Saturday, November 30, 2013

Wisconsin Smaller Non-Profit Hospital Modest Profits Show Need For Medicaid Expansion

From a review of audited financial statements in the Electronic Municipal Market Access (EMMA), I found a huge number of 34 Non-Profit Hospital Organizations headquartered in the State of Wisconsin with Total Operating Revenues of more than $10 mil each in the most recent fiscal year.

To understand what is going on with Wisconsin Non-Profit Hospital Organization Earnings, it is helpful to break them down by how financially strong the Hospitals are.....or by their Net Assets.

When this breakdown is done, there is a crystal-clear conclusion.....the weaker the financial strength of the Hospital Organization, the lower the earnings.

Bottom Line Earnings is a combination of Operating Income and Non-Operating Income, with the latter being due predominantly to Investment Returns.

On a Hospital Operating Income basis, here is a summary of the most recent audited annual earnings results of these Hospitals by Net Asset size:

Net Assets > $1 Bil..............Total Operating Income as % of Total Revenues..4.5%
Net Assets $400 Mil-$1 Bil.Total Operating Income as % of Total Revenues..4.0%
Net Assets $200-400 Mil...Total Operating Income as % of Total Revenues..3.5%
Net Assets < $200 Mil........Total Operating Income as % of Total Revenues..2.5%

When the 16 Wisconsin Hospitals with Net Assets of less than $200 mil are generating Total Operating Income of a very modest 2.5% of their Total Operating Revenues, then they are struggling and need financial help.

The best way to provide this needed financial boost is to simply Expand Medicaid in Wisconsin.  This will substantially reduce two Hospital Operating Statement Earnings Charges.....Provisions for Bad Debts and Uncompensated Charity Care Costs.

And it's the same pattern with Bottom Line Profits by Net Asset size:

Net Assets > $1 Bil..............Total Bottom Line Profits as % of Total Revenues..7.5%
Net Assets $400 Mil-$1 Bil.Total Bottom Line Profits as % of Total Revenues..6.9%
Net Assets $200-400 Mil....Total Bottom Line Profits as % of Total Revenues..6.0%
Net Assets < $200 Mil........Total Bottom Line Profits as % of Total Revenues..4.2%

The large Wisconsin Hospitals are doing just great.....but clearly not the smaller ones.

From a review of audited financial statements in the Electronic Municipal Market Access (EMMA), below here are the Bottom Line Profits, Operating Profits and Operating Revenues of the 34 Non-Profit Hospital Organizations headquartered in the State of Wisconsin with Total Operating Revenues of more than $10 mil each in the most recent fiscal year, stratified by Net Asset size:
`
Most






Recent

Bottom
 Operating 


Annual Bottom
Line
 Income 

Fiscal Line Total Profit      Profit 

City Year Net Operating Margin  Operating  Margin

HQs End Income Revenues %  Income  %



mils $s mils $s
mils $s mils $s
Wisconsin Non-Profit Hospital Organizations













Net Assets > $1 Bil






Aurora Health Care Milwaukee Dec 2012          198       4,125 4.8%          138 3.3%
Froedtert Milwaukee Jun 2013          179       1,499 11.9%            83 5.5%
Sisters St. Francis in Wisconsin Various Jun 2013          120          868 13.8%            62 7.1%
Ministry Health Care Milwaukee Jun 2013          101       1,597 6.3%            89 5.6%
Medical College Wisconsin Milwaukee Jun 2013            81          926 8.7%            31 3.3%








Total all 5...Net Assets > $1 Bil

         679       9,015 7.5%          403 4.5%















Net Assets $400 Mil-$1 Bil






ProHealth Care Waukesha Sep 2013            97          688 14.1%            33 4.8%
Univ Wisconsin Hosps&Clinics Madison Jun 2013            84       1,258 6.7%          109 8.7%
Gundersen Lutheran Health La Crosse Dec 2012            83          882 9.4%            43 4.9%
Marshfield Clinic Eau Claire Sep 2012            79       1,872 4.2%            48 2.6%
Wheaton Franciscan Health Glendale Jun 2013            69       1,763 3.9%            39 2.2%
ThedaCare Appleton Dec 2012            62          709 8.7%            28 3.9%
Children's Hospital & Health Milwaukee Dec 2012            58          724 8.0%            17 2.3%
Aspirus Wausau Obligated Group Wausau Jun 2013            57          628 9.1%            28 4.5%








