Urban and rural hospitals: how do they differ?

When the Health Care Financing Administration implemented the Medicare prospective payment system (PPS), the payment rates for inpatient hospital operating costs were derived on an urban and rural basis within each region. The rates were also adjusted for area wage levels and other factors affecting hospital costs. The effect of PPS on rural hospitals is of widespread interest. This article provides data on rural and urban hospital facilities, utilization, and charges, as of April 1985. Almost 48 percent of the 5,821 short stay hospitals included in the PPS recalibration file for Federal fiscal year 1984 are located in rural areas. Rural and urban areas are designated by the Executive Office of Management and Budget or, in some instances by regulation.

Differences

Comparison of facilities and rates

Although about equal in number nationally, rural hospitals differ markedly from urban hospitals in other characteristics and utilization. Rural hospitals are much smaller—less than one-third the size of urban hospitals in average bed size (76 beds to 252 beds per hospital). Rural hospitals have about one-fourth the total number (or 2.6 million) of Medicare discharges. Rural hospitals have a utilization rate (as measured by Medicare discharges per hospital), about one-third that for urban hospitals, 945 versus 2,704. The average length of stay for rural hospitals is two days shorter per Medicare discharge (7.4 days and 9.5 days, respectively). Rural hospitals account for only 15 percent of the more than $52 billion in total inpatient charges for Medicare stays.

Charges per discharge

Total charges per discharge in rural hospitals are only slightly more than one-half (56 percent) of total charges in urban hospitals, ($3,007 versus $5,367). Ancillary charges per discharge in rural hospitals follow a similar pattern ($1,782 versus $3,072). As a percent of total charges, ancillary charges are slightly higher in rural hospitals than in urban hospitals, 59 percent and 57 percent, respectively.

Case-mix index

The average case-mix index (CMI) reflects the relative costliness of treating a mix of cases compared to a national mix of cases. For rural hospitals, the CMI is 1.0229, compared to an average of 1.1423 for urban hospitals.

State differences

Distribution of hospitals

The distribution of rural and urban hospitals by State varies widely. The District of Columbia, New Jersey, and Rhode Island are classified as completely urban and have no rural hospitals. Another 14 States have less than 50 percent of the total hospitals classified as rural hospitals. Arizona and Indiana have an equal number of each. The remaining 32 States have a higher proportion of rural hospitals than urban hospitals, with Idaho, Montana, and South Dakota having more than 90 percent of their hospitals classified as rural.

Discharges

More than 50 percent of all Medicare discharges from rural hospitals occur in just 14 of the 48 States that have rural hospitals. In three of these States— Idaho, Mississippi, and Vermont—rural hospital discharges exceed 75 percent of the total number of discharges. In contrast, fewer than 5 percent of the discharges in California, Connecticut, and Massachusetts are from rural hospitals. The range of variation in the number of Medicare discharges per hospital is large from 134 discharges per rural hospital in Alaska to 4,857 discharges per urban hospital in Delaware.

Average length of stay

Variation in the average length of stay (ALOS) is significant between States, and between rural and urban hospitals within States. New York has the longest ALOS, 13.7 days, comprised of 13.9 days for urban hospitals, and 12.2 days for rural hospitals. Short-stay hospitals in Idaho have the shortest ALOS, 6.3 days. The State of Oregon has the shortest ALOS for urban hospitals, 6.6 days, and Utah has the shortest ALOS for rural hospitals, 5.4 days.

Nationally, the difference in ALOS between urban and rural hospitals is 2.1 days. Of the 48 States that have rural hospitals, 40 States have absolute differences between urban and rural hospital ALOS lower than the absolute difference for the national urban and rural ALOS. The difference in ALOS between urban and rural hospitals in the State of Idaho is a mere one-half day; the differences in the States of Alaska and Hawaii approach 3 days.

Total charges per discharge

Total charges per discharge by State for all hospitals are nearly three times higher in the District of Columbia ($8,659) than in Mississippi ($3,050). Total charges per discharge are higher in urban hospitals than in rural hospitals in every State. The differences in two States, West Virginia and New Hampshire, are minimal, where charges in rural hospitals are 80 and 94 percent of charges in urban hospitals, respectively. At the other extreme, total charges per discharge in rural hospitals in Nevada reached only 40 percent of charges in urban hospitals. The lowest total charges per discharge for urban hospitals, $3,666, are found in the State of Arkansas. The highest average charges per discharge for urban hospitals are in the District of Columbia, $8,659. Minnesota has the lowest charges per discharge, $2,347, for rural hospitals, and California has the highest, $4,734.

