Sutter Health · Novato, CA
5 of 5
CMS star rating
47
Beds
1,709
Inpatient discharges a year
$108.7M
Net patient revenue a year
28
In-network payers
Novato Community Hospital is a 47-bed voluntary non-profit - other hospital in Novato, CA, affiliated with Sutter Health. Below you'll find publicly disclosed negotiated rates and facility details, including 28 in-network payers and 333 disclosed rate categories.
The 24 services Novato Community Hospital most likely performs, ranked by likely volume and what it is paid. Each service names one insurer. * marks hidden insurer names; A, B and C rank the remaining rates from low to high and reset for each service.
Book a demo to see hidden insurer names, more payer rates, and hospital data, or start a free trial.
Medicine & Surgery · Inpatient
MS-DRG 470
$82,456 - $95,390
from 4 insurers · median $83,539
103 Medicare discharges for this DRG in CMS hospital data
CT imaging
CPT 74177
$4,424 - $6,152
from 4 insurers · median $5,854
Common here, based on CMS Medicare volume
Childbirth · Inpatient
MS-DRG 807
$15,147 - $22,790
from 4 insurers · median $19,028
CMS lists this service as CPT 59400, the obstetrician's global fee. The hospital bills the delivery stay as MS-DRG 807, so these are facility case rates.
Hospital reports obstetrics / child birth services to CMS
Childbirth · Inpatient
MS-DRG 788
$26,867 - $34,656
from 4 insurers · median $29,069
CMS lists this service as CPT 59510, the obstetrician's global fee. The hospital bills the delivery stay as MS-DRG 788, so these are facility case rates.
Hospital reports obstetrics / child birth services to CMS
CT imaging
CPT 74176
$3,474 - $4,585
from 3 insurers · median $4,426
Common here, based on CMS Medicare volume
Cardiology and vascular testing
CPT 93306
$895 - $3,167
from 3 insurers · median $3,125
Common here, based on CMS Medicare volume
Medicine & Surgery
CPT 47562
$11,202 - $13,549
from 4 insurers · median $12,219
35 Medicare claims in Level 1 Laparoscopy and Related Services (CMS 2024)
CT imaging
CPT 70450
$875 - $1,092
from 4 insurers · median $1,010
Common here, based on CMS Medicare volume
Gynecology
CPT 58571
$35,536 - $39,047
from 4 insurers · median $36,875
Typical for a hospital with this service line
Digestive procedures
CPT 49650
$7,990 - $13,549
from 4 insurers · median $12,219
35 Medicare claims in Level 1 Laparoscopy and Related Services (CMS 2024)
MRI imaging
CPT 70553
$4,142 - $4,959
from 4 insurers · median $4,700
Common here, based on CMS Medicare volume
Digestive procedures
CPT 43239
$1,304 - $3,084
from 4 insurers · median $2,695
Common here, based on CMS Medicare volume
Medicine & Surgery
CPT 49505
$2,864 - $8,751
from 4 insurers · median $8,539
20 Medicare claims in Level 1 Abdominal/Peritoneal/Biliary and Related Procedures (CMS 2024)
Digestive procedures
CPT 45380
$830 - $3,419
from 4 insurers · median $2,621
Common here, based on CMS Medicare volume
Childbirth · Inpatient
MS-DRG 807
$15,147 - $22,790
from 4 insurers · median $19,028
CMS lists this service as CPT 59610, the obstetrician's global fee. The hospital bills the delivery stay as MS-DRG 807, so these are facility case rates.
Hospital reports obstetrics / child birth services to CMS
Orthopedics and pain
CPT 63030
$5,314 - $28,671
from 4 insurers · median $26,843
42 Medicare claims in Level 4 Musculoskeletal Procedures (CMS 2024)
Digestive procedures
CPT 47563
$3,897 - $13,549
from 4 insurers · median $12,219
35 Medicare claims in Level 1 Laparoscopy and Related Services (CMS 2024)
Medicine & Surgery
CPT 55866
$5,989 - $66,265
from 4 insurers · median $61,201
Typical for a hospital with this service line
CT imaging
CPT 71260
$1,477 - $1,709
from 4 insurers · median $1,654
Common here, based on CMS Medicare volume
Mammography
CPT 77067
$371 - $491
from 3 insurers · median $376
Common here, based on CMS Medicare volume
MRI imaging
CPT 70551
$1,132 - $2,931
from 4 insurers · median $2,578
Common here, based on CMS Medicare volume
Gynecology
CPT 58661
$14,568 - $26,962
from 4 insurers · median $23,817
Typical for a hospital with this service line
MRI imaging
CPT 74183
$2,512 - $5,014
from 4 insurers · median $4,601
Common here, based on CMS Medicare volume
MRI imaging
CPT 72148
$1,379 - $2,848
from 4 insurers · median $2,737
Common here, based on CMS Medicare volume
Median rate as a percent of Medicare across the outpatient services above, and how many services sit above or below the same insurer's median at nearby hospitals. * marks hidden insurer names. These table labels track the same insurers across services; the labels on each service card reset.
| Insurer | Services | Median % of Medicare | Above nearby | Below nearby |
|---|---|---|---|---|
| Insurer A* | 24 | 498% | 11 | 5 |
| Insurer B* | 24 | 456% | 9 | 3 |
| Insurer C* | 21 | 411% | 14 | 3 |
| Insurer D* | 24 | 282% | 15 | 6 |
How we chose these services: 6 appear in this hospital's own Medicare claims, 12 are common here based on CMS Medicare volume, and 6 are typical for the service lines it reports to CMS. Rates come from insurer and hospital price transparency files as of October 2026. Rates under a quarter of Medicare or over 20 times Medicare are left out as likely physician-fee rows or file errors. Book a demo to see all 300 CMS shoppable services for Novato Community Hospital, or start a free trial.
Acceptance varies by plan and service. Confirm coverage with your insurer or the hospital's billing department.
Quality
5 of 5 stars
Doctors and services
Accredited by The Joint Commission
Finances
$108.7M net patient revenue
Ownership and leadership
Owned by Sutter Health
The employer identification numbers (EINs) health plans and networks list for Novato Community Hospital in the in-network rate files they publish, with the organization NPIs billed under each.
| Tax ID (EIN) | Plans and networks listing it | Organization NPIs |
|---|---|---|
| 94-0562680Sutter Bay Hospitals | 41Aetna, Cigna, United Healthcare (incl Optum, Rocky Mountain, Health Plan of Nevada, Sierra Health), Allied Benefit Systems, Ambetter and 36 more | 1043670334 Sutter Bay Hospitals1659439834 Sutter Bay Hospitals1740348929 Sutter Bay Hospitalsand 87 more |
Source: PayerPrice analysis of insurers' Transparency in Coverage in-network files. An EIN can cover several hospitals and clinics in a health system, and insurers sometimes list other organizations' NPIs under it.
180 Rowland Way, Novato, CA 94945
(415) 209-1300
How Novato Community Hospital compares with other US facilities on the measures CMS publishes, mostly from Medicare patients.
Overall star rating
5 of 5
The top rating, shared by 12% of US hospitals
Combines death rates, safety, readmissions, patient experience and timely care
Death rates
No different on 5 measures
0 better, 5 no different, 0 worse than the US rate
Deaths within 30 days, such as after a heart attack, pneumonia or stroke
Safety
No different on 3 measures
0 better, 3 no different, 0 worse than the US rate
Infections, surgical complications and other harm in the hospital
Readmissions
No different on 7 measures
0 better, 7 no different, 0 worse than the US rate
Patients back in the hospital or ER soon after leaving
Patient survey rating
4 of 5
Higher than 60% of US hospitals
From the HCAHPS survey of recent inpatients
Would definitely recommend
84%
Higher than 89% of US hospitals
US median: 71%
Surveyed patients who would definitely recommend the hospital
Hospital-acquired condition penalty
Not penalized
Not among the worst-performing 25%
Medicare cuts payments 1% for the worst-performing 25% of hospitals on infections and injuries acquired in the hospital
Serious complications (PSI 90)
0.85
Lower than 86% of US hospitals
US median: 0.96
Risk-adjusted composite of complications such as bedsores, falls with hip fracture and blood clots after surgery; lower is better
Time in the ER before going home
156 min
Higher than 55% of US hospitals
US median: 148 min
Median minutes from arrival to leaving for ER patients who were sent home; lower is better
Sepsis care
71%
Higher than 63% of US hospitals
US median: 65%
Patients with severe sepsis or septic shock who got every step of the recommended early treatment; higher is better
| Measure | Result | Period |
|---|---|---|
| Overall star ratingCMS: Overall hospital quality star rating | 5 of 5 | |
| Death rates | No different on 5 measures | |
| Safety | No different on 3 measures | |
| Readmissions | No different on 7 measures | |
| Patient survey ratingCMS: Summary star rating | 4 of 5 | 2024-10-01 to 2025-09-30 |
| Would definitely recommendCMS: "YES", patients would definitely recommend the hospital | 84% | 2024-10-01 to 2025-09-30 |
| Hospital-acquired condition penaltyCMS: HAC Reduction Program payment reduction | Not penalized | 2026 |
| Serious complications (PSI 90)CMS: Patient safety and adverse events composite (PSI 90) | 0.85 | 2022-07-01 to 2024-06-30 |
| Time in the ER before going homeCMS: Average (median) time patients spent in the emergency department before leaving from the visit, excluding patients transferred to another facility or psychiatric care/mental health patients. A lower number of minutes is better | 156 min | 2024-10-01 to 2025-09-30 |
| Sepsis careCMS: Appropriate care for severe sepsis and septic shock | 71% | 2024-10-01 to 2025-09-30 |
Source: CMS Provider Data Catalog, released 2026-08-13. US comparisons rank this facility among every facility CMS reports for each measure. See Medicare Care Compare.
