6 health systems with lowered outlooks

Here are six health systems that had their outlooks downgraded by Fitch Ratings or Moody's Investors Service since Nov. 5: 

Note: This is not an exhaustive list. Health systems were compiled from credit rating reports. 

Allina Health's outlook was revised to negative from stable by Moody's. The revision reflects Moody's view that despite year-over-year improvement, continued "lackluster" financial performance and elevated capital spending will likely result in the Minneapolis-based system's days cash on hand and/or cash-to-debt ratio falling below levels consistent with its "A1" rating.

Children's Hospital Los Angeles' outlook was revised to negative from stable by Moody's. The revision reflects the system's very weak liquidity following delayed state funding and receivables due to the Change Healthcare cyberattack, Moody's said. The system has a "Baa2" rating with Moody's. 

Crouse Health System's outlook was revised to negative from stable by Fitch. The revision reflects "considerable uncertainty regarding recent and unexpected changes" to New York's Directed Payment Template, Fitch said. Syracuse, N.Y.-based system has a "BB" rating with Fitch. 

Mary Greeley Medical Center's rating was revised to negative from stable by Moody's. The revision is driven by an imminent opening of a joint venture ambulatory surgery center, which will materially redirect surgical volumes from the Ames, Iowa-based hospital, Moody's said. The hospital has an "A2" rating with Moody's.

Orlando (Fla.) Health's outlook was revised to stable from positive by Moody's. The revision comes after the system acquired eight hospitals in October. Moody's said the lowered outlook is driven by a meaningful increase in debt — about 46% — related to the acquisitions, as well as an anticipated reduction in days cash on hand related to an expanded expense base. Orlando Health has an "A2" rating with Moody's. 

Vandalia Health's outlook was revised to negative from stable by Moody's. The revision reflects potential challenges in improving liquidity due to ongoing revenue cycle issues and the lingering effects of recently integrated hospitals, Moody's said. The Charleston, W.Va.-based system has a "Baa1" rating with Moody's.

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