Author here. This is Issue #6 of The American Healthcare Conundrum, a data-driven newsletter that analyzes CMS cost report data to find where U.S. healthcare dollars actually go.

For this issue I downloaded all 5,480 hospital cost reports from CMS HCRIS and extracted supply cost centers (medical supplies, implantable devices, drugs charged to patients). Key findings:

- Hospitals at the 90th percentile spend 3-7x more per discharge on supplies than the 10th percentile, even after adjusting for case mix - The gap persists within the same bed-size tier and teaching status - A 50-state ranking shows where the waste concentrates geographically - Conservative estimate: $28B/year in addressable waste

All analysis scripts and raw data pipelines are open source: https://github.com/rexrodeo/american-healthcare-conundrum/tr...

Previous issue on admin waste (Issue #5) hit the front page here 20 days ago. Happy to answer questions about methodology.