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CHAPTER 17
Financial Condition Analysis
One of the most important characteristics of
a healthcare organization is its financial
condition. Does it have the financial capacity
to perform its mission? A provider’s financial
condition is of great importance to its
managers as well as to other stakeholders
such as investors, employees, and even the
communities served.
Copyright © 2012 by the Foundation of the American College of Healthcare Executives
2/15/12 Version
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Overview
 Financial condition analysis consists of
several techniques:
 Financial statement analysis focuses on the
information in a business’s financial statements
with the goal of assessing financial condition.
 Operating indicator analysis focuses on
operating data with the goal of explaining
financial performance.
 EVA analysis focuses on assessing overall
organizational (managerial) performance.
 To illustrate, consider the following data for
Riverside Memorial Hospital, all in
thousands of dollars.
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Income Statement
2011
2010
Net patient service revenue
Other revenue
Total revenue
Nursing services
Dietary services
General services
Administrative services
Employee health and welfare
Provision for uncollectibles
Provision for malpractice
Depreciation
Interest expense
Total expenses
Operating income
Nonoperating income
$108,600
3,644
$112,244
$ 58,285
5,424
13,198
11,427
10,250
3,328
1,320
4,130
1,542
$108,904
$ 3,340
5,232
$ 97,393
6,014
$103,407
$ 56,752
4,718
11,655
11,585
10,705
3,469
1,204
4,025
1,521
$105,634
($ 2,227)
4,622
Net income
$
8,572
$
2,395
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Balance Sheet: Assets
2011
2010
Cash and equivalents
Short-term investments
Accounts receivable
Inventories
Total current assets
Gross plant and equipment
Accumulated depreciation
Net plant and equipment
$
4,263
2,000
21,840
3,177
$ 31,280
$145,158
25,160
$119,998
$
5,095
0
20,738
2,982
$ 28,815
$140,865
21,030
$119,835
Total assets
$151,278
$148,650
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Balance Sheet: Liabilities and Equity
2011
2010
Accounts payable
Accrued expenses
Notes payable
Current portion of LT debt
Total current liabilities
Long-term debt
Capital lease obligations
Total LT liabilities
Net assets (equity)
$
4,707
5,650
825
2,150
$ 13,332
$ 28,750
1,832
$ 30,582
$107,364
$
Total claims
$151,278
$148,650
$
$
$
$
5,145
5,421
4,237
2,000
16,803
30,900
2,155
33,055
98,792
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2011 Statement of Cash Flows (Part 1)
Cash Flows from Operating Activities
Net income
Adjustments:
Depreciation
Increase in accounts receivable
Increase in inventories
Decrease in accounts payable
Increase in accrued expenses
Net cash flow from operations
Cash Flows from Investing Activities
Investment in plant and equipment
Investment in short-term securities
Net cash flow from investing
$ 8,572
4,130
(1,102)
(195)
(438)
229
$11,196
($ 4,293)
(2,000)
($ 6,293)
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2011 Statement of Cash Flows (Part 2)
Cash Flows from Financing Activities
Repayment of notes payable
Repayment of long-term debt
Capital lease principal repayment
Change in current portion of LT debt
Net cash flow from financing
(3,412)
(2,150)
(323)
150
($ 5,735)
Net increase (decrease) in cash
($
832)
Beginning cash and equivalents
$ 5,095
Ending cash and securities
$ 4,263
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Statement of Cash Flows Analysis
Operations and nonoperating income
provided about $11 million in net cash
flow in 2011.
Riverside invested $4.3 million in new
fixed assets and $2.0 million in shortterm securities.
Riverside repaid about $5.5 million in
short-term and long-term debt
financing.
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Financial Ratio Analysis
Ratio analysis is a technique used in
financial condition analysis (and in
other analyses).
Financial ratio analysis combines
values from the financial statements
to create single numbers that:
Have easily interpretable economic
significance.
Facilitate comparisons.
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Interpreting Ratios
A single ratio value has little meaning.
