Primary cohort
The 2024 explorer uses the pivot workbook's curated Data sheet and filters to TYPE_CARE = General Acute and TYPE_HOSP = Comparable. That produces 299 facilities.
Methodology
Methods and limitations
How this draft release builds the 299-hospital cohort, calculates each measure and links other sources. Facility values come from the downloaded Department of Health Care Access and Information (HCAI) workbook. The state open-data portal (CKAN) holds only aggregate rows, which are used for reconciliation.
Duplicate handling
6 displaced duplicate or partial-period rows remain documented on the workbook's Duplicates sheet but are excluded from analysis. Historical files retain the latest ending record for duplicate facility numbers.
Reporting periods
Values are shown as reported, without annualization. The 7 hospitals that did not report all 366 days of leap-year 2024 are flagged.
Care types and utilization
6 HCAI care types reconcile to each hospital’s licensed beds, patient days and discharges. Licensed beds exclude suspended beds and nursery bassinets. Discharges include transfers between care types, so they are not unique patients. Admissions are a distinct complete-disclosure field (page 18, column 13, line 170). Admissions are available for 296 of 299 cohort hospitals, from reports with the same begin and end dates as the annual record. The other 3 are blank in the source and are not imputed.
Adjusted discharge cost
Adjusted discharges equal DIS_TOT × (GR_PT_REV / GR_IP_TOT). Cost per adjusted discharge divides reported operating expense by that inpatient-equivalent volume.
Income and liquidity
Net income equals the operating result plus nonoperating revenue, less nonoperating expense and income taxes. All 299 income bridges are available to download. Net income margin uses total revenue. Annual reported reserve assets equal CASH + ASST_LIMTD. Reserve days divide that balance by daily operating expense net of depreciation. INV_OTH is excluded because it mixes investments with other noncurrent assets. Reserve days are not unrestricted days cash on hand.
Regional rollups
14 HCAI Health Service Areas use one taxonomy. Finance uses ratios of sums. Quality uses unweighted summaries of matched hospitals. Office of Health Care Affordability (OHCA) and quarterly fields use hospital medians, with denominators shown. A Health Service Area (HSA) is a reporting region, not a legal market.
Identifier-only linkage
HCAI IDs, Medicare certification numbers (CCNs) and National Provider Identifiers (NPIs) link the public files. When a hospital has no match in a Centers for Medicare & Medicaid Services (CMS), Agency for Healthcare Research and Quality (AHRQ), OHCA, HCAI mortality, quarterly or equity file, its fields are left blank. Records are never matched by name.
Market structure
Within each California residence county, combine the disjoint Inpatient (not from ED) and Inpatient from ED settings; exclude ED Only and AS Only. Aggregate by stable facility ID, not name. Shares divide each facility's inpatient discharges by all included discharges for that county. HHI is the sum of squared percentage shares (0–10,000). System HHI groups only explicit AHRQ 2023 system IDs reached through documented HCAI-to-CCN links; all others remain separately identified and unclassified. The patient-origin population is broader than the 299-hospital comparable financial cohort; discharge totals are not interchangeable. Residence counties are descriptive screens, not antitrust markets. No adjustment for service, payer or travel time is made. Non-California and unknown residences are excluded and tabulated. AHRQ 2023 affiliations predate 2024 flows. Unclassified does not mean independent; incomplete system linkage may understate concentration. This raw workbook contains numeric counts; suppression rules from other HCAI products are not assumed. A separate 9-hospital documented ownership sensitivity tests year-end ownership against the 2023 baseline; the largest change is in San Francisco County, where system HHI moves from 1,687.0 to 1,978.2. It covers documented 2024 closings only and does not estimate merger effects.
Separate quality constructs
CMS overall ratings, HCAI condition-level mortality ratings and hospital equity reports are shown separately. No composite score is calculated.
Payer allocation
Net patient revenue for each broad payer group is compared with the operating expense HCAI allocates to that group. The difference reflects an accounting allocation and does not measure payer profitability.
