Georgia: Medicare Utilization At Largest Hospitals
Medicare utilization is simply the total number of Medicare days divided by the total number of days. Let us break that down just a little further, though.
Medicare is a government health insurance program in the United States for Americans 65 and older. It also covers younger people with disability status as determined by the Social Security Administration. Inpatient hospital days are covered under Part A or Part C plans. Part A is the traditional Medicare plan, whereas Part C is called Medicare Advantage or Managed Medicare. Part C allows patients to choose a plan that covers at least what Part A does and sometimes more.
Total days above refers to the inpatient acute days. These are days patients spent receiving acute level care at the hospital during the Medicare cost report period, which is usually is for a year.
The data below takes a look at what percentage of the Inpatient total days at the larger hospitals in Georgia were Medicare patients.
| Hospital | City | Cost Report YE | Mcare Days | Total Days | Mcare Util % |
|---|---|---|---|---|---|
| KENNESTONE HOSPITAL | MARIETTA | 6/30/21 | 94,954 | 211,401 | 45% |
| NORTHSIDE HOSPITAL | ATLANTA | 9/30/20 | 36,808 | 204,691 | 18% |
| EMORY UNIVERSITY HOSPITAL | ATLANTA | 8/31/21 | 96,017 | 201,730 | 48% |
| NORTHEAST GEORGIA MEDICAL CENTER | GAINESVILLE | 9/30/20 | 95,095 | 184,683 | 51% |
| GRADY MEMORIAL HOSPITAL | ATLANTA | 12/31/20 | 55,711 | 184,137 | 30% |
| MEDICAL CENTER OF CENTRAL GEORGIA | MACON | 12/31/20 | 70,011 | 178,941 | 39% |
| EMORY UNIVERSITY HOSPITAL MIDTOWN | ATLANTA | 8/31/21 | 67,687 | 172,474 | 39% |
| MEMORIAL HEALTH UNIV MED CENTER | SAVANNAH | 12/31/20 | 59,622 | 171,462 | 35% |
| PIEDMONT HOSPITAL INC. | ATLANTA | 6/30/21 | 79,462 | 157,187 | 51% |
| NORTHSIDE HOSPITAL - GWINNETT | LAWRENCEVILLE | 9/30/20 | 52,775 | 147,103 | 36% |
| UNIVERSITY HEALTH SERVICES INC. | AUGUSTA | 12/31/20 | 76,558 | 136,390 | 56% |
| AU MEDICAL CENTER INC | AUGUSTA | 6/30/21 | 46,542 | 132,720 | 35% |
| PHOEBE PUTNEY MEMORIAL HOSPITAL | ALBANY | 7/31/21 | 49,623 | 122,237 | 41% |
| ST. JOSEPHS OF ATLANTA | ATLANTA | 8/31/21 | 60,119 | 105,728 | 57% |
| PIEDMONT ATHENS REGIONAL MEDICAL CE | ATHENS | 6/30/21 | 52,847 | 103,544 | 51% |
Northside Hospital has a really low Medicare utilization percentage. I believe this is because they are a big baby hospital. Let’s take a look at their L&D, Nursery & NICU days to see if this might be the answer.
| Hospital | City | Mcare Util % | NICU Days | Nursery Days | Baby % | L&D Days |
|---|---|---|---|---|---|---|
| KENNESTONE HOSPITAL | MARIETTA | 45% | 8,529 | 10,780 | 9% | 2,969 |
| NORTHEAST GEORGIA MEDICAL CENTER | GAINESVILLE | 51% | 17,460 | 9% | 1,313 | |
| NORTHSIDE HOSPITAL | ATLANTA | 18% | 27,263 | 33,961 | 30% | 8,671 |
| MEMORIAL HEALTH UNIV MED CENTER | SAVANNAH | 35% | 23,241 | 4,376 | 15% | 1,016 |
| MEDICAL CENTER OF CENTRAL GEORGIA | MACON | 39% | 21,691 | 3,829 | 14% | 2,878 |
| GRADY MEMORIAL HOSPITAL | ATLANTA | 30% | 9,057 | 4,339 | 7% | 3,834 |
| PIEDMONT HOSPITAL INC. | ATLANTA | 51% | 2,025 | 7,173 | 5% | 2,129 |
| UNIVERSITY HEALTH SERVICES INC. | AUGUSTA | 56% | 5,379 | 3% | 1,006 | |
| EMORY UNIVERSITY HOSPITAL | ATLANTA | 48% | 0% | |||
| NORTHSIDE HOSPITAL - GWINNETT | LAWRENCEVILLE | 36% | 11,064 | 6,859 | 12% | 2,879 |
| PIEDMONT ATHENS REGIONAL MEDICAL CE | ATHENS | 51% | 4,646 | 4,267 | 7% | 1,924 |
| AU MEDICAL CENTER INC | AUGUSTA | 35% | 7,341 | 6% | 394 | |
| EMORY UNIVERSITY HOSPITAL MIDTOWN | ATLANTA | 39% | 15,365 | 21,774 | 30% | 4,142 |
Looking at the above data, you may first notice some holes. Some hospitals report NICU days with their ICU days and some report nursery days with Adults & Peds. There is no way just looking at a cost report to derive these figures. Also, L&D days are an estimate of time a mother is in labor until the baby is born and thus admitted to the hospital. These days are carved out and reported separately on the cost report. The postpartum portion of their stay is reported with Adults & Pediatrics. Due to this, we can see L&D days, but not cannot see the postpartum days.
With all of that out of the way, we can see that Northside Hospital is indeed a big baby hospital. Looks like 30% of their inpatient business is babies, and that is not even considering the mother’s portion.
Musing Revelations
Prior to looking at this data, I never thought about how much hospital business is for Medicare patients. Despite working with Medicare for almost 20 years; it just never occurred to me. It does make sense though, because as we age our bodies break down and need some repair work to keep going.