Top 25 IDNs by net patient revenue

Integrated delivery networks (IDNs), or 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.

25 largest IDNs in the U.S. in 2021

IDN Name Definitive ID State Net Patient Revenue # of Hospitals # of Discharges

HCA Healthcare

4710

TN

$42,945,358,828

211

1,857,196

CommonSpirit Health

981465

IL

$29,813,296,010

198

895,823

Ascension Health

4695

MO

$22,587,431,574

133

753,721

Providence St Joseph Health

4716

WA

$16,232,451,121

58

407,267

Trinity Health

4712

MI

$15,118,643,048

69

557,467

University of California Health

560423

CA

$14,875,522,334

22

166,227

Tenet Healthcare

4685

TX

$13,214,321,067

83

525,445

Dignity Health

4698

CA

$12,991,195,170

50

373,166

Community Health Systems

542233

TN

$9,909,230,808

90

420,393

LifePoint Health

7004

TN

$9,553,925,272

151

291,429

AdventHealth

4694

FL

$9,044,810,859

43

320,888

Northwell Health

4744

NY

$8,937,459,144

20

228,051

University of Pittsburgh Medical Center

6448

PA

$8,928,278,852

36

252,220

Cleveland Clinic Health System

274173

OH

$8,808,677,158

21

224,692

Atrium Health

4697

NC

$8,725,276,358

39

255,039

Universal Health Services

7055

PA

$8,696,950,743

179

675,582

Advocate Aurora Health

965729

IL

$8,211,691,653

30

246,144

NYU Langone Health

579801

NY

$8,208,565,651

8

151,738

NewYork-Presbyterian Healthcare System

7066

NY

$7,964,971,495

13

182,437

Baylor Scott & White Health

577357

TX

$7,923,033,422

50

208,844

Sutter Health

4717

CA

$7,712,003,148

29

167,312

Mass General Brigham

7001

MA

$7,690,293,965

16

147,300

Mayo Clinic

7104

MN

$7,643,977,864

21

110,658

Bon Secours Mercy Health

975303

OH

$7,604,910,882

39

273,008

BHSH System

1044485

MI

$7,275,008,167

22

222,728

Fig. 1 – Data from the Definitive Healthcare HospitalView product. Net patient revenue is an aggregate of member hospital financial information from the January 2022 Medicare Cost Report release. The next scheduled Medicare Cost Report release is April 2022. Data is accurate as of March 2022. 

Which IDNs have the highest net patient revenue?

With 211 member hospitals and a total net patient revenue of $42.9 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 $29.8 billion and $22.5 billion in net patient revenue reported as of the January 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. Fourteen of the top IDNs, or 56%, 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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