Oregon Acute Care Hospitals: Financial and Utilization Trends

Oregon Acute Care Hospitals: Financial and Utilization Trends 13 Q June 1

About This Report This report and subsequent quarterly updates will monitor and compare the financials and utilization Oregon's hospitals through the upcoming period of health reform and market changes. The report includes financial and utilization trends for different hospital cohorts: hospitals, hospitals, and hospitals. Hospitals with 5 or fewer beds are classified as A or B depending on their distance from another acute inpatient care facility. hospitals are primarily large, urban hospitals. The receives the data from each of Oregon's hospitals at the end of each quarter. The hospitals report the data to the Databank program and Hospital Discharge Database, state-mandated hospital reporting programs administered by Apprise Health Insights. The financial and utilization compares full year data in 13 with previous calendar years. Please note that all data are self-reported by each hospital and are not audited. (In some cases, hospitals also may revise previous Databank entries if finalized data were not available at the time of the original monthly report.) Accordingly, Databank data are not intended to serve as a substitute for annual audited financial statements and may not match the information in the hospital's audited financial statement. Additionally, hospitals may account for the hospital assessment (provider tax) differently, which could lead to an overstatement of some revenues and expenses. For information on hospital's audited financials, please see: www.oregon.gov/oha/ohpr/rsch/pages/hospital_reporting.aspx#audited_financi ALS_&_FR-3 Kaiser does not report financial information for its hospitals in Databank. Kaiser has an integrated system that makes it difficult to separate hospital financial information from other operations. As a result, the financial data in this report cover only 57 hospitals, while the utilization data includes all 59 hospitals. Kaiser Westside Medical Center opened in 13 Q3. As a result, its utilization data is included in the totals for 13, but may not be included in the list of hospitals on the right side of most pages because there is no data from previous years to compare to. Additional Data Supplemental quarterly hospital data from Databank not included in this report can be found on our website: www.oregon.gov/oha/ohpr/ RSCH/Pages/databank.aspx Contents Financial Operating Margin.... 1 Total Margin.... Payer Mix. 3 Charity Care.. Bad Debt...... 5 Total Uncompensated Care..6 Utilization Inpatient Discharges 7 Average Length of Stay. 8 Emergency Department Visits 9 Outpatient Discharges 1 Oregon Hospital Trends, 13

Operating Margin Operating margin measures the financial performance of a hospital s daily operating activities. Operating margin is calculated as a ratio of operating revenue minus operating costs divided by total operating revenue. Operating revenue includes revenue received from patient care activities as well as other sources, such as cafeteria sales, gift shop sales, and research grants, but does not include investments or taxes. If total operating revenue exceeds operating costs, the ratio will be positive and the hospital is operating at a profit. If operating revenue is less than operating expenses, the hospital is operating at a loss and will have a negative operating margin. Many factors affect a hospital s operating margin including utilization, medical case mix, labor costs, range of services provided, and payer mix. Oregon Hospital Operating Margin (%) 8 6 - - -6 5.9 5.7 6.9 6.5.8.3.5.. -. -. -1..1 75th Percentile -. Median -. 5th Percentile Operating Margin 13 (%) Willamette Valley Med Ctr 13.6 McKenzie-Willamette Med Ctr 1.5 Legacy Meridian Park Med Center 1.5 Mercy Med Center 9.6 Providence St Vincent Med Ctr 8.3 Sky Lakes Med Center 8. PeaceHealth Sacred Heart Riverbend 8.1 Asante Rogue Med Center 7.1 OHSU Hospital 6.7 Legacy Mt Hood Med Center 6. Salem Hospital.3 Legacy Good Samaritan Med Ctr. St Charles - Bend 3.9 Bay Area Hospital. Legacy Emanuel Med Center.3 Providence Milwaukie Hospital.3 Providence Portland Med Center.7 PeaceHealth Sacred Heart University.3 Providence Willamette Falls.1 Adventist Med Center -.7 Asante Three Rivers Med Center -1.1 Tuality Healthcare -1.7 Samaritan Albany Hospital -.5 Good Samaritan Regional Med Ctr -3.9 Providence Medford Med Center -. Only 11 of 57 hospitals (19%) reported operating margins for 13 that exceeded operating margins in 1. 