Providence Saint Joseph Health · Petaluma, CA
4 of 5
CMS star rating
58
Beds
1,758
Inpatient discharges a year
$85.6M
Net patient revenue a year
35
In-network payers
Petaluma Valley Hospital is a 58-bed voluntary non-profit - other hospital in Petaluma, CA, affiliated with Providence Saint Joseph Health. Below you'll find publicly disclosed negotiated rates and facility details, including 35 in-network payers and 288 disclosed rate categories.
The 24 services Petaluma Valley 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
$14,939 - $24,396
from 3 insurers · median $18,199
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 neonatal nursery services to CMS
Childbirth · Inpatient
MS-DRG 788
$15,212 - $33,627
from 3 insurers · median $23,227
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 neonatal nursery services to CMS
Medicine & Surgery
CPT 66984
$10,316 - $35,406
from 4 insurers · median $15,441
314 Medicare claims in Level 1 Intraocular Procedures (CMS 2024)
Medicine & Surgery · Inpatient
MS-DRG 470
$18,779 - $70,842
from 4 insurers · median $48,888
16 Medicare discharges for this DRG in CMS hospital data
Digestive procedures
CPT 45380
$7,260 - $24,227
from 4 insurers · median $9,120
Common here, based on CMS Medicare volume
Digestive procedures
CPT 43239
$2,480 - $8,185
from 3 insurers · median $7,260
Common here, based on CMS Medicare volume
Digestive procedures
CPT 45385
$7,260 - $21,626
from 4 insurers · median $8,979
Common here, based on CMS Medicare volume
CT imaging
CPT 74177
$611 - $3,653
from 3 insurers · median $1,510
Common here, based on CMS Medicare volume
Digestive procedures
CPT 45378
$7,260 - $8,566
from 3 insurers · median $8,203
Common here, based on CMS Medicare volume
Medicine & Surgery
CPT 47562
$18,258 - $53,252
from 4 insurers · median $25,382
Typical for a hospital with this service line
Mammography
CPT 77067
$160 - $1,306
from 4 insurers · median $704
Common here, based on CMS Medicare volume
Childbirth · Inpatient
MS-DRG 807
$14,939 - $24,396
from 3 insurers · median $18,199
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 neonatal nursery services to CMS
Medicine & Surgery
CPT 29881
$12,458 - $29,554
from 4 insurers · median $21,409
28 Medicare claims in Level 3 Musculoskeletal Procedures (CMS 2024)
Gynecology
CPT 58571
$14,416 - $64,312
from 4 insurers · median $26,662
Typical for a hospital with this service line
Cardiology and vascular testing
CPT 93306
$985 - $2,990
from 4 insurers · median $1,797
Common here, based on CMS Medicare volume
CT imaging
CPT 74176
$373 - $3,635
from 4 insurers · median $1,328
Common here, based on CMS Medicare volume
CT imaging
CPT 70450
$246 - $1,128
from 3 insurers · median $586
Common here, based on CMS Medicare volume
Urology
CPT 50590
$24,039 - $31,837
from 3 insurers · median $24,572
26 Medicare claims in Level 4 Urology and Related Services (CMS 2024)
CT imaging
CPT 71260
$468 - $3,247
from 4 insurers · median $1,725
Common here, based on CMS Medicare volume
Gynecology
CPT 58661
$13,914 - $53,252
from 4 insurers · median $26,662
Typical for a hospital with this service line
Gynecology
CPT 58662
$13,150 - $53,252
from 4 insurers · median $29,723
Typical for a hospital with this service line
Ear, nose and throat
CPT 69436
$7,327 - $20,739
from 3 insurers · median $9,446
Typical for a hospital with this service line
Gynecology
CPT 58558
$4,386 - $18,315
from 4 insurers · median $9,884
Typical for a hospital with this service line
Orthopedics and pain
CPT 29880
$11,733 - $29,554
from 4 insurers · median $21,409
28 Medicare claims in Level 3 Musculoskeletal Procedures (CMS 2024)
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* | 18 | 759% | 13 | 4 |
| Insurer B* | 23 | 682% | 14 | 5 |
| Insurer C* | 22 | 551% | 14 | 4 |
| Insurer D* | 24 | 389% | 12 | 5 |
How we chose these services: 5 appear in this hospital's own Medicare claims, 10 are common here based on CMS Medicare volume, and 9 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 Petaluma Valley 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
$85.6M net patient revenue
Ownership and leadership
Owned by Norcal Healthconnect LLC
The employer identification numbers (EINs) health plans and networks list for Petaluma Valley 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 |
|---|---|---|
| 85-2390012Healdsburg Hospital | 46Aetna, Cigna, United Healthcare (incl Optum, Rocky Mountain, Health Plan of Nevada, Sierra Health), Allied Benefit Systems, Aspirus Health Plan and 41 more | 1235162645 Norcal Healthconnect LLC1861009672 Norcal Healthconnect LLC1205443025 Norcal Healthconnect LLCand 9 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.
400 North Mcdowell Boulevard, Petaluma, CA 94954
(707) 778-1111
How Petaluma Valley 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 1 of 7 measures
0 better, 6 no different, 1 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
70%
Lower than 53% of US hospitals
US median: 71%
Surveyed patients who would definitely recommend the hospital
Hospital-acquired condition penalty
Penalized
Among the worst-performing 25% of US hospitals
Medicare cuts payments 1% for the worst-performing 25% of hospitals on infections and injuries acquired in the hospital
Serious complications (PSI 90)
0.88
Lower than 77% 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
170 min
Higher than 64% 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
67%
Higher than 53% 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 1 of 7 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 | 70% | 2024-10-01 to 2025-09-30 |
| Hospital-acquired condition penaltyCMS: HAC Reduction Program payment reduction | Penalized | 2026 |
| Serious complications (PSI 90)CMS: Patient safety and adverse events composite (PSI 90) | 0.88 | 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 | 170 min | 2024-10-01 to 2025-09-30 |
| Sepsis careCMS: Appropriate care for severe sepsis and septic shock | 67% | 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 Petaluma Valley Hospital's inpatient payments for its readmissions, quality and cost results.
No penalty
Readmissions penalty
Hospital Readmissions Reduction Program adjustment for excess readmissions, as estimated in the FY 2027 IPPS final rule.
