As the healthcare industry is ever-changing, hospitals must constantly be ready to evolve and adapt. Recently, major changes that have impacted the hospital industry include healthcare reform, the continual shift from fee-for-service to value-based care, hospital closures, technological advancements and the physician shortage, to name a few.
That is why Becker's Hospital Review has provided this new list of things to know about the hospital industry, an updated version of the 2013 edition.
Topics include hiring practices and demographics, workforce compensation data, construction trends, technology updates, hospital admission information and more.
To learn more about hospitals as well as the healthcare industry as a whole, read "100 healthcare statistics to know."
Hospitals by the numbers
1. There are roughly 4,007 hospitals in the U.S., according to the most recent American Hospital Directory data based on the most recent Medicare cost reports.
2. There are approximately 2.6 staffed hospital beds per 1,000 people in the U.S., 1.7 of which are nonprofit hospital beds, according to the most recent Kaiser Family Foundation data from 2012.
3. Forty-three rural hospitals, with more than a combined 1,500 beds, have closed from 2010 through November of this year, according to North Carolina Rural Health Research Program data in USA Today.
4. The number of hospital mergers and acquisitions remained the same in the second and third quarters of this year, with nine transactions taking place during both quarters, according to a recent Irving Levin Associates report.
5. Hospital merger and acquisition activity decreased by 61 percent between the third quarter of 2013 and the same time frame this year.
Workforce and compensation
6. According to a study on hospital hiring trends by Billian's HealthDATA, hospitals have increasingly sought outside their organization for executive hires. Outside candidates have made up 60 percent of executive hospital placements as opposed to 40 percent internal promotions.
7. Billian's also discovered women made up 28 percent of executive placements, of which CEO hires made up 38 percent, CNOs made up 26 percent and COOs made up 13 percent.
8. Additionally, after analyzing executive moves from January to July of this year, Billian's found that C-suite placement activity is up 37 percent from 2013.
9. Across all specialties, approximately 21 percent of physicians are employed by a hospital.
10. Hospitals added roughly 3,500 jobs in October, according to the most recent jobs report from the Bureau of Labor Statistics.
11. The median turnover of physicians in adult hospitalist groups was 8 percent, with 38.1 percent of the groups indicating no physician turnover. For pediatric hospitalist groups, the median turnover was zero: 63.2 percent of the groups had no physician leaving the group, according to the Society of Hospital Medicine's 2014 State of Hospital Medicine report.
12. Hospitalists are expanding to responsibilities outside the inpatient environment with 25.4 percent of groups seeing patients in post-acute care facilities and 13.3 percent doing some outpatient care, according to the SHM report.
13. The primary care physician shortage remains a concern for 68.3 percent of hospital C-suite executives, with concerns being higher in the northeast/mid-Atlantic (70.4 percent) and the southeast (73.3 percent) regions.
14. Sixty-seven percent of the 51.6 million hospital-based services in 2012 was provided by hospitalists as opposed to traditionalists (primary care physicians and others whose services primarily take place outside an acute-care facility), according to an analysis of Medicare payment data.
15. The number of hospitals and healthcare facilities that have reported using locum tenens physicians increased to 90 percent in 2013 from 73.6 percent in 2012, according to a Staff Care survey.
16. Since 2012, the median salary for non-academic adult hospitalists has increased 8.2 percent annually, from $233,855 to $252,996. Hospitalists at non-academic pediatric hospitals saw a median compensation increase of 9.5 percent, from $178,885 to $195,832, over the past two years.
Leadership and management
17. Due to the PPACA, many hospitals are uncertain about whether or not to commence previously planned construction projects, according to a Hospitals & Health Networks report. Of the facilities questioned for the 2014 Hospital Construction Survey, 24 percent have decided completely against proceeding with renovation and construction plans and 41 percent said they are less likely to proceed.
18. According to the 2014 Hospital Construction Survey, 65 percent of hospitals and health systems that are executing construction and renovation projects are demanding all or most materials be green or environmentally friendly.