9 hospitals (51%) reported a negative operating margin in 13. In comparison, 16 hospitals had negative operating margins through all of 1. Historically, hospitals generally have higher operating margins than the state's rural hospitals. While only 6 of 5 reporting hospitals have negative operating margins, 65% of and 83% of hospitals have negative operating margins. Until 13, overall operating margins had been steady. The median operating margin for the state is now negative for the first time in 5 years. This is largely due to significantly more rural hospitals facing negative margins in 13 than in previous years. Median Operating Margin by Cohort (%) (57 hospitals) (5 hospitals) 9 1 11 1.8.3.5. 3.6. 5.5 3.3.8.8. 1.3.6.9-3.6 -.6 Oregon Hospital Trends, 13-1- 13 -. 3.9-1.5-6.3 Hospitals Providence Newberg Med Center 5.5 St Charles - Redmond.1 Columbia Memorial Hospital.7 Mid-Columbia Med Center.7 Coquille Valley Hospital*. West Valley Hospital. Samaritan Pacific Comm Hospital* 1.6 Providence Hood River Hospital -.5 Silverton Hospital -1. Samaritan North Lincoln Hospital* -1.3 PeaceHealth Peace Harbor -1.7 Samaritan Lebanon Hospital -1.9 Pioneer Memorial Prineville -. Providence Seaside Hospital* -. PeaceHealth Cottage Grove -.1 Ashland Comm Hospital -6. Santiam Memorial Hospital -7.8 Southern Coos Hospital* -7.9 St Charles - Madras* -1.1 Lower Umpqua Hospital* -17.9 Hospitals Good Shepherd Med Center 1.8 Grande Ronde Hospital. Tillamook County Gen Hospital -. St Alphonsus Med Ctr Baker City -.5 Curry General Hospital* -3.3 St Anthony Hospital -5.8 Lake District Hospital* -6.7 St Alphonsus Med Ctr Ontario -6.9 Wallowa Memorial Hospital* -8.8 Pioneer Memorial Heppner* -11.9 Harney District Hospital* -15. Blue Mountain Hospital* -18.6 *Health district hospital Source: Databank

(5 hospitals) 5. 6.6 5.6 6.5 7.8 3.5. Total Margin Total margin measures the overall financial performance of a hospital. Total margin is calculated as a ratio of total revenue minus operating costs divided by total revenue. Unlike operating margin, total margin includes non-operating income or losses. These revenues or expenses are peripheral transactions outside of a hospital s daily activities, such as investments and tax revenues. Total margin may differ significantly from the operating margin if substantial amounts of non-operating revenue or expenses are reported. For example, many of Oregon s rural hospitals are operated by health districts, which collect property tax revenue from local residents to support the hospital. These tax revenues are considered non-operating income and can significantly increase a hospital s total margin compared to its operating margin. Some hospitals do not regularly report non-operating revenue. Therefore, the total margin for these hospitals equals the operating margin. Oregon Hospital Total Margin (%) 1 8 6 - - Eight hospitals did not report non-operating income to Databank in 13. Six did not report in calendar year 1. Nine hospitals (15%) reported total margins greater than 1 percent in 13, compared to 1 for the 1 calendar year. Twenty-one hospitals (37%) reported negative total margins in 13, compared with 9 for the 1 calendar year. Nineteen hospitals (33%) reported total margins in 13 that exceeded those for in 1. hospitals showed significant growth in total margins while both and B hospitals had significant reductions in total margins. Median Total Margin by Cohort (%) (57 hospitals) 7.5 7.6.9 7.1.1.7.5..6.5.9.1.7.5 3.1 3..3.6..7 8.3 7.8 75th Percentile 1.3.3 Median -1.9 5th Percentile.3 -.6.3 Total Margin 13 (%) Legacy Meridian Park Med Center 18.1 Asante Rogue Med Center 17. St Charles - Bend 15.3 Willamette Valley Med Ctr 13.6 Mercy Med Center 13.1 Asante Three Rivers Med Center 1.6 Salem Hospital 1.1 McKenzie-Willamette Med Ctr 1.5 Sky Lakes Med Center 9. PeaceHealth Sacred Heart Riverbend 8.5 Providence St Vincent Med Ctr 8.3 Legacy Good Samaritan Med Ctr 8.1 Legacy Mt Hood Med Center 7.8 OHSU Hospital 7.3 Legacy Emanuel Med Center. Providence Milwaukie Hospital.3 Bay Area Hospital.9 PeaceHealth Sacred Heart University.6 Providence Portland Med Center. Providence Willamette Falls.1 Tuality Healthcare -. Adventist Med Center -.7 Samaritan Albany Hospital -.1 Good Samaritan Regional Med Ctr -3.5 Providence Medford Med Center -. Hospitals Providence Newberg Med Center 5.5 Coquille Valley Hospital* 5. Columbia Memorial Hospital. Mid-Columbia Med Center. St Charles - Redmond.1 Southern Coos Hospital* 3.7 Samaritan Pacific Comm Hospital* 3.1 West Valley Hospital 1.9 Samaritan North Lincoln Hospital* 1. Providence Hood River Hospital -.5 Samaritan Lebanon Hospital -.7 PeaceHealth Peace Harbor -.8 Silverton Hospital -1.9 Pioneer Memorial Prineville -3.7 PeaceHealth Cottage Grove -3.7 Providence Seaside Hospital* -. Ashland Comm Hospital -6.1 Lower Umpqua Hospital* -6.6 Santiam Memorial Hospital -7.6 St Charles - Madras* -1.1 Hospitals Good Shepherd Med Center.8 Lake District Hospital* 7.8 Grande Ronde Hospital 7.7 Pioneer Memorial Heppner* 7. St Anthony Hospital 3.9 Wallowa Memorial Hospital*.6 Tillamook County Gen Hospital. Curry General Hospital* -.5 St Alphonsus Med Ctr Baker City -.1 St Alphonsus Med Ctr Ontario -.7 Blue Mountain Hospital* -6.6 Harney District Hospital* -7.6 *Health district hospital Source: Databank Oregon Hospital Trends, 13 --

