As of the July, 2022, release via CMS

METROWEST MEDICAL CENTER

CMS id: 220175
67 UNION STREET, NATICK MA 1760. County: MIDDLESEX
System: TENET HEALTHCARE CORPORATION
CBSA: Boston-Cambridge-Newton, MA-NH

The 282-bed, acute-care hospital had $-26,532,314 in net service to patients*, with a total profit margin of 3.09770% in fiscal year 2021, the latest year available.
It spent 2.35% 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	366	365	365	365	366
Ownership	forprofit	forprofit	forprofit	forprofit	forprofit
Acute beds Median	199 118	202 118	194 119.5	194 118	190 119
Total beds Median	299 162	296 162	288 162	288 162	282 163.5
FTEs Median	1,451.80 788.06	1,265.37 793.42	1,212.00 806.03	1,187.00 787.61	717.00 804.34

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	253,571,059 150,932,746	239,688,064 158,950,878	249,096,927 168,696,998	265,561,115 163,454,693	212,534,968 186,589,412
Operating expenses Median	243,884,909 149,311,209	241,321,955 156,110,414	249,164,647 164,890,568	260,662,945 166,516,854	239,067,282 180,120,888
Net income from service 2 patients (NS2P) ? Median	9,686,150 -964,173	-1,633,891 -643,601.5	-67,720 -116,254	4,898,170 -5,025,862	-26,532,314 -1,284,564
NS2P margin ? Median	3.82% -0.62	-0.68% -0.29	-0.03% 0.18	1.84% -5.07	-12.48% -0.88

Range* of Net Service to Patient (NS2P) margins

= NS2P margin for METROWEST MEDICAL CENTER 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	5,335,434 5,089,215	3,796,421 4,572,541	2,954,327 5,268,134	2,574,110 13,092,619	34,174,631 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	23,435 188,688.5	11,632 370,813	34,181 309,361.5	28,382 375,329
⊳ Line 8: Revenue from telephone service	NULL	NULL	NULL	NULL	NULL
⊳ Line 9: Revenue from tv and radio	--	15,311	172	--	--
⊳ Line 10: Purchase discounts	7,431	1,367	390	1,151	2,494
⊳ Line 11: Rebates and refunds of expenses	0	57,460	88,707	105,336	189,186
⊳ Line 12: Parking lot receipts	612	0	60	0	60
⊳ Line 13: Revenue from laundry and linen service	0	0	0	0	0
⊳ Line 14: Revenue from meals sold to emplyees and guests	1,031,547	933,220	905,994	935,714	461,483
⊳ 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	19,684	30,072	31,772	28,266	20,163
⊳ 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	16,279	0	0	0	0
⊳ Line 22: Rental of hospital space	734,590	720,736	699,787	587,979	579,438
⊳ 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	3,395,492	1,946,233	1,215,813	881,483	32,893,425
Total income ? Median	15,021,584 6,586,430	2,162,530 6,767,106	2,886,607 8,419,950	7,472,280 8,094,175	7,642,317 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	15,021,584 6,043,842	2,162,530 5,845,112	2,886,607 7,606,259	7,472,280 7,283,041	7,642,317 14,957,241
Net margin Median	5.80193% 4.62%	0.88816% 4.42%	1.14525% 5.16%	2.78676% 5.2%	3.09770% 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 METROWEST MEDICAL CENTER 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	50,824,383 23,241,334	45,922,711 23,709,545	49,673,217 24,248,380	55,930,599 22,858,541	48,767,699 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	43,818,747 21,577,146	38,789,224 22,041,594	42,527,026 22,722,063	48,055,511 21,570,441	43,383,606 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	7,005,636 1,845,420	7,133,487 1,757,392	7,146,191 1,738,842	7,875,088 1,510,463	5,384,093 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	29,239,497 11,160,864	27,735,300 11,987,345	24,399,876 12,926,866	23,228,166 11,884,480	17,093,064 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	23,290,847 10,918,923	23,682,591 11,706,976	24,399,876 12,615,917	23,228,166 11,458,116	17,093,064 12,776,716
⊳ Home Health agencies (HHA) ⊳ Median	5,948,650 1,282,808	4,052,709 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	5,056,552 3,284,314	4,778,056 3,250,551	5,098,085 3,386,837	5,825,877 3,360,806	5,472,939 3,508,953
Disproportionate-share hospital (DSH) Median	1,334,954 594,888	1,279,262 595,761	1,355,376 577,894	1,438,320 542,168	1,239,571 549,667
Outlier Median	549,793 582,572	436,071 538,116	1,242,096 212,434	673,871 126,559	92,888 139,139

Uncompensated care

Item	2017	2018	2019	2020	2021
Medicaid shortfall Median	4,201,766 3,662,910	5,527,395 3,730,911	0 4,081,319	443,919 4,643,908	0 4,389,147
Charity care Median	4,973,235 2,654,636	2,215,551 2,940,659	425,792 3,380,215	820,194 3,488,738	1,434,914 3,233,405
Uncompensated care (UCC) Median	6,959,153 5,147,790	5,150,361 5,337,617	3,107,405 5,711,082	3,728,046 5,923,418	5,619,642 5,508,107
UCC as a % of operating expenses Median	2.85% 3.24	2.13% 3.12	1.25% 3.21	1.43% 3.3	2.35% 2.86
Total shortfall/UCC Median	11,160,919 9,489,989	10,677,756 9,424,297	3,107,405 10,120,158	4,171,965 11,171,337	5,619,642 10,133,851

Labor costs

	2017	2018	2019	2020	2021
Total salaries Median	117,839,022 52,142,039	111,803,942 54,485,252	112,589,679 57,395,589	116,401,773 58,830,919	101,688,337 61,722,907
Salaries as a % of operating expenses Median	48.32 36.68	45.12 36.56	45.19 36.37	44.65 35.93	42.53 35.24
Intern, resident salaries* Median	2,800,925 2,598,592	2,719,700 2,686,824	2,937,206 2,753,773	3,019,108 2,937,156	3,071,759 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	1,416,907 1,449,244	1,111,846 1,475,986	1,441,749 1,563,078	1,377,265 1,721,954	4,001,446 2,991,828
Contract hours, direct-care Median	18,575.00 22,725	13,080.00 23,018.5	18,829.00 24,503.48	18,664.00 25,026.5	42,244.00 33,786
Contract wages, direct-care Median	76.28 64.67	85.00 64.53	76.57 65.06	73.79 68.97	94.72 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.