+0.14% 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 Petaluma Valley 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 | Petaluma Valley Hospital | US median | CA average | CMS comparison | US rank |
|---|---|---|---|---|---|
| Rate of complications for hip/knee replacement patients2023-04-01 to 2025-03-31 · 26 cases | 6.1 | 4.1 | 4.075 | Worse than 97% of US hospitals | |
| Hybrid Hospital-Wide All-Cause Risk Standardized Mortality Rate2024-07-01 to 2025-06-30 · 533 cases | 4 | 3.9 | 3.81 | Worse than 51% 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 · 49 cases | 8.6 | 8.5 | 8.235 | Worse than 53% of US hospitals | |
| Death rate for heart failure patients2022-07-01 to 2025-06-30 · 118 cases | 11.6 | 11 | 10.29 | Worse than 62% of US hospitals | |
| Death rate for pneumonia patients2022-07-01 to 2025-06-30 · 154 cases | 14.9 | 15.2 | 14.49 | Better than 53% of US hospitals | |
| Death rate for stroke patients2023-07-01 to 2025-06-30 · 57 cases | 12.7 | 11.6 | 11.57 | Worse than 66% of US hospitals | |
| Pressure ulcer rate2022-07-01 to 2024-06-30 · 1,184 cases | 0.37 | 0.51 | 0.4818 | No Different Than the National Rate | Better than 71% 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 · 1,427 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 · 1,398 cases | 0.26 | 0.27 | 0.261 | No Different Than the National Rate | Better than 54% of US hospitals |
| Postoperative hemorrhage or hematoma rate2022-07-01 to 2024-06-30 · 202 cases | 2.27 | 2.29 | 2.308 | No Different Than the National Rate | Better than 53% of US hospitals |
| Postoperative acute kidney injury requiring dialysis rate2022-07-01 to 2024-06-30 · 43 cases | 1.66 | 1.63 | 1.668 | No Different Than the National Rate | Worse than 64% of US hospitals |
| Postoperative respiratory failure rate2022-07-01 to 2024-06-30 · 49 cases | 8.61 | 8.88 | 9.555 | 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 · 216 cases | 3.15 | 3.4 | 3.521 | No Different Than the National Rate | Better than 72% of US hospitals |
| Postoperative sepsis rate2022-07-01 to 2024-06-30 · 44 cases | 5.16 | 5.105 | 5.495 | No Different Than the National Rate | Worse than 55% of US hospitals |
| Postoperative wound dehiscence rate2022-07-01 to 2024-06-30 · 45 cases | 1.73 | 1.72 | 1.796 | No Different Than the National Rate | Worse than 52% of US hospitals |
| Abdominopelvic accidental puncture or laceration rate2022-07-01 to 2024-06-30 · 147 cases | 1.31 | 1.02 | 1.061 | No Different Than the National Rate | Worse than 89% of US hospitals |
Unplanned returns to a hospital after a stay or an outpatient procedure; lower is better.
| Measure | Petaluma Valley 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 · 110 cases | 6.6 | 1.25 | 7.901 | Worse than 57% of US hospitals | |
| Hospital return days for pneumonia patients2022-07-01 to 2025-06-30 · 143 cases | -3 | 3.85 | 16.67 | Better than 59% 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 · 364 cases | 13.3 | 12.9 | 12.91 | No Different Than the National Rate | Worse than 67% 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 · 138 cases | 1.1 | 1 | 1.001 | No Different than expected | Worse than 69% 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 · 52 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 · 103 cases | 21.7 | 21.3 | 21.41 | Worse than 61% of US hospitals | |
| Rate of readmission after hip/knee replacement2023-07-01 to 2025-06-30 · 26 cases | 6 | 5.8 | 5.612 | Worse than 61% of US hospitals | |
| Pneumonia (PN) 30-Day Readmission Rate2023-07-01 to 2025-06-30 · 131 cases | 17.4 | 17.2 | 17.7 | Worse than 55% of US hospitals |
Standardized infection ratios (1 is the US baseline) and the counts behind them; lower is better.
| Measure | Petaluma Valley 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 | 1,095 | 1,370 | 5,722 | ||
| Central Line Associated Bloodstream Infection (ICU + select Wards): Predicted Cases2024-10-01 to 2025-09-30 | 0.656 | 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 | 1,182 | 1,799 | 5,308 | ||
| Catheter Associated Urinary Tract Infections (ICU + select Wards): Predicted Cases2024-10-01 to 2025-09-30 | 0.599 | 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 | 13 | 61 | 112 | ||
| SSI - Colon Surgery: Predicted Cases2024-10-01 to 2025-09-30 | 0.342 | 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 | 32 | 38 | 73.49 | ||
| SSI - Abdominal Hysterectomy: Predicted Cases2024-10-01 to 2025-09-30 | 0.248 | 0.328 | 0.6136 | ||
| SSI - Abdominal Hysterectomy: Observed Cases2024-10-01 to 2025-09-30 | 0 | 0 | 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 | 9,972 | 14,451 | 52,601 | ||
| MRSA Bacteremia: Predicted Cases2024-10-01 to 2025-09-30 | 0.437 | 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 | 0.015 | 0.127 | 0.1925 | No Different than National Benchmark | |
| Clostridium Difficile (C.Diff): Upper Confidence Limit2024-10-01 to 2025-09-30 | 1.518 | 0.747 | 0.9502 | No Different than National Benchmark | |
| Clostridium Difficile (C.Diff): Patient Days2024-10-01 to 2025-09-30 | 9,972 | 13,646 | 48,317 | No Different than National Benchmark | |
| Clostridium Difficile (C.Diff): Predicted Cases2024-10-01 to 2025-09-30 | 3.249 | 5.683 | 27.04 | No Different than National Benchmark | |
| Clostridium Difficile (C.Diff): Observed Cases2024-10-01 to 2025-09-30 | 1 | 2 | 9.99 | No Different than National Benchmark | |
| Clostridium Difficile (C.Diff)2024-10-01 to 2025-09-30 | 0.308 | 0.279 | 0.383 | No Different than National Benchmark | Worse than 54% of US hospitals |
How recent inpatients answered each survey question, with CMS's star rating per topic.
