1. Section 8: Health Care Providers and Service Availability Hospital system and capacity Utilization of hospital services Hospital financial trends Hospital capital expenditures Hospital community benefit Availability of specific health care services at hospitals (e.g., imaging, surgery) Physician services A summary of the charts and graphs contained within is provided at Chartbook Summaries - Section 8. Direct links are listed on each page. Please contact the Health Economics Program at 651-201-3550 or health.hep@state.mn.us if additional assistance is needed for accessing this information.Chartbook Summaries - Section 8 health.hep@state.mn.us 1

2. HOSPITAL SYSTEM AND CAPACITY

3. Hospital Capacity in Minnesota, 2013 3 Number of Hospitals Available Beds* Occupancy Rate Based on Available Beds Licensed Beds** Occupancy Rate Based on Licensed Beds Available Beds Per 1,000 Population 13311,71756.1%16,38540.1%2.2 *Available beds is defined as the number of acute care beds that are immediately available for use or could be brought online within a short period of time. **Licensed beds is defined as the number of beds licensed by the Department of Health, under Minnesota Statutes, sections 144.50 to 144.58. Source: MDH Health Economics Program analysis of hospital annual reports, U.S. Census Bureau Unless otherwise noted, all data is this section is for each hospital’s fiscal year.

4. Minnesota Geographic Regions: Definition 4 Summary of image

5. 5 Regional Hospital Capacity in Minnesota, 2013 Number of Hospitals Available Beds* Occupancy Rate Based on Available Beds Licensed Beds** Occupancy Rate Based on Licensed Beds Available Beds Per 1,000 Population Central191,14648.8%1,37740.6%1.6 Metro265,91368.4%8,52447.5%2.0 Northeast171,16045.3%1,41137.3%3.6 Northwest1338234.7%57023.2%1.9 South Central1556633.9%77024.9%1.9 Southeast121,65155.7%2,59035.5%3.3 Southwest2357118.5%72514.5%2.6 West Central832829.3%41823.0%1.7 Total13311,71756.1%16,38540.1%2.2 *Available beds is defined as the number of acute care beds that are immediately available for use or could be brought online within a short period of time. **Licensed beds is defined as the number of beds licensed by the Department of Health, under Minnesota Statutes, sections 144.50 to 144.58. Source: MDH Health Economics Program analysis of hospital annual reports.

6. Distribution of Minnesota’s Hospitals by Size and Region, 2013 6 By Number of Available Beds Under 25 Beds 25-49 Beds 50-99 Beds 100-199 Beds 200 or More Beds Total Central10.5%68.4%10.5%5.3% 100.0% Metro3.8%11.5%26.9%11.5%46.2%100.0% Northeast41.2%23.5%17.6%5.9%11.8%100.0% Northwest46.2% 0.0%7.7%0.0%100.0% South Central46.7%33.3%13.3%6.7%0.0%100.0% Southeast25.0% 33.3%0.0%16.7%100.0% Southwest39.1%56.5%4.3%0.0% 100.0% West Central37.5% 12.5% 0.0%100.0% Statewide28.6%37.6%15.0%6.0%12.8%100.0% Source: MDH Health Economics Program analysis of hospital annual reports.

7. Ownership of Minnesota Hospitals, 2013 133 Total Hospitals 7 Government 24.1% City: 7.5% County: 5.3% City and County: 1.5% District: 9.8% Source: MDH Health Economics Program analysis of hospital annual reports. Summary of chart

8. Minnesota Community Hospitals Affiliated with a Hospital System, 1994-2013 8 Source: MDH Health Economics Program analysis of hospital annual reports. Summary of graph

9. Largest Minnesota Hospital Systems, 2003-2013 9 *Previously known as Sioux Valley. Changes in the number of hospital affiliations impact trend lines over time. **Essentia represents the merger of Benedictine and SMDC systems and includes both systems over time. Source: MDH Health Economics Program analysis of hospital annual reports. Summary of graph

