Hospital Margins Stabilizing Among External Pressures

Kaufman Hall analysis illustrates increasing costs of goods and services and flat patient volumes pointing to new normal for hospital finances

CHICAGO – March 28TH, 2023 – Hospital finances are beginning to stabilize as razor thin margins become the new normal, according to the newest data from Kaufman Hall.

The latest National Hospital Flash Report shows that the high level of variance that plagued hospital margins over the past three years is beginning to subside as external economic factors like labor shortages, higher material expenses, and a patient population that is increasingly seeking care outside of the hospital affect hospital finances. 

Median YTD Operating Margin Remains Negative

The median year-to-date operating margin index for hospitals was -1.1% in February, down slightly compared to -0.8% in January. Despite the slight dip in financial performance, February marked the eighth month in which the variation in month-to-month margins decreased relative to the last three years.

“After years of erratic fluctuations, over the last several months we are beginning to see trends emerge in the factors that affect hospital finances like labor costs, goods and services expenses, and patient care preferences,” said Erik Swanson, senior vice president of Data and Analytics with Kaufman Hall. “In this new normal of razor thin margins, hospitals now have more reliable information to help make the necessary strategic decisions to chart a path toward financial security.”

Non-Labor Costs Drive Hospital Expenses

Hospitals continued to incur high expenses that negatively affect margins. Kaufman Hall experts point out that February represented a shift from labor to goods and services as the primary driver of hospital expenses. Inflationary pressures led to significant cost increases in goods and services, increasing non-labor expenses by 6% year-over-year. While hospitals still face labor shortages, labor expenses appeared to hold steady, indicating less dependence on contract labor.

“Hospital leaders face an existential crisis as the new reality of financial performance begins to set in,” said Swanson. “2023 may turn out to be the year hospitals redefine their goals, mission, and idea of success in response to expense and revenue challenges that appear to be here for the long haul.”

Ongoing Shift in Patient Care Setting

The onset of the COVID-19 pandemic kickstarted a shift in patient behavior that continues today. Patients continued to seek more of their care away from inpatient settings, with February 2023 outpatient revenue up 14% compared to February 2022. Due to the shorter month, discharges, patient days, and ED visits were all down slightly in February compared to January. On a per-day basis, however, the average length of stay in hospitals was down, while ambulatory surgery centers and outpatient operating room minutes saw volume increases last month.

The National Hospital Flash Report draws on data from more than 900 hospitals from Syntellis Performance Solutions.

Kaufman Hall experts are available for comment, contact Tyler Williams (, 434-329-0940).

About Kaufman Hall 

Kaufman Hall provides management consulting solutions to help society’s foundational institutions realize sustained success amid changing market conditions. Since 1985, Kaufman Hall has been a trusted advisor to boards and executive management teams, helping them incorporate proven methods, rigorous analytics, and industry-leading solutions into their strategic planning and financial management processes, with a focus on achieving their most challenging goals.

Kaufman Hall services use a rigorous, disciplined, and structured approach that is based on the principles of corporate finance. The breadth and integration of Kaufman Hall advisory services are unparalleled, encompassing strategy; financial and capital planning; performance improvement; treasury and capital markets management; mergers, acquisitions, partnerships, and joint ventures; and real estate.