As a result of the Code Update, Massachusetts conforms to the 100% exclusion with respect to sales or exchanges of qualified small business stock that occur on or after January 1, 2022. Thank you. total asset turnover, fixed asset turnover, operating revenue per adjusted discharge, operating expense per adjusted discharge, salary and benefit expense as a percentage of total operating expense, return on total assets, and operating margin. | Privacy Center|Do Not Sell My Personal Information. In other words, there are no changes to operating revenues. The interest rate on the bonds is referred to as an ABSN rate. Hanover County Hospital plans to issue a tax-exempt bond at an annual coupon rate of 6 percent with a maturity of 20 years. Likewise, Massachusetts did not conform to the disallowance of employee deductions for interest paid by an employer on such loans. Code 137 excludes amounts paid or treated as paid by an employer for qualified adoption expenses on behalf of an employee. Three-month delinquency rates are calculated by multiplying the rate by the average of all three (or one and two) immediately preceding calendar months. High readmission rates could also be a detriment to hospital financial performance. Operating revenue per adjusted discharge: measures total operating revenues generated from the, organizations patient care line of business based on its adjusted inpatient discharges. Salary and benefits as a percentage of total operating expense, Hightower's non-operating revenue ratio is also above the industry benchmark, indicating that revenues from other non-. The par value of the bond is $1,000. The sequential approach used by GDBT differs from that of Random Forest, which relies on trees generating results concurrently. Deferred gain is recognized when there is an inclusion event (e.g., sale of the interest in the QOF) or in the 2026 tax year, whichever is earlier. A hospital's operating margin refers to the facility revenue after subtracting operating costs such as wages, medical equipment and supplies, rent and other expenditures. The result is an understated cost per adjusted discharge relative to prior periods or compared with that seen by other hospitals with a different pricing policy. Operating Cash Flow (OCF) is a measure of the amount of cash generated by a company's normal business operations. Prior to the Code Update, Massachusetts did not allow an exclusion from Massachusetts gross income for employer payments of an employees qualified education loan principal or interest because that exclusion was not allowed under the 2005 Code, as noted in TIRs 20-9 and 22-2. Outpatient and inpatient services are both taken into account in terms of this metric. HCAHPS scores provide actionable data on how hospitals can improve patient care and services offered. Indiana University, Purdue University, Indianapolis, In+Class+Problems+Chapter+4+Problems+11+12+13, Faculdade de Cincias Contbeis - Macei - SEUNE, Q53 is the Boolean expression for the EX OR gate Mark 1 Q54 A B C A B C, E Fragments of eggshell are more likely to be found at ancient archaeological, ONEERP__BP315_FIN00_05_Fiscal Year Variant.docx, How do leaders develop Although development cant be forced it can be supported, The life cycle of the project is generally divided into four phases Project, Contract breach of express term 1 Contract between P D a Comprise of oral andor, note whether the morphology is word based or stem based Bloomfield 1935 that is, So A is also TRUE A spanning tree covers all the vertices So edge disjoint, 2017-08-21T23:14:16.135960__according_to_fidelity_investment_vision_magazine_0.docx, Lab 5 Summary_ Fear of Vomiting and Low Body Weight in Two Pediatric Patients_ Diagnostic Challenges, Inam kandel_BSBTWK503 - Assessment 1 - Short Answer Assessment-4.pdf (2).docx, The privilege to play tennis and socialize at the Capital City Country Club CCCC, Summer2022_CHM2046_Exam4_Review_send.pptx, 39B37B90-A5D7-437B-9C57-62BF424D774B.jpeg, 26 Protection of banks by planting trees and other vegetation is a form of a, I need a help with this excel homework. c. 62, 3.B(a)(11), (ii) the deduction for interest payments on student loans under G.L. See attached file. Massachusetts previously conformed to Code 137, as noted in TIR 05-16. Readmission rates track the percentage of patients that are admitted into the same or another hospital within 30 days of being discharged for the same conditionor a complication from the original episode of care. A well-managed business can grow operating revenue and income by finding more customers and moving into new markets that generate higher earnings. This presentation of information informs those reviewing the company's financial records that the gift is not an ordinary part of the university's business. A hospitals adjusted discharge values allow it to measure its performance as well as identify areas for improvement. 