JFMH has thus far benefitted from better Medicare and Medicaid reimbursement due to its status as a rural SCH provider, equating to approximately $725,000 in fiscal 2012.
The Stable Outlook is supported by Fitch's expectation that JFMH will continue to benefit from its market position and alignment with BHC, producing consistent operating cash flow which support its capital needs and allow for balance sheet growth.
While the disproportionate share hospital (DSH) program is being phased out in Missouri, JFMH receives supplemental Medicare reimbursement as a low-volume Medicare Dependent Hospital, which should offset any DSH reductions going forward.
Additionally, Fitch expects JFMH to strengthen its balance sheet metrics over the medium term as the organization maintains solid operating cash flow against a minimal need for capital expenditures.
JFMH covenants to provide audited annual statements within 180 days of each fiscal year end and quarterly statements within 60 days of each quarter end to the Municipal Securities Rulemaking Board's EMMA system.
Further, as a rural provider, JFMH has a small active physician base of 11, relying heavily on its top 10 providers to generate approximately 65% of its admissions, in addition to 28 courtesy and 41 consulting staff to provide specialty support.
Additionally, Fitch expects JFMH to strengthen its balance sheet metrics over the short to medium term as the organization maintains solid operating cash flow against a minimal need for capital expenditures.