Friday, March 21, 2014

Florida Hospitals Net Assets Up 80% Under Obama and the Affordable Care Act

From a review of the Electronic Municipal Market Access (EMMA) and SEC filings, I found 13 Non-Profit Hospital Organizations which weren't Public Governmental Ones, 5 Non-Profit Public Governmental Hospital Organizations and 2 Publicly-held Hospital Companies which were all headquartered in the State of Florida and which also had Net Assets (i.e. Financial Strength or Total Assets minus Total Liabilities) at the most recent date reported of more than $400 mil each.

Below here are the Net Assets of each of these 20 Hospital Organizations at both the most recent reported date and also at the Fiscal Year End (FYE) closest to the beginning of the Obama Administration:






FYE Balance Net




Most
Balance Sheet Assets



Most Recent
Sheet Net %



Recent Balance
Date Assets Change



Balance Sheet
Beginning Beginning During
City State Sheet Net
Obama Obama Obama
Hospital Organization HQs HQs Date Assets
Admin Admin Admin




mil $s

mil $s
Non-Profit Hospitals
















…..Non-Public Hospitals







Adventist Health System Altamonte Springs FL Dec 13     6,320
Dec 08       3,407 86%
BayCare Health System Clearwater FL Dec 13     3,504
Dec 08       1,523 130%
Baptist Health South Florida Coral Gables FL Dec 13     2,849
Sep 09       1,571 81%
Baptist Health System Jacksonville FL Mar 14     1,511
Sep 09          687 120%
Nemours Foundation Jacksonville FL Dec 12        956
Dec 08          744 28%
Shands Teaching Hospitals & Clinics Gainesville FL Dec 13        898
Jun 09          569 58%
Health First Rockledge FL Dec 13        666
Sep 09          481 38%
Tampa General Hospital Tampa FL Dec 13        655
Sep 09          331 98%
All Children's Hospital St Petersburg FL Dec 13        640
Sep 09          516 24%
Lakeland Regional Health Lakeland FL Dec 13        576
Sep 09          390 48%
Miami Children's Hospital Miami FL Dec 13        540
Dec 08          236 129%
H. Lee Moffitt Cancer Center Tampa FL Dec 13        434
Jun 09          352 23%
NCH Healthcare System Naples FL Dec 13        430
Sep 09          353 22%









Total all 13 Non-Public Non-Profit Hospitals

  19,979

    11,160 79%









…..Public Governmental Hospitals







South Broward Hospital District Hollywood FL Jan 14     1,619
Apr 09       1,011 60%
Orlando Health Orlando FL Mar 14     1,263
Sep 09          875 44%
North Broward Hospital District Fort Lauderdale FL Dec 13        850
Jun 09          564 51%
Lee Memorial Health System Fort Myers FL Dec 13        865
Sep 09          576 50%
Sarasota County Public Hosp District Sarasota FL Mar 14        761
Sep 09          542 40%









Total all 5 Public Governmental Hospitals


    5,358

      3,568 50%









Publicly-held Hospitals







Mednax Sunrise FL Dec 13     2,343
Dec 08          965 143%
Health Management Associates Naples FL Sep 13     1,008
Dec 08          286 252%









Total all 2 Publicly-held Hospitals


    3,351

      1,251 168%









Total all 20 Non-Profit and Publicly-held Hospitals

   28,688

      15,979 80%

As you can see from the above chart, the Total Net Assets (Financial Strength) of these 20 Florida Hospital Organizations increased by an exceptional 80% to a massive $28.688 bil for their average 4.50 years so far during the Obama Administration. 

Also as you can see from the above chart, the Total Net Assets (Financial Strength) of the 13 Non-Profit Hospital Organizations which are not Public Governmental ones increased by an exceptional 79% to $19.979 bil for their average 4.44 years so far during the Obama Administration.  Further, in just the past 6 months, these 13 Florida Hospital Organizations had this Total Net Asset growth increase substantially from 63% to 79%.
Very positively impacting this major increase in the Net Assets (Financial Strength) of these 20 Florida Hospital Organizations were actions taken by both the Obama Administration and the US Fed to strengthen the US Financial Foundation which was severely damaged from the financial meltdown in late 2008.

In addition, the Affordable Care Act (ACA) has also played a key role in this substantial increase in Net Assets (Financial Strength) of these 20 Florida Hospital Organizations.

