Healthcare Insights

Top 25 IDNs by net patient revenue

Integrated delivery networks (IDNs), sometimes called health systems, are organizations responsible for managing one or more healthcare facilities within a defined geographic area. These networks can vary in both size and service offerings and, because of this, may be affiliated with many different inpatient and outpatient provider types.

Some IDNs have hundreds of member facilities within their networks and can leverage their size to exert industry influence and increase their purchasing power. This allows them to negotiate supply chain costs in the same way that a group purchasing organization (GPO) would.

Below we’ve compiled a list of the top 25 largest IDNs by net patient revenue. Our list is based on the most recent 12-month interval tracked in our database.

25 largest IDNs in the U.S. by NPR in 2022

RankIDN nameCityState# of hospitalsNPR# of staffed beds# of dischargesExplore dataset
1HCA Healthcare (FKA Hospital Corporation of America)NashvilleTN209$47,440,144,679 42,3001,883,616Explore
2CommonSpirit HealthChicagoIL165$31,019,616,953 19,596827,797Explore
3Ascension HealthSaint LouisMO129$21,994,513,119 18,007730,161Explore
4Kaiser PermanenteOaklandCA43$21,466,800,788 9,773438,141Explore
5Trinity Health (FKA CHE Trinity Health)LivoniaMI105$20,146,316,427 14,550674,658Explore
6Advocate HealthCharlotteNC69$18,569,527,647 11,638508,696Explore
7Providence St Joseph Health (AKA Providence)RentonWA57$17,318,812,826 10,530410,831Explore
8University of California Health (AKA UC Health-CA)OaklandCA23$15,158,951,541 4,716165,725Explore
9Dignity HealthSan FranciscoCA52$14,235,984,061 7,648388,262Explore
10Tenet HealthcareDallasTX83$14,092,955,236 14,074526,524Explore
11AdventHealth (FKA Adventist Health System)Altamonte SpringsFL47$11,698,304,391 8,395367,164Explore
12Kaiser Permanente Northern CaliforniaOaklandCA21$11,306,310,062 4,186213,148Explore
13Cleveland Clinic Health SystemClevelandOH22$10,811,857,015 5,100237,761Explore
14Community Health Systems (AKA CHS)FranklinTN87$10,660,925,865 10,537414,426Explore
15Northwell Health (AKA North Shore Long Island Jewish Health System)New Hyde ParkNY20$10,029,546,979 5,204247,995Explore
16Universal Health ServicesKing Of PrussiaPA178$9,804,358,744 21,354695,371Explore
17University of Pittsburgh Medical Center (AKA UPMC)PittsburghPA36$9,658,186,034 7,251257,959Explore
18Kaiser Permanente Southern CaliforniaPasadenaCA15$9,499,179,595 4,622181,013Explore
19Mass General Brigham (FKA Partners HealthCare)BostonMA16$9,033,149,499 3,360151,016Explore
20Mayo ClinicRochesterMN22$8,957,642,234 3,475118,083Explore
21Mount Sinai Health System (FKA Mount Sinai Medical Center)New YorkNY10$8,766,335,585 3,293120,049Explore
22Baylor Scott & White HealthDallasTX50$8,760,492,530 4,792210,171Explore
23NewYork-Presbyterian Healthcare SystemNew YorkNY13$8,197,110,141 3,794186,232Explore
24NYC Health and Hospitals (FKA New York City Health and Hospitals Corporation)New YorkNY12$7,340,950,411 3,463122,877Explore
25University of Texas SystemAustinTX12$7,096,266,707 3,344106,168Explore

Fig. 1 – Data from the Definitive Healthcare HospitalView product. Net patient revenue is an aggregate of member hospital financial information from the October 2022 Medicare Cost Report release. Data is accurate as of February 2023. 

Which IDNs have the highest net patient revenue?

With 209 member hospitals and a total net patient revenue of $47.4 billion, Nashville-based HCA Healthcare is the largest IDN in the United States. CommonSpirit Health and Ascension Health are the second and third largest health systems by net patient revenue—with $31.0 billion and $22.0 billion in net patient revenue reported as of the October 2022 Medicare Cost Report.

We might expect that health systems with more member hospitals would report higher net patient revenues. However, 20 of the top 25 IDNs—or 80%—have fewer than 100 member hospitals. Thirteen of the top IDNs, or 52%, have fewer than 50 member facilities.

There is little correlation between the number of member hospitals and net patient revenue. It is more likely that the performance of these member hospitals is a stronger contributing factor to the financial success of the top 25 IDNs.

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