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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

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IDN NameDefinitive IDTotal Operating ExpensesNet Patient RevenueNumber of Staffed BedsExplore This Dataset
1.HCA Healthcare 4710$33,300,008,566 $42,213,477,560 42,190Explore This Profile
2.CommonSpirit Health981465$28,888,478,741 $28,582,130,311 23,358Explore This Profile
3.Kaiser Permanente4713$17,660,010,388 $13,261,153,753 9,625Explore This Profile
4.Ascension Health4695$17,167,222,743 $17,441,876,135 16,713Explore This Profile
5.Providence St Joseph Health 4716$16,315,418,947 $15,696,161,401 10,345Explore This Profile
6.Trinity Health 4712$13,649,806,250 $13,132,792,081 10,471Explore This Profile
7.Tenet Healthcare4685$12,417,064,388 $13,652,040,731 15,870Explore This Profile
8.Dignity Health4698$12,106,979,191 $11,817,607,947 7,407Explore This Profile
9.University of California (UC) Health560423$12,076,399,009 $12,063,083,551 4,651Explore This Profile
10.Northwell Health 4744$11,706,478,894 $9,410,545,687 6,075Explore This Profile
11.Kaiser Permanente Northern California845347$9,716,119,594 $7,224,288,886 4,163Explore This Profile
12.Community Health Systems 542233$9,578,338,754 $10,516,859,767 13,783Explore This Profile
13.Partners HealthCare7001$9,384,902,385 $7,599,868,208 3,464Explore This Profile
14.Cleveland Clinic Health System274173$9,095,968,769 $8,636,380,142 4,504Explore This Profile
15.University of Pittsburgh Medical Center 6448$8,284,711,893 $8,056,954,680 7,072Explore This Profile
16.Universal Health Services7055$8,083,891,361 $9,212,756,052 20,607Explore This Profile
17.LifePoint Health 7004$7,869,059,572 $8,025,621,851 9,374Explore This Profile
18.NewYork-Presbyterian Healthcare System7066$7,654,676,520 $7,698,677,961 3,945Explore This Profile
19.AdventHealth4694$7,468,577,781 $7,952,813,318 8,019Explore This Profile
20.Bon Secours Mercy Health975303$7,260,348,716 $7,665,638,269 5,834Explore This Profile
21.Advocate Aurora Health965729$7,236,864,135 $8,026,280,391 6,695Explore This Profile
22.Baylor Scott & White Health577357$7,109,094,723 $7,190,163,055 4,779Explore This Profile
23.Atrium Health4697$6,850,312,196 $7,958,708,764 6,038Explore This Profile
24.NYC Health and Hospitals7112$6,809,806,459 $5,626,899,758 3,390Explore This Profile
25.Kaiser Permanente Southern California845346$6,684,088,335 $5,400,415,526 4,487Explore This Profile
26.Sutter Health4717$6,277,018,670 $6,676,610,412 4,308Explore This Profile
27.NYU Langone Health579801$5,980,491,570 $5,743,904,918 1,990Explore This Profile
28.Mayo Clinic7104$5,959,511,166 $6,881,687,038 3,561Explore This Profile
29.Penn Medicine 7033$5,771,945,775 $5,674,917,621 2,758Explore This Profile
30.Banner Health4732$5,699,171,163 $5,978,246,087 5,274Explore This Profile
31.Mount Sinai Health System577655$5,692,425,783 $5,166,329,392 3,572Explore This Profile
32.Stanford Medicine938977$5,672,660,109 $5,857,963,567 942Explore This Profile
33.University of Texas System274141$5,482,915,384 $5,384,305,964 2,776Explore This Profile
34.Indiana University Health7012$5,218,549,857 $4,840,509,929 2,964Explore This Profile
35.University Hospitals Health System4729$5,076,206,993 $5,372,012,087 2,729Explore This Profile
36.Montefiore Health System 2754$5,022,238,945 $3,972,696,844 3,307Explore This Profile
37.SSM Health6446$4,893,026,030 $4,763,284,753 4,519Explore This Profile
38.BJC HealthCare7076$4,875,745,564 $4,900,898,464 3,583Explore This Profile
39.RWJBarnabas Health835851$4,775,388,779 $4,823,961,325 4,269Explore This Profile
40.Mercy (MO)7027$4,575,171,446 $4,963,556,308 5,369Explore This Profile
41.Beth Israel Lahey Health992199$4,492,210,432 $4,133,231,979 2,313Explore This Profile
42.Hackensack Meridian Health829066$4,440,522,329 $4,502,658,114 4,440Explore This Profile
43.CHRISTUS Health4702$4,417,481,589 $4,458,272,875 5,574Explore This Profile
44.Johns Hopkins Health System7213$4,406,068,645 $4,406,170,200 2,290Explore This Profile
45.Steward Health Care System4684$4,331,846,541 $4,358,628,896 5,635Explore This Profile
46.Northwestern Medicine 550112$4,329,442,569 $4,288,496,959 2,391Explore This Profile
47.Memorial Hermann Health System7017$4,322,955,548 $4,445,641,747 4,241Explore This Profile
48.University of California San Francisco Health System 551802$4,287,577,607 $4,223,673,020 1,609Explore This Profile
49.Prime Healthcare Services542003$4,277,398,988 $4,376,608,561 6,548Explore This Profile
50.Intermountain Healthcare4727$4,246,262,963 $4,821,813,781 2,421Explore 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.