The Moody's report also found that:
- Median growth rate of inpatient admissions remained flat in FY2011 at 0.1% growth, following a 0.4% decline in FY2010 and zero growth in FY2009.
- Growth in governmental payers continues as Medicaid now represents 13% of gross revenues, up from 12.4% in FY2010. Medicare grew to 43.7%, up from 43.4%. Median revenue from managed care, Blue Cross / Blue Shield, and other commercial payers declined for the third consecutive year.
- Although the median debt load at not-for-profit hospitals increased to $191.9 million in FY2011, up from $189.3 million in FY2010, the median rate of change for debt outstanding was a decline of 1.6%.
- Median days cash on hand was 165 days, up from 159.8 days in FY2010, and nearly approaching the FY2007 median of 172.8 days seen prior to the economic downturn and severe market losses.
Martin cautioned that the approximately 800not-for-profit hospitals reviewed by Moody's for bond rating purposes are only a fraction of the estimated 5,000 not-for-profit hospitals in the United States, and thus may not accurately reflect the overall health of the sector. "There are many out there that are struggling, and many of them we do not have readings on," she says. "There is a wide variation in operating performance within the portfolio we do maintain. While the median is up a little on some measures, there is a big disparity between those that tend to be the larger health systems in multiple regions or markets compared with some of the smaller standalone hospitals that are struggling now, and that is even before some of the negative effects of federal budget cuts and other Medicare pressures."
John Commins is a senior editor with HealthLeaders Media.