1. 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

2. HOSPITAL SYSTEM AND CAPACITY

3. Hospital Capacity in Minnesota, 2012 3 *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 144.50 to 144.58. 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 13311,72156.9%16,41240.6%2.2

4. Minnesota Geographic Regions: Definition 4

5. 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 Central191,18947.2%1,37740.7%1.6 Metro265,88369.0%8,48447.9%2.0 Northeast171,16545.5%1,41137.6%3.6 Northwest1339035.8%57824.2%1.9 South Central1555937.0%77926.5%1.9 Southeast121,62258.6%2,64036.0%3.3 Southwest2358518.6%72515.0%2.7 West Central832832.0%41825.1%1.7 Total13311,72156.9%16,41240.6%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 144.50 to 144.58. Source: MDH Health Economics Program analysis of hospital annual reports. 5

6. Distribution of Minnesota’s Hospitals by Size and Region, 2012 6 Source: MDH Health Economics Program analysis of hospital annual reports. Under 25 Beds 25-49 Beds 50-99 Beds 100-199 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

7. Ownership of Minnesota Hospitals, 2012 7 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%

8. Affiliation of Minnesota Community Hospitals, 1992- 2012 8 Number of Hospitals Source: MDH Health Economics Program analysis of hospital annual reports.

9. Largest Minnesota Hospital Systems, 2002-2012 9 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.

10. Minnesota Hospital System Ownership, 2012 Hospital SystemOwnedManagedLeasedTotalAvailable Beds Allina Hospitals and Clinics1010111,857 Avera Health120399 Catholic Health Initiatives5005107 CentraCare Health System2013515 Children's Hospitals and Clinics1001279 Essentia Community Hospitals and Clinics (ECHC) 91010773 Fairview Health Services70071,414 HealthEast Care System4004630 HealthPartners, Inc.2002502 Mayo Clinic1300 1,748 Ministry Health Care100123 North Memorial Health Care2002440 Park Nicollet Health Services2103433 Paynesville Area Health Care System100130 Quorum Health Resources010125 Rice Memorial Hospital100118 Sanford Health56415430 Select Medical Corporation100192 St. Luke's Hospital, Duluth0202284 Total6714586*9,699 Unaffiliated Hospitals492,022 10 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.

11. Composition of Minnesota’s Hospital Workforce, 2012 11 *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.

12. UTILIZATION OF HOSPITAL SERVICES

13. Minnesota Hospital Outpatient Visits and Inpatient Admissions, 2002 to 2012 13 Source: MDH Health Economics Program analysis of hospital annual reports. Admissions Outpatient visits Inpatient admissions

14. Average Length of Stay in Minnesota Hospitals, 2002 to 2012 14 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)

15. Average Length of Stay: Rural and Urban Minnesota Hospitals, 2002 to 2012 15 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)

16. Minnesota Hospital Utilization by Region, 2012 16 Source: MDH Health Economics Program analysis of hospital annual reports. Inpatient Admissions Inpatient Days Average Length of Stay (days) Outpatient Visits Central56,477204,6413.61,602,863 Metro326,2031,482,4134.54,290,921 Northeast43,984193,4044.4949,749 Northwest14,98551,0313.4647,816 South Central21,21775,4723.6724,323 Southeast74,919347,1804.61,804,865 Southwest12,41639,7143.2557,534 West Central10,47838,3433.7554,025 Statewide560,6792,432,1984.311,132,096

17. 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.

18. Trend in Outpatient Surgeries at Minnesota Hospitals, 2002 to 2012 18 Source: MDH Health Economics Program analysis of hospital annual reports.

19. Trend in Emergency Room Visits at Minnesota Hospitals, 2002 to 2012 19 Source: MDH Health Economics Program analysis of hospital annual reports. Emergency Room Visits in Thousands

20. HOSPITAL FINANCIAL TRENDS

21. Net Assets of Minnesota Hospitals, 2002 to 2012 21 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

22. Net Income of Minnesota Hospitals, 2002 to 2012 22 Source: MDH Health Economics Program analysis of hospital annual reports. Millions of dollars

23. Minnesota Hospitals' Net Income as a Percent of Revenue, 2002 to 2012 23 Source: MDH Health Economics Program analysis of hospital annual reports.