Total all 8 With Net Assets $400 Mil-$1 Bil
         589       8,524 6.9%          345 4.0%








Net Assets $200-400 Mil






Meriter Hospital Madison Dec 2012         35.0          432 8.1% 18.9 4.4%
Agnesian HealthCare Fond du Lac Jun 2013         30.4          413 7.4% 23.2 5.6%
Bellin Health Green Bay Sep 2012         17.9          399 4.5% 9.6 2.4%
Franciscan Sisters Christian Charity Manitowoc Dec 2012         17.1          185 9.2% 2.1 1.1%
Mercy Alliance Janesville Jun 2012         16.1          497 3.2% 13.7 2.8%








Total all 5..Net Assets $200-400 mil

      116.5       1,926 6.0% 67.5 3.5%








Net Assets < $200 Mil






Beloit Health Beloit Dec 2012           7.7          191 4.0% 5.0 2.6%
Riverview Hospital Association Wisconsin Rapids Aug 2012           7.5            86 8.7% 5.0 5.8%
Sauk Prairie Memorial Hospital Prairie du Sac Dec 2012           5.6            62 9.0% 3.1 5.0%
Watertown Regional Medical Center Watertown Sep 2012           5.2            96 5.4% 1.2 1.3%
Tomah Memorial Hospital Tomah Sep 2012           5.1            36 14.2% 3.6 10.0%
Monroe Clinic Monroe Dec 2012           4.1          163 2.5% 5.8 3.6%
Divine Savior Healthcare Portage Jun 2013           4.1            79 5.2% 2.8 3.5%
Bay Area Medical Center Marinette Dec 2012           4.0          113 3.5% 1.6 1.4%
Upland Hills Health Dodgeville Sep 2012           2.7            45 6.0% 1.9 4.2%
Richland Hospital Richland Center Dec 2012           2.6            35 7.4% 2.0 5.7%
Beaver Dam Community Hospitals Beaver Dam Jun 2013           2.5            97 2.6% 2.7 2.8%
Fort HealthCare Atkinson Sep 2012           1.5          120 1.3% -2.3 -1.9%
Cumberland Memorial Hospital Cumberland Jun 2012           1.0            22 4.5% 0.9 4.1%
Moundview Memorial Hospital Friendship Jun 2012           0.6            15 4.0% 0.5 3.3%
Community Memorial Hospital Oconto Falls Sep 2012           0.1            35 0.3% -0.1 -0.3%
Community Health Network Berlin Sep 2012          (1.3)            78 -1.7% -1.8 -2.3%








Total all 16..Net Assets < $200 mil

        53.0       1,273 4.2% 31.9 2.5%








    
    

Georgia Smaller Non-Profit Hospitals Very Weak Profits Show Need For Medicaid Expansion

In an earlier recent post Georgia Non-Profit Hospital Earnings On Fire, I showed that the 11 large Georgia Non-Profit Hospital Organizations with Net Assets above $400 mil each experienced earnings in the most recent year which were on fire.

Bottom Line Earnings is a combination of Operating Income and Non-Operating Income, with the latter being due predominantly to Investment Returns.

These 11 large Georgia Non-Profit Hospital Organizations generated Audited Total Bottom Line Profits of $1.034 bil in the most recent fiscal year, which was an exceptionally robust 10.2% of their Total Operating Revenues of $10.176 bil.

So what about the smaller Georgia Non-Profit Hospital Organizations?  How did they do?

From a review of audited financial statements in the Electronic Municipal Market Access (EMMA), I found 12 Non-Profit Hospital Organizations headquartered in the State of Georgia with Total Operating Revenues of more than $10 mil each in the most recent fiscal year but also with Net Assets of less than $400 mil each.

