The 2025 St. Louis Hospital Industry Overview report from Gateway Business Health Coalition (formerly St. Louis Area Business Health Coalition) finds a decrease in the number of high-quality St. Louis hospitals. Over half of St. Louis hospitals (58%) received more than double their Medicare reimbursement from commercial payers, and no St. Louis hospital achieved both a commercial price under 200% of Medicare and 5 stars from CMS. While two hospitals achieved 5-stars on CMS ratings, neither had commercial prices below the “fair price” limit of 200% of Medicare.

“Patients in the St. Louis community shouldn’t have to choose between safety and affordability when choosing where to receive care,” said Laurel Pickering, President and CEO of Gateway Business Health Coalition. “We recognize the ongoing work of the hospitals in our region and also know there is still much work to be done in improving health care quality, affordability, and value.”

Data presented in the report, sourced from the RAND Corporation, show what commercial payers paid St. Louis hospitals as a percentage of the rates Medicare would have paid for those same services. In aggregate, commercial price across St. Louis area hospitals from 2020 to 2022, was 233% of Medicare. It is important to note that the St. Louis market is not facing the extreme health care affordability crisis that many other metropolitan areas around the country are battling and hospital costs and prices are not as high. Despite this, it remains an important issue for St. Louis workers and their families, as local health care costs outpace growth in wages.

Utilization and financial metrics, sourced from publicly available hospital Medicare Cost Reports, show recent trends in hospital operations. Hospital discharges increased 7.1%, while net patient revenue received by these hospitals increased 9.9% from 2022 to 2023. This substantial increase in revenue from patients resulted in a patient service income of $283 million, reflecting recovery for health systems from a challenging 2022.

Also in the report are the most recent quality scores from the Centers for Medicare and Medicaid (CMS) and The Leapfrog Group. BHC reports that fewer St. Louis hospitals received 5-star ratings from CMS and “A” Safety Grades from The Leapfrog Group, showing a decline in the number of local high-quality hospitals. Five hospitals did achieve either an “A” or 5-star rating: Mercy Hospital Jefferson (A), Mercy Hospital Washington (A), OSF St. Anthony Health Center (A), Barnes-Jewish St. Peters (5 stars), and Missouri Baptist Medical Center (5 stars).

“As a local employer committed to providing access to high value healthcare for our employees, retirees and their families, we rely upon relevant, timely, and transparent information to make informed decisions,” said Dave Toben, Senior Director, Total Rewards at Bi-State Development. “Gateway BHC’s St. Louis Hospital Industry Overview report is a valuable tool for us as an employer advocate for high quality, affordable health care and helps us guide our health plan members to hospitals delivering the best quality of care at the best possible value. Our plan is funded by employee and employer contributions, and we realize the importance of making informed decisions around quality and affordability and look to health systems to partner with us in delivering on that value proposition. Together we can help our community prosper physically, mentally, and financially by partnering to ensure the best health outcomes at the most affordable cost.”

Highlights from the St. Louis Hospital Industry Overview:

1. Overall quality and safety of St. Louis hospitals declined from the previous year, with fewer hospitals achieving 4- and 5-star CMS ratings and “A” and “B” Leapfrog Safety Grades. (Page 5 and 6)
   
   
2. Three St. Louis hospitals received an “A” Leapfrog Safety Grade in Spring 2025. (Page 5)
   • Mercy Hospital Jefferson – 2 consecutive “A” Safety Grades
   • Mercy Hospital Washington – 4 consecutive “A” Safety Grades
   • OSF St. Anthony’s Health Center – 3 consecutive “A” Safety Grades
     
     
3. Two hospitals, both part of BJC HealthCare, achieved 5-Star Overall Star Ratings in 2024. (Page 6)
   • Missouri Baptist Medical Center – 4 consecutive 5-star ratings
   • Barnes-Jewish St. Peters Hospital
     
     
4. Though overall quality saw a decline from the previous year, St. Louis hospitals improved for the three healthcare-associated infection (HAI) measures that BHC examined: CAUTI, C. diff, and MRSA. Nineteen hospitals (68%) in St. Louis performed better than the national benchmark for C. diff infections, and 9 hospitals (43%) performed better for CAUTIs. (Page 7, 8, 9).
   
   
5. St. Louis hospital discharges increased 7.1% and adjusted discharges, a proxy measure of volume that includes inpatient and outpatient, increased 11.4% from 2022 to 2023. (Page 15)
   
   
6. St. Louis hospitals’ net patient revenue increased 9.9%, while operating expenses increased by 6.1% from 2022 to 2023. This shifted 2022’s patient service loss of $73 million to a patient service income of $289 million in 2023, a patient service profit margin of 2.1%. (Page 16)
   
   
7. Net income across all hospitals, which includes non-operating revenue and expenses, totaled nearly $865 million in 2023, over 3.5 times higher than $232 million in 2022, for a total profit margin of 6.2%. (Page 16)