As of the July, 2022, release via CMS

SMDC MEDICAL CENTER

CMS id: 240019
502 EAST 2ND STREET, DULUTH MN 55805. County: ST. LOUIS
System: ESSENTIA HEALTH SYSTEM
CBSA: Duluth, MN-WI

The 150-bed, acute-care hospital had $-3,223,023 in net service to patients*, with a total profit margin of 12.28423% in fiscal year 2021, the latest year available.
It spent 0.34% of its operating expenses on uncompensated care and reported $16,032,238 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	95 118	95 118	95 119.5	95 118	114 119
Total beds Median	139 162	139 162	139 162	139 162	150 163.5
FTEs Median	1,619.61 788.06	1,622.41 793.42	1,603.79 806.03	1,574.12 787.61	1,571.26 804.34

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	386,658,780 150,932,746	420,456,055 158,950,878	431,837,989 168,696,998	407,814,540 163,454,693	462,302,490 186,589,412
Operating expenses Median	413,705,970 149,311,209	423,439,559 156,110,414	435,165,684 164,890,568	446,638,757 166,516,854	465,525,513 180,120,888
Net income from service 2 patients (NS2P) ? Median	-27,047,190 -964,173	-2,983,504 -643,601.5	-3,327,695 -116,254	-38,824,217 -5,025,862	-3,223,023 -1,284,564
NS2P margin ? Median	-7.00% -0.62	-0.71% -0.29	-0.77% 0.18	-9.52% -5.07	-0.70% -0.88

Range* of Net Service to Patient (NS2P) margins

= NS2P margin for SMDC 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	29,431,067 5,089,215	10,837,518 4,572,541	12,818,111 5,268,134	22,416,620 13,092,619	68,393,529 12,369,236
⊳ Line 6: Contributions ? ⊳ Median	174,006 224,999	0 199,009	0 206,870.5	0 194,343	0 249,496
⊳ Line 7: Investments ? ⊳ Median	7,501,891 299,524	0 188,688.5	0 370,813	0 309,361.5	0 375,329
⊳ 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	362,530	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	1,475,895	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	5,000	0	0	0	0
⊳ Line 23: Gov appropriations ? ⊳ Median	407,998 1,017,693	0 983,261.5	0 1,173,286	0 1,987,202	0 1,597,664
⊳ Sum Line 24	19,503,747	10,837,518	12,818,111	22,416,620	68,393,529
Total income ? Median	2,383,877 6,586,430	7,854,014 6,767,106	9,490,416 8,419,950	-16,407,597 8,094,175	65,170,506 15,162,888
Non-operating expenses Median	0 146,289.5	0 164,857	0 89,880.5	0 106,761	-21,398 31,473.5
Net income Median	2,383,877 6,043,842	7,854,014 5,845,112	9,490,416 7,606,259	-16,407,597 7,283,041	65,191,904 14,957,241
Net margin Median	0.57292% 4.62%	1.82104% 4.42%	2.13433% 5.16%	-3.81367% 5.2%	12.28423% 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 SMDC 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	19,527,421 23,241,334	20,692,001 23,709,545	20,207,782 24,248,380	17,756,485 22,858,541	19,116,262 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	13,233,459 21,577,146	14,079,768 22,041,594	13,591,697 22,722,063	10,010,552 21,570,441	11,100,723 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	6,293,962 3,535,627	6,612,233 3,746,588	6,616,085 3,782,288	7,745,933 3,865,578	8,015,539 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	44,591,978 11,160,864	48,298,766 11,987,345	52,456,554 12,926,866	46,511,986 11,884,480	49,840,900 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	44,591,978 10,918,923	48,298,766 11,706,976	52,456,554 12,615,917	46,511,986 11,458,116	49,840,900 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	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	61,834 3,284,314	63,658 3,250,551	63,916 3,386,837	43,903 3,360,806	45,184 3,508,953
Disproportionate-share hospital (DSH) Median	810,945 594,888	773,462 595,761	836,592 577,894	661,127 542,168	741,634 549,667
Outlier Median	5,826,262 582,572	7,179,273 538,116	7,969,990 212,434	4,959,298 126,559	5,832,950 139,139

Uncompensated care

Item	2017	2018	2019	2020	2021
Medicaid shortfall Median	9,551,655 3,662,910	12,378,288 3,730,911	15,603,289 4,081,319	18,224,689 4,643,908	16,032,238 4,389,147
Charity care Median	866,137 2,654,636	1,008,415 2,940,659	1,217,093 3,380,215	1,547,286 3,488,738	613,991 3,233,405
Uncompensated care (UCC) Median	4,858,600 5,147,790	1,851,606 5,337,617	2,477,818 5,711,082	2,488,141 5,923,418	1,588,280 5,508,107
UCC as a % of operating expenses Median	1.17% 3.24	0.44% 3.12	0.57% 3.21	0.56% 3.3	0.34% 2.86
Total shortfall/UCC Median	14,410,255 9,489,989	14,229,894 9,424,297	18,081,107 10,120,158	20,712,830 11,171,337	17,620,518 10,133,851

Labor costs

	2017	2018	2019	2020	2021
Total salaries Median	188,215,920 52,142,039	194,510,131 54,485,252	202,956,849 57,395,589	204,827,492 58,830,919	211,806,704 61,722,907
Salaries as a % of operating expenses Median	63.15 36.68	62.05 36.56	61.60 36.37	60.04 35.93	58.31 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	11,431 1,449,244	0 1,475,986	294,305 1,563,078	54,648 1,721,954	54,648 2,991,828
Contract hours, direct-care Median	112.00 22,725	0.00 23,018.5	3,054.24 24,503.48	824.06 25,026.5	824.06 33,786
Contract wages, direct-care Median	102.06 64.67	0.00 64.53	96.36 65.06	66.32 68.97	66.32 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.