These 12 smaller Georgia Non-Profit Hospital Organizations generated Total Bottom Line Earnings of $93.2 mil in the most recent fiscal year, which was a very weak 2.5% of Total Operating Revenues.  And this $93.2 mil of Earnings was substantially overstated in real terms since Grady Memorial Hospital's Bottom Line Earnings of $46.3 mil included $63.3 mil of Contributions from Fulton and DeKalb Counties.  Absent these $63.3 mil of County Contributions, the Total Bottom Line Earnings of these 12 smaller Georgia Hospital Organizations drops to a dismal $29.9 mil, or only 0.8% of Total Operating Revenues.

The two very positive earnings performing hospitals.....in Tifton and in Valdosta.....are both just off of I-75 on the way to Florida.

But this story of dismal smaller Georgia Non-Profit Hospital earnings gets even worse.  In the most recent fiscal year, the Total Operating Loss of these 12 smaller Georgia Hospitals was $41 mil.

Below here are the Bottom Line Earnings (Losses) and Total Operating Revenues of each of these 12 smaller Georgia Non-Profit Hospital Organizations for the most recent fiscal year:


Most Bottom



Recent Line Total Bottom


Annual Net Operating Line

Fiscal Income Revenues Profit

City Year Current Current Margin

HQs End Year Year %



mils $s mils $s
Smaller Georgia Non-Profit Hospital Organizations










Hosp Authority Futon-DeKalb County (Grady Memorial Hosp) Atlanta Dec 2012       46.3        705 6.6%
Hosp Authority Tift County Tifton Sep 2012       41.5        268 15.5%
Hosp Authority Valdosta&Lowndes County Valdosta Sep 2012       28.4        316 9.0%
Floyd Healthcare Rome Jun 2013         6.7        328 2.0%
Crisp Regional Health Cordele Jun 2012         4.4          66 6.7%
Bacon County Health Alma Jun 2012         2.0          32 6.3%
Memorial Health Savannah Dec 2012        (0.7)        534 -0.1%
Columbus Regional Healthcare Columbus Jun 2013        (1.0)        424 -0.2%
Hosp Authority Wilkes County Washington Apr 2013        (1.8)          15 -12.0%
Athens Regional Health Athens Sep 2012        (2.2)        421 -0.5%
Southern Regional Health Riverdale Jun 2012      (13.4)        202 -6.6%
DeKalb Regional Health Decatur Jun 2013      (17.0)        415 -4.1%






Total all 12

      93.2      3,726 2.5%

So, the country's huge and continually expanding income inequality is not just related to very wealthy individuals and everyone else.  It also clearly exists in the Non-Profit Hospital arena.

The solution to this massive income inequality in the Non-Profit Hospital arena really isn't that difficult.  It's a two-step process.

The first step of the solution is simply for every State to Expand Medicaid.  And there shouldn't be a problem with some States being permitted to do a creative disguised Expansion of Medicaid.

Let me show the relevant amounts related to the financial impact of Georgia Expanding Medicaid.

Under the Affordable Care Act (ACA), Hospital Organizations' both future Hospital Operating Income and Bottom Line Income will be bolstered very robustly due to many of the Uninsured getting insurance and also due to the many of the Underinsured getting much better insurance.

And for Hospital Organizations operating hospitals in States electing to Expand Medicaid, this future Profit growth will be exceptionally robust.

There are specifically two items which will drive higher Hospital Organization profits due to the ACA and also especially due to States electing the Expansion of Medicaid.

First, there is the Operating Statement Provision for Bad Debts' earnings charge which will be dramatically reduced due to the substantially better insurance situation of hospital patients.  This Provision for Bad Debts' earnings charge is usually a separate report line on a Hospital Organization's audited Operating Statement.

And second, there is the Operating Statement Uncompensated Charity Care Costs' earnings charge for the amounts hospitals spend on charity care which will also be dramatically reduced.  This Estimated Costs for Uncompensated Charity Care is usually disclosed in a Hospital Organization's footnotes which accompany its audited financial statements.

So what about the amounts of these two items?  Well, they are very large, especially when compared to the related Hospital Operating Income.