How Medicare adjusts Novato Community Hospital's inpatient payments for its readmissions, quality and cost results.
-0.02% on Medicare payments
Readmissions penalty
Hospital Readmissions Reduction Program adjustment for excess readmissions, as estimated in the FY 2027 IPPS final rule.
+0.62% on Medicare payments
Value-based purchasing
Hospital Value-Based Purchasing bonus or reduction for quality and cost, as estimated in the FY 2027 IPPS final rule.
Source: CMS IPPS final rule Impact File (FY 2027).
Each result CMS publishes for Novato Community Hospital, beside the US median and the average of CA hospitals. The rank says what share of US hospitals the result is better or worse than; counts and confidence limits are not ranked.
Risk-adjusted 30-day death rates and surgical complications; lower is better.
| Measure | Novato Community Hospital | US median | CA average | CMS comparison | US rank |
|---|---|---|---|---|---|
| Rate of complications for hip/knee replacement patients2023-04-01 to 2025-03-31 · 143 cases | 3.2 | 4.1 | 4.075 | Better than 88% of US hospitals | |
| Hybrid Hospital-Wide All-Cause Risk Standardized Mortality Rate2024-07-01 to 2025-06-30 · 627 cases | 3.8 | 3.9 | 3.81 | Better than 56% of US hospitals | |
| Death rate for heart attack patients2022-07-01 to 2025-06-30 | Not Available | 11.57 | |||
| Death rate for CABG surgery patients2022-07-01 to 2025-06-30 | Not Available | 2.379 | |||
| Death rate for COPD patients2022-07-01 to 2025-06-30 · 25 cases | 8.2 | 8.5 | 8.235 | Better than 56% of US hospitals | |
| Death rate for heart failure patients2022-07-01 to 2025-06-30 · 111 cases | 10 | 11 | 10.29 | Better than 69% of US hospitals | |
| Death rate for pneumonia patients2022-07-01 to 2025-06-30 · 140 cases | 16.1 | 15.2 | 14.49 | Worse than 63% of US hospitals | |
| Death rate for stroke patients2023-07-01 to 2025-06-30 · 42 cases | 11.3 | 11.6 | 11.57 | Better than 55% of US hospitals | |
| Pressure ulcer rate2022-07-01 to 2024-06-30 · 1,320 cases | 0.41 | 0.51 | 0.4818 | No Different Than the National Rate | Better than 65% of US hospitals |
| Death rate among surgical inpatients with serious treatable complications2022-07-01 to 2024-06-30 | Not Available | 171 | Number of Cases Too Small | ||
| Iatrogenic pneumothorax rate2022-07-01 to 2024-06-30 · 1,872 cases | 0.2 | 0.2 | 0.21 | No Different Than the National Rate | Better than 46% of US hospitals |
| In-hospital fall-associated fracture rate2022-07-01 to 2024-06-30 · 1,796 cases | 0.25 | 0.27 | 0.261 | No Different Than the National Rate | Better than 71% of US hospitals |
| Postoperative hemorrhage or hematoma rate2022-07-01 to 2024-06-30 · 495 cases | 2.2 | 2.29 | 2.308 | No Different Than the National Rate | Better than 66% of US hospitals |
| Postoperative acute kidney injury requiring dialysis rate2022-07-01 to 2024-06-30 · 317 cases | 1.64 | 1.63 | 1.668 | No Different Than the National Rate | Worse than 50% of US hospitals |
| Postoperative respiratory failure rate2022-07-01 to 2024-06-30 · 323 cases | 7.93 | 8.88 | 9.555 | No Different Than the National Rate | Better than 72% of US hospitals |
| Perioperative pulmonary embolism or deep vein thrombosis rate2022-07-01 to 2024-06-30 · 505 cases | 2.92 | 3.4 | 3.521 | No Different Than the National Rate | Better than 85% of US hospitals |
| Postoperative sepsis rate2022-07-01 to 2024-06-30 · 311 cases | 4.88 | 5.105 | 5.495 | No Different Than the National Rate | Better than 67% of US hospitals |
| Postoperative wound dehiscence rate2022-07-01 to 2024-06-30 · 96 cases | 1.75 | 1.72 | 1.796 | No Different Than the National Rate | Worse than 66% of US hospitals |
| Abdominopelvic accidental puncture or laceration rate2022-07-01 to 2024-06-30 · 213 cases | 1 | 1.02 | 1.061 | No Different Than the National Rate | Better than 57% of US hospitals |
Unplanned returns to a hospital after a stay or an outpatient procedure; lower is better.
| Measure | Novato Community Hospital | US median | CA average | CMS comparison | US rank |
|---|---|---|---|---|---|
| Hospital return days for heart attack patients2022-07-01 to 2025-06-30 | Not Available | 11.09 | |||
| Hospital return days for heart failure patients2022-07-01 to 2025-06-30 · 121 cases | -31.9 | 1.25 | 7.901 | Better than 89% of US hospitals | |
| Hospital return days for pneumonia patients2022-07-01 to 2025-06-30 · 150 cases | 1.1 | 3.85 | 16.67 | Better than 54% of US hospitals | |
| Hybrid Hospital-Wide All-Cause Readmission Measure (HWR)2024-07-01 to 2025-06-30 | Not Available | ||||
| Rate of unplanned hospital visits after colonoscopy (per 1,000 colonoscopies)2022-01-01 to 2024-12-31 · 930 cases | 12.5 | 12.9 | 12.91 | No Different Than the National Rate | Better than 75% of US hospitals |
| Rate of inpatient admissions for patients receiving outpatient chemotherapy2024-01-01 to 2024-12-31 | Not Available | 11.39 | Number of Cases Too Small | ||
| Rate of emergency department (ED) visits for patients receiving outpatient chemotherapy2024-01-01 to 2024-12-31 | Not Available | 5.546 | Number of Cases Too Small | ||
| Ratio of unplanned hospital visits after hospital outpatient surgery2024-01-01 to 2024-12-31 · 184 cases | 1 | 1 | 1.001 | No Different than expected | Worse than 32% of US hospitals |
| Acute Myocardial Infarction (AMI) 30-Day Readmission Rate2023-07-01 to 2025-06-30 | Not Available | 14.43 | |||
| Rate of readmission for CABG2023-07-01 to 2025-06-30 | Not Available | 11.19 | |||
| Rate of readmission for chronic obstructive pulmonary disease (COPD) patients2023-07-01 to 2025-06-30 · 27 cases | 19.6 | 19.8 | 19.94 | Better than 58% of US hospitals | |
| Heart failure (HF) 30-Day Readmission Rate2023-07-01 to 2025-06-30 · 108 cases | 19.6 | 21.3 | 21.41 | Better than 92% of US hospitals | |
| Rate of readmission after hip/knee replacement2023-07-01 to 2025-06-30 · 118 cases | 5.4 | 5.8 | 5.612 | Better than 71% of US hospitals | |
| Pneumonia (PN) 30-Day Readmission Rate2023-07-01 to 2025-06-30 · 143 cases | 16.6 | 17.2 | 17.7 | Better than 77% of US hospitals |
Standardized infection ratios (1 is the US baseline) and the counts behind them; lower is better.
