Safety-net hospitals care for a unique, vulnerable patient population. Hoehn et al examined 12 638 166 patients undergoing a major procedure. For all 9 procedures examined in 231 hospitals, patients at hospitals with high safety-net burden were most likely to be young, to be black, to be of the lowest socioeconomic status, and to have the highest severity of illness and the highest cost for surgical care. They found that high safety-net burden correlated with increased surgical costs that were independent of patient factors. Medicare Hospital Compare data indicated that these centers also had slower emergency department throughput, suggesting inferior staffing or systems.