As of the July, 2022, release via CMS

MIDDLESBORO ARH

CMS id: 180020
3600 WEST CUMBERLAND AVE., MIDDLESBORO KY 40965. County: BELL
System: APPALACHAIN REGIONAL HEALTHCARE
CBSA: Middlesborough, KY

The 46-bed, acute-care hospital had $4,139,729 in net service to patients*, with a total profit margin of 26.31215% in fiscal year 2021, the latest year available.
It spent 2.43% of its operating expenses on uncompensated care and reported $0 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	nfp	nfp	nfp	nfp	nfp
Acute beds Median	66 118	66 118	39 119.5	39 118	39 119
Total beds Median	73 162	73 162	46 162	46 162	46 163.5
FTEs Median	281.49 788.06	288.07 793.42	272.30 806.03	258.49 787.61	258.27 804.34

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	37,374,833 150,932,746	32,763,562 158,950,878	42,245,678 168,696,998	40,428,811 163,454,693	49,004,279 186,589,412
Operating expenses Median	42,035,976 149,311,209	43,625,024 156,110,414	40,847,782 164,890,568	40,380,024 166,516,854	44,864,550 180,120,888
Net income from service 2 patients (NS2P) ? Median	-4,661,143 -964,173	-10,861,462 -643,601.5	1,397,896 -116,254	48,787 -5,025,862	4,139,729 -1,284,564
NS2P margin ? Median	-12.47% -0.62	-33.15% -0.29	3.31% 0.18	0.12% -5.07	8.45% -0.88

Range* of Net Service to Patient (NS2P) margins

= NS2P margin for MIDDLESBORO ARH 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	2,845,434 5,089,215	10,647,857 4,572,541	1,770,449 5,268,134	5,362,315 13,092,619	11,880,320 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	98,782 188,688.5	82,615 370,813	113,069 309,361.5	129,449 375,329
⊳ 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	35,628	15,631	30,115	10,634
⊳ 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	33,181	31,641	27,647	29,561
⊳ Line 15: Revenue from rental of living quarters	0	148,018	135,088	161,735	188,983
⊳ Line 16: Revenue from sale of medical and surgical supplies	0	-13,737	136	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	15,634	7,509
⊳ 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	5,946	11,057	6,867	2,231
⊳ Line 22: Rental of hospital space	0	0	0	0	0
⊳ Line 23: Gov appropriations ? ⊳ Median	0 1,017,693	0 983,261.5	0 1,173,286	0 1,987,202	0 1,597,664
⊳ Sum Line 24	2,845,434	10,340,039	1,494,281	5,007,248	11,511,953
Total income ? Median	-1,815,709 6,586,430	-213,605 6,767,106	3,168,345 8,419,950	5,411,102 8,094,175	16,020,049 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	-1,815,709 6,043,842	-213,605 5,845,112	3,168,345 7,606,259	5,411,102 7,283,041	16,020,049 14,957,241
Net margin Median	-4.51441% 4.62%	-0.49205% 4.42%	7.19815% 5.16%	11.81692% 5.2%	26.31215% 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 MIDDLESBORO ARH 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	5,156,465 23,241,334	5,302,991 23,709,545	5,243,410 24,248,380	5,579,369 22,858,541	4,533,402 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	5,156,465 21,577,146	5,302,991 22,041,594	5,243,410 22,722,063	5,579,369 21,570,441	4,533,402 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	4,237,352 11,160,864	4,666,160 11,987,345	4,212,140 12,926,866	4,281,086 11,884,480	4,020,551 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	4,237,352 10,918,923	4,666,160 11,706,976	4,163,978 12,615,917	4,219,048 11,458,116	3,830,140 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	48,162 690,232	62,038 684,010	190,411 670,558
⊳ 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	120,968 594,888	126,367 595,761	124,755 577,894	111,106 542,168	99,725 549,667
Outlier Median	45,200 582,572	62,617 538,116	3,650 212,434	4,479 126,559	2,110 139,139

Uncompensated care

Item	2017	2018	2019	2020	2021
Medicaid shortfall Median	647,569 3,662,910	994,644 3,730,911	291,469 4,081,319	0 4,643,908	0 4,389,147
Charity care Median	581,995 2,654,636	459,134 2,940,659	488,090 3,380,215	444,475 3,488,738	355,806 3,233,405
Uncompensated care (UCC) Median	1,296,212 5,147,790	1,364,452 5,337,617	965,501 5,711,082	1,090,869 5,923,418	1,091,593 5,508,107
UCC as a % of operating expenses Median	3.08% 3.24	3.13% 3.12	2.36% 3.21	2.70% 3.3	2.43% 2.86
Total shortfall/UCC Median	1,943,781 9,489,989	2,359,096 9,424,297	1,256,970 10,120,158	1,090,869 11,171,337	1,091,593 10,133,851

Labor costs

	2017	2018	2019	2020	2021
Total salaries Median	16,865,756 52,142,039	18,985,958 54,485,252	15,827,853 57,395,589	14,938,753 58,830,919	16,560,743 61,722,907
Salaries as a % of operating expenses Median	40.12 36.68	43.52 36.56	38.75 36.37	37.00 35.93	36.91 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	0 1,449,244	0 1,475,986	0 1,563,078	66,999 1,721,954	130,508 2,991,828
Contract hours, direct-care Median	0.00 22,725	0.00 23,018.5	0.00 24,503.48	971.00 25,026.5	1,677.41 33,786
Contract wages, direct-care Median	0.00 64.67	0.00 64.53	0.00 65.06	69.00 68.97	77.80 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.