| Measure | Novato Community Hospital | US median | CA average | CMS comparison | US rank |
|---|---|---|---|---|---|
| Central Line Associated Bloodstream Infection (ICU + select Wards): Lower Confidence Limit2024-10-01 to 2025-09-30 | Not Available | 0.2347 | |||
| Central Line Associated Bloodstream Infection (ICU + select Wards): Upper Confidence Limit2024-10-01 to 2025-09-30 | Not Available | 1.834 | |||
| Central Line Associated Bloodstream Infection: Number of Device Days2024-10-01 to 2025-09-30 | 475 | 1,370 | 5,722 | ||
| Central Line Associated Bloodstream Infection (ICU + select Wards): Predicted Cases2024-10-01 to 2025-09-30 | 0.302 | 0.9835 | 5.638 | ||
| Central Line Associated Bloodstream Infection (ICU + select Wards): Observed Cases2024-10-01 to 2025-09-30 | 0 | 0 | 3.347 | ||
| Central Line Associated Bloodstream Infection (ICU + select Wards)2024-10-01 to 2025-09-30 | Not Available | 0.5696 | |||
| Catheter Associated Urinary Tract Infections (ICU + select Wards): Lower Confidence Limit2024-10-01 to 2025-09-30 | Not Available | 0.2147 | |||
| Catheter Associated Urinary Tract Infections (ICU + select Wards): Upper Confidence Limit2024-10-01 to 2025-09-30 | Not Available | 1.749 | |||
| Catheter Associated Urinary Tract Infections (ICU + select Wards): Number of Urinary Catheter Days2024-10-01 to 2025-09-30 | 761 | 1,799 | 5,308 | ||
| Catheter Associated Urinary Tract Infections (ICU + select Wards): Predicted Cases2024-10-01 to 2025-09-30 | 0.394 | 1.377 | 6.105 | ||
| Catheter Associated Urinary Tract Infections (ICU + select Wards): Observed Cases2024-10-01 to 2025-09-30 | 0 | 0 | 3.273 | ||
| Catheter Associated Urinary Tract Infections (ICU + select Wards)2024-10-01 to 2025-09-30 | Not Available | 0.5366 | |||
| SSI - Colon Surgery: Lower Confidence Limit2024-10-01 to 2025-09-30 | Not Available | 0.32 | |||
| SSI - Colon Surgery: Upper Confidence Limit2024-10-01 to 2025-09-30 | Not Available | 2.433 | |||
| SSI - Colon Surgery: Number of Procedures2024-10-01 to 2025-09-30 | 18 | 61 | 112 | ||
| SSI - Colon Surgery: Predicted Cases2024-10-01 to 2025-09-30 | 0.457 | 1.591 | 2.999 | ||
| SSI - Colon Surgery: Observed Cases2024-10-01 to 2025-09-30 | 1 | 1 | 2.368 | ||
| SSI - Colon Surgery2024-10-01 to 2025-09-30 | Not Available | 0.8107 | |||
| SSI - Abdominal Hysterectomy: Lower Confidence Limit2024-10-01 to 2025-09-30 | Not Available | 0.2606 | |||
| SSI - Abdominal Hysterectomy: Upper Confidence Limit2024-10-01 to 2025-09-30 | Not Available | 3.273 | |||
| SSI - Abdominal Hysterectomy: Number of Procedures2024-10-01 to 2025-09-30 | Not Available | 73.49 | |||
| SSI - Abdominal Hysterectomy: Predicted Cases2024-10-01 to 2025-09-30 | Not Available | 0.6136 | |||
| SSI - Abdominal Hysterectomy: Observed Cases2024-10-01 to 2025-09-30 | Not Available | 0.5911 | |||
| SSI - Abdominal Hysterectomy2024-10-01 to 2025-09-30 | Not Available | 0.7863 | |||
| MRSA Bacteremia: Lower Confidence Limit2024-10-01 to 2025-09-30 | Not Available | 0.3103 | |||
| MRSA Bacteremia: Upper Confidence Limit2024-10-01 to 2025-09-30 | Not Available | 2.305 | |||
| MRSA Bacteremia: Patient Days2024-10-01 to 2025-09-30 | 6,613 | 14,451 | 52,601 | ||
| MRSA Bacteremia: Predicted Cases2024-10-01 to 2025-09-30 | 0.282 | 0.567 | 3.111 | ||
| MRSA Bacteremia: Observed Cases2024-10-01 to 2025-09-30 | 0 | 0 | 2.166 | ||
| MRSA Bacteremia2024-10-01 to 2025-09-30 | Not Available | 0.7784 | |||
| Clostridium Difficile (C.Diff): Lower Confidence Limit2024-10-01 to 2025-09-30 | Not Available | 0.1925 | Better than the National Benchmark | ||
| Clostridium Difficile (C.Diff): Upper Confidence Limit2024-10-01 to 2025-09-30 | 0.936 | 0.747 | 0.9502 | Better than the National Benchmark | |
| Clostridium Difficile (C.Diff): Patient Days2024-10-01 to 2025-09-30 | 6,613 | 13,646 | 48,317 | Better than the National Benchmark | |
| Clostridium Difficile (C.Diff): Predicted Cases2024-10-01 to 2025-09-30 | 3.202 | 5.683 | 27.04 | Better than the National Benchmark | |
| Clostridium Difficile (C.Diff): Observed Cases2024-10-01 to 2025-09-30 | 0 | 2 | 9.99 | Better than the National Benchmark | |
| Clostridium Difficile (C.Diff)2024-10-01 to 2025-09-30 | 0 | 0.279 | 0.383 | Better than the National Benchmark | The best result, shared by 19% of US hospitals |
How recent inpatients answered each survey question, with CMS's star rating per topic.
| Measure | Novato Community Hospital | US median | CA average | CMS comparison | US rank |
|---|---|---|---|---|---|
| Room was "always" clean2024-10-01 to 2025-09-30 · 334 cases | 78 | 73 | 72.2 | Better than 68% of US hospitals | |
| Room was "sometimes" or "never" clean2024-10-01 to 2025-09-30 · 334 cases | 7 | 8 | 8.78 | Better than 56% of US hospitals | |
| Room was "usually" clean2024-10-01 to 2025-09-30 · 334 cases | 15 | 18 | 19.02 | ||
| Cleanliness - linear mean score2024-10-01 to 2025-09-30 · 334 cases | 90 | 87 | 86.82 | Better than 74% of US hospitals | |
| Cleanliness - star rating2024-10-01 to 2025-09-30 · 334 cases | 4 | 4 | 3.514 | Better than 47% of US hospitals | |
| Nurses "always" communicated well2024-10-01 to 2025-09-30 · 334 cases | 81 | 80 | 75.76 | Better than 56% of US hospitals | |
| Nurse communication - linear mean score2024-10-01 to 2025-09-30 · 334 cases | 93 | 91 | 89.84 | Better than 69% of US hospitals | |
| Nurses "sometimes" or "never" communicated well2024-10-01 to 2025-09-30 · 334 cases | 3 | 4 | 5.713 | Better than 58% of US hospitals | |
| Nurse communication - star rating2024-10-01 to 2025-09-30 · 334 cases | 4 | 3 | 2.855 | Better than 51% of US hospitals | |
| Nurses "usually" communicated well2024-10-01 to 2025-09-30 · 334 cases | 16 | 16 | 18.53 | ||
| Doctors "always" communicated well2024-10-01 to 2025-09-30 · 334 cases | 83 | 79 | 75.81 | Better than 71% of US hospitals | |
| Doctor communication - linear mean score2024-10-01 to 2025-09-30 · 334 cases | 93 | 91 | 89.11 | Better than 77% of US hospitals | |
| Doctors "sometimes" or "never" communicated well2024-10-01 to 2025-09-30 · 334 cases | 5 | 5 | 7.043 | Better than 44% of US hospitals | |
| Doctor communication - star rating2024-10-01 to 2025-09-30 · 334 cases | 4 | 3 | 2.688 | Better than 63% of US hospitals | |
| Doctors "usually" communicated well2024-10-01 to 2025-09-30 · 334 cases | 12 | 16 | 17.15 | ||
| Staff "always" explained2024-10-01 to 2025-09-30 · 334 cases | 63 | 61 | 58.95 | Better than 58% of US hospitals | |
| Communication about medicines - linear mean score2024-10-01 to 2025-09-30 · 334 cases | 78 | 77 | 75.75 | Better than 57% of US hospitals | |
| Staff "sometimes" or "never" explained2024-10-01 to 2025-09-30 · 334 cases | 22 | 19 | 21.56 | Worse than 65% of US hospitals | |
| Communication about medicines - star rating2024-10-01 to 2025-09-30 · 334 cases | 3 | 3 | 2.449 | Better than 47% of US hospitals | |
| Staff "usually" explained2024-10-01 to 2025-09-30 · 334 cases | 15 | 19 | 19.48 | ||
| Discharge information - linear mean score2024-10-01 to 2025-09-30 · 334 cases | 89 | 86 | 84.61 | Better than 78% of US hospitals | |
| No, staff "did not" give patients this information2024-10-01 to 2025-09-30 · 334 cases | 11 | 13 | 15.03 | Better than 68% of US hospitals | |
| Discharge information - star rating2024-10-01 to 2025-09-30 · 334 cases | 4 | 3 | 3.08 | Better than 55% of US hospitals | |
| Yes, staff "did" give patients this information2024-10-01 to 2025-09-30 · 334 cases | 89 | 87 | 84.97 | Better than 68% of US hospitals | |
| No, staff "did not" give patients information about help after discharge2024-10-01 to 2025-09-30 · 334 cases | 11 | 14 | 16.39 | Better than 77% of US hospitals | |
| Yes, staff "did" give patients information about help after discharge2024-10-01 to 2025-09-30 · 334 cases | 89 | 86 | 83.61 | Better than 77% of US hospitals | |
| Doctors "always" explained things so they could understand2024-10-01 to 2025-09-30 · 334 cases | 78 | 74 | 70.69 | Better than 72% of US hospitals | |
| Doctors "sometimes" or "never" explained things so they could understand2024-10-01 to 2025-09-30 · 334 cases | 6 | 7 | 8.855 | Better than 53% of US hospitals | |
| Doctors "usually" explained things so they could understand2024-10-01 to 2025-09-30 · 334 cases | 16 | 19 | 20.45 | ||
| Doctors "always" listened carefully2024-10-01 to 2025-09-30 · 334 cases | 84 | 77 | 73.94 | Better than 84% of US hospitals | |
| Doctors "sometimes" or "never" listened carefully2024-10-01 to 2025-09-30 · 334 cases | 5 | 6 | 7.637 | Better than 53% of US hospitals | |
| Doctors "usually" listened carefully2024-10-01 to 2025-09-30 · 334 cases | 11 | 17 | 18.43 | ||
| Doctors "always" treated them with courtesy and respect2024-10-01 to 2025-09-30 · 334 cases | 87 | 85 | 81.99 | Better than 62% of US hospitals | |
| Doctors "sometimes" or "never" treated them with courtesy and respect2024-10-01 to 2025-09-30 · 334 cases | 3 | 3 | 4.958 | Better than 49% of US hospitals | |
