Methods

How the figures are made

Delgam draws on two kinds of public record: filings in which hospitals describe their building projects, and the cost reports every Medicare hospital files each year.

The filings are certificate of need (CON) applications and staff reports, master plans, environmental reviews, board items, budgets and zoning cases: 1,125 documents with 6,521 figures, from 42 states and the District of Columbia, filed 1970 to 2026. The cost reports come from the Centers for Medicare & Medicaid Services (CMS) through its Healthcare Cost Report Information System (HCRIS): 6,109 reports for fiscal year 2023, covering 6,046 hospitals.

Sources

Documents by kind of filing, as stored in documents.source_type:

What each kind is, from the database README:

• CON (certificate of need): state approval for hospital construction, beds or major equipment. Applications and agency staff reports often list square footage by department, beds by type, operating rooms (ORs) and imaging units.
• DoN (Determination of Need): Massachusetts' version of a certificate of need. Every application has a capital-costs chart by functional area: present, new construction, renovation and resulting square footage, net and gross.
• COPN (Certificate of Public Need): Virginia's version. Staff reports give beds, ORs, imaging, cost and often gross square feet.
• state_review: other state health-planning filings, such as Minnesota bed-moratorium public interest reviews and New York Public Health and Health Planning Council (PHHPC) staff reports.
• IMP (institutional master plan): city-required campus plans (Boston, Pittsburgh, Providence, San Francisco; Seattle calls them major institution master plans). Campus-scale: square footage by building and use, development limits, parking.
• EIS (environmental review): federal, state or city environmental impact reviews, including California Environmental Quality Act (CEQA) environmental impact reports, New York City environmental quality review (CEQR), Massachusetts Environmental Policy Act (MEPA) and Washington State Environmental Policy Act (SEPA) filings, and federal environmental assessments.
• zoning: rezonings, planned developments, special permits, variances, campus plans.
• board_item: university regents/trustees and public hospital board capital approvals (University of California Regents, University of Michigan Regents, UT System capital program and others).
• budget: federal and public budget documents: Department of Veterans Affairs (VA) major construction volumes, Department of Defense military construction justification sheets (DD Form 1391), county bond programs, and Texas' accessibility project registry.

The second-pass check

A second reader re-opened a stratified sample of 39 documents. 209 of 218 figures (96%) matched the source. Of the documents, 33 were fully confirmed, 3 corrected and 3 had problems. Corrections are applied in the database and marked in metrics.check_flag; on the charts, a flagged value carries an asterisk and a note.

The research and checking method, from the README:

• Research:
  • Agents and rounds: 11 Claude Opus 5.5 research agents split by region and source type ran in three rounds: New York CON; New England; Mid-Atlantic/DC/Virginia/West Virginia; Southeast; Illinois; Midwest and Plains; West and South-Central; East Coast master plans and environmental review; West/South/Midwest master plans and environmental review; federal, public and university systems.
  • How documents were read: each document was opened and its figures read from the fetched text. URLs were copied from search results, never constructed.
  • Limits: a shared web-search budget and site rate limits cut each round short, so coverage is broad but not complete.
• Second-pass check:
  • Claude Fable 5.1 re-opened a stratified sample of 39 documents (about 4 per research slice).
  • Figures: 209 of 218 matched the source (96%).
  • Documents: 33 fully confirmed, 3 corrected, 3 with problems.
  • Error types: net-new beds tagged as resulting totals, a gross figure labeled net, combined OR-plus-procedure-room counts recorded as ORs, a design budget recorded as total project cost, a cost range recorded as one number, and two figures that came from a different document than the one cited.
  • Fixes: corrections are applied and marked in metrics.check_flag. In round 3 the agents also relabeled about 50 values (net-new beds, demolition, zoning floor area) to follow the same rules.
• Text recognition (OCR): 16 scanned Hawaii State Health Planning and Development Agency (SHPDA) PDFs (11 applications plus 5 decisions) were read with tesseract. They replaced 11 snippet-only records (verification = 'ocr'). Illegible figures were left out.

Linking filings to hospitals

596 documents are linked to 379 cost report hospitals by fuzzy matching of facility name and city within the state. Hand spot checks put the precision at about 97% for the 577 high-confidence links and about 80% for the 19 medium ones. 529 documents are not linked.

