6K/ MONTH
UTILITIES
PROPERTY. INS/TAX
LIAB. INS (REFORMED)
SUPPLIES
EQUIP. RENT ($500K/5YR)
OTHER
TOTAL
$70K
$12K
$12K
$12K
$120K
$100K
$64K
$945K
The above will support 3,000 patient’s 1 hr cleanings twice per year (hygienists). And 1,500 1 hr
procedures with the Dentist. Leaving 400 hrs per year for admin & professional development.
The cost is $315/patient/yr (2 cleanings @ $75/ea + 1 hr procedure every other yr on average).
180 OPTOMETRIST PRACTICES
(1) OPTOMETRIST $130K + BEN.
(1) RECPT/ADMIN $45K +BEN.
COST
$175K
$60K
RENT $6K/ MONTH
UTILITIES
PROPERTY. INS/TAX
LIAB. INS (REFORMED)
SUPPLIES
EQUIP. RENT ($500K/5YR)
OTHER
TOTAL
$70K
$12K
$12K
$12K
$120K
$100K
$64K
$625K
The above will support 6,000 patient’s 1/2 hr exam every 2 years (3,000/yr) . Leaving 400 hrs for
Admin & Professional development. The cost is $208 per patient every 2 yrs ($104/yr).
940 PC MD’s REQUIRED IN RI
AGE
RANGE
POP. (000) # DOC’S POP. (000) # DOC’S
2007
( Practices) 2027
(Practices)
0-1 (8x/ yr)
15
20
15
20
2-17 (4x/ yr)
220
140
225
140
18-64 (4x/ yr) 680
425
655
410
+65 (8x/ yr) 155
195
215
270
TOTAL
1,070
780
1,110
840
18-64 FEMALE
OB/GYN (3X/ YR)
340
160
330
155
2007: # PC’s IS 940 (780+160) @ $1.2M/ EA = $1.1B 2027: # PC’s IS 995 (840+155) @ $1.2M/ EA = $1.2B
EVERYBODY SEES A DOCTOR 4 OR 8 TIMES PER YR ON AVG. + OB/GYN. 100% ACCESS.
LICENSED DOCTORS IN RI
L ic ens ed
0-20 yrs
L ic ens ed
+ 20 yrs
L ic ens ed
+ 30 yrs
PRIMARY CARE
940 PRACTICES:
T otal
G ov't/ C orp/ O ther
H os pital-B as ed
525
768
71
98
5
62
601
928
P rimary C are:
F amily P rac tic e
Internal Medic ine
P ediatric s
O B -G Y N
T O T AL P R IMAR Y C AR E
148
351
159
96
754
68
129
37
32
266
51
118
50
34
253
267
598
246
162
1,273
Medic al S pec ialis ts :
Anes thes iolog y
C ardiovas c ular
D ermatolog y
E merg enc y
G as trolog y
Neurolog y
P s yc hiatry
P ulmonary
R adiolog y
Urolog y
All O ther S pec ialis ts
T O T AL S P E C IAL IS T S
69
60
27
40
31
38
116
21
104
27
147
680
22
14
14
10
14
14
32
10
22
8
60
220
16
20
16
7
7
10
47
5
34
16
52
230
107
94
57
57
52
62
195
36
160
51
259
1,130
S urg eons :
C olon & R ec tal
H and
Neurolog ic al
O phthamolog y
O rthopaedic
P las tic
T horac ic
Vas c ular
G eneral/ O ther
T O T AL S UR G E O NS
3
6
15
48
69
9
9
5
26
190
1
0
2
20
28
5
1
1
57
115
1
1
8
29
38
7
6
4
51
145
5
7
25
97
135
21
16
10
134
450
2,917
770
695
4,382
T O T AL MD 's in R I
Trust contracts with 620 of these
425 General + 195 Geriatric
(need 75 more Geriatric 10-20 yrs)
Trust contracts with 160 pediatricians
Trust contracts with all OB/GYN
•PAY PARITY WITH SPECIALISTS
•LOWER TOTAL COST
•BETTER HEALTH STATS
OTHER LICENSED PROFESSIONALS
Licensed
0-20 yrs
Licensed
+20 yrs
Licensed
+30 yrs
Total
Avg.
Salary
OPTOMETRISTS
105
53
59
217
130
DENTISTS
300
141
172
613
160
ATHLETIC TRAINERS
DIETICIANS/NUTRITIONISTS
DENTAL HYGIENISTS
PSYCHOLOGIST
PHYSICIAN'S ASSIST.
RADIOLOGY TECH'S
134
370
964
643
318
1,480
45
50
70
90
85
50
LPN
RN
RN- NURSE PRACTITIONER
RN- NURSE ANESTHESIOLOGY
CERT. NURSE'S ASSIST.
2,038
15,791
619
236
13,839
40
60
85
150
25
PRIMARY CARE IN RI:
THE TRUST WILL CONTRACT
WITH 780 MD’S & 160 OB/GYN’S
TO CARE FOR 800 TO 1,600
PATIENTS EACH (by age/health)
PAYING $750 TO $1,500/EA/YR TO
RECOVER $1.2M COST OF
PRIMARY CARE OFFICE PRACTICE
AS DEFINED. COST: $1.1B PER
YEAR OR AVG. $187/VISIT
PRIMARY CARE IN RI:
CURRENTLY WE SPEND $1.5B
ON HOSP. OUTPATIENT VISITS
AND MD FEES ARE $1.7B A TOTAL
OF $3.2B. RE-DIRECT $1.1B TO
PRIMARY CARE AS DESCRIBED.
NOTE: HOSP OUTPATIENT 2.3M VISITS + 440K ER VISITS
PER YEAR. THAT’S NEARLY 3 VISITS FOR EVERY PERSON IN RI!
LET’S GET 100% COVERAGE & MOVE MUCH OF THIS TO
PRIMARY CARE OFFICE VISITS. BETTER OUTCOME, ½ COST.
PRIMARY CARE IN RI:
PC MD’S WOULD BE REQUIRED
TO ACTIVELY CONTACT PATIENT
ROSTER TO ENCOURAGE
COMPLIANCE WITH VISITS, TESTING
ETC INCLUDING LIFE INS ENROLL.
FOR PC MD TO RECEIVE PAYMENT.
“ACTIVE MEDICAL HOME CONCEPT”
PRIMARY CARE IN RI:
IF CONTACT IS LOST OR PATIENT
NON-COMPLIANT COVERAGE IS
LOST & PATIENT PAYS UNTIL BACK
ON COMPLIANT ROSTER
“ACTIVE MEDICAL HOME CONCEPT”
PRIMARY CARE IN RI:
PC MD’S WOULD SUBMIT THEIR ROSTERS FOR PAYMENT
ONCE PER MONTH (LIKE A NURSING HOME) ALONG WITH
COMPLIANCE STATUS OF EACH PATIENT BASED ON
CLINICAL GUIDELINES AND SUBJECT TO AUDIT.
PAYMENT IS $100K PER MONTH FOR 800 PATIENTS (< 1, +65)
OR 1,600 OTHER PATIENTS BASED ON HEALTH &
COMPLIANCE (includes Federal Payments). PAY RATE AND
OFFICE CAPABILITY WOULD BE SET TO MINIMIZE OR
ELIMINATE ANY OTHER BILLING (routine lab, imaging, etc).
ACHIEVE PRIMARY PAY PARITY WITH SPECIALISTS ETC.
“ACTIVE MEDICAL HOME CONCEPT”
PRIMARY CARE IN RI:
IF PATIENT SHOWS UP AT HOSPITAL
WITH NO COVERAGE OR PC MD
THEY ARE ASSIGNED ONE BASED
ON AGE, ZIPCODE AND MD AVAIL.
OR SELECT AN MD OF THEIR PREFERENCE.
PC MD ACTIVELY ENGAGES PATIENT
“ACTIVE MEDICAL HOME CONCEPT”
PRIMARY CARE IN RI:
PRACTICES THAT CONTRACT WITH THE TRUST WILL
OPERATE LIKE A FRANCHISE. THE MD WILL RUN THEIR
BUSINESS WITHIN STANDARD PROCEDURES SHARED
AMONG ALL OFFICES. SAME SOFTWARE, E-MEDICAL
RECORDS, ADMIN PROCEDURES, AND MEDICAL
ROUTINES TO ENSURE CONSISTENT PATIENT & STAFF
EXPERIENCE. NIGHT & WEEKEND HOURS REQUIRED.
EMPHASIS IS ON HEALTH METRICS OF PATIENT ROSTER
AND IMPROVING THEREON. NOT BILLING EVENTS.
100% ACCESS & CONVENIENT, NO 2 HOUR WAITS. DRIVE
VOLUME TO OFFICE AWAY FROM HOSPITAL. BETTER
HEALTH OUTCOME ½ THE COST. PRIMARY PAY PARITY.
“ACTIVE MEDICAL HOME CONCEPT”
PRIMARY CARE IN RI:
THE TRUST WILL BE GOVERNED BY A BOARD WITH
REPRESENTATION FROM PATIENTS, & MINORITY (or
non-voting) EMPLOYERS, PROVIDERS, GOVERNMENT &
UNIONS. “PATIENT-DRIVEN”
PATIENT FEEDBACK WOULD BE AN
IMPORTANT CONSIDERATION FOR PRIMARY
CARE CONTRACT RENEWAL. CUSTOMER (TRUST) HAS
OPTION TO SAY “NO”.
TRUST IS PRIMARILY A BUYER’S CO-OP SEEKING VALUE
AND ACCESS. SIMILAR TO FED. 330 CLINICS.
“ACTIVE MEDICAL HOME CONCEPT”
HOSPITAL COSTS IN RI:
MOVING BACK TO THE MD
OFFICE FROM HOSP. OUTPATIENT
(NEXT 6 SLIDES)
Table of Contents
WHAT HOSPITALS DO FOR US EACH YEAR
IN RI AT A COST OF $2.8B
• IN-PATIENT SURGERIES: 36,500 DISCHARGES*
$ 609M (B3)
(300 CRITICAL PATIENTS AND 500 RECOVERING PATIENTS ON AVG., 24/7)
• IN-PATIENT MENTAL HEALTH: 12,400
$ 129M (B3)
(300 PATIENTS ON AVG. ALL DAY, EVERYDAY, 24/7)
• IN-PATIENT ALL OTHER MEDICAL: 78,000**
$ 592M (B3)
(800 PATIENTS ON AVG. ALL DAY, EVERYDAY, 24/7)
• OUT-PATIENT ER: 440,000 VISITS
$ 300M (B4)
(300 SERIOUS PATIENTS & 100 WAITING ON AVG. ALL DAY, EVERYDAY, 24/7)
• OUT-PATIENT SURGERIES: 82,000
$ 100M (B4)
(350 PATIENTS, 235 DAYS PER YR, 8 HRS PER DAY ON AVG.)
• OUT-PATIENT ALL OTHER: 2.2 million VISITS
(50k mental health visits, 650k imaging, 1.3m lab visits, 200k misc. visits)
$1,154M (B5)
$2,884M
2.2m out patient visits (not ER, not Surgery). Cost $1.1B. Drive much of this back to the PC Office.
SHRINK & FOCUS HOSPITALS TO: IN-PATIENT, OP-ER & OP-SURGERY. This is +2 visits
for every man, woman & child in the state!! Over use and most should be included in PC.
* excludes births ** includes births
HOSPITAL COSTS IN RI $2.8B
(BY FACILITY)
WAGES & OTHER
TOTAL
BENEFITS COSTS DEP'N COSTS
FACILITY
Bradley
Butler
Kent
Landmark
Memorial
Miriam
Newport
Rehab Hosp RI
RI Hospital
Roger Williams
St Joseph's
South County
Westerly
Woman & Infants
TOTAL
40
50
141
71
108
155
57
23
470
87
107
53
45
207
1,614
10
17
101
70
61
145
44
10
383
75
69
48
30
107
1,170
1
3
9
3
4
9
6
2
30
6
5
6
4
12
100
51
70
251
144
173
309
107
35
883
168
181
107
79
326
2,884
CAPEX
2
6
9
2
4
38
7
2
66
7
5
18
2
18
186
# EE's
798
1,000
2,300
1,021
1,675
2,475
981
450
6,863
1,400
1,873
1,021
821
3,100
25,778
STAFFED IN-PATIENT
DISBEDS
DAYS CHARGES
60
105
338
131
159
193
123
43
562
156
275
86
71
137
2,439
19,105
35,954
82,401
35,584
38,191
64,761
27,851
14,777
165,968
39,034
77,954
21,292
17,726
48,651
689,249
Includes outpatient costs
VA Med Center: $156m costs, 3,169 discharges, 17,750 in-patient days, 1,187 ee's. 86 beds.
925
4,147
14,561
7,150
7,765
12,797
6,045
918
30,004
7,890
11,016
5,357
4,629
13,580
126,784
HOSPITALS IN RI RECEIVE APPROX. THE SAME REVENUE
AS THE 25 MOST PROFITABLE HOSP’S IN THE USA (APPEND. C)
EACH RECEIVE APPROX. $1.1 MILLION PER YEAR, PER BED.
BUT THE 25 MOST PROFITABLE COST 30% LESS THAN RI.
CERTAINLY SOME OF THIS IS GEOGRAPHIC BUT CERTAINLY
SOME OF THE DIFFERENCE IS NOT.
2.2 MIL. OUT-PATIENT VISTS (not ER, not Surgery) at 2x cost of PC
SETTING FOR EXAMPLE (APPEND. D). MINIMIZE & MOVE TO PC
ALSO, HOSP’S IN RI EMPLOY 9,000 MD’S, NURSES & C.N.A.’S
BUT THEY EMPLOY 17,000 OTHER PEOPLE, NEARLY A 2:1
RATIO. HOW MANY OF THESE “OTHER PEOPLE” ARE NOT
ADDING VALUE TO THE DELIVERY OF HEALTH CARE?
LET’S STREAMLINE HOSPITALS & BILLING PROCESS:
300 SURGICAL/CRITICAL BEDS @ $1.15M
500 SURGICAL/RECOVERY BEDS @ $528K
300 MENTAL HEALTH BEDS @ $430K
800 MEDICAL BEDS @ $740K
1,900 IN-PATIENT BEDS (127K discharges, 689k days) **
$345M
$264M
$129M
$592M
$1,330M
440K ER VISITS @ $680/EA AVG.
82K OUT-PATIENT SURGERIES @ $1,200/EA AVG.
$300M
$100M
2.2 MILLION OTHER OUT-PATIENT VISITS
$1,154M (to PC)
(most “OP Other” move to PC office, heavy scrutiny, cut rates)
TOTAL HOSPITAL COSTS
$2,884M
** Each facility will submit a bill once per month to recover cost of having beds available & staffed,
subject to audit. Utilization would be reviewed periodically. Under-utilized beds would be shifted to
needed facilities or de-funded if not needed. Adding beds to the system, and/or rate increases would
be scrutinized in public. THE CUSTOMER (TRUST) WOULD HAVE THE OPTION OF “NO”.
Facilities would bill ER Visits & OP Surgeries at fixed rates once per month to recover costs to a max
number allowed per year for the facility. Exceeding this number would be scrutinized.
SHRINK & FOCUS HOSPITALS AND SPECIALISTS
IF THE PATIENT HAS A GENUINE NEED FOR ON GOING, LONG
TERM SPECIALIST TREATMENT, THEN THE SPECIALIST CAN
BE DESIGNATED THE PRIMARY CARE MD. COMPENSATION
WOULD BE AS PC, NOT VIA ½ HOUR ($100) REFERRALS.
THE OBJECT OF PRIMARY CARE IS TO MANAGE BEHAVIOR IN
ORDER TO IMPROVE HEALTH STATISTICS, QUALITY OF LIFE
AND AVOID CHRONIC DISEASE.
AND/OR MANAGE CHRONIC DISEASE IN ORDER TO MINIMIZE
OR ELIMINATE THE NEED FOR HOSPITAL CARE & SPECIALISTS
THRU IMPROVED HEALTH STATISTICS & QUALITY OF LIFE.
“ACTIVE MEDICAL HOME CONCEPT”
MDs & SPECIALISTS (NOT HOSP EEs OR PC)
ASSOCIATED WITH HOSPITAL ACTIVITY:
158 SURGEONS: 31,500 OPERATIONS @ $3,500/EA
107 ANESTHESIOLOGISTS: 25,000
@ $1,500/EA
$105M (B3)
$ 50M (B3)
235 SURGEONS/SPECIALISTS: 82,000
OUTPATIENT SURGERIES
@ $1,000/EA
$ 85M (B4)
135 RADIOLOGISTS: 475,000
OUTPATIENT IMAGES
$ 60M (B5) (drive to PC)
@ $125/EA
635 TOTAL ASSOCIATED WITH HOSPITALS (EST)
$300M
ALL OTHER MD/ SPECIALISTS (approx. 945) **
$200M
GRAND TOTAL (SLIDE 19 & 32)
$500M
** Each PC doctor would be given $200k of non-Hosp. “Specialist Referrals” per year
based on patient roster. They would decide how to “spend” them ($100/referral).
Table of Contents
APPENDIX A
REVIEW OF HEALTH
COSTS IN RI
(NEXT 7 SLIDES)
Table of Contents
RI HEALTH COSTS BY POPULATION: 1,070K PEOPLE, $7.7B, $7,200/PERSON
A1
Uninsured 100k people
2007 est.
MedicaidElderly/disabled
57k people
$1.3 billion
$23,435/person
medicaid- elderly/disabled
17%
medicaid- families & children
5%
Private Plans
526k people
$3.7 billion
$7,035/person
Who Pays?
ER’s $2.7 billion
Fed $2.5 billion
State $1.1 billion
Muni $0.4 billion
EE’s $1.0 billion
17% GDP
26% Gen. Fund
MedicaidFam & Child.
130k people
$0.4 billion
$3,045/person
private plans
50%
Medicare
154k people
$1.4 billion
$8,903/person
medicare
17%
federal employees
2%
muni employees
5%
State ee 35k people
$0.3 billion
$8,000/person
state employees
4%
Fed ee 18k people
$0.2 billion
$8,000/person
Muni ee 50k people
$.4 billion
$8,000/ person
INFLATION 10%, DEMOGRAPHICS MOVING TO $23K/PERSON, CAN’T SUSTAIN
RI HEALTH COSTS BY SERVICE: 1,070K PEOPLE, $7.7B, $7,200/PERSON
A2
2007 est.
Hosp- Inpatient
127k admissions
689k patient days
5.4 days avg. stay
$1.3 billion
$1,900/day
2,439 beds staffed
14 hosp’s
77% utilization
other
10%
dental
4%
Nursing Home
8,600 beds
85 homes
$0.7 billion
$81k/ bed
92% utilization
home care
3%
hosp-inpatient
17%
nursing home
9%
hosp-outpatient
19%
non-durables
4%
Hosp- Outpatient
2.2m visits +
440k ER visits
$1.5 billion
$550/ visit
Drugs
12%
Hosp
Required
at 2X cost?
physicians/other
22%
Drugs
15m scripts
$0.9 billion
$841/ person
$60/ script
Physicians
4,500 MDs
$1.7 billion
$1,600/person
$377k/ MD avg.
HOSP OUTPATIENT: 3 VISITS/YR FOR EVERY PERSON IN RI? $60 PER SCRIPT?
Health Cost (bil $)
A3
RI HEALTH COST TREND (IN CONSTANT 2007 $)
9.3
8.8
8.3
7.8
7.3
6.8
6.3
5.8
5.3
4.8
4.3
3.8
3.3
2.8
2.3
8.6
8.5
7.7
5.2
8.0
7.8
7.5
5.3
7.3
5.1
4.7
4.7
4.6
4.4
3.9
3.4
2.5
2007
3.3
3.1
2.7
2.5
2017
2027
Total
2037
Fed $
2047
2057
2067
In-State (ex Fed)
(SEE TABLE 3 (A6) FOR DETAIL)
LET’S CUT THE YELLOW LINE BY 40% USING LIFE INSURANCE
A4 TABLE 1:
RI HEALTH CARE CASH FLOW (USING LIFE INS. ASSIGNMENT)
2007
2017
2027
2037
2047
2057
2067
2077
2087
2097
7.7
(2.5)
5.2
7.8
(2.5)
5.3
8.5
(3.4)
5.1
8.6
(3.9)
4.7
8.0
(3.3)
4.7
7.5
(3.1)
4.4
7.3
(2.7)
4.6
7.7
(3.3)
4.4
7.7
(3.3)
4.4
7.6
(3.2)
4.4
0.3
0.7
0.9
0.9
0.8
0.8
0.8
0.8
0.8
0.8
CASH OUT (table 3 for details):
HEALTH COST (bil $)/ yr
Less: FED $/ yr
IN-STATE $/ yr (bil)
Life Prem's (bil $)
(@ $2k/ea- Table 2)
TOTAL CASH OUT/ yr
5.5
6.0
6.0
5.6
5.5
(25.0)
(80.0)
(75.0)
25.0
80.0
75.0
5.2
5.4
5.2
5.2
5.2
60.0
55.0
55.0
70.0
60.0
(In-State & Life Prem's)
CASH IN (table 2 for details):
Assign Death Ben. (bil $)*
30.0
Death Benefits (bil $) 10yr
INVEST. INCOME/ yr
2.4
2.4
2.4
2.4
2.4
2.4
2.4
2.4
2.4
2.4
(3.2)
(2.5)
(2.7)
(4.2)
(3.2)
(@ 8% ON $30 Bil)
NET IN-STATE COST/ yr
3.1
3.6
3.6
3.2
3.1
[------- +40% REDUCTION IN HEALTH BURDEN ----------------] [------- DEATH BENEFITS EXCEED HEALTH COSTS ---------------]
*Assign 30 years ($180 bil) of future death benefits to investors for $30 bil today (pv using 4%-5% discount). Invest funds at 8%
to offset baby boomer health costs netting 40% reduction in out-of-pocket costs paid by RI Families, Employers & Governments.
After the 30 year assignment period, On-going Death benefits from a fully insured population, will equal or exceed health costs.
NOTE: 2007 constant dollars. As future prices inflate, so will the face value of life ins. Demographic impact on cost is considered in the
above per table 3. Medical inflation that exceeds general inflation however, will be an additional burden not reflected above.
40% REDUCTION NOW, +100% REDUCTION FOR OUR KIDS & GRAND KIDS
NOW THAT’S A COMPETITIVE ADVANTAGE!
A5 TABLE 2:
AGE
RI POP. TREND BY AGE (CONSTANT 2007 DOLLARS)
Baseline
2007
POP (000)
2017
2027
2037
2047
2057
2067
2077
2087
2097
135
100
110
140
170
160
100
75
80
120
135
100
110
140
170
160
80
75
120
120
135
100
110
140
170
135
80
120
120
120
135
100
110
140
140
85
120
120
120
120
135
100
110
120
85
120
120
120
120
120
135
100
95
75
120
120
120
120
120
120
135
85
55
120
120
120
120
120
120
120
115
50
120
120
120
120
120
120
120
100
65
120
120
120
120
120
120
120
100
60
0-9
10-17
18-24
25-34
35-44
45-54
55-64
65-74
+75
TOTAL POP
1,070
Births
Deaths
ins. Deaths
1,090
1,110
120
100
1,070
120
100
25
1,030
120
160
50
ins. Deaths
ins. Deaths
30
Death Benefit (bil $)
$
25
$
80
$
1,005
995
1,005
1,005
1,000
120
160
85
120
145
85
120
130
75
120
110
55
120
120
50
120
125
65
ins exp
ins exp
ins exp
ins exp
ins exp
ins exp
55
20
45
15
40
15
20
35
50
20
40
20
75
$
60
$
55
$
55
$
70
$
60
Insured Lives
160
330
445
475
415
405
395
405
405
400
Prem's (mil $)
(@ $2k/ea
320
660
890
890
830
810
790
810
810
800
Death benefit based on purchasing $1m 30 yr term policies for 45-54 age group at $1,500 to $2,000 per yr per person
assumes half out live policy period.
Population assumes 12k births per year, no signifigant change in average life expectancy, and deaths are in
the 65-74 group (early death is insured). Migration is assumed neutral.
BUY LIFE INSURANCE FOR 45-54 AGE GROUP TO FUND HEALTH COSTS
A6 TABLE 3:
RI POP. TREND BY PAYER (CONSTANT 2007 DOLLARS)
2007
2017
2027
2037
2047
2057
2067
2077
2087
2097
RI TOTAL
Population (000)
Cost/ Person (000)
Total Cost (000)
1,070
7.2
7,700
1,090
7.2
7,809
1,110
7.7
8,517
1,070
8.1
8,627
1,030
7.8
7,990
1,005
7.5
7,505
995
7.4
7,328
1,005
7.7
7,707
1,005
7.7
7,707
1,000
7.6
7,590
Medicaid- Elderly/Disabled
Population (000)
Cost/ Person (000)
Total Cost (000)
57
23.4
1,300
65
23.4
1,521
90
23.4
2,106
110
23.4
2,574
90
23.4
2,106
75
23.4
1,755
70
23.4
1,638
85
23.4
1,989
85
23.4
1,989
80
23.4
1,872
130
3.0
400
150
3.0
450
140
3.0
420
130
3.0
390
130
3.0
390
130
3.0
390
125
3.0
375
125
3.0
375
125
3.0
375
125
3.0
375
154
8.9
1,400
160
8.9
1,424
225
8.9
2,003
240
8.9
2,136
225
8.9
2,003
190
8.9
1,691
165
8.9
1,469
200
8.9
1,780
200
8.9
1,780
200
8.9
1,780
State Employee Plans
Population (000)
Cost/ Person (000)
Total Cost (000)
35
8.0
300
35
8.0
280
35
8.0
280
35
8.0
280
35
8.0
280
35
8.0
280
35
8.0
280
35
8.0
280
35
8.0
280
35
8.0
280
Federal Employee Plans
Population (000)
Cost/ Person (000)
Total Cost (000)
18
8.0
200
18
8.0
144
18
8.0
144
18
8.0
144
18
8.0
144
18
8.0
144
18
8.0
144
18
8.0
144
18
8.0
144
18
8.0
144
Medicaid- Fam & Child.
Population (000)
Cost/ Person (000)
Total Cost (000)
Medicare
Population (000)
Cost/ Person (000)
Total Cost (000)
Uninsured
Population (000)
Cost/ Person (000)
Total Cost (000)
Private Plans
Population (000)
Cost/ Person (000)
Total Cost (000)
100
576
7.1
4,100
100
562
7.1
3,990
100
502
7.1
3,564
100
437
7.1
3,103
100
432
7.1
3,067
100
457
7.1
3,245
100
482
7.1
3,422
100
442
7.1
3,139
100
442
7.1
3,139
100
442
7.1
3,139
A7
SCHEDULE
OF PREM.
PAID &
REBATE
EARNED
BY WAGE
LEVEL
EE pays 2%
of wages or
AGI if < $20k
4% if > $20k
Max $100/wk
ER pays 5%
1st $10k wages
Then 10%
Next $10k &
15% next $10k
20% > $30k
Max $1k/mo.
ANNUAL
WAGES
(or AGI)
5,000
10,000
15,000
20,000
25,000
30,000
ANNUAL
EE
PREM.
100
200
300
800
1,000
1,200
%
ANNUAL
ER PREM.
(GROSS)
2.0%
2.0%
2.0%
4.0%
4.0%
4.0%
250
500
1,000
1,500
2,250
3,000
%
5.0%
5.0%
6.7%
7.5%
9.0%
10.0%
$3.0 BIL
$60 MIL
$140 MIL
FROM APPROX 170K JOBS (EST) @$18k avg,
35,000
40,000
45,000
50,000
55,000
60,000
70,000
80,000
90,000
100,000
1,400
1,600
1,800
2,000
2,200
2,400
2,800
3,200
3,600
4,000
4.0%
4.0%
4.0%
4.0%
4.0%
4.0%
4.0%
4.0%
4.0%
4.0%
7,000
8,000
9,000
10,000
11,000
12,000
12,000
12,000
12,000
12,000
4,400
4,800
5,200
5,200
5,200
4.0%
4.0%
4.0%
3.5%
2.6%
12,000
12,000
12,000
12,000
12,000
350
700
1,300
2,300
3,250
4,200
(100)
(200)
(400)
(600)
(900)
(1,200)
$200 MIL
20.0%
20.0%
20.0%
20.0%
20.0%
20.0%
17.1%
15.0%
13.3%
12.0%
$11.2 BIL
$445 MIL
$2,595 MIL
FROM APPROX 247K JOBS (EST) @ $45k avg,
110,000
120,000
130,000
150,000
200,000
TRUST
REBATE
TO ER
TOTAL
PREM.
10.9%
10.0%
9.2%
8.0%
6.0%
%
150
300
600
900
1,350
1,800
3.0%
3.0%
4.0%
4.5%
5.4%
6.0%
4,200
4,800
5,400
6,000
6,600
7,200
7,200
7,200
7,200
7,200
12.0%
12.0%
12.0%
12.0%
12.0%
12.0%
10.3%
9.0%
8.0%
7.2%
7,200
7,200
7,200
7,200
7,200
6.5%
6.0%
5.5%
4.8%
3.6%
7,200
3.6%
($55 MIL)
8,400
9,600
10,800
12,000
13,200
14,400
14,800
15,200
15,600
16,000
$3,040 MIL
ANNUAL
ER PREM.
(NET)
(2,800)
(3,200)
(3,600)
(4,000)
(4,400)
(4,800)
(4,800)
(4,800)
(4,800)
(4,800)
($1,040 MIL)
16,400
16,800
17,200
17,200
17,200
(4,800)
(4,800)
(4,800)
(4,800)
(4,800)
$6.1 BIL
$230 MIL
$725 MIL
$955 MIL
($290 MIL)
FROM APPROX 15K JOBS (EST) @ $150k avg, & $3.8B SE, INVEST.
+200,000
5,200
12,000
17,200
(4,800)
$7.1 BIL
$65 MIL
$190 MIL
$255 MIL
FROM APPROX 10K JOBS (EST) @ $250k avg, & $4.6B SE, INVEST.
($75 MIL)
GRAND TOTAL
FROM APPROX 442K JOBS (EST) @ $43k avg, & $8.4B SE, INVEST.
$27.4 BIL
$800 MIL
$3,650 MIL
STATE MEDICAID SPENDING
FED. MEDICAID & MEDICARE SPENDING
TOTAL RI HEALTH CARE SPENDING
$4,450 MIL
($1,460 MIL)
$1,000 MIL
$2,300 MIL
($440 MIL)
$7,750 MIL
($1,900 MIL)
BACK
APPENDIX B
HOSPITAL
COSTS IN RI
(NEXT 6 SLIDES)
Table of Contents
B1: HOSPITAL COSTS IN RI $2.8B
(BY PRIMARY DIAGNOSIS)
Primary Diagnosis
Avg
Discharges Stay
Patient
Days
%
Days
110% Beds
Needed
Cost /
Day
Total
($mil)
Heart Disease
Other Circulatory
15,579
5,695
4.9
6.0
76,337
34,170
11.1%
5.0%
230
105
3,500
3,500
267
120
Births & Related
Respiratory
Mental Disease
Digestive
Injury & Poisioning
Cancer (neoplasms)
Musculoskeletal
Genitourinary (urogenital)
Endocdrine (nutrition, metabolic, immune)
14,963
12,875
12,378
11,636
9,621
6,870
6,811
6,565
4,626
3.1
5.9
8.7
5.4
6.2
7.1
4.1
4.1
4.6
46,385
75,963
107,689
62,834
59,650
48,777
27,925
26,917
21,280
6.7%
11.0%
15.6%
9.1%
8.7%
7.1%
4.1%
3.9%
3.1%
140
230
325
190
180
150
85
80
65
2,900
1,600
1,200
1,600
1,600
1,600
1,600
1,600
1,600
135
122
129
101
95
78
45
43
34
19,165
126,784
5.3
5.4
101,323
689,249
14.7%
100.0%
305
2,085
1,600
1,930
162
1,330
680
1,200
525
550
300
100
1,154
1,554
All Other
TOTAL IN-PATIENT
440,000 ER visits (8 hrs/ea avg)
82,000 Out Patient Surgeries (8 hrs/ea avg.)
2,200,000 Out Patient- other visits
TOTAL OUT-PATIENT
TOTAL HOSPITAL COSTS
2.2m out patient visits (not ER, not Surgery). Cost $1.1B. Drive much of this back to the PC Office.
SHRINK & FOCUS HOSPITALS TO: IN-PATIENT, OP-ER & OP-SURGERY
2,884
B2: HOSPITAL COSTS IN RI $2.8B
(BY ACTIVITY)
($ Millions)
COST ACTIVITY
36,500 In-Patient Surgeries (8 days avg)
InNursing
Patient Payroll $
Days (4,000)
292,000
C.N.A. Hosp MD
Payroll $ Payroll $
(4,000)
(928)
107
43
109
Other
Payroll $
(16,850)
Other
Hosp
Costs
75
275
Total
Hosp
Costs
108,000
18
8
11
60
32
(635)
609
$16,000/ea
12,400 In-Patient Mental Disease (8.7 days)
Non-Hosp
MD Costs
155
$5,000/ea
129
-
$10,400/ea
77,884 All Other In-Patient (3.7 days avg.)
289,249
48
20
30
227
267
592
-
$7,600/ea
TOTAL IN-PATIENT (126,784 discharges)
82,000 Out Patient Surgeries (8 hrs/ea avg.)
689,249
173
71
35
6
$1200/ea
150
362
574
14
45
1,330
100
$1,200/ea
440,000 ER visits (8 hrs/ea avg)
TOTAL OUT-PATIENT ER & SURGERY
$680/ea
Imaging: 650k visits
$900/ea
72
107
-
30
36
-
30
30
33
47
135
180
23
287
275
155
85
$1,000/ea
300
400
TOTAL HOSPITAL COSTS
$600/ea
$350/ea
$420/ea
$525/ea
689,249
-
-
85
585
$900/ea
Mental Health: 50k visits
Lab: 1.3m visits (7m tests @ $65)
Misc: 200k visits
TOTAL OUT-PATIENT OTHER (2.2 MIL VISITS)
-
60
$125/ea
48
16
64
20
7
27
7
33
7
70
15
160
15
477
8
194
39
516
30
455
84
1,154
-
344
134
250
886
1,270
2,884
300
2.2m out patient visits (not ER, not Surgery). Cost $1.1B. Drive much of this back to the PC Office.
SHRINK & FOCUS HOSPITALS TO: IN-PATIENT, OP-ER & OP-SURGERY
60
B3: HOSPITAL COSTS IN RI $2.8B
(BY ACTIVITY: IN-PATIENT DETAIL)
($ Millions)
COST ACTIVITY
36,500 In-Patient Surgeries (8 days avg):
183 Surgeons (200/yr/ea) 25 are Hosp EE's
157 Anesthesiologists 50 are Hosp EE's
26 RN- Anesthesiologists 26 are Hosp EE's
300 Critical Patients (3 days) 900 Nurses
(1:1 x 3 shifts)
ALSO 900 C.N.A.'s
(5:1 x 3 shifts)
ALSO 200 MD's
500 Recovery Patients (5 days) 375 Nurses
(4:1 x 3 shifts)
ALSO 375 C.N.A.'s
(20:1 x 3 shifts)
ALSO 75 MD's
Allocated Facility Costs
TOTAL IN-PATIENT: SURGERY
InNursing
Patient Payroll $
Days
(4,000)
C.N.A. Hosp MD
Payroll $ Payroll $
(4,000)
(928)
Other
Payroll $
(16,850)
Other
Hosp
Costs
Total
Hosp
Costs
275
275
17
23
5
72
30
50
30
13
19
350
609
Non-Hosp
MD Costs
(635)
292,000
17
23
5
72
30
50
30
13
19
292,000
107
43
109
75
75
105
50
300 beds X
$1.15m/bed
500 beds x
$528k/bed
155
$16,000/ea
12,400 In-Patient Mental Disease (8.7 days):
$5,000/ea
108,000
40 Psychiatrists 40 are Hosp EE's
300 Patients (8.7 days) 225 Nurses
(4:1 x 3 shifts)
ALSO 225 C.N.A.'s
Allocated Facility Costs
TOTAL IN-PATIENT: MENTAL DISEASE
108,000
77,884 All Other In-Patient (3.7 days avg.)
289,249
11
32
32
11
18
8
92
129
300 beds x
$430k/bed
-
800 beds x
$740k/bed
-
18
8
18
8
11
60
60
(20:1 x 3 shifts)
ALSO 120 MD's
800 Patients (3.7 days) 600 Nurses
(4:1 x 3 shifts)
ALSO 600 C.N.A.'s
Allocated Facility Costs
TOTAL IN-PATIENT: ALL OTHER MEDICAL
289,249
48
20
30
227
227
267
267
30
48
20
494
592
TOTAL IN-PATIENT (126,784 discharges)
689,249
173
71
150
362
574
1,330
155
72
35
64
171
30
6
27
63
30
70
100
33
14
477
524
135
45
516
696
300
100
1,154
1,554
85
60
145
344
134
250
886
1,270
2,884
300
440,000 ER visits (8 hrs/ea avg)
82,000 Out Patient Surgeries (8 hrs/ea avg.)
2,200,000 Out Patient- other visits
TOTAL OUT-PATIENT
TOTAL HOSPITAL COSTS
30
48
20
$680/ea
$1200/ea
$525/ea
689,249
B4: HOSPITAL COSTS IN RI $2.8B
(BY ACTIVITY: OUT-PATIENT ER & SURGERY DETAIL)
($ Millions)
COST ACTIVITY
InNursing
C.N.A. Hosp MD
Patient Payroll $ Payroll $ Payroll $
Days (4,000)
(4,000)
(928)
TOTAL IN-PATIENT (126,784 discharges)
689,249
440,000 Out-Patient ER Visits (8 hrs/ea avg):
N/A
300 Critical Patients
900 Nurses
(1:1 x 3 shifts)
ALSO 900 C.N.A.'s
(7:1 x 3 shifts)
ALSO 120 MD's
Allocated Facility Costs
TOTAL OUT-PATIENT: ER
82,000 Out-Patient Surgeries (8 hrs/ea avg.)
235 Surgeons/Specialists (350/ea/yr)
175 RN- Anesthesiologists all are Hosp EE's
350 Patients (open 235 days/yr)
(2:1 x 1 shift)
ALSO 175 C.N.A.'s
Allocated Facility Costs
TOTAL OUT-PATIENT: SURGERIES
173
71
150
Other
Payroll $
(16,850)
Other
Hosp
Costs
Total
Hosp
Costs
362
574
1,330
135
135
72
30
30
168
300
72
30
30
$680/visit
72
30
30
33
33
MENTAL DISEASE
(50k visits)
IMAGING
(650k visits)
LAB
(1.3m visits)
MISC.
(200k visits)
TOTAL OUT-PATIENT: OTHER Visits
(635)
155
-
N/A
85
35
35
6
$1,200/ea
35
6
14
14
-
45
45
6
59
100
$1,200/ea
2,200,000 Out Patient- other visits:
Non-Hosp
MD Costs
85
$1,000/ea
N/A
$525/visit
48
16
64
20
7
27
7
23
33
7
70
15
287
160
15
477
8
275
194
39
516
30
585
455
84
1,154
60
60
$125/ea
GRAND TOTAL OUT-PATIENT
TOTAL HOSPITAL COSTS
689,249
171
63
100
524
696
1,554
145
344
134
250
886
1,270
2,884
300
B5: HOSPITAL COSTS IN RI $2.8B
(BY ACTIVITY: OUT-PATIENT 2.2M OTHER VISITS DETAIL)
($ Millions)
COST ACTIVITY
TOTAL IN-PATIENT (126,784 discharges)
InNursing
Patient Payroll $
Days
(4,000)
689,249
C.N.A.
Payroll $
(4,000)
Total
Hosp
Costs
150
362
574
1,330
30
33
135
300
14
45
100
15
15
8
8
7
23
30
275
275
13
23
549
585
72
30
TOTAL OUT-PATIENT: SURGERIES
$1,200/ea
35
6
Imaging: 650k visits @ $900/ea
2,800 Patients (open 235 days/yr) 1/2 hr ea
(1:1 x 1 shift)
200 TECHS
185 Radiologists 50 are Hosp. EE's
Allocated Facility Costs
TOTAL IMAGING (650k visits)
Other
Hosp
Costs
71
$680/ea
Mental Health: 50k visits @ $600/ea
25 Psychiatrists 25 are Hosp EE's (1 hr/ea)
Allocated Facility Costs
TOTAL MENTAL DISEASE (50k visits)
Other
Payroll $
(16,850)
173
TOTAL OUT-PATIENT: ER
2,200,000 Out Patient- other visits:
Hosp MD
Payroll $
(928)
-
Non-Hosp
MD Costs
(635)
155
85
N/A
7
$600/ea
-
-
7
13
23
$900/ea
-
-
23
274
287
-
60
60
$125/ea
Lab: 1.3m visits @ $350/ea (7m tests @ $65)
50 Pathologists
175 Phlebotomists/techs (1.3m @ 15 mins)
600 Nurses & 600 C.N.A.'s
Allocate 150 MD's residents, part time, etc.
Allocated Facility Costs
TOTAL LAB (1.3m visits)
13
194
194
13
7
68
20
347
455
-
-
7
48
20
20
$350/ea
48
20
16
7
33
153
160
Misc: 200k visits @ $420/ea
200 Nurses & 200 C.N.A.'s
Allocate 50 MD's residents, part time, etc.
Allocated Facility Costs
TOTAL MISC. (200k visits)
$420/ea
16
7
7
15
15
39
39
23
7
54
84
TOTAL OUT-PATIENT: OTHER (2.2m Visits)
$525/visit
64
27
70
477
516
1,154
60
171
63
100
524
696
1,554
145
344
134
250
886
1,270
2,884
300
7
TOTAL OUT-PATIENT ALL
TOTAL HOSPITAL COSTS
689,249
B6: MD’S EMPLOYED BY RI HOSPITALS
(INCLUDED IN THE $2.8B COST OF HOSPITALS)
SPECIALTY
NUMBER
EMPLOYED
ANESTHESIOLOGY
CARDIO
ER
FAMILY
GASTRO
HEMA
ID
INTERNAL MED.
NEPHROLOGY
NEUROLOGY
OB-GYN
PATHOLOGY
PEDI
PSYCHIATRISTS
PULMONARY
RADIOLOGY
SURGEONS
OTHER
50
15
125
30
13
14
20
174
7
11
28
51
85
91
14
50
25
125
TOTAL NUMBER (EST)
928
EST. COST SALARY & BEN.
(million $)
250
APPENDIX C
TOP 25 MOST PROFITABLE
HOSPITALS IN THE USA
Table of Contents
C1: 25 MOST PROFITABLE HOSPITALS IN THE USA
RANK
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
NAME
LOCATION
OWNER
FLOWERS
DEL SOL
METHODIST
ST LUKES
SETON
SWEDISH
DOCTORS
OH STATE
ST MARK'S
NORTHRIDGE
LUTHERAN
ERLANGER
REGIONAL
SUTTER
EASTERN ID
CONROE
MED. CNTR.
ST LUKE'S
MED. CITY
MEMORIAL
ST FRANCIS
MED. CNTR.
LAS PALMAS
NORTHWEST
ST. MARY'S
DOLTHAN, AL
EL PASO, TX
ROCHESTER, MN
CEDAR RAPIDS, IA
AUSTIN, TX
ENGLEWOOD, CO
AUGUSTA, GA
COLUMBUS, OH
SALT LAKE CITY, UT
NORTHRIDGE, CA
FORT WAYNE, IN
CHATTANOSA, TN
HUDSON, FL
SACRAMENTO, CA
IDAHO FALLS, ID
CONROE, TX
PLANO, TX
JACKSONVILLE, FL
DALLAS, TX
LAS CRUCES, NM
MONROE, LA
AURORA, CO
EL PASO, TX
SPRINGDALE, AK
ROCHESTER, MN
CHS
HCA
MAYO *
IA HEALTH *
ASCENSION *
HCA
HCA
UNIV MED. *
HCA
CATHOLIC *
CHS
ERLANGER *
HCA
SUTTER *
HCA
HCA
HCA
ASCENSION *
HCA
CHS/LIFE PT
CATHOLIC *
HCA
HCA
CHS
MAYO *
TOTAL
PATIENT
REVENUE
(MIL $)
BEDS
389
243
446
263
432
447
272
1,980
283
458
431
400
185
688
231
261
254
309
567
220
377
336
203
230
701
235
304
336
296
405
296
215
835
250
335
380
521
268
627
242
258
403
204
677
286
500
259
247
249
821
1,655,319
799,342
1,327,381
888,514
1,066,667
1,510,135
1,265,116
2,371,257
1,132,000
1,367,164
1,134,211
767,754
690,299
1,097,289
954,545
1,011,628
630,273
1,514,706
837,518
769,231
754,000
1,297,297
821,862
923,695
853,837
53
45
37
36
34
33
33
32
31
30
30
29
28
28
28
28
28
27
26
26
26
26
25
25
24
778,000
439,638
836,250
568,649
704,000
1,011,791
847,628
1,612,455
781,080
957,015
793,947
545,106
497,015
790,048
687,273
728,372
453,797
1,105,735
619,764
569,231
557,960
960,000
616,397
692,771
648,916
10,606
9,449
1,122,447
30
752,113
REVENUE
PER BED
OP%
COST
PER BED
* THESE ARE NON-PROFIT OWNERS. HCA = HOSPITAL CORP OF AMERICA- NASHVILLE, TN
CHS = COMMUNITY HEALTH SYSTEMS- BRENTWOOD, TN. ASCENSION HEALTH- ST LOUIS, MO
APPROX. SAME REVENUE AS HOSP’S IN RI ($1.1 M/ BED). BUT COST 30% LESS
APPENDIX D
HOSPITAL OUTPATIENT PRICES
HOSP. 50% TO +200% MORE THAN PC
AND A COMPLETE LACK OF PRICE
TRANSPARENCY
RI SPENDS $1.5B OUT-PATIENT
FOLLOWING IS PRICE DATA FOR RI
ON 247 MOST COMMON HOSP.
OUT-PATIENT PROCEDURES
(NEXT 11 SLIDES)
Table of Contents
D1: SUMMARY OF PRICES IN RI FOR 247 COMMON PROCEDURES
(DETALED ON THE NEXT 10 SLIDES... HOSP 50% TO +200% MORE EXPENSIVE)
HCPCS
Hospital Common Procedure
Service Description
Facility
Rank Low
Avg
High
505
907
2,247
LAB AVERAGE (86 tests)
28
65
OTHER LAB AVERAGE (14 tests)
35
MISC. PROCEDURE AVG. (67)
212
TOTAL IMAGING AVERAGE (74)
OTHER (6)
#N/A
HOSPITAL OUT PATIENT
Physician
Total
Low
Avg
High
Low
Avg
1,027
2,404
427
-28%
705
-31%
833
-65%
176
28
65
176
22
-21%
34
-48%
47
-73%
72
94
35
72
94
22
-37%
23
-68%
23
-75%
691
2,359
330
915
2,690
198
-40%
270
-70%
375
-86%
#N/A
118
#N/A
120
224
#N/A
157
High
593
#N/A
88
High
IDTF/OFFICE
Total
Low
Avg
331
#N/A
#N/A
#N/A
#N/A
#N/A
#N/A
ATTACHED IS DETAIL PRICING INFORMATION FOR RI ON THE 247 MOST COMMON HOSPITAL OUT-PATIENT PROCEDURES, AS COMPILED BY THE CENTER FOR MEDICARE
AND MEDICAID SERVICES (CMS) AND REPORTED ON WWW.MYMEDICALEXPENSES.COM (JUNE 2010).
RANK: THE LOWER THE NUMBER THE MORE COMMON THE PROCEDURE. IDTF: INDEPENDENT DIAGNOSTIC & TEST FACILITY.
HCPCS: HOSPITAL COMMON PROCEDURE CODING SYSTEM (USED BY MEDICARE)
#N/A
D2: TYPICAL IMAGING PRICES IN RI ( 1 of 3)
HCPCS
Hospital Common Procedure
Service Description
Facility
Rank Low
Avg
High
HOSPITAL OUT PATIENT
Physician
Total
Low
Avg High
Low
Avg
High
IDTF/OFFICE
Total
Low
Avg
High
Ct abdomen w/dye
Ct abdomen w/o & w/dye
Ct abdomen w/o dye
Ct angiography, chest
Ct head/brain w/o & w/dye
Ct head/brain w/o dye
Ct lumbar spine w/o dye
Ct maxillofacial w/o dye
Ct neck spine w/o dye
Ct pelvis w/dye
Ct pelvis w/o & w/dye
Ct pelvis w/o dye
Ct soft tissue neck w/dye
Ct thorax w/dye
Ct thorax w/o dye
CT AVERAGE
69
70
68
37
27
26
42
28
41
48
49
47
29
36
35
1,225
1,087
858
1,133
1,056
709
958
325
872
1,049
1,331
858
949
949
774
942
1,494
1,474
1,040
1,885
1,439
990
1,005
1,236
1,709
1,588
1,392
941
1,930
1,391
932
1,363
3,765
4,998
6,758
3,663
2,877
4,557
2,602
3,290
3,968
3,687
3,911
2,568
3,221
11,357
6,218
4,496
155
170
145
217
175
105
160
129
140
140
165
148
176
155
140
155
192
216
183
280
217
145
193
185
168
181
213
174
229
192
175
196
253
296
238
339
246
172
245
199
201
221
232
213
238
242
221
237
1,380
1,257
1,003
1,350
1,231
814
1,118
454
1,012
1,189
1,496
1,006
1,125
1,104
914
1,097
1,686
1,690
1,223
2,165
1,656
1,135
1,198
1,421
1,877
1,769
1,605
1,115
2,159
1,583
1,107
1,559
4,018
5,294
6,996
4,002
3,123
4,729
2,847
3,489
4,169
3,908
4,143
2,781
3,459
11,599
6,439
4,733
602
793
524
1,089
673
448
541
488
675
613
746
587
607
672
513
638
-42%
1,233
1,480
932
2,123
1,236
808
1,030
801
1,066
1,216
1,467
1,008
1,055
1,252
1,029
1,182
-24%
1,297
1,560
1,088
2,232
1,368
904
1,111
911
1,126
1,279
1,584
1,101
1,112
1,354
1,121
1,276
-73%
Mri brain w/o & w/dye
Mri brain w/o dye
Mri jnt of lwr extre w/o dye
Mri joint upr extrem w/o dye
Mri lumbar spine w/o & w/dye
Mri lumbar spine w/o dye
Mri neck spine w/o dye
MRI AVERAGE
31 1,152
30 852
65 852
56 852
45 1,152
44 852
43 1,807
1,074
3,272
1,428
1,824
1,427
3,395
1,099
2,493
2,134
6,013
4,472
4,376
2,718
4,040
5,510
4,933
4,580
310
203
122
139
305
223
234
219
418
263
262
262
446
256
268
311
606
308
375
375
473
300
282
388
1,462
1,055
974
991
1,457
1,075
2,041
1,293
3,690
1,691
2,086
1,689
3,841
1,355
2,761
2,445
6,619
4,780
4,751
3,093
4,513
5,810
5,215
4,968
1,990
906
994
1,057
1,914
886
926
1,238
-4%
3,789
1,838
1,712
1,746
3,520
1,841
1,781
2,317
-5%
4,411
2,029
2,019
2,091
4,280
2,252
2,101
2,740
-45%
D3: TYPICAL IMAGING PRICES IN RI ( 2 of 3)
HCPCS
Hospital Common Procedure
Service Description
Chest x-ray
Cine/vid x-ray, throat/esoph
Contrast x-ray, esophagus
X-ray exam of abdomen
X-ray exam of ankle
X-ray exam of elbow
X-ray exam of finger(s)
X-ray exam of foot
X-ray exam of hand
X-ray exam of hip
X-ray exam of humerus
X-ray exam of knee, 1 or 2
X-ray exam of knee, 3
X-ray exam of lower leg
X-ray exam of lower spine
X-ray exam of neck spine
X-ray exam of pelvis
X-ray exam of ribs
X-ray exam of ribs/chest
X-ray exam of shoulder
X-ray exam of thigh
X-ray exam of thoracic spine
X-ray exam of wrist
X-ray exam series, abdomen
X-ray exam, knee, 4 or more
X-Ray AVERAGE
Rank
Low
Facility
Avg
High
32
72
71
66
63
52
55
64
54
57
51
59
60
62
40
38
46
33
34
50
58
39
53
67
61
91
205
231
151
77
82
62
77
77
88
82
56
84
118
98
91
95
112
132
83
82
96
77
119
93
102
214
310
467
211
270
135
136
204
117
200
221
208
201
273
253
288
190
206
371
158
149
246
169
232
228
226
312
873
1,548
265
313
313
294
312
312
588
330
335
588
313
455
339
312
312
447
339
357
393
312
436
455
434
HOSPITAL OUT PATIENT
Physician
Total
Low
Avg
High
Low
Avg
21
54
57
24
14
20
18
17
18
25
19
16
20
18
25
25
20
29
36
20
23
25
14
41
25
25
29
78
67
28
26
29
24
27
26
36
26
27
29
28
37
37
28
34
45
29
28
33
27
55
39
35
36
106
80
36
42
33
35
95
38
45
36
46
47
37
57
42
37
46
49
43
36
45
39
75
61
50
112
259
288
175
91
102
80
94
95
113
101
72
104
136
123
116
115
141
168
103
105
121
91
160
118
127
243
388
534
239
296
164
160
231
143
236
247
235
230
301
290
325
218
240
416
187
177
279
196
287
267
261
High
348
979
1,628
301
355
346
329
407
350
633
366
381
635
350
512
381
349
358
496
382
393
438
351
511
516
484
IDTF/OFFICE
Total
Low
Avg
55
259
148
58
56
57
45
53
58
60
51
46
58
45
67
58
49
66
73
59
55
59
56
74
69
69
-45%
89
388
149
97
111
106
95
102
107
108
92
90
110
103
138
117
94
87
143
125
95
102
117
80
142
119
-54%
High
107
979
150
115
161
138
133
142
172
166
159
137
160
149
242
157
139
112
185
181
152
135
157
86
171
183
-62%
D4: TYPICAL IMAGING PRICES IN RI ( 3 of 3)
HCPCS
Hospital Common Procedure
Service Description
Transvaginal us, non-ob
Us exam abdo back wall, comp
Us exam abdo back wall, lim
Us exam of head and neck
Us exam, abdom, complete
Us exam, breast(s)
Us exam, pelvic, complete
ULTRA-SOUND AVERAGE
Bone imaging, whole body
Cardiac rehab/monitor
Doppler color flow add-on
Doppler echo exam, heart
ECG monitor/record, 24 hrs
ECG monitor/report, 24 hrs
Echo exam of abdomen
Echo exam of heart
Echo guidance radiotherapy
Echo guide for biopsy
Echo transthoracic
Fluoroscope examination
Heart function add-on
Heart image (3d), multiple
Heart wall motion add-on
Pet image w/ct, skull-thigh
Polysomnography, 4 or more
Rhythm ECG, tracing
Telephone analy, pacemaker
Telephonic analy, pacemaker
OTHER IMAGING AVERAGE
Rank
Facility
Low
Avg
High
HOSPITAL OUT PATIENT
Physician
Total
Low
Avg
High
Low
Avg
High
IDTF/OFFICE
Total
Low
Avg
High
80 313
78 378
79 #N/A
74 278
76 389
75 227
81 313
316
704
575
#N/A
542
511
671
534
590
895
1,996
#N/A
884
1,115
3,909
1,214
1,669
74
82
#N/A
65
91
65
85
77
105
107
#N/A
85
126
80
105
101
165
153
#N/A
119
154
123
150
144
387
460
#N/A
343
480
292
398
393
809
682
#N/A
627
637
751
639
691
1,060
2,149
#N/A
1,003
1,269
4,032
1,364
1,813
189
157
151
202
192
149
132
170
-57%
390
419
152
319
429
255
348
360
-48%
441
524
156
385
530
364
507
459
-75%
86 345
219
54
214 100
213
0
210 117
211 204
77 283
212 382
83
0
82 380
214 401
73 127
89 470
87 2,374
88 330
90 4,279
231 1,372
209
47
217
0
218
0
563
1,354
129
387
192
296
459
541
1,521
0
808
1,849
698
864
5,337
1,438
4,530
2,050
104
0
0
1,128
1,888
862
512
598
584
713
1,677
3,919
0
1,237
3,995
9,135
1,681
7,970
1,687
4,825
4,254
367
0
0
2,295
111
0
6
34
0
0
74
60
70
68
210
26
59
142
62
296
310
0
24
28
79
129
0
45
83
0
0
86
168
90
102
234
106
95
252
98
371
359
0
35
32
114
157
0
170
130
0
0
108
250
93
199
282
200
150
327
130
436
527
0
53
40
163
456
54
106
34
117
204
357
442
70
448
611
153
529
2,516
392
4,575
1,682
47
24
28
642
1,483
129
432
275
296
459
627
1,689
90
910
2,083
804
959
5,589
1,536
4,901
2,409
104
35
32
1,242
2,045
862
682
728
584
713
1,785
4,169
93
1,436
4,277
9,335
1,831
8,297
1,817
5,261
4,781
367
53
40
2,458
740
54
171
154
90
225
149
342
70
310
488
96
209
972
208
4,521
1,517
23
130
109
529
-18%
796
129
288
251
120
334
285
486
90
415
533
161
258
1,426
272
4,782
2,033
65
163
137
651
-48%
813
862
445
406
130
336
352
881
93
682
565
174
333
1,531
304
5,172
2,457
75
199
154
798
-67%
D5: TYPICAL LAB PRICES IN RI ( 1 of 4)
HCPCS
Hospital Common Procedure
Service Description
Alanine amino (ALT) (SGPT)
Antinuclear antibodies
Assay alkaline phosphatase
Assay of amylase
Assay of blood lipoprotein
Assay of blood/uric acid
Assay of calcium
Assay of ck (cpk)
Assay of creatinine
Assay of digoxin
Assay of ethanol
Assay of ferritin
Assay of free thyroxine
Assay of gammaglobulin igm
Assay of GGT
Assay of iron
Assay of lipase
Assay of magnesium
Assay of parathormone
Assay of phenytoin, total
Assay of phosphorus
Assay of protein, serum
Assay of psa, total
Assay of serum albumin
Assay of serum potassium
Assay of serum sodium
Assay of total thyroxine
Assay of troponin, quant
Assay of urea nitrogen
Rank
153
168
142
111
137
156
115
118
120
99
110
123
150
125
131
133
136
138
141
101
143
146
145
108
144
148
149
154
155
Facility
Low
Avg
18
34
9
22
20
15
5
24
14
31
67
54
39
19
34
29
20
17
87
40
12
29
65
27
15
21
50
77
14
32
77
36
59
56
34
35
43
36
85
88
118
86
83
51
44
61
53
106
78
39
30
93
37
32
33
62
106
27
High
49
136
49
90
90
41
190
106
62
126
136
132
207
145
77
44
263
75
190
142
49
49
159
62
49
49
81
129
36
HOSPITAL OUT PATIENT
Physician
Total
Low
Avg
High
Low
Avg
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
18
34
9
22
20
15
5
24
14
31
67
54
39
19
34
29
20
17
87
40
12
29
65
27
15
21
50
77
14
32
77
36
59
56
34
35
43
36
85
88
118
86
83
51
44
61
53
106
78
39
30
93
37
32
33
62
106
27
High
49
136
49
90
90
41
190
106
62
126
136
132
207
145
77
44
263
75
190
142
49
49
159
62
49
49
81
129
36
INDEPENDENT LAB
Total
Low
Avg
High
12
18
9
18
20
13
9
19
9
35
17
35
23
15
17
11
10
19
103
48
16
5
42
8
9
12
23
34
10
16
52
11
31
31
17
13
33
15
55
18
54
57
26
20
24
28
30
148
61
16
12
62
12
18
16
32
94
12
22
80
25
49
46
19
35
36
23
55
26
60
60
53
33
33
37
60
156
70
20
20
98
35
32
20
33
128
14
D6: TYPICAL LAB PRICES IN RI ( 2 of 4)
HCPCS
Hospital Common Procedure
Service Description
Assay of urine creatinine
Assay thyroid stim hormone
Assay, bld/serum cholesterol
Assay, dipropylacetic acid
Assay, glucose, blood quant
Automated reticulocyte count
Bilirubin, direct
Bilirubin, total
Bl smear w/diff wbc count
Blood culture for bacteria
Blood folic acid serum
Blood typing, ABO
Blood typing, Rh (D)
Carcinoembryonic antigen
Complete cbc w/auto diff wbc
Comprehen metabolic panel
C-reactive protein
Creatine, MB fraction
Cultr bacteria, except blood
Culture aerobic identify
Culture screen only
Culture, bacteria, other
Drug screen, qualitate/multi
Drug screen, single
Electrolyte panel
Fibrin degradation, quant
Flowcytometry/tc, add-on
Fungus isolation culture
Rank
121
151
117
100
128
161
113
112
157
178
124
172
173
116
160
93
169
119
180
181
182
179
97
98
92
163
190
185
Facility
Low
Avg
16
51
13
42
14
36
19
22
13
76
34
16
18
48
16
27
15
36
49
22
15
43
54
5
10
34
8
39
56
115
41
108
37
40
35
35
28
98
85
17
18
138
64
113
30
85
62
50
74
115
55
44
110
36
69
105
High
96
280
62
150
59
58
62
62
185
184
140
39
40
265
133
1,185
121
131
356
181
147
151
112
276
362
102
305
111
HOSPITAL OUT PATIENT
Physician
Total
Low
Avg
High
Low
Avg
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
16
51
13
42
14
36
19
22
13
76
34
16
18
48
16
27
15
36
49
22
15
43
54
5
10
34
8
39
56
115
41
108
37
40
35
35
28
98
85
17
18
138
64
113
30
85
62
50
74
115
55
44
110
36
69
105
High
96
280
62
150
59
58
62
62
185
184
140
39
40
265
133
1,185
121
131
356
181
147
151
112
276
362
102
305
111
INDEPENDENT LAB
Total
Low
Avg
High
8
47
11
34
8
11
4
6
8
29
41
8
10
75
25
24
14
22
39
14
19
17
14
11
20
79
44
55
10
53
16
57
17
29
11
9
15
60
43
17
19
92
31
54
33
66
57
15
29
45
24
20
25
94
45
55
31
65
20
84
20
30
22
20
16
64
56
24
22
101
40
61
53
67
108
28
33
65
138
64
28
106
56
69
D7: TYPICAL LAB PRICES IN RI ( 3 of 4)
HCPCS
Hospital Common Procedure
Service Description
Glycosylated hemoglobin test
Hematocrit
Hemoglobin
Hepatic function panel
Iron binding test
Lactate (LD) (LDH) enzyme
Lipid panel
Metabolic panel total ca
Microalbumin, quantitative
Microbe susceptible, mic
Mycobacteria culture
Natriuretic peptide
Protein e-phoresis, serum
Prothrombin time
RBC antibody screen
Rbc sed rate, automated
Rbc sed rate, nonautomated
Renal function panel
Routine venipuncture
Smear, fluorescent/acid stai
Smear, gram stain
Thromboplastin time, partial
Transferase (AST) (SGOT)
Urinalysis nonauto w/o scope
Urinalysis, auto w/scope
Urinalysis, auto, w/o scope
Urinalysis, nonauto w/scope
Urine bacteria culture
Urine culture/colony count
LAB AVERAGE (86 tests)
Rank
132
158
159
96
134
135
94
91
109
187
186
140
147
164
170
166
165
95
11
189
188
167
152
105
104
106
103
184
183
Facility
Low
Avg
33
11
11
39
21
18
26
23
18
23
26
70
23
17
37
15
15
63
4
13
12
20
18
4
28
17
20
21
31
28
59
22
21
142
69
40
134
95
93
79
58
232
95
68
60
62
28
172
12
65
50
44
39
10
36
35
36
54
110
65
High
136
40
32
488
79
166
285
700
142
83
116
446
173
89
90
93
42
494
2,359
111
59
105
83
23
56
40
38
81
111
176
HOSPITAL OUT PATIENT
Physician
Total
Low
Avg
High
Low
Avg
0
0
0
0
0
0
0
0
0
0
0
0
50
6
0
0
0
0
5
0
0
0
0
12
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
62
6
0
0
0
0
16
0
0
0
0
16
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
71
17
0
0
0
0
24
0
0
0
0
18
0
0
0
0
0
33
11
11
39
21
18
26
23
18
23
26
70
73
23
37
15
15
63
9
13
12
20
18
16
28
17
20
21
31
28
59
22
21
142
69
40
134
95
93
79
58
232
157
74
60
62
28
172
28
65
50
44
39
26
36
35
36
54
110
65
High
136
40
32
488
79
166
285
700
142
83
116
446
244
106
90
93
42
494
2,383
111
59
105
83
41
56
40
38
81
111
176
INDEPENDENT LAB
Total
Low
Avg
High
26
12
12
23
24
17
31
23
15
24
30
63
30
15
15
30
10
24
5
15
12
17
12
20
9
13
9
24
23
22
-21%
44
17
16
28
30
20
78
29
32
30
31
157
41
22
26
31
18
30
9
16
18
36
15
25
16
17
12
27
30
34
-48%
60
21
20
40
31
23
78
40
40
36
83
186
61
30
29
32
18
34
20
18
48
41
23
25
47
17
16
39
55
47
-73%
D8: TYPICAL LAB PRICES IN RI ( 4 of 4)
HCPCS
Hospital Common Procedure
Service Description
Assay of tacrolimus
Assay of myoglobin
Blood gases w/o2 saturation
Blood gases: pH, pO2 & pCO2
Blood typing, antigen screen
Blood typing, RBC antigens
Compatibility test, antiglob
Compatibility test, spin
Coombs test, indirect, qual
Fibrin degrade, semiquant
Glucose blood test
Occult blood, feces
Reagent strip/blood glucose
Urine pregnancy test
OTHER LAB AVERAGE (14 tests)
Facility
Rank Low
Avg
High
HOSPITAL OUT PATIENT
Physician
Total
Low
Avg High
Low
Avg
102 #N/A #N/A
#N/A
#N/A #N/A #N/A
139
75
101
111
0
0
0
127
54
227
251
0
0
0
126
54
108
171
0
0
0
174
41
54
116
0
0
0
175
15
53
57
0
0
0
177
20
21
72
0
0
0
176
41
47
54
0
0
0
171
60
60
60
0
0
0
162
53
88
92
0
0
0
130
14
14
15
0
0
0
114
6
30
58
0
0
0
129
16
16
25
0
0
0
107
11
113
135
0
0
0
35
72
94
High
#N/A
#N/A
#N/A
75
101
111
54
227
251
54
108
171
41
54
116
15
53
57
20
21
72
41
47
54
60
60
60
53
88
92
14
14
15
6
30
58
16
16
25
11
113
135
35
72
94
PREF. PROVIDER
Total
Low
Avg
15
27
59
41
21
21
33
33
12
15
5
7
5
13
22
-37%
23
27
59
41
22
22
34
34
12
15
5
7
6
13
23
-68%
High
26
27
59
41
22
22
35
35
12
15
5
7
7
13
23
-75%
D9: MISC. PROCEDURE PRICES IN RI ( 1 of 3)
HCPCS
Hospital Common Procedure
Service Description
Admin influenza virus vac
Airway inhalation treatment
Application of paste boot
Apply forearm splint
Blood transfusion service
Breathing capacity test
Capillary blood draw
Cardiovascular stress test
Cataract surg w/iol, 1 stage
Colon ca scrn not hi rsk ind
Colonoscopy and biopsy
Debride skin, full
Debride skin, partial
Debride skin/tissue
Destruct premalg les, 2-14
Destruct premalg lesion
Diagnostic colonoscopy
Drain/inject, joint/bursa
Electrocardiogram, tracing
Evaluate pt use of inhaler
Evaluation of wheezing
Extracranial study
Extremity study
Eye exam & treatment
Eye exam established pat
Facility
Rank Low
Avg
243
227
9
8
13
222
12
208
25
244
18
2
1
3
6
5
17
7
206
228
223
220
221
203
202
15
24
165
82
137
23
0
394
724
556
700
43
56
145
60
16
80
41
36
29
162
604
330
0
0
23
144
485
131
2,997
250
0
635
5,847
1,709
1,630
259
195
306
433
451
1,955
262
173
99
368
718
687
0
0
High
3,221
1,898
1,003
549
18,931
481
0
1,118
8,611
2,436
4,901
3,708
846
7,356
1,370
1,010
4,701
3,158
6,572
1,903
574
2,857
1,519
0
0
HOSPITAL OUT PATIENT
Physician
Total
Low
Avg
High
Low
Avg
16
19
66
73
0
23
15
0
440
506
675
72
37
90
15
90
557
97
0
26
31
52
28
94
77
21
30
132
104
0
43
18
0
2,170
793
1,002
91
79
168
31
151
928
188
0
28
70
124
116
123
106
47
38
225
175
0
63
18
0
2,767
1,300
1,382
236
205
350
88
227
1,267
330
0
41
95
208
211
163
113
31
43
231
155
137
46
15
394
1,164
1,062
1,375
115
93
235
75
106
637
138
36
55
193
656
358
94
77
44
174
617
235
2,997
293
18
635
8,017
2,502
2,632
350
274
474
464
602
2,883
450
173
127
438
842
803
123
106
High
3,268
1,936
1,228
724
18,931
544
18
1,118
11,378
3,736
6,283
3,944
1,051
7,706
1,458
1,237
5,968
3,488
6,572
1,944
669
3,065
1,730
163
113
IDTF/OFFICE
Total
Low
Avg
15
28
50
75
152
50
8
75
2
455
685
45
36
65
6
68
494
96
25
25
92
340
219
93
65
25
41
128
134
154
75
12
197
132
860
895
95
76
148
26
97
796
160
45
38
191
440
342
126
90
High
37
70
209
212
155
96
16
314
1,753
1,025
1,000
202
121
266
98
177
1,002
312
65
60
259
799
623
172
120
D10: MISC. PROCEDURE PRICES IN RI ( 2 of 3)
HCPCS
Hospital Common Procedure
Service Description
Flu vaccine, 3 yrs & >, im
Gait training therapy
Group psychotherapy
Immunization admin
Inj foramen epidural l/s
Inj paravertebral l/s add-on
Inject spine l/s (cd)
Insert temp bladder cath
Left heart catheterization
Lesion removal colonoscopy
Lesion remove colonoscopy
Measure airflow resistance
Measure blood oxygen level
Medication management
Monoxide diffusing capacity
Motion fluoroscopy/swallow
Motor nerve conduction test
Office/outpatient visit, est
Office/outpatient visit, new
Ophth dx imaging post seg
Oth resp proc, group
Place needle in vein
Pneumococcal vaccine
Psy dx interview
Psytx, off, 45-50 min
Facility
Rank Low
Avg
192
0
236
35
200
75
191
15
24 177
23
48
22 367
21
0
216 4,998
20 111
19 332
226
58
230
8
201
0
229 127
205 293
232 243
240
66
239
66
204
0
247
76
10
68
195
0
197 165
199 140
13
83
222
45
839
3,360
942
365
7,252
1,645
2,215
93
77
0
203
580
309
155
80
0
76
200
88
780
140
High
42
88
600
1,229
1,827
7,841
2,260
1,213
14,808
7,246
3,812
348
518
0
460
754
1,126
207
207
0
123
664
119
814
140
HOSPITAL OUT PATIENT
Physician
Total
Low
Avg High
Low
Avg
15
0
31
11
332
119
247
117
557
900
808
32
5
72
20
0
41
49
49
37
0
25
0
140
95
21
0
52
35
599
358
554
194
1,522
1,186
996
37
25
95
52
0
86
103
103
74
0
88
0
227
144
29
0
94
39
1,277
675
896
280
1,752
1,700
1,423
60
40
120
78
0
119
208
208
88
0
110
0
326
201
15
35
106
26
509
167
614
117
5,555
1,011
1,140
90
13
72
147
293
284
115
115
37
76
93
0
305
235
34
83
274
80
1,438
3,718
1,496
559
8,774
2,831
3,211
130
102
95
255
580
395
258
183
74
76
288
88
1,007
284
High
71
88
694
1,268
3,104
8,516
3,156
1,493
16,560
8,946
5,235
408
558
120
538
754
1,245
415
415
88
123
774
119
1,140
341
IDTF/OFFICE
Total
Low
Avg
11
23
31
16
321
150
376
112
3,884
1,013
838
62
6
66
109
250
100
62
62
76
39
41
11
120
85
19
40
55
28
871
381
643
162
3,929
1,138
1,220
71
26
87
183
251
145
102
102
127
39
53
42
189
110
High
33
71
66
36
1,600
791
808
250
4,018
1,235
1,261
88
40
105
231
254
273
220
220
170
40
85
50
250
155
D11: MISC. PROCEDURE PRICES IN RI ( 3 of 3)
HCPCS
Hospital Common Procedure
Service Description
Facility
Rank Low
Avg
High
HOSPITAL OUT PATIENT
Physician
Total
Low
Avg
High
Low
Avg
High
Psytx, office, 20-30 min
Pt evaluation
Radiation treatment delivery
Repair superficial wound(s)
Residual lung capacity
Self care mngment training
Sense nerve conduction test
Td vaccine > 7, im
Td vaccine no prsrv >/= 7 im
Ther/proph/diag inj, sc/im
Therapeutic activities
Therapeutic exercises
Thoracic gas volume
Upper GI endoscopy, biopsy
Uppr gi endoscopy, diagnosis
Vitamin B-12
Withdrawal of arterial blood
MISC. PROCEDURE AVG. (67)
198
234
84
4
224
238
233
194
193
196
237
235
225
16
15
122
14
185
261
810
22
125
45
95
0
14
10
66
48
68
274
215
34
38
212
185
263
949
205
274
67
247
32
15
572
94
80
126
1,985
1,457
85
114
691
185
275
2,857
810
386
118
331
46
392
14,619
137
114
427
6,313
4,657
138
1,069
2,359
65
0
0
98
30
0
43
23
0
16
0
0
18
470
322
0
48
118
95
0
0
148
51
0
83
24
0
43
0
0
31
772
652
0
70
224
119
0
0
327
81
0
114
24
0
92
0
0
43
1,020
956
0
100
331
250
261
810
120
155
45
138
23
14
26
66
48
86
744
537
34
86
330
280
263
949
353
325
67
330
56
15
615
94
80
157
2,757
2,109
85
184
915
304
275
2,857
1,137
467
118
445
70
392
14,711
137
114
470
7,333
5,613
138
1,169
2,690
Emergency dept visit
HYPERBARIC Oxygen
Oth resp proc, indiv
Radiation tx delivery, imrt
Therapeutic procd strg endur
Transmission of ecg
241
242
246
85
245
207
75
375
#N/A
#N/A
#N/A
#N/A
107
427
#N/A
#N/A
#N/A
#N/A
786
562
#N/A
#N/A
#N/A
#N/A
40
0
#N/A
#N/A
#N/A
#N/A
69
0
#N/A
#N/A
#N/A
#N/A
87
0
#N/A
#N/A
#N/A
#N/A
115
375
#N/A
#N/A
#N/A
#N/A
176
427
#N/A
#N/A
#N/A
#N/A
873
562
#N/A
#N/A
#N/A
#N/A
IDTF/OFFICE
Total
Low
Avg
56
69
300
160
106
27
88
5
5
19
25
23
59
544
555
32
50
198
-40%
69
125
320
225
143
39
134
23
37
36
48
55
59
698
660
45
65
270
-70%
High
98
182
360
300
208
55
329
40
48
66
80
68
80
852
745
62
70
375
-86%
#N/A #N/A #N/A
#N/A #N/A #N/A
24
26
27
1,800 1,805 1,840
39
39
40
#N/A #N/A #N/A
Table of Contents
PART 2: GOING NATIONAL
ESTIMATE ON
EXPANDING THE
RI MODEL
NATIONALLY
(APPENDIX E, F, G, H, I, J, K, L)
APPENDIX E
ESTIMATE ON
EXPANDING THE
RI MODEL
NATIONALLY
(NEXT 22 SLIDES)
Table of Contents
E1: 185 BUYER’S CO-OPs (MARKETS)
(see Appendix E13-21 for CO-OP definition)

EMPLOYERS & Gov’t CONTRIBUTE CURRENT PREMIUMS TO COOP FOR SIMILAR PLAN RECEIVE A 40% REBATE/REFUND (see A7
for RI example).

COVERAGE IS NOT DEPENDEND ON EMPLOYMENT

ALL SMALL / UN-INSURED EMPLOYERS MUST CONTRIBUTE
SOMETHING: (EX: $500/EE/YR, 3 YR PHASE-IN, see RI example slide
17, 18 & A7)

FAMILIES PAY BASED ON ABILITY (AGI)
INSURERS (Blue Cross) BECOME BENEFIT MANAGERS
100% ACCESS/COVERAGE (see RI example slide 16)


PATIENTS are free to purchase added coverage with their own funds
through the Co-OP or in the open market. CO-OP focus is on health
care as a “public utility” for all in the area.
E2: USE LIFE INS TO FINANCE







BUY LIFE INS FOR 45-54 AGE GROUP
$1M 30YR TERM INS POLICIES (54m lives).
$2K PER PERSON PER YR COST
CREATES $54T DEATH BENEFIT STREAM
ASSIGN TO INVESTORS FOR $9T NOW
$9T GENERATES $720B INCOME FOR REBATES
5% -10% OF DEATH BEN. TO FAMILY
USE 185 CO-OPs AS VEHICLE
(see appendix A4 for RI example, appendix E13 co-ops defined)
BACK
E3: HOW WE SPEND $2.3T
SAVE $360B 15%
(re-invest in Nursing Homes & Home Care)
CURRENT COSTS:
MOVE TO
(see appendix A & B)
MD/Other fees
$484B 21%
Dental
$ 115B 5%
Hosp-546m OP other $285B 12%
MD FEEs (slide 80):
135k Surgeons
$68b
25k Psychiatrists
$10b
118k Medical
$73b
Hosp-138m OP ER $ 95B 4%
Hosp-25m OP Surg. $ 30B 1%
Hosp-39m inpatient $402B 18%
Drugs
Nursing Homes
Non-Durables
Home Care
Other
TOTAL
$ 270B 12%
$ 135B 6%
$ 137B 6%
$ 74B 3%
$ 273B 12%
$2,300B
MD PRIMARY CARE:
122k Gen. Practices $146b
50k Geriatric
$61b
49k Pediatric
$59b
47k Ob/Gyn
$56b
101k Dentists
$95b
52k Optometrists $33b
111k Diet/Nutri
$8b
39k Ath. Trainers
$3b
TOTAL
$461b
Also, this population
will double 10-20 yrs
see A5/A6, global waiver
Hospitals
$527b
Drugs
Nursing Homes
Non-Durables
Home Care
Other
TOTAL
$185b
$135b
$137b
$74b
$273b
$1,943b
Primary Care is 660m 1/2hr MD visits & 1B 1hr nurse visits per year. Should include
routine lab, imaging, etc. 100% access. Shrink & focus hospitals to ER, Surgery & Inpatient.
E4: WHO PAYS? 100% ACCESS
FED. MEDICARE
FED. MEDICAID
FED. EE, Retired, Military, etc
FED. CO-OP REFUND
STATE- MEDICAID
STATE- EE/Retired/OTHER
STATE- CO-OP REFUND
MUNI- EE/Retired/OTHER
MUNI- CO-OP REFUND
FAMILIES/EE (based on $)
EMPLOYERS/ OTHER
ER CO-OP REFUND
CO-OP PAYS
BUSINESS FRIENDLY!
NOW
$.5T
$.3T
$.2T
$0
$.1T
$.05T
$0
$.15T
$0
$.3T
$.7T
$0
$2.3T
NEW
$.5T
$.3T
$.2T
($.3T)
$.1T
$.05T
($.06T)
$.15T
($.06T)
$.3T
$.7T
($.3T)
$1.58T -33%
$.72T
$2.3T
From
investing
Life Ins
assign $9T
BAL. GOV’T BUDGETS!
E5: 268K PC MD’s REQUIRED IN USA
AGE
RANGE
POP. (000) # DOC’S POP. (000) # DOC’S
2010 est
( Practices) 2030 est
(Practices)
0-1 (8x/ yr)
4,316
5,395
4,532
5,665
2-17 (4x/ yr)
70,116
43,822
81,175
50,734
18-64 (4x/ yr) 195,109
121,943
206,424
129,015
+65 (8x/ yr) 40,244
50,305
71,453
89,316
TOTAL
309,785
221,465
363,584
274,730
18-64 FEMALE
OB/GYN (3X/ YR)
97,513
46,435
102,995
49,100
2010: # PC’s IS 267,900 (221,465+46,435) @ $1.2M/ EA = $321.5B 2030: # PC’s IS 324k (275+49 @ $1.2M/ EA = $389B
EVERYBODY SEES A DOCTOR 4 OR 8 TIMES PER YR ON AVG. + OB/GYN. 100% ACCESS.
E6: US FAMILY’S PAYROLL DEDUCT (see A7)
PEOPLE (EXEMPTS)
RATE
TOTAL
PREM.
