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Texas Hospitals

Texas hospitals are as diverse as the state’s geography. In 2013, Texas had 649 hospitals with 84,000 licensed beds. About 26 percent of Texas hospitals are located in rural areas. According to a December 2013 Texas Department of State Health Services report, Harris County (Houston) has the highest number of hospitals with 83, followed by Dallas County with 43, Tarrant County (Fort Worth) with 40 and Bexar County (San Antonio) with 38.

Ownership of Texas hospitals varies among government-owned, nonprofit and investor-owned facilities. In 2012, government- owned hospitals accounted for 20 percent of the hospitals in Texas, with nonprofit hospitals accounting for 29 percent and investor-owned facilities comprising 51 percent of all hospitals in the state.

Many hospitals offer a full range of acute-care services, while larger facilities often provide a higher level of care (tertiary) to more severely ill or injured patients. In addition, Texas has a number of specialty providers, including:

  • Long-term acute-care hospitals (for ventilator dependent patients and others with chronic conditions that require a higher level of care indefinitely);
  • Pediatric (children’s) hospitals;
  • Psychiatric (mental health) hospitals;
  • Rehabilitation hospitals (for those recovering from major surgeries, injuries or illnesses who require inpatient care as well as physical, occupational and/or speech therapy); and
  • Specialty hospitals (such as those that treat heart, cancer or bone problems).


Oversight of Hospitals

The Texas Department of State Health Services licenses hospitals in Texas. Hospitals must comply with the federal Medicare Conditions of Participation to receive payment for treating Medicare patients, and Texas licensure standards mirror Medicare’s requirements. The state requires inspections of hospitals at least once every three years (the term of the license), and will make unannounced visits to investigate complaints related to patient safety.

Most hospitals engage independent reviewing organizations to assess compliance with the Medicare Conditions of Participation and state requirements. These organizations conduct comprehensive reviews, assess compliance with all state and federal requirements, and identify areas for improvement and make recommendations. Hospitals that receive accreditation from one of these organizations to participate in Medicare are granted deemed status by the state.

All complaints are investigated by the Texas Department of State Health Services, and hospitals must report certain adverse events to their accrediting body, which conducts reviews and ensures appropriate follow-up actions are taken.

Special Designations

Hospitals that meet specific state requirements may become designated trauma centers (from Level I – the highest level of care – to Level IV – the lowest level of care to stabilize and transfer the patient). Texas also designates stroke centers, facilities with specific resources and specially trained staff to treat patients who are believed to have suffered a stroke. These designations require regular inspections, and continual compliance with state standards.

Hospitals whose nurse staffing comply with 14 core characteristics of nursing excellence may achieve status as a Magnet Recognition Program® organization. The program is administered by the American Nurses Credentialing Center.