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MASSACHUSETTS
ACUTE HOSPITAL
FINANCIAL
PERFORMANCE
FI S CA L Y E A R 2 015
AUG U ST 2016
CHIA
Key Findings
This report examines hospital profitability, liquidity, and solvency in order to monitor and
compare the financial status of acute care hospitals. The following metrics are examined: total
margin, operating margin, non-operating margin, current ratio, days in accounts receivable,
average payment period, cash flow to total debt, debt service coverage, and the equity
financing ratio. Together, these metrics provide insight into each hospitals financial health.
Metrics included in this report are based on financial information from Fiscal Year (FY) 2013
through FY 2015. This reporting period reflects acute hospital financial data for the full 12
months of each fiscal year, regardless of each hospitals fiscal year-end date. FY 2015 data
used to calculate these metrics is provided in the databook published on the Center for Health
Information and Analysis (CHIA) website. Fact sheets for individual hospitals will also be
available following the release of this report. For more information on hospital reporting
periods, data caveats, and definitions of hospital cohorts and regions used in this report, see
Report Notes.
UPDATES FROM LAST YEARS REPORT
Sixty-five hospitals are examined in this report, compared with 62 in last years report. Quincy
Medical Center, which closed in December 2014, North Adams Regional Hospital, which
closed in March 2014, and Merrimack Valley Hospital, which merged with Steward Holy
Family Hospital in August 2014, are not displayed in this years report, but are included in
cohort and statewide median calculations for the applicable periods. The Shriners Hospitals for
Children in both Boston and Springfield, and Kindred Hospital-Boston and Kindred HospitalBoston North Shore are included for the first time. FY 2014 hospital cohort designations
are used in this report (see Report Notes for hospital cohort designations). Additionally, this
report examines multi-acute hospital system performance, which play a central role in the
Massachusetts health care environment.
STATEWIDE PERFORMANCE
Profitability declined for acute hospitals statewide in FY 2015 relative to FY 2014, with the
statewide median total margin decreasing from 4.2% in FY 2014 to 3.7% in FY 2015. The
majority of hospitals remained profitable, however; 80%, or 52 acute hospitals, reported
positive total margins in FY 2015. Operating margin improved overall, with the statewide
median rising from 2.4% in FY 2014 to 3.0% in FY 2015, as 49 hospitals reported positive
operating margins.
Overall, liquidity remained consistent with FY 2014 performance. In FY 2015 the median
current ratio for all hospitals in Massachusetts was 1.6, remaining level with FY 2014. The
median days in accounts receivable for all hospitals was 38 days for FY 2015, a decrease of
three days from 41 in the previous year. The statewide median average payment period was
58 days in FY 2015, equal to FY 2014.
Solvency trends for FY 2015 were mixed. The statewide median cash flow to total debt
increased slightly in FY 2015 to 20.5%. The debt service coverage ratio improved slightly
in FY 2015 to 5.7 and has remained consistent with the prior year. In FY 2015 the median
equity financing ratio decreased statewide, indicating that overall Massachusetts hospitals
are becoming more highly leveraged.
center
for health
information
and analysis
center
for health
information
and analysis
Northeastern
Massachusetts
2.5%
Central
Massachusetts
Western
Massachusetts
Metro
Boston
4.2%
2.8%
1.7%
Metro
West
5.7%
Metro
South
5.2%
Southcoast
10.2%
Cape and
Islands
-4% - 0%
0% - 1%
1% - 5%
> 5%
There were a few notable regional differences in financial performance in FY 2015. The
Southcoast region had the highest median total margin at 10.2% for the two hospitals in the
region. Four regions had median total margins above the statewide median of 3.7%. Only
two of the eight regions in Massachusetts had an increase in median total margin from FY
2014 to FY 2015: Metro West and Central Massachusetts. Three of the five hospitals in
Metro West and four of the seven Central Massachusetts hospitals reported increases in
total margin. The region with the largest decrease in median total margin was Metro South;
however, all five hospitals reported positive total margins, and the regions median was
higher than the median total margin statewide. Thirteen of the 20 hospitals in Metro Boston
reported lower total margins in FY 2015 than in FY 2014. Five hospitals in Metro Boston
reported negative total margins, and an additional eight hospitals with negative total margins
were spread throughout the state: four in Northeastern Massachusetts, and two in both the
Western and Central Massachusetts regions. The Cape and Islands, Metro South, Metro
West, and Southcoast regions did not have any hospitals reporting negative total margins in
FY 2015.
