Fitch medians: 10 things to know

Improving hospital and health system operating margins in 2025 were among the findings in the latest Fitch Ratings medians.

Here are 10 insights from the Fitch Ratings’ 2026 medians (subscription required), based on audited 2025 data of its 222 rated organizations:

1. Median operating margins improved from 1.1% to 1.5%.
2. 67% of the rated portfolio had positive operating margins up from 50% in fiscal 2022.
3. Operating margins ranged from 34.4% to a low of -17.3%.
4. Days cash on hand was stable at 212 days versus 215 days in fiscal 2024.
5. Cash to debt improved to a record 188.0% from 169.2%.
6. Debt to capitalization declined to a historical low of 28.9%.
7. Personnel costs declined to 52.6% of total operating revenues from 53.5%.
8. Capital spending reached a 17-year high, with the median capex ratio surging to 142.7% of depreciation expense.
9. Below investment grade organizations’ operating margin worsened to -2.8% from 1.6%.
10. Year-over-year volumes generally have continued to increase, resulting in additional throughput issues.