National Daily Hospital Executive Briefing Thursday December 4th, 2025

 

NATIONAL DAILY HOSPITAL NEWS — EXECUTIVE BRIEFING

Thursday, December 4, 2025

Today:

>260% Rise in Agency Labor Cost Expense Since 2019
>Hospital Bad Debt Expected to Rise
>Only 20% of U.S. Healthcare workers say their boss supports long-term career growth 
>Hospital At Home Patients have lower mortality and spending

This Executive Briefing summarizes key developments impacting hospital leaders today, with links, recommendations, case examples, and metrics you can use directly with your teams.

1. Global and Health Sector Headlines – Hospital Finance & Workforce Stability

1. Hospital margins improve in early 2025 but remain fragile — Kaufman Hall’s analysis (summarized by CDI Strategies) finds hospital profit margins in April 2025 improved due to stronger patient demand, but performance remains uneven and pressure from expenses and workforce costs continues.
   https://acdis.org/articles/news-us-hospitals-see-positive-financial-developments-2025-challenges-remain-report-says
2. Margins soften again as expenses catch up — A HealthLeaders review of Kaufman Hall’s May 2025 National Hospital Flash Report notes median calendar-year-to-date operating margins dipped to 1.7% (with allocations), down from 1.9%, underscoring how quickly financial gains can erode when labor and supply costs rise.
   https://www.healthleadersmedia.com/ceo/hospital-margins-softening-expenses-catch
3. Burnout and agency nurse dependence drive structural cost pressure — Essential Hospitals highlights that agency nurse use increased 133% between 2019 and 2022, contributing to a 260% rise in total agency labor costs and a 178% increase in agency labor’s share of hospital labor expenses, directly tying burnout and retention problems to margin compression.
   https://essentialhospitals.org/building-workforce-stability-nursing-retention-strategies-for-acute-care-hospitals/
4. Over half of U.S. healthcare workers plan to switch jobs by next year — A Harris Poll survey for Strategic Education finds 55% of U.S. healthcare workers plan to look for or switch jobs by 2026, with 84% feeling underappreciated and only 20% believing their employer supports long-term career growth, signaling heightened retention risk across hospitals and health systems.
   https://www.reuters.com/business/healthcare-pharmaceuticals/over-half-us-healthcare-workers-plan-switch-jobs-by-next-year-survey-finds-2025-09-15/
5. CASE STUDY – HCA’s multi-pronged workforce retention strategy — HCA Healthcare leaders describe a 2025 workforce plan that combines flexible schedules, career-ladder pathways, well-being resources, and data-driven staffing analytics to reduce turnover and stabilize staffing across a large hospital system.
   https://hrhealthcare.wbresearch.com/blog/hca-healthcare-addresses-workforce-retention-crisis

2. Emergency Services, ED Boarding, and Hospital-at-Home

1. AHRQ identifies system-level levers to reduce ED boarding — An AHRQ report summarizes that the root causes of ED boarding originate at the hospital and health system level (bed management, discharge processes, inpatient flow), and highlights multi-component interventions (real-time bed tracking, early discharge planning, hospital-wide surge protocols) as key strategies.
   https://www.ahrq.gov/news/newsletters/e-newsletter/951.html
2. ED boarding nearly doubles daily cost of care — An American College of Emergency Physicians analysis finds that caring for patients who are boarding in the ED nearly doubles the daily cost of care to the hospital, reinforcing that boarding is both a quality and margin issue requiring cross-departmental solutions.
   https://www.emergencyphysicians.org/press-releases/2024/10-21-24-boarding-patients-in-emergency-departments-nearly-doubles-daily-cost-of-care-study-finds
3. National trends in prolonged ED length of stay for older adults — A JAMA Network study discussed in an AMA podcast reports rising rates of prolonged ED length of stay for older adults between 2017 and 2024, linking crowding and boarding to worse patient experience and higher risk in a growing high-acuity population.
   https://edhub.ama-assn.org/jn-learning/audio-player/18984038
4. CMS report: Hospital-at-Home patients show lower mortality and spending — CMS’ fact sheet on the Acute Hospital Care at Home (AHCAH) initiative concludes that hospital-at-home patients generally had lower mortality and 30-day spending than traditional inpatients, with high patient and caregiver satisfaction, supporting the model as a safe and effective ED-pressure relief valve.
   https://www.cms.gov/newsroom/fact-sheets/fact-sheet-report-study-acute-hospital-care-home-initiative
   https://www.ama-assn.org/public-health/population-health/hospital-home-saves-lives-and-money-cms-report
5. PROGRAM STATUS & POLICY RISK – Hospital-at-Home as shutdown collateral damage — Recent coverage from Axios and Politico reports that the federal shutdown temporarily halted Medicare funding authority for the Acute Hospital Care at Home waiver, forcing participating hospitals to discharge or transfer patients back to brick-and-mortar beds and threatening capacity ahead of winter respiratory surges until Congress acts.
   https://www.axios.com/2025/10/01/telehealth-services-seniors-shutdown
   https://www.politico.com/news/2025/10/14/hospital-at-home-program-collateral-damage-of-the-shutdown-00602997
6. CONTEXT & CASE EXAMPLES – AHCAH scale and performance — MedPAC and the John A. Hartford Foundation summarize that as of April 2024 there were ~23,000 AHCAH discharges across 328 hospitals, with lower mortality and infection rates than comparable inpatients and strong patient satisfaction, illustrating the scale of impact if the program lapses.
   https://www.medpac.gov/wp-content/uploads/2024/06/Jun24_Ch6_MedPAC_Report_To_Congress_SEC.pdf
   https://www.johnahartford.org/resources/view/centers-for-medicare-and-medicaid-services-report-on-the-study-of-the-acute-hospital-care-at-home-initiative