5.6%
2.0%
2.5%
2.3%
5.8%
6.7%
10.2%
0.4%
1.4%
3.8%
7.4%
10.4%
1.0%
1.0%
1.2%
4.7%
2.4%
FY13
FY14
FY15
Statewide Median*
4.1%
4.2%
3.7%
AMC
4.6%
4.7%
2.4%
Teaching
7.6%
8.2%
4.2%
Community
3.6%
2.9%
3.0%
Community-DSH
3.7%
5.3%
5.4%
Specialty Hospitals
-1.7%
Athol Memorial Hospital
Baystate Franklin Medical Center
Baystate Noble Hospital
-7.3%
Baystate Wing Hospital
Beth Israel Deaconess Hospital - Plymouth
Cape Cod Hospital
-4.6%
Clinton Hospital
Fairview Hospital
Falmouth Hospital
Harrington Memorial Hospital
HealthAlliance Hospital
Heywood Hospital
Holyoke Medical Center
-1.7%
Lawrence General Hospital
Lowell General Hospital
Marlborough Hospital
Martha's Vineyard Hospital
Mercy Medical Center
Morton Hospital
Nashoba Valley Medical Center
-8.6%
North Shore Medical Center
Signature Healthcare Brockton Hospital
Southcoast Hospitals Group
Steward Good Samaritan Medical Center
Steward Holy Family Hospital
Steward Norwood Hospital
Steward Saint Anne's Hospital
Sturdy Memorial Hospital
FY15
Statewide
Median: 3.7%
3.9%
4.2%
4.8%
1.5%
3.7%
2.3%
4.3%
3.9%
8.9%
15.9%
Total Margin
Academic
Medical Centers
Teaching Hospitals
Solvency
Community Hospitals
Liquidity
Community-DSH Hospitals ^
Profitability
10.7%
1.3%
3.0%
8.0%
10.2%
9.3%
7.3%
4.2%
4.3%
2.8%
2.5%
5.7%
3.1%
6.2%
4.7%
6.9%
5.2%
10.5%
8.6%
7.3%
7.6%
10.0%
10.4%
^ Indicates hospital meets the DSH criteria. For DSH criteria, see Report Notes
Note: Values are rounded. Refer to databook for full numbers.
FY14
FY15
Statewide Median*
2.3%
2.4%
3.0%
AMC
2.2%
2.6%
2.6%
Teaching
3.6%
5.6%
4.2%
Community
2.0%
1.3%
2.4%
Community-DSH
2.0%
4.5%
5.2%
2.7%
0.7%
2.5%
6.1%
4.4%
7.0%
0.4%
0.9%
Academic
Medical Centers
Operating Margin
Teaching Hospitals
Community Hospitals
Solvency
Community-DSH-Hospitals ^
Liquidity
Specialty Hospitals
Profitability
FY15
Statewide
Median: 3.0%
2.8%
3.7%
7.3%
10.4%
4.2%
6.9%
4.0%
2.4%
0.7%
1.5%
1.1%
3.4%
5.0%
2.5%
4.0%
2.4%
5.9%
1.1%
3.0%
6.9%
5.8%
8.2%
5.6%
4.6%
4.8%
2.7%
3.2%
5.0%
5.2%
6.1%
4.6%
6.9%
5.1%
7.4%
8.5%
7.3%
7.6%
9.9%
6.3%
2.1%
-4.1%
-9.0%
-0.9%
-10.3%
1.4%
-98.4%
-67.7%
^ Indicates hospital meets the DSH criteria. For DSH criteria, see Report Notes
Note: Values are rounded. Refer to databook for full numbers.