$937B
2.0% < $20k
$20B
106m/65m
$3,122B
4.0%
$125B
125m/55m
AGI
RANGE
AGI (B$)
TOTAL
< $30K
$30- $100K
HOUSEHOLDS
(RETURNS)
$100- $200K $1,801B
4.0% $100/wk max $70B
38m/14m
+$200K
4.0% $100/wk max $30B
13m/6m
$1,766B
NO TAX RETURN
MEDICARE/
MEDICAID
TOTAL
28m/??
$7,626B
$300B today
$245B
310m/140m
$19K PAYS $7/ WK, $40K PAYS $30/ WK, $80K PAYS $60/ WK, $100K PAYS $77/WK, $200K PAYS $100/ WK
Coverage is based on living or working in RI not employment and includes a life insurance benefit.
BACK
E7: US EMPLOYER’S CONTRIBUTION (see A7)
(Jobs < $20k would pay avg. of $125/mo/ee, Jobs > $20k would pay avg. $750/mo/ee. Scaled- $1k max)
# OF
EE’S
# OF
FIRMS
TOTAL
JOBS
1 to 19
7.75 mil 28 mil
20 to 99 880,000 34 mil
TOTAL
WAGES
PREMIUMS
TO PAY
$.7T
$60B
$1.5T
$300B > $30k-$60k , 20% of all wages
1st $10k wages 5%, next $10k 10% , 15%
($1.2T X 20% + 4m jobs >$60k X $12k/ea.)
+100
175,000 47 mil
$2.4T
$340B
> $30k-$60k , 20% of all wages
($1.2T X 20% + 7m jobs >$60k X $12k/ea.)
Gov’t
Total
23 mil
8.8 mil 132 mil
$1.1T
$400B
$5.7T
$1,100B
approx. same as today (in Fed EE)
(Private $700B + Gov’t $400B)
Employers who currently offer insurance would continue to contribute the same amount on a % of payroll or per
Employee basis during a transitional period of several years to the above. New employers or those not offering
insurance now would Contribute based on the above. Rebates from Trust income could be skewed to smaller
employers to defray cost. Net cost to Employers after rebates could be 40% less than today, a true competitive
advantage for the state. (** non-farm jobs & wages). DEFINED CONTRIBUTION FOR BUSINESS 5-10 years.
Cost risk shifts to TRUST.
Coverage is based on living or working in USA not employment and includes a life insurance benefit.
BACK
E8: US EMPLOYER’S CONTRIBUTION (see A7)
(Jobs < $20k would pay avg. of $125/mo/ee, Jobs > $20k would pay avg. $750/mo/ee. Scaled- $1k max)
INDUSTRY
JOBS
(mils)
AVG TOTAL WAGES TOTAL PREMIUM
WAGE
($ BIL)
($ BIL)
HEALTH CARE & SOCIAL ASSISTANCE
RETAIL TRADE
MANUFACTURING
ACCOMMODATION & FOOD SERVICE
FINANCE & INSURANCE
ADMINISTRATIVE & WASTE SERVICES
PROFESSIONAL & TECHNICAL SERVICES
CONSTRUCTION
EDUCATIONAL SERVICES
OTHER SERVICES
WHOLESALE TRADE
INFORMATION
TRANSPORTATION & WAREHOUSING
MANAGEMENT OF COMPANIES
ART, ENTERTAINMENT & RECREATION
REAL ESTATE & RENTAL & LEASING
UTILITIES
AGRICULTURE, FISHING, HUNTING
MINING
TOTAL PRIVATE SECTOR (non-farm)
16.7
14.4
11.6
11.2
5.6
7.8
7.5
5.7
3.4
4.6
5.4
2.6
4.2
1.9
2.0
1.9
0.6
1.1
0.8
109.0
38,600
23,900
49,700
15,600
78,200
29,500
68,100
45,100
37,700
26,700
57,000
65,300
39,600
87,400
29,400
39,600
77,300
23,900
80,100
41,400
644.6
344.2
576.5
174.7
437.9
230.1
510.8
257.1
128.2
122.8
307.8
169.8
166.3
166.1
58.8
75.2
46.4
26.3
64.1
4,507.6
129
30
115
12
67
23
90
51
26
11
62
31
33
23
6
15
7
2
10
743
23.0
52,000
1,196.0
132.0
43,200
5,703.6
240
110
1,093
GOVERNMENT EMPLOYMENT
GRAND TOTAL
AVG. PREM
PER EE/ MO
643
175
828
88
1,000
245
1,000
750
628
209
950
1,000
660
1,000
245
660
1,000
175
1,000
568
most pt , < $20k
most pt , < $20k
max $1k/ mo
max $1k/ mo
most pt , < $20k
max $1k/ mo
max $1k/ mo
most pt , < $20k
max $1k/ mo
most pt , < $20k
max $1k/ mo
870 same as today
mil/retire/ other
690
1st
Premiums would be 5% on $10k in wages, 10% on next $10k, 15% on next $10k. From $30k to $60k its 20% of all wages.
Rebates from Trust income could be skewed to smaller employers to defray cost. Net cost to Employers after rebates
could be 40% less than what is shown above (which is today’s cost) , a true competitive advantage for the state.
DEFINED CONTRIBUTION FOR BUSINESS 5-10 years. Cost risk shifts to TRUST.
Coverage is based on living or working in USA not employment and includes a life insurance benefit.
BACK
E9: NATIONAL COUNCIL OF CO-OP’S
A NATIONAL COUNCIL OF CO-OP’s WOULD BE ESTABLISHED TO
NEGOTIATE CONTRACTS WITH MULTI-STATE BUSINESSES AND EMPLOYERS
TO ASSESS THE BUSINESS’S HEALTH CONTRIBUTION. THE NATIONAL
COUNCIL WILL DISTRIBUTE THE FUNDS TO THE 185 CO-OP’s ON A PER CAPITA
BASIS.
ANY BUSINESS THAT BENEFITS FROM OPERATING IN THE USA, MUST
CONTRIBUTE TO THE HEALTH (AND FRANKLY SOC. SECURITY) SYSTEMS.
THE EXAMPLES SHOWN HERE BASE THIS ASSESMENT ON EMPLOYMENT. THE
ASSESMENT CAN BE BASED ON: REVENUE, PROFIT, ASSETS, ETC. A BUSINESS
CAN NOT BE ALLOWED TO AVOID THIS OBLIGATION SIMPLY BY SHIFTING
EMPLOYMENT OUTSIDE THE USA.
ANY BUSINESS THAT OPERATES IN THE USA SHOULD BE REQUIRED TO
PRODUCE & EMPLOY HERE AS WELL (AS MOST OF OUR TRADING PARTNERS
REQUIRE. WTO NOTWITHSTANDING). THIS MATH IS BECOMING APPARENT IN
GOV’T BUDGETS, PERSISTENTLY HIGH UNEMPLOYMENT, STAGNANT WAGES &
GROWING INCOME INEQUALITY.
THE NATIONAL COUNCIL WOULD ALSO MANAGE PUCHASING AGREEMENTS
WITH PHARMA & DEVICE MANUFACTURERS, ETC. TO ENSURE THE CO-OP’s
OBTAIN THE BEST AVAILABLE PRICING ON COMMONLY PURCHASED ITEMS.
“PATIENT-DRIVEN”
10K PEOPLE/DAY FOR NEXT 18 YRS WILL TURN 65 in USA.
CHANGE THE DELIVERY SYSTEM: CHEAPER/ BETTER
E10: WHAT HOSPITALS DO FOR US EACH YEAR
IN THE USA AT A COST OF $810B
• IN-PATIENT SURGERIES: 11.3 Mil. DISCHARGES
$ 191B (E17)
(94k CRITICAL PATIENTS AND 157k RECOVERING PATIENTS ON AVG., 24/7)
• IN-PATIENT MENTAL HEALTH: 3.8 Mil.
$ 39B (E17)
(93k PATIENTS ON AVG. ALL DAY, EVERYDAY, 24/7)
• IN-PATIENT ALL OTHER MEDICAL: 22.9 Mil.
$ 172B (E17)
(232k PATIENTS ON AVG. ALL DAY, EVERYDAY, 24/7, INCLUDES BIRTHS)
• OUT-PATIENT ER: 138 Mil. VISITS
$ 94B (E19)
(84k SERIOUS PATIENTS & 28k WAITING ON AVG. ALL DAY, EVERYDAY, 24/7)
• OUT-PATIENT SURGERIES: 24.4 Mil.
$ 29B (E19)
(108k PATIENTS, 235 DAYS PER YR, 8 HRS PER DAY ON AVG.)
• OUT-PATIENT ALL OTHER: 546 million VISITS
(11m mental health visits, 158m imaging, 322m lab visits, 55m misc. visits)
$ 285B (E21)
$ 810B
546m out patient visits (not ER, not Surgery). Cost $285B. Drive much of this back to the PC Office.
SHRINK & FOCUS HOSPITALS TO: IN-PATIENT, OP-ER & OP-SURGERY. This is nearly
2 visits for every man, woman & child in the USA!! Over use and most should be included in PC.
E11: LET’S STREAMLINE USA HOSPITALS & BILLING PROCESS:
94,000 SURGICAL/CRITICAL BEDS @ $1.15M
157,000 SURGICAL/RECOVERY BEDS @ $528K
93,000 MENTAL HEALTH BEDS @ $430K
232,000 MEDICAL BEDS @ $740K
576,000 IN-PATIENT BEDS (38.2m discharges, 209.7m days) **
$108B
$83B
$39B
$172B
$402B
138 mil. ER VISITS @ $680/EA AVG.
24.4 mil. OUT-PATIENT SURGERIES @ $1,200/EA AVG.
$94B
$29B
546 MILLION OTHER OUT-PATIENT VISITS
$285B (to PC)
(most “OP Other” move to PC office, heavy scrutiny, cut rates)
TOTAL HOSPITAL COSTS
$810B
** Each facility will submit a bill once per month to recover cost of having beds available & staffed,
subject to audit. Utilization would be reviewed periodically. Under-utilized beds would be shifted to
needed facilities or de-funded if not needed. Adding beds to the system, and/or rate increases would
be scrutinized in public. THE CUSTOMER (CO-OP) WOULD HAVE THE OPTION OF “NO”.
Facilities would bill ER Visits & OP Surgeries at fixed rates once per month to recover costs to a max
number allowed per year for the facility. Exceeding this number would be scrutinized.
E12: USA MDs & SPECIALISTS (NOT HOSP EEs OR PC)
ASSOCIATED WITH HOSPITAL ACTIVITY:
49k SURGEONS: 9.75 Mil OPERATIONS @ $3,500/EA
26k ANESTHESIOLOGISTS: 8 Mil
@ $1,500/EA
$ 34B (B3 RI example)
$ 12B (B3 RI example)
69k SURGEONS/SPECIALISTS: 24.3 Mil
OUTPATIENT SURGERIES
@ $1,000/EA
$ 24B (B4 RI example)
34k RADIOLOGISTS: 118.8 Mil
OUTPATIENT IMAGES
$ 15B (B5) (drive to PC)
@ $125/EA
178k TOTAL ASSOCIATED WITH HOSPITALS (EST) $ 85B
ALL OTHER MD/ SPECIALISTS (approx. 100k) **
$ 66B
278k GRAND TOTAL
$151B
** Each PC doctor would be given $200k of non-Hosp. “Specialist Referrals” per year
based on patient roster. They would decide how to “spend” them ($100/referral).
Table of Contents
E13-21: POPULATION by AGE
(US CENSUS 2010)
EXPANDING THE RI MODEL NATIONALLY
185 BUYER CO-OP’s DEFINED
GEOGRAPHIC MARKETS WITHIN STATES
EACH, 1 to 2.5 MIL PEOPLE (1 to 2.5 RI’s)
(NEXT 9 SLIDES)
Each of the 185 CO-OP areas covers 1 or more “Hospital Referral Regions” as
defined by the Dartmouth Atlas of Health Care. Regional hospitals capable of
cardio and/or neuro surgery. (http://www.dartmouthatlas.org/data/region/)
In each of the 15,490 service areas the CO-OP would contract approx. 17 Primary
Care MDs, 7 Dentists and 4 Optometrists to service a population of approx. 20k.
Table of Contents
STATE/
CO-OP
AL1
AL2
AL3
POPULATION BY AGE (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
AL-Birmingham S & Tuscaloosa (28 counties- Central AL)
AL-Birmingham N & Huntsville (15 counties- Northern AL)
AL-Dothan, Mobile & Montgomery (23 counties- Southern AL)
3 ALABAMA-TOTAL
1 ALASKA-TOTAL (AK)
POP.
TOTAL
2010
Age
0-1 yrs
(8x/ yr)
Age
2-17 yrs
(4x/ yr)
Age
18-64 yrs
(4x/ yr)
Age
+65 yrs
(8x/ yr)
MAP
2,001,679
1,233,703
1,544,354
4,779,736
25,508
15,292
20,197
60,997
443,396
274,265
354,062
1,071,724
1,269,549
764,962
954,561
2,989,073
263,225
179,184
215,534
657,943
MAP
710,231
10,796
176,705
468,042
54,688
AZ1
AZ2
AZ3
AZ4
AZ-Mesa (Maricopa SE- Mesa, Chandler, Gilbert, Tempe)
AZ-Phoenix City of (Maricopa central)
AZ-Phoenix N & Sun City (Maricopa- Glendale, Scottsdale & North AZ)
AZ-Phoenix S & Tucson (Maricopa- Avondale, Goodyear & South AZ)
MAP
4 ARIZONA-TOTAL
1,179,761
1,445,632
1,708,721
2,057,903
6,392,017
16,060
23,997
19,310
29,150
88,517
292,340
386,939
364,163
495,649
1,539,090
741,325
915,025
986,199
1,239,290
3,881,839
130,037
119,670
339,049
293,814
882,571
AR1
AR2
AR-Little Rock (South & East AR, 43 counties)
AR-Fort Smith, Jonesboro, Springdale, Texarkana (N&W - 32 counties)
2 ARKANSAS-TOTAL
MAP
1,607,881
1,308,037
2,915,918
21,007
18,538
39,545
359,184
312,839
672,023
992,255
792,057
1,784,311
235,436
184,603
420,039
CA1
CA2
CA3
CA4
CA5
CA6
CA7
CA8
CA9
CA10
CA11
CA12
CA13
CA14
CA15
CA16
CA17
CA18
CA19
CA20
CA21
CA-Orange County N (Anaheim, Garden Grove, Hunt. Bch & North)
CA-Orange County S (Santa Ana, Costa Mesa & South)
CA-Bakersfield & Fresno (Kern, Tulare & Fresno, King, Madera)
CA-Alameda County
CA-LA Central LA, South LA, Northeast LA & Eastside
CA-LA Harbor, South Bay & Westside
CA-LA San Fern. Valley, NW, Antelope, Forest & Santa Monica Mtns.
CA-LA San Gabriel Valley, Pomona & Verdugos
CA-LA Southeast
CA-Modesto & Stockton (Merced, Stanislaus, San Joaquin, +4 more.)
CA-Napa, Chico, Redding & Santa Rosa (15 counties- north CA )
CA-Sacramento (11 counties)
CA-Palm Springs/Rancho Mirage (Riverside County)
CA-San Bernardino & Inyo Counties
CA-San Diego (City of)
CA-San Diego County (ex. City of, + Imperial County)
CA-San Francisco (SF & Marin Counties)
CA-San Jose (Santa Clara & San Benito Counties)
CA-Santa Cruz & San Mateo County
CA-Santa Barbara, San Luis Obispo, Salinas & Ventura
CA-Contra Costa & Solano Counties
MAP
21 CALIFORNIA-TOTAL
1,409,306
1,600,926
2,516,107
1,510,271
2,099,049
2,219,119
2,137,451
2,154,468
1,208,518
1,588,948
1,548,183
2,478,708
2,189,641
2,053,756
1,307,402
1,962,439
1,057,644
1,836,911
980,833
1,931,907
1,462,369
37,253,956
17,693
20,236
43,606
19,634
30,463
26,399
28,524
25,679
18,541
24,400
17,984
33,029
32,407
31,964
16,212
27,369
9,863
25,761
12,331
25,660
18,801
506,554
328,859
364,545
723,725
324,433
528,478
435,762
493,250
471,006
327,267
432,617
322,905
586,671
592,273
571,043
265,821
462,918
151,570
423,279
204,256
449,436
345,967
8,806,083
891,774
1,032,021
1,511,397
1,000,022
1,346,403
1,481,123
1,396,065
1,382,086
747,166
957,044
976,055
1,553,353
1,308,829
1,267,678
886,693
1,236,900
745,865
1,186,513
639,939
1,222,879
922,350
23,692,154
170,980
184,124
237,380
166,183
193,705
275,834
219,613
275,697
115,544
174,887
231,239
305,654
256,132
183,071
138,676
235,253
150,346
201,358
124,307
233,932
175,250
4,249,165
Female
18-64 yrs
(3x/ yr)
656,489
389,138
492,242
1,537,870
<18
%
+65
%
Serv.
Areas
23.4% 13.2%
23.5% 14.5%
24.2% 14.0%
23.7% 13.8%
100
62
78
240
224,660 26.4% 7.7%
36
372,122
456,432
500,933
617,890
1,947,376
26.1% 11.0%
28.4% 8.3%
22.4% 19.8%
25.5% 14.3%
25.5% 13.8%
55
73
87
106
321
505,324 23.6% 14.6%
402,700 25.3% 14.1%
908,025 24.4% 14.4%
81
66
147
452,721
520,186
744,648
510,668
676,254
761,025
702,806
706,370
379,311
480,135
487,443
790,067
658,421
639,187
439,424
618,300
370,064
591,855
324,168
607,548
470,041
11,930,642
24.6% 12.1%
24.0% 11.5%
30.5% 9.4%
22.8% 11.0%
26.6% 9.2%
20.8% 12.4%
24.4% 10.3%
23.1% 12.8%
28.6% 9.6%
28.8% 11.0%
22.0% 14.9%
25.0% 12.3%
28.5% 11.7%
29.4% 8.9%
21.6% 10.6%
25.0% 12.0%
15.3% 14.2%
24.4% 11.0%
22.1% 12.7%
24.6% 12.1%
24.9% 12.0%
25.0% 11.4%
71
80
126
76
110
113
103
105
61
80
77
124
110
103
66
98
53
92
49
97
73
1,867
STATE/
CO-OP
POPULATION BY AGE (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
POP.
TOTAL
2010
Age
0-1 yrs
(8x/ yr)
Age
2-17 yrs
(4x/ yr)
Age
18-64 yrs
(4x/ yr)
Age
+65 yrs
(8x/ yr)
Female
18-64 yrs
(3x/ yr)
<18
%
+65
%
Serv.
Areas
CO1
CO2
CO3
CO4
CO-Boulder, Fort Collins, Greeley (10 counties- NE CO.)
CO-Colorado Springs, Grand Junction & Pueblo (35 counties- S. CO.)
CO-Denver City of & East (7 counties)
CO-Denver West (12 counties)
4 COLORADO-TOTAL
MAP
920,962
1,394,219
1,706,476
1,007,539
5,029,196
11,801
18,717
25,589
12,789
68,896
203,395
319,823
400,784
233,268
1,157,271
604,795
877,187
1,113,294
657,767
3,253,042
100,970
178,491
166,810
103,716
549,987
301,869 23.4% 11.0%
434,327 24.3% 12.8%
559,038 25.0% 9.8%
326,887 24.4% 10.3%
1,622,121 24.4% 10.9%
46
70
86
50
252
CT1
CT2
CT-Hartford (6 counties)
CT-New Haven & Bridgeport (2 counties SW CT.)
2 CONNECTICUT-TOTAL
MAP
1,794,791
1,779,306
3,574,097
19,394
21,028
40,422
379,048
401,378
780,426
1,137,510
1,108,931
2,246,441
258,839
247,969
506,808
581,427 22.2% 14.4%
573,661 23.7% 13.9%
1,155,088 23.0% 14.2%
90
89
179
1 DC, Wash.- TOTAL (DC)
MAP
601,723
6,499
94,591
432,037
68,596
228,116 16.8% 11.4%
30
1 DELAWARE.- TOTAL (DE)
MAP
897,934
11,134
194,493
563,005
129,302
290,510 22.9% 14.4%
41
MAP
1,748,066
1,744,241
1,345,596
2,569,525
1,148,158
1,116,602
1,865,726
1,203,429
1,422,685
2,491,514
2,145,768
18,801,310
20,627
18,764
17,485
30,600
12,142
12,129
22,815
11,800
17,151
26,713
24,412
214,639
370,940
338,242
302,673
527,155
211,900
227,064
406,643
216,155
287,476
467,910
432,517
3,788,675
1,106,526
1,006,861
862,506
1,647,273
716,602
657,276
1,202,498
663,631
927,872
1,396,553
1,349,483
11,537,081
249,973
380,374
162,933
364,496
207,515
220,133
233,770
311,842
190,186
600,337
339,356
3,260,915
570,967 22.4% 14.3%
517,851 20.5% 21.8%
442,485 23.8% 12.1%
847,565 21.7% 14.2%
360,834 19.5% 18.1%
333,864 21.4% 19.7%
614,211 23.0% 12.5%
341,586 18.9% 25.9%
460,983 21.4% 13.4%
711,914 19.9% 24.1%
696,198 21.3% 15.8%
5,898,458 21.3% 17.3%
88
88
68
129
58
56
94
60
71
125
108
945
MAP
2,037,768
2,268,285
2,308,236
1,696,353
1,377,011
9,687,653
28,412
31,035
34,455
24,550
18,943
137,395
497,721
540,847
592,059
401,465
321,911
2,354,002
1,265,904
1,476,463
1,486,793
1,067,604
858,219
6,154,983
245,731
219,941
194,929
202,734
177,938
1,041,273
644,462 25.8% 12.1%
759,811 25.2% 9.7%
767,149 27.1% 8.4%
544,033 25.1% 12.0%
439,212 24.8% 12.9%
3,154,668 25.7% 10.7%
102
114
116
85
69
486
FL1
FL2
FL3
FL4
FL5
FL6
FL7
FL8
FL9
FL10
FL11
GA1
GA2
GA3
GA4
GA5
FL-Fort Lauderdale S. (Broward County)
FL-Fort Lauderdale N. (Martin, Palm Beach & St. Lucie Counties)
FL-Jacksonville (Baker, Clay, Duval, Nassau & St Johns Counties)
FL-Miami-Dade & Monroe Counties (Everglades & Keys)
FL- Gainesville & Ormond Beach (12 Counties)
FL-Orlando S. (Brevard, Hardee, Highlands, Indian., Okee., Osceola)
FL-Orlando N. (Orange, Lake & Seminole counties)
FL-Ocala & Hudson (Citrus, Hernando, Marion, Pasco, Sumter)
FL-Tallahassee, Panama City & Pensacola (19 Counties)
FL-Fort Meyers, Sarasota, Bradenton & Lakeland (9 Counties)
FL-Tampa, St. Petersburg & Clearwater (Hillborough & Pinellas)
11 FLORIDA.- TOTAL
GA-Atlanta North & Rome (36 Counties)
GA-Atlanta City of & West (Fulton, Cobb & West, 11 Counties)
GA-Atlanta East (DeKalb, Gwinnett & East 11 Counties)
GA-Savannah & Augusta (SE. GA 47 Counties)
GA-Macon, Columbus & Albany (SW. GA 54 Counties)
5 GEORGIA.- TOTAL
STATE/
CO-OP
POPULATION BY AGE (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
POP.
TOTAL
2010
Age
0-1 yrs
(8x/ yr)
Age
2-17 yrs
(4x/ yr)
Age
18-64 yrs
(4x/ yr)
Age
+65 yrs
(8x/ yr)
Female
18-64 yrs
(3x/ yr)
<18
%
+65
%
Serv.
Areas
1 HAWAII.- TOTAL (HI)
MAP
1,360,301
17,412
285,935
862,431
194,523
430,353 22.3% 14.3%
68
1 IDAHO.- TOTAL (ID)
MAP
1,567,582
24,454
405,063
943,684
194,380
470,898 27.4% 12.4%
79
20,298
10,859
37,199
28,683
24,512
21,401
24,154
167,106
370,674
205,538
588,049
517,081
470,460
382,012
429,937
2,963,750
965,053
540,646
1,795,268
1,273,311
1,266,522
1,019,046
1,235,401
8,095,247
171,461
120,338
275,082
229,970
255,572
244,257
307,849
1,604,529
487,848 25.6% 11.2%
281,751 24.7% 13.7%
924,563 23.2% 10.2%
647,052 26.6% 11.2%
641,783 24.5% 12.7%
515,750 24.2% 14.7%
623,512 22.7% 15.4%
4,122,259 24.4% 12.5%
77
44
136
102
101
84
100
643
IL1
IL2
IL3
IL4
IL5
IL6
IL7
IL-Bloomington, Joliet & Urbana (East IL- 16 counties)
IL-Blue Island (Cook County- South)
IL-Chicago, city of (Cook County- East)
IL-Melrose Park, & Hinsdale (Cook-west, Dupage & Kane)
IL-Elgin & Evanston (NE. IL: Cook-north, Mchenry & Lake)
IL-Peoria, Rockford & Aurora (NW IL- 25 counties)
IL-Springfield (South IL: 56 counties)
7 ILLINOIS.- TOTAL
MAP
1,527,486
877,381
2,695,598
2,049,045
2,017,066
1,666,715
1,997,341
12,830,632
IN1
IN2
IN3
IN4
IN-Evansville, Gary, Lafayette, Munster, Terre Haute (W IN- 27 counts.)
IN-Fort Wayne, Muncie, South Bend (Northeast IN- 20 counties)
IN-Indianapolis N. (City of, Marion, Hancock, Hendricks & N- 17 counts)
IN-Indianapolis S. (Morgan, Johnson, Shelby & Southeast- 28 counts.)
MAP
4 INDIANA.- TOTAL
1,650,660
1,580,791
2,049,590
1,202,761
6,483,802
21,056
22,022
28,977
14,691
86,746
373,221
384,192
495,223
269,480
1,522,115
1,033,524
962,913
1,280,617
756,998
4,034,052
222,859
211,664
244,773
161,593
840,889
523,406 23.9% 13.5%
489,112 25.7% 13.4%
655,040 25.6% 11.9%
381,929 23.6% 13.4%
2,049,488 24.8% 13.0%
83
79
103
60
325
IA1
IA2
IA-Des Moines, Mason City & Sioux City (West IA)
IA-Cedar Rapids, Davenport, Dubuque, Iowa City & Waterloo (E. IA)
2 IOWA.- TOTAL
MAP
1,734,313
1,312,042
3,046,355
23,591
16,851
40,442
398,072
289,319
687,391
1,051,442
814,373
1,865,814
261,208
191,500
452,708
530,597 24.3% 15.1%
411,339 23.3% 14.6%
941,936 23.9% 14.9%
87
66
153
KS1
KS2
KS-Wichita SE KS (1.1 mil, 28 Counties) & West KS (319k, 51 counts.)
KS-Topeka Northeast KS (26 counties)
2 KANSAS.- TOTAL
MAP
1,414,509
1,438,609
2,853,118
20,515
20,605
41,120
344,178
342,910
687,088
843,672
905,201
1,748,873
206,144
169,893
376,037
424,257 25.8% 14.6%
457,556 25.3% 11.8%
881,813 25.5% 13.2%
71
72
143
KY1
KY2
KY-Lexington & Covington (Eastern KY, 65 counties)
KY-Louisville, Owensboro & Paducah (Western KY, 55 counties)
2 KENTUCKY.- TOTAL
MAP
2,108,136
2,231,231
4,339,367
27,102
29,454
56,556
464,789
502,316
967,105
1,344,465
1,392,863
2,737,328
271,780
306,598
578,378
680,919 23.3% 12.9%
709,464 23.8% 13.7%
1,390,383 23.6% 13.3%
106
112
218
LA-Shreveport, Alexandria, Lafayette, Lake Charles, Monroe (41 counts)
LA-New Orleans, Baton Rouge, Metaire, Slidell & Houma (SE. LA- 23)
MAP
2 LOUISIANA.- TOTAL
2,086,508
2,446,864
4,533,372
29,658
33,241
62,899
496,897
558,448
1,055,344
1,288,617
1,568,935
2,857,552
271,336
286,241
557,576
657,146 25.2% 13.0%
801,166 24.2% 11.7%
1,458,313 24.7% 12.3%
105
123
228
LA1
LA2
STATE/
CO-OP
POPULATION BY AGE (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
1 MAINE.- TOTAL (ME)
MD1
MD2
MD3
MD-Baltimore & Salisbury (Eastern MD, 14 counties)
MD-Takoma Park NW/ DC Area (Northwest MD, 5 counties)
MD-Takoma Park SW/ DC Area (Southwest MD, 5 counties)
3 MARYLAND.- TOTAL
POP.
TOTAL
2010
Age
0-1 yrs
(8x/ yr)
Age
2-17 yrs
(4x/ yr)
Age
18-64 yrs
(4x/ yr)
Age
+65 yrs
(8x/ yr)
Female
18-64 yrs
(3x/ yr)
<18
%
+65
%
Serv.
Areas
MAP
1,328,361
13,815
261,156
842,181
211,209
430,354 20.7% 15.9%
67
MAP
2,574,261
1,457,776
1,741,515
5,773,552
31,310
18,632
23,008
72,951
552,292
326,091
396,462
1,274,844
1,645,741
926,455
1,141,219
3,713,415
344,918
186,597
180,826
712,342
855,819 22.7% 13.4%
475,290 23.6% 12.8%
586,340 24.1% 10.4%
1,917,448 23.3% 12.3%
129
73
88
290
16,712
17,135
21,587
18,136
73,570
282,655
303,722
415,868
345,735
1,347,981
985,217
985,324
1,217,373
1,035,480
4,223,393
180,598
196,904
301,821
223,362
902,685
511,585 20.4% 12.3%
506,816 21.3% 13.1%
630,861 22.4% 15.4%
533,634 22.4% 13.8%
2,182,896 21.7% 13.8%
74
75
98
81
328
MA1
MA2
MA3
MA4
MA-Boston NE (Boston city of, Suffolk & Essex counties)
MA-Boston NW (Middlesex county)
MA-Boston South ( 6 counties including Cape & Islands)
MA-Springfield & Worcester (Western MA 5 counties)
4 MASSACHUSETTS.- TOTAL
MAP
1,465,182
1,503,085
1,956,649
1,622,713
6,547,629
MI1
MI2
MI3
MI4
MI5
MI-Ann Arbor, Kalamazoo & St. Joseph (South MI- 13 counties + Wayne)
MI-Detroit & Dearborn (Southeast MI- 2 counties + Wayne)
MI-Flint, Lansing & Saginaw (Northeast MI- 22 counties)
MI-Marquette, Muskegon, Petoskey, Traverse City & Grand Rapids (44)
MI-Pontiac & Royal Oak (Oakland County, east MI- NW of Detroit)
MAP
5 MICHIGAN.- TOTAL
2,069,580
2,518,013
1,854,393
2,239,292
1,202,362
9,883,640
24,530
31,763
21,291
27,935
13,707
119,226
455,963
587,923
403,231
507,047
269,789
2,223,955
1,311,641
1,566,080
1,160,228
1,378,610
760,154
6,176,714
277,445
332,246
269,643
325,699
158,712
1,363,745
664,754 23.2% 13.4%
809,911 24.6% 13.2%
592,880 22.9% 14.5%
690,784 23.9% 14.5%
391,964 23.6% 13.2%
3,150,294 23.7% 13.8%
104
127
93
112
60
496
MN1
MN2
MN3
MN-Minneapolis NW & St. Cloud (Northwest MN 37 counties)
MN-Minneapolis SW (City of & Southwest MN 31 counties)
MN-Duluth, Rochester & St. Paul (Eastern MN 19 counties)
3 MINNESOTA.- TOTAL
MAP
1,001,172
2,391,592
1,911,161
5,303,925
13,138
32,632
25,303
71,074
225,489
550,444
437,559
1,213,492
604,686
1,524,907
1,206,192
3,335,785
157,858
283,609
242,106
683,574
300,578 23.8% 15.8%
769,295 24.4% 11.9%
611,123 24.2% 12.7%
1,680,995 24.2% 12.9%
50
120
96
266
MAP
1,578,620
1,388,677
2,967,297
22,698
19,484
42,183
387,443
326,578
714,021
974,022
857,755
1,831,776
194,457
184,860
379,317
503,001 26.0% 12.3%
438,591 24.9% 13.3%
941,592 25.5% 12.8%
79
70
149
MO- Columbia, Joplin & Springfield (57 counties- Central & SW MO.)
MO-Kansas City (26 counties- NW MO.)
MO-St. Louis N. (City of & 6 counties- NE MO.)
MO-St. Louis S. & Cape Girardeau (26 counties- SE MO.)
MAP
4 MISSOURI.- TOTAL
1,766,862
1,491,846
1,782,328
947,891
5,988,927
22,825
20,464
22,330
12,349
77,968
389,314
345,125
399,078
213,878
1,347,395
1,084,865
929,609
1,122,215
588,044
3,724,733
269,859
196,648
238,705
133,621
838,832
549,849 23.3% 15.3%
474,632 24.5% 13.2%
582,965 23.6% 13.4%
292,915 23.9% 14.1%
1,900,361 23.8% 14.0%
89
75
90
47
301
MS1
MS2
MO1
MO2
MO3
MO4
MS-Jackson & Oxford (West MS 47 counties)
MS-Gulfport, Hattiesburg, Meridian, Tupelo (East MS 35 counties)
2 MISSISSIPPI.- TOTAL
STATE/
CO-OP
NV1
NV2
NJ1
NJ2
NJ3
NJ4
NJ5
NY1
NY2
NY3
NY4
NY5
NY6
NY7
NY8
NY9
NY10
NY11
POPULATION BY AGE (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
POP.
TOTAL
2010
Age
0-1 yrs
(8x/ yr)
Age
2-17 yrs
(4x/ yr)
Age
18-64 yrs
(4x/ yr)
Age
+65 yrs
(8x/ yr)
Female
18-64 yrs
(3x/ yr)
<18
%
+65
%
Serv.
Areas
1 MONTANA.- TOTAL (MT)
MAP
989,415
12,467
211,141
619,374
146,433
308,448 22.6% 14.8%
50
1 NEBRASKA.- TOTAL (NE)
MAP
1,826,341
26,299
432,112
1,121,373
246,556
565,172 25.1% 13.5%
92
NV-Las Vegas (3 counties- SE NV)
NV-Reno (14 counties- NW NV)
2 NEVADA.- TOTAL
MAP
2,000,560
699,991
2,700,551
28,211
9,149
37,360
470,141
156,854
626,995
1,270,464
441,231
1,711,695
231,744
92,757
324,501
631,269 24.9% 11.6%
216,508 23.7% 13.3%
847,777 24.6% 12.0%
100
36
136
1 NEW HAMPSHIRE.- TOTAL (NH)
MAP
1,316,470
13,955
273,036
851,756
177,723
431,840 21.8% 13.5%
66
NJ-Camden N. (3 counties- South NJ)
NJ-Camden S. (6 counties- South NJ)
NJ-Hackensack, Patterson & Ridgewood (2 counties- NE NJ)
NJ-Morristown & New Brunswick (7 counties- NW NJ)
NJ-Newark (3 counties- NE NJ)
5 NEW JERSEY.- TOTAL
MAP
1,655,681
1,396,740
1,406,342
2,378,397
1,954,734
8,791,894
19,865
17,278
16,954
27,703
26,507
108,307
369,188
313,935
312,408
530,738
431,437
1,957,705
996,182
874,355
880,161
1,516,584
1,273,071
5,540,353
270,446
191,173
196,820
303,372
223,719
1,185,529
512,870 23.5% 16.3%
447,955 23.7% 13.7%
454,975 23.4% 14.0%
772,976 23.5% 12.8%
654,092 23.4% 11.4%
2,842,868 23.5% 13.5%
83
70
71
119
98
441
1 NEW MEXICO.- TOTAL (NM)
MAP
2,059,179
28,829
490,085
1,268,454
271,812
641,838 25.2% 13.2%
104
1,953,167
1,385,108
1,453,693
2,230,722
1,339,532
1,493,350
2,504,700
2,054,603
1,733,323
1,363,694
1,866,210
19,378,102
20,522
20,500
15,687
26,323
14,735
17,323
35,567
20,849
22,438
15,248
21,581
230,772
394,569
347,939
300,368
435,437
297,376
341,081
558,047
323,074
417,970
286,325
392,458
4,094,644
1,252,881
871,233
908,540
1,483,430
822,473
933,344
1,623,046
1,437,058
1,058,157
870,115
1,174,771
12,435,046
285,196
145,436
229,099
285,532
204,948
201,602
288,041
273,622
234,759
192,006
277,400
2,617,641
629,912 21.3% 14.6%
462,625 26.6% 10.5%
467,825 21.7% 15.8%
765,450 20.7% 12.8%
424,396 23.3% 15.3%
474,139 24.0% 13.5%
856,968 23.7% 11.5%
758,278 16.7% 13.3%
542,020 25.4% 13.5%
443,522 22.1% 14.1%
595,118 22.2% 14.9%
6,420,251 22.3% 13.5%
98
69
73
112
67
75
125
103
87
68
94
971
NY-Albany (18 counties NE NY)
NY-NYC Bronx County
NY-Buffalo (6 counties western NY)
NY-NYC East Long Island (Queens County)
NY-East Long Island (Nassau County)
NY-East Long Island (Suffolk County)
NY-NYC Manhattan (Kings County, Brooklyn- West Long Island)
NY-NYC Manhattan (NY & Richmond Counties- Staten Island)
NY-White Plains (Orange, Putnam, Rockland & Weschester counties.)
NY-Rochester (10 counties East of Buffalo area)
NY-Syracuse, Binghamton & Elmira (17 counts. East of Rochester)
MAP
11 NEW YORK.- TOTAL
STATE/
CO-OP
NC1
NC2
NC3
NC4
NC5
OH1
OH2
OH3
OH4
OH5
OH6
OH7
OK1
OK2
OR1
OR2
PA1
PA2
PA3
PA4
PA5
PA6
PA7
PA8
POPULATION BY AGE (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
NC-Charlotte (10 counties- SW NC)
NC-Durham & Greensboro (19 counties- west of Raleigh)
NC-Greenville & Wilmington (29 counties- eastern & coastal NC)
NC-Raleigh (11 counties)
NC-Winston-Salem, Asheville & Hickory (31 counties- west NC)
5 NORTH CAROLINA.- TOTAL
1 NORTH DAKOTA.- TOTAL (ND)
POP.
TOTAL
2010
Age
0-1 yrs
(8x/ yr)
Age
2-17 yrs
(4x/ yr)
Age
18-64 yrs
(4x/ yr)
Age
+65 yrs
(8x/ yr)
Female
18-64 yrs
(3x/ yr)
<18
%
+65
%
Serv.
Areas
MAP
1,975,131
1,967,145
1,480,919
2,004,517
2,107,771
9,535,483
27,467
25,517
19,362
29,451
24,570
126,367
474,270
436,346
310,482
491,130
443,026
2,155,254
1,255,549
1,247,429
938,765
1,276,876
1,301,019
6,019,638
217,844
257,854
212,310
207,059
339,157
1,234,224
643,828 25.4% 11.0%
645,611 23.5% 13.1%
475,710 22.3% 14.3%
655,490 26.0% 10.3%
666,098 22.2% 16.1%
3,086,735 23.9% 12.9%
99
99
74
100
106
478
MAP
672,591
8,878
141,110
425,078
97,526
210,413 22.3% 14.5%
34
1,999,639
1,526,892
2,315,442
1,078,588
2,024,133
1,623,402
968,408
23,092
20,391
27,012
13,721
26,744
20,607
12,291
433,137
353,028
513,412
252,379
452,295
373,549
217,808
1,228,355
958,149
1,422,140
660,842
1,307,863
994,862
603,562
315,056
195,324
352,878
151,646
237,231
234,384
134,747
MAP
11,536,504
143,858
2,595,608
7,175,773
MAP
2,221,941
1,529,410
3,751,351
31,966
20,894
52,860
519,064
357,689
876,753
MAP
1,762,158
2,068,916
3,831,074
20,959
26,515
47,475
PA-Allentown, Scranton & Wilkes-Barre (9 counties- NE PA)
PA-Danville, Erie & Sayre (22 counties- North & West PA)
PA-Harrisburg, Altoona & Johnstown (15 counties- South Central PA)
PA-Lancaster, Reading & York (5 counties- SE PA)
PA-Philadelphia NW (3 counties- SE PA)
PA-Philadelphia (city of & county- SE PA)
PA-Pittsburgh (city of & west- 5 counties SW PA)
PA-Pittsburgh East (7 counties- SW PA)
MAP
8 PENNSYLVANIA- TOTAL
1,571,225
1,401,807
1,546,058
2,013,034
1,984,102
1,526,006
1,731,501
928,646
12,702,379
17,045
15,131
17,800
25,119
23,136
20,143
18,003
9,404
145,782
OH-Akron, Canton, Youngstown (12 counties- NE OH)
OH-Cincinnati (7 counties- SW OH)
OH-Cleveland & Elyria (8 counties- NE OH)
OH-Columbus- North (15 counties- central OH)
OH-Columbus- City of & Southeast (20 counties- SE OH)
OH-Dayton & Kettering (15 counties- West OH)
OH-Toledo (11 counties- NW OH)
7 OHIO.- TOTAL
OK-Oklahoma City & Lawton (54 counties)
OK-Tulsa (23 counties- NE OK)
2 OKLAHOMA- TOTAL
OR-Bend, Eugene, Medford, Salem (20 counties- Southern OR)
OR-Portland (16 counties- Northern OR)
2 OREGON- TOTAL
631,131
493,994
737,853
334,541
662,899
507,886
309,382
100
77
116
54
102
81
49
1,621,265
22.8% 15.8%
24.5% 12.8%
23.3% 15.2%
24.7% 14.1%
23.7% 11.7%
24.3% 14.4%
23.8% 13.9%
3,677,687 23.7% 14.1%
1,377,310
937,834
2,315,144
293,601
212,993
506,594
693,588 24.8% 13.2%
475,304 24.8% 13.9%
1,168,891 24.8% 13.5%
111
77
188
369,610
448,751
818,361
1,086,376
1,345,731
2,432,107
285,213
247,919
533,131
548,822 22.2% 16.2%
679,354 23.0% 12.0%
1,228,176 22.6% 13.9%
88
104
192
326,921
276,167
319,863
458,882
434,663
323,639
329,233
181,029
2,650,396
972,857
883,924
954,870
1,239,864
1,234,302
997,577
1,087,607
575,375
7,946,375
254,401
226,585
253,525
289,170
292,001
184,647
296,658
162,838
1,959,826
497,076 21.9% 16.2%
443,483 20.8% 16.2%
483,900 21.8% 16.4%
630,010 24.0% 14.4%
636,105 23.1% 14.7%
526,948 22.5% 12.1%
564,590 20.1% 17.1%
293,459 20.5% 17.5%
4,075,572 22.0% 15.4%
79
70
78
101
99
77
86
47
637
579
STATE/
CO-OP
POPULATION BY AGE (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
TN1
TN2
TN3
TN4
TX1
TX2
TX3
TX4
TX5
TX6
TX7
TX8
TX9
TX10
TX11
TX12
TX13
TX14
UT1
UT2
Age
0-1 yrs
(8x/ yr)
Age
2-17 yrs
(4x/ yr)
Age
18-64 yrs
(4x/ yr)
Age
+65 yrs
(8x/ yr)
Female
18-64 yrs
(3x/ yr)
<18
%
+65
%
Serv.
Areas
MAP
1,052,567
11,578
212,619
676,801
151,570
349,906 21.3% 14.4%
50
SC-Charleston & Florence (17 counties- SE SC)
SC-Columbia (20 counties- Central SC)
SC-Greenville & Spartanburg (9 counties- NW SC)
3 SOUTH CAROLINA- TOTAL
MAP
1,632,247
1,500,049
1,493,068
4,625,364
21,358
19,563
19,614
60,534
351,492
332,572
337,991
1,022,055
1,026,851
950,423
933,545
2,910,818
232,546
197,491
201,919
631,956
526,917 22.8% 14.2%
488,392 23.5% 13.2%
480,376 24.0% 13.5%
1,495,686 23.4% 13.7%
82
75
75
232
1 SOUTH DAKOTA- TOTAL (SD)
MAP
814,180
11,887
190,844
495,021
116,428
247,511 24.9% 14.3%
41
MAP
1,546,161
1,438,739
1,614,887
1,746,318
6,346,105
21,054
20,251
20,417
19,882
81,605
369,743
328,034
359,454
358,062
1,415,293
967,628
929,824
1,009,862
1,091,774
3,999,086
187,736
160,630
225,154
276,600
850,120
500,632 25.3% 12.1%
475,275 24.2% 11.2%
514,938 23.5% 13.9%
557,003 21.6% 15.8%
2,047,848 23.6% 13.4%
78
72
81
88
319
TX-Amarillo, Lubbock & Witchita Falls (62 counties- TX panhandle)
TX-Austin & Temple (12 counties East TX)
TX-Houston East & Beaumont (19 counties- SE TX)
TX-Houston (city of- Harris County SE TX)
TX-Houston (Harris County excluding Houston)
TX-Houston West (10 counties- SE TX)
TX-Dallas (Dallas County- NE TX)
TX-Dallas East (12 counties- NE TX)
TX-Dallas NW (5 counties- NE TX)
TX-El Paso, Abilene, Odessa & San Angelo (44 counties- West TX)
TX-Fort Worth (7 counties- NE TX)
TX-San Antonio (29 counties- SW TX)
TX-Corpus Christi, Harlingen, McAllen & Victoria (20 counties- SW TX)
TX-Waco, Bryan, Tyler & Longview (32 counties- Central & NE TX)
MAP
14 TEXAS- TOTAL
1,158,243
2,225,009
1,669,145
2,099,451
1,993,008
1,148,672
2,368,139
1,462,994
900,774
1,612,106
2,202,568
2,725,273
1,982,809
1,597,370
25,145,561
17,173
33,928
22,766
34,011
33,105
17,096
38,364
21,096
13,089
24,923
33,741
41,167
33,585
21,237
385,283
281,093
538,909
397,950
510,251
565,346
306,138
615,799
385,235
228,286
423,072
573,010
711,442
580,870
361,836
6,479,237
712,460
1,457,665
1,042,209
1,367,108
1,240,453
714,279
1,506,539
906,913
578,049
970,741
1,382,661
1,665,022
1,146,203
989,554
15,679,855
147,517
194,507
206,220
188,081
154,104
111,159
207,438
149,750
81,349
193,370
213,156
307,642
222,151
224,743
2,601,187
350,463 25.8% 12.7%
729,513 25.7% 8.7%
517,789 25.2% 12.4%
680,638 25.9% 9.0%
628,024 30.0% 7.7%
359,432 28.1% 9.7%
762,105 27.6% 8.8%
460,109 27.8% 10.2%
293,429 26.8% 9.0%
492,616 27.8% 12.0%
702,669 27.5% 9.7%
845,278 27.6% 11.3%
583,027 31.0% 11.2%
492,673 24.0% 14.1%
7,897,765 27.3% 10.3%
58
112
84
105
100
58
119
74
45
81
111
137
100
80
1,264
1,799,952
963,933
2,763,885
33,235
19,615
52,850
518,858
299,151
818,009
1,089,867
553,203
1,643,069
157,993
91,964
249,956
542,306 30.7% 8.8%
275,417 33.1% 9.5%
817,723 31.5% 9.0%
91
48
139
1 RHODE ISLAND- TOTAL (RI)
SC1
SC2
SC3
POP.
TOTAL
2010
TN-Memphis & Jackson (20 counties- west TN)
TN-Nashville City Of & West (18 counties- central TN)
TN-Nashville East & Chattanooga (31 counties- central TN)
TN-Knoxville, Johnson City, Kingsport (26 counties- east TN)
4 TENNESSEE- TOTAL
UT-Salt Lake City NW & Ogden (8 counties- NW UT)
UT-Salt Lake City SE & Provo (21 counties- SE UT)
2 UTAH- TOTAL
MAP
POPULATION BY AGE (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
STATE/
CO-OP
WA1
WA2
WA3
WA4
WI1
WI2
WI3
WI4
Age
0-1 yrs
(8x/ yr)
Age
2-17 yrs
(4x/ yr)
Age
18-64 yrs
(4x/ yr)
Age
+65 yrs
(8x/ yr)
Female
18-64 yrs
(3x/ yr)
<18
%
+65 Serv.
% Areas
MAP
625,741
6,383
123,146
404,854
91,358
MAP
2,525,351
1,977,338
1,768,418
1,729,917
8,001,024
35,887
21,771
22,996
21,297
101,951
587,816
386,998
390,573
386,464
1,751,852
1,667,021
1,253,183
1,142,722
1,107,531
5,170,456
234,627
315,386
212,127
214,625
976,765
843,351
640,761
581,679
566,483
2,632,275
24.7% 9.3%
20.7% 16.0%
23.4% 12.0%
23.6% 12.4%
23.2% 12.2%
127
99
89
87
402
WA-Spokane & Yakima (20 counties- eastern WA)
WA-Seattle City & King County (central WA)
WA-Seattle NW & Everett (10 counties- NW WA)
WA-Olympia & Tacoma (8 counties- SW WA)
4 WASHINGTON- TOTAL
MAP
1,495,054
1,931,249
1,611,556
1,686,681
6,724,540
21,563
23,947
19,571
22,667
87,748
363,087
389,340
345,307
395,135
1,492,869
917,829
1,307,456
1,028,291
1,063,073
4,316,649
192,574
210,506
218,388
205,807
827,275
458,578
656,343
513,527
538,608
2,167,056
25.7% 12.9%
21.4% 10.9%
22.6% 13.6%
24.8% 12.2%
23.5% 12.3%
75
97
81
85
338
1 WEST VIRGINIA- TOTAL (WV)
MAP
1,852,994
20,754
366,522
1,169,239
296,479
592,804 20.9% 16.0%
93
WI-Appleton, Green Bay, Neenah & Wausau (20 counties- NE WI)
WI-Madison (14 counties- SE WI)
WI-Milwaukee (9 counties- SE WI)
WI-La Crosse & Marshfield (29 counties- NW WI)
4 WISCONSIN- TOTAL
MAP
1,224,523
1,149,195
2,237,110
1,076,158
5,686,986
14,984
14,164
29,293
13,199
71,640
270,386
245,917
519,292
231,469
1,267,065
758,805
739,767
1,402,415
669,656
3,570,643
180,347
149,348
286,110
161,833
777,639
379,197 23.3% 14.7%
369,106 22.6% 13.0%
715,965 24.5% 12.8%
334,344 22.7% 15.0%
1,798,612 23.5% 13.7%
61
58
112
54
285
1 WYOMING- TOTAL (WY)
MAP
563,626
8,003
127,267
358,466
69,890
175,648 24.0% 12.4%
29
1 VERMONT- TOTAL (VT)
VA1
VA2
VA3
VA4
POP.
TOTAL
2010
VA-Arlington & Winchester (17 counties- Northeast VA & DC area)
VA-Charlottesville, Lynchburg, Roanoke (61 counties- Western VA)
VA-Norfolk & Newport News (19 counties- Southeast VA)
VA-Richmond (37 counties- Eastern VA)
4 VIRGINIA- TOTAL
185 USA TOTAL
MAP
308,745,538 4,036,340 70,181,692
205,261 20.7% 14.6%
32
194,252,112 40,275,395 98,780,683 24.0% 13.0% 15,490
E22-34: $450B PRIMARY CARE COST
Primary Care MDs, Dentists & Optometrists required by CO-OP
EXPANDING THE RI MODEL NATIONALLY
185 BUYER CO-OP’s DEFINED
GEOGRAPHIC MARKETS WITHIN STATES
EACH, 1 to 2.5 MIL PEOPLE (1 to 2.5 RI’s)
(NEXT 13 SLIDES)
Each of the 185 CO-OP areas covers 1 or more “Hospital Referral Regions” as
defined by the Dartmouth Atlas of Health Care. Regional hospitals capable of
cardio and/or neuro surgery. (http://www.dartmouthatlas.org/data/region/)
In each of the 15,490 service areas the CO-OP would contract approx. 17 Primary
Care MDs, 7 Dentists and 4 Optometrists to service a population of approx. 20k.
BACK
Table of Contents
PRIMARY CARE NOTES:
The number and type of primary care practices depicted on the next 11 slides are
based on the population by age In each CO-OP area as listed in E13-21. The
following assumptions apply:
Population age 0-1 & +65 see a doctor an average of 8 times per year. The population
2 to 64 sees a doctor 4 times per year on average. Female population 18 to 64 see an
OB/GYN an average of 3 times per year. A dentist is seen twice a year and an optometrist is
visited once every two years. As a result in each of the 15,490 service areas the CO-OP
would contract approx. 17 Primary Care MDs, 7 Dentists and 4 Optometrists to service a
population of approx. 20k. Referrals to specialists would be in addition to these visits.
The composition and cost of each practice type is detailed on slides 28-30 in the Rhode
Island example and on the next three slides. Primary Care MD practices cost $1.2 mil per
year and service 800 to 1,600 patients depending on age and health status of the patient
roster. The payment would be fixed, the number of patients would be negotiated With the
CO-OP based on a public formula as above. Each dental practice costs $945k per year and
services approximately 2,900 patients and each optometrist practice costs $625k per year
and services approximately 5,000 patients (2,500/yr). RI cost is presented here for uniformity
& simplicity, geographic COLA’s are applied in appendices F thru J.
Therefore as an example, the Mesa Arizona area CO-OP (AZ1) would contract with 1,006
primary care MDs (203 Pedi’s, 163 Gerri’s, 177 OB/GYN & 463 general), 386 dentists and 198
optometrists at a total cost of nearly $1.7 billion. This to provide care to ALL its population
of nearly 1.2 million people (approximately $1,440 per person, per year (at RI cost).
268,000 PRIMARY CARE PRACTICES
(1) DOCTOR $250K + BEN.
(3) NURSES $60K +BEN.
(2) RECPT/ADMIN $45K +BEN.
COST
$350K
$240K
$120K
RENT $6K/ MONTH
UTILITIES
PROPERTY. INS/TAX
LIAB. INS (REFORMED)
SUPPLIES
EQUIP. RENT ($1M/5YR)
OTHER
TOTAL
$70K
$12K
$12K
$12K
$120K
$200K
$64K
$1,200K
Includes a $50k to $100k
performance bonus
The above will support 2,400 ½ hr MD appointments per yr and 4,000 1 hr nurse appts. That’s 800
patients (+65 y/o or < 1 y/o at 8 times per year.) or 1,600 patients 4 times/ yr. PRIMARY PAY PARITY
This leaves 700 hrs per year for MD professional development & Admin.
101,000 DENTAL PRACTICES
(1) DENTIST $160K + BEN.
(3) HYGIENISTS $70K +BEN.
(1) RECPT/ADMIN $45K +BEN.
COST
$215K
$280K
$60K
RENT $6K/ MONTH
UTILITIES
PROPERTY. INS/TAX
LIAB. INS (REFORMED)
SUPPLIES
EQUIP. RENT ($500K/5YR)
OTHER
TOTAL
$70K
$12K
$12K
$12K
$120K
$100K
$64K
$945K
The above will support 3,000 patient’s 1 hr cleanings twice per year (hygienists). And 1,500 1 hr
procedures with the Dentist. Leaving 400 hrs per year for admin & professional development.
The cost is $315/patient/yr (2 cleanings @ $75/ea + 1 hr procedure every other yr on average).
52,000 OPTOMETRIST PRACTICES
(1) OPTOMETRIST $130K + BEN.
(1) RECPT/ADMIN $45K +BEN.
COST
$175K
$60K
RENT $6K/ MONTH
UTILITIES
PROPERTY. INS/TAX
LIAB. INS (REFORMED)
SUPPLIES
EQUIP. RENT ($500K/5YR)
OTHER
TOTAL
$70K
$12K
$12K
$12K
$120K
$100K
$64K
$625K
The above will support 6,000 patient’s 1/2 hr exam every 2 years (3,000/yr) . Leaving 400 hrs for
Admin & Professional development. The cost is $208 per patient every 2 yrs ($104/yr).
STATE/
CO-OP
AL1
AL2
AL3
$450B PRIMARY CARE COST (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
AL-Birmingham S & Tuscaloosa (28 counties- Central AL)
AL-Birmingham N & Huntsville (15 counties- Northern AL)
AL-Dothan, Mobile & Montgomery (23 counties- Southern AL)
3 ALABAMA-TOTAL
1 ALASKA-TOTAL (AK)
POP.
TOTAL
2010
Serv. Pedi.
Pedi.
Gen.
Gerri. OB/GYN # Prim. Care # Dental Optometrist TOTAL
Areas 0-1 yrs 2-17 yrs 18-64 yrs +65 yrs 18-64 yrs Practices Practices Practices COST
20k/ea (8x/ yr) (4x/ yr) (4x/ yr) (8x/ yr) (3x/ yr) ($1.2m/ EA) ($945k/ EA)($625k/ EA) ($Mils)
2,001,679
1,233,703
1,544,354
4,779,736
100
62
78
240
32
19
25
76
277
171
221
670
793
478
597
1,868
329
224
269
822
313
185
234
732
1,744
1,078
1,347
4,169
655
404
505
1,564
337
208
260
804
$2,922
$1,805
$2,256
6,983
710,231
36
13
110
293
68
107
592
232
119
$1,004
AZ1
AZ2
AZ3
AZ4
AZ-Mesa (Maricopa SE- Mesa, Chandler, Gilbert, Tempe)
AZ-Phoenix City of (Maricopa central)
AZ-Phoenix N & Sun City (Maricopa- Glendale, Scottsdale & North AZ)
AZ-Phoenix S & Tucson (Maricopa- Avondale, Goodyear & South AZ)
4 ARIZONA-TOTAL
1,179,761
1,445,632
1,708,721
2,057,903
6,392,017
55
73
87
106
321
20
30
24
36
111
183
242
228
310
962
463
572
616
775
2,426
163
150
424
367
1,103
177
217
239
294
927
1,006
1,211
1,530
1,782
5,529
386
473
559
673
2,091
198
243
287
346
1,075
$1,696
$2,052
$2,544
$2,991
9,283
AR1
AR2
AR-Little Rock (South & East AR, 43 counties)
AR-Fort Smith, Jonesboro, Springdale, Texarkana (N&W - 32 counties)
2 ARKANSAS-TOTAL
1,607,881
1,308,037
2,915,918
81
66
147
26
23
49
224
196
420
620
495
1,115
294
231
525
241
192
432
1,406
1,136
2,542
526
428
954
271
220
491
$2,353
$1,905
4,258
1,409,306
71
1,600,926
80
2,516,107
126
1,510,271
76
2,099,049
110
2,219,119
113
2,137,451
103
2,154,468
105
1,208,518
61
1,588,948
80
1,548,183
77
2,478,708
124
2,189,641
110
2,053,756
103
1,307,402
66
1,962,439
98
1,057,644
53
1,836,911
92
980,833
49
1,931,907
97
1,462,369
73
37,253,956 1,867
22
25
55
25
38
33
36
32
23
30
22
41
41
40
20
34
12
32
15
32
24
633
206
228
452
203
330
272
308
294
205
270
202
367
370
357
166
289
95
265
128
281
216
5,504
557
645
945
625
842
926
873
864
467
598
610
971
818
792
554
773
466
742
400
764
576
14,808
214
230
297
208
242
345
275
345
144
219
289
382
320
229
173
294
188
252
155
292
219
5,311
216
248
355
243
322
362
335
336
181
229
232
376
314
304
209
294
176
282
154
289
224
5,681
1,214
1,376
2,103
1,303
1,774
1,938
1,826
1,871
1,020
1,346
1,355
2,137
1,862
1,722
1,123
1,685
937
1,572
853
1,659
1,259
31,937
461
524
823
494
687
726
699
705
395
520
506
811
716
672
428
642
346
601
321
632
478
12,186
237
269
423
254
353
373
360
362
203
267
260
417
368
346
220
330
178
309
165
325
246
6,267
$2,041
$2,314
$3,566
$2,190
$2,998
$3,245
$3,076
$3,138
$1,724
$2,274
$2,268
$3,591
$3,142
$2,918
$1,889
$2,835
$1,563
$2,647
$1,430
$2,791
$2,117
53,758
CA1
CA2
CA3
CA4
CA5
CA6
CA7
CA8
CA9
CA10
CA11
CA12
CA13
CA14
CA15
CA16
CA17
CA18
CA19
CA20
CA21
CA-Orange County N (Anaheim, Garden Grove, Hunt. Bch & North)
CA-Orange County S (Santa Ana, Costa Mesa & South)
CA-Bakersfield & Fresno (Kern, Tulare & Fresno, King, Madera)
CA-Alameda County
CA-LA Central LA, South LA, Northeast LA & Eastside
CA-LA Harbor, South Bay & Westside
CA-LA San Fern. Valley, NW, Antelope, Forest & Santa Monica Mtns.
CA-LA San Gabriel Valley, Pomona & Verdugos
CA-LA Southeast
CA-Modesto & Stockton (Merced, Stanislaus, San Joaquin, +4 more.)
CA-Napa, Chico, Redding & Santa Rosa (15 counties- north CA )
CA-Sacramento (11 counties)
CA-Palm Springs/Rancho Mirage (Riverside County)
CA-San Bernardino & Inyo Counties
CA-San Diego (City of)
CA-San Diego County (ex. City of, + Imperial County)
CA-San Francisco (SF & Marin Counties)
CA-San Jose (Santa Clara & San Benito Counties)
CA-Santa Cruz & San Mateo County
CA-Santa Barbara, San Luis Obispo, Salinas & Ventura
CA-Contra Costa & Solano Counties
21 CALIFORNIA-TOTAL
STATE/
CO-OP
$450B PRIMARY CARE COST (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
POP.
TOTAL
2010
Serv. Pedi. Pedi. Gen. Gerri. OB/GYN # Prim. Care # Dental Optometrist TOTAL
Areas 0-1 yrs 2-17 yrs 18-64 yrs +65 yrs 18-64 yrs Practices Practices Practices COST
20k/ea (8x/ yr) (4x/ yr) (4x/ yr) (8x/ yr) (3x/ yr) ($1.2m/ EA) ($945k/ EA)($625k/ EA) ($Mils)
CO1
CO2
CO3
CO4
CO-Boulder, Fort Collins, Greeley (10 counties- NE CO.)
CO-Colorado Springs, Grand Junction & Pueblo (35 counties- S. CO.)
CO-Denver City of & East (7 counties)
CO-Denver West (12 counties)
4 COLORADO-TOTAL
920,962
1,394,219
1,706,476
1,007,539
5,029,196
46
70
86
50
252
15
23
32
16
86
127
200
250
146
723
378
548
696
411
2,033
126
223
209
130
687
144
207
266
156
772
790
1,201
1,453
858
4,302
301
456
558
330
1,645
155
235
287
170
846
CT1
CT2
CT-Hartford (6 counties)
CT-New Haven & Bridgeport (2 counties SW CT.)
2 CONNECTICUT-TOTAL
1,794,791
1,779,306
3,574,097
90
89
179
24
26
51
237
251
488
711
693
1,404
324
310
634
277
273
550
1,573
1,553
3,126
587
582
1,169
302 $2,631
299 $2,601
601 5,232
1 DC, Wash.- TOTAL (DC)
601,723
30
8
59
270
86
109
532
197
101
1 DELAWARE.- TOTAL (DE)
897,934
41
14
122
352
162
138
787
294
151 $1,317
1,748,066
1,744,241
1,345,596
2,569,525
1,148,158
1,116,602
1,865,726
1,203,429
1,422,685
2,491,514
2,145,768
18,801,310
88
88
68
129
58
56
94
60
71
125
108
945
26
23
22
38
15
15
29
15
21
33
31
268
232
211
189
329
132
142
254
135
180
292
270
2,368
692
629
539
1,030
448
411
752
415
580
873
843
7,211
312
475
204
456
259
275
292
390
238
750
424
4,076
272
247
211
404
172
159
292
163
220
339
332
2,809
1,534
1,586
1,164
2,256
1,027
1,002
1,619
1,117
1,238
2,288
1,900
16,732
572
571
440
841
376
365
610
394
465
815
702
6,150
294
293
226
432
193
188
314
202
239
419
361
3,163
$2,564
$2,626
$1,955
$3,772
$1,708
$1,665
$2,716
$1,839
$2,075
$3,778
$3,169
27,867
2,037,768
2,268,285
2,308,236
1,696,353
1,377,011
9,687,653
102
114
116
85
69
486
36
39
43
31
24
172
311
338
370
251
201
1,471
791
923
929
667
536
3,847
307
275
244
253
222
1,302
307
362
365
259
209
1,502
1,752
1,936
1,951
1,461
1,193
8,294
667
742
755
555
450
3,169
343
382
388
285
232
1,630
$2,946
$3,263
$3,298
$2,456
$2,002
13,966
FL1
FL2
FL3
FL4
FL5
FL6
FL7
FL8
FL9
FL10
FL11
GA1
GA2
GA3
GA4
GA5
FL-Fort Lauderdale S. (Broward County)
FL-Fort Lauderdale N. (Martin, Palm Beach & St. Lucie Counties)
FL-Jacksonville (Baker, Clay, Duval, Nassau & St Johns Counties)
FL-Miami-Dade & Monroe Counties (Everglades & Keys)
FL- Gainesville & Ormond Beach (12 Counties)
FL-Orlando S. (Brevard, Hardee, Highlands, Indian., Okee., Osceola)
FL-Orlando N. (Orange, Lake & Seminole counties)
FL-Ocala & Hudson (Citrus, Hernando, Marion, Pasco, Sumter)
FL-Tallahassee, Panama City & Pensacola (19 Counties)
FL-Fort Meyers, Sarasota, Bradenton & Lakeland (9 Counties)
FL-Tampa, St. Petersburg & Clearwater (Hillborough & Pinellas)
11 FLORIDA.- TOTAL
GA-Atlanta North & Rome (36 Counties)
GA-Atlanta City of & West (Fulton, Cobb & West, 11 Counties)
GA-Atlanta East (DeKalb, Gwinnett & East 11 Counties)
GA-Savannah & Augusta (SE. GA 47 Counties)
GA-Macon, Columbus & Albany (SW. GA 54 Counties)
5 GEORGIA.- TOTAL
$1,329
$2,019
$2,451
$1,447
7,246
$887
STATE/
CO-OP
$450B PRIMARY CARE COST (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
POP.
TOTAL
2010
Serv. Pedi.
Pedi.
Gen. Gerri. OB/GYN # Prim. Care # Dental Optometrist TOTAL
Areas 0-1 yrs 2-17 yrs 18-64 yrs +65 yrs 18-64 yrs Practices Practices Practices COST
20k/ea (8x/ yr) (4x/ yr) (4x/ yr) (8x/ yr) (3x/ yr) ($1.2m/ EA) ($945k/ EA)($625k/ EA) ($Mils)
1 HAWAII.- TOTAL (HI)
1,360,301
68
22
179
539
243
205
1,188
445
229
$1,989
1 IDAHO.- TOTAL (ID)
1,567,582
79
31
253
590
243
224
1,341
513
264
$2,258
IL1
IL2
IL3
IL4
IL5
IL6
IL7
IL-Bloomington, Joliet & Urbana (East IL- 16 counties)
IL-Blue Island (Cook County- South)
IL-Chicago, city of (Cook County- East)
IL-Melrose Park, & Hinsdale (Cook-west, Dupage & Kane)
IL-Elgin & Evanston (NE. IL: Cook-north, Mchenry & Lake)
IL-Peoria, Rockford & Aurora (NW IL- 25 counties)
IL-Springfield (South IL: 56 counties)
7 ILLINOIS.- TOTAL
1,527,486
877,381
2,695,598
2,049,045
2,017,066
1,666,715
1,997,341
12,830,632
77
44
136
102
101
84
100
643
25
14
46
36
31
27
30
209
232
128
368
323
294
239
269
1,852
603
338
1,122
796
792
637
772
5,060
214
150
344
287
319
305
385
2,006
232
134
440
308
306
246
297
1,963
1,307
765
2,320
1,750
1,741
1,453
1,753
11,089
500
287
882
670
660
545
653
4,197
257
148
453
345
339
280
336
2,159
$2,201
$1,281
$3,901
$2,949
$2,925
$2,434
$2,931
18,623
IN1
IN2
IN3
IN4
IN-Evansville, Gary, Lafayette, Munster, Terre Haute (W IN- 27
IN-Fort Wayne, Muncie, South Bend (Northeast IN- 20 counties)
IN-Indianapolis N. (City of, Marion, Hancock, Hendricks & N- 17
IN-Indianapolis S. (Morgan, Johnson, Shelby & Southeast- 28
4 INDIANA.- TOTAL
1,650,660
1,580,791
2,049,590
1,202,761
6,483,802
83
79
103
60
325
26
28
36
18
108
233
240
310
168
951
646
602
800
473
2,521
279
265
306
202
1,051
249
233
312
182
976
1,433
1,367
1,764
1,044
5,608
540
517
670
393
2,121
278
266
345
202
1,091
$2,404
$2,295
$2,966
$1,751
9,416
IA1
IA2
IA-Des Moines, Mason City & Sioux City (West IA)
IA-Cedar Rapids, Davenport, Dubuque, Iowa City & Waterloo (E. IA)
2 IOWA.- TOTAL
1,734,313
1,312,042
3,046,355
87
66
153
29
21
51
249
181
430
657
509
1,166
327
239
566
253
196
449
1,515
1,146
2,661
567
429
997
292 $2,536
221 $1,919
513 4,455
KS1
KS2
KS-Wichita SE KS (1.1 mil, 28 Counties) & West KS (319k, 51 counts.)
KS-Topeka Northeast KS (26 counties)
2 KANSAS.- TOTAL
1,414,509
1,438,609
2,853,118
71
72
143
26
26
51
215
214
429
527
566
1,093
258
212
470
202
218
420
1,228
1,236
2,464
463
471
933
238
242
480
KY1
KY2
KY-Lexington & Covington (Eastern KY, 65 counties)
KY-Louisville, Owensboro & Paducah (Western KY, 55 counties)
2 KENTUCKY.- TOTAL
2,108,136
2,231,231
4,339,367
106
112
218
34
37
71
290
314
604
840
871
1,711
340
383
723
324
338
662
1,829
1,942
3,771
690
730
1,419
355 $3,068
375 $3,255
730 6,323
LA1
LA2
LA-Shreveport, Alexandria, Lafayette, Lake Charles, Monroe (41
LA-New Orleans, Baton Rouge, Metaire, Slidell & Houma (SE. LA- 23)
2 LOUISIANA.- TOTAL
2,086,508
2,446,864
4,533,372
105
123
228
37
42
79
311
349
660
805
981
1,786
339
358
697
313
382
694
1,805
2,110
3,916
683
800
1,483
351 $3,031
412 $3,546
763 6,577
$2,059
$2,079
4,139
STATE/
CO-OP
$450B PRIMARY CARE COST (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
POP.
TOTAL
2010
Serv. Pedi. Pedi.
Gen. Gerri. OB/GYN # Prim. Care # Dental Optometrist TOTAL
Areas 0-1 yrs 2-17 yrs 18-64 yrs +65 yrs 18-64 yrs Practices Practices Practices COST
20k/ea (8x/ yr) (4x/ yr) (4x/ yr) (8x/ yr) (3x/ yr) ($1.2m/ EA) ($945k/ EA)($625k/ EA) ($Mils)
1 MAINE.- TOTAL (ME)
1,328,361
67
17
163
526
264
205
1,176
435
MD1
MD2
MD3
MD-Baltimore & Salisbury (Eastern MD, 14 counties)
MD-Takoma Park NW/ DC Area (Northwest MD, 5 counties)
MD-Takoma Park SW/ DC Area (Southwest MD, 5 counties)
3 MARYLAND.- TOTAL
2,574,261
1,457,776
1,741,515
5,773,552
129
73
88
290
39
23
29
91
345
204
248
797
1,029
579
713
2,321
431
233
226
890
408
226
279
913
2,252
1,266
1,495
5,012
842
477
570
1,889
MA1
MA2
MA3
MA4
MA-Boston NE (Boston city of, Suffolk & Essex counties)
MA-Boston NW (Middlesex county)
MA-Boston South ( 6 counties including Cape & Islands)
MA-Springfield & Worcester (Western MA 5 counties)
4 MASSACHUSETTS.- TOTAL
1,465,182
1,503,085
1,956,649
1,622,713
6,547,629
74
75
98
81
328
21
21
27
23
92
177
190
260
216
842
616
616
761
647
2,640
226
246
377
279
1,128
244
241
300
254
1,039
1,283
1,315
1,725
1,419
5,742
479
492
640
531
2,142
246
253
329
273
1,102
$2,146
$2,200
$2,881
$2,375
9,603
MI1
MI2
MI3
MI4
MI5
MI-Ann Arbor, Kalamazoo & St. Joseph (South MI- 13 counties +
MI-Detroit & Dearborn (Southeast MI- 2 counties + Wayne)
MI-Flint, Lansing & Saginaw (Northeast MI- 22 counties)
MI-Marquette, Muskegon, Petoskey, Traverse City & Grand Rapids (44)
MI-Pontiac & Royal Oak (Oakland County, east MI- NW of Detroit)
5 MICHIGAN.- TOTAL
2,069,580
2,518,013
1,854,393
2,239,292
1,202,362
9,883,640
104
127
93
112
60
496
31
40
27
35
17
149
285
367
252
317
169
1,390
820
979
725
862
475
3,860
347
415
337
407
198
1,705
317
386
282
329
187
1,500
1,799
2,187
1,623
1,950
1,046
8,604
677
824
607
733
393
3,233
348
424
312
377
202
1,663
$3,016
$3,667
$2,716
$3,267
$1,753
14,420
MN1
MN2
MN3
MN-Minneapolis NW & St. Cloud (Northwest MN 37 counties)
MN-Minneapolis SW (City of & Southwest MN 31 counties)
MN-Duluth, Rochester & St. Paul (Eastern MN 19 counties)
3 MINNESOTA.- TOTAL
1,001,172
2,391,592
1,911,161
5,303,925
50
120
96
266
16
41
32
89
141
344
273
758
378
953
754
2,085
197
355
303
854
143
366
291
800
876
2,059
1,653
4,587
328
782
625
1,735
MS1
MS2
MS-Jackson & Oxford (West MS 47 counties)
MS-Gulfport, Hattiesburg, Meridian, Tupelo (East MS 35 counties)
2 MISSISSIPPI.- TOTAL
1,578,620
1,388,677
2,967,297
79
70
149
28
24
53
242
204
446
609
536
1,145
243
231
474
240
209
448
1,362
1,204
2,566
516
454
971
266
234
499
$2,288
$2,021
4,309
MO1
MO2
MO3
MO4
MO- Columbia, Joplin & Springfield (57 counties- Central & SW MO.)
MO-Kansas City (26 counties- NW MO.)
MO-St. Louis N. (City of & 6 counties- NE MO.)
MO-St. Louis S. & Cape Girardeau (26 counties- SE MO.)
4 MISSOURI.- TOTAL
1,766,862
1,491,846
1,782,328
947,891
5,988,927
89
75
90
47
301
29
26
28
15
97
243
216
249
134
842
678
581
701
368
2,328
337
246
298
167
1,049
262
226
278
139
905
1,549
1,294
1,555
823
5,221
578
488
583
310
1,959
297
251
300
159
1,008
$2,591
$2,171
$2,604
$1,380
8,746
223
$1,961
433 $3,768
245 $2,123
293 $2,516
971 8,407
168 $1,466
402 $3,461
322 $2,775
892 7,702
$450B PRIMARY CARE COST (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
POP.
TOTAL
2010
Serv. Pedi.
Pedi.
Gen. Gerri. OB/GYN # Prim. Care # Dental Optometrist TOTAL
Areas 0-1 yrs 2-17 yrs 18-64 yrs +65 yrs 18-64 yrs Practices Practices Practices COST
20k/ea (8x/ yr) (4x/ yr) (4x/ yr) (8x/ yr) (3x/ yr) ($1.2m/ EA) ($945k/ EA)($625k/ EA) ($Mils)
MONTANA.- TOTAL (MT)
989,415
50
16
132
387
183
147
865
324
166
$1,447
NEBRASKA.- TOTAL (NE)
1,826,341
92
33
270
701
308
269
1,581
597
307
$2,654
NV-Las Vegas (3 counties- SE NV)
NV-Reno (14 counties- NW NV)
NEVADA.- TOTAL
2,000,560
699,991
2,700,551
100
36
136
35
11
47
294
98
392
794
276
1,070
290
116
406
301
103
404
1,713
604
2,318
654
229
883
337
118
454
$2,885
$1,015
3,900
NEW HAMPSHIRE.- TOTAL (NH)
1,316,470
66
17
171
532
222
206
1,148
431
221
$1,923
NJ-Camden N. (3 counties- South NJ)
NJ-Camden S. (6 counties- South NJ)
NJ-Hackensack, Patterson & Ridgewood (2 counties- NE NJ)
NJ-Morristown & New Brunswick (7 counties- NW NJ)
NJ-Newark (3 counties- NE NJ)
NEW JERSEY.- TOTAL
1,655,681
1,396,740
1,406,342
2,378,397
1,954,734
8,791,894
83
70
71
119
98
441
25
22
21
35
33
135
231
196
195
332
270
1,224
623
546
550
948
796
3,463
338
239
246
379
280
1,482
244
213
217
368
311
1,354
1,460
1,217
1,229
2,062
1,690
7,657
542
457
460
778
639
2,876
279
235
237
400
329
1,479
$2,438
$2,039
$2,058
$3,459
$2,837
12,831
NEW MEXICO.- TOTAL (NM)
2,059,179
104
36
306
793
340
306
1,781
674
346
$2,990
NY-Albany (18 counties NE NY)
NY-NYC Bronx County
NY-Buffalo (6 counties western NY)
NY-NYC East Long Island (Queens County)
NY-East Long Island (Nassau County)
NY-East Long Island (Suffolk County)
NY-NYC Manhattan (Kings County, Brooklyn- West Long Island)
NY-NYC Manhattan (NY & Richmond Counties- Staten Island)
NY-White Plains (Orange, Putnam, Rockland & Weschester counties.)
NY-Rochester (10 counties East of Buffalo area)
NY-Syracuse, Binghamton & Elmira (17 counts. East of Rochester)
NEW YORK.- TOTAL
1,953,167
1,385,108
1,453,693
2,230,722
1,339,532
1,493,350
2,504,700
2,054,603
1,733,323
1,363,694
1,866,210
19,378,102
98
69
73
112
67
75
125
103
87
68
94
971
26
26
20
33
18
22
44
26
28
19
27
288
247
217
188
272
186
213
349
202
261
179
245
2,559
783
545
568
927
514
583
1,014
898
661
544
734
7,772
356
182
286
357
256
252
360
342
293
240
347
3,272
300
220
223
364
202
226
408
361
258
211
283
3,057
1,712
1,190
1,284
1,954
1,177
1,296
2,176
1,829
1,502
1,193
1,637
16,949
639
453
476
730
438
489
819
672
567
446
610
6,339
329
233
245
375
225
251
421
346
292
229
314
3,260
$2,863
$2,001
$2,143
$3,268
$1,967
$2,174
$3,649
$3,046
$2,521
$1,997
$2,737
28,366
STATE/
CO-OP
NC1
NC2
NC3
NC4
NC5
$450B PRIMARY CARE COST (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
NC-Charlotte (10 counties- SW NC)
NC-Durham & Greensboro (19 counties- west of Raleigh)
NC-Greenville & Wilmington (29 counties- eastern & coastal NC)
NC-Raleigh (11 counties)
NC-Winston-Salem, Asheville & Hickory (31 counties- west NC)
5 NORTH CAROLINA.- TOTAL
1 NORTH DAKOTA.- TOTAL (ND)
POP.
TOTAL
2010
Serv. Pedi.
Pedi.