| Measure | Petaluma Valley Hospital | US median | CA average | CMS comparison | US rank |
|---|---|---|---|---|---|
| Room was "always" clean2024-10-01 to 2025-09-30 · 246 cases | 85 | 73 | 72.2 | Better than 89% of US hospitals | |
| Room was "sometimes" or "never" clean2024-10-01 to 2025-09-30 · 246 cases | 3 | 8 | 8.78 | Better than 87% of US hospitals | |
| Room was "usually" clean2024-10-01 to 2025-09-30 · 246 cases | 12 | 18 | 19.02 | ||
| Cleanliness - linear mean score2024-10-01 to 2025-09-30 · 246 cases | 94 | 87 | 86.82 | Better than 95% of US hospitals | |
| Cleanliness - star rating2024-10-01 to 2025-09-30 · 246 cases | 5 | 4 | 3.514 | The top rating, shared by 12% of US hospitals | |
| Nurses "always" communicated well2024-10-01 to 2025-09-30 · 246 cases | 75 | 80 | 75.76 | Worse than 78% of US hospitals | |
| Nurse communication - linear mean score2024-10-01 to 2025-09-30 · 246 cases | 90 | 91 | 89.84 | Worse than 66% of US hospitals | |
| Nurses "sometimes" or "never" communicated well2024-10-01 to 2025-09-30 · 246 cases | 5 | 4 | 5.713 | Worse than 61% of US hospitals | |
| Nurse communication - star rating2024-10-01 to 2025-09-30 · 246 cases | 3 | 3 | 2.855 | Worse than 49% of US hospitals | |
| Nurses "usually" communicated well2024-10-01 to 2025-09-30 · 246 cases | 20 | 16 | 18.53 | ||
| Doctors "always" communicated well2024-10-01 to 2025-09-30 · 246 cases | 74 | 79 | 75.81 | Worse than 83% of US hospitals | |
| Doctor communication - linear mean score2024-10-01 to 2025-09-30 · 246 cases | 88 | 91 | 89.11 | Worse than 83% of US hospitals | |
| Doctors "sometimes" or "never" communicated well2024-10-01 to 2025-09-30 · 246 cases | 8 | 5 | 7.043 | Worse than 84% of US hospitals | |
| Doctor communication - star rating2024-10-01 to 2025-09-30 · 246 cases | 2 | 3 | 2.688 | Worse than 71% of US hospitals | |
| Doctors "usually" communicated well2024-10-01 to 2025-09-30 · 246 cases | 18 | 16 | 17.15 | ||
| Staff "always" explained2024-10-01 to 2025-09-30 · 246 cases | 58 | 61 | 58.95 | Worse than 66% of US hospitals | |
| Communication about medicines - linear mean score2024-10-01 to 2025-09-30 · 246 cases | 77 | 77 | 75.75 | Better than 47% of US hospitals | |
| Staff "sometimes" or "never" explained2024-10-01 to 2025-09-30 · 246 cases | 19 | 19 | 21.56 | Better than 50% of US hospitals | |
| Communication about medicines - star rating2024-10-01 to 2025-09-30 · 246 cases | 3 | 3 | 2.449 | Better than 47% of US hospitals | |
| Staff "usually" explained2024-10-01 to 2025-09-30 · 246 cases | 23 | 19 | 19.48 | ||
| Discharge information - linear mean score2024-10-01 to 2025-09-30 · 246 cases | 87 | 86 | 84.61 | Better than 55% of US hospitals | |
| No, staff "did not" give patients this information2024-10-01 to 2025-09-30 · 246 cases | 12 | 13 | 15.03 | Better than 58% of US hospitals | |
| Discharge information - star rating2024-10-01 to 2025-09-30 · 246 cases | 4 | 3 | 3.08 | Better than 55% of US hospitals | |
| Yes, staff "did" give patients this information2024-10-01 to 2025-09-30 · 246 cases | 88 | 87 | 84.97 | Better than 58% of US hospitals | |
| No, staff "did not" give patients information about help after discharge2024-10-01 to 2025-09-30 · 246 cases | 14 | 14 | 16.39 | Better than 49% of US hospitals | |
| Yes, staff "did" give patients information about help after discharge2024-10-01 to 2025-09-30 · 246 cases | 86 | 86 | 83.61 | Better than 49% of US hospitals | |
| Doctors "always" explained things so they could understand2024-10-01 to 2025-09-30 · 246 cases | 69 | 74 | 70.69 | Worse than 81% of US hospitals | |
| Doctors "sometimes" or "never" explained things so they could understand2024-10-01 to 2025-09-30 · 246 cases | 10 | 7 | 8.855 | Worse than 84% of US hospitals | |
| Doctors "usually" explained things so they could understand2024-10-01 to 2025-09-30 · 246 cases | 21 | 19 | 20.45 | ||
| Doctors "always" listened carefully2024-10-01 to 2025-09-30 · 246 cases | 72 | 77 | 73.94 | Worse than 82% of US hospitals | |
| Doctors "sometimes" or "never" listened carefully2024-10-01 to 2025-09-30 · 246 cases | 8 | 6 | 7.637 | Worse than 77% of US hospitals | |
| Doctors "usually" listened carefully2024-10-01 to 2025-09-30 · 246 cases | 20 | 17 | 18.43 | ||
| Doctors "always" treated them with courtesy and respect2024-10-01 to 2025-09-30 · 246 cases | 80 | 85 | 81.99 | Worse than 85% of US hospitals | |
| Doctors "sometimes" or "never" treated them with courtesy and respect2024-10-01 to 2025-09-30 · 246 cases | 6 | 3 | 4.958 | Worse than 86% of US hospitals | |
| Doctors "usually" treated them with courtesy and respect2024-10-01 to 2025-09-30 · 246 cases | 14 | 11 | 13.06 | ||
| Patients who gave a rating of "6" or lower (low)2024-10-01 to 2025-09-30 · 246 cases | 11 | 8 | 10.01 | Worse than 75% of US hospitals | |
| Patients who gave a rating of "7" or "8" (medium)2024-10-01 to 2025-09-30 · 246 cases | 22 | 20 | 22.36 | ||
| Patients who gave a rating of "9" or "10" (high)2024-10-01 to 2025-09-30 · 246 cases | 67 | 72 | 67.63 | Worse than 68% of US hospitals | |
| Overall hospital rating - linear mean score2024-10-01 to 2025-09-30 · 246 cases | 86 | 88 | 86.85 | Worse than 69% of US hospitals | |
| Overall hospital rating - star rating2024-10-01 to 2025-09-30 · 246 cases | 3 | 3 | 3.047 | Worse than 45% of US hospitals | |
| Staff "always" explained new medications2024-10-01 to 2025-09-30 · 246 cases | 73 | 74 | 72.06 | Worse than 55% of US hospitals | |
| Staff "sometimes" or "never" explained new medications2024-10-01 to 2025-09-30 · 246 cases | 11 | 9 | 10.94 | Worse than 62% of US hospitals | |
| Staff "usually" explained new medications2024-10-01 to 2025-09-30 · 246 cases | 16 | 16 | 17 | ||
| Nurses "always" explained things so they could understand2024-10-01 to 2025-09-30 · 246 cases | 68 | 75 | 71.11 | Worse than 88% of US hospitals | |
| Nurses "sometimes" or "never" explained things so they could understand2024-10-01 to 2025-09-30 · 246 cases | 8 | 5 | 7.488 | Worse than 78% of US hospitals | |
| Nurses "usually" explained things so they could understand2024-10-01 to 2025-09-30 · 246 cases | 24 | 20 | 21.4 | ||
| Nurses "always" listened carefully2024-10-01 to 2025-09-30 · 246 cases | 72 | 77 | 72.49 | Worse than 76% of US hospitals | |
| Nurses "sometimes" or "never" listened carefully2024-10-01 to 2025-09-30 · 246 cases | 4 | 4 | 6.121 | Better than 45% of US hospitals | |
| Nurses "usually" listened carefully2024-10-01 to 2025-09-30 · 246 cases | 24 | 19 | 21.39 | ||
| Nurses "always" treated them with courtesy and respect2024-10-01 to 2025-09-30 · 246 cases | 84 | 86 | 82.8 | Worse than 65% of US hospitals | |
| Nurses "sometimes" or "never" treated them with courtesy and respect2024-10-01 to 2025-09-30 · 246 cases | 3 | 3 | 3.779 | Worse than 50% of US hospitals | |
| Nurses "usually" treated them with courtesy and respect2024-10-01 to 2025-09-30 · 246 cases | 13 | 11 | 13.42 | ||
| "Always" quiet at night2024-10-01 to 2025-09-30 · 246 cases | 45 | 59 | 47.5 | Worse than 90% of US hospitals | |
| "Sometimes" or "never" quiet at night2024-10-01 to 2025-09-30 · 246 cases | 13 | 9 | 17.79 | Worse than 71% of US hospitals | |
| "Usually" quiet at night2024-10-01 to 2025-09-30 · 246 cases | 42 | 31 | 34.71 | ||
| Quietness - linear mean score2024-10-01 to 2025-09-30 · 246 cases | 76 | 82 | 74.85 | Worse than 80% of US hospitals | |
| Quietness - star rating2024-10-01 to 2025-09-30 · 246 cases | 2 | 3 | 2.203 | 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 · 246 cases | 8 | 5 | 7.623 | Worse than 76% of US hospitals | |
| "YES", patients would definitely recommend the hospital2024-10-01 to 2025-09-30 · 246 cases | 70 | 71 | 68.6 | Worse than 53% of US hospitals | |
| Recommend hospital - linear mean score2024-10-01 to 2025-09-30 · 246 cases | 86 | 87 | 85.85 | Worse than 58% of US hospitals | |
| "YES", patients would probably recommend the hospital2024-10-01 to 2025-09-30 · 246 cases | 22 | 23 | 23.77 | ||
| Recommend hospital - star rating2024-10-01 to 2025-09-30 · 246 cases | 3 | 4 | 3.431 | Worse than 58% of US hospitals | |
| Staff "always" explained possible side effects2024-10-01 to 2025-09-30 · 246 cases | 44 | 47 | 45.33 | Worse than 64% of US hospitals | |
| Staff "sometimes" or "never" explained possible side effects2024-10-01 to 2025-09-30 · 246 cases | 27 | 30 | 32.51 | Better than 65% of US hospitals | |
| Staff "usually" explained possible side effects2024-10-01 to 2025-09-30 · 246 cases | 29 | 22 | 22.16 | ||
| Summary star rating2024-10-01 to 2025-09-30 · 246 cases | 3 | 3 | 2.859 | Worse than 40% of US hospitals | |
| No, staff "did not" give patients information about possible symptoms2024-10-01 to 2025-09-30 · 246 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 · 246 cases | 90 | 88 | 86.06 | Better than 70% of US hospitals |
How often the hospital gave recommended care, and how fast.
