Category Archives: Nonoperating Income

Sutter Health’s rising expenses and rough investments yield a $457M net loss for Q2 2022

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Updated on Aug. 5 with comments from Sutter Health.

A $457 million net loss for the quarter ended June 30 has brought Sutter Health even deeper into the red for 2022, according to new financial filings.

The Sacramento-based nonprofit health system brought in $3.49 billion in total operating revenues from the quarter, down slightly from the prior year’s $3.51 billion.

At the same time, the system’s operating expenses grew from $3.41 billion in the second quarter of 2021 to $3.55 billion in the most recent quarter, driven by $30 million and $151 million year-over-year increases in salaries and purchased services, respectively. The latter includes the increased professional fees being felt by labor-strapped systems across the country.

These led the system to report a $51 million operating loss for the quarter as opposed to the $106 million operating gain from last year’s equivalent quarter.

“Poorly” performing financial markets also took a toll on Sutter’s numbers. The system’s quarterly investment income dipped from $251 million to $56 million from 2021 to 2022. A $495 million downward change in net unrealized gains and losses on its investments was also a stark reversal from the prior year’s $270 million increase.

The new numbers cement what was already looking to be a tricky year for Sutter Health, which had previously reported a $184 million net loss for its opening quarter.

Despite a 1.5% year-over-year operating revenue increase to $7.05 billion for the opening six months, a 1.7% year-over-year operating revenue bump places the system’s year-to-date income at $44 million (0.6% operating margin), slightly below last year’s $57 million (0.8% operating margin).

However, market struggles through both quarters and a $208 million loss tied to the disaffiliation of Samuel Merritt University now has Sutter sitting at a $641 million net loss for the opening half of 2022. The system was up $825 million at the same time last year.

“Sutter’s finances have stabilized, but our year-to-date numbers show we still have more affordability work ahead as we strive to best position Sutter Health to serve our patients and communities into the future,” the system wrote in an email statement. “We are grateful for our employees and clinicians who have worked diligently over the last several years to help bring our costs down—at the same time managing through the pandemic and continuing to provide high-quality, nationally recognized care.”

Sutter noted in the filing that it is or will be in labor negotiations with much of its unionized workforce, as 43% of its contract agreements have either expired or will be running their course within the year.

The filing also included notice of a handful of legal matters that have yet to be resolved. These include an antitrust verdict in favor of Sutter that is being appealed by the plaintiff, a lawsuit regarding an alleged privacy breach of two anonymous plaintiffs and two separate class-action complaints regarding employee retirement plan funding, among others.

“The organization continues to face financial headwinds like inflation and increased staffing costs, as evidenced by our near breakeven operating margin,” Sutter said in a statement. “Even still, we are encouraged that independent ratings agencies have recently acknowledged our efforts to date. In the second quarter, Moody’s, S&P and Fitch all affirmed the system’s existing ‘A’ category bond ratings.”

Much of Sutter’s pains are being felt across the industry. A recent Kaufman Hall industrywide report showed only marginal relief from expenses and middling non-COVID volume recovery through June, while a Fitch Ratings update on nonprofit hospitals warned that these challenges and broader inflation pressures will likely weigh down the sector through 2022.

HOSPITALS SEE NEGATIVE MARGINS FOR SIXTH CONSECUTIVE MONTH

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Expenses are still weighing heavily on hospitals, health systems, and physician’s practices as the cost of care continues to rise.

Hospitals, health systems, and physician’s practices are still struggling under the weight of significant financial pressure, that the rise in patient volume and revenue can’t seem to outweigh.

The increase in patient volume and revenue has not been able to offset the historically high operating margins these organizations are facing, according to data from Kaufman Hall’s National Hospital Flash Report and Physician Flash Report. Hospitals, health systems, and physician’s practices dealt with negative margins in June for the sixth consecutive month this year.

“To say that 2022 has challenged healthcare providers is an understatement,” Erik Swanson, a senior vice president of data and analytics with Kaufman Hall, said in an email report. “It’s unlikely that hospitals and health systems can undo the damage caused by the COVID-19 waves of earlier this year, especially with material and labor costs at record highs this summer.”

The median Kaufman Hall year-to-date operating margin index for hospitals was -0.09% through June, for the sixth month of cumulative negative actual operating margins. However, the median change in operating margin in June was up 30.8% compared to May, but down 49.3% from June 2021.