(57 hospitals) 1.3 13. 1.8 15. 1.9 1.6 1.5 1.5 13. 15.3 15.6 13. 13.7 1.9 16.1 Payer Mix Hospital payer mix is one way to measure the volume that a hospital receives from each type of payer, such as Medicare, Medicaid, or private insurance. Payer mix is measured as the percentage of gross patient revenue from Medicare, Medicaid, commercial insurance, and self pay. Hospital payer mix is an important factor in understanding a hospital s financial performance because some payers pay more per service than others. Commercial insurers, as a group, often pay the highest reimbursement to hospitals. Medicare frequently pays less than commercial insurers, and Medicaid generally pays hospitals the same or less than Medicare. A hospital s payer mix tends to be linked to the demographics of the surrounding community. Oregon s expansion of Medicaid under the Affordable Care Act is expected to increase payments to hospitals from Medicaid. Similarly, the Affordable Care Act is expected to increase the number of individuals with commercial insurance. As a result, self pay could become a smaller part hospitals payer mix. Payer Mix Percentage of gross patient revenue by payer 9 1 11 1 13 Medicaid Self- Pay 6.6 6.9 6. 6.6 6.7 It is important to note that although commercial insurance's share of total charges has decreased, total commercial charges have increased every year since 9.The charges from Medicaid and Medicare, however, have increased faster, resulting in the commercial market making up a smaller share of payer mix. In each year, the median and B hospitals receive a slightly greater share of their gross patient revenue from Medicaid than the median hospital. Median Medicaid Share of Patient Revenue by Cohort (5 hospitals) Medicaid Medicare Total Asante Three Rivers Med Center 17 55 7 Providence Medford Med Center 15 5 69 Asante Rogue Med Center 15 5 67 Sky Lakes Med Center 16 51 67 Mercy Med Center 1 51 66 Bay Area Hospital 13 51 63 PeaceHealth Sacred Heart Riverbend 15 9 63 PeaceHealth Sacred Heart University 15 8 63 Willamette Valley Med Ctr 15 8 63 Salem Hospital 1 8 6 St Charles - Bend 11 51 6 Tuality Healthcare 16 6 6 Legacy Mt Hood Med Center 19 61 Good Samaritan Regional Med Ctr 11 5 61 Samaritan Albany Hospital 16 59 Legacy Good Samaritan Med Ctr 9 9 58 Adventist Med Center 13 3 56 Providence Portland Med Center 1 3 55 Providence Milwaukie Hospital 1 1 55 Legacy Meridian Park Med Center 5 5 55 Providence Willamette Falls 15 37 5 OHSU Hospital 31 51 Providence St Vincent Med Ctr 11 51 Legacy Emanuel Med Center 7 3 5 McKenzie-Willamette Med Ctr 13 6 39 13. 13.8 15.3 15.3 15.1 1.1 Medicare 1.1 1.3 1.5. 3.1 Commercial 1.5 1.5 15. 15. 39.1 37.9 37. 35.7 35. Payer Mix 13 Hospitals Coquille Valley Hospital* 9 65 7 Lower Umpqua Hospital* 11 6 7 PeaceHealth Peace Harbor 9 6 71 Pioneer Memorial Prineville 16 5 7 Southern Coos Hospital* 9 61 7 PeaceHealth Cottage Grove 18 9 67 Samaritan Lebanon Hospital 6 66 Samaritan North Lincoln Hospital* 16 5 66 Providence Seaside Hospital* 1 51 65 Samaritan Pacific Comm Hospital* 16 9 65 Mid-Columbia Med Center 13 5 63 Ashland Comm Hospital 9 5 63 St Charles - Madras* 9 33 6 St Charles - Redmond 18 6 Columbia Memorial Hospital 1 7 61 Santiam Memorial Hospital 16 6 West Valley Hospital 17 59 Providence Hood River Hospital 1 58 Silverton Hospital 1 3 5 Providence Newberg Med Center 13 37 5 Hospitals Wallowa Memorial Hospital* 1 58 7 St Alphonsus Med Ctr Baker City 19 9 68 Pioneer Memorial Heppner* 1 5 65 Curry General Hospital* 1 5 6 St Alphonsus Med Ctr Ontario 18 5 6 Blue Mountain Hospital* 16 7 63 Harney District Hospital* 16 3 59 Grande Ronde Hospital 16 3 59 Tillamook County Gen Hospital 13 57 Good Shepherd Med Center 18 37 5 Lake District Hospital* 1 1 5 St Anthony Hospital 1 37 51 *Health district hospital Source: Databank Oregon Hospital Trends, 13-3-

(5 hospitals) 3.9.5.1...6.3.6.7 Charity Care Charity care is the total amount of health care services, based on full, established charges, provided to patients who are determined by the hospital to be unable to pay for the cost of health care services. Charity care is reported as a percentage of gross patient revenue to control for changes in hospital income and spending as well as hospital size. In general, charity care is an indicator of (1) the need for care among people who are unable to pay and () the willingness and capacity of health care providers to absorb the impacts of making such care available. Interpreting the level of charity care across hospitals, however, is difficult. Hospitals do not apply a uniform set of guidelines for determining eligibility for free or discounted care. Accordingly, small amounts of uncompensated care could reflect a hospital's strict eligibility criteria or of little need for free care in the hospital's community. To maintain their tax-exempt status, non-profit hospitals are expected to provide benefits to their communities, including charity care. All of Oregon's hospitals are non-profit except for McKenzie-Willamette and Willamette Valley. Oregon Hospital Charity Care 6 5 3 1 Median Charity Care by Cohort (57 hospitals) 5. 