Emergency Department Labor Costs Climb in Early 2023, According to Latest Syntellis Performance Solutions Report

First glimpse at 2023 healthcare expense data indicates another challenging year for the healthcare industry

CHICAGO - March 9, 2023 - Syntellis Performance Solutionsthe leading provider of enterprise performance management software, data, and intelligence solutions, today released its monthly Syntellis Performance Trends-Healthcare report which reveals ongoing high expenses for the nation’s hospitals — including rapidly rising emergency department labor costs — that show no signs of abating in 2023.

Emergency department (ED) labor costs are on the rise, climbing 50% over the past three years and reaching $186 per visit in January, according to the report which draws data from more than 1,300 hospitals and 135,000 physicians. This trend provides just one example of the long-term effects of inflation, labor shortages, and other economic challenges that continue to strain U.S. healthcare providers in 2023 following a very difficult year in 2022.

“Our data from the first month of 2023 indicates this will be another challenging year for the healthcare industry,” said Steve Wasson, Executive Vice President and General Manager for Data and Intelligence Solutions at Syntellis. “High labor costs are the new normal for the nation’s hospitals, as illustrated by escalating labor expenses in emergency departments nationwide. Ongoing labor shortages have only exacerbated long-running staffing issues in EDs, driving up hourly rates for nurses and other ED labor costs.”

Healthcare Market Analysis


The median national ED labor expense per visit rose in January 2023, up 49.9% compared to January 2020, before the pandemic. By geographic region, hospitals in 13 states defined as the Western region had both the highest median ED labor expense per visit compared to other regions at $260 in January and the greatest regional increase from January 2020 at 52.4%. Over the past four years, the median labor expense per ED visit for hospitals nationwide ranged from a low of $117 in May 2019 to a high of $230 during the Omicron surge in February 2022.

Hourly wages paid to registered nurses (RNs) represent a significant share of overall ED labor costs. Median ED hourly rates for RNs nationwide — including both employed and contract nurses — rose to $42.24 in January 2023, up 19% from January 2020. EDs in the West had the highest median RN hourly rate at $45.84 in January.

High Overall Hospital Expenses Persist

Looking at overall expenses, hospitals and health systems began the year with a 2% year-over-year increase in total expense and a 4.8% year-over-year jump in total non-labor expense, driven in part by sizable inflation over the past 12 months. Total labor expense rose just 0.6% in January compared to January 2022, when labor expenses peaked due to staffing shortages and a spike in contract labor costs amid the Omicron surge.

Even with the expense increases, hospital operating margins rose year-over-year in January for the first time since December 2021. The median change in hospital operating margin increased 3.7 percentage points compared to January 2022, when hospital margins dropped under the pressures of the Omicron surge. Compared to December 2022, however, the median January 2023 change in operating margin was down -2.2 percentage points, reflecting ongoing financial challenges for hospitals nationwide as they work to maintain operations amid high expenses.

About the Data

The Syntellis Performance Trends report — issued monthly — uses data from Syntellis’ Axiom™ Comparative Analytics, which offers access to near real-time data drawn from more than 135,000 physicians from over 10,000 practices and 139 specialty categories, and from 500+ unique departments across more than 1,300 hospitals. Powered by Syntellis IQ, Axiom Comparative Analytics also provides data and comparisons specific to a single organization for visibility into how their market is evolving.

About Syntellis

Syntellis Performance Solutions provides innovative enterprise performance management software, data, and intelligence solutions for healthcare organizations. Its solutions include enterprise planning, cost and decision support, and financial and clinical analytics to elevate organization performance and transform vision into reality. More than 2,800 organizations and 450,000 users rely on Axiom, Connected Analytics, and Stratasan software. With an HFMA Peer Review designation for nearly a decade and No. 1 rankings from Black Book Research multiple years, running, Syntellis helps healthcare providers acquire insights, accelerate decisions, and advance their business plans. For more information, please visit www.syntellis.com.

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Press Contact:
Cam Granstra
Syntellis Performance Solutions