US Not-for-Profit Healthcare Outlook
The outlook remains negative for 2022 as expense growth, driven by nursing shortages and increased labor costs, will outpace revenue gains
- Operating cash flow will decline by 2%-9%
- Staffing shortages will be the main driver of higher expenses
- Choppy recovery in patient volumes will limit revenue growth
- Liquidity will decline as Medicare advances are repaid
- Legislative and regulatory activity will continue to add risk
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SpeakersNaomi Richman Senior Vice President, US Public Finance Moody's Ratings
Kendra Smith Managing Director, US Public Finance Moody's Investors Service
Matthew Cahill, CFA Assistant Vice President - Analyst, US Public Finance Moody's Investors Service
Brad Spielman Vice President – Senior Credit Officer, US Public Finance Moody’s Investors Service
Nansis Hayek Analyst, US Public Finance Moody’s Investors Service
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Naomi Richman is a Senior Vice President in Moody's US Public Finance Group. Naomi manages the Surveillance team and Data and Analytics team. She is also responsible for contributing to state and local government analytical initiatives, research and methodologies. Naomi was previously a Managing Director in US Public Finance and Chief Credit Officer for global public sector ratings. Naomi has over 35 years of experience in credit analysis at Moody's, covering state and local governments, housing, higher education, financial guarantors, and global sovereigns.
Prior to joining Moody's, Naomi spent four years with the New York City Department of Finance. Naomi holds an MPP from Harvard University and an AB from Bryn Mawr College.
Kendra Smith is the Managing Director responsible for several teams in Moody's Public Finance Group including Healthcare, Global Higher Education, Not-For-Profits,US Housing, and Municipal Supported Products. For several years prior, Kendra served as the Managing Director in Moody’s Corporate Finance Group leading the High Yield Team, which covered over 30 industries, and also the Retail, Apparel, Restaurants,Gaming and Lodging Team covering the full ratings spectrum.At Moody’s for approximately 20 years, Kendra has served as a Vice President and Senior Analyst in the Corporate Finance Group covering a myriad of industries serving as both a lead analyst and a Ratings Chairperson. Over the years at Moody’s, Kendra has authored Special Comments on topics such as refunding risk and needs for nonfinancial US Corporates and rating methodologies.Prior to her tenure at Moody’s, Kendra received formal credit training at The Chase Manhattan Bank and then worked in global corporate finance for several years in commercial banking.At Moody’s, Kendra serves on the Diversity Council (CEO, ex-officio); is the senior advisor to the Black Inclusion Group; a presenter and participant in various Employee Resource Group events. Kendra is also a founding member, and past co-chair, of the Women’s Employee Resource Group.Kendra is a graduate of Harvard University with an A.M. degree in Russian Studies. She also participated in the Harvard Business School Executive Education Program. She received a B.A. degree in Foreign Affairs from the University of Virginia.
Matthew Cahill is an Analyst in the Healthcare Ratings Group. He is a lead analyst for ratings of not-for-profit hospitals and healthcare systems in Florida, Georgia, Illinois, Maryland, Missouri, Ohio, and Texas, as well as several other states. Prior to joining the Healthcare Ratings Team, Matthew held multiple Financial Planning and Analysis roles, both within and outside the organization. Matthew received his B.S in Finance from Villanova University and earned the Chartered Financial Analyst Designation in 2019. Matthew is based out of the Moody’s New York Office.
Brad is a Vice President – Senior Credit Officer based out of Moody’s San Francisco public finance office. As a senior member of the Healthcare ratings team, Brad covers a variety of institutions throughout the country, focusing geographically on the western United States. His areas of expertise include derivative products, variable rate financings, liquidity issues, and debt securitization structures. Brad joined Moody’s in 2006.
Prior to joining Moody’s, Brad worked as an investment banker with Goldman Sachs & Co. serving not-for-profit healthcare clients, universities, and other notfor-profit organizations. Prior to working on Wall Street, Brad worked in the field of international economic development in South East Asia.
Brad holds an M.B.A. from the Kellogg Graduate School of Management, with majors in finance and not-forprofit management, and a B.A. from the University of California, Berkeley.
Nansis Hayek joined Moody’s in 2016 and is a lead analyst for the Moody’s Healthcare Ratings group. She covers ratings of not-for-profit hospitals and healthcare systems in Alabama, California, Louisiana, Ohio, and Virginia, as well as several other states.
Prior to joining the Healthcare Ratings Team, Nansis held multiple operations roles, both within and outside the organization. Nansis holds a B.S. in Neuroscience from the College of William and Mary and earned the Chartered Financial Analyst designation in 2019.