AHRQ Unmasks Health System Revenue All in One Place

You youngsters may not believe this, but it’s true.

There was a time when tax-exempt organizations such as not-for-profit hospitals didn’t have to show you their Form 990s, which they use to report revenue and expenses to the Internal Revenue Service, unless you showed up in person at their primary place of business.

And I mean only show it to you. They didn’t have to give you a copy. You had to write dollar figures down longhand and hope you got them right. We didn’t have cameras on our phones. We didn’t have phones. I used to bring blank Form 990s and fill in the lines with the right figures. That is, until I started bringing a portable copier, much to the surprise of the execs at one organization’s primary place of business.

How times have changed. You still can’t find detailed financial information on the websites of most not-for-profit hospitals and health systems unless you can figure out where they stash their annual reports. Even then it’s on the last page of the annual reports, which are often unprintable flipbooks. Clever.

But thankfully, other sources have stepped up over the years to provide publicly available financial data on not-for-profit hospitals and health systems that don’t want anyone to know they generate revenue or pay their executives. You know. Just like a business.

One such source is the Agency for Healthcare Research and Quality (AHRQ), which is part of HHS. The last I checked, AHRQ still exists, at least according to its website. Although AHRQ hasn’t issued a press release since last December, it did tweet out, I mean posted on X, last week that it released an updated version of its Compendium of U.S. Health Systems.

AHRQ defines a health system as including at least one nonfederal acute-care hospital and at least one group of at least 50 physicians under common ownership or joint management with at least 10 of those 50 doctors being primary care physicians.

AHRQ published its first health system compendium in 2017 with data from 2016. The agency published five more since then. The 2025 edition features data from 2023.

The 2025 edition of the compendium also features something that wasn’t included in the previous five: health system revenue. Both total revenue and net revenue. For each of the 639 health systems listed in the compendium by name. It’s available in a downloadable and sortable spreadsheet. For those keeping score at home, net revenue is in column AM, and total revenue is in column AN.

So, I sorted it by net revenue. Here are the 10 health systems with highest net revenue in 2023:

1. HCA Healthcare: $52.2 billion
2. CommonSpirit Health: $29.4 billion
3. Kaiser Permanente: $22.7 billion
4. Advocate Health: $22.4 billion
5. Ascension Health: $21.9 billion
6. Trinity Health: $21.5 billion
7. Providence: $18.2 billion
8. University of California Health: $17.8 billion
9. AdventHealth: $15.6 billion
10. Tenet Healthcare: $13.8 billion

Well, that’s interesting. Eight of the 10 are private or public not-for-profit health systems, and most of the eight are faith-based not-for-profits.

You can do lots of fun things with the downloadable and sortable health system spreadsheets. Like sort net revenue by things like bed count, number of doctors or uncompensated care. They’re just waiting for some enterprising healthcare business journalist to play with them and find news to report to the public.

We’ve come a long way from lugging portable copiers to conference rooms to report on health system executive salaries to the public. Thank goodness for that. I’m getting too old.

Thanks for reading.