Health System Affiliation and Characteristics of Inpatient Stays at Rural and Metropolitan Hospitals

A shift from traditional fee-for-service-based to value-based payments has incentivized hospitals and health systems to integrate, allowing them to better respond to new healthcare delivery and payment models. Understanding the landscape, characteristics, and outcomes of inpatient stays across the U.S. in health system-affiliated versus unaffiliated hospitals in urban and rural areas is important as health system affiliation continues to become more common.

Health System Affiliation and Characteristics of Inpatient Stays at Rural and Metropolitan Hospitals, a statistical brief from the Healthcare Cost and Utilization Project presents statistics on inpatient stays at rural and metropolitan hospitals affiliated and unaffiliated with health systems.

Highlights:

• A total of 70.9 percent of hospitals, representing 92.3 percent of inpatient stays across 47 States and the District of Columbia, were affiliated with a health system in 2016.
• Health system affiliation was higher for hospitalizations in metropolitan areas (85.2 percent of hospitals and 94.8 percent of stays) than in rural areas (50.4 percent of hospitals and 66.6 percent of stays). Chronic conditions overall: more than threefold variation from 323.6 to 1,148.4 per 100,000 population
• Nearly one in five inpatient stays in 2016 (18.0 percent) was at a hospital that was part of one of seven health systems. These seven health systems each included 50 or more general acute care hospitals.
• Inpatient costs were higher at metro than at rural hospitals. However, the average cost per stay was similar at system-affiliated and unaffiliated rural ($8,800 and $8,900) and metro ($11,600 and $11,300) hospitals. CHF: more than threefold variation from 140.4 to 445.6 per 100,000 population
• Surgical stays constituted a greater percentage of stays at health system-affiliated than at unaffiliated hospitals (20.9 vs. 14.4 percent).
• Nearly 1 in 3 stays at unaffiliated metro hospitals were expected to be paid by Medicaid, compared with 21-22 percent of stays at system-affiliated metro and system-affiliated and unaffiliated rural hospitals. At rural hospitals, the expected payer distribution was similar across affiliated and unaffiliated hospitals. The highest rates were primarily located in large portions of States throughout the South and in select areas of States in the East. However, some of these same States had other areas with relatively low rates of potentially preventable inpatient stays.

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