As of the July, 2022, release via CMS

CLAY COUNTY HOSPITAL

CMS id: 010073
83825 HIGHWAY 9, ASHLAND AL 36251. County: CLAY
System: --
CBSA: Rural Alabama

The 139-bed, acute-care hospital had $-3,108,678 in net service to patients*, with a total profit margin of 0.95147% in fiscal year 2021, the latest year available.
It spent 3.92% of its operating expenses on uncompensated care and reported $8,342 in Medicaid shortfall.

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

Note: Medians are from acute-care 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	42 118	42 118	42 119.5	42 118	42 119
Total beds Median	139 162	129 162	129 162	139 162	139 163.5
FTEs Median	223.79 788.06	212.55 793.42	216.78 806.03	221.73 787.61	215.31 804.34

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	16,326,547 150,932,746	17,313,539 158,950,878	17,953,246 168,696,998	18,243,502 163,454,693	19,510,112 186,589,412
Operating expenses Median	18,792,415 149,311,209	17,922,208 156,110,414	19,013,515 164,890,568	19,986,683 166,516,854	22,618,790 180,120,888
Net income from service 2 patients (NS2P) ? Median	-2,465,868 -964,173	-608,669 -643,601.5	-1,060,269 -116,254	-1,743,181 -5,025,862	-3,108,678 -1,284,564
NS2P margin ? Median	-15.10% -0.62	-3.52% -0.29	-5.91% 0.18	-9.56% -5.07	-15.93% -0.88

Range* of Net Service to Patient (NS2P) margins

= NS2P margin for CLAY COUNTY HOSPITAL compared to all** acute-care 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 acute-care hospitals available to calculate medians:

2017	2018	2019	2020	2021
3,157	3,092	3,050	3,052	2,566

	2017	2018	2019	2020	2021
Other income* Median Click here to show/hide details	895,993 5,089,215	981,183 4,572,541	1,063,802 5,268,134	1,061,343 13,092,619	3,325,957 12,369,236
⊳ Line 6: Contributions ? ⊳ Median	39,779 224,999	27,753 199,009	36,052 206,870.5	143,990 194,343	186,500 249,496
⊳ Line 7: Investments ? ⊳ Median	6,082 299,524	7,211 188,688.5	1,790 370,813	25,227 309,361.5	38,740 375,329
⊳ Line 8: Revenue from telephone service	NULL	NULL	NULL	NULL	NULL
⊳ Line 9: Revenue from tv and radio	--	--	--	--	--
⊳ Line 10: Purchase discounts	10,647	6,986	23,634	4,642	14,458
⊳ 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	100,560	116,836	168,152	118,994	71,239
⊳ 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	69,188	106,000	106,180	90,000	120,052
⊳ Line 18: Revenue from sale of medical records and abstracts	845	1,467	848	875	912
⊳ 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	4,135
⊳ Line 22: Rental of hospital space	31,118	41,183	60,943	71,773	77,388
⊳ Line 23: Gov appropriations ? ⊳ Median	345,224 1,017,693	361,035 983,261.5	387,145 1,173,286	362,917 1,987,202	387,212 1,597,664
⊳ Sum Line 24	292,550	312,712	279,058	242,925	2,425,321
Total income ? Median	-1,569,875 6,586,430	372,514 6,767,106	3,533 8,419,950	-681,838 8,094,175	217,279 15,162,888
Non-operating expenses Median	0 146,289.5	0 164,857	0 89,880.5	0 106,761	0 31,473.5
Net income Median	-1,569,875 6,043,842	372,514 5,845,112	3,533 7,606,259	-681,838 7,283,041	217,279 14,957,241
Net margin Median	-9.11524% 4.62%	2.03618% 4.42%	0.01858% 5.16%	-3.53195% 5.2%	0.95147% 9.25%

* 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 CLAY COUNTY HOSPITAL compared to all** acute-care hospitals, from CMS cost reports.
The chart below is interactive: click or touch to see more.