Price evidence matrix
The 5 free peer-reviewed California studies differ in payer, service, period, price concept and design, so they are shown separately and not pooled. OHCA revenue per adjusted unit is not treated as a negotiated price. A focused literature search on September 26, 2026 found no new peer-reviewed California-specific hospital price study from 2025 or 2026. Read the search decisions.
Matched CMS comparisons
5 CMS comparisons use the same measure definitions and, where applicable, the same periods. Suppressed results are excluded. Both geographies use unweighted hospital means for ratings, HCAHPS and SEP-1, a median of hospital medians for ED time, and reporting-hospital shares for emergency-service availability. U.S. values include California.
Expanded national context
7 AHA/CMS rows cover capacity, volume, ownership, system affiliation, and spending. Each row shows its numerator, denominator and comparability class. Contextual rows are not used as rankings.
Federal exposure screen
The 1%, 3% and 5% values are analyst-selected sensitivities applied to 2024 Medi-Cal net patient revenue. They are not official estimates or forecasts. The separate Hospital Quality Assurance Fee (HQAF) cap calculation holds the fee base constant and does not measure hospital payment losses.
Dated policy status
Each of the 25 timeline events carries its source status, such as enacted, final rule, proposed rule, approved or scheduled, as of September 26, 2026.
Metric registry
Definitions used in the explorer
Derived metrics return no value when the denominator is zero or missing. Currency is reported in nominal dollars.
Licensed beds
bedsBeds licensed for use, excluding nursery bassinets.
BED_LICPatient days
daysCensus days for formally admitted patients; nursery and purchased inpatient days are excluded.
DAY_TOTDischarges
dischargesFormal inpatient releases, including deaths and transfers between types of care.
DIS_TOTOutpatient visits
visitsHospital outpatient appearances across reported ambulatory and referred services.
VIS_TOTEmergency room visits
visitsUnscheduled emergency room visits reported during the facility period.
VIS_ERAvailable-bed occupancy
percentPatient days divided by available bed days.
DAY_TOT / (BED_AVL × DAY_PER)Average length of stay
daysApproximate inpatient days per discharge, including long-term care.
DAY_TOT / DIS_TOTTotal operating revenue
USDNet patient revenue plus other operating revenue.
NET_PT_REV + OTH_OP_REVOperating expense
USDCosts incurred by operating cost centers; excludes specified nonoperating items.
TOT_OP_EXPNet from operations
USDTotal operating revenue less total operating expense.
NET_FRM_OPOperating margin
percentShare of operating revenue remaining after operating expenses.
NET_FRM_OP / total operating revenueNet income
USDReported income after operating and nonoperating activity and applicable taxes.
NET_INCOMENet income margin
percentNet income divided by operating and nonoperating revenue.
NET_INCOME / (total operating revenue + NONOP_REV)Current ratio
ratioCurrent assets per dollar of current liabilities.
CUR_ASST / CUR_LIABDays in accounts receivable
daysApproximate collection period for net accounts receivable.
ACCTS_REC / (NET_PT_REV / DAY_PER)Adjusted discharges
adjusted dischargesHCAI-style inpatient-equivalent volume that scales discharges for outpatient activity. Undefined when gross inpatient revenue is zero or missing.
DIS_TOT × (GR_PT_REV / GR_IP_TOT)Operating cost per adjusted discharge
USDReported operating expense per inpatient-equivalent adjusted discharge using the HCAI adjusted-discharge method.
TOT_OP_EXP / adjusted dischargesCash
USDReported cash balance at the end of the reporting period. Not equivalent to days cash on hand; some hospitals report liquidity at a system level.
CASHAssets limited as to use
USDReported assets whose use is limited by agreement, designation, or other restriction. Do not treat all balances as unrestricted operating liquidity.
ASST_LIMTDInvestments and other assets
USDReported investments and other noncurrent assets. The selected field may include assets that are not liquid or available for operations.
