The National Academy for State Health Policy’s (NASHP) Hospital Cost Tool (HCT) dashboard aims to provide state policymakers and researchers with analytical insights into how much hospitals spend on patient care services, and how such costs relate to the hospital charges (list prices) and actual prices paid by health plans. The dashboard reports on a range of measures for hospital revenue, costs, profitability, and break-even points across over 5,000 hospitals nationwide for the period from 2011 through 2022. The dashboard offers options to view data at the hospital, state, and health system levels. The underlying HCT dataset includes more than 100 variables extracted and calculated using data from the national Healthcare Cost Report Information System (HCRIS) as the main data source. Hospitals in this dataset represent approximately 64 million patient discharges and $36 billion hospital net income in the most recent reporting year.
Dashboard last updated on December 15, 2023
Dashboard Overview
- Compare among hospitals: View hospital-level metrics for a group of hospitals based on the filter selections. The state and national medians shown also relate to the selected hospital attributes.
- View a single hospital: View metrics for the selected hospital over time.
- Explore by state: View state medians on financial metrics for the selected states over time and by hospital attributes.
- Explore by health system: View hospital profit generated from patient care services aggregated at the health system level (shown as medians and totals).
Key Concepts
The Hospital Cost Tool provides data and information from the Medicare Cost Reports on many hospital performance measures. The figure below depicts the key concepts that appear in the tabs that follow.
Release Notes
December 15, 2023
- HCT 3.0 includes more recent data than was previously available (2022 Medicare Cost Reports, 2020 and 2021 health system data) and presents new data points and visualizations on various categories of hospital expenses and labor costs.
- The Overview tab now provides key concepts in plain language to help users make sense of the technical terminologies on hospital costs and more easily navigate the visualizations.
November 21, 2022
- HCT 2.0 includes more recent data than was previously available (2020 and 2021 Medicare Cost Reports, RAND 4.0 commercial price 2018-2020 aggregate) and offers new datapoints: labor and benefits costs, hospital-level COVID-19 provider relief funds (available in the downloadable Excel dataset), operating profit margin visualizations, and more.
- NASHP made smaller refinements to the tool, such as improved accuracy in excluding outliers/ reporting errors, calculating net charity care which includes charity care grants, and assigning appropriate Medicare costs for organ acquisition.
April 5, 2022
- Released HCT 1.0 with four dashboard tabs to examine hospital cost metrics across different dimensions. The data includes 2011-2019 Medicare Cost Reports and RAND 3.0 commercial price 2016-2018 aggregate.
Disclaimer
Although the information, analysis, and methodology in the Hospital Cost Tool is presented in good faith and reasonably believed to be correct at the time of publishing, National Academy for State Health Policy (NASHP) utilizes costs as reported by hospitals. As such, hospital reporting errors may impact the calculations produced by the tool. Persons receiving or utilizing this tool will make their own assessment and determination as to its suitability for their own purposes prior to use and as such, users of the information are doing so at their own risk. NASHP reserves the right to change, delete, or otherwise modify the information and analysis herein without any prior notice. The views, information, and opinions presented in Hospital Cost Tool supplemental materials are solely those of NASHP staff and do not reflect the view of any specific NASHP members or any other third parties.
Getting Started
- View hospital-level metrics for a group of hospitals based on the filter selections. Metrics include hospital patient revenue, operating cost, operating profit (loss), net profit margin, charity care costs, uninsured & bad debt costs, cost-to-charge ratio, commercial breakeven, RAND commercial prices, and direct patient care labor costs and full-time equivalents (for non-critical access hospitals only). The state and national medians shown also relate to the selected hospital attributes.
- Click on each input box to view the filter options. Some may take longer to load than others.
- The charts will display no data if multiple years are selected.
- The dashboard shows results from all filters combined. If no results appear, try applying fewer filter selections.
- Under the Health System filter, "Independent" denotes hospitals that are not identified with any health systems or have no record in the 2018 Compendium of U.S. Health Systems database.
- Hover over chart data elements to view more information about specific hospitals and states.
Getting Started
- View metrics for the selected hospital over time. Metrics include hospital patient revenue, operating cost, operating profit (loss), net profit margin, charity care costs, uninsured & bad debt costs, payer mix, payer type-specific operating profit margins, cost-to-charge ratio, commercial breakeven, and direct patient care labor costs and full-time equivalents (for non-critical access hospitals only).
- Click on each input box to view the filter options. Some may take longer to load than others.
- The charts will display no data if multiple years or multiple hospitals are selected.
- Hover over chart data elements to view more information about the hospital.
Getting Started
- View state medians on financial metrics for the selected states over time and by hospital attributes. Metrics include hospital patient revenue, operating cost, operating profit (loss), net profit margin, cost-to-charge ratio, commercial breakeven, and direct patient care labor costs and full-time equivalents (for non-critical access hospitals only).
- Click on each input box to view the filter options. Some may take longer to load than others.
- The charts will display no data if multiple years are selected.
- Select "National" from the Geography filter to compare selected states with the national median.
- Hover over chart data elements to view more information about specific states.
Getting Started
- View hospital profit generated from patient care services aggregated at the health system level (shown as medians and totals). Metric includes total adjusted discharge for the selected system, median operating profit (loss) per adjusted discharge, and total operating profit (loss) within the system.
- Click on each input box to view the filter options. Some may take longer to load than others.
- The charts will display no data if multiple years are selected.
- Under the Health System filter, "Independent" denotes hospitals that are not identified with any health systems or have no record in the 2018 Compendium of U.S. Health Systems database.
- Hover over chart data elements to view more information about specific health systems.
Footnotes
- For each metric reported, the dashboard excludes observations that do not have a valid value, either due to missing data or due to invalid data input. In the downloadable Excel dataset, "." denotes missing data and "NA" denotes invalid data values instead of the original values.
- The dashboard excludes Kaiser Permanente hospitals and non-hospital facilities such as rehabilitation facilities, hospice facilities, emergency hospitals, and facilities that did not report inpatient beds. In addition, a small number of hospitals submit multiple Medicare Cost Reports in a given year, thus have multiple records in the HCT dataset. In such cases, the dashboard uses the Cost Report record that covers the longest duration of the reporting year for the hospital.
- For time series charts, the dashboard may show incomplete trends for certain hospitals that experienced changes in the CMS Certification Number (CCN) due to consolidations, changes in ownership, or changes in critical access hospital qualifications during the data period.