19. For hospitals considering construction and renovations plans, the Hospitals & Health Networks reports that the PPACA isn't the only federal legislation driving the decision–making process. The "two-midnight rule" is a new regulation that states hospital stays lasting fewer than two midnights must be classified and billed as outpatient services. Since cases have to be managed more effectively, 22 percent of hospitals are considering adding observation units to consolidate patients rather than having them dispersed around the building.
20. As of June, 34 hospitals and health systems announced plans for or opened ambulatory surgical centers.
21. To improve cost efficiencies, hospitals have been increasingly partnering with federal and private payers in risk-based contracting, according to an ITG Market Research survey of hospital executives.
22. A vast majority (77.5 percent) of hospital C-suite executives has resource utilization programs in place to better control the use of expensive supplies and purchased services, allowing them to better manage reimbursement reductions.
Quality
23. The Joint Commission recognized 1,224 out of more than 3,300 hospitals as "Top Performer" hospitals in its America's Hospitals: Improving Quality and Safety: The Joint Commission's 2014 Annual Report, an 11 percent increase from the previous year's report.
24. Roughly 60.8 percent of hospital C-suite executives have implemented clinical quality programs to help them reduce patient length of stay.
25. The following cities have the most hospitals with readmission rates exceeding the national average:
- Chicago - 19 hospitals with readmission rates exceeding national average
- Brooklyn - 11
- Philadelphia - 10
- Baltimore - 7
- Manhattan - 7
- Boston - 5
- Los Angeles - 4
- Miami - 4
26. The CDC tracks six categories of infections including central-line associated bloodstream infections, catheter-associated urinary tract infections, two surgical site infections, MRSA infections and Clostridium difficile infections. According to CDC's benchmarks, 695 hospitals had higher than expected infection rates for at least one of those infections during the first nine months of 2013 and, for some of the infections, also the last three months of 2012. The three states listed below had the highest percentage of hospitals with at least one infection rate worse than the benchmark:
- Connecticut: 53 percent (16 hospitals)
- Nevada: 48 percent (10 hospitals)
- New Jersey: 46 percent (29 hospitals)
27. Medication errors are present in approximately half of patients after hospital discharge.
28. Approximately 1,400 U.S. hospitals — nearly 1 in 4 — have at least one da Vinci robotic surgery, according to a USA Today report. A study published in July in the journal HealthCare suggests that hospitals are more likely to obtain a surgical robot if the hospital closest to them has one. The study was completed by examining surgical robot acquisition timing at 554 different U.S. hospitals from 2001 to 2008.
Health IT
29. While there are thousands of hospitals in the U.S., there are only 205 hospital-branded mobile apps for patients, according to a recent MobiHealthNews study. Of the 205 apps, 34 are for children's hospitals and seven include fitness trackers.
30. Just this summer, three hospitals have announced intentions to improve the patient experience using consumer-facing apps including:
- New York-Presbyterian Hospital's Innovation Center
- The Mount Sinai Hospital (New York) Patient Itinerary App
- Dignity Health's ED Scheduling App
31. As of November, a mere 17 percent of hospitals — 840 — have successfully satisfied Meaningful Use Stage 2 standards. In all, 1,903 hospitals successfully met MU measures in 2014 through November, with 221 new participants in the MU program.
32. Roughly 4.7 percent of eligible hospitals failed their post-payment meaningful use audits, which were completed between January 2011 and August 2014, resulting in those hospitals being required to return their EHR incentive payments. The overall proposed returned incentives total nearly $33 million.