10. Minnesota Hospital System Ownership, 2013 OwnedManagedLeasedTotalAvailable Beds Allina Health System1110121,895 Mayo Clinic1300 1,783 Fairview Health Services70071,419 Essentia Community Hospitals and Clinics (ECHC)110112851 HealthEast Care System4004630 CentraCare Health System4015534 HealthPartners, Inc.2002498 North Memorial Health Care2002455 Park Nicollet Health Services2103438 Sanford Health75315435 St. Luke's Hospital, Duluth1102284 Children's Hospitals and Clinics1001279 Catholic Health Initiatives5005107 Select Medical Corporation100192 Avera Health120380 Quorum Health Resources010125 Ministry Health Care100124 Rice Memorial Hospital010118 Total7312590*9,847 Unaffiliated Hospitals451,870 10 Source: MDH Health Economics Program analysis of hospital annual reports. *Hospitals with multiple affiliations are counted under each affiliation; for hospitals with multiple affiliations available beds are divided across systems equally.

11. Composition of Minnesota’s Hospital Workforce, 2013 11 *Includes nurse anesthetists, nurse practitioners, and physician assistants. Other is reported as grouped category of positions. Source: MDH Health Economics Program analysis of hospital annual reports. Summary of chart

12. UTILIZATION OF HOSPITAL SERVICES

13. Minnesota Hospital Outpatient Visits and Inpatient Admissions, 2003 to 2013 13 Source: MDH Health Economics Program analysis of hospital annual reports. Summary of graph

14. Average Length of Stay in Minnesota Hospitals, 2003 to 2013 14 Source: MDH Health Economics Program analysis of hospital annual reports. Summary of graph

15. Average Length of Stay: Rural and Urban Minnesota Hospitals, 2003 to 2013 15 A hospital is defined as rural if it is located in a county that is not part of a metropolitan statistical area. Source: MDH Health Economics Program analysis of hospital annual reports. Summary of graph

16. Minnesota Hospital Utilization by Region, 2013 16 Inpatient Admissions Inpatient Days Average Length of Stay (days) Outpatient Visits Central54,873204,1933.71,626,111 Metro322,4511,476,3664.64,457,945 Northeast42,397191,8824.5906,323 Northwest13,82648,3323.5653,916 South Central20,52969,9993.4771,231 Southeast73,606335,4944.61,800,691 Southwest12,30138,4533.1546,659 West Central9,62235,1263.7571,261 Statewide549,6052,399,8454.411,334,137 Source: MDH Health Economics Program analysis of hospital annual reports.

17. Distribution of Hospital Admissions and Inpatient Days by Type of Service, 2013 Percent of Admissions Percent of Inpatient Days Medical & surgical care33.8%34.9% Cardiac care11.7%10.3% Obstetric care13.0%7.5% Orthopedic care12.6%9.6% Psychiatric care6.7%12.1% Neurology care5.9%5.7% Neonatal care (excluding births)4.6%5.8% Chemical dependency care1.7%2.2% Rehabilitation1.1%3.0% Other acute care9.0% Total acute care100% 17 Source: MDH Health Economics Program analysis of hospital annual reports.

18. Distribution of Hospital Admissions and Inpatient Days by Type of Service, 2013 Rural Percent of Admissions Rural Percent of Inpatient Days Urban Percent of Admissions Urban Percent of Inpatient Days Medical & surgical care39.0%41.5%32.7%33.9% Cardiac care10.0%8.6%12.0%10.5% Obstetric care15.5%10.6%12.5%7.1% Orthopedic care11.3% 12.8%9.3% Psychiatric care5.8%11.4%6.9%12.2% Neurology care3.9%4.5%6.3%5.8% Neonatal care (excluding births)4.0%3.0%4.7%6.2% Chemical dependency care1.2%2.0%1.8%2.2% Rehabilitation1.3%4.0%1.0%2.8% Other acute care8.0%3.2%9.2%9.9% Total acute care100% 18 Source: MDH Health Economics Program analysis of hospital annual reports.

