Advocate Aurora Health’s net income more than doubles in Q2

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Outpatient volume growth helped push Advocate Aurora Health’s revenue higher in the second quarter of 2019, according to unaudited financial documents released Aug. 22.

Advocate Aurora Health, which was formed in April 2018 and has dual headquarters in Downers Grove, Ill., and Milwaukee, reported revenue of $3.2 billion in the second quarter of 2019, up from $3 billion in the same period a year earlier. Patient service revenue climbed 8.8 percent year over year partially due to increased outpatient volume. The health system said capitation revenue dropped 9.9 percent year over year due to the conversion of a full-risk arrangement to fee-for-service.

After factoring in a 4.7 percent year-over-year increase in expenses, Advocate Aurora posted operating income of $132.3 million in the second quarter of 2019. That’s up from $107.2 million in the same period a year earlier.

The 28-hospital system reported nonoperating income of $286 million in the second quarter of this year, which includes investment income of $194.4 million. Advocate Aurora ended the second quarter of 2019 with net income of $418.4 million, up from $158.7 million a year earlier.




Allegheny Health Network adds 9th hospital

Highmark's Allegheny Health Network has reached an affiliation agreement with Grove City Medical Center in Mercer County.

Pittsburgh-based Allegheny Health Network signed an affiliation agreement with Grove City (Pa.) Medical Center, the organizations said Aug. 19.

AHN, a subsidiary of Pittsburgh-based Highmark Health, and GCMC plan to close the affiliation in the next few months, pending government approval. GCMC will become AHN’s ninth hospital.

Under the agreement, AHN and GCMC will co-fund an independent Grove City Health Care Foundation, with an initial endowment of up to $30 million. In addition, GCMC will get a $40 million investment from AHN to support GCMC’s clinical programs, technological assets and physical infrastructure over the next 10 years. GCMC will also go live on Epic as part of the transition.

GCMC, a small, rural hospital, has faced growing financial struggles, according to the Pittsburgh Post-Gazette. For the past five years, the hospital has recorded negative operating margins. 


11 hospitals with strong finances

Here are 11 hospitals and health systems with strong operational metrics and solid financial positions, according to recent reports from Moody’s Investors Service, Fitch Ratings and S&P Global Ratings.

1. Altamonte Springs, Fla.-based AdventHealth has an “Aa2” rating and stable outlook with Moody’s. The health system has strong margins, low operating leverage and solid cash levels, according to Moody’s.

2. Children’s Healthcare of Atlanta has an “Aa2” rating and stable outlook with Moody’s. The health system has strong margins, and its good management discipline and detailed planning capabilities will drive consistent operating performance, according to Moody’s.

3. Falls Church, Va.-based Inova Health System has an “Aa2” rating and stable outlook with Moody’s. The health system has a leading market position in the broader northern Virginia region and strong operating cash flow margins, according to Moody’s.

4. IHC Health Services, the borrowing group of Salt Lake City-based Intermountain Healthcare, has an “Aa1” rating and stable outlook with Moody’s. Intermountain’s exceptional credit quality is supported by low debt levels, strong cash levels, solid operating performance and its leading market position, according to Moody’s.

5. Oakland, Calif.-based Kaiser Permanente has an “AA-” rating and stable outlook with Fitch and S&P. Kaiser has a robust integrated business model, strong operational cash flow and ample unrestricted reserves, according to S&P.

6. Bryn Mawr, Pa.-based Main Line Health has an “Aa3” rating and stable outlook with Moody’s. The health system has a leading market position in the Philadelphia suburbs, strong balance sheet measures and a modest debt load, according to Moody’s.

7. Chicago-based Northwestern Memorial HealthCare has an “Aa2” rating and stable outlook with Moody’s. The health system has a prominent market position in the broader Chicago region because of its strong brand, and its consolidated operating model and comprehensive IT systems will allow it to execute growth strategies while maintaining good margins, according to Moody’s.

8. Renton, Wash.-based Providence St. Joseph Health has an “Aa3” rating and stable outlook with Moody’s and an “AA-” rating and stable outlook with Fitch. The health system has a large service area, a revenue base of more than $24 billion and an integrated care delivery platform, which includes health plans, employed physicians and inpatient and outpatient services, according to Moody’s.

9. Broomfield, Colo.-based SCL Health has an “AA-” rating and stable outlook with S&P. The health system has ample liquidity and a healthy balance sheet, according to S&P.

10. San Diego-based Scripps Health has an “Aa3” rating and stable outlook with Moody’s. The health system has strong market share within San Diego County, a history of strong and stable management, and favorable balance sheet measures, according to Moody’s.

