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Revenue
3 Months Ended
Mar. 31, 2019
Revenue From Contract With Customer [Abstract]  
Revenue

(12) Revenue

In May 2014 and March 2016, the FASB issued ASU 2014-09 and ASU 2016-08, “Revenue from Contracts with Customers (Topic 606)” and “Revenue from Contracts with Customers: Principal versus Agent Considerations (Reporting Revenue Gross versus Net)”, respectively, which provides guidance for revenue recognition. The standard’s core principle is that a company will recognize revenue when it transfers promised goods or services to customers in an amount that reflects the consideration to which the company expects to be entitled in exchange for those goods or services. Under the new standards, 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 month periods ended March 31, 2019 and 2018 (in thousands):

 

 

For the three months ended March 31, 2019

 

 

Acute Care

 

 

Behavioral Health

 

 

Other

 

 

Total

 

Medicare

$

335,909

 

 

22

%

 

$

137,456

 

 

11

%

 

 

 

 

 

$

473,365

 

 

17

%

Managed Medicare

 

209,103

 

 

14

%

 

 

52,259

 

 

4

%

 

 

 

 

 

 

261,362

 

 

9

%

Medicaid

 

104,510

 

 

7

%

 

 

172,916

 

 

13

%

 

 

 

 

 

 

277,426

 

 

10

%

Managed Medicaid

 

133,731

 

 

9

%

 

 

267,273

 

 

21

%

 

 

 

 

 

 

401,004

 

 

14

%

Managed Care (HMO and PPOs)

 

570,383

 

 

38

%

 

 

347,882

 

 

27

%

 

 

 

 

 

 

918,265

 

 

33

%

UK Revenue

 

0

 

 

0

%

 

 

136,702

 

 

11

%

 

 

 

 

 

 

136,702

 

 

5

%

Other patient revenue and adjustments, net

 

51,883

 

 

3

%

 

 

123,478

 

 

10

%

 

 

 

 

 

 

175,361

 

 

6

%

Other non-patient revenue

 

109,325

 

 

7

%

 

 

48,417

 

 

4

%

 

 

3,164

 

 

 

160,906

 

 

6

%

Total Net Revenue

$

1,514,844

 

 

100

%

 

$

1,286,383

 

 

100

%

 

$

3,164

 

 

 

2,804,391

 

 

100

%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

For the three months ended March 31, 2018

 

 

Acute Care

 

 

Behavioral Health

 

 

Other

 

 

Total

 

Medicare

$

342,718

 

 

24

%

 

$

142,527

 

 

12

%

 

 

 

 

 

$

485,245

 

 

18

%

Managed Medicare

 

176,957

 

 

12

%

 

 

44,995

 

 

4

%

 

 

 

 

 

 

221,952

 

 

8

%

Medicaid

 

105,966

 

 

7

%

 

 

177,336

 

 

14

%

 

 

 

 

 

 

283,302

 

 

11

%

Managed Medicaid

 

111,277

 

 

8

%

 

 

230,776

 

 

19

%

 

 

 

 

 

 

342,053

 

 

13

%

Managed Care (HMO and PPOs)

 

497,780

 

 

34

%

 

 

358,062

 

 

29

%

 

 

 

 

 

 

855,842

 

 

32

%

UK Revenue

 

0

 

 

0

%

 

 

114,741

 

 

9

%

 

 

 

 

 

 

114,741

 

 

4

%

Other patient revenue and adjustments, net

 

112,570

 

 

8

%

 

 

116,985

 

 

9

%

 

 

 

 

 

 

229,555

 

 

9

%

Other non-patient revenue

 

98,364

 

 

7

%

 

 

52,574

 

 

4

%

 

 

3,888

 

 

 

154,826

 

 

6

%

Total Net Revenue

$

1,445,632

 

 

100

%

 

$

1,237,996

 

 

100

%

 

$

3,888

 

 

 

2,687,516

 

 

100

%