Several hospitals and health systems have experienced downgrades to their financial ratings this year amid ongoing operating losses, declines in investment values and challenging work environments.
Here are 46 hospitals and health systems that received credit rating downgrades since January:
Editor's Note: This webpage was updated Oct. 13 and will continue to be updated.
1. Legacy Health (Portland, Ore.): Legacy was downgraded from "A" to "A-" as the health system deals with sustained operating losses resulting in fewer days' cash on hand, S&P Global said Nov. 1.
2. Luminis Health (Annapolis, Md.): The system was downgraded from "A" to "A-" amid "consistently negative operating performance and modest cash flow," according to S&P Global in an Oct. 25 report.
3. Adventist Health (Roseville, Calif): The 26-hospital system received recent bond downgrades from two agencies, according to an Oct. 23 filing. While Fitch Ratings downgraded a 2009-dated bond series long-term from "AA+" to "AA," the agency also downgraded its short-term rating for the bonds. S&P Global maintained its long-term rating for two separate Adventist bond series at "AA-" but downgraded the short-term grade.
4. Methodist Le Bonheur Healthcare (Memphis, Tenn.): The system had bond ratings downgraded to "A+" from "AA-" amid persistent financial challenges that could give rise to a potential future default, S&P Global said Oct. 13.
5. Kuakini Health System (Honolulu): Kuakini Health had bond ratings downgraded to "CCC-" amid a challenging operational environment and slower-than-expected progress in certain asset sales, S&P Global said Oct. 9.
6. Bon Secours Mercy Health (Cincinnati): The system had its long-term bond rating downgraded from "A1" to "A2," Moody's said Oct. 5.
7. St. Luke's Duluth (Minn.): The system saw its long-term rating on a series of bonds lowered to "BB+" from "BBB-" amid weaker balance sheet metrics, S&P Global said Oct. 5.
8. Ascension (St. Louis): While it had its default rating and that on a series of $6.6 billion of bonds affirmed at "AA+" Sept. 26, Fitch revised the outlook for the 140-hospital system to negative from stable. The move follows a $3 billion operating loss reported Sept. 14.
9. Guthrie Clinic (Sayre, Pa.): The system was downgraded to "A" from "A+" amid "accelerated" and higher-than-expected operating losses in fiscal 2023, Fitch said Sept. 22.
10. Nuvance Health (Danbury, Conn.): Concerns about the system not meeting debt obligations led to its rating being downgraded from "BBB+" to "BBB," S&P said Sept. 21.
11. Reid Health (Richmond, Ind.): Reid Health saw its long-term rating on a series of bonds lowered to "BBB+" from "A-" Sept. 21 amid "accelerating operating losses" and weak debt service coverage, S&P said. The outlook is stable, reflecting sound strategies to improve margins, the agency noted.
12. Tower Health (West Reading, Pa.): Tower Health was downgraded from "CCC+" to "CCC" amid ongoing financial losses, Fitch said Sept. 19.
13. Children's Hospital Los Angeles: The system was downgraded Sept. 15 to "BBB" with a stable outlook by S&P Global.
14. Wise Health System (Decatur, Texas): The three-hospital system was downgraded five notches from "BB+" to "B-" as it continues to suffer from operating losses that are only likely to worsen in the near term, S&P Global said Sept. 15.
15. Tufts Medicine (Burlington, Mass.): "Significantly elevated" operating losses at Burlington, Mass.-based Tufts Medicine have resulted in the system having credit ratings downgraded two notches to "BBB-" from "BBB+," S&P Global said Sept. 14.
16. Catholic Medical Center (Manchester, N.H.): The system suffered its second downgrade in a matter of weeks when S&P Global lowered its rating two notches from "BBB+" to "BBB-" Sept. 6 amid declining operating margins. That downgrade followed another by Moody's in late August.
17. Redeemer Health (Meadowbrook, Pa.): Redeemer saw its credit rating downgraded to "BB" on Aug. 22 by S&P Global. The system has rapidly "declining operating margins" and is seeking a partner to help it recover, according to the report.
18. Adventist Health (Roseville, Calif.): The 27-hospital system had its credit rating downgraded by S&P Global from "A1" to "A2," according to an Aug. 21 filing.
19. ECU Health (Greenville, N.C.): ECU, formerly known as Vidant Health, was downgraded from "A+" to "A" because of recent operating losses, S&P said Aug. 15.
20. Mount Sinai Hospital (New York City): Moody's on Aug. 10 downgraded the hospital's rating to "Baa1" from "A3" as the agency expects the system's operating performance and liquidity to be below historical averages for several years.
