Healthcare Information Division

Statewide Hospital Financial Trends

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Glossary

Financial Performance

Revenue and Expenses

Labor Costs and Staffing

Capacity and Utilization

Hospital Characteristics

2006 2007 2008
General Acute 361 359 357
Acute Psychiatric 52 52 58
Specialty 33 33 30
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Charges vs. Net Revenue per Adjusted Day

2006 2007 2008 2009 2010
Charges $7,865 $8,526 $9,171 $10,040 $10,830
Net Revenue $2,114 $2,253 $2,397 $2,568 $2,777
  • Charges per adjusted day increased from $7,865 in 2006 to $10,830 in 2010, or by 37.7%
  • Net revenue (Payments) per adjusted day increased from $2,114 in 2006 to $2,777 in 2010, or by 31.3%
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Expense vs. Net Revenue per Adjusted Day

2006 2007 2008 2009 2010
Net Revenue $2,114 $2,253 $2,397 $2,568 $2,777
Operating Expense $2,103 $2,238 $2,383 $2,516 $2,702
  • Expense per adjusted day increased from $2,103 in 2006 to $2,702 in 2010, or by 28.5%
  • Net revenue (Payments) per adjusted day increased from $2,114 in 2006 to $2,777 in 2010, or by 31.3%
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Operating Margin vs. net Income

2006 2007 2008 2009 2010
Operating Margin $275,214,853 $375,011,665 $369,175,322 $1,317,411,499 $1,835,910,221
Net Income $2,977,970,864 $3,572,386,355 $2,081,349,722 $2,539,914,251 $4,135,305,165
  • Operating Margin averaged $339.8 million from 2006 to 2008, and increased significantly to an average of $1.58 billion in 2009 and 2010
  • Net income decreased by $1.49 billion from 2007 to 2008 due primarily to decrease in investment income, and increased by $1.60 billion from 2009 to 2010 to over $4.1 billion
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Operating Margin vs. Total Margin - Quarterly

2nd Qtr 2011 3rd Qtr 2011 4th Qtr 2011 1st Qtr 2012
Operating Margin 3.2% 0.0% 3.4% 2.0%
Total Margin 5.8% -2.7% 6.4% 7.2%
  • This chart is the only chart created using quarterly report data from the Quarterly Financial database; all the other charts are created using annual report data from the SIERA database.
  • Operating Margin averaged 2.9% for the 2nd Qtr 2011, 4th Qtr 2011, and 1st Qtr 2012 but decreased to 0% in 3rd Qtr 2011.
  • Total Margin decreased from 5.8% in 2nd Qtr 2011 to (2.7%) in 3rd Qtr 2011, and increased to 6.4% in 4th Qtr 2011.

Operating Margin vs. Total Margin

2006 2007 2008 2009 2010
Operating Margin 0.51% 0.64% 0.59% 1.98% 2.59%
Total Margin 5.50% 6.16% 3.37% 3.89% 5.99%
  • Operating Margin averaged 0.58% from 2006 to 2008, but increased to 1.98% in 2009 and 2.59% in 2010
  • Total Margin decreased from 6.16% in 2007 to 3.37% in 2008, and increased to 5.99% in 2010
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Sources of Non-Operating Revenue

2006 2007 2008 2009 2010
Contributions $193,964,138 $191,354,098 $249,589,866 $212,650,558 $257,014,632
Investments $803,007,269 $1,047,810,183 ($144,022,474) ($303,118,769) $757,683,337
District Assessments $121,106,164 $126,491,590 $130,101,594 $84,495,444 $104,974,406
County Funds $1,345,562,791 $1,507,715,774 $1,372,418,857 $1,224,740,011 $1,137,926,557
  • Income from investments reported as a loss of $144.0 million in 2008 and a loss of $303.1 million in 2009, before increasing to $757.7 million in 2010
  • City/County hospitals received 24.5% less county funding in 2010 than 2007
  • Unrestricted contributions averaged $220.9 million from 2006 to 2010, and increased by 32.5% from 2006 to 2010
  • District hospitals averaged $113.4 million in assessments from 2006 to 2010, with a low of $84.5 million in 2009 and a high of $130.1 million in 2008
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Percent of Hospitals with Positive Operating Margin by Type of Control

