Munson Healthcare · Gaylord, MI
4 of 5
CMS star rating
78
Beds
1,923
Inpatient discharges a year
$134.7M
Net patient revenue a year
29
In-network payers
Otsego Memorial Hospital is a 78-bed voluntary non-profit - private hospital in Gaylord, MI, affiliated with Munson Healthcare. Below you'll find publicly disclosed negotiated rates and facility details, including 29 in-network payers and 236 disclosed rate categories.
The 24 services Otsego Memorial 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.
Childbirth · Inpatient
MS-DRG 807
$19,864
negotiated rate
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
CT imaging
CPT 74177
$410 - $2,889
from 4 insurers · median $1,523
Common here, based on CMS Medicare volume
Medicine & Surgery
CPT 47562
$4,366 - $5,600
from 3 insurers · median $4,568
68 Medicare claims in Level 1 Laparoscopy and Related Services (CMS 2024)
Childbirth · Inpatient
MS-DRG 788
$13,532
negotiated rate
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 70450
$115 - $1,243
from 4 insurers · median $741
Common here, based on CMS Medicare volume
CT imaging
CPT 74176
$247 - $2,356
from 4 insurers · median $1,367
Common here, based on CMS Medicare volume
MRI imaging
CPT 70553
$430 - $3,829
from 4 insurers · median $2,292
Common here, based on CMS Medicare volume
Mammography
CPT 77067
$153 - $312
from 4 insurers · median $277
Common here, based on CMS Medicare volume
CT imaging
CPT 71275
$341 - $1,950
from 4 insurers · median $1,112
Common here, based on CMS Medicare volume
Cardiology and vascular testing
CPT 93306
$216 - $1,543
from 4 insurers · median $891
Common here, based on CMS Medicare volume
Digestive procedures
CPT 49650
$6,803
negotiated rate
68 Medicare claims in Level 1 Laparoscopy and Related Services (CMS 2024)
MRI imaging
CPT 72197
$854 - $3,577
from 4 insurers · median $3,138
Common here, based on CMS Medicare volume
X-ray and bone density
CPT 71046
$34 - $235
from 4 insurers · median $149
Common here, based on CMS Medicare volume
Medicine & Surgery
CPT 66984
$763 - $1,147
from 2 insurers · median $955
250 Medicare claims in Level 1 Intraocular Procedures (CMS 2024)
Gynecology
CPT 58571
$11,227
negotiated rate
15 Medicare claims in Level 2 Laparoscopy and Related Services (CMS 2024)
MRI imaging
CPT 72148
$258 - $2,193
from 4 insurers · median $1,334
Common here, based on CMS Medicare volume
MRI imaging
CPT 74183
$457 - $3,331
from 4 insurers · median $2,087
Common here, based on CMS Medicare volume
Nuclear imaging
CPT 78452
$517 - $2,999
from 4 insurers · median $1,986
Common here, based on CMS Medicare volume
Childbirth · Inpatient
MS-DRG 807
$19,864
negotiated rate
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
Digestive procedures
CPT 43239
$490 - $1,731
from 2 insurers · median $1,110
Common here, based on CMS Medicare volume
Digestive procedures
CPT 47563
$5,396
negotiated rate
68 Medicare claims in Level 1 Laparoscopy and Related Services (CMS 2024)
Ultrasound
CPT 76705
$88 - $530
from 4 insurers · median $351
Common here, based on CMS Medicare volume
Ultrasound
CPT 76856
$127 - $631
from 4 insurers · median $382
Common here, based on CMS Medicare volume
Ultrasound
CPT 76830
$143 - $526
from 4 insurers · median $363
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* | 16 | 701% | 0 | 0 |
| Insurer B* | 16 | 557% | 14 | 0 |
| Insurer C* | 24 | 232% | 0 | 0 |
| Insurer D* | 17 | 108% | 1 | 16 |
How we chose these services: 5 appear in this hospital's own Medicare claims, 16 are common here based on CMS Medicare volume, and 3 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 Otsego Memorial Hospital, or start a free trial.
Acceptance varies by plan and service. Confirm coverage with your insurer or the hospital's billing department.
Quality
4 of 5 stars
Doctors and services
Accredited by The Joint Commission
Finances
$134.7M net patient revenue
Ownership and leadership
Owned by Munson Healthcare
The employer identification numbers (EINs) health plans and networks list for Otsego Memorial 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 |
|---|---|---|
| 38-1303843Munson Healthcare Otsego Memorial Hospital | 44Aetna, Cigna, United Healthcare (incl Optum, Rocky Mountain, Health Plan of Nevada, Sierra Health), Allied Benefit Systems, Aspirus Health Plan and 39 more | 1124028972 Munson Healthcare Otsego Memorial Hospital1851341333 Munson Healthcare Otsego Memorial Hospital1518982073 Munson Healthcare Otsego Memorial Hospitaland 18 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.
825 North Center Avenue, Gaylord, MI 49735
(989) 731-2100
How Otsego Memorial Hospital compares with other US facilities on the measures CMS publishes, mostly from Medicare patients.
Overall star rating
4 of 5
Higher than 58% 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
Worse on 2 of 8 measures
0 better, 6 no different, 2 worse than the US rate
Patients back in the hospital or ER soon after leaving
Patient survey rating
3 of 5
Lower than 40% of US hospitals
From the HCAHPS survey of recent inpatients
Would definitely recommend
56%
Lower than 92% 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)
0.92
Lower than 68% 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
177 min
Higher than 69% 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
62%
Lower than 57% 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 | 4 of 5 | |
| Death rates | No different on 5 measures | |
| Safety | No different on 3 measures | |
| Readmissions | Worse on 2 of 8 measures | |
| Patient survey ratingCMS: Summary star rating | 3 of 5 | 2024-10-01 to 2025-09-30 |
| Would definitely recommendCMS: "YES", patients would definitely recommend the hospital | 56% | 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) | 0.92 | 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 | 177 min | 2024-10-01 to 2025-09-30 |
| Sepsis careCMS: Appropriate care for severe sepsis and septic shock | 62% | 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 Otsego Memorial Hospital's inpatient payments for its readmissions, quality and cost results.
-0.86% on Medicare payments
Readmissions penalty
Hospital Readmissions Reduction Program adjustment for excess readmissions, as estimated in the FY 2027 IPPS final rule.
