Stories
What US hospitals build, how full they are, what their space costs and whether the promises in their filings come true. Every number comes from public filings and Medicare cost reports; each story says how.
National
- United States · Space Hospitals added 19% more floor space from 2011 to 2024, and 3% more beds In 2,155 general hospitals that reported every year, the building around each bed grew from 2,392 square feet to 2,756. Clinics, emergency rooms and intensive care grew fastest. Discharges barely moved; staff grew 19%.
- United States · Beds Fewer hospitals, fuller beds: general hospitals filled 68% of their beds in 2024, up from 63% in 2019 315 fewer general hospitals filed Medicare cost reports than in 2011, with 22,017 fewer beds, while more patients stayed overnight. 481 hospitals were at least 80% full on an average night, up from 253.
- Rural hospitals Rural critical access hospitals discharge 31% fewer patients than in 2011, from a fifth more building per bed On an average night in 2024, the typical critical access hospital had 6 patients for its 25 beds. Its clinic space grew 71%.
- United States · Closures One in seven hospitals that filed Medicare cost reports in 2011 had stopped by 2022. For most, no later report says what happened Of 974 hospitals that stopped filing, 191 carried on under a new number, 91 of them as critical access hospitals. For 690, no later record shows a successor. Meanwhile 700 new hospitals began filing, 418 of them psychiatric or rehabilitation hospitals.
States
- States · Space A hospital bed in Wisconsin comes with 2.8 times the building of one in Nevada. Patient rooms are 3% of the difference General hospitals' building per bed in fiscal year 2024: 4,279 square feet in Wisconsin, 1,554 in Nevada. The gap holds among hospitals of the same size. It is offices, clinics, treatment rooms and support space.
- States · Regulation Hospitals in certificate of need states built about as much as hospitals elsewhere Certificate of need laws exist to restrain hospital building. From 2011 to 2024, general hospitals in the 18 jurisdictions whose law reviews capital spending grew their floor space 18%; in the 19 states without one, 19%.
Filings
- Forecast audit · Beds Of 23 hospital projects that promised more beds, 10 showed the full gain in Medicare reports 3 years later Filings in 9 states promised a bed total; cost reports, followed year by year, show which hospitals got there. 7 of the 23 had added no beds at all, and the two counts rarely agree.
- Filings · Replacement hospitals Replacement hospitals usually get more floor space and fewer beds than the buildings they retire In filings that describe both buildings, the new hospital was larger in 8 of 11 and had fewer beds in 10 of 15. A small sample, from 94 replacement filings in the Delgam database.
- Environmental review Eight in ten full environmental reviews of California hospital projects found harm that could not be avoided. The projects were approved anyway Delgam read the State Clearinghouse record for 251 California hospital projects since 2000: a full review took a median 13 months from notice to decision.
- Forecast audit The typical Illinois hospital uses its operating rooms 756 hours a year, half the 1,500 the state approves them for Only 24 of 139 reach the standard. In North Carolina, the list of approved operating rooms that have not opened grew from 49 in 2016 to 103 in 2023.
Benchmarks
- Benchmark · Operating cost A hospital spends about $530 a year on each square foot. The building itself is 3 cents of every dollar Medicare cost reports from 2,859 general hospitals show what a square foot costs to run, department by department. At the median, a hospital spends the cost of a new building every 25 months.
- Benchmark · Construction cost Hospital building plans filed since 2023 budget a median $1,112 a square foot, nearly double the 2014–2016 median 359 projects from 32 states, each budget over its gross area, in the dollars of its filing year.
- Benchmark 7 of 18 Illinois surgery projects plan more space per operating room than the state standard Across Medicare cost reports, the typical hospital has 2,306 square feet of building for every bed. Illinois filings show how much surgery space new projects plan against the state's standard.