Gen. Gerri. OB/GYN # Prim. Care # Dental Optometrist TOTAL
Areas 0-1 yrs 2-17 yrs 18-64 yrs +65 yrs 18-64 yrs Practices Practices Practices COST
20k/ea (8x/ yr) (4x/ yr) (4x/ yr) (8x/ yr) (3x/ yr) ($1.2m/ EA) ($945k/ EA)($625k/ EA) ($Mils)
1,975,131
1,967,145
1,480,919
2,004,517
2,107,771
9,535,483
99
99
74
100
106
478
34
32
24
37
31
158
296
273
194
307
277
1,347
785
780
587
798
813
3,762
272
322
265
259
424
1,543
307
307
227
312
317
1,470
1,694
1,714
1,297
1,713
1,862
8,280
646
643
484
656
689
3,119
332
331
249
337
355
1,604
$2,851
$2,872
$2,170
$2,886
$3,107
13,886
672,591
34
11
88
266
122
100
587
220
113
$983
OH1
OH2
OH3
OH4
OH5
OH6
OH7
OH-Akron, Canton, Youngstown (12 counties- NE OH)
OH-Cincinnati (7 counties- SW OH)
OH-Cleveland & Elyria (8 counties- NE OH)
OH-Columbus- North (15 counties- central OH)
OH-Columbus- City of & Southeast (20 counties- SE OH)
OH-Dayton & Kettering (15 counties- West OH)
OH-Toledo (11 counties- NW OH)
7 OHIO.- TOTAL
1,999,639
1,526,892
2,315,442
1,078,588
2,024,133
1,623,402
968,408
11,536,504
100
77
116
54
102
81
49
579
29
25
34
17
33
26
15
180
271
221
321
158
283
233
136
1,622
768
599
889
413
817
622
377
4,485
394
244
441
190
297
293
168
2,027
301
235
351
159
316
242
147
1,751
1,762
1,324
2,036
937
1,746
1,416
844
10,065
654
499
757
353
662
531
317
3,774
336
257
390
181
341
273
163
1,941
$2,942
$2,222
$3,402
$1,571
$2,933
$2,372
$1,415
16,857
OK1
OK2
OK-Oklahoma City & Lawton (54 counties)
OK-Tulsa (23 counties- NE OK)
2 OKLAHOMA- TOTAL
2,221,941
1,529,410
3,751,351
111
77
188
40
26
66
324
224
548
861
586
1,447
367
266
633
330
226
557
1,922
1,328
3,251
727
500
1,227
374
257
631
$3,227
$2,228
5,455
OR1
OR2
OR-Bend, Eugene, Medford, Salem (20 counties- Southern OR)
OR-Portland (16 counties- Northern OR)
2 OREGON- TOTAL
1,762,158
2,068,916
3,831,074
88
104
192
26
33
59
231
280
511
679
841
1,520
357
310
666
261
324
585
1,554
1,788
3,342
576
677
1,253
296 $2,595
348 $3,003
645 5,598
PA1
PA2
PA3
PA4
PA5
PA6
PA7
PA8
PA-Allentown, Scranton & Wilkes-Barre (9 counties- NE PA)
PA-Danville, Erie & Sayre (22 counties- North & West PA)
PA-Harrisburg, Altoona & Johnstown (15 counties- South Central PA)
PA-Lancaster, Reading & York (5 counties- SE PA)
PA-Philadelphia NW (3 counties- SE PA)
PA-Philadelphia (city of & county- SE PA)
PA-Pittsburgh (city of & west- 5 counties SW PA)
PA-Pittsburgh East (7 counties- SW PA)
8 PENNSYLVANIA- TOTAL
1,571,225
1,401,807
1,546,058
2,013,034
1,984,102
1,526,006
1,731,501
928,646
12,702,379
79
70
78
101
99
77
86
47
637
21
19
22
31
29
25
23
12
182
204
173
200
287
272
202
206
113
1,656
608
552
597
775
771
623
680
360
4,966
318
283
317
361
365
231
371
204
2,450
237
211
230
300
303
251
269
140
1,941
1,388
1,238
1,366
1,755
1,740
1,333
1,548
828
11,196
514
459
506
658
649
499
566
304
4,155
264
236
260
339
334
257
291
156
2,137
$2,317
$2,067
$2,280
$2,939
$2,910
$2,231
$2,575
$1,378
18,697
STATE/
CO-OP
SC1
SC2
SC3
$450B PRIMARY CARE COST (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
TX1
TX2
TX3
TX4
TX5
TX6
TX7
TX8
TX9
TX10
TX11
TX12
TX13
TX14
UT1
UT2
Serv. Pedi.
Pedi.
Gen. Gerri. OB/GYN # Prim. Care # Dental Optometrist TOTAL
Areas 0-1 yrs 2-17 yrs 18-64 yrs +65 yrs 18-64 yrs Practices Practices Practices COST
20k/ea (8x/ yr) (4x/ yr) (4x/ yr) (8x/ yr) (3x/ yr) ($1.2m/ EA) ($945k/ EA)($625k/ EA) ($Mils)
1 RHODE ISLAND- TOTAL (RI)
1,052,567
50
14
133
423
189
167
926
344
SC-Charleston & Florence (17 counties- SE SC)
SC-Columbia (20 counties- Central SC)
SC-Greenville & Spartanburg (9 counties- NW SC)
3 SOUTH CAROLINA- TOTAL
1,632,247
1,500,049
1,493,068
4,625,364
82
75
75
232
27
24
25
76
220
208
211
639
642
594
583
1,819
291
247
252
790
251
233
229
712
1,430
1,306
1,300
4,036
534
491
488
1,513
814,180
41
15
119
309
146
118
707
266
137
$1,186
1,546,161
1,438,739
1,614,887
1,746,318
6,346,105
78
72
81
88
319
26
25
26
25
102
231
205
225
224
885
605
581
631
682
2,499
235
201
281
346
1,063
238
226
245
265
975
1,335
1,239
1,408
1,542
5,524
506
471
528
571
2,076
260
242
272
294
1,068
$2,243
$2,082
$2,359
$2,574
9,258
1,158,243
58
2,225,009
112
1,669,145
84
2,099,451
105
1,993,008
100
1,148,672
58
2,368,139
119
1,462,994
74
900,774
45
1,612,106
81
2,202,568
111
2,725,273
137
1,982,809
100
1,597,370
80
25,145,561 1,264
21
42
28
43
41
21
48
26
16
31
42
51
42
27
482
176
337
249
319
353
191
385
241
143
264
358
445
363
226
4,050
445
911
651
854
775
446
942
567
361
607
864
1,041
716
618
9,800
184
243
258
235
193
139
259
187
102
242
266
385
278
281
3,251
167
347
247
324
299
171
363
219
140
235
335
403
278
235
3,761
994
1,881
1,433
1,775
1,662
969
1,997
1,240
762
1,379
1,866
2,324
1,677
1,387
21,343
379
728
546
687
652
376
775
479
295
527
720
891
649
523
8,226
195
374
281
353
335
193
398
246
152
271
371
458
334
269
4,230
$1,672
$3,179
$2,411
$3,000
$2,820
$1,639
$3,377
$2,094
$1,287
$2,322
$3,151
$3,918
$2,833
$2,326
36,029
42
25
66
324
187
511
681
346
1,027
197
115
312
258
131
389
1,503
803
2,306
589
315
904
1 SOUTH DAKOTA- TOTAL (SD)
TN1
TN2
TN3
TN4
POP.
TOTAL
2010
TN-Memphis & Jackson (20 counties- west TN)
TN-Nashville City Of & West (18 counties- central TN)
TN-Nashville East & Chattanooga (31 counties- central TN)
TN-Knoxville, Johnson City, Kingsport (26 counties- east TN)
4 TENNESSEE- TOTAL
TX-Amarillo, Lubbock & Witchita Falls (62 counties- TX panhandle)
TX-Austin & Temple (12 counties East TX)
TX-Houston East & Beaumont (19 counties- SE TX)
TX-Houston (city of- Harris County SE TX)
TX-Houston (Harris County excluding Houston)
TX-Houston West (10 counties- SE TX)
TX-Dallas (Dallas County- NE TX)
TX-Dallas East (12 counties- NE TX)
TX-Dallas NW (5 counties- NE TX)
TX-El Paso, Abilene, Odessa & San Angelo (44 counties- West TX)
TX-Fort Worth (7 counties- NE TX)
TX-San Antonio (29 counties- SW TX)
TX-Corpus Christi, Harlingen, McAllen & Victoria (20 counties- SW TX)
TX-Waco, Bryan, Tyler & Longview (32 counties- Central & NE TX)
14 TEXAS- TOTAL
UT-Salt Lake City NW & Ogden (8 counties- NW UT)
UT-Salt Lake City SE & Provo (21 counties- SE UT)
2 UTAH- TOTAL
1,799,952
963,933
2,763,885
91
48
139
177
$1,548
275 $2,392
252 $2,188
251 $2,179
778 6,759
303 $2,549
162 $1,363
465 3,912
STATE/
CO-OP
$450B PRIMARY CARE COST (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
1 VERMONT- TOTAL (VT)
POP.
TOTAL
2010
Serv. Pedi. Pedi.
Gen. Gerri. OB/GYN # Prim. Care # Dental Optometrist TOTAL
Areas 0-1 yrs 2-17 yrs 18-64 yrs +65 yrs 18-64 yrs Practices Practices Practices COST
20k/ea (8x/ yr) (4x/ yr) (4x/ yr) (8x/ yr) (3x/ yr) ($1.2m/ EA) ($945k/ EA)($625k/ EA) ($Mils)
625,741
32
8
77
253
114
98
550
205
105
$919
VA1
VA2
VA3
VA4
VA-Arlington & Winchester (17 counties- Northeast VA & DC area)
VA-Charlottesville, Lynchburg, Roanoke (61 counties- Western VA)
VA-Norfolk & Newport News (19 counties- Southeast VA)
VA-Richmond (37 counties- Eastern VA)
4 VIRGINIA- TOTAL
2,525,351
1,977,338
1,768,418
1,729,917
8,001,024
127
99
89
87
402
45
27
29
27
127
367
242
244
242
1,095
1,042
783
714
692
3,232
293
394
265
268
1,221
402
305
277
270
1,253
2,149
1,752
1,529
1,498
6,928
826
647
578
566
2,617
425
333
298
291
1,346
$3,625
$2,921
$2,568
$2,515
11,629
WA1
WA2
WA3
WA4
WA-Spokane & Yakima (20 counties- eastern WA)
WA-Seattle City & King County (central WA)
WA-Seattle NW & Everett (10 counties- NW WA)
WA-Olympia & Tacoma (8 counties- SW WA)
4 WASHINGTON- TOTAL
1,495,054
1,931,249
1,611,556
1,686,681
6,724,540
75
97
81
85
338
27
30
24
28
110
227
243
216
247
933
574
817
643
664
2,698
241
263
273
257
1,034
218
313
245
256
1,032
1,287
1,666
1,400
1,453
5,807
489
632
527
552
2,200
252
325
271
284
1,131
$2,163
$2,799
$2,348
$2,443
9,754
1 WEST VIRGINIA- TOTAL (WV)
1,852,994
93
26
229
731
371
282
1,639
606
312
$2,734
WI-Appleton, Green Bay, Neenah & Wausau (20 counties- NE WI)
WI-Madison (14 counties- SE WI)
WI-Milwaukee (9 counties- SE WI)
WI-La Crosse & Marshfield (29 counties- NW WI)
4 WISCONSIN- TOTAL
1,224,523
1,149,195
2,237,110
1,076,158
5,686,986
61
58
112
54
285
19
18
37
16
90
169
154
325
145
792
474
462
877
419
2,232
225
187
358
202
972
181
176
341
159
856
1,068
996
1,936
941
4,942
401
376
732
352
1,860
206
193
376
181
957
$1,789
$1,672
$3,250
$1,575
8,286
563,626
29
10
80
224
87
84
485
184
95
$815
308,745,538 15,490
5,045
50,344 47,038
267,699
100,996
51,942 449,145
TOTAL (@ RI Costs above)
$321,249
$95,441
$32,464 $449,154
TOTAL (@ Local Cost) **
$293,343
$87,161
$29,647 $410,152
-8.7%
WI1
WI2
WI3
WI4
1 WYOMING- TOTAL (WY)
185 USA TOTAL
** After Geographic COLA's see Appendices F-J
43,864 121,408
E35-44: $402B HOSPITAL IN-PATIENT COST
ICU, Recovery, MHSA & Other Medical Beds required by CO-OP
EXPANDING THE RI MODEL NATIONALLY
185 BUYER CO-OP’s DEFINED
GEOGRAPHIC MARKETS WITHIN STATES
EACH, 1 to 2.5 MIL PEOPLE (1 to 2.5 RI’s)
(NEXT 9 SLIDES)
Each of the 185 CO-OP areas covers 1 or more “Hospital Referral Regions” as
defined by the Dartmouth Atlas of Health Care. Regional hospitals capable of
cardio and/or neuro surgery. (http://www.dartmouthatlas.org/data/region/)
In each of the 15,490 service areas the CO-OP would contract approx. 17 Primary
Care MDs, 7 Dentists and 4 Optometrists to service a population of approx. 20k.
BACK
Table of Contents
HOSPITAL IN-PATIENT NOTES:
The number and type of hospital in-patient visits depicted on the next 8 slides are based on the population by age In
each CO-OP area as listed in E13-21 and utilization rates E65-68. The following methods & assumptions apply:
The number of hospital in-patient visits per 1,000 people in each state per the AHA Annual Survey Copyright 2012
(http://www.statehealthfacts.org/comparemaptable.jsp?ind=386&cat=8 at August 2012) was used to calculate the
estimated total number of in-patient visits in each state (35.2 million total USA). Since this excludes Federal Hospitals,
Rehab Hospitals and MHSA Hospitals 9% was added to the rates to account for this activity at these facilities. This
totaled 38.2 million In-Patient visits or 124 per 1,000 people for the USA as a whole (vs. 114 in the AHA data). This
national total is consistent with the RI experience (121/k) & The National Health Statistics Report. However IP usage
rates vary widely by state & within states. DC, WV & PA had the highest rates (at 238/k, 164/k & 155/k) with VT, AK & UT
the lowest (at 86/k, 87/k & 88/k). DC, WV & PA are 2.5 times the VT, AK or UT rate!
Within each state, the total number of IP visits for the state were apportioned to the individual CO-Ops (markets within
states) based on the +65 population at a 4:1 ratio. As an example, FL has a 142/1k rate (+65 375 & <65 93) the Ocala &
Hudson area in Florida (CO-OP FL8) has the highest % +65 population at 26% (see E13-21). Its estimated IP rate is 166 per
1,000 people (applying +65 375 & <65 93). Whereas Jacksonville (FL3) has just 12% +65 and an estimated IP rate of 127
per 1,000 people or 24% less (after applying rates). Fewer beds, less funding needed for hospital in-patient visits.
The total IP visits were further detailed into three groups based on the RI experience. That is 30% of the visits are
estimated to be Surgery visits (11.5 mil), 10% are estimated to be MHSA visits (3.8 mil), 60% are Other medical visits
including births (22.9 mil). Surgery visits consist of 3 days in ICU & 5 days in recovery, MHSA average 8.7 days and
Other Medical visits average 3.7 days. The total average stay is 5.4 days. The preceding suggests the need for 94k ICU
beds, 157k Recovery beds, 91k MHSA beds & 233k Other Medical beds for a total 575k beds and 210 mil IP days of care in
the USA as a whole as detailed by CO-OP in the next eight slides. These data are consistent with the RI experience, the
national Medicare statistics, the first listed discharge report & HCUP (bulletin #62).
The staffing and cost of each bed type is detailed on B3 in the Rhode Island example. ICU beds would be funded at $1.15
million each per year, Recovery beds $528k, Medical beds $740k and MHSA beds $430k to allow the hospital to recover
the cost of having the beds available & staffed under agreement with the local CO-OP. It’s not about billing the patient,
it’s about having the capability available to the community as agreed with the community (CO-OP of patients). RI cost is
presented here for uniformity & simplicity, geographic COLA’s are applied in appendices F thru J.
STATE/
CO-OP
AL1
AL2
AL3
$402B HOSPITAL IN-PATIENT COST (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
AL-Birmingham S & Tuscaloosa (28 counties- Central AL)
AL-Birmingham N & Huntsville (15 counties- Northern AL)
AL-Dothan, Mobile & Montgomery (23 counties- Southern AL)
3 ALABAMA-TOTAL
1 ALASKA-TOTAL (AK)
# In-Pat.
Visits
per 1,000
# In-Pat.
TOTAL # Surgeries
Discharges (30%)
est/ yr
est/ yr
# In-Pat.
MHSA
(10%)
est/ yr
# In-Pat. # Surg
# Surg
Other Beds/ICU Beds/rec.
(60%)
3 days
5 days
est/ yr ($1.15m) ($528k)
# MHSA
Beds
8.7 days
($430k)
# Other
Med. Beds
3.7 days
($740k)
TOTAL #
IP Days
5.4 days
est/ yr
TOTAL
IN-PAT.
COST
($Mils)
144
148
147
146
288,299
182,977
226,315
697,591
86,490
54,893
67,895
209,277
28,830
18,298
22,632
69,759
172,979
109,786
135,789
418,555
711
451
558
1,720
1,185
752
930
2,867
687
436
539
1,663
1,753
1,113
1,376
4,243
1,582,762
1,004,543
1,242,469
3,829,774
3,036
1,927
2,383
7,346
87
61,809
18,543
6,181
37,085
152
254
147
376
339,330
651
AZ1
AZ2
AZ3
AZ4
AZ-Mesa (Maricopa SE- Mesa, Chandler, Gilbert, Tempe)
AZ-Phoenix City of (Maricopa central)
AZ-Phoenix N & Sun City (Maricopa- Glendale, Scottsdale & North AZ)
AZ-Phoenix S & Tucson (Maricopa- Avondale, Goodyear & South AZ)
4 ARIZONA-TOTAL
114
106
136
122
121
133,927
153,844
232,972
250,948
771,692
40,178
46,153
69,892
75,284
231,508
13,393
15,384
23,297
25,095
77,169
80,356
92,306
139,783
150,569
463,015
330
379
574
619
1,903
550
632
957
1,031
3,171
319
367
555
598
1,839
815
936
1,417
1,526
4,694
735,262
844,604
1,279,018
1,377,705
4,236,589
1,410
1,620
2,453
2,643
8,127
AR1
AR2
AR-Little Rock (South & East AR, 43 counties)
AR-Fort Smith, Jonesboro, Springdale, Texarkana (N&W - 32 counties)
2 ARKANSAS-TOTAL
139
137
138
223,379
179,644
403,024
67,014
53,893
120,907
22,338
17,964
40,302
134,028
107,787
241,814
551
443
994
918
738
1,656
532
428
961
1,359
1,093
2,451
1,226,353
986,248
2,212,601
2,352
1,892
4,244
CA-Orange County N (Anaheim, Garden Grove, Hunt. Bch & North)
CA-Orange County S (Santa Ana, Costa Mesa & South)
CA-Bakersfield & Fresno (Kern, Tulare & Fresno, King, Madera)
CA-Alameda County
CA-LA Central LA, South LA, Northeast LA & Eastside
CA-LA Harbor, South Bay & Westside
CA-LA San Fern. Valley, NW, Antelope, Forest & Santa Monica Mtns.
CA-LA San Gabriel Valley, Pomona & Verdugos
CA-LA Southeast
CA-Modesto & Stockton (Merced, Stanislaus, San Joaquin, +4 more.)
CA-Napa, Chico, Redding & Santa Rosa (15 counties- north CA )
CA-Sacramento (11 counties)
CA-Palm Springs/Rancho Mirage (Riverside County)
CA-San Bernardino & Inyo Counties
CA-San Diego (City of)
CA-San Diego County (ex. City of, + Imperial County)
CA-San Francisco (SF & Marin Counties)
CA-San Jose (Santa Clara & San Benito Counties)
CA-Santa Cruz & San Mateo County
CA-Santa Barbara, San Luis Obispo, Salinas & Ventura
CA-Contra Costa & Solano Counties
21 CALIFORNIA-TOTAL
101
100
95
99
95
102
97
103
96
99
108
102
100
94
98
101
106
99
103
101
101
100
142,930
160,081
239,840
149,317
199,107
226,553
207,804
221,738
115,543
157,107
166,825
252,502
219,919
193,352
128,089
198,388
112,244
181,438
100,675
195,830
147,822
3,717,104
42,879
48,024
71,952
44,795
59,732
67,966
62,341
66,521
34,663
47,132
50,048
75,751
65,976
58,006
38,427
59,516
33,673
54,431
30,203
58,749
44,347
1,115,131
14,293
85,758
16,008
96,048
23,984
143,904
14,932
89,590
19,911
119,464
22,655
135,932
20,780
124,682
22,174
133,043
11,554
69,326
15,711
94,264
16,683
100,095
25,250
151,501
21,992
131,952
19,335
116,011
12,809
76,853
19,839
119,033
11,224
67,346
18,144
108,863
10,068
60,405
19,583
117,498
14,782
88,693
371,710 2,230,262
352
395
591
368
491
559
512
547
285
387
411
623
542
477
316
489
277
447
248
483
364
9,165
587
658
986
614
818
931
854
911
475
646
686
1,038
904
795
526
815
461
746
414
805
607
15,276
341
382
572
356
475
540
495
529
275
374
398
602
524
461
305
473
268
432
240
467
352
8,860
869
784,687
974
878,842
1,459 1,316,720
908
819,753
1,211 1,093,097
1,378 1,243,778
1,264 1,140,843
1,349 1,217,342
703
634,332
956
862,516
1,015
915,872
1,536 1,386,237
1,338 1,207,357
1,176 1,061,502
779
703,206
1,207 1,089,148
683
616,219
1,104
996,096
612
552,706
1,191 1,075,105
899
811,542
22,608 20,406,901
1,505
1,686
2,526
1,572
2,097
2,386
2,188
2,335
1,217
1,655
1,757
2,659
2,316
2,036
1,349
2,089
1,182
1,911
1,060
2,062
1,557
39,146
CA1
CA2
CA3
CA4
CA5
CA6
CA7
CA8
CA9
CA10
CA11
CA12
CA13
CA14
CA15
CA16
CA17
CA18
CA19
CA20
CA21
STATE/
CO-OP
$402B HOSPITAL IN-PATIENT COST (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
# In-Pat. # In-Pat.
# In-Pat. TOTAL # Surgeries MHSA
Visits Discharges (30%)
(10%)
per 1,000
est/ yr
est/ yr
est/ yr
# In-Pat. # Surg
# Surg
Other Beds/ICU Beds/rec.
(60%)
3 days
5 days
est/ yr ($1.15m) ($528k)
# MHSA
Beds
8.7 days
($430k)
# Other TOTAL #
Med. Beds IP Days
3.7 days 5.4 days
($740k)
est/ yr
TOTAL
IN-PAT.
COST
($Mils)
CO1
CO2
CO3
CO4
CO-Boulder, Fort Collins, Greeley (10 counties- NE CO.)
CO-Colorado Springs, Grand Junction & Pueblo (35 counties- S. CO.)
CO-Denver City of & East (7 counties)
CO-Denver West (12 counties)
4 COLORADO-TOTAL
97
101
95
96
97
89,646
141,403
161,604
96,575
489,228
26,894
42,421
48,481
28,973
146,769
8,965
14,140
16,160
9,658
48,923
53,787
84,842
96,963
57,945
293,537
221
349
398
238
1,206
368
581
664
397
2,011
214
337
385
230
1,166
545
860
983
587
2,976
492,155
776,303
887,209
530,198
2,685,864
944
1,489
1,702
1,017
5,152
CT1
CT2
CT-Hartford (6 counties)
CT-New Haven & Bridgeport (2 counties SW CT.)
2 CONNECTICUT-TOTAL
125
124
124
224,221
220,015
444,237
67,266
66,005
133,271
22,422
22,002
44,424
134,533
132,009
266,542
553
543
1,095
921
904
1,826
534
524
1,059
1,364
1,338
2,702
1,230,976
1,207,884
2,438,860
2,361
2,317
4,678
1 DC, Wash.- TOTAL (DC)
238
143,210
42,963
14,321
85,926
353
589
341
871
786,223
1,508
1 DELAWARE.- TOTAL (DE)
123
110,446
33,134
11,045
66,268
272
454
263
672
606,349
1,163
133
154
127
133
144
149
128
166
131
161
138
142
233,063
269,480
171,088
341,754
165,298
165,922
239,436
199,858
185,942
401,006
295,255
2,668,100
69,919
80,844
51,326
102,526
49,589
49,776
71,831
59,958
55,783
120,302
88,576
800,430
23,306 139,838
26,948 161,688
17,109 102,653
34,175 205,052
16,530
99,179
16,592
99,553
23,944 143,661
19,986 119,915
18,594 111,565
40,101 240,604
29,525 177,153
266,810 1,600,860
575
664
422
843
408
409
590
493
458
989
728
6,579
958
1,107
703
1,404
679
682
984
821
764
1,648
1,213
10,965
556
642
408
815
394
395
571
476
443
956
704
6,360
1,418 1,279,514
1,639 1,479,444
1,041
939,270
2,079 1,876,227
1,005
907,485
1,009
910,910
1,456 1,314,502
1,216 1,097,223
1,131 1,020,822
2,439 2,201,523
1,796 1,620,948
16,228 14,647,869
2,454
2,838
1,802
3,599
1,741
1,747
2,522
2,105
1,958
4,223
3,109
28,098
111
105
102
111
113
108
226,246
238,496
235,504
187,885
155,844
1,043,977
67,874
71,549
70,651
56,366
46,753
313,193
22,625
23,850
23,550
18,789
15,584
104,398
558
588
581
463
384
2,574
930
980
968
772
640
4,290
539
568
561
448
371
2,488
1,376
1,451
1,432
1,143
948
6,350
2,383
2,512
2,480
1,979
1,641
10,994
FL1
FL2
FL3
FL4
FL5
FL6
FL7
FL8
FL9
FL10
FL11
GA1
GA2
GA3
GA4
GA5
FL-Fort Lauderdale S. (Broward County)
FL-Fort Lauderdale N. (Martin, Palm Beach & St. Lucie Counties)
FL-Jacksonville (Baker, Clay, Duval, Nassau & St Johns Counties)
FL-Miami-Dade & Monroe Counties (Everglades & Keys)
FL- Gainesville & Ormond Beach (12 Counties)
FL-Orlando S. (Brevard, Hardee, Highlands, Indian., Okee., Osceola)
FL-Orlando N. (Orange, Lake & Seminole counties)
FL-Ocala & Hudson (Citrus, Hernando, Marion, Pasco, Sumter)
FL-Tallahassee, Panama City & Pensacola (19 Counties)
FL-Fort Meyers, Sarasota, Bradenton & Lakeland (9 Counties)
FL-Tampa, St. Petersburg & Clearwater (Hillborough & Pinellas)
11 FLORIDA.- TOTAL
GA-Atlanta North & Rome (36 Counties)
GA-Atlanta City of & West (Fulton, Cobb & West, 11 Counties)
GA-Atlanta East (DeKalb, Gwinnett & East 11 Counties)
GA-Savannah & Augusta (SE. GA 47 Counties)
GA-Macon, Columbus & Albany (SW. GA 54 Counties)
5 GEORGIA.- TOTAL
135,748
143,098
141,303
112,731
93,507
626,386
1,242,091
1,309,345
1,292,919
1,031,491
855,586
5,731,433
STATE/
CO-OP
$402B HOSPITAL IN-PATIENT COST (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
# In-Pat.
# In-Pat. TOTAL # Surgeries
Visits Discharges (30%)
per 1,000
est/ yr
est/ yr
# In-Pat.
MHSA
(10%)
est/ yr
# In-Pat. # Surg
# Surg
Other Beds/ICU Beds/rec.
(60%)
3 days
5 days
est/ yr ($1.15m) ($528k)
# MHSA
Beds
8.7 days
($430k)
# Other TOTAL #
Med. Beds IP Days
3.7 days 5.4 days
($740k)
est/ yr
TOTAL
IN-PAT.
COST
($Mils)
1 HAWAII.- TOTAL (HI)
88
120,235
36,071
12,024
72,141
296
494
287
731
660,093
1,266
1 IDAHO.- TOTAL (ID)
91
142,846
42,854
14,285
85,708
352
587
340
869
784,226
1,504
19,434 116,602
11,809
70,856
33,481 200,886
26,068 156,409
26,525 159,152
22,897 137,383
27,887 167,324
168,102 1,008,612
479
291
826
643
654
565
688
4,145
799
485
1,376
1,071
1,090
941
1,146
6,908
463
281
798
621
632
546
665
4,007
1,182
718
2,036
1,586
1,613
1,393
1,696
10,224
1,066,905
648,336
1,838,109
1,431,141
1,456,242
1,257,052
1,531,014
9,228,799
2,047
1,244
3,526
2,745
2,793
2,411
2,937
17,703
IL1
IL2
IL3
IL4
IL5
IL6
IL7
IL-Bloomington, Joliet & Urbana (East IL- 16 counties)
IL-Blue Island (Cook County- South)
IL-Chicago, city of (Cook County- East)
IL-Melrose Park, & Hinsdale (Cook-west, Dupage & Kane)
IL-Elgin & Evanston (NE. IL: Cook-north, Mchenry & Lake)
IL-Peoria, Rockford & Aurora (NW IL- 25 counties)
IL-Springfield (South IL: 56 counties)
7 ILLINOIS.- TOTAL
127
135
124
127
132
137
140
131
194,336
118,094
334,810
260,681
265,253
228,971
278,873
1,681,020
58,301
35,428
100,443
78,204
79,576
68,691
83,662
504,306
IN1
IN2
IN3
IN4
IN-Evansville, Gary, Lafayette, Munster, Terre Haute (W IN- 27 counts.)
IN-Fort Wayne, Muncie, South Bend (Northeast IN- 20 counties)
IN-Indianapolis N. (City of, Marion, Hancock, Hendricks & N- 17 counts)
IN-Indianapolis S. (Morgan, Johnson, Shelby & Southeast- 28 counts.)
4 INDIANA.- TOTAL
123
122
118
122
121
202,219
193,196
242,690
147,139
785,244
60,666
57,959
72,807
44,142
235,573
20,222
19,320
24,269
14,714
78,524
121,332
115,918
145,614
88,283
471,147
499
476
598
363
1,936
831
794
997
605
3,227
482
460
578
351
1,872
1,230
1,175
1,476
895
4,776
1,110,185
1,060,648
1,332,366
807,793
4,310,992
2,130
2,035
2,556
1,550
8,270
IA1
IA2
IA-Des Moines, Mason City & Sioux City (West IA)
IA-Cedar Rapids, Davenport, Dubuque, Iowa City & Waterloo (E. IA)
2 IOWA.- TOTAL
123
121
122
212,552
159,236
371,787
63,765
47,771
111,536
21,255
15,924
37,179
127,531
95,541
223,072
524
393
917
873
654
1,528
507
380
886
1,293
969
2,261
1,166,908
874,203
2,041,111
2,238
1,677
3,915
KS1
KS2
KS-Wichita SE KS (1.1 mil, 28 Counties) & West KS (319k, 51 counts.)
KS-Topeka Northeast KS (26 counties)
2 KANSAS.- TOTAL
120
113
116
169,353
162,218
331,570
50,806
48,665
99,471
16,935
16,222
33,157
101,612
97,331
198,942
418
400
818
696
667
1,363
404
387
790
1,030
987
2,017
929,746
890,574
1,820,321
1,783
1,708
3,492
KY1
KY2
KY-Lexington & Covington (Eastern KY, 65 counties)
KY-Louisville, Owensboro & Paducah (Western KY, 55 counties)
2 KENTUCKY.- TOTAL
152
154
153
319,746
344,688
664,434
95,924
103,406
199,330
31,975
34,469
66,443
191,848
206,813
398,660
788
850
1,638
1,314
1,417
2,731
762
822
1,584
1,945
2,096
4,041
1,755,405
1,892,338
3,647,743
3,367
3,630
6,997
LA1
LA2
LA-Shreveport, Alexandria, Lafayette, Lake Charles, Monroe (41 counts)
LA-New Orleans, Baton Rouge, Metaire, Slidell & Houma (SE. LA- 23)
2 LOUISIANA.- TOTAL
152
148
150
317,241
361,454
678,695
95,172
108,436
203,609
31,724
36,145
67,870
190,345
216,872
407,217
782
891
1,673
1,304
1,485
2,789
756
862
1,618
1,930
2,198
4,128
1,741,656
1,984,382
3,726,037
3,341
3,807
7,147
STATE/
CO-OP
$402B HOSPITAL IN-PATIENT COST (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
# In-Pat.
# In-Pat. TOTAL # Surgeries
Visits Discharges (30%)
per 1,000
est/ yr
est/ yr
# In-Pat.
MHSA
(10%)
est/ yr
# In-Pat. # Surg
# Surg
Other Beds/ICU Beds/rec.
(60%)
3 days
5 days
est/ yr ($1.15m) ($528k)
# MHSA
Beds
8.7 days
($430k)
# Other TOTAL #
Med. Beds IP Days
3.7 days 5.4 days
($740k)
est/ yr
TOTAL
IN-PAT.
COST
($Mils)
1 MAINE.- TOTAL (ME)
120
159,024
47,707
15,902
95,414
392
654
379
967
873,040
1,675
MD1
MD2
MD3
MD-Baltimore & Salisbury (Eastern MD, 14 counties)
MD-Takoma Park NW/ DC Area (Northwest MD, 5 counties)
MD-Takoma Park SW/ DC Area (Southwest MD, 5 counties)
3 MARYLAND.- TOTAL
136
134
127
133
350,260
195,739
221,252
767,251
105,078
58,722
66,376
230,175
35,026
19,574
22,125
76,725
210,156
117,443
132,751
460,351
864
483
546
1,892
1,439
804
909
3,153
835
467
527
1,829
2,130
1,191
1,346
4,667
1,922,925
1,074,607
1,214,676
4,212,209
3,689
2,061
2,330
8,080
MA1
MA2
MA3
MA4
MA-Boston NE (Boston city of, Suffolk & Essex counties)
MA-Boston NW (Middlesex county)
MA-Boston South ( 6 counties including Cape & Islands)
MA-Springfield & Worcester (Western MA 5 counties)
4 MASSACHUSETTS.- TOTAL
133
135
142
137
137
194,656
203,170
278,083
222,566
898,475
58,397
60,951
83,425
66,770
269,543
19,466
20,317
27,808
22,257
89,848
116,794
121,902
166,850
133,539
539,085
480
501
686
549
2,215
800
835
1,143
915
3,692
464
484
663
530
2,142
1,184
1,236
1,691
1,354
5,465
1,068,663
1,115,406
1,526,675
1,221,885
4,932,629
2,050
2,140
2,929
2,344
9,462
MI1
MI2
MI3
MI4
MI5
MI-Ann Arbor, Kalamazoo & St. Joseph (South MI- 13 counties + Wayne)
MI-Detroit & Dearborn (Southeast MI- 2 counties + Wayne)
MI-Flint, Lansing & Saginaw (Northeast MI- 22 counties)
MI-Marquette, Muskegon, Petoskey, Traverse City & Grand Rapids (44)
MI-Pontiac & Royal Oak (Oakland County, east MI- NW of Detroit)
5 MICHIGAN.- TOTAL
132
132
136
136
132
133
273,890
331,716
251,431
303,643
158,414
1,319,093
82,167
99,515
75,429
91,093
47,524
395,728
27,389
33,172
25,143
30,364
15,841
131,909
164,334
199,029
150,858
182,186
95,048
791,456
675
818
620
749
391
3,253
1,126
1,363
1,033
1,248
651
5,421
653
791
599
724
378
3,144
1,666
2,018
1,529
1,847
964
8,023
1,503,655
1,821,119
1,380,355
1,667,002
869,691
7,241,822
2,884
3,493
2,648
3,198
1,668
13,892
MN1
MN2
MN3
MN-Minneapolis NW & St. Cloud (Northwest MN 37 counties)
MN-Minneapolis SW (City of & Southwest MN 31 counties)
MN-Duluth, Rochester & St. Paul (Eastern MN 19 counties)
3 MINNESOTA.- TOTAL
128
118
120
121
128,619
282,658
229,945
641,221
38,586
84,797
68,984
192,366
12,862
28,266
22,995
64,122
77,171
169,595
137,967
384,733
317
697
567
1,581
529
1,162
945
2,635
307
674
548
1,528
782
1,719
1,399
3,900
706,117
1,551,790
1,262,398
3,520,305
1,355
2,977
2,422
6,753
MS1
MS2
MS-Jackson & Oxford (West MS 47 counties)
MS-Gulfport, Hattiesburg, Meridian, Tupelo (East MS 35 counties)
2 MISSISSIPPI.- TOTAL
147
150
148
231,310
208,019
439,329
69,393
62,406
131,799
23,131
20,802
43,933
138,786
124,811
263,597
570
513
1,083
951
855
1,805
551
496
1,047
1,407
1,265
2,672
1,269,892
1,142,024
2,411,916
2,436
2,191
4,627
MO1
MO2
MO3
MO4
MO- Columbia, Joplin & Springfield (57 counties- Central & SW MO.)
MO-Kansas City (26 counties- NW MO.)
MO-St. Louis N. (City of & 6 counties- NE MO.)
MO-St. Louis S. & Cape Girardeau (26 counties- SE MO.)
4 MISSOURI.- TOTAL
153
146
147
149
149
270,231
217,964
261,636
141,327
891,158
81,069
65,389
78,491
42,398
267,347
27,023
21,796
26,164
14,133
89,116
162,138
130,778
156,982
84,796
534,695
666
537
645
348
2,197
1,111
896
1,075
581
3,662
644
520
624
337
2,124
1,644
1,326
1,591
860
5,420
1,483,566
1,196,622
1,436,383
775,884
4,892,455
2,846
2,295
2,755
1,488
9,385
STATE/
CO-OP
NV1
NV2
$402B HOSPITAL IN-PATIENT COST (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
# MHSA # Other TOTAL #
Beds Med. Beds IP Days
8.7 days 3.7 days 5.4 days
($430k)
($740k)
est/ yr
TOTAL
IN-PAT.
COST
($Mils)
107
106,065
31,819
10,606
63,639
262
436
253
645
582,296
1,117
1 NEBRASKA.- TOTAL (NE)
124
226,466
67,940
22,647
135,880
558
931
540
1,377
1,243,300
2,385
NV-Las Vegas (3 counties- SE NV)
NV-Reno (14 counties- NW NV)
2 NEVADA.- TOTAL
96
100
97
192,792
70,013
262,805
57,838
21,004
78,841
19,279
7,001
26,280
115,675
42,008
157,683
475
173
648
792
288
1,080
460
167
626
1,173
426
1,598
1,058,427
384,372
1,442,799
2,030
737
2,768
99
130,740
39,222
13,074
78,444
322
537
312
795
717,761
1,377
140
132
133
130
126
132
231,596
184,763
187,277
308,259
245,998
1,157,893
69,479
55,429
56,183
92,478
73,799
347,368
23,160
18,476
18,728
30,826
24,600
115,789
138,958
110,858
112,366
184,955
147,599
694,736
571
456
462
760
607
2,855
952
759
770
1,267
1,011
4,758
552
440
446
735
586
2,760
1,409
1,124
1,139
1,875
1,496
7,043
1,271,463
1,014,351
1,028,151
1,692,340
1,350,527
6,356,832
2,439
1,946
1,972
3,246
2,591
12,194
98
202,177
60,653
20,218
121,306
499
831
482
1,230
1,109,953
2,129
144
132
147
138
146
141
135
140
141
142
145
141
280,875
182,142
214,099
308,732
195,438
209,816
336,882
287,547
243,760
193,971
269,841
2,723,102
84,263
54,643
64,230
92,620
58,631
62,945
101,065
86,264
73,128
58,191
80,952
816,931
28,088 168,525
18,214 109,285
21,410 128,459
30,873 185,239
19,544 117,263
20,982 125,889
33,688 202,129
28,755 172,528
24,376 146,256
19,397 116,383
26,984 161,905
272,310 1,633,861
693
449
528
761
482
517
831
709
601
478
665
6,714
1,154
749
880
1,269
803
862
1,384
1,182
1,002
797
1,109
11,191
669
434
510
736
466
500
803
685
581
462
643
6,491
1,708 1,542,006
1,108
999,958
1,302 1,175,403
1,878 1,694,938
1,189 1,072,953
1,276 1,151,888
2,049 1,849,483
1,749 1,578,632
1,483 1,338,242
1,180 1,064,902
1,641 1,481,427
16,562 14,949,832
2,958
1,918
2,255
3,251
2,058
2,210
3,548
3,028
2,567
2,043
2,842
28,678
NJ-Camden N. (3 counties- South NJ)
NJ-Camden S. (6 counties- South NJ)
NJ-Hackensack, Patterson & Ridgewood (2 counties- NE NJ)
NJ-Morristown & New Brunswick (7 counties- NW NJ)
NJ-Newark (3 counties- NE NJ)
5 NEW JERSEY.- TOTAL
1 NEW MEXICO.- TOTAL (NM)
NY1
NY2
NY3
NY4
NY5
NY6
NY7
NY8
NY9
NY10
NY11
# In-Pat. # Surg
# Surg
Other Beds/ICU Beds/rec.
(60%)
3 days
5 days
est/ yr ($1.15m) ($528k)
1 MONTANA.- TOTAL (MT)
1 NEW HAMPSHIRE.- TOTAL (NH)
NJ1
NJ2
NJ3
NJ4
NJ5
# In-Pat. # In-Pat.
# In-Pat. TOTAL # Surgeries MHSA
Visits Discharges (30%)
(10%)
per 1,000
est/ yr
est/ yr
est/ yr
NY-Albany (18 counties NE NY)
NY-NYC Bronx County
NY-Buffalo (6 counties western NY)
NY-NYC East Long Island (Queens County)
NY-East Long Island (Nassau County)
NY-East Long Island (Suffolk County)
NY-NYC Manhattan (Kings County, Brooklyn- West Long Island)
NY-NYC Manhattan (NY & Richmond Counties- Staten Island)
NY-White Plains (Orange, Putnam, Rockland & Weschester counties.)
NY-Rochester (10 counties East of Buffalo area)
NY-Syracuse, Binghamton & Elmira (17 counts. East of Rochester)
11 NEW YORK.- TOTAL
STATE/
CO-OP
NC1
NC2
NC3
NC4
NC5
$402B HOSPITAL IN-PATIENT COST (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
# In-Pat.
# In-Pat. TOTAL # Surgeries
Visits Discharges (30%)
per 1,000
est/ yr
est/ yr
# In-Pat.
MHSA
(10%)
est/ yr
# In-Pat. # Surg
# Surg
Other Beds/ICU Beds/rec.
(60%)
3 days
5 days
est/ yr ($1.15m) ($528k)
# MHSA
Beds
8.7 days
($430k)
# Other
Med. Beds
3.7 days
($740k)
TOTAL #
IP Days
5.4 days
est/ yr
TOTAL
IN-PAT.
COST
($Mils)
NC-Charlotte (10 counties- SW NC)
NC-Durham & Greensboro (19 counties- west of Raleigh)
NC-Greenville & Wilmington (29 counties- eastern & coastal NC)
NC-Raleigh (11 counties)
NC-Winston-Salem, Asheville & Hickory (31 counties- west NC)
5 NORTH CAROLINA.- TOTAL
113
118
122
111
126
118
223,436
232,960
180,017
223,184
265,645
1,125,243
67,031
69,888
54,005
66,955
79,694
337,573
22,344
23,296
18,002
22,318
26,565
112,524
134,062
139,776
108,010
133,910
159,387
675,146
551
574
444
550
655
2,775
918
957
740
917
1,092
4,624
533
555
429
532
633
2,682
1,359
1,417
1,095
1,357
1,616
6,844
1,226,666
1,278,951
988,295
1,225,281
1,458,394
6,177,585
2,353
2,453
1,896
2,350
2,798
11,850
1 NORTH DAKOTA.- TOTAL (ND)
153
102,644
30,793
10,264
61,586
253
422
245
624
563,516
1,081
OH1
OH2
OH3
OH4
OH5
OH6
OH7
OH-Akron, Canton, Youngstown (12 counties- NE OH)
OH-Cincinnati (7 counties- SW OH)
OH-Cleveland & Elyria (8 counties- NE OH)
OH-Columbus- North (15 counties- central OH)
OH-Columbus- City of & Southeast (20 counties- SE OH)
OH-Dayton & Kettering (15 counties- West OH)
OH-Toledo (11 counties- NW OH)
7 OHIO.- TOTAL
148
139
146
143
136
144
142
143
296,056
212,263
339,172
154,111
274,769
233,827
137,939
1,648,136
88,817
63,679
101,752
46,233
82,431
70,148
41,382
494,441
29,606
21,226
33,917
15,411
27,477
23,383
13,794
164,814
177,634
127,358
203,503
92,467
164,861
140,296
82,763
988,882
730
523
836
380
678
577
340
4,064
1,217
872
1,394
633
1,129
961
567
6,773
706
506
808
367
655
557
329
3,928
1,801
1,291
2,063
937
1,671
1,422
839
10,024
1,625,347
1,165,323
1,862,053
846,069
1,508,480
1,283,712
757,284
9,048,268
3,118
2,235
3,572
1,623
2,894
2,462
1,453
17,357
OK1
OK2
OK-Oklahoma City & Lawton (54 counties)
OK-Tulsa (23 counties- NE OK)
2 OKLAHOMA- TOTAL
123
125
124
273,922
191,457
465,379
82,177
57,437
139,614
27,392
19,146
46,538
164,353
114,874
279,228
675
472
1,148
1,126
787
1,913
653
456
1,109
1,666
1,164
2,831
1,503,834
1,051,099
2,554,933
2,885
2,016
4,901
OR1
OR2
OR-Bend, Eugene, Medford, Salem (20 counties- Southern OR)
OR-Portland (16 counties- Northern OR)
2 OREGON- TOTAL
96
87
91
168,680
181,003
349,682
50,604
54,301
104,905
16,868
18,100
34,968
101,208
108,602
209,809
416
446
862
693
744
1,437
402
431
833
1,026
1,101
2,127
926,052
993,705
1,919,757
1,776
1,906
3,683
PA1
PA2
PA3
PA4
PA5
PA6
PA7
PA8
PA-Allentown, Scranton & Wilkes-Barre (9 counties- NE PA)
PA-Danville, Erie & Sayre (22 counties- North & West PA)
PA-Harrisburg, Altoona & Johnstown (15 counties- South Central PA)
PA-Lancaster, Reading & York (5 counties- SE PA)
PA-Philadelphia NW (3 counties- SE PA)
PA-Philadelphia (city of & county- SE PA)
PA-Pittsburgh (city of & west- 5 counties SW PA)
PA-Pittsburgh East (7 counties- SW PA)
8 PENNSYLVANIA- TOTAL
158
158
158
152
153
144
161
162
155
247,659
220,830
244,732
305,349
303,231
220,241
278,222
150,430
1,970,693
74,298
66,249
73,420
91,605
90,969
66,072
83,466
45,129
591,208
24,766 148,595
22,083 132,498
24,473 146,839
30,535 183,209
30,323 181,939
22,024 132,144
27,822 166,933
15,043
90,258
197,069 1,182,416
611
545
603
753
748
543
686
371
4,859
1,018
908
1,006
1,255
1,246
905
1,143
618
8,099
590
526
583
728
723
525
663
359
4,697
1,506 1,359,648
1,343 1,212,356
1,489 1,343,577
1,857 1,676,364
1,844 1,664,739
1,340 1,209,122
1,692 1,527,437
915
825,862
11,986 10,819,105
2,608
2,326
2,577
3,216
3,193
2,319
2,930
1,584
20,754
STATE/
CO-OP
SC1
SC2
SC3
TN1
TN2
TN3
TN4
TX1
TX2
TX3
TX4
TX5
TX6
TX7
TX8
TX9
TX10
TX11
TX12
TX13
TX14
UT1
UT2
$402B HOSPITAL IN-PATIENT COST (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
# In-Pat.
# In-Pat. TOTAL # Surgeries
Visits Discharges (30%)
per 1,000
est/ yr
est/ yr
# In-Pat.
MHSA
(10%)
est/ yr
# In-Pat. # Surg
# Surg
Other Beds/ICU Beds/rec.
(60%)
3 days
5 days
est/ yr ($1.15m) ($528k)
# MHSA
Beds
8.7 days
($430k)
# Other TOTAL #
Med. Beds IP Days
3.7 days 5.4 days
($740k)
est/ yr
TOTAL
IN-PAT.
COST
($Mils)
1 RHODE ISLAND- TOTAL (RI)
128
134,729
40,419
13,473
80,837
332
554
321
819
739,662
1,419
SC-Charleston & Florence (17 counties- SE SC)
SC-Columbia (20 counties- Central SC)
SC-Greenville & Spartanburg (9 counties- NW SC)
3 SOUTH CAROLINA- TOTAL
124
121
122
123
202,928
182,129
182,720
567,777
60,878
54,639
54,816
170,333
20,293
18,213
18,272
56,778
121,757
109,278
109,632
340,666
500
449
451
1,400
834
748
751
2,333
484
434
436
1,353
1,234
1,108
1,111
3,453
1,114,075
999,890
1,003,133
3,117,098
2,137
1,918
1,924
5,979
1 SOUTH DAKOTA- TOTAL (SD)
135
109,921
32,976
10,992
65,953
271
452
262
669
603,468
1,158
TN-Memphis & Jackson (20 counties- west TN)
TN-Nashville City Of & West (18 counties- central TN)
TN-Nashville East & Chattanooga (31 counties- central TN)
TN-Knoxville, Johnson City, Kingsport (26 counties- east TN)
4 TENNESSEE- TOTAL
139
136
145
151
143
215,111
195,751
233,802
263,231
907,894
64,533
58,725
70,141
78,969
272,368
21,511
19,575
23,380
26,323
90,789
129,067
117,450
140,281
157,938
544,737
530
483
576
649
2,239
884
804
961
1,082
3,731
513
467
557
627
2,164
1,308
1,191
1,422
1,601
5,522
1,180,962
1,074,671
1,283,572
1,445,136
4,984,340
2,265
2,061
2,462
2,772
9,561
117
107
117
108
105
110
107
111
108
116
110
114
114
121
111
136,068
238,725
194,463
226,414
208,702
125,983
254,188
162,541
97,310
186,338
241,573
310,097
225,187
193,086
2,800,675
40,820
71,617
58,339
67,924
62,611
37,795
76,257
48,762
29,193
55,901
72,472
93,029
67,556
57,926
840,203
13,607
81,641
23,872 143,235
19,446 116,678
22,641 135,848
20,870 125,221
12,598
75,590
25,419 152,513
16,254
97,524
9,731
58,386
18,634 111,803
24,157 144,944
31,010 186,058
22,519 135,112
19,309 115,852
280,068 1,680,405
336
589
479
558
515
311
627
401
240
459
596
765
555
476
6,906
559
981
799
930
858
518
1,045
668
400
766
993
1,274
925
794
11,510
324
569
464
540
497
300
606
387
232
444
576
739
537
460
6,676
828
747,011
1,452 1,310,600
1,183 1,067,604
1,377 1,243,013
1,269 1,145,775
766
691,645
1,546 1,395,494
989
892,349
592
534,231
1,133 1,022,997
1,469 1,326,236
1,886 1,702,432
1,370 1,236,278
1,174 1,060,042
17,034 15,375,707
1,433
2,514
2,048
2,384
2,198
1,327
2,677
1,712
1,025
1,962
2,544
3,266
2,371
2,033
29,495
88
89
88
157,533
85,916
243,449
47,260
25,775
73,035
15,753
8,592
24,345
388
212
600
647
353
1,000
375
205
580
TX-Amarillo, Lubbock & Witchita Falls (62 counties- TX panhandle)
TX-Austin & Temple (12 counties East TX)
TX-Houston East & Beaumont (19 counties- SE TX)
TX-Houston (city of- Harris County SE TX)
TX-Houston (Harris County excluding Houston)
TX-Houston West (10 counties- SE TX)
TX-Dallas (Dallas County- NE TX)
TX-Dallas East (12 counties- NE TX)
TX-Dallas NW (5 counties- NE TX)
TX-El Paso, Abilene, Odessa & San Angelo (44 counties- West TX)
TX-Fort Worth (7 counties- NE TX)
TX-San Antonio (29 counties- SW TX)
TX-Corpus Christi, Harlingen, McAllen & Victoria (20 counties- SW TX)
TX-Waco, Bryan, Tyler & Longview (32 counties- Central & NE TX)
14 TEXAS- TOTAL
UT-Salt Lake City NW & Ogden (8 counties- NW UT)
UT-Salt Lake City SE & Provo (21 counties- SE UT)
2 UTAH- TOTAL
94,520
51,549
146,069
958
523
1,481
864,857
471,677
1,336,534
1,659
905
2,564
STATE/
CO-OP
$402B HOSPITAL IN-PATIENT COST (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
1 VERMONT- TOTAL (VT)
# In-Pat.
MHSA
(10%)
est/ yr
# In-Pat. # Surg
# Surg
Other Beds/ICU Beds/rec.
(60%)
3 days
5 days
est/ yr ($1.15m) ($528k)
# MHSA
Beds
8.7 days
($430k)
# Other TOTAL #
Med. Beds IP Days
3.7 days 5.4 days
($740k)
est/ yr
TOTAL
IN-PAT.
COST
($Mils)
86
53,881
16,164
5,388
32,328
133
221
128
328
295,804
567
98
113
104
105
105
246,829
224,078
184,038
181,696
836,641
74,049
67,223
55,211
54,509
250,992
24,683
22,408
18,404
18,170
83,664
148,098
134,447
110,423
109,018
501,985
609
553
454
448
2,063
1,014
921
756
747
3,438
588
534
439
433
1,994
1,501
1,363
1,119
1,105
5,089
1,355,093
1,230,188
1,010,366
997,511
4,593,159
2,599
2,360
1,938
1,913
8,811
96
92
97
94
95
143,452
177,005
156,976
159,354
636,787
43,036
53,101
47,093
47,806
191,036
14,345
17,700
15,698
15,935
63,679
86,071
106,203
94,186
95,613
382,072
354
436
387
393
1,570
590
727
645
655
2,617
342
422
374
380
1,518
873
1,077
955
969
3,873
787,553
971,756
861,798
874,855
3,495,963
1,511
1,864
1,653
1,678
6,706
1 WEST VIRGINIA- TOTAL (WV)
164
303,101
90,930
30,310
181,860
747
1,246
722
1,844
1,664,023
3,192
WI-Appleton, Green Bay, Neenah & Wausau (20 counties- NE WI)
WI-Madison (14 counties- SE WI)
WI-Milwaukee (9 counties- SE WI)
WI-La Crosse & Marshfield (29 counties- NW WI)
4 WISCONSIN- TOTAL
115
111
111
116
113
141,245
127,779
247,635
124,933
641,592
42,374
38,334
74,291
37,480
192,478
14,125
12,778
24,764
12,493
64,159
84,747
76,667
148,581
74,960
384,955
348
315
611
308
1,582
580
525
1,018
513
2,637
337
305
590
298
1,529
859
777
1,506
760
3,902
775,436
701,507
1,359,518
685,880
3,522,341
1,487
1,346
2,608
1,316
6,757
96
54,097
16,229
5,410
32,458
133
222
129
329
296,994
570
38,203,374 11,461,012 3,820,337 22,922,024
94,200
157,000
91,060
VA1
VA2
VA3
VA4
VA-Arlington & Winchester (17 counties- Northeast VA & DC area)
VA-Charlottesville, Lynchburg, Roanoke (61 counties- Western VA)
VA-Norfolk & Newport News (19 counties- Southeast VA)
VA-Richmond (37 counties- Eastern VA)
4 VIRGINIA- TOTAL
WA1
WA2
WA3
WA4
WA-Spokane & Yakima (20 counties- eastern WA)
WA-Seattle City & King County (central WA)
WA-Seattle NW & Everett (10 counties- NW WA)
WA-Olympia & Tacoma (8 counties- SW WA)
4 WASHINGTON- TOTAL
WI1
WI2
WI3
WI4
# In-Pat.
# In-Pat. TOTAL # Surgeries
Visits Discharges (30%)
per 1,000
est/ yr
est/ yr
1 WYOMING- TOTAL (WY)
185 USA TOTAL
124
232,360 209,736,521 402,329
NOTE: "Other" Medical includes Births.
TOTAL IN-PATIENT @ RI Costs above
$108,330
$82,896
$39,156
$171,947
$402,329
"'* after Geographic COLA's see Appendices F thru J
TOTAL IN-PATIENT @ Local Costs (**)
$98,543
$75,407
$35,618
$156,411
$365,979
-9.0%
E45-54: $123B HOSPITAL OUT-PATIENT COST
ER VISITS & OP SURGERIES by CO-OP
EXPANDING THE RI MODEL NATIONALLY
185 BUYER CO-OP’s DEFINED
GEOGRAPHIC MARKETS WITHIN STATES
EACH, 1 to 2.5 MIL PEOPLE (1 to 2.5 RI’s)
(NEXT 9 SLIDES)
Each of the 185 CO-OP areas covers 1 or more “Hospital Referral Regions” as
defined by the Dartmouth Atlas of Health Care. Regional hospitals capable of
cardio and/or neuro surgery. (http://www.dartmouthatlas.org/data/region/)
In each of the 15,490 service areas the CO-OP would contract approx. 17 Primary
Care MDs, 7 Dentists and 4 Optometrists to service a population of approx. 20k.
BACK
Table of Contents
HOSPITAL OUT-PATIENT ER & SURGERY NOTES:
The number and type of hospital out-patient ER & Surgery visits depicted on the next 8 slides are based on the population by age In
each CO-OP area as listed in E13-21 and utilization rates E65-68. The following methods & assumptions apply:
ER Visits: The number of ER visits per 1,000 people in each state per the AHA Annual Survey Copyright 2012
(http://www.statehealthfacts.org/comparemaptable.jsp?ind=388&cat=8 at August 2012) was used to calculate the estimated total number
of ER visits in each state. This totaled 127 million ER visits or 411 per 1,000 people for the USA as a whole. This national total is
consistent with the RI experience (418/k) & The National Health Statistics Report #8. Since the AHA data exclude Federal, Rehab &
MHSA Hospitals, 9% was added to account for this activity at these facilities. Resulting in 138 million OP “ER” visits or 447 per 1,000
people. However ER usage rates vary widely by state & within states. DC, WV & ME had the highest rates (at 776/k, 711/k & 649/k)
with HI, CA & UT the lowest (at 292/k, 319/k & 328/k). WV, ME & DC are more than double the HI, CA or UT rate! Within each state,
the total number of ER visits for the state were apportioned to the individual CO-Ops (markets within states) using the % of the
state’s total poverty population that resides in each geographic CO-OP (appendix H). The poverty population is used as a proxy for:
low income, high un-insurance rates, densely populated urban areas, high concentration of minorities, children, crime & accidents.
All of which drive increased use of the ER. Although the +65 population used the ER 490/k (40% more than <65), the <1 population,
young minorities, urban areas and other groups have usage rates nearly 900/k or 2.5x the average. Since poverty is not the only
factor, no CO-OP was reported with a rate lower than HI’s 292k although 19 CO-Ops (10 in CA) with low poverty calculated lower.
Likewise, no CO-OP was reported higher than 735/k although the Bronx (NY2) & Philadelphia (PA6) with high concentration of the
state’s poverty population calculated above this rate. DC at 776 is an exception.
OP Surgery Visits: Per National Health Statistics Report #11 (http://www.cdc.gov/nchs/data/nhsr/nhsr011.pdf pg. 12)
There were 30.8 million procedures performed during 19.9 million visits to hospital based out-patient surgical facilities or 67 visits
per 1k people in 2006. Since these data exclude Federal, Rehab & MHSA Hospitals, 9% was added to account for this activity at
these facilities & 2% per year 2007-10 for population growth & aging. Resulting in 24 million OP “Surgery” visits or 79 per 1,000
people. This is consistent with the RI experience and this NHS report (revised Sept 2009). NOTE: The 17 mil visits to non-hospital
free standing surgi-centers referenced in the NHS report are included in MD fees & “non-durable/other costs”, not here.
Usage rates vary widely by state (FL 108, WV 105 vs CO 55, UT 54). The total number of OP Surgery visits in a state were
apportioned to CO-OP’s based on the +65 population at a 4:1 ratio. As an example, FL has a 108/k rate (+65 296 & <65 69) the Ocala
& Hudson area in Florida (CO-OP FL8) has the highest % +65 population at 26% (see E13-21). It’s estimated OP surgery rate is 127
per 1,000 people (after applying the +65 & <65 rates). Whereas Jacksonville (FL3) has just 12% +65 and an estimated OP surgery
rate of 97 per 1,000 people or 24% less (after applying rates). Fewer beds, less funding needed for hospital out-patient surgeries.
Each ER visit would be funded at $680 and Each OP Surgery at $1,200 (hosp cost plus $1,000 non-hosp MD). RI cost is presented
here (see B4) for uniformity & simplicity, geographic COLA’s are applied in appendices F,G,H & J. It’s not about billing the patient,
it’s about having the capability available to the community as agreed with the community
(CO-OP of patients) and allowing the Hospital to recover the cost thereof.
STATE/
CO-OP
AL1
AL2
AL3
AZ1
AZ2
AZ3
AZ4
AR1
AR2
CA1
CA2
CA3
CA4
CA5
CA6
CA7
CA8
CA9
CA10
CA11
CA12
CA13
CA14
CA15
CA16
CA17
CA18
CA19
CA20
CA21
$123B HOSPITAL OUT-PATIENT ER & SURG COST (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
# Out-Pat.
ER Visits
per 1,000
AL-Birmingham S & Tuscaloosa (28 counties- Central AL)
AL-Birmingham N & Huntsville (15 counties- Northern AL)
AL-Dothan, Mobile & Montgomery (23 counties- Southern AL)
3 ALABAMA-TOTAL
532
465
564
525
1 ALASKA-TOTAL (AK)
452
AZ-Mesa (Maricopa SE- Mesa, Chandler, Gilbert, Tempe)
AZ-Phoenix City of (Maricopa central)
AZ-Phoenix N & Sun City (Maricopa- Glendale, Scottsdale & North AZ)
AZ-Phoenix S & Tucson (Maricopa- Avondale, Goodyear & South AZ)
4 ARIZONA-TOTAL
307
440
355
402
380
AR-Little Rock (South & East AR, 43 counties)
AR-Fort Smith, Jonesboro, Springdale, Texarkana (N&W - 32 counties)
2 ARKANSAS-TOTAL
CA-Orange County N (Anaheim, Garden Grove, Hunt. Bch & North)
CA-Orange County S (Santa Ana, Costa Mesa & South)
CA-Bakersfield & Fresno (Kern, Tulare & Fresno, King, Madera)
CA-Alameda County
CA-LA Central LA, South LA, Northeast LA & Eastside
CA-LA Harbor, South Bay & Westside
CA-LA San Fern. Valley, NW, Antelope, Forest & Santa Monica Mtns.
CA-LA San Gabriel Valley, Pomona & Verdugos
CA-LA Southeast
CA-Modesto & Stockton (Merced, Stanislaus, San Joaquin, +4 more.)
CA-Napa, Chico, Redding & Santa Rosa (15 counties- north CA )
CA-Sacramento (11 counties)
CA-Palm Springs/Rancho Mirage (Riverside County)
CA-San Bernardino & Inyo Counties
CA-San Diego (City of)
CA-San Diego County (ex. City of, + Imperial County)
CA-San Francisco (SF & Marin Counties)
CA-San Jose (Santa Clara & San Benito Counties)
CA-Santa Cruz & San Mateo County
CA-Santa Barbara, San Luis Obispo, Salinas & Ventura
CA-Contra Costa & Solano Counties
21 CALIFORNIA-TOTAL
# Out-Pat.
ER Visits
est/ yr
State
Rank
COST
($mils)
ER Visits
($680/EA)
COST
# Out-Pat. # Out-Pat.
($mils)
Surg Visits Surg Visits OP Surg Visits
per 1,000
est/ yr
($1,200/EA)
13
1,065,842
574,007
871,329
2,511,178
725
390
593
1,708
99
102
101
100
197,978
125,778
155,505
479,261
238
151
187
575
28
321,273
218
70
49,546
59
40
361,839
636,738
605,862
827,148
2,431,587
246
433
412
562
1,653
55
51
67
59
59
64,986
74,321
114,297
122,324
375,928
78
89
137
147
451
513
513
513
17
825,462
671,541
1,497,003
561
457
1,018
102
101
101
163,509
131,558
295,068
196
158
354
292 min.
292 min.
402 *
292 min.
516 *
292 min.
309
292 min.
299 *
329 *
294 *
303
309 *
318 *
317
292 min.
292 min.
292 min.
292 min.
299
292 min.
319
412,217
467,808
1,010,285
441,154
1,083,690
648,122
659,593
628,943
361,922
523,493
454,963
750,301
676,105
653,433
414,952
573,616
308,545
537,241
286,003
578,531
426,881
50 11,897,796
280
318
687
300
737
441
449
428
246
356
309
510
460
444
282
390
210
365
194
393
290
8,091
57
57
54
56
54
58
55
58
54
56
61
58
57
53
55
57
60
56
58
57
57
57
81,030
90,708
135,672
84,576
112,610
128,466
117,633
125,770
65,367
88,988
94,766
143,169
124,634
109,325
72,528
112,457
63,730
102,766
57,098
111,017
83,793
2,106,102
97
109
163
101
135
154
141
151
78
107
114
172
150
131
87
135
76
123
69
133
101
2,527
STATE/
CO-OP
CO1
CO2
CO3
CO4
CT1
CT2
FL1
FL2
FL3
FL4
FL5
FL6
FL7
FL8
FL9
FL10
FL11
GA1
GA2
GA3
GA4
GA5
$123B HOSPITAL OUT-PATIENT ER & SURG COST (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
# Out-Pat.
ER Visits
per 1,000
COST
# Out-Pat. ($mils)
ER Visits ER Visits
est/ yr
($680/EA)
State
Rank
CO-Boulder, Fort Collins, Greeley (10 counties- NE CO.)
CO-Colorado Springs, Grand Junction & Pueblo (35 counties- S. CO.)
CO-Denver City of & East (7 counties)
CO-Denver West (12 counties)
4 COLORADO-TOTAL
381
365
390
292 min.
362
CT-Hartford (6 counties)
CT-New Haven & Bridgeport (2 counties SW CT.)
2 CONNECTICUT-TOTAL
COST
# Out-Pat. # Out-Pat.
($mils)
Surg Visits Surg Visits OP Surg Visits
per 1,000
est/ yr
($1,200/EA)
43
351,260
509,250
664,955
294,500
1,819,965
239
346
452
200
1,238
55
58
54
54
55
51,010
80,743
91,732
54,878
278,363
61
97
110
66
334
470
542
506
20
843,514
964,122
1,807,635
574
656
1,229
67
66
67
120,517
118,263
238,780
145
142
287
1 DC, Wash.- TOTAL (DC)
776
1
466,985
318
138
83,297
100
1 DELAWARE.- TOTAL (DE)
493
22
442,394
301
101
91,024
109
32
661,469
736,970
522,251
1,312,986
615,778
468,590
713,904
505,133
747,037
1,035,069
898,679
8,217,865
450
501
355
893
419
319
485
343
508
704
611
5,588
102
118
97
101
110
114
98
127
99
123
105
108
177,529
206,258
130,099
260,299
126,238
126,843
182,134
153,292
141,536
307,299
225,148
2,036,677
213
248
156
312
151
152
219
184
170
369
270
2,444
25
877,958
908,838
916,789
939,972
812,570
4,456,127
597
618
623
639
553
3,030
97
92
89
97
99
94
197,677
208,415
205,821
164,162
136,158
912,233
237
250
247
197
163
1,095
FL-Fort Lauderdale S. (Broward County)
FL-Fort Lauderdale N. (Martin, Palm Beach & St. Lucie Counties)
FL-Jacksonville (Baker, Clay, Duval, Nassau & St Johns Counties)
FL-Miami-Dade & Monroe Counties (Everglades & Keys)
FL- Gainesville & Ormond Beach (12 Counties)
FL-Orlando S. (Brevard, Hardee, Highlands, Indian., Okee., Osceola)
FL-Orlando N. (Orange, Lake & Seminole counties)
FL-Ocala & Hudson (Citrus, Hernando, Marion, Pasco, Sumter)
FL-Tallahassee, Panama City & Pensacola (19 Counties)
FL-Fort Meyers, Sarasota, Bradenton & Lakeland (9 Counties)
FL-Tampa, St. Petersburg & Clearwater (Hillborough & Pinellas)
11 FLORIDA.- TOTAL
GA-Atlanta North & Rome (36 Counties)
GA-Atlanta City of & West (Fulton, Cobb & West, 11 Counties)
GA-Atlanta East (DeKalb, Gwinnett & East 11 Counties)
GA-Savannah & Augusta (SE. GA 47 Counties)
GA-Macon, Columbus & Albany (SW. GA 54 Counties)
5 GEORGIA.- TOTAL
378
423
388
511
536
420
383
420
525
415
419
437
431
401
397
554
590
460
STATE/
CO-OP
IL1
IL2
IL3
IL4
IL5
IL6
IL7
IN1
IN2
IN3
IN4
IA1
IA2
KS1
KS2
KY1
KY2
LA1
LA2
$123B HOSPITAL OUT-PATIENT ER & SURG COST (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
# Out-Pat.
ER Visits
per 1,000
COST
# Out-Pat. ($mils)
ER Visits ER Visits
est/ yr
($680/EA)
State
Rank
COST
# Out-Pat. # Out-Pat.
($mils)
Surg Visits Surg Visits OP Surg Visits
per 1,000
est/ yr
($1,200/EA)
1 HAWAII.- TOTAL (HI)
292
51
397,371
270
60
81,550
98
1 IDAHO.- TOTAL (ID)
340
47
533,103
363
77
121,315
146
IL-Bloomington, Joliet & Urbana (East IL- 16 counties)
IL-Blue Island (Cook County- South)
IL-Chicago, city of (Cook County- East)
IL-Melrose Park, & Hinsdale (Cook-west, Dupage & Kane)
IL-Elgin & Evanston (NE. IL: Cook-north, Mchenry & Lake)
IL-Peoria, Rockford & Aurora (NW IL- 25 counties)
IL-Springfield (South IL: 56 counties)
7 ILLINOIS.- TOTAL
406
395
713
293
292 min.
436
522
456
26
619,797
346,815
1,920,767
599,443
589,625
726,794
1,042,652
5,845,893
421
236
1,306
408
401
494
709
3,975
78
83
76
78
81
84
86
81
119,454
72,592
205,798
160,235
163,048
140,748
171,424
1,033,298
143
87
247
192
196
169
206
1,240
IN-Evansville, Gary, Lafayette, Munster, Terre Haute (W IN- 27 counts.)
IN-Fort Wayne, Muncie, South Bend (Northeast IN- 20 counties)
IN-Indianapolis N. (City of, Marion, Hancock, Hendricks & N- 17 counts)
IN-Indianapolis S. (Morgan, Johnson, Shelby & Southeast- 28 counts.)
4 INDIANA.- TOTAL
543
541
545
500
535
12
896,407
855,534
1,117,224
600,901
3,470,066
610
582
760
409
2,360
82
82
80
82
81
135,926
129,851
162,961
98,898
527,636
163
156
196
119
633
IA-Des Moines, Mason City & Sioux City (West IA)
IA-Cedar Rapids, Davenport, Dubuque, Iowa City & Waterloo (E. IA)
2 IOWA.- TOTAL
423
456
437
33
733,146
598,385
1,331,531
499
407
905
85
84
85
147,739
110,655
258,394
177
133
310
KS-Wichita SE KS (1.1 mil, 28 Counties) & West KS (319k, 51 counts.)
KS-Topeka Northeast KS (26 counties)
2 KANSAS.- TOTAL
398
380
389
39
562,882
547,352
1,110,234
383
372
755
84
79
82
119,241
114,034
233,275
143
137
280
KY-Lexington & Covington (Eastern KY, 65 counties)
KY-Louisville, Owensboro & Paducah (Western KY, 55 counties)
2 KENTUCKY.- TOTAL
664
536
598
8
1,399,932
1,196,789
2,596,721
952
814
1,766
98
100
99
206,904
223,157
430,061
248
268
516
LA-Shreveport, Alexandria, Lafayette, Lake Charles, Monroe (41 counts)
LA-New Orleans, Baton Rouge, Metaire, Slidell & Houma (SE. LA- 23)
2 LOUISIANA.- TOTAL
645
566
603
7
1,346,456
1,386,125
2,732,581
916
943
1,858
99
96
97
205,889
234,342
440,231
247
281
528
STATE/
CO-OP
MD1
MD2
MD3
MA1
MA2
MA3
MA4
MI1
MI2
MI3
MI4
MI5
MN1
MN2
MN3
MS1
MS2
MO1
MO2
MO3
MO4
$123B HOSPITAL OUT-PATIENT ER & SURG COST (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
# Out-Pat.
ER Visits
per 1,000
1 MAINE.- TOTAL (ME)
649
MD-Baltimore & Salisbury (Eastern MD, 14 counties)
MD-Takoma Park NW/ DC Area (Northwest MD, 5 counties)
MD-Takoma Park SW/ DC Area (Southwest MD, 5 counties)
3 MARYLAND.- TOTAL
568
392
369
463
MA-Boston NE (Boston city of, Suffolk & Essex counties)
MA-Boston NW (Middlesex county)
MA-Boston South ( 6 counties including Cape & Islands)
MA-Springfield & Worcester (Western MA 5 counties)
4 MASSACHUSETTS.- TOTAL
711
376
418
621
524
MI-Ann Arbor, Kalamazoo & St. Joseph (South MI- 13 counties + Wayne)
MI-Detroit & Dearborn (Southeast MI- 2 counties + Wayne)
MI-Flint, Lansing & Saginaw (Northeast MI- 22 counties)
MI-Marquette, Muskegon, Petoskey, Traverse City & Grand Rapids (44)
MI-Pontiac & Royal Oak (Oakland County, east MI- NW of Detroit)
5 MICHIGAN.- TOTAL
459
607
559
480
314
502
MN-Minneapolis NW & St. Cloud (Northwest MN 37 counties)
MN-Minneapolis SW (City of & Southwest MN 31 counties)
MN-Duluth, Rochester & St. Paul (Eastern MN 19 counties)
3 MINNESOTA.- TOTAL
432
349
381
376
MS-Jackson & Oxford (West MS 47 counties)
MS-Gulfport, Hattiesburg, Meridian, Tupelo (East MS 35 counties)
2 MISSISSIPPI.- TOTAL
658
589
626
MO- Columbia, Joplin & Springfield (57 counties- Central & SW MO.)
MO-Kansas City (26 counties- NW MO.)
MO-St. Louis N. (City of & 6 counties- NE MO.)
MO-St. Louis S. & Cape Girardeau (26 counties- SE MO.)
4 MISSOURI.- TOTAL
633
471
424
581
522
COST
# Out-Pat. ($mils)
ER Visits ER Visits
est/ yr
($680/EA)
State
Rank
COST
# Out-Pat. # Out-Pat.
($mils)
Surg Visits Surg Visits OP Surg Visits
per 1,000
est/ yr
($1,200/EA)
3
861,509
586
83
110,041
132
24
1,462,039
570,741
641,818
2,674,598
994
388
436
1,819
99
98
93
97
255,901
142,983
161,499
560,383
307
172
194
672
15
1,041,973
564,879
817,510
1,008,494
3,432,856
709
384
556
686
2,334
64
65
69
66
66
94,264
98,351
134,476
107,707
434,798
113
118
161
129
522
21
949,150
1,528,014
1,037,375
1,073,923
377,968
4,966,430
645
1,039
705
730
257
3,377
82
82
84
84
82
83
170,063
205,944
156,211
188,651
98,351
819,220
204
247
187
226
118
983
41
432,957
833,912
727,672
1,994,541
294
567
495
1,356
86
79
81
81
86,229
189,169
153,951
429,348
103
227
185
515
4
1,038,948
817,571
1,856,519
706
556
1,262
97
99
98
153,152
137,778
290,930
184
165
349
16
1,118,603
702,169
755,771
550,336
3,126,879
761
477
514
374
2,126
86
82
82
83
83
151,194
121,980
146,417
79,083
498,673
181
146
176
95
598
STATE/
CO-OP
NV1
NV2
NJ1
NJ2
NJ3
NJ4
NJ5
NY1
NY2
NY3
NY4
NY5
NY6
NY7
NY8
NY9
NY10
NY11
$123B HOSPITAL OUT-PATIENT ER & SURG COST (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
# Out-Pat.
ER Visits
per 1,000
COST
# Out-Pat. ($mils)
ER Visits ER Visits
est/ yr ($680/EA)
State
Rank
COST
# Out-Pat. # Out-Pat.
($mils)
Surg Visits Surg Visits OP Surg Visits
per 1,000
est/ yr
($1,200/EA)
1 MONTANA.- TOTAL (MT)
393
38
389,325
265
81
79,806
96
1 NEBRASKA.- TOTAL (NE)
417
35
762,443
518
82
149,303
179
NV-Las Vegas (3 counties- SE NV)
NV-Reno (14 counties- NW NV)
2 NEVADA.- TOTAL
331
328
330
48
662,385
229,526
891,911
450
156
606
57
59
57
113,773
41,475
155,249
137
50
186
1 NEW HAMPSHIRE.- TOTAL (NH)
553
10
727,521
495
80
104,752
126
NJ-Camden N. (3 counties- South NJ)
NJ-Camden S. (6 counties- South NJ)
NJ-Hackensack, Patterson & Ridgewood (2 counties- NE NJ)
NJ-Morristown & New Brunswick (7 counties- NW NJ)
NJ-Newark (3 counties- NE NJ)
5 NEW JERSEY.- TOTAL
316
485
448
293
580
416
36
522,492
676,828
629,923
697,355
1,134,170
3,660,769
355
460
428
474
771
2,489
71
67
67
65
63
66
116,808
93,179
94,448
155,455
124,051
583,942
140
112
113
187
149
701
1 NEW MEXICO.- TOTAL (NM)
446
30
918,003
624
78
161,604
194
27
707,479
1,018,704
651,230
905,182
391,260
435,812
1,700,407
996,173
541,751
569,432
869,379
8,786,807
481
693
443
616
266
296
1,156
677
368
387
591
5,975
68
62
70
65
69
66
64
66
67
67
68
66
132,890
86,004
101,347
145,948
92,495
99,220
159,153
135,966
115,274
91,751
127,684
1,287,731
159
103
122
175
111
119
191
163
138
110
153
1,545
NY-Albany (18 counties NE NY)
NY-NYC Bronx County
NY-Buffalo (6 counties western NY)
NY-NYC East Long Island (Queens County)
NY-East Long Island (Nassau County)
NY-East Long Island (Suffolk County)
NY-NYC Manhattan (Kings County, Brooklyn- West Long Island)
NY-NYC Manhattan (NY & Richmond Counties- Staten Island)
NY-White Plains (Orange, Putnam, Rockland & Weschester counties.)
NY-Rochester (10 counties East of Buffalo area)
NY-Syracuse, Binghamton & Elmira (17 counts. East of Rochester)
11 NEW YORK.- TOTAL
362
735 max
448
406
292 min.
292 min.
679
485
313
418
466
453
STATE/
CO-OP
NC1
NC2
NC3
NC4
NC5
OH1
OH2
OH3
OH4
OH5
OH6
OH7
OK1
OK2
OR1
OR2
PA1
PA2
PA3
PA4
PA5
PA6
PA7
PA8
$123B HOSPITAL OUT-PATIENT ER & SURG COST (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
# Out-Pat.
ER Visits
per 1,000
COST
# Out-Pat. ($mils)
ER Visits ER Visits
est/ yr
($680/EA)
State
Rank
NC-Charlotte (10 counties- SW NC)
NC-Durham & Greensboro (19 counties- west of Raleigh)
NC-Greenville & Wilmington (29 counties- eastern & coastal NC)
NC-Raleigh (11 counties)
NC-Winston-Salem, Asheville & Hickory (31 counties- west NC)
5 NORTH CAROLINA.- TOTAL
432
544
562
437
476
486
1 NORTH DAKOTA.- TOTAL (ND)
571
OH-Akron, Canton, Youngstown (12 counties- NE OH)
OH-Cincinnati (7 counties- SW OH)
OH-Cleveland & Elyria (8 counties- NE OH)
OH-Columbus- North (15 counties- central OH)
OH-Columbus- City of & Southeast (20 counties- SE OH)
OH-Dayton & Kettering (15 counties- West OH)
OH-Toledo (11 counties- NW OH)
7 OHIO.- TOTAL
606
560
617
512
735
518
595
603
OK-Oklahoma City & Lawton (54 counties)
OK-Tulsa (23 counties- NE OK)
2 OKLAHOMA- TOTAL
510
513
511
OR-Bend, Eugene, Medford, Salem (20 counties- Southern OR)
OR-Portland (16 counties- Northern OR)
2 OREGON- TOTAL
398
307
349
PA-Allentown, Scranton & Wilkes-Barre (9 counties- NE PA)
PA-Danville, Erie & Sayre (22 counties- North & West PA)
PA-Harrisburg, Altoona & Johnstown (15 counties- South Central PA)
PA-Lancaster, Reading & York (5 counties- SE PA)
PA-Philadelphia NW (3 counties- SE PA)
PA-Philadelphia (city of & county- SE PA)
PA-Pittsburgh (city of & west- 5 counties SW PA)
PA-Pittsburgh East (7 counties- SW PA)
8 PENNSYLVANIA- TOTAL
532
691
513
423
292 min.
