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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 CityStateDefinitive IDTotal operating expensesExplore dataset
1Tisch HospitalNew YorkNY2843$7,808,637,443 Explore
2NewYork-Presbyterian Weill Cornell Medical CenterNew YorkNY541974$7,795,492,000 Explore
3Cleveland Clinic Main CampusClevelandOH3120$7,507,484,998 Explore
4Stanford Hospital - 300 Pasteur DrStanfordCA588$6,512,933,260 Explore
5Vanderbilt University Medical CenterNashvilleTN3742$6,305,974,522 Explore
6Memorial Sloan Kettering Cancer CenterNew YorkNY2846$5,754,582,348 Explore
7UCSF Helen Diller Medical Center at Parnassus HeightsSan FranciscoCA560$5,728,166,739 Explore
8Massachusetts General HospitalBostonMA1973$5,513,953,107 Explore
9AdventHealth Orlando (FKA Florida Hospital Orlando)OrlandoFL873$5,269,388,338 Explore
10IU Health Methodist HospitalIndianapolisIN1365$4,952,031,319 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 2024.

Which hospitals have the highest operating expense?

The top hospital by operating expense is non-profit Tisch Hospital. Part of NYU Langone Health, Tisch Hospital serves a large and densely populated area in New York City, leading to a high volume of patients and medical services provided. It offers a wide range of specialized medical services and advanced treatments, which can be more costly to provide. Additionally, as a major academic medical center, Tisch Hospital is heavily involved in medical research and education. These activities require substantial funding and contribute to higher operating expenses. Operating in New York City, where the cost of living and doing business is high, contributes to higher salaries for staff and higher costs for goods and services. Like the other top hospitals, Tisch Hospital tops other hospital expense lists such as accrued salary expense, operating room costs, and housekeeping expense.

In second place 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 third place by operating expense is Cleveland Clinic Main Campus. This hospital also tops the list of hospitals with the highest accrued salary expense. 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.

How does non-profit hospital status influence operating expenses?

The three top hospitals by operating expense listed above are all non-profit hospitals affiliated with major academic medical centers, which invest heavily in medical research and education. They are also located in urban areas. Urban hospitals, whether non-profit or for-profit, generally face higher costs related to staffing, real estate, and facilities maintenance. This is particularly true in cities like New York, where the cost of living is significantly higher. Non-profit hospitals’ focus on community service, research, and education can also contribute to their overall higher operating expenses compared to many for-profit hospitals.

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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Healthcare Insights are developed with healthcare commercial intelligence from the Definitive Healthcare platform. Want even more insights? Start a free trial now and get access to the latest healthcare commercial intelligence on hospitals, physicians, and other healthcare providers.