| Doctors "usually" treated them with courtesy and respect2024-10-01 to 2025-09-30 · 334 cases | 10 | 11 | 13.06 | ||
| Patients who gave a rating of "6" or lower (low)2024-10-01 to 2025-09-30 · 334 cases | 5 | 8 | 10.01 | Better than 73% of US hospitals | |
| Patients who gave a rating of "7" or "8" (medium)2024-10-01 to 2025-09-30 · 334 cases | 13 | 20 | 22.36 | ||
| Patients who gave a rating of "9" or "10" (high)2024-10-01 to 2025-09-30 · 334 cases | 82 | 72 | 67.63 | Better than 85% of US hospitals | |
| Overall hospital rating - linear mean score2024-10-01 to 2025-09-30 · 334 cases | 92 | 88 | 86.85 | Better than 86% of US hospitals | |
| Overall hospital rating - star rating2024-10-01 to 2025-09-30 · 334 cases | 4 | 3 | 3.047 | Better than 55% of US hospitals | |
| Staff "always" explained new medications2024-10-01 to 2025-09-30 · 334 cases | 77 | 74 | 72.06 | Better than 66% of US hospitals | |
| Staff "sometimes" or "never" explained new medications2024-10-01 to 2025-09-30 · 334 cases | 9 | 9 | 10.94 | Better than 48% of US hospitals | |
| Staff "usually" explained new medications2024-10-01 to 2025-09-30 · 334 cases | 14 | 16 | 17 | ||
| Nurses "always" explained things so they could understand2024-10-01 to 2025-09-30 · 334 cases | 76 | 75 | 71.11 | Better than 55% of US hospitals | |
| Nurses "sometimes" or "never" explained things so they could understand2024-10-01 to 2025-09-30 · 334 cases | 5 | 5 | 7.488 | Better than 49% of US hospitals | |
| Nurses "usually" explained things so they could understand2024-10-01 to 2025-09-30 · 334 cases | 19 | 20 | 21.4 | ||
| Nurses "always" listened carefully2024-10-01 to 2025-09-30 · 334 cases | 82 | 77 | 72.49 | Better than 79% of US hospitals | |
| Nurses "sometimes" or "never" listened carefully2024-10-01 to 2025-09-30 · 334 cases | 3 | 4 | 6.121 | Better than 64% of US hospitals | |
| Nurses "usually" listened carefully2024-10-01 to 2025-09-30 · 334 cases | 15 | 19 | 21.39 | ||
| Nurses "always" treated them with courtesy and respect2024-10-01 to 2025-09-30 · 334 cases | 86 | 86 | 82.8 | Worse than 47% of US hospitals | |
| Nurses "sometimes" or "never" treated them with courtesy and respect2024-10-01 to 2025-09-30 · 334 cases | 2 | 3 | 3.779 | Better than 50% of US hospitals | |
| Nurses "usually" treated them with courtesy and respect2024-10-01 to 2025-09-30 · 334 cases | 12 | 11 | 13.42 | ||
| "Always" quiet at night2024-10-01 to 2025-09-30 · 334 cases | 54 | 59 | 47.5 | Worse than 67% of US hospitals | |
| "Sometimes" or "never" quiet at night2024-10-01 to 2025-09-30 · 334 cases | 12 | 9 | 17.79 | Worse than 66% of US hospitals | |
| "Usually" quiet at night2024-10-01 to 2025-09-30 · 334 cases | 34 | 31 | 34.71 | ||
| Quietness - linear mean score2024-10-01 to 2025-09-30 · 334 cases | 80 | 82 | 74.85 | Worse than 59% of US hospitals | |
| Quietness - star rating2024-10-01 to 2025-09-30 · 334 cases | 3 | 3 | 2.203 | Worse than 44% of US hospitals | |
| "NO", patients would not recommend the hospital (they probably would not or definitely would not recommend it)2024-10-01 to 2025-09-30 · 334 cases | 3 | 5 | 7.623 | Better than 70% of US hospitals | |
| "YES", patients would definitely recommend the hospital2024-10-01 to 2025-09-30 · 334 cases | 84 | 71 | 68.6 | Better than 89% of US hospitals | |
| Recommend hospital - linear mean score2024-10-01 to 2025-09-30 · 334 cases | 93 | 87 | 85.85 | Better than 90% of US hospitals | |
| "YES", patients would probably recommend the hospital2024-10-01 to 2025-09-30 · 334 cases | 13 | 23 | 23.77 | ||
| Recommend hospital - star rating2024-10-01 to 2025-09-30 · 334 cases | 5 | 4 | 3.431 | The top rating, shared by 24% of US hospitals | |
| Staff "always" explained possible side effects2024-10-01 to 2025-09-30 · 334 cases | 49 | 47 | 45.33 | Better than 58% of US hospitals | |
| Staff "sometimes" or "never" explained possible side effects2024-10-01 to 2025-09-30 · 334 cases | 34 | 30 | 32.51 | Worse than 69% of US hospitals | |
| Staff "usually" explained possible side effects2024-10-01 to 2025-09-30 · 334 cases | 17 | 22 | 22.16 | ||
| Summary star rating2024-10-01 to 2025-09-30 · 334 cases | 4 | 3 | 2.859 | Better than 60% of US hospitals | |
| No, staff "did not" give patients information about possible symptoms2024-10-01 to 2025-09-30 · 334 cases | 10 | 12 | 13.94 | Better than 70% of US hospitals | |
| Yes, staff "did" give patients information about possible symptoms2024-10-01 to 2025-09-30 · 334 cases | 90 | 88 | 86.06 | Better than 70% of US hospitals |
How often the hospital gave recommended care, and how fast.
| Measure | Novato Community Hospital | US median | CA average | CMS comparison | US rank |
|---|---|---|---|---|---|
| Emergency department volume2024-01-01 to 2024-12-31 | low | ||||
| Global Malnutrition Composite Score2024-01-01 to 2024-12-31 | Not Available | ||||
| Global Malnutrition Composite Score: Malnutrition Diagnosis Documented2024-01-01 to 2024-12-31 | Not Available | ||||
| Global Malnutrition Composite Score: Malnutrition Risk Screening2024-01-01 to 2024-12-31 | Not Available | ||||
| Global Malnutrition Composite Score: Nutrition Assessment2024-01-01 to 2024-12-31 | Not Available | ||||
| Global Malnutrition Composite Score: Nutritional Care Plan2024-01-01 to 2024-12-31 | Not Available | ||||
| Hospital Harm - Severe Hyperglycemia2024-01-01 to 2024-12-31 | Not Available | 8.289 | |||
| Hospital Harm - Severe Hypoglycemia2024-01-01 to 2024-12-31 · 362 cases | 1 | 1 | 1.008 | Worse than 34% of US hospitals | |
| Hospital Harm - Opioid Related Adverse Events2024-01-01 to 2024-12-31 | Not Available | 0.1852 | |||
| Healthcare workers given influenza vaccination2024-10-01 to 2025-03-31 · 655 cases | 77 | 79 | 69.96 | Worse than 54% of US hospitals | |
| Average (median) time all patients spent in the emergency department before leaving from the visit, including psychiatric/mental health patients and patients who were transferred to another facility. A lower number of minutes is better2024-10-01 to 2025-09-30 · 407 cases | 156 | 154 | 187 | Worse than 51% of US hospitals | |
| Average (median) time patients spent in the emergency department before leaving from the visit, excluding patients transferred to another facility or psychiatric care/mental health patients. A lower number of minutes is better2024-10-01 to 2025-09-30 · 374 cases | 156 | 148 | 182 | Worse than 55% of US hospitals | |
| Average (median) time psychiatric/mental health patients spent in the emergency department before leaving from the visit. A lower number of minutes is better2024-10-01 to 2025-09-30 · 23 cases | 129 | 247 | 282 | Better than 94% of US hospitals | |
| Average (median) time patients spent in the emergency department before being transferred to another facility. A lower number of minutes is better2024-10-01 to 2025-09-30 | Not Available | 411 | |||
| Left before being seen2024-01-01 to 2024-12-31 · 18,532 cases | 2 | 1 | 2.162 | Worse than 58% of US hospitals | |
| Head CT results2024-10-01 to 2025-09-30 | Not Available | 75.06 | |||
| Endoscopy/polyp surveillance: appropriate follow-up interval for normal colonoscopy in average risk patients2024-01-01 to 2024-12-31 · 74 cases | 88 | 97 | 92.55 | Worse than 82% of US hospitals | |
| Improvement in Patient's Visual Function within 90 Days Following Cataract Surgery2024-01-01 to 2024-12-31 | Not Available | 80 | |||
| ST-Segment Elevation Myocardial Infarction (STEMI)2024-01-01 to 2024-12-31 | Not Available | 48.75 | |||
| Safe Use of Opioids - Concurrent Prescribing2024-01-01 to 2024-12-31 · 698 cases | 18 | 15 | 13.67 | Worse than 73% of US hospitals | |
| Appropriate care for severe sepsis and septic shock2024-10-01 to 2025-09-30 · 75 cases | 71 | 65 | 68.8 | Better than 63% of US hospitals | |
| Septic Shock 3-Hour Bundle2024-10-01 to 2025-09-30 · 24 cases | 75 | 73 | 76.38 | Better than 53% of US hospitals | |
| Septic Shock 6-Hour Bundle2024-10-01 to 2025-09-30 · 12 cases | 75 | 88 | 86.64 | Worse than 81% of US hospitals | |
| Severe Sepsis 3-Hour Bundle2024-10-01 to 2025-09-30 · 75 cases | 87 | 82 | 82.89 | Better than 69% of US hospitals | |
| Severe Sepsis 6-Hour Bundle2024-10-01 to 2025-09-30 · 51 cases | 96 | 94 | 93.98 | Better than 60% of US hospitals | |
| Discharged on Antithrombotic Therapy2024-01-01 to 2024-12-31 | Not Available | 93.4 | |||
| Anticoagulation Therapy for Atrial Fibrillation/Flutter2024-01-01 to 2024-12-31 | Not Available | 70.68 | |||
| Antithrombotic Therapy by End of Hospital Day 22024-01-01 to 2024-12-31 | Not Available | 89.93 | |||
| Venous Thromboembolism Prophylaxis2024-01-01 to 2024-12-31 · 952 cases | 99 | 90 | 86.9 | Better than 90% of US hospitals | |
| Intensive Care Unit Venous Thromboembolism Prophylaxis2024-01-01 to 2024-12-31 · 262 cases | 100 | 97 | 94.78 | The best result, shared by 14% of US hospitals |
How often scans were ordered when they may not be needed; lower is better.
