Desk

Financial distress

Hospital closures, bankruptcies, and debt cycles — the balance-sheet signals that precede a facility going dark.

6 studies on this desk

Hospital charity care, by the numbers: who actually gives the most free care
Nonprofit hospitals — tax-exempt in exchange for community benefit — deliver charity care worth just 1.53% of their patient revenue, the lowest share of any ownership type, below for-profit hospitals (3.00%) and less than half the government rate (3.76%), across $27.68 billion in free care in the federal HCRIS cost reports.
2026-06-11 · 12 min
Rural hospital closures, by the numbers: which hospitals are most at risk
Rural Critical Access Hospitals — the small facilities at the center of the closure crisis — run a 50.4% financial-distress rate, against 39.2% for urban hospitals, across 6,019 Medicare hospitals in the federal HCRIS cost reports. Their average operating margin is −8.93%, and 682 are losing money on patient care.
2026-06-11 · 13 min
For-profit, nonprofit, or government: who owns America's hospitals, and which model makes money
Across 6,019 US hospitals in the federal HCRIS cost reports, for-profit facilities are the only ownership class earning a positive average operating margin — +0.19% — while nonprofit hospitals average −4.75% and government hospitals −62.38%. The ranking holds on every measure, but the gap is narrower than the averages suggest.
2026-06-11 · 12 min
The OIG exclusion list, explained: who gets barred from Medicare, and why
The OIG List of Excluded Individuals and Entities (LEIE) holds 68,055 active exclusions spanning 1977–2026. The most common reason to be barred from Medicare is not fraud — it is losing a state license: §1128(b)(4) license actions are 41% of the list. And only 10.3% of records carry an NPI, so the list is mostly non-clinicians.
2026-06-11 · 11 min
Hospitals running out of cash: the days-cash signal, and why most of it is a reporting artifact
Federal HCRIS cost reports let us compute days cash on hand for 5,459 hospitals, but facility-level figures are distorted by system-level cash pooling — so the raw '2,800 hospitals under 30 days' headline is mostly noise. The defensible signal is narrower: 690 hospitals that report thin cash and also run an operating loss.
2026-06-04 · 14 min
Provider exclusions aren't rising — but they cluster around distressed operators
New additions to the OIG exclusion list are flat to declining — down 2.4% year-over-year through April 2026, and down 18.7% across full-year 2024 to 2025. The count is not the story. What concentrates is the composition: new exclusions cluster in facilities already showing the balance-sheet markers of financial distress.
2026-05-05 · 7 min

Other desks

All research →

Financial distress

Hospital closures, bankruptcies, and debt cycles — the balance-sheet signals that precede a facility going dark.

6 studies on this desk

Hospital charity care, by the numbers: who actually gives the most free care

Nonprofit hospitals — tax-exempt in exchange for community benefit — deliver charity care worth just 1.53% of their patient revenue, the lowest share of any ownership type, below for-profit hospitals (3.00%) and less than half the government rate (3.76%), across $27.68 billion in free care in the federal HCRIS cost reports.

2026-06-11 · 12 min

Rural hospital closures, by the numbers: which hospitals are most at risk

Rural Critical Access Hospitals — the small facilities at the center of the closure crisis — run a 50.4% financial-distress rate, against 39.2% for urban hospitals, across 6,019 Medicare hospitals in the federal HCRIS cost reports. Their average operating margin is −8.93%, and 682 are losing money on patient care.

2026-06-11 · 13 min

For-profit, nonprofit, or government: who owns America's hospitals, and which model makes money

Across 6,019 US hospitals in the federal HCRIS cost reports, for-profit facilities are the only ownership class earning a positive average operating margin — +0.19% — while nonprofit hospitals average −4.75% and government hospitals −62.38%. The ranking holds on every measure, but the gap is narrower than the averages suggest.

2026-06-11 · 12 min

The OIG exclusion list, explained: who gets barred from Medicare, and why

The OIG List of Excluded Individuals and Entities (LEIE) holds 68,055 active exclusions spanning 1977–2026. The most common reason to be barred from Medicare is not fraud — it is losing a state license: §1128(b)(4) license actions are 41% of the list. And only 10.3% of records carry an NPI, so the list is mostly non-clinicians.

2026-06-11 · 11 min

Hospitals running out of cash: the days-cash signal, and why most of it is a reporting artifact

Federal HCRIS cost reports let us compute days cash on hand for 5,459 hospitals, but facility-level figures are distorted by system-level cash pooling — so the raw '2,800 hospitals under 30 days' headline is mostly noise. The defensible signal is narrower: 690 hospitals that report thin cash and also run an operating loss.

2026-06-04 · 14 min

Provider exclusions aren't rising — but they cluster around distressed operators

New additions to the OIG exclusion list are flat to declining — down 2.4% year-over-year through April 2026, and down 18.7% across full-year 2024 to 2025. The count is not the story. What concentrates is the composition: new exclusions cluster in facilities already showing the balance-sheet markers of financial distress.

2026-05-05 · 7 min

Other desks

All research →