From a review of EMMA, below here are the Provisions for Bad Debts and Costs of their Uncompensated Charity Care disclosed in their most recent audited financial statements of each of these 12 smaller Georgia Non-Profit Hospital Organizations:


Most
One Year One One


Recent One Year Estimated Year Year


Annual Provision Cost of Total Hospital

Fiscal For Uncompensated Earnings Operating

City Year Bad Charity Charge Income

HQs End Debts Care of Both (Loss)



mils $s mils $s mils $s mils $s
Smaller Georgia Non-Profit Hospital Organizations











Hosp Auth Fulton-DeKalb County (Grady Mem Hosp) Atlanta Dec 2012        263        107        370       (30)
DeKalb Regional Health Decatur Jun 2013        105            9        114       (27)
Hosp Authority Tift County Tifton Sep 2012          33          59          92        22
Memorial Health Savannah Dec 2012          44          34          78         -  
Southern Regional Health Riverdale Jun 2012          55            8          63       (14)
Floyd Healthcare Rome Jun 2013          38          23          61          2
Hosp Authority Valdosta&Lowndes County Valdosta Sep 2012          43          12          55        19
Columbus Regional Healthcare Columbus Jun 2013          39          12          51       (17)
Athens Regional Health Athens Sep 2012          29          19          48         (1)
Crisp Regional Health Cordele Jun 2012          15            1          16          4
Bacon County Health Alma Jun 2012            5            1            6          2
Hosp Authority Wilkes County Washington Apr 2013            1           -              1         (1)







Total all 12

       670        285        955       (41)







Provision for Bad Debts



          670
Estimated Costs of Uncompensated Charity Care



          285





   
Operating Income Excluding Bad Debts and Uncompensated Charity Care Costs


      914

So, these 12 smaller Georgia Non-Profit Hospital Organizations generated Audited Total Hospital Operating Loss of $41 mil in the most recent fiscal year.  Causing this $41 mil Total Hospital Operating Loss were Total Provisions for Bad Debts of $670 mil and Total Costs of Uncompensated Charity Care of another $285 mil.  Thus, exclusive of these two earnings charges, Total Hospital Operating Income would have been $914 mil, which is $955 mil higher than the reported $41 mil Hospital Operating Loss.

Now let me focus on a Bottom Line Profit Margin % basis.  For all 12 smaller Georgia Non-Profit Hospital Organizations combined, the Total Bottom Line Profits were $93 mil in the most recent fiscal year and Total Operating Revenues were $3.726 bil in the most recent year resulting in a 2.5% Profit Margin.

Excluding the above $670 mil of Provisions for Bad Debts and the above $285 mil of Uncompensated Charity Care Costs, the Total Bottom Line Profits exclusive of these two charges would be $1.048 bil, which would yield a Profit Margin of 28.1% in the most recent year for these 12 smaller Georgia Non-Profit Hospital Organizations.....yeah, that's more than 11 times the reported 2.5% Profit Margin.

Granted these two earnings charges will not be totally eliminated with the ACA and in combination with States electing to Expand Medicaid, but a substantial amount of these two earnings charges will be eliminated, and especially so if Georgia wisely elects to Expand Medicaid, which is the predominant driver of these two earnings charges being very substantially reduced.

Which takes me to the second step of this solution.

There are so many extremely profitable Non-Profit Hospital Organizations all over the country, like the 11 large ones in Georgia which generated a Total Bottom Line Profit Margin of 10.2% of Total Operating Revenues in the most recent fiscal year.

These excessive profits have been going on, and compounding, for many years, particularly during the entire period of the Obama Administration, where interest rates have been extremely low and the stock market appreciation extremely high.

Further, these highly profitable large Non-Profit Hospital Organizations will also have their already sky-high annual earnings get an additional huge dose of profits from the ACA and especially from the Expansion of Medicaid.

Thus it only makes sense that the clearly excessive past and future profits of these large Non-Profit Hospital Organizations be used in wisely-designed, creative ways to grow the US economy and bring down US unemployment and US underemployment.  For instance, a wisely designed, creative removal of these excess profits could be used to finance a substantial portion of the 3 or 4 years elimination of the US sequester budget cuts.  And this removal of excess profits could also be used to finance US infrastructure investments.

The end result of this two-step solution process will be to increase US real GDP growth, to decrease US unemployment and US underemployment, to substantially enhance the financial strength of severely struggling smaller hospitals, to reduce the debt load of both US and State Governments, and to simultaneously substantially bend back the long-term US Total Health Care Cost Curve.