| Measure | Novato Community Hospital | US median | CA average | CMS comparison | US rank |
|---|---|---|---|---|---|
| Abdomen CT Use of Contrast Material2024-07-01 to 2025-06-30 | 3.6 | 5 | 4.959 | Better than 67% of US hospitals | |
| Breast Cancer Screening Recall Rates2024-07-01 to 2025-06-30 | 6.4 | 6.6 | 8.417 | Better than 52% of US hospitals |
Medicare spending around an inpatient stay compared with the US (1 is the US median).
| Measure | Novato Community Hospital | US median | CA average | CMS comparison | US rank |
|---|---|---|---|---|---|
| Medicare hospital spending per patient (Medicare Spending per Beneficiary)2024-01-01 to 2024-12-31 | 0.93 | 0.99 | 1.024 | Better than 78% of US hospitals |
The scores Medicare uses to raise or lower inpatient payments; higher is better.
| Measure | Novato Community Hospital | US median | CA average | CMS comparison | US rank |
|---|---|---|---|---|---|
| VBP clinical outcomes domain scoreFY 2026 | 20 | 20 | 30.07 | Better than 48% of US hospitals | |
| VBP clinical outcomes weighted domain scoreFY 2026 | 5 | 5 | 7.571 | Worse than 48% of US hospitals | |
| VBP efficiency and cost reduction domain scoreFY 2026 | 40 | 10 | 16.48 | Better than 77% of US hospitals | |
| VBP efficiency and cost reduction weighted domain scoreFY 2026 | 10 | 2.5 | 4.567 | Better than 76% of US hospitals | |
| VBP person and community engagement domain scoreFY 2026 | 67 | 34 | 28.67 | Better than 91% of US hospitals | |
| VBP person and community engagement weighted domain scoreFY 2026 | 16.75 | 8.75 | 7.519 | Better than 90% of US hospitals | |
| VBP safety domain scoreFY 2026 | 25 | 40 | 45.16 | Worse than 78% of US hospitals | |
| VBP safety weighted domain scoreFY 2026 | 6.25 | 10 | 11.79 | Worse than 78% of US hospitals | |
| VBP total performance scoreFY 2026 | 38 | 29.5 | 30.43 | Better than 75% of US hospitals |
| By fiscal year | FY 2021 | FY 2022 | FY 2023 | FY 2024 | FY 2025 | FY 2026 |
|---|---|---|---|---|---|---|
| VBP clinical outcomes domain score | 25 | 17.5 | 23.33 | 13.33 | 40 | 20 |
| VBP clinical outcomes weighted domain score | 8.333 | 4.375 | 5.833 | 4.444 | 13.33 | 5 |
| VBP efficiency and cost reduction domain score | 70 | Not Available | 50 | 60 | 40 | 40 |
| VBP efficiency and cost reduction weighted domain score | 23.33 | Not Available | 12.5 | 20 | 13.33 | 10 |
| VBP person and community engagement domain score | 41 | Not Available | Not Available | 22 | 45 | 67 |
| VBP person and community engagement weighted domain score | 13.67 | Not Available | Not Available | 7.333 | 15 | 16.75 |
| VBP safety domain score | Not Available | Not Available | Not Available | Not Available | Not Available | 25 |
| VBP safety weighted domain score | Not Available | Not Available | Not Available | Not Available | Not Available | 6.25 |
| VBP total performance score | 45.33 | Not Available | Not Available | 31.78 | 41.67 | 38 |
Excess readmission ratios by condition; above 1 means more readmissions than expected.
| Measure | Novato Community Hospital | US median | CA average | CMS comparison | US rank |
|---|---|---|---|---|---|
| READM-30-AMI-HRRP2021-07-01 to 2024-06-30 | N/A | 1.015 | |||
| READM-30-CABG-HRRP2021-07-01 to 2024-06-30 | N/A | 1.005 | |||
| READM-30-COPD-HRRP2021-07-01 to 2024-06-30 | 1.03 | 0.9969 | 1.002 | Worse than 76% of US hospitals | |
| READM-30-HF-HRRP2021-07-01 to 2024-06-30 · 115 cases | 0.9256 | 0.9983 | 1.017 | Better than 90% of US hospitals | |
| READM-30-HIP-KNEE-HRRP2021-07-01 to 2024-06-30 | 0.8975 | 0.9916 | 0.9788 | Better than 76% of US hospitals | |
| READM-30-PN-HRRP2021-07-01 to 2024-06-30 · 123 cases | 0.9893 | 0.9955 | 1.026 | Better than 54% of US hospitals |
| By fiscal year | FY 2021 | FY 2022 | FY 2023 | FY 2024 | FY 2025 | FY 2026 |
|---|---|---|---|---|---|---|
| READM-30-AMI-HRRP | N/A | N/A | N/A | N/A | N/A | N/A |
| READM-30-CABG-HRRP | N/A | N/A | N/A | N/A | N/A | N/A |
| READM-30-COPD-HRRP | 1 | 1.012 | 0.9917 | 1.042 | 1.033 | 1.03 |
| READM-30-HF-HRRP | 0.9587 | 0.9934 | 1.009 | 0.9923 | 0.9474 | 0.9256 |
| READM-30-HIP-KNEE-HRRP | 0.9236 | 0.9006 | 0.8325 | 0.805 | 0.7834 | 0.8975 |
| READM-30-PN-HRRP | 1.05 | 1.005 | 0.9833 | 0.9919 | 1.012 | 0.9893 |
Infection ratios, the PSI 90 composite and the total score Medicare ranks hospitals on; lower is better.
| Measure | Novato Community Hospital | US median | CA average | CMS comparison | US rank |
|---|---|---|---|---|---|
| CAUTI standardized infection ratio2023-01-01 to 2024-12-31 | N/A | 0.6114 | |||
| CDI standardized infection ratio2023-01-01 to 2024-12-31 | 0.137 | 0.346 | 0.449 | Better than 82% of US hospitals | |
| CLABSI standardized infection ratio2023-01-01 to 2024-12-31 | N/A | 0.679 | |||
| HAC Reduction Program payment reductionFY 2026 | No | ||||
| MRSA standardized infection ratio2023-01-01 to 2024-12-31 | N/A | 0.7204 | |||
| Patient safety and adverse events composite (PSI 90)2022-07-01 to 2024-06-30 | 0.8474 | 0.9628 | 0.9656 | Better than 86% of US hospitals | |
| SSI standardized infection ratio2023-01-01 to 2024-12-31 | N/A | 0.8116 | |||
| Total HAC scoreFY 2026 | -0.9582 | -0.0453 | 0.02733 | Better than 96% of US hospitals |
| By fiscal year | FY 2021 | FY 2022 | FY 2023 | FY 2024 | FY 2025 | FY 2026 |
|---|---|---|---|---|---|---|
| HAC Reduction Program payment reduction | No | No | N/A | No | No | No |
| Total HAC score | -0.5562 | -0.3004 | 0 | -1.14 | -1.376 | -0.9582 |
Source: CMS Care Compare hospital files, latest release 2026-09-30, with program results for earlier fiscal years from CMS's archived snapshots. US medians and ranks count every hospital CMS reports; state averages are plain means of the state's reporting hospitals, not CMS's patient-weighted state rates.
The Joint Commission (since 2025)
Accreditation
None
Medical school affiliation
Private (not for profit)
Ownership type
75
Medicare-certified beds
1977
In Medicare since
Source: CMS Provider of Services file, as reported by the hospital and state surveyors.
What Novato Community Hospital reported to Medicare in its latest cost report, covering Jan 1, 2025 to Dec 31, 2025.
1,709
Inpatient discharges
Medicare 54%, Medicaid 2%
5,509
Inpatient days
32% of available bed days used
258
Employees (full-time equivalent)
Source: CMS cost report (HCRIS) (report 839241). Figures cover the reporting period, which is not always 12 months, and are self-reported.
Inpatient days and discharges Novato Community Hospital reported by payer. Medicare and Medicaid include their managed care plans, shown separately below.
| Medicare | Medicaid | Other | Total | |
|---|---|---|---|---|
| Inpatient days | 3,075 | 200 | 2,234 | 5,509 |
| Discharges | 923 | 42 | 744 | 1,709 |
| Average length of stay | 3.3 days | 4.8 days | 3.0 days | 3.2 days |
| Average daily census | 8.4 | 0.5 | 6.1 | 15.1 |
884
Medicare Advantage days
233 discharges
612
Medicaid managed care days
203 discharges
387
Observation bed days
| Unit | Beds | Inpatient days | Medicare days | Occupancy |
|---|---|---|---|---|
| Adults & pediatrics | 39 | 5,169 | 2,897 | 36% |
| Intensive care unit | 8 | 340 | 178 | 12% |
Source: CMS cost report (HCRIS, Form 2552-10), report 839241, as submitted. Hospitals report these figures themselves; they are not audited financial statements. Worksheet S-3 Part I.
What Novato Community Hospital treats Medicare patients for most often, in 2024. 446 Medicare discharges in 15 published DRGs; 18% surgical; 64% in DRGs with complications (CC or MCC).