+1.45% 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 Otsego Memorial Hospital, beside the US median and the average of MI 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 | Otsego Memorial Hospital | US median | MI average | CMS comparison | US rank |
|---|---|---|---|---|---|
| Rate of complications for hip/knee replacement patients2023-04-01 to 2025-03-31 | Not Available | 4.186 | |||
| Hybrid Hospital-Wide All-Cause Risk Standardized Mortality Rate2024-07-01 to 2025-06-30 · 567 cases | 4.5 | 3.9 | 3.903 | Worse than 76% of US hospitals | |
| Death rate for heart attack patients2022-07-01 to 2025-06-30 | Not Available | 12 | |||
| Death rate for CABG surgery patients2022-07-01 to 2025-06-30 | Not Available | 2.376 | |||
| Death rate for COPD patients2022-07-01 to 2025-06-30 · 52 cases | 10.1 | 8.5 | 8.576 | Worse than 86% of US hospitals | |
| Death rate for heart failure patients2022-07-01 to 2025-06-30 · 63 cases | 15.1 | 11 | 11.26 | Worse than 97% of US hospitals | |
| Death rate for pneumonia patients2022-07-01 to 2025-06-30 · 92 cases | 14.6 | 15.2 | 15.18 | Better than 59% of US hospitals | |
| Death rate for stroke patients2023-07-01 to 2025-06-30 · 38 cases | 11.8 | 11.6 | 11.95 | Worse than 52% of US hospitals | |
| Pressure ulcer rate2022-07-01 to 2024-06-30 · 641 cases | 0.5 | 0.51 | 0.6149 | No Different Than the National Rate | Better than 51% of US hospitals |
| Death rate among surgical inpatients with serious treatable complications2022-07-01 to 2024-06-30 | Not Available | 178 | Number of Cases Too Small | ||
| Iatrogenic pneumothorax rate2022-07-01 to 2024-06-30 · 843 cases | 0.2 | 0.2 | 0.2198 | No Different Than the National Rate | Better than 46% of US hospitals |
| In-hospital fall-associated fracture rate2022-07-01 to 2024-06-30 · 844 cases | 0.27 | 0.27 | 0.2762 | No Different Than the National Rate | Worse than 46% of US hospitals |
| Postoperative hemorrhage or hematoma rate2022-07-01 to 2024-06-30 · 116 cases | 2.28 | 2.29 | 2.378 | No Different Than the National Rate | Better than 51% of US hospitals |
| Postoperative acute kidney injury requiring dialysis rate2022-07-01 to 2024-06-30 · 66 cases | 1.66 | 1.63 | 1.689 | No Different Than the National Rate | Worse than 64% of US hospitals |
| Postoperative respiratory failure rate2022-07-01 to 2024-06-30 · 65 cases | 8.61 | 8.88 | 9.51 | No Different Than the National Rate | Better than 57% of US hospitals |
| Perioperative pulmonary embolism or deep vein thrombosis rate2022-07-01 to 2024-06-30 · 123 cases | 3.3 | 3.4 | 3.553 | No Different Than the National Rate | Better than 60% of US hospitals |
| Postoperative sepsis rate2022-07-01 to 2024-06-30 · 53 cases | 5.04 | 5.105 | 5.252 | No Different Than the National Rate | Better than 56% of US hospitals |
| Postoperative wound dehiscence rate2022-07-01 to 2024-06-30 · 72 cases | 1.73 | 1.72 | 1.76 | No Different Than the National Rate | Worse than 52% of US hospitals |
| Abdominopelvic accidental puncture or laceration rate2022-07-01 to 2024-06-30 · 145 cases | 1 | 1.02 | 1.117 | 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 | Otsego Memorial Hospital | US median | MI average | CMS comparison | US rank |
|---|---|---|---|---|---|
| Hospital return days for heart attack patients2022-07-01 to 2025-06-30 | Not Available | 9.875 | |||
| Hospital return days for heart failure patients2022-07-01 to 2025-06-30 · 80 cases | 92.6 | 1.25 | 2.533 | Worse than 98% of US hospitals | |
| Hospital return days for pneumonia patients2022-07-01 to 2025-06-30 · 95 cases | 34 | 3.85 | 5.307 | Worse than 85% 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 · 743 cases | 12.5 | 12.9 | 12.94 | 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 · 56 cases | 11.9 | 10.7 | 10.6 | No Different Than the National Rate | Worse than 81% of US hospitals |
| Rate of emergency department (ED) visits for patients receiving outpatient chemotherapy2024-01-01 to 2024-12-31 · 56 cases | 6.2 | 5.3 | 5.333 | No Different Than the National Rate | Worse than 87% of US hospitals |
| Ratio of unplanned hospital visits after hospital outpatient surgery2024-01-01 to 2024-12-31 · 166 cases | 1.2 | 1 | 0.9865 | No Different than expected | Worse than 89% of US hospitals |
| Acute Myocardial Infarction (AMI) 30-Day Readmission Rate2023-07-01 to 2025-06-30 | Not Available | 14.28 | |||
| Rate of readmission for CABG2023-07-01 to 2025-06-30 | Not Available | 10.41 | |||
| Rate of readmission for chronic obstructive pulmonary disease (COPD) patients2023-07-01 to 2025-06-30 · 78 cases | 20.3 | 19.8 | 19.73 | Worse than 69% of US hospitals | |
| Heart failure (HF) 30-Day Readmission Rate2023-07-01 to 2025-06-30 · 134 cases | 25.3 | 21.3 | 21.19 | Worse than 99% of US hospitals | |
| Rate of readmission after hip/knee replacement2023-07-01 to 2025-06-30 | Not Available | 5.984 | |||
| Pneumonia (PN) 30-Day Readmission Rate2023-07-01 to 2025-06-30 · 145 cases | 16.2 | 17.2 | 17.08 | Better than 88% of US hospitals |
Standardized infection ratios (1 is the US baseline) and the counts behind them; lower is better.
| Measure | Otsego Memorial Hospital | US median | MI average | CMS comparison | US rank |
|---|---|---|---|---|---|
| Central Line Associated Bloodstream Infection (ICU + select Wards): Lower Confidence Limit2024-10-01 to 2025-09-30 | Not Available | 0.2592 | |||
| Central Line Associated Bloodstream Infection (ICU + select Wards): Upper Confidence Limit2024-10-01 to 2025-09-30 | Not Available | 1.909 | |||
| Central Line Associated Bloodstream Infection: Number of Device Days2024-10-01 to 2025-09-30 | 289 | 1,370 | 4,065 | ||
| Central Line Associated Bloodstream Infection (ICU + select Wards): Predicted Cases2024-10-01 to 2025-09-30 | 0.18 | 0.9835 | 4.274 | ||
| Central Line Associated Bloodstream Infection (ICU + select Wards): Observed Cases2024-10-01 to 2025-09-30 | 0 | 0 | 2.649 | ||
| Central Line Associated Bloodstream Infection (ICU + select Wards)2024-10-01 to 2025-09-30 | Not Available | 0.6721 | |||
| Catheter Associated Urinary Tract Infections (ICU + select Wards): Lower Confidence Limit2024-10-01 to 2025-09-30 | Not Available | 0.1561 | |||
| Catheter Associated Urinary Tract Infections (ICU + select Wards): Upper Confidence Limit2024-10-01 to 2025-09-30 | Not Available | 1.389 | |||
| Catheter Associated Urinary Tract Infections (ICU + select Wards): Number of Urinary Catheter Days2024-10-01 to 2025-09-30 | 1,145 | 1,799 | 4,188 | ||
| Catheter Associated Urinary Tract Infections (ICU + select Wards): Predicted Cases2024-10-01 to 2025-09-30 | 0.591 | 1.377 | 5.413 | ||
| Catheter Associated Urinary Tract Infections (ICU + select Wards): Observed Cases2024-10-01 to 2025-09-30 | 1 | 0 | 2.168 | ||
| Catheter Associated Urinary Tract Infections (ICU + select Wards)2024-10-01 to 2025-09-30 | Not Available | 0.3966 | |||
| SSI - Colon Surgery: Lower Confidence Limit2024-10-01 to 2025-09-30 | Not Available | 0.4382 | No Different than National Benchmark | ||
| SSI - Colon Surgery: Upper Confidence Limit2024-10-01 to 2025-09-30 | 1.428 | 2.135 | 2.741 | No Different than National Benchmark | |
| SSI - Colon Surgery: Number of Procedures2024-10-01 to 2025-09-30 | 84 | 61 | 118 | No Different than National Benchmark | |
