Recent declines in the total number of hospitals and beds nationwide have raised questions about effects on emergency department (ED) services. A study of Medicare cost reports for the years 2000 through 2006 indicate, however, that such services have actually increased.

Exhibit 1 discloses that the number of short-term acute care hospital (STACH) beds decreased from 689,037 to 608,954 (-11.6) during the period studied. Some of this decrease can be attributed to the reclassification of smaller STACHs to critical access hospital status and to a marked increase in the number of long-term acute care facilities.

Exhibit 1

exhibit-1-Trends in Emergency Department Capacities and Costs

Despite the decrease, however, exhibit 2 shows that the total square footage of EDs in STACHs increased 15 percent during the period. Because STACHs represent the great majority of hospitals, and because there are influential operational differences among types of hospitals, this study concentrates primarily on STACH EDs.

Exhibit 2

exhibit-2-Trends in Emergency Department Capacities and Costs

EDs increased on a per hospital basis in terms of size but remained steady in terms of operating cost.

Exhibit 3 shows that average ED square footage increased 55.5 percent, while ED operating cost as a percentage of total hospital cost remained at about 3.2 percent. This disparity might be explained in part by increased volumes of nonemergent primary care being delivered in the ED.

Exhibit 3

exhibit-3-Trends in Emergency Department Capacities and Costs

The study also examined differences between teaching and nonteaching hospitals. As seen in exhibit 4, the average size of an ED in a teaching hospital is more than twice that of an ED in a nonteaching hospital (17,076 square feet versus 8,199 square feet in 2006). Surprisingly, however, the ED square footage as a percentage of total hospital square footage is 2.4 percent for teaching hospitals versus 3.3 percent for nonteaching in 2006. Also, ED operating cost as a percentage of total hospital operating cost is 2.8 percent for teaching versus 3.7 percent for nonteaching hospitals. These differences are most likely due to the characteristically larger size of teaching hospitals.

Exhibit 4

exhibit-4-Trends in Emergency Department Capacities and Costs

ED operating costs were also studied by type of hospital control. Exhibit 5 shows that average ED costs as a percentage of total hospital operating costs during 2006 were highest for governmentally controlled hospitals (3.6 percent), followed by proprietary hospitals (3.3 percent) and voluntary hospitals (3.1 percent).

Exhibit 5

exhibit-5-Trends in Emergency Department Capacities and Costs

Hospitals may find this information useful in comparing their own ED capacities and operating costs with national averages. By obtaining cost reports for neighboring facilities, hospitals may also benchmark their operations within their own communities. Although many factors influence ED operations, the wide variability among types of hospitals and hospital control may indicate opportunities for improvement.

About the Study

The study of emergency department capacities and costs was conducted by Cost Report Data Resources, and is based on available Medicare cost report data for all hospital cost reporting periods ending in federal fiscal years 2000 through 2006.a

Various types of measures were used to examine relationships among ED and total hospital capacities and costs. For purposes of this study, the following Medicare cost report data elements were used in the examination:

  • Total hospital beds. Total beds were determined from Worksheet S-3, Part I, Line 12, Column 1.
  • Emergency department square feet. ED square feet were determined from Worksheet B, Line 61, Column 1.
  • Total hospital square feet. Total hospital square feet were determined from Worksheet B, Line 1, Column 1.
  • Emergency department costs. ED costs were determined from Worksheet A, Line 61, Column 3.
  • Total hospital costs. Total hospital costs were determined from Worksheet A, Line 101, Column 3.


a. All measures were computed from Medicare cost report data obtained from the Centers for Medicare and Medicaid Services (CMS). The Healthcare Cost Report Information System (HCRIS) dataset contains the most recent version (i.e., as submitted, settled, reopened) of each cost report filed with CMS since federal fiscal year (FFY) 1996. The most recent HCRIS dataset available at the time of this study was for the cutoff at Sept. 30, 2007. Data and computations were assigned to each FFY based on the cost report end date. This study looked at more than 40,000 Medicare cost reports from FFY00 to FFY06. Approximately two percent of the cost reports were excluded because of missing, incomplete, or unreasonable data (e.g. no total cost reported, no beds reported, no square footage reported, etc.).

Publication Date: Saturday, March 01, 2008

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