21. Regional West Health Services (Scottsbluff, Neb.): Regional West Health was downgraded to "BB-" and placed on a negative rating watch as "sizeable fiscal 2022 operational losses" continue to affect the system, according to a July 31 Fitch report.
22. PeaceHealth (Vancouver, Wash.): The 11-hospital system saw its credit rating on a series of bonds downgraded to "A-" as it continues to face labor challenges and high average length-of-stay issues, S&P Global said July 7.
23. University of Vermont Medical Center (Burlington): While management's efforts to reverse the trend are likely to lead to eventual recovery, several years of weak operating results saw Fitch downgrade the six-hospital system's bond rating to "A" from "A+" June 30.
24. Heritage Valley Health System (Beaver, Pa.): Heritage Valley suffered a credit downgrade from "AA-" to "A+" following sustained operating challenges that are not likely to recover substantially for the foreseeable future, Fitch said July 14.
25. UNC Southeastern: Part of Chapel Hill, N.C.-based UNC Health system, UNC Southeastern saw its ratings on a series of bonds downgraded to "BB" amid operating losses and sustained weakness in its balance sheet, according to S&P Global.
26. UC Health (Cincinnati): Moody's Investor Service downgraded the system to a "Baa3" grade in May. That move followed a similar downgrade because of "significantly escalating losses" in February.
27. Yale New Haven (Conn.) Health: The system's bond rating slipped from "Aa3" to "A1" due to operating weakness and elevated debt, Moody's said May 5.
28. ProMedica (Toledo, Ohio): ProMedica had its ratings on various bonds and its default grade downgraded to "BB-" from "BB+". The move reflected the "precipitous decline in liquidity" in fiscal 2022, according to Fitch.
29. 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.
30. 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+".
31. Penn State Health (Hershey, Pa.): Higher-than-expected operating losses led to Penn State Health being downgraded on a series of bonds from "A+" to "A," S&P Global said April 6.
32. 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 about $7.4 billion. 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, while Moody's downgraded a series of Providence bonds from "A1" to "A2."
33. Thomas Jefferson University (Philadelphia): Thomas Jefferson University received a credit downgrade with cash flow margins expected to stay low for "several years," Moody's said March 30.
34. 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 said March 29.
35. 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.
36. AU Health System (Augusta, Ga.): AU 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.
37. 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.
38. 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."
39. Northern Regional Hospital (Mount Airy, N.C.): The 133-bed public hospital saw its rating on specific bonds downgraded as it faces sustained financial challenges, S&P Global said March 2. The downgrade to "BB+" from "BBB" reflects widening operating losses and unrestricted reserves continuing to decline from its last review, S&P said.
40. Overlake Hospital Medical Center (Bellevue, Wash.): The 310-bed community hospital on the eastern side of Seattle saw its rating on a series of bonds downgraded to "Baa1" from "A2" while its outlook remained negative, Moody's said March 9.
41. Tufts Medicine (Boston): Tufts Medicine was downgraded from "BBB+" to "BBB" both on its default rating and on various bonds as the health system continues to endure significant financial challenges, Fitch Ratings said Feb. 28.
42. Geisinger Health System (Danville, Pa.): Moody's Investors Service downgraded Geisinger Health System's outstanding bonds from "A1" to "A2" Feb. 13 amid expectations of continued cash flow weakness.
43. Tower Health (West Reading, Pa.): Tower Health was hit with a rating downgrade on its bonds in February, according to S&P Global, which revised the system's outlook to negative.
44. Community Health System (Fresno, Calif.): The three acute care hospital system saw ratings on a series of its bonds downgraded amid sustained financial struggles, S&P Global said March 3.
45. Fairview Health (Minneapolis): Moody's Investors Service downgraded the revenue bond ratings of Fairview Health from "A3" to "Baa1." The downgrade reflects Moody's projection that weak operating performance will be challenging to overcome due to increased labor costs and lower inpatient volume.
45. Marshfield (Wis.) Clinic Health System: The system suffered a credit downgrade because of recent operating losses and amid expectations of no immediate financial improvement. The S&P Global move Feb. 7 to downgrade the system to "BBB+" from "A-" follows a similar move from Fitch Jan. 18.
46. Butler (Pa.) Health: Butler, which merged with Greensburg, Pa.-based Excela Health to form Independence Health System in January, saw its credit rating downgraded from "A" to "BBB. The move reflects continued operating challenges and low patient volumes, according to Fitch Ratings.