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74 FINANCE Tenet Posts $140M Net Loss in 2015: 6 Things to Know By Ayla Ellison D allas-based Tenet Healthcare saw its net revenue increase in the fourth quarter of 2015, but including the results of both continuing and discontinued operations, the for-profit hospital operator ended the period with a net loss. Here are six things to know about Tenet's financial and operating results for the fourth quarter. 1. e for-profit hospital operator said revenue rose to $5.03 bil- lion, up 12.6 percent from the same period a year earlier. 2. Tenet, which operates 84 acute care hospitals across the nation, saw adjusted admissions increase 0.3 percent and revenue per ad- justed admission increase 3.2 percent in the fourth quarter of 2015 compared to the year prior. 3. rough its subsidiaries, partnerships and joint ventures, Tenet operates 20 short-stay surgical hospital and more than 470 outpa- tient centers. On a same-facility basis, cases in Tenet's ambulatory care segment increased 6.9 percent in the fourth quarter of 2015. 4. Tenet reported a net loss of $97 million in the fourth quarter of 2015. at's compared to a net profit of $61 million in the same period of the year prior. For full year 2015, Tenet reported a net loss of $140 million. 5. Tenet's losses include a $218 million increase in litigation reserves. e for-profit hospital operator previously disclosed it is the subject of a criminal investigation by the Department of Jus- tice. e criminal lawsuit arose out of a civil lawsuit filed under the qui tam provision of the False Claims Act. e lawsuit alleges four Tenet hospitals paid illegal kickbacks to clinics that referred undocumented pregnant patients to them for Medicaid-paid deliveries. Undocumented patients are not eligible for regular Medicaid coverage. However, they typically qualify for emergency medical assistance when they deliver their babies. Tenet offered to pay $238 million to settle the criminal investigation and civil litigation Feb. 18, according to a recent Securities and Exchange Commission filing. 6. Commenting on the hospital operator's most recent financial results, Tenet Chairman and CEO Trevor Fetter said, "Similar to our results in the third quarter, we experienced pressure on lower acuity inpatient hospital admissions and continued to drive increases in higher-acuity admissions." Tenet expects to deliver revenue in the range of $18.8 billion to $19.2 billion during 2016. n Bad Debt on the Rise for Hospitals Nationally: 4 Takeaways By Brooke Murphy T he Affordable Care Act has lowered the uninsured rate in the U.S., but it has not relieved the finan- cial pressure hospitals experience from caring for uninsured patients. It is clear to many hospital leaders bad debt is going nowhere soon, and may even be getting worse thanks to the rise in high deductible health plans, reports Bloomberg. Below are four things to know about the rise in bad debt at U.S. hospitals. 1. The uninsured rate has fallen, but the percentage of Americans with high deductible health plans is up. The uninsured rate in the U.S. has fallen from 15.7 percent in 2009 to 9.1 percent in 2015, according to a report from the CDC. Since 2010, however, the per- centage of Americans with high deductible or consum- er-directed health plans has risen from 25 percent to 36 percent in the first nine months of 2015. 2. Patients are unlikely to have the ability to pay medical bills greater than 5 percent of their house- hold income, according to The Advisory Board. As median household income in the U.S. is about $53,000, out-of-pocket medical expenses exceeding $2,600 may be difficult or impossible for hospitals to collect, Spencer Perlman, an analyst with Height Securities, told Bloomberg. "When someone has a really high deductible, effectively they're still uninsured," John Hen- derson, Childress (Texas) Regional Medical Center CEO, told Bloomberg. 3. Some hospitals have reported increased bad debt expenses due to patients' inability to pay. This month, Community Health Systems in Franklin, Tenn., revised its fourth quarter 2015 financial report for bad debt, increasing the amount to $169 million. CHS officials attributed 40 percent, or almost $68 million of bad debt, to patients being unable to pay deductibles and co-pays. 4. Rural hospitals have been hit particularly hard by bad debt. Minnesota Hospital Association Vice Presi- dent of Finance Joe Schindler said the shift in Minne- sota employers offering HDHPs negatively impacted bad debt numbers last year, reports Bloomberg. In 2015, bad debt rose by 20 percent, amounting to $425 million, at the association's 140 member hospi- tals. "We have 39 hospitals that have negative mar- gins and the majority of them are rural," Mr. Schindler told Bloomberg. n