| SSI - Colon Surgery: Predicted Cases2024-10-01 to 2025-09-30 | 2.098 | 1.591 | 3.112 | No Different than National Benchmark | |
| SSI - Colon Surgery: Observed Cases2024-10-01 to 2025-09-30 | 0 | 1 | 3.074 | No Different than National Benchmark | |
| SSI - Colon Surgery2024-10-01 to 2025-09-30 | 0 | 0.7155 | 1.049 | No Different than National Benchmark | The best result, shared by 19% of US hospitals |
| SSI - Abdominal Hysterectomy: Lower Confidence Limit2024-10-01 to 2025-09-30 | Not Available | 0.6144 | |||
| SSI - Abdominal Hysterectomy: Upper Confidence Limit2024-10-01 to 2025-09-30 | Not Available | 4.322 | |||
| SSI - Abdominal Hysterectomy: Number of Procedures2024-10-01 to 2025-09-30 | 6 | 38 | 75.28 | ||
| SSI - Abdominal Hysterectomy: Predicted Cases2024-10-01 to 2025-09-30 | 0.048 | 0.328 | 0.6545 | ||
| SSI - Abdominal Hysterectomy: Observed Cases2024-10-01 to 2025-09-30 | 0 | 0 | 0.9634 | ||
| SSI - Abdominal Hysterectomy2024-10-01 to 2025-09-30 | Not Available | 1.462 | |||
| MRSA Bacteremia: Lower Confidence Limit2024-10-01 to 2025-09-30 | Not Available | 0.2675 | |||
| MRSA Bacteremia: Upper Confidence Limit2024-10-01 to 2025-09-30 | Not Available | 2.176 | |||
| MRSA Bacteremia: Patient Days2024-10-01 to 2025-09-30 | 6,043 | 14,451 | 42,903 | ||
| MRSA Bacteremia: Predicted Cases2024-10-01 to 2025-09-30 | 0.156 | 0.567 | 2.796 | ||
| MRSA Bacteremia: Observed Cases2024-10-01 to 2025-09-30 | 0 | 0 | 1.826 | ||
| MRSA Bacteremia2024-10-01 to 2025-09-30 | Not Available | 0.7532 | |||
| Clostridium Difficile (C.Diff): Lower Confidence Limit2024-10-01 to 2025-09-30 | Not Available | 0.1572 | No Different than National Benchmark | ||
| Clostridium Difficile (C.Diff): Upper Confidence Limit2024-10-01 to 2025-09-30 | 1.407 | 0.747 | 1.134 | No Different than National Benchmark | |
| Clostridium Difficile (C.Diff): Patient Days2024-10-01 to 2025-09-30 | 5,650 | 13,646 | 40,305 | No Different than National Benchmark | |
| Clostridium Difficile (C.Diff): Predicted Cases2024-10-01 to 2025-09-30 | 2.129 | 5.683 | 21.05 | No Different than National Benchmark | |
| Clostridium Difficile (C.Diff): Observed Cases2024-10-01 to 2025-09-30 | 0 | 2 | 6.934 | No Different than National Benchmark | |
| Clostridium Difficile (C.Diff)2024-10-01 to 2025-09-30 | 0 | 0.279 | 0.3227 | No Different than 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 | Otsego Memorial Hospital | US median | MI average | CMS comparison | US rank |
|---|---|---|---|---|---|
| Room was "always" clean2024-10-01 to 2025-09-30 · 368 cases | 66 | 73 | 69.3 | Worse than 79% of US hospitals | |
| Room was "sometimes" or "never" clean2024-10-01 to 2025-09-30 · 368 cases | 11 | 8 | 10.85 | Worse than 70% of US hospitals | |
| Room was "usually" clean2024-10-01 to 2025-09-30 · 368 cases | 23 | 18 | 19.85 | ||
| Cleanliness - linear mean score2024-10-01 to 2025-09-30 · 368 cases | 84 | 87 | 84.11 | Worse than 71% of US hospitals | |
| Cleanliness - star rating2024-10-01 to 2025-09-30 · 368 cases | 3 | 4 | 2.86 | Worse than 53% of US hospitals | |
| Nurses "always" communicated well2024-10-01 to 2025-09-30 · 368 cases | 78 | 80 | 79.59 | Worse than 58% of US hospitals | |
| Nurse communication - linear mean score2024-10-01 to 2025-09-30 · 368 cases | 91 | 91 | 91.42 | Worse than 49% of US hospitals | |
| Nurses "sometimes" or "never" communicated well2024-10-01 to 2025-09-30 · 368 cases | 4 | 4 | 4.111 | Worse than 42% of US hospitals | |
| Nurse communication - star rating2024-10-01 to 2025-09-30 · 368 cases | 3 | 3 | 3.5 | Worse than 49% of US hospitals | |
| Nurses "usually" communicated well2024-10-01 to 2025-09-30 · 368 cases | 18 | 16 | 16.3 | ||
| Doctors "always" communicated well2024-10-01 to 2025-09-30 · 368 cases | 81 | 79 | 78.2 | Better than 59% of US hospitals | |
| Doctor communication - linear mean score2024-10-01 to 2025-09-30 · 368 cases | 92 | 91 | 90.27 | Better than 63% of US hospitals | |
| Doctors "sometimes" or "never" communicated well2024-10-01 to 2025-09-30 · 368 cases | 4 | 5 | 5.521 | Better than 62% of US hospitals | |
| Doctor communication - star rating2024-10-01 to 2025-09-30 · 368 cases | 4 | 3 | 3.07 | Better than 63% of US hospitals | |
| Doctors "usually" communicated well2024-10-01 to 2025-09-30 · 368 cases | 15 | 16 | 16.28 | ||
| Staff "always" explained2024-10-01 to 2025-09-30 · 368 cases | 65 | 61 | 61.03 | Better than 68% of US hospitals | |
| Communication about medicines - linear mean score2024-10-01 to 2025-09-30 · 368 cases | 80 | 77 | 76.51 | Better than 72% of US hospitals | |
| Staff "sometimes" or "never" explained2024-10-01 to 2025-09-30 · 368 cases | 17 | 19 | 19.58 | Better than 63% of US hospitals | |
| Communication about medicines - star rating2024-10-01 to 2025-09-30 · 368 cases | 3 | 3 | 2.63 | Better than 47% of US hospitals | |
| Staff "usually" explained2024-10-01 to 2025-09-30 · 368 cases | 18 | 19 | 19.38 | ||
| Discharge information - linear mean score2024-10-01 to 2025-09-30 · 368 cases | 89 | 86 | 85.82 | Better than 78% of US hospitals | |
| No, staff "did not" give patients this information2024-10-01 to 2025-09-30 · 368 cases | 11 | 13 | 13.17 | Better than 68% of US hospitals | |
| Discharge information - star rating2024-10-01 to 2025-09-30 · 368 cases | 4 | 3 | 3.35 | Better than 55% of US hospitals | |
| Yes, staff "did" give patients this information2024-10-01 to 2025-09-30 · 368 cases | 89 | 87 | 86.83 | Better than 68% of US hospitals | |
| No, staff "did not" give patients information about help after discharge2024-10-01 to 2025-09-30 · 368 cases | 14 | 14 | 14.7 | Better than 49% of US hospitals | |
| Yes, staff "did" give patients information about help after discharge2024-10-01 to 2025-09-30 · 368 cases | 86 | 86 | 85.3 | Better than 49% of US hospitals | |
| Doctors "always" explained things so they could understand2024-10-01 to 2025-09-30 · 368 cases | 75 | 74 | 72.65 | Better than 55% of US hospitals | |
| Doctors "sometimes" or "never" explained things so they could understand2024-10-01 to 2025-09-30 · 368 cases | 5 | 7 | 7.064 | Better than 68% of US hospitals | |
| Doctors "usually" explained things so they could understand2024-10-01 to 2025-09-30 · 368 cases | 20 | 19 | 20.28 | ||
| Doctors "always" listened carefully2024-10-01 to 2025-09-30 · 368 cases | 80 | 77 | 75.91 | Better than 65% of US hospitals | |
| Doctors "sometimes" or "never" listened carefully2024-10-01 to 2025-09-30 · 368 cases | 5 | 6 | 6.191 | Better than 53% of US hospitals | |
| Doctors "usually" listened carefully2024-10-01 to 2025-09-30 · 368 cases | 15 | 17 | 17.9 | ||
| Doctors "always" treated them with courtesy and respect2024-10-01 to 2025-09-30 · 368 cases | 87 | 85 | 84.26 | Better than 62% of US hospitals | |
| Doctors "sometimes" or "never" treated them with courtesy and respect2024-10-01 to 2025-09-30 · 368 cases | 3 | 3 | 3.827 | Better than 49% of US hospitals | |
| Doctors "usually" treated them with courtesy and respect2024-10-01 to 2025-09-30 · 368 cases | 10 | 11 | 11.91 | ||
| Patients who gave a rating of "6" or lower (low)2024-10-01 to 2025-09-30 · 368 cases | 13 | 8 | 9.248 | Worse than 85% of US hospitals | |
| Patients who gave a rating of "7" or "8" (medium)2024-10-01 to 2025-09-30 · 368 cases | 24 | 20 | 21.47 | ||
