The report showed a deepening K-shaped recovery at not-for-profit hospitals. Lower-rated hospitals saw their finances deteriorate, reversing years of modest progress. The report showed a widening gap between stronger and weaker providers. AA rated systems saw median operating margins improve to 2.8% in fiscal 2025, near pre-pandemic levels, while junk-rated hospitals saw the same metric fall to -2.8% from -1.6% the year prior. That concentration is the result of decades of consolidation in the sector and the attrition of weaker credits.