Hospital revenues for June continued to trend upward, even as volumes evened out, according to the Kauffman Hall data. Organizations saw a 2.1% drop in patient length of stay. Both patient days and emergency department visits each dropped by 2.6% in June when compared to May. Hospital’s gross operating revenue was up 1.2% in June from May.

Expenses have been dragging down hospital margins for months, however, June saw a slight month-over-month improvement as total hospital expenses dropped 1.3%, despite this, year-over-year expenses are still up 7.5% from June 2021. Physician practices saw a drop in provider compensation, according to the Kaufman Hall data, however, this wasn’t enough to offset expenses. The competitive labor market for healthcare support staff resulted in a new high for total direct expense per provider FTE in Q2 2022 of $619,682—up 7% from the second quarter of 2021 and 12% from the second quarter of 2020.

“Given the trends in the data, physician practices need to focus on efficiency in the second half of 2022,” Matthew Bates, managing director and Physician Enterprise service line lead with Kaufman Hall, said in the email report. “Amid historically high expenses, shifting some services away from physicians to advanced practice providers like nurse practitioners or physician assistants could help rein in the costs of treating an increased patient load while taking some of the weight off the shoulders of physicians.”

Fitch: Outlook is negative for CHS

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Fitch Ratings has affirmed the “B-” long-term issuer default ratings of Franklin, Tenn.-based Community Health Systems, and revised the company’s rating outlook to negative from stable. 

The credit rating agency said the negative outlook reflects operating performance deterioration in the first half of this year, with significant increases in labor costs. Higher costs, weakness in volumes and acuity mix drove a downturn in the for-profit company’s revenue, resulting in a reduction in its financial guidance for this year, Fitch said. 

CHS ended the first six months of this year with a net loss of $327 million on revenues of $6.04 billion. In the first half of 2021, the company posted a net loss of $58 million on revenues of $6.02 billion.

Fitch noted that CHS still benefits from its strengthened liquidity and balance sheet after several debt refinancing and exchange transactions. CHS also benefits from investments in outpatient care and higher-acuity inpatient services, the credit rating agency said. 

For-profit hospital company earnings announcements show economic headwinds are mounting

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While for-profit health system giants HCA Healthcare and Tenet Healthcare reported reductions in contract labor usage last quarter, sustained higher labor costs and sluggish demand resulted in both of them, along with Community Health Systems and Universal Health Services, seeing their net income decline in the second quarter.

Like many systems, the for-profit chains seem to have successfully weaned themselves from earlier reliance on expensive temporary nurses, but are facing more structural increases in labor costs as salaries have risen to remain competitive in a very tight labor market.

The Gist: The earnings reports from for-profit companies are a canary in the coal mine for the overall margin performance of the industry. Although investor-owned companies are vastly outnumbered by their not-for-profit peers, they often move more quickly, and with more vigor, to reduce costs in order to meet the earnings expectations of Wall Street investors. They also typically rely more heavily on volume growth—particularly emergency department visits—as a driver of earnings. 

If for-profits are now finding it more difficult to pull those levers, we’d expect that the broader universe of nonprofit systems is experiencing even tougher sledding. That’s consistent with what we’re hearing anecdotally from health systems we work with.

Washington hospitals report $929M loss over 3 months

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Washington State Hospital Association reported a $929 million net loss due to an increase in operating expenses and nonoperating investment losses, The News Tribune reported July 21. 

The review reflected January through March 2022 and showed operating revenue increased by 5 percent; however, operating expenses increased by 11 percent. 

“This combined with non-operating investment losses, resulted in a total margin of negative 13 percent,” WSHA said in a briefing of the review July 21. 

The losses were mainly seen in urban Washington hospitals, though rural hospitals were also affected. 

“All 52 urban hospitals/health systems reported negative margins and account for 86 percent of the losses statewide,” WSHA said. “Of the independent rural hospitals responding, 18 out of 32 had negative margins.”

WSHA said lower Medicaid reimbursements were part of the problem. In the first quarter, Medicaid reimbursements covered 42 percent of the cost of care delivery. 

Pandemic pressures also had a negative effect, according to WSHA. It said federal COVID-19 relief funds have been depleted. 

Additionally, WSHA said labor costs have continued to rise because of a need to retain staff and a reliance on travel nurses with high wages. 

