Revenue

9 Months Ended

Sep. 30, 2024

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, 2024 and 2023 (in thousands):

	For the three months ended September 30, 2024
	Acute Care				Behavioral Health				Other		Total
Medicare	$	322,466	14	%	$	81,148	5	%			$	403,614	10	%
Managed Medicare		361,804	16	%		107,910	6	%				469,714	12	%
Medicaid		296,966	13	%		262,393	15	%				559,359	14	%
Managed Medicaid		154,762	7	%		422,563	25	%				577,325	15	%
Managed Care (HMO and PPOs)		725,014	32	%		401,004	23	%				1,126,018	28	%
UK Revenue		0	0	%		230,153	13	%				230,153	6	%
Other patient revenue and adjustments, net		117,679	5	%		155,332	9	%				273,011	7	%
Other non-patient revenue		266,826	12	%		54,411	3	%		2,596		323,833	8	%
Total Net Revenue	$	2,245,517	100	%	$	1,714,914	100	%	$	2,596		3,963,027	100	%
	For the nine months ended September 30, 2024
	Acute Care				Behavioral Health				Other		Total
Medicare	$	1,009,630	15	%	$	234,295	5	%			$	1,243,925	11	%
Managed Medicare		1,104,493	17	%		307,388	6	%				1,411,881	12	%
Medicaid		771,298	12	%		804,254	16	%				1,575,552	13	%
Managed Medicaid		466,881	7	%		1,262,108	25	%				1,728,989	15	%
Managed Care (HMO and PPOs)		2,129,117	32	%		1,227,056	24	%				3,356,173	29	%
UK Revenue		0	0	%		650,655	13	%				650,655	6	%
Other patient revenue and adjustments, net		375,161	6	%		449,609	9	%				824,770	7	%
Other non-patient revenue		747,427	11	%		166,925	3	%		7,916		922,268	8	%
Total Net Revenue	$	6,604,007	100	%	$	5,102,290	100	%	$	7,916	$	11,714,213	100	%
	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	%