FY14
FY15
Statewide Median*
1.1%
0.6%
0.1%
AMC
1.0%
1.2%
-0.2%
Teaching
0.0%
0.1%
0.1%
Community
1.1%
0.8%
0.6%
Community-DSH
1.0%
0.8%
0.1%
2.3%
3.3%
0.1%
1.8%
0.1%
0.1%
0.0%
0.0%
0.0%
Academic
Medical Centers
Non-Operating Margin
FY15
Beth Israel Deaconess Medical Center -0.7%
Boston Medical Center^
1.9% Statewide
Median: 0.1%
Brigham and Women's Hospital
-0.1%
-0.3%
Massachusetts General Hospital
-0.5%
Tufts Medical Center
1.1%
UMass Memorial Medical Center^
Teaching Hospitals
Community Hospitals
Solvency
Community-DSH Hospitals ^
Liquidity
Specialty Hospitals
Profitability
^ Indicates hospital meets the DSH criteria. For DSH criteria, see Report Notes
Note: Values are rounded. Refer to databook for full numbers.
Liquidity
Solvency
Profitability
Community Hospitals
Community-DSH Hospitals ^
Teaching Hospitals
Current Ratio
FY13
FY14
FY15
Statewide Median*
1.5
1.6
1.6
AMC
1.7
1.6
1.6
Teaching
1.1
1.1
1.3
Community
1.7
1.8
2.0
Community-DSH
1.2
1.5
1.5
Specialty Hospitals
3.2
1.9
1.3
1.7
1.4
1.4
2.7
1.2
1.0
1.3
2.4
4.5
1.6
0.2
0.3
2.7
1.6
2.1
1.9
0.7
2.0
3.6
1.5
3.3
2.1
1.2
1.7
2.0
1.7
0.6
1.5
0.4
1.3
1.9
1.5
1.9
1.1
1.3
2.7
1.7
1.0
1.4
2.0
1.7
1.5
2.6
4.3
0.3
0.6
2.2
1.4
1.7
0.6
0.7
0.3
3.5
11.6
8.0
0.9
2.4
2.0
1.0
3.4
0.4
1.4
^ Indicates hospital meets the DSH criteria. For DSH criteria, see Report Notes
Note: Values are rounded. Refer to databook for full numbers.
FY14
FY15
Statewide Median*
40
41
38
AMC
46
46
44
Teaching
37
39
36
Community
43
44
39
Community-DSH
40
36
35
45
27
51
49
42
43
36
43
30
27
35
41
42
37
33
38
40
38
36
29
45
38
42
48
55
27
44
46
37
42
40
30
35
42
34
52
35
32
47
32
37
34
51
40
19
37
47
30
28
34
37
42
34
33
33
33
35
63
46
64
62
46
36
140
46
FY15
Statewide
Median 38
Academic
Medical Centers
= ten days
Teaching Hospitals
Community Hospitals
Solvency
Community-DSH Hospitals ^
Liquidity
Specialty
Hospitals
Profitability
^ Indicates hospital meets the DSH criteria. For DSH criteria, see Report Notes
Note: Values are rounded. Refer to databook for full numbers.
FY13
FY14
FY15
Statewide Median*
60
58
58
AMC
62
63
63
Teaching
53
63
68
Community
53
54
55
Community-DSH
68
68
64
38
48
53
63
65
60
68
33
54
47
57
68
52
58
48
68
45
107
127
64
37
255
127
FY15 Statewide
Median 58
58
107
68
45
58
120
Academic
Medical Centers
= thirty days
Teaching Hospitals
Community Hospitals
Solvency
Community-DSH Hospitals ^
Liquidity
Specialty Hospitals
Profitability
^ Indicates hospital meets the DSH criteria. For DSH criteria, see Report Notes
Note: Values are rounded. Refer to databook for full numbers.
Liquidity
Solvency
Profitability
Community Hospitals
The statewide median cash flow to total debt has been stable
between FY 2013 and FY 2015, increasing slightly from 19.5%
in FY 2013 to 20.5% in FY 2015. In FY 2015 the statewide
median and the medians of all four cohorts were higher than the
FY 2014 Northeast US median of 12.4%. AMCs had the lowest
median cash flow to total debt ratio among all the cohorts,
with a median of 15.0%. The community-DSH cohort median
increased from FY 2013 to FY 2015, with a cash flow to total
debt ratio of 29.1% in FY 2015, the highest of all cohorts. The
teaching cohort had the largest decrease in median cash flow to
total debt, falling to 21.1% from 31.0% in FY 2014.
