Reasons that some hospitals are more profitable than others?

[FFH]

EDIT: Misread the ranking. Grossing not Profiting.

Here is the ranking.

http://www.beckershospitalreview.com/lists/25-top-grossing-non-profit-hospitals.html

1. University of Pittsburgh Medical Center Presbyterian — $10.19 billion
2. The Cleveland Clinic — $9.86 billion
3. New York-Presbyterian Hospital/Weill Cornell Medical Center (New York City) — $8.06 billion
4. Florida Hospital Orlando — $8.01 billion
5. Cedars-Sinai Medical Center (Los Angeles) — $7.99 billion
6. Stanford (Calif.) Hospital — $6.71 billion
7. Montefiore Medical Center – Moses Division Hospital (Bronx, N.Y.)— $6.49 billion
8. Hospital of the University of Pennsylvania (Philadelphia) — $5.98 billion
9. Temple University Hospital (Philadelphia) — $5.9 billion
10. Orlando Regional Medical Center — $5.71 billion
11. Massachusetts General Hospital (Boston) — $5.64 billion
12. Hackensack (N.J.) University Medical Center — $4.83 billion
13. Crozer-Chester Medical Center (Upland, Pa.) — $4.81 billion
14. Indiana University Health Methodist Hospital (Indianapolis) — $4.75 billion
15. Brigham and Women's Hospital (Boston) — $4.58 billion
16. Vanderbilt University Medical Center (Nashville, Tenn.) — $4.52 billion
17. New York University Langone Medical Center (New York City) — $4.21 billion
18. Tampa (Fla.) General Hospital — $4.16 billion
19. Norton Hospital (Louisville, Ky.) — $4.15 billion
20. Northwestern Memorial Hospital (Chicago) — $4.15 billion
21. Thomas Jefferson University Hospital (Philadelphia) — $4.12 billion
22. North Shore University Hospital (Manhasset, N.Y.) — $4.09 billion
23. The Methodist Hospital (Houston) — $4.04 billion
24. Loma Linda (Calif.) University Medical Center — $3.95 billion
25. Duke University Hospital (Durham, N.C.) — $3.92 billion

Additional questions, I wonder if this list should go into my consideration when it comes to choosing a school. Wouldn't more profitable hospital can afford better facility and equipment? I mean, Pittsburgh has the best simulation in the country. No one is anywhere near what they have there. Would it be because of how rich the hospital is? Also I'm interested in getting a good knowledge regarding how hospitals are run during med school.
Notes: Financially, most schools would be similar at this point. The difference is negligible. Geologically, I don't have a strong preference.

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[FFH]

These are the top 25 grossing hospitals, not the top profiting hospitals.

AHHHHH! Then it makes sense, since UPMC is so large in scale and the only major hospital system in the area.

EDIT: So here are some of the most profiting ones, although it's not a list that has only not non-profit hospitals.

http://www.forbes.com/2010/08/30/profitable-hospitals-hca-healthcare-business-mayo-clinic.html

"Profitability can be as simple as being in a protected market [with little competition] and having lots of privately insured patients,” says Michael Millenson, a consultant with Health Quality Advisors in Highland Park, Ill. Private insurance usually pays more than the federal Medicare program."

 

[Cyberdyne 101]

I can't comment on profitability or whatever, but I think a school's county hospital affiliation is something that should be explored.

 

[TxC]

the administrators probably do a good job keeping the costs low.

 

[kevinsword91]

A dirty secret whispered at my hospital is that we have a lot of "soft admits" which are basically patients who could have gone home from the ER, but instead get admitted under observation status for some costly TLC. I think the charge for a bed is like $1,600 a day plus whatever we can charge up in IV fluids, painkillers, etc. The nurses even chart IV fluids differently just to increase how much we can charge.

 

[NickNaylor]

A dirty secret whispered at my hospital is that we have a lot of "soft admits" which are basically patients who could have gone home from the ER, but instead get admitted under observation status for some costly TLC. I think the charge for a bed is like $1,600 a day plus whatever we can charge up in IV fluids, painkillers, etc. The nurses even chart IV fluids differently just to increase how much we can charge.

EMR: saving lives, $1 at a time.

 

[TooMuchResearch]

Those sorts of things are not really giant money-makers for hospitals. Procedures are where the money is. HCA buys hospitals in areas with good payer mixes and/or areas of high medicare reimbursement rates (medicare reimbursement varies by region). If you look at their hospital profiles they are all pretty similar - tons of high throughput procedures, medium sized in terms of inpatient beds, have an ED but are in areas of low ED acuity. HCA has a good model down to make hospitals cost-efficient (for them in terms of fixed and variables costs) and max out reimbursement.

Add in some illegal agreements with EMCare, fire a bunch of doctors for not playing along, and they're set.

 

[Straw Hat]

"Others see the high profits simply as sign of efficiency and good quality."

All I've ever heard from coworkers about HCA hospitals is that they're horrendous to work for, perform many unnecessary surgeries, and the care is terrible all around.

 

[IlDestriero]

"Others see the high profits simply as sign of efficiency and good quality."

All I've ever heard from coworkers about HCA hospitals is that they're horrendous to work for, perform many unnecessary surgeries, and the care is terrible all around.

That's why they're #1 for profits.
Welcome to the future.
Until Maobama care blows the whole thing up.