2006 2007 2008 2009 2010
City / County 4.8% 9.5% 21.1% 31.6% 21.1%
District 27.7% 24.4% 24.4% 31.1% 35.6%
Investor 52.9% 50.4% 64.2% 68.7% 77.5%
Non-Profit 67.7% 69.0% 64.6% 71.1% 71.2%
Statewide Average 54.8% 54.7% 57.5% 63.6% 66.1%
  • Percent of hospitals statewide operating profitably increased from 54.8% in 2006 to 66.1% in 2010, averaging 59.3%
  • Percent of non-profit hospitals operating profitably increased from 67.7% in 2006 to 71.2% in 2010, averaging 68.7%
  • Percent of investor hospitals operating profitably increased from 50.4% in 2007 to 77.5% in 2010, averaging 62.7%
  • Percent of city/county hospitals operating profitably increased from 4.8% in 2006 to 21.1% in 2010, averaging 17.6%
  • Percent of district hospitals operating profitably increased from 27.7% in 2006 to 35.6% in 2010, averaging 28.6%
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Percent of Hospitals with Positive Net Income by Type of Control

2006 2007 2008 2009 2010
City / County 47.6% 57.1% 47.4% 47.4% 47.4%
District 66.0% 53.3% 64.4% 68.9% 71.1%
Investor 54.6% 52.1% 65.8% 70.4% 81.1%
Non-Profit 77.8% 78.7% 66.2% 68.5% 79.1%
Statewide Average 67.5% 66.2% 64.9% 68.1% 77.0%
  • Percent of hospitals statewide with positive net income increased from 67.5% in 2006 to 77.0% in 2010, averaging 68.8%
  • Percent of non-profit hospitals with positive net income increased from 77.8% in 2006 to 79.1% in 2010, averaging 74.0%
  • Percent of investor hospitals with positive net income increased from 54.6% in 2006 to 81.1% in 2010, averaging 64.8%
  • Percent of city/county hospitals with positive net income was constant at 47.4% except for 2007, when 57.1% reported a positive net income
  • Percent of district hospitals with positive net income increased from 66.0% in 2006 to 71.1% in 2010, averaging 64.7%
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Net Revenue (Payments) per Adjusted Day by Payer

2006 2007 2008 2009 2010
Medicare $1,872 $1,989 $2,102 $2,305 $2,426
Medi-Cal $1,491 $1,537 $1,618 $1,647 $1,943
Other 3rd Parties $3,627 $3,882 $4,261 $4,616 $5,054
Indigent & Self-Pay $1,091 $1,290 $1,093 $1,318 $1,255
Average Cost per Adjusted Day $2,103 $2,238 $2,383 $2,516 $2,702
  • Payments for Other 3rd Parties, which consists mostly of private managed care health plans, was substantially higher than any other payer, increasing from $3,627 per adjusted day in 2006 to $5,054 per adjusted day in 2010, or by 39%. 
  • Payments for Other 3rd Parties were well above the average cost per adjusted day, which increased from $2,103 per adjusted day in 2006 to $2,702 per adjusted day in 2010, or by 28.5%
  • Medicare payments increased by 29.6%, from $1,872 per adjusted day in 2006 to $2,426 per adjusted day in 2010, and were below the average cost per adjusted day
  • Medi-Cal payments increased from $1,491 per adjusted day in 2006 to $1,647 per adjusted day in 2009, or by 10.5%; and then to $1,943 per adjusted day in 2010, or by 18.0%
  • Increase in Medi-Cal payments in 2010 due to Quality Assurance Fee program established by AB 1383 (Statutes of 2009)
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Average Reimbursement (Payment) Percentage by Payer

2006 2007 2008 2009 2010
Medicare 21.9% 21.3% 21.0% 20.3% 19.9%
Medi-Cal 24.1% 23.4% 22.7% 21.5% 23.2%
Other 3rd Parties 36.2% 35.9% 36.7% 36.4% 37.1%
Indigent & Self-Pay 18.3% 19.3% 15.3% 16.9% 14.7%
Average Payment Percentage 26.9% 26.4% 26.1% 25.6% 25.6%
  • Percent of charges paid (reimbursement percentage) statewide decreased from 26.9% of gross revenue in 2006 to 25.6% of gross revenue in 2010, averaging 26.1%
  • Percent of charges paid by Medi-Cal decreased from 24.1% in 2006 to 21.5% in 2009, before increasing to 23.2% in 2010; and were higher than Medicare, which decreased from 21.9% in 2006 to 19.9% in 2010, averaging 20.9%
  • Percent of charges paid by Other 3rd Parties was the highest, increasing from 36.2% in 2006 to 37.1% in 2010, averaging 36.4%
  • Percent of charges paid by Indigent and Self-Pay was the lowest, averaging 16.9%
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Payment Mix (Based on Net Revenue) by Payer