For example, a total (profit) margin of
7.3%.
Therefore, two techniques are used to
help interpret “the numbers”.
Trend analysis
Comparative analysis
Both techniques will be illustrated in
the examples to follow.
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Ratio Analysis Categories
Profitability: Is the business
generating sufficient profits?
Liquidity: Can the business meet its
cash obligations?
Debt management: Is the business
using the right mix of debt and equity?
Asset management: Does the business
have the right amount of assets for its
patient volume?
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Profitability Ratios (2011)
Net income
Total margin =
Total revenue
$8,572
=
= 0.073 = 7.3%.
$117,476
Operating income
Operating margin =
Operating revenue
$3,340
=
= 0.030 = 3.0%.
$112,244
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Profitability Ratios (2011) (Cont.)
Net income
ROA =
Total assets
$8,572
=
= 0.057 = 5.7%.
$151,278
Net income
ROE =
Total equity
$8,572
=
= 0.080 = 8.0%.
$107,364
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Profitability Ratios (2011) (Cont.)
TM
OM
ROA
ROE
2011
7.3%
3.0%
5.7%
8.0%
2010
2.2%
2.8%
1.6%
2.4%
Ind.
5.0%
3.6%
4.8%
8.4%
What is your interpretation?
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Liquidity Ratios (2011)
CA $31,280
CR = CL = $13,332 = 2.3 times.
Cash + Marketable securities
DCOH =
Cash expenses / 365
$4,263 + $2,000
=
=
22.5
days.
$277.93
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Liquidity Ratios (2011) (Cont.)
2011
2010
Ind.
CR
2.3x
1.7x
2.0x
DCOH
22.5
18.9
30.6
What is your interpretation?
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Debt Management Ratios (2011)
Total debt
Debt ratio =
Total assets
$43,814
=
= 0.290 = 29.0%.
$151,278
EBIT
TIE ratio =
Interest expense
$10,114
=
= 6.6 times.
$1,542
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Debt Management Ratios (2011) (Cont.)
2011
2010
Ind.
DR
29.0% 33.5% 43.3%
TIE
6.6x
2.6x
4.0x
What is your interpretation?
Note that the debt ratio is a capitalization ratio,
while the TIE ratio is a coverage ratio. There
are many variations of these ratios.
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Asset Management Ratios (2011)
Total revenue
FA turnover =
Net fixed assets
$117,476
=
= 0.98 times.
$119,998
Total revenue
TA turnover =
Total assets
$117,476
=
= 0.78 times.
$151,278
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Net patient accounts rec.
ACP =
Net patient service rev. / 365
$21,840
=
= 73.4 days.
$108,600 / 365
FATO
TATO
ACP
2011
0.98
0.78
73.4
2010
0.90
0.73
77.7
Ind.
2.2
0.97
64.0
What is your interpretation?
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Du Pont Analysis
Du Pont analysis summarizes and
highlights a business’s financial
condition.
It is based on the fact that ROE can
be expressed as the product of
three ratios:
Total margin (expense control)
Total asset turnover (asset utilization)
Equity multiplier (debt utilization)
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Total x
TA
x Equity = ROE
margin turnover multiplier
NI
Rev
x
Rev
TA
x
TA
TE
= ROE .
2010: 2.22% x 0.73 x 1.50 = 2.43%.
2011: 7.30% x 0.78 x 1.41 = 7.98%.
Ind: 5.00% x 0.97 x 1.73 = 8.39%.
What does it all mean?
Note that the Du Pont equation could be
recast to focus on operating margin.
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Other Analytical Techniques
In addition to ratio and Du Pont analyses,
there are two other techniques commonly
used in financial statement analysis.
 In common size analysis, all income statement
items and balance sheet accounts are
expressed as percentages of revenue or total
assets, which facilitates comparisons when
there are scale differences.
 In percentage change analysis, year-to-year
changes in income statement items and
balance sheet accounts are expressed as
percentage changes, which helps identify items
that are “out of control.”
