Example: a hospital peer group for prospect research

The question

A consultant who helps hospitals with reimbursement and revenue-cycle work asks: which mid-size community hospitals in one state show thin or negative margins on patient services, and how do they compare with their peers? This is a prospecting question. The answer is a short list worth researching, not a verdict on any hospital.

Step 1: choose the cohort

In the portal's search, set Facility type to Short-Term Acute Hospital and State to OH. Set Fiscal year from and to 2024. Add two metric filters: Total Beds greater than or equal to 150, and Total Beds less than or equal to 300.

That returns 31 hospitals. A fiscal year in the portal is the calendar year in which a hospital's fiscal year ends, so the 31 are not the same twelve months: 22 end on December 31, 8 on June 30, and 1 on September 30. Of the 31 reports, 26 are as submitted, 2 are settled without audit, and 3 are amended.

Step 2: read the group before the individuals

The margin used here is net income divided by net patient revenue, where net income is net patient revenue less total operating expenses (Worksheet G-3, lines 3 and 4). It does not include the other revenue reported on lines 6 through 24 of the same worksheet.

Across the 31 hospitals the median margin is 0.4 percent. The middle half of the group sits between -3.6 and 3.0 percent, and the full range runs from -40.3 to 19.8 percent. 15 of the 31 have a margin below zero, and 5 are below -5 percent.

Step 3: look at the lowest margins

Sorting the group by margin puts five hospitals at the bottom. They are the first to research, which is not the same as the first to approach. The table below shows them.

Step 4: check what qualifies each figure

The two lowest margins are far from the rest of the group. They are also persistent: the first hospital's margin was -36.6, -42.0, -40.3, and -43.4 percent in fiscal years 2022 through 2025, and the second's was -19.1, -38.4, -35.7, and -22.0 percent. A gap that size, held for four years, is more likely to reflect how revenue and expenses are reported than a sudden change. Before reading anything into it, look at the non-patient revenue on G-3 lines 6 through 24 and at the hospital's own financial statements.

Then check the rest. All five reports in the table are as submitted, so values can change when a report is settled. Three of the five have June 30 year ends, so they are not directly comparable by month with the December hospitals. And the portal's latest years can be thin: Ohio has 117 short-term acute hospitals with a processed fiscal year 2024 report, 115 for fiscal year 2025, and 2 for fiscal year 2026, because hospitals file after their year ends and CMS processes reports afterwards.

Step 5: prepare the conversation

Turn each signal into a question you can ask, not a claim you can be wrong about. For example: how does the hospital account for non-patient revenue in its own view of margin, what changed between fiscal years 2022 and 2023, and which of its payer and payment arrangements matter most to its finance team. Export the cohort as CSV so your notes keep the filters, the fiscal year, and the report status next to every figure.

What this example does not show

It does not say why a hospital's margin is what it is, whether any hospital is performing well or badly, or that there is a reimbursement opportunity at any of them. The figures are derived from filed cost reports, they are screening signals, and the public hospital pages show each hospital's latest filed year, which is fiscal year 2025 for these, so they differ from the fiscal year 2024 figures here.

Portal rows for fiscal year 2024 (short-term acute hospitals in Ohio with 150 to 300 beds), read 2026-10-20. Margin is net patient revenue less total operating expenses, divided by net patient revenue. All five reports are as submitted.

Frequently asked questions

Why compare within a cohort instead of ranking every hospital?

Hospitals differ in size, type, and fiscal year end, so a cohort of similar hospitals is a fairer starting point than a national ranking. The filters make the cohort explicit and repeatable.

Does a negative margin mean a hospital is losing money?

Not necessarily. The margin here is calculated from patient revenue and total operating expenses and leaves out other revenue reported elsewhere on the worksheet. Treat it as a reason to look closer.

Why might a public hospital page show different figures?

Public pages show a hospital's latest filed year, which is fiscal year 2025 for these hospitals. This example uses fiscal year 2024, so the figures can differ.

Sources

• CMS Cost ReportsWhat HCRIS is and the hospital files CMS publishes
• CMS HCRIS documentation for hospital 2552-10 filesReport status codes (1 as submitted, 2 settled without audit, 3 settled with audit, 4 reopened, 5 amended) and the highest-status rule
• CMS Provider Reimbursement Manual, Part 2, Chapter 40, section 4040.4 (Worksheet G-3)The definitions of G-3 lines 3, 4, and 6 through 24

This guide is general information drawn from the sources above, last reviewed October 20, 2026. It is not legal, reimbursement, or filing advice. Rules, figures, and file listings change; confirm against the source before relying on them.

Related

• UNIV OF TOLEDO MEDL CENTER (public page)→
• LAKE HOSPITAL SYSTEM (public page)→
• SOUTHERN OHIO MEDICAL CENTER (public page)→
• MARIETTA MEMORIAL HOSPITAL (public page)→
• TRINITY HOSPITAL HOLDING COMPANY (public page)→
• Built for reimbursement consultants→
• How the data is built→