Denver Metro area hospitals posted combined profits of nearly $1.4 billion in 2020; rural hospitals faced financial devastation without economic stimulus funding
FOR IMMEDIATE RELEASE
March 30, 2022
Media Contacts
Marc Williams
Dept. of Health Care Policy & Financing
720-626-0801 (cell)
Denver, CO - Colorado hospitals continue to rank among the most profitable in the nation, making Colorado one of the most expensive states for hospital care according to the Hospital Insights Report released today by the Colorado Department of Health Care Policy & Financing (Department). Today’s report synthesizes information and findings from six recent reports on Colorado hospital financial positions.
Colorado hospital data indicates that the increase in hospital profits in pre-pandemic years largely went toward building reserves, expanding market share, and capital investments. Hospitals also received an estimated $1.07 billion in federal stimulus (a 263% increase to patient service profits). Most hospitals/systems (41 out of 45) increased or maintained days cash on hand reserves from 2019 to 2020.
“We are all thankful that Colorado’s hospitals were able to address the unprecedented challenges they have faced due to COVID-19. As we shift from pandemic response to endemic management, we have an opportunity not only to commit to hospital preparedness and workforce readiness to be ready for future crises, but also to continue our work to make care more accessible, affordable, and equitable,” said Lt. Governor Dianne Primavera, Director of the Office of Saving People Money on Health Care.
Colorado and Alaska are the only two states to rank in the top 10 for all four measures of hospital cost, price and profit. While national ranking on hospital profits remains high, they are trending lower since 2018 compared to other states.
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The higher profits are also partly due to higher reimbursements from Health First Colorado (Colorado’s Medicaid program) and health care coverage expansions, which when combined create a lower uninsured rate of approximately 6.5%. Uncompensated care remained relatively flat during the pandemic despite the economic downturn. Concurrent with coverage expansion, commercial insurance carriers reimburse hospitals $1.66 for every dollar of hospital costs driving the overall patient service payment-to-cost ratio to $1.02 and total profit margins of 9.3%. This means Colorado hospitals are overcharging commercial insurance carriers (and therefore their employer and individual clients) more than they need to cover the underpayments of public programs. The continued trend of high hospital profits ultimately results in health care costs consuming more of Coloradans’ dollars and the total state budget.
In 2020, total profit margins were 9.3% compared to 12.0% in 2019, despite the revenue volatility and unprecedented nature of the pandemic. The vast majority of Colorado hospitals (92.6%) did not record losses or a decrease in total profits from 2019 to 2020, when including federal stimulus dollars.
All national health systems with hospitals in Colorado earned a profit for every pandemic period reviewed. UCHealth and HCA HealthONE realized higher total profits than before the pandemic. UCHealth’s total profits increased from 10% in 2019, to 14.7% in 2020, to 17.4% through September 2021, with earnings on track to double between 2019 and 2021 (UCHealth $540 million in profits for 2019, $845 million in profits for 2020, and 2021 through Q3, $878 million in profits), likely on track to achieve $1 billion in profits for 2021. It’s important to note that, as a system, HCA HealthONE returned more than $6 billion of the federal stimulus dollars it received, including more than $100 million provided to its Colorado hospitals.
However, a different picture emerges when analyzing Colorado’s rural hospitals. Had it not been for federal stimulus and other non-patient sources of profit, rural hospitals would have barely broken even (0.8% patient service margins). Federal stimulus and other non-patient forms of revenue are why rural hospitals were profitable (8.9% total margins). The Department’s analysis demonstrates that rural and frontier hospitals are vulnerable to patient, revenue and expense volatility caused by pandemic surges and related economic downturns due to their low margins.
The Hospital Insights Report demonstrates a continued opportunity for Colorado hospitals to partner with the state to reduce their commercial prices and lower their overall costs, including reviewing hospitals under each system to address outliers. There is also opportunity to study and learn how hospitals spent their 2020 federal pandemic stimulus dollars to further shape future stimulus policy.
“We have a shared goal to learn from this experience, evaluate the present and create new policy to prevent the need to activate or even consider crisis standards of care in Colorado again,'' said Kim Bimestefer, executive director for the Department. “This new insights report identifies opportunities for partnership that strengthen hospitals’ pandemic readiness in a way that addresses community needs while also identifying system sustainability and affordability priorities.”
More information is needed to better evaluate hospital community investments. Colorado hospitals invested $836.3 million in community benefits in 2020, not including Medicaid underpayment shortfalls. These community investments equal 6% of hospital patient revenue received. Unfortunately, the Department does not have enough detailed information to identify where and how the state’s nonprofit, tax exempt hospitals spend their community benefit dollars, nor can it properly determine if those community benefit investments match each community's identified needs.
For more information on the 2022 Hospital Insights Report, along with previous hospital financial analysis, please visit the Department’s Hospital Reports Hub webpage.
Please register for the Colorado Health Cabinet Policy Summit happening this Thursday, March 31 at 3 p.m. (MT) where the Hospital Insights Report and the state’s pandemic readiness roadmap will be discussed in greater detail.
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About the Colorado Department of Health Care Policy & Financing: The Department administers Health First Colorado (Colorado's Medicaid program), Child Health Plan Plus, and other programs for Coloradans who qualify. For more information about the Department, please visit HCPF.Colorado.gov.