Hospitals using lenders of last resort. Some struggling providers say nontraditional financiers are abandoning them.

Hospitals and health systems are increasingly turning to nontraditional lenders to sell their receivables or back multimillion-dollar sales of troubled operations. But as some recent incidents show, the relationships with those financiers also can be troubled. Some critics contend that these lenders of last resort can be prone to panic.

Falling behind in the payment game. Providers are feeling squeezed by HMOs that don't pay on time and keep changing the rules.

When hospitals provide services, they naturally expect to be paid. But providers are waiting longer and longer for payment from HMOs, sometimes 90 to 120 days, putting the squeeze on cash flow. The problem has led states to enact prompt-payment laws. Health plans defend their record, saying hospitals' billing mistakes and antiquated computer systems are often to blame for the tardy payments.

Chock-full of change. Opportunities, and perils, abound as industry continues to evolve.

Tighten your belt and hold onto your wallet: Another year of change looms for healthcare. In a 1999 outlook report, our staff tells all about Medicare cutbacks, managed-care turbulence and a looming crisis in skilled nursing. And everyone is braced for the appearance of that ugly year-2000 computer bug.