Here’s the difference three months can make:

In March, HCA Holdings Inc., a Nashville-based hospital company, debuted on Wall Street by raising $4.4 billion. Based on the high dollar volume of such IPO offerings in general, the Wall Street Journal breathlessly suggested that March was the highest month for stock issuance since 2000 and that Debt, Stock Issuance Shows Encouraging Signs.

Then, we get to June, and things aren’t busting out all over for stock issuance. Just ask hospital company Vanguard Health Systems Inc..

Pricing its shares at $18 each, the company was only able to raise $450 million — ten times less than HCA — rather than the hoped-for $511.6 million.

So what happened?

Threats of another recession aren’t helping anyone trying to debut an IPO on Wall Street. However, specifically related to hospital groups trying to make a strong showing: hospital bad debt is taking the wind out of a lot of sails. Back in March (remember how much younger, how much more innocent we were?), when everyone talked of recessions and bad economies as if they were things from the past in spats and bustles, hospital bad debt was manageable. “It’ll be fine seemed to be the common– well, “wisdom” seems the wrong term.

Now, we’re in June, and bad debt on top of a bad economy makes it tough for everyone out there.

It’s a Catch-22 for hospital companies. Many are rushing to market to shore up cash in the hopes of stemming the tide of a double-dip recession — however, it’s this rush to market that’s encouraging thoughts of a slow economy. And, in the case of Vanguard, a portfolio that wasn’t as matured as it needed to be in order to get the asking price it wanted.

A.J. Rice, an analyst with Susquehanna Financial Group, is quoted in a Reuters article on the state of Vanguard’s portfolio: “People are less optimistic about the (hospital) group right now than they were when HCA debuted. They are now focused on the possibility of a double-dip recession and hospital bad debt is directly tied to the economy. People just find Vanguard’s portfolio a little harder to get their arms around. HCA’s portfolio is easier to understand.”

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