Top 50 IDNs by operating expenses

Integrated delivery networks (IDNs) are health systems with multiple healthcare facilities, including a variety of care settings and services. The largest of these organizations operate hundreds of facilities and incur high costs in providing patient care.  Understanding and managing expenses are more important than ever as hospitals saw revenue decreases and increases in medical supply and contract labor expenses in 2020.

What is the average IDN operating expense?

The Definitive Healthcare HospitalView product tracks operating expenses for over 860 IDNs. The figure is aggregated from the Medicare Cost Report for the health system’s member hospitals. Among these 860 IDNs, the average annual total operating expense is $1.48 billion.

The following table lists the top 50 IDNs in the U.S. by total operating expenses. The figures used for IDN expenses is based on a hospital’s most recent Medicare Cost Report, which can include both 2020 and 2021 data.

Top IDNs by total operating expenses

Rank Definitive ID IDN Name Location Number of hospitals Total operating expenses
1 4710 HCA Healthcare Nashville, TN 211 $35,048,672,786
2 981465 CommonSpirit Health Chicago, IL 162 $29,527,047,966
3 4695 Ascension Health Saint Louis, MO 130 $21,339,186,067
4 4712 Trinity Health Livonia, MI 107 $19,981,313,189
5 4716 Providence St Joseph Health Renton, WA 57 $17,625,680,141
6 560423 University of California Health Oakland, CA 22 $15,494,599,713
7 4698 Dignity Health San Francisco, CA 50 $13,867,408,971
8 4685 Tenet Healthcare Dallas, TX 82 $12,207,633,149
9 4744 Northwell Health New Hyde Park, NY 20 $12,085,937,329
10 7001 Mass General Brigham Boston, MA 16 $11,298,833,558
11 274173 Cleveland Clinic Health System Cleveland, OH 21 $10,268,981,126
12 7066 NewYork-Presbyterian Healthcare System New York, NY 13 $10,083,031,799
13 4694 AdventHealth Altamonte Springs, FL 47 $9,744,976,276
14 6448 University of Pittsburgh Medical Center (UPMC) Pittsburgh, PA 36 $9,737,630,346
15 7112 NYC Health and Hospitals New York, NY 12 $9,502,262,194
16 579801 NYU Langone Health New York, NY 8 $9,069,184,934
17 542233 Community Health Systems (CHS) Franklin, TN 90 $8,959,434,343
18 4697 Atrium Health Charlotte, NC 39 $8,452,014,470
19 7055 Universal Health Services King Of Prussia, PA 179 $8,034,898,815
20 4717 Sutter Health Sacramento, CA 29 $7,956,143,613
21 577357 Baylor Scott & White Health Dallas, TX 50 $7,859,317,174
22 965729 Advocate Aurora Health Downers Grove, IL 30 $7,747,702,248
23 938977 Stanford Medicine Stanford, CA 4 $7,493,083,072
24 274141 University of Texas System Austin, TX 11 $7,448,872,061
25 1045820 HCA Florida Healthcare Aventura, FL 47 $7,379,827,850
26 975303 Bon Secours Mercy Health Cincinnati, OH 39 $7,365,570,946
27 4727 Intermountain Healthcare Salt Lake City, UT 32 $7,354,040,780
28 1044485 BHSH System Grand Rapids, MI 22 $7,303,871,221
29 7033 Penn Medicine Philadelphia, PA 12 $6,997,382,600
30 7104 Mayo Clinic Rochester, MN 21 $6,880,465,454
31 577655 Mount Sinai Health System New York, NY 10 $6,515,223,738
32 4732 Banner Health Phoenix, AZ 35 $6,508,920,392
33 7004 LifePoint Health Brentwood, TN 74 $6,447,735,486
34 2754 Montefiore Health System Bronx, NY 10 $6,043,515,393
35 7012 Indiana University Health Indianapolis, IN 18 $5,809,430,893
36 550112 Northwestern Medicine Chicago, IL 12 $5,625,996,921
37 829072 Stanford Health Care Stanford, CA 2 $5,609,678,997
38 542209 Vanderbilt Health Nashville, TN 7 $5,575,114,126
39 835851 RWJBarnabas Health West Orange, NJ 18 $5,557,242,822
40 4702 CHRISTUS Health Irving, TX 38 $5,517,947,916
41 274282 UNC Health Chapel Hill, NC 23 $5,495,434,841
42 4767 Yale New Haven Health System New Haven, CT 11 $5,486,300,135
43 7210 Jefferson Health Philadelphia, PA 16 $5,476,184,404
44 551802 University of California San Francisco Health System San Francisco, CA 9 $5,302,376,605
45 7017 Memorial Hermann Health System Houston, TX 19 $5,284,947,223
46 829066 Hackensack Meridian Health Edison, NJ 17 $5,259,058,701
47 551851 Cedars-Sinai Health System Los Angeles, CA 4 $5,218,004,050
48 7228 Northside Hospital System Atlanta, GA 6 $5,050,501,771
49 7213 Johns Hopkins Health System Baltimore, MD 6 $5,044,766,414
50 6446 SSM Health Saint Louis, MO 34 $5,038,940,741

Fig. 1 Data is from the Definitive Healthcare HospitalView product. IDN data is aggregated from hospital Medicare Cost Report financials. Data accurate as of May 2022.

Total operating expenses at each of the top 50 IDNs are over $5 billion and average at $9.3 billion. Average net patient revenue for these IDNs is $9.2 billion.

HCA Healthcare has the highest total operating expense at over $35 billion. HCA Healthcare also has the most hospitals and discharges among IDNs across the country. Operating expenses for CommonSpirit Health approached $30 billion while Ascension Health had total costs just over $21 billion.

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