As of the July, 2022, release via CMS

KOOTENAI HOSPITAL DISTRICT

CMS id: 130049
2003 KOOTENAI HEALTH WAY, COEUR DALENE ID 83814. County: KOOTENAI
System: KOOTENAI HEALTH
CBSA: Coeur d'Alene, ID

The 329-bed, acute-care hospital had $-75,474,210 in net service to patients*, with a total profit margin of 8.61140% in fiscal year 2020, the latest year available.
It spent 1.77% of its operating expenses on uncompensated care and reported $2,319,206 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	--
Ownership	gov	gov	gov	gov	--
Acute beds Median	219 118	228 118	260 119.5	260 118	-- 119
Total beds Median	289 162	297 162	329 162	329 162	-- 163.5
FTEs Median	2,620.64 788.06	2,794.83 793.42	2,938.54 806.03	3,020.09 787.61	-- 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	474,499,198 150,932,746	507,623,711 158,950,878	558,295,241 168,696,998	560,861,117 163,454,693	-- 186,589,412
Operating expenses Median	477,974,902 149,311,209	524,897,430 156,110,414	575,588,903 164,890,568	636,335,327 166,516,854	-- 180,120,888
Net income from service 2 patients (NS2P) ? Median	-3,475,704 -964,173	-17,273,719 -643,601.5	-17,293,662 -116,254	-75,474,210 -5,025,862	-- -1,284,564
NS2P margin ? Median	-0.73% -0.62	-3.40% -0.29	-3.10% 0.18	-13.46% -5.07	--% -0.88

Range* of Net Service to Patient (NS2P) margins

= NS2P margin for KOOTENAI HOSPITAL DISTRICT 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	51,290,195 5,089,215	44,398,378 4,572,541	82,453,921 5,268,134	135,435,032 13,092,619	-- 12,369,236
⊳ Line 6: Contributions ? ⊳ Median	0 224,999	2,664,165 199,009	7,792,620 206,870.5	3,539,723 194,343	-- 249,496
⊳ Line 7: Investments ? ⊳ Median	4,062,627 299,524	1,672,738 188,688.5	13,638,853 370,813	11,569,508 309,361.5	-- 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	7,299	0	0	--
⊳ Line 11: Rebates and refunds of expenses	0	810	1,790	125,359	--
⊳ Line 12: Parking lot receipts	0	0	0	0	--
⊳ Line 13: Revenue from laundry and linen service	18,845	20,588	0	0	--
⊳ Line 14: Revenue from meals sold to emplyees and guests	2,240,455	2,730,497	2,819,977	2,598,173	--
⊳ Line 15: Revenue from rental of living quarters	0	0	0	0	--
⊳ Line 16: Revenue from sale of medical and surgical supplies	109,227	156	1,933	3	--
⊳ Line 17: Revenue from sale of drugs to other than patients	24,670	14,291,361	28,517,931	44,900,702	--
⊳ Line 18: Revenue from sale of medical records and abstracts	410,742	55,595	55,045	46,955	--
⊳ Line 19: Tuition (fees, sale of textbooks, uniforms, etc.)	0	0	0	0	--
⊳ Line 20: Revenue from gifts, flowers, coffee shops, canteen	0	299,250	314,740	198,449	--
⊳ Line 21: Rental of vending machines	0	1,773,827	859,428	0	--
⊳ Line 22: Rental of hospital space	0	0	0	1,413,867	--
⊳ Line 23: Gov appropriations ? ⊳ Median	0 1,017,693	0 983,261.5	0 1,173,286	0 1,987,202	-- 1,597,664
⊳ Sum Line 24	44,423,629	20,882,092	28,451,604	71,042,293	--
Total income ? Median	47,814,491 6,586,430	27,124,659 6,767,106	65,160,259 8,419,950	59,960,822 8,094,175	-- 15,162,888
Non-operating expenses Median	0 146,289.5	145,002 164,857	2,055,260 89,880.5	0 106,761	-- 31,473.5
Net income Median	47,814,491 6,043,842	26,979,657 5,845,112	63,104,999 7,606,259	59,960,822 7,283,041	-- 14,957,241
Net margin Median	9.09385% 4.62%	4.88742% 4.42%	9.84863% 5.16%	8.61140% 5.2%	--% 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 KOOTENAI HOSPITAL DISTRICT 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	65,183,055 23,241,334	65,824,337 23,709,545	70,236,020 24,248,380	73,298,682 22,858,541	-- 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	65,183,055 21,577,146	65,824,337 22,041,594	70,236,020 22,722,063	73,298,682 21,570,441	-- 22,140,684
⊳ Swingbeds ⊳ Median	0 --	0 --	0 --	0 --	-- --
⊳ Tax Equity and Fiscal Responsibility Act payments (TEFRA) ⊳ Median	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	-- 1,393,140
⊳ Inpatient rehabilitation facility (IRF) ⊳ Median	0 3,535,627	0 3,746,588	0 3,782,288	0 3,865,578	-- 3,983,889
⊳ Long-term care hospital (LTCH) ⊳ Median	0 --	0 --	0 --	0 --	-- --
⊳ Critical-access hospitals ⊳ Median	0 --	0 --	0 --	0 --	-- --
⊳ Skilled-nursing facilities (SNF) ⊳ Median	0 1,203,033	0 1,215,295	0 1,313,657	0 1,365,298	-- 1,179,746
All outpatient revenue Median Click here to show/hide details	52,824,249 11,160,864	56,542,957 11,987,345	68,553,971 12,926,866	72,575,392 11,884,480	-- 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	52,824,249 10,918,923	56,542,957 11,706,976	68,553,971 12,615,917	72,575,392 11,458,116	-- 12,776,716
⊳ Home Health agencies (HHA) ⊳ Median	0 1,282,808	0 1,407,728	0 1,341,512	0 1,407,046	-- 1,476,867
⊳ Community mental health clinics (CMHC) ⊳ Median	0 --	0 --	0 --	0 --	-- --
⊳ Rural health clinics ⊳ Median	0 618,038	0 697,279	0 690,232	0 684,010	-- 670,558
⊳ Other federally qualified health clinics ⊳ Median	0 --	0 --	0 --	0 --	-- --

