Section 8: Health Care Providers and Service Availability Hospital system and capacity Utilization of hospital services Hospital financial trends Hospital capital expenditures Hospital community benefit Availability of specific health care services at hospitals (e.g., imaging, surgery) Physician services 1

HOSPITAL SYSTEM AND CAPACITY

Hospital Capacity in Minnesota, *Available beds is defined as the number of acute care beds that are immediately available for use or could be brought online within a short period of time. **Licensed beds is defined as the number of beds licensed by the Department of Health, under Minnesota Statutes, sections to Source: MDH Health Economics Program analysis of hospital annual reports, U.S. Census Bureau Unless otherwise noted, all data is this section is for each hospital’s fiscal year. Number of Hospitals Available Beds* Occupancy Rate Based on Available Beds Licensed Beds** Occupancy Rate Based on Licensed Beds Available Beds Per 1,000 Population 13311, %16, %2.2

Minnesota Geographic Regions: Definition 4

Regional Hospital Capacity in Minnesota, 2012 Number of Hospitals Available Beds* Occupancy Rate Based on Available Beds Licensed Beds** Occupancy Rate Based on Licensed Beds Available Beds Per 1,000 Population Central191, %1, %1.6 Metro265, %8, %2.0 Northeast171, %1, %3.6 Northwest % %1.9 South Central % %1.9 Southeast121, %2, %3.3 Southwest % %2.7 West Central % %1.7 Total13311, %16, %2.2 *Available beds is defined as the number of acute care beds that are immediately available for use or could be brought online within a short period of time. **Licensed beds is defined as the number of beds licensed by the Department of Health, under Minnesota Statutes, sections to Source: MDH Health Economics Program analysis of hospital annual reports. 5

Distribution of Minnesota’s Hospitals by Size and Region, Source: MDH Health Economics Program analysis of hospital annual reports. Under 25 Beds Beds Beds Beds 200 or More Beds Total Central10.5%68.4%10.5%5.3% 100.0% Metro3.8%11.5%26.9%11.5%46.2%100.0% Northeast41.2%23.5%17.6%5.9%11.8%100.0% Northwest46.2% 0.0%7.7%0.0%100.0% South Central46.7%33.3%13.3%6.7%0.0%100.0% Southeast25.0% 33.3%0.0%16.7%100.0% Southwest39.1%56.5%4.3%0.0% 100.0% West Central37.5% 12.5% 0.0%100.0% Statewide28.6%37.6%15.0%6.0%12.8%100.0% By Number of Available Beds

Ownership of Minnesota Hospitals, Source: MDH Health Economics Program analysis of hospital annual reports. Government, 34, 25.6% City: 7.5% County: 5.3% City and County: 1.5% District: 11.3%

Affiliation of Minnesota Community Hospitals, Number of Hospitals Source: MDH Health Economics Program analysis of hospital annual reports.

Largest Minnesota Hospital Systems, Number of Hospitals *Previously known as Sioux Valley. Changes in the number of hospital affiliations impact trend lines over time. **Essentia represents the merger of Benedictine and SMDC systems and includes both systems over time. Source: MDH Health Economics Program analysis of hospital annual reports.

Minnesota Hospital System Ownership, 2012 Hospital SystemOwnedManagedLeasedTotalAvailable Beds Allina Hospitals and Clinics ,857 Avera Health Catholic Health Initiatives CentraCare Health System Children's Hospitals and Clinics Essentia Community Hospitals and Clinics (ECHC) Fairview Health Services70071,414 HealthEast Care System HealthPartners, Inc Mayo Clinic1300 1,748 Ministry Health Care North Memorial Health Care Park Nicollet Health Services Paynesville Area Health Care System Quorum Health Resources Rice Memorial Hospital Sanford Health Select Medical Corporation St. Luke's Hospital, Duluth Total *9,699 Unaffiliated Hospitals492, Source: MDH Health Economics Program analysis of hospital annual reports. *Hospitals with multiple affiliations are counted under each affiliation; for hospitals with multiple affiliations available beds are divided across systems equally.

Composition of Minnesota’s Hospital Workforce, *Includes nurse anesthetists, nurse practitioners, and physician assistants. **Other is reported as a grouped category of positions. Source: MDH Health Economics Program analysis of hospital annual reports.

