Health system leaders use benchmarking as a way to determine how their organizations stack up against both local and regional peers.
Below are 67 financial benchmarks, including key ratios for health systems, as well as revenue and margin metrics, broken down by rating category.
Key balance sheet metrics, ratios:
Source: Fitch Ratings' "2021 Median Ratios: Not-for-Profit Hospitals and Healthcare Systems" report. It was released Aug. 3.
1. Cash on hand: 255 days
2. Accounts receivable: 44.6 days
3. Cushion ratio: 29x
4. Current liabilities: 95 days
5. Cash to debt: 169.9 percent
6. Cash to adjusted debt: 161.1 percent
7. Operating margin: 1.3 percent
8. Operating EBITDA margin: 6.7 percent
9. Excess margin: 3.1 percent
10. EBITDA margin: 8.5 percent
11. Net adjusted debt to adjusted EBITDA: -2.6 percent
12. Personnel costs as percent of total operating revenue: 55 percent
13. EBITDA debt service coverage: 3.9x
14. Operating EBITDA debt service coverage: 3.2x
15. Maximum annual debt service as percent of revenues: 2.2 percent
16. Debt to EBITDA ratio: 4.4x
17. Debt to capitalization: 35.2 percent
18. Average age of plant: 11.4 years
19. Capital expenditures as percent of depreciation expense: 110.1 percent
Margins, revenue financial benchmarks broken down by rating category:
Source: S&P Global Ratings "U.S. Not-For-Profit Health Care System Median Financial Ratios — 2019 vs. 2021" report." The report was released Aug. 30.
"AA+" rating
20. Net patient service revenue: $4.16 billion
21. Total operating revenue: $4.43 billion
22. Operating margin: 4.5 percent
23. Operating EBIDA margin: 11.3 percent
24. Excess margin: 5.5 percent
25. EBIDA margin: 12.2 percent
"AA" rating
26. Net patient service revenue: $3.98 billion
27. Total operating revenue: $4.95 billion
28. Operating margin: 3.2 percent
29. Operating EBIDA margin: 8.3 percent
30. Excess margin: 5.8 percent
31. EBIDA margin: 10.7 percent
"AA-" rating
32. Net patient service revenue: $3.08 billion
33. Total operating revenue: $3.41 billion
34. Operating margin: 1.9 percent
35. Operating EBIDA margin: 7.1 percent
36. Excess margin: 4.1 percent
37. EBIDA margin: 9.2 percent
"A+" rating
38. Net patient service revenue: $2.26 billion
39. Total operating revenue: $2.55 billion
40. Operating margin: 3 percent
41. Operating EBIDA margin: 7.1 percent
42. Excess margin: 5.5 percent
43. EBIDA margin: 10.9 percent
"A" rating
44. Net patient service revenue: $2.69 billion
45. Total operating revenue: $3.07 billion
46. Operating margin: 0.7 percent
47. Operating EBIDA margin: 6.6 percent
48. Excess margin: 5.5 percent
49. EBIDA margin: 2.3 percent
"A-" rating
50. Net patient service revenue: $2.08 billion
51. Total operating revenue: $2.69 billion
52. Operating margin: 0.6 percent
53. Operating EBIDA margin: 6.7 percent
54. Excess margin: 2.4 percent
55. EBIDA margin: 8 percent
"BBB+" rating
56. Net patient service revenue: $1.85 billion
57. Total operating revenue: $2.27 billion
58. Operating margin: -0.2 percent
59. Operating EBIDA margin: 5 percent
60. Excess margin: 0.5 percent
61. EBIDA margin: 6 percent
"BBB" rating
62. Net patient service revenue: $2.96 billion
63. Total operating revenue: $4.11 billion
64. Operating margin: -3.2 percent
65. Operating EBIDA margin: 1.6 percent
66. Excess margin: -2 percent
67. EBIDA margin: 2.8 percent