Ethan Rhodes
Hospitals are required to file financial reports on a quarterly and annual basis, which are publicly available. These reports contain a wealth of information, including general hospital information, ownership, medical staff specialties, hospital services, utilization data, and financial statements such as balance sheets and income statements. To access these financial statements for government hospitals, you can refer to the websites of relevant government departments, such as the Department of Health, or utilize tools like the Hospital Cost Tool provided by organizations like NASHP. These sources provide insights into the financial health and performance of hospitals, aiding analysts and officials in making informed decisions regarding healthcare in their respective states.
| Characteristics | Values |
|---|---|
| Reporting frequency | Annual and quarterly |
| Report contents | Balance sheet, income statement, equity, cash flow, revenue, expenses, salaries, etc. |
| Reporting requirements | Varies by state and hospital type |
| Data sources | NASHP Hospital Cost Tool, Audited Financial Statements, Electronic Municipal Market Access (EMMA) database, CMS provider and service data, IRS Form 990s, RAND’s Hospital Price Transparency Study, etc. |
| Data analysis tools | Peterson-Milbank analytics, Bailit Health's Financial Analysis Template, NASHP's Hospital Cost Tool (HCT) |
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What You'll Learn
Annual financial disclosure reports
Hospitals are required to submit detailed annual financial disclosure reports and less detailed quarterly financial reports. These reports are filed with the Hospital Cost Tool (HCT) of the Health Care Authority (HCAI) in California. The HCAI website provides access to the data products based on these reports.
The annual financial disclosure reports contain detailed financial and utilisation information about the facility, including:
- Type of ownership and inventory of services
- Number of beds and patient utilisation statistics by payer
- Balance sheet, income statement, and statement of cash flows
- Productive hours and average hourly rates by employee classification and cost centre
The complete set of hospital annual financial data is collected from all acute care hospitals licensed by the State of California. It includes:
- General hospital information
- Type of ownership
- Medical staff specialties
- Hospital services inventory
- Number of beds
- Utilisation data by payer
- Balance sheets
- Statements of changes in equity
- Income statements
- Statements of cash flows
- Revenuess by payer
- Expenses by natural classification
- Cost allocation statistics and calculations
- Labour hours and hourly rates
The HCAI website also provides hospital financial data visualisations, which summarise data from the financial reports in an easy-to-use manner. This includes information on operating margin, net revenue, operating expense, uncompensated care costs, bed counts, discharges, and staffing hours.
In addition to the HCAI, other sources of hospital financial data include the Electronic Municipal Market Access (EMMA) database, Centers for Medicare & Medicaid Services (CMS) provider and service data, IRS Form 990s, and the RAND’s corporation’s Hospital Price Transparency Study.
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Quarterly financial reports
Hospitals are required to file detailed annual financial disclosure reports and less detailed quarterly financial reports. These reports are filed with the Department of Health Care Access and Information (HCAI). The HCAI website provides access to hospital financial data, including quarterly financial reports for individual hospitals. The data is presented in an easy-to-use format, with data fields spanning across columns.
The quarterly financial reports include information such as admissions, patient days, payer, billed charges, net revenue, operating expense, and net income. Additionally, the reports may include balance sheets, income statements, and statements of cash flows. The reports are typically less detailed than the annual financial disclosure reports.
To access the quarterly financial reports, you can visit the HCAI website and look for the Quarterly Profile Characteristics section. This section provides quarterly financial data for individual hospitals, allowing you to select data for specific quarters or the sum of four quarters. The data is updated quarterly to reflect any corrections made during the review process.
It is important to note that, starting in 2022, Hospital Annual Financial Data became available by individual hospital, except for balance sheet, equity, and cash flow statements, which are reported on a system-wide regional basis. Additionally, certain hospitals, such as Kaiser Hospitals, may have different reporting requirements due to reduced exemptions.
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Utilization data
In California, the Department of Health Care Access and Information (HCAI) collects and publishes comprehensive utilization data for acute care hospitals licensed by the state. The HCAI Hospital Annual Financial Data series includes information on inpatient and outpatient utilization, patient volumes, and service capacity. It also covers utilization data by payer, including details on revenues and expenses by type and payer. This data is used to create visualizations that facilitate comparisons and assessments of hospital performance.
The HCAI financial reports include a range of utilization metrics, such as annual licensed beds, annual discharges, annual patient days, annual outpatient visits, and annual inpatient and outpatient surgeries. These metrics provide a quantitative overview of the hospital's patient throughput and service utilization.