| Patients who gave a rating of "9" or "10" (high)2024-10-01 to 2025-09-30 · 368 cases | 63 | 72 | 69.28 | Worse than 82% of US hospitals | |
| Overall hospital rating - linear mean score2024-10-01 to 2025-09-30 · 368 cases | 84 | 88 | 87.04 | Worse than 85% of US hospitals | |
| Overall hospital rating - star rating2024-10-01 to 2025-09-30 · 368 cases | 2 | 3 | 3.12 | Worse than 78% of US hospitals | |
| Staff "always" explained new medications2024-10-01 to 2025-09-30 · 368 cases | 79 | 74 | 74.28 | Better than 76% of US hospitals | |
| Staff "sometimes" or "never" explained new medications2024-10-01 to 2025-09-30 · 368 cases | 7 | 9 | 9.173 | Better than 71% of US hospitals | |
| Staff "usually" explained new medications2024-10-01 to 2025-09-30 · 368 cases | 14 | 16 | 16.55 | ||
| Nurses "always" explained things so they could understand2024-10-01 to 2025-09-30 · 368 cases | 73 | 75 | 74.9 | Worse than 60% of US hospitals | |
| Nurses "sometimes" or "never" explained things so they could understand2024-10-01 to 2025-09-30 · 368 cases | 4 | 5 | 5.573 | Better than 66% of US hospitals | |
| Nurses "usually" explained things so they could understand2024-10-01 to 2025-09-30 · 368 cases | 23 | 20 | 19.53 | ||
| Nurses "always" listened carefully2024-10-01 to 2025-09-30 · 368 cases | 75 | 77 | 76.58 | Worse than 58% of US hospitals | |
| Nurses "sometimes" or "never" listened carefully2024-10-01 to 2025-09-30 · 368 cases | 4 | 4 | 4.364 | Better than 45% of US hospitals | |
| Nurses "usually" listened carefully2024-10-01 to 2025-09-30 · 368 cases | 21 | 19 | 19.05 | ||
| Nurses "always" treated them with courtesy and respect2024-10-01 to 2025-09-30 · 368 cases | 85 | 86 | 85.7 | Worse than 56% of US hospitals | |
| Nurses "sometimes" or "never" treated them with courtesy and respect2024-10-01 to 2025-09-30 · 368 cases | 3 | 3 | 2.773 | Worse than 50% of US hospitals | |
| Nurses "usually" treated them with courtesy and respect2024-10-01 to 2025-09-30 · 368 cases | 12 | 11 | 11.53 | ||
| "Always" quiet at night2024-10-01 to 2025-09-30 · 368 cases | 43 | 59 | 56.73 | Worse than 93% of US hospitals | |
| "Sometimes" or "never" quiet at night2024-10-01 to 2025-09-30 · 368 cases | 21 | 9 | 11.16 | Worse than 94% of US hospitals | |
| "Usually" quiet at night2024-10-01 to 2025-09-30 · 368 cases | 36 | 31 | 32.11 | ||
| Quietness - linear mean score2024-10-01 to 2025-09-30 · 368 cases | 72 | 82 | 80.12 | Worse than 93% of US hospitals | |
| Quietness - star rating2024-10-01 to 2025-09-30 · 368 cases | 2 | 3 | 3.12 | Worse than 76% 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 · 368 cases | 8 | 5 | 6.291 | Worse than 76% of US hospitals | |
| "YES", patients would definitely recommend the hospital2024-10-01 to 2025-09-30 · 368 cases | 56 | 71 | 68.51 | Worse than 92% of US hospitals | |
| Recommend hospital - linear mean score2024-10-01 to 2025-09-30 · 368 cases | 82 | 87 | 85.75 | Worse than 85% of US hospitals | |
| "YES", patients would probably recommend the hospital2024-10-01 to 2025-09-30 · 368 cases | 36 | 23 | 25.2 | ||
| Recommend hospital - star rating2024-10-01 to 2025-09-30 · 368 cases | 2 | 4 | 3.39 | Worse than 85% of US hospitals | |
| Staff "always" explained possible side effects2024-10-01 to 2025-09-30 · 368 cases | 52 | 47 | 46.3 | Better than 72% of US hospitals | |
| Staff "sometimes" or "never" explained possible side effects2024-10-01 to 2025-09-30 · 368 cases | 26 | 30 | 30.8 | Better than 69% of US hospitals | |
| Staff "usually" explained possible side effects2024-10-01 to 2025-09-30 · 368 cases | 22 | 22 | 22.9 | ||
| Summary star rating2024-10-01 to 2025-09-30 · 368 cases | 3 | 3 | 3.21 | Worse than 40% of US hospitals | |
| No, staff "did not" give patients information about possible symptoms2024-10-01 to 2025-09-30 · 368 cases | 9 | 12 | 12.2 | Better than 80% of US hospitals | |
| Yes, staff "did" give patients information about possible symptoms2024-10-01 to 2025-09-30 · 368 cases | 91 | 88 | 87.8 | Better than 80% of US hospitals |
How often the hospital gave recommended care, and how fast.
| Measure | Otsego Memorial Hospital | US median | MI average | CMS comparison | US rank |
|---|---|---|---|---|---|
| Emergency department volume2024-01-01 to 2024-12-31 | medium | ||||
| 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 · 1,058 cases | 0 | 8 | 8.08 | The best result, shared by 7% of US hospitals | |
| Hospital Harm - Severe Hypoglycemia2024-01-01 to 2024-12-31 · 305 cases | 0 | 1 | 0.9722 | The best result, shared by 34% of US hospitals | |
| Hospital Harm - Opioid Related Adverse Events2024-01-01 to 2024-12-31 | Not Available | 0.4118 | |||
| Healthcare workers given influenza vaccination2024-10-01 to 2025-03-31 · 534 cases | 95 | 79 | 74.71 | Better than 86% 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 · 377 cases | 188 | 154 | 167 | Worse than 71% 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 · 347 cases | 177 | 148 | 161 | Worse than 69% 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 · 12 cases | 340 | 247 | 300 | Worse than 78% 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 · 19 cases | 425 | 293 | 338 | Worse than 88% of US hospitals | |
| Left before being seen2024-01-01 to 2024-12-31 · 20,005 cases | 4 | 1 | 1.933 | Worse than 88% of US hospitals | |
| Head CT results2024-10-01 to 2025-09-30 · 26 cases | 73 | 74 | 73.42 | Worse than 51% of US hospitals | |
| Endoscopy/polyp surveillance: appropriate follow-up interval for normal colonoscopy in average risk patients2024-01-01 to 2024-12-31 · 66 cases | 92 | 97 | 93.2 | Worse than 72% of US hospitals | |
| Improvement in Patient's Visual Function within 90 Days Following Cataract Surgery2024-01-01 to 2024-12-31 | Not Available | ||||
| ST-Segment Elevation Myocardial Infarction (STEMI)2024-01-01 to 2024-12-31 | Not Available | 39.25 | |||
| Safe Use of Opioids - Concurrent Prescribing2024-01-01 to 2024-12-31 · 448 cases | 9 | 15 | 15.67 | Better than 86% of US hospitals | |
| Appropriate care for severe sepsis and septic shock2024-10-01 to 2025-09-30 · 89 cases | 62 | 65 | 59.69 | Worse than 57% of US hospitals | |
| Septic Shock 3-Hour Bundle2024-10-01 to 2025-09-30 · 24 cases | 79 | 73 | 69.54 | Better than 62% of US hospitals | |
| Septic Shock 6-Hour Bundle2024-10-01 to 2025-09-30 · 13 cases | 77 | 88 | 83.94 | Worse than 78% of US hospitals | |
| Severe Sepsis 3-Hour Bundle2024-10-01 to 2025-09-30 · 89 cases | 80 | 82 | 77.12 | Worse than 56% of US hospitals | |
| Severe Sepsis 6-Hour Bundle2024-10-01 to 2025-09-30 · 59 cases | 86 | 94 | 90.36 | Worse than 84% of US hospitals | |
| Discharged on Antithrombotic Therapy2024-01-01 to 2024-12-31 | Not Available | 94.44 | |||
| Anticoagulation Therapy for Atrial Fibrillation/Flutter2024-01-01 to 2024-12-31 | Not Available | 69.44 | |||
| Antithrombotic Therapy by End of Hospital Day 22024-01-01 to 2024-12-31 | Not Available | 91.64 | |||
| Venous Thromboembolism Prophylaxis2024-01-01 to 2024-12-31 · 602 cases | 62 | 90 | 82.06 | Worse than 85% of US hospitals | |
| Intensive Care Unit Venous Thromboembolism Prophylaxis2024-01-01 to 2024-12-31 · 230 cases | 67 | 97 | 91 | Worse than 97% of US hospitals |
How often scans were ordered when they may not be needed; lower is better.
