The fallacy of financial heuristics

In turbulent times, the financial policies and decisions about cash and debt make or break hospitals' financial condition. Decisions about whether to continue saving cash or reduce debt burdens are probably the most vital policy decision for the hospital CFO. Unfortunately, my research shows that most administrators are relying on judgment, or best-guess heuristics to address these policy issues. This article explores one of the most common heuristics in health finance-ratios gauging debt and cash on hand. The subject is explored through the research and analysis of over 40 hospitals in a very competitive marketplace-the boroughs of New York City. Analyses of financial strength, through various statistical models, were conducted to explore the linkages between traditional heuristics and long-term economic results. Data were collected for 30 operational and financial indicators. Findings suggest that organizations require different cash-debt positions based on their overall financial health, and that a one-number heuristic does not fit all. Extremely financially constrained hospitals (those approaching bankruptcy conditions) should be building free cash flow and minimizing debt service, while financially secure hospitals need to minimize cash on hand while reducing debt. If all hospitals continue to try to meet an arbitrary days of cash heuristic, this simplification could cripple an organization. A much more effective metric requires each organization to model decisions more comprehensively.