Basis of Presentation and Significant Accounting Policies (Tables)

3 Months Ended

Mar. 31, 2017

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):

	Three Months Ended March 31,
	2017			2016
Operating revenues	$	3,068,323		$	3,080,653
Less: Contractual allowances		(2,371,292	)		(2,361,035	)
Less: Discounts		(109,086	)		(105,134	)
Total net operating revenues, before the provision for bad debts	$	587,945		$	614,484

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):

	Three Months Ended March 31,
	2017					2016
	$ Amount		% of Total			$ Amount		% of Total
Medicare	$	175,293		29.8	%	$	175,534		28.6	%
Medicaid		96,669		16.4	%		103,068		16.8	%
Managed care and commercial plans		231,557		39.4	%		244,284		39.8	%
Self-pay		59,080		10.0	%		64,754		10.5	%
Non-patient		25,346		4.4	%		26,844		4.3	%
Total net operating revenues, before the provision for bad debts	$	587,945		100.0	%	$	614,484		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 (in thousands):

	March 31,		December 31,
	2017		2016
Amounts due from third-party payors:
Previous program reimbursements and final cost report settlements	$	23,573	$	23,876
State supplemental payment programs		82,807		92,359
Total amounts due from third-party payors	$	106,380	$	116,235
Amounts due to third-party payors:
Previous program reimbursements and final cost report settlements	$	34,675	$	33,366
State supplemental payment programs		9,048		9,171
Total amounts due to third-party payors	$	43,723	$	42,537

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):

	Three Months Ended March 31,
	2017		2016
Medicaid revenues	$	45,297	$	52,215
Provider taxes and other expenses		16,893		19,426
Reimbursements attributable to state supplemental payment programs, net of expenses	$	28,404	$	32,789

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):

	March 31, 2017					December 31, 2016
	$ Amount		% of Total			$ Amount		% of Total
Third-parties	$	2,050,321		75.8	%	$	1,930,103		74.6	%
Self-pay		654,955		24.2	%		656,373		25.4	%
Total patient accounts receivable, gross	$	2,705,276		100.0	%	$	2,586,476		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):

	Three Months Ended
	March 31,
	2017
Balance at beginning of period	$	360,796
Provision for bad debts		60,305
Amounts written off, net of recoveries		(63,904	)
Balance at end of period	$	357,197

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 period (dollars in thousands):

	Number of	Three Months Ended March 31,
	Hospitals at	2017					2016
	March 31, 2017	$  Amount		% of Total			$  Amount		% of Total
Illinois	9	$	203,372		36.1	%	$	201,851		34.3	%
Oregon	1		52,996		9.4	%		52,848		9.0	%
Georgia	3		45,876		8.2	%		54,254		9.2	%
California	2		38,957		6.9	%		51,045		8.7	%
Kentucky	3		30,984		5.5	%		30,892		5.3	%
Alabama	2		28,629		5.1	%		27,312		4.6	%

Summary of Major Components of Other Operating Expenses

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

	Three Months Ended March 31,
	2017		2016
Purchased services	$	45,596	$	44,438
Taxes and insurance		34,243		35,306
Medical specialist fees		28,463		24,350
Transition services agreements and allocations from Parent		16,282		16,257
Repairs and maintenance		11,443		11,236
Utilities		6,665		7,155
Management fees from Parent		—		8,826
Other miscellaneous operating expenses		20,732		16,895
Total other operating expenses	$	163,424	$	164,463

Summary of Activity Related to Electronic Health Records Incentives

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

	Three Months Ended March 31,
	2017			2016
Electronic health records incentives receivable at beginning of period	$	4,189		$	11,227
Electronic health records incentives earned		2,452			4,208
Cash incentive payments received		(842	)		(7,625	)
Adjustments to receivable based on final cost report settlement or audit		(221	)		(1,925	)
Electronic health records incentives receivable at end of period	$	5,578		$	5,885
Deferred revenue related to electronic health records incentives at beginning of period	$	—		$	—
Cash received and deferred during period		—			(4,693	)
Recognition of deferred incentives as earned		—			—
Deferred revenue related to electronic health records incentives at end of period	$	—		$	(4,693	)
Total electronic health records incentives earned during period	$	2,452		$	4,208
Total cash incentive payments received during period		842			12,318