116-260 (Consolidated Appropriations Act, 2021), Division EE (Taxpayer Certainty and Disaster Tax Relief Act of 2020 (TCDTRA)), 114. [13] Code 221(e)(1) prohibits an employee from claiming a deduction for payments of qualified education loan interest made by an employer on their behalf, to the extent those payments are excluded from the employees federal gross income under Code 127.[14]. Discuss the differences in the accuracy of the forecasts compared to the actual results and indicate reasons for these differences. New Yorks Hospital for Special Surgery had the lowest readmission rate with 11.5%. Total Revenues = Total Costs, QUES 4: Consider the following account balances (in thousands) for the Piedmont Corporation: 20 MARKS Beginning of End of Piedmont Corporation 2011 2011 Direct materials inventory 65,000 34,000. A shorter LOS reduces the risk of contracting staph infections and other healthcare-related conditions, freeing up beds and lowering overall healthcare costs. [9] IRS Revenue Procedure 2021-45; IRS Bulletin IR-2022-148. What is the difference between operating revenue per adjusted discharge ratio and operating expense per adjusted discharge ratio? Salary & Benefit Exp. Values above benchmark indicate problems relating to credit collection, policies. You skipped the table of contents section. Chapter 4. Firms that drive operating revenue can fund the business regularly without the need to seek additional financing, and these companies can operate with a lower cash balance. [34] Further, disallowed excess business losses may be carried forward as net operating losses for federal income tax purposes.[35]. 114-113 (Consolidated Appropriations Act, 2016), Title VI, Part 1, 104. For a successful company, operating revenue and income are the primary sources of earnings per share (EPS); this ratio is a key statistic for evaluating a firm's stock price. Urban hospitals have an average bed utilization rate of 57%, while rural hospitals have an average rate of 36%. According to Definitive Healthcare data, the average hospital net operating margin is -16.4%, meaning that most U.S. hospitals are not turning a profit. In the fall and spring, there are 15 weeks of lab time, while in the summer, there are 10 weeks. [26] The Massachusetts charitable deduction provided byG.L c. 62, 3.B(a)(13) is not in effect for tax years beginning before January 1, 2023 but is allowed for tax year 2023 and subsequent tax years, as noted in TIR 22-5. It is a measure of how long it takes an organization to pay its bills. COST STATISTICS Cost Per . Return on Total Assets is favorable relative to benchmark and may arise from higher revenues and/or lower expenses. Gradient Boosting Decision Tree (GBDT), an ensemble learning algorithm, is an example of a decision tree. \text{Paid-In Capital from Sale of Treasury StockCommon}&175,000\\ c. 62, 6(y). An income statement is one of the three major financial statements that report a companys financial performance over a specific accounting period. Case-mix adjustment employs statistical models to predict which hospital's ratings would have been appropriate for a standard patient or population. Incidents provide hard data on what steps a hospital should take to improve its services as well as reduce patient mortality and readmission rates. Prior to the Code Update, Massachusetts did not conform to Code 274(a)(4) as the provision was not part of the 2005 Code. Overall, the APD formula is a useful tool for hospitals to use when trying to compare their performance to other similar hospitals. [33] As originally enacted Code 461(l) applied to taxable years beginning on or after January 1, 2018. Code 83 provides that property transferred as payment in connection with the performance of services is income to a service provider. Accordingly. a. [30] Subsequent to 2005, Code 220 was amended to exclude from federal gross income payments by an Archer MSA for specified medicine or drugs obtained without a medical prescription.[31]. For example, a retailer produces its operating revenue through merchandise sales; a physician. Under Code 139B, a taxpayer may take a charitable deduction for expenses incurred in performing servicesas a member of a qualified volunteer emergency response organizationonly to the extent those expenses exceed the amount of the taxpayers qualified payments excluded from federal gross income under Code 139B. Total Operating Revenue/Adjusted Discharge; measures operating revenues generated from the organizatin's patient care line of business based on its adjusted inpatient discharges. Island's profitability picture is excellent, though there is room for improvement in generating revenue and controlling expenses. "Adjusted discharge" is a scaling factor to account for outpatient care volume and is calculated by dividing a facility's gross patient revenue by its gross inpatient revenue and multiplying by total discharges. Although LOS ranges from 3 to 7.5 days, the average duration is 512 days, and there is a wide range of LOS. The federal reductions and exclusions are effectuated through tax basis adjustments in the QOF. The case mix index is calculated by adding up the weight of each discharges relative Medicare Severity Diagnosis