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Basis of Presentation and Significant Accounting Policies (Policies) | 9 Months Ended
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Sep. 30, 2017
Basis of Presentation | Basis of Presentation The accompanying unaudited condensed consolidated financial statements have been prepared in accordance with generally accepted accounting principles for interim financial information and with the instructions to Form 10-Q and Article 10 of Regulation S-X. Accordingly, they do not include all the information and footnotes required by generally accepted accounting principles for complete consolidated financial statements. In the opinion of management, all adjustments considered necessary for a fair presentation have been included and are of a normal and recurring nature. The majority of our expenses are “costs of revenues” items. Costs that could be classified as general and administrative would include our corporate office costs, which were $91 million and $94 million for the quarters ended September 30, 2017 and 2016, respectively, and $273 million and $272 million for the nine months ended September 30, 2017 and 2016, respectively. Operating results for the quarter and nine months ended September 30, 2017 are not necessarily indicative of the results that may be expected for the year ending December 31, 2017. For further information, refer to the consolidated financial statements and footnotes thereto included in our annual report on Form 10-K for the year ended December 31, 2016.
Revenues | Revenues Revenues are recorded during the period the health care services are provided, based upon the estimated amounts due from the patients and third-party payers. Third-party payers include federal and state agencies (under the Medicare and Medicaid programs), managed care health plans and commercial insurance companies (including plans offered through the health insurance exchanges), and employers. Estimates of contractual allowances under managed care health plans are based upon the payment terms specified in the related contractual agreements. Revenues related to uninsured patients and uninsured copayment and deductible amounts for patients who have health care coverage may have discounts applied (uninsured discounts and contractual discounts). We also record a provision for doubtful accounts (based primarily on historical collection experience) related to uninsured accounts to record net self-pay revenues at the estimated amounts we expect to collect. Our revenues from third-party payers, the uninsured and other for the quarters and nine months ended September 30, 2017 and 2016 are summarized in the following table (dollars in millions):
|  | Quarter |
|  | 2017 |  |  | Ratio |  |  | 2016 |  |  | Ratio |
Medicare |  | $ | 2,354 |  |  |  | 22.0 | % |  | $ | 2,158 |  |  |  | 21.0 | %
Managed Medicare |  |  | 1,156 |  |  |  | 10.8 |  |  |  | 1,068 |  |  |  | 10.4 |
Medicaid |  |  | 362 |  |  |  | 3.4 |  |  |  | 405 |  |  |  | 3.9 |
Managed Medicaid |  |  | 582 |  |  |  | 5.4 |  |  |  | 611 |  |  |  | 6.0 |
Managed care and other insurers |  |  | 6,039 |  |  |  | 56.4 |  |  |  | 5,863 |  |  |  | 57.1 |
International (managed care and other insurers) |  |  | 276 |  |  |  | 2.6 |  |  |  | 285 |  |  |  | 2.8 |
|  |  | 10,769 |  |  |  | 100.6 |  |  |  | 10,390 |  |  |  | 101.2 |
Uninsured |  |  | 849 |  |  |  | 7.9 |  |  |  | 336 |  |  |  | 3.3 |
Other |  |  | 349 |  |  |  | 3.3 |  |  |  | 384 |  |  |  | 3.7 |
Revenues before provision for doubtful accounts |  |  | 11,967 |  |  |  | 111.8 |  |  |  | 11,110 |  |  |  | 108.2 |
Provision for doubtful accounts |  |  | (1,271 | ) |  |  | (11.8 | ) |  |  | (840 | ) |  |  | (8.2 | )
Revenues |  | $ | 10,696 |  |  |  | 100.0 | % |  | $ | 10,270 |  |  |  | 100.0 | %
|  | Nine Months |
|  | 2017 |  |  | Ratio |  |  | 2016 |  |  | Ratio |
Medicare |  | $ | 7,080 |  |  |  | 22.1 | % |  | $ | 6,641 |  |  |  | 21.5 | %
Managed Medicare |  |  | 3,546 |  |  |  | 11.1 |  |  |  | 3,250 |  |  |  | 10.5 |
Medicaid |  |  | 1,188 |  |  |  | 3.7 |  |  |  | 1,248 |  |  |  | 4.0 |
Managed Medicaid |  |  | 1,798 |  |  |  | 5.6 |  |  |  | 1,816 |  |  |  | 5.9 |
Managed care and other insurers |  |  | 18,071 |  |  |  | 56.4 |  |  |  | 17,324 |  |  |  | 56.2 |
International (managed care and other insurers) |  |  | 814 |  |  |  | 2.5 |  |  |  | 926 |  |  |  | 3.0 |
|  |  | 32,497 |  |  |  | 101.4 |  |  |  | 31,205 |  |  |  | 101.1 |
Uninsured |  |  | 1,593 |  |  |  | 5.0 |  |  |  | 750 |  |  |  | 2.4 |
Other |  |  | 1,066 |  |  |  | 3.3 |  |  |  | 1,286 |  |  |  | 4.2 |
Revenues before provision for doubtful accounts |  |  | 35,156 |  |  |  | 109.7 |  |  |  | 33,241 |  |  |  | 107.7 |
Provision for doubtful accounts |  |  | (3,104 | ) |  |  | (9.7 | ) |  |  | (2,392 | ) |  |  | (7.7 | )
Revenues |  | $ | 32,052 |  |  |  | 100.0 | % |  | $ | 30,849 |  |  |  | 100.0 | %
Recent Pronouncements | Recent Pronouncements In May 2014, the Financial Accounting Standards Board (“FASB”) and the International Accounting Standards Board issued a final, converged, principles-based standard on revenue recognition. Companies across all industries will use a five-step model to recognize revenue from customer contracts. The new standard, which replaces nearly all existing revenue recognition guidance, will require significant management judgments and change the way many companies recognize revenue in their financial statements. In July 2015, the FASB decided to defer the effective date of the new revenue standard by one year to annual and interim periods beginning after December 15, 2017 for public entities and permit entities to adopt one year earlier if they choose. The FASB decided, based on its outreach to various stakeholders and continuing amendments to the new revenue standard, that a deferral was necessary to provide adequate time to effectively implement the new standard. We are continuing to evaluate the effects the adoption of this standard will have on our financial statements and financial disclosures. We believe the most significant impact will be to the presentation of our income statement where the provision for doubtful accounts will be recorded as a direct reduction to revenues and will not be presented as a separate line item. We expect to adopt the new standard using the full retrospective application, and we do not currently believe the adoption will have a significant impact on our recognition of net revenues or related disclosures for any period. In February 2016, the FASB issued Accounting Standards Update 2016-02, Leases (“ASU 2016-02”), which requires lessees to recognize assets and liabilities for most leases. ASU 2016-02 is effective for public business entities for annual and interim periods beginning after December 15, 2018. Early adoption is permitted. ASU 2016-02’s transition provisions will be applied using a modified retrospective approach at the beginning of the earliest comparative period presented in the financial statements. We are currently evaluating the provisions of ASU 2016-02 to determine how our financial statements will be affected, and we believe the primary effect of adopting the new standard will be to record right-of-use assets and obligations for our leases currently classified as operating leases.
