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Top Hospitals by Medicaid and Medicare Payor Mix

According to a survey released by the Medical Group Management Association (MGMA), operating expenses for medical practices increased at nearly the same rate as revenue between 2015 and 2016. Practices with increased revenue primarily attribute this growth to a greater number of non-physician providers (NPP) and key support staff.

The MGMA study states that medical practices with a higher NPP-to-physician ratio earn more in net revenue than those with lower ratios while also reporting greater productivity. The study compared more than 2,900 provider organizations and over 40 practice types.

Another key point from the survey stated that primary care practices with lower percentages of government payor mixes, like Medicaid and Medicare, were more likely to have both higher operating costs and greater revenue. On average, practices with a payor mix of less than 30 percent yielded more than $159,000 more in revenue per physician than those with a mix of 50 percent or more. That number jumps to $221,000 for hospital-owned practices.

Practices that serve primarily Medicare and Medicaid beneficiaries, such as safety-net hospitals, rely far more heavily on 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 their practices to balance the scales.

Below are the top hospitals with the highest and lowest payor mixes for Medicaid and Medicare, as well as net patient revenue.

Top 10 Hospitals with Highest Medicare Payor Mix in 2015

Hospital Payor Mix # Medicare Discharges Net Patient Revenue (M)
Tennessee Health Management 98.8% 1,115 $15.1
Ridgeview Behavioral Hospital 94.7% 1,003 $12.7
The Willough at Naples 92.2% 1,001 $16.1
Promise Hospital of Louisiana – Shreveport 88.2% 1,753 $53.6
HealthSouth Rehabilitation Hospital of Wichita Falls 87.0% 1,263 $26.9
Levindale Hebrew Geriatric Center and Hospital 86.8% 1,286 $77.4
NeuroPsychiatric Hospitals 86.3% 1,740 $29.3
Kindred Hospital South Bay 85.9% 554 $29.2
Preferred Management Healthcare Specialists 85.8% 1,422 $64.1
One Cura Wellness 85.6% 185 $35.5

Fig 1 Data from Definitive Healthcare using most recent CMS data. Only hospitals with 50 or more beds and 50 or more Medicare discharges were included to decrease variability.

Top 10 Hospitals with Lowest Medicare Payor Mix in 2015

Hospital Payor Mix # Medicare Discharges Net Patient Revenue (M)
Texas Children’s Hospital 0.2% 95 $1,695
Cincinnati Children’s Hospital Medical Center – Burnet Campus 0.3% 97 $1,597
Children’s Mercy Hospital 0.4% 55 $1,149
Children’s Hospital of Philadelphia 0.4% 107 $1,796
Ann & Robert H. Lurie Children’s Hospital of Chicago 0.4% 58 $679.4
Nationwide Children’s Hospital 0.4% 95 $1,385
Children’s Hospital of Alabama 0.4% 95 $693.3
Stanford Children’s Health 0.4% 53 $1,239
University of South Alabama Childrens & Womens Hospital 0.5% 82 $131.6
Cook Children’s Medical Center – Ft Worth 0.5% 59 $841.6

Fig 2 Data from Definitive Healthcare using most recent CMS data. Only hospitals with 50 or more beds and 50 or more Medicare discharges were included to decrease variability.

Top 10 Hospitals with Highest Medicaid Payor Mix in 2015

Hospital Payor Mix # Medicaid Discharges Net Patient Revenue (M)
College Hospital Costa Mesa 83.3% 2,117 $102.1
Lakeland Regional Hospital 81.3% 1,701 $28.4
Hebrew Rehabilitation Center 81.1% 195 $116.3
University of South Alabama Childrens & Womens Hospital 80.2% 6,960 $131.6
Hospital for Special Care 79.8% 202 $93.6
Lake Taylor Transitional Care Hospital 76.3% 85 $40.0
Strategic Behavioral Center – Wilmington 76.3% 305 $18.3
Fort Defiance Indian Hospital 75.8% 1,474
Tewksbury Hospital 75.6% 725
North Star Behavioral Hospital 75.-% 972 $26.7

Fig 3 Data from Definitive Healthcare using most recent CMS data. Only hospitals with 50 or more beds and 50 or more Medicare discharges were included to decrease variability.

Top 10 Hospitals with Lowest Medicaid Payor Mix in 2015

Hospital Payor Mix # Medicaid Discharges Net Patient Revenue (M)
Kapiolani Medical Center 0.2% 57 $379.4
Hancock Regional Hospital 0.3% 229 $103.4
Western State Hospital 0.4% 75 $15.2
Shawnee Mission Medical Center 0.5% 92 $454.8
Our Lady of Bellafonte Hospital 0.5% 169 $161.5
Boca Raton Regional Hospital 0.6% 80 $424.6
Paoli Hospital 0.6% 67 $299.0
Carlsbad Medical Center 0.6% 719 $83.4
Manteca Medical Center 0.6% 68
Central Baptist Hospital 0.7% 135 $515.0

Fig 4 Data from Definitive Healthcare using most recent CMS data. Only hospitals with 50 or more beds and 50 or more Medicare discharges were included to decrease variability.

Visit the Definitive Blog to read more about CMS programs like bundled payments and CJR coverage at ASCs.

Definitive Healthcare has the most up-to-date, comprehensive and integrated data on over 7,700 hospitals, 1.4 million physicians, and numerous other healthcare providers. Our database features detailed clinical information on hospitals and health systems, including procedure analytics, payments, and participation in CMS programs.

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