Part B needs to be done within 12 hrs
Needhelp9438495
2024CaseStudy1A1B1.xlsxAssumptions
| GENERAL CASE STUDY ASSUMPTIONS: | |
| 1 | Assume a moderate - sized community with four main hospital systems - 2 private (not-for-profit) one public (university) and one pediatric |
| 2 | 837,200 total hospital visits per year are split between hospitals |
| 3 | Patients are 38% Commercial; 31% Medicare; 23% Medicaid: 9% Self-pay - split differently by hospital |
| 4 | We assume different hospitals have different average costs and charges and apply those averages to each of their visits. |
| 5 | In 2024, Hospitals earn 50% of charges for commercial; 30% for Medicare; 25% for Medicaid. Exception is pediatric, who earns 80% for commercial. |
| 6 | In 2025, Medicare payments reduce per ACA to 28% of charges |
| 7 | In 2025, Exchanges will eliminate all but 6300 self-pay visits. Remainder are now split Medicaid/Commercial (50/50) |
| 8 | See data tab for additional assumptions and information |
Data Inputs
| DATA: | ||||
| 2024 Patient visits | Commercial | Medicare | Medicaid | Uninsured/Self-pay |
| Mercy | 82,000 | 104,000 | 22,000 | 20,500 |
| St. Sebastian | 100,500 | 100,200 | 12,500 | 8,500 |
| Gen. Pediatric | 71,000 | 3,500 | 112,500 | 15,000 |
| Gen. University | 65,000 | 46,000 | 47,500 | 26,500 |
| Community Total | 318,500 | 253,700 | 194,500 | 70,500 |
| 2024 Financials | Charge/Svc | Cost/Svc | ||
| Mercy | $4,500 | $1,500 | ||
| St. Sebastian | $4,650 | $1,795 | ||
| Gen. Pediatric | $5,000 | $2,100 | ||
| Gen. University | $5,750 | $1,875 | ||
| Payers | Reimbursement Percentages | |||
| Commercial | 50.00% | |||
| Commercial Pediatric | 80.00% | |||
| Exchange 120% | 33.60% | |||
| Medicare | 30.00% | |||
| Medicare 2025 | 28.00% | |||
| Medicaid | 25.00% | |||
| Self-Pay | 2.00% | |||
| 2025 Baseline Patient Visits* | Commercial | Medicare | Medicaid | Uninsured/Self-pay |
| Mercy | 82,000 | 104,000 | 22,000 | |
| St. Sebastian | 100,500 | 100,200 | 12,500 | |
| Gen. Pediatric | 71,000 | 3,500 | 112,500 | |
| Gen. University | 65,000 | 46,000 | 47,500 | |
| Community Total | 350,600 | 253,700 | 226,600 | 6,300 |
| *Uninsured/Self-Pay reduces to 6300 total. The reduction of 64,200 is split 50/50 (32,100) between Commercial & Medicaid. | ||||
| 2025 Exchange Patient Visits** | % | |||
| Commercial | 75.00% | |||
| Exchange | 25.00% | |||
| **25% of 2025 Baseline Commercial lives are in Exchange. | ||||
| 2025 Exchange Narrow Network Patient Visits*** | % | |||
| Narrow Network Partner | 75.00% | |||
| Non-NN Partners | 50.00% | |||
| ***Health System that agrees to Narrow Network Arrangement gets 75% of total exchange patient visits. Pediatrics maintains same visits and other systems split the remainder 50/50. |
Financial Summary
| Financial Summary | ||||||||||||||
| 2024 Projected (baseline) | ||||||||||||||
| Services | Share | Chg/visit | Gr. Rev | Net Rev | Costs | Cost/visit | Margin | Margin (%) | ||||||
| Mercy | 228,500 | 27.3% | $ 4,500 | $ 1,028,250,000 | $ 351,495,000 | $ 342,750,000 | $ 1,500 | $ 8,745,000 | 2.49% | |||||
| St. Sebastian | 221,700 | 26.5% | $ 4,650 | $ 1,030,905,000 | $ 388,763,250 | $ 397,951,500 | $ 1,795 | $ (9,188,250) | -2.36% | |||||
| General Pediatric | 202,000 | 24.1% | $ 5,000 | $ 1,010,000,000 | $ 431,375,000 | $ 424,200,000 | $ 2,100 | $ 7,175,000 | 1.66% | |||||
| General University | 185,000 | 22.1% | $ 5,750 | $ 1,063,750,000 | $ 337,553,750 | $ 346,875,000 | $ 1,875 | $ (9,321,250) | -2.76% | |||||
| Total Community | 837,200 | 100.0% | $ 4,937 | $ 4,132,905,000 | $ 1,509,187,000 | $ 1,511,776,500 | $ 1,806 | $ (2,589,500) | -0.17% | |||||
| Assume all costs are variable | Assume all costs are fixed | |||||||||||||
| 2025 with exchanges paying 100% of commercial rates | ||||||||||||||
| Services | Share | Chg/visit | Gr. Rev | Net Rev | Costs | Cost/visit | Margin | Margin (%) | Costs | Cost/visit | Margin | Margin (%) | ||
| Mercy | 221,727 | 26.5% | $ 4,500 | 997,772,073 | 363,134,396 | 332,590,691 | $ 1,500 | $ 30,543,705 | 8.41% | |||||
| St. Sebastian | 226,151 | 27.0% | $ 4,650 | 1,051,604,205 | 404,672,666 | 405,941,838 | $ 1,795 | $ (1,269,173) | -0.31% | |||||
