Desk

Financial distress

Hospital closures, bankruptcies, and debt cycles — the balance-sheet signals that precede a facility going dark.

17 studies on this desk

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 →

Financial distress

Hospital closures, bankruptcies, and debt cycles — the balance-sheet signals that precede a facility going dark.

17 studies on this desk

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 →