Wednesday, March 19, 2014

Missouri Non-Profit Hospitals Net Assets Up 96% Under Obama and the Affordable Care Act

From a review of the Electronic Municipal Market Access (EMMA), I found 11 Non-Profit Hospital Organizations headquartered in the State of Missouri 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 11 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 Recent
Balance Sheet Assets

Recent Balance
Sheet Net %

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

mil $s
Admin Admin Admin

mil $s
Ascension Health Edmundson MO Dec 13   18,237
Jun 09       8,275 120%
BJC Healthcare St Louis MO Dec 13     5,177
Dec 08       2,705 91%
Mercy Health Chesterfield MO Dec 13     3,394
Jun 09       2,118 60%
SSM Health Care St Louis MO Dec 13     1,967
Dec 08          933 111%
St Luke's Health System Kansas City MO Dec 13     1,130
Dec 08          703 61%
Children's Mercy Hospitals Kansas City MO Dec 13     1,032
Jun 09          668 54%
CoxHealth Springfield MO Dec 13        687
Sep 09          456 51%
University Missouri Health Care Columbia MO Jun 13        557
Jun 09          365 53%
North Kansas City Hospital Kansas City MO Sep 13        556
Jun 09          452 23%
Saint Francis Medical Center Cape Girardeau MO Dec 13        496
Jun 09          274 81%
Heartland Regional Medical Center St Joseph MO Dec 13        467
Jun 09          214 118%

Total all 11


      17,163 96%

As you can see from the above chart, the Total Net Assets (Financial Strength) of these 11 Missouri Non-Profit Hospital Organizations increased by a phenomenal 96% to a massive $33.700 bil for their average 4.55 years during the Obama Administration, driven by huge Ascension Health's Net Asset Increase of nearly $10 bil or up 120%.

Very positively impacting this spectacular increase in the Net Assets (Financial Strength) of these 11 Missouri 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 robust increase in Net Assets (Financial Strength) of these 11 Missouri 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 very impressive Net Asset percentage increases of these 11 Missouri Hospitals, a key beneficiary of this will be Missouri citizens electing to buy health insurance on the Health Insurance Exchange. And since the giant Ascension Health, which has increased its Net Assets by nearly $10 bil or by 120% during the Obama Administration, has Hospitals located all over the US, citizens in many US States electing to buy health insurance on the Health Insurance Exchange will also be key beneficiaries. This strong Net Asset growth gives these Missouri 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.    

Missouri Struggling Hospitals

The State of Missouri is being very transparent with its citizens by having available for review annually at its State Dept of Health website very detailed financial information on each of its 117 Short-term Acute Care Hospitals which disclosed their numbers.  I excluded Mercy Hospital Joplin below because it had a huge operating loss, coupled with a massive insurance recovery gain, both due to the horrific tornado it had there in 2012. 

These 117 Missouri Hospitals generated Total Operating Income of $779 mil in the most recent year reported, which was a modest 4.5% of their Total Operating Revenues of $17.180 bil.

As you can see in the below chart, 18 of these 117 Missouri Hospitals, all with Operating Income Margins as a Percentage of Total Operating Revenues of above 10.0%, generated Total Operating Income of $337 mil, which was a very steep 12.8% of their Total Operating Revenues.....clearly way too much Hospital pricing greed exhibited here:


Operating Total Income

Missouri Income Operating (Loss)
County Hospital Name City (Loss) Revenues Margin

000s 000s %

Dunklin Twin Rivers Reg Med Ctr Kennett      13,414       46,072 29.1%
Randolph Moberly Reg Med Ctr Moberly      16,839       62,956 26.7%
Laclede Mercy Hospital Lebanon Lebanon      19,963       80,832 24.7%
Adair Northeast Regional Med Ctr Kirksville      15,377       66,162 23.2%
Cass Belton Reg Med Ctr Belton       7,342       39,488 18.6%
Jackson/KC Area Lee's Summit Med Ctr Lee's Summit      13,510       72,744 18.6%
Barry Mercy Hospital Cassville Cassville       2,272       13,129 17.3%
Newton Freeman Neosho Hospital Neosho       2,938       18,336 16.0%
Butler Poplar Bluff Reg Med Ctr Poplar Bluff      20,004      137,482 14.6%
Stoddard Southeast Health Ctr Stoddard Dexter       1,409       10,434 13.5%
Jackson/KC Area Centerpoint Med Ctr Independence Independence      26,078      197,858 13.2%
Jackson/KC Area Saint Luke's Cancer Institute Kansas City       2,249       19,185 11.7%
Livingston Hedrick Med Ctr Chillicothe       4,120       35,264 11.7%
Phelps Phelps County Reg Med Ctr Rolla      15,409      138,853 11.1%
St Louis County Barnes-Jewish West County Hosp St Louis      11,765      106,590 11.0%
Jackson/KC Area St Luke's East Lee's Summit Hosp Lee's Summit      15,490      140,882 11.0%
St Louis City SSM Cardinal Glennon Children's Med Ctr St Louis      33,025      309,980 10.7%
Greene Mercy Hospital Springfield Springfield    115,896   1,140,432 10.2%

Total all 18
   337,100   2,636,679 12.8%

But nearly half or 58 of these 117 Missouri Hospitals had Operating Income as a Percentage of Total Operating Revenues of 2.5% or below.  These 58 Missouri Hospitals generated a Total Operating Loss of $73 mil on Total Operating Revenues of $5,950 mil, yielding a Total Operating Loss as a Percentage of Total Operating Revenues of a negative 1.2%, as you can see in the below chart:


Operating Total Income

Missouri Income Operating (Loss)
County Hospital Name City (Loss) Revenues Margin