| General Pediatric | 214,063 | 25.6% | $ 5,000 | 1,070,314,968 | 481,490,510 | 449,532,286 | $ 2,100 | $ 31,958,224 | 6.64% | |||||
| General University | 175,258 | 20.9% | $ 5,750 | 1,007,736,014 | 359,591,803 | 328,609,570 | $ 1,875 | $ 30,982,233 | 8.62% | |||||
| Total Community | 837,200 | 100.0% | $ 4,930 | 4,127,427,259 | 1,608,889,374 | 1,516,674,385 | $ 1,812 | $ 92,214,989 | 5.73% | |||||
| 2025 with exchanges paying 120% of Medicare rates/ same network dist. | ||||||||||||||
| Services | Share | Chg/visit | Gr. Rev | Net Rev | Costs | Cost/visit | Margin | Margin (%) | Costs | Cost/visit | Margin | Margin (%) | ||
| Mercy | 221,727 | 26.5% | $ 4,500 | 997,772,073 | 346,480,621 | 332,590,691 | $ 1,500 | $ 13,889,930 | 4.01% | |||||
| St. Sebastian | 226,151 | 27.0% | $ 4,650 | 1,051,604,205 | 383,581,269 | 405,941,838 | $ 1,795 | $ (22,360,570) | -5.83% | |||||
| General Pediatric | 214,063 | 25.6% | $ 5,000 | 1,070,314,968 | 436,160,187 | 449,532,286 | $ 2,100 | $ (13,372,100) | -3.07% | |||||
| General University | 175,258 | 20.9% | $ 5,750 | 1,007,736,014 | 342,723,650 | 328,609,570 | $ 1,875 | $ 14,114,080 | 4.12% | |||||
| Total Community | 837,200 | 100.0% | $ 4,930 | 4,127,427,259 | 1,508,945,726 | 1,516,674,385 | $ 1,812 | $ (7,728,660) | -0.51% | |||||
| 2025 with exchanges paying 120% of Medicare rates/ St. Sebastian takes 75% of adult exchange share | ||||||||||||||
| Services | Share | Chg/visit | Gr. Rev | Net Rev | Costs | Cost/visit | Margin | Margin (%) | Costs | Cost/visit | Margin | Margin (%) | ||
| Mercy | ||||||||||||||
| St. Sebastian | ||||||||||||||
| General Pediatric | ||||||||||||||
| General University | ||||||||||||||
| Total Community | ||||||||||||||
| 2025 with exchanges paying 120% of Medicare rates/ Mercy takes 75% of adult exchange share | ||||||||||||||
| Services | Share | Chg/visit | Gr. Rev | Net Rev | Costs | Cost/visit | Margin | Margin (%) | Costs | Cost/visit | Margin | Margin (%) | ||
| Mercy | ||||||||||||||
| St. Sebastian | ||||||||||||||
| General Pediatric | ||||||||||||||
| General University | ||||||||||||||
| Total Community | ||||||||||||||
Current
| Current | |||||||||||
| Mercy | |||||||||||
| Mercy | Pt. Visits | % of visits | Chg/Svc | Gross Rev | Net Rev | Costs | Cost/Svc | Margin | Margin (%) | % of market | |
| Commercial | 82,000 | 36% | $ 4,500 | $ 369,000,000 | $ 184,500,000 | $ 123,000,000 | $ 1,500 | $ 61,500,000 | 33.3% | 25.7% | |
| Medicare | 104,000 | 46% | $ 4,500 | $ 468,000,000 | $ 140,400,000 | $ 156,000,000 | $ 1,500 | $ (15,600,000) | -11.1% | 41.0% | |
| Medicaid | 22,000 | 10% | $ 4,500 | $ 99,000,000 | $ 24,750,000 | $ 33,000,000 | $ 1,500 | $ (8,250,000) | -33.3% | 11.3% | |
| Self-Pay | 20,500 | 9% | $ 4,500 | $ 92,250,000 | $ 1,845,000 | $ 30,750,000 | $ 1,500 | $ (28,905,000) | -1566.7% | 29.1% | |
| Total | 228,500 | 100% | $ 4,500 | $ 1,028,250,000 | $ 351,495,000 | $ 342,750,000 | $ 1,500 | $ 8,745,000 | 2.5% | ||
| St. Sebastian Healthcare | |||||||||||
| Pt. Visits | % of visits | Chg/Svc | Gross Rev | Net Rev | Costs | Cost/Svc | Margin | Margin (%) | |||
| Commercial | 100,500 | 45% | $ 4,650 | $ 467,325,000 | $ 233,662,500 | $ 180,397,500 | $ 1,795 | $ 53,265,000 | 22.8% | 31.6% | |
| Medicare | 100,200 | 45% | $ 4,650 | $ 465,930,000 | $ 139,779,000 | $ 179,859,000 | $ 1,795 | $ (40,080,000) | -28.7% | 39.5% | |
| Medicaid | 12,500 | 6% | $ 4,650 | $ 58,125,000 | $ 14,531,250 | $ 22,437,500 | $ 1,795 | $ (7,906,250) | -54.4% | 6.4% | |
| Self-Pay | 8,500 | 4% | $ 4,650 | $ 39,525,000 | $ 790,500 | $ 15,257,500 | $ 1,795 | $ (14,467,000) | -1830.1% | 12.1% | |
| Total | 221,700 | 100% | $ 4,650 | $ 1,030,905,000 | $ 388,763,250 | $ 397,951,500 | $ 1,795 | $ (9,188,250) | -2.4% | ||
| General Pediatric Hospital | |||||||||||
| Pt. Visits | % of visits | Chg/Svc | Gross Rev | Net Rev | Costs | Cost/Svc | Margin | Margin (%) | |||
| Commercial | 71,000 | 35% | $ 5,000 | $ 355,000,000 | $ 284,000,000 | $ 149,100,000 | $ 2,100 | $ 134,900,000 | 47.5% | 22.3% | |
