National Daily Hospital Executive Briefing
Friday, November 14, 2025
Today: Hospitalizations up 4% YoY, Growing Sepsis Hospitalizations, ED Boarding, Executive's Top Concerns, Burden of Turnover on Margin, Retention Case Study, Growing Margin Gap Between Higher and Lower Hospital Performers, and CMS now requires ED and Transfer Protocols
Global & Health Sector Headlines — Hospital Finance and Operations
News — Hospital margins are up slightly overall, but the gap between top and bottom performers is widening; Kaufman Hall reports a 2.9% adjusted year-to-date operating margin with bottom-quartile hospitals at –1.8% and top quartile at 14.7%.
https://www.beckershospitalreview.com/finance/profitability-gap-widens-for-top-bottom-performing-hospitals/News — Hospital financial performance held steady in early 2025, with a 4% year-over-year increase in discharges per calendar day, although labor costs and payer pressure continue to strain weaker organizations.
https://www.healthcaredive.com/news/hospital-financial-performance-holds-steady-but-headwinds-loom-kaufman-hall-flash-report/759642/News — A 2025 survey shows executives’ top concerns are maintaining quality (39%), capacity/LOS challenges (30%), OR efficiency (26%), and workforce burnout (26%).
https://fticommunications.com/2025-hospital-operations-survey-report/Recommendation — Use FY2025 IPPS and IQR rules to stress test financial stability under new quality reporting and value-based purchasing requirements.
https://www.cms.gov/newsroom/fact-sheets/fy-2025-hospital-inpatient-prospective-payment-system-ipps-and-long-term-care-hospital-prospective
https://blog.medisolv.com/articles/2025-hospital-iqr-requirementsCase Study — NSI’s 2025 retention report finds RN turnover at 16.4% with an average cost of $61,110 per nurse, resulting in $4.75M in annual turnover-related losses for the average acute-care hospital.
https://www.nsinursingsolutions.com/documents/library/nsi_national_health_care_retention_report.pdf
Emergency Services and Emergency Department Boarding
News — AHRQ’s 2024 ED Boarding Summit identifies boarding as a national patient safety emergency requiring system-wide solutions.
https://www.ahrq.gov/sites/default/files/wysiwyg/topics/ed-boarding-summit-report.pdfRecommendation — ACEP urges CMS to maintain and strengthen ED throughput measures such as “Admit Decision Time to ED Departure Time for Admitted Patients,” calling them essential for reducing boarding.
https://www.acep.org/administration/crowding--boardingNew Case Study — NEJM Catalyst reports a public–private partnership model that reduced ED boarding through shared accountability and coordinated resource mobilization across systems.
https://pmc.ncbi.nlm.nih.gov/articles/PMC11963249/News — CMS updates Conditions of Participation for hospitals and CAHs, with multi-phase requirements for emergency services and transfers, including a July 2025 compliance deadline.
https://hallrender.com/2025/07/02/compliance-deadline-july-1-2025-cms-hospital-and-cah-cop-changes-for-emergency-services-and-patient-transfers/News — New Joint Commission requirements align with CMS rules on emergency care access, discharge planning, and obstetrical services.
https://www.jointcommission.org/en-us/knowledge-library/newsletters/joint-commission-online/23-jul-25Case Study — AP News reports dementia patients sometimes board for 12–24 hours or longer while waiting for placement, raising risks of delirium, functional decline, and unsafe care delays.
https://apnews.com/article/daf48acf11631cffdaeb5de4abe3722e
Hospital Quality, Infection Control, and Readmissions — Sepsis and Care Transitions
News — A 2024 NHSN sepsis management survey reveals that hospitals implementing structured sepsis improvement programs achieve reductions in mortality, LOS, and costs, although variation persists in screening and antibiotic timing.
https://www.cdc.gov/sepsis/media/pdfs/hospital-2024-annual-survey-508.pdfNews — AHRQ reports that sepsis hospitalizations at acute care hospitals rose from 1.8M (2016) to 2.5M (2021), a nearly 40% increase.
https://www.ahrq.gov/news/newsletters/e-newsletter/949.htmlNew Case Study — State-level sepsis regulations and reporting requirements correlate with improved early detection and reductions in case-fatality when implemented alongside sepsis bundles.
https://www.astho.org/communications/blog/2025/state-health-policies-reduce-sepsis-cases/Recommendation — Hospitals should align sepsis pathways and transitional care processes with CMS FY2025 IPPS quality expectations for early detection, timely antibiotics, and robust follow-up.
https://www.cms.gov/newsroom/fact-sheets/fy-2025-hospital-inpatient-prospective-payment-system-ipps-and-long-term-care-hospital-prospective
https://www.qualityreportingcenter.com/globalassets/2023/03/iqr/2.-hospital-iqr-fy-2025-program-guide_vfinal508.pdf
Early Morning Briefing Highlights
Hospital margins remain thin at a 2.9% median, with a widening performance gap between top- and bottom-quartile hospitals.
https://www.beckershospitalreview.com/finance/profitability-gap-widens-for-top-bottom-performing-hospitals/ED boarding is increasingly recognized as a major national patient safety issue requiring measurable standards across hospitals.