Other payments

Item	2017	2018	2019	2020	2021
Graduate Medical Education (GME) Median	2,406,507 3,284,314	2,169,935 3,250,551	2,439,351 3,386,837	2,358,584 3,360,806	-- 3,508,953
Disproportionate-share hospital (DSH) Median	1,777,411 594,888	1,413,268 595,761	1,499,717 577,894	2,370,372 542,168	-- 549,667
Outlier Median	2,732,188 582,572	3,310,111 538,116	797,127 212,434	494,691 126,559	-- 139,139

Uncompensated care

Item	2017	2018	2019	2020	2021
Medicaid shortfall Median	0 3,662,910	347,801 3,730,911	0 4,081,319	2,319,206 4,643,908	-- 4,389,147
Charity care Median	3,015,881 2,654,636	1,825,067 2,940,659	6,004,893 3,380,215	4,040,417 3,488,738	-- 3,233,405
Uncompensated care (UCC) Median	14,245,809 5,147,790	13,308,178 5,337,617	13,453,596 5,711,082	11,273,522 5,923,418	-- 5,508,107
UCC as a % of operating expenses Median	2.98% 3.24	2.54% 3.12	2.34% 3.21	1.77% 3.3	--% 2.86
Total shortfall/UCC Median	14,245,809 9,489,989	13,655,979 9,424,297	13,453,596 10,120,158	13,592,728 11,171,337	-- 10,133,851

Labor costs

	2017	2018	2019	2020	2021
Total salaries Median	213,653,738 52,142,039	230,414,578 54,485,252	254,521,456 57,395,589	277,168,696 58,830,919	-- 61,722,907
Salaries as a % of operating expenses Median	44.70 36.68	43.90 36.56	44.22 36.37	43.56 35.93	-- 35.24
Intern, resident salaries* Median	0 2,598,592	0 2,686,824	0 2,753,773	0 2,937,156	-- 2,909,848
Contract intern, resident salaries* Median	0 1,251,927	0 1,186,494	0 1,204,885	0 1,279,653	-- 1,469,317
Contract adjusted salaries, direct-care Median	1,678,122 1,449,244	2,321,139 1,475,986	5,475,679 1,563,078	11,201,486 1,721,954	-- 2,991,828
Contract hours, direct-care Median	23,149.00 22,725	34,336.00 23,018.5	68,566.00 24,503.48	110,931.00 25,026.5	-- 33,786
Contract wages, direct-care Median	72.49 64.67	67.60 64.53	79.86 65.06	100.98 68.97	-- 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.