As of the July, 2022, release via CMS

HILL COUNTRY MEMORIAL HOSPITAL

CMS id: 450604
1020 KERRVILLE HWY, FREDERICKSBURG TX 78624. County: GILLESPIE
System: --
CBSA: Fredericksburg, TX

The 57-bed, acute-care hospital had $-9,670,826 in net service to patients*, with a total profit margin of 20.44456% in fiscal year 2021, the latest year available.
It spent 8.90% of its operating expenses on uncompensated care and reported $73,462 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	47 118	47 118	47 119.5	47 118	47 119
Total beds Median	57 162	57 162	57 162	57 162	57 163.5
FTEs Median	450.78 788.06	449.07 793.42	401.94 806.03	380.14 787.61	383.69 804.34

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	77,107,653 150,932,746	73,740,270 158,950,878	76,379,528 168,696,998	72,684,740 163,454,693	75,610,909 186,589,412
Operating expenses Median	78,215,565 149,311,209	78,456,694 156,110,414	79,015,598 164,890,568	81,301,420 166,516,854	85,281,735 180,120,888
Net income from service 2 patients (NS2P) ? Median	-1,107,912 -964,173	-4,716,424 -643,601.5	-2,636,070 -116,254	-8,616,680 -5,025,862	-9,670,826 -1,284,564
NS2P margin ? Median	-1.44% -0.62	-6.40% -0.29	-3.45% 0.18	-11.85% -5.07	-12.79% -0.88

Range* of Net Service to Patient (NS2P) margins

= NS2P margin for HILL COUNTRY MEMORIAL HOSPITAL 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	23,103,557 5,089,215	25,230,768 4,572,541	31,228,479 5,268,134	23,211,354 13,092,619	30,289,602 12,369,236
⊳ Line 6: Contributions ? ⊳ Median	0 224,999	0 199,009	0 206,870.5	0 194,343	0 249,496
⊳ Line 7: Investments ? ⊳ Median	536,053 299,524	827,566 188,688.5	1,038,424 370,813	721,807 309,361.5	670,496 375,329
⊳ 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	178,994	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	7,692	6,487	2,709	3,552	1,495
⊳ Line 19: Tuition (fees, sale of textbooks, uniforms, etc.)	0	0	0	0	0
⊳ Line 20: Revenue from gifts, flowers, coffee shops, canteen	43,130	40,681	39,174	16,370	16,921
⊳ Line 21: Rental of vending machines	557	0	0	0	0
⊳ Line 22: Rental of hospital space	0	0	0	0	0
⊳ 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	22,337,131	24,356,034	30,148,172	22,469,625	29,600,690
Total income ? Median	21,995,645 6,586,430	20,514,344 6,767,106	28,592,409 8,419,950	14,594,674 8,094,175	20,618,776 15,162,888
Non-operating expenses Median	514,125 146,289.5	470,490 164,857	927,267 89,880.5	-368,230 106,761	-1,032,122 31,473.5
Net income Median	21,481,520 6,043,842	20,043,854 5,845,112	27,665,142 7,606,259	14,962,904 7,283,041	21,650,898 14,957,241
Net margin Median	21.43624% 4.62%	20.25224% 4.42%	25.70919% 5.16%	15.60325% 5.2%	20.44456% 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 HILL COUNTRY MEMORIAL HOSPITAL 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	11,354,644 23,241,334	11,029,704 23,709,545	12,724,010 24,248,380	10,484,661 22,858,541	8,800,221 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	11,354,644 21,577,146	11,029,704 22,041,594	12,724,010 22,722,063	10,484,661 21,570,441	8,800,221 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	0 3,535,627	0 3,746,588	0 3,782,288	0 3,865,578	0 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	14,857,921 11,160,864	14,182,242 11,987,345	15,478,854 12,926,866	16,856,777 11,884,480	19,294,990 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	13,051,627 10,918,923	12,624,360 11,706,976	13,884,761 12,615,917	14,820,065 11,458,116	17,569,782 12,776,716
⊳ Home Health agencies (HHA) ⊳ Median	1,806,294 1,282,808	1,557,882 1,407,728	1,594,093 1,341,512	2,036,712 1,407,046	1,725,208 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	0 3,284,314	0 3,250,551	0 3,386,837	0 3,360,806	0 3,508,953
Disproportionate-share hospital (DSH) Median	83,181 594,888	63,945 595,761	60,093 577,894	54,316 542,168	45,565 549,667
Outlier Median	161,075 582,572	102,309 538,116	74,347 212,434	161,981 126,559	78,167 139,139

Uncompensated care

Item	2017	2018	2019	2020	2021
Medicaid shortfall Median	13,901 3,662,910	285,463 3,730,911	219,312 4,081,319	0 4,643,908	73,462 4,389,147
Charity care Median	3,097,267 2,654,636	4,238,878 2,940,659	5,506,527 3,380,215	5,655,810 3,488,738	7,477,018 3,233,405
Uncompensated care (UCC) Median	3,963,712 5,147,790	5,656,622 5,337,617	6,067,807 5,711,082	6,245,959 5,923,418	7,589,317 5,508,107
UCC as a % of operating expenses Median	5.07% 3.24	7.21% 3.12	7.68% 3.21	7.68% 3.3	8.90% 2.86
Total shortfall/UCC Median	3,977,613 9,489,989	5,942,085 9,424,297	6,287,119 10,120,158	6,245,959 11,171,337	7,662,779 10,133,851

Labor costs

	2017	2018	2019	2020	2021
Total salaries Median	29,808,604 52,142,039	29,579,286 54,485,252	26,086,913 57,395,589	27,753,410 58,830,919	28,937,993 61,722,907
Salaries as a % of operating expenses Median	38.11 36.68	37.70 36.56	33.01 36.37	34.14 35.93	33.93 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	656,701 1,449,244	978,259 1,475,986	1,936,573 1,563,078	1,761,770 1,721,954	1,517,215 2,991,828
Contract hours, direct-care Median	12,380.00 22,725	14,734.00 23,018.5	28,026.75 24,503.48	24,729.69 25,026.5	15,703.62 33,786
Contract wages, direct-care Median	53.05 64.67	66.39 64.53	69.10 65.06	71.24 68.97	96.62 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.