Ancillary charges per discharge

Ancillary charges per discharge for all hospitals by State vary by a factor in excess of three. For example, ancillary charges per discharge in Nevada ($5,276) are three times higher than in Vermont ($1,695). For rural hospitals, Minnesota ($1,255) and California ($3,049) are at the extreme ends of the range of ancillary charges per discharge, as was the case for total charges per discharge. For urban hospital ancillary charges per discharge, the range is defined by the States of New Hampshire, $2,037 and Nevada, $5,713. By State, ancillary charges as a percent of total charges for rural hospitals are characterized by less variation, with Vermont beginning the range at 45 percent, and Louisiana limiting the range at 71 percent. The range for urban hospitals extends from 43 percent in New York to 72 percent in Nevada.

Table 1

Number and percent distribution of urban and rural hospitals, by State: Federal fiscal year 1984

State	Total	Urban hospitals		Rural hospitals
		Number	Percent	Number	Percent
United States	5,821	3,041	52.2	2,780	47.8
Alabama	129	56	43.4	73	56.6
Alaska	22	3	13.6	19	86.4
Arizona	72	36	50.0	36	50.0
Arkansas	96	19	19.8	77	80.2
California	486	425	87.4	61	12.6
Colorado	80	33	41.3	47	58.8
Connecticut	35	33	94.3	2	5.7
Delaware	7	3	42.9	4	57.1
District of Columbia	11	11	100.0	0	0.0
Florida	217	177	81.6	40	18.4
Georgia	166	68	41.0	98	59.0
Hawaii	19	9	47.4	10	52.6
Idaho	45	2	4.4	43	95.6
Illinois	240	149	62.1	91	37.9
Indiana	118	59	50.0	59	50.0
Iowa	130	26	20.0	104	80.0
Kansas	145	21	14.5	124	85.5
Kentucky	106	30	28.3	76	71.7
Louisiana	144	69	47.9	75	52.1
Maine	45	19	42.2	26	57.8
Maryland	53	46	86.8	7	13.2
Massachusetts	110	104	94.5	6	5.5
Michigan	204	124	60.8	80	39.2
Minnesota	171	55	32.2	116	67.8
Mississippi	118	15	12.7	103	87.3
Missouri	151	73	48.3	78	51.7
Montana	63	4	6.3	59	93.7
Nebraska	99	13	13.1	86	86.9
Nevada	24	13	54.2	11	45.8
New Hampshire	27	13	48.1	14	51.9
New Jersey	94	94	100.0	0	0.0
New Mexico	49	11	22.4	38	77.6
New York	260	202	77.7	58	22.3
North Carolina	134	51	38.1	83	61.9
North Dakota	54	8	14.8	46	85.2
Ohio	194	126	64.9	68	35.1
Oklahoma	132	44	33.3	88	66.7
Oregon	75	34	45.3	41	54.7
Pennsylvania	228	181	79.4	47	20.6
Rhode Island	14	14	100.0	0	0.0
South Carolina	73	33	45.2	40	54.8
South Dakota	63	5	7.9	58	92.1
Tennessee	147	69	46.9	78	53.1
Texas	471	241	51.2	230	48.8
Utah	39	16	41.0	23	59.0
Vermont	16	2	12.5	14	87.5
Virginia	102	56	54.9	46	45.1
Washington	105	56	53.3	49	46.7
West Virginia	66	19	28.8	47	71.2
Wisconsin	145	68	46.9	77	53.1
Wyoming	27	3	11.1	24	88.9

Prospective payment system recalibration file.

Table 2

Number of beds and average bed size of urban and rural hospitals, by State: Federal fiscal year 1984

