As of the July, 2022, release via CMS

LAKES REGIONAL HEALTHCARE

CMS id: 160124
HIGHWAY 71 SOUTH, SPIRIT LAKE IA 51360. County: DICKINSON
System: AVERA MCKENNAN HOSPITAL
CBSA: Spirit Lake, IA

The 44-bed, acute-care hospital had $-1,308,290 in net service to patients*, with a total profit margin of 9.55940% in fiscal year 2021, the latest year available.
It spent 1.39% of its operating expenses on uncompensated care and reported $1,925,778 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	41 118	41 118	41 119.5	41 118	41 119
Total beds Median	44 162	44 162	44 162	44 162	44 163.5
FTEs Median	209.68 788.06	211.42 793.42	214.92 806.03	219.77 787.61	252.03 804.34

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	37,699,895 150,932,746	39,645,044 158,950,878	42,136,141 168,696,998	43,154,000 163,454,693	53,612,965 186,589,412
Operating expenses Median	38,344,142 149,311,209	40,212,305 156,110,414	43,096,156 164,890,568	47,173,344 166,516,854	54,921,255 180,120,888
Net income from service 2 patients (NS2P) ? Median	-644,247 -964,173	-567,261 -643,601.5	-960,015 -116,254	-4,019,344 -5,025,862	-1,308,290 -1,284,564
NS2P margin ? Median	-1.71% -0.62	-1.43% -0.29	-2.28% 0.18	-9.31% -5.07	-2.44% -0.88

Range* of Net Service to Patient (NS2P) margins

= NS2P margin for LAKES REGIONAL HEALTHCARE 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	1,889,517 5,089,215	2,005,203 4,572,541	2,170,187 5,268,134	7,348,663 13,092,619	7,113,364 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	234,674 299,524	371,746 188,688.5	558,177 370,813	601,384 309,361.5	442,917 375,329
⊳ 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	167,064	183,202	177,293	171,088	160,996
⊳ 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	0
⊳ Line 23: Gov appropriations ? ⊳ Median	650,000 1,017,693	700,000 983,261.5	730,000 1,173,286	750,000 1,987,202	790,000 1,597,664
⊳ Sum Line 24	837,779	750,255	704,717	5,826,191	5,719,451
Total income ? Median	1,245,270 6,586,430	1,437,942 6,767,106	1,210,172 8,419,950	3,329,319 8,094,175	5,805,074 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	1,245,270 6,043,842	1,437,942 5,845,112	1,210,172 7,606,259	3,329,319 7,283,041	5,805,074 14,957,241
Net margin Median	3.14546% 4.62%	3.45242% 4.42%	2.73138% 5.16%	6.59236% 5.2%	9.55940% 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 LAKES REGIONAL HEALTHCARE 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	5,375,142 23,241,334	6,056,419 23,709,545	6,921,381 24,248,380	6,189,332 22,858,541	6,831,976 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	5,375,142 21,577,146	6,056,419 22,041,594	6,921,381 22,722,063	6,189,332 21,570,441	6,831,976 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	0 1,203,033	0 1,215,295	0 1,313,657	0 1,365,298	0 1,179,746
All outpatient revenue Median Click here to show/hide details	6,183,400 11,160,864	5,894,748 11,987,345	6,726,086 12,926,866	7,131,189 11,884,480	9,653,984 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	5,905,591 10,918,923	5,560,224 11,706,976	6,399,068 12,615,917	6,714,168 11,458,116	8,869,150 12,776,716
⊳ Home Health agencies (HHA) ⊳ Median	277,809 1,282,808	334,524 1,407,728	327,018 1,341,512	417,021 1,407,046	784,834 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	0 594,888	0 595,761	0 577,894	0 542,168	0 549,667
Outlier Median	477,477 582,572	147,998 538,116	90,214 212,434	60,430 126,559	222,198 139,139

Uncompensated care

Item	2017	2018	2019	2020	2021
Medicaid shortfall Median	826,660 3,662,910	1,543,132 3,730,911	1,645,010 4,081,319	1,780,330 4,643,908	1,925,778 4,389,147
Charity care Median	380,190 2,654,636	176,880 2,940,659	187,600 3,380,215	291,542 3,488,738	239,967 3,233,405
Uncompensated care (UCC) Median	832,363 5,147,790	498,913 5,337,617	535,577 5,711,082	586,350 5,923,418	762,404 5,508,107
UCC as a % of operating expenses Median	2.17% 3.24	1.24% 3.12	1.24% 3.21	1.24% 3.3	1.39% 2.86
Total shortfall/UCC Median	1,659,023 9,489,989	2,042,045 9,424,297	2,180,587 10,120,158	2,366,680 11,171,337	2,688,182 10,133,851

Labor costs

	2017	2018	2019	2020	2021
Total salaries Median	11,587,008 52,142,039	12,343,355 54,485,252	13,193,167 57,395,589	14,032,318 58,830,919	15,983,044 61,722,907
Salaries as a % of operating expenses Median	30.22 36.68	30.70 36.56	30.61 36.37	29.75 35.93	29.10 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	2,039,658 1,449,244	2,296,628 1,475,986	2,993,121 1,563,078	3,234,297 1,721,954	3,825,514 2,991,828
Contract hours, direct-care Median	73,761.00 22,725	78,204.00 23,018.5	79,424.00 24,503.48	82,970.00 25,026.5	91,104.00 33,786
Contract wages, direct-care Median	27.65 64.67	29.37 64.53	37.69 65.06	38.98 68.97	41.99 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.