How many hospitals don't participate?? - Medicare Googling fail

December 17, 2011 6:55 PM

How many American hospitals do not participate in Medicare?

I'm having a hard time getting either number or proportion of hospitals that participate and do not participate in Medicare. Any ideas where to find this information?

posted by treehorn+bunny to Grab Bag (4 answers total)

According to my dad, who is a health care attorney, the VA (government-funded care for veterans) and Shriners (free orthopedic and burn care for children) are pretty much the only two he can think of. Other military hospitals for active-duty soldiers probably don't either. A quick Google also points to facilities run by Indian Health Services as nonparticipating hospitals. There are likely some other odd exceptions, but the vast majority of hospitals in the US participate in Medicare Part A for inpatient services. More clinics, physicians, and providers, such as the Mayo Clinic, do not participate in Part B, which covers physician fees and outpatient services.
posted by zachlipton at 8:08 PM on December 17, 2011 [1 favorite]

For a more authoritative citation, see this bill analysis from the CA state legislature:

"EMTALA applies only to participating hospitals, i.e., hospitals that have entered into provider agreements under which they will accept payment from the Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) under the Medicare program for services provided to beneficiaries of that program. In practical terms, this means that it applies to virtually all hospitals in the United States, with the exception of the Shriners' Hospital for Crippled Children and many military hospitals. Its provisions apply to all patients and not just to Medicare patients."
posted by zachlipton at 8:16 PM on December 17, 2011 [1 favorite]

"Vast majority" is a good way to describe it. In my state of Oklahoma just one hospital has chosen not to participate in Medicare, out of a total of over 150 hospitals. It's a private psychiatric hospital serving children and adolescents. You can't generalize this to all children's hospitals, though, because Medicare is available to permanently disabled children.

Medicare provides some data on participating hospitals on sites like Hospital Compare. Data.Medicare.gov has more, including a list of Medicare hospitals. (Despite the list's title, these are only the short term acute hospitals, and doesn't include the psychiatric, long-term, or rehabilitation hospitals that participate in Medicare.)

I am not aware of a single national listing of all hospitals that could be compared with the Medicare participating hospital list to get an exact nationwide answer to your question. Except for federal (Veterans, Indian Health Service, military) hospitals, licensing is handled by the states. If you're interested in Medicare participation info for a specific state or area, MeMail me.
posted by Snerd at 9:34 AM on December 18, 2011 [1 favorite]

Sorry, I don't know where to find this information definitively, but you can try searching for information on "investor run hospitals" aka for-profit hospitals. I have heard that Cancer Treatment Centers of America do not take Medicare, Medicaid or most HMOs.
posted by abirae at 10:10 AM on September 6, 2012