8 health systems with strong finances

https://www.beckershospitalreview.com/finance/8-health-systems-with-strong-finances-091620.html?utm_medium=email

Here are eight health systems with strong operational metrics and solid financial positions, according to reports from Fitch Ratings, Moody’s Investors Service and S&P Global Ratings.

1. Minneapolis-based Allina Health has an “AA-” rating and stable outlook with Fitch. The health system has a strong financial profile and is the acute care leader in the broad Twin Cities metro area, Fitch said. The credit rating agency said Allina’s proven ability to rebound quickly from operating challenges supports the stable outlook.

2. Children’s Healthcare of Atlanta has an “Aa2” rating and stable outlook with Moody’s. The system has strong operating margins and is the leading pediatric provider in the Atlanta area, Moody’s said. The credit rating agency expects Children’s Healthcare of Atlanta to continue to generate robust margins and maintain exceptional liquidity while undergoing a new campus expansion project.

3. La Crosse, Wis.-based Gundersen Health System has an “AA-” rating and stable outlook with Fitch. The health system has consistently strong operating performance, strong balance sheet metrics and a low debt burden, Fitch said. The credit rating agency said Gundersen’s rating continues to be supported by its leading market position and expanding operating platform.

4. Houston Methodist has an “AA” rating and stable outlook with S&P. The system, which comprises an academic medical center and six community hospitals, has a strong enterprise profile and a history of excellent margins and cash flow, S&P said. The credit rating agency said Houston Methodist is well positioned to withstand the pressures from COVID-19.

5. Indianapolis-based Indiana University Health has an “AA” rating and stable outlook with Fitch. The health system has a solid balance sheet and strong operating cash flow despite short-term pressure from the COVID-19 pandemic. The credit rating agency expects IU Health’s EBITDA margins will range between 12 percent and 14 percent annually when margins recover from the pandemic.

6. Broomfield, Colo.-based SCL Health has an “AA-” rating and stable outlook with Fitch and an “Aa3” rating and stable outlook with Moody’s. The system has a track record of exceptional operations, consistent improvement in unrestricted liquidity levels and significant financial flexibility, Fitch said. The credit rating agency said SCL Health is well positioned to manage the pressures of COVID-19, having built up cash reserves.

7. San Diego-based Scripps Health has an “AA” rating and stable outlook with Fitch and an “Aa3” rating and stable outlook with Moody’s. The health system has a strong balance sheet, strong operations and has maintained a low leverage position, Fitch said. The credit rating agency expects Scripps will continue generating operating levels that are consistent with historical trends following recovery from the pandemic.

8. San Diego-based Sharp HealthCare has an “Aa3” rating and stable outlook with Moody’s and an “AA” rating and stable outlook with S&P. The health system has a healthy financial profile, an excellent balance sheet, a solid business position and is the leading provider in a competitive service area, S&P said. The credit rating agency said the system’s financial performance has remained stable despite COVID-19 and the recession.

 

 

110 hospital benchmarks | 2020

https://www.beckershospitalreview.com/lists/110-hospital-benchmarks-2020.html?utm_medium=email

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Hospitals across the nation compete in a number of ways, including on quality of care and price, and many use benchmarking to determine the top priorities for improvement. The continuous benchmarking process allows hospital executives to see how their organizations stack up against regional competitors as well as national leaders.

Becker’s Hospital Review has collected benchmarks related to some of the most important day-to-day areas hospital executives oversee: quality, finance, staffing and utilization.

Finance

Key ratios

Source: Moody’s Investors Service, “Not-for-profit and public healthcare – US: Medians” report, September 2019. 

The medians are based on an analysis of audited fiscal 2018 financial statements for 284 freestanding hospitals, single-state health systems and multistate health systems, representing 79 percent of all Moody’s-rated healthcare entities. Children’s hospitals, hospitals for which five years of data are not available and certain specialty hospitals were not eligible for inclusion in the medians.

1. Maintained bed occupancy: 66.6 percent

2. Operating margin: 1.8 percent

3. Excess margin: 4.3 percent

4. Operating cash flow margin: 7.9 percent

5. Return on assets: 3.6 percent

6. Three-year operating revenue CAGR: 5.6 percent

7. Three-year operating expense CAGR: 6.4 percent

8. Cash on hand: 200.9 days

9. Annual operating revenue growth rate: 5.5 percent

10. Annual operating expense growth rate: 5.4 percent

11. Total debt-to-capitalization: 33.7 percent

12. Total debt-to-operating revenue: 33.3 percent

13. Current ratio: 1.9x

14. Cushion ratio: 21.6x

15. Annual debt service coverage: 4.7x

16. Maximum annual debt service coverage: 4.4x

17. Debt-to-cash flow: 3.1x

18. Capital spending ratio: 1.2x

19. Accounts receivable: 45.9 days

20. Average payment period: 61.4 days

21. Average age of plant: 11.7 years

Hospital margins by credit rating group

Source: S&P Global Ratings “U.S. Not-For-Profit Health Care System Median Financial Ratios — 2018 vs. 2017” report, September 2019.

