As of the July, 2022, release via CMS

NIX HEALTH CARE SYSTEM

CMS id: 450130
414 NAVARRO STREET SUITE 600, SAN ANTONIO TX 78205. County: BEXAR
System: ALTA HOSPITALS SYSTEM LLC
CBSA: San Antonio-New Braunfels, TX

The 234-bed, acute-care hospital had $-74,656,312 in net service to patients*, with a total profit margin of -121.08495% in fiscal year 2019, the latest year available.
It spent 16.75% of its operating expenses on uncompensated care and reported $194,942,611 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	335	--	--
Ownership	forprofit	forprofit	forprofit	--	--
Acute beds Median	189 118	189 118	189 119.5	-- 118	-- 119
Total beds Median	252 162	252 162	234 162	-- 162	-- 163.5
FTEs Median	1,354.00 788.06	1,250.00 793.42	616.00 806.03	-- 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	114,317,837 150,932,746	118,192,326 158,950,878	50,950,376 168,696,998	-- 163,454,693	-- 186,589,412
Operating expenses Median	135,361,456 149,311,209	138,514,907 156,110,414	125,606,688 164,890,568	-- 166,516,854	-- 180,120,888
Net income from service 2 patients (NS2P) ? Median	-21,043,619 -964,173	-20,322,581 -643,601.5	-74,656,312 -116,254	-- -5,025,862	-- -1,284,564
NS2P margin ? Median	-18.41% -0.62	-17.19% -0.29	-146.53% 0.18	--% -5.07	--% -0.88

Range* of Net Service to Patient (NS2P) margins

= NS2P margin for NIX HEALTH CARE SYSTEM 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	10,536,901 5,089,215	16,215,105 4,572,541	5,863,390 5,268,134	-- 13,092,619	-- 12,369,236
⊳ Line 6: Contributions ? ⊳ Median	0 224,999	0 199,009	0 206,870.5	-- 194,343	-- 249,496
⊳ Line 7: Investments ? ⊳ Median	0 299,524	0 188,688.5	0 370,813	-- 309,361.5	-- 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	--	--
⊳ Line 11: Rebates and refunds of expenses	44,922	0	0	--	--
⊳ Line 12: Parking lot receipts	0	0	0	--	--
⊳ Line 13: Revenue from laundry and linen service	0	0	0	--	--
⊳ Line 14: Revenue from meals sold to emplyees and guests	567,028	595,416	428,560	--	--
⊳ Line 15: Revenue from rental of living quarters	0	0	0	--	--
⊳ Line 16: Revenue from sale of medical and surgical supplies	0	0	0	--	--
⊳ Line 17: Revenue from sale of drugs to other than patients	0	0	0	--	--
⊳ Line 18: Revenue from sale of medical records and abstracts	3,961	5,750	4,357	--	--
⊳ Line 19: Tuition (fees, sale of textbooks, uniforms, etc.)	0	0	0	--	--
⊳ Line 20: Revenue from gifts, flowers, coffee shops, canteen	0	0	0	--	--
⊳ Line 21: Rental of vending machines	0	0	0	--	--
⊳ Line 22: Rental of hospital space	143,404	247,556	205,418	--	--
⊳ Line 23: Gov appropriations ? ⊳ Median	0 1,017,693	0 983,261.5	0 1,173,286	-- 1,987,202	-- 1,597,664
⊳ Sum Line 24	9,677,592	15,286,463	5,163,473	--	--
Total income ? Median	-10,506,718 6,586,430	-4,107,476 6,767,106	-68,792,922 8,419,950	-- 8,094,175	-- 15,162,888
Non-operating expenses Median	0 146,289.5	0 164,857	0 89,880.5	-- 106,761	-- 31,473.5
Net income Median	-10,506,718 6,043,842	-4,107,476 5,845,112	-68,792,922 7,606,259	-- 7,283,041	-- 14,957,241
Net margin Median	-8.41515% 4.62%	-3.05599% 4.42%	-121.08495% 5.16%	--% 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 NIX HEALTH CARE SYSTEM 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	25,490,464 23,241,334	21,065,748 23,709,545	12,832,591 24,248,380	-- 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	18,792,248 21,577,146	17,369,355 22,041,594	10,976,158 22,722,063	-- 21,570,441	-- 22,140,684
⊳ Swingbeds ⊳ Median	0 --	0 --	0 --	-- --	-- --
⊳ Tax Equity and Fiscal Responsibility Act payments (TEFRA) ⊳ Median	0 --	0 --	0 --	-- --	-- --
⊳ Inpatient psychiatric facility (IPF) ⊳ Median	3,869,690 1,845,420	3,115,564 1,757,392	1,856,433 1,738,842	-- 1,510,463	-- 1,393,140
⊳ Inpatient rehabilitation facility (IRF) ⊳ Median	2,828,526 3,535,627	580,829 3,746,588	0 3,782,288	-- 3,865,578	-- 3,983,889
⊳ Long-term care hospital (LTCH) ⊳ Median	0 --	0 --	0 --	-- --	-- --
⊳ Critical-access hospitals ⊳ Median	0 --	0 --	0 --	-- --	-- --
⊳ Skilled-nursing facilities (SNF) ⊳ Median	0 1,203,033	0 1,215,295	0 1,313,657	-- 1,365,298	-- 1,179,746
All outpatient revenue Median Click here to show/hide details	6,982,014 11,160,864	5,610,456 11,987,345	3,053,539 12,926,866	-- 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	5,612,650 10,918,923	5,242,029 11,706,976	3,053,539 12,615,917	-- 11,458,116	-- 12,776,716
⊳ Home Health agencies (HHA) ⊳ Median	1,369,364 1,282,808	368,427 1,407,728	0 1,341,512	-- 1,407,046	-- 1,476,867
⊳ Community mental health clinics (CMHC) ⊳ Median	0 --	0 --	0 --	-- --	-- --
⊳ Rural health clinics ⊳ Median	0 618,038	0 697,279	0 690,232	-- 684,010	-- 670,558
⊳ Other federally qualified health clinics ⊳ Median	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	-- 3,360,806	-- 3,508,953
Disproportionate-share hospital (DSH) Median	1,277,123 594,888	1,157,926 595,761	569,880 577,894	-- 542,168	-- 549,667
Outlier Median	737,955 582,572	596,017 538,116	168,650 212,434	-- 126,559	-- 139,139

