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Revenue
9 Months Ended
Sep. 30, 2023
Revenue from Contract with Customer [Abstract]  
Revenue

(12) Revenue

We recognize revenue when we transfer promised goods or services to customers in an amount that reflects the consideration to which we expect to be entitled in exchange for those goods or services. Our estimate for amounts not expected to be collected based on historical experience will continue to be recognized as a reduction to net revenue. However, subsequent changes in estimate of collectability due to a change in the financial status of a payer, for example a bankruptcy, will be recognized as bad debt expense in operating charges.

The performance obligation is separately identifiable from other promises in the customer contract. As the performance obligations are met (i.e.: room, board, ancillary services, level of care), revenue is recognized based upon allocated transaction price. The transaction price is allocated to separate performance obligations based upon the relative standalone selling price. In instances where we determine there are multiple performance obligations across multiple months, the transaction price will be allocated by applying an estimated implicit and explicit rate to gross charges based on the separate performance obligations.

In assessing collectability, we have elected the portfolio approach. This portfolio approach is being used as we have large volume of similar contracts with similar classes of customers. We reasonably expect that the effect of applying a portfolio approach to a group of contracts would not differ materially from considering each contract separately. Management’s judgment to group the contracts by portfolio is based on the payment behavior expected in each portfolio category. As a result, aggregating all of the contracts (which are at the patient level) by the particular payer or group of payers, will result in the recognition of the same amount of revenue as applying the analysis at the individual patient level.

We group our revenues into categories based on payment behaviors. Each component has its own reimbursement structure which allows us to disaggregate the revenue into categories that share the nature and timing of payments. The other patient revenue consists primarily of self-pay, government-funded non-Medicaid, and other.

The following table disaggregates our revenue by major source for the three and nine-month periods ended September 30, 2023 and 2022 (in thousands):

 

 

For the three months ended September 30, 2023

 

 

Acute Care

 

 

Behavioral Health

 

 

Other

 

 

Total

 

Medicare

$

298,121

 

 

15

%

 

$

81,689

 

 

5

%

 

 

 

 

$

379,810

 

 

11

%

Managed Medicare

 

324,486

 

 

16

%

 

 

95,094

 

 

6

%

 

 

 

 

 

419,580

 

 

12

%

Medicaid

 

201,148

 

 

10

%

 

 

204,154

 

 

13

%

 

 

 

 

 

405,302

 

 

11

%

Managed Medicaid

 

181,051

 

 

9

%

 

 

387,975

 

 

25

%

 

 

 

 

 

569,026

 

 

16

%

Managed Care (HMO and PPOs)

 

651,816

 

 

32

%

 

 

383,146

 

 

25

%

 

 

 

 

 

1,034,962

 

 

29

%

UK Revenue

 

0

 

 

0

%

 

 

202,994

 

 

13

%

 

 

 

 

 

202,994

 

 

6

%

Other patient revenue and adjustments, net

 

108,676

 

 

5

%

 

 

129,492

 

 

8

%

 

 

 

 

 

238,168

 

 

7

%

Other non-patient revenue

 

251,990

 

 

12

%

 

 

58,151

 

 

4

%

 

 

2,791

 

 

 

312,932

 

 

9

%

Total Net Revenue

$

2,017,288

 

 

100

%

 

$

1,542,695

 

 

100

%

 

$

2,791

 

 

 

3,562,774

 

 

100

%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

For the nine months ended September 30, 2023

 

 

Acute Care

 

 

Behavioral Health

 

 

Other

 

 

Total

 

Medicare

$

961,640

 

 

16

%

 

$

233,930

 

 

5

%

 

 

 

 

$

1,195,570

 

 

11

%

Managed Medicare

 

1,013,493

 

 

17

%

 

 

255,782

 

 

6

%

 

 

 

 

 

1,269,275

 

 

12

%

Medicaid

 

445,678

 

 

7

%

 

 

625,956

 

 

14

%

 

 

 

 

 

1,071,634

 

 

10

%

Managed Medicaid

 

545,173

 

 

9

%

 

 

1,184,315

 

 

