S&P Global Ratings maintained 18 ratings without revising the outlooks, took two positive rating actions, and three negative rating actions in January. In addition, we revised five outlooks favorably, and revised one outlook unfavorably, all without changing the ratings in the U.S. not-for-profit health care sector. Two of the favorable outlook revisions (to positive from stable) are related to the pending consolidation of two hospitals under a common parent company.
There were seven new debt issuances in the month, four of which were joint criteria ratings on variable-rate demand bonds.
The 11 rating actions and outlook revisions consisted of the following:
- Two upgrades, one of which was related to a merger;
- Three downgrades on stand-alone hospitals, one each in the 'A', 'BB', and 'B' rating categories;
- Five favorable outlook revisions on two systems and three stand-alone hospitals, with one outlook revised to stable from negative and four revised to positive from stable; and
- One unfavorable outlook revision on a system with the outlook revised to negative from stable.
Chart 1
Chart 2
January 2024, U.S. not-for-profit health care rating actions | ||||||
---|---|---|---|---|---|---|
State | Rating | Outlook | Entity type | Action | Description | |
BJC HealthCare |
MO | AA | Stable | System | Maintained | Credit quality consistent with existing rating |
Bowling Green-Warren County Community Hospital |
KY | AA- | Stable | Stand-alone | Maintained; new sale | Credit quality consistent with existing rating |
Cedars-Sinai Health System |
CA | AA- | Stable | System | Maintained | Credit quality consistent with existing rating |
Chesapeake Regional Medical Center |
VA | A | Stable | Stand-alone | Maintained | Credit quality consistent with existing rating |
Children's Hospital of Boston |
MA | AA | Stable | Stand-alone | Maintained; new sale | Credit quality consistent with existing rating |
Children's Hospital of Boston |
MA | AA | Stable | Stand-alone | Maintained; new sale | Credit quality consistent with existing rating |
Denver Health & Hospital Authority |
CO | BBB | Stable | Stand-alone | Maintained | Credit quality consistent with existing rating |
Elliot Hospital |
NH | A- | Positive | Stand-alone | Favorable outlook revision | Continued operational improvement and reserve stability with near term consolidation expected under SolutionHealth |
Hendrick Health |
TX | A | Stable | Stand-alone | Maintained | Credit quality consistent with existing rating |
Infirmary Health System Inc. |
AL | A- | Negative | System | Unfavorable outlook revision | Financial profile deterioration and likely additional debt |
Lifespan |
RI | BBB+ | Stable | System | Maintained; new sale | Credit quality consistent with existing rating |
Mass General Brigham |
MA | AA- | Stable | System | Maintained; new sale | Credit quality consistent with existing rating |
Methodist Hospital |
IN | BB+ | Stable | Stand-alone | Downgrade | Decline in balance sheet metrics and significant operating losses |
Milford Regional Medical Center |
MA | B | Developing | Stand-alone | Downgrade | Weak balance sheet and persistent operating losses; higher rating dependent on affiliation with UMass |
Montefiore Health System |
NY | BBB- | Negative | System | Maintained | Credit quality consistent with existing rating |
North Oaks Health |
LA | A- | Stable | Stand-alone | Upgrade | Trend of positive operational performance and balance sheet strength |
Ochsner LSU Health System of Northern Louisiana |
LA | BBB- | Negative | Stand-alone | Maintained | Credit quality consistent with existing rating |
Orlando Health |
FL | A+ | Positive | System | Favorable outlook revision | Consistent operating income and cash flow strength expected support multiyear capital plan and balance sheet growth |
ProHealth Care |
WI | A+ | Stable | System | Maintained | Credit quality consistent with existing rating |
ProMedica Healthcare |
OH | BB | Stable | System | Favorable outlook revision | Successful divestment of non-core business, paydown of all private debt, and elimination of near-term covenant risk |
Saint Luke's Health System |
MO | AA | Stable | System | Upgrade | Merger with BJC Health System |
Saint Peter's University Hospital |
NJ | BBB | Stable | Stand-alone | Maintained | Credit quality consistent with existing rating |
Scripps Health |
CA | AA- | Stable | System | Maintained; new sale | Credit quality consistent with existing rating |
Sharp HealthCare |
CA | AA | Stable | System | Maintained; new sale | Credit quality consistent with existing rating |
Southern New Hampshire Medical Center |
NH | A- | Positive | Stand-alone | Favorable outlook revision | Continued operational improvement and reserve stability with near term consolidation expected under SolutionHealth |
St. Tammany Parish Hospital Service District No. 2 |
LA | A | Stable | Stand-alone | Downgrade | Weakening operations with significant finance lease, declined days' cash on hand, increase in payables |
Tarrant County Hospital District |
TX | AA | Stable | Stand-alone | Maintained | Credit quality consistent with existing rating |
TriHealth |
OH | A+ | Stable | System | Maintained | Credit quality consistent with existing rating |
Winkler County Hospital District |
TX | BB+ | Positive | Stand-alone | Favorable outlook revision | Strong cash, debt service coverage, and operating performance with low debt levels compared to peers |
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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