5.6 3.9.3.3 9 1 11 1 3.9.3 5. 5. 3.6 3.8 3.9 3.6 3.8 3.3 5. 5th Percentile.6.5.6.9.1.9 75th Percentile Median Total charity care charges have grown from $75m in 9 to $8m in 13, keeping pace with yearly increases in gross patient revenue. 13 results suggests that charity care as a percentage of total patient revenue remains steady. Median charity care charges for 13 were 3.9% of total charges compared to 3.8% in 1. 8 hospitals (9%) reported charity care levels were greater in 13 than in 1. 13 3.9 3.9. 3. Charity Care 13 Legacy Mt Hood Med Center 8.1 Providence Milwaukie Hospital 7.3 Providence Medford Med Center 6.7 Providence Willamette Falls 6. Asante Three Rivers Med Center 6. PeaceHealth Sacred Heart University 6.3 Legacy Emanuel Med Center 5.9 Providence Portland Med Center 5.3 Legacy Good Samaritan Med Ctr 5. Salem Hospital.9 Providence St Vincent Med Ctr.5 PeaceHealth Sacred Heart Riverbend.1 Asante Rogue Med Center 3.9 Good Samaritan Regional Med Ctr 3.9 Legacy Meridian Park Med Center 3.8 OHSU Hospital 3.5 Sky Lakes Med Center 3. Samaritan Albany Hospital 3. Mercy Med Center 3. St Charles - Bend 3.1 Tuality Healthcare.9 Adventist Med Center. Bay Area Hospital 1.8 McKenzie-Willamette Med Ctr 1.3 Willamette Valley Med Ctr.8 Hospitals Providence Seaside Hospital* 7. Providence Newberg Med Center 6.9 West Valley Hospital 6. PeaceHealth Peace Harbor 5.5 Providence Hood River Hospital 5.5 Silverton Hospital 5. St Charles - Redmond.9 PeaceHealth Cottage Grove.6 Pioneer Memorial Prineville. St Charles - Madras*.3 Lower Umpqua Hospital* 3.7 Samaritan North Lincoln Hospital* 3.6 Mid-Columbia Med Center 3.5 Samaritan Lebanon Hospital 3.5 Samaritan Pacific Comm Hospital* 3. Columbia Memorial Hospital.6 Santiam Memorial Hospital.1 Ashland Comm Hospital 1.7 Southern Coos Hospital* 1.3 Coquille Valley Hospital*.7 Hospitals Good Shepherd Med Center 7.8 Tillamook County Gen Hospital 7.1 St Alphonsus Med Ctr Ontario.1 Grande Ronde Hospital. Curry General Hospital* 3.9 Blue Mountain Hospital* 3.3 St Alphonsus Med Ctr Baker City 3. St Anthony Hospital.3 Harney District Hospital*. Lake District Hospital* 1.9 Wallowa Memorial Hospital* 1.5 Pioneer Memorial Heppner* 1. *Health district hospital Source: Databank Oregon Hospital Trends, 13 --

Bad Debt Bad debt is the unpaid obligation for care, based on a hospital s full, established charges, for which the hospital expects payment but is unable to collect. Bad debt arises when a patient has either not requested financial assistance or does not qualify for financial assistance. For uninsured patients, the amount of bad debt can pertain to all or any portion of the bill that is not paid. For insured patients, certain amounts that are the patient s responsibility, such as deductibles and coinsurance, are also counted as bad debt if not paid. In general, bad debt is an indicator of employment and insurance trends in a community as well as a hospital's charity care and collection practices. Under the Affordable Care Act, bad debt likely will decrease as insurance coverage expands. Obtaining insurance coverage, however, does not necessarily mean an individual will be able to pay the entire cost of their hospital bill. While the Affordable Care Act's limits on out-of-pocket expenses and regulations for minimum coverage should prevent many insured individuals from being unable to pay their bill, some insured patients will continue to not pay. Oregon Hospital Bad Debt 5 3 1.8.8 3. 3..5 Median Bad Debt by Cohort.1.1 3.8.9 3.1 3..1. 1.9. 75th Percentile Median 5th Percentile Total bad debt peaked in 9 at $53m (3.% of total charges) and declined to $5m (3.1% of total charges) in 1 before rising again in 13. Overall, total bad debt in Oregon hospitals is up $18m in 13 from 1 ($3m) but has fallen slightly as a share of total charges (3.%). 