American Hospital Directory - Fort Memorial Hospital (520071)

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Financial data for hospital cost report period ending 09/30/2023 (HCRIS 766018 - 2010).
Medicare IPPS claims data are for federal fiscal year ending 09/30/2023 (Proposed rule MedPAR).
Medicare OPPS claims data are for calendar year ending 12/31/2022 (Final rule OPPS).
Data from other sources and their effective periods are identified within report headers.
Errata: Please notify us by email of any corrections or updates.

Fort Atkinson, WI 53538

CMS Certification Number: 520071

Name and Address:	Fort Memorial Hospital 611 Sherman Avenue East Fort Atkinson, WI 53538
Telephone Number:	(920) 568-5000
Hospital Website:	www.forthealthcare.com
CMS Certification Number:	520071

Type of Facility:	Short Term Acute Care
Type of Control:	Voluntary Nonprofit, Other
Total Staffed Beds:	49

Total Patient Revenue:	$434,946,844
Total Discharges:	1,278
Total Patient Days:	4,520
TPS Quality Score:	30.00
Patient Experience Rating:

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Cardiovascular Services: Cardiac Rehab
Emergency Services: Emergency Department
Orthopedic Services: Arthroscopy; Joint Replacement
Other Services: Obstetrics
Radiology / Nuclear Medicine / Imaging: Computed Tomography (CT); Computed Tomography-Angiography (CTA); Digital Mammography; Magnetic Resonance Imaging (MRI); Single Photon Emission Computerized Tomography (SPECT)

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	Number Medicare Inpatients	Average Length of Stay	Average Charges	Medicare Case Mix Index (CMI)
Cardiology	50	2.86	$30,864	1.2329
Medicine	124	3.51	$32,229	1.5505
Neurology	18	2.67	$32,384	1.4520
Orthopedic Surgery	31	4.10	$46,574	2.5330
Pulmonology	79	3.25	$31,882	1.3021
Surgery	52	5.56	$53,561	2.7679
Urology	33	3.42	$27,405	1.2104
Total	407	3.62	$35,144	1.6494

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Medicare Hospital Market Service Area File for calendar year ending 12/31/2022 / Definitions

ZIP Code of Residence	Discharges	Days of Care	Charges	Discharges Inc/(Dec)	Market Share
53538	231	850	$8,205,626	20.9%	40.5%
53549	105	346	$3,311,372	12.9%	32.4%
53190	96	307	$3,027,643	10.3%	24.2%

APC Number	APC Description	Number Patient Claims	Average Charge	Average Cost
5115	Level 5 Musculoskeletal Procedures	85	$11,804	$2,793
8011	Comprehensive Observation Services	367	$1,084	$328
5054	Level 4 Skin Procedures	312	$2,229	$729
5012	Clinic Visits and Related Services	8,098	$188	$61
5114	Level 4 Musculoskeletal Procedures	88	$13,854	$3,278
5024	Level 4 Type A ED Visits	1,139	$843	$255
5312	Level 2 Lower GI Procedures	314	$4,922	$1,075
5693	Level 3 Drug Administration	1,258	$366	$100
5025	Level 5 Type A ED Visits	622	$1,051	$318
5113	Level 3 Musculoskeletal Procedures	104	$9,111	$2,156
5491	Level 1 Intraocular Procedures	139	$8,922	$2,111
5051	Level 1 Skin Procedures	1,345	$580	$178
5593	Level 3 Nuclear Medicine and Related Services	165	$5,042	$742
5771	Cardiac Rehabilitation	302	$190	$62
5572	Level 2 Imaging with Contrast	557	$4,226	$622
5023	Level 3 Type A ED Visits	893	$521	$158
5522	Level 2 Imaging without Contrast	1,636	$1,313	$193
5441	Level 1 Nerve Injections	672	$431	$110
5524	Level 4 Imaging without Contrast	385	$4,315	$942
5431	Level 1 Nerve Procedures	101	$7,092	$1,678

	Available Beds	Inpatient Days
HOSPITAL (including swing beds)
Routine Services	45	3,477
Special Care	4	423
Nursery		620
Total Hospital	49	4,520

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