The changing healthcare environment has put pressure on healthcare organizations to deliver top-quality care while keeping costs under control. Superior operational and financial performance can be measured by high margins and low costs. But there are significant operational indicators that differ between high- and low-performing hospitals, depending on whether performance is defined by expense or by margin. Often, hospitals with the lowest costs are considered the most successful. But low-cost hospitals do not necessarily behave the same way as hospitals with healthy margins. Low-cost hospitals can include both efficient hospitals and hospitals that are in dire financial circumstances that have forced them to even eliminate expenses necessary for their long-term fiscal health.