735 max
578
563
525
COST
# Out-Pat. # Out-Pat.
($mils)
Surg Visits Surg Visits OP Surg Visits
per 1,000
est/ yr
($1,200/EA)
23
853,590
1,071,103
832,628
875,539
1,002,719
4,635,580
580
728
566
595
682
3,152
94
99
101
93
105
98
185,987
194,283
150,287
185,651
222,083
938,292
223
233
180
223
266
1,126
9
384,157
261
84
56,451
68
6
1,212,772
855,481
1,428,473
552,229
1,488,316
840,137
576,450
6,953,859
825
582
971
376
1,012
571
392
4,729
86
81
86
83
79
84
83
83
172,869
123,763
197,997
89,914
160,117
136,449
80,473
961,583
207
149
238
108
192
164
97
1,154
19
1,132,725
785,003
1,917,728
770
534
1,304
99
101
100
219,968
153,821
373,788
264
185
449
44
702,004
634,274
1,336,279
477
431
909
63
57
60
111,793
118,840
230,633
134
143
277
14
836,383
968,245
792,522
851,536
580,099
1,121,452
1,000,756
522,583
6,673,576
569
658
539
579
394
763
681
355
4,538
68
68
68
65
66
62
69
69
67
106,316
94,800
105,045
131,241
130,299
94,817
119,364
64,523
846,405
128
114
126
157
156
114
143
77
1,016
STATE/
CO-OP
SC1
SC2
SC3
TN1
TN2
TN3
TN4
TX1
TX2
TX3
TX4
TX5
TX6
TX7
TX8
TX9
TX10
TX11
TX12
TX13
TX14
UT1
UT2
$123B HOSPITAL OUT-PATIENT ER & SURG COST (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
# Out-Pat.
ER Visits
per 1,000
1 RHODE ISLAND- TOTAL (RI)
512
SC-Charleston & Florence (17 counties- SE SC)
SC-Columbia (20 counties- Central SC)
SC-Greenville & Spartanburg (9 counties- NW SC)
3 SOUTH CAROLINA- TOTAL
COST
# Out-Pat. ($mils)
ER Visits ER Visits
est/ yr
($680/EA)
State
Rank
COST
# Out-Pat. # Out-Pat.
($mils)
Surg Visits Surg Visits OP Surg Visits
per 1,000
est/ yr
($1,200/EA)
18
539,230
367
86
90,637
109
326
322
293
342
46
532,364
482,837
437,163
1,452,364
362
328
297
988
101
99
100
100
165,321
148,342
148,835
462,498
198
178
179
555
1 SOUTH DAKOTA- TOTAL (SD)
347
45
282,211
192
84
68,334
82
TN-Memphis & Jackson (20 counties- west TN)
TN-Nashville City Of & West (18 counties- central TN)
TN-Nashville East & Chattanooga (31 counties- central TN)
TN-Knoxville, Johnson City, Kingsport (26 counties- east TN)
4 TENNESSEE- TOTAL
582
425
463
494
536
11
899,887
611,800
747,903
862,694
3,122,284
612
416
509
587
2,123
97
94
101
105
99
149,401
135,909
162,474
183,026
630,810
179
163
195
220
757
419
339
385
506
299
292 min.
451
292 min.
292 min.
487
341
454
709
480
421
485,820
754,531
642,824
1,063,008
596,088
335,068
1,067,737
427,024
262,734
785,711
750,442
1,236,113
1,406,596
766,046
34 10,579,743
330
513
437
723
405
228
726
290
179
534
510
841
956
521
7,194
79
71
78
72
70
73
71
74
72
77
73
76
76
81
74
91,079
158,882
130,101
150,740
138,675
83,968
169,179
108,424
64,793
124,605
161,009
207,163
150,420
129,463
1,868,500
109
191
156
181
166
101
203
130
78
150
193
249
181
155
2,242
529,754
377,049
906,803
360
256
617
54
55
54
96,597
52,757
149,354
116
63
179
TX-Amarillo, Lubbock & Witchita Falls (62 counties- TX panhandle)
TX-Austin & Temple (12 counties East TX)
TX-Houston East & Beaumont (19 counties- SE TX)
TX-Houston (city of- Harris County SE TX)
TX-Houston (Harris County excluding Houston)
TX-Houston West (10 counties- SE TX)
TX-Dallas (Dallas County- NE TX)
TX-Dallas East (12 counties- NE TX)
TX-Dallas NW (5 counties- NE TX)
TX-El Paso, Abilene, Odessa & San Angelo (44 counties- West TX)
TX-Fort Worth (7 counties- NE TX)
TX-San Antonio (29 counties- SW TX)
TX-Corpus Christi, Harlingen, McAllen & Victoria (20 counties- SW TX)
TX-Waco, Bryan, Tyler & Longview (32 counties- Central & NE TX)
14 TEXAS- TOTAL
UT-Salt Lake City NW & Ogden (8 counties- NW UT)
UT-Salt Lake City SE & Provo (21 counties- SE UT)
2 UTAH- TOTAL
294
391
328
49
STATE/
CO-OP
VA1
VA2
VA3
VA4
WA1
WA2
WA3
WA4
WI1
WI2
WI3
WI4
$123B HOSPITAL OUT-PATIENT ER & SURG COST (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
# Out-Pat.
ER Visits
per 1,000
COST
# Out-Pat. ($mils)
ER Visits ER Visits
est/ yr
($680/EA)
State
Rank
1 VERMONT- TOTAL (VT)
615
VA-Arlington & Winchester (17 counties- Northeast VA & DC area)
VA-Charlottesville, Lynchburg, Roanoke (61 counties- Western VA)
VA-Norfolk & Newport News (19 counties- Southeast VA)
VA-Richmond (37 counties- Eastern VA)
4 VIRGINIA- TOTAL
292 min.
608
458
458
443
WA-Spokane & Yakima (20 counties- eastern WA)
WA-Seattle City & King County (central WA)
WA-Seattle NW & Everett (10 counties- NW WA)
WA-Olympia & Tacoma (8 counties- SW WA)
4 WASHINGTON- TOTAL
COST
# Out-Pat. # Out-Pat.
($mils)
Surg Visits Surg Visits OP Surg Visits
per 1,000
est/ yr
($1,200/EA)
5
384,681
262
81
50,472
61
31
737,038
1,202,091
809,297
792,348
3,540,773
501
817
550
539
2,408
90
105
96
97
97
228,084
207,725
170,302
168,169
774,280
274
249
204
202
929
502
295
336
373
371
42
751,261
569,231
541,765
629,858
2,492,115
511
387
368
428
1,695
59
56
60
58
58
88,163
108,674
96,506
97,903
391,247
106
130
116
117
469
1 WEST VIRGINIA- TOTAL (WV)
711
2
1,316,886
895
105
193,897
233
WI-Appleton, Green Bay, Neenah & Wausau (20 counties- NE WI)
WI-Madison (14 counties- SE WI)
WI-Milwaukee (9 counties- SE WI)
WI-La Crosse & Marshfield (29 counties- NW WI)
4 WISCONSIN- TOTAL
350
400
456
417
414
37
428,286
459,129
1,019,647
448,487
2,355,550
291
312
693
305
1,602
85
81
81
85
83
103,569
93,575
181,319
91,628
470,091
124
112
218
110
564
1 WYOMING- TOTAL (WY)
447
29
251,884
171
77
43,619
52
138,063,118
$93,883
79 24,338,711
$29,206
185 USA TOTAL (@ RI Costs above)
447
$123 Bil
HOSP. OP-ER VISITS @ Local Costs ($mils)
HOSP. OP-Surg. VISITS @ Local Costs ($mils)
TOTAL
"'* after Geographic COLA's see Appendices F thru J
$85,182
$26,433
111,615
-9.3%
-9.5%
-9.3%
Non-Hosp Facilities
Total OP Surg Visits
54 16,639,655
133 40,978,366
19,968
$49,174
E55-64: $285B HOSPITAL OUT-PATIENT “OTHER”
MHSA, IMAGING, LAB & MISC by CO-OP
(NOT ER, NOT SURGERY)
EXPANDING THE RI MODEL NATIONALLY
185 BUYER CO-OP’s DEFINED
GEOGRAPHIC MARKETS WITHIN STATES
EACH, 1 to 2.5 MIL PEOPLE (1 to 2.5 RI’s)
(NEXT 9 SLIDES)
Each of the 185 CO-OP areas covers 1 or more “Hospital Referral Regions” as
defined by the Dartmouth Atlas of Health Care. Regional hospitals capable of cardio
and/or neuro surgery. (http://www.dartmouthatlas.org/data/region/)
In each of the 15,490 service areas the CO-OP would contract approx. 17 Primary Care
MDs, 7 Dentists and 4 Optometrists to service a population of approx. 20k.
BACK
Table of Contents
HOSPITAL OUT-PATIENT “OTHER” NOTES:
The number and type of hospital out-patient “other” visits (excludes OP-ER & OP-Surgeries) depicted on the next 8
slides are based on the population by age In each CO-OP area as listed in E13-21 and utilization rates in E65-68. The
following methods & assumptions apply:
The number of hospital out-patient visits per 1,000 people in each state per the AHA Annual Survey Copyright 2012
(http://www.statehealthfacts.org/comparemaptable.jsp?ind=392&cat=8&sub=217&yr=138&typ=1&sort=a&rgnhl=1
at August 2012) was used to calculate the estimated total number of OP “other” visits in each state. The total OP visits per
1,000 for the state less the OP-ER & OP-Surgery rate (E45-54) equals the OP-”Other” rate shown on the next 8 slides.
This totaled 501 million OP-”Other” visits or 1,623 per 1,000 people for the USA as a whole. This national total is
consistent with the RI experience (1,942/k) & The National Health Statistics Report. Since the AHA data excludes Federal,
Rehab & MHSA Hospitals, 9% was added to account for this activity at these facilities. Resulting in 546 million OP “other”
visits or 1,769 per 1,000 people. However OP-”Other” (not ER or Surgery) usage rates vary widely by state & within
states. VT, ND & ME had the highest rates (at 5,1428/k, 4,315/k & 4,166/k) with NV, FL & AZ the lowest (at 688/k, 857/k &
941/k). VT, ND & ME are 5 times the NV, FL or AZ rate!
Within each state, the total number of OP-”Other” visits for the state were apportioned to the individual CO-Ops (markets
within states) based on the +65 population at a 4:1 ratio. As an example, FL has a 857/1k rate (+65 2,300 & <65 554) the
Ocala & Hudson area in Florida (CO-OP FL8) has the highest % +65 population at 26% (see E13-21). Its estimated OP
“Other” rate is 1,006 per 1,000 people (applying +65 2,300 & <65 554). Whereas Jacksonville (FL3) has just 12% +65 and
an estimated OP “Other” rate of 766 per 1,000 people or 24% less (after applying the 2,300 & 554 to its population). Fewer
beds, less funding needed for hospital out-patient “other” visits.
The total OP “Other” visits were further detailed into four groups based on the RI experience. That is 2% of the visits are
estimated to be MHSA visits, 29% are estimated to be Imaging visits, 59% are Lab visits, and 10% are misc visits.
Each MHSA visit would be funded at $600, each Imaging visit at $900 hosp cost (plus $125 non-hosp MD), each Lab visit
$350 and each misc visit at $420. RI cost is presented here (see B5) for uniformity & simplicity, geographic COLA’s are
applied in appendices F thru J. It’s not about billing the patient, it’s about having the capability available to the
community as agreed with the community (CO-OP of patients) and allowing the Hospital to recover the cost thereof.
MUCH OF THIS ACTIVITY SHOULD BE DRIVEN BACK TO THE PRIMARY CARE OFFICE AT LESS THAN HALF THE COST.
THE CO-OP WOULD HEAVILY SCRUTINIZE OP (not ER or Surgery) BEFORE INCLUDING IN HOSPITAL FUNDING.
STATE/
CO-OP
AL1
AL2
AL3
AZ1
AZ2
AZ3
AZ4
AR1
AR2
CA1
CA2
CA3
CA4
CA5
CA6
CA7
CA8
CA9
CA10
CA11
CA12
CA13
CA14
CA15
CA16
CA17
CA18
CA19
CA20
CA21
$285B HOSPITAL OUT-PATIENT "OTHER" COST (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
# Out-Pat.
# Out-Pat.
Other Visits
Other Visits
per 1,000
no ER or Surg
(ex ER & Surg)
est/ yr
AL-Birmingham S & Tuscaloosa (28 counties- Central AL)
AL-Birmingham N & Huntsville (15 counties- Northern AL)
AL-Dothan, Mobile & Montgomery (23 counties- Southern AL)
3 ALABAMA-TOTAL
1,361
1,401
1,385
1,379
2,724,253
1,728,729
2,138,326
6,591,308
1 ALASKA-TOTAL (AK)
2,200
1,562,238
AZ-Mesa (Maricopa SE- Mesa, Chandler, Gilbert, Tempe)
AZ-Phoenix City of (Maricopa central)
AZ-Phoenix N & Sun City (Maricopa- Glendale, Scottsdale & North AZ)
AZ-Phoenix S & Tucson (Maricopa- Avondale, Goodyear & South AZ)
4 ARIZONA-TOTAL
883
826
1,067
951
941
1,042,104
1,194,416
1,822,892
1,957,147
6,016,559
AR-Little Rock (South & East AR, 43 counties)
AR-Fort Smith, Jonesboro, Springdale, Texarkana (N&W - 32 counties)
2 ARKANSAS-TOTAL
1,265
1,251
1,259
2,034,653
1,636,608
3,671,261
1,152
1,136
1,084
1,124
1,079
1,160
1,105
1,169
1,087
1,124
1,223
1,157
1,141
1,071
1,114
1,149
1,205
1,123
1,166
1,152
1,148
1,134
1,623,818
1,818,998
2,727,061
1,696,951
2,264,068
2,573,634
2,362,166
2,518,671
1,313,712
1,785,472
1,893,844
2,868,493
2,498,802
2,198,858
1,455,868
2,253,959
1,274,459
2,062,022
1,143,584
2,224,820
1,679,465
42,238,726
CA-Orange County N (Anaheim, Garden Grove, Hunt. Bch & North)
CA-Orange County S (Santa Ana, Costa Mesa & South)
CA-Bakersfield & Fresno (Kern, Tulare & Fresno, King, Madera)
CA-Alameda County
CA-LA Central LA, South LA, Northeast LA & Eastside
CA-LA Harbor, South Bay & Westside
CA-LA San Fern. Valley, NW, Antelope, Forest & Santa Monica Mtns.
CA-LA San Gabriel Valley, Pomona & Verdugos
CA-LA Southeast
CA-Modesto & Stockton (Merced, Stanislaus, San Joaquin, +4 more.)
CA-Napa, Chico, Redding & Santa Rosa (15 counties- north CA )
CA-Sacramento (11 counties)
CA-Palm Springs/Rancho Mirage (Riverside County)
CA-San Bernardino & Inyo Counties
CA-San Diego (City of)
CA-San Diego County (ex. City of, + Imperial County)
CA-San Francisco (SF & Marin Counties)
CA-San Jose (Santa Clara & San Benito Counties)
CA-Santa Cruz & San Mateo County
CA-Santa Barbara, San Luis Obispo, Salinas & Ventura
CA-Contra Costa & Solano Counties
21 CALIFORNIA-TOTAL
# Out-Pat. # Out-Pat. # Out-Pat. # Out-Pat.
MHSA
Imaging
Lab
Misc.
Visits (2%) Visits (29%) Visits (59%) Visits (10%)
($600/EA) ($900/EA) ($350/EA) ($420/EA)
State
Rank
TOTAL
OP OTHER
COST
($ Mils)
37
54,485
34,575
42,767
131,826
790,033
501,331
620,115
1,911,479
1,607,309
1,019,950
1,261,613
3,888,872
272,425
172,873
213,833
659,131
1,421
902
1,115
3,437
22
31,245
453,049
921,721
156,224
815
49
20,842
23,888
36,458
39,143
120,331
302,210
346,381
528,639
567,573
1,744,802
614,841
704,706
1,075,506
1,154,717
3,549,770
104,210
119,442
182,289
195,715
601,656
543
623
951
1,021
3,138
41
40,693
32,732
73,425
590,049
474,616
1,064,666
1,200,445
965,599
2,166,044
203,465
163,661
367,126
1,061
853
1,915
32,476
470,907
958,053
36,380
527,510 1,073,209
54,541
790,848 1,608,966
33,939
492,116 1,001,201
45,281
656,580 1,335,800
51,473
746,354 1,518,444
47,243
685,028 1,393,678
50,373
730,415 1,486,016
26,274
380,977
775,090
35,709
517,787 1,053,429
37,877
549,215 1,117,368
57,370
831,863 1,692,411
49,976
724,653 1,474,293
43,977
637,669 1,297,326
29,117
422,202
858,962
45,079
653,648 1,329,836
25,489
369,593
751,931
41,240
597,986 1,216,593
22,872
331,639
674,714
44,496
645,198 1,312,644
33,589
487,045
990,884
844,775 12,249,230 24,920,848
162,382
181,900
272,706
169,695
226,407
257,363
236,217
251,867
131,371
178,547
189,384
286,849
249,880
219,886
145,587
225,396
127,446
206,202
114,358
222,482
167,946
4,223,873
847
949
1,422
885
1,181
1,342
1,232
1,313
685
931
988
1,496
1,303
1,147
759
1,175
665
1,075
596
1,160
876
22,027
43
STATE/
CO-OP
CO1
CO2
CO3
CO4
CT1
CT2
FL1
FL2
FL3
FL4
FL5
FL6
FL7
FL8
FL9
FL10
FL11
GA1
GA2
GA3
GA4
GA5
$285B HOSPITAL OUT-PATIENT "OTHER" COST (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
# Out-Pat.
# Out-Pat.
Other Visits Other Visits
per 1,000
no ER or Surg
(ex ER & Surg)
est/ yr
CO-Boulder, Fort Collins, Greeley (10 counties- NE CO.)
CO-Colorado Springs, Grand Junction & Pueblo (35 counties- S. CO.)
CO-Denver City of & East (7 counties)
CO-Denver West (12 counties)
4 COLORADO-TOTAL
1,364
1,422
1,327
1,343
1,363
1,256,115
1,982,211
2,263,713
1,352,983
6,855,022
CT-Hartford (6 counties)
CT-New Haven & Bridgeport (2 counties SW CT.)
2 CONNECTICUT-TOTAL
1,957
1,937
1,947
1 DC, Wash.- TOTAL (DC)
1 DELAWARE.- TOTAL (DE)
FL-Fort Lauderdale S. (Broward County)
FL-Fort Lauderdale N. (Martin, Palm Beach & St. Lucie Counties)
FL-Jacksonville (Baker, Clay, Duval, Nassau & St Johns Counties)
FL-Miami-Dade & Monroe Counties (Everglades & Keys)
FL- Gainesville & Ormond Beach (12 Counties)
FL-Orlando S. (Brevard, Hardee, Highlands, Indian., Okee., Osceola)
FL-Orlando N. (Orange, Lake & Seminole counties)
FL-Ocala & Hudson (Citrus, Hernando, Marion, Pasco, Sumter)
FL-Tallahassee, Panama City & Pensacola (19 Counties)
FL-Fort Meyers, Sarasota, Bradenton & Lakeland (9 Counties)
FL-Tampa, St. Petersburg & Clearwater (Hillborough & Pinellas)
11 FLORIDA.- TOTAL
GA-Atlanta North & Rome (36 Counties)
GA-Atlanta City of & West (Fulton, Cobb & West, 11 Counties)
GA-Atlanta East (DeKalb, Gwinnett & East 11 Counties)
GA-Savannah & Augusta (SE. GA 47 Counties)
GA-Macon, Columbus & Albany (SW. GA 54 Counties)
5 GEORGIA.- TOTAL
# Out-Pat. # Out-Pat. # Out-Pat. # Out-Pat.
MHSA
Imaging
Lab
Misc.
Visits (2%) Visits (29%) Visits (59%) Visits (10%)
($600/EA) ($900/EA) ($350/EA) ($420/EA)
State
Rank
TOTAL
OP OTHER
COST
($ Mils)
38
25,122
39,644
45,274
27,060
137,100
364,273
574,841
656,477
392,365
1,987,956
741,108
1,169,505
1,335,591
798,260
4,044,463
125,612
198,221
226,371
135,298
685,502
655
1,034
1,181
706
3,575
3,511,871
3,445,985
6,957,856
25
70,237
68,920
139,157
1,018,443
999,336
2,017,778
2,072,004
2,033,131
4,105,135
351,187
344,598
695,786
1,831
1,797
3,629
3,267
1,965,560
7
39,311
570,012
1,159,680
196,556
1,025
1,571
1,410,648
32
28,213
409,088
832,282
141,065
736
805
935
766
803
870
899
774
1,006
788
975
831
857
1,406,341
1,630,922
1,031,284
2,062,093
999,036
1,003,432
1,443,579
1,211,140
1,121,518
2,428,749
1,782,819
16,120,913
50
28,127
32,618
20,626
41,242
19,981
20,069
28,872
24,223
22,430
48,575
35,656
322,418
407,839
472,967
299,072
598,007
289,720
290,995
418,638
351,231
325,240
704,337
517,018
4,675,065
829,741
962,244
608,457
1,216,635
589,431
592,025
851,711
714,573
661,695
1,432,962
1,051,863
9,511,339
140,634
163,092
103,128
206,209
99,904
100,343
144,358
121,114
112,152
242,875
178,282
1,612,091
733
851
538
1,075
521
523
753
632
585
1,267
930
8,407
1,081
1,024
994
1,078
1,102
1,049
2,202,287
2,322,328
2,293,648
1,828,910
1,516,817
10,163,990
45
44,046
46,447
45,873
36,578
30,336
203,280
638,663
673,475
665,158
530,384
439,877
2,947,557
1,299,349
1,370,173
1,353,252
1,079,057
894,922
5,996,754
220,229
232,233
229,365
182,891
151,682
1,016,399
1,148
1,211
1,196
954
791
5,301
STATE/
CO-OP
IL1
IL2
IL3
IL4
IL5
IL6
IL7
IN1
IN2
IN3
IN4
IA1
IA2
KS1
KS2
KY1
KY2
LA1
LA2
$285B HOSPITAL OUT-PATIENT "OTHER" COST (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
# Out-Pat.
# Out-Pat.
Other Visits
Other Visits
per 1,000
no ER or Surg
(ex ER & Surg)
est/ yr
# Out-Pat. # Out-Pat. # Out-Pat. # Out-Pat.
MHSA
Imaging
Lab
Misc.
Visits (2%) Visits (29%) Visits (59%) Visits (10%)
($600/EA) ($900/EA) ($350/EA) ($420/EA)
State
Rank
TOTAL
OP OTHER
COST
($ Mils)
1 HAWAII.- TOTAL (HI)
1,401
1,906,318
36
38,126
552,832
1,124,728
190,632
994
1 IDAHO.- TOTAL (ID)
1,776
2,783,892
29
55,678
807,329
1,642,496
278,389
1,452
IL-Bloomington, Joliet & Urbana (East IL- 16 counties)
IL-Blue Island (Cook County- South)
IL-Chicago, city of (Cook County- East)
IL-Melrose Park, & Hinsdale (Cook-west, Dupage & Kane)
IL-Elgin & Evanston (NE. IL: Cook-north, Mchenry & Lake)
IL-Peoria, Rockford & Aurora (NW IL- 25 counties)
IL-Springfield (South IL: 56 counties)
7 ILLINOIS.- TOTAL
2,163
2,286
2,113
2,163
2,235
2,332
2,370
2,226
3,304,459
2,005,799
5,695,896
4,432,588
4,507,323
3,887,499
4,733,296
28,566,858
19
66,089
40,116
113,918
88,652
90,146
77,750
94,666
571,337
958,293 1,949,631
581,682 1,183,421
1,651,810 3,360,578
1,285,450 2,615,227
1,307,124 2,659,320
1,127,375 2,293,624
1,372,656 2,792,644
8,284,389 16,854,446
330,446
200,580
569,590
443,259
450,732
388,750
473,330
2,856,686
1,723
1,046
2,970
2,312
2,351
2,027
2,468
14,898
IN-Evansville, Gary, Lafayette, Munster, Terre Haute (W IN- 27 counts.)
IN-Fort Wayne, Muncie, South Bend (Northeast IN- 20 counties)
IN-Indianapolis N. (City of, Marion, Hancock, Hendricks & N- 17 counts)
IN-Indianapolis S. (Morgan, Johnson, Shelby & Southeast- 28 counts.)
4 INDIANA.- TOTAL
2,559
2,552
2,471
2,555
2,529
4,223,378
4,034,687
5,064,222
3,072,908
16,395,195
14
84,468
80,694
101,284
61,458
327,904
1,224,779
1,170,059
1,468,625
891,143
4,754,606
2,491,793
2,380,465
2,987,891
1,813,016
9,673,165
422,338
403,469
506,422
307,291
1,639,519
2,202
2,104
2,641
1,603
8,550
IA-Des Moines, Mason City & Sioux City (West IA)
IA-Cedar Rapids, Davenport, Dubuque, Iowa City & Waterloo (E. IA)
2 IOWA.- TOTAL
3,434
3,400
3,419
5,954,881
4,460,770
10,415,651
4
119,098
89,215
208,313
1,726,915
1,293,623
3,020,539
3,513,380
2,631,855
6,145,234
595,488
446,077
1,041,565
3,105
2,326
5,432
KS-Wichita SE KS (1.1 mil, 28 Counties) & West KS (319k, 51 counts.)
KS-Topeka Northeast KS (26 counties)
2 KANSAS.- TOTAL
2,138
2,015
2,076
3,023,784
2,898,291
5,922,075
24
60,476
57,966
118,441
876,897
840,504
1,717,402
1,784,032
1,709,992
3,494,024
302,378
289,829
592,207
1,577
1,511
3,088
KY-Lexington & Covington (Eastern KY, 65 counties)
KY-Louisville, Owensboro & Paducah (Western KY, 55 counties)
2 KENTUCKY.- TOTAL
1,901
1,937
1,920
4,008,415
4,321,678
8,330,093
27
80,168
86,434
166,602
1,162,440
1,253,287
2,415,727
2,364,965
2,549,790
4,914,755
400,841
432,168
833,009
2,090
2,254
4,344
LA-Shreveport, Alexandria, Lafayette, Lake Charles, Monroe (41 counts)
LA-New Orleans, Baton Rouge, Metaire, Slidell & Houma (SE. LA- 23)
2 LOUISIANA.- TOTAL
2,299
2,234
2,264
4,796,700
5,467,335
10,264,036
18
95,934
109,347
205,281
1,391,043
1,585,527
2,976,570
2,830,053
3,225,728
6,055,781
479,670
546,734
1,026,404
2,501
2,851
5,353
STATE/
CO-OP
MD1
MD2
MD3
MA1
MA2
MA3
MA4
MI1
MI2
MI3
MI4
MI5
MN1
MN2
MN3
MS1
MS2
MO1
MO2
MO3
MO4
$285B HOSPITAL OUT-PATIENT "OTHER" COST (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
# Out-Pat.
# Out-Pat.
Other Visits Other Visits
per 1,000
no ER or Surg
(ex ER & Surg)
est/ yr
1 MAINE.- TOTAL (ME)
4,166
5,534,108
MD-Baltimore & Salisbury (Eastern MD, 14 counties)
MD-Takoma Park NW/ DC Area (Northwest MD, 5 counties)
MD-Takoma Park SW/ DC Area (Southwest MD, 5 counties)
3 MARYLAND.- TOTAL
1,041
1,027
971
1,017
2,680,780
1,497,836
1,691,652
5,870,269
MA-Boston NE (Boston city of, Suffolk & Essex counties)
MA-Boston NW (Middlesex county)
MA-Boston South ( 6 counties including Cape & Islands)
MA-Springfield & Worcester (Western MA 5 counties)
4 MASSACHUSETTS.- TOTAL
2,929
2,980
3,134
3,024
3,025
4,291,195
4,479,054
6,131,182
4,906,782
19,808,213
MI-Ann Arbor, Kalamazoo & St. Joseph (South MI- 13 counties + Wayne)
MI-Detroit & Dearborn (Southeast MI- 2 counties + Wayne)
MI-Flint, Lansing & Saginaw (Northeast MI- 22 counties)
MI-Marquette, Muskegon, Petoskey, Traverse City & Grand Rapids (44)
MI-Pontiac & Royal Oak (Oakland County, east MI- NW of Detroit)
5 MICHIGAN.- TOTAL
2,730
2,717
2,799
2,799
2,717
2,754
5,649,505
6,841,242
5,190,322
6,268,171
3,267,105
27,216,344
MN-Minneapolis NW & St. Cloud (Northwest MN 37 counties)
MN-Minneapolis SW (City of & Southwest MN 31 counties)
MN-Duluth, Rochester & St. Paul (Eastern MN 19 counties)
3 MINNESOTA.- TOTAL
1,927
1,773
1,805
1,814
1,928,970
4,241,083
3,449,824
9,619,877
949
970
959
1,498,416
1,347,533
2,845,949
3,077
2,940
2,954
3,000
2,994
5,436,618
4,385,963
5,264,647
2,843,586
17,930,813
MS-Jackson & Oxford (West MS 47 counties)
MS-Gulfport, Hattiesburg, Meridian, Tupelo (East MS 35 counties)
2 MISSISSIPPI.- TOTAL
MO- Columbia, Joplin & Springfield (57 counties- Central & SW MO.)
MO-Kansas City (26 counties- NW MO.)
MO-St. Louis N. (City of & 6 counties- NE MO.)
MO-St. Louis S. & Cape Girardeau (26 counties- SE MO.)
4 MISSOURI.- TOTAL
# Out-Pat. # Out-Pat. # Out-Pat. # Out-Pat.
MHSA
Imaging
Lab
Misc.
Visits (2%) Visits (29%) Visits (59%) Visits (10%)
($600/EA) ($900/EA) ($350/EA) ($420/EA)
State
Rank
TOTAL
OP OTHER
COST
($ Mils)
3
110,682
1,604,891
3,265,124
553,411
2,886
47
53,616
29,957
33,833
117,405
777,426
434,373
490,579
1,702,378
1,581,660
883,723
998,075
3,463,459
268,078
149,784
169,165
587,027
1,398
781
882
3,061
9
85,824
89,581
122,624
98,136
396,164
1,244,446 2,531,805
1,298,926 2,642,642
1,778,043 3,617,397
1,422,967 2,895,001
5,744,382 11,686,845
429,119
447,905
613,118
490,678
1,980,821
2,238
2,336
3,197
2,559
10,330
11
112,990
136,825
103,806
125,363
65,342
544,327
1,638,356 3,333,208
1,983,960 4,036,333
1,505,193 3,062,290
1,817,770 3,698,221
947,460 1,927,592
7,892,740 16,057,643
564,950
684,124
519,032
626,817
326,711
2,721,634
2,946
3,568
2,707
3,269
1,704
14,193
28
38,579
84,822
68,996
192,398
559,401
1,229,914
1,000,449
2,789,764
1,138,092
2,502,239
2,035,396
5,675,727
192,897
424,108
344,982
961,988
1,006
2,212
1,799
5,017
48
29,968
26,951
56,919
434,541
390,785
825,325
884,066
795,044
1,679,110
149,842
134,753
284,595
781
703
1,484
10
108,732
87,719
105,293
56,872
358,616
1,576,619 3,207,604
1,271,929 2,587,718
1,526,748 3,106,141
824,640 1,677,716
5,199,936 10,579,179
543,662
438,596
526,465
284,359
1,793,081
2,835
2,287
2,746
1,483
9,351
STATE/
CO-OP
NV1
NV2
NJ1
NJ2
NJ3
NJ4
NJ5
NY1
NY2
NY3
NY4
NY5
NY6
NY7
NY8
NY9
NY10
NY11
$285B HOSPITAL OUT-PATIENT "OTHER" COST (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
# Out-Pat.
# Out-Pat.
Other Visits Other Visits
per 1,000 no ER or Surg
(ex ER & Surg)
est/ yr
# Out-Pat. # Out-Pat. # Out-Pat. # Out-Pat.
MHSA
Imaging
Lab
Misc.
Visits (2%) Visits (29%) Visits (59%) Visits (10%)
($600/EA) ($900/EA) ($350/EA) ($420/EA)
State
Rank
TOTAL
OP OTHER
COST
($ Mils)
1 MONTANA.- TOTAL (MT)
3,380
3,344,396
5
66,888
969,875
1,973,193
334,440
1,744
1 NEBRASKA.- TOTAL (NE)
2,223
4,059,365
20
81,187
1,177,216
2,395,025
405,936
2,117
681
707
688
1,362,305
495,087
1,857,392
51
27,246
9,902
37,148
395,069
143,575
538,644
803,760
292,101
1,095,861
136,231
49,509
185,739
710
258
969
1 NEW HAMPSHIRE.- TOTAL (NH)
3,323
4,374,765
6
87,495
1,268,682
2,581,111
437,476
2,281
NJ-Camden N. (3 counties- South NJ)
NJ-Camden S. (6 counties- South NJ)
NJ-Hackensack, Patterson & Ridgewood (2 counties- NE NJ)
NJ-Morristown & New Brunswick (7 counties- NW NJ)
NJ-Newark (3 counties- NE NJ)
5 NEW JERSEY.- TOTAL
1,590
1,503
1,513
1,473
1,430
1,497
2,631,961
2,099,824
2,128,380
3,503,399
2,795,863
13,159,426
34
52,639
41,996
42,568
70,068
55,917
263,189
763,269
608,949
617,230
1,015,986
810,800
3,816,234
1,552,857
1,238,896
1,255,744
2,067,005
1,649,559
7,764,062
263,196
209,982
212,838
350,340
279,586
1,315,943
1,373
1,095
1,110
1,827
1,458
6,863
1 NEW MEXICO.- TOTAL (NM)
1,924
3,961,303
26
79,226
1,148,778
2,337,169
396,130
2,066
2,555
2,335
2,617
2,458
2,593
2,496
2,389
2,486
2,498
2,527
2,569
2,496
4,990,548
3,234,111
3,804,713
5,483,976
3,472,860
3,727,347
5,982,723
5,108,085
4,330,393
3,446,181
4,794,675
48,375,612
99,811 1,447,259 2,944,423
64,682
937,892 1,908,126
76,094 1,103,367 2,244,781
109,680 1,590,353 3,235,546
69,457 1,007,129 2,048,988
74,547 1,080,931 2,199,135
119,654 1,734,990 3,529,807
102,162 1,481,345 3,013,770
86,608 1,255,814 2,554,932
68,924
999,392 2,033,247
95,894 1,390,456 2,828,859
967,512 14,028,927 28,541,611
499,055
323,411
380,471
548,398
347,286
372,735
598,272
510,808
433,039
344,618
479,468
4,837,561
2,603
1,687
1,984
2,860
1,811
1,944
3,120
2,664
2,258
1,797
2,500
25,228
NV-Las Vegas (3 counties- SE NV)
NV-Reno (14 counties- NW NV)
2 NEVADA.- TOTAL
NY-Albany (18 counties NE NY)
NY-NYC Bronx County
NY-Buffalo (6 counties western NY)
NY-NYC East Long Island (Queens County)
NY-East Long Island (Nassau County)
NY-East Long Island (Suffolk County)
NY-NYC Manhattan (Kings County, Brooklyn- West Long Island)
NY-NYC Manhattan (NY & Richmond Counties- Staten Island)
NY-White Plains (Orange, Putnam, Rockland & Weschester counties.)
NY-Rochester (10 counties East of Buffalo area)
NY-Syracuse, Binghamton & Elmira (17 counts. East of Rochester)
11 NEW YORK.- TOTAL
15
STATE/
CO-OP
NC1
NC2
NC3
NC4
NC5
OH1
OH2
OH3
OH4
OH5
OH6
OH7
OK1
OK2
OR1
OR2
PA1
PA2
PA3
PA4
PA5
PA6
PA7
PA8
$285B HOSPITAL OUT-PATIENT "OTHER" COST (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
# Out-Pat.
# Out-Pat.
Other Visits
Other Visits
per 1,000
no ER or Surg
(ex ER & Surg)
est/ yr
NC-Charlotte (10 counties- SW NC)
NC-Durham & Greensboro (19 counties- west of Raleigh)
NC-Greenville & Wilmington (29 counties- eastern & coastal NC)
NC-Raleigh (11 counties)
NC-Winston-Salem, Asheville & Hickory (31 counties- west NC)
5 NORTH CAROLINA.- TOTAL
1,437
1,505
1,545
1,415
1,602
1,500
2,838,965
2,960,307
2,287,686
2,835,645
3,376,144
14,298,747
1 NORTH DAKOTA.- TOTAL (ND)
4,315
2,902,457
OH-Akron, Canton, Youngstown (12 counties- NE OH)
OH-Cincinnati (7 counties- SW OH)
OH-Cleveland & Elyria (8 counties- NE OH)
OH-Columbus- North (15 counties- central OH)
OH-Columbus- City of & Southeast (20 counties- SE OH)
OH-Dayton & Kettering (15 counties- West OH)
OH-Toledo (11 counties- NW OH)
7 OHIO.- TOTAL
2,790
2,620
2,760
2,693
2,558
2,714
2,684
2,692
5,578,777
4,000,194
6,391,340
2,904,170
5,178,339
4,406,342
2,599,421
31,058,583
OK-Oklahoma City & Lawton (54 counties)
OK-Tulsa (23 counties- NE OK)
2 OKLAHOMA- TOTAL
1,023
1,038
1,029
2,272,335
1,588,217
3,860,552
OR-Bend, Eugene, Medford, Salem (20 counties- Southern OR)
OR-Portland (16 counties- Northern OR)
2 OREGON- TOTAL
2,315
2,117
2,208
4,078,527
4,379,592
8,458,118
PA-Allentown, Scranton & Wilkes-Barre (9 counties- NE PA)
PA-Danville, Erie & Sayre (22 counties- North & West PA)
PA-Harrisburg, Altoona & Johnstown (15 counties- South Central PA)
PA-Lancaster, Reading & York (5 counties- SE PA)
PA-Philadelphia NW (3 counties- SE PA)
PA-Philadelphia (city of & county- SE PA)
PA-Pittsburgh (city of & west- 5 counties SW PA)
PA-Pittsburgh East (7 counties- SW PA)
8 PENNSYLVANIA- TOTAL
2,757
2,755
2,768
2,655
2,674
2,528
2,809
2,832
2,714
4,331,242
3,862,074
4,279,719
5,343,950
5,306,142
3,858,166
4,864,063
2,629,548
34,474,903
# Out-Pat. # Out-Pat. # Out-Pat. # Out-Pat.
MHSA
Imaging
Lab
Misc.
Visits (2%) Visits (29%) Visits (59%) Visits (10%)
($600/EA) ($900/EA) ($350/EA) ($420/EA)
State
Rank
TOTAL
OP OTHER
COST
($ Mils)
33
56,779
59,206
45,754
56,713
67,523
285,975
823,300
858,489
663,429
822,337
979,082
4,146,637
1,674,989
1,746,581
1,349,735
1,673,030
1,991,925
8,436,261
283,896
296,031
228,769
283,564
337,614
1,429,875
1,481
1,544
1,193
1,479
1,761
7,457
2
58,049
841,712
1,712,449
290,246
1,514
13
111,576
80,004
127,827
58,083
103,567
88,127
51,988
621,172
1,617,845 3,291,478
1,160,056 2,360,114
1,853,489 3,770,891
842,209 1,713,460
1,501,718 3,055,220
1,277,839 2,599,742
753,832 1,533,659
9,006,989 18,324,564
557,878
400,019
639,134
290,417
517,834
440,634
259,942
3,105,858
2,909
2,086
3,333
1,515
2,701
2,298
1,356
16,197
46
45,447
31,764
77,211
658,977
460,583
1,119,560
1,340,678
937,048
2,277,726
227,234
158,822
386,055
1,185
828
2,013
21
81,571
87,592
169,162
1,182,773
1,270,082
2,452,854
2,406,331
2,583,959
4,990,290
407,853
437,959
845,812
2,127
2,284
4,411
12
86,625
77,241
85,594
106,879
106,123
77,163
97,281
52,591
689,498
1,256,060 2,555,433
1,120,002 2,278,624
1,241,118 2,525,034
1,549,745 3,152,930
1,538,781 3,130,624
1,118,868 2,276,318
1,410,578 2,869,797
762,569 1,551,433
9,997,722 20,340,193
433,124
386,207
427,972
534,395
530,614
385,817
486,406
262,955
3,447,490
2,259
2,014
2,232
2,787
2,767
2,012
2,537
1,371
17,979
STATE/
CO-OP
SC1
SC2
SC3
TN1
TN2
TN3
TN4
TX1
TX2
TX3
TX4
TX5
TX6
TX7
TX8
TX9
TX10
TX11
TX12
TX13
TX14
UT1
UT2
$285B HOSPITAL OUT-PATIENT "OTHER" COST (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
# Out-Pat.
# Out-Pat.
Other Visits
Other Visits
per 1,000
no ER or Surg
(ex ER & Surg)
est/ yr
1 RHODE ISLAND- TOTAL (RI)
2,117
2,228,115
SC-Charleston & Florence (17 counties- SE SC)
SC-Columbia (20 counties- Central SC)
SC-Greenville & Spartanburg (9 counties- NW SC)
3 SOUTH CAROLINA- TOTAL
1,070
1,046
1,054
1,057
1 SOUTH DAKOTA- TOTAL (SD)
TN-Memphis & Jackson (20 counties- west TN)
TN-Nashville City Of & West (18 counties- central TN)
TN-Nashville East & Chattanooga (31 counties- central TN)
TN-Knoxville, Johnson City, Kingsport (26 counties- east TN)
4 TENNESSEE- TOTAL
TX-Amarillo, Lubbock & Witchita Falls (62 counties- TX panhandle)
TX-Austin & Temple (12 counties East TX)
TX-Houston East & Beaumont (19 counties- SE TX)
TX-Houston (city of- Harris County SE TX)
TX-Houston (Harris County excluding Houston)
TX-Houston West (10 counties- SE TX)
TX-Dallas (Dallas County- NE TX)
TX-Dallas East (12 counties- NE TX)
TX-Dallas NW (5 counties- NE TX)
TX-El Paso, Abilene, Odessa & San Angelo (44 counties- West TX)
TX-Fort Worth (7 counties- NE TX)
TX-San Antonio (29 counties- SW TX)
TX-Corpus Christi, Harlingen, McAllen & Victoria (20 counties- SW TX)
TX-Waco, Bryan, Tyler & Longview (32 counties- Central & NE TX)
14 TEXAS- TOTAL
UT-Salt Lake City NW & Ogden (8 counties- NW UT)
UT-Salt Lake City SE & Provo (21 counties- SE UT)
2 UTAH- TOTAL
# Out-Pat. # Out-Pat. # Out-Pat. # Out-Pat.
MHSA
Imaging
Lab
Misc.
Visits (2%) Visits (29%) Visits (59%) Visits (10%)
($600/EA) ($900/EA) ($350/EA) ($420/EA)
State
Rank
TOTAL
OP OTHER
COST
($ Mils)
23
44,562
646,153
1,314,588
222,811
1,162
1,747,212
1,568,840
1,573,691
4,889,743
44
34,944
31,377
31,474
97,795
506,692
454,964
456,370
1,418,025
1,030,855
925,616
928,477
2,884,948
174,721
156,884
157,369
488,974
911
818
821
2,550
2,296
1,869,673
17
37,393
542,205
1,103,107
186,967
975
1,288
1,260
1,340
1,395
1,324
1,991,647
1,812,655
2,164,152
2,435,958
8,404,412
40
39,833
36,253
43,283
48,719
168,088
577,578
525,670
627,604
706,428
2,437,279
1,175,072
1,069,466
1,276,850
1,437,215
4,958,603
199,165
181,265
216,415
243,596
840,441
1,039
945
1,129
1,270
4,383
1,222
1,114
1,212
1,120
1,087
1,140
1,115
1,155
1,122
1,202
1,140
1,183
1,181
1,259
1,158
1,415,873
2,479,184
2,023,168
2,351,610
2,166,178
1,308,993
2,639,799
1,689,325
1,010,730
1,938,313
2,510,008
3,224,585
2,341,545
2,010,363
29,109,676
42
28,317
49,584
40,463
47,032
43,324
26,180
52,796
33,787
20,215
38,766
50,200
64,492
46,831
40,207
582,194
410,603
835,365
718,963 1,462,719
586,719 1,193,669
681,967 1,387,450
628,192 1,278,045
379,608
772,306
765,542 1,557,482
489,904
996,702
293,112
596,331
562,111 1,143,605
727,902 1,480,905
935,130 1,902,505
679,048 1,381,511
583,005 1,186,114
8,441,806 17,174,709
141,587
247,918
202,317
235,161
216,618
130,899
263,980
168,933
101,073
193,831
251,001
322,459
234,154
201,036
2,910,968
738
1,293
1,055
1,226
1,130
683
1,377
881
527
1,011
1,309
1,682
1,221
1,048
15,181
1,756
1,789
1,768
3,161,240
1,724,568
4,885,808
30
63,225
34,491
97,716
316,124
172,457
488,581
1,649
899
2,548
916,760
500,125
1,416,884
1,865,131
1,017,495
2,882,627
STATE/
CO-OP
VA1
VA2
VA3
VA4
WA1
WA2
WA3
WA4
WI1
WI2
WI3
WI4
$285B HOSPITAL OUT-PATIENT "OTHER" COST (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
# Out-Pat.
# Out-Pat.
Other Visits Other Visits
per 1,000 no ER or Surg
(ex ER & Surg)
est/ yr
1 VERMONT- TOTAL (VT)
5,142
3,217,794
VA-Arlington & Winchester (17 counties- Northeast VA & DC area)
VA-Charlottesville, Lynchburg, Roanoke (61 counties- Western VA)
VA-Norfolk & Newport News (19 counties- Southeast VA)
VA-Richmond (37 counties- Eastern VA)
4 VIRGINIA- TOTAL
1,247
1,445
1,327
1,339
1,333
3,148,023
2,856,709
2,346,769
2,316,853
10,668,354
WA-Spokane & Yakima (20 counties- eastern WA)
WA-Seattle City & King County (central WA)
WA-Seattle NW & Everett (10 counties- NW WA)
WA-Olympia & Tacoma (8 counties- SW WA)
4 WASHINGTON- TOTAL
1,498
1,433
1,520
1,476
1,479
1 WEST VIRGINIA- TOTAL (WV)
# Out-Pat. # Out-Pat. # Out-Pat. # Out-Pat.
MHSA
Imaging
Lab
Misc.
Visits (2%) Visits (29%) Visits (59%) Visits (10%)
($600/EA) ($900/EA) ($350/EA) ($420/EA)
State
Rank
TOTAL
OP OTHER
COST
($ Mils)
1
64,356
933,160
1,898,498
321,779
1,678
39
62,960
57,134
46,935
46,337
213,367
912,927
828,446
680,563
671,887
3,093,823
1,857,333
1,685,459
1,384,594
1,366,943
6,294,329
314,802
285,671
234,677
231,685
1,066,835
1,642
1,490
1,224
1,208
5,564
2,239,451
2,767,158
2,449,464
2,488,872
9,944,945
35
44,789
55,343
48,989
49,777
198,899
649,441
802,476
710,345
721,773
2,884,034
1,321,276
1,632,623
1,445,184
1,468,435
5,867,518
223,945
276,716
244,946
248,887
994,495
1,168
1,443
1,277
1,298
5,186
3,097
5,738,284
8
114,766
1,664,102
3,385,587
573,828
2,993
WI-Appleton, Green Bay, Neenah & Wausau (20 counties- NE WI)
WI-Madison (14 counties- SE WI)
WI-Milwaukee (9 counties- SE WI)
WI-La Crosse & Marshfield (29 counties- NW WI)
4 WISCONSIN- TOTAL
2,353
2,268
2,258
2,368
2,301
2,881,008
2,606,034
5,050,414
2,548,327
13,085,784
16
57,620
52,121
101,008
50,967
261,716
835,492
755,750
1,464,620
739,015
3,794,877
1,699,795
1,537,560
2,979,744
1,503,513
7,720,612
288,101
260,603
505,041
254,833
1,308,578
1,502
1,359
2,634
1,329
6,824
1 WYOMING- TOTAL (WY)
1,597
899,908
31
17,998
260,973
530,946
89,991
469
1,769
546,091,885
10,921,838 158,366,647 322,194,212 54,609,188
$284,787
185 USA TOTAL OP OTHER VISITS
USA TOTAL OP OTHER @ RI costs above
$6,553
$142,530
$112,768
$22,936
$284,787
USA TOTAL OP OTHER @ Local Cost (after Geographic Colas append. F-J)
$5,994
$130,374
$103,150
$20,980
$260,499
-9%
E65-70 : HOSPITAL UTILIZATION RATES
BY STATE & REGION
EXPANDING THE RI MODEL NATIONALLY
185 BUYER CO-OP’s DEFINED
GEOGRAPHIC MARKETS WITHIN STATES
EACH, 1 to 2.5 MIL PEOPLE (1 to 2.5 RI’s)
(NEXT 4 SLIDES)
Each of the 185 CO-OP areas covers 1 or more “Hospital Referral Regions” as
defined by the Dartmouth Atlas of Health Care. Regional hospitals capable of cardio
and/or neuro surgery. (http://www.dartmouthatlas.org/data/region/)
In each of the 15,490 service areas the CO-OP would contract approx. 17 Primary Care
MDs, 7 Dentists and 4 Optometrists to service a population of approx. 20k.
BACK
Table of Contents
HOSPITAL UTILIZATION NOTES:
The number and type of hospital visits depicted on the next 2 slides are based on the population by age In each CO-OP
area as listed in E13-21. The following methods & assumptions apply:
The number of hospital visits per 1,000 people in each state per the AHA Annual Survey Copyright 2012
(http://www.statehealthfacts.org/comparemaptable.jsp?ind=392&cat=8&sub=217&yr=138&typ=1&sort=a&rgnhl=1
at August 2012) was used to calculate the estimated total number of In-Patient & Out Patient visits in each state. The total
OP visits per 1,000 for the state less the OP-ER & OP-Surgery rate (E45-54) equals the OP-”Other” rate.
Since the AHA data excludes Federal, Rehab & MHSA Hospitals, 9% was added to account for this activity at these
facilities. However Hospital usage rates vary widely by state & within states. For example VT, ND & ME had the highest
OP “other” rates (at 5,142/k, 4,315/k & 4,166/k) with NV, FL & AZ the lowest (at 688/k, 857/k & 941/k). VT, ND & ME are 5
times the NV, FL or AZ rate!
Within each state, the total number of IP & OP visits for the state were apportioned to the individual CO-Ops (markets
within states) based on the +65 population at a 4:1 ratio (consistent with the RI experience and national statistics). As an
example, FL has an 857/1k OP “other” rate (+65 2,300 & <65 554) the Ocala & Hudson area in Florida (CO-OP FL8) has the
highest % +65 population at 26% (see E13-21). Its estimated OP “Other” rate is 1,006 per 1,000 people (applying +65 2,300
& <65 554). Whereas Jacksonville (FL3) has just 12% +65 and an estimated OP “Other” rate of 766 per 1,000 people or
24% less (after applying the 2,300 & 554 rates to its population). Fewer beds, less funding needed for hospital out-patient
“other” visits.
ER VISITS: Within each state, the total number of ER visits for the state were apportioned to the individual CO-Ops
(markets within states) using the % of the state’s total poverty population that resides in each geographic CO-OP
(appendix H). The poverty population is used as a proxy for: low income, high un-insurance rates, densely populated
urban areas, high concentration of minorities, children, crime & accidents. All of which drive increased use of the ER.
Although the +65 population used the ER 490/k (40% more than <65), the <1 population, young minorities, urban areas
and other groups have usage rates nearly 900/k or 2.5x the average. Accordingly, +65 population was used to apportion
IP, OP Surgery & OP Other visits to CO-Ops within states and the poverty population was used to apportion ER visits.
MUCH OF THE OP “other” ACTIVITY SHOULD BE DRIVEN BACK TO THE PRIMARY CARE OFFICE AT LESS THAN HALF
THE COST. THE CO-OP WOULD HEAVILY SCRUTINIZE OP (not ER or Surgery) BEFORE INCLUDING IN HOSPITAL
FUNDING. SHRINK & FOCUS HOSPITALS IN MARKETS WITH SUFFICIENT POPULATIONS & ALTERNATIVES.
HOSPITAL UTILIZATION RATES BY STATE & REGION
(9% higher than AHA data at August 2012 to include Federal, ReHab & MHSA hospitals)
STATE
IP
State
Rank
OP
IP
OP
State Total Total
Rank rate/1k rate/1k
OP
ER
rate/1k
OP
Surg.
rate/1k
OP
Other
rate/1k
POP
IP
IP
OP
OP
OP
OP
Total Total Surg. Surg. Other Other
un+65
<65
+65
<65
+65
<65
insured Poverty rate/1k rate/1k rate/1k rate/1k rate/1k rate/1k
Illinois
Indiana
Iowa
Kansas
Michigan
Minnesota
Missouri
Nebraska
North Dakota
Ohio
South Dakota
Wisconsin
Midwest Total
20
30
27
33
18
28
7
22
5
10
16
34
18
14
6
25
12
28
10
20
2
11
19
17
131
121
122
116
133
121
149
124
153
143
135
113
131
2,763
3,145
3,942
2,547
3,338
2,271
3,599
2,722
4,970
3,379
2,727
2,797
3,095
456
535
437
389
502
376
522
417
571
603
347
414
487
81
81
85
82
83
81
83
82
84
83
84
83
82
2,226
2,529
3,419
2,076
2,754
1,814
2,994
2,223
4,315
2,692
2,296
2,301
2,526
12,830,632
6,483,802
3,046,355
2,853,118
9,883,640
5,303,925
5,988,927
1,826,341
672,591
11,536,504
814,180
5,686,986
66,927,001
15%
14%
12%
13%
13%
9%
14%
12%
12%
14%
13%
9%
13%
13.3%
14.4%
11.8%
13.2%
16.1%
10.9%
14.6%
12.2%
11.7%
15.1%
14.2%
12.4%
13.9%
390
350
340
335
380
350
430
355
427
405
380
320
373
94
87
84
83
94
87
103
88
106
100
94
80
93
238
238
244
238
238
236
238
234
235
238
240
239
239
58 6,605
58 7,420
57 9,650
58 6,000
58 7,995
58 5,220
58 8,500
58 6,340
58 12,070
58 7,600
58 6,470
58 6,570
58 7,316
1,600
1,800
2,331
1,480
1,915
1,310
2,097
1,580
3,000
1,890
1,600
1,625
1,780
Connecticut
Maine
Massachusetts
New Hampshire
New Jersey
New York
Pennsylvania
Rhode Island
Vermont
Northeast Total
24
31
15
40
19
13
3
21
51
26
3
9
5
35
15
13
22
1
124
120
137
99
132
141
155
128
86
139
2,519
4,898
3,616
3,955
1,979
3,016
3,306
2,715
5,838
3,050
506
649
524
553
416
453
525
512
615
486
67
83
66
80
66
66
67
86
81
68
1,947
4,166
3,025
3,323
1,497
2,496
2,714
2,117
5,142
2,497
3,574,097
1,328,361
6,547,629
1,316,470
8,791,894
19,378,102
12,702,379
1,052,567
625,741
55,317,240
11%
10%
5%
10%
15%
15%
11%
12%
9%
12%
9.3%
12.6%
10.3%
8.6%
9.4%
14.2%
12.5%
12.0%
11.5%
12.0%
350
330
395
281
380
400
430
360
244
392
87
80
96
71
93
100
105
89
59
97
192
230
187
231
191
191
185
240
225
193
46 5,500
55 11,310
47 8,700
56 9,490
47 4,300
47 7,179
45 7,425
60 5,915
56 14,455
47 7,095
1,360
2,815
2,118
2,360
1,060
1,765
1,855
1,478
3,550
1,742
STATE
IP
State
Rank
OP
State
Rank
IP
Total
rate/1k
OP
Total
rate/1k
OP
ER
rate/1k
OP
Surg.
rate/1k
OP
Other
rate/1k
POP
IP
Total
un+65
insured Poverty rate/1k
IP
Total
<65
rate/1k
OP
Surg.
+65
rate/1k
OP
Surg.
<65
rate/1k
OP
Other
+65
rate/1k
OP
Other
<65
rate/1k
Alabama
Arkansas
DC, Washington
Delaware
Florida
Georgia
Kentucky
Louisiana
Maryland
Mississippi
North Carolina
Oklahoma
South Carolina
Tennessee
Texas
Virginia
West Virginia
South Total
9
14
1
25
12
36
4
6
17
8
32
23
26
11
35
38
2
34
38
4
30
49
45
23
16
46
42
33
44
48
36
43
39
7
146
138
238
123
142
108
153
150
133
148
118
124
123
143
111
105
164
128
2,005
1,874
4,182
2,165
1,402
1,604
2,618
2,964
1,577
1,683
2,085
1,640
1,499
1,960
1,652
1,872
3,912
1,829
525
513
776
493
437
460
598
603
463
626
486
511
342
536
421
443
711
475
100
101
138
101
108
94
99
97
97
98
98
100
100
99
74
97
105
95
1,379
1,259
3,267
1,571
857
1,049
1,920
2,264
1,017
959
1,500
1,029
1,057
1,324
1,158
1,333
3,097
1,259
4,779,736
2,915,918
601,723
897,934
18,801,310
9,687,653
4,339,367
4,533,372
5,773,552
2,967,297
9,535,483
3,751,351
4,625,364
6,346,105
25,145,561
8,001,024
1,852,994
114,555,744
16%
19%
12%
12%
21%
20%
15%
17%
13%
19%
18%
18%
19%
15%
25%
13%
14%
19%
17.5%
18.5%
17.6%
11.2%
15.0%
16.6%
18.4%
17.6%
9.2%
21.8%
16.2%
16.1%
17.1%
17.2%
17.1%
10.6%
17.8%
16.0%
415
395
708
350
375
330
440
440
395
435
340
355
355
415
340
310
445
366
103
95
178
85
93
81
109
109
96
106
85
88
86
101
85
76
110
92
296
292
420
294
296
295
295
290
289
282
290
283
290
289
233
282
281
274
69
69
102
69
69
70
69
70
70
71
70
71
70
70
56
71
71
68
3,980
3,510
9,730
4,430
2,300
3,200
5,595
6,650
3,000
2,800
4,345
2,945
3,000
3,803
3,565
3,920
8,400
3,616
964
880
2,435
1,090
554
790
1,355
1,649
738
689
1,077
730
750
941
880
973
2,087
906
Alaska
Arizona
California
Colorado
Hawaii
Idaho
Montana
Nevada
New Mexico
Oregon
Utah
Washington
Wyoming
West Total
50
29
39
43
48
47
37
42
41
46
49
45
44
21
50
47
40
41
29
8
51
27
24
31
37
32
87
121
100
97
88
91
107
97
98
91
88
95
96
100
2,722
1,381
1,510
1,781
1,754
2,193
3,855
1,076
2,448
2,616
2,150
1,908
2,121
1,717
452
380
319
362
292
340
393
330
446
349
328
371
447
342
70
59
57
55
60
77
81
57
78
60
54
58
77
59
2,200
941
1,134
1,363
1,401
1,776
3,380
688
1,924
2,208
1,768
1,479
1,597
1,316
710,231
6,392,017
37,253,956
5,029,196
1,360,301
1,567,582
989,415
2,700,551
2,059,179
3,831,074
2,763,885
6,724,540
563,626
71,945,553
16%
19%
19%
14%
8%
17%
17%
21%
21%
17%
14%
13%
16%
18%
9.1%
16.5%
14.2%
12.6%
10.4%
14.4%
15.0%
12.4%
18.2%
14.3%
11.7%
12.3%
10.2%
13.9%
285
340
300
295
246
269
298
290
283
260
280
285
280
295
71
85
74
73
62
66
74
71
70
64
69
68
70
73
225
168
170
172
168
228
223
171
200
173
175
174
229
175
57
41
42
41
42
56
56
42
60
42
42
42
56
43
7,230
2,695
3,400
4,100
3,955
5,210
9,370
2,100
5,570
6,280
5,600
4,325
4,685
3,915
1,780
655
842
1,027
975
1,290
2,340
495
1,370
1,550
1,387
1,080
1,160
966
124
2,296
79
1,769
308,745,538
16%
13.8%
356
89
USA Total
447
231
56
5,182
1,257
[----- BEDS STAFFED 2010 -------]
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
DC, Washington
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
POP
4,779,736
710,231
6,392,017
2,915,918
37,253,956
5,029,196
3,574,097
601,723
897,934
18,801,310
9,687,653
1,360,301
1,567,582
12,830,632
6,483,802
3,046,355
2,853,118
4,339,367
4,533,372
1,328,361
5,773,552
6,547,629
9,883,640
5,303,925
2,967,297
5,988,927
989,415
1,826,341
2,700,551
1,316,470
8,791,894
2,059,179
19,378,102
Beds
per 1k
# beds
3.2
2.2
2.1
3.2
1.9
2.0
2.3
5.7
2.4
2.8
2.6
2.3
2.1
2.6
2.7
3.3
3.5
3.3
3.4
2.7
2.0
2.4
2.6
2.9
4.4
3.1
3.7
4.0
1.9
2.2
2.4
1.9
3.1
15,068
1,535
13,340
9,433
70,260
10,168
8,084
3,442
2,151
53,199
25,448
3,140
3,368
33,277
17,740
10,063
9,944
14,215
15,384
3,573
11,657
15,671
25,639
15,327
12,913
18,722
3,686
7,230
5,184
2,850
21,073
3,962
59,466
[---BEDS USED 2010 +9%---]
IP
# beds
Admissions
(5.4 days)
per 1k
E35-44
146
87
121
138
100
97
124
238
123
142
108
88
91
131
121
122
116
153
150
120
133
137
133
121
148
149
107
124
97
99
132
98
141
10,493
930
11,607
6,062
55,909
7,359
6,682
2,154
1,661
40,131
15,703
1,808
2,149
25,284
11,811
5,592
4,987
9,994
10,208
2,392
11,540
13,514
19,841
9,645
6,608
13,404
1,595
3,406
3,953
1,966
17,416
3,041
40,958
# beds
Reduced
from CO-OP
activity
<112
<112
<112
<112
<112
<112
<112
<112
(4,576)
(605)
(1,733)
(3,371)
(14,351)
(2,809)
(1,402)
(1,288)
(489)
(13,068)
(9,745)
(1,332)
(1,219)
(7,993)
(5,929)
(4,471)
(4,957)
(4,222)
(5,176)
(1,181)
(117)
(2,157)
(5,798)
(5,682)
(6,305)
(5,318)
(2,091)
(3,824)
(1,231)
(884)
(3,657)
(921)
(18,508)
-30.4%
-39.4%
-13.0%
-35.7%
-20.4%
-27.6%
-17.3%
-37.4%
-22.8%
-24.6%
-38.3%
-42.4%
-36.2%
-24.0%
-33.4%
-44.4%
-49.8%
-29.7%
-33.6%
-33.1%
-1.0%
-13.8%
-22.6%
-37.1%
-48.8%
-28.4%
-56.7%
-52.9%
-23.8%
-31.0%
-17.4%
-23.2%
-31.1%
[----- BEDS STAFFED 2010 -------]
State
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Total
[---BEDS USED 2010 +9%---]
IP
# beds
Admissions
(5.4 days)
per 1k
E35-44
Beds
per 1k
# beds
9,535,483
672,591
11,536,504
3,751,351
3,831,074
12,702,379
1,052,567
4,625,364
814,180
6,346,105
25,145,561
2,763,885
625,741
8,001,024
6,724,540
1,852,994
5,686,986
563,626
2.4
5.0
3.0
3.0
1.7
3.1
2.4
2.7
5.0
3.3
2.4
1.8
2.1
2.2
1.7
3.9
2.4
3.5
22,949
3,336
34,317
11,139
6,407
39,866
2,478
12,465
4,097
20,795
61,086
5,063
1,288
17,695
11,503
7,294
13,510
1,955
118
153
143
124
91
155
128
123
135
143
111
88
86
105
95
164
113
96
308,745,538
2.6
803,457
124
POP
16,925
1,544
24,790
7,000
5,260
29,641
2,026
8,540
1,653
13,656
42,125
3,662
810
12,584
9,578
4,559
9,650
814
574,621
# beds
Reduced
from CO-OP
activity
<112
<112
<112
<112
<112
(6,024)
(1,792)
(9,527)
(4,139)
(1,147)
(10,225)
(452)
(3,925)
(2,443)
(7,139)
(18,961)
(1,401)
(477)
(5,111)
(1,925)
(2,735)
(3,860)
(1,141)
-26.3%
-53.7%
-27.8%
-37.2%
-17.9%
-25.6%
-18.2%
-31.5%
-59.6%
-34.3%
-31.0%
-27.7%
-37.1%
-28.9%
-16.7%
-37.5%
-28.6%
-58.4%
(228,836)
-28.5%
Beds Staffed: http://www.statehealthfacts.org/comparemaptable.jsp?ind=384&cat=8
Beds Used: http://www.statehealthfacts.org/comparemaptable.jsp?ind=386&cat=8
Data include staffed beds for community hospitals, which represent 85% of all hospitals. Federal hospitals, long term care hospitals,
psychiatric hospitals, institutions for the mentally retarded, and alcoholism and other chemical dependency hospitals are not included.
Community Hospitals:&nbsp;All nonfederal, short-term general, and specialty hospitals whose facilities and services are available to the public.
Annual Survey Copyright 2012 by Health Forum LLC, an affiliate of the American Hospital Association, special data request, April 2012.
Available at http://www.ahaonlinestore.comPopulation data from Annual Population Estimates by State, U.S. Census Bureau.
NOTE: "<112" states with low IP utilization (< -10% of Nat'l Avg). These may see an increase with 100% financial access. 6k fewer excess beds than shown.
E71-80: $209B LONG TERM CARE
NURSING HOME & HOME CARE by CO-OP
EXPANDING THE RI MODEL NATIONALLY
185 BUYER CO-OP’s DEFINED
GEOGRAPHIC MARKETS WITHIN STATES
EACH, 1 to 2.5 MIL PEOPLE (1 to 2.5 RI’s)
(NEXT 9 SLIDES)
Each of the 185 CO-OP areas covers 1 or more “Hospital Referral Regions” as
defined by the Dartmouth Atlas of Health Care. Regional hospitals capable of
cardio and/or neuro surgery. (http://www.dartmouthatlas.org/data/region/)
In each of the 15,490 service areas the CO-OP would contract approx. 17 Primary
Care MDs, 7 Dentists and 4 Optometrists to service a population of approx. 20k.
BACK
Table of Contents
NURSING HOME & HOME CARE NOTES:
The number and type of Nursing Home Beds & Home Care Days depicted on the next 8 slides are based on the
population by age In each CO-OP area as listed in E13-21. The following methods & assumptions apply:
NURSING HOME BEDS: The number of certified nursing home beds in each state (2009) came from Table 2
"Nursing, Facilities, Staffing, Residents, and Facility Deficiencies, 2005 Through 2010," Department of Social and
Behavioral Sciences, University of California, San Francisco, accessed January 2012. Available at
http://www.pascenter.org. Based on the Online Survey, Certification, and Reporting system (OSCAR), Centers for
Medicare and Medicaid Services, U.S. Department of Health and Human Services and posted on
www.statehealthfacts.org December 2012. This total for each state was apportioned to individual CO-Ops (markets
within states) based on the +65 population in each area. For example, there are 26,662 certified nursing home beds in
Alabama. That’s 41 beds per 1,000 people +65. Therefore, CO-OP AL1 would be funded for 10,667 beds, AL2: 7,261 beds
and AL3: 8,734 beds based on the +65 population in each area (E13-21) and the state’s ratio of 41 beds per 1,000 +65.
Each bed is funded at $81k per year. RI cost is presented here for uniformity & simplicity, geographic COLA’s are applied
in appendices F thru J. It’s not about billing the patient, it’s about having the capability available to the community as
agreed with the community (CO-OP of patients) and allowing the Nursing Facility to recover the cost thereof.
HOME CARE DAYS: The following two data sources were used.
(A) Percent of total health care dollars spent on Home care in each state per: Distribution of Health Care
Expenditures by Service by State of Residence (in millions), 2009. Centers for Medicare & Medicaid Services (2011).
Health Expenditures by State of Residence. Retrieved (December 2011) at
/www.cms.gov/NationalHealthExpendData/downloads/resident-state-estimates.zip and posted on
www.statehealthfacts.org December 2012.
(B) Total Health Spending in each state per: Centers for Medicare & Medicaid Services (2011). Health Expenditures
by State of Residence. Retrieved (December 2011) at http://www.cms.gov/NationalHealthExpendData/downloads/residentstate-estimates.zip and posted on www.statehealthfacts.org December 2012.
(A) X (B) = total spending in each state on Home Care. Divide this by the health COLA vs RI (appendix H) and this yields
total home care spending in each state at a constant RI cost. Divide this by the cost of one home care day in RI ($67) and
this yields the estimated total number of home care days in each state. Apportion to CO-Ops based on +65 population.
Example: Alabama 3.1% x $29.5b / .80 = $1.173b / $67= 17.5 mil Home Care Days, or 27 days per person +65.
STATE/
CO-OP
AL1
AL2
AL3
AZ1
AZ2
AZ3
AZ4
AR1
AR2
CA1
CA2
CA3
CA4
CA5
CA6
CA7
CA8
CA9
CA10
CA11
CA12
CA13
CA14
CA15
CA16
CA17
CA18
CA19
CA20
CA21
$209B NURSING HOME & HOME CARE (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
# Nursing
Home Beds
per 1k +65
AL-Birmingham S & Tuscaloosa (28 counties- Central AL)
AL-Birmingham N & Huntsville (15 counties- Northern AL)
AL-Dothan, Mobile & Montgomery (23 counties- Southern AL)
3 ALABAMA-TOTAL
41
41
41
41
1 ALASKA-TOTAL (AK)
12
AZ-Mesa (Maricopa SE- Mesa, Chandler, Gilbert, Tempe)
AZ-Phoenix City of (Maricopa central)
AZ-Phoenix N & Sun City (Maricopa- Glendale, Scottsdale & North AZ)
AZ-Phoenix S & Tucson (Maricopa- Avondale, Goodyear & South AZ)
4 ARIZONA-TOTAL
18
18
18
18
18
AR-Little Rock (South & East AR, 43 counties)
AR-Fort Smith, Jonesboro, Springdale, Texarkana (N&W - 32 counties)
2 ARKANSAS-TOTAL
60
60
60
CA-Orange County N (Anaheim, Garden Grove, Hunt. Bch & North)
CA-Orange County S (Santa Ana, Costa Mesa & South)
CA-Bakersfield & Fresno (Kern, Tulare & Fresno, King, Madera)
CA-Alameda County
CA-LA Central LA, South LA, Northeast LA & Eastside
CA-LA Harbor, South Bay & Westside
CA-LA San Fern. Valley, NW, Antelope, Forest & Santa Monica Mtns.
CA-LA San Gabriel Valley, Pomona & Verdugos
CA-LA Southeast
CA-Modesto & Stockton (Merced, Stanislaus, San Joaquin, +4 more.)
CA-Napa, Chico, Redding & Santa Rosa (15 counties- north CA )
CA-Sacramento (11 counties)
CA-Palm Springs/Rancho Mirage (Riverside County)
CA-San Bernardino & Inyo Counties
CA-San Diego (City of)
CA-San Diego County (ex. City of, + Imperial County)
CA-San Francisco (SF & Marin Counties)
CA-San Jose (Santa Clara & San Benito Counties)
CA-Santa Cruz & San Mateo County
CA-Santa Barbara, San Luis Obispo, Salinas & Ventura
CA-Contra Costa & Solano Counties
21 CALIFORNIA-TOTAL
28
28
28
28
28
28
28
28
28
28
28
28
28
28
28
28
28
28
28
28
28
28
# Nursing
COST
Home
($mils)
Beds
($81k/ EA)
State
Rank
Home Care
Days
per +65
28
10,667
7,261
8,734
26,662
864
588
707
2,160
27
27
27
27
51
682
55
13
49
2,370
2,181
6,178
5,354
16,083
192
177
500
434
1,303
16
16
16
16
16
7
14,198
11,132
25,330
1,150
902
2,052
15
15
15
42
4,822
5,192
6,694
4,686
5,462
7,779
6,193
7,775
3,258
4,932
6,521
8,619
7,223
5,163
3,911
6,634
4,240
5,678
3,505
6,597
4,942
119,826
391
421
542
380
442
630
502
630
264
399
528
698
585
418
317
537
343
460
284
534
400
9,706
32
32
32
32
32
32
32
32
32
32
32
32
32
32
32
32
32
32
32
32
32
32
Total #
Home Care
Days (mils)
State
Rank
COST
($mils)
($67/ Day)
16
7.00
4.77
5.73
17.50
469
319
384
1,173
45
0.73
49
41
2.05
1.88
5.34
4.63
13.90
137
126
358
310
931
43
3.48
2.73
6.22
233
183
416
8
5.53
5.95
7.68
5.37
6.26
8.92
7.10
8.91
3.74
5.65
7.48
9.88
8.28
5.92
4.48
7.61
4.86
6.51
4.02
7.56
5.67
137.39
370
399
514
360
420
598
476
597
250
379
501
662
555
397
300
510
326
436
269
507
380
9,205
STATE/
CO-OP
CO1
CO2
CO3
CO4
CT1
CT2
FL1
FL2
FL3
FL4
FL5
FL6
FL7
FL8
FL9
FL10
FL11
GA1
GA2
GA3
GA4
GA5
$209B NURSING HOME & HOME CARE (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
# Nursing
Home Beds
per 1k +65
CO-Boulder, Fort Collins, Greeley (10 counties- NE CO.)
CO-Colorado Springs, Grand Junction & Pueblo (35 counties- S. CO.)
CO-Denver City of & East (7 counties)
CO-Denver West (12 counties)
4 COLORADO-TOTAL
37
37
37
37
37
CT-Hartford (6 counties)
CT-New Haven & Bridgeport (2 counties SW CT.)
2 CONNECTICUT-TOTAL
State
Rank
# Nursing
COST
Home
($mils)
Beds
($81k/ EA)
Home Care
Days
per +65
30
3,701
6,543
6,115
3,802
20,162
300
530
495
308
1,633
20
20
20
20
20
56
56
56
14
14,538
13,927
28,465
1,178
1,128
2,306
1 DC, Wash.- TOTAL (DC)
35
34
2,408
1 DELAWARE.- TOTAL (DE)
32
38
FL-Fort Lauderdale S. (Broward County)
FL-Fort Lauderdale N. (Martin, Palm Beach & St. Lucie Counties)
FL-Jacksonville (Baker, Clay, Duval, Nassau & St Johns Counties)
FL-Miami-Dade & Monroe Counties (Everglades & Keys)
FL- Gainesville & Ormond Beach (12 Counties)
FL-Orlando S. (Brevard, Hardee, Highlands, Indian., Okee., Osceola)
FL-Orlando N. (Orange, Lake & Seminole counties)
FL-Ocala & Hudson (Citrus, Hernando, Marion, Pasco, Sumter)
FL-Tallahassee, Panama City & Pensacola (19 Counties)
FL-Fort Meyers, Sarasota, Bradenton & Lakeland (9 Counties)
FL-Tampa, St. Petersburg & Clearwater (Hillborough & Pinellas)
11 FLORIDA.- TOTAL
GA-Atlanta North & Rome (36 Counties)
GA-Atlanta City of & West (Fulton, Cobb & West, 11 Counties)
GA-Atlanta East (DeKalb, Gwinnett & East 11 Counties)
GA-Savannah & Augusta (SE. GA 47 Counties)
GA-Macon, Columbus & Albany (SW. GA 54 Counties)
5 GEORGIA.- TOTAL
25
25
25
25
25
25
25
25
25
25
25
25
36
36
36
36
36
36
Total #
Home Care
Days (mils)
State
Rank
COST
($mils)
($67/ Day)
30
1.97
3.49
3.26
2.03
10.75
132
234
218
136
720
26
26
26
17
6.77
6.49
13.26
454
435
888
195
91
1
6.24
418
4,168
338
22
25
2.87
193
44
6,318
9,614
4,118
9,213
5,245
5,564
5,909
7,882
4,807
15,174
8,578
82,423
512
779
334
746
425
451
479
638
389
1,229
695
6,676
30
30
30
30
30
30
30
30
30
30
30
30
12
7.46
11.36
4.86
10.88
6.20
6.57
6.98
9.31
5.68
17.92
10.13
97.36
500
761
326
729
415
440
468
624
380
1,201
679
6,523
31
8,818
7,893
6,995
7,275
6,385
37,366
714
639
567
589
517
3,027
20
20
20
20
20
20
29
4.91
4.40
3.90
4.05
3.56
20.81
329
295
261
271
238
1,394
STATE/
CO-OP
IL1
IL2
IL3
IL4
IL5
IL6
IL7
IN1
IN2
IN3
IN4
IA1
IA2
KS1
KS2
KY1
KY2
LA1
LA2
$209B NURSING HOME & HOME CARE (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
# Nursing
Home Beds
per 1k +65
# Nursing
COST
Home
($mils)
Beds
($81k/ EA)
State
Rank
Home Care
Days
per +65
Total #
Home Care
Days (mils)
State
Rank
COST
($mils)
($67/ Day)
1 HAWAII.- TOTAL (HI)
16
50
3,184
258
12
47
2.25
151
1 IDAHO.- TOTAL (ID)
32
39
6,153
498
15
42
3.01
202
IL-Bloomington, Joliet & Urbana (East IL- 16 counties)
IL-Blue Island (Cook County- South)
IL-Chicago, city of (Cook County- East)
IL-Melrose Park, & Hinsdale (Cook-west, Dupage & Kane)
IL-Elgin & Evanston (NE. IL: Cook-north, Mchenry & Lake)
IL-Peoria, Rockford & Aurora (NW IL- 25 counties)
IL-Springfield (South IL: 56 counties)
7 ILLINOIS.- TOTAL
60
60
60
60
60
60
60
60
8
10,215
7,169
16,389
13,701
15,226
14,552
18,341
95,593
827
581
1,327
1,110
1,233
1,179
1,486
7,743
22
22
22
22
22
22
22
22
24
3.84
2.70
6.16
5.15
5.73
5.47
6.90
35.96
257
181
413
345
384
367
462
2,409
IN-Evansville, Gary, Lafayette, Munster, Terre Haute (W IN- 27 counts.)
IN-Fort Wayne, Muncie, South Bend (Northeast IN- 20 counties)
IN-Indianapolis N. (City of, Marion, Hancock, Hendricks & N- 17 counts)
IN-Indianapolis S. (Morgan, Johnson, Shelby & Southeast- 28 counts.)
4 INDIANA.- TOTAL
59
59
59
59
59
10
13,055
12,399
14,339
9,466
49,259
1,057
1,004
1,161
767
3,990
17
17
17
17
17
37
3.78
3.59
4.15
2.74
14.24
253
240
278
183
954
IA-Des Moines, Mason City & Sioux City (West IA)
IA-Cedar Rapids, Davenport, Dubuque, Iowa City & Waterloo (E. IA)
2 IOWA.- TOTAL
70
70
70
1
18,221
13,359
31,580
1,476
1,082
2,558
16
16
16
39
4.20
3.08
7.28
281
206
488
KS-Wichita SE KS (1.1 mil, 28 Counties) & West KS (319k, 51 counts.)
KS-Topeka Northeast KS (26 counties)
2 KANSAS.- TOTAL
61
61
61
6
12,477
10,283
22,760
1,011
833
1,844
16
16
16
40
3.25
2.68
5.93
218
180
397
KY-Lexington & Covington (Eastern KY, 65 counties)
KY-Louisville, Owensboro & Paducah (Western KY, 55 counties)
2 KENTUCKY.- TOTAL
45
45
45
23
12,192
13,754
25,946
988
1,114
2,102
23
23
23
23
6.12
6.90
13.02
410
462
872
LA-Shreveport, Alexandria, Lafayette, Lake Charles, Monroe (41 counts)
LA-New Orleans, Baton Rouge, Metaire, Slidell & Houma (SE. LA- 23)
2 LOUISIANA.- TOTAL
63
63
63
4
17,072
18,009
35,081
1,383
1,459
2,842
40
40
40
5
10.95
11.56
22.51
734
774
1,508
STATE/
CO-OP
MD1
MD2
MD3
MA1
MA2
MA3
MA4
MI1
MI2
MI3
MI4
MI5
MN1
MN2
MN3
MS1
MS2
MO1
MO2
MO3
MO4
$209B NURSING HOME & HOME CARE (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
# Nursing
Home Beds
per 1k +65
1 MAINE.- TOTAL (ME)
34
MD-Baltimore & Salisbury (Eastern MD, 14 counties)
MD-Takoma Park NW/ DC Area (Northwest MD, 5 counties)
MD-Takoma Park SW/ DC Area (Southwest MD, 5 counties)
3 MARYLAND.- TOTAL
38
38
38
38
MA-Boston NE (Boston city of, Suffolk & Essex counties)
MA-Boston NW (Middlesex county)
MA-Boston South ( 6 counties including Cape & Islands)
MA-Springfield & Worcester (Western MA 5 counties)
4 MASSACHUSETTS.- TOTAL
54
54
54
54
54
MI-Ann Arbor, Kalamazoo & St. Joseph (South MI- 13 counties + Wayne)
MI-Detroit & Dearborn (Southeast MI- 2 counties + Wayne)
MI-Flint, Lansing & Saginaw (Northeast MI- 22 counties)
MI-Marquette, Muskegon, Petoskey, Traverse City & Grand Rapids (44)
MI-Pontiac & Royal Oak (Oakland County, east MI- NW of Detroit)
5 MICHIGAN.- TOTAL
35
35
35
35
35
35
MN-Minneapolis NW & St. Cloud (Northwest MN 37 counties)
MN-Minneapolis SW (City of & Southwest MN 31 counties)
MN-Duluth, Rochester & St. Paul (Eastern MN 19 counties)
3 MINNESOTA.- TOTAL
47
47
47
47
MS-Jackson & Oxford (West MS 47 counties)
MS-Gulfport, Hattiesburg, Meridian, Tupelo (East MS 35 counties)
2 MISSISSIPPI.- TOTAL
49
49
49
MO- Columbia, Joplin & Springfield (57 counties- Central & SW MO.)
MO-Kansas City (26 counties- NW MO.)
MO-St. Louis N. (City of & 6 counties- NE MO.)
MO-St. Louis S. & Cape Girardeau (26 counties- SE MO.)
