As of the July, 2022, release via CMS

HOSP. METROPOLITANO DE SAN GERMAN

CMS id: 400126
JAVILLA #8, SAN GERMAN PR 683. County: SAN GERMAN
System: --
CBSA: San German, PR

The 57-bed, acute-care hospital had $-2,980,565 in net service to patients*, with a total profit margin of 4.64412% in fiscal year 2020, the latest year available.
It spent 1.00% of its operating expenses on uncompensated care and reported $880,307 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	--
Ownership	forprofit	forprofit	forprofit	forprofit	--
Acute beds Median	59 118	59 118	57 119.5	51 118	-- 119
Total beds Median	65 162	65 162	63 162	57 162	-- 163.5
FTEs Median	355.95 788.06	239.28 793.42	241.83 806.03	250.96 787.61	-- 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	26,093,737 150,932,746	32,341,261 158,950,878	23,413,481 168,696,998	18,757,440 163,454,693	-- 186,589,412
Operating expenses Median	32,238,369 149,311,209	32,077,412 156,110,414	23,369,766 164,890,568	21,738,005 166,516,854	-- 180,120,888
Net income from service 2 patients (NS2P) ? Median	-6,144,632 -964,173	263,849 -643,601.5	43,715 -116,254	-2,980,565 -5,025,862	-- -1,284,564
NS2P margin ? Median	-23.55% -0.62	0.82% -0.29	0.19% 0.18	-15.89% -5.07	--% -0.88

Range* of Net Service to Patient (NS2P) margins

= NS2P margin for HOSP. METROPOLITANO DE SAN GERMAN 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	8,930,235 5,089,215	1,680,460 4,572,541	1,953,722 5,268,134	4,039,272 13,092,619	-- 12,369,236
⊳ Line 6: Contributions ? ⊳ Median	0 224,999	0 199,009	0 206,870.5	0 194,343	-- 249,496
⊳ Line 7: Investments ? ⊳ Median	0 299,524	0 188,688.5	0 370,813	0 309,361.5	-- 375,329
⊳ Line 8: Revenue from telephone service	NULL	NULL	NULL	NULL	NULL
⊳ Line 9: Revenue from tv and radio	3,452	4,3--9	4,5--0	3,6--0	--
⊳ Line 10: Purchase discounts	84,642	143,841	155,220	120,204	--
⊳ Line 11: Rebates and refunds of expenses	0	0	0	0	--
⊳ Line 12: Parking lot receipts	0	0	725	12,997	--
⊳ Line 13: Revenue from laundry and linen service	0	0	0	0	--
⊳ Line 14: Revenue from meals sold to emplyees and guests	0	0	0	0	--
⊳ Line 15: Revenue from rental of living quarters	0	0	0	0	--
⊳ Line 16: Revenue from sale of medical and surgical supplies	0	0	0	0	--
⊳ Line 17: Revenue from sale of drugs to other than patients	0	0	0	0	--
⊳ Line 18: Revenue from sale of medical records and abstracts	69,358	61,103	44,227	41,477	--
⊳ Line 19: Tuition (fees, sale of textbooks, uniforms, etc.)	0	0	0	0	--
⊳ Line 20: Revenue from gifts, flowers, coffee shops, canteen	0	0	0	0	--
⊳ Line 21: Rental of vending machines	2,637	0	1,717	0	--
⊳ Line 22: Rental of hospital space	7,100	2,950	11,075	4,650	--
⊳ Line 23: Gov appropriations ? ⊳ Median	0 1,017,693	0 983,261.5	0 1,173,286	0 1,987,202	-- 1,597,664
⊳ Sum Line 24	8,763,029	1,468,257	1,736,258	3,856,344	--
Total income ? Median	2,785,603 6,586,430	1,944,309 6,767,106	1,997,437 8,419,950	1,058,707 8,094,175	-- 15,162,888
Non-operating expenses Median	0 146,289.5	0 164,857	0 89,880.5	0 106,761	-- 31,473.5
Net income Median	2,785,603 6,043,842	1,944,309 5,845,112	1,997,437 7,606,259	1,058,707 7,283,041	-- 14,957,241
Net margin Median	7.95342% 4.62%	5.71490% 4.42%	7.87409% 5.16%	4.64412% 5.2%	--% 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 HOSP. METROPOLITANO DE SAN GERMAN 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	2,066,552 23,241,334	1,987,100 23,709,545	2,321,053 24,248,380	1,901,024 22,858,541	-- 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	2,066,552 21,577,146	1,987,100 22,041,594	2,321,053 22,722,063	1,901,024 21,570,441	-- 22,140,684
⊳ Swingbeds ⊳ Median	0 --	0 --	0 --	0 --	-- --
⊳ Tax Equity and Fiscal Responsibility Act payments (TEFRA) ⊳ Median	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	-- 1,393,140
⊳ Inpatient rehabilitation facility (IRF) ⊳ Median	0 3,535,627	0 3,746,588	0 3,782,288	0 3,865,578	-- 3,983,889
⊳ Long-term care hospital (LTCH) ⊳ Median	0 --	0 --	0 --	0 --	-- --
⊳ Critical-access hospitals ⊳ Median	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	-- 1,179,746
All outpatient revenue Median Click here to show/hide details	61,405 11,160,864	66,854 11,987,345	98,183 12,926,866	95,040 11,884,480	-- 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	61,405 10,918,923	66,854 11,706,976	98,183 12,615,917	95,040 11,458,116	-- 12,776,716
⊳ Home Health agencies (HHA) ⊳ Median	0 1,282,808	0 1,407,728	0 1,341,512	0 1,407,046	-- 1,476,867
⊳ Community mental health clinics (CMHC) ⊳ Median	0 --	0 --	0 --	0 --	-- --
⊳ Rural health clinics ⊳ Median	0 618,038	0 697,279	0 690,232	0 684,010	-- 670,558
⊳ Other federally qualified health clinics ⊳ Median	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	-- 3,508,953
Disproportionate-share hospital (DSH) Median	38,855 594,888	35,026 595,761	41,095 577,894	29,133 542,168	-- 549,667
Outlier Median	34,752 582,572	38,097 538,116	3,820 212,434	2,866 126,559	-- 139,139

