Kaiser Foundation Hospitals again topped Modern Healthcare's largest not-for-profit hospital systems list in 2014, based on total revenue, while Catholic Health Initiatives saw a big revenue increase fueled by an acquisition.
Oakland, Calif.-based Kaiser leveraged its integrated provider-insurer model and saw a 6% increase in total revenue and total operating revenue over 2013. Plan membership also grew, from 9.1 million in 2013 to 9.6 million in 2014, the first year of the Affordable Care Act coverage expansion.
“The big continue to be big,” said Ken Gacka, a director at Standard & Poor's.
While Kaiser topped the list, other not-for-profit systems experienced larger growth. Englewood, Colo.-based CHI enjoyed a 29.2% increase in total revenue over the prior year. CHI's surge was associated with its acquisition of Houston-based St. Luke's Episcopal Health System in April 2013. CHI spent $1 billion to establish the Episcopal Health Foundation as part of the deal, and also agreed to pay St. Luke's $1 billion for capital improvements.
The number of hospitals in the CHI system grew from 74 to 93 in 2014, with a 3.7% increase in staffed beds.
The University of California Health System saw a 14.5% increase in total revenue last year, with its hospitals experiencing higher patient volumes. The UC Davis Medical Center in Sacramento credited the ACA Medicaid expansion and an increase in contracted payment rates for its 7%-plus increase in total operating revenue and net patient service revenue.
Kevin Holloran, senior director at S&P, said a U.S. Supreme Court ruling striking down federal premium subsidies in up to 37 states using the federal insurance exchange would not severely hurt not-for-profit hospital system income. For one, hospitals in states such as California and New York running their own exchanges would not be affected. And for hospitals and health systems in states that rely on the federal exchange, the exchange business hasn't been around long enough or provided a large enough patient volume to have a serious impact, he said.
Still, he added, “systems have seen a slight gain, financially, and more people are getting covered.”