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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