I'm inclined to believe those analysts hailing the end of the nation's economic nightmare. During the recent NFL playoff game between Chicago and Green Bay here in the Windy City, a souvenir vendor told me he sold out his entire stock of headgear depicting either a snarling grizzly bear or a slab of cheddar cheese. Even considering the ferocity of this rivalry, that's a lot of hard cash disposed of on really dopey stuff.

There are other hopeful and arguably more reliable signs of recovery. Unemployment appears to be leveling off, though for many Americans the prospect of ever returning to a job corresponding to their expertise and previous income remains next to nil. The foreclosure crisis seems to be easing in many regions, retail is showing signs of life and manufacturing output is inching up. And, of course, Wall Street payouts have returned to heights the Hubble telescope wouldn't be able to bring into focus for the rest of us earthlings.

Even hospitals saw their bottom lines improve last year, though in the median the improvement was very modest and certainly not across the board.

While it's nice that margins are more robust for some, a whole lot of pressure is coming to bear on every hospital's budget that a little, or even a lot, of cash on hand won't be able to meet. Hospitals are going to have to employ or otherwise better integrate with physicians and other providers, invest in electronic health records and other information technology, and make sure their facilities have the capacity to handle the demands for better technology, quality and safety, and patient and employee satisfaction. All that's on top of increasing pressure from public and private payers to, as the cliché goes, bend the cost curve. Just a couple of weeks ago, Andrew Dreyfuss, the CEO of Blue Cross Blue Shield of Massachusetts, was no doubt speaking for all his colleagues in the insurance sector when he was quoted in The Boston Globe as saying, "Fee-for-service payment rates cannot continue to rise if we are to meet the community's goal of affordable care. Ultimately, we must continue our work to identify ways to reduce the level of payments."

Obviously, operating income is no longer enough to keep up—if it ever was. Access to external capital is critically important. But with competition for borrowing extremely heated, figuring out your prospects and coming up with the right approach is daunting. "A Guide to Financing Strategies for Hospitals" describes today's capital markets and gives hospitals ways to evaluate their needs. Most helpfully, the guide, part of the Hospitals in Pursuit of Excellence Signature Leadership Series, spells out seven strategies for accessing capital, ranging from the basic ("understand your strategic financial position and maintain credit strength") to the more problematic ("consider partnership as a broad strategic capital option"). It provides key takeaways and recommended action items. It includes information specifically geared to smaller hospitals, though every type of hospital will find information beneficial to its own situation. For a copy, go to www.hpoe.org.