| Measure | Petaluma Valley Hospital | US median | CA 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 | Not Available | 8.289 | |||
| Hospital Harm - Severe Hypoglycemia2024-01-01 to 2024-12-31 | Not Available | 1.008 | |||
| 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 · 664 cases | 76 | 79 | 69.96 | Worse than 56% 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 | 180 | 154 | 187 | Worse than 67% 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 · 326 cases | 170 | 148 | 182 | Worse than 64% 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 · 22 cases | 274 | 247 | 282 | Worse than 59% 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 · 30 cases | 344 | 293 | 411 | Worse than 70% of US hospitals | |
| Left before being seen2024-01-01 to 2024-12-31 · 20,105 cases | 2 | 1 | 2.162 | Worse than 58% of US hospitals | |
| Head CT results2024-10-01 to 2025-09-30 · 25 cases | 84 | 74 | 75.06 | Better than 74% of US hospitals | |
| Endoscopy/polyp surveillance: appropriate follow-up interval for normal colonoscopy in average risk patients2024-01-01 to 2024-12-31 · 70 cases | 77 | 97 | 92.55 | Worse than 92% 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 · 512 cases | 17 | 15 | 13.67 | Worse than 66% of US hospitals | |
| Appropriate care for severe sepsis and septic shock2024-10-01 to 2025-09-30 · 164 cases | 67 | 65 | 68.8 | Better than 53% of US hospitals | |
| Septic Shock 3-Hour Bundle2024-10-01 to 2025-09-30 · 53 cases | 74 | 73 | 76.38 | Better than 51% of US hospitals | |
| Septic Shock 6-Hour Bundle2024-10-01 to 2025-09-30 · 33 cases | 91 | 88 | 86.64 | Better than 57% of US hospitals | |
| Severe Sepsis 3-Hour Bundle2024-10-01 to 2025-09-30 · 165 cases | 82 | 82 | 82.89 | Better than 48% of US hospitals | |
| Severe Sepsis 6-Hour Bundle2024-10-01 to 2025-09-30 · 96 cases | 96 | 94 | 93.98 | Better than 60% of US hospitals | |
| Discharged on Antithrombotic Therapy2024-01-01 to 2024-12-31 · 34 cases | 94 | 98 | 93.4 | Worse than 83% of US hospitals | |
| 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 · 32 cases | 97 | 94 | 89.93 | Better than 73% of US hospitals | |
| Venous Thromboembolism Prophylaxis2024-01-01 to 2024-12-31 | Not Available | 86.9 | |||
| Intensive Care Unit Venous Thromboembolism Prophylaxis2024-01-01 to 2024-12-31 · 253 cases | 96 | 97 | 94.78 | Worse than 55% of US hospitals |
How often scans were ordered when they may not be needed; lower is better.
| Measure | Petaluma Valley Hospital | US median | CA average | CMS comparison | US rank |
|---|---|---|---|---|---|
| Abdomen CT Use of Contrast Material2024-07-01 to 2025-06-30 | 4.7 | 5 | 4.959 | Better than 52% of US hospitals | |
| Breast Cancer Screening Recall Rates2024-07-01 to 2025-06-30 | 2.6 | 6.6 | 8.417 | Better than 95% of US hospitals |
Medicare spending around an inpatient stay compared with the US (1 is the US median).
| Measure | Petaluma Valley 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 | 0.97 | 0.99 | 1.024 | Better than 58% of US hospitals |
The scores Medicare uses to raise or lower inpatient payments; higher is better.
| Measure | Petaluma Valley Hospital | US median | CA average | CMS comparison | US rank |
|---|---|---|---|---|---|
| VBP clinical outcomes domain scoreFY 2026 | 34 | 20 | 30.07 | Better than 75% of US hospitals | |
| VBP clinical outcomes weighted domain scoreFY 2026 | 8.5 | 5 | 7.571 | Better than 75% of US hospitals | |
| VBP efficiency and cost reduction domain scoreFY 2026 | 10 | 10 | 16.48 | Better than 43% of US hospitals | |
| VBP efficiency and cost reduction weighted domain scoreFY 2026 | 2.5 | 2.5 | 4.567 | Worse than 44% of US hospitals | |
| VBP person and community engagement domain scoreFY 2026 | 35 | 34 | 28.67 | Better than 50% of US hospitals | |
| VBP person and community engagement weighted domain scoreFY 2026 | 8.75 | 8.75 | 7.519 | Better than 50% of US hospitals | |
| VBP safety domain scoreFY 2026 | 45 | 40 | 45.16 | Better than 57% of US hospitals | |
| VBP safety weighted domain scoreFY 2026 | 11.25 | 10 | 11.79 | Better than 56% of US hospitals | |
| VBP total performance scoreFY 2026 | 31 | 29.5 | 30.43 | Better than 56% of US hospitals |
| By fiscal year | FY 2021 | FY 2022 | FY 2023 | FY 2024 | FY 2025 | FY 2026 |
|---|---|---|---|---|---|---|
| VBP clinical outcomes domain score | 66 | 58 | 40 | 5 | 20 | 34 |
| VBP clinical outcomes weighted domain score | 22 | 14.5 | 10 | 1.667 | 6.667 | 8.5 |
| VBP efficiency and cost reduction domain score | 20 | Not Available | 20 | 0 | 0 | 10 |
| VBP efficiency and cost reduction weighted domain score | 6.667 | Not Available | 5 | 0 | 0 | 2.5 |
| VBP person and community engagement domain score | 22 | Not Available | Not Available | 9 | 13 | 35 |
| VBP person and community engagement weighted domain score | 7.333 | Not Available | Not Available | 3 | 4.333 | 8.75 |
| VBP safety domain score | Not Available | Not Available | Not Available | Not Available | Not Available | 45 |
| VBP safety weighted domain score | Not Available | Not Available | Not Available | Not Available | Not Available | 11.25 |
| VBP total performance score | 36 | Not Available | Not Available | 4.667 | 11 | 31 |
Excess readmission ratios by condition; above 1 means more readmissions than expected.