24. Hospital Financial Indicators by Region, 2012 Net Income (Million Dollars) Net Income as a % of Revenue Central$85.05.2% Metro$556.16.4% Northeast$86.05.9% Northwest$42.79.9% South Central$50.17.5% Southeast$298.412.8% Southwest$26.85.9% West Central$14.24.0% Statewide$1,159.27.3% 24 Source: MDH Health Economics Program analysis of hospital annual reports.

25. Hospital Financial Indicators by Hospital Size, 2012 25 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 $34.66.9% 25 to 49 Beds $153.77.6% 50 to 99 Beds $152.67.2% 100 to 199 Beds $103.46.7% 200 Beds or More $714.97.3% Critical Access $133.37.2% PPS $1,016.67.3% Other $9.47.9% All Hospitals $1,159.27.3%

26. Sources of Patient Revenue for Minnesota Hospitals, 2012 26 *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%

27. HOSPITAL CAPITAL EXPENDITURES

28. Capital Expenditure Commitments by Minnesota Hospitals, 2012 20112012 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 $569.9 28 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.

29. Minnesota Hospital Capital Expenditure Commitments by Type, 2012 Capital Expenditure Commitments (Millions) Percent of Total Capital Expenditure Commitments Medical equipment $85.415.0% Building and space $452.879.5% Other $31.75.6% All Major Capital Expenditure Commitments $569.9100% 29 Source: MDH Health Economics Program analysis of hospital annual reports.

30. Minnesota Hospital Capital Expenditure Commitment by Category, 2012 Capital Expenditure Commitments (Millions) Percent of Total Capital Expenditure Commitment Other Patient Care Services$299.052.5% General Infrastructure$131.223.0% Diagnostic Imaging$35.36.2% Surgery$30.95.4% Cardiac Care$26.84.7% Intensive Care (ICU or NICU)$15.92.8% 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$569.9100.0% 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.

31. COMMUNITY BENEFIT

32. Community Benefit Provided by Minnesota Hospitals, 2012 Community Benefit (Millions) Percent of Total Operating Expenses Community Care$144.91.0% State Health Care Programs Underpayment$488.73.3% Operating Subsidized Services$127.30.9% Education$201.81.4% Research$16.30.1% Community Health Services$36.70.2% Financial and In-Kind Contributions$10.50.1% Community Building Activities$5.40.0% Community Benefit Operation$12.00.1% Total$1,043.57.1% 32 Source: MDH Health Economics Program analysis of hospital annual reports.

33. Distribution of Minnesota Hospitals’ Community Benefit by Category, 2012 33 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,” (www.health.state.mn.us/healtheconomics).www.health.state.mn.us/healtheconomics

34. AVAILABILITY OF SPECIFIC HOSPITAL SERVICES

35. Services Available in Minnesota Hospitals, 2012 35 *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 18115 Organ Transplant Services 6127 Mental Health/Chemical Dependency Services Outpatient Psychiatric Services 6271 Detoxification Services 25109 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

36. PHYSICIAN SERVICES

37. Number of Physicians Practicing in Minnesota, 2011 37 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

38. Number of Physicians Practicing in Minnesota by MSA and Non-MSA Counties, 2011 38 MSA Defintions, OMB 2008. 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 3415284,0684,937 Specialty Care Physicians 1004187,0147,532 Physicians per 100,000 Population:88168364290 Primary Care Physicians527810192 Specialty Care Physicians1562175141

39. Distribution of Number of Physicians Practicing in Minnesota by Location and Specialty, 2011 39 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 2008. 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.

40. Additional Information from the Health Economics Program Available Online Health Economics Program Home Page www.health.state.mn.us/divs/hpsc/hep/index.html Publications www.health.state.mn.us/divs/hpsc/hep/publications/yearly/2010.html Health Care Market Statistics (Chartbook Updates) www.health.state.mn.us/divs/hpsc/hep/chartbook/index.html Interactive Health Insurance Statistics https://pqc.health.state.mn.us/mnha/Welcome.action 40