{ "study": { "slug": "hospital-margin-gap", "title": "Hospital Margin Gap Analysis (2024)", "url": "https://fonteum.com/research/hospital-margin-gap", "methodology_version": "hospital-margin/v1" }, "data_as_of": "2024", "temporal_coverage": "2024", "sources": [ { "name": "CMS HCRIS Hospital Cost Reports (form CMS-2552-10)", "publisher": "U.S. Centers for Medicare & Medicaid Services", "url": "https://www.cms.gov/Research-Statistics-Data-and-Systems/Downloadable-Public-Use-Files/Cost-Reports/Hospital-2010-form", "release_date": null, "retrieved_at": null, "license": "U.S. Government Works (17 U.S.C. §105)" } ], "headline": { "issuance_period": "2024", "hospitals_in_index": 6019, "hospitals_with_operating_margin": 5787, "hospitals_flagged_distressed": 2368, "national_operating_margin_avg_pct": -13.8401, "distress_threshold_pct": -5, "aggregation_path": "rpc" }, "sections": [ { "id": "margin_distribution", "label": "Hospitals by operating-margin bucket", "columns": [ "bucket", "bucket_key", "hospitals", "is_distress_bucket" ], "rows": [ { "bucket": "< −10%", "bucket_key": "lt_neg10", "hospitals": 1759, "is_distress_bucket": true }, { "bucket": "−10% to −5%", "bucket_key": "neg10_neg5", "hospitals": 609, "is_distress_bucket": true }, { "bucket": "−5% to 0%", "bucket_key": "neg5_0", "hospitals": 754, "is_distress_bucket": false }, { "bucket": "0% to 5%", "bucket_key": "p0_5", "hospitals": 723, "is_distress_bucket": false }, { "bucket": "5% to 10%", "bucket_key": "p5_10", "hospitals": 586, "is_distress_bucket": false }, { "bucket": "> 10%", "bucket_key": "gte10", "hospitals": 1356, "is_distress_bucket": false } ] }, { "id": "by_state", "label": "State median operating margin", "columns": [ "state", "hospitals_with_margin", "hospitals_flagged_distressed", "median_operating_margin_pct" ], "rows": [ { "state": "UT", "hospitals_with_margin": 56, "hospitals_flagged_distressed": 11, "median_operating_margin_pct": 8.78 }, { "state": "SC", "hospitals_with_margin": 81, "hospitals_flagged_distressed": 20, "median_operating_margin_pct": 7.75 }, { "state": "DE", "hospitals_with_margin": 15, "hospitals_flagged_distressed": 2, "median_operating_margin_pct": 7.31 }, { "state": "FL", "hospitals_with_margin": 266, "hospitals_flagged_distressed": 68, "median_operating_margin_pct": 6.84 }, { "state": "VA", "hospitals_with_margin": 104, "hospitals_flagged_distressed": 25, "median_operating_margin_pct": 6.58 }, { "state": "NV", "hospitals_with_margin": 53, "hospitals_flagged_distressed": 15, "median_operating_margin_pct": 5.85 }, { "state": "NM", "hospitals_with_margin": 45, "hospitals_flagged_distressed": 16, "median_operating_margin_pct": 5.36 }, { "state": "AZ", "hospitals_with_margin": 112, "hospitals_flagged_distressed": 27, "median_operating_margin_pct": 4.58 }, { "state": "NC", "hospitals_with_margin": 123, "hospitals_flagged_distressed": 32, "median_operating_margin_pct": 4.52 }, { "state": "KY", "hospitals_with_margin": 118, "hospitals_flagged_distressed": 31, "median_operating_margin_pct": 3.57 }, { "state": "WI", "hospitals_with_margin": 149, "hospitals_flagged_distressed": 44, "median_operating_margin_pct": 3.29 }, { "state": "DC", "hospitals_with_margin": 11, "hospitals_flagged_distressed": 3, "median_operating_margin_pct": 2.94 }, { "state": "AK", "hospitals_with_margin": 18, "hospitals_flagged_distressed": 6, "median_operating_margin_pct": 2.68 }, { "state": "OH", "hospitals_with_margin": 215, "hospitals_flagged_distressed": 62, "median_operating_margin_pct": 2.65 }, { "state": "TX", "hospitals_with_margin": 564, "hospitals_flagged_distressed": 222, "median_operating_margin_pct": 1.43 }, { "state": "TN", "hospitals_with_margin": 133, "hospitals_flagged_distressed": 49, "median_operating_margin_pct": 1.42 }, { "state": "IN", "hospitals_with_margin": 169, "hospitals_flagged_distressed": 