SSM Health’s 2018 net income more than doubles through acquisitions

Early 2018 acquisitions helped SSM Health more than double its revenue over expenses last year. 

While many large health systems saw their profits sink on investment losses last year, the St. Louis-based health system more than doubled that metric. SSM drew $505.2 million in revenue over expenses last year, up from $246 million in 2017. 

That was mostly thanks to nearly $600 million in so-called “inherent contribution” gains in 2018 stemming from acquisitions in Wisconsin. Inherent contributions are reported when the value of acquired assets exceeds the acquired liabilities, according to a 2016 report by BDO.

SSM acquired Agnesian HealthCare in Fond du Lac, Wis., and Monroe (Wis.) Clinic from the Congregation of Sisters of St. Agnes at the beginning of 2018. The deal added four hospitals, four long-term care facilities and multiple outpatient sites to SSM’s portfolio and extended its reach in Wisconsin to northern Illinois. 

SSM has been growing rapidly in recent years, having acquired St. Louis University Hospital from Tenet Healthcare in 2015, and took control of 26 St. Louis-area health clinics in Walgreens stores in 2016.

The health system’s total operating revenue spiked 16.2% year-over-year, from $6.5 billion in 2017 to nearly $7.6 billion in 2018. Expenses rose 15% during that time, to $7.4 billion last year. Net patient service revenue grew 18% year-over-year.

Kris Zimmer, SSM’s chief financial officer, said in a statement that the Wisconsin acquisitions were the primary driver of SSM’s increased patient service revenue last year. Favorable payer and revenue mixes in other parts of the system helped increase that revenue as well. 

The system’s operating income narrowed in the year, however, to $11.2 million, compared with $30.8 million in 2017. Excluding impairment losses primarily on assets at its mid-Missouri locations, SSM’s operating income before nonrecurring items was $124 million in 2018 compared with $40.1 million in 2017. 

SSM certainly wasn’t immune to the stock market volatility that struck most health systems at the end of 2018. It lost nearly $82 million on investments last year, compared with a nearly $243 million gain in the previous year. 

SSM stated that it continues to appeal a CMS determination that it needs to repay the agency for behavioral health services provided at an Oklahoma hospital. SSM had $37.7 million in a reserve fund connected to the dispute last year and $44.5 million in 2017. The health system repaid the agency $10.5 million last year. 

At issue is the fact that the CMS determined it had overpaid SSM for inpatient behavioral health services provided to children and adolescents at the hospital in 2006. An audit determined certain services should have been classified as non-acute residential treatment services, which are less expensive than inpatient care, and the CMS in 2013 determined the facility would need to repay money it provided to the hospital’s adolescent psychiatric program in 2006. Ultimately, SSM said it expects the ruling will be expanded to payments received in 2004 through 2013.

SSM recorded a $107.3 million impairment loss last year mostly related to assets at its mid-Missouri locations. Roughly $6 million was related to assets held for sale in Wisconsin. The system did not record any impairment charges in 2017.

SSM spent $117 million providing charity care last year, down from $121.1 million in 2017. The system also spent $164.5 million last year on community health improvement services, education, research, community building activities and other community benefits, compared with $161.4 million in 2017.

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