HCA Holdings 2011 Annual Report Download - page 73

HCA HOLDINGS, INC.
MANAGEMENT’S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION
AND RESULTS OF OPERATIONS — (Continued)
Results of Operations (Continued)
Revenue/Volume Trends (Continued)
The approximate percentages of our inpatient revenues, before provision for doubtful accounts, related to
Medicare, managed Medicare, Medicaid, managed Medicaid, managed care plans and other insurers and the
uninsured for the years ended December 31, 2011, 2010 and 2009 are set forth below.
Years Ended December 31,
2011 2010 2009
Medicare ...................................................... 31% 31% 31%
Managed Medicare .............................................. 998
Medicaid ...................................................... 898
Managed Medicaid .............................................. 444
Managed care and other insurers ................................... 45 44 44
Uninsured(a) ................................................... 335
100% 100% 100%
(a) Increases in discounts to uninsured revenues have resulted in declines in the percentage of our inpatient
revenues related to the uninsured, as the percentage of uninsured admissions compared to total admissions
has increased slightly.
At December 31, 2011, we owned and operated 39 hospitals and 31 surgery centers in the state of Florida.
Our Florida facilities’ revenues totaled $6.989 billion, $6.538 billion and $6.217 billion for the years ended
December 31, 2011, 2010 and 2009, respectively. At December 31, 2011, we owned and operated 36 hospitals
and 22 surgery centers in the state of Texas. Our Texas facilities’ revenues totaled $7.829 billion, $7.597 billion
and $7.180 billion for the years ended December 31, 2011, 2010 and 2009, respectively. During each year 2011,
2010 and 2009, 57% of our admissions and 50% of our revenues were generated by our Florida and Texas
facilities. Uninsured admissions in Florida and Texas represented 63%, 63% and 64% of our uninsured
admissions during 2011, 2010 and 2009, respectively.
We receive a significant portion of our revenues from government health programs, principally Medicare
and Medicaid, which are highly regulated and subject to frequent and substantial changes. We provide indigent
care services in several communities in the state of Texas, in affiliation with other hospitals. The state of Texas
has been involved in efforts to increase the indigent care provided by private hospitals. As a result of additional
indigent care being provided by private hospitals, public hospital districts or counties in Texas have available
funds that were previously devoted to indigent care. The public hospital districts or counties are under no
contractual or legal obligation to provide such indigent care. The public hospital districts or counties have elected
to transfer some portion of these available funds to the state’s Medicaid program. Such action is at the sole
discretion of the public hospital districts or counties. It is anticipated that these contributions to the state will be
matched with federal Medicaid funds. The state then may make supplemental payments to hospitals in the state
for Medicaid services rendered. Hospitals receiving Medicaid supplemental payments may include those that are
providing additional indigent care services. Our Texas Medicaid revenues included $540 million, $657 million
and $474 million during 2011, 2010 and 2009, respectively, of Medicaid supplemental payments. In addition, we
receive supplemental payments in several other states. We are aware these supplemental payment programs are
currently being reviewed by certain state agencies and some states have made waiver requests to the Centers for
Medicare & Medicaid Services (“CMS”) to replace their existing supplemental payment programs. It is possible
these reviews and waiver requests will result in the restructuring of such supplemental payment programs and
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