| Measure | Petaluma Valley 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 | 0.9863 | 0.9969 | 1.002 | Better than 59% of US hospitals | |
| READM-30-HF-HRRP2021-07-01 to 2024-06-30 · 108 cases | 0.9953 | 0.9983 | 1.017 | Better than 52% of US hospitals | |
| READM-30-HIP-KNEE-HRRP2021-07-01 to 2024-06-30 | 0.9506 | 0.9916 | 0.9788 | Better than 62% of US hospitals | |
| READM-30-PN-HRRP2021-07-01 to 2024-06-30 · 140 cases | 0.9986 | 0.9955 | 1.026 | Worse than 52% of US hospitals |
| By fiscal year | FY 2021 | FY 2022 | FY 2023 | FY 2024 | FY 2025 | FY 2026 |
|---|---|---|---|---|---|---|
| READM-30-AMI-HRRP | 0.99 | 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 | 0.9378 | 0.9611 | 1.011 | 1.011 | 1.017 | 0.9863 |
| READM-30-HF-HRRP | 0.9513 | 0.9565 | 0.9062 | 0.9014 | 0.9492 | 0.9953 |
| READM-30-HIP-KNEE-HRRP | 1.211 | 1.23 | 1.015 | 1.047 | 0.9611 | 0.9506 |
| READM-30-PN-HRRP | 0.9515 | 0.9233 | 0.9123 | 0.9593 | 0.9532 | 0.9986 |
Infection ratios, the PSI 90 composite and the total score Medicare ranks hospitals on; lower is better.
| Measure | Petaluma Valley Hospital | US median | CA average | CMS comparison | US rank |
|---|---|---|---|---|---|
| CAUTI standardized infection ratio2023-01-01 to 2024-12-31 | 2.471 | 0.489 | 0.6114 | Worse than 99% of US hospitals | |
| CDI standardized infection ratio2023-01-01 to 2024-12-31 | 0.314 | 0.346 | 0.449 | Better than 55% of US hospitals | |
| CLABSI standardized infection ratio2023-01-01 to 2024-12-31 | 0 | 0.559 | 0.679 | The best result, shared by 14% of US hospitals | |
| HAC Reduction Program payment reductionFY 2026 | Yes | ||||
| 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 | 0.8839 | 0.9628 | 0.9656 | Better than 77% of US hospitals | |
| SSI standardized infection ratio2023-01-01 to 2024-12-31 | 2.171 | 0.7945 | 0.8116 | Worse than 95% of US hospitals | |
| Total HAC scoreFY 2026 | 0.4351 | -0.0453 | 0.02733 | Worse than 77% 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 | Yes | No | Yes |
| Total HAC score | 0.0029 | -0.6918 | 0 | 1.379 | -0.3167 | 0.4351 |
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 2026)
Accreditation
None
Medical school affiliation
Other
Ownership type
97
Medicare-certified beds
93
Registered nurses (full-time equivalent)
1966
In Medicare since
Source: CMS Provider of Services file, as reported by the hospital and state surveyors.
What Petaluma Valley Hospital reported to Medicare in its latest cost report, covering Jul 1, 2024 to Jun 30, 2025.
1,758
Inpatient discharges
Medicare 47%, Medicaid n/a
7,532
Inpatient days
36% of available bed days used
266
Employees (full-time equivalent)
Source: CMS cost report (HCRIS) (report 823802). Figures cover the reporting period, which is not always 12 months, and are self-reported.
Inpatient days and discharges Petaluma Valley Hospital reported by payer. Medicare and Medicaid include their managed care plans, shown separately below.
| Medicare | Medicaid | Other | Total | |
|---|---|---|---|---|
| Inpatient days | 3,586 | 0 | 3,946 | 7,532 |
| Discharges | 818 | 0 | 940 | 1,758 |
| Average length of stay | 4.4 days | 4.2 days | 4.3 days | |
| Average daily census | 9.8 | 0.0 | 10.8 | 20.6 |
1,418
Medicare Advantage days
313 discharges
1,769
Medicaid managed care days
335 discharges
1,836
Observation bed days
| Unit | Beds | Inpatient days | Medicare days | Occupancy |
|---|---|---|---|---|
| Adults & pediatrics | 52 | 6,870 | 3,300 | 36% |
| Intensive care unit | 6 | 662 | 286 | 30% |
Source: CMS cost report (HCRIS, Form 2552-10), report 823802, as submitted. Hospitals report these figures themselves; they are not audited financial statements. Worksheet S-3 Part I.
What Petaluma Valley Hospital treats Medicare patients for most often, in 2024. 448 Medicare discharges in 18 published DRGs; 11% surgical; 81% 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 | 123 | $121,469 | $18,251 | $25,509 | 1.98 |
| Heart failure and shock with MCCMS-DRG 291, medical | 45 | $97,197 | $12,429 | $20,411 | 1.28 |
| Simple pneumonia and pleurisy with MCCMS-DRG 193, medical | 32 | $114,641 | $12,451 | $24,075 | 1.33 |
| Septicemia or severe sepsis without MV >96 hours without MCCMS-DRG 872, medical | 28 | $92,574 | $9,430 | $19,440 | 1.03 |
| Renal failure with CCMS-DRG 683, medical | 24 | $65,118 | $8,550 | $13,675 | 0.90 |
| Respiratory infections and inflammations with MCCMS-DRG 177, medical | 22 | $154,778 | $16,785 | $32,503 | 1.70 |
| Pulmonary edema and respiratory failureMS-DRG 189, medical | 20 | $105,883 | $12,222 | $22,236 | 1.23 |
| Hip and femur procedures except major joint with CCMS-DRG 481, surgical | 19 | $153,576 | $20,259 | $32,251 | 2.07 |
| Infectious and parasitic diseases with o.r. procedures with MCCMS-DRG 853, surgical | 18 | $313,579 | $50,133 | $65,852 | 5.00 |
| Other kidney and urinary tract diagnoses with MCCMS-DRG 698, medical | 17 | $117,948 | $14,449 | $24,769 | 1.65 |
| Renal failure with MCCMS-DRG 682, medical | 16 | $115,850 | $13,563 | $24,328 | 1.50 |
| Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes with MCCMS-DRG 640, medical | 14 | $80,754 | $12,513 | $16,958 | 1.32 |
| Kidney and urinary tract infections with MCCMS-DRG 689, medical | 13 | $76,040 | $10,762 | $15,968 | 1.17 |
| Major hip and knee joint replacement or reattachment of lower extremity without MCCMS-DRG 470, surgical | 12 | $160,560 | $18,612 | $33,718 | 1.88 |
| Cellulitis without MCCMS-DRG 603, medical | 12 | $57,989 | $8,699 | $12,178 | 0.88 |
| Intracranial hemorrhage or cerebral infarction with CC or tpa in 24 hoursMS-DRG 065, medical | 11 | $106,542 | $9,420 | $22,374 | 1.02 |
| Cardiac arrhythmia and conduction disorders with CCMS-DRG 309, medical | 11 | $70,147 | $7,631 | $14,731 | 0.74 |
| Kidney and urinary tract infections without MCCMS-DRG 690, medical | 11 | $65,707 | $7,457 | $13,798 | 0.81 |
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) Petaluma Valley Hospital billed Medicare for most in 2024: 767 services in all.
