Top hospitals by Medicaid and Medicare payor mix

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Revenue sources for U.S. hospitals play an important role in an organization's financial health and performance. This payor mix refers to the percentage of hospital revenue coming from private insurance companies versus government insurance programs like Medicare and Medicaid.

How is payor mix calculated?

In the Definitive Healthcare HospitalView product, payor mix data represents the breakdown of revenues, charges, discharges and patient days that come from different medical insurance claims payors. The proprietary calculation is based on a facility’s charge and revenue measures in the Medicare Cost Report.

Why is payor mix important in healthcare?

Payor mix is an important metric to track because self-paying patients and private insurance companies compensate hospitals at a higher rate than government programs like Medicare. Government programs may pay hospitals less than the actual cost of patient treatment, impacting hospital revenue.

Facilities that serve primarily Medicare and/or Medicaid beneficiaries, such as safety-net hospitals, rely far more heavily on government reimbursement levels than hospitals with a lower percentage of Medicare and Medicaid patients. Hospitals with greater numbers of Medicaid and Medicare beneficiaries can struggle to draw patients with private insurance to balance the scales.

What is the average payor mix at U.S. hospitals?

On average, payor mix between Medicare, Medicaid and private/self-pay at U.S. hospitals is estimated at:

Average payor mix based on net patient revenue

 


Fig. 1 Data is from the Definitive Healthcare HospitalView product. Data is sourced from the Medicare Cost Report. The most recent data is from the January 2022 release and new data is released quarterly. Accessed February 2022.

How is payor mix changing?

The percentage of the total payor mix from private/self-pay revenue increased from 66.5% in 2018 to 67.4% in 2020. The Medicare percentage decreased from 21.8% to 20.5%.

In addition, the percentage of patient days covered by private/self-payors has increased from 42.5% in 2010 to 53.3% in 2020 while the percentage of Medicare patient days decreased by about six percentage points to 38.6%. This trend points towards the increase in Medicare Advantage enrollment, or the Medicare Part C plans offered by private payors approved by Medicare.

The payor mix percentage for Medicaid revenue increased slightly from 12.8% to 13.2% 2018 to 2020. As Medicaid enrollment has been increasing with the expansion of the Affordable Care Act (ACA) and through the COVID-19 pandemic, this metric may continue to see an uptick through 2021 (pending hospital data).

Which hospitals have the highest and lowest Medicare payor mix?

Below are the top hospitals with the highest and lowest payor mixes for Medicare and Medicaid.

Top Hospitals with Highest Medicare Payor Mix

Hospital Definitive ID Payor Mix: Medicare Days Number of Medicare Discharges Net Patient Revenue 
Ridgeview Behavioral Hospital 585562 96.2% 1,071 $22,370,454
Encompass Health Rehabilitation Hospital of Wichita Falls 6273 86.3% 1,323 $32,278,434
Levindale Hebrew Geriatric Center & Hospital 5112 82.4% 942 $82,024,554
Intensive Specialty Hospital - Shreveport Campus 5258 82.0% 1.297 $61,567,066
Vibra Rehabilitation Hospital of Rancho Mirage 966404 81.5% 652 $18,569,881
Encompass Health Rehabilitation Hospital of Salisbury 5295 81.4% 1,303 $30,613,814
Tidelands Health Rehabilitation Hospital - Murrells Inlet 981256 80.2% 1,118 $29,190,788
PAM Health Specialty Hospital of Oklahoma City 5946 79.9% 230 $13,756,150
The Blackberry Center 976111 79.7% 797 $14,677,483
AnMed Health Rehabilitation Hospital 274169 79.6% 1,007 $23,893,752


Fig. 2 Data is from the Definitive Healthcare HospitalView product. Data is sourced from the Medicare Cost Report. The most recent data is from the January 2022 release and new data is released quarterly. Accessed February 2022.

Ridgeview Behavioral Hospital, a psychiatric hospital in Middle Point, Ohio has a Medicare payor mix of over 96%. The payor mix for Encompass Health Rehabilitation Hospital of Wichita Falls was 86%.