2006 2007 2008 2009 2010
Medicare 31.5% 31.1% 31.1% 30.9% 30.6%
Medi-Cal 19.1% 18.9% 18.7% 18.2% 20.0%
Other 3rd Parties 44.8% 44.9% 46.3% 46.3% 45.4%
Indigent & Self-Pay 4.6% 5.1% 3.9% 4.5% 4.1%
  • Payments (net revenue) from Other 3rd Parties averaged 45.6% of total payments, compared to 23.2% of patient days
  • Medicare payments averaged 31.0% of total payments, compared to 38.9% of patient days
  • Medi-Cal payments averaged 19.0% of total payments, compared to 30.4% of patient days
  • Indigent and Self-Pay payments averaged 4.4% of total payments,  compared to 7.5% of patient days
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Uncompensated Care Charges % of Charges by Type of Control

2006 2007 2008 2009 2010
Statewide Avg 5.4% 5.5% 5.3% 5.5% 5.7%
City/County 23.8% 23.2% 22.7% 23.7% 25.5%
District 5.3% 5.1% 5.0% 5.3% 5.6%
Investor 3.5% 4.2% 4.1% 4.4% 4.3%
Non-Profit 4.3% 4.3% 4.2% 4.2% 4.4%
  • City/county hospitals provided significantly more uncompensated care than other facility types, averaging 23.8% of gross revenue, and increasing to 25.5% in 2010
  • District hospitals provided more uncompensated care than private hospitals (investor and non-profit), averaging 5.3% of gross revenue
  • Investor and Non-Profit hospitals provided about the same level of uncompensated care, averaging 4.1% and 4.3% of gross revenue, respectively
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Total Operating Expenses (Labor Vs. Non-Labor)

2006 2007 2008 2009 2010
Labor Expense $28,117,895,394 $30,178,296,243 $32,580,422,177 $34,919,947,032 $36,422,570,228
Non-Labor Expense $26,068,205,080 $27,794,716,308 $29,168,353,729 $30,422,229,009 $32,565,194,569
  • Labor costs (salaries, wages and employee benefits) increased from $28.1 billion in 2006 to $36.4 billion in 2010, or by 29.5%
  • Non-labor costs increased from $26.1 billion to $32.6 billion from 2006 to 2010, or by 24.9%
  • Total operating expenses increased from $54.2 billion in 2006 to $69.0 billion in 2010, or by 27.3%
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Operating Expense per Adjusted Day By Expense Category

2006 2007 2008 2009 2010
Salaries & Benefits $1,126 $1,205 $1,301 $1,390 $1,473
Pro Fees $162 $170 $176 $173 $172
Supplies $346 $366 $383 $406 $422
Purchased Services $282 $303 $318 $334 $352
Depre, Leases & Interest $152 $161 $173 $183 $194
Insurance and All Other $102 $110 $113 $116 $176
  • Labor costs (salaries, wages and employee benefits) were substantially higher and increased faster than any other expense category
  • Labor costs increased from $1,126 per adjusted day in 2006 to $1,473 per adjusted day in 2010, or by 30.8%
  • Supplies increased from $346 per adjusted day in 2006 to $422 per adjusted day in 2010, or by 22.0%
  • Purchased Services increased from $282 per adjusted day in 2006 to $352 per adjusted day in 2010, or by 24.8%
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Labor costs per Paid Full-Time Equivalent (FTE)

2006 2007 2008 2009 2010
Labor Costs per Paid FTE $77,021 $81,445 $85,553 $90,289 $95,222

Labor Costs % of Total Operating Expenses

2006 2007 2008 2009 2010
Labor Costs % of Total Expenses 51.9% 52.1% 52.8% 53.4% 52.8%

Paid FTEs per Adjusted Occupied Bed

2006 2007 2008 2009 2010
Paid FTEs per Adjusted Occupied Bed 5.37 5.44 5.57 5.65 5.64

Productive FTEs by Employee Classification

2006 2007 2008 2009 2010
Management & Supervision 25,964 25,983 26,395 26,661 26,985
Technician & Specialist 72,056 73,150 75,136 77,040 78,335
Registered Nurse 89,846 92,361 95,984 98,288 97,393
LVN, Aide & Orderlies 34,288 34,313 34,095 33,605 32,259
Clerical & Other Administrative 57,253 56,658 56,875 56,402 55,850
Environmental & Food Service 21,981 21,858 22,420 22,747 22,726
All Other 21,053 20,836 20,973 21,742 21,014
Total 322,441 325,159 331,879 336,485 334,564
  • Registered Nurses were the largest employee category and comprised between 27.9% and 29.2% of total productive FTEs
  • Productive FTE Registered Nurses increased form 89,846 in 2006 to 98,288 productive FTEs in 2009, before decreasing to 97,393 productive FTEs in 2010.
  • Employees classified as Technical and Specialist grew steadily from 72,056 productive FTEs in 2006 to 78,335 productive FTEs in 2010, were the second largest employee category after Registered Nurses, and comprised between 22.3% and 23.4% of total productive FTEs
  • Employees classified as Clerical and Other Administrative decreased slightly from 57,253 productive FTEs in 2006 to 55,850 productive FTEs in 2010, and were the third largest employee category
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Licensed Beds by Type of Care