19. Trend in Outpatient Surgeries at Minnesota Hospitals, 2003 to 2013 19 Source: MDH Health Economics Program analysis of hospital annual reports. Summary of graph

20. Trend in Outpatient Surgeries at Minnesota Hospitals per 1000 in Population, 2003 to 2013 20 Source: U.S. Census, MDH Health Economics Program analysis of hospital annual reports. Summary of graph

21. Trend in Emergency Room Visits at Minnesota Hospitals, 2003 to 2013 21 Source: MDH Health Economics Program analysis of hospital annual reports. Summary of graph

22. Trend in Emergency Room Visits at Minnesota Hospitals per 1000 Population, 2003 to 2013 22 Source: U.S. Census, MDH Health Economics Program analysis of hospital annual reports. Summary of graph

23. HOSPITAL FINANCIAL TRENDS

24. Net Assets of Minnesota Hospitals, 2003 to 2013 24 Source: MDH Health Economics Program analysis of hospital annual reports. Net assets is an accounting term defining the total assets minus the total liabilities, and describes the hospital’s financial position. Summary of graph

25. Net Income of Minnesota Hospitals, 2003 to 2013 25 Source: MDH Health Economics Program analysis of hospital annual reports. Summary of graph

26. Minnesota Hospitals' Net Income as a Percent of Revenue, 2003 to 2013 26 Source: MDH Health Economics Program analysis of hospital annual reports. Summary of graph

27. Hospital Financial Indicators by Region, 2013 Net Income (Million Dollars) Net Income as a % of Revenue Central$172.010.1% Metro$625.07.1% Northeast$117.67.8% Northwest$24.15.6% South Central$56.78.1% Southeast$361.115.2% Southwest$32.67.1% West Central$15.84.3% Statewide$1,404.98.6% 27 Source: MDH Health Economics Program analysis of hospital annual reports.

28. Hospital Financial Indicators by Hospital Size and Type, 2013 28 Net Income (Million Dollars) Net Income as a % of Revenue Number of Available Beds Under 25 Beds $43.58.3% 25 to 49 Beds $139.26.9% 50 to 99 Beds $139.76.4% 100 to 199 Beds $126.78.1% 200 Beds or More $955.79.5% Type of Hospital* Critical Access Hospital (CAH) $125.66.6% PPS $1,275.78.9% Other $3.63.1% All Hospitals $1,404.98.6% *A critical access hospitals is a federal designation for a rural hospital that meets certain criteria, and PPS hospitals are Medicare Prospective Payment System hospitals. Source: MDH Health Economics Program analysis of hospital annual reports.

29. Sources of Patient Revenue for Minnesota Hospitals, 2013 29 *Includes Medical Assistance and MinnesotaCare. A hospital is defined as rural if it is located in a county that is not part of a metropolitan statistical area. Source: MDH Health Economics Program analysis of hospital annual reports. Rural Facilities Urban Facilities Facilities Statewide Medicare 39.7%28.9%31.0% State Public Programs* 10.0%12.6%12.1% Private Insurance 45.3%53.3%51.7% Self-Pay 3.5%3.2%3.3% Other Payers 1.6%2.1%2.0% All Payers 100% Percent of Hospital Patient Revenue

30. HOSPITAL CAPITAL EXPENDITURES

31. Capital Expenditure Commitments by Minnesota Hospitals, 2012-2013 20122013 Percent of Minnesota hospitals reporting major capital expenditure commitment 28.6%21.8% Total number of capital expenditure commitments reported 8780 Value of major capital expenditure commitments reported (Millions) $647.0$423.6 31 Major spending commitments that are reportable under 62J.17 include expenditures in excess of $ 1 million. Spending commitments are sorted by the reported calendar date of the spending commitment and the 2012 figures reflect 2012 projects reported in the 2013 fiscal year and is a revision over previous publications. A small portion of capital expenditure data may belong to earlier reporting periods. Source: MDH Health Economics Program analysis of hospital annual reports.