| Medicare | 3,500 | 2% | $ 5,000 | $ 17,500,000 | $ 5,250,000 | $ 7,350,000 | $ 2,100 | $ (2,100,000) | -40.0% | 1.4% | |
| Medicaid | 112,500 | 56% | $ 5,000 | $ 562,500,000 | $ 140,625,000 | $ 236,250,000 | $ 2,100 | $ (95,625,000) | -68.0% | 57.8% | |
| Self-Pay | 15,000 | 7% | $ 5,000 | $ 75,000,000 | $ 1,500,000 | $ 31,500,000 | $ 2,100 | $ (30,000,000) | -2000.0% | 21.3% | |
| Total | 202,000 | 100% | $ 5,000 | $ 1,010,000,000 | $ 431,375,000 | $ 424,200,000 | $ 2,100 | $ 7,175,000 | 1.7% | ||
| General University Hospital | |||||||||||
| Pt. Visits | % of visits | Chg/Svc | Gross Rev | Net Rev | Costs | Cost/Svc | Margin | Margin (%) | |||
| Commercial | 65,000 | 35% | $ 5,750 | $ 373,750,000 | $ 186,875,000 | $ 121,875,000 | $ 1,875 | $ 65,000,000 | 34.8% | 20.4% | |
| Medicare | 46,000 | 25% | $ 5,750 | $ 264,500,000 | $ 79,350,000 | $ 86,250,000 | $ 1,875 | $ (6,900,000) | -8.7% | 18.1% | |
| Medicaid | 47,500 | 26% | $ 5,750 | $ 273,125,000 | $ 68,281,250 | $ 89,062,500 | $ 1,875 | $ (20,781,250) | -30.4% | 24.4% | |
| Self-Pay | 26,500 | 14% | $ 5,750 | $ 152,375,000 | $ 3,047,500 | $ 49,687,500 | $ 1,875 | $ (46,640,000) | -1530.4% | 37.6% | |
| Total | 185,000 | 100% | $ 5,750 | $ 1,063,750,000 | $ 337,553,750 | $ 346,875,000 | $ 1,875 | $ (9,321,250) | -2.8% | ||
| Total Community | |||||||||||
| Pt. Visits | % of visits | Chg/Svc | Gross Rev | Net Rev | Costs | Cost/Svc | Margin | Margin (%) | |||
| Commercial | 318500 | 38% | $ 4,914 | $ 1,565,075,000 | $ 889,037,500 | $ 574,372,500 | $ 1,803 | $ 314,665,000 | 35.4% | ||
| Medicare | 253700 | 30% | $ 4,793 | $ 1,215,930,000 | $ 364,779,000 | $ 429,459,000 | $ 1,693 | $ (64,680,000) | -17.7% | ||
| Medicaid | 194500 | 23% | $ 5,104 | $ 992,750,000 | $ 248,187,500 | $ 380,750,000 | $ 1,958 | $ (132,562,500) | -53.4% | ||
| Self-Pay | 70500 | 8% | $ 5,094 | $ 359,150,000 | $ 7,183,000 | $ 127,195,000 | $ 1,804 | $ (120,012,000) | -1670.8% | ||
| Total | 837,200 | 100% | $ 4,937 | $ 4,132,905,000 | $ 1,509,187,000 | $ 1,511,776,500 | $ 1,806 | $ (2,589,500) | -0.2% |
2025Baseline
| 2025Baseline | ||||||||||||||
| Mercy | Assumptions: | |||||||||||||
| Mercy | Pt. Visits | % of visits | Chg/Svc | Gross Rev | Net Rev | Costs | Cost/Svc | Margin | Margin (%) | % of market | 1 | Regional Self Pay goes from 70,500 to 6,300 visits | ||
| Commercial | 90,264 | 41% | $ 4,500 | $ 406,189,639 | $ 203,094,819 | $ 135,396,546 | $ 1,500 | $ 67,698,273 | 33.3% | 25.7% | 2 | Remaining Self-pay volume goes to Medicaid (32,100) and Commercial(32,100) | ||
| Medicare | 104,000 | 47% | $ 4,500 | $ 468,000,000 | $ 131,040,000 | $ 156,000,000 | $ 1,500 | $ (24,960,000) | -19.0% | 41.0% | 3 | That volume shifts to hospitals accordning to previous year's share of Mediacid/Comm'l | ||
| Medicaid | 25,631 | 12% | $ 4,500 | $ 115,338,817 | $ 28,834,704 | $ 38,446,272 | $ 1,500 | $ (9,611,568) | -33.3% | 11.3% | 4 | Hospitals have same cost structure and % market share by payer class | ||
| Self-Pay | 1,832 | 1% | $ 4,500 | $ 8,243,617 | $ 164,872 | $ 2,747,872 | $ 1,500 | $ (2,583,000) | -1566.7% | 29.1% | 5 | Medicare reimbursement is lower as DSH and other initiatives take hold | ||
| Total | 221,727 | 100% | $ 4,500 | $ 997,772,073 | $ 363,134,396 | $ 332,590,691 | $ 1,500 | $ 30,543,705 | 8.4% | 6 | Exchanges are paid commercial rates | |||
| St. Sebastian Healthcare | ||||||||||||||
| Pt. Visits | % of visits | Chg/Svc | Gross Rev | Net Rev | Costs | Cost/Svc | Margin | Margin (%) | ||||||
| Commercial | 110,629 | 49% | $ 4,650 | $ 514,424,317 | $ 257,212,159 | $ 198,578,849 | $ 1,795 | $ 58,633,309 | 22.8% | 31.6% | ||||
| Medicare | 100,200 | 44% | $ 4,650 | $ 465,930,000 | $ 130,460,400 | $ 179,859,000 | $ 1,795 | $ (49,398,600) | -37.9% | 39.5% | ||||
| Medicaid | 14,563 | 6% | $ 4,650 | $ 67,717,866 | $ 16,929,467 | $ 26,140,553 | $ 1,795 | $ (9,211,086) | -54.4% | 6.4% | ||||
| Self-Pay | 760 | 0% | $ 4,650 | $ 3,532,021 | $ 70,640 | $ 1,363,436 | $ 1,795 | $ (1,292,796) | -1830.1% | 12.1% | ||||
| Total | 226,151 | 100% | $ 4,650 | $ 1,051,604,205 | $ 404,672,666 | $ 405,941,838 | $ 1,795 | $ (1,269,173) | -0.3% | |||||
| General Pediatric Hospital | ||||||||||||||