Community-DSH Hospitals ^
Teaching Hospitals
FY13
FY14
FY15
Statewide Median*
19.5%
20.2%
20.5%
AMC
19.5%
17.6%
15.0%
Teaching
26.3%
31.0%
21.1%
Community
20.0%
15.8%
19.9%
Community-DSH
17.6%
23.3%
29.1%
Specialty Hospitals
19.1%
11.2%
10.5%
36.5%
0.7%
18.9%
21.1%
38.6%
28.6%
18.4%
27.0%
20.5%
158.0%
-5.7%
20.5%
14.7%
34.9%
11.7%
20.5%
16.1%
11.1%
18.3%
33.8%
11.7%
35.1%
21.1%
19.2%
36.6%
46.4%
5.7%
32.6%
12.9%
-8.8%
16.1%
27.6%
1.6%
59.2%
38.0%
34.5%
32.1%
23.4%
29.1%
5.4%
13.3%
21.7%
54.4%
29.1%
18.7%
31.7%
-3.4%
20.2%
34.6%
58.4%
61.7%
29.1%
197.9%
105.0%
8.7%
12.6%
-98.1%
-2.2%
17.8%
18.5%
-1.6%
121.4%
^ Indicates hospital meets the DSH criteria. For DSH criteria, see Report Notes
Note: Values are rounded. Refer to databook for full numbers.
Academic
Medical Centers
3.5
7.8
6.6
8.8
8.7
3.7
86.4
-5.3
25.8
4.2
3.0
4.5
2.5
2.1
2.9
12.8
3.6
14.5
3.2
7.3
5.8
8.9
3.6
20.1
1.4
-2.3
3.2
4.6
0.8
14.4
7.5
5.7
15.6
6.8
7.0
2.6
2.5
6.4
24.8
10.9
513.5
6.8
0.0
3.0
7.5
43.5
115.6
89.1
324.2
-
FY15
Statewide Median*
4.6
5.6
5.7
AMC
3.2
3.6
2.6
Teaching
5.9
6.8
7.8
3.9
6.3
3.2
3.1
-
Community
2.9
3.3
4.2
Community-DSH
5.5
7.1
6.8
Specialty Hospitals
FY14
3.3
5.1
1.8
6.5
0.9
1.6
Teaching Hospitals
Solvency
Community Hospitals
Liquidity
Community-DSH Hospitals ^
Profitability
^ Indicates hospital meets the DSH criteria. For DSH criteria, see Report Notes
Note: Values are rounded. Refer to databook for full numbers.
* Indicates a hospital with no current portion of long-term debt or interest
expense. These hospitals are excluded from median calculations.
Liquidity
Solvency
Profitability
Community Hospitals
Community-DSH Hospitals ^
Teaching Hospitals
Equity Financing
FY13
FY14
FY15
Statewide Median*
49.3%
51.1%
47.4%
AMC
40.2%
40.4%
37.2%
Teaching
49.5%
50.7%
47.4%
Community
46.8%
44.2%
44.1%
Community-DSH
47.7%
51.1%
47.0%
Specialty Hospitals
52.7%
53.7%
9.7%
60.6%
15.1%
21.7%
47.4%
62.3%
62.9%
26.6%
19.0%
55.9%
103.0%
-30.0%
32.4%
24.9%
46.5%
6.3%
58.2%
38.0%
59.1%
47.5%
67.3%
77.0%
51.5%
74.1%
55.7%
-20.3%
54.8%
33.8%
39.3%
84.6%
62.6%
39.3%
9.4%
0.4%
23.8%
52.7%
39.6%
24.9%
22.7%
83.3%
91.4%
^ Indicates hospital meets the DSH criteria. For DSH criteria, see Report Notes
Note: Values are rounded. Refer to databook for full numbers.
Twelve multi-acute hospital systems does not include Wellforce, which was created on October 1, 2014 and
did not function as a consolidated health care system in FY 2015.