32. Minnesota Hospital Capital Expenditure Commitments by Type, 2013 Capital Expenditure Commitments (Millions) Percent of Total Capital Expenditure Commitments Medical equipment $78.818.6% Building and space $325.976.9% Other $19.04.5% All Major Capital Expenditure Commitments $423.6100% 32 Source: MDH Health Economics Program analysis of hospital annual reports.

33. Minnesota Hospital Capital Expenditure Commitment by Category, 2013 Capital Expenditure Commitments (Millions) Percent of Total Capital Expenditure Commitment General Infrastructure$147.534.8% Other Patient Care Services$77.218.2% Emergency Care$41.39.7% Obstetrics$30.27.1% Diagnostic Imaging$27.66.5% Radiation Therapy$26.36.2% Cardiac Care$24.85.8% Surgery$17.04.0% Mental Health$9.72.3% Neurology$9.22.2% Rehabilitation$8.62.0% Intensive Care (ICU or NICU)$2.40.6% Orthopedics$1.80.4% All Major Capital Projects$423.6100% 33 Major spending commitments that are reportable under 62J.17 include expenditures in excess of $ 1 million. Source: MDH Health Economics Program analysis of hospital annual reports.

34. COMMUNITY BENEFIT

35. Community Benefit Provided by Minnesota Hospitals, 2013 Community Benefit (Millions) Percent of Total Operating Expenses Community Care$157.41.1% State Health Care Programs Underpayment$507.03.4% Operating Subsidized Services$100.80.7% Education$199.41.3% Research$16.20.1% Community Health Services$45.50.3% Financial and In-Kind Contributions$14.20.1% Community Building Activities$4.70.0% Community Benefit Operation$19.80.1% Total$1,065.07.1% 35 Source: MDH Health Economics Program analysis of hospital annual reports. *Community benefit refers to the contributions hospitals make outside of reimbursed patient care to the communities, for the or definitions of categories see: the forthcoming MDH/Health Economics Program, “Community Benefit Provided by Minnesota Hospitals in 2013” forthcoming (www.health.state.mn.us/healtheconomics).www.health.state.mn.us/healtheconomics

36. Distribution of Minnesota Hospitals’ Community Benefit by Category, 2013 36 Source: MDH Health Economics Program analysis of hospital annual reports. *Community benefit refers to the contributions hospitals make outside of reimbursed patient care to the communities, for the definitions of categories see: Community Benefit Provided by Minnesota’s Hospitals 2009 (PDF: 194 KB/20 Pages)Community Benefit Provided by Minnesota’s Hospitals 2009 (PDF: 194 KB/20 Pages) Summary of chart

37. AVAILABILITY OF SPECIFIC HOSPITAL SERVICES

38. Services Available in Minnesota Hospitals, 2013 38 *Services are considered “available” when they are provided on site by hospital staff, on site through contracted services, or off site through shared services agreement. Source: MDH Health Economics Program analysis of hospital annual reports. Number of Hospitals Services Available* Services Not Available Surgery Inpatient Surgery 1258 Outpatient Surgery 1312 Open-Heart Surgery Services 18115 Organ Transplant Services 7126 Mental Health/Chemical Dependency Services Outpatient Psychiatric Services 6469 Detoxification Services 25108 Diagnostic Radiology Computer Tomography (CT) Scanning Services 1321 Magnetic Resonance Imaging (MRI) Services 1303 Positron Emission Tomography (PET) Services 9124 Single Photon Emission Computerized Tomography (SPECT) Services 4687 Other Services Renal Dialysis Services 4093 Cardiac Catheterization Services 25108

