Healthcare Insights

Top hospitals by total operating expense

As you can imagine, running a hospital is expensive, regardless of whether the hospital is a small rural facility or is central to a big city.

Operating expenses for hospitals, as defined by the Health Resource and Services Administration (HRSA), are expenses incurred as part of the delivery of care. Operating expense examples include salaries and benefits of staff and providers, employed and contracted physicians, medical supplies, and interest and depreciation on buildings and equipment used in care delivery.

What costs hospitals the most money?

A hospital’s operating cost breakdown may differ among facilities. However, the list of operating expenses generally includes:

Of these operating costs, the three biggest expenses for hospitals are salaries, medical and surgical supply costs, and fringe benefits.

Understanding what drives hospital expenses and which hospitals cost the most to operate can help map the financial landscape of the American healthcare system.

Using the Definitive Healthcare HospitalView product, we have listed the top 25 hospitals in the U.S. with the highest total operating expenses. The data is from the Medicare Cost Report and is according to the most recent 12-month interval tracked in our database.

Top hospitals by total operating expense

RankHospital nameCityStateDefinitive IDTotal operating expensesExplore dataset
1NewYork-Presbyterian Weill Cornell Medical CenterNew YorkNY541974$7,795,492,000 Explore
2Cleveland Clinic Main CampusClevelandOH3120$7,507,484,998 Explore
3Tisch HospitalNew YorkNY2843$6,904,030,927 Explore
4Stanford Hospital - 300 Pasteur DrStanfordCA588$6,005,442,455 Explore
5Vanderbilt University Medical CenterNashvilleTN3742$5,797,013,606 Explore
6Memorial Sloan Kettering Cancer CenterNew YorkNY2846$5,754,582,348 Explore
7AdventHealth Orlando (FKA Florida Hospital Orlando)OrlandoFL873$5,269,388,338 Explore
8UCSF Helen Diller Medical Center at Parnassus HeightsSan FranciscoCA560$5,093,328,738 Explore
9Massachusetts General HospitalBostonMA1973$5,077,757,817 Explore
10IU Health Methodist HospitalIndianapolisIN1365$4,952,031,319 Explore
11Montefiore Hospital - Moses CampusBronxNY273024$4,639,100,000 Explore
12University of Texas MD Anderson Cancer CenterHoustonTX4017$4,502,386,871 Explore
13University HospitalAnn ArborMI2096$4,242,054,807 Explore
14Yale New Haven HospitalNew HavenCT731$3,986,198,759 Explore
15Cedars-Sinai Medical CenterLos AngelesCA430$3,943,176,746 Explore
16Long Island Jewish Medical CenterNew Hyde ParkNY2828$3,775,481,449 Explore
17Brigham and Womens HospitalBostonMA1969$3,709,762,000 Explore
18The Mount Sinai Hospital (AKA Mount Sinai Medical Center)New YorkNY2837$3,587,645,469 Explore
19Hospital of the University of PennsylvaniaPhiladelphiaPA3571$3,470,521,066 Explore
20North Shore University HospitalManhassetNY2824$3,437,814,264 Explore
21Texas Childrens HospitalHoustonTX6386$3,242,137,982 Explore
22The University of Kansas HospitalKansas CityKS1631$3,200,203,960 Explore
23Atrium Health Carolinas Medical CenterCharlotteNC3003$3,194,704,019 Explore
24University of California Davis Medical Center (AKA UC Davis Medical Center)SacramentoCA515$2,971,027,553 Explore
25Childrens Hospital of Philadelphia (AKA CHOP)PhiladelphiaPA3567$2,961,639,476 Explore

Fig 1. Data is from the Definitive Healthcare HospitalView product. Data is from the Medicare Cost Report and is displayed according to the most recent 12-month interval tracked in our database. Accessed July 2023.

Which hospitals have the highest operating expense?

The top hospital in the U.S. by operating expense is NewYork-Presbyterian Weill Cornell Medical Center. Unsurprisingly, this New York City-based hospital also tops the list of hospitals with the highest accrued salary, housekeeping, and dietary expenses, as well as the lists of hospitals with the highest operating room and medical supply costs. Additionally, New York-Presbyterian Weill Cornell Medical Center is one of the top U.S. hospitals by patient discharges. The high patient volume, as well as high individual expenses, may explain why this hospital tops the list of hospitals with the highest operating expenses.

In second place by operating expense is Cleveland Clinic Main Campus. This hospital also tops the list of hospitals with the highest accrued salary expense (second place). Additionally, it makes the list of hospitals with the highest bed count and highest number of operating rooms. Being able to accommodate so many patients and procedures may be one of the major factors landing this hospital on the list of top hospitals by operating expense.

The third top hospital by operating expense is Tisch Hospital. Like the other top hospitals, Tisch Hospital  tops other hospital expense lists such as accrued salary expense (fifth place), operating room costs (seventh place), and housekeeping expense (second place).

How does non-profit hospital status influence operating expenses?

The three top hospitals by operating expense listed above are all non-profit hospitals. Compared to for-profit healthcare organizations, non-profit healthcare organizations tend to be located in higher-income areas and therefore serve higher-income populations. In these wealthier areas, like New York City where two of the top facilities are located, hospitals are likely to have higher costs for expenses such as salaries, benefits, and facility construction and upkeep, which would all drive higher total operating expenses.

Additionally, these top three hospitals rank as the top three non-profit hospitals by net patient revenue (NPR). Based on the high NPR for these hospitals, it is reasonable to conclude that they see a higher volume of patients, requiring that they have more providers, staff, equipment, and facility space.

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