State	Total		Urban		Rural
	Number of beds	Average bed size	Number of beds	Average bed size	Number of beds	Average bed size
United States	976,787	168	766,610	252	210,177	76
Alabama	19,345	150	13,809	247	5,536	76
Alaska	1,255	57	601	200	654	34
Arizona	10,419	145	8,309	231	2,110	59
Arkansas	10,892	113	4,928	259	5,964	77
California	82,109	169	78,967	186	3,142	52
Colorado	10,978	137	8,794	266	2,184	46
Connecticut	10,677	305	10,374	314	303	152
Delaware	2,026	289	1,408	469	618	155
District of Columbia	4,438	403	4,438	403	0	—
Florida	50,557	233	47,037	266	3,520	88
Georgia	24,552	148	16,227	239	8,325	85
Hawaii	2,356	124	1,796	200	560	56
Idaho	2,884	64	521	261	2,363	55
Illinois	55,549	231	46,525	312	9,024	99
Indiana	24,465	207	18,254	309	6,211	105
Iowa	14,827	114	7,954	306	6,873	66
Kansas	12,663	87	5,901	281	6,762	55
Kentucky	15,589	147	8,549	285	7,040	93
Louisiana	19,824	138	14,754	214	5,070	68
Maine	4,681	104	2,769	146	1,912	74
Maryland	14,876	281	13,872	302	1,004	143
Massachusetts	25,241	229	24,572	236	669	112
Michigan	38,183	187	32,132	259	6,051	76
Minnesota	18,783	110	13,117	238	5,666	49
Mississippi	12,858	109	3,471	231	9,387	91
Missouri	28,247	187	20,857	286	7,390	95
Montana	3,696	59	979	245	2,717	46
Nebraska	8,937	90	3,858	297	5,079	59
Nevada	3,409	142	3,033	233	376	34
New Hampshire	3,206	119	1,971	152	1,235	88
New Jersey	29,135	310	29,135	310	0	—
New Mexico	4,319	88	2,200	200	2,119	56
New York	73,493	283	67,126	332	6,367	110
North Carolina	23,163	173	13,483	264	9,680	117
North Dakota	3,753	70	1,545	193	2,208	48
Ohio	49,014	253	40,563	322	8,451	124
Oklahoma	14,434	109	8,932	203	5,502	63
Oregon	8,998	120	6,261	184	2,737	67
Pennsylvania	52,686	231	45,898	254	6,788	144
Rhode Island	3,465	248	3,465	248	0	—
South Carolina	11,204	153	7,079	215	4,125	103
South Dakota	3,776	60	1,200	240	2,576	44
Tennessee	25,149	171	18,671	271	6,478	83
Texas	63,724	135	51,188	212	12,536	55
Utah	4,351	112	3,405	213	946	41
Vermont	2,059	129	643	322	1,416	101
Virginia	21,627	212	15,978	285	5,649	123
Washington	11,820	113	9,386	168	2,434	50
West Virginia	10,069	153	4,688	247	5,381	114
Wisconsin	21,292	147	15,419	227	5,873	76
Wyoming	1,734	64	568	189	1,166	49

Prospective payment system recalibration file.

Table 3

Number and percent of Medicare discharges from urban and rural hospitals, by State: Federal fiscal year 1984