HCA, Tenet profits sink: 10 things to know

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HCA Healthcare and Tenet Healthcare, two of the largest for-profit hospital operators in the U.S., reported lower net income in the second quarter of this year than in the same period of 2021. 

HCA Healthcare

1. Nashville, Tenn.-based HCA Healthcare, a 182-hospital system, reported revenues of $14.82 billion in the second quarter of this year, up from $14.44 billion in the same period last year. 

2. HCA’s net income totaled $1.16 billion in the second quarter of 2022, down from $1.45 billion in the same period a year ago. The second quarter of this year included $32 million in losses on the sales of facilities and and losses on retirement of debt of $78 million. 

3. HCA said same-facility admissions declined 1.2 percent year over year in the second quarter of this year. Emergency room visits were up 7.3 percent year over year. 

4. “Many aspects of our business were positive considering the challenges we faced with the labor market and other inflationary pressures on costs,” Sam Hazen, CEO of HCA, said in a July 22 earnings release. “Our teams executed well as they have in the past through other difficult environments. Again, I want to thank them for their dedication and excellent work.”

5. For the six months ended June 30, HCA reported net income of $2.43 billion on revenues of $29.77 billion. In the same period a year earlier, the company posted net income of $2.87 billion on revenues of $28.41 billion. 

Tenet Healthcare

1. Dallas-based Tenet Healthcare reported revenues of $4.64 billion in the second quarter of this year, down from $4.95 billion in the same period a year earlier. The decrease was primarily attributed to the sale of the company’s Miami-area hospitals in the third quarter of 2021 and the impact of a cybersecurity incident. 

2. The 60-hospital system ended the second quarter of this year with net income of $38 million, down from $119 million in the same quarter last year. 

3. Same-hospital admissions adjusted for outpatient activity were down 5.3 percent year over year in the second quarter of this year. Tenet said a cybersecurity incident in April that temporarily disrupted some acute care operations contributed to the decline. 

4. “We demonstrated resilience in the face of a disruptive cyber attack and discipline through challenging market conditions,” Saum Sutaria, MD, CEO of Tenet, said in a July 21 earnings release. “The ongoing diversification of Tenet driven by our capital efficient ambulatory expansion is a key differentiator that presents compelling opportunities for growth in earnings and free cash flows.”

5. Looking at the six months ended June 30, Tenet reported net income of $178 million on revenues of $9.38 billion. In the same period of 2021, the company reported net income of $216 million on revenues of $9.74 billion. 

10 health systems with strong finances

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Here are 10 health systems with strong operational metrics and solid financial positions, according to reports from Fitch Ratings and Moody’s Investors Service.

1. AnMed Health has an “AA-” rating and stable outlook with Fitch. The Anderson, S.C.-based system has a leading market share in most service lines, strong operating performance and very solid EBITDA margins, Fitch said. 

2. Banner Health has an “AA-” rating and stable outlook with Fitch. The Phoenix-based health system’s core hospital delivery system and growth of its insurance division combine to make it a successful highly integrated delivery system, Fitch said. The credit rating agency said it expects Banner to maintain operating EBITDA margins of about 8 percent on an annual basis, reflecting the growing revenues from the system’s insurance division and large employed physician base. 

3. Franciscan Alliance has an “AA” rating and stable outlook with Fitch. The Mishawaka, Ind.-based health system has a very strong cash position and maintains leading market shares in seven of its nine defined primary service areas, Fitch said. The health system benefits from a good payer mix, the credit rating agency said. 

4. Gundersen Health System has an “AA-” rating and stable outlook with Fitch. The La Crosse, Wis.-based health system has strong balance sheet metrics and a leading market position and expanding operating platform in its service area, Fitch said. The credit rating agency expects the health system to return to strong operating performance as it emerges from disruption related to the COVID-19 pandemic. 

5. Hackensack Meridian Health has an “AA-” rating and stable outlook with Fitch. The Edison, N.J.-based health system has shown consistent year-over-year increases in market share and has a solid liquidity position, Fitch said. 

6. Falls Church, Va.-based Inova Health System has an “Aa2” rating and stable outlook with Moody’s. The health system has a consistently strong operating cash flow margin and ample balance sheet resources, Moody’s said. Inova’s financial excellence will remain undergirded by its favorable regulatory and economic environment, the credit rating agency said. 