11. Tahoe Forest Hospital District, which operates Tahoe Forest Hospital in Truckee, Calif., and Incline Village (Nev.) Community Hospital, has an “Aa3” rating and stable outlook with Moody’s. The hospital district has a healthy cash position, low debt burden and a large and increasing tax base, according to Moody’s.


Kaiser’s net income surges to $2B in Q2

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Oakland, Calif.-based Kaiser Permanente’s revenue, operating income and net income for its nonprofit hospital and health plan units increased year over year in the second quarter of 2019.

The healthcare giant reported operating revenue of $21.4 billion in the second quarter of this year, up 9.3 percent from $19.6 billion in the same period a year prior.

Kaiser’s health plan unit — as well as favorable accounting estimates compared to the second quarter of 2018 — contributed to the growth. Kaiser saw health plan membership increase from 12.2 million as of June 30, 2018, to 12.3 million as of June 30.

As Kaiser’s revenue grew, so did operating expenses. Expenses climbed from $19.3 billion in the second quarter of 2018 to $20.3 billion in the second quarter of 2019.

With operating expenses accounted for, Kaiser reported operating income of $1.1 billion in the second quarter of 2019. That’s up from $345 million in the first quarter of 2018.

Kaiser’s nonoperating income was $930 million in the second quarter of this year, up from $308 million in the same period a year prior.

The boost was attributable to strong investment performance, along with an accounting change that took effect Jan. 1, the organization said. Under the accounting change, Kaiser reported unrealized gains on certain equities as net nonoperating income, which added $223 million to the organization’s nonoperating income and expenses in the second quarter of 2019.

Kaiser ended the second quarter of 2019 with net income of $2 billion. That’s up more than 213 percent from its net income of $653 million in the first quarter of last year.

“Strong results are essential for us to deliver on our nonprofit mission to improve affordability while advancing our high-quality care and service for our members and customers. This also allows us to make strategic investments in technology, people and care facilities,” said Kaiser Executive Vice President and CFO Kathy Lancaster. “At the same time, it’s critical we remain fiscally vigilant in today’s increasingly competitive environment with growing industry and financial pressures.”


Seventy two percent of all rural hospital closures are in states that rejected the Medicaid expansion

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States that refused Obamacare’s Medicaid expansion are hemorrhaging hospitals in rural areas.

Roughly 20 percent of Americans live in rural areas, including more than 13 million children, according to the last U.S. census. And, according to research and reporting by the Pittsburg Morning Sun and its parent company, GateHouse Media, those people have been steadily losing access to hospitals for years.

In Oklahoma, Georgia, South Carolina, and Mississippi, at least 52 percent of all rural hospitals spent more money than they made between 2011 to 2017. In Kansas, it’s 64 percent, and five hospitals there shut down completely in that time. Since 2010, 106 rural hospitals have closed across the country. (Another 700 are “on shaky ground,” and about 200 are “on the verge of collapse,” according to Gatehouse.) Of those 106 that closed, 77 were in deep red states where local politicians refused the Obama administration’s Medicaid expansion that came about as a result of the Affordable Care Act.

In short, the federal government provided funds to expand coverage for Medicaid, a program that helps pay for health care for low income patients. But the expansion was optional, and 14 Republican-controlled states rejected to take the money. The only state that bucked this trend was Utah, where rural hospitals were among the most profitable in the country thanks to a policy of shifting funds and resources from urban hospitals. Only 14 percent of rural hospitals operated at a loss and none shut down over the same time period.

The number of rural hospitals has been shriveling for some time now: more than 200 rural hospitals closed between 1990 and 2000, according to a report from the Office of Health and Human Services. Since rural areas have been losing hospitals for decades already, every additional closure is more devastating. And even the hospitals that remain open are struggling to stay fully staffed. According to the Health Resources and Services Administration, rural parts of the U.S. need an additional 4,022 doctors to completely close their coverage gaps.

Just refusing the Medicaid expansion alone doesn’t completely account for the hundreds of rural hospital closures across Republican-controlled states. For one thing, medical treatment and technology has gotten more advanced. Dr. Nancy Dickey, president of the Rural and Community Health Institute at Texas A&M, told Gatehouse, “Most of what we knew how to do in the 1970s and 1980s could be done reasonably well in small towns. But scientific developments and advances in neurosurgery, microscopic surgery and the like required a great deal more technology and a bigger population to support the array of technology specialists.” As a result, the number of services that rural hospitals offered started to shrink, while at the same time rural populations dwindled as both jobs and young people moved away. What’s left were older, poorer populations that needed more medical care and had less money to pay for it. In that situation, hospitals can’t generate enough revenue to stay open, let alone enough to pay the salaries of even new doctors, who carry an average of $200,000 in student debt.

