S&P Global Ratings revised Seguin, Texas-based Guadalupe Regional Medical Center's outlook to negative from stable.
"The negative outlook revision reflects widening losses at the [medical center's] employed physician group, which were worse than budgeted projections due in part to slower-than-expected practice growth. The revision also reflects softer volumes and GRMC's highly elevated leverage," said S&P analyst Patrick Zagar.
The ratings agency also affirmed the "BB" rating on the medical center's series 2015 revenue refunding and improvement bonds.