4 MISSOURI.- TOTAL
62
62
62
62
62
# Nursing
COST
Home
($mils)
Beds
($81k/ EA)
State
Rank
Home Care
Days
per +65
36
7,105
576
19
29
13,018
7,043
6,825
26,886
1,054
570
553
2,178
19
19
19
19
15
9,700
10,576
16,211
11,997
48,484
786
857
1,313
972
3,927
40
40
40
40
40
35
9,596
11,492
9,327
11,265
5,490
47,170
777
931
755
913
445
3,821
32
32
32
32
32
32
19
7,409
13,310
11,362
32,081
600
1,078
920
2,599
39
39
39
39
17
9,489
9,021
18,510
769
731
1,499
28
28
28
5
16,836
12,269
14,893
8,336
52,334
1,364
994
1,206
675
4,239
20
20
20
20
20
Total #
Home Care
Days (mils)
State
Rank
COST
($mils)
($67/ Day)
34
3.93
263
31
6.72
3.64
3.53
13.89
451
244
236
930
6
7.26
7.91
12.13
8.98
36.28
486
530
813
601
2,431
9
8.91
10.67
8.66
10.46
5.10
43.80
597
715
580
701
341
2,934
7
6.12
10.99
9.39
26.50
410
737
629
1,775
14
5.42
5.15
10.58
363
345
709
28
5.51
4.02
4.88
2.73
17.14
369
269
327
183
1,148
STATE/
CO-OP
NV1
NV2
NJ1
NJ2
NJ3
NJ4
NJ5
NY1
NY2
NY3
NY4
NY5
NY6
NY7
NY8
NY9
NY10
NY11
$209B NURSING HOME & HOME CARE (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
# Nursing
Home Beds
per 1k +65
# Nursing
COST
Home
($mils)
Beds
($81k/ EA)
State
Rank
Home Care
Days
per +65
Total #
Home Care
Days (mils)
State
Rank
COST
($mils)
($67/ Day)
1 MONTANA.- TOTAL (MT)
47
18
6,952
563
12
46
1.81
122
1 NEBRASKA.- TOTAL (NE)
64
3
15,674
1,270
11
48
2.65
178
NV-Las Vegas (3 counties- SE NV)
NV-Reno (14 counties- NW NV)
2 NEVADA.- TOTAL
18
18
18
48
4,186
1,676
5,862
339
136
475
23
23
23
21
5.31
2.13
7.44
356
142
498
1 NEW HAMPSHIRE.- TOTAL (NH)
44
25
7,742
627
21
27
3.69
247
NJ-Camden N. (3 counties- South NJ)
NJ-Camden S. (6 counties- South NJ)
NJ-Hackensack, Patterson & Ridgewood (2 counties- NE NJ)
NJ-Morristown & New Brunswick (7 counties- NW NJ)
NJ-Newark (3 counties- NE NJ)
5 NEW JERSEY.- TOTAL
43
43
43
43
43
43
26
11,684
8,259
8,503
13,107
9,665
51,219
946
669
689
1,062
783
4,149
23
23
23
23
23
23
20
6.32
4.47
4.60
7.09
5.23
27.70
423
299
308
475
350
1,856
1 NEW MEXICO.- TOTAL (NM)
25
45
6,707
543
79
2
21.53
1,442
22
12,862
6,559
10,332
12,878
9,243
9,092
12,991
12,340
10,588
8,660
12,511
118,057
1,042
531
837
1,043
749
736
1,052
1,000
858
701
1,013
9,563
42
42
42
42
42
42
42
42
42
42
42
42
4
12.03
6.13
9.66
12.04
8.64
8.50
12.15
11.54
9.90
8.10
11.70
110.39
806
411
647
807
579
570
814
773
663
543
784
7,396
NY-Albany (18 counties NE NY)
NY-NYC Bronx County
NY-Buffalo (6 counties western NY)
NY-NYC East Long Island (Queens County)
NY-East Long Island (Nassau County)
NY-East Long Island (Suffolk County)
NY-NYC Manhattan (Kings County, Brooklyn- West Long Island)
NY-NYC Manhattan (NY & Richmond Counties- Staten Island)
NY-White Plains (Orange, Putnam, Rockland & Weschester counties.)
NY-Rochester (10 counties East of Buffalo area)
NY-Syracuse, Binghamton & Elmira (17 counts. East of Rochester)
11 NEW YORK.- TOTAL
45
45
45
45
45
45
45
45
45
45
45
45
STATE/
CO-OP
NC1
NC2
NC3
NC4
NC5
OH1
OH2
OH3
OH4
OH5
OH6
OH7
OK1
OK2
OR1
OR2
PA1
PA2
PA3
PA4
PA5
PA6
PA7
PA8
$209B NURSING HOME & HOME CARE (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
# Nursing
Home Beds
per 1k +65
NC-Charlotte (10 counties- SW NC)
NC-Durham & Greensboro (19 counties- west of Raleigh)
NC-Greenville & Wilmington (29 counties- eastern & coastal NC)
NC-Raleigh (11 counties)
NC-Winston-Salem, Asheville & Hickory (31 counties- west NC)
5 NORTH CAROLINA.- TOTAL
35
35
35
35
35
35
1 NORTH DAKOTA.- TOTAL (ND)
67
OH-Akron, Canton, Youngstown (12 counties- NE OH)
OH-Cincinnati (7 counties- SW OH)
OH-Cleveland & Elyria (8 counties- NE OH)
OH-Columbus- North (15 counties- central OH)
OH-Columbus- City of & Southeast (20 counties- SE OH)
OH-Dayton & Kettering (15 counties- West OH)
OH-Toledo (11 counties- NW OH)
7 OHIO.- TOTAL
57
57
57
57
57
57
57
57
OK-Oklahoma City & Lawton (54 counties)
OK-Tulsa (23 counties- NE OK)
2 OKLAHOMA- TOTAL
58
58
58
OR-Bend, Eugene, Medford, Salem (20 counties- Southern OR)
OR-Portland (16 counties- Northern OR)
2 OREGON- TOTAL
23
23
23
PA-Allentown, Scranton & Wilkes-Barre (9 counties- NE PA)
PA-Danville, Erie & Sayre (22 counties- North & West PA)
PA-Harrisburg, Altoona & Johnstown (15 counties- South Central PA)
PA-Lancaster, Reading & York (5 counties- SE PA)
PA-Philadelphia NW (3 counties- SE PA)
PA-Philadelphia (city of & county- SE PA)
PA-Pittsburgh (city of & west- 5 counties SW PA)
PA-Pittsburgh East (7 counties- SW PA)
8 PENNSYLVANIA- TOTAL
45
45
45
45
45
45
45
45
45
# Nursing
COST
Home
($mils)
Beds
($81k/ EA)
State
Rank
Home Care
Days
per +65
33
7,704
9,119
7,508
7,323
11,994
43,648
624
739
608
593
972
3,535
26
26
26
26
26
26
2
6,491
526
6
13
18,037
11,183
20,203
8,682
13,582
13,419
7,714
92,820
1,461
906
1,636
703
1,100
1,087
625
7,518
28
28
28
28
28
28
28
28
11
17,055
12,373
29,428
1,381
1,002
2,384
30
30
30
47
6,576
5,717
12,293
533
463
996
14
14
14
21
11,539
10,278
11,500
13,116
13,245
8,375
13,456
7,386
88,896
935
832
931
1,062
1,073
678
1,090
598
7,201
19
19
19
19
19
19
19
19
19
State
Rank
Total #
Home Care
Days (mils)
COST
($mils)
($67/ Day)
19
5.60
6.62
5.45
5.32
8.71
31.70
375
444
365
356
584
2,124
51
0.54
36
15
8.76
5.43
9.81
4.21
6.59
6.51
3.74
45.06
587
364
657
282
442
436
251
3,019
11
8.89
6.45
15.34
596
432
1,028
44
4.06
3.53
7.58
272
236
508
32
4.84
4.31
4.82
5.50
5.55
3.51
5.64
3.10
37.27
324
289
323
368
372
235
378
207
2,497
STATE/
CO-OP
SC1
SC2
SC3
TN1
TN2
TN3
TN4
TX1
TX2
TX3
TX4
TX5
TX6
TX7
TX8
TX9
TX10
TX11
TX12
TX13
TX14
UT1
UT2
$209B NURSING HOME & HOME CARE (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
# Nursing
Home Beds
per 1k +65
1 RHODE ISLAND- TOTAL (RI)
57
SC-Charleston & Florence (17 counties- SE SC)
SC-Columbia (20 counties- Central SC)
SC-Greenville & Spartanburg (9 counties- NW SC)
3 SOUTH CAROLINA- TOTAL
# Nursing
COST
Home
($mils)
Beds
($81k/ EA)
State
Rank
Home Care
Days
per +65
12
8,694
704
23
30
30
30
30
41
6,923
5,880
6,011
18,814
561
476
487
1,524
1 SOUTH DAKOTA- TOTAL (SD)
60
9
6,936
TN-Memphis & Jackson (20 counties- west TN)
TN-Nashville City Of & West (18 counties- central TN)
TN-Nashville East & Chattanooga (31 counties- central TN)
TN-Knoxville, Johnson City, Kingsport (26 counties- east TN)
4 TENNESSEE- TOTAL
44
44
44
44
44
TX-Amarillo, Lubbock & Witchita Falls (62 counties- TX panhandle)
TX-Austin & Temple (12 counties East TX)
TX-Houston East & Beaumont (19 counties- SE TX)
TX-Houston (city of- Harris County SE TX)
TX-Houston (Harris County excluding Houston)
TX-Houston West (10 counties- SE TX)
TX-Dallas (Dallas County- NE TX)
TX-Dallas East (12 counties- NE TX)
TX-Dallas NW (5 counties- NE TX)
TX-El Paso, Abilene, Odessa & San Angelo (44 counties- West TX)
TX-Fort Worth (7 counties- NE TX)
TX-San Antonio (29 counties- SW TX)
TX-Corpus Christi, Harlingen, McAllen & Victoria (20 counties- SW TX)
TX-Waco, Bryan, Tyler & Longview (32 counties- Central & NE TX)
14 TEXAS- TOTAL
UT-Salt Lake City NW & Ogden (8 counties- NW UT)
UT-Salt Lake City SE & Provo (21 counties- SE UT)
2 UTAH- TOTAL
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
31
31
31
Total #
Home Care
Days (mils)
State
Rank
COST
($mils)
($67/ Day)
22
3.43
230
19
19
19
19
35
4.33
3.67
3.76
11.76
290
246
252
788
562
6
50
0.76
51
24
8,264
7,071
9,911
12,176
37,422
669
573
803
986
3,031
26
26
26
26
26
18
4.84
4.14
5.80
7.13
21.92
324
277
389
478
1,468
16
7,317
9,648
10,229
9,330
7,644
5,514
10,290
7,428
4,035
9,592
10,573
15,260
11,020
11,148
129,030
593
782
829
756
619
447
833
602
327
777
856
1,236
893
903
10,451
44
44
44
44
44
44
44
44
44
44
44
44
44
44
44
3
6.44
8.50
9.01
8.22
6.73
4.86
9.06
6.54
3.55
8.45
9.31
13.44
9.70
9.82
113.62
432
569
604
550
451
325
607
438
238
566
624
900
650
658
7,613
40
4,842
2,819
7,661
392
228
621
31
31
31
10
4.92
2.86
7.79
330
192
522
STATE/
CO-OP
VA1
VA2
VA3
VA4
WA1
WA2
WA3
WA4
WI1
WI2
WI3
WI4
$209B NURSING HOME & HOME CARE (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
# Nursing
Home Beds
per 1k +65
1 VERMONT- TOTAL (VT)
36
VA-Arlington & Winchester (17 counties- Northeast VA & DC area)
VA-Charlottesville, Lynchburg, Roanoke (61 counties- Western VA)
VA-Norfolk & Newport News (19 counties- Southeast VA)
VA-Richmond (37 counties- Eastern VA)
4 VIRGINIA- TOTAL
33
33
33
33
33
WA-Spokane & Yakima (20 counties- eastern WA)
WA-Seattle City & King County (central WA)
WA-Seattle NW & Everett (10 counties- NW WA)
WA-Olympia & Tacoma (8 counties- SW WA)
4 WASHINGTON- TOTAL
State
Rank
# Nursing
COST
Home
($mils)
Beds
($81k/ EA)
Home Care
Days
per +65
32
3,276
265
28
37
7,708
10,361
6,969
7,051
32,090
624
839
564
571
2,599
17
17
17
17
17
26
26
26
26
26
43
5,098
5,573
5,781
5,448
21,900
413
451
468
441
1,774
1 WEST VIRGINIA- TOTAL (WV)
24
46
7,162
WI-Appleton, Green Bay, Neenah & Wausau (20 counties- NE WI)
WI-Madison (14 counties- SE WI)
WI-Milwaukee (9 counties- SE WI)
WI-La Crosse & Marshfield (29 counties- NW WI)
4 WISCONSIN- TOTAL
46
46
46
46
46
1 WYOMING- TOTAL (WY)
42
185 USA TOTAL (@ RI Costs above)
NURSING HOME BEDS @ Local Costs ($mils)
HOME CARE DAYS @ Local Costs ($mils)
TOTAL
"'* after Geographic COLA's see Appendices F thru J
Total #
Home Care
Days (mils)
COST
($mils)
($67/ Day)
13
2.58
173
38
3.96
5.32
3.58
3.62
16.49
265
357
240
243
1,105
17
17
17
17
17
36
3.33
3.64
3.78
3.56
14.32
223
244
253
239
959
580
19
33
5.60
375
20
8,350
6,915
13,247
7,493
36,005
676
560
1,073
607
2,916
21
21
21
21
21
26
3.84
3.18
6.10
3.45
16.58
258
213
409
231
1,111
27
2,965
240
11
49
0.75
50
1,663,445
$134,739
28
1,112
$74,478
41
$122,019
$70,187
$192,206
State
Rank
-9.4%
-5.8%
-8.1%
$209 BIL
E81-90: $270B PRESCRIPTION DRUGS
BY STATE & CO-OP
EXPANDING THE RI MODEL NATIONALLY
185 BUYER CO-OP’s DEFINED
GEOGRAPHIC MARKETS WITHIN STATES
EACH, 1 to 2.5 MIL PEOPLE (1 to 2.5 RI’s)
(NEXT 9 SLIDES)
Each of the 185 CO-OP areas covers 1 or more “Hospital Referral Regions” as
defined by the Dartmouth Atlas of Health Care. Regional hospitals capable of
cardio and/or neuro surgery. (http://www.dartmouthatlas.org/data/region/)
In each of the 15,490 service areas the CO-OP would contract approx. 17 Primary
Care MDs, 7 Dentists and 4 Optometrists to service a population of approx. 20k.
BACK
Table of Contents
PRESCRIPTION DRUG NOTES:
The number and type of drug prescriptions depicted on the next 8 slides are based on the population by
age In each CO-OP area as listed in E13-21. The following methods & assumptions apply:
RETAIL PRESCRIPTIONS: The number of retail prescriptions (2011) per person for age groups 0-18, 1964 and 65+ came from IMS’s Vector One database posted on statehealthfacts.org December 2012. This
per person total for each age group and state was applied to individual CO-Op (markets within states)
populations (E13-21) to derive the total number of retail prescriptions in each geographic area within
each state. This totaled 3.75 billion retail prescriptions nationally.
NON-RETAIL PRESCRIPTIONS: IMS also estimates that retail prescriptions (chain pharmacy stores,
grocery stores, big box & independent pharmacies) account for 83% of the market with mail order and
other delivery formats (not included in the per person data above) adding an additional 17%. This is
consistent with www.NACDS.org data as well. Accordingly, this added 750 million prescriptions to the
above retail amount. Total prescriptions nationwide (retail & non-retail): 4.5 billion.
USAGE PER PERSON: varies widely by state within each age group. 0-18 is lowest in DC (2.3),
AK (2.4), NV (2.6) & VT (2.9) compared to IA (7.2), KY (6.6), DE (6.4) & WV (6.0). 19-64 is lowest in
DC (7.7), AK (8.4), TX (8.8) & NC (9.8) compared to KY (19.8), WV (19.4), TN (17.8) & VT (17.5). 65+ is
lowest in AK (18.3), DC (20.4), NM (21.5) & NC (22.1) compared to KY (40.4), MS (39.5), WV (37.3) &
ND (36.7). In all age groups the highest states are more than double the rate of the lowest states!
STATE/
CO-OP
AL1
AL2
AL3
$270B PRESCRIPTION DRUGS (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
Age # Retail
0-18 Scripts
#/EA Age 0-18
Age # Retail
19-64 Scripts
#/EA Age 19-64
AL-Birmingham S & Tuscaloosa (28 counties- Central AL)
AL-Birmingham N & Huntsville (15 counties- Northern AL)
AL-Dothan, Mobile & Montgomery (23 counties- Southern AL)
3 ALABAMA-TOTAL
5.5
5.5
5.5
5.5
2,578,975
1,592,564
2,058,424
6,229,963
16.7
16.7
16.7
16.7
1 ALASKA-TOTAL (AK)
2.4
450,002
8.4
AZ1
AZ2
AZ3
AZ4
AZ-Mesa (Maricopa SE- Mesa, Chandler, Gilbert, Tempe)
AZ-Phoenix City of (Maricopa central)
AZ-Phoenix N & Sun City (Maricopa- Glendale, Scottsdale & North AZ)
AZ-Phoenix S & Tucson (Maricopa- Avondale, Goodyear & South AZ)
4 ARIZONA-TOTAL
3.5
3.5
3.5
3.5
3.5
1,070,755
1,426,839
1,331,388
1,822,144
5,651,126
12.1
12.1
12.1
12.1
12.1
AR1
AR2
AR-Little Rock (South & East AR, 43 counties)
AR-Fort Smith, Jonesboro, Springdale, Texarkana (N&W - 32 counties)
2 ARKANSAS-TOTAL
4.9
4.9
4.9
1,862,934 13.6
1,623,749 13.6
3,486,683 13.6
CA1
CA2
CA3
CA4
CA5
CA6
CA-Orange County N (Anaheim, Garden Grove, Hunt. Bch & North)
CA-Orange County S (Santa Ana, Costa Mesa & South)
CA-Bakersfield & Fresno (Kern, Tulare & Fresno, King, Madera)
CA-Alameda County
CA-LA Central LA, South LA, Northeast LA & Eastside
CA-LA Harbor, South Bay & Westside
CA-LA San Fern. Valley, NW, Antelope, Forest & Santa Monica Mtns.
CA8
CA-LA San Gabriel Valley, Pomona & Verdugos
CA9
CA-LA Southeast
CA10 CA-Modesto & Stockton (Merced, Stanislaus, San Joaquin, +4 more.)
CA11 CA-Napa, Chico, Redding & Santa Rosa (15 counties- north CA )
CA12 CA-Sacramento (11 counties)
CA13 CA-Palm Springs/Rancho Mirage (Riverside County)
CA14 CA-San Bernardino & Inyo Counties
CA15 CA-San Diego (City of)
CA16 CA-San Diego County (ex. City of, + Imperial County)
CA17 CA-San Francisco (SF & Marin Counties)
CA18 CA-San Jose (Santa Clara & San Benito Counties)
CA19 CA-Santa Cruz & San Mateo County
CA20 CA-Santa Barbara, San Luis Obispo, Salinas & Ventura
CA21 CA-Contra Costa & Solano Counties
21 CALIFORNIA-TOTAL
3.3 1,143,619
3.3 1,269,779
3.3 2,532,191
3.3 1,135,419
3.3 1,844,506
3.3 1,525,133
3.3 1,721,853
3.3 1,639,059
3.3 1,141,167
3.3 1,508,155
3.3 1,124,935
3.3 2,045,011
3.3 2,061,443
3.3 1,989,925
3.3
930,709
3.3 1,617,946
3.3
532,728
3.3 1,481,833
3.3
714,737
3.3 1,567,819
3.3 1,203,735
3.3 30,731,701
9.9
9.9
9.9
9.9
9.9
9.9
9.9
9.9
9.9
9.9
9.9
9.9
9.9
9.9
9.9
9.9
9.9
9.9
9.9
9.9
9.9
9.9
21,201,476
12,774,865
15,941,172
49,917,513
Age # Retail
65+ Scripts
#/EA Age 65+
Age
All
#/EA
35.6
35.6
35.6
35.6
9,373,441
6,380,740
7,675,161
23,429,342
16.6
16.8
16.6
16.6
3,931,555 18.3
1,000,787
7.6
3,008,510
2,768,674
7,844,187
6,797,643
20,419,014
11.1
10.6
12.3
11.5
11.4
8,976,734
11,090,021
11,909,801
14,993,694
46,970,251
22.8
22.8
22.8
22.8
22.8
13,494,661 29.3
10,771,972 29.3
24,266,633 29.3
8,828,566
10,217,004
14,962,827
9,900,214
13,329,387
14,663,116
13,821,045
13,682,656
7,396,945
9,474,735
9,662,946
15,378,198
12,957,411
12,550,007
8,778,258
12,245,306
7,384,066
11,746,475
6,335,397
12,106,497
9,131,270
234,552,328
29.5
29.5
29.5
29.5
29.5
29.5
29.5
29.5
29.5
29.5
29.5
29.5
29.5
29.5
29.5
29.5
29.5
29.5
29.5
29.5
29.5
29.5
6,898,271 13.8
5,408,863 13.6
12,307,134 13.7
5,043,920
5,431,656
7,002,699
4,902,401
5,714,293
8,137,116
6,478,575
8,133,056
3,408,541
5,159,179
6,821,538
9,016,803
7,555,895
5,400,592
4,090,948
6,939,954
4,435,211
5,940,060
3,667,056
6,900,986
5,169,889
125,350,369
10.7
10.6
9.7
10.6
10.0
11.0
10.3
10.9
9.9
10.2
11.4
10.7
10.3
9.7
10.6
10.6
11.7
10.4
10.9
10.7
10.6
10.5
Total #
# Non-
Retail
Scripts
(83%)
Retail
Scripts
(17%)
33,153,893 6,632,370
20,748,169 4,150,630
25,674,757 5,136,184
79,576,819 15,919,184
Total #
Scripts
(100%)
COST
($mils)
($60/ EA)
39,786,262
24,898,799
30,810,941
95,496,002
2,387
1,494
1,849
5,730
1,076,727
6,459,071
388
13,055,999 2,611,826
15,285,535 3,057,841
21,085,376 4,218,087
23,613,481 4,723,830
73,040,390 14,611,584
15,667,825
18,343,375
25,303,464
28,337,310
87,651,975
940
1,101
1,518
1,700
5,259
22,255,866
17,804,584
40,060,450
4,452,242
3,561,772
8,014,013
26,708,107
21,366,356
48,074,463
1,602
1,282
2,884
15,016,106 3,003,942
16,918,439 3,384,500
24,497,717 4,900,719
15,938,034 3,188,372
20,888,186 4,178,640
24,325,366 4,866,241
22,021,473 4,405,352
23,454,771 4,692,080
11,946,653 2,389,904
16,142,069 3,229,189
17,609,419 3,522,729
26,440,012 5,289,272
22,574,748 4,516,033
19,940,525 3,989,062
13,799,914 2,760,645
20,803,206 4,161,640
12,352,005 2,470,994
19,168,369 3,834,594
10,717,190 2,143,952
20,575,303 4,116,048
15,504,894 3,101,723
390,634,397 78,145,631
18,020,048
20,302,938
29,398,436
19,126,406
25,066,826
29,191,607
26,426,824
28,146,851
14,336,557
19,371,258
21,132,148
31,729,284
27,090,782
23,929,587
16,560,560
24,964,846
14,822,998
23,002,963
12,861,142
24,691,351
18,606,617
468,780,028
1,081
1,218
1,764
1,148
1,504
1,751
1,586
1,689
860
1,162
1,268
1,904
1,625
1,436
994
1,498
889
1,380
772
1,481
1,116
28,127
5,382,344
STATE/
CO-OP
$270B PRESCRIPTION DRUGS (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
Age # Retail
0-18 Scripts
#/EA Age 0-18
Age # Retail
19-64 Scripts
#/EA Age 19-64
CO1
CO2
CO3
CO4
CO-Boulder, Fort Collins, Greeley (10 counties- NE CO.)
CO-Colorado Springs, Grand Junction & Pueblo (35 counties- S. CO.)
CO-Denver City of & East (7 counties)
CO-Denver West (12 counties)
4 COLORADO-TOTAL
3.2
3.2
3.2
3.2
3.2
688,630
1,083,329
1,364,392
787,381
3,923,733
CT1
CT2
CT-Hartford (6 counties)
CT-New Haven & Bridgeport (2 counties SW CT.)
2 CONNECTICUT-TOTAL
3.6
3.6
3.6
1,434,390 10.8
1,520,664 10.8
2,955,054 10.8
1 DC, Wash.- TOTAL (DC)
2.3
1 DELAWARE.- TOTAL (DE)
6.4
FL1
FL2
FL3
FL4
FL5
FL6
FL7
FL8
FL9
FL10
FL11
GA1
GA2
GA3
GA4
GA5
FL-Fort Lauderdale S. (Broward County)
FL-Fort Lauderdale N. (Martin, Palm Beach & St. Lucie Counties)
FL-Jacksonville (Baker, Clay, Duval, Nassau & St Johns Counties)
FL-Miami-Dade & Monroe Counties (Everglades & Keys)
FL- Gainesville & Ormond Beach (12 Counties)
FL-Orlando S. (Brevard, Hardee, Highlands, Indian., Okee., Osceola)
FL-Orlando N. (Orange, Lake & Seminole counties)
FL-Ocala & Hudson (Citrus, Hernando, Marion, Pasco, Sumter)
FL-Tallahassee, Panama City & Pensacola (19 Counties)
FL-Fort Meyers, Sarasota, Bradenton & Lakeland (9 Counties)
FL-Tampa, St. Petersburg & Clearwater (Hillborough & Pinellas)
11 FLORIDA.- TOTAL
GA-Atlanta North & Rome (36 Counties)
GA-Atlanta City of & West (Fulton, Cobb & West, 11 Counties)
GA-Atlanta East (DeKalb, Gwinnett & East 11 Counties)
GA-Savannah & Augusta (SE. GA 47 Counties)
GA-Macon, Columbus & Albany (SW. GA 54 Counties)
5 GEORGIA.- TOTAL
232,506
10.2
10.2
10.2
10.2
10.2
6,168,907
8,947,308
11,355,596
6,709,221
33,181,033
Age # Retail
65+ Scripts
#/EA Age 65+
Age
All
#/EA
Total #
# Non-
Retail
Scripts
(83%)
Retail
Scripts
(17%)
(100%)
Total #
Scripts
COST
($mils)
($60/ EA)
22.2
22.2
22.2
22.2
22.2
2,241,544 9.9
3,962,510 10.0
3,703,174 9.6
2,302,487 9.7
12,209,715 9.8
9,099,081
13,993,148
16,423,162
9,799,090
49,314,480
1,820,253
2,799,301
3,285,421
1,960,288
9,865,263
10,919,333
16,792,449
19,708,583
11,759,378
59,179,743
655
1,008
1,183
706
3,551
12,285,113 24.2
11,976,452 24.2
24,261,565 24.2
6,263,903 11.1
6,000,840 11.0
12,264,743 11.0
19,983,405
19,497,956
39,481,362
3,997,640
3,900,527
7,898,168
23,981,046
23,398,484
47,379,529
1,439
1,404
2,843
7.7
3,326,686 20.4
1,399,367
8.2
4,958,559
991,950
5,950,508
357
1,316,012 15.9
8,951,773 24.7
3,193,772 15.0
13,461,557
2,692,958
16,154,515
969
4.1 1,605,424
4.1 1,463,726
4.1 1,312,645
4.1 2,286,799
4.1
918,571
4.1
980,690
4.1 1,760,776
4.1
934,617
4.1 1,248,971
4.1 2,027,957
4.1 1,873,411
4.1 16,413,587
11.4
11.4
11.4
11.4
11.4
11.4
11.4
11.4
11.4
11.4
11.4
11.4
12,614,394
11,478,215
9,832,565
18,778,917
8,169,258
7,492,945
13,708,477
7,565,396
10,577,745
15,920,702
15,384,105
131,522,719
25.9
25.9
25.9
25.9
25.9
25.9
25.9
25.9
25.9
25.9
25.9
25.9
6,474,312
9,851,681
4,219,963
9,440,439
5,374,630
5,701,455
6,054,655
8,076,719
4,925,807
15,548,738
8,789,309
84,457,710
11.8 20,694,130
13.1 22,793,621
11.4 15,365,173
11.9 30,506,155
12.6 14,462,460
12.7 14,175,090
11.5 21,523,908
13.8 16,576,732
11.8 16,752,523
13.4 33,497,398
12.1 26,046,826
12.4 232,394,016
4,139,819
24,833,949
4,559,818
27,353,440
3,073,772
18,438,945
6,102,695
36,608,851
2,893,186
17,355,646
2,835,698
17,010,788
4,305,815
25,829,723
3,316,142
19,892,874
3,351,309
20,103,832
6,701,088
40,198,486
5,210,615
31,257,441
46,489,959 278,883,975
1,490
1,641
1,106
2,197
1,041
1,021
1,550
1,194
1,206
2,412
1,875
16,733
4.0
4.0
4.0
4.0
4.0
4.0
11.9
11.9
11.9
11.9
11.9
11.9
15,064,263
17,569,908
17,692,833
12,704,483
10,212,812
73,244,299
31.3
31.3
31.3
31.3
31.3
31.3
7,691,372
6,884,151
6,101,278
6,345,587
5,569,453
32,591,841
12.2 24,860,166 4,973,227 29,833,393
11.8 26,741,584 5,349,600 32,091,184
11.4 26,300,168 5,261,296 31,561,464
12.2 20,754,130 4,151,822 24,905,952
12.5 17,145,680 3,429,959 20,575,639
12.0 115,801,728 23,165,904 138,967,632
1,790
1,925
1,894
1,494
1,235
8,338
2,104,531
2,287,525
2,506,057
1,704,060
1,363,415
9,965,588
STATE/
CO-OP
$270B PRESCRIPTION DRUGS (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
Age # Retail
0-18 Scripts
#/EA Age 0-18
Age # Retail
19-64 Scripts
#/EA Age 19-64
Age # Retail
65+ Scripts
#/EA Age 65+
Age
All
#/EA
Total #
# Non-
Retail
Scripts
(83%)
Retail
Scripts
(17%)
(100%)
Total #
Scripts
COST
($mils)
($60/ EA)
1 HAWAII.- TOTAL (HI)
4.2
1,274,058 11.1
9,572,982 29.0
5,641,168 12.1
16,488,208
3,298,433
19,786,642
1,187
1 IDAHO.- TOTAL (ID)
3.4
1,460,359 13.0
12,267,897 28.8
5,598,149 12.3
19,326,405
3,866,209
23,192,614
1,392
IL1
IL2
IL3
IL4
IL5
IL6
IL7
IL-Bloomington, Joliet & Urbana (East IL- 16 counties)
IL-Blue Island (Cook County- South)
IL-Chicago, city of (Cook County- East)
IL-Melrose Park, & Hinsdale (Cook-west, Dupage & Kane)
IL-Elgin & Evanston (NE. IL: Cook-north, Mchenry & Lake)
IL-Peoria, Rockford & Aurora (NW IL- 25 counties)
IL-Springfield (South IL: 56 counties)
7 ILLINOIS.- TOTAL
4.4 1,720,276
4.4
952,147
4.4 2,751,092
4.4 2,401,362
4.4 2,177,879
4.4 1,775,014
4.4 1,997,999
4.4 13,775,769
11.4
11.4
11.4
11.4
11.4
11.4
11.4
11.4
11,001,609
6,163,360
20,466,058
14,515,744
14,438,346
11,617,120
14,083,577
92,285,812
29.9
29.9
29.9
29.9
29.9
29.9
29.9
29.9
5,126,676
3,598,119
8,224,940
6,876,106
7,641,601
7,303,286
9,204,680
47,975,406
11.7
12.2
11.7
11.6
12.0
12.4
12.7
12.0
17,848,561 3,570,569
10,713,625 2,143,239
31,442,090 6,289,927
23,793,211 4,759,784
24,257,825 4,852,729
20,695,420 4,140,077
25,286,256 5,058,465
154,036,988 30,814,792
21,419,130
12,856,864
37,732,017
28,552,996
29,110,555
24,835,497
30,344,721
184,851,780
1,285
771
2,264
1,713
1,747
1,490
1,821
11,091
IN1
IN2
IN3
IN4
IN-Evansville, Gary, Lafayette, Munster, Terre Haute (W IN- 27 counts.)
IN-Fort Wayne, Muncie, South Bend (Northeast IN- 20 counties)
IN-Indianapolis N. (City of, Marion, Hancock, Hendricks & N- 17 counts)
IN-Indianapolis S. (Morgan, Johnson, Shelby & Southeast- 28 counts.)
4 INDIANA.- TOTAL
3.4
3.4
3.4
3.4
3.4
1,340,539
1,381,128
1,782,279
966,181
5,470,128
11.5
11.5
11.5
11.5
11.5
11,885,528
11,073,501
14,727,099
8,705,473
46,391,601
25.3
25.3
25.3
25.3
25.3
5,638,345
5,355,089
6,192,755
4,088,292
21,274,482
11.4
11.3
11.1
11.4
11.3
18,864,413 3,773,788
17,809,719 3,562,799
22,702,133 4,541,516
13,759,946 2,752,650
73,136,211 14,630,753
22,638,201
21,372,518
27,243,649
16,512,595
87,766,963
1,358
1,282
1,635
991
5,266
IA1
IA2
IA-Des Moines, Mason City & Sioux City (West IA)
IA-Cedar Rapids, Davenport, Dubuque, Iowa City & Waterloo (E. IA)
2 IOWA.- TOTAL
7.2
7.2
7.2
3,035,978 14.9
2,204,421 14.9
5,240,398 14.9
15,666,479 34.8
12,134,150 34.8
27,800,629 34.8
9,090,036 16.0
6,664,198 16.0
15,754,234 16.0
27,792,492
21,002,769
48,795,261
5,559,833
4,201,562
9,761,395
33,352,325
25,204,331
58,556,656
2,001
1,512
3,513
KS1
KS2
KS-Wichita SE KS (1.1 mil, 28 Counties) & West KS (319k, 51 counts.)
KS-Topeka Northeast KS (26 counties)
2 KANSAS.- TOTAL
4.1
4.1
4.1
1,495,239 12.1
1,490,411 12.1
2,985,650 12.1
10,208,433 26.9
10,952,933 26.9
21,161,366 26.9
5,545,287 12.2
4,570,121 11.8
10,115,407 12.0
17,248,958
17,013,465
34,262,423
3,450,620
3,403,510
6,854,129
20,699,578
20,416,975
41,116,552
1,242
1,225
2,467
KY1
KY2
KY-Lexington & Covington (Eastern KY, 65 counties)
KY-Louisville, Owensboro & Paducah (Western KY, 55 counties)
2 KENTUCKY.- TOTAL
6.6
6.6
6.6
3,246,482 19.8
3,509,682 19.8
6,756,164 19.8
26,620,409 40.4
27,578,686 40.4
54,199,095 40.4
10,979,897 19.4
12,386,562 19.5
23,366,459 19.4
40,846,788 8,171,318
43,474,930 8,697,073
84,321,718 16,868,391
49,018,107
52,172,003
101,190,109
2,941
3,130
6,071
LA1
LA2
LA-Shreveport, Alexandria, Lafayette, Lake Charles, Monroe (41 counts)
LA-New Orleans, Baton Rouge, Metaire, Slidell & Houma (SE. LA- 23)
2 LOUISIANA.- TOTAL
5.9
5.9
5.9
3,106,675 13.8
3,490,960 13.8
6,597,635 13.8
17,782,919 32.7
21,651,303 32.7
39,434,222 32.7
8,872,674 14.3
9,360,074 14.1
18,232,749 14.2
29,762,268 5,953,882
34,502,338 6,902,124
64,264,606 12,856,006
35,716,151
41,404,462
77,120,612
2,143
2,484
4,627
STATE/
CO-OP
$270B PRESCRIPTION DRUGS (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
Age # Retail
0-18 Scripts
#/EA Age 0-18
Age # Retail
19-64 Scripts
#/EA Age 19-64
Age # Retail
65+ Scripts
#/EA Age 65+
Age
All
#/EA
Total #
# Non-
Retail
Scripts
(83%)
Retail
Scripts
(17%)
(100%)
20,650,434
4,131,078
24,781,513
1,487
Total #
Scripts
COST
($mils)
($60/ EA)
1 MAINE.- TOTAL (ME)
5.2
1,429,848 15.7
13,222,240 28.4
MD1
MD2
MD3
MD-Baltimore & Salisbury (Eastern MD, 14 counties)
MD-Takoma Park NW/ DC Area (Northwest MD, 5 counties)
MD-Takoma Park SW/ DC Area (Southwest MD, 5 counties)
3 MARYLAND.- TOTAL
3.7
3.7
3.7
3.7
2,159,327
1,275,477
1,552,039
4,986,842
10.4
10.4
10.4
10.4
17,115,704
9,635,136
11,868,677
38,619,517
22.6
22.6
22.6
22.6
7,795,156
4,217,096
4,086,670
16,098,922
10.5
10.4
10.1
10.3
27,070,186 5,415,337
15,127,709 3,026,268
17,507,386 3,502,318
59,705,281 11,943,922
32,485,523
18,153,977
21,009,704
71,649,203
1,949
1,089
1,261
4,299
MA1
MA2
MA3
MA4
MA-Boston NE (Boston city of, Suffolk & Essex counties)
MA-Boston NW (Middlesex county)
MA-Boston South ( 6 counties including Cape & Islands)
MA-Springfield & Worcester (Western MA 5 counties)
4 MASSACHUSETTS.- TOTAL
3.4
3.4
3.4
3.4
3.4
1,017,848
1,090,914
1,487,347
1,237,164
4,833,273
10.6
10.6
10.6
10.6
10.6
10,443,303
10,444,432
12,904,149
10,976,083
44,767,967
24.5
24.5
24.5
24.5
24.5
4,424,647
4,824,151
7,394,626
5,472,361
22,115,785
10.8
10.9
11.1
10.9
11.0
15,885,797 3,177,922
16,359,497 3,272,685
21,786,122 4,358,270
17,685,608 3,537,971
71,717,025 14,346,848
19,063,719
19,632,182
26,144,393
21,223,579
86,063,873
1,144
1,178
1,569
1,273
5,164
MI1
MI2
MI3
MI4
MI5
MI-Ann Arbor, Kalamazoo & St. Joseph (South MI- 13 counties + Wayne)
MI-Detroit & Dearborn (Southeast MI- 2 counties + Wayne)
MI-Flint, Lansing & Saginaw (Northeast MI- 22 counties)
MI-Marquette, Muskegon, Petoskey, Traverse City & Grand Rapids (44)
MI-Pontiac & Royal Oak (Oakland County, east MI- NW of Detroit)
5 MICHIGAN.- TOTAL
4.4 2,114,171
4.4 2,726,622
4.4 1,867,897
4.4 2,353,923
4.4 1,247,383
4.4 10,309,995
12.8
12.8
12.8
12.8
12.8
12.8
16,789,010
20,045,826
14,850,920
17,646,212
9,729,973
79,061,942
23.7
23.7
23.7
23.7
23.7
23.7
6,575,452
7,874,233
6,390,534
7,719,070
3,761,469
32,320,757
12.3
12.2
12.5
12.4
12.3
12.3
25,478,633 5,096,950
30,646,680 6,130,807
23,109,351 4,622,980
27,719,205 5,545,171
14,738,825 2,948,473
121,692,695 24,344,380
30,575,583
36,777,488
27,732,331
33,264,376
17,687,298
146,037,075
1,835
2,207
1,664
1,996
1,061
8,762
MN1
MN2
MN3
MN-Minneapolis NW & St. Cloud (Northwest MN 37 counties)
MN-Minneapolis SW (City of & Southwest MN 31 counties)
MN-Duluth, Rochester & St. Paul (Eastern MN 19 counties)
3 MINNESOTA.- TOTAL
3.8
3.8
3.8
3.8
906,783
2,215,691
1,758,879
4,881,352
11.6
11.6
11.6
11.6
7,014,363
17,688,918
13,991,825
38,695,106
27.7
27.7
27.7
27.7
4,372,680
7,855,963
6,706,349
18,934,991
12.3
11.6
11.8
11.8
12,293,826 2,459,355
27,760,571 5,553,447
22,457,052 4,492,488
62,511,449 12,505,290
14,753,181
33,314,018
26,949,540
75,016,740
885
1,999
1,617
4,501
MS1
MS2
MS-Jackson & Oxford (West MS 47 counties)
MS-Gulfport, Hattiesburg, Meridian, Tupelo (East MS 35 counties)
2 MISSISSIPPI.- TOTAL
5.7
5.7
5.7
2,337,806 15.9
1,972,552 15.9
4,310,358 15.9
15,486,945 39.5
13,638,301 39.5
29,125,245 39.5
7,681,049 16.2
7,301,989 16.5
14,983,038 16.3
25,505,800
22,912,841
48,418,641
5,102,384
4,583,668
9,686,052
30,608,184
27,496,510
58,104,694
1,836
1,650
3,486
MO1
MO2
MO3
MO4
MO- Columbia, Joplin & Springfield (57 counties- Central & SW MO.)
MO-Kansas City (26 counties- NW MO.)
MO-St. Louis N. (City of & 6 counties- NE MO.)
MO-St. Louis S. & Cape Girardeau (26 counties- SE MO.)
4 MISSOURI.- TOTAL
4.3
4.3
4.3
4.3
4.3
1,772,195
1,572,035
1,812,054
972,773
6,129,058
14,103,243
12,084,915
14,588,797
7,644,569
48,421,524
7,124,269
5,191,498
6,301,808
3,527,593
22,145,168
22,999,708 4,601,046
18,848,448 3,770,594
22,702,660 4,541,622
12,144,935 2,429,570
76,695,750 15,342,831
27,600,753
22,619,042
27,244,281
14,574,505
92,038,581
1,656
1,357
1,635
874
5,522
13.0
13.0
13.0
13.0
13.0
26.4
26.4
26.4
26.4
26.4
5,998,347 15.5
13.0
12.6
12.7
12.8
12.8
STATE/
CO-OP
NV1
NV2
NJ1
NJ2
NJ3
NJ4
NJ5
NY1
NY2
NY3
NY4
NY5
NY6
NY7
NY8
NY9
NY10
NY11
$270B PRESCRIPTION DRUGS (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
Age # Retail
0-18 Scripts
#/EA Age 0-18
Age # Retail
19-64 Scripts
#/EA Age 19-64
Age # Retail
65+ Scripts
#/EA Age 65+
Age
All
#/EA
Total #
# Non-
Retail
Scripts
(83%)
Retail
Scripts
(17%)
(100%)
Total #
Scripts
COST
($mils)
($60/ EA)
1 MONTANA.- TOTAL (MT)
3.3
737,906 11.2
6,936,986 26.1
3,821,912 11.6
11,496,804
2,299,913
13,796,717
828
1 NEBRASKA.- TOTAL (NE)
5.2
2,383,740 13.1
14,689,991 31.9
7,865,138 13.7
24,938,869
4,988,971
29,927,840
1,796
NV-Las Vegas (3 counties- SE NV)
NV-Reno (14 counties- NW NV)
2 NEVADA.- TOTAL
2.6
2.6
2.6
1,295,715 11.0
431,608 11.0
1,727,323 11.0
13,975,103 24.5
4,853,540 24.5
18,828,643 24.5
5,677,733 10.5
2,272,548 10.8
7,950,281 10.6
20,948,551
7,557,696
28,506,247
4,190,716
1,511,902
5,702,618
25,139,267
9,069,598
34,208,865
1,508
544
2,053
1 NEW HAMPSHIRE.- TOTAL (NH)
5.1
1,463,651 13.9
11,839,410 25.3
4,496,403 13.5
17,799,464
3,560,747
21,360,212
1,282
NJ-Camden N. (3 counties- South NJ)
NJ-Camden S. (6 counties- South NJ)
NJ-Hackensack, Patterson & Ridgewood (2 counties- NE NJ)
NJ-Morristown & New Brunswick (7 counties- NW NJ)
NJ-Newark (3 counties- NE NJ)
5 NEW JERSEY.- TOTAL
4.7
4.7
4.7
4.7
4.7
4.7
1,828,551
1,556,699
1,547,999
2,624,674
2,152,335
9,710,258
11,655,330
10,229,951
10,297,882
17,744,029
14,894,936
64,822,128
12.8 21,218,623 4,244,743 25,463,367
12.4 17,254,187 3,451,666 20,705,852
12.4 17,474,923 3,495,823 20,970,746
12.2 29,045,143 5,810,423 34,855,565
12.0 23,445,633 4,690,252 28,135,885
12.3 108,438,509 21,692,907 130,131,416
1,528
1,242
1,258
2,091
1,688
7,808
1 NEW MEXICO.- TOTAL (NM)
3.4
1,764,305 10.2
NY-Albany (18 counties NE NY)
NY-NYC Bronx County
NY-Buffalo (6 counties western NY)
NY-NYC East Long Island (Queens County)
NY-East Long Island (Nassau County)
NY-East Long Island (Suffolk County)
NY-NYC Manhattan (Kings County, Brooklyn- West Long Island)
NY-NYC Manhattan (NY & Richmond Counties- Staten Island)
NY-White Plains (Orange, Putnam, Rockland & Weschester counties.)
NY-Rochester (10 counties East of Buffalo area)
NY-Syracuse, Binghamton & Elmira (17 counts. East of Rochester)
11 NEW YORK.- TOTAL
4.5 1,867,909
4.5 1,657,974
4.5 1,422,245
4.5 2,077,918
4.5 1,404,499
4.5 1,612,818
4.5 2,671,263
4.5 1,547,655
4.5 1,981,834
4.5 1,357,078
4.5 1,863,177
4.5 19,464,369
11.7
11.7
11.7
11.7
11.7
11.7
12.6
12.6
12.6
12.6
12.6
12.6
12.6
12.6
12.6
12.6
12.6
12.6
28.6
28.6
28.6
28.6
28.6
28.6
12,938,233 21.5
15,786,295
10,977,535
11,447,602
18,691,220
10,363,155
11,760,131
20,450,375
18,106,933
13,332,773
10,963,447
14,802,114
156,681,580
29.8
29.8
29.8
29.8
29.8
29.8
29.8
29.8
29.8
29.8
29.8
29.8
7,734,742
5,467,536
5,629,042
8,676,440
6,398,363
33,906,123
5,843,950 10.0
8,498,827
4,334,003
6,827,141
8,508,866
6,107,462
6,007,747
8,583,607
8,153,923
6,995,814
5,721,788
8,266,511
78,005,688
20,546,488
4,110,284
24,656,772
1,479
13.4 26,153,031 5,231,862 31,384,893
12.3 16,969,512 3,394,717 20,364,229
13.5 19,696,988 3,940,343 23,637,332
13.1 29,278,003 5,857,006 35,135,009
13.3 17,875,117 3,575,881 21,450,998
13.0 19,380,696 3,877,070 23,257,766
12.7 31,705,244 6,342,571 38,047,815
13.5 27,808,510 5,563,037 33,371,547
12.9 22,310,421 4,463,155 26,773,576
13.2 18,042,313 3,609,329 21,651,641
13.4 24,931,802 4,987,557 29,919,359
13.1 254,151,638 50,842,527 304,994,165
1,883
1,222
1,418
2,108
1,287
1,395
2,283
2,002
1,606
1,299
1,795
18,300
STATE/
CO-OP
NC1
NC2
NC3
NC4
NC5
$270B PRESCRIPTION DRUGS (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
Age # Retail
0-18 Scripts
#/EA Age 0-18
Age # Retail
19-64 Scripts
#/EA Age 19-64
Age # Retail
65+ Scripts
#/EA Age 65+
Age
All
#/EA
Total #
# Non-
Retail
Scripts
(83%)
Retail
Scripts
(17%)
NC-Charlotte (10 counties- SW NC)
NC-Durham & Greensboro (19 counties- west of Raleigh)
NC-Greenville & Wilmington (29 counties- eastern & coastal NC)
NC-Raleigh (11 counties)
NC-Winston-Salem, Asheville & Hickory (31 counties- west NC)
5 NORTH CAROLINA.- TOTAL
3.4
3.4
3.4
3.4
3.4
3.4
1 NORTH DAKOTA.- TOTAL (ND)
4.2
OH1
OH2
OH3
OH4
OH5
OH6
OH7
OH-Akron, Canton, Youngstown (12 counties- NE OH)
OH-Cincinnati (7 counties- SW OH)
OH-Cleveland & Elyria (8 counties- NE OH)
OH-Columbus- North (15 counties- central OH)
OH-Columbus- City of & Southeast (20 counties- SE OH)
OH-Dayton & Kettering (15 counties- West OH)
OH-Toledo (11 counties- NW OH)
7 OHIO.- TOTAL
4.8 2,189,895
4.8 1,792,413
4.8 2,594,035
4.8 1,277,279
4.8 2,299,388
4.8 1,891,950
4.8 1,104,476
4.8 13,149,436
OK1
OK2
OK-Oklahoma City & Lawton (54 counties)
OK-Tulsa (23 counties- NE OK)
2 OKLAHOMA- TOTAL
4.0
4.0
4.0
2,204,120 11.0
1,514,332 11.0
3,718,452 11.0
15,150,407 25.9
10,316,178 25.9
25,466,585 25.9
7,604,273 11.2
5,516,507 11.3
13,120,781 11.3
24,958,800
17,347,017
42,305,818
OR1
OR2
OR-Bend, Eugene, Medford, Salem (20 counties- Southern OR)
OR-Portland (16 counties- Northern OR)
2 OREGON- TOTAL
3.6
3.6
3.6
1,406,050 13.7
1,710,960 13.7
3,117,010 13.7
14,883,351 27.7
18,436,511 27.7
33,319,862 27.7
7,900,389 13.7
6,867,345 13.1
14,767,734 13.4
PA1
PA2
PA3
PA4
PA5
PA6
PA7
PA8
PA-Allentown, Scranton & Wilkes-Barre (9 counties- NE PA)
PA-Danville, Erie & Sayre (22 counties- North & West PA)
PA-Harrisburg, Altoona & Johnstown (15 counties- South Central PA)
PA-Lancaster, Reading & York (5 counties- SE PA)
PA-Philadelphia NW (3 counties- SE PA)
PA-Philadelphia (city of & county- SE PA)
PA-Pittsburgh (city of & west- 5 counties SW PA)
PA-Pittsburgh East (7 counties- SW PA)
8 PENNSYLVANIA- TOTAL
4.2 1,444,659
4.2 1,223,453
4.2 1,418,183
4.2 2,032,803
4.2 1,922,754
4.2 1,443,887
4.2 1,458,390
4.2
799,820
4.2 11,743,949
1,705,907
1,570,332
1,121,467
1,769,977
1,589,826
7,757,510
9.8
9.8
9.8
9.8
9.8
9.8
629,949 11.7
15.3
15.3
15.3
15.3
15.3
15.3
15.3
15.3
13.2
13.2
13.2
13.2
13.2
13.2
13.2
13.2
13.2
12,304,385
12,224,803
9,199,900
12,513,385
12,749,982
58,992,455
22.1
22.1
22.1
22.1
22.1
22.1
4,814,353 9.5
5,698,568 9.9
4,692,057 10.1
4,576,014 9.4
7,495,361 10.4
27,276,354 9.9
4,973,407 36.7
3,579,193 13.7
18,793,833
14,659,680
21,758,750
10,110,878
20,010,305
15,221,389
9,234,492
109,789,328
12,841,719
11,667,793
12,604,287
16,366,201
16,292,786
13,168,011
14,356,408
7,594,945
104,892,152
29.5
29.5
29.5
29.5
29.5
29.5
29.5
29.5
30.8
30.8
30.8
30.8
30.8
30.8
30.8
30.8
30.8
9,294,144
5,762,049
10,409,887
4,473,570
6,998,307
6,914,321
3,975,045
47,827,324
7,835,554
6,978,819
7,808,576
8,906,425
8,993,641
5,687,119
9,137,081
5,015,414
60,362,629
15.1
14.5
15.0
14.7
14.5
14.8
14.8
14.8
14.1
14.2
14.1
13.6
13.7
13.3
14.4
14.4
13.9
18,824,646 3,765,833
19,493,703 3,899,676
15,013,425 3,003,406
18,859,376 3,772,780
21,835,169 4,368,082
94,026,319 18,809,777
Total #
Scripts
(100%)
COST
($mils)
($60/ EA)
22,590,478
23,393,380
18,016,831
22,632,156
26,203,251
112,836,097
1,355
1,404
1,081
1,358
1,572
6,770
1,836,951
11,019,499
661
30,277,872 6,057,028
22,214,141 4,443,895
34,762,672 6,954,203
15,861,728 3,173,107
29,308,000 5,863,007
24,027,660 4,806,685
14,314,013 2,863,490
170,766,087 34,161,414
36,334,900
26,658,036
41,716,875
19,034,835
35,171,007
28,834,346
17,177,503
204,927,501
2,180
1,599
2,503
1,142
2,110
1,730
1,031
12,296
4,992,958
3,470,236
8,463,194
29,951,758
20,817,254
50,769,012
1,797
1,249
3,046
24,189,790 4,839,119
27,014,816 5,404,260
51,204,606 10,243,379
29,028,909
32,419,076
61,447,985
1,742
1,945
3,687
22,121,932 4,425,448
19,870,065 3,974,967
21,831,046 4,367,257
27,305,429 5,462,396
27,209,182 5,443,142
20,299,018 4,060,778
24,951,880 4,991,574
13,410,179 2,682,679
176,998,730 35,408,242
26,547,380
23,845,032
26,198,303
32,767,825
32,652,324
24,359,795
29,943,454
16,092,858
212,406,972
1,593
1,431
1,572
1,966
1,959
1,462
1,797
966
12,744
9,182,549
STATE/
CO-OP
SC1
SC2
SC3
TN1
TN2
TN3
TN4
TX1
TX2
TX3
TX4
TX5
TX6
TX7
TX8
TX9
TX10
TX11
TX12
TX13
TX14
UT1
UT2
$270B PRESCRIPTION DRUGS (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
Age # Retail
0-18 Scripts
#/EA Age 0-18
1 RHODE ISLAND- TOTAL (RI)
3.5
SC-Charleston & Florence (17 counties- SE SC)
SC-Columbia (20 counties- Central SC)
SC-Greenville & Spartanburg (9 counties- NW SC)
3 SOUTH CAROLINA- TOTAL
4.1
4.1
4.1
4.1
1 SOUTH DAKOTA- TOTAL (SD)
4.6
TN-Memphis & Jackson (20 counties- west TN)
TN-Nashville City Of & West (18 counties- central TN)
TN-Nashville East & Chattanooga (31 counties- central TN)
TN-Knoxville, Johnson City, Kingsport (26 counties- east TN)
4 TENNESSEE- TOTAL
5.1
5.1
5.1
5.1
5.1
TX-Amarillo, Lubbock & Witchita Falls (62 counties- TX panhandle)
TX-Austin & Temple (12 counties East TX)
TX-Houston East & Beaumont (19 counties- SE TX)
TX-Houston (city of- Harris County SE TX)
TX-Houston (Harris County excluding Houston)
TX-Houston West (10 counties- SE TX)
TX-Dallas (Dallas County- NE TX)
TX-Dallas East (12 counties- NE TX)
TX-Dallas NW (5 counties- NE TX)
TX-El Paso, Abilene, Odessa & San Angelo (44 counties- West TX)
TX-Fort Worth (7 counties- NE TX)
TX-San Antonio (29 counties- SW TX)
TX-Corpus Christi, Harlingen, McAllen & Victoria (20 counties- SW TX)
TX-Waco, Bryan, Tyler & Longview (32 counties- Central & NE TX)
14 TEXAS- TOTAL
UT-Salt Lake City NW & Ogden (8 counties- NW UT)
UT-Salt Lake City SE & Provo (21 counties- SE UT)
2 UTAH- TOTAL
Age # Retail
19-64 Scripts
#/EA Age 19-64
784,689 11.2
1,528,686
1,443,754
1,466,178
4,438,618
11.2
11.2
11.2
11.2
932,562 11.4
Age # Retail
65+ Scripts
#/EA Age 65+
7,580,167 26.4
11,500,731
10,644,733
10,455,700
32,601,165
25.7
25.7
25.7
25.7
5,643,244 32.5
Age
All
#/EA
4,001,439 11.7
5,976,424
5,075,526
5,189,319
16,241,269
11.6
11.4
11.5
11.5
3,783,902 12.7
Total #
# Non-
Retail
Scripts
(83%)
Retail
Scripts
(17%)
(100%)
12,366,294
2,473,852
14,840,146
890
19,005,841 3,802,081
17,164,013 3,433,627
17,111,197 3,423,061
53,281,052 10,658,768
22,807,922
20,597,640
20,534,258
63,939,820
1,368
1,236
1,232
3,836
10,359,708
2,072,439
12,432,147
746
Total #
Scripts
COST
($mils)
($60/ EA)
1,993,066
1,776,254
1,937,345
1,927,515
7,634,181
17.8
17.8
17.8
17.8
17.8
17,223,772
16,550,860
17,975,535
19,433,572
71,183,739
39.3
39.3
39.3
39.3
39.3
7,378,030
6,312,770
8,848,546
10,870,384
33,409,731
17.2
17.1
17.8
18.5
17.7
26,594,868 5,320,250
24,639,884 4,929,160
28,761,426 5,753,666
32,231,472 6,447,842
112,227,651 22,450,917
31,915,119
29,569,044
34,515,092
38,679,313
134,678,568
1,915
1,774
2,071
2,321
8,081
4.1 1,222,891
4.1 2,348,632
4.1 1,724,938
4.1 2,231,474
4.1 2,453,650
4.1 1,325,260
4.1 2,682,066
4.1 1,665,956
4.1
989,640
4.1 1,836,779
4.1 2,487,679
4.1 3,085,697
4.1 2,519,267
4.1 1,570,600
4.1 28,144,529
8.8
8.8
8.8
8.8
8.8
8.8
8.8
8.8
8.8
8.8
8.8
8.8
8.8
8.8
8.8
6,269,644
12,827,455
9,171,439
12,030,547
10,915,985
6,285,653
13,257,543
7,980,834
5,086,833
8,542,525
12,167,416
14,652,193
10,086,583
8,708,074
137,982,725
24.6
24.6
24.6
24.6
24.6
24.6
24.6
24.6
24.6
24.6
24.6
24.6
24.6
24.6
24.6
3,628,926
4,784,862
5,073,002
4,626,803
3,790,954
2,734,515
5,102,965
3,683,859
2,001,188
4,756,892
5,243,638
7,567,994
5,464,912
5,528,680
63,989,189
9.6
9.0
9.6
9.0
8.6
9.0
8.9
9.1
9.0
9.4
9.0
9.3
9.1
9.9
9.2
11,121,461 2,224,826
19,960,948 3,993,148
15,969,378 3,194,642
18,888,824 3,778,672
17,160,590 3,432,942
10,345,428 2,069,582
21,042,574 4,209,525
13,330,648 2,666,770
8,077,662 1,615,920
15,136,196 3,027,966
19,898,733 3,980,702
25,305,885 5,062,392
18,070,763 3,615,020
15,807,353 3,162,229
230,116,443 46,034,335
13,346,287
23,954,096
19,164,020
22,667,496
20,593,531
12,415,010
25,252,099
15,997,418
9,693,582
18,164,162
23,879,435
30,368,276
21,685,783
18,969,583
276,150,778
801
1,437
1,150
1,360
1,236
745
1,515
960
582
1,090
1,433
1,822
1,301
1,138
16,569
21,571,298
11,436,492
33,007,790
1,294
686
1,980
2.9
2.9
2.9
1,601,069 11.4
924,423 11.4
2,525,492 11.4
12,424,480 25.0
6,306,510 25.0
18,730,990 25.0
3,949,814 10.0
2,299,096 9.9
6,248,910 10.0
17,975,363
9,530,029
27,505,392
3,595,935
1,906,463
5,502,399
STATE/
CO-OP
$270B PRESCRIPTION DRUGS (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
Age # Retail
0-18 Scripts
#/EA Age 0-18
Age # Retail
19-64 Scripts
#/EA Age 19-64
Age # Retail
65+ Scripts
#/EA Age 65+
Age
All
#/EA
Total #
# Non-
Retail
Scripts
(83%)
Retail
Scripts
(17%)
(100%)
10,929,443
2,186,413
13,115,856
787
Total #
Scripts
COST
($mils)
($60/ EA)
1 VERMONT- TOTAL (VT)
5.7
VA1
VA2
VA3
VA4
VA-Arlington & Winchester (17 counties- Northeast VA & DC area)
VA-Charlottesville, Lynchburg, Roanoke (61 counties- Western VA)
VA-Norfolk & Newport News (19 counties- Southeast VA)
VA-Richmond (37 counties- Eastern VA)
4 VIRGINIA- TOTAL
3.7
3.7
3.7
3.7
3.7
2,307,702
1,512,445
1,530,207
1,508,717
6,859,071
11.0
11.0
11.0
11.0
11.0
18,337,228
13,785,014
12,569,937
12,182,836
56,875,015
25.7
25.7
25.7
25.7
25.7
6,029,915
8,105,418
5,451,666
5,515,868
25,102,867
10.6
11.8
11.1
11.1
11.1
26,674,845 5,336,249 32,011,094
23,402,877 4,681,699 28,084,576
19,551,809 3,911,300 23,463,110
19,207,421 3,842,406 23,049,827
88,836,953 17,771,655 106,608,607
1,921
1,685
1,408
1,383
6,397
WA1
WA2
WA3
WA4
WA-Spokane & Yakima (20 counties- eastern WA)
WA-Seattle City & King County (central WA)
WA-Seattle NW & Everett (10 counties- NW WA)
WA-Olympia & Tacoma (8 counties- SW WA)
4 WASHINGTON- TOTAL
3.6
3.6
3.6
3.6
3.6
1,384,742
1,487,834
1,313,559
1,504,084
5,690,220
11.9
11.9
11.9
11.9
11.9
10,922,166
15,558,721
12,236,659
12,650,571
51,368,117
24.1
24.1
24.1
24.1
24.1
4,641,040
5,073,198
5,263,145
4,959,942
19,937,325
11.3
11.5
11.7
11.3
11.4
16,947,948 3,390,403
22,119,754 4,425,012
18,813,364 3,763,576
19,114,597 3,823,837
76,995,662 15,402,828
20,338,352
26,544,766
22,576,939
22,938,434
92,398,490
1,220
1,593
1,355
1,376
5,544
1 WEST VIRGINIA- TOTAL (WV)
6.0
2,323,654 19.4
22,683,241 37.3
11,058,668 19.5
36,065,563
7,214,844
43,280,407
2,597
WI-Appleton, Green Bay, Neenah & Wausau (20 counties- NE WI)
WI-Madison (14 counties- SE WI)
WI-Milwaukee (9 counties- SE WI)
WI-La Crosse & Marshfield (29 counties- NW WI)
4 WISCONSIN- TOTAL
4.1
4.1
4.1
4.1
4.1
1,170,019
1,066,332
2,249,196
1,003,142
5,488,689
9,788,585
9,542,989
18,091,156
8,638,562
46,061,292
5,139,901
4,256,404
8,154,147
4,612,248
22,162,701
16,098,506 3,220,474
14,865,725 2,973,858
28,494,499 5,700,268
14,253,952 2,851,475
73,712,682 14,746,075
19,318,980
17,839,583
34,194,767
17,105,427
88,458,756
1,159
1,070
2,052
1,026
5,308
1 WYOMING- TOTAL (WY)
3.8
7,729,921
464
4.1 305,238,742 11.9 2,315,312,962 28.0 1,128,777,806 12.1 3,749,329,510 750,045,877 4,499,375,388
$269,963
WI1
WI2
WI3
WI4
185 USA TOTAL # PRESCRIPTIONS
USA TOTAL $ (MILS @ RI Costs above)
738,312 17.5
12.9
12.9
12.9
12.9
12.9
514,027 11.7
$18,314
7,084,952 34.0
28.5
28.5
28.5
28.5
28.5
4,194,054 24.8
$138,919
3,106,178 17.5
13.1
12.9
12.7
13.2
13.0
1,733,263 11.4
$67,727
6,441,343
$224,960
1,288,578
$45,003
PRESCRIPTION DRUGS @ Local Costs ($mils) ***
"'* after Geographic COLA's see Appendices F thru J
$269,963
$245,391
-9.1%
E91-103: $151B DOCTOR FEES
(NOT HOSP EE’s OR PRIMARY CARE)
BY STATE & CO-OP
EXPANDING THE RI MODEL NATIONALLY
185 BUYER CO-OP’s DEFINED
GEOGRAPHIC MARKETS WITHIN STATES
EACH, 1 to 2.5 MIL PEOPLE (1 to 2.5 RI’s)
(NEXT 12 SLIDES)
Each of the 185 CO-OP areas covers 1 or more “Hospital Referral Regions” as
defined by the Dartmouth Atlas of Health Care. Regional hospitals capable of
cardio and/or neuro surgery. (http://www.dartmouthatlas.org/data/region/)
In each of the 15,490 service areas the CO-OP would contract approx. 17 Primary
Care MDs, 7 Dentists and 4 Optometrists to service a population of approx. 20k.
BACK
Table of Contents
DOCTOR FEE NOTES:
(NOT HOSPITAL EE’s OR PRIMARY CARE)
TOTAL DOCTORS BY STATE: The number of doctors in each state (2012) came from a special data
request on State Licensing Information from Redi-Data, Inc. Data includes active MD’s & DO’s at
November 2012 as posted at http://www.statehealthfacts.org/comparemaptable.jsp?ind=934&cat=8 .
This per state information totaled 836k active doctors for the USA or 27.1 doctors per 10k people using
E13-21 for population. States varied widely from a high in MA (46 per 10k) & NY (36 per 10k) to a low in
ID of just 17.5 per 10k with AR, MS, NV & WY all under 20 per 10k (less than half MA & NY!!). Some of
this difference is certainly due to population demographics. The +65 and under 1 populations use
doctors more than the general population. But this accounts for just 6.5% difference between the
highest and lowest states. The balance is simply mal-distribution of resources due to reimbursement,
insurance, doctor practice & lifestyle choices etc. CO-Ops are expected to contract with private practice
doctors and support hospital budgets etc in their local areas which will better distribute resources.
Accordingly a re-distribution of doctors among states is expected over time as depicted on the following
slides. In total 8 states would likely see a reduction of 31k doctors with 30 states seeing an increase of
45k doctors. A doctor shortage of 14k today. Certainly there will be re-distribution within states as well.
NOTE: obviously all doctors are free to contract with the CO-OP and/or solicit private pay patients.
DOCTORS BY CO-OP: The total number of doctors expected in each CO-OP is presented in four
groups: 1) Primary Care (per E22-34), 2) Hospital Activity (per E35-64) private practice doctors involved
in hospital inpatient surgeries, outpatient surgeries & outpatient imaging, etc. 3) Doctors who are
employees of hospitals, governments, corporations etc. and 4) All Other Private Practice Specialists not
Primary Care, Hospital Related or Employees. Since Primary Care (E22-34) already considered
population demographics, the number of doctors estimated in group 4 was set at 1/3 the primary care
doctors in each CO-OP area (a patient sees a specialist once for every 3 visits to a PC doctor. Note: if
patient has chronic condition specialist can be PC and see generalist 1/3). The number of doctors in
group 3 was considered 1/3 of all doctors in the area consistent with RI and national stats. Finally the
total number of doctors was between 25 & 30 per 10k (USA avg. 27.1 +/- 10% for aging, etc.). NOTE:
there will be more or less in group 3 or 4 based on local markets and negotiation with CO-OP.
USA MDs & SPECIALISTS (NOT HOSP EEs OR PC)
ASSOCIATED WITH HOSPITAL ACTIVITY:
49k SURGEONS: 9.75 Mil OPERATIONS @ $3,500/EA
26k ANESTHESIOLOGISTS: 8 Mil
@ $1,500/EA
$ 34B (B3 RI example)
$ 12B (B3 RI example)
69k SURGEONS/SPECIALISTS: 24.3 Mil
OUTPATIENT SURGERIES
@ $1,000/EA
$ 24B (B4 RI example)
34k RADIOLOGISTS: 118.8 Mil
OUTPATIENT IMAGES
$ 15B (B5) (drive to PC)
@ $125/EA
178k TOTAL ASSOCIATED WITH HOSPITALS (EST) $ 85B
ALL OTHER MD/ SPECIALISTS (approx. 100k) **
$ 66B
278k GRAND TOTAL
$151B
(SLIDE 75)
** Each PC doctor would be given $200k of non-Hosp. “Specialist Referrals” per year
based on patient roster. They would decide how to “spend” them ($100/referral).
STATE
[--- BEFORE ---]
Total #
Doc's
2012
Expected [----- AFTER -----]
per Doc Re-Dist.
# Doc's
per
10K from CO-OP
after
10K
POP
Activity
Re-Dist.
POP
STATES WITH EXCESS DOCTORS:
Connecticut
Maryland
Massachusetts
Michigan
New York
Pennsylvania
Rhode Island
Washington
SUBTOTAL
12,268
20,060
30,091
31,172
68,898
41,437
4,055
18,773
226,754
# Doc's
per Non-Hosp
10K Activity
total # Doc's
paid by
per hosp govt
10K corp, other
per
10K
[-------- PVT PRACTICE DOC's PAID BY CO-OP ----------]
34.3
34.7
46.0
31.5
35.6
32.6
38.5
27.9
34.5
(1,700)
(2,700)
(10,000)
(1,835)
(9,500)
(3,150)
(700)
(1,250)
(30,835)
10,568
17,360
20,091
29,337
59,398
38,287
3,355
17,523
195,919
29.6
30.1
30.7
29.7
30.7
30.1
31.9
26.1
29.8
STATES NEEDING DOCTORS:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
DC, Washington
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
# Primary
# Doc's
Care Doc's
Hosp
pd by CO-OP per Activity
E22-34
10K E35-64
10,446 21.9
1,652 23.3
15,269 23.9
5,747 19.7
95,041 25.5
12,838 25.5
6,238 103.7
2,657 29.6
46,830 24.9
21,558 22.3
3,464 25.5
2,738 17.5
35,643 27.8
14,654 22.6
7,133 23.4
6,439 22.6
10,192 23.5
11,169 24.6
3,126
5,012
5,742
8,604
16,949
11,196
926
5,807
57,362
8.7
8.7
8.8
8.7
8.7
8.8
8.8
8.6
8.7
1,982
3,464
4,227
6,607
12,002
8,408
660
2,979
40,331
5.5
6.0
6.5
6.7
6.2
6.6
6.3
4.4
6.1
1,168
1,872
2,145
3,214
6,330
4,182
346
2,169
21,425
3.3
3.2
3.3
3.3
3.3
3.3
3.3
3.2
3.3
4,293
7,012
7,977
10,912
24,117
14,501
1,422
6,568
76,802
12.0
12.1
12.2
11.0
12.4
11.4
13.5
9.8
11.7
4,579
630
5,420
2,597
35,275
4,752
4,868
1,012
16,419
7,545
1,247
1,398
12,402
5,132
2,497
2,253
3,569
3,910
9.6
8.9
8.5
8.9
9.5
9.4
80.9
11.3
8.7
7.8
9.2
8.9
9.7
7.9
8.2
7.9
8.2
8.6
[-------- PVT PRACTICE DOC's PAID BY CO-OP ----------]
3,000
150
700
2,200
4,600
2,655
1,300
2,240
1,130
880
1,600
1,340
13,446 28.1
1,802 25.4
15,969 25.0
7,947 27.3
95,041 25.5
12,838 25.5
6,238 103.7
2,657 29.6
51,430 27.4
24,213 25.0
3,464 25.5
4,038 25.8
35,643 27.8
16,894 26.1
8,263 27.1
7,319 25.7
11,792 27.2
12,509 27.6
4,169
592
5,529
2,542
31,937
4,302
532
787
16,732
8,294
1,188
1,341
11,089
5,608
2,661
2,464
3,771
3,916
8.7
8.3
8.7
8.7
8.6
8.6
8.8
8.8
8.9
8.6
8.7
8.6
8.6
8.6
8.7
8.6
8.7
8.6
3,141
359
2,955
1,858
15,900
2,176
640
563
12,030
5,276
586
799
8,010
4,060
2,111
1,682
3,044
3,221
6.6
5.1
4.6
6.4
4.3
4.3
10.6
6.3
6.4
5.4
4.3
5.1
6.2
6.3
6.9
5.9
7.0
7.1
1,557
221
2,065
949
11,929
1,607
199
294
6,249
3,098
444
501
4,142
2,095
994
920
1,408
1,462
3.3
3.1
3.2
3.3
3.2
3.2
3.3
3.3
3.3
3.2
3.3
3.2
3.2
3.2
3.3
3.2
3.2
3.2
STATE
[--- BEFORE ---]
Total #
Doc's
2012
Expected [----- AFTER -----]
per Doc Re-Dist.
# Doc's
per
10K from CO-OP
after
10K
POP
Activity
Re-Dist.
POP
STATES NEEDING DOCTORS (continued):
Maine
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
West Virginia
Wisconsin
Wyoming
SUBTOTAL
4,109
15,412
5,681
16,824
2,072
4,495
5,221
3,683
25,117
4,841
23,253
1,649
34,656
8,064
10,380
10,424
1,874
16,526
54,508
5,741
2,022
20,688
4,750
15,256
1,061
610,027
30.9
29.1
19.1
28.1
20.9
24.6
19.3
28.0
28.6
23.5
24.4
24.5
30.0
21.5
27.1
22.5
23.0
26.0
21.7
20.8
32.3
25.9
25.6
26.8
18.8
25.1
GRAND TOTAL
836,781
27.1
# Primary
Care Doc's
pd by CO-OP per
E22-34
10K
# Doc's
Hosp
Activity
E35-64
# Doc's
per Non-Hosp
10K Activity
total # Doc's
paid by
per hosp govt
10K corp, other
per
10K
[-------- PVT PRACTICE DOC's PAID BY CO-OP ----------]
575
650
280
360
45,085
4,109
15,412
7,681
17,339
2,622
4,895
6,821
3,683
25,117
5,241
25,278
1,924
34,656
9,504
10,380
11,924
2,154
17,466
62,808
6,941
2,022
21,263
5,400
15,536
1,421
653,100
30.9
29.1
25.9
29.0
26.5
26.8
25.3
28.0
28.6
25.5
26.5
28.6
30.0
25.3
27.1
25.8
26.5
27.5
25.0
25.1
32.3
26.6
29.1
27.3
25.2
26.9
1,176
4,587
2,566
5,221
865
1,581
2,318
1,148
7,657
1,781
8,280
587
10,065
3,251
3,342
4,036
707
5,524
21,343
2,306
550
6,928
1,639
4,942
485
210,337
8.9
8.6
8.6
8.7
8.7
8.7
8.6
8.7
8.7
8.6
8.7
8.7
8.7
8.7
8.7
8.7
8.7
8.7
8.5
8.3
8.8
8.7
8.8
8.7
8.6
8.7
969
3,076
1,866
4,279
643
1,121
1,072
826
4,747
1,103
5,766
542
7,895
2,216
1,867
2,734
526
4,097
12,616
1,206
449
4,509
1,502
3,409
286
137,733
7.3
5.8
6.3
7.1
6.5
6.1
4.0
6.3
5.4
5.4
6.0
8.1
6.8
5.9
4.9
5.9
6.5
6.5
5.0
4.4
7.2
5.6
8.1
6.0
5.1
5.7
439
1,713
959
1,950
323
591
866
429
2,860
665
3,093
219
3,759
1,214
1,248
1,507
264
2,063
7,972
861
205
2,588
612
1,846
181
78,561
3.3
3.2
3.2
3.3
3.3
3.2
3.2
3.3
3.3
3.2
3.2
3.3
3.3
3.2
3.3
3.3
3.2
3.3
3.2
3.1
3.3
3.2
3.3
3.2
3.2
3.2
1,525
6,035
2,290
5,889
792
1,602
2,566
1,279
9,853
1,693
8,139
576
12,937
2,822
3,922
3,647
657
5,782
20,877
2,568
817
7,238
1,647
5,340
469
226,469
11.5
11.4
7.7
9.8
8.0
8.8
9.5
9.7
11.2
8.2
8.5
8.6
11.2
7.5
10.2
7.9
8.1
9.1
8.3
9.3
13.1
9.0
8.9
9.4
8.3
9.3
14,250
849,019
27.5
267,699
8.7
178,064
5.8
99,986
3.2
303,270
9.8
2,000
515
550
400
1,600
400
2,025
275
1,440
1,500
280
940
8,300
1,200
278k Doc’s $151B Fees
See next 8 slides
STATE/
CO-OP
AL1
AL2
AL3
$151B DOCTOR FEES- NOT HOSP. EE OR PC (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
AL-Birmingham S & Tuscaloosa (28 counties- Central AL)
AL-Birmingham N & Huntsville (15 counties- Northern AL)
AL-Dothan, Mobile & Montgomery (23 counties- Southern AL)
3 ALABAMA-TOTAL
1 ALASKA-TOTAL (AK)
# Surgeons
Not Hosp
Employees
(est 85%)
# Anesthesiologists
Not Hosp
(est 70%)
# Specialists
Not Hosp
Employees
(est 100%)
# Radiologists
Not Hosp
(est 75%)
total hosp
related
MD FEES
($ mil)
# Other
Doc's
Not Hosp
Not PC
total other
Doc's
MD FEES
($ mil)
Total
# Doc's
Not Hosp
Not PC
Total
MD FEES
($ mils)
368
233
289
889
195
124
153
473
566
359
444
1,369
169
107
133
410
620
394
487
1,501
652
402
503
1,557
430
265
332
1,028
1,950
1,226
1,522
4,698
1,051
659
819
2,529
79
42
142
97
167
221
146
580
313
AZ1
AZ2
AZ3
AZ4
AZ-Mesa (Maricopa SE- Mesa, Chandler, Gilbert, Tempe)
AZ-Phoenix City of (Maricopa central)
AZ-Phoenix N & Sun City (Maricopa- Glendale, Scottsdale & North AZ)
AZ-Phoenix S & Tucson (Maricopa- Avondale, Goodyear & South AZ)
4 ARIZONA-TOTAL
171
196
297
320
984
91
104
158
170
523
186
212
327
349
1,074
65
74
113
122
374
255
293
445
479
1,471
381
467
552
665
2,065
252
308
364
439
1,363
893
1,054
1,447
1,626
5,020
507
601
810
917
2,834
AR1
AR2
AR-Little Rock (South & East AR, 43 counties)
AR-Fort Smith, Jonesboro, Springdale, Texarkana (N&W - 32 counties)
2 ARKANSAS-TOTAL
285
229
514
151
122
273
467
376
843
126
102
228
489
393
882
524
426
949
346
281
627
1,553
1,254
2,808
834
674
1,508
182
204
306
190
254
289
265
283
147
200
213
322
280
247
163
253
143
231
128
250
188
4,739
97
108
162
101
135
153
141
150
78
106
113
171
149
131
87
134
76
123
68
133
100
2,518
232
259
388
242
322
367
336
359
187
254
271
409
356
312
207
321
182
294
163
317
239
6,017
101
113
169
105
141
160
147
157
82
111
118
178
155
137
90
140
79
128
71
138
104
2,625
298
333
499
311
415
472
433
462
241
327
348
526
458
403
267
413
234
378
210
408
308
7,743
451
513
806
484
672
711
684
690
387
509
496
794
701
658
419
628
339
588
314
619
468
11,929
298
338
532
319
444
469
452
455
255
336
327
524
463
434
276
415
224
388
207
408
309
7,873
1,063
1,197
1,831
1,122
1,523
1,680
1,573
1,639
881
1,181
1,210
1,874
1,642
1,484
966
1,477
819
1,364
745
1,456
1,101
27,828
596
672
1,031
630
858
941
884
917
496
663
675
1,050
921
837
543
828
457
766
417
816
617
15,616
CA1
CA2
CA3
CA4
CA5
CA6
CA7
CA8
CA9
CA10
CA11
CA12
CA13
CA14
CA15
CA16
CA17
CA18
CA19
CA20
CA21
CA-Orange County N (Anaheim, Garden Grove, Hunt. Bch & North)
CA-Orange County S (Santa Ana, Costa Mesa & South)
CA-Bakersfield & Fresno (Kern, Tulare & Fresno, King, Madera)
CA-Alameda County
CA-LA Central LA, South LA, Northeast LA & Eastside
CA-LA Harbor, South Bay & Westside
CA-LA San Fern. Valley, NW, Antelope, Forest & Santa Monica Mtns.
CA-LA San Gabriel Valley, Pomona & Verdugos
CA-LA Southeast
CA-Modesto & Stockton (Merced, Stanislaus, San Joaquin, +4 more.)
