Desk
Financial distress
Hospital closures, bankruptcies, and debt cycles — the balance-sheet signals that precede a facility going dark.
25 studies on this desk
- The excluded-provider landscape: no single list catches them all
Across the federal OIG LEIE, SAM.gov, and five state Medicaid programs, 10,020 NPI-identified providers are barred from a public health program — yet the single most complete list, the OIG LEIE, names only 6,880 of them. Screen one source and 31% of excluded providers come back clean.
2026-06-14 · 11 min - Barred but billable: excluded providers still enrolled in Medicare
19 providers barred from all federal health programs by the OIG still hold an active Medicare enrollment record in PECOS — out of 6,880 in-force NPI-identified federal exclusions. Most trace to a single refresh cycle's lag, but two have stood for over a year, one excluded since 2015.
2026-06-14 · 9 min - The exclusion gap: federal screening misses most state Medicaid bars
Federal-only exclusion screening misses most state Medicaid exclusions: of 3,794 NPI-identified providers excluded by New York, Ohio, Georgia, or Pennsylvania, 2,242 — 59.1% — carry no record on the federal OIG LEIE. An employer checking the federal list alone clears nearly three in five state-barred providers as clean.
2026-06-14 · 9 min - Industry payments to providers on the OIG exclusion list
In program year 2024, drug and device manufacturers reported $3.84 million in Open Payments to 294 physicians and other providers who now sit on the federal OIG exclusion list, spread across 3,055 separate transfers. A single category — debt forgiveness — accounts for $3.27 million of that total.
2026-06-14 · 10 min - Same DRG, wildly different price: hospital charge variation, 2024
For the same Medicare DRG, hospitals bill wildly different amounts: across 219 high-volume codes in 2024, the 90th-percentile hospital charged a median of 3.8× what the 10th-percentile hospital charged for the identical stay. For sepsis — the most common code, billed by 2,661 hospitals — the spread is 4.4×.
2026-06-14 · 10 min - DRG codes: Medicare inpatient payment and volume, 2024
Across all 540 MS-DRGs in the 2024 Medicare inpatient file, hospitals were paid an average of $15,166 per stay against $92,408 in billed charges — a 6.1× gap. Sepsis (DRG 871) was the highest-volume code at 577,119 discharges; CAR T-cell therapy (DRG 018) the costliest at $434,771 per stay.
2026-06-14 · 10 min - The 5% of prescribers behind half of Medicare's drug bill
In 2024 the top 5% of Medicare Part D prescribers — 56,973 of 1.14 million — accounted for 53.5% of the program's $226.7 billion drug bill, while the bottom half split 0.4%. The top 1% alone drove $53.5 billion. The Gini coefficient across prescribers is 0.841.
2026-06-14 · 11 min - The 1% of doctors who get two-thirds of industry money
In 2024 the top 1% of physicians — 9,792 of the 979,136 who received any industry money — captured 66% of every general-payment dollar tied to a recipient, $1.74 billion of $2.64 billion. The bottom half split 1.2%. Measured across recipients, the Gini coefficient is 0.927, far above the ~0.41 of US household income.
2026-06-14 · 11 min - GLP-1 makers paid 120,237 Medicare prescribers $32.8 million in 2024 — and the prescribers they paid wrote far more
In 2024, the makers of Ozempic and Mounjaro paid $32.8 million to 120,237 Medicare prescribers for meals, talks, and travel tied to GLP-1 drugs. Prescribers who accepted a payment wrote 78% more GLP-1 prescriptions than those who did not — a correlation this study reports at the group level, without inferring cause.
2026-06-12 · 12 min - The most expensive Medicare Part D drugs are rarely the most prescribed
Eliquis cost Medicare Part D $19.88 billion in 2024 — the single costliest drug in the program, yet only its 12th most-prescribed. That inversion defines Part D: brand-name drugs are 23.9% of prescriptions but 90.1% of the dollars, while cheap generics carry the volume and almost none of the cost.
2026-06-12 · 12 min - Industry payments to physicians by state: where the money lands
Industry's $3.31 billion in 2024 general payments to physicians spread across 59 U.S. jurisdictions, but not in proportion to population. California led at $334.5 million, yet Pennsylvania ranked third and Massachusetts fourth on far fewer payments — Massachusetts averaged $1,031 per payment against Texas's $153. Where royalty recipients live, not where patients are, shapes the map.
2026-06-12 · 10 min - Which companies pay U.S. doctors the most? Device makers, not pharma
In 2024, drug and device companies disclosed $3.31 billion in general payments to U.S. physicians under the Sunshine Act — and the largest payers are device makers, not pharma. BioNTech led at $180.6 million from just 164 royalty payments; the top 25 of 1,763 reporting companies account for 52% of every general-payment dollar.
2026-06-12 · 11 min - Which medical specialties take the most industry money?
In 2024, U.S. orthopedic surgeons received $381.4 million in general industry payments — more than any other specialty and over three times the second-place field. Counting spine, joint and sports-medicine subspecialties, orthopedics drew $531.8 million, about 16% of the $3.31 billion total. The average orthopedic payment was $1,711; the average internal-medicine payment was $96.