3. Early Morning Briefing Highlights

1. Margins are up but precarious — Hospitals have seen modest margin improvements in early 2025, but even small increases in labor and supply costs rapidly erode gains, leaving most organizations operating on thin, volatile margins.
2. Workforce risk is now a macro-level financial threat — Escalating reliance on agency nursing and the fact that more than half of healthcare workers plan to look for a new job by 2026 transform burnout from a “staffing problem” into a major balance-sheet risk.
3. ED boarding remains a leading driver of waste and risk — New analyses demonstrate that ED boarding can nearly double the daily cost of care and is closely linked to longer stays and poorer outcomes, particularly for older adults.
4. Hospital-at-Home is both a relief valve and a policy exposure — Evidence continues to show hospital-at-home reduces mortality and spending, yet shutdown-related funding lapses reveal how dependent local capacity strategies are on federal policy stability.

4. Strategic Implications for Leadership

• Treat workforce strategy as core to margin strategy by explicitly linking agency spend, turnover, and engagement to operating margin in executive and board dashboards.
• Quantify the cost of ED boarding locally so that capacity and discharge projects can be justified with concrete dollar and quality impacts.
• Integrate hospital-at-home into bed-capacity planning, not just innovation pilots, with clear triggers for enrollment from ED and inpatient units.
• Scenario-plan around federal policy risk for telehealth and AHCAH, including contingencies if waivers or authorities lapse.
• Elevate frontline input into board-level dashboards by tracking perceived career growth, appreciation, and psychological safety alongside financial and quality indicators.

Quality Metrics to Share With Your Team

1. Operating margin index — Median calendar year-to-date operating margin for hospitals with corporate allocations fell to 1.7% in May 2025, down from 1.9%, and only slightly above the 1.4% average for 2024.
   https://www.healthleadersmedia.com/ceo/hospital-margins-softening-expenses-catch
2. Profitability versus demand — Kaufman Hall’s April 2025 data show improved margins driven by higher patient demand, but with continued variability and exposure to workforce and expense shocks.
   https://acdis.org/articles/news-us-hospitals-see-positive-financial-developments-2025-challenges-remain-report-says
3. Agency nurse growth — Agency nurse use increased 133% between 2019 and 2022, contributing to a 260% increase in total agency labor costs and a 178% rise in agency labor’s share of hospital labor expenses.
   https://essentialhospitals.org/building-workforce-stability-nursing-retention-strategies-for-acute-care-hospitals/
4. Turnover risk — 55% of U.S. healthcare workers say they plan to search for or switch jobs by 2026; 84% feel underappreciated and only 20% feel supported in long-term career growth.
   https://www.reuters.com/business/healthcare-pharmaceuticals/over-half-us-healthcare-workers-plan-switch-jobs-by-next-year-survey-finds-2025-09-15/
5. Cost of ED boarding — Caring for patients boarding in the ED nearly doubles the daily cost of care for hospitals.
   https://www.emergencyphysicians.org/press-releases/2024/10-21-24-boarding-patients-in-emergency-departments-nearly-doubles-daily-cost-of-care-study-finds
6. Scale of hospital-at-home — As of April 2024, there were approximately 23,000 Acute Hospital Care at Home discharges and 328 participating hospitals.
   https://www.medpac.gov/wp-content/uploads/2024/06/Jun24_Ch6_MedPAC_Report_To_Congress_SEC.pdf
7. AHCAH clinical outcomes — CMS found hospital-at-home patients generally had lower mortality, lower 30-day spending, and positive experiences compared with similar inpatients.
   https://www.cms.gov/newsroom/fact-sheets/fact-sheet-report-study-acute-hospital-care-home-initiative

Leadership Call to Action

• Build a joint CFO–CNO workforce and margin dashboard that tracks agency spend, vacancy rates, retention, and engagement alongside operating margin trends.
• Quantify and publish your local “cost of boarding” estimate so capacity and discharge projects can be justified with concrete dollar and quality impacts.
• Develop or refine a Hospital-at-Home playbook that specifies which DRGs and patient profiles can transition to AHCAH and how ED/inpatient teams trigger enrollment.
• Create a shutdown/policy-lapse contingency plan for telehealth and hospital-at-home programs, including criteria for temporary back-shifting to inpatient beds.
• Launch or expand a structured retention initiative with 12-month targets for turnover and agency reliance, incorporating flexible scheduling, career-ladder pathways, and frontline leadership rounding.

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