UTILIZATION OF HOSPITAL SERVICES

Minnesota Hospital Outpatient Visits and Inpatient Admissions, 2002 to Source: MDH Health Economics Program analysis of hospital annual reports. Admissions Outpatient visits Inpatient admissions

Average Length of Stay in Minnesota Hospitals, 2002 to Source: MDH Health Economics Program analysis of hospital annual reports. Average length of stay grew by 1.9% in 2012 but due to rounding it appears constant. Average length of stay (days)

Average Length of Stay: Rural and Urban Minnesota Hospitals, 2002 to A hospital is defined as rural if it is located in a county that is not part of a metropolitan statistical area. Source: MDH Health Economics Program analysis of hospital annual reports. Average length of stay (days)

Minnesota Hospital Utilization by Region, Source: MDH Health Economics Program analysis of hospital annual reports. Inpatient Admissions Inpatient Days Average Length of Stay (days) Outpatient Visits Central56,477204, ,602,863 Metro326,2031,482, ,290,921 Northeast43,984193, ,749 Northwest14,98551, ,816 South Central21,21775, ,323 Southeast74,919347, ,804,865 Southwest12,41639, ,534 West Central10,47838, ,025 Statewide560,6792,432, ,132,096

Distribution of Hospital Admissions and Inpatient Days by Type of Service, 2012 Percent of Admissions Percent of Inpatient Days Medical & surgical care30.5%31.4% Cardiac care11.4%9.6% Obstetric care11.6%6.9% Orthopedic care11.5%8.9% Psychiatric care5.9%10.4% Neurology care5.2%5.4% Neonatal care (excluding births)3.6%4.4% Chemical dependency care1.4%1.8% Rehabilitation1.0%2.7% Other acute care17.8%18.4% Total acute care100.0% 17 Source: MDH Health Economics Program analysis of hospital annual reports.

Trend in Outpatient Surgeries at Minnesota Hospitals, 2002 to Source: MDH Health Economics Program analysis of hospital annual reports.

Trend in Emergency Room Visits at Minnesota Hospitals, 2002 to Source: MDH Health Economics Program analysis of hospital annual reports. Emergency Room Visits in Thousands

HOSPITAL FINANCIAL TRENDS

Net Assets of Minnesota Hospitals, 2002 to Source: MDH Health Economics Program analysis of hospital annual reports. Net assets is an accounting term defining the total assets minus the total liabilities, and describes the hospital’s financial position. Billions of dollars

Net Income of Minnesota Hospitals, 2002 to Source: MDH Health Economics Program analysis of hospital annual reports. Millions of dollars

Minnesota Hospitals' Net Income as a Percent of Revenue, 2002 to Source: MDH Health Economics Program analysis of hospital annual reports.

Hospital Financial Indicators by Region, 2012 Net Income (Million Dollars) Net Income as a % of Revenue Central$ % Metro$ % Northeast$ % Northwest$ % South Central$ % Southeast$ % Southwest$ % West Central$ % Statewide$1, % 24 Source: MDH Health Economics Program analysis of hospital annual reports.

Hospital Financial Indicators by Hospital Size, Number of available beds. Source: MDH Health Economics Program analysis of hospital annual reports. Net Income (Million Dollars) Net Income as a % of Revenue Under 25 Beds $ % 25 to 49 Beds $ % 50 to 99 Beds $ % 100 to 199 Beds $ % 200 Beds or More $ % Critical Access $ % PPS $1, % Other $9.47.9% All Hospitals $1, %

Sources of Patient Revenue for Minnesota Hospitals, *Includes Medical Assistance and MinnesotaCare. A hospital is defined as rural if it is located in a county that is not part of a metropolitan statistical area. Source: MDH Health Economics Program analysis of hospital annual reports. Percent of Hospital Patient Revenue Rural Facilities Urban Facilities Facilities Statewide Medicare 38.8%28.5%30.6% State Public Programs* 10.4%12.7%12.3% Private Insurance 44.8%53.1%51.4% Self-Pay 4.4%3.5%3.7% Other Payers 1.6%2.2%2.1% All Payers 100.0%

HOSPITAL CAPITAL EXPENDITURES

Capital Expenditure Commitments by Minnesota Hospitals, Percent of Minnesota hospitals reporting major capital expenditure commitment 30.8% 25.6% Total number of capital expenditure commitments reported91 83 Value of major capital expenditure commitments reported (Millions) $412.0 $ Major spending commitments that are reportable under 62J.17 include expenditures in excess of $ 1 million. Spending commitments are included by calendar date; 2011 figures reflect projects reported during 2012 and is a revision over previous publications. Source: MDH Health Economics Program analysis of hospital annual reports.