| Service group | Services | Patients | Average charges | Average Medicare payment | US average payment |
|---|---|---|---|---|---|
| Level 1 Intraocular ProceduresAPC 5491 | 314 | 207 | $16,722 | $2,468 | $1,752 |
| Comprehensive Observation ServicesAPC 8011 | 155 | 148 | $58,745 | $2,909 | $2,090 |
| Level 2 Intraocular ProceduresAPC 5492 | 62 | 47 | $26,023 | $4,319 | $3,116 |
| Level 5 Urology and Related ServicesAPC 5375 | 55 | 51 | $57,693 | $5,503 | $3,918 |
| Level 2 Excision/ Biopsy/ Incision and DrainageAPC 5072 | 42 | 39 | $14,386 | $1,678 | $1,220 |
| Level 3 Musculoskeletal ProceduresAPC 5113 | 28 | 28 | $30,716 | $3,426 | $2,373 |
| Level 4 Musculoskeletal ProceduresAPC 5114 | 26 | 26 | $73,223 | $7,902 | $5,339 |
| Level 4 Urology and Related ServicesAPC 5374 | 26 | 22 | $46,433 | $3,708 | $2,629 |
| Level 3 Excision/ Biopsy/ Incision and DrainageAPC 5073 | 16 | 16 | $28,973 | $3,022 | $2,141 |
| Level 5 Musculoskeletal ProceduresAPC 5115 | 16 | 16 | $133,001 | $15,897 | $10,772 |
See all 12 Medicare outpatient services at Petaluma Valley 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 Petaluma Valley 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 782 in 2020 to 921 in 2025.
| ZIP code | Stays | Of this hospital's stays | Days | Charges | Market share | Share in 2020 |
|---|---|---|---|---|---|---|
| 94954 | 385 | 42% | 1,667 | $46M | 27% | 31% |
| 94952 | 299 | 32% | 1,330 | $35.6M | 25% | 32% |
| 94928 | 65 | 7% | 285 | $7.3M | 4% | 8% |
| 95401 | 32 | 3% | 159 | $3.6M | 2% | 2% |
| 95407 | 20 | 2% | 62 | $1.5M | 2% | |
| 95472 | 19 | 2% | 88 | $1.9M | 2% | 2% |
| 95404 | 18 | 2% | 88 | $2.3M | 1% | |
| 94931 | 17 | 2% | 63 | $1.8M | 7% | 14% |
| 94951 | 15 | 2% | 64 | $1.5M | 11% | 16% |
| 95403 | 15 | 2% | 139 | $2.3M | 1% | |
| 95482 | 14 | 2% | 69 | $1.9M | 1% | 1% |
| 95409 | 11 | 1% | 43 | $1.3M | 1% | |
| 95476 | 11 | 1% | 79 | $1.7M | 1% | 1% |
Source: CMS Hospital Service Area file. Shares are of the 921 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 Petaluma Valley Hospital reported at its latest Medicare certification survey (2026). Counts are people, not full-time equivalents.
93
Registered nurses
4
Licensed practical nurses
3
Pharmacists
9
Respiratory therapists
1
Dietitians
1
Social workers
377
Other personnel
Source: CMS Provider of Services file.
312 clinicians who bill Medicare list Petaluma Valley 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.
Steven Hartzman, M.D.
Diagnostic Radiology Physician
NPI 1255330833
See commercial rates for Steven Hartzman, M.D.Basil Hamblin, MD
Geriatric Medicine (Family Medicine) Physician
NPI 1114095106
See commercial rates for Basil Hamblin, MDAditi Choudhry, M.D.
Hematology & Oncology Physician
NPI 1427218908
See commercial rates for Aditi Choudhry, M.D.Harjot Bhandal, MD
Interventional Pain Medicine Physician
NPI 1245611250
See commercial rates for Harjot Bhandal, MDSanjay Dhar, MD
Cardiovascular Disease Physician
NPI 1811074586
See commercial rates for Sanjay Dhar, MDAvinash Ramchandani, MD
Pain Medicine (Physical Medicine & Rehabilitation) Physician
NPI 1730358532
See commercial rates for Avinash Ramchandani, MDVu Tran
Sleep Medicine (Internal Medicine) Physician
NPI 1528021490
See commercial rates for Vu TranNoah Weiss, MD
Orthopaedic Surgery Physician
NPI 1225126444
See commercial rates for Noah Weiss, MDErin Hanauer, PA-C
Medical Physician Assistant
NPI 1851490718
See commercial rates for Erin Hanauer, PA-CJeffery Nielson, MD
Diagnostic Radiology Physician
NPI 1134147358
See commercial rates for Jeffery Nielson, MDWanhua Yang, M.D. PH.D.
Anatomic Pathology & Clinical Pathology Physician
NPI 1922360627
See commercial rates for Wanhua Yang, M.D. PH.D.Christopher Kim, M.D.
Anatomic Pathology & Clinical Pathology Physician
NPI 1356607121
See commercial rates for Christopher Kim, M.D.Tomas Vasiliauskas, M.D.
Cardiovascular Disease Physician
NPI 1073612529
See commercial rates for Tomas Vasiliauskas, M.D.Jason Bacharach, MD
Glaucoma Specialist (Ophthalmology) Physician
NPI 1639160112
See commercial rates for Jason Bacharach, MDAron Rosenthal, MD
Diagnostic Radiology Physician
NPI 1245443258
See commercial rates for Aron Rosenthal, MDNikola Lozanov, MD
Family Medicine Physician
NPI 1417968512
See commercial rates for Nikola Lozanov, MDChau Vu, MD
Interventional Pain Medicine Physician
NPI 1538508841
See commercial rates for Chau Vu, MDMasis Babajanian, M.D.
Cardiovascular Disease Physician
NPI 1609873850
See commercial rates for Masis Babajanian, M.D.Neil Levin, M.D.
Internal Medicine Physician
NPI 1285633081
See commercial rates for Neil Levin, M.D.Rajina Ranadive, MD
Internal Medicine Physician
NPI 1447200480
See commercial rates for Rajina Ranadive, MDDaniel Wang
Family Medicine Physician
NPI 1346336195
See commercial rates for Daniel WangPhilip Shumsky, MD
Pain Medicine Physician
NPI 1609258763
See commercial rates for Philip Shumsky, MDThong Nguyen, D.O.
