The difficult financial climate has not only hurt hospitals' ability to borrow, but it's also caused health systems to rethink their banking relationships and forced them to deal with new banking partners.
The partnership between hospital chief financial officers and bankers historically has been cordial and built on trust, but as capital funds have dried up and the financial sector has seen much upheaval, hospital CFOs are facing a situation with fewer available dollars and new bankers and institutions.
Mike Rowe is senior vice president of finance and CFO of Sisters of Charity of Leavenworth Health System, a Lenexa, KS-based system with nine facilities in four states, with 2,054 staffed beds. He notes that the hospital banking community is much smaller than a year ago. Many bankers who built strong relationships with health systems are no longer in the business, which has caused hospitals to forge ahead with new people and banks.
One example of the changing dynamic is at Crouse Hospital, a 439-staffed bed facility in Syracuse, NY. Kimberly Boynton, CFO, says her hospital uses a regional banking institution that has cut back on the hospital's credit line.
"When things are good, the relationship just kind of coasts along and you don't have the kind of scrutiny that goes on now," says Boynton.
Investment banker Jeffrey Cohen, managing director at Jefferies & Company, Inc., in Albany, NY, says commercial banks are asking his hospital clients to reevaluate their capital structure.
"Hospitals have to wait it out. The hospital industry—like other industries—got spoiled when credit was so cheap and credit was so easy to come by," he says.
So how are hospitals handling the situation? Here are three ways they are surviving the current capital crisis.
Banks are looking across all of their letters of credit with hospitals and shrinking lines of credit. Hospitals, in turn, are looking at how to cut costs and whether to move their business to other banks.
The result is that banks are now offering broader relationships with hospitals.
"They are looking for an opportunity such as your primary cash management functions, to do lockbox services, to do patient receivables financing. They don't just want to write you a loan," says Rowe.
Hospitals have responded to the changes by looking to other banks.
"We are broadening our relationships with banks in general, simply because one of the big lessons you learned from this economic recession is you can't afford having too much of a dependency on one bank or one banking institution or one vender to provide you with everything you are going to need—no matter how strong you are," says Rowe.