Utilization Report

Southern California Hospital System

From 2017 to 2018 a three hospital system in Southern California, comprised of two acute care facilities and one critical care facility, saw a significant decline in inpatient admissions of Medicare Supplement policyholders from USA SCN client carriers. The decline across all facilities was 16%, representing $2.6 million in lost inpatient revenue.

The system contracted with USA Senior Care Network to join our Medicare Supplement Network in December of 2018. After a full year as part of USA SCN, the three facilities experienced a net increase of 478 admissions. This represents a 64.5% increase and translates to an estimated $7.1 million in additional inpatient revenue.

In 2020, despite the COVID-19 pandemic, the hospital system continued to see growth in volume compared to the pre-contract period. In total, the system saw 1,014 admissions in 2020 with 173 at Acute Care Hospital 01, 828 at Acute Care Hospital 02, and 13 at the Critical Access Hospital.

Contracted with USA Senior Care Network 12/20/18
Number of Medigap Policyholders in their CBSA: 21,651
Number of Competing Hospitals – 5 Acute Care representing 1,261 Beds


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  • The increase in inpatient admissions from 2018 to 2019 equals $7,155,913 in new inpatient revenue

  • Additional inpatient admissions results in an estimated increase of $5,215,936 in 2019 Part B revenue**

**Based on actuarial findings, policyholders that experienced a hospital admission generated additional Part B revenue more than 8 times higher than the amount of the Part A deductible: 478 x (8 x $1,364) = $5,215,936