| Measure | Otsego Memorial Hospital | US median | MI average | CMS comparison | US rank |
|---|---|---|---|---|---|
| Abdomen CT Use of Contrast Material2024-07-01 to 2025-06-30 | 3.9 | 5 | 6.103 | Better than 63% of US hospitals | |
| Breast Cancer Screening Recall Rates2024-07-01 to 2025-06-30 | 9.2 | 6.6 | 7.033 | Worse than 77% of US hospitals |
Medicare spending around an inpatient stay compared with the US (1 is the US median).
| Measure | Otsego Memorial Hospital | US median | MI average | CMS comparison | US rank |
|---|---|---|---|---|---|
| Medicare hospital spending per patient (Medicare Spending per Beneficiary)2024-01-01 to 2024-12-31 | 0.9 | 0.99 | 0.9406 | Better than 87% of US hospitals |
The scores Medicare uses to raise or lower inpatient payments; higher is better.
| Measure | Otsego Memorial Hospital | US median | MI average | CMS comparison | US rank |
|---|---|---|---|---|---|
| VBP clinical outcomes domain scoreFY 2026 | 0 | 20 | 19.22 | The worst result, shared by 11% of US hospitals | |
| VBP clinical outcomes weighted domain scoreFY 2026 | 0 | 5 | 4.872 | The worst result, shared by 11% of US hospitals | |
| VBP efficiency and cost reduction domain scoreFY 2026 | 80 | 10 | 42.06 | Better than 94% of US hospitals | |
| VBP efficiency and cost reduction weighted domain scoreFY 2026 | 20 | 2.5 | 11.12 | Better than 93% of US hospitals | |
| VBP person and community engagement domain scoreFY 2026 | 37 | 34 | 38.03 | Better than 55% of US hospitals | |
| VBP person and community engagement weighted domain scoreFY 2026 | 9.25 | 8.75 | 9.925 | Better than 54% of US hospitals | |
| VBP safety domain scoreFY 2026 | 83.33 | 40 | 33.39 | Better than 96% of US hospitals | |
| VBP safety weighted domain scoreFY 2026 | 20.83 | 10 | 8.389 | Better than 95% of US hospitals | |
| VBP total performance scoreFY 2026 | 50.08 | 29.5 | 33.57 | Better than 94% of US hospitals |
| By fiscal year | FY 2021 | FY 2022 | FY 2023 | FY 2024 | FY 2025 | FY 2026 |
|---|---|---|---|---|---|---|
| VBP clinical outcomes domain score | 55 | 80 | 33.33 | 13.33 | 0 | 0 |
| VBP clinical outcomes weighted domain score | 13.75 | 20 | 8.333 | 3.333 | 0 | 0 |
| VBP efficiency and cost reduction domain score | 60 | Not Available | 90 | 70 | 50 | 80 |
| VBP efficiency and cost reduction weighted domain score | 15 | Not Available | 22.5 | 17.5 | 12.5 | 20 |
| VBP person and community engagement domain score | 50 | Not Available | Not Available | 21 | 22 | 37 |
| VBP person and community engagement weighted domain score | 12.5 | Not Available | Not Available | 5.25 | 5.5 | 9.25 |
| VBP safety domain score | 50 | Not Available | Not Available | 55 | 50 | 83.33 |
| VBP safety weighted domain score | 12.5 | Not Available | Not Available | 13.75 | 12.5 | 20.83 |
| VBP total performance score | 53.75 | Not Available | Not Available | 39.83 | 30.5 | 50.08 |
Excess readmission ratios by condition; above 1 means more readmissions than expected.
| Measure | Otsego Memorial Hospital | US median | MI average | CMS comparison | US rank |
|---|---|---|---|---|---|
| READM-30-AMI-HRRP2021-07-01 to 2024-06-30 | N/A | 0.995 | |||
| READM-30-CABG-HRRP2021-07-01 to 2024-06-30 | N/A | 0.9907 | |||
| READM-30-COPD-HRRP2021-07-01 to 2024-06-30 | 0.9667 | 0.9969 | 0.9989 | Better than 78% of US hospitals | |
| READM-30-HF-HRRP2021-07-01 to 2024-06-30 · 75 cases | 1.102 | 0.9983 | 1.002 | Worse than 93% of US hospitals | |
| READM-30-HIP-KNEE-HRRP2021-07-01 to 2024-06-30 | N/A | 1.061 | |||
| READM-30-PN-HRRP2021-07-01 to 2024-06-30 · 120 cases | 1.043 | 0.9955 | 0.9984 | Worse than 77% 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 | 0.9558 | 0.9381 | 0.9955 | 0.959 | 0.9646 | 0.9667 |
| READM-30-HF-HRRP | 0.9759 | 1.002 | 0.9967 | 1.005 | 1.023 | 1.102 |
| READM-30-HIP-KNEE-HRRP | 1.029 | 0.9858 | 1.123 | N/A | N/A | N/A |
| READM-30-PN-HRRP | 0.9768 | 0.948 | 0.962 | 0.9755 | 1.029 | 1.043 |
Infection ratios, the PSI 90 composite and the total score Medicare ranks hospitals on; lower is better.
| Measure | Otsego Memorial Hospital | US median | MI average | CMS comparison | US rank |
|---|---|---|---|---|---|
| CAUTI standardized infection ratio2023-01-01 to 2024-12-31 | 0.943 | 0.489 | 0.5894 | Worse than 84% of US hospitals | |
| CDI standardized infection ratio2023-01-01 to 2024-12-31 | 0.455 | 0.346 | 0.3948 | Worse than 66% of US hospitals | |
| CLABSI standardized infection ratio2023-01-01 to 2024-12-31 | N/A | 0.7747 | |||
| HAC Reduction Program payment reductionFY 2026 | No | ||||
| MRSA standardized infection ratio2023-01-01 to 2024-12-31 | N/A | 0.8034 | |||
| Patient safety and adverse events composite (PSI 90)2022-07-01 to 2024-06-30 | 0.9188 | 0.9628 | 1.007 | Better than 68% of US hospitals | |
| SSI standardized infection ratio2023-01-01 to 2024-12-31 | 0 | 0.7945 | 1.234 | The best result, shared by 12% of US hospitals | |
| Total HAC scoreFY 2026 | -0.1722 | -0.0453 | 0.1353 | Better than 59% 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 | -1.084 | -0.9227 | 0 | -0.7091 | -0.4303 | -0.1722 |
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 2021)
Accreditation
None
Medical school affiliation
Private (not for profit)
Ownership type
53
Medicare-certified beds
68
Registered nurses (full-time equivalent)
1966
In Medicare since
Source: CMS Provider of Services file, as reported by the hospital and state surveyors.
What Otsego Memorial Hospital reported to Medicare in its latest cost report, covering Jul 1, 2024 to Jun 30, 2025.
1,923
Inpatient discharges
Medicare 23%, Medicaid 3%
5,711
Inpatient days
34% of available bed days used
279
Employees (full-time equivalent)
Source: CMS cost report (HCRIS) (report 840917). Figures cover the reporting period, which is not always 12 months, and are self-reported.
Inpatient days and discharges Otsego Memorial Hospital reported by payer. Medicare and Medicaid include their managed care plans, shown separately below.
| Medicare | Medicaid | Other | Total | |
|---|---|---|---|---|
| Inpatient days | 1,393 | 176 | 4,142 | 5,711 |
| Discharges | 451 | 60 | 1,412 | 1,923 |
| Average length of stay | 3.1 days | 2.9 days | 2.9 days | 3.0 days |
| Average daily census | 3.8 | 0.5 | 11.3 | 15.6 |
1,691
Medicare Advantage days
557 discharges
905
Medicaid managed care days
318 discharges
1,443
Observation bed days
| Unit | Beds | Inpatient days | Medicare days | Occupancy |
|---|---|---|---|---|
| Adults & pediatrics | 42 | 3,995 | 1,018 | 26% |
| Intensive care unit | 4 | 1,245 | 375 | 85% |
| Nursery | 471 | |||
| Skilled nursing facility | 32 | 9,750 | 693 | 83% |
Source: CMS cost report (HCRIS, Form 2552-10), report 840917, as submitted. Hospitals report these figures themselves; they are not audited financial statements. Worksheet S-3 Part I.
