Moody's Investors Service has downgraded the ratings on Prime Healthcare's probability of default rating to "B2-PD" from "B1-PD" as well as its ratings of the system's senior secured notes to "B3" from "B2."
Moody's also revised the outlook to negative from stable because it projects operating expenses will continue to pressure the 45-hospital system's profitability in the near term, presenting challenges for "the company's pace of deleveraging," according to a Nov. 18 news release.
The downgrade of the Ontario, Calif.-based system's ratings reflects Moody's expectation of continued pressure on the Prime's profitability in the coming quarters and elevated financial leverage, Moody's said.
Prime's debt/EBITDA jumped to about 6.1 times at the end of September from high-3.0 times one year ago, according to Moody's. While a large part of the leverage increase was due to weak earnings in the first quarter, Moody's expects the system's financial leverage will remain high in the 6-6.5 times range in the next 12 months.
This year, the health system saw a surge in operating expenses, not fully offset by an increase in reimbursements, according to Moody's. A significant portion of the increased expenses can be attributed to rising contract labor costs. Contract labor cost per hour dipped in the third quarter but still remains far higher than in prior years.
Moody's said social and governance risk considerations are material to the rating downgrade, arguing that Prime's reliance on clinical labor makes it vulnerable to worsening supply-demand imbalance of such labor and the resultant spike in labor costs. The risk has become more prominent after the pandemic, which triggered increased retirement and a shift from permanent to temporary staffing, especially for nurses, Moody's said.