Broadlawns, UIHC & Adair County Health System: three public hospitals, one Medicaid program

Polk County’s tax-supported safety-net hospital against the state’s university medical center — the two most publicly documented hospitals in Iowa, compared through the money trails that are actually public: the state’s certified DSH examinations, Broadlawns’ own audited agreements, and (after one script run) their annual Medicare cost reports with whatever Medicaid measures the current HCRIS release carries.

The DSH examination trail (Iowa Auditor of State)

Three views over time (examination years; cost-report years extend these after the fetcher run)

Total hospital cost, all payers — UIHC runs ~12× Broadlawns’ scale.

Medicaid cost of care as a share of total hospital cost — the comparable line: Broadlawns ≈ half-to-two-thirds Medicaid by cost; UIHC ≈ quarter.

Total DSH payments received (schedule p.7, col R) — the corrected series: UIHC rose $29.0M → $64.8M; Broadlawns held ≈ $6.5–7.2M.

Broadlawns: hand-verified agreement figures

Annual cost reports (HCRIS CMS-2552-10)

Cost-report figures are as filed, on each hospital’s own fiscal year, before Medicare settlement; they are self-reported to a federal reimbursement system and best used for trends, not audits of a single year.

Reading this honestly

UIHC appears in the DSH schedules as “Clinics” (a name truncation in the extraction) and files no 990 and no separate federal single audit — it is state-owned, audited by the Iowa Auditor of State and inside the statewide single audit. Broadlawns files no 990 either (county-owned); its levy and IGT mechanics come from its audited statements. The two DSH measures disagree (examination “DSH payments” vs the hospital’s reported agreement amounts) and are never summed here. An earlier version of this page mislabeled the schedule columns and claimed a UIHC DSH collapse ($33.3M → $1.5M); that was a column-shift artifact, now corrected against the full schedules: UIHC’s DSH received rose from $29.0M to $64.8M, and the ~$3.2M Broadlawns figure was FFS rate payments, not DSH. MCO-to-hospital payments remain non-public; the visible flows are the state-visible ones.