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Septicemia or severe sepsis without MV >96 hours with MCCMS-DRG 871, medical | 163 | $70,734 | $19,359 | $24,474 | 1.98 |
| Septicemia or severe sepsis without MV >96 hours without MCCMS-DRG 872, medical | 50 | $42,764 | $10,004 | $14,796 | 1.03 |
| Heart failure and shock with MCCMS-DRG 291, medical | 44 | $57,182 | $12,831 | $19,785 | 1.28 |
| Major hip and knee joint replacement or reattachment of lower extremity without MCCMS-DRG 470, surgical | 30 | $100,873 | $18,105 | $34,902 | 1.88 |
| Combined anterior and posterior spinal fusion without cc/mccMS-DRG 455, surgical | 25 | $244,352 | $49,900 | $84,546 | 4.61 |
| Kidney and urinary tract infections without MCCMS-DRG 690, medical | 19 | $39,220 | $7,698 | $13,570 | 0.81 |
| Simple pneumonia and pleurisy with MCCMS-DRG 193, medical | 16 | $44,780 | $12,993 | $15,494 | 1.33 |
| Hip replacement with principal diagnosis of hip fracture without MCCMS-DRG 522, surgical | 15 | $108,727 | $21,848 | $37,620 | 2.11 |
| Gastrointestinal obstruction with CCMS-DRG 389, medical | 14 | $43,707 | $7,473 | $15,123 | 0.80 |
| Gastrointestinal hemorrhage with CCMS-DRG 378, medical | 12 | $57,684 | $9,626 | $19,959 | 0.98 |
| Esophagitis, gastroenteritis and miscellaneous digestive disorders without MCCMS-DRG 392, medical | 12 | $38,587 | $7,433 | $13,351 | 0.79 |
| Hip and femur procedures except major joint with CCMS-DRG 481, surgical | 12 | $94,468 | $21,562 | $32,686 | 2.07 |
| Kidney and urinary tract infections with MCCMS-DRG 689, medical | 12 | $52,564 | $11,653 | $18,187 | 1.17 |
| Respiratory infections and inflammations with MCCMS-DRG 177, medical | 11 | $50,355 | $16,493 | $17,423 | 1.70 |
| Cellulitis without MCCMS-DRG 603, medical | 11 | $35,807 | $8,188 | $12,389 | 0.88 |
Source: CMS Medicare Inpatient Hospitals by Provider and Service (2024 data, released 2026-04-10), traditional Medicare only; CMS omits DRGs with fewer than 11 discharges. Estimated cost is average charges times the hospital's Medicare cost-to-charge ratio from the IPPS Impact File. Weights are the MS-DRG relative weights for the same year.
The comprehensive outpatient service groups (APCs) Novato Community Hospital billed Medicare for most in 2024: 701 services in all.
| Service group | Services | Patients | Average charges | Average Medicare payment | US average payment |
|---|---|---|---|---|---|
| Level 5 Musculoskeletal ProceduresAPC 5115 | 284 | 277 | $88,984 | $16,588 | $10,772 |
| Comprehensive Observation ServicesAPC 8011 | 106 | 101 | $33,742 | $3,017 | $2,090 |
| Level 6 Musculoskeletal ProceduresAPC 5116 | 54 | 52 | $105,822 | $24,321 | $15,763 |
| Level 4 Musculoskeletal ProceduresAPC 5114 | 42 | 42 | $48,381 | $8,351 | $5,339 |
| Level 2 Excision/ Biopsy/ Incision and DrainageAPC 5072 | 39 | 36 | $14,326 | $1,742 | $1,220 |
| Level 1 Laparoscopy and Related ServicesAPC 5361 | 35 | 35 | $40,670 | $6,426 | $4,358 |
| Level 2 Upper GI ProceduresAPC 5302 | 25 | 24 | $13,676 | $2,133 | $1,445 |
| Level 1 Intraocular ProceduresAPC 5491 | 23 | 17 | $16,684 | $2,593 | $1,752 |
| Level 1 Abdominal/Peritoneal/Biliary and Related ProceduresAPC 5341 | 20 | 20 | $29,304 | $3,830 | $2,636 |
| Level 2 Musculoskeletal ProceduresAPC 5112 | 18 | 18 | $9,975 | $1,785 | $1,196 |
See all 14 Medicare outpatient services at Novato Community Hospital
Source: CMS Medicare Outpatient Hospitals by Provider and Service (2024 data, released 2026-06-24), comprehensive APCs for traditional Medicare; CMS omits services with fewer than 11 claims. The US average weights every hospital by its services.
ZIP codes with the most Medicare inpatient stays at Novato Community Hospital in 2025. Market share is this hospital's part of every hospital's Medicare stays from the ZIP code. Its published Medicare stays went from 980 in 2020 to 958 in 2025.
| ZIP code | Stays | Of this hospital's stays | Days | Charges | Market share | Share in 2020 |
|---|---|---|---|---|---|---|
| 94947 | 304 | 32% | 1,013 | $18.5M | 33% | 37% |
| 94949 | 169 | 18% | 547 | $10.3M | 26% | 31% |
| 94945 | 158 | 16% | 504 | $9M | 26% | 39% |
| 94903 | 84 | 9% | 283 | $6M | 7% | 11% |
| 94901 | 39 | 4% | 111 | $3.6M | 3% | 8% |
| 94954 | 33 | 3% | 133 | $2.4M | 2% | 2% |
| 94941 | 30 | 3% | 80 | $3M | 3% | 5% |
| 94952 | 23 | 2% | 73 | $1.4M | 2% | 3% |
| 95476 | 19 | 2% | 74 | $1.5M | 1% | 2% |
| 94102 | 17 | 2% | 68 | $1.1M | 1% | 1% |
| 94920 | 15 | 2% | 45 | $1.2M | 3% | 5% |
| 94948 | 15 | 2% | 62 | $1.1M | 31% | 46% |
| 95482 | 15 | 2% | 36 | $2.9M | 1% | |
| 94928 | 13 | 1% | 78 | $948,155 | 1% | |
| 94904 | 12 | 1% | 30 | $1.3M | 2% | 8% |
| 95453 | 12 | 1% | 53 | $1.6M | 2% |
Source: CMS Hospital Service Area file. Shares are of the 958 stays from ZIP codes CMS publishes; it omits ZIP codes with fewer than 11 stays, so market shares count published stays only.
Staff by profession and the rooms and units Novato Community Hospital reported at its latest Medicare certification survey (2025). Counts are people, not full-time equivalents.
3
Operating rooms
1
Endoscopy rooms
1
Off-site locations
1
Off-site emergency departments
Source: CMS Provider of Services file.
603 clinicians who bill Medicare list Novato Community Hospital as a hospital affiliation. Showing 24 of them. Book a demo to see the commercial rates insurers publish for them, or start a free trial.
Ari Baron, M.D.
Specialist
NPI 1013086420
See commercial rates for Ari Baron, M.D.Caroline Behler, M.D., M.S.
Hematology & Oncology Physician
NPI 1518155357
See commercial rates for Caroline Behler, M.D., M.S.Bertrand Tuan, M.D.
Specialist
NPI 1578632980
See commercial rates for Bertrand Tuan, M.D.Corrie Nunan-Lui, PA
Physician Assistant
NPI 1548227507
See commercial rates for Corrie Nunan-Lui, PAKevin Kim, M.D.
Medical Oncology Physician
NPI 1851485056
See commercial rates for Kevin Kim, M.D.Alex Metzger, M.D.
Hematology & Oncology Physician
NPI 1821070590
See commercial rates for Alex Metzger, M.D.Ilkcan Cokgor, M.D.
Neurology Physician
NPI 1235100603
See commercial rates for Ilkcan Cokgor, M.D.Jennifer Lucas, M.D.
Specialist
NPI 1619078979
See commercial rates for Jennifer Lucas, M.D.Kristin Anderson, MD, MPH
Student in an Organized Health Care Education/Training Program
NPI 1962732354
See commercial rates for Kristin Anderson, MD, MPHNeal Birnbaum, M.D.
Rheumatology Physician
NPI 1437142882
See commercial rates for Neal Birnbaum, M.D.John Mendius, M.D.
Neurology Physician
NPI 1295765881
See commercial rates for John Mendius, M.D.Barbara Galligan, MD
Internal Medicine Physician
NPI 1679896013
See commercial rates for Barbara Galligan, MDRobert Mayle, M.D.
Orthopaedic Surgery Physician
NPI 1174710545
See commercial rates for Robert Mayle, M.D.Jacqueline Tran, M.D.
Neurology Physician
NPI 1760486534
See commercial rates for Jacqueline Tran, M.D.Basil Hamblin, MD
Geriatric Medicine (Family Medicine) Physician
NPI 1114095106
See commercial rates for Basil Hamblin, MDKatherine Ziesing, PA-C
Physician Assistant
NPI 1710467774
See commercial rates for Katherine Ziesing, PA-CAlexandra Haessler, M.D.
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
NPI 1407998164
See commercial rates for Alexandra Haessler, M.D.Joshua Sampson, M.D.
Sports Medicine (Family Medicine) Physician
NPI 1497098909
See commercial rates for Joshua Sampson, M.D.Harjot Bhandal, MD
Interventional Pain Medicine Physician
NPI 1245611250
See commercial rates for Harjot Bhandal, MDElizabeth Tong, M.D.
Neuroradiology Physician
NPI 1932495496
See commercial rates for Elizabeth Tong, M.D.Stephen Dalton, M.D.
Dermatology Physician
NPI 1053318824
See commercial rates for Stephen Dalton, M.D.Peter Callander, M.D.
Orthopaedic Surgery Physician
NPI 1144316688
See commercial rates for Peter Callander, M.D.Arshia Sadreddin
Neurology Physician
NPI 1033308903
See commercial rates for Arshia SadreddinNoah Weiss, MD
Orthopaedic Surgery Physician
NPI 1225126444
See commercial rates for Noah Weiss, MDSource: CMS Doctors and Clinicians facility affiliations, released 2026-10-15, with names and specialties from NPPES. Affiliation means the clinician bills Medicare for care at this hospital; it is not employment.
