Thursday, March 20, 2014

Iowa Non-Profit Hospitals Net Assets Up 67% Under Obama and the Affordable Care Act

From a review of the Electronic Municipal Market Access (EMMA), I found 3 Non-Profit Hospital Organizations headquartered in the State of Iowa with Net Assets (i.e. Financial Strength or Total Assets minus Total Liabilities) at the most recent date of more than $400 mil each.  Below here are the Net Assets of these 3 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









UnityPoint Health Des Moines IA Dec 13     2,322
Dec 08       1,067 118%
University Iowa Hospitals & Clinics Iowa City IA Jun 13     1,172
Jun 09          969 21%
Genesis Health System Davenport IA Dec 13        549
Jun 09          387 42%









Total all 3


     4,043

       2,423 67%

As you can see from the above chart, the Total Net Assets (Financial Strength) of these 3 Iowa Non-Profit Hospital Organizations increased by a very impressive 67% to $4.043 bil for their average 4.50 years during the Obama Administration.

Very positively impacting this very robust increase in the Net Assets (Financial Strength) of these 3 Iowa 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 very impressive increase in Net Assets (Financial Strength) of these 3 Iowa Non-Profit Hospital Organizations.

A remarkable thing is that these very robust increases in Net Assets (Financial Strength) of these Non-Profit Hospital Organizations occurred when these Non-Profit 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 impressive Net Asset percentage increases of these 3 Iowa Hospitals, a key beneficiary of this will be Iowa citizens electing to buy health insurance on the Health Insurance Exchange.  This strong Net Asset growth gives these Iowa Hospitals 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.
 
Iowa's Many Struggling Smaller Hospitals

Iowa's Hospital Facts at the Iowa Hospital Association's website contains key operating data related to Iowa's individual Hospitals.  There were 118 Iowa Hospitals presented there.

The positive side here is that the 22 Iowa Urban Hospitals generated an operating Income Margin of a very respectable 4.1% of Total Operating Revenues in 2012.  The Iowa rural Hospitals also did just fine.

But the big negative side here is that the 82 Iowa smaller Critical Access Hospitals generated an operating Income Margin of a very modest 1.1% of Total Operating Revenues in 2012.

Altogether, there were 41 or 35% of these 118 Iowa Hospitals which had Operating Losses in 2012, with 37 of them in the smaller Critical Access Hospital category.  Yeah, an amazingly high 37 or 45% of the 82 Iowa Critical Access Hospitals had Operating Losses.

In addition, there were another 21 or 18% of these 118 Iowa Hospitals which had very modest Operating Income of 0.0% to 2.5% of their Total Operating Revenues in 2012.  Again, Iowa's smaller Critical Access Hospitals comprised the bulk of these with 16.

In the chart below are these 118 Iowa Hospitals.




2012


2012 2012 Operating


Operating Total Income


Income Operating (Loss)
Iowa City Iowa Community Hospitals (Loss) Revenues Margin


$000s $000s %
Urban Hospitals



Des Moines Broadlawns Medical Center     (47,430)       72,174 -65.7%
Sioux City Mercy Medical Center-Sioux City           448     194,503 0.2%
Dubuque Mercy Medical Center-Dubuque        4,307     142,233 3.0%
Cedar Rapids UnityPoint Health-St Luke's Hospital       10,119     324,526 3.1%
Sioux City UnityPoint Health-St Luke's Hospital        4,472     128,363 3.5%
Council Bluffs Methodist Jennie Edmundson Hospital        3,255       89,364 3.6%
Iowa City University Iowa Hospitals and Clinics       42,645  1,098,292 3.9%
Waterloo Covenant Medical Center       10,642     254,753 4.2%
Dubuque UnityPoint Health-Finley Hospital        4,110       96,370 4.3%
Waterloo UnityPoint Health-Allen Hospital        9,427     209,552 4.5%
Des Moines Mercy Medical Center-Des Moines       27,809     589,348 4.7%
Cedar Rapids Mercy Medical Center-Cedar Rapids       13,158     264,282 5.0%
West Des Moines UnityPoint Health-Methodist West Hospital        4,034       75,131 5.4%
Davenport Genesis Medical Center-Davenport       17,895     332,137 5.4%
Des Moines UnityPoint Health-Iowa Methodist Med Ctr       27,284     460,944 5.9%
Des Moines UnityPoint Health-Iowa Lutheran Hosp        7,378     118,446 6.2%
Iowa City Mercy Iowa City        9,807     152,176 6.4%
Council Bluffs Alegent Creighton Health Mercy Hosp       10,296     125,357 8.2%
Ames Mary Greeley Medical Center       16,042     171,416 9.4%
Bettendorf UnityPoint Health-Quad Cities        7,594       69,481 10.9%
Cedar Falls Sartori Memorial Hospital        5,893       35,102 16.8%
West Des Moines Mercy Medical Center-West Lakes       17,895       66,823 26.8%
Total 22 Urban Hospitals
    207,080  5,070,773 4.1%





