Revenue Can't Fix Bad Metrics; Only Strategy Can

Indeed, many hospitals and health systems that saw upgrades on their debt were able to realize a stronger financial position through expense management strategies and balance sheet improvement, showing that those strategies may still have some room to run.

Yet Moody's expects similarly bleak results in terms of upgrades vs. downgrades in 2013. Clearly, this trend is not your friend.

It's difficult to make correlations between individual systems and the macro environment. Your hospital or health system may be doing well. You know all the stuff going on at your organizations better than analysts at Moody's do, after all, and if you're comfortable, maybe this news is concerning to a degree, but it's not going to change your long-term strategy.

So why does it matter?

To make a deeply flawed, but helpful analogy, your state may be running a budget surplus, but that doesn't mean that unsustainable federal deficits won't have a detrimental effect on you, eventually. Similarly, the view that healthcare is at best a low-growth business is reinforced when downgrades outpace upgrades.

There are positives. Low interest rates have allowed many to refinance and even take on additional debt to fund the deep structural changes that are needed to transform business and clinical practices away from the current fee-for-service reimbursement environment.