Texas Smaller Non-Profit Hospitals Weak Profits Show Need For Medicaid Expansion

In an earlier recent post Texas Non-Profit Hospital Earnings On Fire, I showed that the 16 large Texas Non-Profit Hospital Organizations with Net Assets above $400 mil each experienced earnings in the most recent year which were on fire.

Bottom Line Earnings is a combination of Operating Income and Non-Operating Income, with the latter being due predominantly to Investment Returns.

These 16 Large Texas Non-Profit Hospital Organizations generated Audited Total Bottom Line Profits of $2.759 bil in the most recent fiscal year, which was a very robust 9.1% of their Total Operating Revenues of $30.350 bil.

So what about the Texas County District Hospitals and the smaller Texas Non-Profit Hospital Organizations?  How did they do?

From a review of audited financial statements in the Electronic Municipal Market Access (EMMA), I found 21 Texas County District Hospital Organizations headquartered with Total Operating Revenues of more than $10 mil each in the most recent fiscal year.

These 21 Texas County District Hospitals Organizations generated Total Bottom Line Earnings of $129 mil in the most recent fiscal year, which was down 39% from the prior year and a very modest 2.9% of Total Operating Revenues.

But this story of dismal Texas County District Hospital earnings gets much worse.  In the most recent fiscal year, their Total Operating Losses were a massive $1.604 bil.  Property Tax Revenues provided the dominant funding vehicle for these Operating Losses and turned this Total Operating Loss of $1.604 bil into a modest Total Bottom Line Profit of $129 mil, nearly all of which was related to the Bexar County San Antonio Hospital Organization.

Below here are the Bottom Line Earnings (Losses) and Total Operating Revenues of each of these 21 Texas County District Hospital Organizations for each of the most recent two fiscal years:



Most Bottom Bottom



Recent Line Line Total Total


Annual Net Net Operating Operating

Fiscal Income Income Revenues Revenues

City Year Current Prior Current Prior

HQs End Year Year Year Year



mils $s mils $s mils $s mils $s
Texas County District Hospitals











Bexar San Antonio Dec 2012          100                     76          773          705
Dallas (Parkland) Dallas Sep 2012            33                   106       1,235       1,208
Midland Midland Sep 2012            15                     (4)          231          209
Tarrant Fort Worth Sep 2012            14                      3          442          420
Scurry Snyder Dec 2012              5                      5            20            21
Wilson Floresville Sep 2012              4                      1            22            19
Andrews Andrews Sep 2012              3                      4            24            24
Dawson Lamesa Mar 2012              3                      2            17            18
Ector Odessa Sep 2012              3                     (2)          211          215
ElPaso El Paso Sep 2012              3                      4          376          343
Metagorda Bay City Sep 2012              3                      3            37            36
Deaf Smith Hereford Sep 2012              1                      1            18            15
Hunt Memorial Greenville Sep 2012              1                      3            97            95
Mitchell Colorado City Sep 2012              1                      1            15            16
Angleton-Danbury Angleton Sep 2012            -                       -              30            29
Gaines Seminole Sep 2012            -                        1            19            15
Titus Mt Pleasant Sep 2012            -                        3            62            67
Hopkins Sulphur Springs Sep 2012             (5)                      2            53            54
Gainesville Gainesville Sep 2012             (7)                     (1)            26            30
Nacogdoches Nacogdoches Jun 2012             (7)                     (5)            74            80
Harris Houston Feb 2013           (41)                      7          593          559






   
Total all 21

         129                   210       4,375       4,178







% Change From Prior Year
-39%
5%







Total Bottom Line Profits as % of Total Operating Revenues 2.9% 5.0%


And in an earlier post Texas County District Hospitals, I showed how Texans paying the Property Taxes funding these massive Operating Losses of $1.604 bil should get huge Property Tax relief if Medicaid were expanded in Texas.


OK so what about the smaller Texas Non-Profit Hospital Organizations which weren't Texas County District Hospitals?  How did they do?

From a review of audited financial statements in the Electronic Municipal Market Access (EMMA), I found 13 Non-Profit Hospital Organizations headquartered in the State of Texas with Total Operating Revenues of more than $10 mil each in the most recent fiscal year but also with Net Assets of less than $400 mil each.