CA-Napa, Chico, Redding & Santa Rosa (15 counties- north CA )
CA-Sacramento (11 counties)
CA-Palm Springs/Rancho Mirage (Riverside County)
CA-San Bernardino & Inyo Counties
CA-San Diego (City of)
CA-San Diego County (ex. City of, + Imperial County)
CA-San Francisco (SF & Marin Counties)
CA-San Jose (Santa Clara & San Benito Counties)
CA-Santa Cruz & San Mateo County
CA-Santa Barbara, San Luis Obispo, Salinas & Ventura
CA-Contra Costa & Solano Counties
21 CALIFORNIA-TOTAL
STATE/
CO-OP
$151B DOCTOR FEES- NOT HOSP. EE OR PC (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
# Surgeons # Anesthe- # Specialists # RadiNot Hosp siologists Not Hosp
ologists
Employees Not Hosp Employees Not Hosp
(est 85%) (est 70%) (est 100%) (est 75%)
total hosp
related
MD FEES
($ mil)
# Other total other
Doc's
Doc's
Not Hosp MD FEES
Not PC
($ mil)
Total
# Doc's
Total
Not Hosp MD FEES
Not PC
($ mils)
CO1
CO2
CO3
CO4
CO-Boulder, Fort Collins, Greeley (10 counties- NE CO.)
CO-Colorado Springs, Grand Junction & Pueblo (35 counties- S. CO.)
CO-Denver City of & East (7 counties)
CO-Denver West (12 counties)
4 COLORADO-TOTAL
114
180
206
123
624
61
96
109
65
331
146
231
262
157
795
78
123
141
84
426
193
305
348
208
1,055
294
445
545
322
1,607
194
294
360
212
1,061
693
1,075
1,264
751
3,783
388
599
708
421
2,116
CT1
CT2
CT-Hartford (6 counties)
CT-New Haven & Bridgeport (2 counties SW CT.)
2 CONNECTICUT-TOTAL
286
281
566
152
149
301
344
338
682
218
214
432
487
478
964
586
581
1,168
387
384
771
1,587
1,563
3,149
874
861
1,735
1 DC, Wash.- TOTAL (DC)
183
97
238
122
310
199
131
838
441
1 DELAWARE.- TOTAL (DE)
141
75
260
88
263
294
194
857
457
297
344
218
436
211
212
305
255
237
511
376
3,402
158
183
116
232
112
112
162
135
126
272
200
1,807
507
589
372
744
361
362
520
438
404
878
643
5,819
87
101
64
128
62
62
90
75
70
151
111
1,002
497
576
365
729
353
354
511
428
397
858
630
5,697
581
580
447
854
382
371
620
400
473
828
713
6,249
383
383
295
564
252
245
409
264
312
547
471
4,125
1,631
1,797
1,217
2,393
1,127
1,120
1,698
1,303
1,310
2,640
2,044
18,279
881
959
660
1,293
605
599
920
692
709
1,404
1,101
9,821
288
304
300
240
199
1,331
153
162
160
127
106
707
565
595
588
469
389
2,606
137
144
143
114
94
632
531
560
553
441
366
2,449
652
725
738
542
440
3,098
430
479
487
358
291
2,044
1,795
1,931
1,928
1,492
1,228
8,374
961
1,038
1,040
799
656
4,494
FL1
FL2
FL3
FL4
FL5
FL6
FL7
FL8
FL9
FL10
FL11
GA1
GA2
GA3
GA4
GA5
FL-Fort Lauderdale S. (Broward County)
FL-Fort Lauderdale N. (Martin, Palm Beach & St. Lucie Counties)
FL-Jacksonville (Baker, Clay, Duval, Nassau & St Johns Counties)
FL-Miami-Dade & Monroe Counties (Everglades & Keys)
FL- Gainesville & Ormond Beach (12 Counties)
FL-Orlando S. (Brevard, Hardee, Highlands, Indian., Okee., Osceola)
FL-Orlando N. (Orange, Lake & Seminole counties)
FL-Ocala & Hudson (Citrus, Hernando, Marion, Pasco, Sumter)
FL-Tallahassee, Panama City & Pensacola (19 Counties)
FL-Fort Meyers, Sarasota, Bradenton & Lakeland (9 Counties)
FL-Tampa, St. Petersburg & Clearwater (Hillborough & Pinellas)
11 FLORIDA.- TOTAL
GA-Atlanta North & Rome (36 Counties)
GA-Atlanta City of & West (Fulton, Cobb & West, 11 Counties)
GA-Atlanta East (DeKalb, Gwinnett & East 11 Counties)
GA-Savannah & Augusta (SE. GA 47 Counties)
GA-Macon, Columbus & Albany (SW. GA 54 Counties)
5 GEORGIA.- TOTAL
STATE/
CO-OP
$151B DOCTOR FEES- NOT HOSP. EE OR PC (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
# Surgeons
Not Hosp
Employees
(est 85%)
# Anesthe- # Specialists
siologists
Not Hosp
Not Hosp Employees
(est 70%)
(est 100%)
# Radiologists
Not Hosp
(est 75%)
total hosp
related
MD FEES
($ mil)
# Other
Doc's
Not Hosp
Not PC
total other
Doc's
MD FEES
($ mil)
Total
# Doc's
Not Hosp
Not PC
Total
MD FEES
($ mils)
1 HAWAII.- TOTAL (HI)
153
81
233
118
279
444
293
1,030
571
1 IDAHO.- TOTAL (ID)
182
97
347
173
369
501
331
1,299
700
IL1
IL2
IL3
IL4
IL5
IL6
IL7
IL-Bloomington, Joliet & Urbana (East IL- 16 counties)
IL-Blue Island (Cook County- South)
IL-Chicago, city of (Cook County- East)
IL-Melrose Park, & Hinsdale (Cook-west, Dupage & Kane)
IL-Elgin & Evanston (NE. IL: Cook-north, Mchenry & Lake)
IL-Peoria, Rockford & Aurora (NW IL- 25 counties)
IL-Springfield (South IL: 56 counties)
7 ILLINOIS.- TOTAL
248
151
427
332
338
292
356
2,143
132
80
227
177
180
155
189
1,139
341
207
588
458
466
402
490
2,952
205
125
354
275
280
242
294
1,775
444
270
765
596
606
523
637
3,840
493
283
870
661
651
538
645
4,142
325
187
574
437
430
355
426
2,734
1,419
846
2,466
1,904
1,915
1,629
1,973
12,151
769
457
1,339
1,032
1,036
878
1,062
6,573
IN1
IN2
IN3
IN4
IN-Evansville, Gary, Lafayette, Munster, Terre Haute (W IN- 27 counts.)
IN-Fort Wayne, Muncie, South Bend (Northeast IN- 20 counties)
IN-Indianapolis N. (City of, Marion, Hancock, Hendricks & N- 17 counts)
IN-Indianapolis S. (Morgan, Johnson, Shelby & Southeast- 28 counts.)
4 INDIANA.- TOTAL
258
246
309
188
1,001
137
131
164
100
532
388
371
466
283
1,508
262
251
315
191
1,019
495
473
594
360
1,922
533
511
662
389
2,095
352
337
437
256
1,382
1,579
1,510
1,916
1,149
6,154
847
810
1,031
617
3,304
IA1
IA2
IA-Des Moines, Mason City & Sioux City (West IA)
IA-Cedar Rapids, Davenport, Dubuque, Iowa City & Waterloo (E. IA)
2 IOWA.- TOTAL
271
203
474
144
108
252
422
316
738
370
277
647
566
424
991
566
428
994
373
282
656
1,773
1,332
3,105
940
707
1,646
KS1
KS2
KS-Wichita SE KS (1.1 mil, 28 Counties) & West KS (319k, 51 counts.)
KS-Topeka Northeast KS (26 counties)
2 KANSAS.- TOTAL
216
207
423
115
110
225
341
326
666
188
180
368
406
389
795
456
464
920
301
306
607
1,315
1,287
2,602
707
695
1,402
KY1
KY2
KY-Lexington & Covington (Eastern KY, 65 counties)
KY-Louisville, Owensboro & Paducah (Western KY, 55 counties)
2 KENTUCKY.- TOTAL
408
439
847
217
233
450
591
638
1,229
249
269
518
702
757
1,459
684
724
1,408
452
478
930
2,149
2,303
4,452
1,154
1,235
2,388
LA1
LA2
LA-Shreveport, Alexandria, Lafayette, Lake Charles, Monroe (41 counts)
LA-New Orleans, Baton Rouge, Metaire, Slidell & Houma (SE. LA- 23)
2 LOUISIANA.- TOTAL
404
461
865
215
245
460
588
670
1,258
298
340
638
719
819
1,539
673
789
1,462
444
521
965
2,179
2,504
4,683
1,164
1,340
2,504
STATE/
CO-OP
$151B DOCTOR FEES- NOT HOSP. EE OR PC (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
# Surgeons
Not Hosp
Employees
(est 85%)
# Anesthe- # Specialists
siologists
Not Hosp
Not Hosp Employees
(est 70%)
(est 100%)
# Radiologists
Not Hosp
(est 75%)
total hosp
related
MD FEES
($ mil)
# Other total other
Doc's
Doc's
Not Hosp MD FEES
Not PC
($ mil)
Total
# Doc's
Total
Not Hosp MD FEES
Not PC
($ mils)
1 MAINE.- TOTAL (ME)
203
108
314
344
453
439
290
1,408
742
MD1
MD2
MD3
MD-Baltimore & Salisbury (Eastern MD, 14 counties)
MD-Takoma Park NW/ DC Area (Northwest MD, 5 counties)
MD-Takoma Park SW/ DC Area (Southwest MD, 5 counties)
3 MARYLAND.- TOTAL
447
250
282
978
237
133
150
520
731
409
461
1,601
167
93
105
365
752
420
475
1,646
835
473
565
1,872
551
312
373
1,236
2,416
1,356
1,563
5,336
1,303
732
847
2,882
MA1
MA2
MA3
MA4
MA-Boston NE (Boston city of, Suffolk & Essex counties)
MA-Boston NW (Middlesex county)
MA-Boston South ( 6 counties including Cape & Islands)
MA-Springfield & Worcester (Western MA 5 counties)
4 MASSACHUSETTS.- TOTAL
248
259
355
284
1,146
132
138
188
151
609
269
281
384
308
1,242
267
278
381
305
1,231
446
465
637
510
2,058
480
492
641
532
2,145
317
325
423
351
1,415
1,396
1,448
1,949
1,579
6,372
763
790
1,060
861
3,474
MI1
MI2
MI3
MI4
MI5
MI-Ann Arbor, Kalamazoo & St. Joseph (South MI- 13 counties + Wayne)
MI-Detroit & Dearborn (Southeast MI- 2 counties + Wayne)
MI-Flint, Lansing & Saginaw (Northeast MI- 22 counties)
MI-Marquette, Muskegon, Petoskey, Traverse City & Grand Rapids (44)
MI-Pontiac & Royal Oak (Oakland County, east MI- NW of Detroit)
5 MICHIGAN.- TOTAL
349
423
321
387
202
1,682
186
225
170
206
107
894
486
588
446
539
281
2,341
351
425
323
390
203
1,691
654
792
601
726
378
3,152
673
819
603
728
391
3,214
444
540
398
481
258
2,121
2,045
2,480
1,863
2,249
1,184
9,821
1,099
1,333
999
1,206
636
5,273
MN1
MN2
MN3
MN-Minneapolis NW & St. Cloud (Northwest MN 37 counties)
MN-Minneapolis SW (City of & Southwest MN 31 counties)
MN-Duluth, Rochester & St. Paul (Eastern MN 19 counties)
3 MINNESOTA.- TOTAL
164
360
293
818
87
191
156
434
246
540
440
1,227
120
264
214
598
294
646
525
1,465
323
773
617
1,713
213
510
407
1,131
941
2,128
1,721
4,790
507
1,156
933
2,596
MS1
MS2
MS-Jackson & Oxford (West MS 47 counties)
MS-Gulfport, Hattiesburg, Meridian, Tupelo (East MS 35 counties)
2 MISSISSIPPI.- TOTAL
295
265
560
157
141
298
438
394
831
93
84
177
473
426
899
510
449
959
337
296
633
1,492
1,332
2,824
810
722
1,531
MO1
MO2
MO3
MO4
MO- Columbia, Joplin & Springfield (57 counties- Central & SW MO.)
MO-Kansas City (26 counties- NW MO.)
MO-St. Louis N. (City of & 6 counties- NE MO.)
MO-St. Louis S. & Cape Girardeau (26 counties- SE MO.)
4 MISSOURI.- TOTAL
345
278
334
180
1,136
183
148
177
96
604
432
349
418
226
1,425
338
273
327
177
1,114
625
504
605
327
2,062
575
486
580
309
1,950
380
321
383
204
1,287
1,873
1,532
1,837
987
6,229
1,005
825
989
531
3,349
STATE/
CO-OP
NV1
NV2
NJ1
NJ2
NJ3
NJ4
NJ5
$151B DOCTOR FEES- NOT HOSP. EE OR PC (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
# Radiologists
Not Hosp
(est 75%)
total hosp
related
MD FEES
($ mil)
# Other total other
Doc's
Doc's
Not Hosp MD FEES
Not PC
($ mil)
Total
# Doc's
Total
Not Hosp MD FEES
Not PC
($ mils)
1 MONTANA.- TOTAL (MT)
135
72
228
208
299
323
213
966
512
1 NEBRASKA.- TOTAL (NE)
289
153
427
252
533
591
390
1,712
923
NV-Las Vegas (3 counties- SE NV)
NV-Reno (14 counties- NW NV)
2 NEVADA.- TOTAL
246
89
335
131
47
178
325
119
444
85
31
115
384
139
523
641
224
866
423
148
571
1,427
510
1,938
807
288
1,094
1 NEW HAMPSHIRE.- TOTAL (NH)
167
89
299
272
382
429
283
1,255
665
295
236
239
393
314
1,476
157
125
127
209
167
784
334
266
270
444
354
1,668
164
130
132
218
174
818
468
373
378
623
497
2,340
539
454
457
774
636
2,860
355
300
302
511
420
1,888
1,488
1,212
1,225
2,037
1,644
7,607
823
673
680
1,134
917
4,227
258
137
462
246
513
665
439
1,768
952
358
232
273
394
249
268
430
367
311
247
344
3,472
190
123
145
209
132
142
228
195
165
131
183
1,845
380
246
290
417
264
283
455
388
329
262
365
3,679
310
201
236
341
216
232
372
317
269
214
298
3,006
608
394
463
668
423
454
729
622
527
420
584
5,891
638
452
475
729
438
488
818
671
566
445
610
6,330
421
299
313
481
289
322
540
443
374
294
402
4,178
1,876
1,255
1,419
2,089
1,299
1,413
2,302
1,939
1,641
1,301
1,799
18,332
1,029
693
777
1,149
712
776
1,269
1,065
901
714
986
10,069
NJ-Camden N. (3 counties- South NJ)
NJ-Camden S. (6 counties- South NJ)
NJ-Hackensack, Patterson & Ridgewood (2 counties- NE NJ)
NJ-Morristown & New Brunswick (7 counties- NW NJ)
NJ-Newark (3 counties- NE NJ)
5 NEW JERSEY.- TOTAL
1 NEW MEXICO.- TOTAL (NM)
NY1
NY2
NY3
NY4
NY5
NY6
NY7
NY8
NY9
NY10
NY11
# Surgeons # Anesthe- # Specialists
Not Hosp siologists
Not Hosp
Employees Not Hosp Employees
(est 85%) (est 70%) (est 100%)
NY-Albany (18 counties NE NY)
NY-NYC Bronx County
NY-Buffalo (6 counties western NY)
NY-NYC East Long Island (Queens County)
NY-East Long Island (Nassau County)
NY-East Long Island (Suffolk County)
NY-NYC Manhattan (Kings County, Brooklyn- West Long Island)
NY-NYC Manhattan (NY & Richmond Counties- Staten Island)
NY-White Plains (Orange, Putnam, Rockland & Weschester counties.)
NY-Rochester (10 counties East of Buffalo area)
NY-Syracuse, Binghamton & Elmira (17 counts. East of Rochester)
11 NEW YORK.- TOTAL
STATE/
CO-OP
NC1
NC2
NC3
NC4
NC5
$151B DOCTOR FEES- NOT HOSP. EE OR PC (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
NC-Charlotte (10 counties- SW NC)
NC-Durham & Greensboro (19 counties- west of Raleigh)
NC-Greenville & Wilmington (29 counties- eastern & coastal NC)
NC-Raleigh (11 counties)
NC-Winston-Salem, Asheville & Hickory (31 counties- west NC)
5 NORTH CAROLINA.- TOTAL
1 NORTH DAKOTA.- TOTAL (ND)
# Surgeons
Not Hosp
Employees
(est 85%)
# Anesthe- # Specialists
siologists
Not Hosp
Not Hosp Employees
(est 70%)
(est 100%)
# Radiologists
Not Hosp
(est 75%)
total hosp
related
MD FEES
($ mil)
# Other total other
Doc's
Doc's
Not Hosp MD FEES
Not PC
($ mil)
Total
# Doc's
Total
Not Hosp MD FEES
Not PC
($ mils)
285
297
230
285
339
1,435
151
158
122
151
180
762
531
555
429
530
635
2,681
176
184
142
176
210
889
533
556
430
532
635
2,686
641
638
480
650
684
3,093
423
421
317
429
451
2,041
1,785
1,832
1,403
1,793
2,047
8,859
956
977
747
961
1,086
4,727
131
70
161
180
259
219
145
761
404
377
271
432
196
350
298
176
2,101
201
144
230
104
186
158
93
1,116
494
354
566
257
457
390
230
2,747
347
249
397
180
322
274
162
1,930
682
489
781
355
633
539
318
3,796
652
498
754
351
660
529
316
3,759
430
328
498
232
435
349
208
2,481
2,070
1,514
2,380
1,090
1,975
1,649
976
11,655
1,112
817
1,279
587
1,068
888
526
6,277
OH1
OH2
OH3
OH4
OH5
OH6
OH7
OH-Akron, Canton, Youngstown (12 counties- NE OH)
OH-Cincinnati (7 counties- SW OH)
OH-Cleveland & Elyria (8 counties- NE OH)
OH-Columbus- North (15 counties- central OH)
OH-Columbus- City of & Southeast (20 counties- SE OH)
OH-Dayton & Kettering (15 counties- West OH)
OH-Toledo (11 counties- NW OH)
7 OHIO.- TOTAL
OK1
OK2
OK-Oklahoma City & Lawton (54 counties)
OK-Tulsa (23 counties- NE OK)
2 OKLAHOMA- TOTAL
349
244
593
186
130
315
628
439
1,068
141
99
240
613
428
1,041
719
495
1,214
475
327
801
2,024
1,407
3,431
1,087
755
1,842
OR1
OR2
OR-Bend, Eugene, Medford, Salem (20 counties- Southern OR)
OR-Portland (16 counties- Northern OR)
2 OREGON- TOTAL
215
231
446
114
123
237
319
340
659
253
272
526
426
456
883
574
674
1,248
379
445
824
1,476
1,639
3,116
805
901
1,707
PA1
PA2
PA3
PA4
PA5
PA6
PA7
PA8
PA-Allentown, Scranton & Wilkes-Barre (9 counties- NE PA)
PA-Danville, Erie & Sayre (22 counties- North & West PA)
PA-Harrisburg, Altoona & Johnstown (15 counties- South Central PA)
PA-Lancaster, Reading & York (5 counties- SE PA)
PA-Philadelphia NW (3 counties- SE PA)
PA-Philadelphia (city of & county- SE PA)
PA-Pittsburgh (city of & west- 5 counties SW PA)
PA-Pittsburgh East (7 counties- SW PA)
8 PENNSYLVANIA- TOTAL
316
282
312
389
387
281
355
192
2,513
168
150
166
207
205
149
188
102
1,335
304
271
300
375
372
271
341
184
2,418
269
240
266
332
330
240
302
163
2,142
523
466
517
645
641
466
588
318
4,163
517
461
509
663
653
502
570
306
4,182
341
305
336
437
431
332
376
202
2,760
1,574
1,403
1,553
1,966
1,947
1,443
1,757
947
12,590
865
771
853
1,083
1,072
797
964
519
6,923
STATE/
CO-OP
SC1
SC2
SC3
TN1
TN2
TN3
TN4
TX1
TX2
TX3
TX4
TX5
TX6
TX7
TX8
TX9
TX10
TX11
TX12
TX13
TX14
UT1
UT2
$151B DOCTOR FEES- NOT HOSP. EE OR PC (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
# Surgeons
Not Hosp
Employees
(est 85%)
# Anesthe- # Specialists
siologists
Not Hosp
Not Hosp Employees
(est 70%)
(est 100%)
# Radiologists
Not Hosp
(est 75%)
total hosp
related
MD FEES
($ mil)
# Other total other
Doc's
Doc's
Not Hosp MD FEES
Not PC
($ mil)
Total
# Doc's
Total
Not Hosp MD FEES
Not PC
($ mils)
1 RHODE ISLAND- TOTAL (RI)
172
91
259
138
314
346
228
1,006
542
SC-Charleston & Florence (17 counties- SE SC)
SC-Columbia (20 counties- Central SC)
SC-Greenville & Spartanburg (9 counties- NW SC)
3 SOUTH CAROLINA- TOTAL
259
232
233
724
137
123
124
385
472
424
425
1,321
109
97
98
304
458
411
412
1,281
532
489
487
1,507
351
323
321
995
1,509
1,366
1,366
4,241
809
734
733
2,276
1 SOUTH DAKOTA- TOTAL (SD)
140
74
195
116
252
264
174
790
426
274
250
298
336
1,158
146
133
158
178
615
427
388
464
523
1,802
124
113
134
151
522
463
422
504
567
1,956
503
468
525
568
2,063
332
309
347
375
1,362
1,473
1,351
1,580
1,756
6,160
795
730
850
942
3,317
173
304
248
289
266
161
324
207
124
238
308
395
287
246
3,571
92
162
132
153
141
85
172
110
66
126
164
210
153
131
1,897
260
454
372
431
396
240
483
310
185
356
460
592
430
370
5,339
88
154
126
146
135
81
164
105
63
120
156
200
146
125
1,809
294
515
420
488
450
272
548
351
210
402
521
669
486
417
6,042
367
705
529
666
632
364
751
464
286
511
698
864
629
506
7,972
242
466
349
439
417
240
495
306
188
337
461
570
415
334
5,261
981
1,779
1,406
1,684
1,570
931
1,894
1,196
723
1,351
1,786
2,262
1,644
1,378
20,587
536
980
769
927
867
512
1,043
657
398
740
982
1,239
901
751
11,303
201
110
310
107
58
165
276
151
427
196
107
304
373
203
576
561
300
861
370
198
568
1,341
726
2,067
743
402
1,145
TN-Memphis & Jackson (20 counties- west TN)
TN-Nashville City Of & West (18 counties- central TN)
TN-Nashville East & Chattanooga (31 counties- central TN)
TN-Knoxville, Johnson City, Kingsport (26 counties- east TN)
4 TENNESSEE- TOTAL
TX-Amarillo, Lubbock & Witchita Falls (62 counties- TX panhandle)
TX-Austin & Temple (12 counties East TX)
TX-Houston East & Beaumont (19 counties- SE TX)
TX-Houston (city of- Harris County SE TX)
TX-Houston (Harris County excluding Houston)
TX-Houston West (10 counties- SE TX)
TX-Dallas (Dallas County- NE TX)
TX-Dallas East (12 counties- NE TX)
TX-Dallas NW (5 counties- NE TX)
TX-El Paso, Abilene, Odessa & San Angelo (44 counties- West TX)
TX-Fort Worth (7 counties- NE TX)
TX-San Antonio (29 counties- SW TX)
TX-Corpus Christi, Harlingen, McAllen & Victoria (20 counties- SW TX)
TX-Waco, Bryan, Tyler & Longview (32 counties- Central & NE TX)
14 TEXAS- TOTAL
UT-Salt Lake City NW & Ogden (8 counties- NW UT)
UT-Salt Lake City SE & Provo (21 counties- SE UT)
2 UTAH- TOTAL
STATE/
CO-OP
$151B DOCTOR FEES- NOT HOSP. EE OR PC (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
1 VERMONT- TOTAL (VT)
# Surgeons # Anesthe- # Specialists # RadiNot Hosp siologists Not Hosp
ologists
Employees Not Hosp Employees Not Hosp
(est 85%) (est 70%) (est 100%) (est 75%)
total hosp
related
MD FEES
($ mil)
# Other total other
Doc's
Doc's
Not Hosp MD FEES
Not PC
($ mil)
Total
# Doc's
Total
Not Hosp MD FEES
Not PC
($ mils)
69
36
144
200
203
205
136
655
339
315
286
235
232
1,067
167
152
125
123
567
652
593
487
480
2,212
196
178
146
144
663
612
556
456
451
2,075
817
640
572
559
2,588
539
422
377
369
1,708
2,146
1,848
1,564
1,539
7,096
1,151
978
834
820
3,782
VA1
VA2
VA3
VA4
VA-Arlington & Winchester (17 counties- Northeast VA & DC area)
VA-Charlottesville, Lynchburg, Roanoke (61 counties- Western VA)
VA-Norfolk & Newport News (19 counties- Southeast VA)
VA-Richmond (37 counties- Eastern VA)
4 VIRGINIA- TOTAL
WA1
WA2
WA3
WA4
WA-Spokane & Yakima (20 counties- eastern WA)
WA-Seattle City & King County (central WA)
WA-Seattle NW & Everett (10 counties- NW WA)
WA-Olympia & Tacoma (8 counties- SW WA)
4 WASHINGTON- TOTAL
183
226
200
203
812
97
120
106
108
431
252
310
276
280
1,118
139
172
152
155
618
322
398
353
358
1,431
482
623
520
544
2,169
318
411
343
359
1,431
1,153
1,451
1,254
1,290
5,148
641
809
696
717
2,862
1 WEST VIRGINIA- TOTAL (WV)
386
205
554
357
716
612
404
2,114
1,120
WI-Appleton, Green Bay, Neenah & Wausau (20 counties- NE WI)
WI-Madison (14 counties- SE WI)
WI-Milwaukee (9 counties- SE WI)
WI-La Crosse & Marshfield (29 counties- NW WI)
4 WISCONSIN- TOTAL
180
163
316
159
818
96
87
168
85
435
296
267
518
262
1,343
179
162
314
158
813
352
319
618
312
1,601
397
373
726
349
1,846
262
246
479
231
1,218
1,148
1,052
2,041
1,013
5,255
615
565
1,097
542
2,819
69
37
125
56
133
181
119
467
253
48,709
25,880
69,539
33,936
85,316
99,986
65,991
278,050
151,307
WI1
WI2
WI3
WI4
1 WYOMING- TOTAL (WY)
185 USA TOTAL (@ RI Costs- above)
DOCTOR FEES @ Local Costs ($mils)
"'* after Geographic COLA's see Appendices F thru J
137,835
IP SURGERIES
# Doc’s
E35-44
OP
SURGERIES
#Doc’s E45-54
OP
IMAGING
#Doc’s E55-64
NON HOSP
#Doc’s
-8.9%
E104-113: $410B NON-DURABLES & OTHER
(includes durables, non-doctor fees, other health, residential & personal care)
BY STATE & CO-OP
EXPANDING THE RI MODEL NATIONALLY
185 BUYER CO-OP’s DEFINED
GEOGRAPHIC MARKETS WITHIN STATES
EACH, 1 to 2.5 MIL PEOPLE (1 to 2.5 RI’s)
(NEXT 12 SLIDES)
Each of the 185 CO-OP areas covers 1 or more “Hospital Referral Regions” as
defined by the Dartmouth Atlas of Health Care. Regional hospitals capable of
cardio and/or neuro surgery. (http://www.dartmouthatlas.org/data/region/)
In each of the 15,490 service areas the CO-OP would contract approx. 17 Primary
Care MDs, 7 Dentists and 4 Optometrists to service a population of approx. 20k.
BACK
Table of Contents
notes
NON-DURABLE & OTHER: The following two data sources were used.
(A) Percent of total health care dollars spent on “Medical Durables” in each state plus percent of total
health care dollars spent on “Other health, residential and personal care” in each state per: Distribution of
Health Care Expenditures by Service by State of Residence (in millions), 2009. Centers for Medicare & Medicaid
Services (2011). Health Expenditures by State of Residence. Retrieved (December 2011) at
/www.cms.gov/NationalHealthExpendData/downloads/resident-state-estimates.zip and
posted on www.statehealthfacts.org December 2012.
(B) Total Health Spending in each state 2009 per: Centers for Medicare & Medicaid Services (2011). Health
Expenditures by State of Residence. Retrieved (December 2011)
at http://www.cms.gov/NationalHealthExpendData/downloads/resident-state-estimates.zip and
posted on www.statehealthfacts.org December 2012.
(A) X (B) = total spending in each state on the above. Divide this by the total for all states to calculate each state’s
percent of the total from 2009. Use this percent to apportion the $410 billion in “Non-Durable & Other” to
individual states. Further apportioned to CO-OP’s within states based on number of Primary Care practices.
Note: number of primary care practices is weighted for population under 1 & +65 in each CO-OP. Heaviest users
of health care services.
Note: “Non-Durables & Other” ($410 B) is broadly defined and includes “Medical Durables”,
“Other health, residential and personal care” from (A) above. It also includes fees for other professional services
often included with Physician Fees. An estimate of inflation since 2009 is also included.
$410B NON-DURABLES & OTHER (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
Non-Durable
and Other
(mils $)
AL-Birmingham S & Tuscaloosa (28 counties- Central AL)
AL-Birmingham N & Huntsville (15 counties- Northern AL)
AL-Dothan, Mobile & Montgomery (23 counties- Southern AL)
3 ALABAMA-TOTAL
2,133
1,318
1,647
5,099
17.3%
1,066
1,069
1,067
1,067
1 ALASKA-TOTAL (AK)
1,397
23.4%
1,968
AZ-Mesa (Maricopa SE- Mesa, Chandler, Gilbert, Tempe)
AZ-Phoenix City of (Maricopa central)
AZ-Phoenix N & Sun City (Maricopa- Glendale, Scottsdale & North AZ)
AZ-Phoenix S & Tucson (Maricopa- Avondale, Goodyear & South AZ)
4 ARIZONA-TOTAL
1,102
1,326
1,677
1,953
6,058
16.7%
934
918
981
949
948
AR-Little Rock (South & East AR, 43 counties)
AR-Fort Smith, Jonesboro, Springdale, Texarkana (N&W - 32 counties)
2 ARKANSAS-TOTAL
1,972
1,594
3,566
18.8%
1,226
1,218
1,223
15.9%
955
952
926
956
936
968
946
962
935
939
970
955
942
929
952
951
982
948
963
951
954
950
STATE/
CO-OP
AL1
AL2
AL3
AZ1
AZ2
AZ3
AZ4
AR1
AR2
CA1
CA2
CA3
CA4
CA5
CA6
CA7
CA8
CA9
CA10
CA11
CA12
CA13
CA14
CA15
CA16
CA17
CA18
CA19
CA20
CA21
CA-Orange County N (Anaheim, Garden Grove, Hunt. Bch & North)
CA-Orange County S (Santa Ana, Costa Mesa & South)
CA-Bakersfield & Fresno (Kern, Tulare & Fresno, King, Madera)
CA-Alameda County
CA-LA Central LA, South LA, Northeast LA & Eastside
CA-LA Harbor, South Bay & Westside
CA-LA San Fern. Valley, NW, Antelope, Forest & Santa Monica Mtns.
CA-LA San Gabriel Valley, Pomona & Verdugos
CA-LA Southeast
CA-Modesto & Stockton (Merced, Stanislaus, San Joaquin, +4 more.)
CA-Napa, Chico, Redding & Santa Rosa (15 counties- north CA )
CA-Sacramento (11 counties)
CA-Palm Springs/Rancho Mirage (Riverside County)
CA-San Bernardino & Inyo Counties
CA-San Diego (City of)
CA-San Diego County (ex. City of, + Imperial County)
CA-San Francisco (SF & Marin Counties)
CA-San Jose (Santa Clara & San Benito Counties)
CA-Santa Cruz & San Mateo County
CA-Santa Barbara, San Luis Obispo, Salinas & Ventura
CA-Contra Costa & Solano Counties
21 CALIFORNIA-TOTAL
1,345
1,524
2,330
1,444
1,965
2,147
2,023
2,073
1,130
1,491
1,502
2,368
2,063
1,908
1,244
1,867
1,038
1,741
945
1,838
1,395
35,381
% of
State
Spending
Per Capita
STATE/
CO-OP
CO1
CO2
CO3
CO4
CT1
CT2
FL1
FL2
FL3
FL4
FL5
FL6
FL7
FL8
FL9
FL10
FL11
GA1
GA2
GA3
GA4
GA5
$410B NON-DURABLES & OTHER (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
Non-Durable
and Other
(mils $)
CO-Boulder, Fort Collins, Greeley (10 counties- NE CO.)
CO-Colorado Springs, Grand Junction & Pueblo (35 counties- S. CO.)
CO-Denver City of & East (7 counties)
CO-Denver West (12 counties)
4 COLORADO-TOTAL
1,113
1,693
2,048
1,209
6,063
CT-Hartford (6 counties)
CT-New Haven & Bridgeport (2 counties SW CT.)
2 CONNECTICUT-TOTAL
% of
State
Spending
Per Capita
20.6%
1,209
1,214
1,200
1,200
1,206
3,995
3,946
7,941
25.7%
2,226
2,218
2,222
1 DC, Wash.- TOTAL (DC)
1,210
19.6%
2,011
1 DELAWARE.- TOTAL (DE)
1,469
21.8%
1,636
19.8%
1,233
1,278
1,217
1,234
1,257
1,261
1,220
1,305
1,224
1,291
1,245
1,251
16.8%
944
938
929
946
952
940
FL-Fort Lauderdale S. (Broward County)
FL-Fort Lauderdale N. (Martin, Palm Beach & St. Lucie Counties)
FL-Jacksonville (Baker, Clay, Duval, Nassau & St Johns Counties)
FL-Miami-Dade & Monroe Counties (Everglades & Keys)
FL- Gainesville & Ormond Beach (12 Counties)
FL-Orlando S. (Brevard, Hardee, Highlands, Indian., Okee., Osceola)
FL-Orlando N. (Orange, Lake & Seminole counties)
FL-Ocala & Hudson (Citrus, Hernando, Marion, Pasco, Sumter)
FL-Tallahassee, Panama City & Pensacola (19 Counties)
FL-Fort Meyers, Sarasota, Bradenton & Lakeland (9 Counties)
FL-Tampa, St. Petersburg & Clearwater (Hillborough & Pinellas)
11 FLORIDA.- TOTAL
GA-Atlanta North & Rome (36 Counties)
GA-Atlanta City of & West (Fulton, Cobb & West, 11 Counties)
GA-Atlanta East (DeKalb, Gwinnett & East 11 Counties)
GA-Savannah & Augusta (SE. GA 47 Counties)
GA-Macon, Columbus & Albany (SW. GA 54 Counties)
5 GEORGIA.- TOTAL
2,156
2,230
1,637
3,172
1,443
1,409
2,276
1,570
1,741
3,216
2,671
23,521
1,924
2,127
2,144
1,605
1,310
9,111
STATE/
CO-OP
IL1
IL2
IL3
IL4
IL5
IL6
IL7
IN1
IN2
IN3
IN4
IA1
IA2
KS1
KS2
KY1
KY2
LA1
LA2
$410B NON-DURABLES & OTHER (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
Non-Durable
and Other
(mils $)
% of
State
Spending
Per Capita
1 HAWAII.- TOTAL (HI)
1,311
15.3%
964
1 IDAHO.- TOTAL (ID)
1,900
20.2%
1,212
15.9%
1,140
1,161
1,147
1,139
1,151
1,162
1,170
1,152
18.4%
1,232
1,227
1,221
1,231
1,227
19.6%
1,471
1,471
1,471
20.4%
1,281
1,268
1,274
18.2%
1,236
1,240
1,238
17.9%
1,310
1,307
1,308
IL-Bloomington, Joliet & Urbana (East IL- 16 counties)
IL-Blue Island (Cook County- South)
IL-Chicago, city of (Cook County- East)
IL-Melrose Park, & Hinsdale (Cook-west, Dupage & Kane)
IL-Elgin & Evanston (NE. IL: Cook-north, Mchenry & Lake)
IL-Peoria, Rockford & Aurora (NW IL- 25 counties)
IL-Springfield (South IL: 56 counties)
7 ILLINOIS.- TOTAL
1,742
1,019
3,092
2,333
2,321
1,937
2,336
14,779
IN-Evansville, Gary, Lafayette, Munster, Terre Haute (W IN- 27
IN-Fort Wayne, Muncie, South Bend (Northeast IN- 20 counties)
IN-Indianapolis N. (City of, Marion, Hancock, Hendricks & N- 17
IN-Indianapolis S. (Morgan, Johnson, Shelby & Southeast- 28
4 INDIANA.- TOTAL
2,033
1,939
2,502
1,480
7,954
IA-Des Moines, Mason City & Sioux City (West IA)
IA-Cedar Rapids, Davenport, Dubuque, Iowa City & Waterloo (E. IA)
2 IOWA.- TOTAL
2,551
1,930
4,481
KS-Wichita SE KS (1.1 mil, 28 Counties) & West KS (319k, 51 counts.)
KS-Topeka Northeast KS (26 counties)
2 KANSAS.- TOTAL
1,812
1,824
3,636
KY-Lexington & Covington (Eastern KY, 65 counties)
KY-Louisville, Owensboro & Paducah (Western KY, 55 counties)
2 KENTUCKY.- TOTAL
2,605
2,767
5,372
LA-Shreveport, Alexandria, Lafayette, Lake Charles, Monroe (41
LA-New Orleans, Baton Rouge, Metaire, Slidell & Houma (SE. LA- 23)
2 LOUISIANA.- TOTAL
2,734
3,197
5,931
STATE/
CO-OP
MD1
MD2
MD3
MA1
MA2
MA3
MA4
MI1
MI2
MI3
MI4
MI5
MN1
MN2
MN3
MS1
MS2
MO1
MO2
MO3
MO4
$410B NON-DURABLES & OTHER (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
Non-Durable
and Other
(mils $)
1 MAINE.- TOTAL (ME)
4,074
MD-Baltimore & Salisbury (Eastern MD, 14 counties)
MD-Takoma Park NW/ DC Area (Northwest MD, 5 counties)
MD-Takoma Park SW/ DC Area (Southwest MD, 5 counties)
3 MARYLAND.- TOTAL
3,145
1,768
2,089
7,002
MA-Boston NE (Boston city of, Suffolk & Essex counties)
MA-Boston NW (Middlesex county)
MA-Boston South ( 6 counties including Cape & Islands)
MA-Springfield & Worcester (Western MA 5 counties)
4 MASSACHUSETTS.- TOTAL
3,020
3,095
4,062
3,341
13,517
MI-Ann Arbor, Kalamazoo & St. Joseph (South MI- 13 counties +
MI-Detroit & Dearborn (Southeast MI- 2 counties + Wayne)
MI-Flint, Lansing & Saginaw (Northeast MI- 22 counties)
MI-Marquette, Muskegon, Petoskey, Traverse City & Grand Rapids (44)
MI-Pontiac & Royal Oak (Oakland County, east MI- NW of Detroit)
5 MICHIGAN.- TOTAL
2,223
2,703
2,006
2,409
1,293
10,634
MN-Minneapolis NW & St. Cloud (Northwest MN 37 counties)
MN-Minneapolis SW (City of & Southwest MN 31 counties)
MN-Duluth, Rochester & St. Paul (Eastern MN 19 counties)
3 MINNESOTA.- TOTAL
2,042
4,801
3,854
10,698
MS-Jackson & Oxford (West MS 47 counties)
MS-Gulfport, Hattiesburg, Meridian, Tupelo (East MS 35 counties)
2 MISSISSIPPI.- TOTAL
1,976
1,748
3,724
MO- Columbia, Joplin & Springfield (57 counties- Central & SW MO.)
MO-Kansas City (26 counties- NW MO.)
MO-St. Louis N. (City of & 6 counties- NE MO.)
MO-St. Louis S. & Cape Girardeau (26 counties- SE MO.)
4 MISSOURI.- TOTAL
1,923
1,606
1,930
1,022
6,480
% of
State
Spending
Per Capita
29.7%
3,067
19.0%
1,222
1,213
1,199
1,213
20.6%
2,061
2,059
2,076
2,059
2,064
15.6%
1,074
1,073
1,082
1,076
1,075
1,076
25.8%
2,040
2,008
2,017
2,017
19.5%
1,252
1,259
1,255
14.5%
1,088
1,077
1,083
1,078
1,082
STATE/
CO-OP
NV1
NV2
NJ1
NJ2
NJ3
NJ4
NJ5
$410B NON-DURABLES & OTHER (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
% of
State
Spending
Per Capita
1 MONTANA.- TOTAL (MT)
1,363
18.7%
1,378
1 NEBRASKA.- TOTAL (NE)
2,388
19.4%
1,308
NV-Las Vegas (3 counties- SE NV)
NV-Reno (14 counties- NW NV)
2 NEVADA.- TOTAL
1,533
541
2,074
15.0%
766
772
768
1 NEW HAMPSHIRE.- TOTAL (NH)
1,889
17.2%
1,435
2,319
1,932
1,952
3,273
2,683
12,158
19.7%
1,401
1,383
1,388
1,376
1,372
1,383
3,096
23.4%
1,504
26.2%
2,587
2,535
2,607
2,585
2,592
2,561
2,564
2,628
2,558
2,582
2,588
2,581
NJ-Camden N. (3 counties- South NJ)
NJ-Camden S. (6 counties- South NJ)
NJ-Hackensack, Patterson & Ridgewood (2 counties- NE NJ)
NJ-Morristown & New Brunswick (7 counties- NW NJ)
NJ-Newark (3 counties- NE NJ)
5 NEW JERSEY.- TOTAL
1 NEW MEXICO.- TOTAL (NM)
NY1
NY2
NY3
NY4
NY5
NY6
NY7
NY8
NY9
NY10
NY11
Non-Durable
and Other
(mils $)
NY-Albany (18 counties NE NY)
NY-NYC Bronx County
NY-Buffalo (6 counties western NY)
NY-NYC East Long Island (Queens County)
NY-East Long Island (Nassau County)
NY-East Long Island (Suffolk County)
NY-NYC Manhattan (Kings County, Brooklyn- West Long Island)
NY-NYC Manhattan (NY & Richmond Counties- Staten Island)
NY-White Plains (Orange, Putnam, Rockland & Weschester counties.)
NY-Rochester (10 counties East of Buffalo area)
NY-Syracuse, Binghamton & Elmira (17 counts. East of Rochester)
11 NEW YORK.- TOTAL
5,052
3,511
3,790
5,766
3,473
3,825
6,421
5,399
4,433
3,521
4,830
50,021
STATE/
CO-OP
NC1
NC2
NC3
NC4
NC5
$410B NON-DURABLES & OTHER (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
NC-Charlotte (10 counties- SW NC)
NC-Durham & Greensboro (19 counties- west of Raleigh)
NC-Greenville & Wilmington (29 counties- eastern & coastal NC)
NC-Raleigh (11 counties)
NC-Winston-Salem, Asheville & Hickory (31 counties- west NC)
5 NORTH CAROLINA.- TOTAL
1 NORTH DAKOTA.- TOTAL (ND)
OH1
OH2
OH3
OH4
OH5
OH6
OH7
OK1
OK2
OR1
OR2
PA1
PA2
PA3
PA4
PA5
PA6
PA7
PA8
OH-Akron, Canton, Youngstown (12 counties- NE OH)
OH-Cincinnati (7 counties- SW OH)
OH-Cleveland & Elyria (8 counties- NE OH)
OH-Columbus- North (15 counties- central OH)
OH-Columbus- City of & Southeast (20 counties- SE OH)
OH-Dayton & Kettering (15 counties- West OH)
OH-Toledo (11 counties- NW OH)
7 OHIO.- TOTAL
Non-Durable
and Other
(mils $)
Per Capita
2,763
2,795
2,115
2,793
3,036
13,503
21.6%
1,399
1,421
1,428
1,393
1,441
1,416
1,337
21.5%
1,988
18.0%
1,390
1,368
1,387
1,370
1,360
1,376
1,375
1,376
19.3%
1,176
1,181
1,178
22.9%
1,665
1,632
1,647
22.6%
1,749
1,749
1,749
1,725
1,736
1,729
1,769
1,764
1,745
2,779
2,089
3,211
1,478
2,754
2,233
1,332
15,876
OK-Oklahoma City & Lawton (54 counties)
OK-Tulsa (23 counties- NE OK)
2 OKLAHOMA- TOTAL
2,613
1,806
4,419
OR-Bend, Eugene, Medford, Salem (20 counties- Southern OR)
OR-Portland (16 counties- Northern OR)
2 OREGON- TOTAL
2,935
3,377
6,312
PA-Allentown, Scranton & Wilkes-Barre (9 counties- NE PA)
PA-Danville, Erie & Sayre (22 counties- North & West PA)
PA-Harrisburg, Altoona & Johnstown (15 counties- South Central PA)
PA-Lancaster, Reading & York (5 counties- SE PA)
PA-Philadelphia NW (3 counties- SE PA)
PA-Philadelphia (city of & county- SE PA)
PA-Pittsburgh (city of & west- 5 counties SW PA)
PA-Pittsburgh East (7 counties- SW PA)
8 PENNSYLVANIA- TOTAL
% of
State
Spending
2,748
2,451
2,704
3,473
3,444
2,638
3,063
1,639
22,161
STATE/
CO-OP
SC1
SC2
SC3
TN1
TN2
TN3
TN4
TX1
TX2
TX3
TX4
TX5
TX6
TX7
TX8
TX9
TX10
TX11
TX12
TX13
TX14
UT1
UT2
$410B NON-DURABLES & OTHER (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
Non-Durable
and Other
(mils $)
1 RHODE ISLAND- TOTAL (RI)
2,530
SC-Charleston & Florence (17 counties- SE SC)
SC-Columbia (20 counties- Central SC)
SC-Greenville & Spartanburg (9 counties- NW SC)
3 SOUTH CAROLINA- TOTAL
% of
State
Spending
Per Capita
26.5%
2,404
1,797
1,641
1,634
5,071
18.5%
1,101
1,094
1,094
1,096
1 SOUTH DAKOTA- TOTAL (SD)
1,105
18.8%
1,357
TN-Memphis & Jackson (20 counties- west TN)
TN-Nashville City Of & West (18 counties- central TN)
TN-Nashville East & Chattanooga (31 counties- central TN)
TN-Knoxville, Johnson City, Kingsport (26 counties- east TN)
4 TENNESSEE- TOTAL
1,788
1,658
1,885
2,065
7,396
17.8%
1,156
1,153
1,167
1,182
1,165
17.4%
955
941
955
941
928
939
938
943
941
952
942
949
941
966
944
21.4%
1,115
1,113
1,114
TX-Amarillo, Lubbock & Witchita Falls (62 counties- TX panhandle)
TX-Austin & Temple (12 counties East TX)
TX-Houston East & Beaumont (19 counties- SE TX)
TX-Houston (city of- Harris County SE TX)
TX-Houston (Harris County excluding Houston)
TX-Houston West (10 counties- SE TX)
TX-Dallas (Dallas County- NE TX)
TX-Dallas East (12 counties- NE TX)
TX-Dallas NW (5 counties- NE TX)
TX-El Paso, Abilene, Odessa & San Angelo (44 counties- West TX)
TX-Fort Worth (7 counties- NE TX)
TX-San Antonio (29 counties- SW TX)
TX-Corpus Christi, Harlingen, McAllen & Victoria (20 counties- SW TX)
TX-Waco, Bryan, Tyler & Longview (32 counties- Central & NE TX)
14 TEXAS- TOTAL
UT-Salt Lake City NW & Ogden (8 counties- NW UT)
UT-Salt Lake City SE & Provo (21 counties- SE UT)
2 UTAH- TOTAL
1,106
2,093
1,594
1,975
1,849
1,078
2,222
1,380
848
1,534
2,076
2,586
1,866
1,543
23,749
2,007
1,073
3,080
STATE/
CO-OP
$410B NON-DURABLES & OTHER (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
1 VERMONT- TOTAL (VT)
VA1
VA2
VA3
VA4
WA1
WA2
WA3
WA4
WI1
WI2
WI3
WI4
Non-Durable
and Other
(mils $)
719
% of
State
Spending
Per Capita
13.8%
1,148
19.3%
1,170
1,218
1,189
1,191
1,191
VA-Arlington & Winchester (17 counties- Northeast VA & DC area)
VA-Charlottesville, Lynchburg, Roanoke (61 counties- Western VA)
VA-Norfolk & Newport News (19 counties- Southeast VA)
VA-Richmond (37 counties- Eastern VA)
4 VIRGINIA- TOTAL
2,955
2,408
2,103
2,060
9,526
WA-Spokane & Yakima (20 counties- eastern WA)
WA-Seattle City & King County (central WA)
WA-Seattle NW & Everett (10 counties- NW WA)
WA-Olympia & Tacoma (8 counties- SW WA)
4 WASHINGTON- TOTAL
1,650
2,137
1,796
1,864
7,446
18.9%
1,104
1,106
1,114
1,105
1,107
1 WEST VIRGINIA- TOTAL (WV)
3,118
20.5%
1,683
WI-Appleton, Green Bay, Neenah & Wausau (20 counties- NE WI)
WI-Madison (14 counties- SE WI)
WI-Milwaukee (9 counties- SE WI)
WI-La Crosse & Marshfield (29 counties- NW WI)
4 WISCONSIN- TOTAL
1,428
1,332
2,588
1,258
6,606
16.3%
1,166
1,159
1,157
1,169
1,162
748
22.8%
1,326
19.4%
1,328
1 WYOMING- TOTAL (WY)
185 USA TOTAL (@ RI Cost above)
410,000
TOTAL @ Local Costs ($mils)
"'* after Geographic COLA's see Appendices F thru J
378,504
-7.7%
APPENDIX F: $2.2T FUNDING & SPENDING
BY STATE & CO-OP
EXPANDING THE RI MODEL NATIONALLY
185 BUYER CO-OP’s DEFINED
GEOGRAPHIC MARKETS WITHIN STATES
EACH, 1 to 2.5 MIL PEOPLE (1 to 2.5 RI’s)
(NEXT 23 SLIDES)
Each of the 185 CO-OP areas covers 1 or more “Hospital Referral Regions” as
defined by the Dartmouth Atlas of Health Care. Regional hospitals capable of
cardio and/or neuro surgery. (http://www.dartmouthatlas.org/data/region/)
In each of the 15,490 service areas the CO-OP would contract approx. 17 Primary
Care MDs, 7 Dentists and 4 Optometrists to service a population of approx. 20k.
BACK
Table of Contents
FUNDING: WHO’S PAYING THE MONEY
(BASED ON CO-OP FUNDING PROPOSAL & CURRENT FEDERAL, STATE & LOCAL)
WORKING FAMILIES
BUSINESS/EMPLOYERS
STATE & LOCAL GOV’T
STATE MEDICAID
FEDERAL MEDICAID
FEDERAL MEDICARE
FEDERAL OTHER
RE-DISTRIBUTE GOV’T
$220 BIL
$743 BIL
$200 BIL
$127 BIL
$365 BIL
$515 BIL
$220 BIL
($153)
TOTAL ……………………….
$2,237 BIL
FUNDING DETAIL BY CO-OP
(NEXT 11 SLIDES)
APPENDIX F: NOTES ON FUNDING (page 1 of 3)
Two tables FUNDING & SPENDING. The $2.2 Trillion CO-OP FUNDING depicted on the next 8 slides is based
on the population by age In each CO-OP area as listed in E13-21. The following methods & assumptions apply:
WORKING FAMILIES: pay based on ability as follows: 2% of wages or AGI if less than $20k, 4% of wages or AGI
if greater than $20k to a max of $100 per week (see A7 for RI example). Also See E6 at end of table. Accordingly a
$19k income pays $7 per week, a $40k income pays $30/wk, $80k income pays $60/wk, a $100k income pays $77/wk,
a $130k income and above would max out at $100/wk. These payments are in addition to medicare but in place of
employer or private plans. This would also include a life insurance benefit (see E2). COVERAGE IS NOT
BASED ON EMPLOYMENT. Anyone who lives or works in an area can join the CO-OP & must contribute.
This formula would generate $800 mil in RI and an estimated $220 bil nationwide after adjusting for population and
per capita income versus RI. For example, Birmingham, AL (AL1) has a population of 2 mil (twice RI’s) but a per
capita income 18% less (H). Therefore we estimate the working families in this area would contribute $1.3 bil toward
their health care (800m x 2 -18%). Conversely, San Jose, CA (CA18) has a population of 1.8 mil and a per capita
income 36% higher than RI’s. That would be 800 mil x 1.8 or $1.4 bil from working families. Since health costs in
San Jose are 5% higher than in RI we estimated that $1.5 bil ($1.4 + 5%) would be contributed from working families
in San Jose. In areas with higher per cap incomes than RI, increases were limited to health care COLA vs RI to
avoid over estimating contributions. If per cap. income was higher & health cost not higher, only pop was adjusted.
These funds are contributed to the local CO-OP (self-insured buying group). The CO-OP negotiates funding
provider’s budgets (not fee-for-service or billing the patient). Any increases or decreases to these rates must be
agreed to by a vote of patients as part of an annual or biennial contract renewal between CO-OP and providers.
Only individuals vote (no Gov’t, Business, Unions). These entities provide defined contributions under 5 to 10 year
agreements. No vote.
BUSINESS/EMPLOYERS: The example provided here is based on wages paid, but every business must pay
a fair share (based on sales, assets, income etc) and can’t avoid paying by shifting employment offshore for example.
Employers pay 5% on 1st $10k in wages paid to an employee, 10% on the next $10k and 15% on the next $10k, 20% on
APPENDIX F: NOTES ON FUNDING (page 2 of 3)
wages over $30k to a max health payment of $1,000 per month. Accordingly, a $15k job would require
a $1,000 annual health payment a $30k job a $3,000 annual payment, a $45k job a $9,000 annual payment
and a $60k or above job a $12,000 annual payment (see A7 for RI example). Also See E7 & E8 at end of table.
These payments are in addition to medicare but in place of employer or private plans. COVERAGE IS NOT
BASED ON EMPLOYMENT. Anyone who lives or works in an area can join the CO-OP & must contribute.
This formula would generate $2.7 bil in RI and an estimated $743 bil nationwide after adjusting for population
and per capita income versus RI. For example, Birmingham, AL (AL1) has a population of 2 mil (twice RI’s)
but a per capita income 18% less. Therefore we estimate the businesses in this area would contribute $4.4 bil
toward health care costs (2.7b x 2 -18%). Conversely, San Jose, CA (CA18) has a population of 1.8 mil and a per
capita income 36% higher than RI’s (H). That would be 2.7 bil x 1.8 or $4.9 bil from businesses. Since health
costs in San Jose are 5% higher than in RI we estimated that $5.2 bil ($4.9 + 5%) would be contributed from
businesses in San Jose. In areas with higher per cap incomes than RI, increases were limited to health care
COLA vs RI to avoid over estimating contributions. If per cap. income was higher & health cost not higher, only
pop was adjusted.
These funds are contributed to the local CO-OP (self-insured buying group). The CO-OP negotiates funding
provider’s budgets (not fee-for-service or billing the patient). Any increases or decreases to these rates are
governed by 5 to 10 year contracts between the business & CO-OP. These are defined contribution agreements
adjusted for population & inflation over time. Any agreed provider costs not covered by Business & Government
contributions are paid by individuals via the CO-OP. Only individuals vote (no Gov’t, Business, Unions).
A national council of CO-OPs would negotiate agreements with Global, National, and Multi-State businesses as
well as purchase agreements with Pharma, device manufacturers and other common providers. Buyers in charge.
FEDERAL, STATE & LOCAL GOVERNMENTS: would contribute at current levels (see I, J, K & L at the end
of the table for details). Like businesses, any change to these defined contributions for population & inflation will
be governed by 5 to 10 years agreements with the CO-OP. Only individuals vote (no Gov’t, Business, Unions).
There would be a limited number of plans (4 to 6) or menu of benefits available in all 185 CO-OPs nationwide.
“Medicare-Like” but little or no fee-for-service.
APPENDIX F: NOTES ON FUNDING (page 3 of 3)
FUNDING RE-DISTRIBUTION: this is the amount by which funding (as defined above) needs to be adjusted to
equal 106% of spending (as defined herein) in each CO-OP. It is assumed this is adjusted to Federal, State &
Local Government Funding, as presented on the following 8 slides, saving $153 billion per year on government
budgets (10% of current government health spending). As with expected “savings” in hospitals & drug
SPENDING, it is unlikely this “savings” in government FUNDING will actually be realized. It is more likely it
will simply be used to fund more health activity for an aging population over time (2x +65 pop). The benefit will
be to keep total cost in the $2.3 trillion range (ex-inflation), 100% access even as the current population ages. We
already spend more than enough money. More savings are very likely as 185 large customers (CO-OPs) demand
value & cost reductions rather than seek increased contributions (payroll deductions) from voting patients.
Government & business contributions to the CO-OPs are known & defined under public contracts. CO-OPs would
report as public companies do today with their own version of 10-Ks on a quarterly or biannual basis. Increased
financial & health info transparency will further reduce cost & improve health awareness. What areas are improving
health & costs and what areas are not. Buyers in charge…. a completely changed dynamic in the health market.
“SPEND @ LOCAL COST”: this is the total spending expected in each CO-OP after adjusting for health pricing
levels vs RI. These costs are detailed in the second table (in this appendix F) which follows this first table on funding.
“VS. ’09 BASE”: this compares “SPEND @ LOCAL COST” to health spending at the state level in 2009.
Source http://www.cms.gov/NationalHealthExpendData/downloads/resident-state-estimates.zip (Dec 2011).
As posted on http://www.statehealthfacts.org/comparemaptable.jsp?ind=261&cat=5
In nine states, we calculated CO-OP spending more than 5% less than the 2009 base (AK,
DE, FL, KS, MD, NV, TX, WA, WY). CO-OP spending was based on current activity in
the state, which was costed at RI cost, then a COLA was applied. Therefore it is likely any
difference vs. 2009 base is related to rates not amount of health care activity in the area.
Also, MD should likely be look at with DC as a total area in this regard.
STATE/
CO-OP
AL1
AL2
AL3
$2.2T EXPECTED TOTAL FUNDING (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
PER CAP.
INCOME
vs RI
AL-Birmingham S & Tuscaloosa (28 counties- Central AL)
AL-Birmingham N & Huntsville (15 counties- Northern AL)
AL-Dothan, Mobile & Montgomery (23 counties- Southern AL)
3 ALABAMA-TOTAL
MAP
1 ALASKA-TOTAL (AK)
Working
Families
(mils $)
Business/ State &
Employers Local
(mils $) (mils $)
State
Federal
Medicaid Medicaid
(mils $) (mils $)
Federal
Medicare
(mils $)
Federal
Other
(mils $)
Funding
Re-Dist.
(mils $)
Total
Funding
@ 106%
-18%
-20%
-24%
-21%
1,313
790
942
3,045
4,432
2,665
3,180
10,276
1,180
727
910
2,818
325
175
266
766
1,833
987
1,498
4,318
3,507
2,387
2,872
8,766
2,034
1,253
1,569
4,856
(1,629)
(843)
(1,060)
(3,532)
12,994
8,142
10,177
31,313
MAP +20% +3%
682
2,301
783
405
1,199
602
1,233
(875)
6,330
SPEND @
vs.
Local Cost
'09
(mils $) Base
12,259
7,681
9,600
29,540 100%
5,971
94%
AZ1
AZ2
AZ3
AZ4
AZ-Mesa (Maricopa SE- Mesa, Chandler, Gilbert, Tempe)
AZ-Phoenix City of (Maricopa central)
AZ-Phoenix N & Sun City (Maricopa- Glendale, Scottsdale & North AZ)
AZ-Phoenix S & Tucson (Maricopa- Avondale, Goodyear & South AZ)
4 ARIZONA-TOTAL
MAP
-6%
-14%
-3%
-21%
-12%
885
989
1,323
1,294
4,491
2,986
3,338
4,465
4,367
15,157
595
729
862
1,038
3,224
227
399
380
519
1,525
1,206
2,122
2,019
2,757
8,103
1,357
1,249
3,539
3,067
9,212
843
1,033
1,221
1,471
4,569
(1,520)
(1,600)
(2,300)
(2,341)
(7,762)
6,580
8,260
11,508
12,171
38,519
6,207
7,792
10,857
11,482
36,339 102%
AR1
AR2
AR-Little Rock (South & East AR, 43 counties)
AR-Fort Smith, Jonesboro, Springdale, Texarkana (N&W - 32 counties)
2 ARKANSAS-TOTAL
MAP
-25%
-28%
-27%
961
753
1,714
3,245
2,542
5,786
917
746
1,662
446
363
809
2,206
1,795
4,001
2,845
2,231
5,076
1,173
954
2,126
(639)
(417)
(1,056)
11,153
8,966
20,119
10,522
8,458
18,980 107%
CA-Orange County N (Anaheim, Garden Grove, Hunt. Bch & North)
+2%
CA-Orange County S (Santa Ana, Costa Mesa & South)
+33%
CA-Bakersfield & Fresno (Kern, Tulare & Fresno, King, Madera)
-32%
CA-Alameda County
+18%
CA-LA Central LA, South LA, Northeast LA & Eastside
-34%
CA-LA Harbor, South Bay & Westside
+27%
CA-LA San Fern. Valley, NW, Antelope, Forest & Santa Monica Mtns.
+7%
CA-LA San Gabriel Valley, Pomona & Verdugos
-6%
CA-LA Southeast
-38%
CA-Modesto & Stockton (Merced, Stanislaus, San Joaquin, +4 more.)
-23%
CA-Napa, Chico, Redding & Santa Rosa (15 counties- north CA )
-6%
CA-Sacramento (11 counties)
0%
CA-Palm Springs/Rancho Mirage (Riverside County)
-14%
CA-San Bernardino & Inyo Counties
-24%
CA-San Diego (City of)
+14%
CA-San Diego County (ex. City of, + Imperial County)
-1%
CA-San Francisco (SF & Marin Counties)
+5% +63%
CA-San Jose (Santa Clara & San Benito Counties)
+5% +36%
CA-Santa Cruz & San Mateo County
+5% +42%
CA-Santa Barbara, San Luis Obispo, Salinas & Ventura
+4%
CA-Contra Costa & Solano Counties
+23%
MAP
21 CALIFORNIA-TOTAL
+1%
1,127
1,281
1,374
1,208
1,109
1,775
1,710
1,620
603
983
1,168
1,975
1,509
1,255
1,046
1,547
888
1,543
824
1,546
1,170
27,262
3,805
4,323
4,638
4,078
3,742
5,992
5,771
5,467
2,036
3,317
3,943
6,665
5,094
4,235
3,530
5,221
2,998
5,208
2,781
5,216
3,948
92,008
1,060
1,204
1,892
1,136
1,579
1,669
1,607
1,620
909
1,195
1,164
1,864
1,647
1,545
983
1,476
795
1,381
738
1,453
1,100
28,017
401
474
1,492
443
1,597
665
796
693
517
748
610
906
827
947
501
642
306
461
247
698
391
14,364
1,108
1,310
4,123
1,225
4,412
1,838
2,200
1,914
1,429
2,066
1,686
2,503
2,285
2,615
1,384
1,773
846
1,275
684
1,930
1,080
39,686
2,233
2,405
3,100
2,170
2,530
3,602
2,868
3,601
1,509
2,284
3,020
3,992
3,345
2,391
1,811
3,072
1,964
2,630
1,623
3,055
2,289
55,495
757
860
1,352
812
1,128
1,193
1,149
1,158
649
854
832
1,332
1,177
1,104
703
1,055
568
987
527
1,038
786
20,019
(1,367)
(1,605)
(3,229)
(1,460)
(3,592)
(2,916)
(3,375)
(2,624)
(607)
(1,399)
(1,856)
(3,119)
(1,888)
(1,636)
(1,674)
(2,130)
(806)
(1,269)
(664)
(2,437)
(1,325)
(40,978)
9,125
10,252
14,742
9,612
12,505
13,818
12,727
13,449
7,046
10,047
10,568
16,118
13,996
12,454
8,284
12,657
7,560
12,217
6,760
12,499
9,439
235,874
CA1
CA2
CA3
CA4
CA5
CA6
CA7
CA8
CA9
CA10
CA11
CA12
CA13
CA14
CA15
CA16
CA17
CA18
CA19
CA20
CA21
8,608
9,671
13,908
9,068
11,797
13,036
12,006
12,687
6,647
9,478
9,970
15,206
13,204
11,749
7,815
11,940
7,132
11,525
6,378
11,792
8,905
222,522
97%
STATE/
CO-OP
$2.2T EXPECTED TOTAL FUNDING (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
PER CAP. Working
INCOME Families
vs RI (mils $)
Business/ State &
Employers Local
(mils $) (mils $)
State
Federal
Medicaid Medicaid
(mils $) (mils $)
Federal
Medicare
(mils $)
Federal
Other
(mils $)
Funding
Re-Dist.
(mils $)
Total
Funding
@ 106%
SPEND @
vs.
Local Cost '09
(mils $) Base
CO1
CO2
CO3
CO4
CO-Boulder, Fort Collins, Greeley (10 counties- NE CO.)
CO-Colorado Springs, Grand Junction & Pueblo (35 counties- S. CO.)
CO-Denver City of & East (7 counties)
CO-Denver West (12 counties)
4 COLORADO-TOTAL
MAP
+3%
-11%
+2%
+28%
+4%
737
995
1,365
806
3,903
2,487
3,359
4,607
2,720
13,173
607
919
1,125
664
3,316
342
495
651
179
1,668
754
1,090
1,435
395
3,674
1,051
1,858
1,737
1,080
5,727
791
1,198
1,466
866
4,321
(1,188)
(1,230)
(1,700)
(412)
(4,530)
5,583
8,684
10,687
6,298
31,252
5,267
8,193
10,082
5,941
29,483 98%
CT1
CT2
CT-Hartford (6 counties)
CT-New Haven & Bridgeport (2 counties SW CT.)
2 CONNECTICUT-TOTAL
MAP
+15%
+40%
+28%
1,436
1,423
2,859
4,846
4,804
9,650
1,375
1,363
2,739
2,212
2,529
4,741
2,380
2,720
5,100
3,444
3,300
6,744
839
832
1,670
(49)
(693)
(743)
16,483
16,278
32,761
15,550
15,356
30,907 102%
1 DC, Wash.- TOTAL (DC)
MAP
+43%
481
1,625
723
-
2,140
933
5,229
(4,603)
6,528
6,158 99%
1 DELAWARE.- TOTAL (DE)
MAP
+1%
718
2,424
596
662
1,399
1,648
717
(1,029)
7,136
6,732 90%
FL1
FL2
FL3
FL4
FL5
FL6
FL7
FL8
FL9
FL10
FL11
FL-Fort Lauderdale S. (Broward County)
FL-Fort Lauderdale N. (Martin, Palm Beach & St. Lucie Counties)
FL-Jacksonville (Baker, Clay, Duval, Nassau & St Johns Counties)
FL-Miami-Dade & Monroe Counties (Everglades & Keys)
FL- Gainesville & Ormond Beach (12 Counties)
FL-Orlando S. (Brevard, Hardee, Highlands, Indian., Okee., Osceola)
FL-Orlando N. (Orange, Lake & Seminole counties)
FL-Ocala & Hudson (Citrus, Hernando, Marion, Pasco, Sumter)
FL-Tallahassee, Panama City & Pensacola (19 Counties)
FL-Fort Meyers, Sarasota, Bradenton & Lakeland (9 Counties)
FL-Tampa, St. Petersburg & Clearwater (Hillborough & Pinellas)
11 FLORIDA.- TOTAL
MAP
0%
+13%
-4%
-20%
-21%
-12%
-7%
-19%
-17%
0%
-2%
-7%
1,392
1,395
1,033
1,653
729
785
1,384
776
942
2,001
1,677
13,767
4,697
4,709
3,487
5,580
2,461
2,649
4,670
2,618
3,178
6,752
5,661
46,462
912
910
702
1,340
599
582
973
628
742
1,299
1,119
9,804
338
376
267
670
314
239
364
258
381
528
459
4,194
1,310
1,460
1,034
2,600
1,220
928
1,414
1,000
1,480
2,050
1,780
16,276
3,294
5,012
2,147
4,803
2,734
2,901
3,080
4,109
2,506
7,911
4,472
42,970
1,103
1,101
849
1,621
724
705
1,177
759
898
1,572
1,354
11,864
(1,577)
(2,082)
(1,481)
(253)
(1,561)
(1,247)
(1,838)
(1,779)
(1,835)
(3,125)
(2,831)
(19,608)
11,469
12,881
8,037
18,015
7,221
7,542
11,225
8,369
8,291
18,988
13,690
125,728
10,820
12,152
7,582
16,995
6,812
7,115
10,589
7,896
7,822
17,913
12,916
118,612 90%
GA1
GA2
GA3
GA4
GA5
GA-Atlanta North & Rome (36 Counties)
GA-Atlanta City of & West (Fulton, Cobb & West, 11 Counties)
GA-Atlanta East (DeKalb, Gwinnett & East 11 Counties)
GA-Savannah & Augusta (SE. GA 47 Counties)
GA-Macon, Columbus & Albany (SW. GA 54 Counties)
5 GEORGIA.- TOTAL
MAP
-19%
+11%
-10%
-27%
-31%
-12%
1,328
1,815
1,667
995
762
6,567
4,483
6,124
5,628
3,357
2,573
22,165
1,071
1,192
1,213
892
724
5,091
437
452
456
468
404
2,218
1,664
1,723
1,738
1,782
1,540
8,447
3,021
2,704
2,396
2,492
2,187
12,799
1,710
1,903
1,937
1,423
1,155
8,128
(1,207)
(2,589)
(1,834)
(867)
(1,579)
(8,076)
12,506
13,324
13,201
10,542
7,768
57,340
11,798
12,569
12,453
9,945
7,328
54,094 101%
STATE/
CO-OP
$2.2T EXPECTED TOTAL FUNDING (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
PER CAP.
INCOME
vs RI
Working
Families
(mils $)
Business/ State &
Employers Local
(mils $) (mils $)
State
Federal
Medicaid Medicaid
(mils $) (mils $)
Federal
Medicare
(mils $)
Federal
Other
(mils $)
Funding
Re-Dist.
(mils $)
Total
Funding
@ 106%
SPEND @
vs.
Local Cost
'09
(mils $) Base
1 HAWAII.- TOTAL (HI)
MAP
0%
1,092
3,686
873
550
1,222
1,671
2,465
(2,489)
9,069
8,555
1 IDAHO.- TOTAL (ID)
MAP
-22%
978
3,300
780
407
1,554
1,907
1,198
(132)
9,992
9,427 108%
MAP
-9%
-9%
-5%
+14%
+31%
-12%
-18%
0%
1,116
639
2,047
1,639
1,614
1,167
1,306
9,528
3,767
2,157
6,909
5,532
5,446
3,938
4,407
32,156
991
569
1,749
1,330
1,309
1,081
1,296
8,325
578
324
1,803
548
444
678
972
5,348
1,362
762
4,248
1,291
1,046
1,597
2,291
12,597
2,234
1,568
3,583
2,996
3,329
3,182
4,010
20,902
837
481
1,477
1,122
1,105
913
1,094
7,029
171
85
18
166
179
77
61
2,757
11,056
6,585
21,834
14,625
14,472
12,633
15,437
98,641
10,902
6,589
19,466
14,457
14,691
12,107
14,846
93,058 107%
IN1
IN2
IN3
IN4
IN-Evansville, Gary, Lafayette, Munster, Terre Haute (W IN- 27
IN-Fort Wayne, Muncie, South Bend (Northeast IN- 20 counties)
IN-Indianapolis N. (City of, Marion, Hancock, Hendricks & N- 17
IN-Indianapolis S. (Morgan, Johnson, Shelby & Southeast- 28
MAP
4 INDIANA.- TOTAL
-19%
-21%
-8%
-19%
-16%
1,073
998
1,514
782
4,368
3,622
3,368
5,110
2,640
14,740
870
833
1,080
634
3,416
389
372
485
261
1,508
1,571
1,499
1,958
1,053
6,081
2,801
2,660
3,076
2,031
10,569
892
855
1,108
650
3,505
603
685
(92)
522
1,719
11,822
11,270
14,239
8,573
45,905
11,153
10,632
13,433
8,088
43,306 101%
IA1
IA2
IA-Des Moines, Mason City & Sioux City (West IA)
IA-Cedar Rapids, Davenport, Dubuque, Iowa City & Waterloo (E. IA)
2 IOWA.- TOTAL
MAP
-11%
-13%
-12%
1,228
911
2,139
4,145
3,074
7,219
1,182
894
2,076
398
325
724
1,824
1,488
3,312
2,722
1,996
4,718
1,040
787
1,827
920
1,292
2,212
13,460
10,767
24,227
12,698
10,158
22,856 110%
KS1
KS2
KS-Wichita SE KS (1.1 mil, 28 Counties) & West KS (319k, 51 counts.)
KS-Topeka Northeast KS (26 counties)
2 KANSAS.- TOTAL
MAP
-20%
-2%
-11%
910
1,130
2,041
3,072
3,815
6,887
968
985
1,953
512
498
1,009
1,433
1,393
2,826
2,396
1,974
4,370
1,184
1,204
2,387
(1,154)
(1,430)
(2,584)
9,319
9,569
18,888
8,792
9,027
17,819
KY1
KY2
KY-Lexington & Covington (Eastern KY, 65 counties)
KY-Louisville, Owensboro & Paducah (Western KY, 55 counties)
MAP
2 KENTUCKY.- TOTAL
-24%
-19%
-22%
1,275
1,441
2,716
4,303
4,864
9,167
1,118
1,183
2,301
677
579
1,255
2,969
2,538
5,508
3,668
4,138
7,807
1,710
1,810
3,520
(538)
(428)
(966)
15,183
16,126
31,309
14,324
15,213
29,537 104%
LA1
LA2
LA-Shreveport, Alexandria, Lafayette, Lake Charles, Monroe (41
LA-New Orleans, Baton Rouge, Metaire, Slidell & Houma (SE. LA- 23)
2 LOUISIANA.- TOTAL
MAP
-26%
-16%
-21%
1,227
1,635
2,862
4,141
5,517
9,658
1,308
1,534
2,842
676
695
1,371
3,027
3,116
6,143
4,166
4,395
8,561
1,413
1,657
3,070
507
171
678
16,465
18,720
35,185
15,533
17,661
33,194 109%
IL1
IL2
IL3
IL4
IL5
IL6
IL7
IL-Bloomington, Joliet & Urbana (East IL- 16 counties)
IL-Blue Island (Cook County- South)
IL-Chicago, city of (Cook County- East)
IL-Melrose Park, & Hinsdale (Cook-west, Dupage & Kane)
IL-Elgin & Evanston (NE. IL: Cook-north, Mchenry & Lake)
IL-Peoria, Rockford & Aurora (NW IL- 25 counties)
IL-Springfield (South IL: 56 counties)
7 ILLINOIS.- TOTAL
97%
93%
STATE/
CO-OP
$2.2T EXPECTED TOTAL FUNDING (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
1 MAINE.- TOTAL (ME)
MD1
MD2
MD3
MA1
MA2
MA3
MA4
MI1
MI2
MI3
MI4
MI5
PER CAP.
INCOME
vs RI
Working
Families
(mils $)
Business/ State &
Employers Local
(mils $) (mils $)
State
Federal
Medicaid Medicaid
(mils $) (mils $)
Federal
Medicare
(mils $)
Federal
Other
(mils $)
Funding
Re-Dist.
(mils $)
Total
Funding
@ 106%
SPEND @
vs.
Local Cost
'09
(mils $) Base
MAP
-13%
929
3,135
684
614
1,668
2,491
1,219
3,795
14,536
13,713 122%
MD-Baltimore & Salisbury (Eastern MD, 14 counties)
MD-Takoma Park NW/ DC Area (Northwest MD, 5 counties)
MD-Takoma Park SW/ DC Area (Southwest MD, 5 counties)
3 MARYLAND.- TOTAL
MAP
+9%
+42%
+18%
+20%
2,059
1,166
1,393
4,619
6,951
3,936
4,702
15,589
1,896
1,074
1,283
4,253
1,521
594
668
2,783
3,753
1,465
1,647
6,865
4,617
2,498
2,421
9,536
3,970
2,248
2,686
8,904
(8,406)
(2,397)
(2,704)
(13,507)
16,361
10,584
12,095
39,041
15,435
9,985
11,411
36,831
+10% +13%
+10% +37%
+10% +21%
1,289
1,323
1,722
1,267
5,601
4,352
4,464
5,811
4,275
18,902
992
1,018
1,325
1,098
4,432
3,235
1,754
2,538
3,131
10,659
3,359
1,821
2,635
3,251
11,066
2,556
2,787
4,272
3,161
12,775
845
867
1,128
936
3,775
(874)
1,926
2,277
(1,003)
2,326
15,754
15,958
21,708
16,117
69,537
14,862
15,055
20,479
15,205
65,601 107%
5,113
5,480
4,020
4,884
3,246
22,743
1,232
1,499
1,104
1,333
716
5,884
366
588
400
414
146
1,913
2,171
3,496
2,373
2,457
865
11,361
3,911
4,684
3,801
4,592
2,237
19,226
983
1,196
881
1,064
571
4,696
(599)
(547)
578
30
152
(386)
14,693
18,021
14,349
16,220
8,895
72,177
13,861
17,001
13,536
15,302
8,391
68,091 103%
MA-Boston NE (Boston city of, Suffolk & Essex counties)
MA-Boston NW (Middlesex county)
MA-Boston South ( 6 counties including Cape & Islands)
MA-Springfield & Worcester (Western MA 5 counties)
4 MASSACHUSETTS.- TOTAL
MAP
-2%
+17%
86%
MI-Ann Arbor, Kalamazoo & St. Joseph (South MI- 13 counties +
MI-Detroit & Dearborn (Southeast MI- 2 counties + Wayne)
MI-Flint, Lansing & Saginaw (Northeast MI- 22 counties)
MI-Marquette, Muskegon, Petoskey, Traverse City & Grand Rapids (44)
MI-Pontiac & Royal Oak (Oakland County, east MI- NW of Detroit)
5 MICHIGAN.- TOTAL
MAP
-8%
-19%
-20%
-19%
-12%
1,515
1,624
1,191
1,447
962
6,739
MN1
MN2
MN3
MN-Minneapolis NW & St. Cloud (Northwest MN 37 counties)
MN-Minneapolis SW (City of & Southwest MN 31 counties)
MN-Duluth, Rochester & St. Paul (Eastern MN 19 counties)
3 MINNESOTA.- TOTAL
MAP
-17%
+10%
+4%
+3%
664
1,913
1,529
4,106
2,241
6,457
5,160
13,858
670
1,601
1,280
3,551
814
1,567
1,368
3,749
1,776
3,420
2,984
8,180
1,726
3,101
2,647
7,473
569
1,360
1,087
3,017
310
22
(242)
89
8,769
19,442
15,812
44,023
8,273
18,341
14,917
41,532 107%
MS1
MS2
MS-Jackson & Oxford (West MS 47 counties)
MS-Gulfport, Hattiesburg, Meridian, Tupelo (East MS 35 counties)
2 MISSISSIPPI.- TOTAL
MAP
-31%
-32%
-32%
871
760
1,630
2,938
2,564
5,503
917
806
1,723
216
170
386
2,152
1,693
3,845
2,909
2,765
5,674
1,259
1,107
2,366
(259)
(637)
(895)
11,002
9,230
20,232
10,379
8,708
19,087
MO- Columbia, Joplin & Springfield (57 counties- Central & SW MO.)
MO-Kansas City (26 counties- NW MO.)
MO-St. Louis N. (City of & 6 counties- NE MO.)
MO-St. Louis S. & Cape Girardeau (26 counties- SE MO.)
MAP
4 MISSOURI.- TOTAL
-28%
-13%
+4%
-28%
-15%
1,020
1,036
1,426
550
4,031
3,443
3,495
4,812
1,855
13,606
923
779
931
495
3,128
628
394
425
309
1,756
2,301
1,444
1,554
1,132
6,431
3,360
2,448
2,972
1,664
10,444
1,429
1,206
1,441
767
4,843
952
447
701
997
3,097
14,056
11,251
14,262
7,768
47,337
13,260
10,614
13,455
7,328
44,657 107%
MO1
MO2
MO3
MO4
+27%
98%
STATE/
CO-OP
NV1
NV2
NJ1
NJ2
NJ3
NJ4
NJ5
NY1
NY2
NY3
NY4
NY5
NY6
NY7
NY8
NY9
NY10
NY11
$2.2T EXPECTED TOTAL FUNDING (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
PER CAP. Working
INCOME Families
vs RI (mils $)
Business/ State &
Employers Local
(mils $) (mils $)
State
Federal
Medicaid Medicaid
(mils $) (mils $)
Federal
Medicare
(mils $)
Federal
Other
(mils $)
Funding
Re-Dist.
(mils $)
Total
Funding
@ 106%
SPEND @
vs.