A remarkable thing is that these very robust increases in Net Assets (Financial Strength) of these Florida Hospital Organizations occurred when these Hospitals were also playing very instrumental roles in the substantial annual percentage growth reduction of Total US Health Care Costs which occurred in each of the most recent three years under the ACA.

With such substantial Net Asset percentage increases of these 20 Florida Hospital Organizations, a key beneficiary of this will be Florida citizens electing to buy health insurance on the Health Insurance Exchange.  This exceptional Net Asset growth gives these 20 Florida Hospital Organizations the financial flexibility to moderate their pricing for hospital procedures in their negotiations with health insurance companies which ultimately determines what insurance premium prices are set at by health insurance companies on the Health Insurance Exchange.

Not included in the above large Hospital Organizations is the Clearwater Florida Headquartered Shriners Hospitals For Children.  It hasn't disclosed its Audited December 2013 Financial Statements yet on its website.  Its Total Net Assets at December 31, 2012 were a huge $8.334 bil, which was an 18% increase from the $7.061 bil of Total Net Assets at December 31, 2008.   It should have a very robust increase in Net Assets in 2013, due to the very strong stock market.....it has Total Long-term Investments of $7.6 bil at December 31, 2012.....coupled with a higher discount rate used to measure its pension liabilities from a bit higher long-term interest rate environment.

Florida Safety Net Hospitals:  Public Health Trust of Miami-Dade County

There are a number of Florida Safety Net Public Hospitals.  The largest is the Public Health Trust of Miami-Dade County, which is overwhelmingly the huge Jackson Hospitals.

From reviewing its financial statements on EMMA, the Public Health Trust of Miami-Dade County generated an Operating Loss of a large $339 mil in the fiscal year ended September 2012.  For the most recent 5 years combined, these Operating Losses totaled a monstrous $2.247 bil.

So Many Struggling Florida Hospitals

But it's not just the Miami area Jackson Hospitals which are severely struggling in the State of Florida Hospital universe.

The State of Florida is being very transparent with its citizens by having available for review at its State Dept of Health website (MyFlorida.com) very detailed financial information on each of its 173 Hospitals.  This Operating Statement information presented was for 2011.

Overall, these 173 Florida Hospitals had a Total Operating Income of $1.202 bil in 2011 which was a seemingly respectable Goldilocks 3.9% of their Total Operating Revenues of $31.156 bil.  And these 173 Florida Hospitals' Total Operating Income of $1.202 bil in 2011 was burdened with an Earnings Charge of a massive $4.319 bil due to Total Provisions for Bad Debts.  In addition, their Total Uncompensated Charity Care Charges Foregone were $6.217 bil in 2011. 

But you have to stratify these Hospitals to find out what is really going on with Florida Hospitals.

First, let's look at the upper end Florida Hospitals.

There were 56 of these 173 Florida Hospitals which generated Operating Income as a Percentage of Total Operating Revenues of above 7.5% in 2011.  I'll call these Top 56 the Orange Supreme Hospitals.  In the aggregate, they generated Total Operating Income of an obscene 12.7% of Total Operating Revenues.....that's more than 25% higher than what the 30 Dow Industrials combined generated on an After-tax basis.  This is flat out crazy and tells you why US Health Care Costs have been so incredibly out of control.  Here are the Top 56: 



Operating


Operating Total Income
Florida
Income Operating (Loss)
County Florida Hospital Name (Loss) Revenues Margin