These 13 smaller Texas Non-Profit Hospital Organizations generated Total Bottom Line Earnings of $78 mil in the most recent fiscal year, which was down 36% from the prior year.

These Total Bottom Line Earnings were only 2.2% of the related Total Operating Revenues for these 13 smaller Texas Non-Profit Hospital Organizations as compared with a substantially higher 9.1% for the 15 large ones. 

Below here are the Bottom Line Earnings (Losses) and Total Operating Revenues of each of these 13 smaller Texas Non-Profit Hospital Organizations for each of the most recent two fiscal years:


Most Bottom Bottom



Recent Line Line Total Total


Annual Net Net Operating Operating

Fiscal Income Income Revenues Revenues

City Year Current Prior Current Prior

HQs End Year Year Year Year



mils $s mils $s mils $s mils $s
Smaller Texas Non-County District Hospitals











United Regional Health Care Wichita Falls Dec 2012            40                     40          279          290
Hendrick Medical Center Abilene Aug 2012            34                     41          323          309
East Texas Medical Center Tyler Oct 2012            12                     20          942          888
Decatur Hospital Authority Decatur Dec 2012            12                      2          144          124
Hillcrest Baptist Medical Center Waco Aug 2012              9                      4          223          215
Good Shepherd Health Longview Sep 2012              4                     13          402          375
Mission Hospital Mission Sep 2012            -                        2          112          114
St. Mark's Medical Center LaGrange Jun 2012            -                        1            27            26
Memorial Health System East Texas Lufkin Dec 2012             (1)                    (16)          192          178
Community Hospital Brazosport Lake Jackson Dec 2012             (4)                     (5)            73            73
Guadalupe Regional Medical Center Seguin Sep 2012             (5)                      1            80            79
Trinity Mother Frances Health Tyler Jun 2013             (7)                     27          653          644
Sid Peterson Memorial Hospital Kerrville Jun 2012           (16)                     (8)            93            90







Total all  13

           78                   122       3,543       3,405







% Change From Prior Year

-36%
4%







Total Bottom Line Profits as % of Total Operating Revenues
2.2% 3.6%


So, the country's huge and continually expanding income inequality is not just related to very wealthy individuals and everyone else.  It also clearly exists in the Non-Profit Hospital arena.

The solution to this massive income inequality in the Non-Profit Hospital arena really isn't that difficult.  It's a two-step process.

The first step of the solution is simply for every State to Expand Medicaid.  And there shouldn't be a problem with some States being permitted to do a creative disguised Expansion of Medicaid.

Let me show the relevant amounts related to the financial impact on these smaller Texas Hospitals of Texas Expanding Medicaid.

Under the Affordable Care Act (ACA), Hospital Organizations' both future Hospital Operating Income and Bottom Line Income will be bolstered very robustly due to many of the Uninsured getting insurance and also due to the many of the Underinsured getting much better insurance.

And for Hospital Organizations operating hospitals in States electing to Expand Medicaid, this future Profit growth will be exceptionally robust.

There are specifically two items which will drive higher Hospital Organization profits due to the ACA and also especially due to States electing the Expansion of Medicaid.

First, there is the Operating Statement Provision for Bad Debts' earnings charge which will be dramatically reduced due to the substantially better insurance situation of hospital patients.  This Provision for Bad Debts' earnings charge is usually a separate report line on a Hospital Organization's audited Operating Statement.

And second, there is the Operating Statement Uncompensated Charity Care Costs' earnings charge for the amounts hospitals spend on charity care which will also be dramatically reduced.  This Estimated Costs for Uncompensated Charity Care is usually disclosed in a Hospital Organization's footnotes which accompany its audited financial statements.

So what about the amounts of these two items?  Well, they are very large, especially when compared to the related Hospital Operating Income.

