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Revenue
9 Months Ended
Sep. 30, 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 and nine month periods ended September 30, 2019 and 2018 (in thousands):

 

 

For the three months ended September 30, 2019

 

 

Acute Care

 

 

Behavioral Health

 

 

Other

 

 

Total

 

Medicare

$

333,777

 

 

22

%

 

$

143,514

 

 

11

%

 

 

 

 

 

$

477,291

 

 

17

%

Managed Medicare

 

197,993

 

 

13

%

 

 

60,801

 

 

5

%

 

 

 

 

 

 

258,794

 

 

9

%

Medicaid

 

148,570

 

 

10

%

 

 

168,871

 

 

13

%

 

 

 

 

 

 

317,441

 

 

11

%

Managed Medicaid

 

133,906

 

 

9

%

 

 

278,888

 

 

22

%

 

 

 

 

 

 

412,794

 

 

15

%

Managed Care (HMO and PPOs)

 

554,341

 

 

36

%

 

 

324,140

 

 

25

%

 

 

 

 

 

 

878,481

 

 

31

%

UK Revenue

 

0

 

 

0

%

 

 

134,905

 

 

10

%

 

 

 

 

 

 

134,905

 

 

5

%

Other patient revenue and adjustments, net

 

45,918

 

 

3

%

 

 

130,964

 

 

10

%

 

 

 

 

 

 

176,882

 

 

6

%

Other non-patient revenue

 

114,030

 

 

7

%

 

 

49,733

 

 

4

%

 

 

2,102

 

 

 

165,865

 

 

6

%

Total Net Revenue

$

1,528,535

 

 

100

%

 

$

1,291,816

 

 

100

%

 

$

2,102

 

 

 

2,822,453

 

 

100

%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

For the nine months ended September 30, 2019

 

 

Acute Care

 

 

Behavioral Health

 

 

Other

 

 

Total

 

Medicare

$

988,746

 

 

22

%

 

$

420,218

 

 

11

%

 

 

 

 

 

$

1,408,964

 

 

17

%

Managed Medicare

 

618,756

 

 

14

%

 

 

167,212

 

 

4

%

 

 

 

 

 

 

785,968

 

 

9

%

Medicaid

 

391,762

 

 

9

%

 

 

525,350

 

 

13

%

 

 

 

 

 

 

917,112

 

 

11

%

Managed Medicaid

 

413,607

 

 

9

%

 

 

821,413

 

 

21

%

 

 

 

 

 

 

1,235,020

 

 

15

%

Managed Care (HMO and PPOs)

 

1,690,889

 

 

37

%

 

 

1,018,739

 

 

26

%

 

 

 

 

 

 

2,709,628

 

 

32

%

UK Revenue

 

0

 

 

0

%

 

 

415,407

 

 

11

%

 

 

 

 

 

 

415,407

 

 

5

%

Other patient revenue and adjustments, net

 

133,962

 

 

3

%

 

 

381,345

 

 

10

%

 

 

 

 

 

 

515,307

 

 

6

%

Other non-patient revenue

 

337,366

 

 

7

%

 

 

148,756

 

 

4

%

 

 

8,484

 

 

 

494,606

 

 

6

%

Total Net Revenue

$

4,575,088

 

 

100

%

 

$

3,898,440

 

 

100

%

 

$

8,484

 

 

 

8,482,012

 

 

100

%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

For the three months ended September 30, 2018

 

 

Acute Care

 

 

Behavioral Health

 

 

Other

 

 

Total

 

Medicare

$

295,691

 

 

21

%

 

$

155,642

 

 

12

%

 

 

 

 

 

$

451,333

 

 

17

%

Managed Medicare

 

175,248

 

 

13

%

 

 

55,285

 

 

4

%

 

 

 

 

 

 

230,533

 

 

9

%

Medicaid

 

126,977

 

 

9

%

 

 

169,614

 

 

13

%

 

 

 

 

 

 

296,591

 

 

11

%

Managed Medicaid

 

123,296

 

 

9

%

 

 

242,233

 

 

19

%

 

 

 

 

 

 

365,529

 

 

14

%

Managed Care (HMO and PPOs)

 

500,688

 

 

36

%

 

 

333,585

 

 

26

%

 

 

 

 

 

 

834,273

 

 

31

%

UK Revenue

 

0

 

 

0

%

 

 

129,965

 

 

10

%

 

 

 

 

 

 

129,965

 

 

5

%

Other patient revenue and adjustments, net

 

62,055

 

 

4

%

 

 

126,157

 

 

10

%

 

 

 

 

 

 

188,212

 

 

7

%

Other non-patient revenue

 

99,095

 

 

7

%

 

 

49,991

 

 

4

%

 

 

3,391

 

 

 

152,477

 

 

6

%

Total Net Revenue

$

1,383,050

 

 

100

%

 

$

1,262,472

 

 

100

%

 

$

3,391

 

 

 

2,648,913

 

 

100

%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

For the nine months ended September 30, 2018

 

 

Acute Care

 

 

Behavioral Health

 

 

Other

 

 

Total

 

Medicare

$

972,073

 

 

23

%

 

$

444,812

 

 

12

%

 

 

 

 

 

$

1,416,885

 

 

18

%

Managed Medicare

 

550,683

 

 

13

%

 

 

151,323

 

 

4

%

 

 

 

 

 

 

702,006

 

 

9

%

Medicaid

 

349,794

 

 

8

%

 

 

522,916

 

 

14

%

 

 

 

 

 

 

872,710

 

 

11

%

Managed Medicaid

 

410,243

 

 

10

%

 

 

720,285

 

 

19

%

 

 

 

 

 

 

1,130,528

 

 

14

%

Managed Care (HMO and PPOs)

 

1,547,496

 

 

37

%

 

 

1,052,694

 

 

28

%

 

 

 

 

 

 

2,600,190

 

 

32

%

UK Revenue

 

0

 

 

0

%

 

 

364,163

 

 

10

%

 

 

 

 

 

 

364,163

 

 

5

%

Other patient revenue and adjustments, net

 

104,926

 

 

2

%

 

 

364,534

 

 

10

%

 

 

 

 

 

 

469,460

 

 

6

%

Other non-patient revenue

 

297,458

 

 

7

%

 

 

153,824

 

 

4

%

 

 

10,558

 

 

 

461,840

 

 

6

%

Total Net Revenue

$

4,232,673

 

 

100

%

 

$

3,774,551

 

 

100

%

 

$

10,558

 

 

 

8,017,782

 

 

100

%