7. Salt Lake City-based Intermountain Healthcare has an “Aa1” rating and stable outlook with Moody’s. The health system has exceptional credit quality, which will continue to benefit from its leading market position in Utah, Moody’s said. The credit rating agency said the health system’s merger with Broomfield, Colo.-based SCL Health will give Intermountain greater geographic reach. 

8. Fort Wayne, Ind.-based Parkview Health has an “Aa3” rating and stable outlook with Moody’s. The health system has a leading market position with expansive tertiary and quaternary clinical services in northeastern Indiana and northwestern Ohio, Moody’s said. The credit rating agency said the stable outlook reflects management’s ability to generate strong operating performance during the pandement and with less favorable reimbursement rates. 

9. UnityPoint Health has an “AA-” rating and stable outlook with Fitch. The Des Moines, Iowa-based health system has strong leverage metrics and cash position, Fitch said. The credit rating agency expects the health system’s balance sheet and debt service coverage metrics to remain robust. 

10. Yale New Haven (Conn.) Health has an “AA-” rating and stable outlook with Fitch. The health system’s turnaround efforts, brand recognition and market presence will help it return to strong operating

National Hospital Flash Report (June 2022)

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Click to access KH-NHFR-2022-06.pdf

Summary
U.S. hospitals and health systems continued to face difficult financial
and operational headwinds in May. Operating margins rose from April
but remained significantly lower than pre-pandemic levels and May 2021.

Volumes were up slightly from the previous month, with rising ED
visits close to numbers last seen in 2019 and earlier.
Gross operating revenues rose month-over-month and in comparison
to May 2021. But expenses — especially labor costs — were elevated
across nearly every metric month-over-month.


Margins
The median Kaufman Hall Year-To-Date (YTD) Operating Margin Index
reflecting actual margins was -0.33% through May.
The median change in Operating Margin was up 18.9% from last month
but down 45.6% from May 2021. The median change in Operating
EBITDA Margin was up 13.5% month-over-month, but down 36.1% from
May 2021.

Volumes
Patient volumes rose in May, with Length of Stay (LOS) up 2.3% from
April and 5.5% compared to May 2021. Patient Days increased by 4.8%
month-over-month but dropped 0.5% versus May 2021. Adjusted
Patient Days grew 3.5% from April to May and were 4% above May 2021
levels. Adjusted Discharges rose slightly, at 0.6% month-over-month,
but were down 0.3% compared to May 2021. Surgeries barely
fluctuated, with Operating Room Minutes down 1.0% from last month
and up just 0.1% YOY. Emergency Department (ED) Visits jumped 9.5%
from April to May and were up 4.5% YOY.


Revenues
Volume increases resulted in slightly improved revenue performance in
May. Gross Operating Revenue was up 3.4% from April and 7.6% YOY,
and is up 6.9% YTD. Similarly, Outpatient (OP) Revenue rose 2.2% from
April levels, 9.4% YOY and is up 9.1% YTD. Inpatient (IP) Revenue
climbed 3.5% from the previous month and 2.6% from May 2021, and is
up 4.2% YTD.

Expenses
Total Expenses continued to climb in May, rising 1.1% from April and
10.7% from May 2021. Inflation and labor shortages contributed to
total costs climbing 10.4% YTD.


Labor Expense per Adjusted Discharge inched up by 1.0% from April
and has surged 13.6% YTD, while Full-Time Employees Per Adjusted
Occupied Bed (FTEs per AOB), is down by 2.7% YTD, indicating that
hospitals are spending more on labor costs with fewer hours worked.
However, FTEs per AOB rose slightly in May, up 2.8% from April. Total
Expense per Adjusted Discharge increased by 0.3% from April, and
Labor Expense per Adjusted Discharge rose 1.0% from last month.

Non-Operating
The Federal Reserve raised its benchmark rate by 75 basis points in
mid-June, the most aggressive increase since 1994, as inflation hit a
40-year high of 8.6% in May. New projections show The Federal Open
Market Committee (FOMC) participants expect the Fed to raise rates to
at least 3% this year, with half indicating 3.375%. Labor metrics remain
strong with unemployment reading 3.6% in May and employers adding
390,000 new jobs.


Consumer sentiment hit a record low reading of 50.2 in early June,
comparable to the low point reached during the 1980 recession. US
equities ended May with marginal gains after weeks of volatile trading
due to economic data and corporate earnings sowing doubt over the
health of the US economy.