INV_OTHCash to annual operating expense
percentCash balance as a share of annual operating expense. A simple liquidity indicator, not HCAI days cash on hand.
CASH / TOT_OP_EXPReported reserve assets
USDA reproducible annual balance-sheet screen combining reported cash and assets limited as to use. This is not unrestricted liquidity. ASST_LIMTD can include board-designated, trustee-held, or otherwise limited assets; INV_OTH is excluded because it also contains nonliquid other assets.
CASH + ASST_LIMTDReported reserve days
daysReported reserve assets divided by average daily cash operating expense for the facility's actual reporting period. A balance-sheet exposure screen, not unrestricted days cash on hand and not directly comparable with rating-agency or system-level liquidity measures.
(CASH + ASST_LIMTD) / ((TOT_OP_EXP - EXP_DEPRE) / DAY_PER)Payer revenue less allocated operating expense
USDNet patient revenue minus HCAI-allocated operating expense for each broad payer group. An accounting allocation, not a negotiated-price or causal profitability measure.
NETRV payer fields − allocated payer expense fieldsHospital FTEs
FTEReported hospital full-time-equivalent workforce.
HOSP_FTEReporting-period exceptions
7 hospitals with nonstandard reporting periods
Each remains in the cohort because it is the facility's curated record. Compare them with full-year reporters only with a note.
ST. FRANCIS MEMORIAL HOSPITAL2023-07-01 to 2024-07-31 · 397 daysST. MARY'S MEDICAL CENTER - SAN FRANCISCO2023-07-01 to 2024-07-31 · 397 daysUCI HEALTH-FOUNTAIN VALLEY2024-03-27 to 2024-06-30 · 96 daysUCI HEALTH-LAKEWOOD2024-03-27 to 2024-06-30 · 96 daysUCI HEALTH-LOS ALAMITOS2024-03-27 to 2024-06-30 · 96 daysUCI HEALTH-PLACENTIA LINDA2024-03-27 to 2024-06-30 · 96 daysUCLA WEST VALLEY MEDICAL CENTER2024-03-29 to 2024-06-30 · 94 days
Automated data checks
Nonstandard report periods
Flagged on facility profiles; values are not silently annualized.
County not reported
Retained as County not reported; excluded from named-county claims.
Displaced duplicate/partial-period rows
Excluded from the curated Data sheet and primary analysis.
CKAN DataStore is aggregate-only
Used only for statewide Profile reconciliation; facility data come from the downloaded workbook.
Liquidity categories are not interchangeable
Cash, assets limited as to use, and investments/other assets are displayed separately; annual data are not labeled as HCAI days cash on hand.
Reported reserve days is a bounded annual screen
Calculated only from CASH + ASST_LIMTD and cash operating expense net of depreciation over the actual reporting period. INV_OTH is excluded, and the result is not labeled unrestricted days cash on hand.
Adjusted-discharge cost is derived
Calculated from source fields using HCAI's published adjusted-discharge formula; zero or missing gross inpatient revenue produces no value.
Cross-source linkage
Linkage coverage by source
Every linked row is keyed to the same 299-hospital cohort. Coverage varies because source populations and reporting requirements differ.
core facility count
Expected 299
unique enrichment rows
Expected 299
annual identifier linkage
>=95%
cms linkage
>=80%
cms quality ccn linkage
>=80%
hcahps national exact match
Expected true
ohca 2023 linkage
>=90%
market county coverage
Expected 58
regional cross domain rollups
Expected 14
california us benchmarks
Expected >=5 directly comparable rows
national capacity utilization ownership spending
Expected 7
peer reviewed california price evidence
Expected 5
federal medi cal scenario reconciliation
Expected 44304434123
dated policy timeline
Expected >=10 dated events
AI-use disclosure
AI assistance supported code, drafting, and quality-control preparation for this draft release. Findings may change before the final Almanac.