| Pt. Visits | % of visits | Chg/Svc | Gross Rev | Net Rev | Costs | Cost/Svc | Margin | Margin (%) | ||||||
| Commercial | 78,156 | 37% | $ 5,000 | $ 390,778,650 | $ 312,622,920 | $ 164,127,033 | $ 2,100 | $ 148,495,887 | 47.5% | 22.3% | ||||
| Medicare | 3,500 | 2% | $ 5,000 | $ 17,500,000 | $ 4,900,000 | $ 7,350,000 | $ 2,100 | $ (2,450,000) | -50.0% | 1.4% | ||||
| Medicaid | 131,067 | 61% | $ 5,000 | $ 655,334,190 | $ 163,833,548 | $ 275,240,360 | $ 2,100 | $ (111,406,812) | -68.0% | 57.8% | ||||
| Self-Pay | 1,340 | 1% | $ 5,000 | $ 6,702,128 | $ 134,043 | $ 2,814,894 | $ 2,100 | $ (2,680,851) | -2000.0% | 21.3% | ||||
| Total | 214,063 | 100% | $ 5,000 | $ 1,070,314,968 | $ 481,490,510 | $ 449,532,286 | $ 2,100 | $ 31,958,224 | 6.6% | |||||
| General University Hospital | ||||||||||||||
| Pt. Visits | % of visits | Chg/Svc | Gross Rev | Net Rev | Costs | Cost/Svc | Margin | Margin (%) | ||||||
| Commercial | 71,551 | 41% | $ 5,750 | $ 411,418,367 | $ 205,709,184 | $ 134,158,163 | $ 1,875 | $ 71,551,020 | 34.8% | 20.4% | ||||
| Medicare | 46,000 | 26% | $ 5,750 | $ 264,500,000 | $ 74,060,000 | $ 86,250,000 | $ 1,875 | $ (12,190,000) | -16.5% | 18.1% | ||||
| Medicaid | 55,339 | 32% | $ 5,750 | $ 318,201,157 | $ 79,550,289 | $ 103,761,247 | $ 1,875 | $ (24,210,958) | -30.4% | 24.4% | ||||
| Self-Pay | 2,368 | 1% | $ 5,750 | $ 13,616,489 | $ 272,330 | $ 4,440,160 | $ 1,875 | $ (4,167,830) | -1530.4% | 37.6% | ||||
| Total | 175,258 | 100% | $ 5,750 | $ 1,007,736,014 | $ 359,591,803 | $ 328,609,570 | $ 1,875 | $ 30,982,233 | 8.6% | |||||
| Total Community | ||||||||||||||
| Pt. Visits | % of visits | Chg/Svc | Gross Rev | Net Rev | Costs | Cost/Svc | Margin | Margin (%) | ||||||
| Commercial | 350600 | 42% | $ 4,914 | $ 1,722,810,973 | $ 978,639,082 | $ 632,260,592 | $ 1,803 | $ 346,378,490 | 35.4% | |||||
| Medicare | 253700 | 30% | $ 4,793 | $ 1,215,930,000 | $ 340,460,400 | $ 429,459,000 | $ 1,693 | $ (88,998,600) | -26.1% | |||||
| Medicaid | 226600 | 27% | $ 5,104 | $ 1,156,592,031 | $ 289,148,008 | $ 443,588,432 | $ 1,958 | $ (154,440,424) | -53.4% | |||||
| Self-Pay | 6300 | 1% | $ 5,094 | $ 32,094,255 | $ 641,885 | $ 11,366,362 | $ 1,804 | $ (10,724,477) | -1670.8% | |||||
| Total | 837,200 | 100% | $ 4,930 | $ 4,127,427,259 | $ 1,608,889,374 | $ 1,516,674,385 | $ 1,812 | $ 92,214,989 | 5.7% |
2025Exchange
| 2025Exchange | ||||||||||||||
| Mercy | Assumptions: | |||||||||||||
| Mercy | Pt. Visits | % of visits | Chg/Svc | Gross Rev | Net Rev | Costs | Cost/Svc | Margin | Margin (%) | % of market | 1 | Regional Self Pay goes from 70,500 to 6,300 visits | ||
| Commercial | 67,698 | 31% | $ 4,500 | $ 304,642,229 | $ 152,321,115 | $ 101,547,410 | $ 1,500 | $ 50,773,705 | 33.3% | 25.7% | 2 | Remaining Self-pay volume goes to Medicaid (32,100) and Commercial(32,100) | ||
| Exchange | 22,566 | 10% | $ 4,500 | $ 101,547,410 | $ 34,119,930 | $ 33,849,137 | $ 1,500 | $ 270,793 | 0.8% | 25.7% | 3 | That volume shifts to hospitals accordning to previous year's share of Mediacid/Comm'l | ||
| Medicare | 104,000 | 47% | $ 4,500 | $ 468,000,000 | $ 131,040,000 | $ 156,000,000 | $ 1,500 | $ (24,960,000) | -19.0% | 41.0% | 4 | Hospitals have same cost structure and % market share by payer class | ||
| Medicaid | 25,631 | 12% | $ 4,500 | $ 115,338,817 | $ 28,834,704 | $ 38,446,272 | $ 1,500 | $ (9,611,568) | -33.3% | 11.3% | 5 | Medicare reimbursement is lower as DSH and other initiatives take hold | ||
| Self-Pay | 1,832 | 1% | $ 4,500 | $ 8,243,617 | $ 164,872 | $ 2,747,872 | $ 1,500 | $ (2,583,000) | -1566.7% | 29.1% | 6 | Exchanges are paid at 120% of Medicare rates | ||
| Total | 221,727 | 100% | $ 4,500 | $ 997,772,073 | $ 346,480,621 | $ 332,590,691 | $ 1,500 | $ 13,889,930 | 4.0% | 7 | 25% of commercial lives in the exchanges | |||
| St. Sebastian Healthcare | ||||||||||||||
| Pt. Visits | % of visits | Chg/Svc | Gross Rev | Net Rev | Costs | Cost/Svc | Margin | Margin (%) | ||||||
| Commercial | 82,972 | 37% | $ 4,650 | $ 385,818,238 | $ 192,909,119 | $ 148,934,137 | $ 1,795 | $ 43,974,982 | 22.8% | 31.6% | ||||