19 hospitals (33%) reported more bad debt in 13 than in 1. In general, and B hospitals report a greater percentage of total charges as bad debt. This remains true in 13, with rural hospitals having nearly 1% greater share of bad debt compared to total charges. Bad Debt 13 Tuality Healthcare.5 PeaceHealth Sacred Heart University.1 Bay Area Hospital 3.9 Legacy Mt Hood Med Center 3.9 Salem Hospital 3. Sky Lakes Med Center 3.1 McKenzie-Willamette Med Ctr 3.1 Adventist Med Center 3. Willamette Valley Med Ctr.8 Legacy Emanuel Med Center.5 St Charles - Bend.5 PeaceHealth Sacred Heart Riverbend.5 Samaritan Albany Hospital.3 OHSU Hospital.1 Providence Willamette Falls. Legacy Meridian Park Med Center. Mercy Med Center 1.7 Asante Three Rivers Med Center 1.6 Providence Milwaukie Hospital 1.5 Legacy Good Samaritan Med Ctr 1.3 Good Samaritan Regional Med Ctr 1.3 Asante Rogue Med Center 1.1 Providence St Vincent Med Ctr.9 Providence Portland Med Center.8 Providence Medford Med Center.7 Hospitals West Valley Hospital 6. Southern Coos Hospital* 5. PeaceHealth Cottage Grove 5.1 Santiam Memorial Hospital.9 Lower Umpqua Hospital*. St Charles - Redmond. St Charles - Madras*. Columbia Memorial Hospital 3.8 Samaritan North Lincoln Hospital* 3.7 Coquille Valley Hospital* 3.6 Samaritan Pacific Comm Hospital* 3.3 Pioneer Memorial Prineville 3.1 Samaritan Lebanon Hospital 3.1 Mid-Columbia Med Center.6 PeaceHealth Peace Harbor.3 Silverton Hospital. Ashland Comm Hospital. Providence Seaside Hospital* 1. Providence Newberg Med Center.9 Providence Hood River Hospital.6 (57 hospitals) (5 hospitals) 9 1 11 1 3. 3..9 3.1 3..8.. 3.9 3.9.1 3.9 3.8.3 3.1 3.5 13 3..3 3.5 3.1 Hospitals Harney District Hospital* 6. Lake District Hospital*.9 Good Shepherd Med Center 3.8 Blue Mountain Hospital* 3. Pioneer Memorial Heppner* 3. Curry General Hospital* 3. St Alphonsus Med Ctr Ontario 3.1 Grande Ronde Hospital 3. St Anthony Hospital.9 St Alphonsus Med Ctr Baker City.7 Wallowa Memorial Hospital* 1.5 Tillamook County Gen Hospital 1.3 *Health district hospital Source: Databank Oregon Hospital Trends, 13-5-

Median Uncompensated Care by Cohort (57 hospitals) (5 hospitals) 7.5 7.7 6.8 7. 6.8 7.3 Uncompensated Care Total uncompensated care is the total of charity care and bad debt charges. It measures the total amount of care hospitals provide without receiving payment. Total uncompensated care may provide a better indicator of the level of care hospitals provide to those unable to pay than looking at charity care and bad debt separately. This is because hospitals often have different methods of distinguishing between bad Uncompensated Care 13 debt and charity care. For example, some hospitals have less restrictive eligibility criteria for charity care or a very effective process for identifying charity care patients at the time of service. This likely results in greater charity care charges and less bad debt. At other hospitals, patients' bills may be more likely to be classified as bad debt because the hospital has a more restrictive financial assistance policy or does not have the systems or resources necessary to properly identify patients eligible for charity care. Oregon Hospital Total Uncompensated Care as percentage of gross patient revenue 1 9.6 9. 8.5 8. 8. 8 75th Percentile 7.5 7.7 6.8 7. 6.8 Median 6 6. 6.6 6. 6. 5th Percentile 5.7 As a combination of charity care and bad debt, total uncompensated care follows the trends in those categories. The reduction in total uncompensated care shown above is mostly due to the decline in bad debt, while charity care has remained about the same percentage of gross patient revenue. In 13, 1 hospitals (37%) reported greater levels of uncompensated care than in 1. 9 1 11 1 7.1 6.5 6. 6.1 8.7 8.8 7.6 8. 7. 6.9 7. 6. 6.8 13 6.9 Legacy Mt Hood Med Center 1. PeaceHealth Sacred Heart University 1.3 Providence Milwaukie Hospital 8.9 Providence Willamette Falls 8.5 Legacy Emanuel Med Center 8. Salem Hospital 8.3 Asante Three Rivers Med Center 8. Tuality Healthcare 7. Providence Medford Med Center 7.3 PeaceHealth Sacred Heart Riverbend 6.6 Sky Lakes Med Center 6.6 Legacy Good Samaritan Med Ctr 6.3 Providence Portland Med Center 6.1 Legacy Meridian Park Med Center 5.8 Samaritan Albany Hospital 5.7 Bay Area Hospital 5.7 OHSU Hospital 5.6 St Charles - Bend 5.6 Adventist Med Center 5. Providence St Vincent Med Ctr 5.3 Good Samaritan Regional Med Ctr 5. Asante Rogue Med Center 5. Mercy Med Center.9 McKenzie-Willamette Med Ctr. Willamette Valley Med Ctr 3.6 Hospitals West Valley Hospital 1.6 PeaceHealth Cottage Grove 9.7 St Charles - Redmond 9.1 St Charles - Madras* 8. Providence Seaside Hospital* 8. Lower Umpqua Hospital* 8. PeaceHealth Peace Harbor 7.8 Providence Newberg Med Center 7.8 Silverton Hospital 7.6 Pioneer Memorial Prineville 7.5 Samaritan North Lincoln Hospital* 7.3 Santiam Memorial Hospital 7. Samaritan Pacific Comm Hospital* 6.7 Samaritan Lebanon Hospital 6.5 Southern Coos Hospital* 6. Columbia Memorial Hospital 6. Mid-Columbia Med Center 6.1 Providence Hood River Hospital 6.1 Coquille Valley Hospital*.3 Ashland Comm Hospital 3.7 Hospitals Good Shepherd Med Center 11.6 Tillamook County Gen Hospital 8. Harney District Hospital* 8. St Alphonsus Med Ctr Ontario 7. Grande Ronde Hospital 7. Curry General Hospital* 7. Lake District Hospital* 6.8 Blue Mountain Hospital* 6.8 St Alphonsus Med Ctr Baker City 5.7 St Anthony Hospital 5. Pioneer Memorial Heppner*.6 Wallowa Memorial Hospital* 3.1 *Health district hospital Source: Databank Oregon Hospital Trends, 13-6-

