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The following table lists the top 50 IDNs in the U.S. according to total operating expenses. The IDN with the highest average daily census on our list, HCA Healthcare, leads by a significant margin with a total operating expense of over $33 billion. There is a 14% difference between the total operating costs of HCA Healthcare and CommonSpirit Health, the second IDN in the list. The difference between the second and third IDNs, CommonsSpirit Health and Kaiser Permanente, represent an even greater disparity with a 48% difference in total operating costs.

On average, the top 50 IDNs brought in more than $8.3 billion in net patient revenue during the most recent reporting period. The net patient revenue of HCA Healthcare, the largest IDN, is 138% more than the average of the top 50.

 

Top 50 IDNs by Total Operating Expenses

  IDN Name Definitive ID Total Operating Expenses Net Patient Revenue Number of Staffed Beds

1.

HCA Healthcare

4710

$33,300,008,566

$42,213,477,560

42,190

2.

CommonSpirit Health

981465

$28,888,478,741

$28,582,130,311

23,358

3.

Kaiser Permanente

4713

$17,660,010,388

$13,261,153,753

9,625

4.

Ascension Health

4695

$17,167,222,743

$17,441,876,135

16,713

5.

Providence St Joseph Health

4716

$16,315,418,947

$15,696,161,401

10,345

6.

Trinity Health

4712

$13,649,806,250

$13,132,792,081

10,471

7.

Tenet Healthcare

4685

$12,417,064,388

$13,652,040,731

15,870

8.

Dignity Health

4698

$12,106,979,191

$11,817,607,947

7,407

9.

University of California (UC) Health

560423

$12,076,399,009

$12,063,083,551

4,651

10.

Northwell Health

4744

$11,706,478,894

$9,410,545,687

6,075

11.

Kaiser Permanente Northern California

845347

$9,716,119,594

$7,224,288,886

4,163

12.

Community Health Systems

542233

$9,578,338,754

$10,516,859,767

13,783

13.

Partners HealthCare

7001

$9,384,902,385

$7,599,868,208

3,464

14.

Cleveland Clinic Health System

274173

$9,095,968,769

$8,636,380,142

4,504

15.

University of Pittsburgh Medical Center

6448

$8,284,711,893

$8,056,954,680

7,072

16.

Universal Health Services

7055

$8,083,891,361

$9,212,756,052

20,607

17.

LifePoint Health

7004

$7,869,059,572

$8,025,621,851

9,374

18.

NewYork-Presbyterian Healthcare System

7066

$7,654,676,520

$7,698,677,961

3,945

19.

AdventHealth

4694

$7,468,577,781

$7,952,813,318

8,019

20.

Bon Secours Mercy Health

975303

$7,260,348,716

$7,665,638,269

5,834

21.

Advocate Aurora Health

965729

$7,236,864,135

$8,026,280,391

6,695

22.

Baylor Scott & White Health

577357

$7,109,094,723

$7,190,163,055

4,779

23.

Atrium Health

4697

$6,850,312,196

$7,958,708,764

6,038

24.

NYC Health and Hospitals

7112

$6,809,806,459

$5,626,899,758

3,390

25.

Kaiser Permanente Southern California

845346

$6,684,088,335

$5,400,415,526

4,487

26.

Sutter Health

4717

$6,277,018,670

$6,676,610,412

4,308

27.

NYU Langone Health

579801

$5,980,491,570

$5,743,904,918

1,990

28.

Mayo Clinic

7104

$5,959,511,166

$6,881,687,038

3,561

29.

Penn Medicine

7033

$5,771,945,775

$5,674,917,621

2,758

30.

Banner Health

4732

$5,699,171,163

$5,978,246,087

5,274

31.

Mount Sinai Health System

577655

$5,692,425,783

$5,166,329,392

3,572

32.

Stanford Medicine

938977

$5,672,660,109

$5,857,963,567

942

33.

University of Texas System

274141

$5,482,915,384

$5,384,305,964

2,776

34.

Indiana University Health

7012

$5,218,549,857

$4,840,509,929

2,964

35.

University Hospitals Health System

4729

$5,076,206,993

$5,372,012,087

2,729

36.

Montefiore Health System

2754

$5,022,238,945

$3,972,696,844

3,307

37.

SSM Health

6446

$4,893,026,030

$4,763,284,753

4,519

38.

BJC HealthCare

7076

$4,875,745,564

$4,900,898,464

3,583

39.

RWJBarnabas Health

835851

$4,775,388,779

$4,823,961,325

4,269

40.

Mercy (MO)

7027

$4,575,171,446

$4,963,556,308

5,369

41.

Beth Israel Lahey Health

992199

$4,492,210,432

$4,133,231,979

2,313

42.

Hackensack Meridian Health

829066

$4,440,522,329

$4,502,658,114

4,440

43.

CHRISTUS Health

4702

$4,417,481,589

$4,458,272,875

5,574

44.

Johns Hopkins Health System

7213

$4,406,068,645

$4,406,170,200

2,290

45.

Steward Health Care System

4684

$4,331,846,541

$4,358,628,896

5,635

46.

Northwestern Medicine

550112

$4,329,442,569

$4,288,496,959

2,391

47.

Memorial Hermann Health System

7017

$4,322,955,548

$4,445,641,747

4,241

48.

University of California San Francisco Health System

551802

$4,287,577,607

$4,223,673,020

1,609

49.

Prime Healthcare Services

542003

$4,277,398,988

$4,376,608,561

6,548

50.

Intermountain Healthcare

4727

$4,246,262,963

$4,821,813,781

2,421

Fig 1. Data from Definitive Healthcare based on combined total operating expenses reported by IDN member hospitals from fiscal year 2018, the most recent data available. Data is from July 2019 Medicare Cost Report release; the next scheduled Medicare Cost Report release is October 2019.