000s 000s %

Orange Supreme Hospitals


Duval River Point Behavioral Health                           6,632                 18,270 36.3%
Duval Wekiva Springs                           4,140                 12,673 32.7%
Sarasota Healthsouth                           8,745                 31,004 28.2%
Monroe Depoo Hospital                        23,951                 86,448 27.7%
Baker Ed Fraser Memorial Hospital                           3,982                 14,881 26.8%
Polk Heart of Florida Regional Med Ctr                        32,627               134,821 24.2%
Miami-Dade Univ Miami Hospital and Clinics                        80,667               339,842 23.7%
Miami-Dade St Catherine's Rehabilitation Hospital                           5,860                 25,062 23.4%
Pinellas Healthsouth                           4,562                 20,296 22.5%
Hernando Brooksville Regional Hospital                        33,266               154,398 21.5%
Flagler Florida Hospital Flagler                        22,400               111,093 20.2%
Broward Cleveland Clinic                        35,751               194,016 18.4%
Miami-Dade Baptist Hospital Miami                      162,869               888,007 18.3%
Miami-Dade Doctors Hospital                        35,420               199,402 17.8%
Indian River Sebastian River Medical Center                        12,203                 71,108 17.2%
Brevard Wuesthoff Medical Center-Melbourne                        12,280                 73,123 16.8%
Miami-Dade Kendall Regional Medical Center                        41,358               247,102 16.7%
Broward Memorial Hospital Miramar                        26,421               158,045 16.7%
Monroe Mariners Hospital                           7,167                 46,403 15.4%
Broward St Anthony's Rehabilitation Hospital                           1,484                    9,614 15.4%
Leon Tallahassee Memorial Hospital                        68,652               451,155 15.2%
Broward Memorial Hospital West                        58,590               394,481 14.9%
Marion The Vines Hospital                              993                    6,742 14.7%
Miami-Dade Aventura Hospital and Medical Center                        38,453               266,789 14.4%
Pinellas Mease Dunedin Hospital                        47,589               337,288 14.1%
Citrus Seven Rivers Regional Medical Center                        10,620                 77,659 13.7%
Duval Mayo Clinic                        52,170               385,620 13.5%
Nassau Baptist Medical Center-Nassau                           6,913                 51,152 13.5%
Lee Lee Memorial Hospital                        71,635               569,818 12.6%
Pinellas Morton Plant Hospital                        53,895               429,058 12.6%
Lake South Lake Hospital                        16,729               133,204 12.6%
Miami-Dade South Miami Hospital                        57,379               458,125 12.5%
Lee Cape Coral Hospital                        23,202               186,522 12.4%
Suwanee Shands Live Oak Regional Med Ctr                           2,329                 19,091 12.2%
Monroe Fishermen's Hospital                           1,358                 11,655 11.7%
Walton Sacred Heart Hospital Emerald Coast                           9,001                 78,369 11.5%
Hillsborough St Joseph's Hospital                        84,521               742,385 11.4%
Marion The Centers Inc                              304                    2,790 10.9%
Duval Baptist Medical Center-Downtown                        79,373               728,731 10.9%
Collier Physicians Regional Med Ctr-Pine Ridge                        18,471               170,128 10.9%
Charlotte Charlotte Regional Medical Center                        11,861               111,424 10.6%
Santa Rosa Santa Rosa Medical Center                           5,936                 55,882 10.6%
Pinellas Baycare Alliant Hospital                           1,753                 17,112 10.2%
Pinellas St Anthony's Hospital                        17,595               175,340 10.0%
Osceola St Cloud Regional Medical Center                           4,714                 49,785 9.5%
Pasco Florida Hospital Zephyrhills                        12,832               135,735 9.5%
Orange Florida Hospital                      204,120            2,173,541 9.4%
Sarasota Venice Regional Medical Center                        14,414               154,362 9.3%
Polk Bartow Regional Medical Center                           5,287                 56,620 9.3%
Volusia Florida Hospital Fish Memorial                        11,370               123,838 9.2%
Escambia Baptist Hospital                        31,645               344,755 9.2%
Miami-Dade Anne Bates Leach Hospital                           8,346                 99,758 8.4%
Volusia Florida Hospital Deland                           8,812               111,336 7.9%
Pasco Pasco Regional Medical Center                           3,950                 50,825 7.8%
Duval Baptist Medical Center-Beaches                           7,484                 98,292 7.6%
Orange Orlando Regional Medical Center                      113,515            1,518,411 7.5%




Total all 56 Florida Orange Supreme Hospitals                   1,727,596         13,613,386 12.7%

But you get a completely different story when you look at the bottom portion of these 173 Florida Hospitals.

In total, 67 of the 173 Florida Hospitals had Operating Losses in the most recent year reported (2011).  These Losses totaled $903 mil in 2011, which were a huge (14.0)% of the Total Operating Revenues of $6.439 bil related to these 67 Operating Loss Florida Hospitals, as you can see in the below chart:



Operating


Operating Total Income
Florida
Income Operating (Loss)
County Florida Hospital Name (Loss) Revenues Margin