From a review of EMMA, below here are the Provisions for Bad Debts and Costs of their Uncompensated Charity Care disclosed in their most recent audited financial statements of each of these 13 smaller Texas Non-Profit Hospital Organizations:


Most
One Year One One


Recent One Year Estimated Year Year


Annual Provision Cost of Total Hospital

Fiscal For Uncompensated Earnings Operating

City Year Bad Charity Charge Income

HQs End Debts Care of Both (Loss)



mils $s mils $s mils $s mils $s
Smaller Texas Non-County District Hospitals











East Texas Medical Center Tyler Oct 2012          155                     37          192            12
Good Shepherd Health Longview Sep 2012          134                     19          153              6
Memorial Health System East Texas Lufkin Dec 2012            96                      9          105             (3)
Trinity Mother Frances Health Tyler Jun 2013            51                     20            71              2
Hendrick Medical Center Abilene Aug 2012            43                     14            57            21
United Regional Health Care Wichita Falls Dec 2012            26                     20            46            26
Hillcrest Baptist Medical Center Waco Aug 2012            31                     14            45              7
Guadalupe Regional Medical Center Seguin Sep 2012              9                     22            31             (1)
Community Hospital Brazosport Lake Jackson Dec 2012            26                      2            28             (4)
Decatur Hospital Authority Decatur Dec 2012            20                      7            27            16
Mission Hospital Mission Sep 2012            19                      8            27             (2)
Sid Peterson Memorial Hospital Kerrville Jun 2012              7                      7            14             (5)
St. Mark's Medical Center LaGrange Jun 2012              3                     -                3            -  







Total all  13

         620                   179          799            75







Provision for Bad Debts



             620
Estimated Costs of Uncompensated Charity Care


             179





   
Operating Income Excluding Bad Debts and Uncompensated Charity Care Costs

         874


So, these 13 smaller Texas Non-Profit Hospital Organizations generated Audited Total Hospital Operating Income of $75 mil in the most recent fiscal year.  Driving down this $75 mil Total Hospital Operating Income were Total Provisions for Bad Debts of $620 mil and Total Costs of Uncompensated Charity Care of another $179 mil.  Thus, exclusive of these two earnings charges, Total Hospital Operating Income would have been $874 mil, which is $799 mil higher than the reported $75 mil.

Now let me focus on a Bottom Line Profit Margin % basis.  For all 13 smaller Texas Non-Profit Hospital Organizations combined, the Total Bottom Line Profits were $78 mil in the most recent fiscal year and Total Operating Revenues were $3.543 bil in the most recent year resulting in a 2.2% Profit Margin.

Excluding the above $620 mil of Provisions for Bad Debts and the above $179 mil of Uncompensated Charity Care Costs, the Total Bottom Line Profits exclusive of these two charges would be $877 mil, which would yield a Profit Margin of 24.8% in the most recent year for these 13 smaller Texas Non-Profit Hospital Organizations.....yeah, that's more than 11 times the reported 2.2% Profit Margin %.

Granted these two earnings charges will not be totally eliminated with the ACA and in combination with States electing to Expand Medicaid, but a substantial amount of these two earnings charges will be eliminated, and especially so if Texas were to wisely elect to Expand Medicaid, which is the predominant driver of these two earnings charges being very substantially reduced.

Which takes me to the second step of this solution.

There are so many extremely profitable Non-Profit Hospital Organizations all over the country, like the 16 large ones in Texas which generated a Total Bottom Line Profit Margin of 9.1% of Total Operating Revenues in the most recent fiscal year.

These excessive profits have been going on, and compounding, for many years, particularly during the entire period of the Obama Administration, where interest rates have been extremely low and the stock market appreciation extremely high.

Further, these highly profitable large Non-Profit Hospital Organizations will also have their already sky-high annual earnings get an additional huge dose of profits from the ACA and especially from the Expansion of Medicaid.

Thus it only makes sense that the clearly excessive past and future profits of these large Non-Profit Hospital Organizations be used in wisely-designed, creative ways to grow the US economy and bring down US unemployment and US underemployment.  For instance, a wisely designed, creative removal of these excess profits could be used to finance a substantial portion of the 3 or 4 years elimination of the US sequester budget cuts.  And this removal of excess profits could also be used to finance US infrastructure investments.

The end result of this two-step solution process will be to increase US real GDP growth, to decrease US unemployment and US underemployment, to substantially enhance the financial strength of severely struggling smaller hospitals, to reduce the debt load of both US and State Governments, and to simultaneously substantially bend back the long-term US Total Health Care Cost Curve.