National Daily Hospital News
Executive Briefing
Thursday November 27th, 2025
Today:
> AHA Data: Nearly half of rural hospitals are operating at a loss
> Rural hospitals face heightened risk from Medicaid payment cut
>National ED access study shows sharp rise in prolonged ED stays
>Readmissions cost Medicare at least $17B annually and remain stubbornly high
>Prolonged ED stays are linked to harm in older adults
>Metrics To share with your team, recommendations and case studies
Hospital Margin, Revenue & Rural Sustainability
News – Margins stabilizing overall, but the performance gap is widening.
The Hospital and Healthsystem Association of Pennsylvania’s summary of the latest Kaufman Hall National Hospital Flash Report notes that the adjusted year-to-date operating margin in September 2025 was 2.9% (up from 2.5%), but top-quartile hospitals are at 14.7% while bottom-quartile hospitals remain at –1.7%, with ED visits up 3% and OR minutes up 4%, underscoring higher volumes on flat margins and growing divergence between strong and struggling hospitals.
https://www.haponline.org/News/HAP-News-Articles/Latest-News/hospitals-face-array-of-financial-challenges HAP OnlineNews – Nearly half of rural hospitals are operating at a loss.
An American Hospital Association rural health fact sheet reports that 48% of rural hospitals were operating at a financial loss as of 2022, 136 hospitals have closed since 2010 (including 92 rural and critical access facilities), and many more are at risk due to payer mix, workforce shortages, and inflationary pressures.
https://www.aha.org/fact-sheets/2024-02-01-risk-closure-rural-hospitals American Hospital AssociationNews – Rural hospitals face heightened risk from Medicaid payment cuts.
A 2025 Center for American Progress analysis warns that proposed Medicaid funding reductions and loss of enhanced federal matching funds could push over 190 rural hospitals into “immediate risk of closure,” concentrating the impact in low-income and high-Medicaid states and threatening access to emergency and obstetric services.
https://www.americanprogress.org/article/how-medicaid-funding-cuts-could-devastate-rural-hospitals-and-communities/ Center for American ProgressRecommendation – Tie margin work directly to service-line access and throughput.
Taken together, the Kaufman Hall trends and rural risk analyses suggest that financial stabilization cannot just be cost-cutting; hospitals need explicit service-line margin reviews (e.g., ED, OR, obstetrics) combined with ED and inpatient throughput improvements to handle rising volumes safely on thin margins.
https://www.kaufmanhall.com/insights/research-report/national-hospital-flash-report ACDIS
Hospital Emergency Department Throughput (Older Adults & Boarding)
News – CMS “Age-Friendly Hospital” measure highlights worsening ED LOS for older adults.
Becker’s Hospital Review summarizes new research in JAMA showing that after CMS implemented an Age-Friendly Hospital measure targeting ED length of stay under 8 hours for adults 65+, the share of older-adult encounters exceeding 8 hours rose from 12% in 2017 to 20% in 2024, with boarding times >3 hours increasing from 22% to 36%, especially in academic centers.
https://www.beckershospitalreview.com/quality/patient-safety-outcomes/ed-stays-wait-times-worsening-for-older-adults/ Becker's Hospital ReviewCase Study – National ED access study shows sharp rise in prolonged ED stays.
A national analysis published in JAMA found that from 2017 to 2021, the percentage of ED visits with length of stay ≥8 hours (for admitted patients) grew from 7.8% to 13.9%, and stays ≥4 hours rose from 2.6% to 6.2%, reflecting systemic boarding and crowding that disproportionately affects high-acuity and low-resource hospitals.
https://jamanetwork.com/journals/jama/fullarticle/2803898 PMCNews – Prolonged ED stays are linked to harm in older adults.
The same body of research summarized by Becker’s notes that prolonged ED length of stay in adults 65+ is associated with higher risks of delirium, mortality, functional decline, treatment delays, loss of privacy, and poor patient experience, making ED boarding not only an access problem but also a patient-safety and equity issue.
https://www.beckershospitalreview.com/quality/patient-safety-outcomes/ed-stays-wait-times-worsening-for-older-adults/ Becker's Hospital ReviewRecommendation – Make older-adult ED LOS a daily management metric.