Inpatient Discharges An inpatient discharge is the formal release of the patient after lodging for at least one full day. Inpatient discharges are a common measure of hospital utilization. Many factors can affect the level of hospital discharges including changes in population, offered services, and competition from other hospitals or ambulatory surgery centers. Several health reform initiatives--improved primary care and penalties for readmissions, for example--could reduce hospital admissions. At the same time, expanded insurance coverage could increase the number of individuals seeking hospital care. Annual Discharges Compared to 8 (% Change) -5-1 -15 - -5-3 8 In Oregon, hospital discharges peaked in 8 at about 378,. In 13, discharges totaled just over 356,--an average annual decline of about 1 percent. As shown above, all hospital types have experienced declining admissions and discharges since the peak in 8. The rate of decline, however, has been greater at and hospitals than at hospitals. In 13, four rural hospitals showed significant (3%) reductions in inpatient discharges. Additionally, 1 hospitals in total had at least a 1% reduction in hospitalizations. Acute Inpatient Discharges by Cohort (58 hospitals)¹ 37,736 373,57 371,889 361,673 356,111 (6 hospitals)¹ 38,75 38,78 37,766 3,66 31,36 3,53 3,5 9,57 -.3% All Hospitals -5.9% -13.6% -.% 316, 8,111 1,75 1,573 13,878 1,55 11,556 ¹13 includes 59 statewide hospitals and 7 hospitals due to Kaiser Westside. Inpatient Discharges (% Change) Asante Rogue Med Center 9.5 Legacy Mt Hood Med Center 8.3 Providence Willamette Falls 6. Salem Hospital. Adventist Med Center. St Charles - Bend 3.8 Asante Three Rivers Med Center.9 Legacy Meridian Park Med Center.8 McKenzie-Willamette Med Ctr 1.8 Providence Medford Med Center 1.8 Mercy Med Center.8 Good Samaritan Regional Med Ctr. Kaiser Westside Medical Center. Willamette Valley Med Ctr -1. Bay Area Hospital -.1 PeaceHealth Sacred Heart Riverbend -. Tuality Healthcare -. Legacy Emanuel Med Center -.8 OHSU Hospital -3.1 Kaiser Sunnyside Med Center -. Sky Lakes Med Center -.7 PeaceHealth Sacred Heart University -5.6 Providence Portland Med Center -7.7 Samaritan Albany Hospital -8. Legacy Good Samaritan Med Ctr -8.7 Providence St Vincent Med Ctr -1. Providence Milwaukie Hospital -19. Hospitals Coquille Valley Hospital* 11.5 PeaceHealth Cottage Grove 11.1 Providence Seaside Hospital* 6. Santiam Memorial Hospital 5.3 St Charles - Redmond.3 Mid-Columbia Med Center.5 Pioneer Memorial Prineville 1.9 Providence Newberg Med Center 1.8 West Valley Hospital 1. Columbia Memorial Hospital -.9 PeaceHealth Peace Harbor -1. St Charles - Madras* -1.9 Providence Hood River Hospital -.6 Silverton Hospital -. Samaritan Pacific Comm Hospital* -6.9 Samaritan North Lincoln Hospital* -8.9 Samaritan Lebanon Hospital -1.8 Lower Umpqua Hospital* -13. Ashland Comm Hospital -3.5 Southern Coos Hospital* -3.7 Hospitals Harney District Hospital* 38.6 Pioneer Memorial Heppner* 15. Wallowa Memorial Hospital* 6.8 Lake District Hospital* 1. St Alphonsus Med Ctr Ontario. St Anthony Hospital -1.8 Grande Ronde Hospital -5. Blue Mountain Hospital* -5.9 Good Shepherd Med Center -1.1 St Alphonsus Med Ctr Baker City -17.8 Tillamook County Gen Hospital -3.3 Curry General Hospital* -39. *District Hospital 13 compared to 1 Source: Discharge Database Oregon Hospital Trends, 13-7-

Average Length of Stay The average length of stay measures the average amount of time an admitted patient spends in the hospital until being discharged. The average length of stay is calculated as the total number of acute patient days in the hospital divided by the number of acute discharges. Reducing the length of stay is generally considered one way to improve efficiency and reduce costs. Comparing average length of stay across hospitals, however, has its limitations because the optimal length of stay depends on the mix of diagnoses and procedures that a hospital encounters. Tracking hospitals length of stay could help identify whether broad changes in hospitalization are occurring under health reform. Assessing the cause of those changes, however, may not be straightforward. A reduction in the average length of stay could indicate that a hospital has improved its efficiency for example, eliminating delays or discharging patients to less costly levels of care. On the other hand, it also could mean an increase in hospitalizations for minor cases with very short stays. Oregon Hospital Median Length of Stay 5 Days 3 1 Average length of stay has not changed much over time, as the median for all hospitals has been around 3.1 days for the last 5 years. Oregon's statewide average length of stay is well below the national average of.8 days, according to the Center for Disease Control and Prevention (CDC/NCHS National Hospital Discharge Survey, 1.) The length of stay is typically higher at hospitals, with a median of 3.6 days in 13 compared to.8 and.9 days at and B hospitals, likely due to the mix of services provided. Median Length of Stay by Year (58 hospitals)¹ (6 hospitals)¹ 3.7 3.6 3.6 3.5 3.6 3.1 3.1 3. 