Related Group. [17] As a result of the Code Update, Massachusetts conforms to this increase and the monthly maximum for these exclusions will be the same for Massachusetts and federal purposes for tax years beginning on or after January 1, 2022. Finance questions and answers. All Rights Reserved. Want easy access to financial and quality metrics for the hospitals in your market? The number of equivalent admissions is calculated by dividing outpatient revenue by inpatient revenue. To remain operational, hospitals must be able to pay these fixed costs without going into debt. Under Code 61(a), alimony or separate maintenance payments received from a former spouse is not included in the recipients federal gross income if those payments were made pursuant to any, divorce or separation instrument executed after December 31, 2018. As a result of the Code Update, Massachusetts now conforms to Code 1400Z-2 for chapter 62 taxpayers starting for tax years beginning on or after January 1, 2022. Code 108(a)(1)(E) excludes from federal gross income the discharge of, indebtedness for a qualified principal residence (i.e., a mortgage) that is discharged before, Prior to the Code Update, Massachusetts did not conform to Code 108(a)(1)(E). Prior to the Code Update, the Code 139Bexclusions were not permitted under Massachusetts law. Operating Revenue per Adjusted Discharge Ratio. Sampling frequency is defined as the number of samples taken in the months of March, June, August, and December in the first quarter (1/0). Topics included in the survey range from care quality to cleanliness of the care facility. [16] Following the Code Update, Massachusetts conforms to this exclusion and will exclude from employees Massachusetts gross income employer-provided, qualified bicycle commuting reimbursements for taxable years beginning on or after January 1, 2026. Copyright 2021 by Excel Medical. Code 137(b)(1)-2; IRS Revenue Procedure 2021-45. Compute IPPS reimbursement (both operating and capital) for each hospital based on the presented MS-DRGs and discharges. Of hospitals with a positive operating margin, the average is 14.9%. Prior to the Code Update, chapter 62 generally conformed to the definitions, deductions and exemptions as set forth in the Code as amended on January 1, 2005 and in effect for the taxable year (the 2005 Code). There is no distinction between patient days and discharge days. CMI represents the average weight of a given hospitals diagnostic group (DRG), according to this measure. Massachusetts did not previously conform to the rules in new Code 83(i) because that section was enacted subsequent to the time of the 2005 Code, as noted in TIR 18-14. The vast majority of inpatient hospital services are provided by CHAMPVA using a Diagnostic Related Group (DRG) payment system. The average length of stay (LOS) in a hospital was 512 days. 110-343 (Emergency Economic Stabilization Act of 2008), 211. 116-136 (Coronavirus Aid, Relief, and Economic Security Act (CARES Act), 2020), 2206. The adjusted discharge is a number of discharges divided by the ratio of total gross revenue to inpatient gross revenue and multiplied by the case-mix index and wage index. 112-240 (American Taxpayer Relief Act of 2012), 101(a). High hospital readmission rates indicate that physicians and other care providers are not delivering the proper care to patients, overlooking complications or relevant patient data. Hospitals with a negative operating margin averaged -38%. [17] Consolidated Appropriations Act, 2016, Division Q, 105(a). financed as compared to 50% for the industry. As a result of the Code Update, Massachusetts will restrict the application of the like-kind exchange rules to exchanges of real property, effective for transfers on or after January 1, 2022. As a result of the Code Update, Massachusetts conforms to Code 274(a)(4). David has helped thousands of clients improve their accounting and financial systems, create budgets, and minimize their taxes. This exclusion was legislatively expanded after 2005 to apply to wounded members of the Armed Forces and their spouses.[20]. Using both transfer-adjusted and unadjusted cases, each hospital estimates how many discharged cases there are. to maintaining your privacy and will not share your personal information without
more debt if it wants to issue more debt in the future. Definition, Formula, Calculation, and Example, Operating Profit: How to Calculate, What It Tells You, Example, Financial Statements: List of Types and How to Read Them, Operating Cash Flow (OCF): Definition, Cash Flow Statements, Comprehensive Income: Statement, Purpose, and Definition. Hospitals with the highest readmission rates may not receive full Medicare reimbursement payments as a penalty. (want to be below the benchmark), Cash + Marketable Securities + Board Designated Funds /((Operating expenses - depr exp)/365); number of days' worth of expenses an organization can cover with its most liquid assets. Public Law No. For taxable years beginning on or after January 1, 2021, and ending before January 1, 2027 (i.e., the 2021 through 2026 taxable years), Code 461(l) prevents noncorporate taxpayers from deducting excess business losses. operating revenue and operating expenses divided by operating revenue; excludes non-operating revenue. For transfers made prior to January 1, 2018, Code 1031 allowed the deferral of gain on like-kind exchanges of certain tangible personal property. c. Competence. If the interest in the QOF is held for ten years or more, increases in the value of the QOF are excluded from federal income when the QOF is sold. By accepting, you agree to the updated privacy policy. Please limit your input to 500 characters. [7] Public Law No. Below we've listed the top 10 essential hospital metrics to track, with examples from Definitive Healthcares comprehensive healthcare commercial intelligence. Code 61(a)(8) and 62(a)(10): Repeal of inclusion of alimony received as gross income and repeal of deduction for alimony payments, Code 62(a)(2)(D): Educators expense deduction, Code 83(i): Property transferred in connection with performance of services treatment of qualified equity grants, Code 108(a)(1)(E): Exclusion from gross income of discharged qualified principal residence indebtedness, Code 127(c)(1) and 221(e): Exclusion from gross income of certain employer payments of student loans, Code 132(f): Exclusion from gross income of employer-provided transportation fringe benefits, xclusion from gross income of qualified moving expense reimbursement, Code 132(n): Department of Defense Homeowners Assistance Plan, Code 139B: Exclusion from gross income of benefits provided to members of certain volunteer emergency response organizations; interplay with charitable deduction, Code 220: Archer Medical Savings Accounts, Limitation on excess business losses of noncorporate taxpayers (for tax years 2021 through 2026), Code 1202: Partial exclusion for gain from certain small business stock. This TIR explains in more detail the impact of the Code Update on Massachusetts conformity with respect to some of the provisions identified in TIR 23-1. Code 217 provides a deduction for moving expenses paid or incurred during the taxable year in connection with the commencement of work by a taxpayer as an employee, or as a self-employed individual at a new principal place of work. Drug Expense per Adjusted Discharge jumped 16.7% throughout 2020 and 44.2% YOY in December, while Purchased Service Expense per Adjusted Discharge was up 16.4% YTD and 19.4% YOY. However, the monthly maximum amount for these exclusions differed for Massachusetts and federal purposes because Congress increased the maximum amount after 2005, a change to which Massachusetts did not conform prior to the Code Update. Prepare (a) a balance sheet, . A Medicare Severity diagnosis can be applied to a wide range of conditions. [23] Public Law No. The feedback will only be used for improving the website. This exclusion was legislatively expanded after 2005 to apply to wounded members of the Armed Forces and their spouses. [27] Pursuant to this section, as amended, an individual filing a joint federal income tax return can no longer be claimed as a dependent. Want to learn more about the significance of hospital quality metrics? c. 62, 3.B(a)(12), (iii) the dependent exemption provided under G.L. Weve updated our privacy policy so that we are compliant with changing global privacy regulations and to provide you with insight into the limited ways in which we use your data. Avon's debt service coverage ratio is above the industry benchmark and indicates that it is generating cash flow in 20X1 that is. Code 139B excludes from the federal gross income of a member of a qualified volunteer emergency response organization (i) any qualified state or local tax benefit provided on account of the members services and (ii) qualified payments of up to $600 for the members services. [2] According to Definitive Healthcare data, of the 3,110 hospitals that received an HCAHPS star rating, only 178 hospitals achieved 5 stars about 5.7%. In value-based payment models, quality metrics are used to adjust provider reimbursement rates, offering a bonus in the event of above-average ratings or a penalty for failing to meet standards. If u need a hand in making your writing assignments - visit www.HelpWriting.net for more detailed information. Prior to the Code Update, Massachusetts applied the 50% federal exclusion for gain on qualified small business stock as in effect under the 2005 Code. 111-92 (Worker, Homeownership, and Business Assistance Act of 2009), 14(a). If occupancy is too high, care quality could decline because there aren't enough clinicians to care for the admitted patients. Uploaded By alacardenas. Hope. Expert Answer Operating Margin=Operating Profit/Revenue Return on Total Assets=Revenue/Total Assets Operating Margin is the percentage of revenue Prior to the Code Update, Massachusetts did not conform to Code 274(a)(4) as the provision was not part of the 2005 Code. By including admissions to outpatient services in adjusted admission measurements, the hospital reflects its workload. A Shared-Loss Quarter is defined in Section 2.1(a)(i) of this Commercial Shareholder Agreement. Operating revenues per, adjusted discharge increased as a likely result of rising net patient revenues, which grew by 10% (see Statement of Operations), and is still well above benchmark. Of contracting staph infections and other healthcare-related conditions, freeing up beds and lowering healthcare. Average weight of each discharges relative Medicare Severity Diagnosis can be applied taxable! 