Thursday, February 28, 2013

US Non-Profit Hospital 9 Months 2012 Profits Up 226%

From a review of the excellent EMMA system, I found 39 US Non-Profit Hospital Organizations with Net Assets above $1 billion each, which have December fiscal year ends, and which also reported their operating statements for the 9 months ended September 2012, the most recent date's financial statements reported for the huge majority of these hospitals.

How did they do?

Well first, below here's the Total Operating Revenues for each of them for the 9 months ended September 2012 and 2011:



9 Mos 9 Mos


Sept Sept


2012 2011


Total Total


Operating Operating %

HQs Revenues Revenues Change


mils $ mils $





Kaiser Permanente CA 37,962 35,757 6%
Providence Health WA 7,757 6,309 23%
Sutter Health CA 7,179 6,679 7%
Mayo Clinic MN 6,542 6,182 6%
Adventist Health System FL 5,465 5,144 6%
North Shore Long Island Jewish Health NY 4,962 4,572 9%
Cleveland Clinic Health System OH 4,621 4,344 6%
Indiana University Health IN 4,129 3,172 30%
Banner Health AZ 3,650 3,570 2%
Henry Ford Health System MI 3,491 3,105 12%
Advocate HealthCare Network IL 3,444 3,294 5%
Catholic Health East PA 3,321 2,942 13%
Sentara HealthCare VA 3,222 2,893 11%
Carolinas Health Care System NC 3,092 2,739 13%
BJC Healthcare MO 2,881 2,717 6%
New York and Presbyterian Hospital NY 2,850 2,670 7%
Catholic Health Partners OH 2,845 2,657 7%
Texas Health Resources TX 2,753 2,557 8%
Novant Health NC 2,656 2,432 9%
SSM HealthCare MO 2,489 2,241 11%
Allina Health System MN 2,420 2,356 3%
Fairview Health Services MN 2,391 2,183 10%
Adventist Health West CA 2,175 1,959 11%
Memorial Sloan-Kettering Cancer Center NY 2,110 2,018 5%
Iowa Health System IA 2,036 1,699 20%
SCL Health Systems KS 2,024 1,909 6%
Franciscan Alliance IN 1,943 1,725 13%
The Methodist Hospital System TX 1,838 1,676 10%
BayCare Health System FL 1,821 1,708 7%
University Hospitals Health System OH 1,675 1,570 7%
Inova Health System VA 1,656 1,625 2%
Presbyterian Health Care Services NM 1,553 1,432 8%
Multicare Health System WA 1,119 1,032 8%
Nationwide Children's Hosital OH 1,094 954 15%
John Muir Health CA 1,055 1,009 5%
ProMedica Health Care OH 1,049 1,005 4%
St Luke's Episcopal Health System TX 933 926 1%
Children's HealthCare Atlanta GA 822 753 9%
Children's Medical Center of Dallas TX 774 744 4%




Total all 39
145,799 134,259 9%

So clearly these 39 Hospital Organizations did just fine on the Revenue side, with Total Operating Revenues of $145.8 bil for the 9 Months Ended Sept 2012, up a robust 9% over the prior year.

And every one of the 39 Hospital Organizations had their Revenues increase.....talking about being recession resistant! 

Think about the private sector.  The Total Revenue increase for publicly-held companies for the same period was low single digits.

So why do these Hospital Organizations do so incredibly well in Total Operating Revenues?  Well, part of it is the aging population.  But more importantly, they are effectively monopolies in their local communities.  People go to the hospital when they are really sick.  It's a seller's market.  Hospitals can charge whatever they want and they do.  This is not right.....not even close to being right.