2006 2007 2008 2009 2010
Acute 67,456 69,056 67,862 69,184 68,157
Psychiatric 6,121 6,092 6,095 5,971 5,886
Rehabilitation 2,479 2,458 2,337 2,377 2,317
Long-Term Care 8,588 8,290 8,027 7,696 7,139
All Other 1,108 1,128 1,096 1,062 1,044
Total 85,752 87,024 85,417 86,290 84,543
  • Total licensed beds decreased by 1,209 beds from 2006 to 2010, or by 1.4%
  • Licensed acute care beds increased by 701 beds from 2006 to 2010, or by 1.0%, and comprised 80.6% of total licensed beds in 2010
  • Licensed acute psychiatric and acute rehabilitation beds decreased by 235 beds (3.8%) and 162 beds (6.5%), respectively, from 2006 to 2010
  • Licensed LTC beds decreased by 1,449 beds from 2006 to 2010, or by 16.9%
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Average Daily Number of Inpatients (Census)

2006 2007 2008 2009 2010
Average Daily Census 52,852 52,743 53,186 52,234 50,540
  • Average daily number of inpatients (census) increased from 52,852 patients in 2006 to 53,186 in 2008, before decreasing to 50,540 in 2010, or by 4.4% from 2006 to 2010
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Average Length of Stay (Days) by Payer

2006 2007 2008 2009 2010
Medicare 5.94 5.90 5.93 5.64 5.55
Medi-Cal 6.52 6.50 6.27 6.42 6.22
Other 3rd Parties 4.24 4.22 4.31 4.24 4.22
Indigent & Self-Pay 5.67 5.55 5.60 5.57 5.30
Average (Overall) 5.49 5.45 5.46 5.37 5.28
  • Average length of stay (overall) decreased from 5.49 days in 2006 to 5.28 days in 2010, averaging 5.41 days
  • Average lengths of stay for all payers decreased from 2006 to 2010
  • Medi-Cal patients had the longest lengths of stay, mainly due to long-term care services, averaging 6.39 days from 2006 to 2010
  • Other 3rd Parties patients had the shortest lengths of stay, averaging 4.25 days from 2006 to 2010, and was the only payer below the statewide average
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Occupancy Rate (Licensed Beds) by Type of Care

2006 2007 2008 2009 2010
Acute 59.5% 58.8% 60.6% 58.7% 57.7%
Psychiatric 69.5% 68.8% 66.8% 66.2% 66.3%
Rehabilitation 58.1% 56.8% 58.8% 57.6% 56.4%
Long-Term Care 71.4% 70.4% 71.3% 71.8% 71.1%
All Other 70.5% 61.4% 62.8% 68.8% 65.9%
Average (Overall) 61.5% 60.5% 62.0% 60.5% 59.5%
  • Occupancy rate (overall) decreased from 61.5% in 2006 to 59.5% in 2010, and is consistent with the decrease in average daily census
  • Occupancy rates for all types of care decreased from 2006 to 2010
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Patient Days by Payer (Excluding Nursery)

2006 2007 2008 2009 2010
Medicare 7,647,489 7,530,577 7,564,297 7,283,967 7,238,034
Medi-Cal 5,235,422 5,334,092 5,325,580 5,403,885 5,249,792
Other 3rd Parties 4,965,431 5,003,044 4,991,931 4,872,923 4,595,368
Indigent & Self-Pay 1,411,254 1,337,884 1,315,479 1,313,104 1,267,130
Total 19,259,596 19,205,597 19,197,287 18,873,879 18,350,324
  • Total patient days decreased each year since 2006
  • Total patient days decreased from 19.26 million days in 2006 to 18.35 million days in 2010, or by 4.7%
  • Medi-Cal patient days increased by 0.3% from 2006 to 2010; all other payers showed a decrease
  • Medicare and Other 3rd Parties patient days decreased by 5.4% and 7.5%, respectively, from 2006 to 2010
  • Indigent and Self-Pay patient days decreased the most, by 10.2% from 2006 to 2010
  • Medicare had the highest volume of patient days during this period, averaging 7.45 million days and 39.3% of total days
  • Medi-Cal had the 2nd highest volume of patient days during this period, averaging 5.31 million days and 28.0% of total days
  • Other 3rd Parties had the 3rd highest volume of patient days during this period, averaging 4.89 million days and 25.7% of total days
  • Indigent and Self-Pay had the lowest volume of patient days during this period, averaging 1.33 million days and 7.0% of total days
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Discharges by Payer (excluding Nursery)