Reclassifications | Reclassifications Certain prior year amounts have been reclassified to conform to the current year presentation.
Earning Per Share | We compute basic earnings per share using the weighted average number of common shares outstanding. We compute diluted earnings per share using the weighted average number of common shares outstanding, plus the dilutive effect of outstanding equity awards and potential shares, computed using the treasury stock method.
Fair Value Measurements and Disclosures | Accounting Standards Codification 820, Fair Value Measurements and Disclosures (“ASC 820”) emphasizes fair value is a market-based measurement, and fair value measurements should be determined based on the assumptions market participants would use in pricing assets or liabilities. ASC 820 utilizes a fair value hierarchy that distinguishes between market participant assumptions based on market data obtained from sources independent of the reporting entity (observable inputs classified within Levels 1 and 2 of the hierarchy) and the reporting entity’s own assumptions about market participant assumptions (unobservable inputs classified within Level 3 of the hierarchy). Level 1 inputs utilize quoted prices (unadjusted) in active markets for identical assets or liabilities. Level 2 inputs are inputs other than quoted prices included in Level 1 that are observable for the asset or liability, either directly or indirectly. Level 2 inputs may include quoted prices for similar assets and liabilities in active markets, as well as inputs observable for the asset or liability (other than quoted prices), such as interest rates, foreign exchange rates, and yield curves observable at commonly quoted intervals. Level 3 inputs are unobservable inputs for the asset or liability, which are typically based on an entity’s own assumptions, as there is little, if any, related market activity. In instances where the determination of the fair value measurement is based on inputs from different levels of the fair value hierarchy, the level in the fair value hierarchy within which the entire fair value measurement falls is based on the lowest level input significant to the fair value measurement in its entirety. Our assessment of the significance of a particular input to the fair value measurement in its entirety requires judgment.
Cash Traded Investments | Cash Traded Investments Our cash traded investments are generally classified within Level 1 or Level 2 of the fair value hierarchy because they are valued using quoted market prices, broker or dealer quotations, or alternative pricing sources with reasonable levels of price transparency. Certain types of cash traded instruments are classified within Level 3 of the fair value hierarchy because they trade infrequently and therefore have little or no price transparency. The valuation of these securities involves the consideration of market factors and management’s judgment.
Derivative Financial Instruments | Derivative Financial Instruments We have entered into interest rate swap agreements to manage our exposure to fluctuations in interest rates. The valuation of these instruments is determined using widely accepted valuation techniques, including discounted cash flow analysis on the expected cash flows of each derivative. This analysis reflects the contractual terms of the derivatives, including the period to maturity, and uses observable market-based inputs, including interest rate curves and implied volatilities. We incorporate credit valuation adjustments to reflect both our own nonperformance risk and the respective counterparty’s nonperformance risk in the fair value measurements of these instruments. Although we determined the majority of the inputs used to value our derivatives fall within Level 2 of the fair value hierarchy, the credit valuation adjustments associated with our derivatives utilize Level 3 inputs, such as estimates of current credit spreads to evaluate the likelihood of default by us and our counterparties. We assessed the significance of the impact of the credit valuation adjustments on the overall valuation of our derivative positions, and at September 30, 2017 and December 31, 2016, we determined the credit valuation adjustments were not significant to the overall valuation of our derivatives.
Interest Rate Swaps [Member] |
Interest Rate Swap Agreements | Interest Rate Swap Agreements We have entered into interest rate swap agreements to manage our exposure to fluctuations in interest rates. These swap agreements involve the exchange of fixed and variable rate interest payments between two parties based on common notional principal amounts and maturity dates. Pay-fixed interest rate swaps effectively convert LIBOR indexed variable rate obligations to fixed interest rate obligations. The interest payments under these agreements are settled on a net basis. The net interest payments, based on the notional amounts in these agreements, generally match the timing of the related liabilities for the interest rate swap agreements which have been designated as cash flow hedges. The notional amounts of the swap agreements represent amounts used to calculate the exchange of cash flows and are not our assets or liabilities. Our credit risk related to these agreements is considered low because the swap agreements are with creditworthy financial institutions.

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