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Responses to Kaufman Hall’s 2023 “State of Healthcare Performance Improvement” report indicate ongoing concern regarding covenant challenges in 2024. Organizations need to understand the causes of covenant misses and near misses and build a durable financial plan for the future.

Hospitals and health systems are seeing some signs of stabilization in 2023 following an extremely difficult year in 2022. Workforce-related challenges persist, however, keeping costs high and contributing to issues with patient access to care.

Balance sheet strength has buffered consumers and businesses from some of the restrictive shock of higher rates. With a relatively brittle revenue model in healthcare, the focus becomes whether, when, and how to restructure operations as balance sheets are spent down.

After years of monetary tingle, a more restrictive stance from the Federal Reserve is creating a chill. A sustained higher interest rate environment may require finance teams to rethink external capital formation strategies.

Fitch Ratings recently downgraded the United States’ long-term rating. Healthcare confronts a different manifestation of the same pressures confronting the U.S., and the lesson for leaders is that governance and planning systems matter.

For the Federal Reserve, a soft landing means we arrive at the 2% inflation target without a recession. For healthcare, a soft landing is operating and investment entity recovery that stabilizes credit positioning and facilitates capital formation.

Kaufman Hall hosted its 2023 Summer Rating Agency Update on July 12, featuring Eva Bogaty, Associate Managing Director at Moody’s Investors Service, Suzie Desai, Senior Director at S&P...

In the event of a covenant breach, management typically must hire an independent consultant to identify areas for financial and operational improvement. Find out what a consultant call-in does and does not entail, as well as considerations for timing and implementation.

The challenges facing health system leaders today are so diverse, interconnected, and relentless that an incremental management approach won’t work. The best response is grounded in simultaneous and tightly integrated efforts across multiple areas of focus.

Issuance of tax-exempt debt is one of the most affordable ways for institutions to finance large capital projects. The affordability of debt is partly contingent on an institution’s credit rating, and unrestricted financial reserves are a significant component of that rating.

The maintenance of financial reserves is critical in rating committee during difficult times. Management teams that have outlined a credible plan to create financial durability and have built liquidity are best positioned for today’s harsh environment.

Current Funding Environment IU Health (Aa2/AA/AA), AdventHealth (Aa2/NR/AA), Banner Health (NR/AA-/AA-), and Arkansas Children’s Hospital (A1/AA-/NR) came to market this week with...