State	Total discharges	Urban hospital discharges		Rural hospital discharges
		Number	Percent	Number	Percent
United States	10,849,957	8,224,020	75.8	2,625,937	24.2
Alabama	218,616	153,048	70.0	65,568	30.0
Alaska	4,852	2,314	47.7	2,538	52.3
Arizona	122,380	102,643	83.9	19,737	16.1
Arkansas	157,476	66,347	42.1	91,129	57.9
California	912,430	870,446	95.4	41,984	4.6
Colorado	97,127	76,589	78.9	20,538	21.1
Connecticut	128,720	124,407	96.6	4,313	3.4
Delaware	23,427	14,571	62.2	8,856	37.8
District of Columbia	30,676	30,676	100.0	0	0.0
Florida	699,923	638,748	91.3	61,175	8.7
Georgia	271,506	163,479	60.2	108,027	39.8
Hawaii	23,862	18,226	76.4	5,636	23.6
Idaho	36,231	7,421	20.5	28,810	79.5
Illinois	540,106	423,031	78.3	117,075	21.7
Indiana	264,559	189,918	71.8	74,641	28.2
Iowa	154,012	77,202	50.1	76,810	49.9
Kansas	133,083	56,997	42.8	76,086	57.2
Kentucky	186,866	91,592	49.0	95,274	51.0
Louisiana	204,995	142,002	69.3	62,993	30.7
Maine	60,673	33,307	54.9	27,366	45.1
Maryland	160,007	144,788	90.5	15,219	9.5
Massachusetts	300,210	288,156	96.0	12,054	4.0
Michigan	401,317	323,615	80.6	77,702	19.4
Minnesota	194,341	124,490	64.1	69,851	35.9
Mississippi	159,399	39,099	24.5	120,300	75.5
Missouri	305,499	213,143	69.8	92,356	30.2
Montana	38,140	12,172	31.9	25,968	68.1
Nebraska	96,539	43,728	45.3	52,811	54.7
Nevada	33,752	29,864	88.5	3,888	11.5
New Hampshire	37,744	22,312	59.1	15,432	40.9
New Jersey	321,934	321,934	100.0	0	0.0
New Mexico	44,195	21,970	49.7	22,225	50.3
New York	764,866	677,797	88.6	87,069	11.4
North Carolina	246,532	139,861	56.7	106,671	43.3
North Dakota	47,676	21,394	44.9	26,282	55.1
Ohio	453,186	374,353	82.6	78,833	17.4
Oklahoma	166,403	94,170	56.6	72,233	43.4
Oregon	120,989	83,754	69.2	37,235	30.8
Pennsylvania	678,550	582,355	85.8	96,195	14.2
Rhode Island	46,475	46,475	100.0	0	0.0
South Carolina	124,892	79,602	63.7	45,290	36.3
South Dakota	44,173	15,405	34.9	28,768	65.1
Tennessee	299,096	208,245	69.6	90,851	30.4
Texas	674,777	505,110	74.9	169,667	25.1
Utah	37,523	29,268	78.0	8,255	22.0
Vermont	21,614	5,342	24.7	16,272	75.3
Virginia	221,233	146,549	66.2	74,684	33.8
Washington	167,003	130,642	78.2	36,361	21.8
West Virginia	123,400	52,836	42.8	70,564	57.2
Wisconsin	231,656	157,898	68.2	73,758	31.8
Wyoming	15,316	4,729	30.9	10,587	69.1