Still, if the state legislatures and governors had accepted the money, billions of dollars could have gone to improving insurance coverage and propping up the hospitals’ bottom lines. In a health-care industry where the average CEO pay is $18 million a year, hospitals have to produce a lot of money to justify their existence to shareholders. The Medicaid expansion was one of the few lifelines available to rural Americans, and their politicians snubbed it.



Hospital profitability down as operators lack flexibility to cut costs, Kaufman Hall says

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Dive Brief:

  • Hospital profitability declined for the first time this year during the month of June. Operating margins were down 1.88%, according to a new flash report from Kaufman Hall.
  • Analysts blamed the decline on the inability of many hospitals to rapidly cut expenses to match a decrease in patient volumes. Bad debt and charity care expenses were also up.
  • Meanwhile, non-labor expenses per adjusted discharge rose 5.3% compared to June 2018, while labor expenses per adjusted discharge increased 4.9%.

Dive Insight:

Hospital and healthcare system operations are often so large and complex that at times they can’t act quickly to address declines in profitability. Based on the most recent Kaufman Hall flash hospital report, June 2019 appears to be one of those times.

The report concluded hospitals lacked the flexibility to cut costs as patient volumes decreased. In June, adjusted discharges, patient days and emergency department visits dropped more than 5% compared to May 2019. Operating room minutes declined by 7% compared to May and are down 1.8% year over year, a trend the report said was “most concerning.” At the same time, expenses rose significantly compared to June 2018.

There were some exceptions. Hospitals with 500 beds or more saw an increase in pre-tax profit margins for the third consecutive month, which the report attributed to increased revenues. Smaller hospitals ( fewer than 25 beds and 200-299 beds) also had improved margins, which was connected to increased inpatient volumes. However, mid-sized hospitals (300-499 beds) saw the biggest decline in profitability, while those in the 100-199 bed range also struggled.

Hospitals in the South also fared better than average, which the report attributed to “strong expense management during a period of stagnant volume growth.” By comparison, hospitals in the Midwest, where revenues were flat while bad debt and labor costs were on the rise, had pre-tax margins that were nearly 3.7% lower.

But the report also suggested that most hospital operators are not seeing the big picture. “Nationwide, hospitals continue to be overly optimistic about inpatient volumes, while underestimating the increase in ambulatory care,” it said.

Hospitals also face other potential headwinds: The upcoming Physician Payment Fee Schedule from CMS may not be favorable to providers; federal legislation to end surprise medical bills could wind up being enacted in law; and the courts could wind up striking down the Affordable Care Act, leaving some 20 million Americans without health insurance.

The report concluded “a lack of flexibility is a fundamental risk to hospitals and health systems and something that industry disruptors are likely to use to their advantage in the coming months and years.”




HCA Misses on Key Financials, Stock Drops Sharply

The Nashville-based for-profit hospital operator’s revenues went up slightly, but other metrics missed the mark.

Though HCA Healthcare’s total revenues increased to $12.6 billion in Q2, the company missed on other key areas, according to its latest earnings released Tuesday morning.

HCA reported a net income of $783 million, down from $820 million this time last year, and an adjusted EBTDA of $2.29 that was better than Q2 2018 but fell from Q1 2019.

The Nashville-based for-profit hospital operator’s financial numbers from Q2 sent its stock tumbling in early morning trading, where it was down more than 10% by 10 a.m.  

Same facility admissions and same facility equivalent admissions each rose by 2.1% and 2.6%, respectively, while same facility emergency room visits jumped 3% year-over-year.

However, growth in same facility outpatient surgeries and same facility revenues per equivalent admission slowed in Q2 while same facility inpatient surgeries declined 0.1%.

The company updated its financial guidance in light of its Q2 results, projecting diluted earnings per share in a range between $10.25 and $10.65.

HCA had two major developments in Q2, asking a federal judge to dismiss a class action lawsuit alleging unfair billing practices at three Florida hospitals and its acquisition of 24 MedSpring urgent care centers from Fresenius Medical Care.


  • Salaries, benefits, supplies, and other operating expenses accounted for 81.9% of revenues, down from 80.8% this time last year.
  • The company repurchased $242 million worth of stock in Q2 and has just over $1.75 billion remaining under its existing repurchase agreement.
  • The company also declared a quarterly cash dividend of $0.40 per share to be paid on September 30.
  • By the end of Q2, HCA was operating 184 hospitals, down from 185 hospitals at the end of Q2.

For complete financial information, review HCA Healthcare’s filing with the Securities and Exchange Commission.