What Otsego Memorial Hospital treats Medicare patients for most often, in 2024. 193 Medicare discharges in 10 published DRGs; 6% surgical; 80% 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 | 40 | $30,688 | $16,447 | $9,912 | 1.98 |
| Heart failure and shock with MCCMS-DRG 291, medical | 32 | $16,131 | $10,451 | $5,210 | 1.28 |
| Simple pneumonia and pleurisy with MCCMS-DRG 193, medical | 26 | $20,179 | $10,317 | $6,518 | 1.33 |
| Gastrointestinal hemorrhage with CCMS-DRG 378, medical | 18 | $21,334 | $7,441 | $6,891 | 0.98 |
| Respiratory infections and inflammations with MCCMS-DRG 177, medical | 15 | $21,423 | $13,727 | $6,920 | 1.70 |
| Esophagitis, gastroenteritis and miscellaneous digestive disorders without MCCMS-DRG 392, medical | 14 | $16,418 | $5,559 | $5,303 | 0.79 |
| Chronic obstructive pulmonary disease with MCCMS-DRG 190, medical | 13 | $19,035 | $8,424 | $6,148 | 1.10 |
| Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without MCCMS-DRG 641, medical | 12 | $18,528 | $5,665 | $5,984 | 0.78 |
| Septicemia or severe sepsis without MV >96 hours without MCCMS-DRG 872, medical | 12 | $23,961 | $8,086 | $7,739 | 1.03 |
| Major small and large bowel procedures with CCMS-DRG 330, surgical | 11 | $41,707 | $19,275 | $13,471 | 2.37 |
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) Otsego Memorial Hospital billed Medicare for most in 2024: 706 services in all.
| Service group | Services | Patients | Average charges | Average Medicare payment | US average payment |
|---|---|---|---|---|---|
| Level 1 Intraocular ProceduresAPC 5491 | 250 | 143 | $7,142 | $1,711 | $1,752 |
| Comprehensive Observation ServicesAPC 8011 | 115 | 108 | $12,512 | $1,996 | $2,090 |
| Level 2 Excision/ Biopsy/ Incision and DrainageAPC 5072 | 71 | 70 | $4,969 | $1,194 | $1,220 |
| Level 1 Laparoscopy and Related ServicesAPC 5361 | 68 | 68 | $15,094 | $4,093 | $4,358 |
| Level 5 Musculoskeletal ProceduresAPC 5115 | 44 | 40 | $27,653 | $10,380 | $10,772 |
| Level 2 Upper GI ProceduresAPC 5302 | 32 | 28 | $5,865 | $1,370 | $1,445 |
| Level 3 Vascular ProceduresAPC 5183 | 23 | 22 | $10,979 | $2,370 | $2,405 |
| Level 4 Musculoskeletal ProceduresAPC 5114 | 20 | 20 | $21,333 | $5,318 | $5,339 |
| Level 4 Urology and Related ServicesAPC 5374 | 20 | 16 | $15,466 | $2,589 | $2,629 |
| Level 2 Musculoskeletal ProceduresAPC 5112 | 19 | 16 | $7,985 | $1,185 | $1,196 |
See all 13 Medicare outpatient services at Otsego Memorial 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 Otsego Memorial 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 649 in 2020 to 846 in 2025.
| ZIP code | Stays | Of this hospital's stays | Days | Charges | Market share | Share in 2020 |
|---|---|---|---|---|---|---|
| 49735 | 373 | 44% | 1,111 | $8.5M | 41% | 44% |
| 49756 | 76 | 9% | 240 | $1.8M | 35% | 33% |
| 49709 | 75 | 9% | 238 | $1.9M | 24% | 25% |
| 49795 | 50 | 6% | 174 | $1.4M | 47% | 58% |
| 49751 | 46 | 5% | 156 | $1.2M | 46% | 45% |
| 49721 | 34 | 4% | 89 | $729,674 | 4% | 3% |
| 49799 | 28 | 3% | 85 | $542,055 | 21% | 22% |
| 49730 | 26 | 3% | 75 | $658,869 | 28% | 25% |
| 49659 | 25 | 3% | 84 | $536,399 | 8% | |
| 49734 | 23 | 3% | 53 | $465,176 | 53% | 54% |
| 49749 | 23 | 3% | 62 | $589,749 | 11% | 5% |
| 49765 | 20 | 2% | 81 | $570,953 | 8% | |
| 49738 | 18 | 2% | 50 | $393,548 | 3% | 2% |
| 49733 | 15 | 2% | 53 | $410,684 | 16% | |
| 49746 | 14 | 2% | 47 | $358,215 | 7% |
Source: CMS Hospital Service Area file. Shares are of the 846 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 Otsego Memorial Hospital reported at its latest Medicare certification survey (2000). Counts are people, not full-time equivalents.
68
Registered nurses
9
Licensed practical nurses
18
Physicians
2
Physician assistants
2
Nurse anesthetists (CRNAs)
4
Pharmacists
3
Respiratory therapists
2
Physical therapists
1
Occupational therapists
1
Dietitians
1
Social workers
230
Other personnel
Source: CMS Provider of Services file.
462 clinicians who bill Medicare list Otsego Memorial 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.
James Mackenzie, M.D.
Physical Medicine & Rehabilitation Physician
NPI 1043260102
See commercial rates for James Mackenzie, M.D.Michael Kuhn, D.O.
Diagnostic Radiology Physician
NPI 1184843781
See commercial rates for Michael Kuhn, D.O.Andrew Cole, MD
Physical Medicine & Rehabilitation Physician
NPI 1699901611
See commercial rates for Andrew Cole, MDClark Phelps, MD
Diagnostic Radiology Physician
NPI 1437173630
See commercial rates for Clark Phelps, MDAndrew Kaiser, MD
Diagnostic Radiology Physician
NPI 1588070197
See commercial rates for Andrew Kaiser, MDDonald Cousineau, DO, PC
General Practice Physician
NPI 1841485133
See commercial rates for Donald Cousineau, DO, PCEric Phillips, D.O.
Family Medicine Physician
NPI 1437135134
See commercial rates for Eric Phillips, D.O.Michelle Lung, MD
Diagnostic Radiology Physician
NPI 1275557456
See commercial rates for Michelle Lung, MDTina Crook, PA-C
Physician Assistant
NPI 1285659953
See commercial rates for Tina Crook, PA-CDwayne Griffin, D.O.
Pulmonary Disease Physician
NPI 1699789727
See commercial rates for Dwayne Griffin, D.O.Jesse Johnson, M.D.
Diagnostic Radiology Physician
NPI 1033146212
See commercial rates for Jesse Johnson, M.D.David Dargis, D.O.
Family Medicine Physician
NPI 1457490609
See commercial rates for David Dargis, D.O.Joshua Anderson, MD
Adult Reconstructive Orthopaedic Surgery Physician
NPI 1316300486
See commercial rates for Joshua Anderson, MDRyan Holmes, MD
Diagnostic Radiology Physician
NPI 1124042304
See commercial rates for Ryan Holmes, MDLeah Davis, D.O.
Diagnostic Radiology Physician
NPI 1568787034
See commercial rates for Leah Davis, D.O.Patrick Gartland, M.D.
Diagnostic Radiology Physician
NPI 1649329426
See commercial rates for Patrick Gartland, M.D.Lafayette Richmond, MD
Diagnostic Radiology Physician
NPI 1992729115
See commercial rates for Lafayette Richmond, MDKimberly Johnson, M.D.
Diagnostic Radiology Physician
NPI 1467682971
See commercial rates for Kimberly Johnson, M.D.William Karczewski, M.D.
Diagnostic Radiology Physician
NPI 1275896490
See commercial rates for William Karczewski, M.D.Ryan Overby, MD
Diagnostic Radiology Physician
NPI 1881125516
See commercial rates for Ryan Overby, MDLaura Bottomley-Brown, FNP-C
Family Nurse Practitioner
NPI 1568947596
See commercial rates for Laura Bottomley-Brown, FNP-CMary Stoll, P.A.
Physician Assistant
NPI 1083862098
See commercial rates for Mary Stoll, P.A.Sivaraja Kuppuswami, M.D.
