90 benchmarks to know on payer mix in ASCs

Here are 90 benchmarks on ASC payer mix from VMG Health's 2018 Multi-Specialty ASC Benchmarking Study.

The study is based on 2016 and 2017 data from over 275 centers, encompassing a surgical case volume of over 1.3 million.

Payer mix as a percent of gross charges:

Medicare

1. Mean: 29 percent
2. 25th percentile: 17 percent
3. Median: 27 percent
4. 75th percentile: 39 percent
5. 90th percentile: 49 percent

Medicaid

6. Mean: 10 percent
7. 25th percentile: 4 percent
8. Median: 6 percent
9. 75th percentile: 13 percent
10. 90th percentile: 25 percent

Commercial

11. Mean: 54 percent
12. 25th percentile: 41 percent
13. Median: 55 percent
14. 75th percentile: 65 percent
15. 90th percentile: 72 percent

Worker's comp

16. Mean: 7 percent
17. 25th percentile: 2 percent
18. Median: 4 percent
19. 75th percentile: 10 percent
20. 90th percentile: 14 percent

Self pay

21. Mean: 6 percent
22. 25th percentile: 2 percent
23. Median: 3 percent
24. 75th percentile: 6 percent
25. 90th percentile: 12 percent

Other pay

26. Mean: 9 percent
27. 25th percentile: 2 percent
28. Median: 6 percent
29. 75th percentile: 13 percent
30. 90th percentile: 21 percent

Payer mix as a percent of cases:

Medicare

31. Mean: 34 percent
32. 25th percentile: 22 percent
33. Median: 33 percent
34. 75th percentile: 46 percent
35. 90th percentile: 54 percent

Medicaid

36. Mean: 11 percent
37. 25th percentile: 4 percent
38. Median: 7 percent
39. 75th percentile: 15 percent
40. 90th percentile: 24 percent

Commercial

41. Mean: 47 percent
42. 25th percentile: 36 percent
43. Median: 47 percent
44. 75th percentile: 58 percent
45. 90th percentile: 66 percent

Worker's comp

46. Mean: 7 percent
47. 25th percentile: 2 percent
48. Median: 4 percent
49. 75th percentile: 8 percent
50. 90th percentile: 13 percent

Self pay

51. Mean: 4 percent
52. 25th percentile: 2 percent
53. Median: 2 percent
54. 75th percentile: 4 percent
55. 90th percentile: 7 percent

Other pay

56. Mean: 8 percent
57. 25th percentile: 4 percent
58. Median: 6 percent
59. 75th percentile: 11 percent
60. 90th percentile: 16 percent

Payor mix as a percent of collections:

Medicare

61. Mean: 20 percent
62. 25th percentile: 10 percent
63. Median: 17 percent
64. 75th percentile: 27 percent
65. 90th percentile: 40 percent

Medicaid

66. Mean: 7 percent
67. 25th percentile: 2 percent
68. Median: 4 percent
69. 75th percentile: 9 percent
70. 90th percentile: 17 percent

Commercial

71. Mean: 61 percent
72. 25th percentile: 50 percent
73. Median: 62 percent
74. 75th percentile: 76 percent
75. 90th percentile: 83 percent

Worker's comp

76. Mean: 10 percent
77. 25th percentile: 3 percent
78. Median: 7 percent
79. 75th percentile: 13 percent
80. 90th percentile: 22 percent

Self pay

81. Mean: 6 percent
82. 25th percentile: 2 percent
83. Median: 3 percent
84. 75th percentile: 7 percent
85. 90th percentile: 17 percent

Other pay

86. Mean: 10 percent
87. 25th percentile: 4 percent
88. Median: 7 percent
89. 75th percentile: 12 percent
90. 90th percentile: 20 percent

More articles on benchmarking:
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