• Method: fuzzy matching of facility name plus city within the state (rapidfuzz). Matches are rejected for:
  • facility-type conflicts (rehab, children's, behavioral, cancer, heart, orthopedic, women's)
  • a different city named in the facility name
  • VA and military facilities, which don't file Medicare cost reports
  • proposed hospitals not yet built
• Precision from hand spot checks: about 97% for high (577 documents) and about 80% for medium (19).
• Known pattern: a filing for a satellite campus may link to the parent hospital's CCN when the campus reports under it (for example Erlanger East, Children's Memorial Hermann).
• Unlinked (529 documents): VA/military, proposed hospitals, multi-project agenda filings, ambulatory surgery centers and ambiguous names.

Medicare cost reports

Source: Centers for Medicare & Medicaid Services (CMS), Healthcare Cost Report Information System (HCRIS), hospital cost reports, public use file HOSP10FY2023 (form 2552-10). Square feet: Worksheet B-1; beds: Worksheet S-3 Part I. CMS cost report files.

Of the 6,109 reports, 448 carry a quality flag because their square footage is not usable, and 201 carry a warning: 92 for more space per bed than the threshold, 114 for space repeated across building columns (some have both). The benchmark leaves out both.

• Quality flags:
  • sf_quality_flag is set on 448 reports whose statistic is not usable as square feet. Examples are no building statistics, departments not summing to the total, or a capital cost per square foot outside $2–$400; New York state psychiatric centers report dollars, not square feet.
  • sf_warning is set on 201 reports, for two reasons; when both apply they are joined with " | ".
    • "over 20,000 sf per hospital bed; check" (92 reports, from the original build), usually campuses that include university or research buildings (Rush, MD Anderson).
    • "space repeats across B-1 building columns (N% of department space); total overstated" (114 reports, added October 17, 2026). At least 5% of the hospital's department space repeats exactly across building columns, so its square footage is overstated (see "Square feet by building").
    • Five reports have both.
    • scripts/add_hcris_capacity.py recomputes the second warning each time it runs and leaves the first alone.
• Caveats: a multi-campus system may report several campuses under one CCN. Reported square footage can undercount (Houston Methodist reports 640,000 sq ft; its new Centennial Tower alone is 1.18 million).

How the benchmark is built

National: square feet per bed

4,589 hospitals: the latest fiscal year 2023 report for each, with usable square footage, no warning and 25 or more beds. Operating room (OR) share is operating room square feet over the building's total.

SELECT ccn, hospital_name, city, state, hospital_type,
       beds_hospital_total, building_sf_total, sf_per_bed,
       ROUND(1.0 * sf_operating_room / building_sf_total, 5) AS or_share,
       ROUND(1.0 * sf_emergency / building_sf_total, 5)      AS emergency_share,
       ROUND(1.0 * sf_imaging / building_sf_total, 5)        AS imaging_share
FROM v_hcris_hospital_space
WHERE sf_warning IS NULL AND beds_hospital_total >= 25
ORDER BY ccn

Illinois: departmental gross square feet per operating room

18 projects from 20 Illinois filings that state both surgery space in departmental gross square feet (DGSF) and an OR count. The rules for pairing space with rooms:

1. Illinois filings with at least one Surgery / Perioperative departmental gross square feet (DGSF) row and a facility-level operating room (OR) count (metric 'ors', no department) in the same document.
2. Only the operating-room rows are used. Rows whose name (before any parenthesis) is recovery, PACU (post-anesthesia care unit), prep, pre-op, post-op, anesthesia, support, holding or a procedure room or suite are left out: Illinois sizes those against separate standards. Rows are otherwise used as labeled, so a row called 'Surgery Center', 'Surgical Services' or 'Perioperative' may include such space.
3. Operating-room rows with the same status are summed. They are paired with an OR count of the same status; or, for new_construction or renovation space, with a proposed or new_construction count (both describe the project's rooms); or with a resulting count when the row's own label states the same number of ORs. net_new counts are never paired, so net_new and resulting are not mixed.
4. If a document yields more than one pair, the first in this order is kept: same status before project scope; then resulting, proposed, approved, new_construction, renovation, existing.
5. Duplicates: filings in the same project (project_documents.project_id, which groups by facility and project), or else with the same facility and project name, keep only the latest filing.
6. Where a row's label states a different number of ORs than the paired count, or mentions recovery or a procedure room, the dot carries a note.