Revenue, expenses and income Novato Community Hospital reported to Medicare for Jan 1, 2025 to Dec 31, 2025. Percentages are of net patient revenue.
| Line | Amount | Share |
|---|---|---|
| Gross patient revenue (charges) | $429.4M | 395.1% |
| Inpatient | $131.5M | 121.0% |
| Outpatient | $297.9M | 274.1% |
| Contractual allowances and discounts | -$320.7M | -295.1% |
| Net patient revenue | $108.7M | 100.0% |
| Operating expenses | -$114.6M | -105.5% |
| Operating income from patient care | -$5.9M | -5.5% |
| Other income | $2.8M | 2.6% |
| Contributions and donations | $309,473 | 0.3% |
| Investment income | $115,120 | 0.1% |
| Other | $2.4M | 2.2% |
| Net income | -$3.1M | -2.9% |
| Line | Amount | Share |
|---|---|---|
| Traditional Medicare | $168.7M | 39.3% |
| Medicaid (including managed care) | $76.9M | 17.9% |
| Other payers and self-pay | $183.7M | 42.8% |
| Total charges | $429.3M | 100.0% |
Source: CMS cost report (HCRIS, Form 2552-10), report 839241, as submitted. Hospitals report these figures themselves; they are not audited financial statements. Traditional Medicare is the program charges on Worksheets D-3 and D Part V; Medicaid is from Worksheet S-10.
Computed from Novato Community Hospital's latest cost report.
-5.5%
Operating margin
Operating income from patient care / net patient revenue
-2.8%
Total margin
Net income / net patient revenue plus other income
0.9%
EBITDAR margin
Net income before interest, depreciation and leases (Worksheet A-7), / total revenue
51% of expenses
Personnel costs
Salaries, direct-care contract labor and core wage-related costs / operating expenses
$86.11
Average hourly wage
Adjusted salaries / paid hours (Worksheet S-3 Part II)
-4.5%
Return on assets
Net income for a year / total assets
-4.8%
Return on equity
Net income for a year / fund balance
4.73
Current ratio
Current assets / current liabilities
3.18
Quick ratio
Cash, temporary investments and net receivables / current liabilities
0 days
Days cash on hand
Cash and temporary investments / daily operating expenses excluding depreciation
41 days
Days in patient receivables
Net patient receivables / daily net patient revenue
13 days
Average payment period
Current liabilities / daily operating expenses excluding depreciation
1.60
Asset turnover
Total revenue for a year / total assets
17.8 years
Average age of plant
Accumulated depreciation / depreciation for a year
Source: CMS cost report (HCRIS, Form 2552-10), report 839241, as submitted. Hospitals report these figures themselves; they are not audited financial statements.
What Novato Community Hospital owned and owed at the end of its reporting period (Dec 2025), across all fund types: $69.9M in total assets and a $65.7M fund balance.
| Line | Amount | Of total assets |
|---|---|---|
| Cash and temporary investments | $225 | 0.0% |
| Patient receivables, net | $12.3M | 17.6% |
| Inventory | $1.5M | 2.2% |
| Total current assets | $18.3M | 26.1% |
| Property and equipment, net of depreciation | $36.3M | 51.9% |
| Investments and other assets | $15.3M | 21.9% |
| Total assets | $69.9M | 100.0% |
| Current liabilities | $3.9M | 5.5% |
| Total liabilities | $4.1M | 5.9% |
| Fund balance (net assets) | $65.7M | 94.1% |
Source: CMS cost report (HCRIS, Form 2552-10), report 839241, as submitted. Hospitals report these figures themselves; they are not audited financial statements.
Care Novato Community Hospital provided without full payment, as reported on Worksheet S-10 of its cost report.
$1.1M
Cost of charity care
Care for patients approved for charity care and uninsured discounts, at cost
$4.1M
Bad debt
Patient bills written off as uncollectible, at charges
$10.9M
Medicaid shortfall
Cost of Medicaid patients (charges times the cost-to-charge ratio) minus Medicaid payments; negative means a surplus
$13.1M
Total unreimbursed and uncompensated care
11.5% of operating expenses
Medicaid, CHIP and indigent care shortfalls plus charity care and the cost of bad debt (Worksheet S-10 line 31)
Source: CMS cost report (HCRIS, Form 2552-10), report 839241, as submitted. Hospitals report these figures themselves; they are not audited financial statements.
Novato Community Hospital's full-year cost reports, by fiscal year end. Reports shorter than ten months are left out.
| Fiscal year ending | Dec 2020 | Dec 2021 | Dec 2022 | Dec 2023 | Dec 2024 | Dec 2025 |
|---|---|---|---|---|---|---|
| Net patient revenue | $72.9M | $81.8M | $90.8M | $101.6M | $114.9M | $108.7M |
| Operating expenses | $85.2M | $84.8M | $92.2M | $100.5M | $110.7M | $114.6M |
| Operating margin | -16.8% | -3.6% | -1.5% | 1.1% | 3.7% | -5.5% |
| Net income | -$8.4M | -$1.8M | $469,561 | $4.1M | $5.9M | -$3.1M |
| Total assets | $51.7M | $50.5M | $56.7M | $59.5M | $65.1M | $69.9M |
| Discharges | 1,850 | 1,868 | 1,933 | 1,971 | 1,913 | 1,709 |
| Inpatient days | 6,101 | 5,978 | 6,612 | 6,505 | 6,357 | 5,509 |
| Medicare Advantage days | 627 | 543 | 600 | 778 | 934 | 884 |
| Beds | 47 | 47 | 47 | 47 | 47 | 47 |
| Employees (FTE) | 215 | 206 | 207 | 191 | 252 | 258 |
Source: CMS cost report (HCRIS, Form 2552-10), report 839241, as submitted. Hospitals report these figures themselves; they are not audited financial statements.
Each cost center Novato Community Hospital reports, largest first. Total cost includes its share of overhead; the cost-to-charge ratio is total cost / charges.
| Department | Salaries | Total cost | Charges | Cost-to-charge | Square feet |
|---|---|---|---|---|---|
| Operating room | $7.5M | $18.5M | $81.4M | 0.23 | 12,312 |
| Impl. dev. charged to patients | $11.7M | $37.4M | 0.31 | ||
| Emergency | $5.3M | $11.1M | $84.1M | 0.13 | 4,284 |
| Radiology-diagnostic | $3.6M | $7.5M | $63.4M | 0.12 | 5,130 |
| Drugs charged to patients | $7.4M | $18M | 0.41 | ||
| Laboratory | $2.6M | $7.4M | $48.2M | 0.15 | 1,404 |
| Physical therapy | $3.2M | $6M | $10M | 0.60 | 490 |
| Medical supplies charged to patient | $5.9M | $16.7M | 0.35 | ||
| Respiratory therapy | $1.1M | $2M | $7.6M | 0.27 | 863 |
| Observation beds (non-distinct part | $1.3M | $2.4M | 0.54 | ||
| Mri | $361,777 | $772,305 | $16.1M | 0.05 | 620 |
| Whole blood & packed red blood cell | $390,260 | $920,431 | 0.42 | ||
| Renal dialysis | $267,246 | $631,555 | 0.42 | ||
| Anesthesiology | $88,076 | $9.9M | 0.01 |
| Department | Salaries | Total cost | Charges | Cost-to-charge | Square feet |
|---|---|---|---|---|---|
| Adults & pediatrics | $7.3M | $18.5M | $27.2M | 0.68 | 17,232 |
| Intensive care unit | $3.4M | $7.5M | $5.2M | 1.45 | 4,000 |
| Department | Salaries | Direct cost | Paid hours | Average hourly wage | Square feet |
|---|---|---|---|---|---|
| Administrative & general | $4.1M | $27.9M | 54,767 | $77.25 | 1,904 |
| Maintenance & repairs | $1.8M | $5.6M | 36,389 | $49.87 | 2,883 |
| Employee benefits department | $821,540 | $5M | 480 | ||
| Pharmacy | $2.4M | $2.8M | 23,981 | $103.90 | 782 |
| Nursing administration | $1.9M | $2.4M | 12,994 | $163.86 | 532 |
| Cap rel costs-mvble equip | $2.3M | ||||
| Cap rel costs-bldg & fixt | $1.9M | 56,579 | |||
| Central services & supply | $264,244 | $1.5M | 6,675 | $39.68 | 1,450 |
| Housekeeping | $881,503 | $1.3M | 21,806 | $41.17 | 492 |
| Medical records & library | $125,707 | $671,693 | 2,592 | $50.25 | |
| Cafeteria | $667,222 | 10,245 | $44.51 | 504 | |
| Dietary | $757,277 | $390,095 | 5,270 | $46.50 | 429 |
| Social service | $166,558 | $182,974 | 2,381 | $70.12 | 324 |
| Laundry & linen service | $152,230 | 348 |
Source: CMS cost report (HCRIS, Form 2552-10), report 839241, as submitted. Hospitals report these figures themselves; they are not audited financial statements. Worksheets A, B-1, C Part I and S-3 Part II.
The factors Medicare uses to set what it pays Novato Community Hospital for an inpatient stay.
1.70
Case mix index
Higher than 52% of hospitals paid under Medicare IPPS
Average Medicare DRG weight of its inpatient cases (FY 2027); higher means more complex, costlier care.
No Medicare-funded residents
Teaching status
Medicare-funded interns and residents per bed (FY 2027).
20.6%
Low-income patient share
Disproportionate share percentage: Medicaid and SSI patient days CMS uses for safety-net payments (FY 2027).
897
Medicare inpatient stays
Medicare claims CMS based FY 2027 payment rates on.