| Exchange | 27,657 | 12% | $ 4,650 | $ 128,606,079 | $ 43,211,643 | $ 49,644,712 | $ 1,795 | $ (6,433,070) | -14.9% | 31.6% | ||||
| Medicare | 100,200 | 44% | $ 4,650 | $ 465,930,000 | $ 130,460,400 | $ 179,859,000 | $ 1,795 | $ (49,398,600) | -37.9% | 39.5% | ||||
| Medicaid | 14,563 | 6% | $ 4,650 | $ 67,717,866 | $ 16,929,467 | $ 26,140,553 | $ 1,795 | $ (9,211,086) | -54.4% | 6.4% | ||||
| Self-Pay | 760 | 0% | $ 4,650 | $ 3,532,021 | $ 70,640 | $ 1,363,436 | $ 1,795 | $ (1,292,796) | -1830.1% | 12.1% | ||||
| Total | 226,151 | 100% | $ 4,650 | $ 1,051,604,205 | $ 383,581,269 | $ 405,941,838 | $ 1,795 | $ (22,360,570) | -5.8% | |||||
| General Pediatric Hospital | ||||||||||||||
| Pt. Visits | % of visits | Chg/Svc | Gross Rev | Net Rev | Costs | Cost/Svc | Margin | Margin (%) | ||||||
| Commercial | 58,617 | 27% | $ 5,000 | $ 293,083,987 | $ 234,467,190 | $ 123,095,275 | $ 2,100 | $ 111,371,915 | 47.5% | 22.3% | ||||
| Exchange | 19,539 | 9% | $ 5,000 | $ 97,694,662 | $ 32,825,407 | $ 41,031,758 | $ 2,100 | $ (8,206,352) | -25.0% | 22.3% | ||||
| Medicare | 3,500 | 2% | $ 5,000 | $ 17,500,000 | $ 4,900,000 | $ 7,350,000 | $ 2,100 | $ (2,450,000) | -50.0% | 1.4% | ||||
| Medicaid | 131,067 | 61% | $ 5,000 | $ 655,334,190 | $ 163,833,548 | $ 275,240,360 | $ 2,100 | $ (111,406,812) | -68.0% | 57.8% | ||||
| Self-Pay | 1,340 | 1% | $ 5,000 | $ 6,702,128 | $ 134,043 | $ 2,814,894 | $ 2,100 | $ (2,680,851) | -2000.0% | 21.3% | ||||
| Total | 214,063 | 100% | $ 5,000 | $ 1,070,314,968 | $ 436,160,187 | $ 449,532,286 | $ 2,100 | $ (13,372,100) | -3.1% | |||||
| General University Hospital | ||||||||||||||
| Pt. Visits | % of visits | Chg/Svc | Gross Rev | Net Rev | Costs | Cost/Svc | Margin | Margin (%) | ||||||
| Commercial | 53,663 | 31% | $ 5,750 | $ 308,563,776 | $ 154,281,888 | $ 100,618,622 | $ 1,875 | $ 53,663,265 | 34.8% | 20.4% | ||||
| Exchange | 17,888 | 10% | $ 5,750 | $ 102,854,592 | $ 34,559,143 | $ 33,539,541 | $ 1,875 | $ 1,019,602 | 3.0% | 20.4% | ||||
| Medicare | 46,000 | 26% | $ 5,750 | $ 264,500,000 | $ 74,060,000 | $ 86,250,000 | $ 1,875 | $ (12,190,000) | -16.5% | 18.1% | ||||
| Medicaid | 55,339 | 32% | $ 5,750 | $ 318,201,157 | $ 79,550,289 | $ 103,761,247 | $ 1,875 | $ (24,210,958) | -30.4% | 24.4% | ||||
| Self-Pay | 2,368 | 1% | $ 5,750 | $ 13,616,489 | $ 272,330 | $ 4,440,160 | $ 1,875 | $ (4,167,830) | -1530.4% | 37.6% | ||||
| Total | 175,258 | 100% | $ 5,750 | $ 1,007,736,014 | $ 342,723,650 | $ 328,609,570 | $ 1,875 | $ 14,114,080 | 4.1% | |||||
| Total Community | ||||||||||||||
| Pt. Visits | % of visits | Chg/Svc | Gross Rev | Net Rev | Costs | Cost/Svc | Margin | Margin (%) | ||||||
| Commercial | 262950 | 31% | $ 4,914 | $ 1,292,108,230 | $ 733,979,311 | $ 474,195,444 | $ 1,803 | $ 259,783,867 | 35.4% | |||||
| Exchange | 87650 | 10% | $ 4,914 | $ 430,702,743 | $ 144,716,122 | $ 158,065,148 | $ 1,803 | $ (13,349,026) | -9.2% | |||||
| Medicare | 253700 | 30% | $ 4,793 | $ 1,215,930,000 | $ 340,460,400 | $ 429,459,000 | $ 1,693 | $ (88,998,600) | -26.1% | |||||
| Medicaid | 226600 | 27% | $ 5,104 | $ 1,156,592,031 | $ 289,148,008 | $ 443,588,432 | $ 1,958 | $ (154,440,424) | -53.4% | |||||
| Self-Pay | 6300 | 1% | $ 5,094 | $ 32,094,255 | $ 641,885 | $ 11,366,362 | $ 1,804 | $ (10,724,477) | -1670.8% | |||||
| Total | 837,200 | 100% | $ 4,930 | $ 4,127,427,259 | $ 1,508,945,726 | $ 1,516,674,385 | $ 1,812 | $ (7,728,660) | -0.5% |
2025ExchangeSS75
| 2025Exchange - St. Sebastian 75% | ||||||||||||||
| Mercy | Assumptions: | |||||||||||||
| Mercy | Pt. Visits | % of visits | Chg/Svc | Gross Rev | Net Rev | Costs | Cost/Svc | Margin | Margin (%) | % of market | 1 | Regional Self Pay goes from 70,500 to 6,300 visits | ||
| Commercial | 2 | Remaining Self-pay volume goes to Medicaid (32,100) and Commercial(32,100) | ||||||||||||
| Exchange | 3 | That volume shifts to hospitals accordning to previous year's share of Mediacid/Comm'l | ||||||||||||
| Medicare | 4 | Hospitals have same cost structure and % market share by payer class | ||||||||||||
| Medicaid | 5 | Medicare reimbursement is lower as DSH and other initiatives take hold | ||||||||||||
| Self-Pay | 6 | Exchanges are paid at 120% of Medicare rates | ||||||||||||
