The Definitive Blog

Top Hospitals by Outpatient Medicare Claims

Throughout 2017 hospitals and care providers found themselves competing with outpatient care centers. In addition to nearly 8,700 ambulatory surgery centers (ASCs) in the U.S., hospitals must also compete with over 10,800 urgent care clinics and more than 2,500 retail clinics. Patients are continually seeking care that is both convenient and cost-effective, leading to the rise of these outpatient facilities.

In an effort to stem revenue loss, hospitals and integrated delivery networks (IDNs) are building surgery centers, clinics, and imaging centers so patients have the option to stay in-network when seeking outpatient services. This ensures revenue retention and eases information sharing among providers. Hospitals and IDNs are also partnering with ASCs and retail clinics outside their networks to prevent care fragmentation and improve patient care delivery.

Top 10 Hospitals by Medicare Outpatient Claims

Hospital Name Medicare Claims Q1 2017 Medicare Payments Q1 2017 (M) Avg Payment per Procedure
University of Texas MD Anderson Cancer Center 773,810 $56.6 $73
Cleveland Clinic 732,503 $52.6 $71
Evanston Hospital 565,882 $38.2 $67
Scott & White Medical Center – Temple 492,743 $31.4 $64
Memorial Sloan Kettering Cancer Center 479,032 $68.2 $142
University of Michigan Hospital 469,390 $36.8 $78
Eisenhower Medical Center 439,092 $31.0 $71
Florida Hospital Orlando 426,175 $31.1 $73
New York Presbyterian – Weill Cornell Medical Center 418,135 $38.2 $91
Massachusetts General Hospital 407,741 $42.2 $103

Fig 1 Data from Definitive Healthcare based on most recent CMS data. 2017 Q1 data is latest available; new data is released 6 months after the end of each quarter.

Hospitals and IDNs are also combating revenue loss and care fragmentation through ACO alignment, joint ventures, and improved care outcomes via CMS programs. A shift in focus to a value-based care model—rather than the traditional fee-for-service model—is incentivizing providers to deliver more efficient and cost-effective care. Improved care outcomes are also encouraged under a value-based model, with shorter patient length-of-stay and reduced 30-day readmissions rates being more profitable than under a fee-for-service model.

Joint ventures between hospitals and outpatient care centers can be beneficial for facilities and for patients. For patients with complicated conditions, such as those requiring dialysis treatments, it is essential that acute care is easily accessible. However, it can be difficult for hospitals or large health systems to respond quickly to healthcare trends or to offer a facility in a fast-growing area. In these cases, it is quicker and easier for a hospital or health system to partner with an outpatient clinic or surgery center. The hospital can send patients to an affiliated facility without worry of care fragmentation, clinics receive greater numbers of patient referrals, and patients have a better care experience and, likely, a better care outcome.

Top 10 States with Most Medicare Outpatient Claims

State Medicare Claims Q1 2017 Medicare Payments Q1 2017 (M) Avg Payment per Procedure
CA 12,685,134 $1,039.7 $82
TX 11,505,892 $759.5 $67
FL 9,829,390 $678.3 $69
IL 9,005,505 $573.8 $65
PA 8,285,786 $546.9 $66
NY 8,141,331 $642.5 $78
OH 8,019,707 $491.4 $62
MI 7,399,935 $461.5 $62
NC 6,190,376 $461.8 $74
MA 5,848,208 $439.1 $75

Fig 2 Data from Definitive Healthcare based on most recent CMS data. 2017 Q1 data is latest available; new data is released 6 months after the end of each quarter.

As care costs continue to rise, healthcare providers must continue to find innovative ways to deliver quality care at minimal costs. This is increasingly challenging as the industry is faced with the potential for physician shortages and GPO and IDN consolidation. Hospital and health system executives need to remain focused on financial and clinical performance in order to keep abreast of industry trends and cost fluctuations.

Visit the Definitive blog to read more about Top Hospices by Medicare Payments.

Definitive Healthcare is the leading provider of up-to-date, comprehensive, and integrated data on the healthcare industry. Our database tracks financial and clinical intelligence on more than 8,800 hospitals & IDNs, 1.6 million physicians, 8,700 ambulatory surgery centers, and more.

Related Posts