As hospitals around the country experience reduced patient revenues and profit margins, one type of provider is doing uniquely OK: children’s hospitals, which have stronger liquidity than their peers, according to a new report from ratings agency Fitch.

Summary of the Fitch report via Fierce Healthcare:

In a new report on children’s hospital medians based on 22 providers’ 2020 financials, the ratings agency acknowledged that COVID-19 has had an “undeniable” negative impact on these facilities.

Median total operating revenue for the children’s hospitals reviewed by Fitch was flat year over year at $1.33 billion for 2020. Much of that stability was tied to an estimated $1.1 billion in provider relief funds received by the 22 hospitals, the agency noted.

Profitability, on the other hand, dipped substantially for the children’s hospitals. The median operating margin fell from 7% to 3.8% year over year, the agency wrote, while earnings before interest, taxes, depreciation and amortization (EBITDA) dropped from 12.6% to 9.8% year over year.


But even as volume reductions took a bite out of their operations, Fitch’s overall strong estimation of the children’s hospital sector was fueled by “all-time high” liquidity.

Days cash on hand increased 13% from 350.4 days to 396.1 days thanks to a blend of taxable debt issuances bolstering unrestricted cash and investments, stimulus funding, expense management efforts and investment market returns, the group wrote.

Meanwhile, children’s hospitals took advantage of low interest rates to refund prior debt issuances and issue new debt, leading median cast-to-adjusted debt to fall year over year from 240.9% to 229.6%. The hospitals still continued capital expenditure but at a reduced rate Fitch said it expects to rebound in 2021.

“Capital spending was lower in the past fiscal year, but this is expected to be a temporary reaction to conserve liquidity given the unknown risks of the pandemic during the March/April 2020 timeframe,” Park said.