AA+ rating

22. Operating margin: 5.5 percent

23. Operating EBIDA margin: 12 percent

24. Excess margin: 9.2 percent

25. EBIDA margin: 14.8 percent

AA rating

26. Operating margin: 4.4 percent

27. Operating EBIDA margin: 10.1 percent

28. Excess margin: 6.7 percent

29. EBIDA margin: 12.4 percent

AA- rating

30. Operating margin: 3.4 percent

31. Operating EBIDA margin: 9.5 percent

32. Excess margin: 4.0 percent

33. EBIDA margin: 10.4 percent 

A+ rating

34. Operating margin: 1.6 percent

35. Operating EBIDA margin: 7.4 percent

36. Excess margin: 3.3 percent

37. EBIDA margin: 10.1 percent 

A rating

38. Operating margin: 2.1 percent

39. Operating EBIDA margin: 7.6 percent

40. Excess margin: 3.3 percent

41. EBIDA margin: 8.6 percent

 A- rating

42. Operating margin: 1 percent

43. Operating EBIDA margin: 7.8 percent

44. Excess margin: 2.5 percent

45. EBIDA margin: 8.3 percent

Average adjusted expenses per inpatient day

Source: Kaiser State Health Facts, accessed in 2020 and based on 2018 data. 

Adjusted expenses per inpatient day include all operating and nonoperating expenses for registered U.S. community hospitals, defined as public, nonfederal, short-term general and other hospitals. The figures are an estimate of the expenses incurred in a day of inpatient care and have been adjusted higher to reflect an estimate of the volume of outpatient services.

46. Nonprofit hospitals: $2,653

47. For-profit hospitals: $2,093

48. State/local government hospitals: $2,260

Prescription drug spending

Source: NORC at the University of Chicago’s “Recent Trends in Hospital Drug Spending and Manufacturer Shortages” report, January 2019. Figures below are based on 2017 data.

49. Average prescription drug spending per adjusted admission at U.S. community hospitals: $555 

50. Average outpatient prescription drug spending per adjusted admission at U.S. community hospitals: $523

51. Average inpatient prescription drug spending per admission at U.S. community hospitals: $756

52. GPO hospital spending on Activase:  $210 million

53. GPO hospital spending on Remicade: $138 million

54. GPO hospital spending on Humira: $122 million

55. GPO hospital spending on Rituxan: $92 million

56. GPO hospital spending on Neulasta: $92 million

57. GPO hospital spending on Prolia: $85 million

58. GPO hospital spending on Harvoni: $83 million

59. GPO hospital spending on Procrit: $80 million

60: GPO hospital spending on Lexiscan: $64 million

61. GPO hospital spending on Enbrel: $60 million

Quality and process of care 

Source: Hospital Compare, HHS, Complications and Deaths-National Averages, May 2018, and Timely and Effective Care-National Averages, May 2018, the latest available data for these measures.

Hospital-acquired conditions

The following represent the average percentage of patients in the U.S. who experienced the conditions.

62. Collapsed lung due to medical treatment: 0.27 percent

63. A wound that splits open on the abdomen or pelvis after surgery: 0.95 percent

64. Accidental cuts and tears from medical treatment: 1.29 percent

65. Serious blood clots after surgery: 3.85 percent

66. Serious complications: 1 percent

67. Bloodstream infection after surgery: 5.09 percent

68. Postoperative respiratory failure rate: 7.35 percent

69. Pressure sores: 0.52 percent

70. Broken hip from a fall after surgery: 0.11 percent

71. Perioperative hemorrhage or hematoma rate: 2.53 percent

Death rates

72. Death rate for CABG surgery patients: 3.1 percent

73. Death rate for COPD patients: 8.5 percent

74. Death rate for pneumonia patients: 15.6 percent

75. Death rate for stroke patients: 13.8 percent

76. Death rate for heart attack patients: 12.9 percent

77. Death rate for heart failure patients: 11.5 percent

Outpatients with chest pain or possible heart attack

78. Median time to transfer to another facility for acute coronary intervention: 58 minutes

79. Median time before patient received an ECG: 7 minutes

Lower extremity joint replacement patients

80. Rate of complications for hip/knee replacement patients: 2.5 percent

Flu vaccination

81. Healthcare workers who received flu vaccination: 90 percent

Pregnancy and delivery care

82. Mothers whose deliveries were scheduled one to two weeks early when a scheduled delivery was not medically necessary: 2 percent

Emergency department care

83. Average time patient spent in ED after the physician decided to admit as an inpatient but before leaving the ED for the inpatient room: 103 minutes

84. Average time patient spent in the ED before being sent home: 141 minutes

85. Average time patient spent in the ED before being seen by a healthcare professional: 20 minutes

86. Percentage of patients who left the ED before being seen: 2 percent

Staffing

Source: American Hospital Association “Hospital Statistics” report, 2019 Edition.

Average full-time staff

87. Hospitals with six to 24 beds: 101

88. Hospitals with 25 to 49 beds: 176

89. Hospitals with 50 to 99 beds: 302

90. Hospitals with 100 to 199 beds: 683

91. Hospitals with 200 to 299 beds: 1,264

92. Hospitals with 300 to 399 beds: 1,789

93. Hospitals with 400 to 499 beds: 2,670

94. Hospitals with 500 or more beds: 5,341

Average part-time staff

95. Hospitals with six to 24 beds: 52

96. Hospitals with 25 to 49 beds: 84

97. Hospitals with 50 to 99 beds: 141

98. Hospitals with 100 to 199 beds: 286

99. Hospitals with 200 to 299 beds: 472

100. Hospitals with 300 to 399 beds: 604

101. Hospitals with 400 to 499 beds: 1,009

102. Hospitals with 500 or more beds: 1,468

Utilization 

Source: American Hospital Association “Hospital Statistics” report, 2019 Edition.

Average admissions per year

103. Hospitals with six to 24 beds: 408

104. Hospitals with 25 to 49 beds: 901

105. Hospitals with 50 to 99 beds: 2,097

106. Hospitals with 100 to 199 beds: 5,809

107. Hospitals with 200 to 299 beds: 11,241

108. Hospitals with 300 to 399 beds: 16,635

109. Hospitals with 400 to 499 beds: 20,801

110. Hospitals with 500 or more beds: 34,593