3. 3.1.9.8.7.7.8 3.1 3.1 3. 3. ¹13 includes 59 statewide hospitals and 7 hospitals due to Kaiser Westside. 3.1 3.7 3.6 3.6 3.6 3.6.9.8.8 75th Percentile Median 5th Percentile.8.9.9 3..8.8.8 Average Length of Stay 13 (Days) PeaceHealth Sacred Heart University 8.1 OHSU Hospital 5. Legacy Emanuel Med Center 5. Legacy Good Samaritan Med Ctr.5 Providence Portland Med Center.5 Asante Rogue Med Center. Salem Hospital. PeaceHealth Sacred Heart Riverbend.1 Tuality Healthcare.1 Good Samaritan Regional Med Ctr.1 Providence St Vincent Med Ctr.1 Providence Medford Med Center 3.9 Sky Lakes Med Center 3.7 St Charles - Bend 3.6 Willamette Valley Med Ctr 3.6 Bay Area Hospital 3.6 Adventist Med Center 3.5 Mercy Med Center 3.5 Asante Three Rivers Med Center 3. McKenzie-Willamette Med Ctr 3. Kaiser Sunnyside Med Center 3. Legacy Mt Hood Med Center 3.1 Legacy Meridian Park Med Center 3.1 Samaritan Albany Hospital 3. Providence Milwaukie Hospital 3. Kaiser Westside Medical Center.7 Providence Willamette Falls.7 Hospitals Providence Seaside Hospital*.5 Lower Umpqua Hospital* 3.6 Coquille Valley Hospital* 3.6 Santiam Memorial Hospital 3.3 Mid-Columbia Med Center 3. Pioneer Memorial Prineville 3. PeaceHealth Peace Harbor 3.1 Ashland Comm Hospital 3. Samaritan Lebanon Hospital 3. Samaritan Pacific Comm Hospital*.9 St Charles - Madras*.8 Samaritan North Lincoln Hospital*.8 PeaceHealth Cottage Grove.8 Providence Newberg Med Center.7 St Charles - Redmond.7 Columbia Memorial Hospital.6 West Valley Hospital.5 Southern Coos Hospital*.5 Silverton Hospital.5 Providence Hood River Hospital.3 Hospitals Pioneer Memorial Heppner* 3.3 St Alphonsus Med Ctr Baker City 3.1 Curry General Hospital* 3. Lake District Hospital* 3. Grande Ronde Hospital 3. St Anthony Hospital.9 Tillamook County Gen Hospital.8 Wallowa Memorial Hospital*.7 Blue Mountain Hospital*.7 Good Shepherd Med Center.6 St Alphonsus Med Ctr Ontario.5 Harney District Hospital*. *District Hospital Source: Discharge Database Oregon Hospital Trends, 13-8-

(6 hospitals)¹ Emergency Department Visits Emergency department visits are reported as the number of visits to the hospital emergency department by patients that are not then admitted into the hospital. Many patients seek care in the emergency room that could be provided at a lower cost in an alternative setting. Additionally, some emergency department visits could be prevented with access to consistent, quality primary care. One goal of health reform is to reduce avoidable emergency room visits through increased preventive care and care coordination. Under Oregon s health system transformation, Coordinated Care Organizations and the state are being held accountable for reducing emergency department utilization in Medicaid. Annual Emergency Department Visits Compared to 9 (% Change) 6 - Consistent with national trends, total emergency department visits to Oregon hospitals declined from 9 to 1, but increased again in 11 and 1. In 13,total ER visits have declined across all hospitals for the first time since 1. Emergency Visits by Year (58 hospitals)¹ 1,6,76 1,31,63 1,53,9 1,7,1 1,53,771 99,5 9,597 9,153 6,16,38,51 1.5%.5% All Hospitals.5% - -3.%. 953,597 93,6,15 18,315 91,359 9,8 93,77 96,13 91,85 ¹13 includes 59 statewide hospitals and 7 hospitals due to Kaiser Westside. Emergency Visits (% Change) 13 compared to 1 Asante Rogue Med Center 5.3 McKenzie-Willamette Med Ctr.5 PeaceHealth Sacred Heart Riverbend 3.9 Mercy Med Center. Willamette Valley Med Ctr 1.1 Adventist Med Center.7 PeaceHealth Sacred Heart University.7 St Charles - Bend. Salem Hospital. Legacy Emanuel Med Center -.3 Tuality Healthcare -.5 Asante Three Rivers Med Center -.6 Legacy Mt Hood Med Center -.8 OHSU Hospital -1.1 Sky Lakes Med Center -1. Legacy Meridian Park Med Center -1.6 Kaiser Sunnyside Med Center -1.9 Samaritan Albany Hospital -. Providence Medford Med Center -.3 Bay Area Hospital -.9 Good Samaritan Regional Med Ctr -5.6 Providence Portland Med Center -6. Providence Willamette Falls -7. Providence Milwaukie Hospital -7.8 Legacy Good Samaritan Med Ctr -9.6 Providence St Vincent Med Ctr -1.7 Hospitals Coquille Valley Hospital* 8.3 Silverton Hospital.8 St Charles - Madras*. Samaritan Pacific Comm Hospital* 1.8 Santiam Memorial Hospital 1.6 Columbia Memorial Hospital. Lower Umpqua Hospital* -.1 Pioneer Memorial Prineville -.8 Providence Seaside Hospital* -.8 Providence Newberg Med Center -1. St Charles - Redmond -1. PeaceHealth Cottage Grove -.1 Providence Hood River Hospital -.7 PeaceHealth Peace Harbor -.1 West Valley Hospital -.3 Samaritan North Lincoln Hospital* -6. Ashland Comm Hospital -6.6 Mid-Columbia Med Center -7. Southern Coos Hospital* -8. Samaritan Lebanon Hospital -8.5 Hospitals Curry General Hospital* 1. Blue Mountain Hospital* 1.8 Wallowa Memorial Hospital* -1.3 Good Shepherd Med Center -.3 Lake District Hospital* -.5 St Anthony Hospital -.5 Pioneer Memorial Heppner* -3.8 Harney District Hospital* -.9 St Alphonsus Med Ctr Baker City -.9 St Alphonsus Med Ctr Ontario -7.5 Tillamook County Gen Hospital -7.8 Grande Ronde Hospital -9.1 *Health District Hospital Source: Databank Oregon Hospital Trends, 13-9-