Top Hospitals with Lowest Medicare Payor Mix

Hospital Definitive ID Payor Mix: Medicare Days Number of Medicare Discharges Net Patient Revenue
The Woman's Hospital of Texas 3995 0.2% 64 $388,496,833
Lucile Packard Children’s Hospital Stanford 586 0.3% 51 $1,790,984,113
Nationwide Children’s Hospital 5966 0.3% 67 $1,592,983,991
UPMC Children’s Hospital of Pittsburgh 3443 0.3% 59 $663,784,447
USA Children’s & Women’s Hospital 92 0.3% 52 $203,457,007
Ann & Robert H Lurie Children’s Hospital of Chicago 5783 0.4% 60 $889,202,079
Children’s Hospital Los Angeles 360 0.4% 61 $990,411,478
Children’s Hospital of Michigan 2110 0.4% 50 $333,753,097
Children’s Hospital of Philadelphia (AKA CHOP) 3567 0.4% 78 $2,059,747,363
Children’s of Alabama 5365 0.4% 60 $682,388,215


Fig. 3 Data is from the Definitive Healthcare HospitalView product. Data is sourced from the Medicare Cost Report. The most recent data is from the January 2022 release and new data is released quarterly. Accessed February 2022.

The Woman’s Hospital of Texas in Houston has the lowest payor mix from Medicare at 0.2%. It is the only short-term acute care hospital on the list with the remaining being children’s hospitals.

Which hospitals have the highest and lowest Medicaid payor mix?

Top Hospitals with Highest Medicaid Payor Mix

Hospital Definitive ID Payor Mix: Medicaid Days Number of Medicaid Discharges Net Patient Revenue
College Hospital Costa Mesa 474 84.1% 2,985 $101,039,941
Meadowbrook Rehabilitation Hospital 1565 82.8% 138 $15,139,951
Mohawk Valley Psychiatric Center 5098 82.4% 440 n/a
Hospital for Special Care 5400 80.9% 342 $106,196,817
College Medical Center 391 80.5% 5,941 $140,724,410
Hebrew SeniorLife - Hebrew Rehabilitation Center 6261 79.6% 233 $117,840,533
Lake Taylor Transitional Care Hospital 5279 79.5% 85 $39,864,132
Tewksbury Hospital 5375 77.3% 331 n/a
Cornerstone Behavioral Health - El Dorado 947886 76.8% 1,515 $8,351,105
Nemours Children’s Hospital 541988 74.7% 112 $171,087,886


Fig. 4 Data is from the Definitive Healthcare HospitalView product. Data is sourced from the Medicare Cost Report. The most recent data is from the January 2022 release and new data is released quarterly. Accessed February 2022.

College Hospital Costa Mesa has a Medicare payor mix of about 84%. Meadowbrook Rehabilitation Hospital in Gardner, Kansas and Mohawk Valley Psychiatric Center in Utica, New York each have a Medicaid payor mix of over 82%.

Top Hospitals with Lowest Medicaid Payor Mix

Hospital Definitive ID Payor Mix: Medicaid Days Number of Medicaid Discharges Net Patient Revenue
Spence and Becky Wilson Baptist Children's Hospital 855022 0.0% 2,705 $63,002,072
Carrollton Regional Medical Center 3942 0.1% 183 $60,334,843
AdventHealth Shawnee Mission 1568 0.3% 62 $497,617,635
Laurel Ridge Treatment Center 5223 0.4% 51 $62,824,257
Oro Valley Hospital 202 0.4% 318 $110,074,393
Tulane Medical Center 1794 0.4% 186 $447,623,576
Goshen Health Hospital 1308 0.5% 132 $237,540,895
Ascension Providence 4082 0.6% 107 $282,922,818
Ascension Seton Williamson 4193 0.6% 68 $187,439,134
East Jefferson General Hospital 1769 0.6% 56 $273,007,379


Fig. 5 Data is from the Definitive Healthcare HospitalView product. Data is sourced from the Medicare Cost Report. The most recent data is from the January 2022 release and new data is released quarterly. Accessed February 2022.

Spence and Becky Wilson Baptist Children’s Hospital in Memphis, Tennessee, has the lowest Medicaid payor mix, followed by Carrollton Regional Medical Center in Carrollton, Texas.

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