| Total | 7 | 25% of commercial lives in the exchanges | ||||||||||||
| 8 | St. Sebastian takes 75% of exchange visits; Ped takes same; others split the rest | |||||||||||||
| St. Sebastian Healthcare | ||||||||||||||
| Pt. Visits | % of visits | Chg/Svc | Gross Rev | Net Rev | Costs | Cost/Svc | Margin | Margin (%) | ||||||
| Commercial | ||||||||||||||
| Exchange | ||||||||||||||
| Medicare | ||||||||||||||
| Medicaid | ||||||||||||||
| Self-Pay | ||||||||||||||
| Total | ||||||||||||||
| General Pediatric Hospital | ||||||||||||||
| Pt. Visits | % of visits | Chg/Svc | Gross Rev | Net Rev | Costs | Cost/Svc | Margin | Margin (%) | ||||||
| Commercial | ||||||||||||||
| Exchange | ||||||||||||||
| Medicare | ||||||||||||||
| Medicaid | ||||||||||||||
| Self-Pay | ||||||||||||||
| Total | ||||||||||||||
| General University Hospital | ||||||||||||||
| Pt. Visits | % of visits | Chg/Svc | Gross Rev | Net Rev | Costs | Cost/Svc | Margin | Margin (%) | ||||||
| Commercial | ||||||||||||||
| Exchange | ||||||||||||||
| Medicare | ||||||||||||||
| Medicaid | ||||||||||||||
| Self-Pay | ||||||||||||||
| Total | ||||||||||||||
| Total Community | ||||||||||||||
| Pt. Visits | % of visits | Chg/Svc | Gross Rev | Net Rev | Costs | Cost/Svc | Margin | Margin (%) | ||||||
| Commercial | ||||||||||||||
| Exchange | ||||||||||||||
| Medicare | ||||||||||||||
| Medicaid | ||||||||||||||
| Self-Pay | ||||||||||||||
| Total |
2025ExchangeMercy75
| 2025Exchange - Mercy 75% | ||||||||||||||
| Mercy | Assumptions: | |||||||||||||
| Mercy | Pt. Visits | % of visits | Chg/Svc | Gross Rev | Net Rev | Costs | Cost/Svc | Margin | Margin (%) | % of market | 1 | Regional Self Pay goes from 70,500 to 6,300 visits | ||
| Commercial | 2 | Remaining Self-pay volume goes to Medicaid (32,100) and Commercial(32,100) | ||||||||||||
| Exchange | 3 | That volume shifts to hospitals accordning to previous year's share of Mediacid/Comm'l | ||||||||||||
| Medicare | 4 | Hospitals have same cost structure and % market share by payer class | ||||||||||||
| Medicaid | 5 | Medicare reimbursement is lower as DSH and other initiatives take hold | ||||||||||||
| Self-Pay | 6 | Exchanges are paid at 120% of Medicare rates | ||||||||||||
| Total | 7 | 25% of commercial lives in the exchanges | ||||||||||||
| 8 | Mercy takes 75% of exchange visits; Ped takes same; others split the rest | |||||||||||||
| St. Sebastian Healthcare | ||||||||||||||
| Pt. Visits | % of visits | Chg/Svc | Gross Rev | Net Rev | Costs | Cost/Svc | Margin | Margin (%) | ||||||
| Commercial | ||||||||||||||
| Exchange | ||||||||||||||
| Medicare | ||||||||||||||
| Medicaid | ||||||||||||||
| Self-Pay | ||||||||||||||
| Total | ||||||||||||||
| General Pediatric Hospital | ||||||||||||||
| Pt. Visits | % of visits | Chg/Svc | Gross Rev | Net Rev | Costs | Cost/Svc | Margin | Margin (%) | ||||||
| Commercial | ||||||||||||||
| Exchange | ||||||||||||||
| Medicare | ||||||||||||||
| Medicaid | ||||||||||||||
| Self-Pay | ||||||||||||||
| Total | ||||||||||||||
| General University Hospital | ||||||||||||||
| Pt. Visits | % of visits | Chg/Svc | Gross Rev | Net Rev | Costs | Cost/Svc | Margin | Margin (%) | ||||||
| Commercial | ||||||||||||||
| Exchange | ||||||||||||||
| Medicare | ||||||||||||||
| Medicaid | ||||||||||||||
| Self-Pay | ||||||||||||||
| Total | ||||||||||||||
| Total Community | ||||||||||||||
| Pt. Visits | % of visits | Chg/Svc | Gross Rev | Net Rev | Costs | Cost/Svc | Margin | Margin (%) | ||||||
| Commercial | ||||||||||||||
| Exchange | ||||||||||||||
| Medicare | ||||||||||||||
| Medicaid | ||||||||||||||
| Self-Pay | ||||||||||||||
| Total |
2025BaselineFixed
| 2025BaselineFixed | ||||||||||||||
| Mercy | Assumptions: | |||||||||||||
| Mercy | Pt. Visits | % of visits | Chg/Svc | Gross Rev | Net Rev | Costs | Cost/Svc | Margin | Margin (%) | % of market | 1 | Regional Self Pay goes from 70,500 to 6,300 visits | ||
| Commercial | 2 | Remaining Self-pay volume goes to Medicaid (32,100) and Commercial(32,100) | ||||||||||||
| Medicare | 3 | That volume shifts to hospitals accordning to previous year's share of Mediacid/Comm'l | ||||||||||||
