The financial outcome of the U.S. hospital revenue cycle, from the CMS Hospital Provider Cost Report (CMS-2552-10). Revenue realization = net patient revenue ÷ gross charges. Filter by region, state, ownership, size, and teaching status — every panel recomputes live. FY2023, valid cohort.
Hospitals bill high "sticker" charges; payers pay a negotiated fraction. The distribution below is wide because charge-setting varies enormously — the median hospital realizes about a third of charges, but each system dollar realizes less because large hospitals realize least.
net ÷ gross charges, per hospital. Dashed lines: hospital median & dollar-weighted.
Median realization across the cuts a hospital CFO benchmarks on. Bars reflect the current filter.
Realization is mostly a markup artifact: hospitals that bill higher above cost write off more. The honest scoreboard is operating margin — where the ownership story flips.
each point a hospital; higher markup → lower realization (it was never collectible).
net income from patient care ÷ net revenue. For-profits realize least but earn most.
OLS with robust standard errors, holding all traits constant (national model — not filtered). The raw ownership/rural/teaching gaps mostly dissolve; structure (Critical-Access, specialty, charge-setting) and public-payer mix dominate. Toggle to the operating-margin model to see the ownership story that realization hides.