Urban (metro area)
Location type
Geographic area CMS assigns before any wage index reclassification (FY 2027).
| IPPS fiscal year | FY 2021 | FY 2022 | FY 2023 | FY 2024 | FY 2025 | FY 2026 | FY 2027 |
|---|---|---|---|---|---|---|---|
| Case mix index | 1.56 | 1.56 | 1.60 | 1.66 | 1.64 | 1.71 | 1.70 |
| Wage index | 1.802 | 1.799 | 1.838 | 1.816 | 1.725 | 1.647 | 1.669 |
| Readmissions adjustment | -0.22% | -0.23% | -0.08% | -0.05% | -0.03% | -0.09% | -0.02% |
| Value-based purchasing adjustment | +0.45% | +0.91% | +0.91% | -0.30% | +1.02% | +1.73% | +0.62% |
| Medicare inpatient stays | 1,162 | 1,162 | 821 | 945 | 949 | 969 | 897 |
Source: CMS IPPS final rule Impact File (FY 2027).
Organizations Novato Community Hospital reports to Medicare as owners or with operational control.
Sutter Health
5% or greater direct ownership interest, 100%, since 2010
Sources: CMS Hospital All Owners.
The officers and board members on Novato Community Hospital's Medicare enrollment and on the IRS Form 990 filed under its tax ID.
Source: CMS Hospital All Owners (PECOS), the people the hospital lists on its Medicare enrollment; the first 10 of 11 are shown.
Sutter Bay Hospitals files the Form 990 for the tax ID insurers list for Novato Community Hospital, so these people may lead the wider organization rather than Novato Community Hospital alone.
| Name | Title |
|---|---|
| Mark Sevco | Sh SVP, COO / President Sbh |
| Todd Smith MD | SVP, Chf Phys Ex/asst Sec Sbh |
| Hamila Kownacki | CEO, Cpmc |
| Kevin Cook | President, Silicon Valley |
| David Clark | CEO, Absmc |
| Christina Oh | President, San Francisco Div. |
| Tosan Boyo | President, East Bay Division |
| Raju Iyer | Sh SVP, CFO / CFO Sbh (pt-yr) |
| Megan Gillespie | CEO, Ssrrh |
| Edward Battista | Sh VP, Hr Silicon Valley |
| Ryan Stice | Sh VP, Cpo/asst Sec Sbh |
| Harly Neumann | Sh VP, Hr East Bay Division |
| Gregory Brown | Sh VP, Legal Ops, Bay/ Sec Sbh |
| Dominic Nakis | Sh Interim / Sbh CFO (pt-yr) |
| Theodore Deikel | Dir/chair Fin & Plan |
| Eric Flowers | Director/chair |
Board members: Jill Kacher Cobb MD, Thomas Briody, William Brunetti, Rita Kwan-Feinberg MD, Janet Garufis, Juli Maxworthy, Yumi Nakagawa, Yvonne Richardson, John Ryan, Arnie Schaffer, Ron Sinha MD, Jane Varner MD.
Source: IRS Form 990 Part VII filed by Sutter Bay Hospitals (EIN 94-0562680), via the IRS e-file data. A health system's return can cover several hospitals.
About Novato Community Hospital's rates and hospital price transparency.
For MRI brain before and after contrast (CPT 70553), published negotiated rates at Novato Community Hospital range from $4,142 to $4,959 across 4 insurers. UnitedHealthcare's rate is $4,923. The median at nearby comparable hospitals is $1,418. What a patient pays depends on their plan's deductible, coinsurance and network status.
For CT abdomen and pelvis with contrast (CPT 74177), published negotiated rates at Novato Community Hospital range from $4,424 to $6,152 across 4 insurers. Anthem Blue Cross / Blue Shield of CA's rate is $6,152. The median at nearby comparable hospitals is $1,436. What a patient pays depends on their plan's deductible, coinsurance and network status.
For Colonoscopy with biopsy (CPT 45380), published negotiated rates at Novato Community Hospital range from $830 to $3,419 across 4 insurers. Cigna's rate is $3,419. The median at nearby comparable hospitals is $3,922. What a patient pays depends on their plan's deductible, coinsurance and network status.
For Vaginal delivery, hospital stay (MS-DRG 807), published negotiated rates at Novato Community Hospital range from $15,147 to $22,790 across 4 insurers. Aetna's rate is $19,448. What a patient pays depends on their plan's deductible, coinsurance and network status.
For Screening mammography, bilateral (CPT 77067), published negotiated rates at Novato Community Hospital range from $371 to $491 across 3 insurers. Aetna's rate is $491. The median at nearby comparable hospitals is $324. What a patient pays depends on their plan's deductible, coinsurance and network status.
For Major lower-extremity joint replacement without MCC (MS-DRG 470), published negotiated rates at Novato Community Hospital range from $82,456 to $95,390 across 4 insurers. Aetna's rate is $83,806. The median at nearby comparable hospitals is $41,474. What a patient pays depends on their plan's deductible, coinsurance and network status.
Novato Community Hospital has a CMS overall hospital star rating of 5 out of 5 on Medicare Care Compare (CMS data released 2026-08-13). That is the top rating, shared by 12% of US hospitals.
CMS reports no Medicare-funded interns or residents at Novato Community Hospital for fiscal year 2027.
Yes. Under the Hospital Readmissions Reduction Program, Medicare cuts Novato Community Hospital's base inpatient payments by an estimated 0.02% in fiscal year 2027 for more readmissions than expected.
In 2024, the most common were septicemia or severe sepsis without mv >96 hours with mcc (163 discharges), septicemia or severe sepsis without mv >96 hours without mcc (50 discharges), heart failure and shock with mcc (44 discharges).
Novato Community Hospital's Medicare case mix index is 1.70 for fiscal year 2027, higher than 52% of hospitals paid under the inpatient prospective payment system.
Novato Community Hospital reported 1,709 inpatient discharges and 5,509 inpatient days from Jan 1, 2025 to Dec 31, 2025.
Novato Community Hospital reported 258 full-time-equivalent employees on payroll from Jan 1, 2025 to Dec 31, 2025.
Novato Community Hospital reported $108.7M in net patient revenue on $429.4M of gross charges for Jan 1, 2025 to Dec 31, 2025, an operating margin of -5.5%, and net income of -$3.1M.
Novato Community Hospital reported $13.1M of unreimbursed and uncompensated care for Jan 1, 2025 to Dec 31, 2025, including $1.1M of charity care at cost.
Insurers' price transparency files list Novato Community Hospital under employer identification number 94-0562680 (Sutter Bay Hospitals). 41 health plans and networks list 94-0562680 for it.
603 clinicians who bill Medicare list Novato Community Hospital as a hospital affiliation in CMS's Doctors and Clinicians data. The largest groups are internal medicine physician (81), family medicine physician (58), physician assistant (40).
Yes. CMS's Provider of Services file lists The Joint Commission as the accrediting organization for Novato Community Hospital, effective 2025.
In its Medicare enrollment, Novato Community Hospital reports Sutter Health as 5% or greater direct ownership interest (100%).
CMS lists 19 services at Novato Community Hospital, including Acute Renal Dialysis, Anesthesia, Clinical Laboratory, Coronary Care Unit, Diagnostic Radiology, Dietary Care.
In CMS's 2025 Hospital Service Area file, the most Medicare inpatient stays at Novato Community Hospital came from ZIP codes 94947 (304), 94949 (169), 94945 (158).
Novato Community Hospital has 47 beds, including its psychiatric, rehabilitation and other subprovider units, in its latest Medicare cost report. 75 are Medicare-certified beds in CMS's Provider of Services file. Facility type: Short Term Acute Care Hospital.
Novato Community Hospital is located at 180 Rowland Way, Novato, CA 94945. Its main phone number is (415) 209-1300.
Novato Community Hospital's CMS Certification Number (CCN), also called its Medicare provider number, is 050131.
The National Provider Identifier (NPI) on file for Novato Community Hospital is 1104059153.
Novato Community Hospital is affiliated with Sutter Health.
Novato Community Hospital lists 28 in-network payers, including Aetna, Ambetter, Aspirus Health Plan, BCBS, and is Medicare-certified. Insurance acceptance may vary by plan, so confirm coverage with your insurer or the hospital's billing department.
333 disclosed rate categories. Each shows the payer, category, code type and group with its code range, and contract type, along with how the rate compares with the state average.
Under 45 CFR Part 180, every US hospital must publish a machine-readable file of its standard charges, including gross charges, discounted cash prices and payer-specific negotiated rates, in the CMS template format. PayerPrice can help hospitals publish and maintain these files.
A chargemaster (charge description master, or CDM) is a hospital's master list of billable items, with codes, descriptions and gross charges. A chargemaster review looks at those lines for accuracy and pricing. PayerPrice can help hospitals review their chargemaster; contact us to discuss your needs.
For hospital finance and compliance teams
The data on this page comes from the files hospitals and payers publish. We help hospitals publish theirs correctly, and take a fresh look at their chargemaster.
We turn your chargemaster and payer contracts into the CMS template file, then keep it current as rates change.
{
"description": "MRI of brain (no contrast)",
"code_information": [
{ "code": "611", "type": "RC" },
{ "code": "70551", "type": "CPT" }
],
"standard_charges": [{
"setting": "outpatient",
"minimum": 250,
"maximum": 400,
"gross_charge": 1200,
"discounted_cash": 1080,
"payers_information": [
{
"payer_name": "Platform Health Insurance",
"plan_name": "PPO",
"methodology": "fee schedule",
"standard_charge_dollar": 400
},
{
"payer_name": "Region Health Insurance",
"plan_name": "HMO",
"methodology": "fee schedule",
"standard_charge_dollar": 250
}
]
}]
}Your chargemaster sets the gross charge on every claim, and many payer contracts base payment on it through percent-of-charge, lesser-of and stop-loss terms. We audit it line by line and show how your charges and negotiated rates compare with peer hospitals before your next negotiation.
What a review covers