S&P Global Ratings maintained 22 ratings without revising the outlooks and took eight negative rating actions in March. In addition, we revised two outlooks favorably, and revised two outlooks unfavorably, both without changing the ratings in the U.S. not-for-profit health care sector.
There were five new debt issuances in the month, one of which was a new issuer with an initially assigned rating.
The 12 rating actions and outlook revisions consisted of the following:
- Eight downgrades on four systems and four stand-alone hospitals, with all but two in the 'BBB' rating category;
- Two outlooks revised to stable from negative on systems, one of which was accompanied by a new sale; and
- Two unfavorable outlook revisions on one system from positive to stable and one stand-alone from stable to negative.
Table 1
U.S. not-for-profit health care rating action summary, year-to-date 2024 | ||||
---|---|---|---|---|
January | February | March | First quarter | |
Maintained | 18 | 23 | 22 | 63 |
Downgrades | 3 | 2 | 8 | 13 |
Upgrades | 2 | 1 | 0 | 3 |
Unfavorable outlook revisions | 1 | 1 | 2 | 4 |
Favorable outlook revisions | 5 | 1 | 2 | 8 |
Chart 1
Chart 2
Table 2
March 2024, U.S. not-for-profit health care rating actions | ||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
State | Rating | Outlook | Entity Type | Action | Description | |||||||||
Allegheny Health Network | PA | A | Stable | System | Maintained | Credit quality consistent with existing rating based our GRM criteria for Highmark | ||||||||
Avera Health | SD | AA- | Stable | System | Maintained; new sale | Credit quality consistent with existing rating | ||||||||
Bellin Health | WI | A+ | Stable | System | Maintained | Credit quality consistent with existing rating based on the group credit profile of Bellin Gunderson Health System | ||||||||
Berkshire Health System | MA | A | Stable | Stand-alone | Maintained | Credit quality consistent with existing rating | ||||||||
Carson Tahoe Regional Healthcare | NV | BBB+ | Stable | Stand-alone | Maintained | Credit quality consistent with existing rating | ||||||||
Central Florida Health | FL | A- | Stable | Stand-alone | Maintained | Credit quality consistent with existing rating based our GRM criteria for Shands Teaching Hospital & Clinics | ||||||||
City of Hope | CA | A | Negative | System | Maintained; new sale | Credit quality consistent with existing rating | ||||||||
Columbus Regional Healthcare System | NC | BBB | Stable | Stand-alone | Maintained | Credit quality consistent with existing rating | ||||||||
Eastern Maine Healthcare Systems | ME | BBB- | Negative | System | Downgrade | Operating performance and balance sheet metrics below expectations | ||||||||
El Camino Health | CA | AA | Stable | Stand-alone | Maintained | Credit quality consistent with existing rating | ||||||||
Evangelical Community Hospital | PA | BBB+ | Developing | Stand-alone | Downgrade | Sizeable operating losses with deterioration in balance sheet metrics | ||||||||
Flagler Health + | FL | A- | Stable | Stand-alone | Maintained | Credit quality consistent with existing rating based our GRM criteria for Shands Teaching Hospital & Clinics | ||||||||
Geisinger Health | PA | AA- | Stable | System | Maintained | Credit quality consistent with existing rating | ||||||||
Gundersen Lutheran | WI | A+ | Stable | System | Downgrade | Ratings have been harmonized based on the group credit profile of Bellin Gunderson Health System | ||||||||
Hannibal Regional Healthcare System | MO | BBB | Negative | Stand-alone | Downgrade | Operating losses that have persisted along with deterioration in the balance sheet | ||||||||
Hartford HealthCare | CT | A | Stable | System | Maintained; new sale | Credit quality consistent with existing rating | ||||||||
Hunt Memorial Hospital District | TX | BBB- | Negative | Stand-alone | Downgrade | Debt issuance during a time of persistent operating pressures, weak reserves, and covenant violation | ||||||||
Jackson-Madison County General Hospital | TN | A- | Negative | Stand-alone | Maintained | Credit quality consistent with existing rating | ||||||||
Kaiser Foundation Hospitals (Kaiser Permanente) | CA | AA- | Stable | System | Maintained | Credit quality consistent with existing rating | ||||||||
Marshfield Clinic | WI | BBB | Negative | System | Downgrade | Continuous operating challenges and balance sheet weakening with moderately higher debt levels | ||||||||
Memorial Health System | IL | A+ | Stable | System | Maintained | Credit quality consistent with existing rating | ||||||||
MetroHealth System | OH | BBB | Stable | Stand-alone | Maintained | Credit quality consistent with existing rating | ||||||||
Midland County Hospital District | TX | A- | Stable | Stand-alone | Rating initially assigned; new sale | Rating initially assigned based on dominant market position and positive operations | ||||||||
Mount Nittany Medical Center | PA | A+ | Stable | Stand-alone | Maintained | Credit quality consistent with existing rating | ||||||||
Northern Inyo County Local Hospital District | CA | B+ | Negative | Stand-alone | Maintained | Credit quality consistent with existing rating | ||||||||
Piedmont Healthcare, Inc. | GA | AA- | Stable | System | Favorable outlook revision | Healthy operating performance with further improvement in the balance sheet expected | ||||||||
Presbyterian Healthcare Services | NM | AA- | Stable | System | Downgrade | Deterioration in performance, including the health plan, as well as a decline in reserves | ||||||||
Shands Teaching Hospital & Clinics | FL | A | Stable | System | Maintained | Credit quality consistent with existing rating | ||||||||
Shell Point | FL | BBB+ | Stable | Long Term Care | Maintained | Credit quality consistent with existing rating | ||||||||
Spartanburg Regional Health Services District | SC | A | Stable | System | Maintained | Credit quality consistent with existing rating | ||||||||
St Luke's Episcopal-Presbyterian Hospital | MO | A | Negative | Stand-alone | Unfavorable outlook revision | Multiyear operating losses and decreasing DCOH | ||||||||
UC Health | OH | BBB- | Negative | Stand-alone | Downgrade | Significant deterioration in reserves with ongoing operating losses | ||||||||
University of Pittsburgh Medical Center | PA | A | Stable | System | Unfavorable outlook revision | Weaker-than-anticipated operating performance and balance sheet metrics in fiscal 2023 | ||||||||
Virginia Commonwealth University Health System Authority | VA | AA- | Stable | System | Favorable outlook revision; new sale | Improved operating performance, exceeding budget expectations and stabilizing reserves | ||||||||
Willis-Knighton Health System | LA | A | Stable | System | Maintained | Credit quality consistent with existing rating | ||||||||
GRM--Group Rating Methodology. |
This report does not constitute a rating action.
Primary Credit Analyst: | Blake C Fundingsland, Englewood + 1 (303) 721 4703; blake.fundingsland@spglobal.com |
Secondary Contacts: | Cynthia S Keller, Augusta + 1 (212) 438 2035; cynthia.keller@spglobal.com |
Suzie R Desai, Chicago + 1 (312) 233 7046; suzie.desai@spglobal.com | |
Amy He, New York +1 2124380381; amy.he@spglobal.com |
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