Diagnostic Radiology Physician
NPI 1780747600
See commercial rates for Sivaraja Kuppuswami, M.D.Eric Lerche, D.O.
Orthopaedic Surgery Physician
NPI 1225264005
See commercial rates for Eric Lerche, D.O.Source: 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 Otsego Memorial Hospital reported to Medicare for Jul 1, 2024 to Jun 30, 2025. Percentages are of net patient revenue.
| Line | Amount | Share |
|---|---|---|
| Gross patient revenue (charges) | $316.8M | 235.1% |
| Inpatient | $46M | 34.1% |
| Outpatient | $270.8M | 201.0% |
| Contractual allowances and discounts | -$182.1M | -135.1% |
| Net patient revenue | $134.7M | 100.0% |
| Operating expenses | -$123.9M | -92.0% |
| Operating income from patient care | $10.8M | 8.0% |
| Other income | $4.3M | 3.2% |
| Net income | $15.1M | 11.2% |
| Line | Amount | Share |
|---|---|---|
| Traditional Medicare | $43.4M | 14.6% |
| Medicaid (including managed care) | $43.8M | 14.7% |
| Other payers and self-pay | $210.5M | 70.7% |
| Total charges | $297.7M | 100.0% |
Source: CMS cost report (HCRIS, Form 2552-10), report 840917, 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 Otsego Memorial Hospital's latest cost report.
8.0%
Operating margin
Operating income from patient care / net patient revenue
10.9%
Total margin
Net income / net patient revenue plus other income
13.6%
EBITDAR margin
Net income before interest, depreciation and leases (Worksheet A-7), / total revenue
40% of expenses
Personnel costs
Salaries, direct-care contract labor and core wage-related costs / operating expenses
$45.16
Average hourly wage
Adjusted salaries / paid hours (Worksheet S-3 Part II)
17.2%
Return on assets
Net income for a year / total assets
20.9%
Return on equity
Net income for a year / fund balance
1.70
Current ratio
Current assets / current liabilities
1.34
Quick ratio
Cash, temporary investments and net receivables / current liabilities
1 days
Days cash on hand
Cash and temporary investments / daily operating expenses excluding depreciation
55 days
Days in patient receivables
Net patient receivables / daily net patient revenue
46 days
Average payment period
Current liabilities / daily operating expenses excluding depreciation
1.58
Asset turnover
Total revenue for a year / total assets
4.7 years
Average age of plant
Accumulated depreciation / depreciation for a year
Source: CMS cost report (HCRIS, Form 2552-10), report 840917, as submitted. Hospitals report these figures themselves; they are not audited financial statements.
What Otsego Memorial Hospital owned and owed at the end of its reporting period (Jun 2025), across all fund types: $87.9M in total assets and a $72.6M fund balance.
| Line | Amount | Of total assets |
|---|---|---|
| Cash and temporary investments | $202,430 | 0.2% |
| Patient receivables, net | $20.2M | 23.0% |
| Inventory | $2M | 2.3% |
| Total current assets | $26.1M | 29.7% |
| Property and equipment, net of depreciation | $61.7M | 70.2% |
| Investments and other assets | $100,000 | 0.1% |
| Total assets | $87.9M | 100.0% |
| Current liabilities | $15.3M | 17.4% |
| Total liabilities | $15.3M | 17.4% |
| Fund balance (net assets) | $72.6M | 82.6% |
Source: CMS cost report (HCRIS, Form 2552-10), report 840917, as submitted. Hospitals report these figures themselves; they are not audited financial statements.
Care Otsego Memorial Hospital provided without full payment, as reported on Worksheet S-10 of its cost report.
$253,619
Bad debt
Patient bills written off as uncollectible, at charges
$9.3M
Medicaid shortfall
Cost of Medicaid patients (charges times the cost-to-charge ratio) minus Medicaid payments; negative means a surplus
$88,766
Total unreimbursed and uncompensated care
0.1% 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 840917, as submitted. Hospitals report these figures themselves; they are not audited financial statements.
Otsego Memorial Hospital's full-year cost reports, by fiscal year end. Reports shorter than ten months are left out.
| Fiscal year ending | Jun 2020 | Jun 2021 | Jun 2022 | Jun 2023 | Jun 2024 | Jun 2025 |
|---|---|---|---|---|---|---|
| Net patient revenue | $96.1M | $104.7M | $110.3M | $109.4M | $122.1M | $134.7M |
| Operating expenses | $102.1M | $103.4M | $112.3M | $112.9M | $120.2M | $123.9M |
| Operating margin | -6.2% | 1.2% | -1.8% | -3.2% | 1.6% | 8.0% |
| Net income | $10.1M | $13.9M | $1.3M | -$1.3M | $4.7M | $15.1M |
| Total assets | $117.7M | $128.1M | $101.8M | $54.7M | $64.3M | $87.9M |
| Discharges | 1,716 | 1,451 | 1,557 | 1,440 | 1,697 | 1,923 |
| Inpatient days | 5,656 | 4,741 | 6,153 | 5,093 | 5,590 | 5,711 |
| Medicare Advantage days | 1,072 | 1,113 | 1,473 | 1,290 | 1,593 | 1,691 |
| Beds | 80 | 80 | 78 | 78 | 78 | 78 |
| Employees (FTE) | 430 | 423 | 388 | 293 | 271 | 279 |
Source: CMS cost report (HCRIS, Form 2552-10), report 840917, as submitted. Hospitals report these figures themselves; they are not audited financial statements.
Each cost center Otsego Memorial 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 |
|---|---|---|---|---|---|
| Rural health clinic | $16.4M | $28.6M | $20.9M | 1.37 | 60,571 |
| Drugs charged to patients | $868,718 | $16.7M | $28.3M | 0.59 | 1,570 |
| Operating room | $3.1M | $12.5M | $37.7M | 0.33 | 23,482 |
| Radiology-diagnostic | $2.5M | $7.4M | $71.5M | 0.10 | 9,555 |
| Laboratory | $1.2M | $5.2M | $34.3M | 0.15 | 3,492 |
| Emergency | $2.5M | $5.1M | $31.6M | 0.16 | 9,911 |
| Impl. dev. charged to patients | $3.3M | $6.6M | 0.50 | 30 | |
| Physical therapy | $7,104 | $2.4M | $8.1M | 0.30 | 1,632 |
| Op chemo | $1.4M | $1.9M | $3.1M | 0.61 | 6,487 |
| Observation beds (non-distinct part | $1.6M | $4M | 0.41 | ||
| Medical supplies charged to patient | $1.5M | $8.9M | 0.17 | 10,060 | |
| Respiratory therapy | $534,620 | $1.1M | $2.4M | 0.46 | 3,285 |
| Wound therapy | $404,071 | $947,390 | $1M | 0.94 | 4,944 |
| Occupational therapy | $799,950 | $3.3M | 0.24 | 995 | |
| Cardiac rehabilitation | $364,063 | $633,465 | $973,300 | 0.65 | 980 |
| Anesthesiology | $1M | $524,427 | $6.4M | 0.08 | |
| Speech pathology | $509,020 | $1.3M | 0.40 | 80 | |
| Electrocardiology | $251,537 | $465,133 | $6M | 0.08 |
| Department | Salaries | Total cost | Charges | Cost-to-charge | Square feet |
|---|---|---|---|---|---|
| Adults & pediatrics | $3.6M | $6.2M | $12.3M | 0.50 | 14,135 |
| Skilled nursing facility | $2.3M | $5.5M | $4.4M | 1.25 | 15,188 |
| Intensive care unit | $1.1M | $2.1M | $4M | 0.53 | 3,045 |
| Nursery | $1M | $501,804 | 2.06 | 190 |
| Department | Salaries | Direct cost | Paid hours | Average hourly wage | Square feet |
|---|---|---|---|---|---|
| Administrative & general | $528,618 | $24.6M | 14,727 | $35.89 | 27,200 |
| Employee benefits department | $9.4M | 975 | |||
| Cap rel costs-mvble equip | $2.2M | ||||
| Operation of plant | $450,104 | $2M | 15,508 | $29.02 | 24,523 |
| Cap rel costs-bldg & fixt | $1.5M | 232,959 | |||
| Housekeeping | $695,650 | $1.2M | 35,638 | $19.52 | 2,140 |
| Nursing administration | $688,781 | $739,264 | 13,800 | $49.91 | 145 |
| Dietary | $630,661 | $669,296 | 16,232 | $18.78 | 3,104 |
| Cafeteria | $341,953 | 17,343 | $18.78 | 1,725 |
Source: CMS cost report (HCRIS, Form 2552-10), report 840917, 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 Otsego Memorial Hospital for an inpatient stay.
