Economic activity in the hospital sector expanded in April for the 20th straight month, according to the latest Hospital ISM Report on Business.

The Hospital Purchasing Managers Index (PMI) registered 55 percent in April, up four percentage points from March. The gain indicates strengthening conditions across several key performance indicators, including business activity, new orders and employment.

“Business activity remained in expansion for the sixth consecutive month, and the employment index returned to growth following two months of contraction,” said Nancy LeMaster, MBA, chair of the Institute for Supply Management (ISM) Hospital Business Survey Committee. “Supplier deliveries slowed, which also reflects expansion.”

The case mix index dipped into contraction at 49.5 percent, down five points from March, while the technology spend index rose to 56.5 percent. Days payable outstanding remained in contraction but ticked up to 49 percent. The touchless orders index slipped into contraction at 49.5 percent.

Survey panelists reported a mixed outlook. Some noted higher volumes of elective procedures and seasonal illnesses, which led to reduced inventories. Others cited recruitment efforts tied to expanded services.

“Concerns are rising over second-quarter cost increases, especially in IT, as tariff impacts loom,” LeMaster said. “While some organizations have ramped up bulk purchases or shifted sourcing to U.S. manufacturers, others are facing challenges with product substitutions from distributors.”

The Hospital PMI is a composite index based on four equally weighted components: business activity, new orders, employment and supplier deliveries. A reading above 50 percent generally signals expansion.

The ISM Hospital Report on Business is based on a nationwide survey of hospital supply executives and is released monthly on the fifth business day.