Cardiovascular Disease Physician
NPI 1063866572
See commercial rates for Thong Nguyen, D.O.Mark Northfield, MD
Orthopaedic Surgery Physician
NPI 1861406316
See commercial rates for Mark Northfield, 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 Petaluma Valley 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) | $643.6M | 751.7% |
| Inpatient | $197.5M | 230.6% |
| Outpatient | $446.1M | 521.0% |
| Contractual allowances and discounts | -$558M | -651.7% |
| Net patient revenue | $85.6M | 100.0% |
| Operating expenses | -$110M | -128.4% |
| Operating income from patient care | -$24.3M | -28.4% |
| Other income | $268,755 | 0.3% |
| Investment income | $54,590 | 0.1% |
| Other | $214,165 | 0.3% |
| Net income | -$24.1M | -28.1% |
| Line | Amount | Share |
|---|---|---|
| Traditional Medicare | $167.7M | 26.0% |
| Medicaid (including managed care) | $182.7M | 28.4% |
| Other payers and self-pay | $293.5M | 45.6% |
| Total charges | $643.8M | 100.0% |
Source: CMS cost report (HCRIS, Form 2552-10), report 823802, 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 Petaluma Valley Hospital's latest cost report.
-28.4%
Operating margin
Operating income from patient care / net patient revenue
-28.0%
Total margin
Net income / net patient revenue plus other income
-20.6%
EBITDAR margin
Net income before interest, depreciation and leases (Worksheet A-7), / total revenue
43% of expenses
Personnel costs
Salaries, direct-care contract labor and core wage-related costs / operating expenses
$74.85
Average hourly wage
Adjusted salaries / paid hours (Worksheet S-3 Part II)
123.6%
Return on assets
Net income for a year / total assets
-5.54
Current ratio
Current assets / current liabilities
-7.13
Quick ratio
Cash, temporary investments and net receivables / current liabilities
-376 days
Days cash on hand
Cash and temporary investments / daily operating expenses excluding depreciation
45 days
Days in patient receivables
Net patient receivables / daily net patient revenue
48 days
Average payment period
Current liabilities / daily operating expenses excluding depreciation
-4.41
Asset turnover
Total revenue for a year / total assets
10.6 years
Average age of plant
Accumulated depreciation / depreciation for a year
Source: CMS cost report (HCRIS, Form 2552-10), report 823802, as submitted. Hospitals report these figures themselves; they are not audited financial statements.
What Petaluma Valley Hospital owned and owed at the end of its reporting period (Jun 2025), across all fund types: -$19.5M in total assets and a -$33.5M fund balance.
| Line | Amount | Of total assets |
|---|---|---|
| Cash and temporary investments | -$107.5M | |
| Patient receivables, net | $10.7M | |
| Inventory | $1.5M | |
| Total current assets | -$75.3M | |
| Property and equipment, net of depreciation | $55.3M | |
| Investments and other assets | $500,065 | |
| Total assets | -$19.5M | |
| Current liabilities | $13.6M | |
| Total liabilities | $14M | |
| Fund balance (net assets) | -$33.5M |
Source: CMS cost report (HCRIS, Form 2552-10), report 823802, as submitted. Hospitals report these figures themselves; they are not audited financial statements.
Care Petaluma Valley Hospital provided without full payment, as reported on Worksheet S-10 of its cost report.
$2.5M
Cost of charity care
Care for patients approved for charity care and uninsured discounts, at cost
$2M
Bad debt
Patient bills written off as uncollectible, at charges
$14.9M
Medicaid shortfall
Cost of Medicaid patients (charges times the cost-to-charge ratio) minus Medicaid payments; negative means a surplus
$13.2M
Total unreimbursed and uncompensated care
12.0% 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 823802, as submitted. Hospitals report these figures themselves; they are not audited financial statements.
Petaluma Valley Hospital's full-year cost reports, by fiscal year end. Reports shorter than ten months are left out.
| Fiscal year ending | Jun 2020 | Jun 2022 | Jun 2023 | Jun 2024 | Jun 2025 |
|---|---|---|---|---|---|
| Net patient revenue | $91.5M | $89.4M | $82.9M | $83.6M | $85.6M |
| Operating expenses | $90.1M | $102.2M | $102.8M | $95.3M | $110M |
| Operating margin | 1.6% | -14.4% | -24.0% | -14.1% | -28.4% |
| Net income | $3.7M | -$10.1M | -$19.3M | -$11M | -$24.1M |
| Total assets | $51.6M | $103.2M | $57.6M | $6.4M | -$19.5M |
| Discharges | 2,284 | 2,332 | 2,169 | 1,607 | 1,758 |
| Inpatient days | 10,914 | 10,583 | 9,995 | 6,637 | 7,532 |
| Medicare Advantage days | 788 | 1,277 | 1,744 | 1,123 | 1,418 |
| Beds | 80 | 80 | 58 | 59 | 58 |
| Employees (FTE) | 243 | 216 | 211 | 218 | 266 |
Source: CMS cost report (HCRIS, Form 2552-10), report 823802, as submitted. Hospitals report these figures themselves; they are not audited financial statements.
Each cost center Petaluma Valley 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 |
|---|---|---|---|---|---|
| Emergency | $4.9M | $12.1M | $162.5M | 0.07 | 6,021 |
| Operating room | $2.3M | $9.7M | $73.7M | 0.13 | 10,390 |
| Observation beds (non-distinct part | $5.9M | $11.6M | 0.51 | ||
| Laboratory | $1.6M | $5.6M | $83.3M | 0.07 | 2,507 |
| Radiology-diagnostic | $1.6M | $4.8M | $40.7M | 0.12 | 3,127 |
| Drugs charged to patients | $4.5M | $26.2M | 0.17 | ||
| Recovery room | $1.3M | $2.8M | $7.7M | 0.37 | 821 |
| Impl. dev. charged to patients | $2.3M | $10.8M | 0.21 | ||
| Medical supplies charged to patient | $2.3M | $5.5M | 0.41 | ||
| Respiratory therapy | $683,463 | $2.1M | $17.9M | 0.12 | 1,106 |
| Ultra sound | $703,717 | $1.9M | $11.7M | 0.16 | 1,794 |
| Ct scan | $655,073 | $1.5M | $113M | 0.01 | 803 |
| Physical therapy | $547,362 | $1.1M | $2.4M | 0.46 | 747 |
| Mri | $282,285 | $546,523 | $16.5M | 0.03 | |
| Occupational therapy | $187,536 | $325,754 | $1.5M | 0.21 | |
| Speech pathology | $320,635 | $1.3M | 0.24 | ||
| Renal dialysis | $314,220 | $930,810 | 0.34 | 232 | |
| Echocardiography | $127,990 | $247,366 | $3.2M | 0.08 | 2 |
| Radioisotope | $112,426 | $150,882 | 0.75 | 329 |
| Department | Salaries | Total cost | Charges | Cost-to-charge | Square feet |
|---|---|---|---|---|---|
| Adults & pediatrics | $10.3M | $28M | $43.7M | 0.64 | 18,942 |
| Intensive care unit | $1.9M | $4.7M | $9.4M | 0.51 | 2,530 |
| Department | Salaries | Direct cost | Paid hours | Average hourly wage | Square feet |
|---|---|---|---|---|---|
| Administrative & general | $1.3M | $15.1M | 9,474 | $102.47 | 22,936 |
| Employee benefits department | $487,756 | $8.6M | 2,073 | $235.29 | |
| Cap rel costs-bldg & fixt | $4.2M | 87,580 | |||
| Operation of plant | $684,411 | $4.2M | 7,082 | $96.64 | 6,511 |
| Nursing administration | $2.1M | $2.3M | 22,529 | $91.07 | |
| Cap rel costs-mvble equip | $2.2M | ||||
| Pharmacy | $1.4M | $1.8M | 17,668 | $81.04 | 1,199 |
| Maintenance & repairs | $38,067 | $1.5M | |||
| Housekeeping | $907,574 | $1.4M | 28,076 | $32.33 | 264 |
| Social service | $870,185 | $1.1M | 11,410 | $76.27 | 328 |
| Cafeteria | $715,295 | 11,358 | $35.81 | ||
| Dietary | $663,367 | $504,553 | 7,296 | $35.18 | 3,839 |
| Nursing program | $187,811 | ||||
| Medical records & library | $184,227 | 45 | |||
| Central services & supply | $140,453 | 2,494 | |||
| Laundry & linen service | $68,019 |
Source: CMS cost report (HCRIS, Form 2552-10), report 823802, 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 Petaluma Valley Hospital for an inpatient stay.