Takeaways at a Glance

  1. Nearly halfway through 2022, margins are cumulatively negative.
    While some metrics have normalized, hospitals continue to perform below pre-pandemic levels,
    and there is an uncertain outlook for the rest of the year.
  2. Elevated labor costs remain a significant challenge.
    Hospitals are still seeing higher labor costs and fewer hours worked, a sign of inflation and an
    indicator that long-standing labor shortages are likely worsened by increased turnover.
  3. Warmer temperatures and ED visits drove up volumes and revenues.
    Patients often schedule elective procedures during the summer months, which may have
    contributed to growing volumes. Emergency department visits also spiked this past month as
    people spent more time outdoors.
  4. Pent-up demand for hospital services also contributed to an increase in patients.
    Sicker patients continued to schedule procedures they had previously postponed, suggesting
    a return to normalcy as COVID-19 hospitalizations remained relatively low.

19 health systems with strong finances

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Here are 19 health systems with strong operational metrics and solid financial positions, according to reports from Fitch Ratings, Moody’s Investors Service and S&P Global Ratings.

1. Morristown, N.J.-based Atlantic Health System has an “Aa3” rating and stable outlook with Moody’s. The health system has strong operating performance and liquidity metrics, Moody’s said. The credit rating agency expects Atlantic Health System to sustain strong performance to support capital spending. 

2. Banner Health has an “AA-” rating and stable outlook with Fitch. The Phoenix-based health system’s core hospital delivery system and growth of its insurance division combine to make it a successful highly integrated delivery system, Fitch said. The credit rating agency said it expects Banner to maintain operating EBITDA margins of about 8 percent on an annual basis, reflecting the growing revenues from the system’s insurance division and large employed physician base. 

3. Clearwater, Fla.-based BayCare has an “AA” rating and stable outlook with Fitch. The 14-hospital system has excellent liquidity and operating metrics, which are supported by its leading market position in a four-county area, Fitch said. The credit rating agency expects strong revenue growth and cost management to sustain BayCare’s operating performance.

4. CentraCare has an “AA-” rating and stable outlook with Fitch. The St. Cloud, Minn.-based system has a leading market position and solid operating margins, Fitch said. The credit rating agency said it expects CentraCare’s operating platform to remain strong. 

5. Greensboro, N.C.-based Cone Health has an “AA” rating and stable outlook with Fitch. The health system has a leading market share and a favorable payer mix, Fitch said. The health system’s broad operating platform and strategic capital investments should enable it to return to stronger operating results, the credit rating agency said. 

6. Franciscan Alliance has an “AA” rating and stable outlook with Fitch. The Mishawaka, Ind.-based health system has a very strong cash position and maintains leading market shares in seven of its nine defined primary service areas, Fitch said. The health system benefits from a good payer mix, the credit rating agency said. 

7. Gundersen Health System has an “AA-” rating and stable outlook with Fitch. The La Crosse, Wis.-based health system has strong balance sheet metrics and a leading market position and expanding operating platform in its service area, Fitch said The credit rating agency expects the health system to return to strong operating performance as it emerges from disruption related to the COVID-19 pandemic. 

8. Falls Church, Va.-based Inova Health System has an “Aa2” rating and stable outlook with Moody’s. The health system has a consistently strong operating cash flow margin and ample balance sheet resources, Moody’s said. Inova’s financial excellence will remain undergirded by its favorable regulatory and economic environment, the credit rating agency said. 

9. Vineland, N.J.-based Inspira Health Network has an “AA-” rating and stable outlook with Fitch. The health system has strong operating performance, a leading market position in a stable service area and a growing residency program, Fitch said. The credit rating agency expects the system’s growing outpatient footprint and an increase in patient volumes to support its operating stability. 

10. Oakland, Calif.-based Kaiser Permanente has an “AA-” rating and stable outlook with Fitch. The health system has a strong financial profile, and the system’s operating platform is “arguably the most emulated model” for nonprofit healthcare delivery in the U.S., Fitch said. By revenue base, Kaiser is the largest nonprofit health system in the U.S., and it is the most fully integrated healthcare delivery system in the country, according to the credit rating agency. 

11. Mass General Brigham has an “Aa3” rating and stable outlook with Moody’s and an “AA-” rating and stable outlook with S&P. The Boston-based health system has an excellent clinical reputation, good financial performance and strong balance sheet metrics, Moody’s said. The credit rating agency said it expects Mass General Brigham to maintain a strong market position and stable financial performance. 

