30 health systems ranked by operating margins

The median year-to-date operating margin index for hospitals improved slightly in April to 0 percent. While recent reports show signs of improving margins, they remain far below historical norms, and inflation and workforce expenses continue to challenge hospitals' bottom lines.

"Hospital and health system leaders must figure out how to navigate the new financial reality and begin to take action," Erik Swanson, senior vice president of data and analytics with Kaufman Hall, said in a May 31 report. "In the face of operating margins that may never fully recover and inflated expenses, developing and executing a strategic path forward to a future that is financially sustainable is crucial."

Here are 30 health systems ranked by their operating margins in the first quarter: 

1. Tenet Healthcare (Dallas)

Revenue: $5.02 billion
Expenses: $4.48 billion
Operating income/loss: $603 million
Operating margin: 12 percent

2. HCA Healthcare (Nashville, Tenn.)

Revenue: $15.59 billion
Expenses: $13.67 billion
Operating income/loss: $1.54 billion
Operating margin: 9.9 percent

3. Community Health Systems (Franklin, Tenn.)

Revenue: $3.108 billion
Expenses: $3.111 billion
Operating income/loss: $210 million
Operating margin: 6.7 percent

4. BJC HealthCare (St. Louis)

Revenue: $1.72 billion
Expenses: $1.67 billion
Operating income/loss: $59.5 million 
Operating margin: 3.5 percent

5. Banner Health (Phoenix)

Revenue: $3.51 billion
Expenses: $3.38 billion
Operating income/loss: $128 million
Operating margin: 3.6 percent

6. Mayo Clinic (Rochester, Minn.)

Revenue: $4.27 billion
Expenses: $4.12 billion
Operating income/loss: $149 million
Operating margin: 3.5 percent

7. Intermountain Health (Salt Lake City)

Revenue: $3.99 billion
Expenses: $3.70 billion
Operating income/loss: $104 million
Operating margin: 2.6 percent

8. Sutter Health (Sacramento, Calif.)

Revenue: $3.82 billion 
Expenses: $3.74 billion
Operating income/loss: $88 million 
Operating margin: 2.3 percent

9. IU Health (Indianapolis)

Revenue: $2.08 billion
Expenses: $2.04 billion
Operating income/loss: $45.1 million
Operating margin: 2.1 percent

10. Sanford Health (Sioux Falls, S.D.)

Revenue: $1.76 billion
Expenses: $1.72 billion.
Operating income/loss: $33.7 million
Operating margin: 1.9 percent

11. Trinity Health (Livona, Mich.) 

*Data is for nine-month period 
Revenue: $15.95 billion
Expenses: $16.21 billion
Operating income/loss: ($283.5 million) 
Operating margin: 1.8 percent

12. Montefiore (New York City) 

Revenue: $1.91 billion
Expenses: $1.88 billion
Operating income/loss: $32 million
Operating margin: 1.7 percent

13. UPMC (Pittsburgh)

Revenue: $6.9 billion
Expenses: $6.8 billion
Operating income/loss: $100.4 million
Operating margin: 1.5 percent

14. ThedaCare (Appleton, Wis.)

Revenue: $306.4 million
Expenses: $302.8 million
Operating income/loss: $3.6 million
Operating margin: 1.2 percent

15. Cleveland Clinic

Revenue: $3.51 billion
Expenses: $3.28 billion
Operating income/loss: $32.3 million
Operating margin: 0.9 percent

16. Kaiser Permanente (Oakland, Calif.)

Revenue: $25.2 billion
Expenses: $25 billion
Operating income/loss: $233 million
Operating margin: 0.9 percent

17. Advocate Health (Charlotte, N.C.)

Revenue: $7.54 billion
Expenses: $7.53 billion
Operating income/loss: $10.4 million
Operating margin: 0.1 percent

18. Universal Health Services (King of Prussia, Pa.)

Revenue: $3.47 billion
Expenses: $3.19 billion
Operating income/loss: $278,700
Operating margin: 0 percent

19. MedStar Health (Columbia, Md.)

Revenue: $1.928 billion
Expenses: $1.927 billion
Operating income/loss: $400,000 
Operating margin: 0 percent

20. Geisinger (Danville, Pa.)

Revenue: $1.84 billion
Expenses: $1.88 billion
Operating income/loss: ($36,068)
Operating margin: 0 percent

21. Mass General Brigham

Revenue: $4.5 billion
Expenses: $4.5 billion
Operating income/loss: ($6 million)
Operating margin: (0.1 percent)

22. Novant Health (Winston-Salem, N.C.) 

Revenue: $1.939 billion
Expenses: $1.954 billion
Operating income/loss: ($15.18 million) 
Operating margin: (0.8 percent)

23. Scripps Health

Revenue: $1.01 billion
Expenses: $1.03 billion
Operating income/loss: ($22.2 million) 
Operating margin: (2.2 percent)

24. UnityPoint Health

Revenue: $1.09 billion
Expenses: $1.12 billion
Operating income/loss: ($29.03 million)
Operating margin: (2.7 percent)

25. SSM Health (St. Louis)

Revenue: $2.46 billion 
Expenses: $2.53 billion
Operating income/loss: ($68.4 million)
Operating margin: (2.8 percent)

26. Marshfield (Wis.) Clinic

Revenue: $779.7 million
Expenses: $812.3 million
Operating income/loss: (32.6 million)
Operating margin: (4.2 percent)

27. Providence (Renton, Wash.) 

Revenue: $6.8 billion
Expenses: $7.145 billion
Operating income/loss: ($345 million)
Operating margin: (5.1 percent)

28. MultiCare (Tacoma, Wash.) 

Revenue: $1.16 billion
Expenses: $1.22 billion
Operating income/loss: ($59.9 million)
Operating margin: (5.2 percent)

29. CommonSpirit (Chicago) 

Revenue: $8.3 billion
Expenses: $8.9 billion
Operating income/loss: ($658 million) 
Operating margin: (8 percent)

30. Ascension (St. Louis)

Revenue: $6.94 billion 
Expenses: $7.62 billion 
Operating income/loss: ($1.36 billion)
Operating margin: (19.6 percent)

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