In addition to analyzing data for variations among types of ownership, as discussed in the article, this study also analyzed variations among census divisions, as discussed in the following exhibits.

Exhibit 1: Types of Capital Assets Purchased by Census Division

The national capital spending shifted toward buildings and away from equipment from 2001 to 2007. The shift was highest in the Mountain region but was also high in the East South Central, Pacific, and South Atlantic regions. Most regions followed the national trend except West South Central which shifted in the opposite direction (toward equipment and land and away from buildings).

Exhibit 2: Types of Capital Assets Purchased by Type of Hospital

Many short-term acute care hospitals shifted to critical access status from 2001 to 2007. The result was a large increase in capital asset spending from period to period. Long-term, psychiatric, and rehabilitation hospitals experienced the biggest shift in spending toward buildings and away from equipment.

Exhibit 3: Average Age of Plant by Census Division

The average age of plant (AAP) for all hospitals increased from 9.2 years in 2001 to 10.4 years in 2007. The increase was greatest in East North Central, Middle Atlantic, Pacific, and West South Central regions. AAP decreased in East South Central and Mountain regions.

Exhibit 4:Average Age of Plant by Type of Hospital

The AAP for critical access hospitals decreased dramatically as many hospitals converted to this status between 2001 and 2007 and they focused more capital spending on buildings. The AAP for rehabilitation hospitals rose 4.3 from 2001 to 2007. The other hospitals types followed the national trend.

Exhibit 5: Capital Financing Trends by Census Division

Total funds available to spend increased dramatically in the East North Central Region from 2001 to 2007 due mainly to increasing long-term debt, yet the percentage of funds spent on capital decreased from 78.8 percent in 2001 to only 42.7 percent in 2007. This suggests hospitals in the region are taking on debt for operating and other purposes.

Many regions significantly increased long-term debt from 2001 to 2007, especially the East South Central, Middle Atlantic, and Pacific regions. Some regions were able to significantly reduce debt, especially the Mountain and South Atlantic regions.

The national trend was a reduction in the percentage of funds spent on capital. Six regions followed this trend while the other three actually increased the percentage of spending on capital from 2001 to 2007.

Exhibit 6: Capital Financing Trends by Type of Hospital

The trends for critical access hospitals were greatly affected by the conversion to this status between 2001 and 2007. All other hospital types greatly increased their funds available to spend and actual capital spending from 2001 to 2007, except long-term hospitals.

Exhibit 7: Debt Leverage by Census Division

The debt leverage for all hospitals remained stable from 2001 to 2007. However, leverage increased dramatically in the East North Central and Pacific regions. The highest debt leverage percentages were in the Middle Atlantic and New England regions. The lowest levels were in the Mountain and West South Central regions.

Exhibit 8: Debt Leverage by Type of Hospital

The debt leverage for short-term acute care hospitals remained stable from 2001 to 2007. However, all of the other hospital types were able to reduce leverage from period to period, especially rehabilitation and long term hospitals. Medicare cost reports for the 98 long-term hospitals in 2007 collectively showed "negative" debt, which suggests errors in reporting for that year.

Exhibit 9:Financing Rates by Census Division

The financing rate dropped for all hospitals from 3.3 percent in 2001 to 2.7 percent in 2007. However, financing rates increased in the East South Central and West South Central regions. Financing rates dropped in all other regions, especially in the East North Central, Mountain, New England, and Pacific regions.

Exhibit 10: Financing Rates by Type of Hospital

Rehabilitation hospitals had the highest financing rates which increased from 11.1 percent in 2001 to 19.3 percent in 2007. The long-term hospital rate was high in 2001 at 13.3 percent. The rate for long-term hospitals in 2007 is unusual due mainly to the possible misreporting of debt in 2007, as is discussed with Exhibit 8 above.

Publication Date: Sunday, November 01, 2009

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