Washington State also publishes utilization data for community hospitals, including admissions, patient days, payer information, and length of stay. This data is available through the Washington State Department of Health's website, offering insights into the operational aspects of healthcare delivery in the state.
Additionally, national sources such as the NASHP Hospital Cost Tool, Electronic Municipal Market Access (EMMA) database, and Centers for Medicare & Medicaid Services (CMS) provider data offer utilization metrics and financial information for hospitals across the country. These sources provide a broader perspective, allowing for comparisons between states and national medians.
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Audited financial statements
AFSs include a wide range of financial data, such as income statements, balance sheets, cash flow statements, revenue data, expense data, and financial ratios. This information can be used to evaluate a hospital's financial stability, efficiency, and ability to repay debts. For example, AFSs can reveal how long a hospital can fund its operations without additional revenue, which can inform decisions about financial distributions.
In the United States, AFSs are produced and made public for most health systems and hospitals, including government-owned, nonprofit, and for-profit hospitals. Sources for obtaining these AFSs include the Hospital Cost Tool, the Electronic Municipal Market Access (EMMA) database, Centers for Medicare & Medicaid Services (CMS) provider and service data, IRS Form 990s, and state-specific sources, such as the Maryland Hospital Audited Financial Statements.
To find AFSs for a specific governmental hospital, you can search for the hospital's website and look for an "Annual Report" or "Financial Statements" section. These reports may be available for download or viewing on the hospital's website. Additionally, you can search for the hospital on financial disclosure websites or government portals that aggregate financial data for hospitals, such as the Hospital Financials section on the HCAI website or state-specific portals like the Washington State Department of Health's community hospital data page. These websites may provide access to annual financial data, quarterly financial reports, and other relevant financial information for governmental hospitals.
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IRS Form 990s
IRS Form 990 is a tax document that tax-exempt organizations in the US must file annually. It provides the Internal Revenue Service (IRS) with information on the organization's activities, policies, and financial details. This form is used by the IRS to monitor compliance with tax laws and to ensure that tax-exempt organizations are operating within the scope of their exempt status.
Hospitals, including governmental hospitals, may be required to file Form 990 if they meet certain criteria. Non-profit hospitals that operate for the benefit of the public and meet the requirements of the community benefit standard can be exempt from income tax under Section 501(c)(3) of the IRS Code. These hospitals must offer medical benefits to all patients, regardless of their financial status, and accept patients with public insurance programs like Medicare. They are also allowed to receive donations and funds, which must be used for improving facilities, equipment, and advancing medical education and research.
To maintain their tax-exempt status, these hospitals must file Form 990 annually. They must attach Schedule H to Form 990, which provides additional information about the hospital's activities, policies, and community benefits. Schedule H also collects information on grants and other assistance provided by the hospital, compensation details for key employees, and liabilities associated with tax-exempt bond issues.
The instructions for Schedule H guide hospitals on how to complete the form accurately. For example, hospitals must disclose whether they widely publicized their financial assistance policies (FAP) within the community and if they provided contact information for government benefit programs like Medicaid. Additionally, hospitals must consider input from community representatives, including governmental public health departments, to ensure they are meeting the health needs of the community, especially underserved populations.
By reviewing Form 990 and Schedule H, stakeholders can gain insights into a hospital's financial health, compliance with tax laws, and commitment to serving the community. It is important for hospitals to accurately complete and timely submit these forms to maintain their tax-exempt status and uphold their public benefit obligations.
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Frequently asked questions
Government hospital financial statements are often available through public reporting sites. For example, in the US, IRS Form 990s are available on ProPublica, and the Electronic Municipal Market Access (EMMA) website contains documents filed by not-for-profit entities. Audited Financial Statements for for-profit entities that are publicly traded can be found on the federal Security and Exchange Commission (SEC) Electronic Data Gathering, Analysis, and Retrieval (EDGAR) database.
Hospital financial statements include general hospital information, type of ownership, medical staff specialties, hospital services inventory, number of beds, utilization data by payer, balance sheets, statements of changes in equity, income statements, statements of cash flows, revenues by payer, expenses by natural classification, cost allocation statistics and calculations, and labor hours and hourly rates.
Examples of government hospital financial statements include Year-End Reports, Quarterly Reports, and Health System Consolidated Income Statements and Balance Sheets.
