Denver-area hospitals earned a healthy pretax profit margin of 9 percent on patient revenues of $4.8 billion in 2007, according to a new study, but their financial outlook has likely darkened considerably in recent months.

Three of HealthOne HCA's hospitals - Swedish, Sky Ridge and Presbyterian/St. Luke's - once again ranked as Denver's most profitable, the Colorado Managed Care Review said. Swedish topped the region's medical facilities, with net income of $82 million for a pretax margin of 24 percent. Only one hospital, Centura's Avista in Louisville, posted a loss.

The skittering economy has created a dramatically different landscape for hospitals in 2009. The ranks of the uninsured are swelling as the unemployment rate edges upward, and workers who still have job-based health insurance are increasingly offered only plans with high deductibles that make patients reluctant to seek either preventive or elective medical care.

As individuals rather than insurance companies pay for medical bills, hospitals likely will have a harder time collecting payments, said Allan Baumgarten, whose annual Managed Care Review studies 11 states, including Colorado.

"When you're collecting from individuals, you don't know that they have money in the bank or where you rank on their list of priorities," Baumgarten said.

Colorado hospitals this year are already seeing a "dramatic increase" in the amount of uncompensated care that they provide, said Steven Summer, CEO of the Colorado Hospital Association.

At the same time, the investment income that hospitals rely on has "essentially disappeared" as the stock market tanked, Summer said, and the credit crunch has sharply increased the cost of borrowing money.

That squeeze forced hospitals to freeze plans for all but the most essential upgrades.

Since hospitals usually require a lead time of about five years to plan for an expansion, the lack of new construction will be most noticeable when the projects would have come online in about a decade.

The information for the Health Market Review is taken from reports filed by hospitals with the Centers for Medicare and Medicaid Services, the federal agency overseeing government-run health programs. The report calculates net patient and other revenue, minus total expenses, before taxes.

HCA HealthOne is the only for- profit system in the Denver area, and HCA hospitals hand over half of their earnings to the nonprofit Colorado Health Foundation.

The report also found that Colorado Health Maintenance Organizations had net income of $201.6 million, or 5 percent of premium revenues, even as Colorado HMO enrollment continues its eight- year slide.