Prospective payment system recalibration file.

Table 4

Medicare discharges per urban and rural hospital, average length of stay, and case-mix index, by State: Federal fiscal year 1984

State	Total			Urban			Rural
	Discharges per hospital	ALOS in days	CMI	Discharges per hospital	ALOS in days	CMI	Discharges per hospital	ALOS in days	CMI
United States	1,864	9.0	1.1134	2,704	9.5	1.1423	945	7.4	1.0229
Alabama	1,695	8.1	1.0812	2,733	8.4	1.1169	898	7.2	0.9979
Alaska	221	7.8	1.0572	771	9.3	1.1358	134	6.5	0.9856
Arizona	1,700	7.8	1.1613	2,851	8.1	1.1837	548	6.5	1.0449
Arkansas	1,640	7.2	1.0531	3,492	7.9	1.1276	1,183	6.7	0.9988
California	1,877	7.6	1.1649	2,048	7.7	1.1684	688	6.2	1.0931
Colorado	1,214	7.7	1.1245	2,321	8.1	1.1464	437	6.4	1.0426
Connecticut	3,678	9.7	1.1944	3,770	9.7	1.1966	2,157	8.8	1.1302
Delaware	3,347	10.4	1.1038	4,857	11.0	1.1285	2,214	9.5	1.0632
District of Columbia	2,789	12.2	1.1956	2,789	12.2	1.1956	0	—	—
Florida	3,225	8.3	1.1346	3,609	8.5	1.1437	1,529	7.0	1.0400
Georgia	1,636	7.5	1.0964	2,404	8.1	1.1509	1,102	6.6	1.0139
Hawaii	1,256	8.7	1.2053	2,025	9.4	1.2463	564	6.6	1.0730
Idaho	805	6.3	1.1131	3,711	6.7	1.3119	670	6.2	1.0619
Illinois	2,250	9.6	1.1003	2,839	10.1	1.1271	1,287	7.8	1.0033
Indiana	2,242	8.8	1.1014	3,219	9.2	1.1363	1,265	7.7	1.0124
Iowa	1,185	8.0	1.1185	2,969	9.0	1.1924	739	6.9	1.0442
Kansas	918	7.7	1.1021	2,714	8.3	1.1974	614	7.2	1.0307
Kentucky	1,763	8.4	1.0696	3,053	9.2	1.1256	1,254	7.7	1.0158
Louisiana	1,424	7.8	1.0727	2,058	8.2	1.1194	840	6.7	0.9676
Maine	1,348	8.4	1.1096	1,753	9.2	1.1560	1,053	7.4	1.0531
Maryland	3,019	10.3	1.0968	3,148	10.4	1.0971	2,174	9.3	1.0938
Massachusetts	2,729	11.5	1.0876	2,771	11.6	1.0890	2,009	9.3	1.0539
Michigan	1,967	9.2	1.1085	2,610	9.5	1.1249	971	7.6	1.0400
Minnesota	1,136	7.5	1.1600	2,263	8.1	1.2235	602	6.5	1.0468
Mississippi	1,351	7.7	1.0148	2,607	8.5	1.1003	1,168	7.4	0.9870
Missouri	2,023	8.7	1.1173	2,920	9.3	1.1611	1,184	7.4	1.0161
Montana	605	6.9	1.1147	3,043	8.1	1.2339	440	6.4	1.0588
Nebraska	975	7.8	1.0793	3,364	8.7	1.1630	614	7.0	1.0100
Nevada	1,406	7.8	1.1737	2,297	8.0	1.1917	353	5.6	1.0353
New Hampshire	1,398	8.5	1.0913	1,716	8.9	1.0855	1,102	7.9	1.0998
New Jersey	3,425	12.0	1.1278	3,425	12.0	1.1278	0	—	—
New Mexico	902	7.2	1.1105	1,997	7.7	1.1838	585	6.8	1.0381
New York	2,942	13.7	1.0892	3,355	13.9	1.0980	1,501	12.2	1.0206
North Carolina	1,840	8.7	1.1218	2,742	9.2	1.1638	1,285	7.9	1.0667
North Dakota	883	7.7	1.0750	2,674	8.8	1.2036	571	6.7	0.9704
Ohio	2,336	9.2	1.1299	2,971	9.5	1.1509	1,159	7.8	1.0302
Oklahoma	1,261	7.7	1.0971	2,140	8.2	1.1635	821	7.1	1.0105
Oregon	1,613	6.4	1.1658	2,463	6.6	1.2073	908	6.0	1.0725
Pennsylvania	2,976	9.9	1.1197	3,217	10.1	1.1302	2,047	8.6	1.0561
Rhode Island	3,320	10.2	1.1638	3,320	10.2	1.1638	0	—	—
South Carolina	1,711	8.7	1.1144	2,412	9.0	1.1526	1,132	8.1	1.0472
South Dakota	701	7.2	1.0611	3,081	8.3	1.1931	496	6.6	0.9905
Tennessee	2,035	8.6	1.0677	3,018	9.1	1.1134	1,165	7.4	0.9629
Texas	1,433	8.0	1.1002	2,096	8.4	1.1389	738	6.9	0.9848
Utah	962	6.5	1.2264	1,829	6.8	1.2793	359	5.4	1.0392
Vermont	1,351	8.8	1.1206	2,671	9.9	1.3323	1,162	8.5	1.0511
Virginia	2,169	9.2	1.0932	2,617	9.7	1.1339	1,624	8.3	1.0132
Washington	1,591	6.6	1.1828	2,333	7.0	1.2110	742	5.5	1.0817
West Virginia	1,870	8.1	1.0533	2,781	8.7	1.0984	1,501	7.6	1.0195
Wisconsin	1,598	8.3	1.1285	2,322	8.8	1.1576	958	7.0	1.0663
Wyoming	567	7.4	1.0373	1,576	9.2	1.1181	441	6.6	1.0012

Prospective payment system recalibration file.

NOTES: ALOS is average length of stay. CMI is case-mix index.

Table 5

Total charge per Medicare discharge, ancillary charge, and percent of ancillary charge to total for rural and urban hospitals, by State: Federal fiscal year 1984

