As of the July, 2022, release via CMS

ADVENTHEALTH MANCHESTER

CMS id: 180043
210 MARIE LANGDON DRIVE, MANCHESTER KY 40962. County: CLAY
System: ADVENTIST HEALTH SYSTEM
CBSA: London, KY

The 49-bed, acute-care hospital had $-5,235,440 in net service to patients*, with a total profit margin of -9.85428% in fiscal year 2021, the latest year available.
It spent 0.70% of its operating expenses on uncompensated care and reported $7,785,186 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	57 118	43 118	43 119.5	43 118	43 119
Total beds Median	63 162	49 162	49 162	49 162	49 163.5
FTEs Median	443.08 788.06	449.19 793.42	422.24 806.03	444.70 787.61	460.87 804.34

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	57,004,069 150,932,746	55,973,481 158,950,878	53,503,120 168,696,998	50,371,847 163,454,693	68,777,691 186,589,412
Operating expenses Median	60,331,882 149,311,209	61,332,882 156,110,414	58,289,524 164,890,568	61,889,852 166,516,854	74,013,131 180,120,888
Net income from service 2 patients (NS2P) ? Median	-3,327,813 -964,173	-5,359,401 -643,601.5	-4,786,404 -116,254	-11,518,005 -5,025,862	-5,235,440 -1,284,564
NS2P margin ? Median	-5.84% -0.62	-9.57% -0.29	-8.95% 0.18	-22.87% -5.07	-7.61% -0.88

Range* of Net Service to Patient (NS2P) margins

= NS2P margin for ADVENTHEALTH MANCHESTER 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	2,516,636 5,089,215	1,751,267 4,572,541	1,862,748 5,268,134	7,652,734 13,092,619	-1,403,776 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	722,447 299,524	0 188,688.5	0 370,813	0 309,361.5	867,243 375,329
⊳ 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	2,250
⊳ Line 12: Parking lot receipts	0	0	0	0	0
⊳ Line 13: Revenue from laundry and linen service	8,840	0	0	0	0
⊳ Line 14: Revenue from meals sold to emplyees and guests	303,990	0	0	0	184,082
⊳ Line 15: Revenue from rental of living quarters	42,644	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	660	0	0	0	897,000
⊳ Line 18: Revenue from sale of medical records and abstracts	2,487	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	184,438	0	0	0	114,670
⊳ 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	0 1,017,693	0 983,261.5	0 1,173,286	0 1,987,202	0 1,597,664
⊳ Sum Line 24	1,251,130	1,751,267	1,862,748	7,652,734	-3,469,021
Total income ? Median	-811,177 6,586,430	-3,608,134 6,767,106	-2,923,656 8,419,950	-3,865,271 8,094,175	-6,639,216 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	-811,177 6,043,842	-3,608,134 5,845,112	-2,923,656 7,606,259	-3,865,271 7,283,041	-6,639,216 14,957,241
Net margin Median	-1.36285% 4.62%	-6.25058% 4.42%	-5.28061% 5.16%	-6.66144% 5.2%	-9.85428% 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 ADVENTHEALTH MANCHESTER 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	7,173,341 23,241,334	6,216,575 23,709,545	5,408,420 24,248,380	4,119,800 22,858,541	4,635,598 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	7,173,341 21,577,146	6,216,575 22,041,594	5,408,420 22,722,063	4,119,800 21,570,441	4,635,598 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	7,549,508 11,160,864	6,559,002 11,987,345	6,521,376 12,926,866	5,375,049 11,884,480	5,284,978 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	5,006,413 10,918,923	4,769,961 11,706,976	3,343,103 12,615,917	2,518,567 11,458,116	2,364,284 12,776,716
⊳ Home Health agencies (HHA) ⊳ Median	2,423,783 1,282,808	1,332,915 1,407,728	876,118 1,341,512	824,490 1,407,046	813,315 1,476,867
⊳ Community mental health clinics (CMHC) ⊳ Median	0 --	0 --	0 --	0 --	0 --
⊳ Rural health clinics ⊳ Median	119,312 618,038	456,126 697,279	2,302,155 690,232	2,031,992 684,010	2,107,379 670,558
⊳ 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	463,716 594,888	436,517 595,761	357,047 577,894	330,700 542,168	273,115 549,667
Outlier Median	26,124 582,572	838 538,116	2,070 212,434	8,810 126,559	7,357 139,139

Uncompensated care

Item	2017	2018	2019	2020	2021
Medicaid shortfall Median	4,104,870 3,662,910	5,413,299 3,730,911	7,092,472 4,081,319	8,370,556 4,643,908	7,785,186 4,389,147
Charity care Median	736,175 2,654,636	879,090 2,940,659	2,604,156 3,380,215	513,666 3,488,738	354,814 3,233,405
Uncompensated care (UCC) Median	996,712 5,147,790	1,387,757 5,337,617	3,261,503 5,711,082	1,092,037 5,923,418	514,725 5,508,107
UCC as a % of operating expenses Median	1.65% 3.24	2.26% 3.12	5.60% 3.21	1.76% 3.3	0.70% 2.86
Total shortfall/UCC Median	5,101,582 9,489,989	6,801,056 9,424,297	10,353,975 10,120,158	9,462,593 11,171,337	8,299,911 10,133,851

Labor costs

	2017	2018	2019	2020	2021
Total salaries Median	28,845,847 52,142,039	28,557,171 54,485,252	26,382,474 57,395,589	29,025,968 58,830,919	34,432,005 61,722,907
Salaries as a % of operating expenses Median	46.52 36.68	46.56 36.56	45.26 36.37	46.90 35.93	46.52 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	1,188,801 1,449,244	1,361,275 1,475,986	1,341,578 1,563,078	1,045,435 1,721,954	928,731 2,991,828
Contract hours, direct-care Median	23,062.00 22,725	28,890.00 23,018.5	28,361.50 24,503.48	21,638.55 25,026.5	17,072.00 33,786
Contract wages, direct-care Median	51.55 64.67	47.12 64.53	47.30 65.06	48.31 68.97	54.40 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.