As of the July, 2022, release via CMS

TEXAS SPINE AND JOINT HOSPITAL

CMS id: 450864
1814 ROSELAND BLVD, TYLER TX 75701. County: SMITH
System: --
CBSA: Tyler, TX

The 20-bed, acute-care hospital had $40,901,956 in net service to patients*, with a total profit margin of 31.82273% in fiscal year 2021, the latest year available.
It spent 1.61% of its operating expenses on uncompensated care and reported $1,784,048 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	forprofit	forprofit	forprofit	forprofit	forprofit
Acute beds Median	20 118	20 118	20 119.5	20 118	20 119
Total beds Median	20 162	20 162	20 162	20 162	20 163.5
FTEs Median	362.79 788.06	354.92 793.42	368.92 806.03	354.01 787.61	375.38 804.34

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	98,109,111 150,932,746	108,995,150 158,950,878	124,278,731 168,696,998	136,420,956 163,454,693	140,216,462 186,589,412
Operating expenses Median	93,545,679 149,311,209	91,868,482 156,110,414	94,165,893 164,890,568	92,314,618 166,516,854	99,314,506 180,120,888
Net income from service 2 patients (NS2P) ? Median	4,563,432 -964,173	17,126,668 -643,601.5	30,112,838 -116,254	44,106,338 -5,025,862	40,901,956 -1,284,564
NS2P margin ? Median	4.65% -0.62	15.71% -0.29	24.23% 0.18	32.33% -5.07	29.17% -0.88

Range* of Net Service to Patient (NS2P) margins

= NS2P margin for TEXAS SPINE AND JOINT 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	730,356 5,089,215	941,414 4,572,541	786,760 5,268,134	965,289 13,092,619	5,755,465 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	15,790 299,524	20,453 188,688.5	47,665 370,813	60,412 309,361.5	74,747 375,329
⊳ Line 8: Revenue from telephone service	NULL	NULL	NULL	NULL	NULL
⊳ Line 9: Revenue from tv and radio	--	--	--	--	--
⊳ Line 10: Purchase discounts	68,142	0	0	0	0
⊳ Line 11: Rebates and refunds of expenses	0	118,240	10,940	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	326,035	349,681	400,680	270,596	278,900
⊳ 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	92,512	99,635	86,751	89,270	93,996
⊳ Line 19: Tuition (fees, sale of textbooks, uniforms, etc.)	0	0	0	0	0
⊳ Line 20: Revenue from gifts, flowers, coffee shops, canteen	0	0	0	0	0
⊳ Line 21: Rental of vending machines	0	0	0	0	0
⊳ Line 22: Rental of hospital space	0	26,800	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	227,877	326,605	240,724	545,011	5,307,822
Total income ? Median	5,293,788 6,586,430	18,068,082 6,767,106	30,899,598 8,419,950	45,071,627 8,094,175	46,657,421 15,162,888
Non-operating expenses Median	54,602 146,289.5	195,316 164,857	204,830 89,880.5	0 106,761	205,167 31,473.5
Net income Median	5,239,186 6,043,842	17,872,766 5,845,112	30,694,768 7,606,259	45,071,627 7,283,041	46,452,254 14,957,241
Net margin Median	5.30070% 4.62%	16.25734% 4.42%	24.54296% 5.16%	32.80651% 5.2%	31.82273% 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 TEXAS SPINE AND JOINT 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	14,341,666 23,241,334	14,629,983 23,709,545	15,998,206 24,248,380	16,337,671 22,858,541	16,416,410 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	14,341,666 21,577,146	14,629,983 22,041,594	15,998,206 22,722,063	16,337,671 21,570,441	16,416,410 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	16,995,260 11,160,864	16,516,633 11,987,345	16,470,691 12,926,866	15,225,026 11,884,480	17,000,158 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	16,995,260 10,918,923	16,516,633 11,706,976	16,470,691 12,615,917	15,225,026 11,458,116	17,000,158 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	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	0 594,888	0 595,761	0 577,894	0 542,168	0 549,667
Outlier Median	40,419 582,572	0 538,116	313 212,434	1,824 126,559	2,260 139,139

Uncompensated care

Item	2017	2018	2019	2020	2021
Medicaid shortfall Median	1,163,279 3,662,910	1,057,485 3,730,911	1,624,934 4,081,319	1,570,842 4,643,908	1,784,048 4,389,147
Charity care Median	3,041,349 2,654,636	9,308,452 2,940,659	829,556 3,380,215	503,443 3,488,738	560,228 3,233,405
Uncompensated care (UCC) Median	3,919,432 5,147,790	10,237,036 5,337,617	1,838,466 5,711,082	1,649,274 5,923,418	1,597,659 5,508,107
UCC as a % of operating expenses Median	4.19% 3.24	11.14% 3.12	1.95% 3.21	1.79% 3.3	1.61% 2.86
Total shortfall/UCC Median	5,082,711 9,489,989	11,294,521 9,424,297	3,463,400 10,120,158	3,220,116 11,171,337	3,381,707 10,133,851

Labor costs

	2017	2018	2019	2020	2021
Total salaries Median	18,519,927 52,142,039	19,283,061 54,485,252	20,677,880 57,395,589	20,682,672 58,830,919	22,683,095 61,722,907
Salaries as a % of operating expenses Median	21.22 36.68	20.99 36.56	21.96 36.37	22.40 35.93	22.84 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	884,555 1,449,244	1,122,099 1,475,986	2,111,677 1,563,078	2,212,286 1,721,954	2,611,756 2,991,828
Contract hours, direct-care Median	15,580.35 22,725	20,634.93 23,018.5	41,754.89 24,503.48	41,375.04 25,026.5	48,246.60 33,786
Contract wages, direct-care Median	56.77 64.67	54.38 64.53	50.57 65.06	53.47 68.97	54.13 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.