Basis of Presentation and Significant Accounting Policies (Tables)

12 Months Ended

Dec. 31, 2016

Accounting Policies [Abstract]

Summary of Components of Net Operating Revenues Before Provision for Bad Debts

The following table provides a summary of the components of net operating revenues, before the provision for bad debts (in thousands):

	Year Ended December 31,
	2016			2015			2014
Operating revenues	$	12,104,580		$	11,613,826		$	10,705,195
Less:  Contractual allowances		(9,247,789	)		(8,795,674	)		(7,877,299	)
Less:  Discounts		(437,738	)		(372,294	)		(417,894	)
Total net operating revenues, before the provision for bad debts	$	2,419,053		$	2,445,858		$	2,410,002

Summary of Net Operating Revenues, Before the Provision for Bad Debts, by Payor Source

The following table provides a summary of net operating revenues, before the provision for bad debts, by payor source (dollars in thousands):

	Year Ended December 31,
	2016					2015					2014
	$  Amount		% of Total			$  Amount		% of Total			$  Amount		% of Total
Medicare	$	673,074		27.8	%	$	656,799		26.9	%	$	681,010		28.3	%
Medicaid		446,273		18.4	%		443,479		18.1	%		420,050		17.4	%
Managed care and commercial plans		952,535		39.4	%		984,480		40.3	%		907,667		37.7	%
Self-pay		242,095		10.1	%		247,234		10.0	%		287,470		11.9	%
Non-patient		105,076		4.3	%		113,866		4.7	%		113,805		4.7	%
Total net operating revenues, before the provision for bad debts	$	2,419,053		100.0	%	$	2,445,858		100.0	%	$	2,410,002		100.0	%

Summary of Components of Amounts Due from and Due to Third-Party Payors

The following table provides a summary of the components of amounts due from and due to third-party payors, as presented in the consolidated and combined balance sheets (in thousands):

	December 31,
	2016		2015
Amounts due from third-party payors:
Previous program reimbursements and final cost report settlements	$	23,876	$	33,732
State supplemental payment programs		92,359		77,074
Total amounts due from third-party payors	$	116,235	$	110,806
Amounts due to third-party payors:
Previous program reimbursements and final cost report settlements	$	33,366	$	21,015
State supplemental payment programs		9,171		9,088
Total amounts due to third-party payors	$	42,537	$	30,103

Summary of Portion of Medicaid Reimbursements Attributable to State Supplemental Payment Programs

The following table provides a summary of the portion of Medicaid reimbursements attributable to state supplemental payment programs (in thousands):

	Year Ended December 31,
	2016		2015		2014
Medicaid revenues	$	220,389	$	211,696	$	192,771
Provider taxes and other expenses		76,616		75,929		73,149
Reimbursements attributable to state supplemental payment programs, net of expenses	$	143,773	$	135,767	$	119,622

Summary of Components of Accounts Receivable Before Contractual Allowances Discounts and Allowance for Doubtful Accounts

The following table provides a summary of the components of accounts receivable before contractual allowances, discounts and allowance for doubtful accounts (dollars in thousands):

	December 31,
	2016					2015
	$  Amount		% of Total			$  Amount		% of Total
Third-parties	$	1,930,103		74.6	%	$	1,688,138		72.6	%
Self-pay		656,373		25.4	%		638,694		27.4	%
Total patient accounts receivable, gross	$	2,586,476		100.0	%	$	2,326,832		100.0	%

Summary of Changes in Allowance for Doubtful Accounts

The following table provides a summary of the changes in the allowance for doubtful accounts (in thousands):

	December 31,
	2016			2015			2014
Balance at beginning of period	$	346,507		$	341,527		$	334,210
Acquisitions and divestitures		—			—			34,972
Provision for bad debts		280,586			258,520			264,502
Amounts written off, net of recoveries		(266,297	)		(253,540	)		(292,157	)
Balance at end of period	$	360,796		$	346,507		$	341,527

Summary of States in Which Company Generates More Than 5% of its Total Revenues

The following table provides a summary of the states in which the Company generates more than 5% of total net patient revenues, before the provision for bad debts, as determined in each year (dollars in thousands):

	Number of	Year Ended December 31,
	Hospitals at	2016					2015					2014
	December 31, 2016	$  Amount		% of Total			$  Amount		% of Total			$  Amount		% of Total
Illinois	9	$	811,565		35.1	%	$	822,501		35.3	%	$	856,151		37.3	%
Georgia	3		216,745		9.4	%		224,330		9.6	%		213,509		9.3	%
Oregon	1		210,818		9.1	%		201,610		8.6	%		166,212		7.2	%
California	2		199,743		8.6	%		209,500		9.0	%		195,617		8.5	%
Kentucky	3		121,988		5.3	%		131,077		5.6	%		139,332		6.1	%

Summary of Major Components of Other Operating Expenses

The following table provides a summary of the major components of other operating expenses (in thousands):

	Year Ended December 31,
	2016		2015		2014
Purchased services	$	180,672	$	176,758	$	181,626
Taxes and insurance		129,775		124,635		125,859
Medical specialist fees		106,803		85,042		80,680
Transition services agreements and allocations from Parent		66,441		60,166		40,485
Repairs and maintenance		42,986		45,945		46,069
Utilities		29,833		29,856		30,449
Management fees from Parent		11,792		36,466		36,902
Other miscellaneous operating expenses		77,500		75,365		77,738
Total other operating expenses	$	645,802	$	634,233	$	619,808

Summary of Activity Related to Electronic Health Records Incentives

The following table provided a summary of activity related to EHR incentives (in thousands):

	Year Ended December 31,
	2016			2015			2014
Electronic health records incentives receivable at beginning of period	$	11,227		$	12,204		$	15,350
Electronic health records incentives earned		7,843			11,428			21,312
Cash incentive payments received		(13,808	)		(10,084	)		(20,642	)
Adjustments to receivable based on final cost report settlement or audit		(1,073	)		(2,321	)		(3,816	)
Electronic health records incentives receivable at end of period	$	4,189		$	11,227		$	12,204
Deferred revenue related to electronic health records incentives at beginning of period	$	—		$	(14,351	)	$	(22,601	)
Cash received and deferred during period		(3,639	)		—			(15,098	)
Recognition of deferred incentives as earned		3,639			14,351			23,348
Deferred revenue related to electronic health records incentives at end of period	$	—		$	—		$	(14,351	)
Total electronic health records incentives earned during period	$	11,482		$	25,779		$	44,660
Total cash incentive payments received during period		17,447			10,084			35,740