Critical Access Hospitals



Leon
      (1,669)        7,628 -21.9%
Jefferson
      (3,200)       19,414 -16.5%
Mount Ayr
      (2,282)       14,128 -16.2%
Dyersville
         (584)        4,317 -13.5%
Chariton
      (2,012)       15,689 -12.8%
Corydon
      (2,317)       19,071 -12.1%
Greenfield
      (1,096)        9,262 -11.8%
Guthrie Center
      (1,286)       12,674 -10.1%
Keosauqua
      (1,137)       11,389 -10.0%
Clarinda
      (1,655)       21,817 -7.6%
Nevada
      (1,287)       17,966 -7.2%
Winterset
      (1,128)       16,558 -6.8%
Denison
      (1,329)       23,809 -5.6%
Perry
         (654)       13,165 -5.0%
Marengo
         (738)       15,223 -4.8%
Red Oak
      (1,028)       26,890 -3.8%
Sigourney
         (296)        8,490 -3.5%
West Union
         (671)       21,179 -3.2%
Oskaloosa
      (1,137)       36,524 -3.1%
Belmond
         (338)       13,285 -2.5%
Cresco
         (336)       14,154 -2.4%
Bloomfield
         (434)       20,564 -2.1%
Maquoketa
         (244)       12,673 -1.9%
Sumner
         (179)        9,598 -1.9%
Hunboldt
         (212)       12,789 -1.7%
Sac City
         (190)       11,953 -1.6%
Atlantic
         (445)       33,282 -1.3%
Pocahontas
         (128)        9,681 -1.3%
Osceola
         (207)       17,418 -1.2%
Hampton
         (186)       15,969 -1.2%
Boone
         (340)       42,969 -0.8%
Oelwein
           (94)       12,478 -0.8%
Webster City
         (171)       23,662 -0.7%
Harlan
         (209)       31,004 -0.7%
Manchester
         (198)       35,689 -0.6%
Le Mars
         (118)       31,302 -0.4%
Albia
           (54)       15,819 -0.3%
Hamburg
              8        9,913 0.1%
Sibley
              9       10,349 0.1%
Clarion
            68       45,993 0.1%
Mount Pleasant
            68       30,330 0.2%
Grundy Center
            58       18,236 0.3%
Shenandoah
          166       26,108 0.6%
Cherokee
          217       19,598 1.1%
Audubon
          119       10,182 1.2%
Creston
          457       39,065 1.2%
Britt
          187       14,508 1.3%
Missouri Valley
          291       22,182 1.3%
Algona
          446       29,902 1.5%
Emmetsburg
          371       22,334 1.7%
Iowa Falls
          372       19,962 1.9%
Elkader
          116        6,052 1.9%
Lake City
          647       30,631 2.1%
Ida Grove
          435       16,984 2.6%
Vinton
          637       21,696 2.9%
Osage
          536       18,048 3.0%
Decorah
       1,408       45,024 3.1%
Orange City
       1,422       39,286 3.6%
Charles City
          844       23,052 3.7%
Estherville
          855       23,190 3.7%
Onawa
          951       24,397 3.9%
Sheldon
       1,159       26,760 4.3%
Waverly
       2,260       51,021 4.4%
Waukon
          682       15,145 4.5%
Storm Lake
       1,894       41,859 4.5%
Sioux Center
       1,369       29,231 4.7%
Fairfield
       1,249       25,691 4.9%
Primghar
          371        7,534 4.9%
Rock Rapids
          470        8,284 5.7%
Centerville
       1,392       24,090 5.8%
Washington
       1,482       24,666 6.0%
New Hampton
       1,191       15,801 7.5%
Independence
       1,446       18,930 7.6%
De Witt
       1,378       17,408 7.9%
Rock Valley
       1,352       16,812 8.0%
Knoxville
       2,437       27,081 9.0%
Guttenberg
       1,022       11,003 9.3%
Corning
       1,679       17,150 9.8%
Manning
       1,663       13,908 12.0%
Pella
       9,137       58,800 15.5%
Hawarden
       1,330        7,979 16.7%
Anamosa
       3,485       20,508 17.0%
Total 82 Critical Acess Hospitals
      19,547  1,726,165 1.1%





Rural Hospitals



Keokuk
         (891)       24,854 -3.6%
Grinnell
          776       43,003 1.8%
Newton
          779       38,202 2.0%
Spirit Lake
          804       29,529 2.7%
Fort Madison
       2,445       51,862 4.7%
Carroll
       3,494       63,491 5.5%
Spencer
       6,298       67,720 9.3%
Muscatine
      11,162       47,404 23.5%
Total 8 Rural Hospitals
      24,867     366,065 6.8%





Rural Referral Hospitals



Mason City
      (6,704)     309,829 -2.2%
Marshalltown
         (954)       59,735 -1.6%
Ottumwa
          787       81,138 1.0%
Fort Dodge
       1,296       96,131 1.3%
Clinton
       8,906       93,969 9.5%
West Burlington
      25,602     171,948 14.9%
Total 6 Rural Referral Hospitals
      28,933     812,750 3.6%





Grand Total 118 Hospitals
    280,427  7,975,753 3.5%

When 35% of Iowa's Hospitals have Operating Losses and 53% have Operating Income of 2.5% or less, then the State of Iowa has a huge financial quality problem with its Hospitals, particularly so with its 82 smaller Critical Access Hospitals, which are in desperate need of financial help.  A clear majority of Iowa citizens must be very disappointed that nothing has happened yet.

By far the best and only way to substantially strengthen the financial status of so many Iowa smaller struggling Hospitals is for the State of Iowa to fully expand Medicaid and to do so as soon as possible.  If Iowa did this, with the resultant massive inflow of Patient Revenues from Medicaid expansion, the so many Iowa smaller struggling Hospitals would be able to substantially reduce their huge Losses and perhaps even turn nearly all of them into profits.  And the Iowa smaller Hospitals with very modest Operating Income would have their profits bolstered very robustly.

If Iowa were to fully expanded Medicaid, one of the key beneficiaries of the resultant very healthy profit improvement and thus also Total Net Assets improvement of all Iowa Hospitals would be Iowa citizens electing to buy health insurance on the Health Insurance Exchange.  This exceptional Net Asset growth from Medicaid expansion would give all Iowa 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.