Local Cost '09
(mils $) Base
1 MONTANA.- TOTAL (MT)
MAP
-20%
634
2,139
593
175
806
1,360
1,079
937
7,723
7,286 113%
1 NEBRASKA.- TOTAL (NE)
MAP
-14%
1,257
4,241
1,319
710
1,890
2,745
1,398
(516)
13,045
12,306 97%
NV-Las Vegas (3 counties- SE NV)
NV-Reno (14 counties- NW NV)
2 NEVADA.- TOTAL
MAP
-5%
-3%
-4%
1,524
546
2,070
5,143
1,842
6,985
1,147
401
1,548
434
150
585
1,033
358
1,391
2,588
1,036
3,624
1,262
441
1,703
(2,221)
(1,059)
(3,280)
10,909
3,715
14,624
10,291
3,505
13,796 91%
1 NEW HAMPSHIRE.- TOTAL (NH)
MAP
+7%
1,127
3,803
792
518
1,151
2,076
874
1,279
11,621
10,963 106%
NJ-Camden N. (3 counties- South NJ)
NJ-Camden S. (6 counties- South NJ)
NJ-Hackensack, Patterson & Ridgewood (2 counties- NE NJ)
NJ-Morristown & New Brunswick (7 counties- NW NJ)
NJ-Newark (3 counties- NE NJ)
5 NEW JERSEY.- TOTAL
MAP
+22%
0%
+27%
+37%
+10%
+21%
1,325
1,116
1,125
1,903
1,564
7,032
4,470
3,767
3,797
6,422
5,278
23,734
1,419
1,197
1,205
2,038
1,675
7,535
743
963
896
992
1,613
5,206
1,355
1,755
1,633
1,808
2,941
9,493
3,861
2,729
2,810
4,331
3,194
16,923
836
705
710
1,200
986
4,437
(1,067)
(1,637)
(1,478)
(1,252)
(3,606)
(9,041)
12,941
10,595
10,698
17,441
13,645
65,320
12,208
9,995
10,093
16,454
12,872
61,622 93%
1 NEW MEXICO.- TOTAL (NM)
MAP
-21%
1,296
4,374
1,269
789
3,764
2,689
2,184
(2,313)
14,052
13,257 99%
NY-Albany (18 counties NE NY)
NY-NYC Bronx County
NY-Buffalo (6 counties western NY)
NY-NYC East Long Island (Queens County)
NY-East Long Island (Nassau County)
NY-East Long Island (Suffolk County)
NY-NYC Manhattan (Kings County, Brooklyn- West Long Island)
NY-NYC Manhattan (NY & Richmond Counties- Staten Island)
NY-White Plains (Orange, Putnam, Rockland & Weschester counties.)
NY-Rochester (10 counties East of Buffalo area)
NY-Syracuse, Binghamton & Elmira (17 counts. East of Rochester)
11 NEW YORK.- TOTAL
MAP
-3%
+5% -40%
-13%
+5% -12%
+5% +42%
1,514
670
1,009
1,577
1,125
1,254
1,609
1,890
1,387
963
1,233
14,232
5,111
2,262
3,406
5,321
3,798
4,234
5,429
6,380
4,680
3,251
4,163
48,034
1,801
1,278
1,341
2,057
1,235
1,377
2,310
1,895
1,599
1,258
1,721
17,873
768
1,339
707
983
252
291
1,856
1,081
588
618
944
9,426
4,316
7,523
3,973
5,523
1,414
1,634
10,431
6,078
3,305
3,474
5,304
52,974
4,083
2,082
3,280
4,088
2,934
2,887
4,124
3,918
3,361
2,749
3,972
37,479
903
641
672
1,032
619
691
1,158
950
802
631
863
8,961
1,591
(1,522)
(2,115)
2,937
3,164
3,330
1,852
2,065
1,643
(385)
1,204
13,765
20,090
14,272
12,274
23,518
14,541
15,697
28,768
24,257
17,365
12,559
19,404
202,745
18,952
13,465
11,579
22,187
13,718
14,808
27,140
22,884
16,382
11,848
18,306
191,269 117%
+5% +23%
+15% -20%
+15% +86%
+40%
-12%
-17%
+7%
STATE/
CO-OP
NC1
NC2
NC3
NC4
NC5
$2.2T EXPECTED TOTAL FUNDING (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
PER CAP.
INCOME
vs RI
Working
Families
(mils $)
Business/ State &
Employers Local
(mils $) (mils $)
State
Federal
Medicaid Medicaid
(mils $) (mils $)
Federal
Medicare
(mils $)
Federal
Other
(mils $)
Funding
Re-Dist.
(mils $)
Total
Funding
@ 106%
SPEND @
vs.
Local Cost
'09
(mils $) Base
NC-Charlotte (10 counties- SW NC)
NC-Durham & Greensboro (19 counties- west of Raleigh)
NC-Greenville & Wilmington (29 counties- eastern & coastal NC)
NC-Raleigh (11 counties)
NC-Winston-Salem, Asheville & Hickory (31 counties- west NC)
5 NORTH CAROLINA.- TOTAL
MAP
-4%
-17%
-22%
-9%
-19%
-14%
1,517
1,300
927
1,458
1,359
6,561
5,120
4,386
3,129
4,920
4,588
22,144
1,170
1,166
877
1,188
1,249
5,650
625
785
610
641
734
3,395
2,023
2,538
1,973
2,075
2,376
10,985
2,714
3,212
2,645
2,579
4,225
15,374
1,554
1,547
1,165
1,577
1,658
7,501
(989)
(568)
312
(1,395)
(2,667)
(5,307)
13,734
14,365
11,638
13,043
13,523
66,303
12,956
13,552
10,979
12,305
12,757
62,550 104%
1 NORTH DAKOTA.- TOTAL (ND)
MAP
-13%
470
1,587
475
204
678
937
750
1,477
6,580
6,207 124%
MAP
-18%
-7%
-9%
-14%
-15%
-12%
-18%
-13%
1,315
1,131
1,681
746
1,370
1,137
637
8,015
4,437
3,817
5,673
2,517
4,623
3,836
2,148
27,052
1,217
929
1,409
656
1,232
988
589
7,022
2,193
1,547
2,583
999
2,691
1,519
1,042
12,574
2,589
1,826
3,050
1,179
3,177
1,794
1,231
14,846
4,080
2,530
4,570
1,964
3,072
3,036
1,745
20,997
1,188
907
1,376
641
1,203
965
575
6,855
(1,587)
(878)
(409)
791
37
(1,143)
(748)
(3,938)
15,433
11,810
19,933
9,492
17,405
12,130
7,220
93,423
14,559
11,142
18,805
8,955
16,420
11,444
6,811
88,135 108%
MAP
-21%
-22%
-21%
1,410
960
2,370
4,757
3,241
7,998
1,189
818
2,007
656
455
1,111
2,435
1,688
4,123
3,738
2,712
6,450
2,334
1,607
3,940
(2,201)
(1,485)
(3,686)
14,319
9,996
24,314
13,508
9,430
22,938
OR1
OR2
OR-Bend, Eugene, Medford, Salem (20 counties- Southern OR)
OR-Portland (16 counties- Northern OR)
2 OREGON- TOTAL
MAP
-19%
-1%
-9%
1,138
1,637
2,775
3,839
5,525
9,365
1,134
1,331
2,465
460
415
875
1,591
1,437
3,028
2,896
2,518
5,414
1,199
1,408
2,607
1,303
1,384
2,687
13,560
15,656
29,215
12,792
14,770
27,562 110%
PA1
PA2
PA3
PA4
PA5
PA6
PA7
PA8
PA-Allentown, Scranton & Wilkes-Barre (9 counties- NE PA)
PA-Danville, Erie & Sayre (22 counties- North & West PA)
PA-Harrisburg, Altoona & Johnstown (15 counties- South Central PA)
PA-Lancaster, Reading & York (5 counties- SE PA)
PA-Philadelphia NW (3 counties- SE PA)
PA-Philadelphia (city of & county- SE PA)
PA-Pittsburgh (city of & west- 5 counties SW PA)
PA-Pittsburgh East (7 counties- SW PA)
MAP
8 PENNSYLVANIA- TOTAL
-11%
-25%
-19%
+2%
1,118
846
1,008
1,610
1,587
891
1,324
612
8,997
3,773
2,857
3,401
5,435
5,357
3,008
4,469
2,065
30,366
900
803
886
1,153
1,137
874
992
532
7,276
894
1,036
847
911
598
1,828
1,071
559
7,744
1,776
2,058
1,682
1,811
1,188
3,632
2,128
1,112
15,386
3,363
2,996
3,352
3,823
3,860
2,441
3,922
2,153
25,910
1,044
931
1,027
1,337
1,318
1,014
1,150
617
8,439
112
(496)
(161)
(125)
2,496
(287)
(1,297)
(245)
(5)
12,980
11,031
12,040
15,956
17,541
13,402
13,759
7,405
104,115
12,245
10,406
11,359
15,053
16,548
12,644
12,980
6,986
98,222 101%
OH1
OH2
OH3
OH4
OH5
OH6
OH7
OK1
OK2
OH-Akron, Canton, Youngstown (12 counties- NE OH)
OH-Cincinnati (7 counties- SW OH)
OH-Cleveland & Elyria (8 counties- NE OH)
OH-Columbus- North (15 counties- central OH)
OH-Columbus- City of & Southeast (20 counties- SE OH)
OH-Dayton & Kettering (15 counties- West OH)
OH-Toledo (11 counties- NW OH)
7 OHIO.- TOTAL
OK-Oklahoma City & Lawton (54 counties)
OK-Tulsa (23 counties- NE OK)
2 OKLAHOMA- TOTAL
+26%
-27%
-4%
-18%
-7%
95%
STATE/
CO-OP
$2.2T EXPECTED TOTAL FUNDING (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
1 RHODE ISLAND- TOTAL (RI)
PER CAP.
INCOME
vs RI
Working
Families
(mils $)
Business/ State &
Employers Local
(mils $) (mils $)
State
Federal
Medicaid Medicaid
(mils $) (mils $)
Federal
Medicare
(mils $)
Federal
Other
(mils $)
Funding
Re-Dist.
(mils $)
Total
Funding
@ 106%
SPEND @
vs.
Local Cost
'09
(mils $) Base
MAP
0%
842
2,842
710
894
2,028
1,988
837
(27)
10,115
MAP
-16%
-21%
-19%
-19%
1,096
942
970
3,008
3,699
3,179
3,274
10,152
889
817
813
2,518
268
241
216
725
1,976
1,779
1,596
5,350
2,892
2,456
2,511
7,860
1,421
1,306
1,300
4,027
(1,852)
(830)
(1,854)
(4,535)
10,388
9,891
8,826
29,105
1 SOUTH DAKOTA- TOTAL (SD)
-18%
533
1,799
427
294
828
1,194
857
281
6,214
5,862 102%
TN1
TN2
TN3
TN4
TN-Memphis & Jackson (20 counties- west TN)
TN-Nashville City Of & West (18 counties- central TN)
TN-Nashville East & Chattanooga (31 counties- central TN)
TN-Knoxville, Johnson City, Kingsport (26 counties- east TN)
MAP
4 TENNESSEE- TOTAL
-19%
-7%
-20%
-22%
-17%
997
1,069
1,037
1,085
4,188
3,365
3,609
3,499
3,661
14,134
758
705
791
856
3,110
918
624
763
880
3,185
2,257
1,534
1,876
2,164
7,830
2,488
2,129
2,984
3,666
11,268
937
872
979
1,059
3,848
(1,008)
(869)
(474)
(1,258)
(3,610)
10,712
9,674
11,455
12,112
43,953
10,106
9,126
10,807
11,426
41,465 103%
TX1
TX2
TX3
TX4
TX5
TX6
TX7
TX8
TX9
TX10
TX11
TX12
TX13
TX14
TX-Amarillo, Lubbock & Witchita Falls (62 counties- TX panhandle)
TX-Austin & Temple (12 counties East TX)
TX-Houston East & Beaumont (19 counties- SE TX)
TX-Houston (city of- Harris County SE TX)
TX-Houston (Harris County excluding Houston)
TX-Houston West (10 counties- SE TX)
TX-Dallas (Dallas County- NE TX)
TX-Dallas East (12 counties- NE TX)
TX-Dallas NW (5 counties- NE TX)
TX-El Paso, Abilene, Odessa & San Angelo (44 counties- West TX)
TX-Fort Worth (7 counties- NE TX)
TX-San Antonio (29 counties- SW TX)
TX-Corpus Christi, Harlingen, McAllen & Victoria (20 counties- SW TX)
TX-Waco, Bryan, Tyler & Longview (32 counties- Central & NE TX)
MAP
14 TEXAS- TOTAL
-26%
-3%
-15%
-9%
-3%
-2%
-10%
+7%
+1%
-33%
-8%
-24%
-44%
-28%
-15%
687
1,727
1,138
1,523
1,544
897
1,703
1,170
721
864
1,630
1,647
881
925
17,056
2,320
5,828
3,840
5,139
5,211
3,027
5,746
3,950
2,432
2,916
5,500
5,560
2,975
3,121
57,564
712
1,368
1,026
1,291
1,225
706
1,456
900
554
991
1,354
1,676
1,219
982
15,462
129
200
171
283
158
75
284
99
58
208
199
328
374
203
2,769
954
1,482
1,263
2,093
1,171
554
2,102
734
426
1,544
1,474
2,431
2,766
1,505
20,501
2,076
2,738
2,903
2,647
2,169
1,565
2,920
2,108
1,145
2,722
3,000
4,330
3,127
3,163
36,613
738
1,417
1,063
1,337
1,269
732
1,508
932
574
1,027
1,403
1,736
1,263
1,017
16,015
(593)
(1,753)
(1,387)
(2,453)
(2,102)
(1,133)
(1,724)
(1,116)
(640)
(588)
(2,160)
(2,579)
(1,370)
(1,470)
(21,068)
7,023
13,008
10,017
11,860
10,646
6,422
13,996
8,777
5,268
9,683
12,400
15,130
11,235
9,446
144,913
-16%
-29%
-21%
1,207
546
1,754
4,075
1,843
5,918
1,004
538
1,542
191
136
326
1,003
714
1,717
1,571
914
2,485
1,530
820
2,350
(520)
(334)
(854)
10,061
5,177
15,238
SC1
SC2
SC3
UT1
UT2
SC-Charleston & Florence (17 counties- SE SC)
SC-Columbia (20 counties- Central SC)
SC-Greenville & Spartanburg (9 counties- NW SC)
3 SOUTH CAROLINA- TOTAL
UT-Salt Lake City NW & Ogden (8 counties- NW UT)
UT-Salt Lake City SE & Provo (21 counties- SE UT)
2 UTAH- TOTAL
MAP
9,542 109%
9,800
9,331
8,327
27,457
6,626
12,272
9,450
11,189
10,043
6,059
13,204
8,280
4,970
9,135
11,698
14,274
10,599
8,912
136,710
95%
93%
9,492
4,884
14,376 103%
STATE/
CO-OP
$2.2T EXPECTED TOTAL FUNDING (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
1 VERMONT- TOTAL (VT)
PER CAP.
INCOME
vs RI
Working
Families
(mils $)
Business/ State &
Employers Local
(mils $) (mils $)
State
Federal
Medicaid Medicaid
(mils $) (mils $)
Federal
Medicare
(mils $)
Federal
Other
(mils $)
Funding
Re-Dist.
(mils $)
Total
Funding
@ 106%
SPEND @
vs.
Local Cost '09
(mils $) Base
MAP
-6%
473
1,595
444
215
1,087
1,026
483
205
5,527
5,214 110%
VA1
VA2
VA3
VA4
VA-Arlington & Winchester (17 counties- Northeast VA & DC area)
VA-Charlottesville, Lynchburg, Roanoke (61 counties- Western VA)
VA-Norfolk & Newport News (19 counties- Southeast VA)
VA-Richmond (37 counties- Eastern VA)
4 VIRGINIA- TOTAL
MAP
+54%
2,020
1,265
1,345
1,384
6,014
6,818
4,268
4,540
4,671
20,297
1,543
1,208
1,080
1,057
4,887
654
1,252
842
825
3,573
1,050
2,010
1,352
1,324
5,737
2,549
3,426
2,305
2,332
10,612
3,578
2,801
2,505
2,451
11,335
(3,278)
(3,451)
(1,566)
(1,830)
(10,126)
14,934
12,779
12,404
12,212
52,328
14,088
12,056
11,701
11,521
49,366 100%
WA1
WA2
WA3
WA4
WA-Spokane & Yakima (20 counties- eastern WA)
WA-Seattle City & King County (central WA)
WA-Seattle NW & Everett (10 counties- NW WA)
WA-Olympia & Tacoma (8 counties- SW WA)
4 WASHINGTON- TOTAL
MAP
-1%
-6%
+2%
929
1,545
1,271
1,273
5,017
3,136
5,214
4,288
4,296
16,934
1,129
1,458
1,217
1,273
5,076
1,308
991
943
1,097
4,340
2,165
1,640
1,561
1,815
7,180
2,023
2,211
2,294
2,162
8,689
1,321
1,706
1,423
1,490
5,940
(2,278)
(2,750)
(2,531)
(3,794)
(11,352)
9,731
12,016
10,466
9,611
41,824
9,180
11,336
9,874
9,067
39,457
1 WEST VIRGINIA- TOTAL (WV)
MAP
-27%
1,083
3,656
977
380
2,956
3,838
1,581
1,666
16,137
15,224 109%
WI-Appleton, Green Bay, Neenah & Wausau (20 counties- NE WI)
WI-Madison (14 counties- SE WI)
WI-Milwaukee (9 counties- SE WI)
WI-La Crosse & Marshfield (29 counties- NW WI)
4 WISCONSIN- TOTAL
MAP
-10%
-4%
-4%
-16%
-8%
879
883
1,726
724
4,211
2,965
2,980
5,824
2,445
14,214
739
693
1,350
649
3,432
242
260
576
254
1,332
1,027
1,101
2,445
1,075
5,648
2,008
1,663
3,186
1,802
8,658
614
576
1,122
540
2,853
970
34
597
911
2,512
9,443
8,191
16,825
8,400
42,859
8,909
7,727
15,873
7,925
40,433
99%
MAP
-6%
424
1,431
595
271
619
696
589
(1,153)
3,472
3,276
85%
MAP
-5%
220,306
743,534
200,000
127,000
365,000
515,000
220,000
-153,077
2,237,763
WI1
WI2
WI3
WI4
1 WYOMING- TOTAL (WY)
185 USA TOTAL
FUNDING
TOTAL
BACK
-20%
-5%
+1%
+10%
-22%
+32%
H
G
E6
E7
E8
L
J
I
K
Total
CO-OP
Funding
87%
2,111,097 101%
Spending
Next 9
Slides
APPENDIX F (continued)
SPEND: WHO’S GETTING THE MONEY
(BASED ON EXPECTED CO-OP ACTIVITY & CURRENT UTILIZATION)
PRIMARY CARE
PC- DIET. & TRAIN.
HOSPITALS
HOSP. SAVINGS
MD FEES
NURS HOME/ HOME CARE
RE-INVEST SAVINGS- ELDER
DRUGS
DRUG SAVINGS
NON-DURABLE/OTHER
TOTAL @ RI COST ………………
$450 BIL
$ 12 BIL
$810 BIL
($285)
$151 BIL
$209 BIL
$370 BIL
$270 BIL
($85)
$410 BIL
$2,312 BIL
GEOGRAPHIC COLA’S
TOTAL @ LOCAL COST
($201)
$2,111 BIL
SPENDING DETAIL BY CO-OP
(NEXT 10 SLIDES)
All expected
Hosp & Drug savings
Are consumed by
Rising Nursing Home.
Home Care & other
Elderly related as +65
POP. Nearly doubles
Thru 2030.
This is broadly defined
and includes “other”
professional services
often included with
MD Fees, which is
narrowly defined here
(see appendix E91 ).
APPENDIX F: NOTES ON SPENDING (page 1 of 2)
Two tables FUNDING & SPENDING. The $2.2 Trillion CO-OP SPENDING depicted on the next 8 slides is based
on the population by age In each CO-OP area as listed in E13-21. These methods & assumptions apply:
PRIMARY CARE: Population age 0-1 & +65 see a doctor an average of 8 times per year. The population
2 to 64 sees a doctor 4 times per year on average. Female population 18 to 64 see an OB/GYN an average of 3 times
per year. A dentist is seen twice a year and an optometrist is visited once every two years. As a result in each of the
15,490 service areas the CO-OP would contract approx. 17 Primary Care MDs, 7 Dentists and 4 Optometrists to
service a population of approx. 20k. Referrals to specialists would be in addition to these visits. See E22 at the end
of the table for more detailed information. That’s right, the entire population could receive the basic primary care
listed above for approximately $450 billion. Makes you wonder what we spend the other $2 trillion on?
HOSPITALS: The $810 BIL spent on hospitals each year was divided into three activity groups: In-Patient ($402B),
Out-Patient ER & Surgery ($123B) and Out-Patient Other ($285B). See E35, E45, E55 at end of table for more
detailed information. The CO-OP would fully support the first two groups and would heavily scrutinize the third
group. Much of this activity (often routine lab & imaging) would stop or be pushed back to the primary care setting
at half the cost or less. Also, nearly 30% of the beds staffed in the USA are not used. CO-OPs would exclude these
excesses from hospital funding and reverse the explosion of hospital costs of the past 10 years. See E65 at the end
of this table for more info on hospital utilization rates in each state. Shrink and focus hospitals. They will make up
the revenue as the population ages (the +65 pop uses the hospital 4x more than the under 65 pop).
MD FEES: There are 837k doctors in the USA (MD’s & DO’s). As with most health resources, the country suffers
from mal-distribution. For example, MA has 46 doctors per 10k people while ID has just 17.5 (less than half !!). The
average for the country is 27.1 per 10k. Assuming all states have between 25 & 30 doctors per 10k (USA average +/10% more than allowing for demographic differences) this would require 849k doctors or a current shortage of 14k.
Thru CO-OP activity, it is expected that 268k of these would be engaged in primary care as described above. 303k
are likely employees of hospitals, governments and corporations. The remaining 278k are engaged in private
practice, although this number shrinks with the continued expansion of hospitals. Total fees paid to these 278k
doctors would be $151 billion. CO-OP activity would drive better distribution of all health resources including
doctors. See E91 at the end of the table for more details.
APPENDIX F: NOTES ON SPENDING (page 2 of 2)
NURSING HOMES/HOME CARE: The cost of this service is estimated to be $209 billion. Consisting of 1.7 mil
nursing home beds ($135B) plus 1.1 billion home care days ($74B). However, the +65 population is expected to
nearly double by 2030 before becoming stable and growing at rates similar to the general population thereafter.
Accordingly any expected savings in hospital & drug spending are expected to be re-invested in added nursing
home, home care and other elder activity. See E71 at the end of the table for more info.
DRUGS: There are an estimated 4.5 billion prescriptions dispensed every year at a cost of $270 billion. Number of
prescriptions & prices vary widely by state and age group. Although the national average is 12.1 prescriptions per
person, the 0-18 age group is 4.1, 19-64 is 11.9 and the +65 group is 28. Pharma is one of the most profitable
industries on the planet and one only need watch an hour of television to see they spend an enormous amount on
advertising to create demand. CO-OP bulk buying could easily cut these costs by 1/3. Although the industry will
recover the revenue in volume as the population ages. See E81 at the end of the table for more information.
NON-DURABLE/OTHER: ($410 B) is broadly defined and includes “Medical Durables”,
“Other health, residential and personal care”. It also includes fees for other professional services
often included with Physician Fees. See E104 at end of table for more information.
COLA’s: Using data provided by researchers at C2ER, we compare key expenses in
dozens of major cities. Costs include housing, utilities, transportation and
health care. Data is generated from an average of the past four quarters
ending March 2010. http://cgi.money.cnn.com/tools/costofliving/costofliving.html
See appendix H at the end of the table for more information.
NOTE: ALL ITEMS ABOVE ARE PRESENTED AT RI COST.
A COLA IS THEN APPLIED TO ESTIMATE LOCAL COST.
STATE/
CO-OP
AL1
AL2
AL3
$2.1T EXPECTED TOTAL SPEND (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
Primary
Care
(mils $)
PC Hospital Hospital MD FEES Nurs Home/
Diet & Costs Savings/ not Hosp. Home Care
Train. (mils $) shift to PC not PC.
(mils $)
Increase
Elderly
Related
DRUGS
(mils $)
Expected Non-Durable TOTAL @ Per
cola TOTAL @
Drug
and Other RI Cost Capita vs RI Local Cost
Savings
(mils $)
(mils $) @ RI Cost health (mils $)
AL-Birmingham S & Tuscaloosa (28 counties- Central AL)
AL-Birmingham N & Huntsville (15 counties- Northern AL)
AL-Dothan, Mobile & Montgomery (23 counties- Southern AL)
3 ALABAMA-TOTAL
2,922
1,805
2,256
6,983
78
48
60
186
5,419
3,370
4,278
13,067
(1,421)
(902)
(1,115)
(3,437)
1,051
659
819
2,529
1,333
908
1,092
3,332
2,172
1,372
1,697
5,241
2,387
1,494
1,849
5,730
(751)
(470)
(582)
(1,804)
2,133
1,318
1,647
5,099
15,323
9,601
12,001
36,925
7,655
7,783
7,771
7,725
-20%
-20%
-20%
-20%
12,259
7,681
9,600
29,540
1 ALASKA-TOTAL (AK)
1,004
27
1,744
(815)
313
104
937
388
(122)
1,397
4,976
7,006
+20%
5,971
AZ1
AZ2
AZ3
AZ4
AZ-Mesa (Maricopa SE- Mesa, Chandler, Gilbert, Tempe)
AZ-Phoenix City of (Maricopa central)
AZ-Phoenix N & Sun City (Maricopa- Glendale, Scottsdale & North AZ)
AZ-Phoenix S & Tucson (Maricopa- Avondale, Goodyear & South AZ)
4 ARIZONA-TOTAL
1,696
2,052
2,544
2,991
9,283
45
55
68
80
248
2,278
2,765
3,953
4,373
13,369
(543)
(623)
(951)
(1,021)
(3,138)
507
601
810
917
2,834
329
303
858
744
2,234
839
969
1,429
1,556
4,793
940
1,101
1,518
1,700
5,259
(296)
(346)
(478)
(535)
(1,656)
1,102
1,326
1,677
1,953
6,058
6,897
8,203
11,428
12,758
39,286
5,846
5,674
6,688
6,199
6,146
-10%
-5%
-5%
-10%
-7%
6,207
7,792
10,857
11,482
36,339
AR1
AR2
AR-Little Rock (South & East AR, 43 counties)
AR-Fort Smith, Jonesboro, Springdale, Texarkana (N&W - 32 counties)
2 ARKANSAS-TOTAL
2,353
1,905
4,258
63
51
114
4,171
3,360
7,531
(1,061)
(853)
(1,915)
834
674
1,508
1,383
1,085
2,468
1,566
1,257
2,823
1,602
1,282
2,884
(504)
(404)
(908)
1,972
1,594
3,566
12,379
9,951
22,330
7,699
7,607
7,658
-15%
-15%
-15%
10,522
8,458
18,980
CA1
CA2
CA3
CA4
CA5
CA6
CA7
CA8
CA9
CA10
CA11
CA12
CA13
CA14
CA15
CA16
CA17
CA18
CA19
CA20
CA21
CA-Orange County N (Anaheim, Garden Grove, Hunt. Bch & North)
CA-Orange County S (Santa Ana, Costa Mesa & South)
CA-Bakersfield & Fresno (Kern, Tulare & Fresno, King, Madera)
CA-Alameda County
CA-LA Central LA, South LA, Northeast LA & Eastside
CA-LA Harbor, South Bay & Westside
CA-LA San Fern. Valley, NW, Antelope, Forest & Santa Monica Mtns.
CA-LA San Gabriel Valley, Pomona & Verdugos
CA-LA Southeast
CA-Modesto & Stockton (Merced, Stanislaus, San Joaquin, +4 more.)
CA-Napa, Chico, Redding & Santa Rosa (15 counties- north CA )
CA-Sacramento (11 counties)
CA-Palm Springs/Rancho Mirage (Riverside County)
CA-San Bernardino & Inyo Counties
CA-San Diego (City of)
CA-San Diego County (ex. City of, + Imperial County)
CA-San Francisco (SF & Marin Counties)
CA-San Jose (Santa Clara & San Benito Counties)
CA-Santa Cruz & San Mateo County
CA-Santa Barbara, San Luis Obispo, Salinas & Ventura
CA-Contra Costa & Solano Counties
21 CALIFORNIA-TOTAL
2,041
54
2,314
62
3,566
95
2,190
58
80
2,998
87
3,245
82
3,076
84
3,138
46
1,724
2,274
61
2,268
61
3,591
96
84
3,142
2,918
78
1,889
50
2,835
76
1,563
42
2,647
71
1,430
38
2,791
75
2,117
57
53,758 1,435
2,730
3,061
4,798
2,859
4,150
4,323
4,010
4,227
2,226
3,048
3,168
4,837
4,228
3,758
2,477
3,790
2,133
3,475
1,920
3,749
2,823
71,791
(847)
(949)
(1,422)
(885)
(1,181)
(1,342)
(1,232)
(1,313)
(685)
(931)
(988)
(1,496)
(1,303)
(1,147)
(759)
(1,175)
(665)
(1,075)
(596)
(1,160)
(876)
(22,027)
596
672
1,031
630
858
941
884
917
496
663
675
1,050
921
837
543
828
457
766
417
816
617
15,616
761
819
1,056
740
862
1,228
977
1,227
514
778
1,029
1,360
1,140
815
617
1,047
669
896
553
1,041
780
18,911
1,187
1,332
1,977
1,246
1,654
1,894
1,731
1,845
956
1,297
1,387
2,095
1,815
1,599
1,072
1,647
945
1,510
839
1,627
1,227
30,882
1,081
1,218
1,764
1,148
1,504
1,751
1,586
1,689
860
1,162
1,268
1,904
1,625
1,436
994
1,498
889
1,380
772
1,481
1,116
28,127
(340)
(383)
(555)
(361)
(473)
(551)
(499)
(532)
(271)
(366)
(399)
(599)
(512)
(452)
(313)
(472)
(280)
(434)
(243)
(466)
(351)
(8,854)
1,345
1,524
2,330
1,444
1,965
2,147
2,023
2,073
1,130
1,491
1,502
2,368
2,063
1,908
1,244
1,867
1,038
1,741
945
1,838
1,395
35,381
8,608
9,671
14,640
9,068
12,418
13,722
12,638
13,355
6,997
9,478
9,970
15,206
13,204
11,749
7,815
11,940
6,792
10,976
6,074
11,792
8,905
225,019
6,108
6,041
5,818
6,004
5,916
6,184
5,913
6,199
5,790
5,965
6,440
6,135
6,030
5,721
5,978
6,084
6,422
5,975
6,193
6,104
6,089
6,040
0%
0%
-5%
0%
-5%
-5%
-5%
-5%
-5%
0%
0%
0%
0%
0%
0%
0%
+5%
+5%
+5%
0%
0%
-1%
8,608
9,671
13,908
9,068
11,797
13,036
12,006
12,687
6,647
9,478
9,970
15,206
13,204
11,749
7,815
11,940
7,132
11,525
6,378
11,792
8,905
222,522
STATE/
CO-OP
$2.1T EXPECTED TOTAL SPEND (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
Primary
Care
(mils $)
PC Hospital Hospital MD FEES Nurs Home/ Increase
Diet & Costs Savings/ not Hosp. Home Care Elderly
Train. (mils $) shift to PC not PC. (mils $) Related
DRUGS
(mils $)
Expected Non-Durable TOTAL @ Per cola TOTAL @
Drug
and Other RI Cost Capita vs RI Local Cost
Savings (mils $)
(mils $) @ RI Cost health (mils $)
CO1
CO2
CO3
CO4
CO-Boulder, Fort Collins, Greeley (10 counties- NE CO.)
CO-Colorado Springs, Grand Junction & Pueblo (35 counties- S. CO.)
CO-Denver City of & East (7 counties)
CO-Denver West (12 counties)
4 COLORADO-TOTAL
1,329
2,019
2,451
1,447
7,246
35
54
65
39
193
1,899
2,966
3,445
1,989
10,299
(655)
(1,034)
(1,181)
(706)
(3,575)
388
599
708
421
2,116
432
764
714
444
2,353
861
1,351
1,553
928
4,693
655
1,008
1,183
706
3,551
(206)
(317)
(372)
(222)
(1,118)
1,113
1,693
2,048
1,209
6,063
5,852
9,103
10,613
6,254
31,822
6,354
6,529
6,219
6,207
6,327
-10%
-10%
-5%
-5%
-7%
5,267
8,193
10,082
5,941
29,483
CT1
CT2
CT-Hartford (6 counties)
CT-New Haven & Bridgeport (2 counties SW CT.)
2 CONNECTICUT-TOTAL
2,631
2,601
5,232
70
69
140
4,911
4,912
9,823
(1,831)
(1,797)
(3,629)
874
861
1,735
1,631
1,563
3,194
2,284
2,239
4,523
1,439
1,404
2,843
(453)
(442)
(895)
3,995
3,946
7,941
15,550 8,664
15,356 8,631
30,907 8,647
0%
0%
0%
15,550
15,356
30,907
1 DC, Wash.- TOTAL (DC)
887
24
2,951
(1,025)
441
613
1,137
357
(112)
1,210
6,482 10,773
-5%
6,158
1 DELAWARE.- TOTAL (DE)
1,317
35
2,309
(736)
457
530
1,041
969
(305)
1,469
7,086 7,892
-5%
6,732
FL1
FL2
FL3
FL4
FL5
FL6
FL7
FL8
FL9
FL10
FL11
FL-Fort Lauderdale S. (Broward County)
FL-Fort Lauderdale N. (Martin, Palm Beach & St. Lucie Counties)
FL-Jacksonville (Baker, Clay, Duval, Nassau & St Johns Counties)
FL-Miami-Dade & Monroe Counties (Everglades & Keys)
FL- Gainesville & Ormond Beach (12 Counties)
FL-Orlando S. (Brevard, Hardee, Highlands, Indian., Okee., Osceola)
FL-Orlando N. (Orange, Lake & Seminole counties)
FL-Ocala & Hudson (Citrus, Hernando, Marion, Pasco, Sumter)
FL-Tallahassee, Panama City & Pensacola (19 Counties)
FL-Fort Meyers, Sarasota, Bradenton & Lakeland (9 Counties)
FL-Tampa, St. Petersburg & Clearwater (Hillborough & Pinellas)
11 FLORIDA.- TOTAL
2,564
2,626
1,955
3,772
1,708
1,665
2,716
1,839
2,075
3,778
3,169
27,867
68
70
52
101
46
44
73
49
55
101
85
744
3,851
4,437
2,851
5,880
2,832
2,742
3,978
3,264
3,221
6,562
4,920
44,538
(733)
(851)
(538)
(1,075)
(521)
(523)
(753)
(632)
(585)
(1,267)
(930)
(8,407)
881
959
660
1,293
605
599
920
692
709
1,404
1,101
9,821
1,012
1,540
659
1,475
840
891
946
1,262
770
2,430
1,374
13,199
1,202
1,367
886
1,767
849
845
1,241
1,007
965
2,026
1,520
13,675
1,490
1,641
1,106
2,197
1,041
1,021
1,550
1,194
1,206
2,412
1,875
16,733
(469)
(517)
(348)
(691)
(328)
(321)
(488)
(376)
(380)
(759)
(590)
(5,268)
2,156
2,230
1,637
3,172
1,443
1,409
2,276
1,570
1,741
3,216
2,671
23,521
12,022
13,503
8,921
17,889
8,515
8,371
12,458
9,870
9,777
19,904
15,195
136,423
6,877
7,741
6,629
6,962
7,416
7,497
6,677
8,201
6,872
7,989
7,081
7,256
-10% 10,820
-10% 12,152
-15% 7,582
-5% 16,995
-20% 6,812
-15% 7,115
-15% 10,589
-20% 7,896
-20% 7,822
-10% 17,913
-15% 12,916
-13% 118,612
GA1
GA2
GA3
GA4
GA5
GA-Atlanta North & Rome (36 Counties)
GA-Atlanta City of & West (Fulton, Cobb & West, 11 Counties)
GA-Atlanta East (DeKalb, Gwinnett & East 11 Counties)
GA-Savannah & Augusta (SE. GA 47 Counties)
GA-Macon, Columbus & Albany (SW. GA 54 Counties)
5 GEORGIA.- TOTAL
2,946
3,263
3,298
2,456
2,002
13,966
79
87
88
66
53
373
4,365
4,591
4,547
3,769
3,148
20,420
(1,148)
(1,211)
(1,196)
(954)
(791)
(5,301)
961
1,038
1,040
799
656
4,494
1,043
934
828
861
755
4,421
1,712
1,817
1,792
1,424
1,180
7,925
1,790
1,925
1,894
1,494
1,235
8,338
(563)
(606)
(596)
(470)
(389)
(2,625)
1,924
2,127
2,144
1,605
1,310
9,111
13,109
13,966
13,837
11,050
9,160
61,122
6,433
6,157
5,995
6,514
6,652
6,309
-10%
-10%
-10%
-10%
-20%
-12%
11,798
12,569
12,453
9,945
7,328
54,094
STATE/
CO-OP
$2.1T EXPECTED TOTAL SPEND (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
Primary
Care
(mils $)
PC Hospital Hospital MD FEES Nurs Home/ Increase
Diet & Costs Savings/ not Hosp. Home Care Elderly
Train. (mils $) shift to PC not PC. (mils $)
Related
DRUGS
(mils $)
Expected Non-Durable TOTAL @ Per
cola TOTAL @
Drug
and Other RI Cost Capita vs RI Local Cost
Savings
(mils $)
(mils $) @ RI Cost health (mils $)
1 HAWAII.- TOTAL (HI)
1,989
53
2,628
(994)
571
409
1,368
1,187
(374)
1,311
8,148
5,990
+5%
8,555
1 IDAHO.- TOTAL (ID)
2,258
60
3,464
(1,452)
700
700
1,890
1,392
(438)
1,900
10,474
6,682
-10%
9,427
2,201
1,281
3,901
2,949
2,925
2,434
2,931
18,623
59
34
104
79
78
65
78
497
4,335
2,613
8,049
5,657
5,741
5,102
6,320
37,816
(1,723)
(1,046)
(2,970)
(2,312)
(2,351)
(2,027)
(2,468)
(14,898)
769
457
1,339
1,032
1,036
878
1,062
6,573
1,085
761
1,740
1,455
1,617
1,545
1,948
10,152
2,128
1,289
3,683
2,851
2,900
2,496
3,042
18,389
1,285
771
2,264
1,713
1,747
1,490
1,821
11,091
(405)
(243)
(713)
(539)
(550)
(469)
(573)
(3,491)
1,742
1,019
3,092
2,333
2,321
1,937
2,336
14,779
11,476
6,936
20,490
15,218
15,464
13,452
16,496
99,532
7,513
7,905
7,601
7,427
7,667
8,071
8,259
7,757
-5%
-5%
-5%
-5%
-5%
-10%
-10%
-7%
10,902
6,589
19,466
14,457
14,691
12,107
14,846
93,058
IL1
IL2
IL3
IL4
IL5
IL6
IL7
IL-Bloomington, Joliet & Urbana (East IL- 16 counties)
IL-Blue Island (Cook County- South)
IL-Chicago, city of (Cook County- East)
IL-Melrose Park, & Hinsdale (Cook-west, Dupage & Kane)
IL-Elgin & Evanston (NE. IL: Cook-north, Mchenry & Lake)
IL-Peoria, Rockford & Aurora (NW IL- 25 counties)
IL-Springfield (South IL: 56 counties)
7 ILLINOIS.- TOTAL
IN1
IN2
IN3
IN4
IN-Evansville, Gary, Lafayette, Munster, Terre Haute (W IN- 27
IN-Fort Wayne, Muncie, South Bend (Northeast IN- 20 counties)
IN-Indianapolis N. (City of, Marion, Hancock, Hendricks & N- 17
IN-Indianapolis S. (Morgan, Johnson, Shelby & Southeast- 28
4 INDIANA.- TOTAL
2,404
2,295
2,966
1,751
9,416
64
61
79
47
251
5,105
4,876
6,152
3,679
19,812
(2,202)
(2,104)
(2,641)
(1,603)
(8,550)
847
810
1,031
617
3,304
1,310
1,245
1,439
950
4,944
2,630
2,508
3,156
1,914
10,208
1,358
1,282
1,635
991
5,266
(428)
(404)
(515)
(312)
(1,658)
2,033
1,939
2,502
1,480
7,954
13,121
12,508
15,804
9,515
50,949
7,949
7,913
7,711
7,911
7,858
-15%
-15%
-15%
-15%
-15%
11,153
10,632
13,433
8,088
43,306
IA1
IA2
IA-Des Moines, Mason City & Sioux City (West IA)
IA-Cedar Rapids, Davenport, Dubuque, Iowa City & Waterloo (E. IA)
2 IOWA.- TOTAL
2,536
1,919
4,455
68
51
119
6,020
4,543
10,563
(3,105)
(2,326)
(5,432)
940
707
1,646
1,757
1,288
3,046
3,735
2,802
6,538
2,001
1,512
3,513
(630)
(476)
(1,106)
2,551
1,930
4,481
15,872
11,951
27,823
9,152
9,108
9,133
-20%
-15%
-17%
12,698
10,158
22,856
KS1
KS2
KS-Wichita SE KS (1.1 mil, 28 Counties) & West KS (319k, 51 counts.)
KS-Topeka Northeast KS (26 counties)
2 KANSAS.- TOTAL
2,059
2,079
4,139
55
56
110
3,886
3,729
7,615
(1,577)
(1,511)
(3,088)
707
695
1,402
1,228
1,012
2,241
1,968
1,897
3,865
1,242
1,225
2,467
(391)
(386)
(777)
1,812
1,824
3,636
10,990
10,620
21,610
7,769
7,382
7,574
-20%
-15%
-17%
8,792
9,027
17,819
KY1
KY2
KY-Lexington & Covington (Eastern KY, 65 counties)
KY-Louisville, Owensboro & Paducah (Western KY, 55 counties)
2 KENTUCKY.- TOTAL
3,068
3,255
6,323
82
87
169
6,658
6,965
13,623
(2,090)
(2,254)
(4,344)
1,154
1,235
2,388
1,398
1,577
2,974
3,016
3,239
6,255
2,941
3,130
6,071
(926)
(985)
(1,911)
2,605
2,767
5,372
17,905
19,016
36,921
8,493
8,523
8,508
-20%
-20%
-20%
14,324
15,213
29,537
LA1
LA2
LA-Shreveport, Alexandria, Lafayette, Lake Charles, Monroe (41
LA-New Orleans, Baton Rouge, Metaire, Slidell & Houma (SE. LA- 23)
2 LOUISIANA.- TOTAL
3,031
3,546
6,577
81
95
176
7,005
7,882
14,887
(2,501)
(2,851)
(5,353)
1,164
1,340
2,504
2,117
2,233
4,350
3,176
3,633
6,809
2,143
2,484
4,627
(675)
(782)
(1,457)
2,734
3,197
5,931
18,274
20,777
39,051
8,758
8,491
8,614
-15%
-15%
-15%
15,533
17,661
33,194
STATE/
CO-OP
$2.1T EXPECTED TOTAL SPEND (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
Primary
Care
(mils $)
PC Hospital Hospital MD FEES Nurs Home/ Increase
Diet & Costs Savings/ not Hosp. Home Care Elderly
Train. (mils $) shift to PC not PC. (mils $)
Related
DRUGS
(mils $)
Expected Non-Durable TOTAL @ Per
cola TOTAL @
Drug
and Other RI Cost Capita vs RI Local Cost
Savings
(mils $)
(mils $) @ RI Cost health (mils $)
1 MAINE.- TOTAL (ME)
1,961
52
5,279
(2,886)
742
839
3,354
1,487
(468)
4,074
14,434 10,866
-5%
13,713
MD1
MD2
MD3
MD-Baltimore & Salisbury (Eastern MD, 14 counties)
MD-Takoma Park NW/ DC Area (Northwest MD, 5 counties)
MD-Takoma Park SW/ DC Area (Southwest MD, 5 counties)
3 MARYLAND.- TOTAL
3,768
2,123
2,516
8,407
101
57
67
224
6,388
3,402
3,842
13,633
(1,398)
(781)
(882)
(3,061)
1,303
732
847
2,882
1,505
814
789
3,108
2,012
1,124
1,279
4,415
1,949
1,089
1,261
4,299
(614)
(343)
(397)
(1,353)
3,145
1,768
2,089
7,002
18,159
9,985
11,411
39,555
7,054
6,850
6,552
6,851
-15%
0%
0%
-10%
15,435
9,985
11,411
36,831
MA1
MA2
MA3
MA4
MA-Boston NE (Boston city of, Suffolk & Essex counties)
MA-Boston NW (Middlesex county)
MA-Boston South ( 6 counties including Cape & Islands)
MA-Springfield & Worcester (Western MA 5 counties)
4 MASSACHUSETTS.- TOTAL
2,146
2,200
2,881
2,375
9,603
57
59
77
63
256
5,109
4,978
6,843
5,718
22,648
(2,238)
(2,336)
(3,197)
(2,559)
(10,330)
763
790
1,060
861
3,474
1,272
1,387
2,126
1,573
6,358
2,598
2,707
3,691
2,960
11,956
1,144
1,178
1,569
1,273
5,164
(360)
(371)
(494)
(401)
(1,626)
3,020
3,095
4,062
3,341
13,517
13,511
13,686
18,618
15,205
61,020
9,221
9,105
9,515
9,370
9,319
+10%
+10%
+10%
0%
+7%
14,862
15,055
20,479
15,205
65,601
MI1
MI2
MI3
MI4
MI5
MI-Ann Arbor, Kalamazoo & St. Joseph (South MI- 13 counties +
MI-Detroit & Dearborn (Southeast MI- 2 counties + Wayne)
MI-Flint, Lansing & Saginaw (Northeast MI- 22 counties)
MI-Marquette, Muskegon, Petoskey, Traverse City & Grand Rapids (44)
MI-Pontiac & Royal Oak (Oakland County, east MI- NW of Detroit)
5 MICHIGAN.- TOTAL
3,016
3,667
2,716
3,267
1,753
14,420
81
98
73
87
47
385
6,680
8,347
6,247
7,423
3,747
32,445
(2,946)
(3,568)
(2,707)
(3,269)
(1,704)
(14,193)
1,099
1,333
999
1,206
636
5,273
1,374
1,646
1,336
1,613
786
6,755
3,524
4,262
3,231
3,897
2,038
16,952
1,835
2,207
1,664
1,996
1,061
8,762
(578)
(695)
(524)
(628)
(334)
(2,758)
2,223
2,703
2,006
2,409
1,293
10,634
16,307
20,001
15,041
18,002
9,324
78,674
7,879
7,943
8,111
8,039
7,754
7,960
-15%
-15%
-10%
-15%
-10%
-13%
13,861
17,001
13,536
15,302
8,391
68,091
MN1
MN2
MN3
MN-Minneapolis NW & St. Cloud (Northwest MN 37 counties)
MN-Minneapolis SW (City of & Southwest MN 31 counties)
MN-Duluth, Rochester & St. Paul (Eastern MN 19 counties)
3 MINNESOTA.- TOTAL
1,466
3,461
2,775
7,702
39
92
74
206
2,758
5,983
4,900
13,641
(1,006)
(2,212)
(1,799)
(5,017)
507
1,156
933
2,596
1,010
1,815
1,549
4,374
1,285
2,841
2,308
6,434
885
1,999
1,617
4,501
(279)
(629)
(509)
(1,417)
2,042
4,801
3,854
10,698
8,708
19,307
15,702
43,717
8,698
8,073
8,216
8,242
-5%
-5%
-5%
-5%
8,273
18,341
14,917
41,532
MS1
MS2
MS-Jackson & Oxford (West MS 47 counties)
MS-Gulfport, Hattiesburg, Meridian, Tupelo (East MS 35 counties)
2 MISSISSIPPI.- TOTAL
2,288
2,021
4,309
61
54
115
4,108
3,615
7,722
(781)
(703)
(1,484)
810
722
1,531
1,132
1,076
2,208
1,360
1,222
2,582
1,836
1,650
3,486
(578)
(519)
(1,097)
1,976
1,748
3,724
12,211
10,884
23,096
7,735
7,838
7,783
-15%
-20%
-17%
10,379
8,708
19,087
MO1
MO2
MO3
MO4
MO- Columbia, Joplin & Springfield (57 counties- Central & SW MO.)
MO-Kansas City (26 counties- NW MO.)
MO-St. Louis N. (City of & 6 counties- NE MO.)
MO-St. Louis S. & Cape Girardeau (26 counties- SE MO.)
4 MISSOURI.- TOTAL
2,591
2,171
2,604
1,380
8,746
69
58
70
37
234
6,623
5,207
6,190
3,440
21,461
(2,835)
(2,287)
(2,746)
(1,483)
(9,351)
1,005
825
989
531
3,349
1,733
1,263
1,533
858
5,387
3,357
2,715
3,260
1,758
11,089
1,656
1,357
1,635
874
5,522
(521)
(427)
(515)
(275)
(1,738)
1,923
1,606
1,930
1,022
6,480
15,600
12,487
14,950
8,143
51,179
8,829
8,370
8,388
8,590
8,546
-15%
-15%
-10%
-10%
-13%
13,260
10,614
13,455
7,328
44,657
STATE/
CO-OP
NV1
NV2
NJ1
NJ2
NJ3
NJ4
NJ5
$2.1T EXPECTED TOTAL SPEND (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
PC Hospital Hospital MD FEES Nurs Home/ Increase
Diet & Costs Savings/ not Hosp. Home Care Elderly
Train. (mils $) shift to PC not PC. (mils $) Related
DRUGS
(mils $)
Expected Non-Durable TOTAL @ Per cola TOTAL @
Drug
and Other RI Cost Capita vs RI Local Cost
Savings (mils $)
(mils $) @ RI Cost health (mils $)
1 MONTANA.- TOTAL (MT)
1,447
39
3,222
(1,744)
512
685
2,005
828
(261)
1,363
8,095 8,182
-10%
7,286
1 NEBRASKA.- TOTAL (NE)
2,654
71
5,200
(2,117)
923
1,447
2,682
1,796
(565)
2,388
14,478 7,927
-15%
12,306
NV-Las Vegas (3 counties- SE NV)
NV-Reno (14 counties- NW NV)
2 NEVADA.- TOTAL
2,885
1,015
3,900
77
27
104
3,328
1,201
4,529
(710)
(258)
(969)
807
288
1,094
695
278
973
1,185
429
1,615
1,508
544
2,053
(475)
(171)
(646)
1,533
541
2,074
10,833 5,415
3,894 5,563
14,727 5,453
-5%
-10%
-7%
10,291
3,505
13,796
1 NEW HAMPSHIRE.- TOTAL (NH)
1,923
51
4,279
(2,281)
665
874
2,685
1,282
(403)
1,889
10,963 8,327
0%
10,963
2,438
2,039
2,058
3,459
2,837
12,831
65
54
55
92
76
343
4,307
3,613
3,624
5,734
4,969
22,247
(1,373)
(1,095)
(1,110)
(1,827)
(1,458)
(6,863)
823
673
680
1,134
917
4,227
1,370
968
997
1,537
1,133
6,005
1,854
1,486
1,506
2,485
1,989
9,321
1,528
1,242
1,258
2,091
1,688
7,808
(481)
(391)
(396)
(658)
(531)
(2,458)
2,319
1,932
1,952
3,273
2,683
12,158
12,851
10,521
10,624
17,320
14,303
65,618
7,762
7,533
7,554
7,282
7,317
7,464
-5%
-5%
-5%
-5%
-10%
-6%
12,208
9,995
10,093
16,454
12,872
61,622
2,990
80
5,013
(2,066)
952
1,986
2,532
1,479
(466)
3,096
15,597 7,574
-15%
13,257
2,863
2,001
2,143
3,268
1,967
2,174
3,649
3,046
2,521
1,997
2,737
28,366
76
53
57
87
53
58
97
81
67
53
73
757
6,201
4,401
4,803
6,902
4,246
4,569
8,015
6,533
5,332
4,337
6,087
61,426
(2,603)
(1,687)
(1,984)
(2,860)
(1,811)
(1,944)
(3,120)
(2,664)
(2,258)
(1,797)
(2,500)
(25,228)
1,029
693
777
1,149
712
776
1,269
1,065
901
714
986
10,069
1,848
942
1,484
1,850
1,328
1,306
1,866
1,773
1,521
1,244
1,797
16,959
3,195
2,071
2,431
3,524
2,216
2,383
3,839
3,294
2,764
2,206
3,066
30,989
1,883
1,222
1,418
2,108
1,287
1,395
2,283
2,002
1,606
1,299
1,795
18,300
(593)
(385)
(446)
(664)
(405)
(439)
(719)
(630)
(506)
(409)
(565)
(5,761)
5,052
3,511
3,790
5,766
3,473
3,825
6,421
5,399
4,433
3,521
4,830
50,021
18,952
12,823
14,474
21,130
13,065
14,103
23,600
19,899
16,382
13,165
18,306
185,899
0% 18,952
+5% 13,465
-20% 11,579
+5% 22,187
+5% 13,718
+5% 14,808
+15% 27,140
+15% 22,884
0% 16,382
-10% 11,848
0% 18,306
+4% 191,269
NJ-Camden N. (3 counties- South NJ)
NJ-Camden S. (6 counties- South NJ)
NJ-Hackensack, Patterson & Ridgewood (2 counties- NE NJ)
NJ-Morristown & New Brunswick (7 counties- NW NJ)
NJ-Newark (3 counties- NE NJ)
5 NEW JERSEY.- TOTAL
1 NEW MEXICO.- TOTAL (NM)
NY1
NY2
NY3
NY4
NY5
NY6
NY7
NY8
NY9
NY10
NY11
Primary
Care
(mils $)
NY-Albany (18 counties NE NY)
NY-NYC Bronx County
NY-Buffalo (6 counties western NY)
NY-NYC East Long Island (Queens County)
NY-East Long Island (Nassau County)
NY-East Long Island (Suffolk County)
NY-NYC Manhattan (Kings County, Brooklyn- West Long Island)
NY-NYC Manhattan (NY & Richmond Counties- Staten Island)
NY-White Plains (Orange, Putnam, Rockland & Weschester counties.)
NY-Rochester (10 counties East of Buffalo area)
NY-Syracuse, Binghamton & Elmira (17 counts. East of Rochester)
11 NEW YORK.- TOTAL
9,703
9,258
9,956
9,472
9,753
9,444
9,422
9,685
9,451
9,654
9,809
9,593
STATE/
CO-OP
NC1
NC2
NC3
NC4
NC5
$2.1T EXPECTED TOTAL SPEND (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
NC-Charlotte (10 counties- SW NC)
NC-Durham & Greensboro (19 counties- west of Raleigh)
NC-Greenville & Wilmington (29 counties- eastern & coastal NC)
NC-Raleigh (11 counties)
NC-Winston-Salem, Asheville & Hickory (31 counties- west NC)
5 NORTH CAROLINA.- TOTAL
1 NORTH DAKOTA.- TOTAL (ND)
Primary
Care
(mils $)
PC Hospital Hospital MD FEES Nurs Home/ Increase
Diet & Costs Savings/ not Hosp. Home Care Elderly
Train. (mils $) shift to PC not PC. (mils $)
Related
DRUGS
(mils $)
Expected Non-Durable TOTAL @ Per
cola TOTAL @
Drug
and Other RI Cost Capita vs RI Local Cost
Savings
(mils $)
(mils $) @ RI Cost health (mils $)
2,851
2,872
2,170
2,886
3,107
13,886
76
77
58
77
83
371
4,637
4,959
3,835
4,647
5,507
23,585
(1,481)
(1,544)
(1,193)
(1,479)
(1,761)
(7,457)
956
977
747
961
1,086
4,727
999
1,182
974
949
1,555
5,660
1,907
1,986
1,533
1,906
2,256
9,588
1,355
1,404
1,081
1,358
1,572
6,770
(427)
(442)
(340)
(427)
(495)
(2,131)
2,763
2,795
2,115
2,793
3,036
13,503
13,638
14,265
10,979
13,672
15,947
68,502
6,905
7,252
7,414
6,821
7,566
7,184
-5%
-5%
0%
-10%
-20%
-8%
12,956
13,552
10,979
12,305
12,757
62,550
983
26
2,924
(1,514)
404
562
1,722
661
(208)
1,337
6,897 10,255
-10%
6,207
OH1
OH2
OH3
OH4
OH5
OH6
OH7
OH-Akron, Canton, Youngstown (12 counties- NE OH)
OH-Cincinnati (7 counties- SW OH)
OH-Cleveland & Elyria (8 counties- NE OH)
OH-Columbus- North (15 counties- central OH)
OH-Columbus- City of & Southeast (20 counties- SE OH)
OH-Dayton & Kettering (15 counties- West OH)
OH-Toledo (11 counties- NW OH)
7 OHIO.- TOTAL
2,942
2,222
3,402
1,571
2,933
2,372
1,415
16,857
79
59
91
42
78
63
38
450
7,059
5,052
8,114
3,621
6,798
5,495
3,297
39,436
(2,909)
(2,086)
(3,333)
(1,515)
(2,701)
(2,298)
(1,356)
(16,197)
1,112
817
1,279
587
1,068
888
526
6,277
2,048
1,269
2,294
986
1,542
1,523
876
10,537
3,596
2,590
4,121
1,874
3,365
2,843
1,680
20,068
2,180
1,599
2,503
1,142
2,110
1,730
1,031
12,296
(686)
(504)
(788)
(360)
(664)
(545)
(324)
(3,871)
2,779
2,089
3,211
1,478
2,754
2,233
1,332
15,876
18,199
13,108
20,894
9,426
17,284
14,305
8,514
101,729
9,101
8,585
9,024
8,739
8,539
8,812
8,791
8,818
-20%
-15%
-10%
-5%
-5%
-20%
-20%
-15%
14,559
11,142
18,805
8,955
16,420
11,444
6,811
88,135
OK1
OK2
OK-Oklahoma City & Lawton (54 counties)
OK-Tulsa (23 counties- NE OK)
2 OKLAHOMA- TOTAL
3,227
2,228
5,455
86
59
146
5,104
3,563
8,667
(1,185)
(828)
(2,013)
1,087
755
1,842
1,977
1,434
3,411
1,751
1,221
2,972
1,797
1,249
3,046
(566)
(393)
(959)
2,613
1,806
4,419
15,892
11,094
26,986
7,152
7,254
7,194
-15%
-15%
-15%
13,508
9,430
22,938
OR1
OR2
OR-Bend, Eugene, Medford, Salem (20 counties- Southern OR)
OR-Portland (16 counties- Northern OR)
2 OREGON- TOTAL
2,595
3,003
5,598
69
80
149
4,515
4,764
9,279
(2,127)
(2,284)
(4,411)
805
901
1,707
804
699
1,504
2,675
2,896
5,572
1,742
1,945
3,687
(548)
(612)
(1,161)
2,935
3,377
6,312
13,465
14,770
28,235
7,641
7,139
7,370
-5%
0%
-2%
12,792
14,770
27,562
PA1
PA2
PA3
PA4
PA5
PA6
PA7
PA8
PA-Allentown, Scranton & Wilkes-Barre (9 counties- NE PA)
PA-Danville, Erie & Sayre (22 counties- North & West PA)
PA-Harrisburg, Altoona & Johnstown (15 counties- South Central PA)
PA-Lancaster, Reading & York (5 counties- SE PA)
PA-Philadelphia NW (3 counties- SE PA)
PA-Philadelphia (city of & county- SE PA)
PA-Pittsburgh (city of & west- 5 counties SW PA)
PA-Pittsburgh East (7 counties- SW PA)
8 PENNSYLVANIA- TOTAL
2,317
2,067
2,280
2,939
2,910
2,231
2,575
1,378
18,697
62
55
61
78
78
60
69
37
499
5,563
5,112
5,474
6,739
6,511
5,208
6,290
3,388
44,286
(2,259)
(2,014)
(2,232)
(2,787)
(2,767)
(2,012)
(2,537)
(1,371)
(17,979)
865
771
853
1,083
1,072
797
964
519
6,923
1,259
1,121
1,254
1,431
1,445
914
1,468
806
9,697
2,760
2,464
2,727
3,406
3,384
2,472
3,102
1,675
21,991
1,593
1,431
1,572
1,966
1,959
1,462
1,797
966
12,744
(501)
(450)
(495)
(619)
(617)
(460)
(566)
(304)
(4,012)
2,748
2,451
2,704
3,473
3,444
2,638
3,063
1,639
22,161
14,406
13,008
14,199
17,710
17,419
13,309
16,225
8,732
115,008
9,169
9,279
9,184
8,797
8,779
8,722
9,371
9,403
9,054
-15%
-20%
-20%
-15%
-5%
-5%
-20%
-20%
-15%
12,245
10,406
11,359
15,053
16,548
12,644
12,980
6,986
98,222
STATE/
CO-OP
$2.1T EXPECTED TOTAL SPEND (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
Primary
Care
(mils $)
PC Hospital Hospital MD FEES Nurs Home/ Increase
Diet & Costs Savings/ not Hosp. Home Care Elderly
Train. (mils $) shift to PC not PC. (mils $)
Related
DRUGS
(mils $)
Expected Non-Durable TOTAL @ Per
cola TOTAL @
Drug
and Other RI Cost Capita vs RI Local Cost
Savings
(mils $)
(mils $) @ RI Cost health (mils $)
1 RHODE ISLAND- TOTAL (RI)
1,548
41
3,056
(1,162)
542
934
1,442
890
(280)
2,530
9,542
9,066
0%
9,542
SC-Charleston & Florence (17 counties- SE SC)
SC-Columbia (20 counties- Central SC)
SC-Greenville & Spartanburg (9 counties- NW SC)
3 SOUTH CAROLINA- TOTAL
2,392
2,188
2,179
6,759
64
58
58
180
3,609
3,243
3,221
10,072
(911)
(818)
(821)
(2,550)
809
734
733
2,276
851
722
739
2,312
1,342
1,207
1,209
3,758
1,368
1,236
1,232
3,836
(431)
(389)
(388)
(1,208)
1,797
1,641
1,634
5,071
10,889
9,822
9,796
30,507
6,671
6,548
6,561
6,596
-10%
-5%
-15%
-10%
9,800
9,331
8,327
27,457
1 SOUTH DAKOTA- TOTAL (SD)
1,186
32
2,407
(975)
426
612
1,210
746
(235)
1,105
6,513
8,000
-10%
5,862
TN1
TN2
TN3
TN4
TN-Memphis & Jackson (20 counties- west TN)
TN-Nashville City Of & West (18 counties- central TN)
TN-Nashville East & Chattanooga (31 counties- central TN)
TN-Knoxville, Johnson City, Kingsport (26 counties- east TN)
4 TENNESSEE- TOTAL
2,243
2,082
2,359
2,574
9,258
60
56
63
69
247
4,095
3,586
4,294
4,849
16,824
(1,039)
(945)
(1,129)
(1,270)
(4,383)
795
730
850
942
3,317
994
850
1,192
1,464
4,500
1,641
1,504
1,781
2,001
6,927
1,915
1,774
2,071
2,321
8,081
(603)
(559)
(652)
(731)
(2,544)
1,788
1,658
1,885
2,065
7,396
11,889
10,737
12,714
14,283
49,623
7,690
7,463
7,873
8,179
7,819
-15%
-15%
-15%
-20%
-16%
10,106
9,126
10,807
11,426
41,465
TX1
TX2
TX3
TX4
TX5
TX6
TX7
TX8
TX9
TX10
TX11
TX12
TX13
TX14
TX-Amarillo, Lubbock & Witchita Falls (62 counties- TX panhandle)
TX-Austin & Temple (12 counties East TX)
TX-Houston East & Beaumont (19 counties- SE TX)
TX-Houston (city of- Harris County SE TX)
TX-Houston (Harris County excluding Houston)
TX-Houston West (10 counties- SE TX)
TX-Dallas (Dallas County- NE TX)
TX-Dallas East (12 counties- NE TX)
TX-Dallas NW (5 counties- NE TX)
TX-El Paso, Abilene, Odessa & San Angelo (44 counties- West TX)
TX-Fort Worth (7 counties- NE TX)
TX-San Antonio (29 counties- SW TX)
TX-Corpus Christi, Harlingen, McAllen & Victoria (20 counties- SW TX)
TX-Waco, Bryan, Tyler & Longview (32 counties- Central & NE TX)
14 TEXAS- TOTAL
1,672
3,179
2,411
3,000
2,820
1,639
3,377
2,094
1,287
2,322
3,151
3,918
2,833
2,326
36,029
45
85
64
80
75
44
90
56
34
62
84
105
76
62
962
2,611
4,511
3,696
4,515
3,899
2,338
4,983
3,013
1,808
3,657
4,557
6,036
4,730
3,758
54,112
(738)
(1,293)
(1,055)
(1,226)
(1,130)
(683)
(1,377)
(881)
(527)
(1,011)
(1,309)
(1,682)
(1,221)
(1,048)
(15,181)
536
980
769
927
867
512
1,043
657
398
740
982
1,239
901
751
11,303
1,024
1,351
1,432
1,306
1,070
772
1,441
1,040
565
1,343
1,480
2,136
1,543
1,561
18,064
990
1,745
1,417
1,655
1,519
917
1,854
1,183
710
1,354
1,760
2,255
1,631
1,407
20,397
801
1,437
1,150
1,360
1,236
745
1,515
960
582
1,090
1,433
1,822
1,301
1,138
16,569
(252)
(452)
(362)
(428)
(389)
(234)
(477)
(302)
(183)
(343)
(451)
(574)
(410)
(358)
(5,216)
1,106
2,093
1,594
1,975
1,849
1,078
2,222
1,380
848
1,534
2,076
2,586
1,866
1,543
23,749
7,795
13,635
11,117
13,163
11,816
7,128
14,671
9,200
5,522
10,747
13,762
17,842
13,249
11,139
160,788
6,730
6,128
6,660
6,270
5,929
6,205
6,195
6,289
6,131
6,667
6,248
6,547
6,682
6,974
6,394
-15%
6,626
-10% 12,272
-15%
9,450
-15% 11,189
-15% 10,043
-15%
6,059
-10% 13,204
-10%
8,280
-10%
4,970
-15%
9,135
-15% 11,698
-20% 14,274
-20% 10,599
-20%
8,912
-15% 136,710
UT1
UT2
UT-Salt Lake City NW & Ogden (8 counties- NW UT)
UT-Salt Lake City SE & Provo (21 counties- SE UT)
2 UTAH- TOTAL
2,549
1,363
3,912
68
36
104
3,784
2,124
5,908
(1,649)
(899)
(2,548)
743
402
1,145
722
420
1,142
2,056
1,115
3,171
1,294
686
1,980
(407)
(216)
(623)
2,007
1,073
3,080
11,167
6,105
17,272
6,204
6,333
6,249
-15%
-20%
-17%
SC1
SC2
SC3
9,492
4,884
14,376
STATE/
CO-OP
$2.1T EXPECTED TOTAL SPEND (STATE & CO-OP)
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
Primary
Care
(mils $)
1 VERMONT- TOTAL (VT)
PC Hospital Hospital MD FEES Nurs Home/ Increase
Diet & Costs Savings/ not Hosp. Home Care Elderly
Train. (mils $) shift to PC not PC. (mils $)
Related
DRUGS
(mils $)
Expected Non-Durable TOTAL @ Per
cola TOTAL @
Drug
and Other RI Cost Capita vs RI Local Cost
Savings
(mils $)
(mils $) @ RI Cost health (mils $)
919
25
2,568
(1,678)
339
438
1,926
787
(248)
719
5,794
9,259
-10%
5,214
3,625
2,921
2,568
2,515
11,629
97
78
69
67
310
5,016
4,916
3,917
3,862
17,711
(1,642)
(1,490)
(1,224)
(1,208)
(5,564)
1,151
978
834
820
3,782
890
1,196
804
814
3,704
2,246
2,020
1,667
1,644
7,577
1,921
1,685
1,408
1,383
6,397
(605)
(530)
(443)
(435)
(2,014)
2,955
2,408
2,103
2,060
9,526
15,654
14,183
11,701
11,521
53,059
6,199
7,173
6,617
6,660
6,632
-10%
-15%
0%
0%
-7%
14,088
12,056
11,701
11,521
49,366
VA1
VA2
VA3
VA4
VA-Arlington & Winchester (17 counties- Northeast VA & DC area)
VA-Charlottesville, Lynchburg, Roanoke (61 counties- Western VA)
VA-Norfolk & Newport News (19 counties- Southeast VA)
VA-Richmond (37 counties- Eastern VA)
4 VIRGINIA- TOTAL
WA1
WA2
WA3
WA4
WA-Spokane & Yakima (20 counties- eastern WA)
WA-Seattle City & King County (central WA)
WA-Seattle NW & Everett (10 counties- NW WA)
WA-Olympia & Tacoma (8 counties- SW WA)
4 WASHINGTON- TOTAL
2,163
2,799
2,348
2,443
9,754
58
75
63
65
260
3,295
3,825
3,415
3,522
14,057
(1,168)
(1,443)
(1,277)
(1,298)
(5,186)
641
809
696
717
2,862
636
696
722
680
2,733
1,552
1,944
1,704
1,731
6,932
1,220
1,593
1,355
1,376
5,544
(384)
(501)
(426)
(433)
(1,745)
1,650
2,137
1,796
1,864
7,446
9,663
11,932
10,393
10,667
42,656
6,463
6,179
6,449
6,324
6,343
-5%
-5%
-5%
-15%
-8%
9,180
11,336
9,874
9,067
39,457
1 WEST VIRGINIA- TOTAL (WV)
2,734
73
7,313
(2,993)
1,120
956
3,810
2,597
(817)
3,118
17,910
9,666
-15%
15,224
WI-Appleton, Green Bay, Neenah & Wausau (20 counties- NE WI)
WI-Madison (14 counties- SE WI)
WI-Milwaukee (9 counties- SE WI)
WI-La Crosse & Marshfield (29 counties- NW WI)
4 WISCONSIN- TOTAL
1,789
1,672
3,250
1,575
8,286
48
45
87
42
221
3,405
3,129
6,153
3,060
15,747
(1,502)
(1,359)
(2,634)
(1,329)
(6,824)
615
565
1,097
542
2,819
934
773
1,482
838
4,027
1,867
1,696
3,280
1,652
8,495
1,159
1,070
2,052
1,026
5,308
(365)
(337)
(646)
(323)
(1,671)
1,428
1,332
2,588
1,258
6,606
9,378
8,586
16,708
8,342
43,013
7,658
7,471
7,469
7,751
7,563
-5%
-10%
-5%
-5%
-6%
8,909
7,727
15,873
7,925
40,433
815
22
1,263
(469)
253
290
615
464
(146)
748
3,854
6,838
-15%
3,276
449,145 11,992
810,205
(284,787)
-35.1%
151,307
209,217
369,771
269,963
(84,984)
410,000
2,311,828
7,488
WI1
WI2
WI3
WI4
1 WYOMING- TOTAL (WY)
185 USA TOTAL
SPENDING
TOTAL
E22
$527 Bil Hosp.
E35 E45 E65
Most of E55 CO-OP
shifts to PC/other
-8.7% 2,111,097
-31.5%
E91
E71
$185 Bil Drugs
CO-OP bulk buy
E81
H
E104
Back
Table of Contents
APPENDIX G
REIMBURSEMENT RATES,
GEOGRAPHIC COLA’S
ESTIMATE ON EXPANDING THE RI MODEL NATIONALLY
(NEXT 4 SLIDES)
NOTE: 40.9% OF US POPULATION LIVE IN AREAS WITH THE SAME
HEALTH PRICE LEVELS AS RI (+/- 5%). 3.5% LIVE IN AREAS WITH HIGHER
COSTS & 55.6% WITH LOWER COSTS. NATIONAL HEALTH SPENDING IS
REDUCED 8.5% IF GEOGRAPHIC RATES ARE USED VS RI RATES HEREIN.
BACK
Table of Contents
G1: REIMBURSEMENT RATES & GEOGRAPHIC COLA’s (PG 1/4)
-20%
-15%
-10%
-5%
268k Pedi, Gen., Gerri. & OB/GYN
101k Dentists
52k Optometrists
150k Diet/Nutri/Trainers
$.96m
$756k
$500k
$53k
$1.02m
$804k
$532k
$56k
$1.08m
$850k
$563k
$59k
$1.14m
$898k
$595k
$63k
TOTAL @ RI COST (Bil$)
TOTAL @ LOCAL COST
$61.2
$49.0
$111.4
$94.7
$76.8
$69.1
$115.0
$109.2
RI COST
+5%
+10%
$1.26m
$993k
$656k
$69k
$1.32m
$1,040k
$690k
$73k
$17.9
$18.7
$7.3
$8.1
+15%
+20%
TOTAL
PRIMARY CARE:
$1.2m/ yr/ practice
$945k/ yr/ practice
$625k/ yr/ practice
$66k/ yr
$62.6
$62.6
$1.38m $1.45m
$1,087k $1,134k
$720k
$750k
$76k
$79k
$7.8
$8.9
$1.1
$1.3
$461.0
$421.6
-8.5%
HOSPITAL IN-PATIENT:
94k Surgical Beds- critical
157k Surgical Beds- recovery
93k Mental Health/ SA Beds
232k Other Med. Beds**
$.92m
$423k
$344k
$592k
$.98m
$450k
$366k
$629k
$1.04m
$475k
$387k
$666k
$1.10m
$502k
$408k
$703k
TOTAL @ RI COST (Bil$)
TOTAL @ LOCAL COST
$53.5
$42.8
$97.1
$82.5
$66.9
$60.2
$100.2
$95.2
$1.15m/ yr/ bed
$528k/ yr/ bed
$430k/ yr/ bed
$740k/ yr/ bed
$54.7
$54.7
$1.21m
$555k
$452k
$777k
$1.27m
$581k
$473k
$814k
$1.33m
$608k
$495k
$851k
$1.38m
$634k
$516k
$888k
$15.6
$16.4
$6.3
$6.9
$6.7
$7.7
$1.0
$1.2
** INCLUDES BIRTHS
$402.0
$367.6
-8.5%
HOSPITAL OUT-PATIENT:
138m ER Visits
24.4m OP Surgeries
$544
$960
$578
$1,020
$612
$1,080
$646
$1,140
$680/ visit
$1,200/ OP surgery
$714
$1,260
$750
$1,320
$782
$1,380
$816
$1,440
TOTAL @ RI COST (Bil$)
TOTAL @ LOCAL COST
$16.4
$13.2
$29.8
$25.3
$20.5
$18.5
$30.7
$29.2
$16.7
$16.7
$4.8
$5.0
$1.9
$2.1
$2.0
$2.3
$0.2
$0.24
$123.0
$112.5
-8.5%
Hospital Out-Patient Other:
11m Mental Health/ SA Visits
158m Imaging Visits
322m Lab Visits
55m Misc/Other Visits
$480
$720
$280
$336
$510
$765
$298
$357
$540
$810
$315
$378
$570
$855
$333
$399
TOTAL @ RI COST (Bil$)
TOTAL @ LOCAL COST
$37.9
$30.3
$68.8
$58.5
$47.5
$42.8
$71.1
$67.5
$600/ visit
$900/ visit
$350/ visit
$420/ visit
$38.8
$38.8
$630
$945
$368
$441
$660
$990
$385
$462
$1,380
$1,035
$403
$483
$1,440
$1,080
$420
$504
$11.0
$11.6
$4.5
$5.0
$4.7
$5.4
$0.7
$0.8
NOTE: MUCH OF THIS $285B OF OUT-PATIENT OTHER, IS DUPLICATIVE WITH PRIMARY CARE AS PRESENTED HERE.
OUT-PATIENT OTHER: 546m visits (not ER, not Surgery). Cost $285B. Drive much of this back to the PC Office.
SHRINK & FOCUS HOSPITALS TO: IN-PATIENT, OP-ER & OP-SURGERY. This is nearly 2 visits for every man, woman
& child in the USA!! Over use and most should be included in Primary Care at less than ½ cost or no added cost at all.
$285.0
$260.7
-8.5%
G2: REIMBURSEMENT RATES & GEOGRAPHIC COLA’s
-20%
-15%
-10%
-5%
$2,800
$1,200
$800
$100
$80
$2,975
$1,275
$850
$106
$85
$3,150
$1,350
$900
$113
$90
$3,325
$1,425
$950
$119
$95
$20.1
$16.1
$36.5
$31.0
$25.2
$22.6
$37.6
$35.7
RI COST
(PG 2/4)
+5%
+10%
+15%
+20%
$3,675
$1,575
$1,050
$131
$105
$3,850
$1,650
$1,100
$138
$110
$4,025
$1,725
$1,150
$144
$115
$4,200
$1,800
$1,200
$150
$120
$5.8
$6.1
$2.4
$2.6
$2.5
$2.9
$0.3
$0.4
TOTAL
MD FEEs:
(not Primary Care or Hosp./Other EE's)
49k Surgeons 9.75m IP Surg's
26k Anesthesiologists 8m IP
69k Surg./Specialists 24.3m OP
34k Radiologists 118.8m OP
100k Med. Specialists ($66B)
TOTAL @ RI COST (Bil$)
TOTAL @ LOCAL COST
$3,500/ IP Surg.
$1,500/ IP Surg.
$1,000/ OP Surg.
$125/ OP Image.
$100/ 1/2 hr refer.
$20.6
$20.6
$151.0
$138.1
-8.5%
LONG TERM CARE:
1.1B Days of Care 6m people (1/2)
1.7m Nursing Home Beds
$54
$178
$57
$190
$60
$201
$64
$212
TOTAL @ RI COST (Bil$)
TOTAL @ LOCAL COST
$27.8
$22.2
$50.5
$42.9
$34.8
$31.3
$52.0
$49.4
$12k/ yr $67/day
$81k/ yr $223/day
$28.5
$28.5
$70
$234
$74
$245
$77
$256
$80
$268
$8.1
$8.5
$3.3
$3.6
$3.5
$4.0
$0.5
$0.6
$209.0
$191.0
-8.5%
DRUGS (a):
3.7 bil Retail Scripts by age:
0-18: 74m people X 4.1/ea
19-64: 195m people X 11.9/ ea
+65: 40m people X 28.0 scripts
Mail Order/Other (not retail):
.75 bil scripts @ $60/ EA
TOTAL @ RI COST (Bil$)
TOTAL @ LOCAL COST
$197
$571
$1,344
$209
$607
$1,428
$221
$643
$1,512
$234
$678
$1,596
$48
$51
$54
$57
$35.9
$28.7
$65.3
$55.5
$45.0
$40.5
$67.3
$63.9
$246/pers. $60/ea
$714/pers. $60/ea
$1,680/person $60
$60/ script
$36.7
$36.7
$258
$750
$1,764
$271
$785
$1,848
$283
$821
$1,932
$144**
$504**
$1,098**
$63
$66
$69
$86
$10.4
$10.9
$4.3
$4.7
$4.5
$5.2
$0.6
$0.7
**NOTE: AK USES FEWER SCRIPTS PER PERSON BUT AT HIGHER PRICES.
$270.0
$246.8
-8.5%
NON-DURABLES/ OTHER (a):
309m people @ $1,075/ea
TOTAL @ RI COST (Bil$)
TOTAL @ LOCAL COST
$1,062
$1,129
$1,195
$1,262
$54.5
$43.6
$99.0
$84.2
$68.3
$61.5
$102.2
$97.1
$1,328/ person
$55.8
$55.8
$1,395
$1,461
$1,527
$1,594
$15.9
$16.7
$6.5
$7.2
$6.9
$7.9
$0.9
$1.1
(a) NOTE: DRUGS & NON-DUABLE/OTHER ARE ANTICIPATED TO BE PRICED VIA NATIONAL CONTRACTS WITH THE 185 CO-OPS PROVIDING SAVINGS OF $150B.
COST SAVINGS: OUT-PATIENT OTHER save most of this $285B drive to PC Office, SHRINK & FOCUS HOSPITALS.
Save $85B on Drugs. Spend all on more drugs for 2x increase in +65 POP. Save $65B on Other. All $435B savings to Elderly.
$410.0
$375.1
-8.5%
G3: REIMBURSEMENT RATES & GEOGRAPHIC COLA’s (PG 3/4)
-20%
POP. (mils)
POP. %
# CO-OP's
# Serv. Areas
CO-OP NAMES:
SEE APPENDIX E13, F & H FOR
DETAIL DESCRIPTION
OF CO-OP'S
41.6
13.5%
26
2,087
AL1, AL2
AL3, FL5,
FL8, FL9,
GA5, IA1,
KS1, KY1,
KY2, MS2,
NY3, NC5,
OH1, OH6,
OH7, PA2,
PA3, PA7,
PA8, TN4,
TX12, TX13
TX14, UT2
-15%
76.0
24.5%
44
3,819
AR1, AR2, FL3,
FL6, FL7, FL11,
IN1, IN2, IN3,
IN4, IA2, KS2
LA1, LA2, MD1,
MI1, MI2, MI4,
MS1, MO1, MO2,
NE, NM, OH2,OK1,
OK2, PA1, , PA4,
SC3, TN1, TN2,
TN3, TX1, TX3,
TX4, TX5, TX6,
TX10, TX11, UT1,
VA2, WA4, WV,
WY
-10%
54.6
17.6%
34
2,740
AZ1, AZ4, CO1,
CO2, FL1, FL2,
FL10, GA1, GA2,
GA3, GA4, ID,
IL6, IL7, MI3, MI5
MO3, MO4, MT
NV2, NJ5, NY10,
NC4, ND, OH3,
SC1, SD, TX2,
TX7, TX8, TX9,
VT, VA1, WI2,
-5%
70.3
22.7%
41
3,523
AZ2, AZ3, CA3,
CA5, CA6, CA7,
CA8, CA9, CO3,
CO4, DC, DE,
FL4, IL1,
IL2, IL3, IL4,
IL5, ME, MN1
MN2, MN3, NV1,
NJ1, NJ2, NJ3,
NJ4, NC1, NC2,
OH4, OH5, OR1,
PA5, PA6, SC2,
WA1, WA2, WA3,
WI1, WI3, WI4,
RI COST
44.4
14.4%
26
2,225
CA1, CA2, CA4,
CA10, CA11, CA12,
CA13, CA14, CA15,
CA16, CA20, CA21
CT1, CT2, MD2, MD3,
MA4, NH, NY1, NY9,
NY11, NC3, OR2,
RI, VA3, VA4,
+5%
11.7
3.8%
8
585
+10%
4.9
1.6%
3
247
+15%
4.6
1.7%
2
228
CA17, CA18, MA1, MA2, NY7, NY8,
CA19, HI, MA3
NY2, NY4,
NY5, NY6,
+20%
TOTAL
0.7 308.8
0.2% 100%
1
185
36 15,490
AK
COST SAVINGS: OUT-PATIENT OTHER save most of this $285B drive to PC Office, SHRINK & FOCUS HOSPITALS.