State	Total			Urban			Rural
	Total charge per discharge	Ancillary charge per discharge	Percent	Total charge per discharge	Ancillary charge per discharge	Percent	Total charge per discharge	Ancillary charge per discharge	Percent
United States	$4,796	$2,760	57.5	$5,367	$3,072	57.2	$3,007	$1,782	59.3
Alabama	4,454	3,032	68.1	5,009	3,400	67.9	3,159	2,174	68.8
Alaska	5,320	2,506	47.1	6,848	3,180	46.4	3,926	1,891	48.2
Arizona	4,907	3,037	61.9	5,227	3,220	61.6	3,246	2,085	64.2
Arkansas	3,063	1,951	63.7	3,666	2,349	64.1	2,625	1,661	63.3
California	6,533	3,930	60.2	6,620	3,973	60.0	4,734	3,049	64.4
Colorado	4,449	2,615	58.8	4,808	2,854	59.4	3,111	1,726	55.5
Connecticut	4,939	2,713	54.9	4,985	2,745	55.1	3,633	1,778	48.9
Delaware	4,804	2,359	49.1	5,390	2,544	47.2	3,839	2,055	53.5
District of Columbia	8,659	4,368	50.4	8,659	4,368	50.4	0	0	0.0
Florida	5,327	3,638	68.3	5,468	3,734	68.3	3,854	2,635	68.4
Georgia	3,631	2,397	66.0	4,191	2,744	65.5	2,785	1,872	67.2
Hawaii	5,193	2,959	57.0	5,818	3,353	57.6	3,171	1,685	53.2
Idaho	3,169	1,828	57.7	3,837	2,263	59.0	2,996	1,716	57.3
Illinois	5,724	3,212	56.1	6,428	3,597	56.0	3,181	1,820	57.2
Indiana	3,712	2,054	55.3	4,156	2,323	55.9	2,583	1,371	53.1
Iowa	3,594	2,051	57.1	4,553	2,617	57.5	2,631	1,483	56.4
Kansas	3,607	2,126	58.9	4,853	3,053	62.9	2,673	1,431	53.5
Kentucky	3,610	1,975	54.7	4,315	2,292	53.1	2,933	1,671	57.0
Louisiana	4,146	2,810	67.8	4,690	3,138	66.9	2,922	2,069	70.8
Maine	4,321	2,405	55.7	4,895	2,744	56.0	3,621	1,993	55.0
Maryland	4,308	2,076	48.2	4,451	2,137	48.0	2,954	1,493	50.5
Massachusetts	5,474	2,842	51.9	5,544	2,877	51.9	3,788	1,995	52.7
Michigan	5,509	2,874	52.2	6,019	3,134	52.1	3,388	1,793	52.9
Minnesota	3,663	2,040	55.7	4,402	2,480	56.3	2,347	1,255	53.5
Mississippi	3,050	2,121	69.5	4,042	2,908	71.9	2,728	1,865	68.4
Missouri	4,674	2,868	61.4	5,378	3,313	61.6	3,052	1,842	60.3
Montana	3,477	1,968	56.6	4,681	2,720	58.1	2,912	1,615	55.4
Nebraska	3,493	2,216	63.4	4,824	3,229	66.9	2,390	1,377	57.6
Nevada	7,349	5,276	71.8	7,890	5,713	72.4	3,193	1,922	60.2
New Hampshire	3,848	1,967	51.1	3,940	2,037	51.7	3,714	1,865	50.2
New Jersey	4,570	2,141	46.8	4,570	2,141	46.8	0	0	0.0
New Mexico	4,298	2,717	63.2	5,134	3,295	64.2	3,471	2,146	61.8
New York	5,922	2,530	42.7	6,246	2,647	42.4	3,403	1,620	47.6
North Carolina	3,543	2,129	60.1	3,983	2,393	60.1	2,966	1,784	60.2
North Dakota	3,662	2,167	59.2	4,761	2,935	61.6	2,768	1,542	55.7
Ohio	4,742	2,460	51.9	5,068	2,618	51.7	3,197	1,711	53.5
Oklahoma	4,013	2,646	65.9	4,785	3,227	67.4	3,005	1,887	62.8
Oregon	3,942	2,183	55.4	4,242	2,347	55.3	3,265	1,814	55.6
Pennsylvania	6,153	3,388	55.1	6,526	3,601	55.2	3,896	2,102	53.9
Rhode Island	4,440	2,160	48.6	4,440	2,160	48.6	0	0	0.6
South Carolina	3,928	2,497	63.6	4,328	2,811	64.9	3,225	1,947	60.4
South Dakota	3,159	1,850	58.6	4,160	2,518	60.5	2,623	1,492	56.9
Tennessee	4,154	2,769	66.7	4,783	3,211	67.1	2,713	1,756	64.7
Texas	3,977	2,582	64.9	4,513	2,957	65.5	2,381	1,467	61.6
Utah	3,592	2,161	60.2	3,893	2,344	60.2	2,524	1,512	59.9
Vermont	3,631	1,695	46.7	4,981	2,524	50.7	3,188	1,423	44.6
Virginia	4,352	2,585	59.4	4,916	2,919	59.4	3,245	1,928	59.4
Washington	3,788	2,063	54.5	4,042	2,193	54.3	2,873	1,595	55.5
West Virginia	3,715	2,236	60.2	4,202	2,493	59.3	3,350	2,043	61.0
Wisconsin	3,791	2,261	59.6	4,287	2,528	59.0	2,727	1,688	61.9
Wyoming	3,351	2,026	60.5	4,072	2,370	58.2	3,029	1,872	61.8

Prospective payment system recalibration file.