Much has changed amid the COVID-19 pandemic, but hospitals must remain laser-focused on care quality and costs, using benchmarking to determine top priorities for improvement.
Becker's has collected benchmarks related to some of the most important day-to-day areas hospital executives oversee: finance, patient experience and care quality.
Finance
Key ratios
Source: Moody's Investors Service, "Not-for-profit and public healthcare – US: Medians" report, September 2020.
The medians are based on an analysis of audited fiscal 2020 financial statements for 130 freestanding hospitals, single-state health systems and multistate health systems, representing 40 percent of all Moody's-rated nonprofit healthcare entities. Children's hospitals, hospitals for which five years of data are not available and certain specialty hospitals were not eligible for inclusion in the medians.
1. Maintained bed occupancy: 64.5 percent
2. Operating margin: 0.5 percent
3. Excess margin: 3.7 percent
4. Operating cash flow margin: 6.7 percent
5. Return on assets: 2.9 percent
6. Three-year operating revenue CAGR: 5.2 percent
7. Three-year operating expense CAGR: 5.6 percent
8. Cash on hand: 246.9 days
9. Annual operating revenue growth rate: 3 percent
10. Annual operating expense growth rate: 4.7 percent
11. Total debt-to-capitalization: 33.9 percent
12. Total debt-to-operating revenue: 32.3 percent
13. Current ratio: 1.6x
14. Cushion ratio: 27.8x
15. Annual debt service coverage: 4.7x
16. Maximum annual debt service coverage: 4.1x
17. Total debt-to-cash flow: 3.3x
18. Capital spending ratio: 1.19x
19. Accounts receivable: 44.6 days
20. Average payment period: 99.1 days
21. Average age of plant: 11.9 years
Hospital margins by credit rating group
Source: S&P Global Ratings "U.S. Not-For-Profit Health Care System Median Financial Ratios — 2020 vs. 2019" report, September 2020.
AA+ rating
22. Operating margin: 4.5 percent
23. Operating EBIDA margin: 11.3 percent
24. Excess margin: 5.5 percent
25. EBIDA margin: 12.2 percent
AA rating
26. Operating margin: 3.2 percent
27. Operating EBIDA margin: 8.3 percent
28. Excess margin: 5.8 percent
29. EBIDA margin: 10.7 percent
AA- rating
30. Operating margin: 1.9 percent
31. Operating EBIDA margin: 7.1 percent
32. Excess margin: 4.1 percent
33. EBIDA margin: 9.2 percent
A+ rating
34. Operating margin: 1.6 percent
35. Operating EBIDA margin: 8.1 percent
36. Excess margin: 3.1 percent
37. EBIDA margin: 8.9 percent
A rating
38. Operating margin: 0.7 percent
39. Operating EBIDA margin: 6.6 percent
40. Excess margin: 2.3 percent
41. EBIDA margin: 8 percent
A- rating
42. Operating margin: 0.6 percent
43. Operating EBIDA margin: 6.7 percent
44. Excess margin: 2.4 percent
45. EBIDA margin: 8 percent
Average adjusted expenses per inpatient day
Source: Kaiser State Health Facts, accessed in 2020 and based on 2019 data.
Adjusted expenses per inpatient day includes all operating and nonoperating expenses for registered U.S. community hospitals, defined as public, nonfederal, short-term general and other hospitals. The figures are an estimate of the expenses incurred in a day of inpatient care and have been adjusted higher to reflect an estimate of the volume of outpatient services.
46. Nonprofit hospitals: $2,738
47. For-profit hospitals: $2,149
48. State/local government hospitals: $2,372
Patient experience
Source: HCAHPS' Patients' Perspectives of Care Survey, accessed in January 2022 and based on July 2021 data.
49. Patients who said nurses always communicated well: 80 percent
50. Patients who said nurses always treated them with respect and courtesy: 86 percent
51. Patients who said nurses always listened carefully: 77 percent
52. Patients who reported that their doctors always communicated well: 81 percent
53. Patients who reported that their doctors always treated them with courtesy and respect: 87 percent
54. Patients who reported that their doctors always listened carefully: 79 percent
55. Patients who reported that they always received helped as soon as they wanted: 67 percent
56. Patients who reported that when given new medications staff always communicated what the medication was for: 76 percent
57. Patients who reported that when given new medications staff always communicated possible side effects: 50 percent
58. Patients who reported that hospital staff gave them information regarding at-home recovery: 86 percent
59. Patients who strongly agreed that they understood their care after leaving a hospital: 52 percent
60. Patients who strongly agree that staff took their preferences into consideration: 45 percent
61. Patients who strongly agree that they understood how to manage their health: 52 percent
Quality and process of care
Source: Hospital Compare, CMS, Complications and Deaths-National Averages, January 2022, and Timely and Effective Care-National Averages, January 2022.
Data from the first and second quarters of 2020 are excluded because of the effect of the pandemic. Because of the pandemic-related factors, measures were calculated from differing timeframes, as noted below. All data is the latest available for the measures.
Hospital-acquired conditions
The following represent the average percentage of patients in the U.S. who experienced the conditions from July 1, 2018, to Dec. 31, 2019.
62. Collapsed lung due to medical treatment: 0.23 percent
63. A wound that splits open after surgery: 0.86 percent
64. Accidental cuts and tears from medical treatment: 1.2 percent
65. Serious blood clots after surgery: 3.63 percent
66. Serious complications: 1 percent
67. Bloodstream infection after surgery: 4.9 percent
68. Postoperative respiratory failure rate: 5.03 percent
69. Pressure sores: 0.59 percent
70. Broken hip from a fall after surgery: 0.1 percent
71. Perioperative hemorrhage or hematoma rate: 2.55 percent
Death rates
The following represent average death rates from July 1, 2017, to Dec. 1, 2019.
72. Death rate for CABG surgery patients: 2.9 percent
73. Death rate for COPD patients: 8.1 percent
74. Death rate for pneumonia patients: 15.3 percent
75. Death rate for stroke patients: 13.5 percent
76. Death rate for heart attack patients: 12.3 percent
77. Death rate for heart failure patients: 11.2 percent
Outpatients with chest pain or possible heart attack
Data was collected from July 1, 2020 to March 31, 2021.
78. Median time to transfer to another facility for acute coronary intervention: 61 minutes
Lower extremity joint replacement patients
Data was collected from April 1, 2017, to Oct. 2, 2019.
79. Rate of complications for hip/knee replacement patients: 2.4 percent
Flu vaccination
Data was collected from Oct. 1, 2020, to March 31, 2021.
80. Healthcare workers who received flu vaccination: 86 percent
Pregnancy and delivery care
Data was collected from July 1, 2020, to March 31, 2021.
81. Mothers whose deliveries were scheduled one to two weeks early when a scheduled delivery was not medically necessary: 3 percent
Emergency department care
82. Average time patient spent in the ED before being sent home: 149 minutes
Data was collected from July 1, 2020, to March 31, 2021.
83. Percentage of patients who left the ED before being seen: 2 percent
Data was collected from Jan. 1, 2020, to Dec. 31, 2020.