1.56
Case mix index
Higher than 34% 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).
28.6%
Low-income patient share
Disproportionate share percentage: Medicaid and SSI patient days CMS uses for safety-net payments (FY 2027).
791
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 | 1.50 | 1.50 | 1.67 | 1.61 | 1.58 | 1.54 | 1.56 |
| Wage index | 1.665 | 1.707 | 1.739 | 1.706 | 1.660 | 1.577 | 1.524 |
| Readmissions adjustment | -0.72% | -0.71% | -0.69% | -0.05% | -0.10% | -0.01% | 0.00% |
| Value-based purchasing adjustment | +0.99% | +0.31% | +0.31% | -0.28% | -1.56% | -1.02% | +0.14% |
| Medicare inpatient stays | 1,047 | 1,047 | 786 | 859 | 739 | 742 | 791 |
Source: CMS IPPS final rule Impact File (FY 2027).
Organizations Petaluma Valley Hospital reports to Medicare as owners or with operational control.
Norcal Healthconnect LLC
5% or greater direct ownership interest, since 2021
Providence Health & Services - Washington
Operational/managerial control, since 2021
St Joseph Health Northern California LLC
Operational/managerial control, since 2021
St. Joseph Health System
Operational/managerial control, since 2021
Sources: CMS Hospital All Owners, CMS Hospital Change of Ownership.
The officers and board members on Petaluma Valley 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 22 of 23 are shown.
340B drug pricing program
Participating since 2015
340B ID DSH050136, registered as a disproportionate share hospital; 7 active contract pharmacies. Authorizing official: Claire Julienne Tamo, CFO Northern California.
Source: HRSA 340B Office of Pharmacy Affairs Information System.
About Petaluma Valley Hospital's rates and hospital price transparency.
For CT abdomen and pelvis with contrast (CPT 74177), published negotiated rates at Petaluma Valley Hospital range from $611 to $3,653 across 3 insurers. UnitedHealthcare's rate is $611. The median at nearby comparable hospitals is $4,601. What a patient pays depends on their plan's deductible, coinsurance and network status.
For Colonoscopy with biopsy (CPT 45380), published negotiated rates at Petaluma Valley Hospital range from $7,260 to $24,227 across 4 insurers. Anthem Blue Cross / Blue Shield of CA's rate is $8,973. The median at nearby comparable hospitals is $2,621. 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 Petaluma Valley Hospital range from $14,939 to $24,396 across 3 insurers. Aetna's rate is $24,396. What a patient pays depends on their plan's deductible, coinsurance and network status.
For Screening mammography, bilateral (CPT 77067), published negotiated rates at Petaluma Valley Hospital range from $160 to $1,306 across 4 insurers. Anthem Blue Cross / Blue Shield of CA's rate is $1,306. The median at nearby comparable hospitals is $402. 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 Petaluma Valley Hospital range from $18,779 to $70,842 across 4 insurers. Aetna's rate is $70,842. The median at nearby comparable hospitals is $83,134. What a patient pays depends on their plan's deductible, coinsurance and network status.
Petaluma Valley 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 Petaluma Valley Hospital for fiscal year 2027.
No. Petaluma Valley Hospital has no Hospital Readmissions Reduction Program penalty in fiscal year 2027.
In 2024, the most common were septicemia or severe sepsis without mv >96 hours with mcc (123 discharges), heart failure and shock with mcc (45 discharges), simple pneumonia and pleurisy with mcc (32 discharges).
Petaluma Valley Hospital's Medicare case mix index is 1.56 for fiscal year 2027, higher than 34% of hospitals paid under the inpatient prospective payment system.
Petaluma Valley Hospital reported 1,758 inpatient discharges and 7,532 inpatient days from Jul 1, 2024 to Jun 30, 2025.
Petaluma Valley Hospital reported 266 full-time-equivalent employees on payroll from Jul 1, 2024 to Jun 30, 2025.
Petaluma Valley Hospital reported $85.6M in net patient revenue on $643.6M of gross charges for Jul 1, 2024 to Jun 30, 2025, an operating margin of -28.4%, and net income of -$24.1M.
Petaluma Valley Hospital reported $13.2M of unreimbursed and uncompensated care for Jul 1, 2024 to Jun 30, 2025, including $2.5M of charity care at cost.
Petaluma Valley Hospital's Medicare enrollment lists Laureen T Driscoll as Chief Executive since 2022.
Insurers' price transparency files list Petaluma Valley Hospital under employer identification number 85-2390012 (Healdsburg Hospital). 46 health plans and networks list 85-2390012 for it.
Yes. HRSA's 340B database lists Petaluma Valley Hospital (340B ID DSH050136) as a participating disproportionate share hospital since 2015, with 7 active contract pharmacies.
312 clinicians who bill Medicare list Petaluma Valley Hospital as a hospital affiliation in CMS's Doctors and Clinicians data. The largest groups are family medicine physician (54), internal medicine physician (27), family nurse practitioner (21).
Yes. CMS's Provider of Services file lists The Joint Commission as the accrediting organization for Petaluma Valley Hospital, effective 2026.
In its Medicare enrollment, Petaluma Valley Hospital reports Norcal Healthconnect LLC as 5% or greater direct ownership interest.
CMS lists 26 services at Petaluma Valley Hospital, including Acute Renal Dialysis, Adult Inpatient Psychiatric Care, Anesthesia, Clinical Laboratory, Coronary Care Unit, Dental Care.
In CMS's 2025 Hospital Service Area file, the most Medicare inpatient stays at Petaluma Valley Hospital came from ZIP codes 94954 (385), 94952 (299), 94928 (65).
Petaluma Valley Hospital has 58 beds, including its psychiatric, rehabilitation and other subprovider units, in its latest Medicare cost report. 97 are Medicare-certified beds in CMS's Provider of Services file. Facility type: Short Term Acute Care Hospital.
Petaluma Valley Hospital is located at 400 North Mcdowell Boulevard, Petaluma, CA 94954. Its main phone number is (707) 778-1111.
Petaluma Valley Hospital's CMS Certification Number (CCN), also called its Medicare provider number, is 050136.
The National Provider Identifier (NPI) on file for Petaluma Valley Hospital is 1235162645.
Petaluma Valley Hospital is affiliated with Providence Saint Joseph Health.
Petaluma Valley Hospital lists 35 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.
288 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