| Medicaid | 4 | Hospitals have same cost structure and % market share by payer class | ||||||||||||
| Self-Pay | 5 | Medicare reimbursement is lower as DSH and other initiatives take hold | ||||||||||||
| Total | 6 | Exchanges are paid commercial rates | ||||||||||||
| 7 | Costs for each hospital are fixed overall | |||||||||||||
| St. Sebastian Healthcare | ||||||||||||||
| Pt. Visits | % of visits | Chg/Svc | Gross Rev | Net Rev | Costs | Cost/Svc | Margin | Margin (%) | ||||||
| Commercial | ||||||||||||||
| Medicare | ||||||||||||||
| Medicaid | ||||||||||||||
| Self-Pay | ||||||||||||||
| Total | ||||||||||||||
| General Pediatric Hospital | ||||||||||||||
| Pt. Visits | % of visits | Chg/Svc | Gross Rev | Net Rev | Costs | Cost/Svc | Margin | Margin (%) | ||||||
| Commercial | ||||||||||||||
| Medicare | ||||||||||||||
| Medicaid | ||||||||||||||
| Self-Pay | ||||||||||||||
| Total | ||||||||||||||
| General University Hospital | ||||||||||||||
| Pt. Visits | % of visits | Chg/Svc | Gross Rev | Net Rev | Costs | Cost/Svc | Margin | Margin (%) | ||||||
| Commercial | ||||||||||||||
| Medicare | ||||||||||||||
| Medicaid | ||||||||||||||
| Self-Pay | ||||||||||||||
| Total | ||||||||||||||
| Total Community | ||||||||||||||
| Pt. Visits | % of visits | Chg/Svc | Gross Rev | Net Rev | Costs | Cost/Svc | Margin | Margin (%) | ||||||
| Commercial | ||||||||||||||
| Medicare | ||||||||||||||
| Medicaid | ||||||||||||||
| Self-Pay | ||||||||||||||
| Total |
2025ExchangeFixed
| 2025ExchangeFixed | ||||||||||||||
| Mercy | Assumptions: | |||||||||||||
| Mercy | Pt. Visits | % of visits | Chg/Svc | Gross Rev | Net Rev | Costs | Cost/Svc | Margin | Margin (%) | % of market | 1 | Regional Self Pay goes from 70,500 to 6,300 visits | ||
| Commercial | 2 | Remaining Self-pay volume goes to Medicaid (32,100) and Commercial(32,100) | ||||||||||||
| Exchange | 3 | That volume shifts to hospitals accordning to previous year's share of Mediacid/Comm'l | ||||||||||||
| Medicare | 4 | Hospitals have same cost structure and % market share by payer class | ||||||||||||
| Medicaid | 5 | Medicare reimbursement is lower as DSH and other initiatives take hold | ||||||||||||
| Self-Pay | 6 | Exchanges are paid at 120% of Medicare rates | ||||||||||||
| Total | 7 | 25% of commercial lives in the exchanges | ||||||||||||
| 8 | Costs for each hospital are fixed overall | |||||||||||||
| St. Sebastian Healthcare | ||||||||||||||
| Pt. Visits | % of visits | Chg/Svc | Gross Rev | Net Rev | Costs | Cost/Svc | Margin | Margin (%) | ||||||
| Commercial | ||||||||||||||
| Exchange | ||||||||||||||
| Medicare | ||||||||||||||
| Medicaid | ||||||||||||||
| Self-Pay | ||||||||||||||
| Total | ||||||||||||||
| General Pediatric Hospital | ||||||||||||||
| Pt. Visits | % of visits | Chg/Svc | Gross Rev | Net Rev | Costs | Cost/Svc | Margin | Margin (%) | ||||||
| Commercial | ||||||||||||||
| Exchange | ||||||||||||||
| Medicare | ||||||||||||||
| Medicaid | ||||||||||||||
| Self-Pay | ||||||||||||||
| Total | ||||||||||||||
| General University Hospital | ||||||||||||||
| Pt. Visits | % of visits | Chg/Svc | Gross Rev | Net Rev | Costs | Cost/Svc | Margin | Margin (%) | ||||||
| Commercial | ||||||||||||||
| Exchange | ||||||||||||||
| Medicare | ||||||||||||||
| Medicaid | ||||||||||||||
| Self-Pay | ||||||||||||||
| Total | ||||||||||||||
| Total Community | ||||||||||||||
| Pt. Visits | % of visits | Chg/Svc | Gross Rev | Net Rev | Costs | Cost/Svc | Margin | Margin (%) | ||||||
| Commercial | ||||||||||||||
| Exchange | ||||||||||||||
| Medicare | ||||||||||||||
| Medicaid | ||||||||||||||
| Self-Pay | ||||||||||||||
| Total |
2025ExchangeSS75Fixed
| 2025Exchange - St. Sebastian 75% Fixed | ||||||||||||||
| Mercy | Assumptions: | |||||||||||||
| Mercy | Pt. Visits | % of visits | Chg/Svc | Gross Rev | Net Rev | Costs | Cost/Svc | Margin | Margin (%) | % of market | 1 | Regional Self Pay goes from 70,500 to 6,300 visits | ||
| Commercial | 2 | Remaining Self-pay volume goes to Medicaid (32,100) and Commercial(32,100) | ||||||||||||
