As of the July, 2022, release via CMS

UNIVERSITY HEALTH SYSTEM

CMS id: 450213
STREET:4502 MEDICAL DRIVE, SAN ANTONIO TX 78229. County: BEXAR
System: --
CBSA: San Antonio-New Braunfels, TX

The 650-bed, acute-care hospital had $-1,330,972,669 in net service to patients*, with a total profit margin of 10.79512% in fiscal year 2020, the latest year available.
It spent 11.37% of its operating expenses on uncompensated care and reported $4,246,084 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	gov	gov	gov	gov	--
Acute beds Median	430 118	460 118	477 119.5	468 118	-- 119
Total beds Median	617 162	633 162	650 162	650 162	-- 163.5
FTEs Median	7,550.00 788.06	7,309.41 793.42	7,585.00 806.03	8,514.00 787.61	-- 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	579,507,227 150,932,746	662,696,223 158,950,878	739,696,576 168,696,998	736,212,545 163,454,693	-- 186,589,412
Operating expenses Median	1,718,508,895 149,311,209	1,854,259,215 156,110,414	1,956,104,040 164,890,568	2,067,185,214 166,516,854	-- 180,120,888
Net income from service 2 patients (NS2P) ? Median	-1,139,001,668 -964,173	-1,191,562,992 -643,601.5	-1,216,407,464 -116,254	-1,330,972,669 -5,025,862	-- -1,284,564
NS2P margin ? Median	-196.55% -0.62	-179.81% -0.29	-164.45% 0.18	-180.79% -5.07	--% -0.88

Range* of Net Service to Patient (NS2P) margins

= NS2P margin for UNIVERSITY HEALTH 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	1,197,661,782 5,089,215	1,284,627,030 4,572,541	1,366,834,910 5,268,134	1,581,132,859 13,092,619	-- 12,369,236
⊳ Line 6: Contributions ? ⊳ Median	985,510 224,999	1,539,313 199,009	1,706,350 206,870.5	2,336,971 194,343	-- 249,496
⊳ Line 7: Investments ? ⊳ Median	16,035,019 299,524	26,783,944 188,688.5	33,337,293 370,813	20,347,201 309,361.5	-- 375,329
⊳ Line 8: Revenue from telephone service	NULL	NULL	NULL	NULL	NULL
⊳ Line 9: Revenue from tv and radio	--	--	--	--	--
⊳ Line 10: Purchase discounts	269,749	215,817	158,132	1,645,330	--
⊳ Line 11: Rebates and refunds of expenses	1,443,377	1,011,653	546,402	720,098	--
⊳ Line 12: Parking lot receipts	1,431,044	1,661,582	956,316	0	--
⊳ Line 13: Revenue from laundry and linen service	0	0	0	0	--
⊳ Line 14: Revenue from meals sold to emplyees and guests	5,268,389	5,950,823	6,085,920	3,121,464	--
⊳ 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	4,976,899	6,876,740	7,126,401	10,009,788	--
⊳ Line 18: Revenue from sale of medical records and abstracts	0	0	0	0	--
⊳ 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	0	0	0	0	--
⊳ Line 22: Rental of hospital space	493,913	510,362	856,883	465,494	--
⊳ Line 23: Gov appropriations ? ⊳ Median	564,374,891 1,017,693	608,185,431 983,261.5	190,717,624 1,173,286	305,019,432 1,987,202	-- 1,597,664
⊳ Sum Line 24	602,382,991	631,891,365	1,125,343,589	1,237,467,081	--
Total income ? Median	58,660,114 6,586,430	93,064,038 6,767,106	150,427,446 8,419,950	250,160,190 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	58,660,114 6,043,842	93,064,038 5,845,112	150,427,446 7,606,259	250,160,190 7,283,041	-- 14,957,241
Net margin Median	3.30076% 4.62%	4.77907% 4.42%	7.14100% 5.16%	10.79512% 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 UNIVERSITY HEALTH 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	105,823,786 23,241,334	125,916,430 23,709,545	152,644,041 24,248,380	164,296,768 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	101,562,599 21,577,146	121,547,939 22,041,594	147,942,065 22,722,063	161,573,847 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	4,261,187 3,535,627	4,368,491 3,746,588	4,701,976 3,782,288	2,722,921 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	27,738,542 11,160,864	28,988,538 11,987,345	31,596,553 12,926,866	22,453,625 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	27,738,542 10,918,923	28,988,538 11,706,976	31,596,553 12,615,917	22,453,625 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	16,336,418 3,284,314	18,009,635 3,250,551	21,355,649 3,386,837	20,541,773 3,360,806	-- 3,508,953
Disproportionate-share hospital (DSH) Median	2,991,186 594,888	2,902,956 595,761	3,582,221 577,894	4,474,080 542,168	-- 549,667
Outlier Median	5,445,591 582,572	4,737,801 538,116	1,568,723 212,434	1,019,171 126,559	-- 139,139

Uncompensated care

Item	2017	2018	2019	2020	2021
Medicaid shortfall Median	4,373,320 3,662,910	2,962,076 3,730,911	5,189,331 4,081,319	4,246,084 4,643,908	-- 4,389,147
Charity care Median	107,280,414 2,654,636	197,096,411 2,940,659	228,306,211 3,380,215	194,148,926 3,488,738	-- 3,233,405
Uncompensated care (UCC) Median	212,002,455 5,147,790	235,283,934 5,337,617	265,806,834 5,711,082	235,010,483 5,923,418	-- 5,508,107
UCC as a % of operating expenses Median	12.34% 3.24	12.69% 3.12	13.59% 3.21	11.37% 3.3	--% 2.86
Total shortfall/UCC Median	216,375,775 9,489,989	238,246,010 9,424,297	270,996,165 10,120,158	239,256,567 11,171,337	-- 10,133,851

Labor costs

	2017	2018	2019	2020	2021
Total salaries Median	464,049,766 52,142,039	490,410,016 54,485,252	527,447,302 57,395,589	570,514,300 58,830,919	-- 61,722,907
Salaries as a % of operating expenses Median	27.00 36.68	26.45 36.56	26.96 36.37	27.60 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	1,747,226 1,251,927	0 1,186,494	1,717,472 1,204,885	1,575,088 1,279,653	-- 1,469,317
Contract adjusted salaries, direct-care Median	11,651,554 1,449,244	7,293,168 1,475,986	12,926,679 1,563,078	16,858,081 1,721,954	-- 2,991,828
Contract hours, direct-care Median	186,337.92 22,725	128,451.00 23,018.5	190,514.94 24,503.48	819,254.20 25,026.5	-- 33,786
Contract wages, direct-care Median	62.53 64.67	56.78 64.53	67.85 65.06	20.58 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.