The Age-Friendly Hospital measure requires hospitals to track ED LOS <8 hours and admission decision-to-bed times <3 hours for older adults; organizations that operationalize these as daily management metrics (with visible unit-level dashboards and escalation rules) are better positioned to reduce crowding, improve patient safety, and perform well on emerging CMS and age-friendly benchmarks.
https://www.federalregister.gov/documents/2024/08/02/2024-15366/medicare-program-hospital-inpatient-prospective-payment-systems-for-acute-care-hospitals-and-the Becker's Hospital Review
Transitional Care Management, Case Management & Readmissions
Case Study – Transitional Care Management (TCM) reduces readmissions in large systems.
A PLOS ONE study of over 31,000 Medicare beneficiaries in a large integrated health system found that patients receiving Transitional Care Management services after discharge had significantly lower 30-day readmission rates and higher timely primary-care follow-up than comparable non-TCM patients, even after adjustment for clinical risk.
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315018 PLOSNews – Readmissions cost Medicare at least $17B annually and remain stubbornly high.
A 2025 HealthViewX review of Transitional Care Management reports that roughly 20% of Medicare beneficiaries are readmitted within 30 days of discharge, contributing to more than $17 billion in avoidable spending each year and exposing hospitals to Hospital Readmissions Reduction Program penalties of up to 3% of Medicare inpatient payments.
https://www.healthviewx.com/reducing-30-day-readmission-rates-through-effective-medicare-transitional-care-management/ HealthViewXNews – TCM is a patient-safety intervention, not just a billing code.
Loma Linda University’s Institute for Health Policy Leadership emphasizes that TCM, delivered by multidisciplinary teams, can prevent medication discrepancies, reduce adverse drug events, and lower 30-day readmissions, noting CDC data that 3.8 million U.S. readmissions in 2018 averaged $15,200 each and that 60% of medication errors and over 65% of adverse events occur during transitions of care.
https://ihpl.llu.edu/blog/transitional-care-management-ensuring-patient-safety ihpl.llu.eduCase Study – Multidisciplinary transition programs can nearly cut readmissions in half.
The same IHPL summary cites a multidisciplinary ambulatory care transitions program that reduced 30-day readmissions from 44% to 19% through pharmacist-integrated care teams, intensive follow-up, and medication reconciliation—illustrating the scale of impact possible when TCM programs are fully resourced and standardized.
https://ihpl.llu.edu/blog/transitional-care-management-ensuring-patient-safety ihpl.llu.eduRecommendation – Use TCM as a core lever in your readmissions and margin strategy.
Evidence from PLOS ONE and HealthViewX suggests that robust TCM programs improve timely follow-up, reduce mortality and readmissions, and can increase per-visit reimbursement (e.g., $126 vs. $108 for traditional visits), making TCM a rare intervention that simultaneously supports quality, patient safety, and financial sustainability.
https://www.healthviewx.com/reducing-30-day-readmission-rates-through-effective-medicare-transitional-care-management/ HealthViewX
Quality Metrics to Share with Your Team
National operating margin spread.
In Kaufman Hall’s latest hospital flash report, the adjusted year-to-date operating margin was 2.9%, but top-quartile hospitals averaged 14.7% while bottom-quartile hospitals averaged –1.7%, highlighting the widening gap between high- and low-performing organizations.
https://www.haponline.org/News/HAP-News-Articles/Latest-News/hospitals-face-array-of-financial-challenges HAP OnlineRural financial distress rate.
The American Hospital Association estimates that 48% of rural hospitals are operating at a loss and notes that 92 rural and critical access hospitals have closed since 2010, with many more at risk.
AssociationRural hospitals at immediate risk from Medicaid cuts.
