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

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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