Between 2006 (12,674) and 2007 (12,852), the number of distinct facilities in the most highly integrated systems rose slightly. The number of freestanding outpatient surgery centers (FOSCs) grew 16.1% during this period, to 483 from 416 the previous year. For the first time since 2003, the number of highly integrated systems with six or more delivery components dropped, to 65 in 2007 from 68 in 2006. These systems accounted for 20.2% of all highly integrated systems, down from 21.3% the year before. The total number of equity relationships between diagnostic imaging centers (DICs) and highly integrated systems rose 11.7% in 2007, to 764 from 684 in 2006. In 2006, the average number of emergency department (ED) visits per staffed bed at nonsystem hospitals climbed 5.3%, to 224.3 from 213.1 in 2005, the fifth consecutive annual increase. Since 2001 (177.3), the number of ED visits per staffed bed has jumped 26.5% at these nonsystem hospitals.

The number of HMOs tied to highly integrated systems in the Midwest region dropped a notable 15.6% in 2006, to 27 from 32 in 2005. In spite of this decline, the Midwest region was again home to the most system HMOs. The number of hospital days per 1,000 non-Medicare members of HMOs affiliated with highly integrated systems increased a substantial 9.0% in 2006, to 225.9 from 207.2 the year before. For the fourth straight year, the pharmacy expenditure share of total operating expenses at HMOs tied to systems fell, to 13.5% in 2006 from 13.6% in 2005. Conversely, nonsystem HMOs saw this ratio rise during this time, to 14.5% from 14.4% the prior year. The number of multispecialty medical group practices that were part of integrated health systems rose to 1,679 in 2007 from 1,674 in 2006, the sixth straight annual increase. Since 2001 (1,195), the number of system-affiliated multispecialty group practices has jumped by more than 40%.