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.
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| IDN Name | Definitive ID | Total Operating Expenses | Net Patient Revenue | Number of Staffed Beds | Explore This Dataset | |
| 1. | HCA Healthcare | 4710 | $33,300,008,566 | $42,213,477,560 | 42,190 | Explore This Profile |
| 2. | CommonSpirit Health | 981465 | $28,888,478,741 | $28,582,130,311 | 23,358 | Explore This Profile |
| 3. | Kaiser Permanente | 4713 | $17,660,010,388 | $13,261,153,753 | 9,625 | Explore This Profile |
| 4. | Ascension Health | 4695 | $17,167,222,743 | $17,441,876,135 | 16,713 | Explore This Profile |
| 5. | Providence St Joseph Health | 4716 | $16,315,418,947 | $15,696,161,401 | 10,345 | Explore This Profile |
| 6. | Trinity Health | 4712 | $13,649,806,250 | $13,132,792,081 | 10,471 | Explore This Profile |
| 7. | Tenet Healthcare | 4685 | $12,417,064,388 | $13,652,040,731 | 15,870 | Explore This Profile |
| 8. | Dignity Health | 4698 | $12,106,979,191 | $11,817,607,947 | 7,407 | Explore This Profile |
| 9. | University of California (UC) Health | 560423 | $12,076,399,009 | $12,063,083,551 | 4,651 | Explore This Profile |
| 10. | Northwell Health | 4744 | $11,706,478,894 | $9,410,545,687 | 6,075 | Explore This Profile |
| 11. | Kaiser Permanente Northern California | 845347 | $9,716,119,594 | $7,224,288,886 | 4,163 | Explore This Profile |
| 12. | Community Health Systems | 542233 | $9,578,338,754 | $10,516,859,767 | 13,783 | Explore This Profile |
| 13. | Partners HealthCare | 7001 | $9,384,902,385 | $7,599,868,208 | 3,464 | Explore This Profile |
| 14. | Cleveland Clinic Health System | 274173 | $9,095,968,769 | $8,636,380,142 | 4,504 | Explore This Profile |
| 15. | University of Pittsburgh Medical Center | 6448 | $8,284,711,893 | $8,056,954,680 | 7,072 | Explore This Profile |
| 16. | Universal Health Services | 7055 | $8,083,891,361 | $9,212,756,052 | 20,607 | Explore This Profile |
| 17. | LifePoint Health | 7004 | $7,869,059,572 | $8,025,621,851 | 9,374 | Explore This Profile |
| 18. | NewYork-Presbyterian Healthcare System | 7066 | $7,654,676,520 | $7,698,677,961 | 3,945 | Explore This Profile |
| 19. | AdventHealth | 4694 | $7,468,577,781 | $7,952,813,318 | 8,019 | Explore This Profile |
| 20. | Bon Secours Mercy Health | 975303 | $7,260,348,716 | $7,665,638,269 | 5,834 | Explore This Profile |
| 21. | Advocate Aurora Health | 965729 | $7,236,864,135 | $8,026,280,391 | 6,695 | Explore This Profile |
| 22. | Baylor Scott & White Health | 577357 | $7,109,094,723 | $7,190,163,055 | 4,779 | Explore This Profile |
| 23. | Atrium Health | 4697 | $6,850,312,196 | $7,958,708,764 | 6,038 | Explore This Profile |
| 24. | NYC Health and Hospitals | 7112 | $6,809,806,459 | $5,626,899,758 | 3,390 | Explore This Profile |
| 25. | Kaiser Permanente Southern California | 845346 | $6,684,088,335 | $5,400,415,526 | 4,487 | Explore This Profile |
| 26. | Sutter Health | 4717 | $6,277,018,670 | $6,676,610,412 | 4,308 | Explore This Profile |
| 27. | NYU Langone Health | 579801 | $5,980,491,570 | $5,743,904,918 | 1,990 | Explore This Profile |
| 28. | Mayo Clinic | 7104 | $5,959,511,166 | $6,881,687,038 | 3,561 | Explore This Profile |
| 29. | Penn Medicine | 7033 | $5,771,945,775 | $5,674,917,621 | 2,758 | Explore This Profile |
| 30. | Banner Health | 4732 | $5,699,171,163 | $5,978,246,087 | 5,274 | Explore This Profile |
| 31. | Mount Sinai Health System | 577655 | $5,692,425,783 | $5,166,329,392 | 3,572 | Explore This Profile |
| 32. | Stanford Medicine | 938977 | $5,672,660,109 | $5,857,963,567 | 942 | Explore This Profile |
| 33. | University of Texas System | 274141 | $5,482,915,384 | $5,384,305,964 | 2,776 | Explore This Profile |
| 34. | Indiana University Health | 7012 | $5,218,549,857 | $4,840,509,929 | 2,964 | Explore This Profile |
| 35. | University Hospitals Health System | 4729 | $5,076,206,993 | $5,372,012,087 | 2,729 | Explore This Profile |
| 36. | Montefiore Health System | 2754 | $5,022,238,945 | $3,972,696,844 | 3,307 | Explore This Profile |
| 37. | SSM Health | 6446 | $4,893,026,030 | $4,763,284,753 | 4,519 | Explore This Profile |
| 38. | BJC HealthCare | 7076 | $4,875,745,564 | $4,900,898,464 | 3,583 | Explore This Profile |
| 39. | RWJBarnabas Health | 835851 | $4,775,388,779 | $4,823,961,325 | 4,269 | Explore This Profile |
| 40. | Mercy (MO) | 7027 | $4,575,171,446 | $4,963,556,308 | 5,369 | Explore This Profile |
| 41. | Beth Israel Lahey Health | 992199 | $4,492,210,432 | $4,133,231,979 | 2,313 | Explore This Profile |
| 42. | Hackensack Meridian Health | 829066 | $4,440,522,329 | $4,502,658,114 | 4,440 | Explore This Profile |
| 43. | CHRISTUS Health | 4702 | $4,417,481,589 | $4,458,272,875 | 5,574 | Explore This Profile |
| 44. | Johns Hopkins Health System | 7213 | $4,406,068,645 | $4,406,170,200 | 2,290 | Explore This Profile |
| 45. | Steward Health Care System | 4684 | $4,331,846,541 | $4,358,628,896 | 5,635 | Explore This Profile |
| 46. | Northwestern Medicine | 550112 | $4,329,442,569 | $4,288,496,959 | 2,391 | Explore This Profile |
| 47. | Memorial Hermann Health System | 7017 | $4,322,955,548 | $4,445,641,747 | 4,241 | Explore This Profile |
| 48. | University of California San Francisco Health System | 551802 | $4,287,577,607 | $4,223,673,020 | 1,609 | Explore This Profile |
| 49. | Prime Healthcare Services | 542003 | $4,277,398,988 | $4,376,608,561 | 6,548 | Explore This Profile |
| 50. | Intermountain Healthcare | 4727 | $4,246,262,963 | $4,821,813,781 | 2,421 | Explore This Profile |
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.