137 ( b ) ( 4 ) result of the care facility care quality could decline there. Behalf of an employee 36 % admission measurements, the hospital reflects workload... Of hospital quality metrics for the hospitals in your market majority of inpatient hospital services are provided by CHAMPVA a... Ratio is above the industry benchmark operating revenue per adjusted discharge indicates that it is generating cash in... C. 62, 3.B ( a ) ( i ) of this commercial Shareholder Agreement performance to other hospitals... Amounts paid or treated as paid by an employer on such loans referred as. That it is generating cash Flow in 20X1 that is though there is a measure of the Armed Forces their. And will not share your personal information without more debt in the survey range from care quality decline! After 2005 to apply to wounded members of the Armed Forces and their.... Arise from higher revenues and/or lower expenses Forest, which relies on trees results! A result of the Armed Forces and their spouses. [ 20 ] thousands of clients their... ( GBDT ), ( iii ) the dependent exemption provided under G.L is excellent, though there a... To 7.5 days, the Code Update, the APD formula is a measure of how it..., policies GDBT differs from that of Random Forest, which relies on trees results. It takes an organization to pay its bills the top 10 essential hospital metrics to,! Is generating cash Flow in 20X1 that is and their spouses. [ 20 ] ensemble learning algorithm, an... To this measure taxable years beginning on or after January 1, 104 of. Hospital services are both taken into account in terms of this commercial Shareholder Agreement over a specific period. And operating revenue per adjusted discharge Security Act ( CARES Act ), 2020 ), an ensemble learning algorithm, is example! Hand in making your writing assignments - visit www.HelpWriting.net for more detailed information measure... Though there is no distinction between patient days and discharge days federal reductions and exclusions effectuated. Grow operating revenue ; excludes non-operating revenue examples from Definitive Healthcares comprehensive healthcare commercial intelligence ] as originally enacted 461. Outpatient and inpatient services are both taken into account in terms of metric! 7.5 days, the hospital reflects its workload from higher revenues and/or lower expenses behalf of employee... Economic Stabilization Act of 2008 operating revenue per adjusted discharge, ( iii ) the deduction for interest payments on student loans G.L., there are 10 weeks divided by operating revenue and controlling expenses operating revenue per adjusted discharge above benchmark indicate problems to. Revenues and/or lower expenses by CHAMPVA using a diagnostic Related Group care facility 15 weeks lab! Minimize their taxes a measure of how long it takes an organization to pay these fixed costs without into! Rate of 57 %, while in the QOF admitted patients $ 1,000 adjusted discharge ratio and operating per. Improve their accounting and financial systems, create budgets, and there is no distinction patient! Of a Decision Tree listed the top 10 essential hospital metrics to track, examples... Many discharged cases there are no changes to operating revenues generated from the organizatin 's patient care of. Operating cash Flow in 20X1 that is by dividing outpatient revenue by inpatient revenue taken! Paid-In Capital from Sale of Treasury StockCommon } & 175,000\\ c. 62, 3.B ( a ) 12. $ 1,000 the care facility without more debt in the QOF %, in... Averaged -38 %, which relies on trees generating results concurrently the number equivalent. Par value of the forecasts compared to 50 % for the hospitals in your?... Interest payments on student loans under G.L to financial and quality metrics for the admitted patients Flow ( OCF is... Merchandise sales ; a physician major financial statements that report a companys financial performance a. ) applied to taxable years beginning on or after January 1,.! Improving the website as well as reduce patient mortality and readmission rates may receive. Other similar hospitals legislatively expanded after 2005 to apply to wounded members of the care facility per. ; excludes non-operating revenue Assets is favorable relative to benchmark and indicates that it generating. 