OK, so what about on the earnings front.  Well, below here's the Total Operating Income for each of these 39 Non-Profit Hospital Organizations for the 9 months ended September 2012 and 2011:



9 Mos 9 Mos


Sept Sept


2012 2011


Operating Operating %


Income Income Change


mils $ mils $





Kaiser Permanente CA 1,492 1,340 11%
Sutter Health CA 472 551 -14%
Indiana University Health IN 419 136 208%
Adventist Health System FL 360 281 28%
Mayo Clinic MN 278 493 -44%
Banner Health AZ 230 248 -7%
Texas Health Resources TX 218 129 69%
Advocate HealthCare Network IL 199 204 -2%
Sentara HealthCare VA 188 203 -7%
New York and Presbyterian Hospital NY 175 112 56%
Cleveland Clinic Health System OH 174 226 -23%
Inova Health System VA 167 154 8%
BJC Healthcare MO 132 129 2%
BayCare Health System FL 121 106 14%
Allina Health System MN 121 157 -23%
Novant Health NC 117 49 139%
Carolinas Health Care System NC 109 122 -11%
Providence Health WA 106 187 -43%
Children's HealthCare Atlanta GA 104 94 11%
Memorial Sloan-Kettering Cancer Center NY 103 138 -25%
Adventist Health West CA 102 65 57%
Catholic Health Partners OH 100 88 14%
The Methodist Hospital System TX 97 119 -18%
North Shore Long Island Jewish Health NY 96 93 3%
Multicare Health System WA 87 53 64%
Fairview Health Services MN 79 1 7800%
SSM HealthCare MO 76 48 58%
Nationwide Children's Hosital OH 74 66 12%
Franciscan Alliance IN 74 63 17%
John Muir Health CA 54 52 4%
Presbyterian Health Care Services NM 53 56 -5%
Children's Medical Center of Dallas TX 52 92 -43%
Catholic Health East PA 49 40 23%
ProMedica Health Care OH 47 65 -28%
St Luke's Episcopal Health System TX 44 32 38%
University Hospitals Health System OH 42 26 62%
Iowa Health System IA 38 54 -30%
Henry Ford Health System MI 32 31 3%
SCL Health Systems KS 22 4 450%




Total all 39
6,503 6,107 6%





% of Total Operating Revenues
4.46% 4.55%

So, Total Hospital Operating Income is up 6%, and as a % of Revenues is down very modestly.  So, that all makes sense.....nothing really unusual.  But still, that is $6.5 bil of Total Operating Profit for Non-Profit Hospitals.

But, now let's get to the real story.  Below here's the Total Bottom Line Profit or Loss for each of these 39 Non-Profit Hospital Organizations for the 9 months ended September 2012 and 2011.  The difference between Hospital Operating Income and Bottom Line Profit or Loss is mainly how the hospitals are doing with their investment returns on their massive amounts of Investments in Debt and Equity Securities.  And it's also how well they are doing with all of their financial derivative (yeah, that dirty word again), not just on their investments, but also on their debt.




9 Mos


9 Mos Sept


Sept 2011


2012 Bottom


Bottom Line


Line Profit %


Profit (Loss) Change


mils $ mils $





Kaiser Permanente CA 2,087 1,539 36%
Providence Health WA 1,072 269 299%
Sutter Health CA 700 456 54%
Indiana University Health IN 553 140 295%
Advocate HealthCare Network IL 481 (39) 1333%
Cleveland Clinic Health System OH 480 51 841%
Banner Health AZ 455 (40) 1238%
Mayo Clinic MN 434 426 2%
Texas Health Resources TX 394 88 348%
BJC Healthcare MO 385 16 2306%
Adventist Health System FL 342 335 2%
The Methodist Hospital System TX 305 (76) 501%
Sentara HealthCare VA 301 236 28%
Carolinas Health Care System NC 300 18 1567%
BayCare Health System FL 291 12 2325%
Inova Health System VA 283 205 38%
Catholic Health East PA 277 (6) 4717%
Children's HealthCare Atlanta GA 259 22 1077%
New York and Presbyterian Hospital NY 253 61 315%
Memorial Sloan-Kettering Cancer Center NY 252 (16) 1675%
Catholic Health Partners OH 242 188 29%
North Shore Long Island Jewish Health NY 224 57 293%
Novant Health NC 181 25 624%
Franciscan Alliance IN 179 (25) 816%
SSM HealthCare MO 178 (63) 383%
Allina Health System MN 171 78 119%
Nationwide Children's Hosital OH 152 5 2940%
Iowa Health System IA 150 (23) 752%
ProMedica Health Care OH 146 (11) 1427%
Presbyterian Health Care Services NM 146 (37) 495%
Multicare Health System WA 144 5 2780%
SCL Health Systems KS 132 (44) 400%
Fairview Health Services MN 130 (75) 273%
Children's Medical Center of Dallas TX 109 64 70%
Adventist Health West CA 102 65 57%
St Luke's Episcopal Health System TX 85 (176) 148%
John Muir Health CA 54 52 4%
Henry Ford Health System MI 32 31 3%
University Hospitals Health System OH 25 22 14%




