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Revenue | 9 Months Ended
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Sep. 30, 2018
Revenue From Contract With Customer [Abstract] |
Revenue | (11) 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 payor, 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 payor or group of payors, will result in the recognition of the same amount of revenue as applying the analysis at the individual patient level. On January 1, 2018, we adopted the new accounting standard using the modified retrospective method. The information in comparative periods have not been restated and continues to be reported under the accounting standards in effect for those periods. In accordance with the new revenue standard requirements, the disclosure of the impact of adoption on our condensed consolidated income statement was as follows (in thousands):
|  |  |  |  | Balances Without |  |  |  |  |
| As |  |  | Adoption |  |  | Effect |
| Reported |  |  | ASC 606 |  |  | of Change |
For the three months ended September 30, 2018: |  |  |  |  |  |  |  |  |  |  |
Net Revenue before provision for doubtful accounts |  |  |  |  | $ | 2,929,710 |  |  |  |  |
Less: Provision for doubtful accounts |  |  |  |  |  | 285,044 |  |  |  |  |
Net Revenues | $ | 2,648,913 |  |  | $ | 2,644,666 |  |  | $ | 4,247 |
Other operating expenses | $ | 651,442 |  |  | $ | 647,195 |  |  | $ | 4,247 |
|  |  |  |  | Balances Without |  |  |  |  |
| As |  |  | Adoption |  |  | Effect |
| Reported |  |  | ASC 606 |  |  | of Change |
For the nine months ended September 30, 2018: |  |  |  |  |  |  |  |  |  |  |
Net Revenue before provision for doubtful accounts |  |  |  |  | $ | 8,814,635 |  |  |  |  |
Less: Provision for doubtful accounts |  |  |  |  |  | 807,747 |  |  |  |  |
Net Revenues | $ | 8,017,782 |  |  | $ | 8,006,888 |  |  | $ | 10,894 |
Other operating expenses | $ | 1,896,745 |  |  | $ | 1,885,851 |  |  | $ | 10,894 |
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, 2018 and 2017 (in thousands):
| 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 | %
| For the three months ended September 30, 2017 |
| Acute Care |  |  | Behavioral Health |  |  | Other |  |  | Total |
Medicare | $ | 299,844 |  |  | 23 | % |  | $ | 157,622 |  |  | 13 | % |  |  |  |  |  | $ | 457,466 |  |  | 18 | %
Managed Medicare |  | 160,548 |  |  | 12 | % |  |  | 42,322 |  |  | 3 | % |  |  |  |  |  |  | 202,870 |  |  | 8 | %
Medicaid |  | 121,290 |  |  | 9 | % |  |  | 177,196 |  |  | 14 | % |  |  |  |  |  |  | 298,486 |  |  | 12 | %
Managed Medicaid |  | 124,079 |  |  | 9 | % |  |  | 209,463 |  |  | 17 | % |  |  |  |  |  |  | 333,542 |  |  | 13 | %
Managed Care (HMO and PPOs) |  | 471,623 |  |  | 36 | % |  |  | 335,373 |  |  | 27 | % |  |  |  |  |  |  | 806,996 |  |  | 32 | %
UK Revenue |  | 0 |  |  | 0 | % |  |  | 110,526 |  |  | 9 | % |  |  |  |  |  |  | 110,526 |  |  | 4 | %
Other patient revenue and adjustments, net |  | 26,022 |  |  | 2 | % |  |  | 136,714 |  |  | 11 | % |  |  |  |  |  |  | 162,736 |  |  | 6 | %
Other non-patient revenue |  | 113,342 |  |  | 9 | % |  |  | 55,332 |  |  | 5 | % |  |  | 568 |  |  |  | 169,242 |  |  | 7 | %
Total Net Revenue | $ | 1,316,748 |  |  | 100 | % |  | $ | 1,224,548 |  |  | 100 | % |  | $ | 568 |  |  |  | 2,541,864 |  |  | 100 | %
| For the nine months ended September 30, 2017 |
| Acute Care |  |  | Behavioral Health |  |  | Other |  |  | Total |
Medicare | $ | 925,857 |  |  | 23 | % |  | $ | 451,704 |  |  | 12 | % |  |  |  |  |  | $ | 1,377,561 |  |  | 18 | %
Managed Medicare |  | 471,727 |  |  | 12 | % |  |  | 121,709 |  |  | 3 | % |  |  |  |  |  |  | 593,436 |  |  | 8 | %
Medicaid |  | 343,675 |  |  | 8 | % |  |  | 540,823 |  |  | 15 | % |  |  |  |  |  |  | 884,498 |  |  | 11 | %
Managed Medicaid |  | 384,340 |  |  | 9 | % |  |  | 650,327 |  |  | 18 | % |  |  |  |  |  |  | 1,034,667 |  |  | 13 | %
Managed Care (HMO and PPOs) |  | 1,452,448 |  |  | 36 | % |  |  | 1,050,550 |  |  | 29 | % |  |  |  |  |  |  | 2,502,998 |  |  | 32 | %
UK Revenue |  | 0 |  |  | 0 | % |  |  | 316,938 |  |  | 9 | % |  |  |  |  |  |  | 316,938 |  |  | 4 | %
Other patient revenue and adjustments, net |  | 141,919 |  |  | 3 | % |  |  | 381,723 |  |  | 10 | % |  |  |  |  |  |  | 523,642 |  |  | 7 | %
Other non-patient revenue |  | 352,786 |  |  | 9 | % |  |  | 171,456 |  |  | 5 | % |  |  | 9,096 |  |  |  | 533,338 |  |  | 7 | %
Total Net Revenue | $ | 4,072,752 |  |  | 100 | % |  | $ | 3,685,230 |  |  | 100 | % |  | $ | 9,096 |  |  |  | 7,767,078 |  |  | 100 | %

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- Definition The entire disclosure of revenue from contract with customer to transfer good or service and to transfer nonfinancial asset. Includes, but is not limited to, disaggregation of revenue, credit loss recognized from contract with customer, judgment and change in judgment related to contract with customer, and asset recognized from cost incurred to obtain or fulfill contract with customer. Excludes insurance and lease contracts. + References Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 606 -URI http://asc.fasb.org/topic&trid=49130388 Reference 2: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 235 -URI http://asc.fasb.org/topic&trid=2122369 + Details
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