12. Rochester, Minn.-based Mayo Clinic has an “Aa2” rating and stable outlook with Moody’s. The credit rating agency said Mayo Clinic’s strong market position and patient demand will drive favorable financial results. The health system “will continue to leverage its excellent reputation and patient demand to continue generating favorable operating performance while maintaining strong balance sheet ratios,” Moody’s said. 

13. Methodist Health System has an “Aa3” rating and stable outlook with Moody’s. The Dallas-based system has strong operating performance, and investments in facilities have allowed it to continue to capture more market share in the fast-growing Dallas-Fort Worth, Texas, area, Moody’s said. The credit rating agency said it expects Methodist Health System’s strong operating performance and favorable liquidity to continue.

14. Traverse City, Mich.-based Munson Healthcare has an “AA” rating and stable outlook with Fitch. The health system has a strong market position, a good payer mix and robust cash-to-adjusted debt levels, Fitch said. The credit rating agency expects the system to weather an expected period of weakened operating cash flow margins. 

15. Albuquerque, N.M.-based Presbyterian Healthcare Services has an “Aa3” rating and stable outlook with Moody’s and an “AA” rating and stable outlook with Fitch. Presbyterian Healthcare Services is the largest health system in New Mexico, and it has strong revenue growth and a healthy balance sheet, Moody’s said. The credit rating agency said it expects the health system’s balance sheet and debt metrics to remain strong. 

16. Chicago-based Rush Health has an “AA-” rating and stable outlook with Fitch. The health system has a strong financial profile and a broad reach for high-acuity services as a leading academic medical center, Fitch said. The credit rating agency expects Rush’s services to remain profitable over time. 

17. Stanford (Calif.) Health Care has an “AA” rating and stable outlook with Fitch. The health system has extensive clinical reach in a competitive market and its financial profile is improving, Fitch said. The health system’s EBITDA margins rebounded in fiscal year 2021 and are expected to remain strong going forward, the crediting rating agency said. 

18. University of Chicago Medical Center has an “AA-” rating and stable outlook with Fitch. The credit rating agency said it expects University of Chicago Medical Center’s capital-related ratios to remain strong, in part because of its broad reach of high-acuity services. 

19. University of Iowa Hospitals and Clinics has an “Aa2” rating and stable outlook with Moody’s. The Iowa City-based health system, the only academic medical center in Iowa, has strong patient demand and excellent financial management, Moody’s said. The credit rating agency said it expects the health system to continue to manage the pandemic with improved operating cash flow margins.

Financial updates from 20 health systems

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The health systems listed below recently released financial results for the quarter ended March 31.

1. Pittsburgh-based Highmark Health — which includes the eight-hospital Allegheny Health Network — reported $6.4 billion in revenue for the first quarter of 2022. It posted an operating gain of $100 million for the three months ended March 31.

2. Pittsburgh-based UPMC had an operating revenue of $6.1 billion in the first quarter, increasing from $6.02 billion year over year, a 1.3 percent increase. Operating income in 2022 was $50 million, compared to $288 million during the same period in 2021, an 82.6 percent decrease.

3. Cleveland Clinic‘s revenue climbed to $3 billion in the first quarter of this year, which ended March 31, up from $2.8 billion in the same period of 2021. The hospital system ended the first quarter of 2022 with an operating loss of $104.5 million, compared to operating income of $61.7 million in the same period of 2021. 

4. New York City-based Montefiore Health System had $1.7 billion in total operating revenue for the first quarter of this year, a 7.9 percent increase from the same period last year, at $1.6 billion. The health system had an operating loss of $8.4 million for the first quarter of this year, an improvement from an operating loss of $63.6 million for the same period last year.

5. Livonia, Mich.-based Trinity Health had $15.13 billion in revenue for the nine months ended March 31, up from $15.12 billion in the same period last year. It reported operating income of $139.7 million in the first nine months of fiscal year 2022, down 79 percent from operating income of $653.9 million in the same period a year earlier.

6. Rochester, Minn.-based Mayo Clinic recorded revenue of $3.9 billion for the three months ended March 31, representing about a 7 percent increase compared to the same period one year prior. Mayo Clinic ended the first quarter of this year with an operating gain of $142 million. In the same quarter last year, Mayo posted operating income of $243 million. 