SELECT d.doc_id, d.facility_name, d.project_name, d.filing_year, d.filing_date, d.url,
       pd.project_id, m.metric, m.department, m.status, m.value, m.check_flag
FROM documents d
JOIN metrics m ON m.doc_id = d.doc_id
LEFT JOIN project_documents pd ON pd.doc_id = d.doc_id
WHERE d.state = 'IL'
  AND ((m.metric = 'dgsf' AND m.department_std = 'Surgery / Perioperative')
       OR (m.metric = 'ors' AND m.department IS NULL))
  AND d.doc_id IN (SELECT doc_id FROM metrics WHERE metric = 'ors' AND department IS NULL)
  AND d.doc_id IN (SELECT doc_id FROM metrics
                   WHERE metric = 'dgsf' AND department_std = 'Surgery / Perioperative')
ORDER BY d.doc_id, m.metric, m.status

The Illinois standard

2,750 DGSF per operating room, for a surgical operating suite (Class C), from the Illinois Health Facilities and Services Review Board's guidelines, 77 Ill. Adm. Code 1110 Appendix B (stored with the note "1,500 hours per OR per year"). All 32 Illinois space standards are in il_standards.json.

SELECT m.department, m.value, m.unit, m.status, m.note, m.check_flag,
       d.doc_id, d.facility_name AS source_title, d.project_name AS source_citation, d.url
FROM metrics m JOIN documents d ON d.doc_id = m.doc_id
WHERE d.state = 'IL' AND m.metric = 'dgsf_per_unit_standard'
ORDER BY m.department

Surgical hours are not in the filings, so the benchmark compares space, not use. Hospitals' reported hours are in the database's as-built layer; comparing them is future work, and nothing here approximates them.

Your project's percentile

The share of peers below your value, plus half of any ties, out of all peers: among the 18 Illinois projects, or the 4,589 hospitals for square feet per bed.

Known gaps

From the database README:

• Scanned or blocked:
  • Illinois 2024–2026 applications are image-only; their staff reports are text and mostly included.
  • Alaska application PDFs.
  • Vermont North Country and Copley decisions.
  • Some Maryland staff reports.
  • Connecticut 2010 decisions.
  • Georgia's document repository and Alabama's planning agency site block automated access.
  • Kentucky newsletters and Massachusetts 2026 filings are Word-only.
  • Three Pittsburgh master plans (Children's 2013, Magee-Womens 2011, UPMC St. Margaret 2012).
  • Boston master plans hosted on box.com.
• Not found or not reached:
  • Philadelphia design-review packets.
  • Several DC zoning cases (Children's National, GW, MedStar Washington Hospital Center).
  • Chicago planned developments for Rush, Lurie and UI Health.
  • Oregon Health & Science University (OHSU) master plan.
  • Columbus, Nashville, Atlanta, Dallas and Austin city filings.
  • Some public-university boards (MUSC, Minnesota, Hennepin, MetroHealth).
  • Indian Health Service project documents.
  • VA budget volumes before FY2025.
• New York: many PHHPC meeting PDFs failed to load (2015-03-26, 2015-09-24, 2017-05-18, 2018-03-22, 2022-05-19, 2024-08-22, 2025-06-04, 2025-08-21, all 2026 committee dates). Few self-posted applications were found for Northwell, Montefiore, NYC Health + Hospitals, SUNY, Kaleida or Bassett.
• Michigan: applications are available only by records request; the database uses the monthly status and decision lists.
• Duplicates: a project can appear more than once (application plus staff report, or amendments). Group by facility and project before counting projects. The projects table now does this grouping; uncertain pairs are listed in reports/projects/merge_candidates.csv.
• As-built:
  • Illinois CY 2020, 2024 and 2025 profiles and the NC 2026 SMFP are posted but not loaded yet.
  • North Carolina's acute care bed and MRI inventory tables (other SMFP chapters) are not parsed yet.
  • Filings in the database rarely carry a state license number in their stored text (1 of 72 NC documents, 0 of 130 IL), so joining filings to as-built rows on license would need the filings re-read.

Figures exported 2026-10-19 15:53:15 UTC by scripts/export_site_data.py. Field definitions are in the codebook.