26

%

 

 

 

 

 

1,729,488

 

 

16

%

Managed Care (HMO and PPOs)

 

2,009,110

 

 

34

%

 

 

1,160,820

 

 

25

%

 

 

 

 

 

3,169,930

 

 

30

%

UK Revenue

 

0

 

 

0

%

 

 

560,897

 

 

12

%

 

 

 

 

 

560,897

 

 

5

%

Other patient revenue and adjustments, net

 

303,923

 

 

5

%

 

 

387,327

 

 

8

%

 

 

 

 

 

691,250

 

 

7

%

Other non-patient revenue

 

714,882

 

 

12

%

 

 

166,351

 

 

4

%

 

 

9,153

 

 

 

890,386

 

 

8

%

Total Net Revenue

$

5,993,899

 

 

100

%

 

$

4,575,378

 

 

100

%

 

$

9,153

 

 

$

10,578,430

 

 

100

%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

For the three months ended September 30, 2022

 

 

Acute Care

 

 

Behavioral Health

 

 

Other

 

 

Total

 

Medicare

$

314,785

 

 

16

%

 

$

86,125

 

 

6

%

 

 

 

 

$

400,910

 

 

12

%

Managed Medicare

 

305,239

 

 

16

%

 

 

78,554

 

 

5

%

 

 

 

 

 

383,793

 

 

12

%

Medicaid

 

200,656

 

 

10

%

 

 

195,656

 

 

14

%

 

 

 

 

 

396,312

 

 

12

%

Managed Medicaid

 

213,723

 

 

11

%

 

 

373,456

 

 

26

%

 

 

 

 

 

587,179

 

 

18

%

Managed Care (HMO and PPOs)

 

631,670

 

 

33

%

 

 

363,442

 

 

25

%

 

 

 

 

 

995,112

 

 

30

%

UK Revenue

 

0

 

 

0

%

 

 

166,843

 

 

12

%

 

 

 

 

 

166,843

 

 

5

%

Other patient revenue and adjustments, net

 

38,427

 

 

2

%

 

 

115,969

 

 

8

%

 

 

 

 

 

154,396

 

 

5

%

Other non-patient revenue

 

215,178

 

 

11

%

 

 

54,783

 

 

4

%

 

 

(18,479

)

 

 

251,482

 

 

8

%

Total Net Revenue

$

1,919,678

 

 

100

%

 

$

1,434,828

 

 

100

%

 

$

(18,479

)

 

$

3,336,027

 

 

100

%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

For the nine months ended September 30, 2022

 

 

Acute Care

 

 

Behavioral Health

 

 

Other

 

 

Total

 

Medicare

$

970,060

 

 

17

%

 

$

248,987

 

 

6

%

 

 

 

 

$

1,219,047

 

 

12

%

Managed Medicare

 

944,072

 

 

17

%

 

 

213,281

 

 

5

%

 

 

 

 

 

1,157,353

 

 

12

%

Medicaid

 

540,590

 

 

9

%

 

 

554,970

 

 

13

%

 

 

 

 

 

1,095,560

 

 

11

%

Managed Medicaid

 

547,452

 

 

10

%

 

 

1,071,792

 

 

25

%

 

 

 

 

 

1,619,244

 

 

16

%

Managed Care (HMO and PPOs)

 

1,898,040

 

 

33

%

 

 

1,104,658

 

 

26

%

 

 

 

 

 

3,002,698

 

 

30

%

UK Revenue

 

0

 

 

0

%

 

 

516,166

 

 

12

%

 

 

 

 

 

516,166

 

 

5

%

Other patient revenue and adjustments, net

 

204,660

 

 

4

%

 

 

362,697

 

 

9

%

 

 

 

 

 

567,357

 

 

6

%

Other non-patient revenue

 

602,636

 

 

11

%

 

 

162,664

 

 

4

%

 

 

9,665

 

 

 

774,965

 

 

8

%

Total Net Revenue

$

5,707,510

 

 

100

%

 

$

4,235,215

 

 

100

%

 

$

9,665

 

 

$

9,952,390

 

 

100

%