Uncompensated care

Item	2017	2018	2019	2020	2021
Medicaid shortfall Median	13,784 3,662,910	0 3,730,911	0 4,081,319	880,307 4,643,908	-- 4,389,147
Charity care Median	0 2,654,636	0 2,940,659	0 3,380,215	0 3,488,738	-- 3,233,405
Uncompensated care (UCC) Median	202,508 5,147,790	254,048 5,337,617	224,504 5,711,082	217,147 5,923,418	-- 5,508,107
UCC as a % of operating expenses Median	0.63% 3.24	0.79% 3.12	0.96% 3.21	1.00% 3.3	--% 2.86
Total shortfall/UCC Median	216,292 9,489,989	254,048 9,424,297	224,504 10,120,158	1,097,454 11,171,337	-- 10,133,851

Labor costs

	2017	2018	2019	2020	2021
Total salaries Median	9,695,711 52,142,039	9,034,864 54,485,252	6,422,008 57,395,589	7,142,805 58,830,919	-- 61,722,907
Salaries as a % of operating expenses Median	30.08 36.68	28.17 36.56	27.48 36.37	32.86 35.93	-- 35.24
Intern, resident salaries* Median	0 2,598,592	0 2,686,824	0 2,753,773	0 2,937,156	-- 2,909,848
Contract intern, resident salaries* Median	0 1,251,927	0 1,186,494	0 1,204,885	0 1,279,653	-- 1,469,317
Contract adjusted salaries, direct-care Median	0 1,449,244	0 1,475,986	0 1,563,078	0 1,721,954	-- 2,991,828
Contract hours, direct-care Median	0.00 22,725	0.00 23,018.5	0.00 24,503.48	0.00 25,026.5	-- 33,786
Contract wages, direct-care Median	0.00 64.67	0.00 64.53	0.00 65.06	0.00 68.97	-- 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.