May 2020
EBITDA Margin by Region *
Hospitals across all regions of the country saw Operating EBITDA Margins fall both year-over-year and below budget for the second consecutive month.
Hospitals in the Midwest felt the greatest impact, with Operating EBITDA Margins down 4008 bps or 327% year-over-year and 4456 bps or 300% below budget expectations. Contributing factors included the fact that the region had the greatest volume decreases spanning Discharges, Adjusted Discharges, and Adjusted Patient Days, combined with the highest year-over-year increases in adjusted expenses across all measures.
Year-over-year results for the four other regions ranged from declines of about 1500 to 2840 bps or 101% to 174%.
% Change
Absolute Change
National Margin Observations
Hospitals nationwide felt the first full month of COVID-19’s impacts on operations in April, with brutal results. Steep volume and revenue declines and stagnant expenses drove record-poor margin performance. The median hospital Operating Margin plummeted to –29% and median Operating Earnings Before Interest, Taxes, Depreciation, and Amortization (EBITDA) Margin fell to ­–19%, as represented by Kaufman Hall’s indices. That is about a 120% reduction for both measures from March to April.

Operating EBITDA Margins fell nearly 2800 bps or 174% compared to the same period last year and more than 1150 bps or 118% compared to March, while Operating Margins fell 3025 bps or 282% year-over-year and nearly 1350 bps or 120% compared to March. Both metrics fell massively below hospitals’ budgets for the month, down 2700 bps or 191% for Operating EBITDA Margin, and down more than 3000 bps or 326% for Operating Margin. The results come after a challenging March, when hospitals first saw the pandemic’s affects drive across-the-board volume declines. While those trends primarily hit the last two weeks of March, they continued throughout the full month of April. Unable to resume non-urgent cases in April, many hospitals continued to delay non-COVID related care, causing year-over-year volume declines more than double those seen the month before.
Unless noted, figures are actuals and medians expressed as percentage change
Budget Variance
Month Over Month
Year Over Year
Year Over Year Distributions
(Click to enlarge)
Operating EBITDA Margin
Operating Margin
Unless noted, figures are actuals and medians expressed in basis points
Margin % Change
Margin Absolute Change
Budget Variance
Month Over Month
Year Over Year
Year Over Year Distributions
(Click to enlarge)
Operating EBITDA Margin
Operating Margin
*Note: The Kaufman Hall Hospital Operating Margin and Operating EBITDA Margin Indices are comprised of the national median of our dataset adjusted for allocations from corporate, physician, and other entities to the hospitals.
EBITDA Margin by Bed Size
Operating EBITDA Margins fell significantly both year-over-year and to budget across all bed-size cohorts for the second month in a row. Larger hospitals with 300-499 beds saw the greatest relative declines, down 230% year-over-year and 227% to budget, due to having among the steepest volume declines and relatively high expenses across most measures compared to other bed-size cohorts.
Hospitals of 26-99 beds experienced the greatest real declines in Operating EBITDA Margins of 3380 bps relative to last year. The nation’s the largest hospitals with 500 beds or more saw the least real decrease of 1520 bps or 147% compared with April 2019.
% Change
Absolute Change
©2020 Kaufman, Hall & Associates, LLC
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