2006 2007 2008 2009 2010
Medicare 1,287,299 1,277,415 1,275,936 1,290,610 1,304,219
Medi-Cal 802,558 821,062 848,969 842,030 844,522
Other 3rd Parties 1,171,375 1,185,736 1,159,228 1,147,929 1,088,208
Indigent & Self-Pay 248,905 241,039 234,933 235,630 238,955
Total 3,510,137 3,525,252 3,519,066 3,516,199 3,475,904
  • Total discharges increased from 2006 to 2007, but decreased each year thereafter, and by 1.1% from 2009 to 2010
  • Medicare and Medi-Cal discharges increased by 1.3% and 5.2%, respectively, from 2006 to 2010
  • Other 3rd Parties and Indigent and Self-Pay discharges decreased by 7.1% and 4.0%, respectively, from 2006 to 2010
  • Medicare had the highest volume of discharges, averaging 1.29 million discharges, and 36.7% of total discharges
  • Other 3rd Parties had the 2nd highest volume of discharges, averaging 1.15 million discharges, and 32.8% of total discharges
  • Medi-Cal had the 3rd highest volume of discharges, averaging 831,828 discharges, and 23.7% of total discharges
  • Indigent and Self-Pay had the lowest volume of discharges, averaging 239,892 discharges, and 6.8% of total discharges
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Outpatient Visits by Payer

2006 2007 2008 2009 2010
Medicare 11,733,410 12,178,457 12,202,345 12,553,892 12,749,174
Medi-Cal 9,707,162 9,836,431 9,732,089 10,713,860 10,933,950
Other 3rd Parties 16,596,365 16,770,674 16,936,435 16,821,707 16,810,952
Indigent & Self-Pay 5,786,850 5,796,755 5,664,515 6,174,060 6,707,308
Total 43,823,787 44,582,317 44,535,384 46,263,519 47,201,384
  • Total outpatient visits increased from 43.8 million visits in 2006 to 47.2 million visits in 2010, or by 7.7%
  • Outpatient visits increased for all payers from 2006 to 2010
  • Medi-Cal and Indigent and Self-Pay had the largest increases at 12.6% and 15.9%, respectively, from 2006 to 2010
  • Other 3rd Parties had the highest volume of outpatient visits, with a 1.3% increase in utilization from 2006 to 2010, an average of 16.79 million visits, and a payer mix of 37.1%
  • Medicare had the 2nd highest volume of outpatient visits, with an 8.7% increase in utilization from 2006 to 2010, an average of 12.28 million visits, and a payer mix of 27.1%
  • Medi-Cal had the 3rd highest volume of outpatient visits, with a 12.6% increase in utilization from 2006 to 2010, an average of 10.18 million visits, and a payer mix of 22.5%
  • Indigent and Self-Pay had the lowest volume of outpatient visits during this period, with a 15.9% increase in utilization from 2006 to 2010, averaging 6.03 million visits, and a payer mix of 13.3%
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Visits for Selected Ambulatory Services

2006 2007 2008 2009 2010
Emergency Room 11,041,052 11,017,509 11,289,434 12,133,307 12,138,436
Clinics  13,554,730 14,155,299 13,779,963 14,341,443 14,290,573
O/P Surgeries 1,332,804 1,323,731 1,305,624 1,310,110 1,299,195
O/P Home Care 2,326,035 2,213,315 2,007,608 1,880,025 2,092,411
O/P Referred Visits 15,893,010 16,145,455 16,384,585 17,014,968 17,443,695
  • Outpatient referred visits had the highest volume, averaging 16.58 million visits; increased each year during this period, and increased by 9.8% from 2006 to 2010
  • Clinic visits had the 2nd highest volume, averaging 14.02 million visits, and increased by 5.4% from 2006 to 2010
  • Emergency Room visits (inpatient and outpatient) had the 3rd highest volume, averaging 11.52 million visits, and increased by 9.9% from 2006 to 2010
  • Outpatient surgeries and outpatient home care visits decreased by 2.5% and 10.0%, respectively, from 2006 to 2010
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Page last revised: July 12, 2013 3:26 PM