In understanding hospital finances, it’s crucial to understand the term “payer mix.” That’s the industry lingo for the different sources of payment for hospital patients, and hospitals can live or die based on whether they have enough patients who are privately insured.
The payer mix is divided between the following groups of patients. Some are commercially insured, and they frequently pay the highest rate. Patients older than 65 receive Medicare, which while not generous, generally pays at a level high enough for hospitals to function. Low-income patients receive Medicaid, which pays at a rate that hospital officials say can be difficult to sustain service.
Finally, there are the charity-care patients,. While the number of uninsured patients is declining as a result of the Affordable Care Act, there are some categories of the uninsured, including unauthorized immigrants, who will continue to require charity care.
The following hospitals have the highest share of patients who qualify as charity care or Medicaid. They frequently describe themselves as among the state’s safety-net hospitals. The list was compiled from 2013 state-charge data.
The only county-owned hospital in the state, it primarily serves patients with mental health and addiction issues. It has the largest share of charity-care patients in the state by a large margin, with 55.2 percent.
The hospital is at the center of a recent report on the future of healthcare in the Newark area, with consulting firm Navigant recommending that the state expand the hospital, while converting three others (East Orange General Hospital, Newark Beth Israel Medical Center, and Saint Michael’s Medical Center). It has the highest share of Medicaid patients, at 34.9 percent. Barnabas Health has a management partnership with University, which is state-owned.
St. Joseph’s is third, behind only University Hospital and Newark Beth Israel, in the share of Medicaid patients, at 29.5 percent.
Of all of the hospitals that aren’t primarily focused on behavioral health patients, Jersey City has the highest charity-care share, at 18.6 percent.
The Elizabeth hospital is fourth in charity care, behind Bergen Regional, Jersey City and St. Francis Medical Center in Trenton.
Owned by Barnabas Health, it would be combined with University Hospital under the Navigant recommendations. It is second in Medicaid patients, at 29.5 percent.
This is the first for-profit-owned hospital on the list (although Bergen Regional, while county-owned, is operated by a for-profit company).
The first hospital on the list that’s undergoing a proposed sale, to California company Prospect Medical Holdings. The state Department of Health is reviewing the proposal.
Christ is the second CarePoint facility on the list.
While Capital Health built a new, larger hospital in Hopewell, it continues to operate a trauma center at its facility in Trenton. The hospital is seventh in the charity-care share.