Hospital finance and spending
33. As of June, the 5 top-grossing for-profit hospitals in the U.S. based on gross revenue are:
- Methodist Hospital (San Antonio) — $5.69 billion
- Baptist Medical Center (San Antonio) — $5.3 billion
- CJW Medical Center-Chippenham Campus (Richmond, Va.) — $3.8 billion
- Doctors Medical Center of Modesto (Calif.) — $3.49 billion
- Oklahoma University Medical Center (Oklahoma City) — $3.46 billion
34. As of June, the 5 top-grossing nonprofit hospitals in the U.S. based on gross revenue are:
- UPMC Presbyterian (Pittsburgh) — $12.21 billion
- The Cleveland Clinic — $11.63 billion
- Cedars-Sinai Medical Center (Los Angeles) — $10.59 billion
- Florida Hospital Orlando — $10.17 billion
- Stanford (Calif.) Hospital — $9.41 billion
35. As of July, the 5 top-grossing public hospitals in the U.S. based on gross revenue are:
- University of California San Francisco Medical Center at Parnassus — $7.67 billion
- University of California Davis Medical Center (Sacramento) —$6.36 billion
- University of Michigan Hospitals and Health Centers (Ann Arbor) — $5.32 billion
- Ohio State University Wexner Medical Center (Columbus) — $5.22 billion
- The University of Texas M.D. Anderson Cancer Center (Houston) — $5.19 billion
36. More than half of hospitals (54 percent) consider sustainability while making purchasing decisions, and 80 percent expect to do the same within two years, according to a Harris Poll commissioned by Johnson & Johnson.
37. The five states with highest hospital care spending per capita are Alaska ($3,879), Massachusetts ($3,505), Vermont ($3,408), Maine ($3,268) and North Dakota ($3,183).
38. The five states with lowest hospital care spending per capita are Utah ($1,830), Georgia ($1,922), Nevada ($1,949), Arizona ($1,977) and California ($2,077).
39. Tax-exempt hospitals contributed benefits to their communities worth an average of 12.3 percent of their total expenses in 2011, up from 11.6 percent in 2010, according to a recent Ernst & Young analysis.
Medicaid and Medicare
40. About 3,400 acute-care hospitals and 435 long-term care hospitals receive payments under CMS' Inpatient Prospective Payment System, meaning they agree to pre-determined rates to serve Medicare patients.
41. More than 4,000 hospitals receive reimbursement through Medicare's Outpatient Prospective Payment system, which provides payment for most hospital outpatient department services and partial hospitalization services administered by hospital outpatient departments and community mental health centers.
42. According to the Medicare Payment Advisory Commission, Medicare paid hospital outpatient departments 78 percent more on average than ambulatory surgery centers for the same procedure in 2013. MedPAC and CMS have been considering options to eliminate the gap between payment rates for different settings for certain care services.
43. CMS is exploring whether or not dropping Medicare's nursing home coverage requirement of a preceding inpatient hospital stay of at least three days.
44. States not expanding Medicaid are passing up approximately $423.6 billion in federal funds from 2013 to 2022, meaning hospitals are forced to find creative ways to help absorb some of the costs of providing uncompensated care.
45. As of November, Fitch Ratings has downgraded 12 hospitals this year, six of which are located in states that have not expanded Medicaid.
46. As of November, Fitch Ratings has upgraded 13 hospitals this year, 11 of which are located in expansion states.
Patient demographics
47. Mental health conditions are the principal or secondary diagnosis of one out of every five hospital stays, according to a Healthcare Cost and Utilization Project statistical brief.
48. Roughly 8.4 million hospital stays in 2006 involved a principal or secondary diagnosis of mental illness, according to HCUP.
49. Children 17 years and younger made up approximately 17 percent (or 6.4 million) of hospital stays in 2009, three quarters of which were for infants younger than a year old, according to HCUP.
50. HCUP reports that, on average, children's hospital stays are shorter (3.8 days) when compared with all hospitalizations. These pediatric stays also tend to be cheaper, approximately half to average costs for all stays.
More healthcare lists:
Healthcare in New York State: 10 things to know
130 nonprofit hospital and health system CEOs to know | 2014
100 physician leaders of hospital and health systems | 2014