Same city, same wage index: why Medicare pays five San Antonio hospitals $15,041 to $41,619 for one sepsis stay
Five hospitals from four systems (Methodist, Baptist, Christus Santa Rosa and University Health) share one wage index and one operating base: $13,155.69 for a five-day sepsis stay. The totals run 2.8 to 1. Here is every step, and what it means for the next contract that says “percent of Medicare.”
- Rates
- FY2027, each hospital’s own provider record
- Case
- MS-DRG 871, sepsis with MCC, five days
- Same in all five
- Wage index 0.9909, operating base $13,155.69
- Totals
- $15,040.92 to $41,619.43
On this page
One base, five totals
Five San Antonio hospitals get the same Medicare operating payment for a five-day sepsis stay, $13,155.69, because they share one FY2027 wage index, 0.9909. The wage index is usually the first explanation for why Medicare pays one hospital more than another. Here it explains nothing.
The totals are another matter.
| Hospital | Sepsis with MCCMS-DRG 871, 5 days | Hip or knee replacementMS-DRG 470, 2 days | Heart failure with MCCMS-DRG 291, 4 days | Sepsis stays, 2024 |
|---|---|---|---|---|
| Methodist Hospital Stone OakCCN 670055 · non-teaching | $15,040.92 | $15,221.18 | $10,118.92 | 417 |
| Baptist Medical CenterCCN 450058 · teaching | $16,901.39 | $17,056.46 | $11,877.95 | 805 |
| Methodist HospitalCCN 450388 · teaching | $17,196.97 | $16,997.50 | $12,015.52 | 1,615 |
| Christus Santa Rosa Medical CenterCCN 450237 · teaching | $18,044.28 | $18,084.99 | $12,856.51 | 587 |
| University Health SystemCCN 450213 · teaching | $41,619.43 | $38,933.27 | $34,176.74 | 340 |
Same DRG, same city, same wage index, same operating base, and 2.8 times the total. The percent gets negotiated; the definition of “Medicare” often decides the money.
Methodist Hospital’s provider number billed 1,615 Medicare sepsis stays in 2024, the most of the five and about twice Baptist’s 805. Its FY2027 total for this stay, $17,196.97, sits in the middle of the five. Stone Oak, a Methodist non-teaching hospital on its own provider number in the north of the city, has the lowest total: no teaching or pass-through payments, and the smallest uncompensated-care and low-income amounts of the five.
Where the money differs
Here is the same sepsis stay at each hospital, step by step. The first row is identical. The rest is the hospital’s own provider record at work.
| Step | Methodist Stone Oak | Baptist Medical Center | Methodist Hospital | Christus Santa Rosa | University Health |
|---|---|---|---|---|---|
| Operating DRG paymentweight 1.9320 × the standardized amount, labor share at the same 0.9909 wage index | $13,155.69 | $13,155.69 | $13,155.69 | $13,155.69 | $13,155.69 |
| Teaching (IME)operating indirect medical education | $0.00 | $8.63 | $199.05 | $617.06 | $3,326.95 |
| Low-income (DSH)operating disproportionate share | $179.58 | $494.98 | $316.72 | $375.25 | $1,033.04 |
| Capitalincluding capital teaching and low-income | $1,078.55 | $1,105.07 | $1,100.13 | $1,137.26 | $1,338.20 |
| Uncompensated carea fixed amount per stay | $708.89 | $2,254.12 | $1,841.80 | $2,864.35 | $17,912.96 |
| Pass-throughper day: education and organ acquisition costs | $0.00 | $47.60 | $640.90 | $245.80 | $4,871.75 |
| Quality adjustmentsreadmissions, value-based purchasing, HAC | −$81.78 | −$164.71 | −$57.32 | −$351.13 | −$19.17 |
| Original Medicare total | $15,040.92 | $16,901.39 | $17,196.97 | $18,044.28 | $41,619.43 |
| Medicare Advantage out-of-network amountless operating IME and pass-through | $15,040.92 | $16,845.16 | $16,357.02 | $17,181.42 | $33,420.73 |
Three add-ons do the work. The teaching adjustment (IME) follows residents per bed: $3,326.95 at University Health, a few dollars at Baptist, none at Stone Oak. The per-diem pass-through (education and organ acquisition costs) runs $974.35 a day at University Health against $128.18 at Methodist Hospital. And uncompensated care, the largest of the three, is not a percentage of anything.
Uncompensated care: a flat payment per claim
Medicare pays uncompensated care as an estimated amount per inpatient claim, the same on a heart failure stay as on a joint replacement, and settles it later on the cost report. Medicare sets each qualifying hospital’s uncompensated-care payment as an annual total, from its share of all such hospitals’ uncompensated care. It pays that total out in equal pieces on each inpatient claim, spread over the stays it expects, so a costlier stay does not raise it. A hospital whose uncompensated care is large relative to its Medicare volume, like Bexar County’s public hospital, shows the largest one: at University Health it is $17,912.96 a stay, more than the $13,155.69 operating payment for sepsis. At Methodist Hospital it is $1,841.80; at Stone Oak, $708.89.
