Xinis saw his compensation package jump 307.8 percent to $3.5 million, $2.8 million of which was a required distribution of vested retirement funds from a plan he begin contributing to in 2003, the hospital said in a statement. Xinis has served as CEO for 26 years and plans to retire in the next 18 months, the hospital said. His base salary in fiscal 2012 was $309,557.

Peterson, who oversees six hospitals, earned a $3.5 million compensation package. Peterson's 86.5 percent pay increase largely reflected pension benefits he'd earned during 40 years at Hopkins. His annual base salary increased about $49,500 to $1.1 million in fiscal 2012.

Chrencik, whose system has 12 hospitals, earned about $2.3 million. Chrencik's total pay grew 23.4 percent. Mercy's Mullen saw his pay rise 24 percent to $1.6 million for the fiscal year ending in 2012.

The one CEO earning more than $1 million who saw his compensation fall was Edward D. Miller, who retired in June 2012 as CEO of Johns Hopkins Medicine and dean of the university's medical school. His reported pay dropped to just over $1 million in fiscal 2012 from nearly $2.3 million the prior year, when he took a one-time retirement payout.

In May 2012, the hospitals complained to the state cost review commission about financial pressures, pushing for higher rates. The commission lowered hospital rates for inpatients by 1 percent but raised the rates for outpatient services by 2.59 percent, giving hospitals an overall increase of 0.3 percent.

During the debate last year, Chrencik warned that hospitals would need to make up the lost revenue somehow. "There is a lot of pressure on hospitals to come up with ways to reduce costs," said Chrencik, who declined to be interviewed for this article.

"We are now cutting muscle," Coyle worried at the time.

The hospital association, a nonprofit that also must report top pay packages to the IRS, reported that Coyle made $715,441 in the fiscal year ending in 2012. That's 9 percent more than she made the prior year.

Coyle said that, like hospital CEOs, her compensation is determined through a transparent process by a board of trustees. She said her pay is comparable to that of people in similar positions around the country and that her job is also multi-faceted with duties that include advocacy work, data and research, public policy analysis and member relations.

Former state Sen. George W. Della Jr. has advocated for more public awareness of hospital executive pay. The Baltimore City Democrat introduced legislation in 2008 that passed the Maryland General Assembly requiring the state to make hospital IRS filings more accessible to the public.

"Everybody is being asked to tighten their belt, and I don't know why they think they are immune to doing this," Della said. "I am very cynical when I talk about this. They are overpaid."

But hospital officials point out that executive pay makes up but a small portion of a hospital's overall finances. Johns Hopkins Medicine, for instance, expects to generate more than $6.5 billion in 2013 revenue and employs more than 41,000 people. Peterson's compensation is 0.05 percent of that revenue.

A recent analysis by Modern Healthcare of tax year 2011 shows that Maryland hospital executives make less than those at some of the country's top-paying hospitals. The publication found that the median total compensation for the 25 highest-paid CEOs of health systems was $3.8 million. The median compensation in Maryland was $744,532 in fiscal year 2012.

Pay not the problem

Dr. Stephen F. Jencks, who serves on the board of the cost review commission, said that some hospital CEOs make a "chunk of money" but that their pay is not what's driving health care costs higher. He said executives should be judged by whether they are running cost-efficient organizations.

"You can cut salaries in half, and it wouldn't really make a lot of difference to the cost of health care," said Jencks, who is also a health care safety and quality control consultant.

Steve Ports, deputy director of policy and operations at the commission, said the body "generally does not delve into these salaries as it defers to hospital management to manage effectively and efficiently."

He said the commission, in setting rates, provides hospitals with sufficient revenue.

At the University of Maryland Medical System, officials said executives won't get raises in the fiscal year that began last month because of the financial pressures facing hospitals.

"No senior leader at UMMS will be seeing an increase in compensation no matter how successful they are in steering their organizations through some of the roughest waters and most change health care has ever faced," said Mary Lynn Carver, a spokeswoman for the system.