Outpatient Discharges by Year Outpatient Discharges Outpatient discharges represent surgeries or procedures performed at the hospital that do not require an overnight stay. These discharges consist primarily of non-emergency, planned services that result in the patient being treated and released in the same day. Similar to inpatient visits, changes in population, offered services, and competition can affect a hospital's outpatient discharges. Several hospitals do not provide outpatient surgery services. Outpatient discharges, like inpatient, have been steadily declining for the past several years. Annual Outpatient Discharges Compared to 9 (% Change). -5. -1. -15. -. Total hospital outpatient discharges decreased by over 11 percent between 9 and 1 with an overall decline for all 3 hospital types. In 13, hospitals saw an increase of about 1% year to year. Only 3 hospitals (%) reported year-to-year outpatient discharge growth. As shown above, and B hospitals had the largest between 9 and 13. As shown on the right, Asante facilities experienced very large year-to-year changes. This is attributed to changes in reporting practice as opposed to major increase in discharges. (58 hospitals)¹ 8,97 76,6 61,936 53,6 55,1 (7 hospitals)¹ 3,769 18,98 1,63 8,68,87,5 3,8 3,78 ¹13 includes 59 statewide hospitals and 7 hospitals due to Kaiser Westside. -5.% -1.% -5. -3. -8.7% -9.7% -35. All Hospitals 11,766 3,167 18,918 17,91 1,669 1,1 13,38 Outpatient Discharges (% Change) 13 compared to 1 Asante Three Rivers Med Center 77. Asante Rogue Med Center 95. Kaiser Sunnyside Med Center. Legacy Mt Hood Med Center 38.3 Providence Medford Med Center 13.5 Sky Lakes Med Center 13. Good Samaritan Regional Med Ctr 1. Tuality Healthcare 9.1 McKenzie-Willamette Med Ctr 9. Willamette Valley Med Ctr 5.3 Adventist Med Center.5 Legacy Good Samaritan Med Ctr.6 Providence Willamette Falls. Salem Hospital. Kaiser Westside Medical Center. Legacy Meridian Park Med Center -.7 PeaceHealth Sacred Heart Riverbend -1.3 Samaritan Albany Hospital -1.6 Providence Milwaukie Hospital -.1 Mercy Med Center -3. Providence St Vincent Med Ctr -3. Legacy Emanuel Med Center -3.7 St Charles - Bend -5. Providence Portland Med Center -1. OHSU Hospital -17.1 Bay Area Hospital -17.8 PeaceHealth Sacred Heart University -5. Hospitals Mid-Columbia Med Center 19. Providence Newberg Med Center 1.5 West Valley Hospital 11.3 St Charles - Redmond 5.6 Coquille Valley Hospital* 5. Providence Seaside Hospital* -.5 Pioneer Memorial Prineville -1. Providence Hood River Hospital -1.5 Southern Coos Hospital* -1.7 Columbia Memorial Hospital -.8 Silverton Hospital -3.1 Samaritan Lebanon Hospital -5. Santiam Memorial Hospital -5. PeaceHealth Peace Harbor -6.8 Samaritan North Lincoln Hospital* -7. Samaritan Pacific Comm Hospital* -8.9 Lower Umpqua Hospital* -9.9 St Charles - Madras* -16.3 Ashland Comm Hospital -33.6 Hospitals Lake District Hospital* 13. Wallowa Memorial Hospital* 5.8 Grande Ronde Hospital 3.3 St Alphonsus Med Ctr Ontario.7 Blue Mountain Hospital* -1.7 St Alphonsus Med Ctr Baker City -3.7 St Anthony Hospital -3.9 Tillamook County Gen Hospital -13. Good Shepherd Med Center -17.8 Harney District Hospital* -. Curry General Hospital* -. *District Hospital Source: Discharge Database Oregon Hospital Trends, 13-1-

The Databank files used to compile this report are available at: http://www.oregon.gov/oha/ohpr/rsch/pages/databank.aspx More information on the discharge database is available at: http://www.oregon.gov/oha/ohpr/rsch/pages/hospital_reporting.aspx#inpatient_di SCHARGE_DATA All questions and comments regarding this statistical brief may be directed to: Russell Voth, MPP Health System Research & Data Manager 5 Summer Street NE, E-6 Salem, OR 9731 Russell.Voth@state.or.us The s collects and analyzes data to inform policy development, program implementation, and system evaluation. The Office of Health Analytics supports OHA efforts to further the triple aim goals of improving health, improving health care quality and reducing costs by leveraging qualitative and quantitative data to monitor progress and identify future policy and program opportunities. Oregon Hospital Trends, 13