Cartoon – Latest Round of Budget Cuts
Monthly Archives: September 2022
Cartoon – Why Bother to Budget?
5 health systems hit with credit downgrades
Credit rating downgrades for several health systems were tied to capital expenditures and cash flow issues in recent months.
The following five health system credit rating downgrades occurred since July:
1. Tower Health (West Reading, Pa.) — lowered in September from “B+” to “CCC+” (Fitch Ratings)
“The three-notch downgrade to ‘CCC+’ reflects Tower’s ongoing significant financial losses in fiscal 2022 … with an operating loss of $195 million, or a negative 1.8% operating EBITDA margin,” Fitch said. “Tower Health’s unrestricted liquidity position is also rapidly weakening, falling to just $341.5 million (when excluding $27.9 million in Medicare Advance funding), which results in a very weak cash-to-debt ratio of just 19%.”
2. ProMedica (Toledo, Ohio) — lowered in September from “Baa3” to “Ba2” (Moody’s Investors Service)
“The downgrade to ‘Ba2’ reflects material cashflow losses this year, which exceeded Moody’s prior expectations, a significant drain of liquidity even with one-time cash infusions, and narrowing headroom to quarterly bank covenants,” Moody’s said. “In addition to severe losses in the nursing home and assisted living business, the provider business will need to reverse the year-to-date cashflow loss following solid margins in fiscal 2021. Both operations will continue to be challenged by high labor costs and related capacity constraints.”
3. Premier Health (Dayton, Ohio) — lowered in September from “A” to “A-” (Fitch Ratings)
“The downgrade of [Premier Health’s] revenue bond rating and IDR to ‘A-‘ is driven by multiple years of weak operating cash flow generation … and coronavirus pandemic-related operating challenges that delayed the realization of improvements expected at Fitch’s last review,” the credit rating agency said.
4. MultiCare (Tacoma, Wash.) — lowered in August from “Aa3” to “A1” (Moody’s Investors Service)
“The downgrade to A1 and the revision of the outlook to negative reflect a number of pressures which weaken MultiCare’s credit profile, including: an unexpected 24% increase in debt; a material decline in liquidity; very significant operating losses through the first six months of fiscal 2022; a pending acquisition which would initially be dilutive to credit metrics; and an ambitious capital plan which will entail sizable capital expenditures over the next five years,” Moody’s said. “Operations are expected to improve through the second half of fiscal 2022, but nevertheless full year results will remain weak, providing at best thin headroom to MultiCare’s debt service coverage covenant.”
5. Memorial Health System (Marietta, Ohio) — lowered in July from “BB-” to “B+” (Fitch Ratings)
“The downgrade of the IDR to ‘B+’ reflects MHS’s weak net leverage profile through Fitch’s forward-looking scenario analysis given stated growth and spending objectives,” Fitch said. “While operating performance has stabilized over the past three years … and reflects cost efficiency strategies and pandemic relief funding, improved cash flow funded higher levels of capital spending in fiscals 2020 and 2021.”
Hoag hospital receives $106M, largest ever donation
Newport Beach, Calif.-based Hoag Memorial Hospital Presbyterian has received a $106 million donation from the Audrey Steele Burnand estate, The Orange County Reporter reported Sept. 14.
It is the largest donation in the hospital’s history. The estate has donated $134 million to the hospital throughout the years.
The donation will be used for innovation, growth and expansion of the hospital as well as research and improved patient care, according to the report.
“The Steele family’s decades of generosity, continued by the Audrey Steele Burnand estate, have benefited the Orange County community in immeasurable ways,” Flynn Andrizzi, PhD, president of the Hoag Hospital Foundation, said in a statement shared with the publication. “Through this remarkable gift, they once again have demonstrated their compassion for everyone who needs outstanding medical care.”
Hoag broke off a 10-year partnership with Renton, Wash.-based Providence earlier this year to place more focus on the community it serves, according to the publication.
