As of the July, 2022, release via CMS

PALO ALTO COUNTY HOSPITAL

CMS id: 161357
3201 W. 1ST, EMMETSBURG IA 50536. County: PALO ALTO
System: MERCY HEALTH NETWORK INC.
CBSA: Rural Iowa

The 47-bed, CAH hospital had $-1,943,301 in net service to patients*, with a total profit margin of 18.26576% in fiscal year 2021, the latest year available.
It spent 1.54% of its operating expenses on uncompensated care and reported $931,361 in Medicaid shortfall.

* For more about Net Service to Patients and operating revenue, please the finance section below.

Note: Medians are from CAH hospitals with "complete" fiscal years. For more about how we calculated medians and cost reports in general, please click here.

Details

	2017	2018	2019	2020	2021
# of days in fyear	365	365	365	366	365
Ownership	gov	gov	gov	gov	gov
Acute beds Median	24 23	24 23	24 23	24 23	24 23
Total beds Median	47 25	47 25	47 25	47 25	47 25
FTEs Median	186.21 149.18	165.08 151.6	165.09 151.58	175.14 152.78	166.41 151.99

Finances As they appear in worksheet G3 of the cost reports.

Note: Net Patient Revenue is considered operating revenue, which means Net Service to Patients is considered operating profit. Click here for more about cost report financials

Hospital cost reports are an enormously complicated dataset. There are whole organizations and an offical CMS vendor dedicated to helping researchers work with the data.
It's important to understand that hospital financials in cost reports are not organized in the same as other sources such as annual financial reports to bond holders.

The biggest difference is the concept of operating revenue and profit. Net Service to patients (NS2P), which is the sum of net patient revenue minus operating expenses, is considered the equivalent of operating profit according to the Medicaid and CHIP Payment and Access Commission (MACPAC). See the last paragraph of "Primary Data Sources" on page 55 of Annual Analysis of Disproportionate Share Hospital Allotments to States (PDF).

That would make Net Patient Revenue = operating revenue.

All this makes things challenging when comparing what's reported in cost reports to other sources. It becomes clearer when you consider that, beyond the purpose of reimbursement, cost reports are a tool for policymakers trying to understand the financial situation of a hospital doing the tasks specific to hospitals.

In other words, while a facility with a division that formulates drugs might include earnings from that as operating revenue in their corporate annual result, this is not central to the operations of a hospital caring for patients and so it is counted as "other income." (See below the financials section for more on "other income")

The healthcare consulting firm HMP, in a former partnership with Modern Healthcare, did develop a formula for estimating operating revenue closer to what one might find in other sources. We no longer use this for the following reasons:

The measure was not widely used beyond HMP and Modern Healthcare. Many hospitals had their own internal estimates of operating revenue and profit.
Because of this, there was confusion when reporting operating results for individual hospitals. There was often pushback when a facility's internal numbers did not match what Modern Healthcare was reporting.
The formula includes revenue from portions of the "other income" section, which may also include non-operating revenue. HMP themselves point out in a caveat on their site that they cannot exclude all non-operating revenue from their measure.

HMP's operating measure has proven problematic in the past for our reporting and the partnership with them ended years ago. It's best to not use a measure that we alone cannot defend.

	2017	2018	2019	2020	2021
Net patient revenue ? Median	22,494,256 19,395,819	22,881,902 19,790,685	26,038,110 20,891,573	26,429,926 20,752,910	28,638,222 22,925,976
Operating expenses Median	26,264,451 21,082,256	26,104,546 21,740,728	26,602,833 22,449,917	27,853,626 23,028,561	30,581,523 24,906,213
Net income from service 2 patients (NS2P) ? Median	-3,770,195 -1,166,928	-3,222,644 -1,178,891	-564,723 -1,189,234	-1,423,700 -1,989,193	-1,943,301 -1,175,562
NS2P margin ? Median	-16.76% -6.37	-14.08% -6.47	-2.17% -6.58	-5.39% -10.52	-6.79% -5.81

Range* of Net Service to Patient (NS2P) margins

= NS2P margin for PALO ALTO COUNTY HOSPITAL compared to all** CAH hospitals, from CMS cost reports.
Note: NS2P is considered operating margin by MACPAC. The chart below is interactive: click or touch to see more.

