Chicago-based Rush System for Health has a strong financial profile despite ongoing labor issues and inflationary pressures, according to Fitch, which affirmed the system's "AA-" rating and stable outlook Feb. 13.
Rush includes several high-acuity services, is the "distinct market share lead of its local market," and its university operations report has strong enrollment demand and student quality, according to the report.
"The Stable Outlook considers Fitch's anticipation that notwithstanding the ongoing macro pressures, RUSH's operations will remain profitable over time, although recognize that metrics will likely be more modest in fiscal 2023. Capital-related ratios should remain strong in the forward-looking scenario analysis, including in a stress case," the report notes.
Key points in the report include:
1. Rush has a maximum annual debt service coverage of 1.20x and historical debt service coverage of 1.10x.
2. Rush has around 230 days cash on hand at the end of the 2022 fiscal year.
3. Nearly 24 percent of Rush's patients are Medicaid or self-pay.
4. Average operating margin has been 3 percent, and operating EBITDA margin has been 9.2 percent, from 2015 to 2022, excluding the 2020 fiscal year.
5. Rush had around $1 billion of debt and unrestricted liquidity was $1.8 billion for the 2022 fiscal year. The system reported 180 percent cash-to-adjusted debt.
6. Operating revenue for the 2022 fiscal year hit $3.2 billion.