As of the July, 2022, release via CMS

TRI VALLEY HEALTH SYSTEM

CMS id: 281348
WEST HIGHWAY 6 AND 34, CAMBRIDGE NE 69022. County: FURNAS
System: --
CBSA: Rural Nebraska

The 20-bed, CAH hospital had $-2,763,514 in net service to patients*, with a total profit margin of 14.36577% in fiscal year 2021, the latest year available.
It spent 3.01% of its operating expenses on uncompensated care and reported $79,203 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	nfp	nfp	nfp	nfp	nfp
Acute beds Median	20 23	20 23	20 23	20 23	20 23
Total beds Median	54 25	54 25	54 25	54 25	20 25
FTEs Median	157.36 149.18	148.80 151.6	149.65 151.58	132.52 152.78	142.51 151.99

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	18,178,122 19,395,819	18,495,571 19,790,685	19,588,505 20,891,573	19,156,934 20,752,910	20,586,083 22,925,976
Operating expenses Median	21,277,561 21,082,256	21,363,011 21,740,728	23,257,327 22,449,917	22,817,390 23,028,561	23,349,597 24,906,213
Net income from service 2 patients (NS2P) ? Median	-3,099,439 -1,166,928	-2,867,440 -1,178,891	-3,668,822 -1,189,234	-3,660,456 -1,989,193	-2,763,514 -1,175,562
NS2P margin ? Median	-17.05% -6.37	-15.50% -6.47	-18.73% -6.58	-19.11% -10.52	-13.42% -5.81

Range* of Net Service to Patient (NS2P) margins

= NS2P margin for TRI VALLEY HEALTH SYSTEM 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	1,610,504 1,517,926	1,541,981 1,554,100	2,320,257 1,708,825	3,393,562 3,606,354	6,817,857 4,946,640
⊳ Line 6: Contributions ? ⊳ Median	0 68,435	0 61,711.5	0 71,344	0 80,654	0 103,902
⊳ Line 7: Investments ? ⊳ Median	172,184 25,389	122,007 35,427	149,546 59,240	53,430 47,652	956,464 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	18,925	1,410	5,665
⊳ 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	73,260	92,776	99,681	104,967	88,796
⊳ 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	2,471	1,156	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	0 525,619.5	0 568,101.5	0 581,486	0 657,916	0 640,942
⊳ Sum Line 24	1,362,589	1,326,042	2,052,105	3,233,755	5,766,932
Total income ? Median	-1,488,935 445,049	-1,325,459 379,292	-1,348,565 655,032	-266,894 1,453,054	4,054,343 3,734,026
Non-operating expenses Median	23,086 56,329	21,596 45,230	30,894 61,507	41,000 80,747	117,556 39,130
Net income Median	-1,512,021 309,249	-1,347,055 305,537	-1,379,459 515,321.5	-307,894 1,282,423	3,936,787 3,678,491
Net margin Median	-7.64086% 1.7%	-6.72265% 1.61%	-6.29638% 2.36%	-1.36535% 5.41%	14.36577% 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 TRI VALLEY HEALTH SYSTEM 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	1,709,694 1,512,374	1,259,801 1,478,094	1,434,874 1,365,460	1,386,616 1,289,169	1,827,424 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	1,709,694 1,441,589	1,259,801 1,403,245	1,434,874 1,290,206	1,386,616 1,229,191	1,827,424 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	4,418,200 4,108,627	5,043,166 4,367,646	5,971,947 4,566,928	6,811,182 4,517,324	7,011,124 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	3,391,986 3,508,078	4,066,295 3,742,383	4,812,794 3,932,686	5,688,835 3,847,302	5,844,024 3,879,271
⊳ Home Health agencies (HHA) ⊳ Median	0 299,331.5	0 299,936	0 316,639	0 288,635	0 297,926
⊳ Community mental health clinics (CMHC) ⊳ Median	0 --	0 --	0 --	0 --	0 --
⊳ Rural health clinics ⊳ Median	1,026,214 702,405	976,871 746,179	1,159,153 800,433	1,122,347 774,040	1,167,100 742,054
⊳ 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	0 4,679	0 5,256	0 5,165.5	0 6,341	0 5,998

Uncompensated care

Item	2017	2018	2019	2020	2021
Medicaid shortfall Median	417,989 553,475.5	212,520 567,149	318,938 599,174.5	83,096 641,417	79,203 631,057
Charity care Median	39,153 190,496	23,937 225,101	13,385 238,624	77,657 260,478.5	119,495 225,887
Uncompensated care (UCC) Median	311,862 860,218.5	359,447 933,428	488,472 986,290	886,391 998,939	702,357 871,713
UCC as a % of operating expenses Median	1.47% 3.77	1.68% 3.82	2.10% 3.7	3.88% 3.74	3.01% 3.04
Total shortfall/UCC Median	729,851 1,405,482	571,967 1,525,979	807,410 1,576,055	969,487 1,691,815	781,560 1,476,802

Labor costs

	2017	2018	2019	2020	2021
Total salaries Median	8,853,451 8,521,101	8,479,496 8,786,419	8,800,081 9,086,354	8,384,747 9,512,636	9,206,719 9,933,360
Salaries as a % of operating expenses Median	41.61 42.53	39.69 42.58	37.84 42.62	36.75 42.72	39.43 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.