000s 000s %





Gadsden Florida State Hospital                    (108,699)                    2,794 -3890.4%
Broward South Florida State Hospital                       (28,140)                    3,299 -853.0%
Hillsborough Shriners Hospitals For Children-Tampa                       (19,015)                    3,100 -613.4%
Baker Northeast Florida State Hospital                       (50,701)                    9,018 -562.2%
Miami-Dade West Kendall Baptist Hospital                       (50,240)                 34,435 -145.9%
Palm Beach Jerome Golden Center For Behavioral Health                         (2,616)                    1,809 -144.6%
Palm Beach Holley State Hospital                         (6,233)                    5,780 -107.8%
Brevard Viera Hospital                       (16,043)                 20,385 -78.7%
Brevard Circles of Care                         (4,325)                    6,215 -69.6%
Gulf Sacred Heart Hospital on the Gulf                         (6,000)                    9,349 -64.2%
Franklin Weems Memorial Hospital                         (2,811)                    5,157 -54.5%
Hendry Henry Regional Medical Center                         (7,672)                 14,836 -51.7%
Lake Lifestream Behavioral Center                         (2,180)                    4,749 -45.9%
Orange La Amistad Residential Treatment Ctr                         (2,581)                    5,971 -43.2%
Orange University Behavioral Center                         (1,909)                    5,846 -32.7%
Miami-Dade Jackson Memorial Hospital                    (360,572)            1,127,050 -32.0%
Palm Beach Lakeside Medical Center                         (9,063)                 29,501 -30.7%
Leon Eastside Psychiatric Hospital                         (1,005)                    3,477 -28.9%
Miami-Dade Douglas Gardens Hospital                         (1,843)                    7,622 -24.2%
Putnam Putnam Community Medical Center                         (9,640)                 53,396 -18.1%
Columbia Shands Lake Shore Regional Med Ctr                         (6,379)                 37,531 -17.0%
Volusia Bert Fish Medical Center                         (5,983)                 36,193 -16.5%
Levy Tri County Hospital-Williston                            (850)                    5,165 -16.5%
Collier Willough at Naples                         (2,291)                 14,899 -15.4%
Pinellas Florida Hospital North Pinellas                         (9,271)                 61,266 -15.1%
Madison Madison County Memorial Hospital                            (928)                    6,248 -14.9%
Desoto Desoto Memorial Hospital                         (4,045)                 28,567 -14.2%
Broward Broward Health North                       (21,150)               170,473 -12.4%
Duval St Vincent's Medical Center Southside                       (14,157)               115,139 -12.3%
Jackson Campbellton-Graceville Hospital                            (837)                    6,978 -12.0%
Miami-Dade Metropolitan Hospital Miami                         (4,386)                 39,426 -11.1%
Miami-Dade Homestead Hospital                       (18,191)               165,347 -11.0%
Broward Broward Health Imperial Point                         (6,788)                 95,603 -7.1%
Taylor Doctors Memorial Hospital                         (1,248)                 18,915 -6.6%
Broward Memorial Hospital Pembroke                         (7,504)               113,844 -6.6%
Bay Bay Medical Center: Sacred Heart System                       (12,417)               217,073 -5.7%
Broward University Hospital and Medical Center                         (5,392)                 96,619 -5.6%
Manatee Lakewood Ranch Medical Center                         (2,880)                 54,599 -5.3%
Highlands Highlands Regional Medical Center                         (2,829)                 54,027 -5.2%
Volusia Halifax Health Medical Center                       (19,545)               384,957 -5.1%
Holmes Doctors Memorial Hospital                            (563)                 12,129 -4.6%
Hardee Florida Hospital Wauchula                            (707)                 19,025 -3.7%
Jackson Jackson Hospital                         (1,529)                 43,928 -3.5%
Calhoun Calhoun-Liberty Hospital                             (301)                    9,004 -3.3%
Miami-Dade Mercy Hospital Campus of Plantation General Hospital                         (2,146)                 69,414 -3.1%
Brevard Wuesthoff Medical Center-Rockledge                         (4,133)               136,366 -3.0%
Brevard Palm Bay Hospital                            (997)                 34,577 -2.9%
Indian River Indian River Medical Center                         (4,214)               165,618 -2.5%
Union Lake Butler Hospital Hand Surgery Ctr                            (193)                    8,048 -2.4%
Union Reception and Medical Center Hospital                       (16,369)                           -  
Charlotte Peace River Regional Medical Center                         (1,949)                 89,572 -2.2%
Broward Memorial Regional Hospital                       (15,709)               731,256 -2.1%
Hillsborough Florida Hospital Carrollwood                         (1,557)                 89,325 -1.7%
Walton Healthmark Regional Medical Center                            (172)                 10,026 -1.7%
Citrus Citrus Memorial Hospital                         (2,329)               141,084 -1.7%
Broward Broward Health Coral Springs                         (2,124)               132,657 -1.6%
Hernando Springbrook Hospital                            (252)                 16,038 -1.6%
Lee Lehigh Regional Medical Center                            (545)                 41,025 -1.3%
Bradford Shands Starke Regional Medical Center                            (231)                 20,223 -1.1%
Santa Rosa Jay Hospital                            (128)                 12,350 -1.0%
Miami-Dade University Miami Hospital                         (3,063)               306,483 -1.0%
Lake Leesburg Regional Medical Center                         (1,827)               221,127 -0.8%
Duval Shands Jacksonville Medical Center                         (2,192)               506,849 -0.4%
Volusia Florida Hospital Oceanside                            (753)               205,897 -0.4%
Broward Plantation General Hospital                            (666)               269,396 -0.2%
Brevard Devereux Florida                               (38)                 15,766 -0.2%
Hillsborough Town & Country Hospital                            (106)                 54,870 -0.2%






