As of the July, 2022, release via CMS

MIDMICHIGAN MEDICAL CENTER - ALPENA

CMS id: 230036
1501 W CHISHOLM, ALPENA MI 49707. County: ALPENA
System: MIDMICHIGAN HEALTH
CBSA: Alpena, MI

The 139-bed, acute-care hospital had $16,411,736 in net service to patients*, with a total profit margin of 20.78579% in fiscal year 2021, the latest year available.
It spent 3.81% of its operating expenses on uncompensated care and reported $5,648,572 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	87 118	104 118	119 119.5	119 118	119 119
Total beds Median	122 162	139 162	139 162	139 162	139 163.5
FTEs Median	867.10 788.06	810.33 793.42	766.92 806.03	764.52 787.61	731.19 804.34

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	134,565,839 150,932,746	129,338,391 158,950,878	138,482,610 168,696,998	138,316,226 163,454,693	161,788,625 186,589,412
Operating expenses Median	197,441,605 149,311,209	134,845,478 156,110,414	127,202,666 164,890,568	126,628,099 166,516,854	145,376,889 180,120,888
Net income from service 2 patients (NS2P) ? Median	-62,875,766 -964,173	-5,507,087 -643,601.5	11,279,944 -116,254	11,688,127 -5,025,862	16,411,736 -1,284,564
NS2P margin ? Median	-46.72% -0.62	-4.26% -0.29	8.15% 0.18	8.45% -5.07	10.14% -0.88

Range* of Net Service to Patient (NS2P) margins

= NS2P margin for MIDMICHIGAN MEDICAL CENTER - ALPENA 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	6,015,961 5,089,215	11,238,969 4,572,541	6,763,817 5,268,134	4,095,030 13,092,619	21,735,117 12,369,236
⊳ Line 6: Contributions ? ⊳ Median	19,047 224,999	0 199,009	0 206,870.5	0 194,343	0 249,496
⊳ Line 7: Investments ? ⊳ Median	1,285,038 299,524	3,849,110 188,688.5	1,244,700 370,813	-83,255 309,361.5	16,447,425 375,329
⊳ Line 8: Revenue from telephone service	NULL	NULL	NULL	NULL	NULL
⊳ Line 9: Revenue from tv and radio	--	--	--	--	--
⊳ Line 10: Purchase discounts	21,974	0	0	0	0
⊳ Line 11: Rebates and refunds of expenses	194,141	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	586,299	0	0	0	489,137
⊳ Line 15: Revenue from rental of living quarters	0	0	0	0	0
⊳ Line 16: Revenue from sale of medical and surgical supplies	818	0	0	0	0
⊳ Line 17: Revenue from sale of drugs to other than patients	500	0	0	0	113,983
⊳ Line 18: Revenue from sale of medical records and abstracts	51,360	0	0	0	44,454
⊳ 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	119,057
⊳ Line 21: Rental of vending machines	0	0	0	0	0
⊳ Line 22: Rental of hospital space	107,759	0	0	0	180,132
⊳ 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	3,749,025	7,389,859	5,519,117	4,178,285	4,340,929
Total income ? Median	-56,859,805 6,586,430	5,731,882 6,767,106	18,043,761 8,419,950	15,783,157 8,094,175	38,146,853 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	-56,859,805 6,043,842	5,731,882 5,845,112	18,043,761 7,606,259	15,783,157 7,283,041	38,146,853 14,957,241
Net margin Median	-40.44606% 4.62%	4.07739% 4.42%	12.42286% 5.16%	11.08280% 5.2%	20.78579% 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 MIDMICHIGAN MEDICAL CENTER - ALPENA 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	24,328,836 23,241,334	25,377,047 23,709,545	24,958,960 24,248,380	23,879,330 22,858,541	21,656,009 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	20,940,360 21,577,146	23,117,691 22,041,594	23,005,860 22,722,063	20,289,034 21,570,441	18,830,677 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	1,373,945 1,845,420	665,120 1,757,392	0 1,738,842	0 1,510,463	0 1,393,140
⊳ Inpatient rehabilitation facility (IRF) ⊳ Median	2,014,531 3,535,627	1,594,236 3,746,588	1,953,100 3,782,288	3,590,296 3,865,578	2,825,332 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	24,139,698 11,160,864	24,347,195 11,987,345	24,304,268 12,926,866	22,946,612 11,884,480	25,315,663 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	22,375,929 10,918,923	22,378,089 11,706,976	24,304,268 12,615,917	22,946,612 11,458,116	25,315,663 12,776,716
⊳ Home Health agencies (HHA) ⊳ Median	1,763,769 1,282,808	1,969,106 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	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	298,801 594,888	553,755 595,761	524,983 577,894	509,283 542,168	486,104 549,667
Outlier Median	51,692 582,572	108,009 538,116	208,344 212,434	301,041 126,559	81,497 139,139

Uncompensated care

Item	2017	2018	2019	2020	2021
Medicaid shortfall Median	5,431,475 3,662,910	7,763,395 3,730,911	3,663,751 4,081,319	5,210,661 4,643,908	5,648,572 4,389,147
Charity care Median	205,042 2,654,636	402,747 2,940,659	1,458,665 3,380,215	3,220,727 3,488,738	3,850,459 3,233,405
Uncompensated care (UCC) Median	1,793,925 5,147,790	3,064,266 5,337,617	2,341,013 5,711,082	4,501,082 5,923,418	5,534,523 5,508,107
UCC as a % of operating expenses Median	0.91% 3.24	2.27% 3.12	1.84% 3.21	3.55% 3.3	3.81% 2.86
Total shortfall/UCC Median	7,225,400 9,489,989	10,827,661 9,424,297	6,004,764 10,120,158	9,711,743 11,171,337	11,183,095 10,133,851

Labor costs

	2017	2018	2019	2020	2021
Total salaries Median	54,108,998 52,142,039	50,189,699 54,485,252	46,419,922 57,395,589	45,562,652 58,830,919	43,825,393 61,722,907
Salaries as a % of operating expenses Median	27.00 36.68	36.73 36.56	35.92 36.37	35.11 35.93	30.15 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	1,721,263 1,449,244	0 1,475,986	0 1,563,078	287,840 1,721,954	327,484 2,991,828
Contract hours, direct-care Median	23,223.00 22,725	0.00 23,018.5	0.00 24,503.48	9,167.00 25,026.5	9,583.00 33,786
Contract wages, direct-care Median	74.12 64.67	0.00 64.53	0.00 65.06	31.40 68.97	34.17 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.