Financial Health

Revenue, costs, margin and more — the business side of healthcare, reported annually by every certified facility.

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What is the Healthcare Cost Report Information System

Every Medicare-certified facility files an annual financial report.

The Healthcare Cost Report Information System (HCRIS) is CMS's repository of annual cost reports filed by Medicare-certified providers. Unlike quality measures, which track what happens to patients, cost reports track financial indicators including revenue, expenses, staffing costs, payer mix, and margin.

Cost reports are not optional for Medicare-certified providers. Filing is a condition of participation. That makes HCRIS one of the most comprehensive financial databases in healthcare — covering hospitals, nursing homes, home health agencies, hospices, dialysis facilities, and federally qualified health centers across the country.

Core Indicators

Four financial indicators common to every provider type.

Regardless of whether the report is filed by a hospital or a hospice, the same foundational financial picture emerges from four indicators.

Net Patient Revenue
Total revenue received for patient care services after contractual adjustments — what the facility actually collected, not what it billed. The top line of facility finances.
Total Operating Expenses
All costs incurred to operate the facility — salaries, supplies, contracted services, overhead. The denominator in every efficiency calculation.
Operating Margin
Net income from operations divided by net patient revenue. The single most useful indicator of financial sustainability — a negative margin means the facility is spending more than it earns from patient care.
Payer Mix
The percentage of patient days or discharges covered by Medicare and Medicaid. High government payer concentration constrains pricing flexibility and directly affects margin potential.
By Provider Type

Each provider type has a unit that makes peer comparison meaningful.

Each provider type has a natural unit that makes costs comparable across facilities of different sizes. A 50-bed nursing home and a 300-bed nursing home can't be compared on total expenses alone — but cost per resident day normalizes for scale.

Provider Type CMS Form Primary Cost Unit Additional Indicators
Hospitals CMS-2552 Cost per discharge Cost per day, beds, Medicare/Medicaid days and discharges, IME payments
Nursing Homes CMS-2540-10 Cost per resident day Occupancy rate, average daily census, SNF vs. NF bed split, revenue per bed
Home Health CMS-1728-20 Cost per visit & cost per episode Visit volume by payer, revenue per visit, revenue per episode
Hospice CMS-1984-14 Cost per patient day Cost per patient, total hospice days, Medicare vs. Medicaid day split
Dialysis CMS-265-11 Cost per treatment Cost per patient, total FTE staff, revenue per treatment
What Financial Data Reveals

Three questions financial data answers.

Sustainability
Is this facility financially viable?
A facility with a strong operating record and a negative margin is under pressure. Cost reports show the financial trajectory — whether margins are improving, deteriorating, or chronic.
Efficiency
How does cost per patient compare?
Cost per discharge, per resident day, or per treatment normalizes for volume and allows meaningful peer comparison. A facility spending significantly more per patient than comparable peers is either more complex, more inefficient, or both.
Dependence
Who is paying for care?
Payer mix reveals how dependent a facility is on government reimbursement rates. High Medicare and Medicaid concentration with thin margins signals structural financial risk.
About the Data

Where the data comes from and how often it is updated.

Data is sourced directly from CMS HCRIS filings covering a facility's most recently reported fiscal year, which doesn't always align with the calendar year.