2017	2018	2019	2020	2021
3,157	3,092	3,050	3,052	2,566

Medicare revenue

Inpatient and outpatient revenue

	2017	2018	2019	2020	2021
All inpatient revenue Median Click here to show/hide details	3,766,714 23,241,334	4,006,268 23,709,545	3,308,286 24,248,380	3,740,090 22,858,541	3,723,568 23,620,613
"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	3,590,592 21,577,146	3,943,453 22,041,594	3,262,924 22,722,063	3,624,253 21,570,441	3,663,909 22,140,684
⊳ 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 1,845,420	0 1,757,392	0 1,738,842	0 1,510,463	0 1,393,140
⊳ Inpatient rehabilitation facility (IRF) ⊳ Median	0 3,535,627	0 3,746,588	0 3,782,288	0 3,865,578	0 3,983,889
⊳ Long-term care hospital (LTCH) ⊳ Median	0 --	0 --	0 --	0 --	0 --
⊳ Critical-access hospitals ⊳ Median	0 --	0 --	0 --	0 --	0 --
⊳ Skilled-nursing facilities (SNF) ⊳ Median	176,122 1,203,033	62,815 1,215,295	45,362 1,313,657	115,837 1,365,298	59,659 1,179,746
All outpatient revenue Median Click here to show/hide details	1,241,404 11,160,864	1,127,176 11,987,345	1,149,824 12,926,866	897,706 11,884,480	832,619 13,145,163
"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	1,241,404 10,918,923	1,127,176 11,706,976	1,149,824 12,615,917	897,706 11,458,116	832,619 12,776,716
⊳ Home Health agencies (HHA) ⊳ Median	0 1,282,808	0 1,407,728	0 1,341,512	0 1,407,046	0 1,476,867
⊳ Community mental health clinics (CMHC) ⊳ Median	0 --	0 --	0 --	0 --	0 --
⊳ Rural health clinics ⊳ Median	0 618,038	0 697,279	0 690,232	0 684,010	0 670,558
⊳ 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 3,284,314	0 3,250,551	0 3,386,837	0 3,360,806	0 3,508,953
Disproportionate-share hospital (DSH) Median	164,418 594,888	188,280 595,761	158,540 577,894	158,678 542,168	148,529 549,667
Outlier Median	9,961 582,572	108,602 538,116	152 212,434	314 126,559	210 139,139

Uncompensated care

Item	2017	2018	2019	2020	2021
Medicaid shortfall Median	15,540 3,662,910	0 3,730,911	13,255 4,081,319	28,753 4,643,908	8,342 4,389,147
Charity care Median	100,790 2,654,636	146,217 2,940,659	171,635 3,380,215	302,816 3,488,738	104,318 3,233,405
Uncompensated care (UCC) Median	1,187,735 5,147,790	952,033 5,337,617	1,280,460 5,711,082	1,431,946 5,923,418	886,959 5,508,107
UCC as a % of operating expenses Median	6.32% 3.24	5.31% 3.12	6.73% 3.21	7.16% 3.3	3.92% 2.86
Total shortfall/UCC Median	1,203,275 9,489,989	952,033 9,424,297	1,293,715 10,120,158	1,460,699 11,171,337	895,301 10,133,851

Labor costs

	2017	2018	2019	2020	2021
Total salaries Median	9,027,154 52,142,039	8,398,775 54,485,252	9,035,251 57,395,589	10,136,610 58,830,919	11,453,906 61,722,907
Salaries as a % of operating expenses Median	48.04 36.68	46.86 36.56	47.52 36.37	50.72 35.93	50.64 35.24
Intern, resident salaries* Median	0 2,598,592	0 2,686,824	0 2,753,773	0 2,937,156	0 2,909,848
Contract intern, resident salaries* Median	0 1,251,927	0 1,186,494	0 1,204,885	0 1,279,653	0 1,469,317
Contract adjusted salaries, direct-care Median	142,298 1,449,244	146,800 1,475,986	132,158 1,563,078	382,318 1,721,954	592,087 2,991,828
Contract hours, direct-care Median	1,624.50 22,725	1,736.00 23,018.5	1,451.00 24,503.48	7,596.25 25,026.5	10,789.00 33,786
Contract wages, direct-care Median	87.59 64.67	84.56 64.53	91.08 65.06	50.33 68.97	54.88 88.94

* 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.