7. Advocate Aurora Health, which has dual headquarters in Milwaukee and Downers Grove, Ill., recorded operating revenue of $3.6 billion in the first quarter of 2022. This represents a 9 percent increase over the comparable period in 2021, in which Advocate Aurora had $3.3 billion in revenue. Advocate Aurora ended the period with an operating income of $2.5 million. In the same period in 2021, Advocate Aurora recorded an operating income of $51 million. 

8. Chicago-based CommonSpirit Health saw revenues decline 6.6 percent year over year to $8.3 billion in the third quarter of fiscal year 2022, which ended March 31. CommonSpirit recorded an operating loss of $591 million in the three-month period ended March 31, compared to operating income of $539 million in the same period a year earlier. 

9. Renton, Wash.-based Providence saw its operating revenue hit $6.3 billion for the three months ended March 31. In the same quarter one year prior, Providence recorded operating revenue of $6.4 billion. It recorded an operating loss of $510.2 million in the first quarter of 2022, compared to $221.9 million from the same quarter a year prior.

10. Boston-based Mass General Brigham recorded operating revenue of $4.04 billion in the second quarter of fiscal year 2022, up from the $4.02 billion recorded in the same period one year prior. Mass General Brigham posted an operating loss of $193.2 million. In the same period one year prior, Mass General Brigham recorded an operating gain of $250.2 million.

11. Johnson City, Tenn.-based Ballad Health‘s total revenue reached $564.8 million in the third quarter of fiscal year 2022, a slight increase from the same period last year at $558.9 million. It reported an operating loss of $37.3 million for the three months ended March 31, compared to an operating income of $16 million in the same period last year.

12. Altamonte Springs, Fla.-based AdventHealth saw its revenue increase to $3.7 billion for the three months ended March 31, up nearly 8 percent from the same period last year. AdventHealth ended the first quarter of 2022 with an operating loss of $46.8 million. In the same quarter of 2021, AdventHealth recorded an operating income of $179.1 million. 

13. Oakland, Calif.-based Kaiser Permanente reported total operating revenue of $24.2 billion for the three months ended March 31, up from $23.2 billion the year prior. Kaiser recorded an operating loss of $72 million. In the same quarter last year, Kaiser recorded an operating income of $1 billion.

14. For the three months ended March 31, Sacramento, Calif.-based Sutter Health recorded revenue of $3.6 billion, up 3.7 percent from $3.4 billion recorded in the same period one year prior. Sutter Health ended the period with a $95 million operating gain. In the first quarter of 2021, Sutter had an operating loss of $49 million.

15. St. Louis-based Ascension reported operating revenue of $6.7 billion in the first three months of this year, up from $6.6 billion in the same period of 2021. Ascension ended the most recent quarter with an operating loss of $671.1 million, compared to an operating loss of $16.7 million in the same period last year.

16. Indianapolis-based Indiana University Health System had $1.93 billion in revenue for the three months ended March 31, a 2.9 percent increase year over year from $1.87 billion. IU Health posted an operating loss of $29.8 million for the first quarter of 2022, compared to an operating income of $192.7 million last year.

17. Franklin, Tenn.-based Community Health Systems had $3.1 billion in net operating revenue for the first quarter of 2022, a 3.3 percent increase from the $3 billion reported for the same period last year. The system posted a 17.2 percent decrease in its operating income, to $270 million for the three months ended March 31, compared to $326 million for the same period last year.

18. King of Prussia, Pa.-based Universal Health Services had a 9.3 percent increase in revenue year over year for the first quarter of 2022. Net revenue was $3.3 billion for the three months ended March 31, up from a little over $3 billion in the same period of 2021. UHS’ operating income fell by 21.2 percent year over year for the first quarter of 2022 to $232.9 million, compared to $295.7 million for the same period last year.

19. Nashville, Tenn.-based HCA Healthcare reported revenues of $15 billion in the first quarter of this year, up from $14 billion in the same period of 2021. HCA’s net income in the first quarter of 2022 totaled $1.3 billion, down from $1.4 billion in the same quarter a year earlier.

20. Dallas-based Tenet Healthcare posted net revenue of $4.8 billion in the quarter ended March 31, down 0.8 percent from the same period last year. Tenet recorded an operating income of $648 million in the first quarter of 2022. In the same period last year, Tenet’s operating income was $520 million.