Minnesota Hospital Capital Expenditure Commitments by Type, 2012 Capital Expenditure Commitments (Millions) Percent of Total Capital Expenditure Commitments Medical equipment $ % Building and space $ % Other $ % All Major Capital Expenditure Commitments $ % 29 Source: MDH Health Economics Program analysis of hospital annual reports.

Minnesota Hospital Capital Expenditure Commitment by Category, 2012 Capital Expenditure Commitments (Millions) Percent of Total Capital Expenditure Commitment Other Patient Care Services$ % General Infrastructure$ % Diagnostic Imaging$ % Surgery$ % Cardiac Care$ % Intensive Care (ICU or NICU)$ % Obstetrics$9.71.7% Orthopedics$6.21.1% Radiation Therapy$5.61.0% Emergency Care$4.40.8% Mental Health$2.70.5% Chemical Dependency$2.30.4% All Major Capital Projects$ % 30 Major spending commitments that are reportable under 62J.17 include expenditures in excess of $ 1 million. Source: MDH Health Economics Program analysis of hospital annual reports.

COMMUNITY BENEFIT

Community Benefit Provided by Minnesota Hospitals, 2012 Community Benefit (Millions) Percent of Total Operating Expenses Community Care$ % State Health Care Programs Underpayment$ % Operating Subsidized Services$ % Education$ % Research$ % Community Health Services$ % Financial and In-Kind Contributions$ % Community Building Activities$5.40.0% Community Benefit Operation$ % Total$1, % 32 Source: MDH Health Economics Program analysis of hospital annual reports.

Distribution of Minnesota Hospitals’ Community Benefit by Category, Source: MDH Health Economics Program analysis of hospital annual reports. For definitions see: MDH/Health Economics Program, “Community Benefit Provided by Minnesota Hospitals in 2007, and forthcoming 2012 report,” (

AVAILABILITY OF SPECIFIC HOSPITAL SERVICES

Services Available in Minnesota Hospitals, *Services are considered “available” when they are provided on site by hospital staff, on site through contracted services, or off site through shared services agreement. Source: MDH Health Economics Program analysis of hospital annual reports. Number of Hospitals Services Available* Services Not Available Surgery Inpatient Surgery 1276 Outpatient Surgery 1312 Open-Heart Surgery Services Organ Transplant Services 6127 Mental Health/Chemical Dependency Services Outpatient Psychiatric Services 6271 Detoxification Services Diagnostic Radiology Computer Tomography (CT) Scanning Services 1321 Magnetic Resonance Imaging (MRI) Services 1303 Positron Emission Tomography (PET) Services 8125 Single Photon Emission Computerized Tomography (SPECT) Services 4093 Other Services Renal Dialysis Services 4093 Cardiac Catheterization Services 25108

PHYSICIAN SERVICES

Number of Physicians Practicing in Minnesota, Primary Care includes: General Family Medicine, General Internal Medicine, General Pediatrics. No Certification means there were no board certifications on the record received from the Minnesota Board of Medical Practice. Source: Minnesota Board of Medical Practices, analysis of MDH, Office of Rural Health & Primary Care. Number of Physicians:15,523 Primary Care Physicians4,937 Specialty Care Physicians7,532 No Certification3,054 Physicians per 100,000 Population:290 Primary Care Physicians92 Specialty Care Physicians141

Number of Physicians Practicing in Minnesota by MSA and Non-MSA Counties, MSA Defintions, OMB Note: Due to methodology changes, past Chartbook data should not be used for comparison. Source: Minnesota Board of Medical Practices, analysis by MDH, Office of Rural Health & Primary Care. RuralMicropolitanUrbanStatewide Number of Physicians: 5721,13613,81515,523 Primary Care Physicians ,0684,937 Specialty Care Physicians ,0147,532 Physicians per 100,000 Population: Primary Care Physicians Specialty Care Physicians

Distribution of Number of Physicians Practicing in Minnesota by Location and Specialty, RuralMicropolitanUrbanStatewide Primary Care Physicians59.6%46.5%29.4%31.8% Internal Medicine Subspecialty Physicians 0.9%2.7%10.4%9.5% Surgeons9.8%19.0%13.7%13.9% Other Specialty Physicians 6.8%15.1%26.7%25.1% No Certification22.9%16.7%19.8%19.7% All Specialties 100% MSA Defintions, OMB Note: Due to methodology changes, past Chartbook data should not be used for comparison. Source: Minnesota Board of Medical Practices, analysis by MDH, Office of Rural Health & Primary Care.

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