PORTLAND — Oregon hospitals lost money in 2022, ending the year in the worst overall financial position in 30 years, according to the Oregon Association of Hospitals and Health Systems annual report.

In all, 37 community hospitals ended with a negative ledger balance, according to the report. Generally, expenses outpaced revenues in nine consecutive quarters with a combined loss of $382 million, according to the report.

Central Oregon’s four-hospital health system fared no better, according to an email from Matt Swafford, chief financial officer of St. Charles Health System.

“While our final, audited financial results for 2022 are not yet available to be shared publicly, we can say that St. Charles experienced a level of operating losses consistent with the operating losses experienced by other health systems in the state and nation,” said Swafford in an email. “We can’t sustain and reinvest in our facilities and services without a positive operating margin.”

For the first six months of 2022, St. Charles reported 48,639 patient days, compared to 46,529 in the same period of 2021. Patient days is the measurement of how long a patient stays in the hospital after being admitted

The health system ended its third quarter in September with a loss of $30.4 million, a 4% negative operating margin, according to financial documents.

Moody’s, a creditworthiness investment firm, gave the health system good revenue bond ratings, but revised its outlook to negative from stable because of continued operating challenges.

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“These challenges represent the enduring after effects of the COVID-19 pandemic and significant waves of hospitalizations due to the delta variant in the later part of 2021,” the hospital explained in its financial report for the six months ending June 30, 2022.

Statewide, health systems ended 2022 in the red by 2.8%, compared to a 4.1% operating margin in 2020, according to the report. The outlook may be just as bleak for 2023, with many of the health systems statewide unable to weather the financial problems that a possible recession pose, according to the report

“After two years of losses, hospitals are facing extraordinarily difficult choices,” said Becky Hultberg, Oregon Association of Hospital and Health Systems president and CEO in a prepared statement. “Organizations will struggle to remain sustainable in this type of environment.

“These record losses should create a sense of urgency for legislators to act. We can’t sit back and do nothing, waiting for things to improve.”

Rising labor costs were cited as the chief reason for the negative operating margin. Full-time labor costs rose 26% over pre-pandemic levels, according to the association. Other issues affecting hospital revenue included longer stays by patients because hospitals are unable to discharge them to other care facilities.

In addition, operating expenses rose 11% compared to 2021, but revenue from patients increased by 5.8%. The gap continued through the fourth quarter of 2022, according to the report.

“One of our top strategies to improving financial performance is focusing our efforts on retaining our highly qualified workforce, recruiting new permanent staff, and reducing our reliance on contract and travel labor,” Swafford said.

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Economists are predicting 2023 will also be a difficult year for hospitals, Hultberg said.