Here are five health systems that had their outlooks downgraded by Fitch Ratings or Moody's Investors Service since Aug. 21:
Note: This is not an exhaustive list. Health systems were compiled from credit rating reports.
1. Moody's downgraded St. Louis-based Ascension's outlook to negative from stable. Moody's said the negative outlook reflects Ascension's challenges in improving operating cash flow margins to pre-pandemic levels without relying on positive one-time items, such as Federal Emergency Management Agency grants. Ascension has an "Aa2" rating with Moody's.
2. Moody's downgraded Seattle-based Fred Hutchinson Cancer Center's outlook to negative from stable. The revision reflects weak operating margins that will continue for at least the next year, Moody's said. Fred Hutchinson has an "A2" rating with Moody's.
3. Moody's downgraded Cleveland-based MetroHeath System's outlook to negative from stable. The revision is driven by a decline in financial performance that will be difficult to quickly improve to a level that would support higher capital spending and an already high debt load, Moody's said. MetroHealth has a "Baa2" rating with Moody's.
4. Fitch downgraded Portland-based Oregon Health & Science University's outlook to negative from stable. The ratings agency said the revision reflects recent macro operating trends that OHSU has faced, particularly in fiscal 2024. While metrics are expected to improve in the coming years, margins are expected to remain compressed relative to historical trends in the medium term. OHSU has an "AA-" rating with Fitch.
5. Moody's downgraded Cleveland-based University Hospitals' outlook to negative from stable. The revision reflects challenges to improve upon weak year-to-date financial performance and rebuild lower-than-expected liquidity, Moody's said. University Hospitals has an "A2" rating with Moody's.