Massachusetts nurse pleads guilty in $100M fraud scheme
A Massachusetts nurse has pleaded guilty in federal court in Boston in connection with a $100 million healthcare fraud scheme, the Justice Department announced Sept. 13.
Winnie Waruru, a licensed practical nurse, pleaded guilty Sept. 8 to conspiracy to commit healthcare fraud, healthcare fraud – aiding and abetting, conspiracy to pay and receive kickbacks, making false statements and making a false statement in a healthcare matter.
Ms. Waruru was employed by Chelmsford, Mass.-based Arbor Homecare Service. She was charged in February 2021 alongside Faith Newton, who was part owner and operator of the home healthcare company from 2013 to 2017. Ms. Newton has pleaded not guilty, according to the Justice Department.
Prosecutors allege that the duo used Arbor to defraud MassHealth and Medicare of at least $100 million by committing fraud and paying kickbacks to get referrals. Specifically, prosecutors allege that Arbor billed payers for home health services that were never provided or weren’t medically necessary. Arbor billed MassHealth for Waruru’s skilled nursing visits, many of which she did not perform, according to the Justice Department.
Ms. Waruru is slated to be sentenced in January.
Ohio hospital to lay off 978 employees
St. Vincent Charity Medical Center in Cleveland will lay off 978 workers when it ends many services in November, according to a notice filed with state regulators.
The hospital, part of Sisters of Charity Health System, is ending inpatient care and most other services in November. After the transition, the facility will offer outpatient behavioral health, urgent care and primary care.
The health system attributed the changes to several factors, including the rise in demand for outpatient care, declining inpatient volume and shifts in the healthcare industry over the last 10 years that have made it challenging to continue operating St. Vincent Charity Medical Center as an acute care hospital.
The changes will result in 978 employees being laid off on Nov. 15, according to the notice filed with state regulators.
“This extremely difficult decision is being made with deep respect and gratitude for our caregivers, and we regret the direct impact this decision will have on those individuals,” reads the layoff notice from the hospital. “Unfortunately, the COVID pandemic, the changing health care landscape, and declining inpatient volumes have led to significant financial challenges that became impossible to overcome.”
The layoffs will affect 446 full-time workers, 264 part-time employees and 268 workers who are called into work as needed, a spokesperson for Sisters of Charity Health System told Becker’s Hospital Review.
Ascension reports $1.8B annual loss
St. Louis-based Ascension reported higher expenses in the 12 months ended June 30 and closed out the year with a loss, according to recently released financial documents.
The 144-hospital system reported operating revenue of $27.98 billion in the year ended June 30, up from $27.24 billion a year earlier.
Ascension’s operating expenses climbed to $28.77 billion in the 12 months ended June 30, up from $26.69 billion last year. The increase was attributed to several factors, including higher salaries, wages and benefits due to staffing challenges and increased use of contract and premium labor.
Ascension ended the most recent fiscal year with an operating loss of $879.2 million, compared to an operating income of $676.3 million a year earlier.
After factoring in nonoperating items, Ascension reported a net loss of $1.8 billion for the 12 months ended June 30. A year earlier, the health system posted net income of $5.7 billion.
Ascension is facing many of the same financial pressures as other health systems across the U.S. More than half of hospitals — 53 percent — are projected to have negative margins for the rest of the year.
Thought of the Day: Life is a Team Game
The end of the pandemic “is in sight”
Some good news: The world had its lowest COVID death toll last week since March 2020, the World Health Organization said.
- The end of the pandemic “is in sight,” said WHO Director-General Tedros Adhanom Ghebreyesus.
- But “we are not there yet.”
Zoom out: Last summer’s Delta variant demolished the first sense of relief after vaccines.
- “If we don’t take this opportunity now, Tedros said while calling for more vaccinations and testing, “we run the risk of more variants, more deaths, more disruption and more uncertainty.”
The bottom line: The next surge could come by surprise.
- Johns Hopkins University is scaling back its COVID metrics due to a slowdown in local data reporting, the university confirmed to Axios.
Cartoon – Doubting the Analytics Team
HENRY KOTULA 