TY - JOUR T1 - Multicentre methodological study to create a publicly available score of hospital financial standing in the USA JF - BMJ Open JO - BMJ Open DO - 10.1136/bmjopen-2020-046500 VL - 11 IS - 7 SP - e046500 AU - Radoslav Zinoviev AU - Harlan M Krumholz AU - Richard Ciccarone AU - Rick Antle AU - Howard P Forman Y1 - 2021/07/01 UR - http://bmjopen.bmj.com/content/11/7/e046500.abstract N2 - Objectives To create a straightforward scoring procedure based on widely available, inexpensive financial data that provides an assessment of the financial health of a hospital.Design Methodological study.Setting Multicentre study.Participants All hospitals and health systems reporting the required financial metrics in the USA in 2017 were included for a total of 1075 participants.Interventions We examined a list of 232 hospital financial indicators and used existing models and financial literature to select 30 metrics that sufficiently describe hospital operations. In a set of hospital financial data from 2017, we used principal coordinate analysis to assess collinearity among variables and eliminated redundant variables. We isolated 10 unique variables, each assigned a weight equal to the share of its coefficient in a regression onto Moody’s Credit Rating, our predefined gold standard. The sum of weighted variables is a single composite score named the Yale Hospital Financial Score (YHFS).Primary outcome measures Ability to reproduce both financial trends from a ‘gold-standard’ metric and known associations with non-fiscal data.Results The validity of the YHFS was evaluated by: (1) cross-validating it with previously excluded data; (2) comparing it to existing models and (3) replicating known associations with non-fiscal data. Ten per cent of the initial dataset had been reserved for validation and was not used in creating the model; the YHFS predicts 96.7% of the variation in this reserved sample, demonstrating reproducibility. The YHFS predicts 90.5% and 88.8% of the variation in Moody’s and Standard and Poor’s bond ratings, respectively, supporting its validity. As expected, larger hospitals had higher YHFS scores whereas a greater share of Medicare discharges correlated with lower YHFS scores.Conclusions We created a reliable and publicly available composite score of hospital financial stability.Data are available in a public, open access repository. Hospital financial data for fiscal year 2017 was downloaded from the publicly available Centers for Medicare and Medicaid Services (CMS) Hospital Cost Reports (HCR) database. Hospital demographic data was downloaded from the CMS Hospital Compare database. ER -