|Inpatient Activity Decreases|
|Total Operating Expenses for general acute care (GAC) hospitals increased
2.2% from 1995.
Cost per Discharge (Adjusted) Decreases
The cost per discharge decreased from 1995 to 1996.
Net Patient Revenue increased only 0.8% from 1995.
Total Revenue for all Pennsylvania hospitals -- which includes Net Patient Revenue plus other non-patient revenue -- increased 1.9% in 1996 to $18.6 billion.
Profit Margins Increase
Median Net Margins increased for GAC hospitals from 1995 to 1996.
Balance Sheet Improves slightly
Liquidity for all Pennsylvania hospitals, as measured by the current ratios, decreased slightly from 1995.
Debt to equity ratios, which measure the relative indebtedness of a hospital, remained relatively constant overall for all hospitals.
Medicare & Medicaid Utilization declines slightly
The percentage of patient days used by recipients of the federal Medicare program and the state Medicaid program decreased in 1996.
Charity Care & Uncompensated Care Increase
Hospitals operate under competing financial pressures. As non-profit institutions, they are expected to provide care to anyone who asks for it. As large and complex operations, they must meet operating expenses and also generate sufficient surplus to respond to the growing demand for services as well as new technology.
Charity care is only part of a hospitals commitment to its community. Many hospitals provide a number of community service programs which include services to the needy, health education, wellness programs, counseling, screenings, and professional training programs. Very few hospitals include those costs in their financial statements.
The Health Care Market Place Is Changing
The health care market place in Pennsylvania and in the United States is changing very quickly. Much of this change is led by the rapid growth of managed care and the shifting of services from inpatient to outpatient care. Employers and governments see managed care plans as effective ways to manage health care costs through more efficient utilization of health care services. Ambulatory surgery centers are perceived by many as a more cost effective way of delivering some surgical services.
HMOs Increase Market Share
Ambulatory Surgery Centers (ASC) Increase Volume and Revenue
|Ambulatory Surgery Centers reported a 6 % increase in revenue and an 8.2% increase in the number of surgical visits, (based on facilities that reported in both years). This is a much larger growth in revenue and patient volume than that experienced by hospitals.|
Payors and Payments
In order to track the impact that these changes in the delivery system had on hospitals the Council surveyed Pennsylvania hospitals to ask who paid for services and how they were paid. The survey responses indicate that:
Utilization is Changing
The graphs and tables on pages 20-27 of this report show a declining utilization of hospital services since the Council began reporting financial data in 1990. The total number of admissions, the number of total patient days, and the occupancy rate have declined each year since 1992 for Pennsylvania hospitals.
This pattern is similar to the patterns experienced in other states as managed care markets grow and mature. The map below indicates that in Pennsylvania there is wide variation in the number of patient days per population among Pennsylvania counties. It displays the average number of patient days per thousand in each countys population. A rate of 1000 per thousand would mean that on average, every person in that county spends one day in a hospital somewhere in Pennsylvania. This map does not include Pennsylvania residents who sought care in neighboring states or in federal hospitals, and it is not adjusted for differences in age and sex differences. It does illustrates a wide variation in the rate of hospital use within Pennsylvania that should raise questions about the appropriate rate of utilization.
One strategy that hospitals have developed to respond to a declining market is
consolidation. During the last few years numerous hospitals have formed mergers and
alliances. Later this summer, the Council plans to release a report on hospital systems in