1.47
Case mix index
Higher than 24% 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).
23.8%
Low-income patient share
Disproportionate share percentage: Medicaid and SSI patient days CMS uses for safety-net payments (FY 2027).
472
Medicare inpatient stays
Medicare claims CMS based FY 2027 payment rates on.
Rural
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 | 1.39 | 1.39 | 1.31 | 1.52 | 1.44 | 1.51 | 1.47 |
| Wage index | 0.850 | 0.842 | 0.834 | 0.882 | 0.966 | 0.959 | 0.955 |
| Readmissions adjustment | -0.37% | -0.42% | -0.02% | -0.80% | -0.05% | -0.41% | -0.86% |
| Value-based purchasing adjustment | +2.11% | +1.45% | +1.45% | +0.72% | +1.78% | +0.73% | +1.45% |
| Medicare inpatient stays | 717 | 717 | 490 | 470 | 427 | 448 | 472 |
Source: CMS IPPS final rule Impact File (FY 2027).
Organizations Otsego Memorial Hospital reports to Medicare as owners or with operational control. 1 individuals also hold ownership interests; they are not listed here.
Munson Healthcare
5% or greater direct ownership interest, 100%, since 2017
Sources: CMS Hospital All Owners.
The officers and board members on Otsego Memorial 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 21 of 24 are shown.
Munson Healthcare Otsego Memorial files the Form 990 for the tax ID insurers list for Otsego Memorial Hospital, so these people may lead the wider organization rather than Otsego Memorial Hospital alone.
| Name | Title |
|---|---|
| Laura Glenn | Mhc System C |
| Paul Konopacki | CFO |
| Ellen Smith | President Am |
| Kathleen Laraia | VP Oncology |
| Robert Richardson | President |
| Christopher Squire | President Pt |
| Dawn Halleck | VP Patient C |
| Bonnie Kruszka | Chief App & |
| Kenneth Bloem | Chair |
| Ruth Hoppe MD | V Chair |
| Dave Mengebier | Treasurer |
| Kim Morley | Director |
| Tim Nelson | Secretary |
| Elaine Wood | Director |
Board members: Edwin A Ness, Dino Recchia MD, Vincent Schultz MD, Matt Bulloch, Nick Ceglarek, Kathy Dixon, Jennifer King, Karl Klimek, Andy Page, Brian Postma, Owen Roberts, Mary Sanders, Kristine Thomas, Tom Veryser, David Mccurdy, Sakura Takano.
Source: IRS Form 990 Part VII filed by Munson Healthcare Otsego Memorial (EIN 38-1303843), via the IRS e-file data. A health system's return can cover several hospitals.
340B drug pricing program
Participating since 2010
340B ID SCH230133-00, registered as a sole community hospital; 13 registered outpatient sites; 41 active contract pharmacies. Authorizing official: Kathleen M LaRaia, Vice President.
Source: HRSA 340B Office of Pharmacy Affairs Information System.
Mcreynolds hall
CCN 235006, certified 1966, Medicare prospective payment
Omh medgrp rhc
CCN 238607, certified 2007, Medicare cost reimbursed
Source: Worksheet S-2 Part I of Otsego Memorial Hospital's latest Medicare cost report (HCRIS).
About Otsego Memorial Hospital's rates and hospital price transparency.
For MRI brain before and after contrast (CPT 70553), published negotiated rates at Otsego Memorial Hospital range from $430 to $3,829 across 4 insurers. Blue Cross Blue Shield's rate is $2,985. The median at nearby comparable hospitals is $1,245. 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 Otsego Memorial Hospital range from $410 to $2,889 across 4 insurers. Aetna's rate is $410. The median at nearby comparable hospitals is $1,074. 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 Otsego Memorial Hospital range from $19,864 to $19,864 across 1 insurers. Cigna's rate is $19,864. What a patient pays depends on their plan's deductible, coinsurance and network status.
For Screening mammography, bilateral (CPT 77067), published negotiated rates at Otsego Memorial Hospital range from $153 to $312 across 4 insurers. Aetna's rate is $153. The median at nearby comparable hospitals is $201. What a patient pays depends on their plan's deductible, coinsurance and network status.
Otsego Memorial Hospital has a CMS overall hospital star rating of 4 out of 5 on Medicare Care Compare (CMS data released 2026-08-13). That is higher than 58% of US hospitals.
CMS reports no Medicare-funded interns or residents at Otsego Memorial Hospital for fiscal year 2027.
Yes. Under the Hospital Readmissions Reduction Program, Medicare cuts Otsego Memorial Hospital's base inpatient payments by an estimated 0.86% 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 (40 discharges), heart failure and shock with mcc (32 discharges), simple pneumonia and pleurisy with mcc (26 discharges).
Otsego Memorial Hospital's Medicare case mix index is 1.47 for fiscal year 2027, higher than 24% of hospitals paid under the inpatient prospective payment system.
Otsego Memorial Hospital reported 1,923 inpatient discharges and 5,711 inpatient days from Jul 1, 2024 to Jun 30, 2025.
Otsego Memorial Hospital reported 279 full-time-equivalent employees on payroll from Jul 1, 2024 to Jun 30, 2025.
Otsego Memorial Hospital reported $134.7M in net patient revenue on $316.8M of gross charges for Jul 1, 2024 to Jun 30, 2025, an operating margin of 8.0%, and net income of $15.1M.
Otsego Memorial Hospital reported $88,766 of unreimbursed and uncompensated care for Jul 1, 2024 to Jun 30, 2025.
Otsego Memorial Hospital's Medicare enrollment lists Edwin A Ness as Mhc CEO since 2022.
Insurers' price transparency files list Otsego Memorial Hospital under employer identification number 38-1303843 (Munson Healthcare Otsego Memorial Hospital). 44 health plans and networks list 38-1303843 for it.
Yes. HRSA's 340B database lists Otsego Memorial Hospital (340B ID SCH230133-00) as a participating sole community hospital since 2010, with 41 active contract pharmacies.
462 clinicians who bill Medicare list Otsego Memorial Hospital as a hospital affiliation in CMS's Doctors and Clinicians data. The largest groups are family nurse practitioner (63), physician assistant (57), family medicine physician (55).
Yes. CMS's Provider of Services file lists The Joint Commission as the accrediting organization for Otsego Memorial Hospital, effective 2021.
In its Medicare enrollment, Otsego Memorial Hospital reports Munson Healthcare as 5% or greater direct ownership interest (100%).
CMS lists 20 services at Otsego Memorial Hospital, including Acute Renal Dialysis, Anesthesia, Clinical Laboratory, Diagnostic Radiology, Dietary Care, Inpatient Surgical.
In CMS's 2025 Hospital Service Area file, the most Medicare inpatient stays at Otsego Memorial Hospital came from ZIP codes 49735 (373), 49756 (76), 49709 (75).
Otsego Memorial Hospital has 78 beds, including its psychiatric, rehabilitation and other subprovider units, in its latest Medicare cost report. 53 are Medicare-certified beds in CMS's Provider of Services file. Facility type: Short Term Acute Care Hospital.
Otsego Memorial Hospital is located at 825 North Center Avenue, Gaylord, MI 49735. Its main phone number is (989) 731-2100.
Otsego Memorial Hospital's CMS Certification Number (CCN), also called its Medicare provider number, is 230133.
The National Provider Identifier (NPI) on file for Otsego Memorial Hospital is 1124028972.
Otsego Memorial Hospital is affiliated with Munson Healthcare.
Otsego Memorial Hospital lists 29 in-network payers, including Aetna, Ameri Health, Aspirus Health Plan, Avera Health Plans, and is Medicare-certified. Insurance acceptance may vary by plan, so confirm coverage with your insurer or the hospital's billing department.
236 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