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Top hospitals by Medicaid and Medicare payor mix

Jul 3rd, 2023

By Maggy Bobek Tieché 5 min read
Top hospitals by Medicaid and Medicare payor mix

Revenue sources for U.S. hospitals play an important role in an organization’s financial health and performance. This payor mix, or payer mix, refers to the percentage of hospital revenue from healthcare 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.

Results in the following analysis are aggregated from the most recent 12-month interval tracked in our database. The most recent full calendar year of data available at the time of publishing is for 2021.

Why is payor mix important in healthcare?

Payor mix is an important metric to track because self-paying patients and healthcare 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 and derived from the Medicare Cost Report. Accessed June 2023.

How is payor mix changing?

The percentage of the total payor mix from private/self-pay revenue increased from 66.5% in 2018 to 68.9% in 2021. The Medicare percentage decreased from 21.8% to 18.9%.

In addition, the percentage of patient days covered by private/self-payors has increased from 42.7% in 2011 to 56.5% in 2021 while the percentage of Medicare patient days decreased by about 10 percentage points to 35.6%. 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 13.5% 2018 to 2021. Medicaid enrollment has been increasing with the expansion of the Affordable Care Act (ACA) and during the COVID-19 pandemic.

Which hospitals have the highest and lowest Medicare payor mix?

Below are the top hospitals with the highest and lowest payor mix days for Medicare. For this analysis, only hospitals with more than 50 discharges in the previous year and more than 50 beds are included to minimize outliers.

U.S. hospitals by highest Medicare payor mix

RankDefinitive IDHospital nameHospital typeLocationPayor mix: Medicare days
16194Whittier Rehabilitation Hospital - WestboroughLong-term acute care hospitalWestborough, MA91.3%
2585562Ridgeview Behavioral HospitalPsychiatric hospitalMiddle Point, OH86.1%
36273Encompass Health Rehabilitation Hospital of Wichita FallsRehabilitation hospitalWichita Falls, TX85.9%
45653Deers Head Hospital CenterLong-term acute care hospitalSalisbury, MD82.9%
5274169AnMed Health Rehabilitation HospitalRehabilitation hospitalAnderson, SC82.4%
6981256Tidelands Health Rehabilitation Hospital - Murrells InletRehabilitation hospitalMurrells Inlet, SC82.3%
71012378Encompass Health Rehabilitation Hospital of CummingRehabilitation hospitalCumming, GA80.7%
85295Encompass Health Rehabilitation Hospital of SalisburyRehabilitation hospitalSalisbury, MD80.5%
9976111The Blackberry CenterPsychiatric hospitalSaint Cloud, FL80.3%
101046223Encompass Health Rehabilitation Hospital of LakelandRehabilitation hospitalLakeland, FL77.4%

Fig. 2 Data is from the Definitive Healthcare HospitalView product and derived from the Medicare Cost Report. Accessed June 2023.

Whittier Rehabilitation Hospital - Westborough in Massachusetts, a long-term acute care hospital, has the highest Medicare payor mix at 91.3%. Second, Ridgeview Behavioral Hospital, a psychiatric hospital in Middle Point, Ohio has a Medicare payor mix of over 86.1%.

U.S. hospitals by lowest Medicare payor mix

Definitive IDHospital nameHospital typeLocationPayor mix: Medicare days
4941Austin State HospitalPsychiatric hospitalAustin, TX0.0%
843011Children’s Hospital Colorado - Colorado SpringsChildren’s hospitalColorado Springs, CO0.0%
6343Children’s Scottish Rite HospitalChildren’s hospitalAtlanta, GA0.0%
542196El Paso Children’s HospitalChildren’s hospitalEl Paso, TX0.0%
5579Eleanor Slater HospitalLong-term acute care hospitalCranston, RI0.0%
7252Nationwide Children’s Hospital - ToledoChildren’s hospitalToledo, OH0.0%
6212Nationwide Children’s Hospital - ToledoPsychiatric hospitalRichmond, IN0.0%

Fig. 3 Data is from the Definitive Healthcare HospitalView product and derived from the Medicare Cost Report. Accessed June 2023.