Save $85B on Drugs. Spend all on more drugs for 2x increase in +65 POP. Save $65B on Other. All $435B savings to Elderly.
KEEP TOTAL COST AT $2.3T PLUS INFLATION OVER NEXT 10 YEARS AS +65 POP DOUBLES.
Table of Contents
G4: REIMBURSEMENT RATES & GEOGRAPHIC COLA’s (PG 4/4)
Using data provided by researchers at C2ER, we compare key expenses in
dozens of major cities. Costs include housing, utilities, transportation and
health care. Data is generated from an average of the past four quarters
ending March 2010. http://cgi.money.cnn.com/tools/costofliving/costofliving.html
For example: Madison, Wisconsin (CO-OP: WI2) has a health care cost-ofliving 10% less than RI. Therefore a primary care practice that is reimbursed
at $1.2 million per year in RI, would be reimbursed at $1.08m in Madison.
The make-up & staffing etc of the PC practice is defined herein (E22).
The number of patients each would be required to maintain would be based on age
and health of the patient roster. If all patients were less than 2 years old or over 65
years old (or had a chronic condition), the number of patients would likely be limited
to approximately 800. If the patients were between 2 and 64 years of age and otherwise
healthy, the number of patients would be 1,600. Or somewhere in between since the
roster is likely to be a mixture. But the payment is fixed not fee-for-service. Each
patient is expected to have 4 to 8 visits per year or more (appendix E5, E15, E16).
Similarly, a Surgical/ICU hospital bed in RI that would be reimbursed at $1.15m
per year in RI would be reimbursed at +15% in Manhattan (CO-OP: NY7) or $1.33m.
This is what the hospital would be paid by the CO-OP to have the bed available & staffed.
A non-employee surgeon would be reimbursed approximately $4,025 for services versus
a fee of $3,500 in RI, etc. No cost shifting: the CO-OP is nearly a “single-payer” in town
(appendix E10-12 & E17-18).
APPENDIX H
ECONOMIC & DEMOGRAPHIC
DIFFERENCES AMONG COOP’s
EXPANDING THE RI MODEL NATIONALLY
185 BUYER CO-OP’s DEFINED
GEOGRAPHIC MARKETS WITHIN STATES
EACH, 1 to 2.5 MIL PEOPLE (1 to 2.5 RI’s)
(NEXT 9 SLIDES)
Each of the 185 CO-OP areas covers 1 or more “Hospital Referral Regions” as
defined by the Dartmouth Atlas of Health Care. Regional hospitals capable of cardio and/or
neuro surgery. (http://www.dartmouthatlas.org/data/region/)
In each of the 15,490 service areas the CO-OP would contract approx. 17 Primary Care MDs,
7 Dentists and 4 Optometrists to service a population of approx. 20k.
BACK
Table of Contents
STATE/
CO-OP
AL1
AL2
AL3
ECONOMIC & DEMOGRAPHIC DIFFERENCES AMONG CO-OP's
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
COLA
POP
Serv.
Areas
AL-Birmingham S & Tuscaloosa (28 counties- Central AL)
AL-Birmingham N & Huntsville (15 counties- Northern AL)
AL-Dothan, Mobile & Montgomery (23 counties- Southern AL)
3 ALABAMA-TOTAL
MAP
2,001,679
1,233,703
1,544,354
4,779,736
1 ALASKA-TOTAL (AK)
MAP
710,231
AZ1
AZ2
AZ3
AZ4
AZ-Mesa (Maricopa SE- Mesa, Chandler, Gilbert, Tempe)
AZ-Phoenix City of (Maricopa central)
AZ-Phoenix N & Sun City (Maricopa- Glendale, Scottsdale & North AZ)
AZ-Phoenix S & Tucson (Maricopa- Avondale, Goodyear & South AZ)
4 ARIZONA-TOTAL
MAP
1,179,761
1,445,632
1,708,721
2,057,903
6,392,017
55
73
87
106
321
AR1
AR2
AR-Little Rock (South & East AR, 43 counties)
AR-Fort Smith, Jonesboro, Springdale, Texarkana (N&W - 32 counties)
2 ARKANSAS-TOTAL
MAP
1,607,881
1,308,037
2,915,918
CA1
CA2
CA3
CA4
CA5
CA6
CA7
CA8
CA9
CA10
CA11
CA12
CA13
CA14
CA15
CA16
CA17
CA18
CA19
CA20
CA21
CA-Orange County N (Anaheim, Garden Grove, Hunt. Bch & North)
CA-Orange County S (Santa Ana, Costa Mesa & South)
CA-Bakersfield & Fresno (Kern, Tulare & Fresno, King, Madera)
CA-Alameda County
CA-LA Central LA, South LA, Northeast LA & Eastside
CA-LA Harbor, South Bay & Westside
CA-LA San Fern. Valley, NW, Antelope, Forest & Santa Monica Mtns.
CA-LA San Gabriel Valley, Pomona & Verdugos
CA-LA Southeast
CA-Modesto & Stockton (Merced, Stanislaus, San Joaquin, +4 more.)
CA-Napa, Chico, Redding & Santa Rosa (15 counties- north CA )
CA-Sacramento (11 counties)
CA-Palm Springs/Rancho Mirage (Riverside County)
CA-San Bernardino & Inyo Counties
CA-San Diego (City of)
CA-San Diego County (ex. City of, + Imperial County)
CA-San Francisco (SF & Marin Counties)
CA-San Jose (Santa Clara & San Benito Counties)
CA-Santa Cruz & San Mateo County
CA-Santa Barbara, San Luis Obispo, Salinas & Ventura
CA-Contra Costa & Solano Counties
MAP
21 CALIFORNIA-TOTAL
1,409,306
1,600,926
2,516,107
1,510,271
2,099,049
2,219,119
2,137,451
2,154,468
1,208,518
1,588,948
1,548,183
2,478,708
2,189,641
2,053,756
1,307,402
1,962,439
1,057,644
1,836,911
980,833
1,931,907
1,462,369
37,253,956
PER CAP.
NON-
vs RI
INCOME
INCOME
ENGLISH
Gen. Health
vs RI
($000)
@ HOME
POVERTY
vs RI
COLA PER CAP.
TOTAL
POP. PER
SQ. MILES
SQ. MILE
-25%
-25%
-22%
-24%
-20%
-20%
-20%
-20%
-18%
-20%
-24%
-21%
23.5
22.9
21.8
22.7
4.3%
5.1%
3.9%
4.4%
17.8%
15.6%
18.9%
17.5%
20,742
10,125
19,779
50,645
97
122
78
94
36 +15%
+20%
+3%
29.4
15.5%
9.1%
570,641
1.24
-15%
-18%
-18%
-22%
-18%
-10%
-5%
-5%
-10%
-7%
-6%
-14%
-3%
-21%
-12%
26.8
24.5
27.7
22.5
25.2
22.9%
36.9%
20.8%
30.3%
27.9%
13.3%
19.1%
15.4%
17.4%
16.5%
904
517
68,412
43,761
113,594
1,305
2,796
25
47
56
81
66
147
-22%
-30%
-26%
-15%
-15%
-15%
-25%
-28%
-27%
21.4
20.6
20.9
4.6%
8.6%
6.3%
18.5%
18.5%
18.5%
30,509
21,527
52,035
53
61
56
71
80
126
76
110
113
103
105
61
80
77
124
110
103
66
98
53
92
49
97
73
1,867
+20%
+20%
-10%
+15%
+10%
+10%
+10%
+10%
+10%
-5%
+10%
-5%
+5%
+5%
+7%
+7%
+33%
+27%
+27%
+10%
+20%
+10%
0%
0%
-5%
0%
-5%
-5%
-5%
-5%
-5%
0%
0%
0%
0%
0%
0%
0%
+5%
+5%
+5%
0%
0%
-1%
+2%
+33%
-32%
+18%
-34%
+27%
+7%
-6%
-38%
-23%
-6%
0%
-14%
-24%
+14%
-1%
+63%
+36%
+42%
+4%
+23%
+1%
29.2
38.1
19.5
33.8
18.9
36.4
30.5
26.9
17.8
22.1
27.0
28.5
24.6
21.8
32.6
28.2
46.5
38.8
40.7
29.6
35.1
29.0
47.7%
40.0%
41.8%
41.1%
70.1%
38.5%
51.0%
57.9%
69.9%
37.4%
18.0%
25.0%
38.5%
39.4%
38.8%
37.7%
39.1%
49.3%
39.7%
36.5%
30.7%
42.2%
10.5%
10.9%
21.8%
10.8%
28.0%
11.0%
13.7%
11.8%
15.7%
17.3%
14.5%
13.4%
13.9%
17.0%
14.1%
12.0%
10.6%
9.2%
9.3%
13.3%
9.8%
14.2%
219
572
22,441
739
155
402
2,910
456
135
12,560
41,806
10,723
7,206
30,238
325
8,059
567
2,679
894
11,157
1,538
155,779
6,435
2,799
112
2,044
13,520
5,517
735
4,729
8,937
127
37
231
304
68
4,020
244
1,865
686
1,098
173
951
239
100
62
78
240
STATE/
CO-OP
ECONOMIC & DEMOGRAPHIC DIFFERENCES AMONG CO-OP's
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
POP
Serv.
Areas
COLA
COLA PER CAP.
PER CAP.
NON-
vs RI
vs RI INCOME
INCOME
ENGLISH
vs RI
($000)
@ HOME
POVERTY
Gen. Health
TOTAL
POP. PER
SQ. MILES
SQ. MILE
CO1
CO2
CO3
CO4
CO-Boulder, Fort Collins, Greeley (10 counties- NE CO.)
CO-Colorado Springs, Grand Junction & Pueblo (35 counties- S. CO.)
CO-Denver East (7 counties)
CO-Denver West (12 counties)
4 COLORADO-TOTAL
MAP
920,962
1,394,219
1,706,476
1,007,539
5,029,196
46
70
86
50
252
-10%
-25%
-15%
-15%
-17%
-10%
-10%
-5%
-5%
-7%
+3%
-11%
+2%
+28%
+4%
29.4
25.5
29.1
36.6
29.7
14.3%
12.8%
24.4%
11.3%
16.6%
14.2%
13.5%
14.5%
6.8%
12.6%
18,161
59,805
8,741
16,936
103,642
51
23
195
59
49
CT1
CT2
CT-Hartford (6 counties)
CT-New Haven & Bridgeport (2 counties SW CT.)
2 CONNECTICUT-TOTAL
MAP
1,794,791
1,779,306
3,574,097
90
89
179
0%
0%
0%
0%
0%
0%
+15%
+40%
+28%
32.9
40.1
36.5
16.7%
22.9%
19.7%
8.7%
10.0%
9.3%
3,613
1,229
4,842
497
1,447
738
1 DC, Wash.- TOTAL (DC)
MAP
601,723
30 +25%
-5%
+43%
40.8
14.2%
17.6%
61
9,857
1 DELAWARE.- TOTAL (DE)
MAP
897,934
41
-15%
-5%
+1%
28.9
11.6%
11.2%
1,949
461
FL-Fort Lauderdale S. (Broward County)
FL-Fort Lauderdale N. (Martin, Palm Beach & St. Lucie Counties)
FL-Jacksonville (Baker, Clay, Duval, Nassau & St Johns Counties)
FL-Miami-Dade & Monroe Counties (Everglades & Keys)
FL- Gainesville & Ormond Beach (12 Counties)
FL-Orlando S. (Brevard, Hardee, Highlands, Indian., Okee., Osceola)
FL-Orlando N. (Orange, Lake & Seminole counties)
FL-Ocala & Hudson (Citrus, Hernando, Marion, Pasco, Sumter)
FL-Tallahassee, Panama City & Pensacola (19 Counties)
FL-Fort Meyers, Sarasota, Bradenton & Lakeland (9 Counties)
FL-Tampa, St. Petersburg & Clearwater (Hillborough & Pinellas)
MAP
11 FLORIDA.- TOTAL
1,748,066
1,744,241
1,345,596
2,569,525
1,148,158
1,116,602
1,865,726
1,203,429
1,422,685
2,491,514
2,145,768
18,801,310
88
88
68
129
58
56
94
60
71
125
108
-5%
-5%
-25%
-15%
-20%
-20%
-20%
-20%
-20%
-20%
-25%
945 -18%
-10%
-10%
-15%
-5%
-20%
-15%
-15%
-20%
-20%
-10%
-15%
-13%
0%
+13%
-4%
-20%
-21%
-12%
-7%
-19%
-17%
0%
-2%
-7%
28.5
32.2
27.4
23.0
22.7
25.1
26.5
23.0
23.7
28.7
27.9
26.5
35.2%
23.7%
10.3%
68.9%
11.0%
19.9%
24.7%
10.8%
7.5%
18.4%
19.2%
25.8%
13.0%
14.5%
13.3%
17.6%
18.4%
14.4%
13.1%
14.4%
18.0%
14.3%
14.4%
15.0%
1,210
3,085
3,201
2,881
7,929
5,269
2,151
3,933
13,516
9,156
1,294
53,625
1,445
565
420
892
145
212
867
306
105
272
1,658
351
2,037,768
2,268,285
2,308,236
1,696,353
1,377,011
9,687,653
102
114
116
85
69
486
-10%
-10%
-10%
-10%
-20%
-12%
-19%
+11%
-10%
-27%
-31%
-12%
23.3
31.8
25.8
21.0
19.8
25.1
10.8%
13.7%
19.5%
6.6%
4.9%
12.0%
15.7%
14.6%
14.5%
20.2%
21.5%
16.6%
10,695
3,824
3,153
20,607
19,234
57,513
191
593
732
82
72
168
FL1
FL2
FL3
FL4
FL5
FL6
FL7
FL8
FL9
FL10
FL11
GA1
GA2
GA3
GA4
GA5
GA-Atlanta North & Rome (36 Counties)
GA-Atlanta City of & West (Fulton, Cobb & West, 11 Counties)
GA-Atlanta East (DeKalb, Gwinnett & East 11 Counties)
GA-Savannah & Augusta (SE. GA 47 Counties)
GA-Macon, Columbus & Albany (SW. GA 54 Counties)
5 GEORGIA.- TOTAL
MAP
-22%
-22%
-22%
-24%
-27%
-23%
STATE/
CO-OP
ECONOMIC & DEMOGRAPHIC DIFFERENCES AMONG CO-OP's
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
POP
Serv.
Areas
COLA
COLA PER CAP.
PER CAP.
NON-
vs RI
vs RI INCOME
INCOME
ENGLISH
vs RI
($000)
@ HOME
POVERTY
Gen. Health
TOTAL
POP. PER
SQ. MILES
SQ. MILE
1 HAWAII.- TOTAL (HI)
MAP
1,360,301
68 +30%
+5%
0%
28.7
24.4%
10.4%
6,423
212
1 IDAHO.- TOTAL (ID)
MAP
1,567,582
79
-25%
-10%
-22%
22.3
10.0%
14.4%
82,643
19
MAP
1,527,486
877,381
2,695,598
2,049,045
2,017,066
1,666,715
1,997,341
12,830,632
77
44
136
102
101
84
100
643
-20%
-5%
-5%
-5%
-5%
-25%
-30%
-13%
-5%
-5%
-5%
-5%
-5%
-10%
-10%
-7%
-9%
-9%
-5%
+14%
+31%
-12%
-18%
0%
26.1
26.0
27.1
32.5
37.5
25.0
23.4
28.5
12.4%
20.0%
35.1%
30.9%
30.3%
8.1%
3.6%
21.3%
11.8%
11.5%
20.9%
8.4%
6.9%
12.7%
15.2%
13.3%
10,828
290
228
971
1,351
14,474
27,377
55,519
141
3,026
11,842
2,110
1,493
115
73
231
IN1
IN2
IN3
IN4
IN-Evansville, Gary, Lafayette, Munster, Terre Haute (W IN- 27 counts.)
IN-Fort Wayne, Muncie, South Bend (Northeast IN- 20 counties)
IN-Indianapolis N. (Marion, Hancock, Hendricks & North- 17 counties)
IN-Indianapolis S. (Morgan, Johnson, Shelby & Southeast- 28 counts.)
MAP
4 INDIANA.- TOTAL
1,650,660
1,580,791
2,049,590
1,202,761
6,483,802
83
79
103
60
325
-22%
-25%
-22%
-22%
-23%
-15%
-15%
-15%
-15%
-15%
-19%
-21%
-8%
-19%
-16%
23.2
22.6
26.4
23.3
24.0
8.2%
9.4%
7.3%
4.0%
7.4%
14.7%
14.6%
14.7%
13.5%
14.4%
11,038
8,214
6,641
9,933
35,826
150
192
309
121
181
IA1
IA2
IA-Des Moines, Mason City & Sioux City (West IA)
IA-Cedar Rapids, Davenport, Dubuque, Iowa City & Waterloo (E. IA)
2 IOWA.- TOTAL
MAP
1,734,313
1,312,042
3,046,355
87 -25%
66 -20%
153 -22%
-20%
-15%
-17%
-11%
-13%
-12%
25.3
24.8
25.1
7.1%
5.6%
6.4%
11.4%
12.3%
11.8%
37,916
17,941
55,857
46
73
55
KS1
KS2
KS-Wichita SE KS (1.1 mil, 28 Counties) & West KS (319k, 51 counts.)
KS-Topeka Northeast KS (26 counties)
MAP
2 KANSAS.- TOTAL
1,414,509
1,438,609
2,853,118
71
72
143
-25%
-20%
-22%
-20%
-15%
-17%
-20%
-2%
-11%
23.0
28.1
25.5
10.3%
9.6%
9.9%
13.5%
12.9%
13.2%
65,910
15,849
81,759
21
91
35
KY1
KY2
KY-Lexington & Covington (Eastern KY, 65 counties)
KY-Louisville, Owensboro & Paducah (Western KY, 55 counties)
MAP
2 KENTUCKY.- TOTAL
2,108,136
2,231,231
4,339,367
106 -25%
112 -30%
218 -28%
-20%
-20%
-20%
-24%
-19%
-22%
21.6
23.1
22.3
3.8%
4.9%
4.4%
20.4%
16.5%
18.4%
19,999
19,488
39,486
105
114
110
LA1
LA2
LA-Shreveport, Alexandria, Lafayette, Lake Charles, Monroe (41 counts)
LA-New Orleans, Baton Rouge, Metaire, Slidell & Houma (SE. LA- 23)
MAP
2 LOUISIANA.- TOTAL
2,086,508
2,446,864
4,533,372
105 -25%
123 -22%
228 -23%
-15%
-15%
-15%
-26%
-16%
-21%
21.0
23.9
22.5
8.1%
8.5%
8.4%
18.9%
16.6%
17.6%
31,320
11,884
43,204
67
206
105
IL1
IL2
IL3
IL4
IL5
IL6
IL7
IL-Bloomington, Joliet & Urbana (East IL- 16 counties)
IL-Blue Island (Cook County- South)
IL-Chicago, city of (Cook County- East)
IL-Melrose Park, & Hinsdale (Cook-west, Dupage & Kane)
IL-Elgin & Evanston (NE. IL: Cook-north, Mchenry & Lake)
IL-Peoria, Rockford & Aurora (NW IL- 25 counties)
IL-Springfield (South IL: 56 counties)
7 ILLINOIS.- TOTAL
STATE/
CO-OP
ECONOMIC & DEMOGRAPHIC DIFFERENCES AMONG CO-OP's
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
1 MAINE.- TOTAL (ME)
MD1
MD2
MD3
MA1
MA2
MA3
MA4
MD-Baltimore & Salisbury (Eastern MD, 14 counties)
MD-Takoma Park/ DC Area (Northwest MD, 5 counties)
MD-Takoma Park/ DC Area (Southwest MD, 5 counties)
3 MARYLAND.- TOTAL
MA-Boston NE (Boston city of, Suffolk & Essex counties)
MA-Boston NW (Middlesex county)
MA-Boston South ( 6 counties including Cape & Islands)
MA-Springfield & Worcester (Western MA 5 counties)
4 MASSACHUSETTS.- TOTAL
POP
MAP
1,328,361
Serv.
Areas
67
COLA
COLA PER CAP.
PER CAP.
NON-
vs RI
vs RI INCOME
INCOME
ENGLISH
vs RI
($000)
@ HOME
POVERTY
Gen. Health
TOTAL
POP. PER
SQ. MILES
SQ. MILE
-5%
-5%
-13%
25.0
7.4%
12.6%
30,843
43
MAP
2,574,261
1,457,776
1,741,515
5,773,552
129 -3%
73 +20%
88 +20%
290 +5%
-15%
0%
0%
-10%
+9%
+42%
+18%
+20%
31.2
40.6
33.8
34.2
9.8%
26.4%
13.2%
14.9%
11.2%
7.7%
7.3%
9.2%
5,101
2,681
1,926
9,707
505
544
904
595
MAP
1,465,182
1,503,085
1,956,649
1,622,713
6,547,629
74 +8%
75 +8%
98 +8%
81 -10%
328 +4%
+10%
+10%
+10%
0%
+7%
+13%
+37%
+21%
-2%
+17%
32.3
39.3
34.6
27.9
33.5
28.9%
22.7%
15.6%
16.3%
20.4%
14.0%
7.4%
8.2%
12.2%
10.3%
551
818
2,150
4,281
7,800
2,661
1,838
910
379
839
-20%
-25%
-20%
-25%
-15%
-21%
-15%
-15%
-10%
-15%
-10%
-13%
-8%
-19%
-20%
-19%
+27%
-12%
26.2
23.1
23.0
23.1
36.3
25.2
7.5%
12.2%
5.1%
6.7%
14.4%
9.0%
14.2%
18.7%
17.3%
14.8%
9.7%
16.1%
7,978
1,644
13,364
32,685
868
56,539
259
1,531
139
69
1,386
175
MI1
MI2
MI3
MI4
MI5
MI-Ann Arbor, Kalamazoo & St. Joseph (South MI- 13 counties)
MI-Detroit & Dearborn (Southeast MI- 3 counties)
MI-Flint, Lansing & Saginaw (Northeast MI- 22 counties)
MI-Marquette, Muskegon, Petoskey, Traverse City & Grand Rapids (44)
MI-Pontiac & Royal Oak (Oakland County, east MI- NW of Detroit)
MAP
5 MICHIGAN.- TOTAL
1,202,362
9,883,640
104
127
93
112
60
496
MN1
MN2
MN3
MN-Minneapolis NW & St. Cloud (Northwest MN 37 counties)
MN-Minneapolis SW (City of & Southwest MN 31 counties)
MN-Duluth, Rochester & St. Paul (Eastern MN 19 counties)
3 MINNESOTA.- TOTAL
MAP
1,001,172
2,391,592
1,911,161
5,303,925
50
120
96
266
-10%
-10%
-15%
-12%
-5%
-5%
-5%
-5%
-17%
+10%
+4%
+3%
23.7
31.6
29.7
29.4
4.3%
11.5%
10.0%
9.6%
12.6%
10.1%
11.1%
10.9%
40,975
18,796
19,855
79,627
24
127
96
67
MS1
MS2
MS-Jackson & Oxford (West MS 47 counties)
MS-Gulfport, Hattiesburg, Meridian, Tupelo (East MS 35 counties)
MAP
2 MISSISSIPPI.- TOTAL
1,578,620
1,388,677
2,967,297
79
70
149
-20%
-25%
-22%
-15%
-20%
-17%
-31%
-32%
-32%
19.7
19.6
19.5
3.3%
4.1%
3.6%
22.9%
20.5%
21.8%
27,433
19,491
46,923
58
71
63
MO1
MO2
MO3
MO4
MO- Columbia, Joplin & Springfield (57 counties- Central & SW MO.)
MO-Kansas City (26 counties- NW MO.)
MO-St. Louis N. (City of & 6 counties- NE MO.)
MO-St. Louis S. & Cape Girardeau (26 counties- SE MO.)
MAP
4 MISSOURI.- TOTAL
1,766,862
1,491,846
1,782,328
947,891
5,988,927
89
75
90
47
301
-25%
-20%
-25%
-25%
-24%
-15%
-15%
-10%
-10%
-13%
-28%
-13%
+4%
-28%
-15%
20.6
24.8
29.8
20.7
24.4
4.7%
6.3%
7.4%
3.2%
5.7%
17.7%
13.2%
11.9%
16.2%
14.6%
35,382
14,503
2,856
16,000
68,742
50
103
624
59
87
2,069,580
2,518,013
1,854,393
2,239,292
STATE/
CO-OP
NV1
NV2
NJ1
NJ2
NJ3
NJ4
NJ5
ECONOMIC & DEMOGRAPHIC DIFFERENCES AMONG CO-OP's
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
COLA
COLA PER CAP.
PER CAP.
NON-
vs RI
vs RI INCOME
INCOME
ENGLISH
vs RI
($000)
@ HOME
POVERTY
Gen. Health
TOTAL
POP. PER
SQ. MILES
SQ. MILE
1 MONTANA.- TOTAL (MT)
MAP
989,415
50
-20%
-10%
-20%
22.9
4.7%
15.0%
145,546
7
1 NEBRASKA.- TOTAL (NE)
MAP
1,826,341
92
-25%
-15%
-14%
24.6
9.2%
12.2%
76,824
24
NV-Las Vegas (3 counties- SE NV)
NV-Reno (14 counties- NW NV)
2 NEVADA.- TOTAL
MAP
2,000,560
699,991
2,700,551
100
36
136
-15%
-20%
-17%
-5%
-10%
-7%
-5%
-3%
-4%
27.2
27.9
27.4
30.8%
18.3%
27.5%
12.4%
12.3%
12.4%
36,707
73,075
109,781
55
10
25
1 NEW HAMPSHIRE.- TOTAL (NH)
MAP
1,316,470
66
-5%
0%
+7%
30.6
8.1%
8.6%
8,953
147
NJ-Camden N. (3 counties- South NJ)
NJ-Camden S. (6 counties- South NJ)
NJ-Hackensack, Patterson & Ridgewood (2 counties- NE NJ)
NJ-Morristown & New Brunswick (7 counties- NW NJ)
NJ-Newark (3 counties- NE NJ)
MAP
5 NEW JERSEY.- TOTAL
1,655,681
1,396,740
1,406,342
2,378,397
1,954,734
8,791,894
83
70
71
119
98
441
+5%
+5%
-10%
+5%
+5%
+1%
-5%
-5%
-5%
-5%
-10%
-6%
+22%
0%
+27%
+37%
+10%
+21%
34.9
28.6
36.3
39.1
31.6
34.6
13.3%
15.9%
39.3%
26.6%
41.9%
27.6%
7.1%
11.0%
10.1%
6.6%
13.1%
9.4%
1,896
2,166
418
2,599
275
7,354
873
645
3,368
915
7,101
1,196
MAP
2,059,179
104
-25%
-15%
-21%
22.5
35.9%
18.2%
121,298
17
1,953,167
1,385,108
1,453,693
2,230,722
1,339,532
1,493,350
2,504,700
2,054,603
1,733,323
1,363,694
1,866,210
19,378,102
98
69
73
112
67
75
125
103
87
68
94
971
-12%
+30%
-22%
+18%
+18%
+18%
+76%
+76%
0%
-20%
-20%
+21%
0%
+5%
-20%
+5%
+5%
+5%
+15%
+15%
0%
-10%
0%
+4%
-3%
-40%
-13%
-12%
+42%
+23%
-20%
+86%
+40%
-12%
-17%
+7%
27.7
17.3
24.8
25.3
40.5
35.1
23.0
53.3
40.2
25.3
23.6
30.6
9.2%
55.1%
7.9%
54.4%
25.5%
18.4%
45.4%
36.2%
28.0%
9.6%
6.9%
28.5%
11.5%
28.3%
14.2%
12.9%
5.5%
5.7%
21.7%
15.4%
9.9%
13.3%
14.8%
14.2%
15,757
42
4,818
109
285
912
71
81
1,646
6,686
16,721
47,126
124
32,904
302
20,554
4,705
1,637
35,369
25,303
1,053
204
112
411
1 NEW MEXICO.- TOTAL (NM)
NY1
NY2
NY3
NY4
NY5
NY6
NY7
NY8
NY9
NY10
NY11
POP
Serv.
Areas
NY-Albany (18 counties NE NY)
NY-NYC Bronx County
NY-Buffalo (6 counties western NY)
NY-NYC East Long Island (Queens County)
NY-East Long Island (Nassau County)
NY-East Long Island (Suffolk County)
NY-NYC Manhattan (Kings County, Brooklyn- West Long Island)
NY-NYC Manhattan (NY & Richmond Counties- Staten Island)
NY-White Plains (Orange, Putnam, Rockland & Weschester counties.)
NY-Rochester (10 counties East of Buffalo area)
NY-Syracuse, Binghamton & Elmira (17 counts. East of Rochester)
MAP
11 NEW YORK.- TOTAL
STATE/
CO-OP
NC1
NC2
NC3
NC4
NC5
ECONOMIC & DEMOGRAPHIC DIFFERENCES AMONG CO-OP's
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
COLA
POP
Serv.
Areas
PER CAP.
NON-
vs RI
INCOME
INCOME
ENGLISH
Gen. Health
vs RI
($000)
@ HOME
POVERTY
vs RI
COLA PER CAP.
TOTAL
POP. PER
SQ. MILES
SQ. MILE
NC-Charlotte (10 counties- SW NC)
NC-Durham & Greensboro (19 counties- west of Raleigh)
NC-Greenville & Wilmington (29 counties- eastern & coastal NC)
NC-Raleigh (11 counties)
NC-Winston-Salem, Asheville & Hickory (31 counties- west NC)
5 NORTH CAROLINA.- TOTAL
MAP
1,975,131
1,967,145
1,480,919
2,004,517
2,107,771
9,535,483
99
99
74
100
106
478
-25%
-22%
-20%
-20%
-25%
-23%
-5%
-5%
0%
-10%
-20%
-8%
-4%
-17%
-22%
-9%
-19%
-14%
27.5
23.6
22.4
26.0
23.1
24.5
11.5%
10.8%
6.3%
11.4%
7.6%
9.6%
14.5%
18.3%
18.9%
14.6%
16.0%
16.2%
4,637
9,392
14,709
7,033
12,848
48,618
426
209
101
285
164
196
MAP
672,591
34
-23%
-10%
-13%
25.0
5.4%
11.7%
69,001
10
100
77
116
54
102
81
49
MAP
1,999,639
1,526,892
2,315,442
1,078,588
2,024,133
1,623,402
968,408
11,536,504
579
-25%
-25%
-20%
-25%
-25%
-25%
-25%
-24%
-20%
-15%
-10%
-5%
-5%
-20%
-20%
-15%
-18%
-7%
-9%
-14%
-15%
-12%
-18%
-13%
23.5
26.5
26.0
24.7
24.2
25.0
23.5
24.8
5.7%
5.1%
9.1%
3.9%
7.1%
4.1%
5.3%
6.1%
15.3%
14.1%
15.5%
12.9%
18.5%
13.0%
15.0%
15.1%
5,788
3,361
3,442
7,361
9,568
6,568
4,774
40,861
346
454
673
147
212
247
203
282
MAP
2,221,941
1,529,410
3,751,351
111
77
188
-23%
-28%
-25%
-15%
-15%
-15%
-21%
-22%
-21%
22.7
22.4
22.6
9.4%
7.0%
8.4%
16.1%
16.2%
16.1%
50,416
18,179
68,595
44
84
55
OR1
OR2
OR-Bend, Eugene, Medford, Salem (20 counties- Southern OR)
OR-Portland (16 counties- Northern OR)
MAP
2 OREGON- TOTAL
1,762,158
2,068,916
3,831,074
88
104
192
-10%
-10%
-10%
-5%
0%
-2%
-19%
-1%
-9%
23.1
28.3
25.9
10.9%
16.7%
14.0%
16.4%
12.6%
14.3%
73,316
22,672
95,988
24
91
40
PA1
PA2
PA3
PA4
PA5
PA6
PA7
PA8
PA-Allentown, Scranton & Wilkes-Barre (9 counties- NE PA)
PA-Danville, Erie & Sayre (22 counties- North & West PA)
PA-Harrisburg, Altoona & Johnstown (15 counties- South Central
PA-Lancaster, Reading & York (5 counties- SE PA)
PA-Philadelphia NW (3 counties- SE PA)
PA-Philadelphia (city of & county- SE PA)
PA-Pittsburgh (city of & west- 5 counties SW PA)
PA-Pittsburgh East (7 counties- SW PA)
MAP
8 PENNSYLVANIA- TOTAL
1,571,225
1,401,807
1,546,058
2,013,034
79
70
78
101
99
77
86
47
637
-15%
-25%
-25%
-15%
+5%
+5%
-25%
-25%
-14%
-15%
-20%
-20%
-15%
-5%
-5%
-20%
-20%
-15%
-11%
-25%
-19%
+2%
+26%
-27%
-4%
-18%
-7%
25.4
21.6
23.3
29.3
35.9
20.9
27.3
23.6
26.7
10.7%
4.8%
5.9%
11.3%
10.4%
20.1%
5.8%
3.3%
9.4%
11.6%
15.1%
11.2%
9.3%
6.2%
24.5%
12.6%
12.3%
12.5%
5,148
15,825
9,835
4,234
1,271
134
2,956
5,340
44,743
305
89
157
475
1,561
11,380
586
174
284
1 NORTH DAKOTA.- TOTAL (ND)
OH1
OH2
OH3
OH4
OH5
OH6
OH7
OK1
OK2
OH-Akron, Canton, Youngstown (12 counties- NE OH)
OH-Cincinnati (7 counties- SW OH)
OH-Cleveland & Elyria (8 counties- NE OH)
OH-Columbus- North (15 counties- central OH)
OH-Columbus- City of & Southeast (20 counties- SE OH)
OH-Dayton & Kettering (15 counties- West OH)
OH-Toledo (11 counties- NW OH)
7 OHIO.- TOTAL
OK-Oklahoma City & OK-Lawton (54 counties)
OK-Tulsa (23 counties- NE OK)
2 OKLAHOMA- TOTAL
1,984,102
1,526,006
1,731,501
928,646
12,702,379
STATE/
CO-OP
ECONOMIC & DEMOGRAPHIC DIFFERENCES AMONG CO-OP's
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
1 RHODE ISLAND- TOTAL (RI)
SC1
SC2
SC3
TN1
TN2
TN3
TN4
TX1
TX2
TX3
TX4
TX5
TX6
TX7
TX8
TX9
TX10
TX11
TX12
TX13
TX14
UT1
UT2
POP
Serv.
Areas
COLA
COLA PER CAP.
PER CAP.
NON-
vs RI
vs RI INCOME
INCOME
ENGLISH
vs RI
($000)
@ HOME
POVERTY
Gen. Health
TOTAL
POP. PER
SQ. MILES
SQ. MILE
MAP
1,052,567
50
0%
0%
0%
28.6
20.5%
12.0%
1,034
1,018
SC-Charleston & Florence (17 counties- SE SC)
SC-Columbia (20 counties- Central SC)
SC-Greenville & Spartanburg (9 counties- NW SC)
3 SOUTH CAROLINA- TOTAL
MAP
1,632,247
1,500,049
1,493,068
4,625,364
82
75
75
232
-20%
-20%
-27%
-22%
-10%
-5%
-15%
-10%
-16%
-21%
-19%
-19%
24.0
22.5
23.2
23.2
6.1%
5.4%
7.2%
6.2%
17.9%
17.5%
15.8%
17.1%
12,260
12,068
5,732
30,061
133
124
260
154
1 SOUTH DAKOTA- TOTAL (SD)
MAP
814,180
41
-23%
-10%
-18%
23.4
6.4%
14.2%
75,811
11
MAP
1,546,161
1,438,739
1,614,887
1,746,318
6,346,105
78
72
81
88
319
-30%
-25%
-25%
-30%
-27%
-15%
-15%
-15%
-20%
-16%
-19%
-7%
-20%
-22%
-17%
23.1
26.6
23.0
22.2
23.6
6.1%
9.0%
5.1%
3.9%
5.9%
20.4%
14.9%
16.2%
17.3%
17.2%
10,269
8,739
12,139
10,088
41,235
151
165
133
173
154
TX-Amarillo, Lubbock & Witchita Falls (62 counties- TX panhandle)
TX-Austin & Temple (12 counties East TX)
TX-Houston East & Beaumont (19 counties- SE TX)
TX-Houston (City of- Harris County SE TX)
TX-Houston (Harris County excluding Houston)
TX-Houston West (10 counties- SE TX)
TX-Dallas (Dallas County- NE TX)
TX-Dallas East (12 counties- NE TX)
TX-Dallas NW (5 counties- NE TX)
TX-El Paso, Abilene, Odessa & San Angelo (44 counties- West TX)
TX-Fort Worth (7 counties- NE TX)
TX-San Antonio (29 counties- SW TX)
TX-Corpus Christi, Harlingen, McAllen & Victoria (20 counties- SW TX)
TX-Waco, Bryan, Tyler & Longview (32 counties- Central & NE TX)
MAP
14 TEXAS- TOTAL
1,158,243
2,225,009
1,669,145
2,099,451
1,993,008
1,148,672
2,368,139
1,462,994
900,774
1,612,106
2,202,568
2,725,273
1,982,809
1,597,370
25,145,561
58
112
84
105
100
58
119
74
45
81
111
137
100
80
1,264
-27%
-22%
-25%
-25%
-25%
-25%
-25%
-25%
-25%
-25%
-25%
-22%
-27%
-25%
-25%
-15%
-10%
-15%
-15%
-15%
-15%
-10%
-10%
-10%
-15%
-15%
-20%
-20%
-20%
-15%
-26%
-3%
-15%
-9%
-3%
-2%
-10%
+7%
+1%
-33%
-8%
-24%
-44%
-28%
-15%
21.2
27.7
24.4
25.9
27.7
27.9
25.7
30.7
28.8
19.2
26.4
21.6
15.9
20.7
24.3
23.5%
24.8%
14.7%
45.3%
37.9%
29.4%
39.3%
18.9%
17.7%
50.8%
23.7%
46.2%
64.8%
13.6%
33.6%
17.4%
14.0%
15.9%
21.0%
12.4%
10.2%
18.7%
10.6%
10.0%
20.2%
14.1%
18.8%
29.4%
19.8%
17.1%
59,015
10,610
14,739
600
1,103
8,587
871
9,267
4,521
67,839
5,134
36,212
19,134
23,598
261,232
20
210
113
3,499
1,807
134
2,718
158
199
24
429
75
104
68
96
91 -20%
48 -25%
139 -22%
-15%
-20%
-17%
-16%
-29%
-21%
24.0
20.3
22.7
15.2%
10.9%
13.8%
10.5%
14.0%
11.7%
17,107
65,063
82,170
105
15
34
TN-Memphis & Jackson (20 counties- west TN)
TN-Nashville City Of & West (18 counties- central TN)
TN-Nashville East & Chattanooga (31 counties- central TN)
TN-Knoxville, Johnson City, Kingsport (26 counties- east TN)
4 TENNESSEE- TOTAL
UT-Salt Lake City NW & Ogden (8 counties- NW UT)
UT-Salt Lake City SE & Provo (21 counties- SE UT)
2 UTAH- TOTAL
MAP
1,799,952
963,933
2,763,885
STATE/
CO-OP
ECONOMIC & DEMOGRAPHIC DIFFERENCES AMONG CO-OP's
185 HEALTH MARKETS WITHIN STATES (CO-OP's)
(Based on HRR's- Hosp. Referral Regions)
POP
MAP
625,741
VA1
VA2
VA3
VA4
VA-Arlington & Winchester (17 counties- Northeast VA & DC area)
VA-Charlottesville, Lynchburg, Roanoke (61 counties- Western VA)
VA-Norfolk & Newport News (19 counties- Southeast VA)
VA-Richmond (37 counties- Eastern VA)
4 VIRGINIA- TOTAL
MAP
WA1
WA2
WA3
WA4
WA-Spokane & Yakima (20 counties- eastern WA)
WA-Seattle City & King County (central WA)
WA-Seattle NW & Everett (10 counties- NW WA)
WA-Olympia & Tacoma (8 counties- SW WA)
4 WASHINGTON- TOTAL
1 WEST VIRGINIA- TOTAL (WV)
1 VERMONT- TOTAL (VT)
WI1
WI2
WI3
WI4
Serv.
Areas
COLA PER CAP.
PER CAP.
NON-
vs RI
vs RI INCOME
INCOME
ENGLISH
vs RI
($000)
@ HOME
POVERTY
Gen. Health
TOTAL
POP. PER
SQ. MILES
SQ. MILE
-2%
-10%
-6%
27.0
5.1%
11.5%
9,217
68
2,525,351
1,977,338
1,768,418
1,729,917
8,001,024
127 +14%
99 -13%
89 -15%
87 -15%
402 -6%
-10%
-15%
0%
0%
-7%
+54%
-20%
-5%
+1%
+10%
44.0
22.9
27.2
28.9
31.6
28.0%
4.9%
7.8%
8.1%
13.2%
6.2%
15.1%
11.4%
11.4%
10.6%
3,850
21,074
4,318
10,247
39,490
656
94
410
169
203
MAP
1,495,054
1,931,249
1,611,556
1,686,681
6,724,540
75
97
81
85
338
-25%
0%
0%
-15%
-11%
-5%
-5%
-5%
-15%
-8%
-22%
+32%
-1%
-6%
+2%
22.2
37.8
28.2
27.0
29.3
18.5%
22.9%
12.5%
11.7%
16.5%
16.7%
9.8%
11.2%
12.4%
12.3%
41,819
2,116
13,106
9,415
66,456
36
913
123
179
101
MAP
1,852,994
93
-25%
-15%
-27%
20.9
2.3%
17.8%
24,038
77
WI-Appleton, Green Bay, Neenah & Wausau (20 counties- NE WI)
WI-Madison (14 counties- SE WI)
WI-Milwaukee (9 counties- SE WI)
WI-La Crosse & Marshfield (29 counties- NW WI)
4 WISCONSIN- TOTAL
MAP
1,224,523
1,149,195
2,237,110
1,076,158
5,686,986
61
58
112
54
285
-25%
-10%
-20%
-25%
-20%
-5%
-10%
-5%
-5%
-6%
-10%
-4%
-4%
-16%
-8%
25.6
27.5
27.6
24.1
26.4
6.2%
7.6%
11.0%
5.0%
8.2%
10.5%
12.0%
13.7%
12.5%
12.4%
14,615
10,525
3,845
25,173
54,158
84
109
582
43
105
MAP
563,626
29
-20%
-15%
-6%
26.9
6.4%
10.2%
97,093
6
-5%
27.3
20.1%
13.8%
3,531,906
87
1 WYOMING- TOTAL (WY)
185 USA TOTAL
32
COLA
MAP 308,745,538 15,490
Each of the 185 CO-OP areas covers 1 or more “Hospital Referral Regions” as defined
by the Dartmouth Atlas of Health Care. Regional hospitals capable of cardio
and/or neuro surgery. (http://www.dartmouthatlas.org/data/region/)
In each of the 15,490 service areas the CO-OP would contract approx. 17 Primary
Care MDs, 7 Dentists and 4 Optometrists to service a population of approx.
20k in each area.
COLA’s: Using data provided by researchers at C2ER, we compare key expenses in
dozens of major cities. Costs include housing, utilities, transportation and
health care. Data is generated from an average of the past four quarters
ending March 2010. http://cgi.money.cnn.com/tools/costofliving/costofliving.html
All other data are from 2010 US Census, http://quickfacts.census.gov/qfd/index.html
downloaded at March 22, 2012.
APPENDIX I
ESTIMATE ON EXPANDING
THE RI MODEL NATIONALLY
MEDICARE
FEDERAL FUNDING BY STATE
(NEXT 3 SLIDES)
BACK
Table of Contents
I-1: $515B MEDICARE FUNDING RATES & GEOGRAPHIC COLA’s (PG 1/3)
2012 (EST)
State
Alabama
California
Connecticut
Delaware
District of Columbia
Florida
Georgia
Illinois
Indiana
Kansas
Kentucky
Louisiana
Maryland
Michigan
Mississippi
Missouri
New Jersey
New York
Ohio
Oklahoma
Pennsylvania
Tennessee
Texas
West Virginia
Subtotal (23 states & DC)
(A)
#
Enrollees
(000)
(B)
Total
Funding
(mils $)
Per
Enrollee
($)
877
4,902
592
154
81
3,486
1,266
1,915
1,044
451
788
712
810
1,711
517
1,044
1,383
3,113
1,983
627
2,387
1,093
3,074
400
8,766
55,495
6,744
1,648
933
42,970
12,799
20,902
10,569
4,370
7,807
8,561
9,536
19,226
5,674
10,444
16,923
37,479
20,997
6,450
25,910
11,268
36,613
3,838
9,993
11,321
11,400
10,716
11,473
12,325
10,114
10,916
10,121
9,690
9,907
12,031
11,773
11,234
10,969
9,999
12,240
12,038
10,591
10,283
10,854
10,308
11,911
9,597
34,410
385,921
11,215
(C)
Health
COLA
vs RI
(%)
-20%
-1%
0%
-5%
-5%
-13%
-12%
-7%
-15%
-17%
-20%
-15%
-10%
-8%
-17%
-13%
-6%
+4%
-15%
-15%
-15%
-16%
-15%
-15%
(B)-(C) x (A)
More
Than RI
After
COLA
(%)
RI's
$10,407
x COLA
($)
Medical
Increase
vs RI
(mils $)
8,326
10,303
10,407
9,887
9,887
9,054
9,158
9,679
8,846
8,638
8,326
8,846
9,366
9,574
8,638
9,054
9,783
10,823
8,846
8,846
8,846
8,742
8,846
8,846
1,463
4,990
587
128
129
11,403
1,210
2,369
1,332
474
1,246
2,266
1,949
2,840
1,206
987
3,398
3,783
3,460
901
4,794
1,712
9,423
300
16.7%
9.0%
8.7%
7.7%
13.8%
26.5%
9.4%
11.3%
12.6%
10.9%
16.0%
26.5%
20.4%
14.8%
21.3%
9.5%
20.1%
10.1%
16.5%
14.0%
18.5%
15.2%
25.7%
7.8%
9,398
62,351
16.2%
$62B Overbill vs RI?
We would expect (B) & (C) above to be nearly the same if the medicare populations above consumed approximately
the same services as in RI. However, the above populations consumed $62B (16%) more services than RI. Or the
medicare rates are higher than non-medicare rates in these states making the COLA above n/a to medicare.
This is unlikely. NJ, NY, FL, LA & TX have particularly excessive cost per enrollee vs. RI after COLA.
I-2: $515B MEDICARE FUNDING RATES & GEOGRAPHIC COLA’s (PG 2/3)
2012 (EST)
State
Alaska
Arizona
Arkansas
Colorado
Hawaii
Idaho
Iowa
Maine
Massachusetts
Minnesota
Montana
Nebraska
Nevada
New Hampshire
New Mexico
North Carolina
North Dakota
Oregon
Rhode Island
South Carolina
South Dakota
Utah
Vermont
Virginia
Washington
Wisconsin
Wyoming
Subtotal (27 states)
Grand Total
(A)
(B)
(C)
12,488
9,679
8,846
9,679
10,927
9,366
8,638
9,887
11,135
9,887
9,366
8,846
9,679
10,407
8,846
9,574
9,366
10,199
10,407
9,366
9,366
8,638
9,366
9,679
9,574
9,783
8,846
Medical
Increase
vs RI
(mils $)
More
Than RI
After
COLA
(%)
Total
Funding
(mils $)
Per
Enrollee
($)
66
953
552
638
212
235
542
275
1,102
813
175
292
364
230
322
1,535
114
638
191
794
143
290
114
1,177
994
945
83
602
9,212
5,076
5,727
1,671
1,907
4,718
2,491
12,775
7,473
1,360
2,745
3,624
2,076
2,689
15,374
937
5,414
1,988
7,860
1,194
2,485
1,026
10,612
8,689
8,658
696
9,061
9,661
9,203
8,974
7,869
8,103
8,700
9,071
11,597
9,194
7,791
9,396
9,966
9,011
8,350
10,017
8,183
8,481
10,407
9,904
8,379
8,562
8,966
9,020
8,737
9,160
8,396
+20%
-7%
-15%
-7%
+5%
-10%
-17%
-5%
+7%
-5%
-10%
-15%
-7%
0%
-15%
-8%
-10%
-2%
0%
-10%
-10%
-17%
-10%
-7%
-8%
-6%
-15%
13,790
129,079
9,360
9,706
2,110
1.6%
48,200
515,000
10,685
9,488
64,461
12.5%
#
Enrollees
(000)
RI's
$10,407
x COLA
($)
(B)-(C) x (A)
Health
COLA
vs RI
(%)
197
34
508
161
104
679
427
-37.8%
-0.2%
3.9%
-7.8%
-38.9%
-15.6%
0.7%
-9.0%
4.0%
-7.5%
-20.2%
5.9%
2.9%
-15.5%
-5.9%
4.4%
-14.5%
-20.3%
0.0%
5.4%
-11.8%
-0.9%
-4.5%
-7.3%
-9.6%
-6.8%
-5.4%
The above medicare populations primarily consumed the same or less services than RI after COLA adjustment. HI,
NH and OR have similar populations or COLA but consume dramatically fewer services than RI.
I-3: $515B MEDICARE FUNDING RATES & GEOGRAPHIC COLA’s (PG 3/3)
REDUCING THE PER ENROLLEE COST IN THE 23 STATES & DC
TO THE LEVEL IN RI, WOULD CUT MEDICARE SPENDING $62B (16%).
NATIONALLY: It is known that 15% of the Medicare/Medicaid cases consume a
majority of the services (as in RI). It is likely that these difficult & expensive cases
show up on the Medicaid program in RI and on the MEDICARE program in most other
states. Most states spend dramatically more per enrollee on MEDICARE than RI
(appendix I), the opposite of what we find in Medicaid (appendix J). It would be important
to segregate these expensive cases in each state or CO-OP before making comparisons or
seeking market/practice differences.
FUNDING: Going forward, the baseline funding (Federal $515B) would be sent to the
states and the 185 local CO-OP’s who will interact with the providers and manage the
programs to the patient’s best advantage as described herein. Future federal funding
increases are limited to population growth plus inflation under 10 to 20 year contracts with
the CO-OP’s. NO FEE-FOR-SERVICE at the federal or state level. NO CO-OP voting for
Federal or State governments. Minimum “strings” or mandates on the funding. Although
it is expected that a small number of plans (4 to 6) or a menu of minimum coverage would
be available in every CO-OP nationwide. Like Medicare but not fee-for-service.
PATIENTS are free to purchase added coverage with their own funds through the Co-OP
or in the open market. CO-OP focus is on health care as a “public utility” for all in the area.
APPENDIX J
ESTIMATE ON EXPANDING
THE RI MODEL NATIONALLY
MEDICAID
FEDERAL & STATE FUNDING
(NEXT 3 SLIDES)
BACK
Table of Contents
J-1: $492B MEDICAID FUNDING RATES & GEOGRAPHIC COLA’s (PG 1/3)
2012 (EST)
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
(A)
#
Enrollees
(000)
967
139
1,630
963
12,251
729
611
211
196
3,345
1,995
261
272
2,699
1,312
581
409
1,040
1,348
356
882
1,433
2,085
889
766
1,228
(B)
Total
Federal
Funding
(mils $)
Per
Enrollee
Federal
($)
Total
State
Funding
(mils $)
4,318
1,199
8,103
4,001
39,686
3,674
5,100
1,399
2,140
16,276
8,447
1,222
1,554
12,597
6,081
3,312
2,826
5,508
6,143
1,668
6,865
11,066
11,361
8,180
3,845
6,431
4,466
8,621
4,973
4,153
3,239
5,038
8,351
6,643
10,919
4,866
4,235
4,689
5,725
4,667
4,633
5,704
6,910
5,293
4,558
4,684
7,783
7,721
5,448
9,202
5,020
5,236
766
405
1,525
809
14,364
1,668
4,741
662
4,194
2,218
550
407
5,348
1,508
724
1,009
1,255
1,371
614
2,783
10,659
1,913
3,749
386
1,756
(C)
State
% of
Total
Per
Enrollee
Total
($)
Health
COLA
vs RI
(%)
RI's
$12,309
x COLA
($)
15.1%
25.2%
15.8%
16.8%
26.6%
31.2%
48.2%
32.1%
0.0%
20.6%
20.8%
31.0%
20.8%
29.8%
19.9%
17.9%
26.3%
18.6%
18.2%
26.9%
28.8%
49.1%
14.4%
31.4%
9.1%
21.5%
5,257
11,533
5,909
4,992
4,412
7,324
16,113
9,787
10,919
6,119
5,347
6,800
7,225
6,648
5,782
6,951
9,378
6,500
5,576
6,409
10,938
15,158
6,365
13,419
5,524
6,666
-20%
+20%
-7%
-15%
-1%
-7%
0%
-5%
-5%
-13%
-12%
+5%
-10%
-7%
-15%
-17%
-17%
-20%
-15%
-5%
-10%
+7%
-8%
-5%
-17%
-13%
9,847
14,771
11,447
10,463
12,186
11,447
12,309
11,694
11,694
10,709
10,832
12,924
11,078
11,447
10,463
10,216
10,216
9,847
10,463
11,694
11,078
13,171
11,324
11,694
10,216
10,709
(B)-(C) x (A)
Medical
Increase
vs RI
(mils $)
2,323
(152)
(343)
(123)
2,849
1,534
More
Than RI
After
COLA
(%)
-46.6%
-21.9%
-48.4%
-52.3%
-63.8%
-36.0%
30.9%
-16.3%
-6.6%
-42.9%
-50.6%
-47.4%
-34.8%
-41.9%
-44.7%
-32.0%
-8.2%
-34.0%
-46.7%
-45.2%
-1.3%
15.1%
-43.8%
14.8%
-45.9%
-37.8%
We would expect (B) & (C) above to be nearly the same if the medicaid populations above consumed approximately
the same services as in RI. However, 40 states consumed dramatically fewer services than RI. Or the
medicaid rates are higher than non-medicaid rates in these states making the COLA above n/a to medicaid.
This is unlikely. AR, CA, GA, TX & WI spend less than HALF per enrollee vs. RI after COLA.
J-2: $492B MEDICAID FUNDING RATES & GEOGRAPHIC COLA’s (PG 2/3)
2012 (EST)
State
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
(A)
#
Enrollees
(000)
(B)
Total
Federal
Funding
(mils $)
Per
Enrollee
Federal
($)
Total
State
Funding
(mils $)
(C)
State
% of
Total
Per
Enrollee
Total
($)
Health
COLA
vs RI
(%)
RI's
$12,309
x COLA
($)
-10%
-15%
-7%
0%
-6%
-15%
+4%
-8%
-10%
-15%
-15%
-2%
-15%
0%
-10%
-10%
-16%
-15%
-17%
-10%
-7%
-8%
-15%
-6%
-15%
11,078
10,463
11,447
12,309
11,570
10,463
12,801
11,324
11,078
10,463
10,463
12,063
10,463
12,309
11,078
11,078
10,340
10,463
10,216
11,078
11,447
11,324
10,463
11,570
10,463
132
290
290
153
1,241
591
5,673
2,080
86
2,402
892
568
2,487
237
1,015
159
1,714
4,652
283
189
978
1,384
440
1,784
81
806
1,890
1,391
1,151
9,493
3,764
52,974
10,985
678
14,846
4,123
3,028
15,386
2,028
5,350
828
7,830
20,501
1,717
1,087
5,737
7,180
2,956
5,648
619
6,122
6,511
4,789
7,536
7,649
6,366
9,338
5,281
7,864
6,180
4,624
5,332
6,187
8,545
5,271
5,199
4,568
4,407
6,073
5,753
5,865
5,188
6,719
3,165
7,681
175
710
585
518
5,206
789
9,426
3,395
204
12,574
1,111
875
7,744
894
725
294
3,185
2,769
326
215
3,573
4,340
380
1,332
271
17.8%
27.3%
29.6%
31.0%
35.4%
17.3%
15.2%
23.7%
23.2%
45.9%
21.2%
22.4%
33.6%
30.6%
11.9%
26.2%
28.9%
12.0%
16.0%
16.5%
38.4%
37.7%
11.4%
19.1%
30.4%
7,449
8,957
6,802
10,930
11,844
7,701
10,999
6,914
10,233
11,415
5,870
6,873
9,301
12,309
5,985
7,046
6,426
5,002
7,226
6,893
9,518
8,324
7,583
3,911
11,040
68,400
365,000
5,336
127,000
25.8%
7,193
(B)-(C) x (A)
Medical
Increase
vs RI
(mils $)
340
(73)
2,287
47
More
Than RI
After
COLA
(%)
-32.8%
-14.4%
-40.6%
-11.2%
2.4%
-26.4%
-14.1%
-38.9%
-7.6%
9.1%
-43.9%
-43.0%
-11.1%
0.0%
-46.0%
-36.4%
-37.8%
-52.2%
-29.3%
-37.8%
-16.9%
-26.5%
-27.5%
-66.2%
5.5%
8,688
The degree to which states contribute the their Medicaid programs varies dramatically as shown above. From
nearly half in CT, MA & OH to less than 12% in MS, SC, TX & WV. DC pays zero toward their Medicaid. The
above includes federal “stimulus” as it is unlikely this will be withdrawn given economics & ACA expansion.
Accordingly, this is becoming more of a federal program (75%) and less of a federal-state partnership.
J-3: $492B MEDICAID FUNDING RATES & GEOGRAPHIC COLA’s (PG 3/3)
ONLY SIX STATES (CT, MA, MN, NJ, OH, WY) SPEND MORE PER ENROLLEE ON
MEDICAID THAN RI. ALL BUT MN & WY ALSO SPEND MORE ON MEDICARE.
The RI Medicaid population consists of approximately 75,000 elderly & disabled
people consuming nearly $31k per enrollee or $2.3B. The remaining population is
approx. 162,000 families & children consuming $3,700 per enrollee on average for
a total of approximately $.6B. A total of 237,000 people, $2.9B or $12,309 per enrollee.
NATIONALLY: It is known that 15% of the Medicare/Medicaid cases consume a
majority of the services (as in RI). It is likely that these difficult & expensive cases
show up on the Medicaid program in RI and the six states above and on the MEDICARE
program in most other states. Most states spend dramatically more per enrollee on
MEDICARE than RI (appendix I), the opposite of what we find in Medicaid (appendix J).
It would be important to segregate these expensive cases in each state or CO-OP before
making comparisons or seeking market/practice differences.
FUNDING: The funding shown in this appendix includes Federal “Stimulus” money.
It is assumed that this will become part of the base line given slow economic growth,
persistently high unemployment, population demographics & health care reform.
Going forward, the baseline funding (Federal $365B & States $127B) would be sent to the
states and the 185 local CO-OP’s who will interact with the providers and manage the
programs to the patient’s best advantage as described herein. Future funding increases
are limited to population growth plus inflation under 10 to 20 year contracts with the
CO-OP’s. NO FEE-FOR-SERVICE at the federal or state level. NO CO-OP voting for
Federal or State governments. Minimum “strings” or mandates on the funding.
APPENDIX K
ESTIMATE ON EXPANDING
THE RI MODEL NATIONALLY
OTHER FEDERAL HEALTH SPENDING
(NEXT 3 SLIDES)
BACK
Table of Contents
K-1: $220B OTHER FEDERAL HEALTH SPENDING (PG 1/3)
2012 (EST)
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Active Duty
CG, NG &
Reserves
(000)
Federal
Civilian
Employees
(000)
Federal
Civilian
Retirees
(000)
66
24
40
23
213
50
16
10
23
109
106
46
12
77
28
18
33
55
47
11
57
30
34
26
34
52
52
17
55
21
252
54
18
5
167
121
103
28
14
87
41
18
26
35
31
15
143
50
55
47
25
58
58
7
52
25
214
47
15
9
43
124
81
25
14
66
36
20
24
33
26
14
153
43
42
20
25
53
Total
Federal
People
(000)
176
48
147
69
679
151
49
24
233
354
290
99
40
230
105
56
83
123
104
40
353
123
131
93
84
163
% of
Total
Defense
Fed EE
& Misc.
Health
(mils $)
2.4%
0.6%
2.0%
0.9%
9.1%
2.0%
0.7%
0.3%
3.1%
4.7%
3.9%
1.3%
0.5%
3.1%
1.4%
0.7%
1.1%
1.6%
1.4%
0.5%
4.7%
1.6%
1.8%
1.2%
1.1%
2.2%
3,886
1,060
3,246
1,523
14,992
3,334
1,082
530
5,145
7,816
6,403
2,186
883
5,078
2,318
1,236
1,833
2,716
2,296
883
7,794
2,716
2,892
2,053
1,855
3,599
Veterans
(000)
404
72
551
251
2,093
411
245
78
35
1,685
718
116
131
812
494
246
231
335
322
140
462
441
751
401
213
518
VA
Health
% of Spending
Total
(mils $)
1.8%
0.3%
2.4%
1.1%
9.1%
1.8%
1.1%
0.3%
0.2%
7.4%
3.1%
0.5%
0.6%
3.5%
2.2%
1.1%
1.0%
1.5%
1.4%
0.6%
2.0%
1.9%
3.3%
1.8%
0.9%
2.3%
ESTIMATE OF HOW OTHER FEDERAL HEALTH SPENDING IS DISTRIBUTED BY STATE.
This spending includes: Defense Health ($60B), Fed Employees ($50B), misc ($55B) & VA ($55B).
Note: not all veterans are drawing VA health benefits, this population figure was used to estimate by state $’s.
970
173
1,324
603
5,028
987
589
187
84
4,047
1,725
279
315
1,950
1,187
591
555
805
773
336
1,110
1,059
1,804
963
512
1,244
K-2: $220B OTHER FEDERAL HEALTH SPENDING (PG 2/3)
2012 (EST)
Active Duty
CG, NG &
Reserves
(000)
Federal
Civilian
Employees
(000)
Federal
Civilian
Retirees
(000)
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
10
18
14
6
33
21
71
125
13
51
47
17
56
10
66
10
31
195
18
5
124
66
12
26
7
16
16
17
8
58
32
123
64
9
82
49
30
105
10
30
11
43
191
37
7
169
71
24
29
8
12
13
21
12
55
27
96
70
6
74
47
33
107
9
43
10
45
163
35
4
139
65
17
26
6
GRAND TOTAL
2,292
2,777
2,404
State
Total
Federal
People
(000)
38
47
52
26
146
80
290
259
28
207
143
80
268
29
139
31
119
549
90
16
432
202
53
81
21
7,473
% of
Total
Defense
Fed EE
& Misc.
Health
(mils $)
0.5%
0.6%
0.7%
0.3%
2.0%
1.1%
3.9%
3.5%
0.4%
2.8%
1.9%
1.1%
3.6%
0.4%
1.9%
0.4%
1.6%
7.3%
1.2%
0.2%
5.8%
2.7%
0.7%
1.1%
0.3%
839
1,038
1,148
574
3,224
1,766
6,403
5,719
618
4,570
3,157
1,766
5,917
640
3,069
684
2,627
12,122
1,987
353
9,538
4,460
1,170
1,788
464
100
150
231
125
505
174
1,065
742
55
951
326
350
1,050
82
399
72
508
1,621
151
54
748
616
171
443
52
165,000
22,897
100.0%
Veterans
(000)
VA
Health
% of Spending
Total
(mils $)
0.4%
0.7%
1.0%
0.5%
2.2%
0.8%
4.7%
3.2%
0.2%
4.2%
1.4%
1.5%
4.6%
0.4%
1.7%
0.3%
2.2%
7.1%
0.7%
0.2%
3.3%
2.7%
0.7%
1.9%
0.2%
240
360
555
300
1,213
418
2,558
1,782
132
2,284
783
841
2,522
197
958
173
1,220
3,894
363
130
1,797
1,480
411
1,064
125
100.0%
55,000
$220B
ESTIMATE OF HOW OTHER FEDERAL HEALTH SPENDING IS DISTRIBUTED BY STATE.
This spending includes: Defense Health ($60B), Fed Employees ($50B), misc ($55B) & VA ($55B).
Note: not all veterans are drawing VA health benefits, this population figure was used to estimate by state $’s.
K-3: $220B OTHER FEDERAL HEALTHE SPENDING (PG 3/3)
FUNDING: Going forward, the baseline funding (Federal $220B) would be sent to the states
and the 185 local CO-OP’s who will interact with the providers and manage The programs
to the patient’s best advantage as described herein. Future funding increases are limited to
population growth plus inflation under 10 to 20 year contracts with the CO-OP’s.
NO FEE-FOR-SERVICE at the federal or state level. NO CO-OP voting for
Federal or State governments. Minimum “strings” or mandates on the funding.
APPENDIX L
ESTIMATE ON EXPANDING
THE RI MODEL NATIONALLY
STATE & LOCAL GOVERNMENT
HEALTH SPENDING
EMPLOYEES, RETIREES, OTHER
(ESTIMATE)
(NEXT 3 SLIDES)
BACK
Table of Contents
LOCAL GOVERNMENT: EMPLOYMENT AND PAYROLL DATA BY STATE & BY FUNCTION: MARCH 2011.
SOURCE: 2011 Annual Survey of Public Employment and Payroll. For information on sampling and nonsampling errors and definitions,
see http://www.census.gov/govs/apes/how_data_collected.html. Data users who create their own estimates from these tables
should cite the U.S. Census Bureau as the source of the original data only.
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
DC
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
State
# Total EE's
108,827
30,236
85,187
73,239
491,120
98,890
76,824
31,294
213,662
154,380
72,983
28,341
158,496
118,093
66,751
54,741
96,775
99,787
28,537
91,823
114,104
186,173
99,404
64,905
Payroll
(Mil $)
State &
Local
# Total EE's
89,768 4,369
212,631 195,010 7,529
26,747 1,660
33,689
27,996 1,645
68,786 3,435
247,025 212,009 10,179
62,562 2,882
141,097 127,046 4,138
407,321 28,829 1,655,441 1,344,749 89,478
72,113 4,259
243,026 198,053 9,745
62,090 4,211
144,051 123,119 7,353
43,418
42,502 3,054
26,215 1,311
26,173
23,536 1,204
184,237 8,483
785,844 703,922 32,915
123,627 5,713
422,229 385,649 15,786
58,142 2,777
16,426
15,527
907
21,773 1,117
73,835
56,796 2,176
131,153 7,907
616,379 495,768 27,248
89,796 4,169
284,112 239,707 10,253
50,378 3,130
164,278 126,890 5,637
43,555 2,141
184,895 153,292 6,106
81,493 3,650
192,939 165,366 6,064
84,402 4,231
222,135 197,195 7,772
21,354 1,045
66,474
54,016 1,842
86,714 4,870
254,373 220,317 13,089
92,033 5,538
264,032 228,705 13,179
144,921 8,574
385,511 311,657 16,274
79,672 4,915
254,375 197,507 10,082
57,656 2,486
150,361 134,339 4,790
321,458
63,925
332,212
214,336
2,146,561
341,916
220,875
43,418
57,467
999,506
576,609
89,409
102,176
774,875
402,205
231,029
239,636
289,714
321,922
95,011
346,196
378,136
571,684
353,779
215,266
State
# FTE's
Payroll
Local
(Mil $) # Total EE's
Local
# FTE's
State &
Local
# FTE's
284,778
54,743
280,795
189,608
1,752,070
270,166
185,209
42,502
49,751
888,159
509,276
73,669
78,569
626,921
329,503
177,268
196,847
246,859
281,597
75,370
307,031
320,738
456,578
277,179
191,995
Payroll
(Mil $)
Health Cost
% Total (Mil $)
per FTE
11,898
3,305
13,614
7,020
118,307
14,003
11,564
3,054
2,516
41,398
21,499
3,684
3,293
35,156
14,423
8,767
8,247
9,714
12,002
2,886
17,959
18,717
24,848
14,997
7,275
1.4% 2,818
0.4%
783
1.6% 3,224
0.8% 1,662
14.0% 28,017
1.7% 3,316
1.4% 2,739
0.4%
723
0.3%
596
4.9% 9,804
2.5% 5,091
0.4%
873
0.4%
780
4.2% 8,325
1.7% 3,416
1.0% 2,076
1.0% 1,953
1.2% 2,301
1.4% 2,842
0.3%
684
2.1% 4,253
2.2% 4,432
2.9% 5,884
1.8% 3,551
0.9% 1,723
9,895
14,298
11,482
8,767
15,991
12,275
14,787
17,018
11,975
11,038
9,997
11,844
9,925
13,280
10,366
11,712
9,921
9,319
10,094
9,069
13,852
13,819
12,888
12,813
8,973
per PR$
23.7%
23.7%
23.7%
23.7%
23.7%
23.7%
23.7%
23.7%
23.7%
23.7%
23.7%
23.7%
23.7%
23.7%
23.7%
23.7%
23.7%
23.7%
23.7%
23.7%
23.7%
23.7%
23.7%
23.7%
23.7%
State
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
TOTAL USA
State
# Total EE's
229,949
37,079
88,909
86,186
52,879
341,313
78,870
932,034
401,701
26,455
455,646
146,418
131,757
423,378
30,846
176,232
31,393
241,242
1,131,828
94,090
25,230
313,907
225,231
63,819
212,677
39,316
9,610
1,530
4,104
4,951
2,328
21,645
3,220
59,086
16,796
1,097
21,810
5,340
6,802
21,405
1,794
7,183
1,143
9,386
48,911
3,793
1,074
14,260
14,348
2,423
10,547
1,838
377,881
73,476
145,329
132,212
87,231
573,446
144,706
1,345,387
645,240
59,500
721,858
247,750
248,449
727,733
58,063
285,268
61,637
370,658
1,624,167
199,600
47,234
515,632
424,299
118,761
384,059
64,055
317,310
57,874
120,974
114,307
72,273
488,114
125,664
1,175,681
556,065
45,047
594,695
214,757
197,299
591,926
49,746
253,574
45,851
327,457
1,450,198
147,591
39,649
438,837
346,367
103,701
283,568
52,732
13,210
2,504
5,568
6,535
3,345
31,819
5,360
75,471
23,859
2,007
29,651
8,475
10,410
30,726
2,998
10,633
1,803
13,132
65,290
6,512
1,874
20,637
21,435
4,125
14,491
2,513
5,313,525 4,359,380 239,662 14,099,427 11,999,058 604,869
19,412,952
16,358,438
844,531
3,600
974
1,464
1,584
1,017
10,174
2,141
16,385
7,062
910
7,841
3,135
3,609
9,321
1,204
3,450
660
3,746
16,380
2,720
800
6,377
7,088
1,702
3,944
674
Local
# Total EE's
State &
Local
# FTE's
Payroll
(Mil $)
87,361
20,795
32,065
28,121
19,394
146,801
46,794
243,647
154,364
18,592
139,049
68,339
65,542
168,548
18,900
77,342
14,458
86,215
318,370
53,501
14,419
124,930
121,136
39,882
70,891
13,416
Payroll
(Mil $)
State &
Local
# Total EE's
Local
# FTE's
101,735
26,831
37,060
34,825
26,232
171,697
55,016
279,005
178,488
24,760
186,088
86,893
82,648
208,870
23,783
90,085
18,831
103,867
363,533
70,256
15,846
160,028
154,785
48,334
103,489
15,968
State
# FTE's
276,146
46,645
108,269
97,387
60,999
401,749
89,690
1,066,382
466,752
34,740
535,770
160,857
165,801
518,863
34,280
195,183
42,806
266,791
1,260,634
129,344
31,388
355,604
269,514
70,427
280,570
48,087
Payroll
(Mil $)
Health Cost
% Total (Mil $)
1.6%
0.3%
0.7%
0.8%
0.4%
3.8%
0.6%
8.9%
2.8%
0.2%
3.5%
1.0%
1.2%
3.6%
0.4%
1.3%
0.2%
1.6%
7.7%
0.8%
0.2%
2.4%
2.5%
0.5%
1.7%
0.3%
per FTE
per PR$
3,128
593
1,319
1,548
792
7,535
1,269
17,873
5,650
475
7,022
2,007
2,465
7,276
710
2,518
427
3,110
15,462
1,542
444
4,887
5,076
977
3,432
595
9,859
10,245
10,900
13,540
10,960
15,438
10,102
15,202
10,161
10,551
11,807
9,346
12,495
12,293
14,270
9,930
9,314
9,497
10,662
10,450
11,191
11,137
14,656
9,421
12,102
11,285
23.7%
23.7%
23.7%
23.7%
23.7%
23.7%
23.7%
23.7%
23.7%
23.7%
23.7%
23.7%
23.7%
23.7%
23.7%
23.7%
23.7%
23.7%
23.7%
23.7%
23.7%
23.7%
23.7%
23.7%
23.7%
23.7%
100% 200,000
12,226
23.7%
AL: 3 HEALTH MARKETS
(67 COUNTIES & 4.7 MILLION PEOPLE)
Table of Contents
AK: 1 HEALTH MARKET
(29 COUNTIES & 710K PEOPLE)
Table of Contents
(PG 1 OF 2)
AZ: 4 HEALTH MARKETS
(15 COUNTIES & 6.4 MILLION PEOPLE)
Table of Contents
(PG 2 OF 2)
AZ: MARICOPA COUNTY (3.8 MILLION PEOPLE)
Table of Contents
AR: 2 HEALTH MARKETS (75 COUNTIES & 2.9 MILLION PEOPLE)
Table of Contents
CA: 21 HEALTH MARKETS
(58 COUNTIES & 37.3 MILLION PEOPLE)
(PG 1 OF 4)
Table of Contents
CA: ORANGE COUNTY (3 MILLION PEOPLE)
(PG 2 OF 4)
Table of Contents
CA: LOS ANGELES COUNTY (9.8 MILLION PEOPLE)
(PG 3 OF 4)
NOTE: Data per US Census & Geographic divisions:
http://projects.latimes.com/mapping-la/neighborhoods/
Table of Contents
CA: SAN DIEGO COUNTY (3.1 MILLION PEOPLE)
(PG 4 OF 4)
Table of Contents
CO: 4 HEALTH MARKETS
(64 COUNTIES & 5 MILLION PEOPLE)
Table of Contents
CT: 2 HEALTH MARKETS
(8 COUNTIES & 3.6 MILLION PEOPLE)
Table of Contents
DC: 1 HEALTH MARKET
(0 COUNTIES & 618K PEOPLE)
map
map
Table of Contents
DE: 1 HEALTH MARKET
(3 COUNTIES & 898K PEOPLE)
Table of Contents
FL: 11 HEALTH MARKETS
(67 COUNTIES & 18.8 MILLION PEOPLE)
Table of Contents
GA: 5 HEALTH MARKETS
(159 COUNTIES & 9.7 MILLION PEOPLE)
Table of Contents
HI: 1 HEALTH MARKET
(5 COUNTIES & 1.4 MILLION PEOPLE)
Table of Contents
ID: 1 HEALTH MARKET
(44 COUNTIES & 1.6 MILLION PEOPLE)
Table of Contents
(PG 1 OF 2)
IL: 7 HEALTH MARKETS
(102 COUNTIES & 12.8 MILLION PEOPLE)
Table of Contents
(PG 2 OF 2)
IL: COOK COUNTY (5.2 MILLION PEOPLE)
Table of Content
IN: 4 HEALTH MARKETS
(92 COUNTIES 6.5 MILLION PEOPLE)
Table of Contents
IA: 2 HEALTH MARKETS
(99 COUNTIES & 3 MILLION PEOPLE)
Table of Contents
KS: 2 HEALTH MARKETS
(105 COUNTIES & 2.8 MILLION PEOPLE)
Table of Contents
KY: 2 HEALTH MARKETS
(120 COUNTIES & 4.3 MILLION PEOPLE)
Table of Contents
LA: 2 HEALTH MARKETS
(64 COUNTIES & 4.5 MILLION PEOPLE)
Table of Contents
ME: 1 HEALTH MARKET
(16 COUNTIES & 1.3 MILLION PEOPLE)
Table of Contents
MD: 3 HEALTH MARKETS
(24 COUNTIES & 5.8 MILLION PEOPLE)
Table of Contents
Back
to DC
MA: 4 HEALTH MARKETS
(14 COUNTIES & 6.5 MILLION PEOPLE)
Table of Contents
(PG 1 OF 2)
MI: 5 HEALTH MARKETS
(83 COUNTIES & 9.9 MILLION PEOPLE)
Table of Contents
(PG 2 OF 2)
MI: WAYNE COUNTY (1.8 MILLION PEOPLE)
Table of Contents
MN: 3 HEALTH MARKETS
(87 COUNTIES & 5.3 MILLION PEOPLE)
Table of Contents
MS: 2 HEALTH MARKETS
(82 COUNTIES & 3 MILLION PEOPLE)
Table of Contents
MO: 4 HEALTH MARKETS
(115 COUNTIES & 6 MILLION PEOPLE)
Table of Contents
MT: 1 HEALTH MARKET
(56 COUNTIES & 990K PEOPLE)
Table of Contents
NE: 1 HEALTH MARKET
(93 COUNTIES & 1.8 MILLION PEOPLE)
Table of Contents
NV: 2 HEALTH MARKETS
(17 COUNTIES & 2.7 MILLION PEOPLE)
Table of Contents
NH: 1 HEALTH MARKET
(10 COUNTIES & 1.3 MILLION PEOPLE)
Table of Contents
NJ: 5 HEALTH MARKETS
(21 COUNTIES & 8.8 MILLION PEOPLE)
Table of Contents
NM: 1 HEALTH MARKET
(33 COUNTIES & 2 MILLION PEOPLE)
Table of Contents
NY: 11 HEALTH MARKETS
(62 COUNTIES & 19.3 MILLION PEOPLE)
Table of Contents
NC: 5 HEALTH MARKETS (100 COUNTIES & 9.6 MILLION PEOPLE)
Table of Contents
ND: 1 HEALTH MARKET
(53 COUNTIES & 673K PEOPLE)
Table of Contents
OH: 7 HEALTH MARKETS
(88 COUNTIES & 11.5 MILLION PEOPLE)
Table of Contents
OK: 2 HEALTH MARKETS
(77 COUNTIES & 3.7 MILLION PEOPLE)
Table of Contents
OR: 2 HEALTH MARKETS
(36 COUNTIES & 3.8 MILLION PEOPLE)
Table of Contents
PA: 8 HEALTH MARKETS
(67 COUNTIES & 12.7 MILLION PEOPLE)
Table of Contents
RI: 1 HEALTH MARKET
(5 COUNTIES & 1.1 MILLION PEOPLE)
Table of Contents
SC: 3 HEALTH MARKETS
(46 COUNTIES & 4.6 MILLION PEOPLE)
Table of Contents
SD: 1 HEALTH MARKET
(66 COUNTIES & 814K PEOPLE)
Table of Contents
TN: 4 HEALTH MARKETS
(95 COUNTIES & 6.3 MILLION PEOPLE)
Table of Contents
(PG 1 OF 2)
TX: 14 HEALTH MARKETS
(254 COUNTIES & 25.2 MILLION PEOPLE)
Table of Contents
(PG 2 OF 2)
TX4:
HOUSTON
City Of
2.1 Mil People
TX: HARRIS COUNTY (4.1 MILLION PEOPLE)
TX5:
HARRIS COUNTY
Excluding Houston
2 Mil People
Table of Contents
UT: 2 HEALTH MARKETS
(29 COUNTIES & 2.8 MILLION PEOPLE)
Table of Contents
VT: 1 HEALTH MARKET
(14 COUNTIES & 626K PEOPLE)
Table of Contents
VA: 4 HEALTH MARKETS
(134 COUNTIES & 8 MILLION PEOPLE)
Table of Contents
Back to DC
WA: 4 HEALTH MARKETS
(39 COUNTIES & 6.7 MILLION PEOPLE)
Table of Contents
WV: 1 HEALTH MARKET
(55 COUNTIES & 1.8 MILLION PEOPLE)
Table of Contents
WI: 4 HEALTH MARKETS
(72 COUNTIES & 5.7 MILLION PEOPLE)
Table of Contents
WY: 1 HEALTH MARKET
(23 COUNTIES & 564K PEOPLE)
Table of Contents
USA: 185 HEALTH MARKETS
(50 STATES 3,142 COUNTIES + DC & 308.7 MIL PEOPLE)
Table of Contents