As of the July, 2022, release via CMS

MIDMICHIGAN MEDICAL CENTER-CLARE

CMS id: 230180
703 N. MCEWAN STREET, CLARE MI 48617. County: CLARE
System: NAME: MIDMICHIGAN HEALTH
CBSA: Rural Michigan

The 49-bed, acute-care hospital had $-472,001 in net service to patients*, with a total profit margin of 5.73627% in fiscal year 2021, the latest year available.
It spent 5.35% of its operating expenses on uncompensated care and reported $3,683,955 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	49 118	49 118	49 119.5	49 118	49 119
Total beds Median	49 162	49 162	49 162	49 162	49 163.5
FTEs Median	332.45 788.06	307.93 793.42	297.42 806.03	300.25 787.61	303.05 804.34

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	50,037,064 150,932,746	50,215,938 158,950,878	55,363,877 168,696,998	50,110,371 163,454,693	54,670,734 186,589,412
Operating expenses Median	48,551,231 149,311,209	49,958,356 156,110,414	51,412,778 164,890,568	51,172,087 166,516,854	55,142,735 180,120,888
Net income from service 2 patients (NS2P) ? Median	1,485,833 -964,173	257,582 -643,601.5	3,951,099 -116,254	-1,061,716 -5,025,862	-472,001 -1,284,564
NS2P margin ? Median	2.97% -0.62	0.51% -0.29	7.14% 0.18	-2.12% -5.07	-0.86% -0.88

Range* of Net Service to Patient (NS2P) margins

= NS2P margin for MIDMICHIGAN MEDICAL CENTER-CLARE 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	1,424,551 5,089,215	2,747,693 4,572,541	1,309,491 5,268,134	5,083,588 13,092,619	3,827,624 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	503,980 299,524	1,914,776 188,688.5	618,408 370,813	-57,809 309,361.5	1,360,639 375,329
⊳ 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	0	0	0	0	0
⊳ 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	0 1,017,693	0 983,261.5	0 1,173,286	0 1,987,202	0 1,597,664
⊳ Sum Line 24	920,571	832,917	691,083	5,141,397	2,466,985
Total income ? Median	2,910,384 6,586,430	3,005,275 6,767,106	5,260,590 8,419,950	4,021,872 8,094,175	3,355,623 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	2,910,384 6,043,842	3,005,275 5,845,112	5,260,590 7,606,259	4,021,872 7,283,041	3,355,623 14,957,241
Net margin Median	5.65545% 4.62%	5.67422% 4.42%	9.28230% 5.16%	7.28680% 5.2%	5.73627% 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-CLARE 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	4,506,692 23,241,334	4,183,964 23,709,545	4,441,885 24,248,380	3,408,894 22,858,541	3,477,484 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	4,506,692 21,577,146	4,183,964 22,041,594	4,441,885 22,722,063	3,408,894 21,570,441	3,477,484 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	9,141,295 11,160,864	10,554,859 11,987,345	10,223,137 12,926,866	8,588,364 11,884,480	7,322,888 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	5,815,209 10,918,923	6,823,993 11,706,976	6,939,816 12,615,917	5,908,013 11,458,116	5,445,100 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	3,326,086 618,038	3,730,866 697,279	3,283,321 690,232	2,680,351 684,010	1,877,788 670,558
⊳ 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	73,171 594,888	41,989 595,761	39,152 577,894	25,290 542,168	25,710 549,667
Outlier Median	5,070 582,572	19,881 538,116	0 212,434	2,117 126,559	0 139,139

Uncompensated care

Item	2017	2018	2019	2020	2021
Medicaid shortfall Median	2,500,679 3,662,910	3,459,807 3,730,911	1,173,284 4,081,319	3,944,504 4,643,908	3,683,955 4,389,147
Charity care Median	406,462 2,654,636	586,726 2,940,659	1,493,064 3,380,215	1,647,059 3,488,738	2,105,517 3,233,405
Uncompensated care (UCC) Median	1,747,980 5,147,790	2,238,354 5,337,617	2,565,932 5,711,082	2,491,785 5,923,418	2,951,900 5,508,107
UCC as a % of operating expenses Median	3.60% 3.24	4.48% 3.12	4.99% 3.21	4.87% 3.3	5.35% 2.86
Total shortfall/UCC Median	4,248,659 9,489,989	5,698,161 9,424,297	3,739,216 10,120,158	6,436,289 11,171,337	6,635,855 10,133,851

Labor costs

	2017	2018	2019	2020	2021
Total salaries Median	14,852,322 52,142,039	14,991,279 54,485,252	14,527,254 57,395,589	16,512,513 58,830,919	17,813,778 61,722,907
Salaries as a % of operating expenses Median	30.19 36.68	29.54 36.56	27.74 36.37	31.52 35.93	31.54 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	243,003 1,563,078	229,633 1,721,954	243,487 2,991,828
Contract hours, direct-care Median	0.00 22,725	0.00 23,018.5	7,929.00 24,503.48	7,059.00 25,026.5	7,432.00 33,786
Contract wages, direct-care Median	0.00 64.67	0.00 64.53	30.65 65.06	32.53 68.97	32.76 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.