Fitch Ratings downgraded San Francisco-based Dignity Health's bond ratings to "A-" from "A."
Concurrently, Fitch assigned its "A-" issuer default rating to the health system.
The downgrade and assignment are based on Dignity Health's challenging payer mix and unfavorable leverage metrics due to elevated adjusted debt. Fitch favorably viewed the health system's improving operating margins and geographic diversification efforts.
The bonds have been removed from rating watch negative. The outlook is stable.