Financial Data (below)
Quality measures and mixed incentives
Readmission penalties or xls (6MB)
Biggest penalties (methods)
Previous data: Readmission Penalties (August 2013, 3 MB xls)
List of Accountable Care Organizations (many include hospitals)
Other Medicare data
Medicare Costs, Premiums, and Alternatives
Hospital Financial Statements
A spreadsheet (5MB) shows each hospital's financial statements, and many Medicare calculations at each hospital. It includes both Medicare and non-Medicare revenue and spending. It is compiled by Medicare to provide a context for Medicare spending in each hospital, and is called a "Medicare Cost Report"
The spreadsheet includes:
The spreadsheet has brief labels; fuller explanations are in the original Medicare form and instructions. Chapter 40 of Medicare's manual has the form (R6P240f), including work sheets S (p.1), A (p.22), E (p.84), and G (p.100). Chapter 40 also has the instructions (pr2_40, abbreviations are on pp.9-11), which can answer many questions about the entries on the form. The current format has been used since 2010, and other data are available back to 1995.
Another article shows helpful commands for the spreadsheet.
The source also has each hospital's occupancy rate for several departments: general, maternity, ICU, coronary care, burn, hospice, psychiatric, rehab, etc. These have not been put in this spreadsheet. If you would find the occupancy rates useful, please leave a comment below or send an email.
The original Medicare databases are available from 1995 to the present. They are far more complex than the spreadsheet, with 3 types of records, and millions of records, since every number and answer on each form has a separate record. For those who need it, a CMS documentation page has record counts, a spreadsheet of hospitals covered, and layouts. The Medicare database averages 3,000 numeric records and 600 alpha records per hospital each year. 65 key items are in the spreadsheet, and others can be available if needed.
Other Hospital Financial Data
Electronic Municipal Market Access (EMMA) has PDF copies of operating expense and audited financial statements for each hospital (or other facility), if it has outstanding tax-free bonds. Put hospital name in their search box, to list its past & present bonds. Click any bond which is still outstanding (on right), accept the disclosure, then click "Continuing Disclosure" to see annual and sometimes quarterly data. The data are similar to the spreadsheet above, but in PDF, often with more data from the past, but fewer hospitals.
"Summary of audit findings and federal awards" is an Audit Clearinghouse form a few pages long for each hospital showing checkoffs for any audit findings, and the amount of each federal grant spent during a year ("awards"); it does not cover Medicare or Medicaid, since these are exempt from the federal "single audit" rules. It also shows address, Employer ID number (EIN) and DUNS number.
IRS form 990 is available from Guidestar or Foundation Center or ProPublica for US nonprofit hospitals. It shows total revenue and expense and highly paid staff (schedule J ) and contractors (VII-B). It also shows total received from Medicare and Medicaid in section VIII-2 "Revenue, Program Service," and several types of expenses in section IX, balance sheet in X, political spending in schedule C.
Canadian nonprofits (non-governmental organisations, NGOs) have financial information at donate2charities.ca
Hospital bills for 100 most common diagnoses, 2011 and 2012, for US and each hospital.
Explanation of General Medicare Payment Formula for Hospitals
The explanation is based on information from
Many numbers change each year. There are links to Medicare's "home page" of each year at the bottom of the main CMS readmission page.
Hospital operating base or "Specific standardized amounts"
Hospital capital base
Both hospital bases are multiplied by the DRG weight (Table 5).
Readmission reduction for "excess" readmissions in past years, based on operating costs plus payments for new technology, but excluding capital, and adjusted for transfers.
DSH for poor people
IME for teaching
Outlier payments for very costly hospital stays cover 80% of hospital losses over $23,000 (90% for burns). These total about $16 billion per year and they average about 2.9% of payments for most procedures, including the procedures subject to readmission penalties. They are higher on a few other procedures.
Summary inpatient costs released by Medicare include DRG amount (operating + capital), disproportionate share, teaching, and outlier payments. Operating cost (the base for readmission penalties) is about 73% of these summary costs.
Transfers after short stay get lower payment
New technology add-on payment (NTAP) added if applicable
Large Urban Areas get extra factor, meaning Metro Statistical Areas over 1 million people and New England County Metro Areas over 970,000.
Organ acquisition is paid separately
Value-based purchasing VBP has adjustments, based on operating costs, not capital.
Sole community hospitals (SCH) are paid by other formulas if higher
Medicare dependent hospitals (MDH) are paid by another formula if higher
Low volume hospitals get more, by formula
Qualifying hospitals are in the bottom quartile of counties on Medicare spending per enrollee, and get more
Hospitals not reporting quality data get reduction
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