As of the July, 2022, release via CMS

ALAMEDA HEALTH SYSTEM

CMS id: 050320
1411 EAST 31ST STREET, OAKLAND CA 94602. County: ALAMEDA
System: ALAMEDA HEALTH SYSTEM
CBSA: San Francisco-Oakland-Berkeley, CA

The 415-bed, acute-care hospital had $-1,045,421,245 in net service to patients*, with a total profit margin of -45.63830% in fiscal year 2021, the latest year available.
It spent 10.82% of its operating expenses on uncompensated care and reported $73,008,110 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	112 118	137 118	137 119.5	182 118	182 119
Total beds Median	383 162	408 162	372 162	415 162	415 163.5
FTEs Median	2,446.63 788.06	2,446.65 793.42	2,477.77 806.03	2,758.50 787.61	2,577.91 804.34

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	483,645,984 150,932,746	431,386,626 158,950,878	255,594,332 168,696,998	-243,234,986 163,454,693	-67,750,316 186,589,412
Operating expenses Median	562,834,750 149,311,209	577,605,373 156,110,414	863,127,781 164,890,568	952,040,680 166,516,854	977,670,929 180,120,888
Net income from service 2 patients (NS2P) ? Median	-79,188,766 -964,173	-146,218,747 -643,601.5	-607,533,449 -116,254	-1,195,275,666 -5,025,862	-1,045,421,245 -1,284,564
NS2P margin ? Median	-16.37% -0.62	-33.90% -0.29	-237.69% 0.18	491.41% -5.07	1,543.05% -0.88

Range* of Net Service to Patient (NS2P) margins

= NS2P margin for ALAMEDA HEALTH SYSTEM 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	182,037,753 5,089,215	243,435,774 4,572,541	596,033,542 5,268,134	910,533,657 13,092,619	739,051,008 12,369,236
⊳ Line 6: Contributions ? ⊳ Median	0 224,999	0 199,009	0 206,870.5	0 194,343	0 249,496
⊳ Line 7: Investments ? ⊳ Median	0 299,524	0 188,688.5	0 370,813	0 309,361.5	1,990,152 375,329
⊳ 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	0	0	0	0	0
⊳ 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	0	0	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	131,328
⊳ Line 23: Gov appropriations ? ⊳ Median	168,256,809 1,017,693	239,430,015 983,261.5	363,445,319 1,173,286	500,258,146 1,987,202	379,724,434 1,597,664
⊳ Sum Line 24	13,780,944	4,005,759	232,588,223	410,275,511	357,205,094
Total income ? Median	102,848,987 6,586,430	97,217,027 6,767,106	-11,499,907 8,419,950	-284,742,009 8,094,175	-306,370,237 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	102,848,987 6,043,842	97,217,027 5,845,112	-11,499,907 7,606,259	-284,742,009 7,283,041	-306,370,237 14,957,241
Net margin Median	15.45013% 4.62%	14.40631% 4.42%	-1.35034% 5.16%	-42.67085% 5.2%	-45.63830% 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 ALAMEDA HEALTH SYSTEM 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	61,826,211 23,241,334	63,596,909 23,709,545	76,962,324 24,248,380	96,514,738 22,858,541	108,397,892 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	48,503,712 21,577,146	50,635,957 22,041,594	61,249,335 22,722,063	79,706,290 21,570,441	91,934,996 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	9,398,441 1,845,420	8,631,217 1,757,392	8,991,733 1,738,842	9,231,013 1,510,463	7,809,077 1,393,140
⊳ Inpatient rehabilitation facility (IRF) ⊳ Median	3,868,776 3,535,627	4,304,733 3,746,588	6,601,080 3,782,288	7,558,826 3,865,578	8,048,565 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	55,282 1,203,033	25,002 1,215,295	120,176 1,313,657	18,609 1,365,298	605,254 1,179,746
All outpatient revenue Median Click here to show/hide details	20,538,315 11,160,864	19,522,159 11,987,345	19,668,978 12,926,866	21,002,450 11,884,480	19,514,911 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	20,538,315 10,918,923	19,522,159 11,706,976	19,668,978 12,615,917	21,002,450 11,458,116	19,514,911 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	10,203,184 3,284,314	10,971,171 3,250,551	11,040,192 3,386,837	13,215,908 3,360,806	13,990,604 3,508,953
Disproportionate-share hospital (DSH) Median	3,483,408 594,888	3,136,757 595,761	3,677,988 577,894	4,589,466 542,168	7,145,934 549,667
Outlier Median	8,335,266 582,572	6,583,974 538,116	7,836,159 212,434	3,092,517 126,559	2,024,302 139,139

Uncompensated care

Item	2017	2018	2019	2020	2021
Medicaid shortfall Median	114,093,453 3,662,910	75,620,201 3,730,911	147,559,940 4,081,319	112,113,218 4,643,908	73,008,110 4,389,147
Charity care Median	57,645,543 2,654,636	30,703,328 2,940,659	25,487,125 3,380,215	50,419,137 3,488,738	86,621,343 3,233,405
Uncompensated care (UCC) Median	77,659,568 5,147,790	72,090,903 5,337,617	31,301,377 5,711,082	52,594,136 5,923,418	105,772,648 5,508,107
UCC as a % of operating expenses Median	13.80% 3.24	12.48% 3.12	3.63% 3.21	5.52% 3.3	10.82% 2.86
Total shortfall/UCC Median	191,753,021 9,489,989	147,711,104 9,424,297	178,861,317 10,120,158	164,707,354 11,171,337	178,780,758 10,133,851

Labor costs

	2017	2018	2019	2020	2021
Total salaries Median	276,839,967 52,142,039	302,549,200 54,485,252	324,985,687 57,395,589	377,472,093 58,830,919	432,167,022 61,722,907
Salaries as a % of operating expenses Median	49.19 36.68	52.38 36.56	59.92 36.37	62.02 35.93	57.16 35.24
Intern, resident salaries* Median	8,846,665 2,598,592	9,362,777 2,686,824	9,537,049 2,753,773	9,915,249 2,937,156	9,911,272 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	14,131,495 1,449,244	8,726,045 1,475,986	10,700,041 1,563,078	17,337,759 1,721,954	14,649,695 2,991,828
Contract hours, direct-care Median	198,082.71 22,725	96,703.00 23,018.5	118,512.79 24,503.48	174,841.83 25,026.5	135,329.00 33,786
Contract wages, direct-care Median	71.34 64.67	90.24 64.53	90.29 65.06	99.16 68.97	108.25 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.