* Data range does not show outliers, which fall beyond the minimum and maximum of the range.
** From cost reports with complete fiscal years. Number of CAH hospitals available to calculate medians:

2017	2018	2019	2020	2021
1,314	1,322	1,316	1,319	1,132

	2017	2018	2019	2020	2021
Other income* Median Click here to show/hide details	3,655,900 1,517,926	4,009,160 1,554,100	2,569,653 1,708,825	2,946,449 3,606,354	9,386,714 4,946,640
⊳ Line 6: Contributions ? ⊳ Median	75,649 68,435	70,561 61,711.5	0 71,344	0 80,654	123,480 103,902
⊳ Line 7: Investments ? ⊳ Median	71,772 25,389	210,813 35,427	0 59,240	0 47,652	411,663 52,317
⊳ Line 8: Revenue from telephone service	NULL	NULL	NULL	NULL	NULL
⊳ Line 9: Revenue from tv and radio	--	--	--	--	--
⊳ Line 10: Purchase discounts	0	0	0	0	0
⊳ Line 11: Rebates and refunds of expenses	0	0	0	0	0
⊳ Line 12: Parking lot receipts	0	0	0	0	0
⊳ Line 13: Revenue from laundry and linen service	0	0	0	0	0
⊳ Line 14: Revenue from meals sold to emplyees and guests	62,985	64,876	0	0	53,294
⊳ Line 15: Revenue from rental of living quarters	0	0	0	0	0
⊳ Line 16: Revenue from sale of medical and surgical supplies	0	0	0	0	0
⊳ Line 17: Revenue from sale of drugs to other than patients	0	0	0	0	0
⊳ Line 18: Revenue from sale of medical records and abstracts	4,980	2,379	0	0	0
⊳ Line 19: Tuition (fees, sale of textbooks, uniforms, etc.)	0	0	0	0	0
⊳ Line 20: Revenue from gifts, flowers, coffee shops, canteen	0	0	0	0	0
⊳ Line 21: Rental of vending machines	0	0	0	0	0
⊳ Line 22: Rental of hospital space	0	0	0	0	0
⊳ Line 23: Gov appropriations ? ⊳ Median	1,518,928 525,619.5	1,575,658 568,101.5	0 581,486	0 657,916	0 640,942
⊳ Sum Line 24	1,921,586	2,084,873	2,569,653	2,946,449	8,798,277
Total income ? Median	-114,295 445,049	786,516 379,292	2,004,930 655,032	1,522,749 1,453,054	7,443,413 3,734,026
Non-operating expenses Median	0 56,329	0 45,230	0 61,507	222,972 80,747	497,871 39,130
Net income Median	-114,295 309,249	786,516 305,537	2,004,930 515,321.5	1,299,777 1,282,423	6,945,542 3,678,491
Net margin Median	-0.43707% 1.7%	2.92482% 1.61%	7.00834% 2.36%	4.42457% 5.41%	18.26576% 13.38%

* About "Other income": Other income, or line 25 in worksheet G3, is the sum of lines 6 through 24. It includes three lines that are considered non-operating revenue - contributions, investments and government appropriations. Medians are included for these three lines. It also contains items that are not central to providing healthcare, such as revenue from parking or gift shops.
"Sum Line 24" is a special case. Called "Other (specify)" in the cost reports, CMS allows for this line to be "subscripted," or divided into sublines like 002400, 002401, 002402. And hospitals do that, up to 100 lines, to detail income (and sometimes negative returns) that are otherwise not covered in the previous "other" lines. Therefore, "Sum Line 24" is the sum of all the lines 24.

Range* of total profit (loss) margins

= Total margin for PALO ALTO COUNTY HOSPITAL compared to all** CAH hospitals, from CMS cost reports.
The chart below is interactive: click or touch to see more.

* Data range does not show outliers, which fall beyond the minimum and maximum of the range.
** From cost reports with complete fiscal years. Number of CAH hospitals available to calculate medians:

2017	2018	2019	2020	2021
1,314	1,322	1,316	1,319	1,132

Medicare revenue

Inpatient and outpatient revenue

	2017	2018	2019	2020	2021
All inpatient revenue Median Click here to show/hide details	800,037 1,512,374	870,472 1,478,094	952,562 1,365,460	1,012,320 1,289,169	1,450,785 1,354,214
"All inpatient revenue" is made up of any Medicare payments for routine inpatient, swingbed SNFs, TEFRA, IPF, IRF, inpatient long-term care, CAH and inpatient SNF facilities. Medians are only calculated when there are sufficient facilities reporting revenue.
⊳ Routine inpatient revenue ⊳ Median	0 --	0 --	0 --	0 --	0 --
⊳ Swingbeds ⊳ Median	0 --	0 --	0 --	0 --	0 --
⊳ Tax Equity and Fiscal Responsibility Act payments (TEFRA) ⊳ Median	0 --	0 --	0 --	0 --	0 --
⊳ Inpatient psychiatric facility (IPF) ⊳ Median	0 1,435,730	0 1,483,001	0 1,283,328	0 992,950.5	0 --
⊳ Inpatient rehabilitation facility (IRF) ⊳ Median	0 --	0 --	0 --	0 --	0 --
⊳ Long-term care hospital (LTCH) ⊳ Median	0 --	0 --	0 --	0 --	0 --
⊳ Critical-access hospitals ⊳ Median	800,037 1,441,589	870,472 1,403,245	952,562 1,290,206	1,012,320 1,229,191	1,450,785 1,287,699
⊳ Skilled-nursing facilities (SNF) ⊳ Median	0 206,041.5	0 214,490	0 174,030.5	0 236,717.5	0 192,758.5
All outpatient revenue Median Click here to show/hide details	6,549,578 4,108,627	6,295,981 4,367,646	6,738,301 4,566,928	7,564,807 4,517,324	7,444,769 4,554,272
"All outpatient revenue" is made up of any payments for routine outpatient, HHA, CMHC, rural health and other federally-qualified health clinics. Medians are only calculated when there are sufficient facilities reporting revenue.
⊳ Routine outpatient revenue ⊳ Median	4,924,712 3,508,078	4,610,017 3,742,383	4,847,782 3,932,686	5,073,740 3,847,302	5,313,323 3,879,271
⊳ Home Health agencies (HHA) ⊳ Median	104,847 299,331.5	141,254 299,936	116,245 316,639	138,894 288,635	156,400 297,926
⊳ Community mental health clinics (CMHC) ⊳ Median	0 --	0 --	0 --	0 --	0 --
⊳ Rural health clinics ⊳ Median	1,520,019 702,405	1,544,710 746,179	1,774,274 800,433	2,352,173 774,040	1,975,046 742,054
⊳ Other federally qualified health clinics ⊳ Median	0 --	0 --	0 --	0 --	0 --

Other payments

Item	2017	2018	2019	2020	2021
Graduate Medical Education (GME) Median	0 --	0 --	0 --	0 --	0 --
Disproportionate-share hospital (DSH) Median	0 --	0 --	0 --	0 --	0 --
Outlier Median	1,936 4,679	2,565 5,256	1,202 5,165.5	808 6,341	2,071 5,998

Uncompensated care

Item	2017	2018	2019	2020	2021
Medicaid shortfall Median	1,727,470 553,475.5	60,290 567,149	215,869 599,174.5	561,533 641,417	931,361 631,057
Charity care Median	371,552 190,496	58,636 225,101	110,012 238,624	158,370 260,478.5	157,398 225,887
Uncompensated care (UCC) Median	479,254 860,218.5	413,169 933,428	318,693 986,290	266,715 998,939	472,156 871,713
UCC as a % of operating expenses Median	1.82% 3.77	1.58% 3.82	1.20% 3.7	0.96% 3.74	1.54% 3.04
Total shortfall/UCC Median	2,206,724 1,405,482	473,459 1,525,979	534,562 1,576,055	828,248 1,691,815	1,403,517 1,476,802

Labor costs

	2017	2018	2019	2020	2021
Total salaries Median	10,180,877 8,521,101	9,058,890 8,786,419	9,674,310 9,086,354	10,417,498 9,512,636	11,350,098 9,933,360
Salaries as a % of operating expenses Median	38.99 42.53	35.49 42.58	36.37 42.62	37.40 42.72	37.11 42.27
Intern, resident salaries* Median	0 --	0 --	0 --	0 --	0 --
Contract intern, resident salaries* Median	0 --	0 --	0 --	0 --	0 --
Contract adjusted salaries, direct-care Median	0 --	0 --	0 --	0 --	0 --
Contract hours, direct-care Median	0.00 --	0.00 --	0.00 --	0.00 --	0.00 --
Contract wages, direct-care Median	0.00 --	0.00 --	0.00 --	0.00 --	0.00 --

* in an approved program

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Cost reports are self-reported by the facility, are subject to revision and should be considered preliminary.

* Net Service to patients (NS2P) equals net patient revenue minus operating expenses. NS2P is considered the equivalent of operating profit according to the Medicaid and CHIP Payment and Access Commission (MACPAC). See the last paragraph of "Primary Data Sources" on page 55 of Annual Analysis of Disproportionate Share Hospital Allotments to States (PDF).

About medians

Medians are calculated from reports with "complete" fiscal years, or reports with fiscal years of at least 300 days and no more than 420 days.

In cases where there are fewer than 50 values reported, medians are not calculated. For childrens' hospitals, it's when fewer than 20 are reported.

Web app by Tim Broderick | email.