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Banner Health's academic medical center in Phoenix. Photo: Banner Health

The number of hospital admissions, surgeries and other medical procedures has continued to stay flat in many parts of the country, but that hasn't prevented hospitals from retaining large sums of money and hiring more people.

The big picture: America's rural hospitals are dying. But large not-for-profit hospital systems in cities and suburbs are doing extremely well as premiums rise and as patients struggle to afford their medical bills.

Details: Axios analyzed the financial statements of 31 prominent not-for-profit hospital systems for the first 3 months of 2019.

  • This sample collectively generated $68.5 billion of revenue in the first quarter of this year. That's $274 billion annualized, or more than one-fifth of all hospital spending.
  • The combined operating margin was 5.1%, compared with 4.5% in the first quarter of 2018.
  • The combined net margin (after factoring in investment income) was 16.4%, a large jump from 5.5% in 2018.
  • These margins are on par with some pharmaceutical and medical device companies, and well above the margins for insurers and drug distributors.

Between the lines: Hospitals are feasting on bigger investment returns, boosted by the stock market's run, but they also are profiting more from commercial and public health insurer payments.

The intrigue: Not-for-profit hospitals don't pay taxes and don't have "shareholders" like publicly traded companies, so they are required to reinvest any surplus cash into their communities.

Case in point: Newly opened patient towers at Banner Health's academic medical center campuses in Arizona cost $1 billion and "are expected to drive additional volume increases," Banner said in a memo last week to bondholders. Banner declined an interview request.

  • "It's clear the hospital industry today continues to be driven by volume, which is where the big returns are," said Paul Ginsburg, director of the USC-Brookings Schaeffer Initiative for Health Policy. "Value-based [payment] approaches conflict with that."

Go deeper: Hospitals are making a fortune on Wall Street

Go deeper

Oath Keepers leader denied bail on Capitol riot sedition charge

Oath Keepers co-founder Elmer Stewart Rhodes. Photo: Susan Walsh/AP

A federal judge ordered Oath Keepers leader Stewart Rhodes to remain jailed Wednesday until trial on charges stemming from the Capitol riot.

U.S. Magistrate Judge Kimberly Priest Johnson e in the t figure charged in the Jan. 6, 2021, insurrection had access to weapons and his alleged "continued advocacy for violence against the federal government" gave credence to prosecutors' view that, if released, Rhodes could endanger others.

Who in Congress is talking about Ukraine the most

Data: Quorum; Chart: Will Chase/Axios

Mentions of Ukraine or Ukrainian President Volodymyr Zelensky in congressional statements and social media posts have been on the rise — with nearly 1,000 already this month, according to data from Quorum.

Why it matters: The growing threat of a Russian invasion has been mirrored by a growth in Ukraine-related chatter.

GOP to use Supreme Court fight to target vulnerable Dems

Illustration: Rebecca Zisser/Axios

Conservatives know they're unlikely to stop President Biden from filling a Supreme Court vacancy, but they plan to target Senate Democrats who face competitive re-election fights and are all but certain to vote for the successor to Justice Stephen Breyer.

Between the lines: The general strategy will be to tie those Democrats to positions seen as political liabilities in states like Arizona, Georgia and New Hampshire, where incumbents are seeking re-election this year, an operative briefed on early strategy talks told Axios.