Table 4.1: Aggregate Total Hospital Margins,(1) Operating Margins,(2) and Patient
Margins;(3) Percentage of Hospitals with Negative Total Margins; and Aggregate Nonoperating Gains as a Percentage of Total Net Revenue, 1990 – 2010
Year
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Aggregate
Total Hospital
Margins
3.8%
4.3%
4.6%
4.2%
4.8%
5.6%
6.7%
6.7%
5.8%
4.6%
4.6%
4.2%
4.4%
4.8%
5.2%
5.3%
6.0%
6.9%
2.6%
5.0%
7.2%
Aggregate
Operating
Margins
1.7%
2.2%
2.7%
2.5%
3.4%
3.9%
4.6%
4.0%
3.1%
2.1%
2.0%
2.7%
3.7%
3.3%
3.6%
3.7%
4.0%
4.3%
3.3%
4.4%
5.5%
Aggregate
Patient
Margins
-4.2%
-3.6%
-2.7%
-3.2%
-2.8%
-2.2%
-1.0%
-1.7%
-3.0%
-4.3%
-4.2%
-3.6%
-2.3%
-2.8%
-2.3%
-2.0%
-2.1%
-1.7%
-2.6%
-1.4%
-0.2%
Aggregate
Percent of
Non-operating
Percent of
Hospitals with
Gains as a
Hospitals with
Negative
Percentage of
Negative Total
Operating
Total Net
Margins
Margins
Revenue
27.1%
2.1%
24.7%
2.1%
23.8%
1.9%
24.2%
1.8%
22.4%
1.5%
20.4%
28.0%
1.8%
19.4%
27.7%
2.3%
20.4%
28.9%
2.7%
26.6%
36.1%
2.8%
32.5%
41.9%
2.6%
32.0%
42.2%
2.6%
29.4%
36.7%
1.6%
29.3%
33.4%
0.8%
29.9%
35.9%
1.5%
26.5%
33.4%
1.7%
25.4%
32.0%
1.7%
24.3%
31.8%
2.1%
21.6%
30.2%
2.7%
32.4%
32.8%
-0.7%
27.5%
30.1%
0.6%
22.8%
28.3%
1.8%
Source: Avalere Health analysis of American Hospital Association Annual Survey data, 2010, for community hospitals.
(1)
(2)
(3)
Total Hospital Margin is calculated as the difference between total net revenue and total expenses divided by total net revenue.
Operating Margin is calculated as the difference between operating revenue and total expenses divided by operating revenue.
Patient Margin is calculated as the difference between net patient revenue and total expenses divided by net patient revenue.
Data for Charts 4.1, 4.2, and 4.8
A-32
Table 4.2: Distribution of Inpatient vs. Outpatient Revenues, 1990 – 2010
Year
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Gross Outpatient Revenue
23%
24%
25%
27%
28%
30%
31%
33%
33%
34%
35%
35%
35%
35%
36%
37%
38%
38%
39%
41%
42%
Gross Inpatient Revenue
77%
76%
75%
73%
72%
70%
69%
67%
67%
66%
65%
65%
65%
65%
64%
63%
62%
62%
61%
59%
58%
Source: Avalere Health analysis of American Hospital Association Annual Survey data, 2010, for community hospitals.
Data for Chart 4.3
A-33
Table 4.3: Annual Change in Hospital Operating Revenue and Expenses per Adjusted
Admission,(1) 1990 – 2010
Year
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Expenses per
Adjusted
Admission
$4,947
$5,360
$5,794
$6,132
$6,230
$6,216
$6,225
$6,262
$6,386
$6,509
$6,668
$6,980
$7,355
$7,796
$8,166
$8,535
$8,970
$9,377
$9,788
$10,045
$10,313
Operating Revenue
per Adjusted
Admission
$5,034
$5,481
$5,958
$6,290
$6,446
$6,466
$6,522
$6,526
$6,589
$6,647
$6,806
$7,172
$7,636
$8,065
$8,469
$8,865
$9,345
$9,797
$10,123
$10,503
$10,917
Percent Change
Expenses
7.8%
8.3%
8.1%
5.8%
1.6%
-0.2%
0.2%
0.6%
2.0%
1.9%
2.5%
4.7%
5.4%
6.0%
4.7%
4.5%
5.1%
4.5%
4.4%
2.6%
2.7%
Percent Change
Operating Revenue
8.8%
8.9%
8.7%
5.6%
2.5%
0.3%
0.9%
0.1%
1.0%
0.9%
2.4%
5.4%
6.5%
5.6%
5.0%
4.7%
5.4%
4.8%
3.3%
3.7%
3.9%
Source: Avalere Health analysis of American Hospital Association Annual Survey data, 2010, for community hospitals.
(1)
An aggregate measure of workload reflecting the number of inpatient admissions, plus an estimate of the volume of outpatient
services, expressed in units equivalent to an inpatient admission in terms of level of effort.
Data for Chart 4.4
A-34
Table 4.4: Aggregate Hospital Payment-to-cost Ratios for Private Payers, Medicare
and Medicaid, 1990 – 2010
Year
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Medicare
89.4%
88.5%
89.0%
89.9%
96.9%
99.4%
102.4%
103.7%
101.9%
100.0%
99.1%
98.4%
97.9%
95.3%
91.9%
92.3%
91.3%
90.6%
90.9%
90.1%
92.4%
Medicaid(1)
80.1%
81.9%
89.5%
89.6%
93.7%
94.0%
94.9%
96.0%
96.6%
95.7%
94.5%
95.8%
96.1%
92.3%
89.9%
87.1%
85.8%
87.9%
88.7%
89.0%
92.8%
Private Payer
127.8%
130.8%
131.8%
130.1%
124.4%
124.0%
121.6%
117.5%
115.8%
115.1%
115.7%
116.5%
119.0%
122.3%
128.9%
129.4%
130.3%
132.2%
128.3%
134.1%
133.5%
Source: Avalere Health analysis of American Hospital Association Annual Survey data, 2010, for community hospitals.
(1)
Includes Medicaid Disproportionate Share payments.
Data for Chart 4.6
A-35
Table 4.5: Hospital Payment Shortfall Relative to Costs for Medicare, Medicaid, and
Other Government, 1997 – 2010(1)
Year
1997
1998
1999
2000
2001
2002
2003
Medicare
(billions)
$4.3
$2.3
-$0.1
-$1.3
-$2.3
-$3.3
-$8.1
Medicaid
(billions)
-$1.6
-$1.4
-$1.8
-$2.5
-$2.0
-$2.3
-$4.9
Other Government
(billions)
-$0.7
-$0.6
-$0.4
-$0.4
-$0.6
-$0.6
-$0.5
2004
2005
2006
-$15.0
-$15.5
-$18.6
-$7.1
-$9.8
-$11.3
-$0.5
-$0.4
$1.1
2007
2008
2009
2010
-$21.5
-$21.9
-$25.2
-$20.1
-$10.4
-$10.5
-$11.3
-$7.8
$1.4
$1.2
$0.4
$0.4
Source: Avalere Health analysis of American Hospital Association Annual Survey data, 2010, for community hospitals.
(1)
Costs reflect a cap of 1.0 on the cost-to-charge ratio.
Data for Chart 4.7
A-36