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Operating Indicator Analysis
Operating indicator analysis involves
the use of operating data (as opposed
to financial statement data) to try to
explain a business’s financial
condition.
If mangers understand the underlying
operating conditions, they can better
deal with financial problem areas.
Here, we will present only two
examples.
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Net Price Per Discharge (2011)
Net inpatient revenue
NPPD =
Total discharges
$93,740,000
=
= $5,128.
18,281
Industry average = $5,510.
How is this value interpreted?
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Occupancy Percentage (Rate) (2011)
Inpatient days
OR =
Number of staffed beds x 365
95,061
=
= 0.579 = 57.9%.
450 x 365
Industry average = 44.9%.
How is this value interpreted?
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Limitations of Financial
Performance Analysis
Comparison with industry averages
is difficult if the business operates
many different divisions.
“Average” performance is not
necessarily good performance.
Seasonal factors can distort ratios.
Inflation effects can distort financial
statement data.
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Limitations (Cont.)
Different operating and accounting
practices can distort comparisons.
Sometimes, it is hard to tell if any
given ratio is “good” or “bad.”
It is often difficult to tell whether a
business is, on balance, in a strong
or weak financial position:
Multiple discriminant analysis
Financial flexibility index
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Economic Value Added (EVA)
Economic Value Added (EVA) focuses
on the ability of the business to cover
all costs, including economic (return
on capital) costs.
It is often used to measure managerial
performance, even in not-for-profit
businesses.
 Should not-for-profit managers be
required to generate economic
returns?
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EVA (Cont.)
Dollar earnings
EVA =
to investors
=
NOPAT
= (EBIT x [1 - T])
Dollar cost of
capital employed
-
Dollar capital costs
-
(Total assets x CCC).
NOPAT = net operating profit after taxes.
CCC = corporate cost of capital.
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EVA (Cont.)
 EVA takes into account the total dollar
cost of capital, which includes the cost
of equity.
 EVA is not a cash flow measure. It
attempts to measure the true economic
benefits and costs of an entire business,
division, or project.
 In practice, relatively complex adjustments must be applied to accounting
data to obtain EVA.
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EVA Example ($000s)
Here is Riverside’s 2011 EVA w/ CCC = 10%:
NOPAT = ($8,572 + $1,542) x (1 - 0.0)
= $10,114.
Dollar capital costs
= $151,278 x 0.10
= $15,128.
EVA = $10,114 - $15,128 = -$5,014.
How is this value interpreted?
Does ROE give similar information?
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Benchmarking
The process of comparing a business’s performance
data to selected standards is called benchmarking.
Here are Riverside’s total margin benchmarks:
2011
National/GFB
Ind. top quartile
St. Anthony's
Riverside
Industry median
Pennant Healthcare
Ind. lower quartile
Woodbridge Memorial
2010
9.8%
8.4
8.0
7.3
5.0
4.8
1.8
0.5
National/GFB
9.6%
Ind. top quartile
8.0
St. Anthony’s
7.9
Pennant Healthcare
5.0
Industry median
4.7
Riverside
2.2
Ind. lower quartile 2.1
Woodbridge Memorial (1.3)
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Key Performance Indicators
Ratio analysis results are often
presented in a dashboard format
that focuses on Key Performance
Indicators (KPIs).
The idea here is to keep the data
clutter to the minimum necessary
to adequately monitor the financial
and operating condition of the
business.
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Discussion Items
What are some areas of financial and
operating performance that should be
routinely monitored? In other words, if you
were creating a “dashboard” to track
Riverside’s performance, what areas would
be covered by the Key Performance
Indicators (KPIs)?
Should different dashboards be created for
different purposes? For example, one for
daily operations monitoring and one for
annual presentation to the board.
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Conclusion
This concludes our discussion of
Chapter 17 (Financial Condition
Analysis).
Although not all concepts were
discussed in class, you are
responsible for all of the material in
the text.
 Do you have any questions?