Today, Moody's Investors Service issued a report detailing the different financial metrics of its rated children's hospitals for fiscal year 2011. Moody's rates the $7 billion of debt for 22 pediatric hospitals, most of which have credit ratings of "A" or higher. Per historical norms, children's hospitals continued to post solid balance sheet metrics in fiscal year 2011, especially compared with adult hospitals.
Median days cash on hand for children's hospitals was 316 in FY 2011, which almost doubled the median of 165 for adult hospitals in 2011. Children's hospitals also posted high medians in cash-to-debt ratio (192 percent), operating margin (6.1 percent) and operating cash flow margin (12.9 percent).
However, the revenue growth rate between children's hospitals and adult hospitals is shrinking. In FY 2007, the median growth rate for children's hospitals surpassed adult hospitals by almost 3 percentage points. Last year, the gap narrowed to only a 0.7 percent difference.
The biggest reasons for these revenue challenges included reductions in Medicaid payments, the impact of healthcare reform to disproportionate share funds, declines in commercial payor reimbursements and a growing scrutiny of prices.
"Like adult hospitals, children's hospitals will face cuts in disproportionate share funding," Lisa Martin, senior vice president at Moody's and lead author of the report, said in a news release. "However, children's hospitals will not benefit as much as adult hospitals from more insured patients that health reform should bring because a larger proportion of children are already insured through Medicaid or the Children's Health Insurance Program."
Here are 100 statistics on children's hospital medians from Moody's report. To give a longer time span of comparison, medians are given from FY 2007 and FY 2011.
Note: The following median data are based on audited financial statements for 22 hospitals within Moody's database. All data is as of Oct. 8, 2012. To compare pediatric hospitals and health systems to adult, acute-care hospitals and health systems, click here.
Utilization
|
Category |
FY 2007 |
FY 2011 |
|
Maintained beds |
265 |
309 |
|
Admissions |
13,132 |
13,265 |
|
Patient days |
75,163 |
79,689 |
|
Average length of stay |
6 days |
6.1 days |
|
Maintained bed occupancy |
77.6 percent |
72.7 percent |
|
Emergency room visits |
61,766 |
64,627 |
|
Outpatient visits |
209,345 |
314,820 |
|
Outpatient surgeries |
10,055 |
11,746 |
Financial performance
|
Category |
FY 2007 |
FY 2011 |
|
Net patient revenues |
$394.4 million |
$555.3 million |
|
Total operating revenue |
$479.4 million |
$675.2 million |
|
Interest expense |
$6.9 million |
$7.8 million |
|
Depreciation and amortization expense |
$26.2 million |
$32.1 million |
|
Total operating expenses |
$474.6 million |
$668 million |
|
Income from operations |
$27 million |
$45.4 million |
|
Excess of revenue over expenses |
$46.9 million |
$75.6 million |
|
Net revenue available for debt service |
$71.3 million |
$125.6 million |
|
Operating cash flow |
$51.1 million |
$94.7 million |
|
Debt service |
$10.7 million |
$16.4 million |
|
Additions to property, plan & equipment |
$45 million |
$60.9 million |
Balance sheet
|
Category |
FY 2007 |
FY 2011 |
|
Unrestricted cash and investments |
$352.2 million |
$457.2 million |
|
Restricted cash and investments |
$166.3 million |
$149.7 million |
|
Net fixed assets |
$292 million |
$490.5 million |
|
Total debt |
$184.3 million |
$301.3 million |
|
Unrestricted net assets |
$534.3 million |
$707.9 million |
|
Total comprehensive debt |
$184.5 million |
$367.8 million |
Key ratios
|
Category |
FY 2007 |
FY 2011 |
|
Operating margin |
5 percent |
6.1 percent |
|
Excess margin |
8.9 percent |
10.5 percent |
|
Operating cash flow margin |
11.1 percent |
12.9 percent |
|
Return on assets |
5.9 percent |
6.2 percent |
|
Annual debt service coverage |
8.4x |
8.1x |
|
Maximum annual debt service coverage |
6.3x |
6.7x |
|
Current ratio |
2.2x |
1.7x |
|
Cash on hand |
275.6 days |
315.5 days |
|
Cushion ratio |
30x |
28.9x |
|
Cash-to-debt ratio |
185.3 percent |
191.6 percent |
|
Accounts receivable |
52 days |
47.2 days |
|
Average payment period |
67.3 days |
74 days |
|
Debt-to-capitalization ratio |
26.8 percent |
27.7 percent |
|
Debt-to-cash flow |
2.7x |
2.3x |
|
Bad debt as a percent of net patient revenue |
2.9 percent |
2 percent |
|
Average age of plant |
8.7 years |
7.6 years |
|
Capital spending ratio |
2.5x |
1.3x |
|
Debt-to-total revenue |
45.8 percent |
41.2 percent |
|
Three-year operating revenue CAGR |
9.9 percent |
6.7 percent |
|
Cash-to-total comprehensive debt |
178.2 percent |
146.7 percent |
Patient revenue sources by gross revenue
|
Category |
FY 2007 |
FY 2011 |
|
Medicaid |
48 percent |
53 percent |
|
Blue Cross |
19.1 percent |
16.6 percent |
|
Commercial |
2.2 percent |
1.9 percent |
|
Managed care |
33.6 percent |
29.6 percent |
|
Self-pay and other |
6 percent |
4 percent |
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