2026-06-12 · 11 min - What pharma actually buys: food, travel, consulting and royalties
Industry made 15.4 million general payments to U.S. physicians in 2024, worth $3.31 billion — but the two halves barely overlap. Royalties, speaking and consulting are 2.9% of payments yet 63% of the dollars; food and beverage is 91.7% of payments but 12.4% of the money. The average meal was $29; the average royalty, $56,258.
2026-06-12 · 10 min - Open Payments 2024: $11.96B in Industry Payments to Doctors (Sunshine Act)
$11.96B in industry payments reached US clinicians and teaching hospitals in 2024 under the Sunshine Act, across 16.1M Open Payments records. $3.31B was everyday general payments to 979,136 distinct clinicians — and the money is extraordinarily concentrated: royalties are 0.1% of records but 25.6% of the dollars, and orthopaedic surgery leads every specialty.
2026-06-12 · 12 min - Medicare Part D 2024: The Most-Prescribed and Costliest Drugs
$177.8 billion bought 1.16 billion prescriptions in Medicare Part D in 2024. The most-prescribed drugs are almost all cheap generics, yet 90% of the dollars went to brand-name drugs — the anticoagulant Eliquis alone cost $15.3 billion, and GLP-1 diabetes drugs like Ozempic added $19 billion more.
2026-06-12 · 13 min - What Hospitals Charge for the Same Procedure (2024)
Across 4.95M Medicare inpatient stays at 2,906 hospitals in 2024, hospitals billed an average of $92,408 in covered charges but were paid about $18,360 — a roughly 5x gap. For the same procedure, list-price charges vary up to 59x between hospitals. Charge variation by DRG and state, with reproducible CMS methodology.
2026-06-12 · 12 min - Hospital charity care, by the numbers: who actually gives the most free care
Nonprofit hospitals — tax-exempt in exchange for community benefit — deliver charity care worth just 1.53% of their patient revenue, the lowest share of any ownership type, below for-profit hospitals (3.00%) and less than half the government rate (3.76%), across $27.68 billion in free care in the federal HCRIS cost reports.
2026-06-11 · 12 min - Rural hospital closures, by the numbers: which hospitals are most at risk
Rural Critical Access Hospitals — the small facilities at the center of the closure crisis — run a 50.4% financial-distress rate, against 39.2% for urban hospitals, across 6,019 Medicare hospitals in the federal HCRIS cost reports. Their average operating margin is −8.93%, and 682 are losing money on patient care.
2026-06-11 · 13 min - For-profit, nonprofit, or government: who owns America's hospitals, and which model makes money
Across 6,019 US hospitals in the federal HCRIS cost reports, for-profit facilities are the only ownership class earning a positive average operating margin — +0.19% — while nonprofit hospitals average −4.75% and government hospitals −62.38%. The ranking holds on every measure, but the gap is narrower than the averages suggest.
2026-06-11 · 12 min - The OIG exclusion list, explained: who gets barred from Medicare, and why
The OIG List of Excluded Individuals and Entities (LEIE) holds 68,055 active exclusions spanning 1977–2026. The most common reason to be barred from Medicare is not fraud — it is losing a state license: §1128(b)(4) license actions are 41% of the list. And only 10.3% of records carry an NPI, so the list is mostly non-clinicians.
2026-06-11 · 11 min - Hospitals running out of cash: the days-cash signal, and why most of it is a reporting artifact
Federal HCRIS cost reports let us compute days cash on hand for 5,459 hospitals, but facility-level figures are distorted by system-level cash pooling — so the raw '2,800 hospitals under 30 days' headline is mostly noise. The defensible signal is narrower: 690 hospitals that report thin cash and also run an operating loss.
2026-06-04 · 14 min - Nursing Homes Banned from New Medicare Admissions (DPNA)
1,950 US nursing homes have been barred from accepting new Medicare admissions under the Denial of Payment for New Admissions (DPNA) penalty (42 CFR §488.417), across 2,553 separate enforcement actions. A state-by-state breakdown, the longest active bans named from CMS data, and the reproducible SQL behind every figure.
2026-06-04 · 9 min - Hospital Margin Gap Analysis
Operating-margin data for 6,000+ U.S. hospitals, computed from CMS HCRIS cost reports (form 2552-10) and benchmarked against the national average. Per-hospital financial-distress flags, a state leaderboard, and the margin gap — the same dataset Definitive Healthcare charges $30,000 a year for, published free with cryptographic provenance.
2026-05-24 · 8 min - Provider exclusions aren't rising — but they cluster around distressed operators
New additions to the OIG exclusion list are flat to declining — down 2.4% year-over-year through April 2026, and down 18.7% across full-year 2024 to 2025. The count is not the story. What concentrates is the composition: new exclusions cluster in facilities already showing the balance-sheet markers of financial distress.
2026-05-05 · 7 min
Other desks
All research →