Here is a summary of recent credit downgrades and outlook revisions for hospitals and health systems.
The various downgrades reflect continued operating challenges many nonprofit systems are facing and will likely continue to deal with for some years to come.
ProMedica (Toledo, Ohio): ProMedica has had its ratings on various bonds and its default grade downgraded to "BB-" from "BB+," Fitch Ratings said May 9.
The move reflected the "precipitous decline in liquidity" in fiscal 2022, Fitch said. In addition, the 11-hospital system was placed on "Negative Watch" amid uncertainty over the planned $710 million sale of much of its hospice and home health units.
Baptist Health Care (Pensacola, Fla.): BHC had the rating downgraded on a series of its bonds as a reflection of "pressured operating performance and cash flow," S&P Global said April 19.
As well as typical industry pressures of inflation and labor expenses, the three-hospital system may face further challenge because of a replacement project for its flagship Baptist Hospital that is due to be completed in late 2023.
Beacon Health (South Bend, Ind.): Beacon Health System had its outlook revised to negative from stable on "AA-" rated bonds it holds, S&P Global said April 14.
The move reflects weaker operating results and an expectation of increased debt over the near term.
Kuakini Health System (Honolulu): Kuakini Health System, which has a "CCC" long-term rating, has been placed on CreditWatch with negative implications, S&P Global said April 14.
The move reflects the system's sustained operating challenges with no foreseeable major changes and questions about its long-term viability, the agency said, describing the system's "precarious financial position."
Baystate Health (Springfield, Mass.): Baystate Health had ratings downgraded on specific bonds related to its flagship medical center, S&P Global said April 12.
While ratings were affirmed on other debt, those on others specific to the 780-bed Baystate Medical Center were downgraded to "A" from "A+" as the system's operating challenges continue into 2023, the agency said.
Penn State Health (Hershey, Pa.): Higher-than-expected operating losses have led to Penn State Health being downgraded on a series of bonds from "A+" to "A," S&P Global said April 6.
Original budgets for the first part of fiscal 2023 targeted a slightly positive full-year operating margin, but data shows a $75 million lower-than-forecasted figure, S&P Global said. Operating income showed a loss of $154.5 million for the six months ending Dec. 31 compared with a $48.8 million loss in all of fiscal 2022.
Legacy Health (Portland, Ore.): Legacy Health had its outlook revised to negative from stable amid expectations the eight-hospital system will continue to experience difficult operating conditions and concern it will continue to fail to meet debt obligations, Moody's said April 5.
The rating on its revenue bonds was affirmed at "A1." Total debt stands at $738 million.
Providence (Renton, Wash.): The 51-hospital system recorded the first of three downgrades in the space of a few weeks March 17 when Fitch Ratings attached an "A" grade to both the system's default rating and a series of bonds worth approximately $7.4 billion. The outlook for the system is negative due to its higher-than-average debt loads, Fitch said.
S&P Global then downgraded Providence to the same notch from "A+" March 21 amid higher expenses and an expectation of only a multiyear process of recovery. The outlook for the system was also negative given the steep operating losses that need to be dealt with, S&P said.
Finally, Providence was downgraded by Moody's on a series of bonds from "A1" to "A2."
Thomas Jefferson University (Philadelphia): Thomas Jefferson University has undergone a credit downgrade with cash flow margins expected to stay low for "several years," Moody's said March 30.
The 18-hospital system, which also operates 10 colleges located primarily on two campuses in Philadelphia, is expected to stabilize its days of cash on hand to about 140, but debt will remain high, Moody's said. The outlook is stable.
Oaklawn Hospital (Marshall, Mich.): The 68-bed community hospital was downgraded to "BBB-" from "BBB" as it reported operating losses due to higher expenses and length of patient stay, Fitch Ratings said March 29.
The downgrade refers both to its default rating and on bonds worth $63.5 million. The outlook is negative.
DCH Health (Tuscaloosa, Ala.): The three-hospital system saw its rating on a series of bonds lowered to "A-" from "A" as it continues to suffer operating losses, S&P Global said March 29.
The system's "deeply negative underlying operations" are unlikely to lead to any substantial improvement in the near future, the agency said.
DCH Health operates a total of 510 staffed beds.
AU Health System (Augusta, Ga.): The system, which is being pursued by Marietta, Ga.-based Wellstar Health, was downgraded March 23 amid concern over negative cash flow and that it may breach covenant agreements later this year, Moody's said.
The downgrade to "B2" from "Ba3" applies to revenue bonds the system holds. The outlook is negative.
PeaceHealth (Vancouver, Wash.): "Considerable operating stress" was the driver behind Fitch Ratings downgrading the 10-hospital system March 21.
The downgrade to "A+" from "AA-" applied to both the system's default rating and on a series of bonds. The outlook is stable.
Management is targeting a return to profitability by fiscal 2026, Fitch noted.
Mercy Iowa City (Iowa) Hospital: The hospital, part of Des Moines, Iowa-based MercyOne, was downgraded March 16 to "Caa1" from "B1" because of what Moody's called "severe cash flow deterioration." The "Caa1" categorization is seen as "substantial risk."