Seven U.S. hospitals have zero Medicare payor mix days. Four hospitals on the list are children’s hospitals. Since Medicare supports individuals over the age of 65, it is fitting that many children’s hospitals do not receive any Medicare reimbursement.

Which hospitals have the highest and lowest Medicaid payor mix?

Seven U.S. hospitals have zero Medicare payor mix days. Four hospitals on the list are children’s hospitals. Since Medicare supports individuals over the age of 65, it is fitting that many children’s hospitals do not receive any Medicare reimbursement.

U.S. hospitals with highest Medicaid payor mix

RankDefinitive IDHospital nameHospital typeLocationPayor mix: Medicaid days
11565Meadowbrook Rehabilitation HospitalRehabilitation hospitalGardner, KS85.7%
25279Lake Taylor Transitional Care HospitalLong-term acute care hospitalNorfolk, VA85.4%
36252Brookhaven HospitalPsychiatric hospitalTulsa, OK84.5%
48098Mohawk Valley Psychiatric CenterPsychiatric hospitalUtica, NY83.1%
55122Brentwood Behavioral HealthcarePsychiatric hospitalFlowood, MS82.5%
6840550Perimeter Behavioral Hospital of West MemphisPsychiatric hospitalWest Memphis, AR81.4%
7947886Cornerstone Behavioral Health - El DoradoPsychiatric hospitalTucson, AZ81.0%
8541988Nemours Children’s Hospital - FloridaChildren’s hospitalOrlando, FL80.3%
96261Hebrew SeniorLife - Hebrew Rehabilitation CenterLong-term acute care hospitalBoston, MA79.3%
105400Hospital for Special CareLong-term acute care hospitalBritain, CT79.0%

Fig. 4 Data is from the Definitive Healthcare HospitalView product and derived from the Medicare Cost Report. Accessed June 2023.

Meadowbrook Rehabilitation Hospital in Gardner, Kansas and Lake Taylor Psychiatric Care Hospital in Norfolk, Virginia have the highest Medicaid payor mix days, each at more than 85%.

U.S. hospitals with lowest Medicaid payor mix

Definitive IDHospital nameHospital typeLocationPayor mix: Medicaid days
5670Baton Rouge Rehab HospitalRehabilitation hospitalBaton Rouge, LA0.0%
3916Baylor Scott & White Heart and Vascular Hospital - DallasShort term acute care hospitalDallas, TX0.0%
3942Carrollton Regional Medical CenterShort term acute care hospitalCarrollton, TX0.0%
2548CHI Health Nebraska HeartShort term acute care hospitalLincoln, NE0.0%
577363Hoag Orthopedic InstituteShort term acute care hospitalIrvine, CA0.0%
1079Kuakini Medical CenterShort term acute care hospitalHonolulu, HI0.0%
1566Menorah Medical CenterShort term acute care hospitalOverland Park, KS0.0%
4910Sea Pines Rehabilitation HospitalRehabilitation hospitalMelbourne, FL0.0%
855022Spence and Becky Wilson Baptist Children’s HospitalChildren’s HospitalMemphis, TN0.0%
5391Springbrook Behavioral HealthPsychiatric hospitalTravelers Rest, SC0.0%
6093Terrell State HospitalPsychiatric hospitalTerrell, TX0.0%

Fig. 5 Data is from the Definitive Healthcare HospitalView product and derived from the Medicare Cost Report. Accessed June 2023.

Eleven hospitals currently have Medicaid payor mix days at 0.0%. The hospitals on the list range from a children’s hospital to psychiatric and rehabilitation hospitals. A number of the short-term acute care hospitals on the list are specialty hospitals for the heart or orthopedics.

Learn more

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Start a free trial today to start analyzing hospital financial performance, segmenting accounts by revenue figures or payor mix, and reaching the right key contacts.

Maggy Bobek Tieché

About the Author

Maggy Bobek Tieché

Maggy Bobek Tieché has worked with healthcare data for nearly 18 years. Her positions include roles in product management and custom reporting, working with life science,…

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