https://www.ahrq.gov/sites/default/files/wysiwyg/topics/ed-boarding-summit-report.pdf
https://www.acep.org/administration/crowding--boardingSepsis cases continue to rise nationally, yet structured sepsis programs show consistent improvements in mortality and LOS.
https://www.ahrq.gov/news/newsletters/e-newsletter/949.html
https://www.cdc.gov/sepsis/media/pdfs/hospital-2024-annual-survey-508.pdfWorkforce turnover continues to suppress margins; the average RN turnover cost remains above $61,000 per nurse.
https://www.nsinursingsolutions.com/documents/library/nsi_national_health_care_retention_report.pdf
Strategic Implications for Leadership
Combine margin benchmarks with RN turnover cost modeling to quantify financial gains possible from improving retention and LOS.
https://www.beckershospitalreview.com/finance/profitability-gap-widens-for-top-bottom-performing-hospitals/
https://www.nsinursingsolutions.com/documents/library/nsi_national_health_care_retention_report.pdfRecast ED boarding as a hospital-wide safety priority, assigning senior executive accountability and implementing daily ED boarding dashboards.
https://www.ahrq.gov/sites/default/files/wysiwyg/topics/ed-boarding-summit-report.pdf
https://www.acep.org/administration/crowding--boardingLaunch a system-wide sepsis improvement sprint, standardizing screening, antibiotic timing, and post-discharge follow-up using CDC and AHRQ tools.
https://www.cdc.gov/sepsis/media/pdfs/hospital-2024-annual-survey-508.pdf
https://www.ahrq.gov/news/newsletters/e-newsletter/949.html
https://www.astho.org/communications/blog/2025/state-health-policies-reduce-sepsis-cases/Ensure leadership understands and implements CMS CoP changes and Joint Commission requirements for emergency access and safe discharge processes.
https://hallrender.com/2025/07/02/compliance-deadline-july-1-2025-cms-hospital-and-cah-cop-changes-for-emergency-services-and-patient-transfers/
https://www.jointcommission.org/en-us/knowledge-library/newsletters/joint-commission-online/23-jul-25Use the 2025 Hospital Operations Survey to validate whether local resource allocation matches national operational priorities.
https://fticommunications.com/2025-hospital-operations-survey-report/
Quality Metrics to Share with Your Team
Median nonprofit hospital margin: 2.9% (top quartile: 14.7%; bottom quartile: –1.8%).
https://www.beckershospitalreview.com/finance/profitability-gap-widens-for-top-bottom-performing-hospitals/RN turnover: 16.4% with an average turnover cost of $61,110 per nurse.
https://www.nsinursingsolutions.com/documents/library/nsi_national_health_care_retention_report.pdfInpatient volume: Discharges per calendar day up 4% year-over-year.
https://www.healthcaredive.com/news/hospital-financial-performance-holds-steady-but-headwinds-loom-kaufman-hall-flash-report/759642/ED boarding is now categorized as a national patient safety risk by federal agencies.
https://www.ahrq.gov/sites/default/files/wysiwyg/topics/ed-boarding-summit-report.pdfDementia-related ED boarding frequently exceeds 12–24 hours, increasing complications and delirium.
https://apnews.com/article/daf48acf11631cffdaeb5de4abe3722eSepsis hospitalizations rose nearly 40% from 2016–2021.
https://www.ahrq.gov/news/newsletters/e-newsletter/949.htmlStructured sepsis programs consistently reduce mortality and LOS.
https://www.cdc.gov/sepsis/media/pdfs/hospital-2024-annual-survey-508.pdf
Leadership Call to Action
Model potential financial gains from reducing RN turnover and shortening LOS using national benchmarks.
https://www.beckershospitalreview.com/finance/profitability-gap-widens-for-top-bottom-performing-hospitals/
https://www.nsinursingsolutions.com/documents/library/nsi_national_health_care_retention_report.pdfEstablish a cross-functional ED boarding steering group aligned with AHRQ and ACEP recommendations.
https://www.ahrq.gov/sites/default/files/wysiwyg/topics/ed-boarding-summit-report.pdf
https://www.acep.org/administration/crowding--boardingLaunch a 90-day sepsis improvement sprint to standardize recognition, antibiotics, and transitions of care.
https://www.cdc.gov/sepsis/media/pdfs/hospital-2024-annual-survey-508.pdf
https://www.ahrq.gov/news/newsletters/e-newsletter/949.html
https://www.astho.org/communications/blog/2025/state-health-policies-reduce-sepsis-cases/Integrate CMS and Joint Commission emergency and discharge planning requirements into board and quality committee agendas.
https://hallrender.com/2025/07/02/compliance-deadline-july-1-2025-cms-hospital-and-cah-cop-changes-for-emergency-services-and-patient-transfers/
https://www.jointcommission.org/en-us/knowledge-library/newsletters/joint-commission-online/23-jul-25Validate local strategic priorities using the national 2025 hospital operations survey.
https://fticommunications.com/2025-hospital-operations-survey-report/
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