Dear Readers,

Welcome to a special supplement of the National Hospital Flash Report: Year-In-Review. In this issue, we explore 2018 as a whole as compared to 2017. Overall, 2018 was better than 2017 with medians demonstrating profitability improvements, though pockets of strong and weak performance continue to exist.

Labor expenses and efficiency appeared to have been a primary focus in 2018, and while largely successful, the rate of improvement has declined demonstrating a potential plateau of improvement is being reached.

We have responded to requests from our readers to begin including trend graphs, and you will find them throughout this report. Trend graphs present the year-over-year percent change on a monthly basis, which indicate the magnitude and direction of rate-of-change. When reading and interpreting these graphs, note that a horizontal line represents a constant rate-of-change, with that rate being graphed on the Y-axis. Upward sloping lines indicate rates-of-change that are becoming more positive and downward sloping lines indicating rates-of-change that are becoming more negative. By graphing the percent change in this manner, you should be able to compare your organizations more readily with the national trends.

For this issue we sample - hundreds of times over - our hospital data in the same composition of bed size and regional cohorts as exist for all hospitals in the United States. This ensures that the data presented herein is reflective of the industry as a whole, and that each region and bed-size are reflective of the overall composition. We hope you enjoy reading and find the 2018 Year-In-Review as interesting and insightful as we did.

Thanks, Jim Blake