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Article History

Received: 27 April 2026

Accepted: 29 June 2026

First Online: 9 July 2026

Declarations

:

: Not applicable. This study used only publicly available, de-identified, facility-level federal cost-report data and did not involve human subjects.

: The author used a large language model (Claude, Anthropic) for model development, code generation for the HCRIS analysis, figure preparation, and editing. The author designed the study, directed and verified all analyses, confirmed all numerical results against the source data, and takes full responsibility for the content and integrity of the work. No AI system is listed as an author or cited as a source, consistent with ICMJE and COPE guidance on AI use.

: The authors declare no competing interests.