56, "median_operating_margin_pct": 1.06 }, { "state": "PA", "hospitals_with_margin": 203, "hospitals_flagged_distressed": 70, "median_operating_margin_pct": 0.74 }, { "state": "GA", "hospitals_with_margin": 158, "hospitals_flagged_distressed": 53, "median_operating_margin_pct": 0.66 }, { "state": "MI", "hospitals_with_margin": 158, "hospitals_flagged_distressed": 47, "median_operating_margin_pct": 0.04 }, { "state": "NJ", "hospitals_with_margin": 91, "hospitals_flagged_distressed": 33, "median_operating_margin_pct": -0.31 }, { "state": "IA", "hospitals_with_margin": 119, "hospitals_flagged_distressed": 41, "median_operating_margin_pct": -0.34 }, { "state": "NH", "hospitals_with_margin": 28, "hospitals_flagged_distressed": 11, "median_operating_margin_pct": -0.46 }, { "state": "SD", "hospitals_with_margin": 58, "hospitals_flagged_distressed": 23, "median_operating_margin_pct": -0.79 }, { "state": "WV", "hospitals_with_margin": 59, "hospitals_flagged_distressed": 22, "median_operating_margin_pct": -0.92 }, { "state": "LA", "hospitals_with_margin": 195, "hospitals_flagged_distressed": 79, "median_operating_margin_pct": -1.47 }, { "state": "CO", "hospitals_with_margin": 109, "hospitals_flagged_distressed": 46, "median_operating_margin_pct": -1.59 }, { "state": "IL", "hospitals_with_margin": 196, "hospitals_flagged_distressed": 87, "median_operating_margin_pct": -2.31 }, { "state": "CA", "hospitals_with_margin": 393, "hospitals_flagged_distressed": 172, "median_operating_margin_pct": -2.87 }, { "state": "MN", "hospitals_with_margin": 128, "hospitals_flagged_distressed": 52, "median_operating_margin_pct": -2.91 }, { "state": "ID", "hospitals_with_margin": 51, "hospitals_flagged_distressed": 24, "median_operating_margin_pct": -3.45 }, { "state": "MD", "hospitals_with_margin": 50, "hospitals_flagged_distressed": 22, "median_operating_margin_pct": -3.51 }, { "state": "MO", "hospitals_with_margin": 130, "hospitals_flagged_distressed": 63, "median_operating_margin_pct": -3.69 }, { "state": "MS", "hospitals_with_margin": 109, "hospitals_flagged_distressed": 50, "median_operating_margin_pct": -4.02 }, { "state": "NE", "hospitals_with_margin": 92, "hospitals_flagged_distressed": 45, "median_operating_margin_pct": -4.86 }, { "state": "ME", "hospitals_with_margin": 37, "hospitals_flagged_distressed": 19, "median_operating_margin_pct": -5.16 }, { "state": "OK", "hospitals_with_margin": 137, "hospitals_flagged_distressed": 70, "median_operating_margin_pct": -5.47 }, { "state": "WA", "hospitals_with_margin": 101, "hospitals_flagged_distressed": 53, "median_operating_margin_pct": -5.48 }, { "state": "MT", "hospitals_with_margin": 60, "hospitals_flagged_distressed": 33, "median_operating_margin_pct": -5.8 }, { "state": "WY", "hospitals_with_margin": 29, "hospitals_flagged_distressed": 16, "median_operating_margin_pct": -5.88 }, { "state": "PR", "hospitals_with_margin": 58, "hospitals_flagged_distressed": 32, "median_operating_margin_pct": -6.05 }, { "state": "OR", "hospitals_with_margin": 57, "hospitals_flagged_distressed": 31, "median_operating_margin_pct": -6.62 }, { "state": "CT", "hospitals_with_margin": 36, "hospitals_flagged_distressed": 21, "median_operating_margin_pct": -7.86 }, { "state": "ND", "hospitals_with_margin": 44, "hospitals_flagged_distressed": 27, "median_operating_margin_pct": -9.24 }, { "state": "AL", "hospitals_with_margin": 107, "hospitals_flagged_distressed": 65, "median_operating_margin_pct": -9.38 }, { "state": "AR", "hospitals_with_margin": 105, "hospitals_flagged_distressed": 61, "median_operating_margin_pct": -9.44 }, { "state": "MA", "hospitals_with_margin": 89, "hospitals_flagged_distressed": 59, "median_operating_margin_pct": -10.52 }, { "state": "NY", "hospitals_with_margin": 164, "hospitals_flagged_distressed": 107, "median_operating_margin_pct": -13.14 }, { "state": "KS", "hospitals_with_margin": 148, "hospitals_flagged_distressed": 105, "median_operating_margin_pct": -14.26 }, { "state": "HI", "hospitals_with_margin": 24, "hospitals_flagged_distressed": 16, "median_operating_margin_pct": -14.55 }, { "state": "RI", "hospitals_with_margin": 13, "hospitals_flagged_distressed": 10, "median_operating_margin_pct": -15.04 }, { "state": "VT", "hospitals_with_margin": 15, "hospitals_flagged_distressed": 11, "median_operating_margin_pct": -20.7 }, { "state": "GU", "hospitals_with_margin": 2, "hospitals_flagged_distressed": 1, "median_operating_margin_pct": -22.7 }, { "state": "VI", "hospitals_with_margin": 2, "hospitals_flagged_distressed": 2, "median_operating_margin_pct": -103.21 } ] } ], "limitations": [ "Self-reported cost-report data. HCRIS margins are filed by hospitals on form CMS-2552-10; Fonteum reports the filed values and does not audit them.", "Operating margin here is the headline calculation (net patient revenue minus total operating expense, over net patient revenue), not a full financial statement analysis.", "The distress flag is a fixed threshold — operating margin below −5% — pinned by the published methodology version, not a rating or a prediction of closure.", "One issuance period. Figures describe the most recent computed issuance of the index; a hospital's margin moves with each cost-report filing cycle.", "State aggregates use the median operating margin, because HCRIS self-reported margins contain extreme outliers that dominate a mean.", "Fonteum does not independently rate or rank hospitals. The index reflects CMS-published self-reported financial data." ], "reproducible_sql": "-- Aggregates for one issuance_period of public.hospital_margin_index.\n-- This is the body of the committed hospital_margin_dashboard(p_period)\n-- function; margins come from CMS HCRIS form 2552-10 headline fields as\n-- (net patient revenue - total operating expense) / net patient revenue * 100.\nWITH base AS (\n SELECT state, operating_margin_pct, national_operating_margin_avg, distress_flag\n FROM public.hospital_margin_index\n WHERE issuance_period = :period\n),\nnat AS (\n SELECT\n count(*) AS total_count,\n count(*) FILTER (WHERE operating_margin_pct IS NOT NULL) AS with_margin_count,\n count(*) FILTER (WHERE distress_flag) AS distress_count,\n max(national_operating_margin_avg) AS national_avg,\n count(*) FILTER (WHERE operating_margin_pct < -10) AS b_lt_neg10,\n count(*) FILTER (WHERE operating_margin_pct >= -10 AND operating_margin_pct < -5) AS b_neg10_neg5,\n count(*) FILTER (WHERE operating_margin_pct >= -5 AND operating_margin_pct < 0) AS b_neg5_0,\n count(*) FILTER (WHERE operating_margin_pct >= 0 AND operating_margin_pct < 5) AS b_0_5,\n count(*) FILTER (WHERE operating_margin_pct >= 5 AND operating_margin_pct < 10) AS b_5_10,\n count(*) FILTER (WHERE operating_margin_pct >= 10) AS b_gte10\n FROM base\n),\nstates AS (\n -- hospital_count counts rows with a non-NULL margin (the median's input);\n -- distress_count counts every flagged row in the state; states with zero\n -- non-NULL margins are excluded.\n SELECT\n state,\n count(*) FILTER (WHERE operating_margin_pct IS NOT NULL) AS hospital_count,\n count(*) FILTER (WHERE distress_flag) AS distress_count,\n round((percentile_cont(0.5) WITHIN GROUP (ORDER BY operating_margin_pct))::numeric, 2) AS median_margin\n FROM base\n WHERE state IS NOT NULL\n GROUP BY state\n HAVING count(*) FILTER (WHERE operating_margin_pct IS NOT NULL) > 0\n)\nSELECT * FROM nat;\nSELECT * FROM states ORDER BY median_margin DESC;", "license": "U.S. Government Works (17 U.S.C. §105)", "generated_by": "Fonteum — https://fonteum.com", "notes": "Aggregate, source-traced figures frozen to the as-of date above. Re-derive by running the published query against the named source file; no per-person records are included." }