As of the July, 2022, release via CMS

AVERA MCKENNAN

CMS id: 430016
1325 SOUTH CLIFF, SIOUX FALLS SD 57117. County: MINNEHAHA
System: AVERA MCKENNAN HOSPITAL HO
CBSA: Sioux Falls, SD

The 655-bed, acute-care hospital had $-129,718,342 in net service to patients*, with a total profit margin of 8.26936% in fiscal year 2021, the latest year available.
It spent 1.51% of its operating expenses on uncompensated care and reported $12,682,081 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	412 118	403 118	383 119.5	399 118	415 119
Total beds Median	636 162	625 162	607 162	631 162	655 163.5
FTEs Median	3,889.72 788.06	3,858.39 793.42	4,354.49 806.03	4,538.54 787.61	4,614.90 804.34

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	1,010,883,325 150,932,746	1,093,308,511 158,950,878	1,131,607,187 168,696,998	1,151,373,554 163,454,693	1,328,530,460 186,589,412
Operating expenses Median	1,048,809,851 149,311,209	1,123,645,795 156,110,414	1,229,335,985 164,890,568	1,340,865,489 166,516,854	1,458,248,802 180,120,888
Net income from service 2 patients (NS2P) ? Median	-37,926,526 -964,173	-30,337,284 -643,601.5	-97,728,798 -116,254	-189,491,935 -5,025,862	-129,718,342 -1,284,564
NS2P margin ? Median	-3.75% -0.62	-2.77% -0.29	-8.64% 0.18	-16.46% -5.07	-9.76% -0.88

Range* of Net Service to Patient (NS2P) margins

= NS2P margin for AVERA MCKENNAN 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	83,993,211 5,089,215	88,027,268 4,572,541	127,942,851 5,268,134	184,547,675 13,092,619	261,176,926 12,369,236
⊳ Line 6: Contributions ? ⊳ Median	3,094,702 224,999	3,324,044 199,009	2,541,665 206,870.5	2,297,867 194,343	1,301,960 249,496
⊳ Line 7: Investments ? ⊳ Median	115,533 299,524	316,449 188,688.5	1,615,831 370,813	682,960 309,361.5	918,865 375,329
⊳ 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	2,700,566	2,898,141	3,080,571	2,783,725	2,552,906
⊳ Line 15: Revenue from rental of living quarters	0	0	0	0	0
⊳ Line 16: Revenue from sale of medical and surgical supplies	449,474	489,081	385,146	536,606	1,025,234
⊳ 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.)	131,595	51,484	61,872	59,186	64,463
⊳ Line 20: Revenue from gifts, flowers, coffee shops, canteen	0	0	0	0	0
⊳ Line 21: Rental of vending machines	21,826	21,291	24,109	19,533	40,518
⊳ Line 22: Rental of hospital space	622,641	627,687	1,026,844	1,750,374	1,871,276
⊳ 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	76,856,874	80,299,091	119,206,813	176,417,424	253,401,704
Total income ? Median	46,066,685 6,586,430	57,689,984 6,767,106	30,214,053 8,419,950	-4,944,260 8,094,175	131,458,584 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	46,066,685 6,043,842	57,689,984 5,845,112	30,214,053 7,606,259	-4,944,260 7,283,041	131,458,584 14,957,241
Net margin Median	4.20748% 4.62%	4.88345% 4.42%	2.39880% 5.16%	-0.37010% 5.2%	8.26936% 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 AVERA MCKENNAN 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	101,184,595 23,241,334	105,758,543 23,709,545	109,982,793 24,248,380	107,812,882 22,858,541	126,461,238 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	91,825,674 21,577,146	95,825,426 22,041,594	99,496,345 22,722,063	97,217,875 21,570,441	113,963,289 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	2,907,069 1,845,420	2,775,305 1,757,392	2,713,682 1,738,842	2,438,107 1,510,463	3,626,029 1,393,140
⊳ Inpatient rehabilitation facility (IRF) ⊳ Median	4,129,438 3,535,627	3,969,679 3,746,588	4,220,243 3,782,288	4,198,122 3,865,578	4,987,113 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	2,322,414 1,203,033	3,188,133 1,215,295	3,552,523 1,313,657	3,958,778 1,365,298	3,884,807 1,179,746
All outpatient revenue Median Click here to show/hide details	71,612,318 11,160,864	76,501,010 11,987,345	81,938,285 12,926,866	80,299,649 11,884,480	93,694,263 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	71,612,318 10,918,923	76,501,010 11,706,976	81,938,285 12,615,917	80,299,649 11,458,116	93,694,263 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	3,237,931 3,284,314	3,304,941 3,250,551	3,260,814 3,386,837	3,426,670 3,360,806	3,760,378 3,508,953
Disproportionate-share hospital (DSH) Median	2,681,117 594,888	3,036,269 595,761	2,866,029 577,894	2,589,496 542,168	3,217,552 549,667
Outlier Median	4,078,547 582,572	3,779,798 538,116	5,079,307 212,434	1,650,128 126,559	2,189,558 139,139

Uncompensated care

Item	2017	2018	2019	2020	2021
Medicaid shortfall Median	13,890,242 3,662,910	7,623,041 3,730,911	12,664,975 4,081,319	18,133,246 4,643,908	12,682,081 4,389,147
Charity care Median	1,704,041 2,654,636	10,127,097 2,940,659	11,888,084 3,380,215	9,385,785 3,488,738	6,068,188 3,233,405
Uncompensated care (UCC) Median	6,686,653 5,147,790	22,144,751 5,337,617	26,156,331 5,711,082	21,935,717 5,923,418	22,068,294 5,508,107
UCC as a % of operating expenses Median	0.64% 3.24	1.97% 3.12	2.13% 3.21	1.64% 3.3	1.51% 2.86
Total shortfall/UCC Median	20,576,895 9,489,989	29,767,792 9,424,297	38,821,306 10,120,158	40,068,963 11,171,337	34,750,375 10,133,851

Labor costs

	2017	2018	2019	2020	2021
Total salaries Median	314,276,266 52,142,039	341,835,179 54,485,252	371,960,759 57,395,589	409,068,144 58,830,919	442,016,806 61,722,907
Salaries as a % of operating expenses Median	50.48 36.68	50.46 36.56	50.27 36.37	50.01 35.93	47.72 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	3,809,804 1,251,927	3,974,727 1,186,494	4,104,141 1,204,885	4,157,889 1,279,653	4,475,614 1,469,317
Contract adjusted salaries, direct-care Median	5,679,858 1,449,244	3,974,727 1,475,986	7,352,597 1,563,078	7,587,515 1,721,954	7,320,394 2,991,828
Contract hours, direct-care Median	146,720.40 22,725	111,217.60 23,018.5	157,902.12 24,503.48	160,638.15 25,026.5	144,345.08 33,786
Contract wages, direct-care Median	38.71 64.67	35.74 64.53	46.56 65.06	47.23 68.97	50.71 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.