Hospitals nationwide posted broad revenue growth to open 2026, with gains recorded across net operating revenue, gross operating revenue, inpatient revenue, and outpatient revenue in the first quarter compared to the same period last year, according to Kaufman Hall data from 1,300 hospitals.
The top-line numbers reflect a favorable environment for much of the industry — but hospital leaders gathered at the Becker’s 16th Annual Meeting in April signaled that the picture beneath the surface is more complicated.
Outpatient care was the clearest driver of revenue growth, outpacing inpatient revenue in every region and nearly every bed-size category nationwide. That trend animated significant conversation at the Annual Meeting, where leaders debated whether expanding outpatient and ambulatory access grows the overall revenue pie or cannibalizes inpatient volume, a strategic question with real financial consequences as systems decide where to invest.
The gap between gross and net revenue was another undercurrent. Gross operating revenue outpaced net operating revenue in most regions and size segments, reflecting the difference between what hospitals bill and what they ultimately collect. Policy-driven pressure compounded those concerns, with Medicaid cuts, bad debt, and charity care cited as structural forces weighing on net revenue, particularly for hospitals in high-Medicaid states. Policy pressures at the state and federal level are linked to revenue leakage and thinning margins.
The inpatient picture was more uneven. Mid-size hospitals posted inpatient growth well above the national average, while smaller facilities — those with fewer than 100 beds — saw inpatient revenue decline outright, pointing to distinct financial pressures on smaller and rural hospitals even amid a broadly favorable revenue environment.
Here are 20 things to know from the report, based on revenue per calendar day.
National picture
1. U.S. hospital net operating revenue rose 5% per calendar day in the first quarter of 2026 compared to the previous year.
2. Gross operating revenue grew 7% nationally over the same period.
3. Inpatient revenue increased 4% nationally, while outpatient revenue grew 8% — a four-point gap reflecting a continued structural shift toward outpatient care.
4. Outpatient revenue outpaced inpatient revenue in every region and every bed-size category except hospitals with 0–25 beds.
Regional performance
5. Western hospitals led all regions, with net operating revenue up 7%, gross operating revenue up 10%, and outpatient revenue surging 13% — the highest outpatient figure of any region.
6. Southern hospitals posted 6% net operating revenue growth and 9% outpatient revenue growth, along with the highest inpatient revenue growth of any region at 5%.
7. Northeast/Mid-Atlantic hospitals grew net operating revenue 6% and gross operating revenue 7%, but outpatient revenue of 6% was among the lowest of any region.
8. Great Plains hospitals matched the national averages for net operating revenue (5%) and outpatient revenue (8%), but posted the lowest inpatient growth of any region at 2%.
9. Midwest hospitals posted the most modest gains of any region — net operating revenue up 4%, gross operating revenue up 4%, and outpatient revenue up just 5%.
Performance by hospital size
10. Hospitals in the 200 to 299-bed range led all size segments across every revenue metric: net operating revenue up 8%, gross operating revenue up 9%, inpatient revenue up 7%, and outpatient revenue up 10%.
11. Hospitals with 300 to 499 beds posted equally strong inpatient revenue growth of 7%, alongside net operating revenue growth of 7% and outpatient revenue growth of 9%.
12. Hospitals with 100 to 199 beds grew net operating revenue 7% — above the national average — with outpatient revenue up 9%.
13. The largest hospitals — 500 or more beds — posted the widest gap between net operating revenue growth (4%) and gross operating revenue growth (8%) of any size segment, suggesting payer mix or contractual factors may be compressing net revenue relative to charges.
14. Hospitals with 26 to 99 beds grew outpatient revenue 9% but saw inpatient revenue decline 1% year over year.
15. The smallest hospitals — 0 to 25 beds — recorded the steepest inpatient revenue decline of any segment at -2%, even as outpatient revenue grew 4% and net operating revenue rose 4%.
Broader trends
16. Inpatient revenue declined at hospitals with fewer than 100 beds in both size categories, while every other segment posted inpatient gains — pointing to distinct financial pressures on smaller and rural facilities.
17. Outpatient revenue growth of 9% to 10% was consistent across the all segments of hospitals with more than 100 bed segments, suggesting outpatient expansion is a broadly shared trend among mid-size and large hospitals.
18. The West and South were the only regions where outpatient revenue growth reached or exceeded 9%, separating them from other regions on ambulatory momentum.
19. Gross operating revenue outpaced net operating revenue in most regions and size segments, a pattern that may indicate growing pressure from payer contracting, charity care, or bad debt affecting what hospitals ultimately collect.
20. Across all segments, the data points to a two-speed hospital economy: mid-size facilities in growth regions are accelerating, while the smallest hospitals face inpatient contraction even amid a broadly favorable revenue environment.
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