Page 13
Cohort
Months
Reported
Current
Ratio
Net Assets
in Millions
Profit (Loss)
in Millions
D
C
T
D
D
12
12
12
12
12
10.7%
1.0%
6.7%
1.3%
-7.3%
5.9%
-5.6%
4.4%
1.1%
-6.9%
4.8%
6.7%
2.3%
0.3%
-0.4%
1.5
1.6
2.7
0.4
1.3
$49.5
$16.8
$638.7
$1.9
$42.8
$10.6
$0.3
$76.8
$0.8
($5.4)
T
D
12
12
10.2%
10.2%
7.0%
5.8%
3.3%
4.4%
1.2
1.1
$330.2
$26.7
$46.4
$5.2
D
D
12
12
8.0%
9.3%
6.9%
8.2%
1.1%
1.1%
1.5
1.3
$301.1
$186.1
$38.5
$14.8
C
C
D
A
T
S
12
12
12
12
12
12
1.2%
4.7%
3.0%
2.0%
7.4%
2.4%
6.9%
4.0%
3.0%
2.7%
7.3%
1.4%
-5.7%
0.8%
0.1%
-0.7%
0.1%
1.0%
2.1
1.9
1.9
3.2
4.5
3.4
$66.6
$42.7
$71.1
$850.3
$268.9
$121.0
$1.1
$3.7
$6.6
$29.7
$24.7
$5.9
D
D
12
12
-1.7%
4.3%
-2.2%
4.8%
0.4%
-0.5%
0.6
1.0
$2.6
$53.5
($0.4)
$4.6
S
S
12
12
-0.9%
-9.0%
-0.9%
-9.0%
0.0%
0.0%
2.0
2.4
$0.5
($16.0)
($0.2)
($1.7)
T
C
C
12
12
12
3.8%
3.9%
15.9%
3.7%
2.5%
2.4%
0.1%
1.5%
13.5%
2.4
1.7
1.7
$141.3
$189.5
$253.9
$31.4
$13.9
$50.3
T
A
C
D
A
C
C
D
12
12
12
12
12
12
12
12
0.4%
2.3%
2.4%
3.1%
5.8%
2.3%
4.3%
-8.6%
0.4%
2.5%
2.4%
5.2%
6.1%
-5.8%
5.0%
-8.4%
0.1%
-0.1%
0.0%
-2.1%
-0.3%
8.0%
-0.6%
-0.2%
1.0
1.3
0.7
2.6
1.7
2.1
1.2
2.2
$85.7
$251.8
$59.9
$104.2
$2,128.2
$66.0
$201.1
$2.0
$1.0
$60.8
$3.7
$2.4
$201.1
$1.0
$19.2
($36.0)
S
S
12
12
-8.8%
-0.3%
-98.4%
-67.7%
89.6%
67.4%
0.4
1.4
$51.6
$13.7
($3.2)
($0.1)
D
D
T
D
D
D
D
T
12
12
12
12
12
12
12
12
4.7%
6.9%
-7.3%
8.6%
7.3%
7.6%
10.0%
4.2%
4.6%
6.9%
-7.3%
8.5%
7.3%
7.6%
9.9%
4.2%
0.0%
0.0%
0.0%
0.1%
0.0%
0.0%
0.1%
0.0%
0.3
0.6
0.2
0.6
0.7
0.3
3.5
0.3
$34.6
$2.7
($22.3)
$42.1
$25.2
$19.5
$119.6
$62.9
$5.4
$3.6
($8.3)
$22.4
$17.2
$13.8
$25.3
$13.6
Total
Margin
Operating
Margin
Non-Operating
Margin
T Teaching Hospital
S Specialty Hospital
Page 14
Cohort
Months
Reported
C
T
12
12
1.5%
10.4%
1.1%
10.4%
D
D
D
A
12
12
12
12
-4.6%
4.2%
5.7%
3.9%
D
A
12
12
2.5%
-2.6%
Tenet Healthcare
MetroWest Medical Center
Saint Vincent Hospital^
UMass Memorial Health Care
Clinton Hospital
HealthAlliance Hospital
Marlborough Hospital
UMass Memorial Medical Center^
Wellforce*
Lowell General Hospital
Tufts Medical Center
Total
Margin
Operating
Margin
Non-Operating
Margin
Current
Ratio
Net Assets
in Millions
Profit (Loss)
in Millions
0.4%
0.0%
1.5
1.6
($63.2)
$386.0
$3.9
$44.9
-5.6%
4.6%
5.0%
2.8%
1.0%
-0.4%
0.7%
1.1%
1.9
1.7
1.5
1.4
$17.2
$156.8
$32.2
$286.5
($1.2)
$7.0
$4.6
$60.1
3.2%
-2.2%
-0.7%
-0.5%
1.7
1.4
$158.5
$95.6
$10.7
($18.2)
Net Assets
in Millions
Profit (Loss)
in Millions
Months
Reported
Total
Margin
12
1.0%
0.9%
0.1%
2.7
12
-0.4%
2.1%
-2.5%
12
2.5%
0.7%
1.9%
12
1.4%
-0.5%
12
0.4%
Emerson Hospital
12
Hallmark Health
Hospital Name
Anna Jaques Hospital
Operating
Margin
Non-Operating
Margin
Current
Ratio
$20.7
$1.2
8.0
$3,118.5
($5.5)
1.9
$1,166.1
$29.3
1.8%
1.3
$103.6
$7.9
-4.1%
4.5%
0.9
$1,312.3
$4.7
-0.1%
0.7%
-0.8%
2.0
$40.9
($0.2)
12
4.8%
1.5%
3.3%
3.6
$164.8
$13.0
12
7.3%
5.6%
1.7%
2.7
$64.2
$9.3
12
2.8%
2.7%
0.1%
1.4
($13.8)
$3.6
12
-1.7%
-1.8%
0.1%
2.0
$120.4
($4.0)
12
1.1%
-10.3%
11.5%
1.0
$217.1
$2.9
12
6.2%
6.1%
0.1%
4.3
$157.0
$17.0
12
3.7%
3.4%
0.3%
3.3
$121.6
$7.4
12
5.2%
5.1%
0.1%
1.4
$48.5
