Hospitals across the U.S. are continuing their long recovery from the financial turbulence of the early 2020s, with April’s data from Kaufman Hall’s “National Hospital Flash Report” offering a mixed but cautiously optimistic outlook.
Based on data from more than 1,300 hospitals gathered by Strata Decision Technology, the report shows while year-to-date operating margins are up 63% compared to 2022, month-over-month performance slipped and year-over-year margins declined, highlighting the fragility of recent gains. Operating EBITDA margins followed a similar pattern, falling 2% month over month and 4% year over year.
Regional trends tell a story of uneven momentum. The South and Great Plains regions posted the strongest operating margin improvements year to date — up 8% and 11% over 2024, respectively — with long-term gains from 2022 nearing or exceeding 60%. In contrast, hospitals in the Northeast/Mid-Atlantic saw a steep 16% drop in operating margin month over month, despite showing healthy improvement year to date. The West region stood out for a 7% operating margin increase in April, the strongest monthly gain among all regions, though its year-to-date performance still lagged 2024.
Hospital size also played a key role in financial resilience. The most significant year-to-date margin growth occurred among larger hospitals, where operating margins surged 18% to 117% compared to early 2024 and 2022, respectively.
However, these same institutions also experienced sharp margin drops from March, particularly in the 300-499-bed range, where operating margins fell 16% in just one month. Smaller hospitals remained under pressure, with flat month-over-month performance and continued year-to-date declines, underscoring the financial strain on rural and independent facilities.
Here is the full data:
Operating margin
Month over month: -1%
Year over year: -3%
Year to date vs. 2024: 6%
Year to date vs. 2022: 63%
Operating EBITDA margin
Month over month: -2%
Year over year: -4%
Year to date vs. 2024: 2%
Year to date vs. 2022: 36%
West
Operating margin
Month over month: 7%
Year over year: -7%
Year to date vs. 2024: -7%
Year to date vs. 2022: 62%
Operating EBITDA margin
Month over month: 2%
Year over year: -10%
Year to date vs. 2024: -6%
Year to date vs. 2022: 45%
Midwest
Operating margin
Month over month: 3%
Year over year: -7%
Year to date vs. 2024: 2%
Year to date vs. 2022: 51%
Operating EBITDA margin
Month over month: 1%
Year over year: -11%
Year to date vs. 2024: -2%
Year to date vs. 2022: 27%
South
Operating margin
Month over month: -7%
Year over year: 2%
Year to date vs. 2024: 8%
Year to date vs. 2022: 89%
Operating EBITDA margin
Month over month: -6%
Year over year: -1%
Year to date vs. 2024: 6%
Year to date vs. 2022: 52%
Northeast / Mid-Atlantic
Operating margin
Month over month: -16%
Year over year: -11%
Year to date vs. 2024: 8%
Year to date vs. 2022: 57%
Operating EBITDA margin
Month over month: -9%
Year over year: -5%
Year to date vs. 2024: 5%
Year to date vs. 2022: 20%
Great Plains
Operating margin
Month over month: 12%
Year over year: -6%
Year to date vs. 2024: 11%
Year to date vs. 2022: 64%
Operating EBITDA margin
Month over month: 1%
Year over year: -4%
Year to date vs. 2024: 8%
Year to date vs. 2022: 25%
25-99 beds
Operating margin
Month over month: 0%
Year over year: -6%
Year to date vs. 2024: -6%
Year to date vs. 2022: 58%
Operating EBITDA margin
Month over month: 0%
Year over year: -10%
Year to date vs. 2024: -1%
Year to date vs. 2022: 49%
100-199 beds
Operating margin
Month over month: 0%
Year over year: -2%
Year to date vs. 2024: 2%
Year to date vs. 2022: 47%
Operating EBITDA margin
Month over month: -4%
Year over year: -3%
Year to date vs. 2024: 3%
Year to date vs. 2022: 43%
200-299 beds
Operating margin
Month over month: 1%
Year over year: 3%
Year to date vs. 2024: 8%
Year to date vs. 2022: 55%
Operating EBITDA margin
Month over month: 2%
Year over year: 3%
Year to date vs. 2024: 3%
Year to date vs. 2022: 34%
300-499 beds
Operating margin
Month over month: -16%
Year over year: 3%
Year to date vs. 2024: 18%
Year to date vs. 2022: 97%
Operating EBITDA margin
Month over month: -12%
Year over year: 1%
Year to date vs. 2024: 12%
Year to date vs. 2022: 56%
500+ beds
Operating margin
Month over month: 4%
Year over year: -3%
Year to date vs. 2024: 2%
Year to date vs. 2022: 117%
Operating EBITDA margin
Month over month: 2%
Year over year: -3%
Year to date vs. 2024: -6%
Year to date vs. 2022: 117%
