Despite reporting a $466 million operating loss (-2.4% margin) for the nine months ending March 31, 2025, Ascension saw a significant improvement in its liquidity position, bolstered by the collection of accounts receivable that were temporarily elevated due to the prior fiscal year’s cybersecurity incidents. In a financial report published May 16, the St. Louis-based health system said its “balance sheet and liquidity levels remain strong.”
Eight things to know:
1. Ascension recently recouped about $1 billion in advance payments from Medicare and certain commercial payers related to disruptions from the May 2024 ransomware attack that affected the health system as well as the February 2024 Change Healthcare cyberattack.
2. As of March 31, 2025, Ascension’s net unrestricted cash and investments totaled $15.3 billion, comprising about 39% of the system’s total assets. This increase in liquidity is largely attributed to the collection of outstanding receivables that had been affected by the cybersecurity disruptions in the previous fiscal year. Days cash on hand rose to 218 days, marking an increase of 24 days since June 30, 2024.
3. However, other cash flow factors, including payments of accounts payable, accrued liabilities and capital spending, partially offset these gains. Ascension has implemented a strategic approach to maintain short-term liquidity facilities of up to $3 billion, ensuring robust financial stability amid ongoing recovery efforts.
4. To further bolster its liquidity, Ascension maintains access to a $1 billion syndicated line of credit committed through Nov. 18, 2027. While the system drew on this line during fiscal 2025 to support liquidity needs, it was undrawn as of March 31, 2025. Additionally, in August 2024, Ascension established a $500 million line of credit with a one-year term, which also remained undrawn at the close of the fiscal third quarter.
5. Ascension is also leveraging a $1 billion taxable commercial paper program, receiving $992 million during the fiscal second quarter ending Dec. 31, 2024, to repay outstanding balances on credit lines and bank loans. By the end of quarter ending March 31, 2025, the system said it reduced its commercial paper obligations by nearly $650 million, leaving $345 million in outstanding commercial paper.
6. Beginning in the third quarter of fiscal 2024 through the first quarter of fiscal 2025, Ascension received about $1 billion in advance payments from Medicare and other commercial payers to mitigate the cash flow disruptions caused by the cybersecurity incidents. These payments were fully recouped by Dec. 31, 2024, aligning with program terms and conditions.
7. Net days in accounts receivable was 57.5 as of March 31, 2025 — a decrease of nearly 21 days from the end of fiscal 2024. However, this figure remains slightly elevated compared to the pre-cyberattack period, which averaged 47 days. Ascension continues to make progress in clearing the backlog of claims that accumulated due to billing and payment delays resulting from the cyberincidents.
8. While the cyberattack-related challenges have affected Ascension’s financial position, the system said its disciplined approach to liquidity management, debt reduction and cash collections has contributed to notable improvements. Leadership said continued focus on financial stability and operational resilience will be critical in maintaining the system’s capacity to provide patient care while addressing ongoing financial pressures.