Because it does not scale with the DRG, it weighs most on the cheapest stays. It is 4.7% of the sepsis stay at Stone Oak, 10.7% at Methodist Hospital and 43.0% at University Health, rising to 52.4% of a heart failure stay there. A percent-of-Medicare contract multiplies it on every claim. Any comparison of hospitals’ “Medicare rates” that does not say whether this amount is in the base is comparing different things.
Which “Medicare” is the contract?
Commercial and Medicare Advantage contracts in Texas are often written as a percent of Medicare. The definition of Medicare can get less attention than the percent, and at one San Antonio hospital it is worth more than the percent itself. Take a contract at 130% of Medicare, written so that uncompensated care and the pass-through are excluded.
| Hospital | Original Medicare, all in | Without uncompensated care and pass-through | 130% of that | As % of all-in Medicare |
|---|---|---|---|---|
| Methodist Stone Oak | $15,040.92 | $14,332.03 | $18,631.64 | 123.9% |
| Baptist Medical Center | $16,901.39 | $14,599.67 | $18,979.57 | 112.3% |
| Methodist Hospital | $17,196.97 | $14,714.27 | $19,128.55 | 111.2% |
| Christus Santa Rosa | $18,044.28 | $14,934.13 | $19,414.37 | 107.6% |
| University Health | $41,619.43 | $18,834.72 | $24,485.14 | 58.8% |
Hypothetical definition clause, the line that decides these numbers: “Medicare” means the amount Original Medicare would pay for the claim under the hospital’s provider record in effect on the date of discharge, [including / excluding] operating and capital IME, DSH, uncompensated care and per-diem pass-through amounts.
The same 130% pays Stone Oak 123.9% of what Medicare itself pays, Methodist Hospital 111.2% and University Health 58.8%, below Medicare. Neither side is wrong to argue about whether these add-ons belong in a commercial benchmark. The point is narrower: price the definition before signing the percent.
Four checks for a San Antonio contract
Each check takes one lookup: the hospital lookup shows each hospital’s FY2027 factors, the claim desk prices any stay step by step, and the verify page sets each step next to the official pricer.
- Name the components. Write down whether “Medicare” includes the IME, low-income, uncompensated care and pass-through amounts. In this city they are 5.9% to 65.2% of a sepsis stay.
- Price your own mix, not one DRG. Uncompensated care is flat per stay, so its weight moves with the case mix. A mix heavy in low-paying stays carries more of it than one heavy in high-paying stays: at University Health it is 52.4% of the heart failure stay and 43.0% of the sepsis stay.
- Price each hospital on its own number. Methodist Hospital and Stone Oak carry different provider numbers and different factors. Under the hypothetical 130% above, one system-wide percent pays Stone Oak 123.9% of Medicare and Methodist Hospital 111.2%.
- Recheck every October, and whenever the record changes. Uncompensated care resets each October 1; the teaching factor and the pass-through change whenever the hospital’s provider record is updated. A contract keyed to “current Medicare” changes value even if nobody renegotiates.
Questions
Why is the operating payment the same at every hospital?
Because it depends only on the MS-DRG weight, the national standardized amount (with the full annual update, which all five receive) and the wage index applied to its labor share, and all five San Antonio hospitals have the same FY2027 wage index, 0.9909. Everything that differs comes after that step.
How much is the uncompensated care payment per claim?
It differs by hospital: in this article from $708.89 at Stone Oak to $17,912.96 at University Health. It is paid to hospitals that qualify for the disproportionate share adjustment, based on their share of the uncompensated care of all such hospitals. Medicare pays it as an estimated flat amount on each inpatient claim and reconciles it later, so it is the same on a heart failure stay as on a joint replacement.
Does a Medicare Advantage plan pay the same amount?
Not to an out-of-network hospital. The plan’s amount leaves out the operating IME and the per-diem pass-through, which Medicare pays the hospital itself. For this sepsis stay that is $839.95 at Methodist Hospital and nothing at Methodist Stone Oak, which has neither.
Are these the hospitals’ actual payments?
They are what the FY2027 formulas pay for the sample stays described, on each hospital’s own provider record. Real claims differ with length of stay, discharge status, outliers and the cost-report settlement of the uncompensated-care and pass-through amounts. The 2024 stay counts come from Medicare’s public inpatient file.
About these figures
FY2027 amounts were priced on this site’s engine on October 31, 2026, one claim at a time, for each hospital’s FY2027 provider record: MS-DRG 871 for five days, 470 for two days and 291 for four days, discharged home (status 01) on October 20, 2026, with covered charges of $60,000, $70,000 and $45,000, below each hospital’s outlier threshold. Totals are the Original Medicare payment for the stay before the beneficiary’s deductible and coinsurance and before sequestration, and include each hospital’s readmission, value-based purchasing and hospital-acquired condition adjustments. The teaching and low-income split is derived from the Original Medicare and Medicare Advantage results, which differ by exactly the operating IME and the pass-through. Uncompensated care and the pass-through are interim amounts that Medicare settles on the cost report. The 2024 stay counts come from the Medicare Inpatient Hospitals by Provider and Service file for MS-DRG 871. Each row is one Medicare provider number, and a provider number can cover more than one campus; other San Antonio hospitals are not shown. Methodist Hospital Atascosa, in Jourdanton outside Bexar County, is left out. Nothing on this page is a claims determination.