Center for American Progress modeling suggests that more than 190 rural hospitals could face immediate risk of closure if proposed Medicaid funding reductions proceed, with disproportionate impact in high-Medicaid, low-income regions.
https://www.americanprogress.org/article/how-medicaid-funding-cuts-could-devastate-rural-hospitals-and-communities/ Center for American ProgressOlder-adult ED length of stay ≥8 hours.
Research summarized by Becker’s shows that in 2017, 12% of ED encounters among adults 65+ exceeded 8 hours, rising to 20% by 2024, despite CMS’s goal that older-adult ED stays remain under 8 hours.
https://www.beckershospitalreview.com/quality/patient-safety-outcomes/ed-stays-wait-times-worsening-for-older-adults/ Becker's Hospital ReviewBoarding >3 hours for older adults.
The same study found that the share of older-adult patients with boarding times longer than 3 hours increased from 22% in 2017 to 36% in 2024, with the greatest deterioration in academic hospitals.
https://www.beckershospitalreview.com/quality/patient-safety-outcomes/ed-stays-wait-times-worsening-for-older-adults/ Becker's Hospital ReviewSystem-wide ED prolonged-stay trend (all adults).
A national JAMA analysis found that ED visits with length of stay ≥8 hours increased from 7.8% to 13.9% between 2017 and 2021, while visits ≥4 hours increased from 2.6% to 6.2%, reinforcing that boarding pressures are growing across the board, not just in older adults.
https://jamanetwork.com/journals/jama/fullarticle/2803898 PMCImpact of multidisciplinary TCM on readmissions.
Loma Linda’s IHPL reports that a multidisciplinary transition-of-care program reduced 30-day readmissions from 44% to 19%, while CDC data show 3.8 million annual readmissions in 2018 at an average cost of $15,200 each—underscoring the ROI of targeted TCM investment.
https://ihpl.llu.edu/blog/transitional-care-management-ensuring-patient-safety ihpl.llu.edu
Leadership Call to Action
Create a “margin and access” dashboard that pairs financial and throughput metrics.
Combine operating margin, ED visit volume, OR minutes, and key throughput measures (ED LOS, boarding time, discharge-by-noon rate) into a single weekly dashboard so leaders can see where rising volume is colliding with flat margins and deploy resources accordingly.
https://www.haponline.org/News/HAP-News-Articles/Latest-News/hospitals-face-array-of-financial-challenges HAP OnlineIdentify your highest-risk rural or safety-net services and develop targeted contingency plans.
Use payer mix, margin by service line, and community dependence to flag essential services (e.g., ED, obstetrics) that would be catastrophic to lose in rural or underserved markets, and build specific contingency and advocacy plans around them.
American Hospital AssociationAdopt older-adult ED LOS and boarding thresholds as daily management goals.
Operationalize the CMS Age-Friendly Hospital targets—LOS <8 hours and decision-to-admit to bed <3 hours for adults 65+—as daily run-chart metrics with clear escalation criteria, rather than annual quality indicators.
https://www.beckershospitalreview.com/quality/patient-safety-outcomes/ed-stays-wait-times-worsening-for-older-adults/ Becker's Hospital ReviewStand up or strengthen a system-wide Transitional Care Management program.
Designate high-risk populations (e.g., older adults with multiple chronic conditions), standardize post-discharge contact within 2 business days, and ensure clinic workflows support TCM billing codes (99495/99496) so your program can both reduce readmissions and cover its operating costs.
https://www.healthviewx.com/reducing-30-day-readmission-rates-through-effective-medicare-transitional-care-management/ HealthViewXMake readmission reduction a multidisciplinary safety initiative, not just a finance project.
Frame TCM and transitional care as core patient-safety strategies with pharmacy, nursing, primary care, and case management at the table, using the 44%→19% readmission improvement benchmark as an ambitious—but achievable—goal for high-risk cohorts.
https://ihpl.llu.edu/blog/transitional-care-management-ensuring-patient-safety ihpl.llu.edu
📍 Published at National Daily Hospital News
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