Total all 67                    (903,152)            6,438,711 -14.0%

In addition to the above 67 Florida Hospitals generating Operating Losses in 2011, there were another 23 of these 173 Florida Hospitals which generated very modest Operating Income as a Percentage of Total Operating Revenues from 0.0% to 2.6%, as you can see in the below chart:



Operating


Operating Total Income
Florida
Income Operating (Loss)
County Florida Hospital Name (Loss) Revenues Margin


000s 000s %





Santa Rosa West Florida Community Care Ctr                                   2                    7,486 0.0%
Hillsborough Tampa General Hospital                              720               986,242 0.1%
Polk Winter Haven Hospital                              500               224,952 0.2%
Pasco Morton Plant North Bay Hospital                              208                 83,215 0.2%
Pinellas Bayfront Medical Center                              915               253,064 0.4%
Orange Central Florida Behavioral Hospital                                73                 13,723 0.5%
Brevard Parrish Medical Center                              796               142,763 0.6%
St Lucie Port St Lucie Hospital                              106                 16,466 0.6%
Palm Beach Boca Raton Regional Hospital                           2,397               328,000 0.7%
Lee Gulf Coast Med Ctr Lee Memorial                           2,848               274,635 1.0%
Broward Broward Health Medical Center                           4,364               417,725 1.0%
Miami-Dade Westchester General Hospital                              677                 60,567 1.1%
Pinellas Palms of Pasadena Hospital                              806                 71,032 1.1%
Palm Beach Jupiter Medical Center                           1,927               165,827 1.2%
Miami-Dade Coral Gables Hospital                           1,138                 75,189 1.5%
Hillsborough Florida Hospital Tampa                           4,845               318,530 1.5%
St Johns Flagler Hospital                           3,904               188,155 2.1%
Sarasota Sarasota Memorial Hospital                           9,585               459,027 2.1%
Pinellas All Children's Hospital                           2,152                 86,277 2.5%
Okaloosa Gulf Coast Treatment Center                                47                    1,882 2.5%
Marion Munroe Regional Medical Center                           7,477               292,662 2.6%
Alachua Shands Hospital Univ Florida                        24,717               949,820 2.6%
Hillsborough South Florida Baptist Hospital                           2,165                 81,884 2.6%






Total all 23                        72,369            5,499,123 1.3%

When you have 90 or 52% of Florida Hospitals with these huge Operating Losses or very modest Operating Income, the responsible thing to do is to deal with them and not ignore them.  So far, the State of Florida has irresponsibly decided to ignore them.

The best and only way to substantially strengthen the very poor Operating Results of these so many struggling Florida Hospitals is for the State of Florida to fully expand Medicaid.  This action will dramatically improve the profits of every single Florida Hospital.  If Florida fully expands Medicaid, there will be a resultant massive inflow of Patient Revenues, after all there were a massive $4.319 bil of Total Provisions for Bad Debts Charges that reduced the Total Operating Revenues of all Florida Hospitals in 2011.  In addition, there were $6.217 bil of Uncompensated Charity Care Charges Foregone in 2011.

A key side benefit here to Florida citizens is that the resultant profit enhancements and thus Net Asset enhancements of all of these Florida Hospitals due to Medicaid expansion will give these Florida Hospitals the financial flexibility to moderate their pricing for hospital and other health care procedures in their negotiations with health insurance companies which ultimately determines what insurance premium prices are set at by health insurance companies on the Health Insurance Exchange.