$13.5
12
8.9%
4.0%
4.9%
2.0
$226.3
$50.0
12
10.5%
7.4%
3.0%
1.7
$497.7
$87.2
12
10.4%
6.3%
4.1%
11.6
$334.1
$17.9
T Teaching Hospital
S Specialty Hospital
* Wellforce was created October 1, 2014 but did not function as a consolidated health care system in FY 2015.
Page 15
Report Notes
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9/30
10/1/14 9/30/15
6/30
7/1/14 6/30/15
12/31
1/1/15 12/31/15
Kindred HospitalBoston
Kindred HospitalBoston North Shore
MetroWest Medical Center
Saint Vincent Hospital
Shriners Hospitals for ChildrenBoston
Shriners Hospitals for ChildrenSpringfield
Steward Health Care System Hospitals (8)
DATA CAVEATS
Depending on the organization of each hospital, data may exclude other aspects of financial
health, such as the financial performance of endowments, or the financial health of parent
companies or other affiliated organizations.
Kindred Hospitals are excluded from FY 2013 medians due to differences in reporting
methods between years.
Merrimack Valley merged with Steward Holy Family in August 2014.
Noble Hospital became part of the Baystate system and changed its name to Baystate Noble
Hospital in July 2015.
Quincy Medical Center data is included in this report; however, it should be noted that the
hospital closed in December 2014.
Shriners Hospitals for Children are excluded from FY 2013 due to differences in reporting
methods between years.
ACUTE HOSPITAL COHORT DEFINITIONS
Acute hospitals were assigned to one of the following cohorts according to the criteria below.
Please note that some AMCs and teaching hospitals have Disproportionate Share Hospital
(DSH) status; this has been noted throughout the report where applicable.
Academic medical centers (AMCs) are a subset of teaching hospitals. AMCs are
characterized by (1) extensive research and teaching programs, and (2) extensive resources
for tertiary and quaternary care, and are (3) principal teaching hospitals for their respective
medical schools, and (4) full service hospitals with case mix intensity greater than 5%
above the statewide average.
Metro Boston
M.G.L. c. 6D, Section 1 defines a Disproportionate Share Hospital (DSH) as a hospital with a minimum of 63 percent of patient
charges attributed to Medicare, Medicaid, and other government payers, including Connector Care and the Health Safety Net.
For descriptions of the regions, see http://www.mass.gov/anf/docs/hpc/2013-cost-trends-report-technical-appendix-b3-regionsof-massachusetts.pdf. (last accessed August 10, 2016).
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Northeastern Massachusetts
Central Massachusetts
Metro West
Marlborough Hospital
MetroWest Medical Center
Milford Regional Medical Center
Steward Norwood Hospital
Sturdy Memorial Hospital
Western Massachusetts
Metro South
Southcoast
Individual hospital fact sheets and the databook are available on CHIAs website at
http://chiamass.gov/chia/hospital-financial-performance.
Massachusetts Acute Hospital Financial Performance, Fiscal Year 2015 Page 18
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