Uncompensated care

Item	2017	2018	2019	2020	2021
Medicaid shortfall Median	417,465 3,662,910	18,513,695 3,730,911	194,942,611 4,081,319	-- 4,643,908	-- 4,389,147
Charity care Median	13,450,839 2,654,636	0 2,940,659	18,128,269 3,380,215	-- 3,488,738	-- 3,233,405
Uncompensated care (UCC) Median	16,356,384 5,147,790	193,183 5,337,617	21,037,173 5,711,082	-- 5,923,418	-- 5,508,107
UCC as a % of operating expenses Median	12.08% 3.24	0.14% 3.12	16.75% 3.21	--% 3.3	--% 2.86
Total shortfall/UCC Median	16,773,849 9,489,989	18,706,878 9,424,297	215,979,784 10,120,158	-- 11,171,337	-- 10,133,851

Labor costs

	2017	2018	2019	2020	2021
Total salaries Median	43,509,556 52,142,039	45,016,522 54,485,252	34,970,916 57,395,589	-- 58,830,919	-- 61,722,907
Salaries as a % of operating expenses Median	35.35 36.68	35.94 36.56	29.76 36.37	-- 35.93	-- 35.24
Intern, resident salaries* Median	0 2,598,592	0 2,686,824	0 2,753,773	-- 2,937,156	-- 2,909,848
Contract intern, resident salaries* Median	0 1,251,927	0 1,186,494	0 1,204,885	-- 1,279,653	-- 1,469,317
Contract adjusted salaries, direct-care Median	411,362 1,449,244	5,446 1,475,986	0 1,563,078	-- 1,721,954	-- 2,991,828
Contract hours, direct-care Median	7,244.00 22,725	84.50 23,018.5	0.00 24,503.48	-- 25,026.5	-- 33,786
Contract wages, direct-care Median	56.79 64.67	64.45 64.53	0.00 65.06	-- 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.