| Exchange | 3 | That volume shifts to hospitals accordning to previous year's share of Mediacid/Comm'l | ||||||||||||
| Medicare | 4 | Hospitals have same cost structure and % market share by payer class | ||||||||||||
| Medicaid | 5 | Medicare reimbursement is lower as DSH and other initiatives take hold | ||||||||||||
| Self-Pay | 6 | Exchanges are paid at 120% of Medicare rates | ||||||||||||
| Total | 7 | 25% of commercial lives in the exchanges | ||||||||||||
| 8 | St. Sebastian takes 75% of exchange visits; Ped takes same; others split the rest | |||||||||||||
| St. Sebastian Healthcare | 9 | Costs for each hospital are fixed overall | ||||||||||||
| Pt. Visits | % of visits | Chg/Svc | Gross Rev | Net Rev | Costs | Margin | Margin (%) | |||||||
| Commercial | ||||||||||||||
| Exchange | ||||||||||||||
| Medicare | ||||||||||||||
| Medicaid | ||||||||||||||
| Self-Pay | ||||||||||||||
| Total | ||||||||||||||
| General Pediatric Hospital | ||||||||||||||
| Pt. Visits | % of visits | Chg/Svc | Gross Rev | Net Rev | Costs | Cost/Svc | Margin | Margin (%) | ||||||
| Commercial | ||||||||||||||
| Exchange | ||||||||||||||
| Medicare | ||||||||||||||
| Medicaid | ||||||||||||||
| Self-Pay | ||||||||||||||
| Total | ||||||||||||||
| General University Hospital | ||||||||||||||
| Pt. Visits | % of visits | Chg/Svc | Gross Rev | Net Rev | Costs | Cost/Svc | Margin | Margin (%) | ||||||
| Commercial | ||||||||||||||
| Exchange | ||||||||||||||
| Medicare | ||||||||||||||
| Medicaid | ||||||||||||||
| Self-Pay | ||||||||||||||
| Total | ||||||||||||||
| Total Community | ||||||||||||||
| Pt. Visits | % of visits | Chg/Svc | Gross Rev | Net Rev | Costs | Cost/Svc | Margin | Margin (%) | ||||||
| Commercial | ||||||||||||||
| Exchange | ||||||||||||||
| Medicare | ||||||||||||||
| Medicaid | ||||||||||||||
| Self-Pay | ||||||||||||||
| Total |
2025ExchangeMercy75Fixed
| 2025Exchange - Mercy 75% Fixed | ||||||||||||||
| Mercy | Assumptions: | |||||||||||||
| Mercy | Pt. Visits | % of visits | Chg/Svc | Gross Rev | Net Rev | Costs | Cost/Svc | Margin | Margin (%) | % of market | 1 | Regional Self Pay goes from 70,500 to 6,300 visits | ||
| Commercial | 2 | Remaining Self-pay volume goes to Medicaid (32,100) and Commercial(32,100) | ||||||||||||
| Exchange | 3 | That volume shifts to hospitals accordning to previous year's share of Mediacid/Comm'l | ||||||||||||
| Medicare | 4 | Hospitals have same cost structure and % market share by payer class | ||||||||||||
| Medicaid | 5 | Medicare reimbursement is lower as DSH and other initiatives take hold | ||||||||||||
| Self-Pay | 6 | Exchanges are paid at 120% of Medicare rates | ||||||||||||
| Total | 7 | 25% of commercial lives in the exchanges | ||||||||||||
| 8 | Mercy takes 75% of exchange visits; Ped takes same; others split the rest | |||||||||||||
| St. Sebastian Healthcare | 9 | Costs for each hospital are fixed overall | ||||||||||||
| Pt. Visits | % of visits | Chg/Svc | Gross Rev | Net Rev | Costs | Cost/Svc | Margin | Margin (%) | ||||||
| Commercial | ||||||||||||||
| Exchange | ||||||||||||||
| Medicare | ||||||||||||||
| Medicaid | ||||||||||||||
| Self-Pay | ||||||||||||||
| Total | ||||||||||||||
| General Pediatric Hospital | ||||||||||||||
| Pt. Visits | % of visits | Chg/Svc | Gross Rev | Net Rev | Costs | Cost/Svc | Margin | Margin (%) | ||||||
| Commercial | ||||||||||||||
| Exchange | ||||||||||||||
| Medicare | ||||||||||||||
| Medicaid | ||||||||||||||
| Self-Pay | ||||||||||||||
| Total | ||||||||||||||
| General University Hospital | ||||||||||||||
| Pt. Visits | % of visits | Chg/Svc | Gross Rev | Net Rev | Costs | Cost/Svc | Margin | Margin (%) | ||||||
| Commercial | ||||||||||||||
| Exchange | ||||||||||||||
| Medicare | ||||||||||||||
| Medicaid | ||||||||||||||
| Self-Pay | ||||||||||||||
| Total | ||||||||||||||
| Total Community | ||||||||||||||
| Pt. Visits | % of visits | Chg/Svc | Gross Rev | Net Rev | Costs | Cost/Svc | Margin | Margin (%) | ||||||
| Commercial | ||||||||||||||
| Exchange | ||||||||||||||
| Medicare | ||||||||||||||
| Medicaid | ||||||||||||||
| Self-Pay | ||||||||||||||
| Total |
