John Morrow, managing director of the healthcare data and analytics firm Franklin Trust Ratings, said shareholders tend to get frustrated with health systems when their quarterly earnings calls seem to oversimplify important issues, such as missing their own guidance on key metrics. Investors begin to question whether they're getting the whole story.
"It's one thing if you miss the Street's guidance, but if you miss your own, there's got to be frustration there," he said. "So you read these things and you say, 'Gee, what's going on?'"
All things considered, healthcare is no different from other industries in that shareholders are simply looking for a return on their investments, Morrow said. The difference here, though, is that's becoming an increasingly tricky proposition.
"People don't see certainty," he said, "and when people don't see certainty, they become skittish."
With no indication the stress on hospitals will let up anytime soon, experts say investor-owned health systems should expect to see shareholder activism ramp up even more.
"When you have an industry where a number of the participants have struggled and are laggards to their peers, that's the type of industry that is more likely to attract activist investors because of the opportunity to catalyze a turnaround," Cadwalader Wickersham's Brand said.
The best way to prevent negative scrutiny—or to at least shield from its most damaging effects—is to get out in front of it, Glass Lewis' McPherson said. When a health system's leaders see challenges on the horizon, McPherson recommends they let shareholders know sooner rather than later, and share the system's plan for weathering the storm.