000s 000s %

St Louis County Shriners Hospitals for Children St Louis     (20,579)         7,337 -280.5%
Ripley Ripley County Meml Hosp Doniphon      (1,739)         6,254 -27.8%
Callaway Callaway Community Hospital Fulton      (2,294)         9,477 -24.2%
Cooper Cooper County Meml Hospital Boonville      (1,717)         9,459 -18.2%
Saline I-70 Community Hospital Sweet Springs         (831)         6,111 -13.6%
Atchison Community Hospital-Fairfax Fairfax      (1,243)         9,617 -12.9%
Henry Royal Oaks Hospital Windsor      (1,049)         9,933 -10.6%
Pemiscot Pemiscot County Meml Hosp Hayti      (3,449)       37,674 -9.2%
Jackson/KC Area Truman Med Ctr Lakewood Kansas City      (9,398)      110,631 -8.5%
Nodaway St. Francis Hospital Maryville      (4,261)       54,427 -7.8%
Bates Bates County Meml Hospital Butler      (1,701)       27,314 -6.2%
St Charles CenterPointe Hospital St Charles      (1,810)       29,421 -6.2%
St Louis City St Louis University Hospital St Louis     (20,812)      343,507 -6.1%
St Clair Sac-Osage Hosp Osceola         (400)         6,640 -6.0%
Franklin Mercy Hospital Washington Washington      (4,961)       87,550 -5.7%
Putnam Putnam Ciunty Meml Hosp Unionville         (324)         6,359 -5.1%
Gentry Northwest Med Ctr Albany         (633)       12,902 -4.9%
Pike Pike County Meml Hosp Louisiana         (527)       11,495 -4.6%
Washington Washington Meml Hosp Potosi         (963)       21,481 -4.5%
Texas Texas County Meml Hosp Houston         (928)       21,702 -4.3%
Scott Missouri Delta Med Ctr Sikeston      (3,069)       72,475 -4.2%
Linn Pershing Memorial Hospital Brookfield         (614)       14,916 -4.1%
Barton Barton County Meml Hospital Lamar         (792)       19,378 -4.1%
Cole St. Mary's Health Ctr Jefferson City      (4,940)      125,631 -3.9%
Scotland Scotland County Hosp Memphis         (488)       16,143 -3.0%
Greene Ozarks Community Hospital Springfield      (1,242)       42,994 -2.9%
Dent Salem Meml District Hospital Salem         (404)       14,990 -2.7%
Gasconade Hermann Area District Hospital Hermann         (402)       15,111 -2.7%
St Louis County Christian Hospital St Louis      (6,806)      269,706 -2.5%
Macon Samaritan  Macon         (488)       19,893 -2.5%
Grundy Wright Memorial Hospital Trenton         (589)       24,474 -2.4%
Jackson/KC Area Saint Luke's Hospital of KC Kansas City      (9,393)      498,933 -1.9%
Iron Iron County Hospital Pilot Knob         (115)         7,438 -1.5%
Clay Liberty Hospital Liberty      (2,548)      175,185 -1.5%
St Louis County St Anthony's Med Ctr St Louis      (5,571)      411,588 -1.4%
Sullivan Sullivan County Meml Hosp Milan           (63)         6,304 -1.0%
Audrain Audrain Medical Center Mexico         (418)       53,010 -0.8%
Harrison Harrison County Community Hosp Bethany           (33)       13,954 -0.2%
Jackson/KC Area Children's Mercy Hospital Kansas City      (1,000)      709,589 -0.1%
Jackson/KC Area Crittenton Children's Center Kansas City              5       23,984 0.0%
St Charles Progress West HealthCare Ctr O Fallon          241       55,849 0.4%
Newton Freeman Health System Joplin       3,035      369,928 0.8%
Lincoln Lincoln County Med Ctr Troy          312       32,363 1.0%
Pettis Bothwell Reg Med Cre Sedalia          923       85,983 1.1%
Jackson/KC Area Truman Med Ctr Hospital Hill Kansas City       4,262      321,551 1.3%
St Francois Mineral Area Reg Med Ctr Farmington          542       40,541 1.3%
St Louis County SSM St Clare Health Ctr Fenton       2,394      163,260 1.5%
Carroll Carroll County Meml Hospital Carrollton          174       11,794 1.5%
Crawford Missouri Baptist Hosp Sullivan Sullivan          670       40,671 1.6%
Camden Lake Regional Health Osage Beach       2,719      154,794 1.8%
St Charles SSM St Joseph Health Ctr St Charles       3,313      184,998 1.8%
Johnson Western Missouri Med Ctr Warrensburg       1,329       67,561 2.0%
Ste. Genevieve Ste. Genevieve County Mem Hosp Sainte Genevieve          628       31,389 2.0%
Polk Citizens Meml Hospital Bolivar       1,936       92,129 2.1%
Madison Madison Med Ctr Fredericktown          326       14,825 2.2%
Jackson/KC Area Research  Medical Center Kansas City       6,812      281,198 2.4%
Boone University Hospital and Clinics Columbia      13,854      570,099 2.4%
Jackson/KC Area St. Mary's Med Center Blue Springs Blue Springs       1,651       65,705 2.5%

Total all 58
    (73,468)   5,949,625 -1.2%

Of these 117 Missouri Hospitals, 39 of them posted Operating Losses in the most recent year.

The best and only way to substantially strengthen these struggling Missouri Hospitals is for the State of Missouri to fully expand Medicaid.

A key side benefit to Missouri citizens of Missouri Medicaid expansion is that the resultant profit enhancements and thus Net Asset enhancements to all of Missouri's Hospitals would give them 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.