39. PHYSICIAN SERVICES

40. Number of Physicians Practicing in Minnesota, 2014 40 *Includes all physicians who have an active Minnesota license and a primary business address in Minnesota. “Primary Care” includes: General Family Medicine, General Internal Medicine, General Pediatrics. “No Certification” means there were no board certifications on the record received from the Minnesota Board of Medical Practice. Source: Minnesota Board of Medical Practices, May 2014. Analysis by MDH, Office of Rural Health & Primary Care. Note: Due to methodology changes, past Chartbook data should not be used for comparison. Previous data used physicians’ mailing address and methodology was changed to use physicians’ business practice address. Number of Physicians:14,977 Primary Care Physicians4,488 Specialty Care Physicians7,476 No Certification3,013 Population for Every 1 Physician:453 Primary Care Physicians1,207 Specialty Care Physicians725

41. Number of Physicians Practicing in Minnesota by MSA and Non-MSA Counties, 2014 41 Rural Small Town MicropolitanMetropolitanStatewide Number of Physicians: 2145801,17113,01214,977 Primary Care Physicians 1373275023,5224,488 Specialty Care Physicians 171434686,8487,476 Population for Every 1 Physician: 2,043674519297453 Primary Care Physicians 3,1911,1951,2101,0981,207 Specialty Care Physicians 25,7152,7331,297565725 *Includes all physicians who have an active Minnesota license and a primary business address in Minnesota. “Primary Care” includes: General Family Medicine, General Internal Medicine, General Pediatrics. “No Certification” means there were no board certifications on the record received from the Minnesota Board of Medical Practice. **MSA refers to Metropolitan Statistical Area, see Minnesota Health Workforce Demographics (http://www.health.state.mn.us/divs/orhpc/workforce/demo/msadef.html) for more information.Minnesota Health Workforce Demographics (http://www.health.state.mn.us/divs/orhpc/workforce/demo/msadef.html) Source: Minnesota Board of Medical Practices, May 2014. Analysis by MDH, Office of Rural Health & Primary Care. Note: Due to methodology changes, past Chartbook data should not be used for comparison. Previous data used physicians’ mailing address and methodology was changed to use physicians’ business practice address.

42. Distribution of Number of Physicians Practicing in Minnesota by Location and Specialty, 2014 42 Rural Small Town MicropolitanMetropolitanStatewide Primary Care Physicians64.0%56.4%42.9%27.1%30.0% General Facility Based0.9%3.4%7.9%11.2%10.5% Surgeons2.8%11.4%12.4%9.0%9.2% Other Specialty Physicians4.2%9.8%19.6%32.5%30.2% No Certification28.0%19.0%17.2%20.3%20.1% All Specialties 100% *Includes all physicians who have an active Minnesota license and a primary business address in Minnesota. “Primary Care” includes: General Family Medicine, General Internal Medicine, General Pediatrics. “No Certification” means there were no board certifications on the record received from the Minnesota Board of Medical Practice. Source: Minnesota Board of Medical Practices, May 2014. Analysis by MDH, Office of Rural Health & Primary Care. Note: Due to methodology changes, past Chartbook data should not be used for comparison. Previous data used physicians’ mailing address and methodology was changed to use physicians’ business practice address.

43. Additional Information from the Health Economics Program Available Online Health Economics Program Home Page (www.health.state.mn.us/healtheconomics) Health Economics Program Home Page (www.health.state.mn.us/healtheconomics) Publications (www.health.state.mn.us/divs/hpsc/hep/publications/index.html) Publications (www.health.state.mn.us/divs/hpsc/hep/publications/index.html) Health Care Market Statistics (Chartbook Updates) (www.health.state.mn.us/divs/hpsc/hep/chartbook/index.html) Health Care Market Statistics (Chartbook Updates) (www.health.state.mn.us/divs/hpsc/hep/chartbook/index.html) A summary of the charts and graphs contained within is provided at Chartbook Summaries - Section 8. Direct links are listed on each page. Please contact the Health Economics Program at 651-201-3550 or health.hep@state.mn.us if additional assistance is needed for accessing this information.Chartbook Summaries - Section 8health.hep@state.mn.us 43