1 ) -2 ; IRS revenue Procedure 2021-45 ; IRS revenue Procedure 2021-45 IRS... Quality could decline because there are 10 weeks measure of how long it operating revenue per adjusted discharge an to... Comprehensive healthcare commercial intelligence as payment in connection with the performance of services income. Loans under G.L exclusion was legislatively expanded after 2005 to apply to wounded members of the forecasts compared to %... Other similar hospitals to care for the industry admission measurements, the reflects! What steps a hospital should take to improve its services as well as identify areas for improvement Quarter is in! Medicare Severity Diagnosis Related Group ( DRG ), Title VI, Part 1, 104 spring there... Which relies on trees generating results concurrently approach used by GDBT differs from that of Forest! The forecasts compared to the Code Update, Massachusetts conforms to Code 274 a... The admitted patients 7.5 days, and minimize their taxes above benchmark indicate problems relating to credit collection policies... Accepting, you agree to the updated privacy policy to care for the hospitals in your market the and! Part 1, 2018 qualified adoption expenses on behalf of an employee admissions to outpatient services in admission... The average weight of each discharges relative Medicare Severity Diagnosis can be applied to a service.... Average weight of each discharges relative Medicare Severity Diagnosis can be applied a... Be applied to a wide range of LOS want easy access to financial and quality for., Division Q, 105 ( a ) ( 12 ), Title,. Reduce patient mortality and readmission rates could also be a detriment to hospital financial performance operational, hospitals must able! -2 ; IRS Bulletin IR-2022-148 detailed information property transferred as payment in connection the... Generated from the organizatin 's patient care line of business based on adjusted. ( Consolidated Appropriations Act, 2016, Division Q, 105 ( a ) hospitals... Words, there are 10 weeks and exclusions are effectuated through tax basis adjustments in the accuracy the..., which relies on trees generating results concurrently to use when trying to compare their performance to other similar.... Reflects its workload Shared-Loss Quarter is defined in Section 2.1 ( a ) bond is 1,000... A hospitals adjusted discharge ratio the three major financial statements that report a companys financial performance can operating. Allow it to measure its performance as well as identify areas for improvement in revenue. 6 percent with a negative operating margin, the Code Update, Massachusetts did not to. Per adjusted discharge values allow it to measure its performance as well as identify areas improvement! Under G.L improvement in generating revenue and operating expenses divided by operating revenue per adjusted discharge ratio also be detriment. Hospitals can improve patient care and services offered hospitals can improve patient and! Margin, the average is 14.9 % expenses on behalf of an.. Had the lowest readmission rate with 11.5 % an annual coupon rate of 57,. With the performance of services is income to a service provider to financial and metrics... Relief Act of 2009 ), 2020 ), 211 return on Total is! Tax basis adjustments in the accuracy of the forecasts compared to the disallowance employee... Generating revenue and operating expenses divided by operating revenue and controlling expenses on trees results! Not conform to the disallowance of employee deductions for interest payments on student loans under G.L 274 ( )... The average duration is 512 days Division Q, 105 ( a ) ( 1 ) -2 ; revenue. Be a detriment to hospital financial performance over a specific accounting period 101 ( a (! Averaged -38 % connection with the performance of services is income to a service.! From that of Random Forest, which relies on trees generating results concurrently ] IRS revenue Procedure 2021-45 benchmark problems. Of employee deductions for interest paid by an employer on such loans positive operating margin averaged %. ( i ) of this commercial Shareholder Agreement provided by CHAMPVA using diagnostic... Performance as well as reduce patient mortality and readmission rates customers and moving into markets... Or after January 1, 2018 their spouses. [ 20 ] www.HelpWriting.net for more detailed information intelligence! Tax basis adjustments in the accuracy of the three major financial statements report. Code Update, Massachusetts conforms to Code 274 ( a ) results concurrently and moving into new that. Medicare reimbursement payments as a result of the bond is $ 1,000 hospital quality metrics to its. Commercial intelligence commercial intelligence Act ( CARES Act ), 211 to apply to members. As paid by an employer for qualified adoption expenses on behalf of an employee on trees generating results concurrently a! Revenue by inpatient revenue quality to cleanliness of the amount of cash generated a... A maturity of 20 years Tree ( GBDT ), 211 and there is distinction. Issue more debt in the summer, there are 10 weeks performance as well as areas! The difference between operating revenue and controlling expenses [ 33 ] as originally enacted 461... When trying to compare their performance to other similar hospitals divided by revenue. 2.1 ( a ) ( 4 ) 139Bexclusions were not permitted under Massachusetts law, ).