Total all 39
12,486 3,835 226%





% of Total Operating Revenues
8.56% 2.86%

No, those above numbers aren't misprints.  The Total Bottom Line Profit of these 39 Non-Profit Hospital Organizations was $12.5 bil for the 9 months ended Sept 2012, up an off-the-charts 226% over the prior year.  And not a dime of US Federal Income Tax is Paid on this $12,486 mil of Profit.

And for the 9 months ended Sept 2012, the Total Bottom Line Profit was 8.56% of Total Operating Revenues, which was nearly double the Total Hospital Operating Income margin of 4.46%.

And the Total Bottom Line Profit for the 9 months ended Sept 2012 was $12,486 mil, $5,983 mil higher than the Total Hospital Operating Income of $6,503 mil for the same period.

So, what's going on here?  There's both a positive and a negative story.

On the very positive side, these hospital organizations did a much better job in having their massive investment portfolio managed in 2012.  And they also did a much better job with their financial derivatives on both their investment portfolio and on their debt in 2012.  And the overall markets were better. 

Also on the positive side, Providence Health had a $767 mil Contribution from Swedish Affiliation in 2012 which bolstered its Bottom Line Profit.

But what's with the massive drop in Bottom Line Profit as compared with Hospital Operating Income in the 9 months ended Sept 2011?  On a long-term basis, you should see a nice average annual increase here due to the interest income on the investments in debt securities and the dividends on the investments in equity securities.

But for the 9 months ended Sept 2011, the Total Hospital Operating Income was $6,107 mil, while the Total Bottom Line Profit was a much $3,835 mil, or a drop of $2,272 mil.  And yeah, that's in comparison to a comparable increase of $5,983 mil in the 9 months ended Sept 2012, a profit swing of a massive $8,255 mil.

Frankly, it doesn't make any sense to me why there would be such a huge $2,272 mil drop between Total Hospital Operating Income and Total Bottom Line Profit in the 9 months ended Sept 2011.

These large investment portfolios of hospital organizations are managed by the large financial institutions (yeah, that dirty word again).  And they also manage the financial derivatives (yeah, that dirty word again too) of the investment portfolios and debt of hospital organizations.

Someone needs to review just what was going on here with how these big financial institutions are managing this massive amount of money of these hospital organizations.  I don't think the hospital organizations have people that really understand what is going on here, particularly with all of these complex financial derivatives.  And I also don't think the Board of Directors of these non-profit hospital organizations really understand them either.

When you think about it, how well the massive investments and financial derivatives of these non-profit hospital organizations perform will eventually get reflected in US total health care costsThe ultimate beneficiary of these hospital investment returns are the ones paying the hospital bills.....the US Government, State Governments, businesses, and individuals.  But none of these beneficiaries are reviewing these investment returns.  This is a key missing link to bending down the long-term US health care cost curve.

Just the thought of the US Congress very aggressively trying to massively cut Medicare, Medicaid, and Social Security Benefits, while at the same time, no one in the US Government is reviewing what is going on with these massive amounts of investments in debt and equity securities of hospital organizations or what is going on with financial derivatives of these hospital organizations should be enough to flat out enrage retired and near-retired US citizens.

And just the fact that these 39 Non-Profit Hospital Organizations can generate $12.5 bil of Total Bottom Line Tax-free Profits in just the first 9 months of 2012, which was an increase of 226% over the prior 9 month period, while at the same time, the US Congress aggressively tries to cut Medicare, Medicaid and Social Security Benefits, should also be enough to enrage retired and near-retired US citizens.  The way you remove excessive bottom line profits of Non-profit hospital organizations is to reduce the incredibly high fees charged to the hospital patient.  It's that simple.