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U.S. Not-For-Profit Health Care Rating Actions, August 2022

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U.S. Not-For-Profit Health Care Rating Actions, August 2022

S&P Global Ratings affirmed 23 ratings without revising the outlooks, took eight rating actions, and revised six outlooks without changing the ratings in the U.S. not-for-profit health care sector in August 2022. We also placed ProMedica Healthcare Obligated Group on CreditWatch with negative implications in addition to lowering the rating and revised the outlook on Princeton Community Hospital in West Virginia from negative to developing. There was one new sale in August. The 14 rating and outlook actions consist of the following:

  • Seven downgrades, on six stand-alone hospitals and one system;
  • One upgrade, on one standalone hospital;
  • Five unfavorable outlook revisions on one standalone hospital, three systems, and one long-term care provider (all to negative from stable); and
  • One favorable outlook revision on one standalone hospital (from stable to positive).

The table below summarizes S&P Global Ratings' monthly bond rating actions for U.S. not-for-profit health care providers in August. We based the credit rating affirmations and rating actions on several factors within enterprise and financial profiles, including business position, utilization, financial performance, debt levels, bond-issuance activity, physician relationships, and the external regulatory and reimbursement environment. This also incorporates our stable sector view but we are incorporating the changing dynamics of the sector including the increased inflationary pressures, economic developments, and investment market volatility.

August 2022 Not-For-Profit Health Care Ratings Actions
Hospitals State Rating Outlook Action Description

AnMed Health System and Affiliates

SC A+ Stable Rating maintained Credit quality consistent with existing rating

Bexar County Hospital District

TX AA Stable Rating maintained Credit quality consistent with existing rating

Boston Medical Center

MA BBB Positive Rating maintained; outlook revised from stable Strengthened balance sheet, coupled with projections that operating margins will stabilize during the outlook period

Children's Hospital Los Angeles

CA BBB+ Negative Rating maintained; outlook revised from stable Elevated operating losses coupled with lighter balance sheet metrics and potential capital spending

Comanche County Memorial Hospital

OK BB+ Stable Rating maintained Credit quality consistent with existing rating

Good Shepherd Group

PA BBB+ Negative Rating lowered from A-; previous outlook negative Ongoing operating losses and weakening debt metrics

Grand River Hosp Dist

CO BB+ Negative Rating maintained Credit quality consistent with existing rating

Grand View Hospital

PA BB Stable Rating lowered from BB+; previous outlook stable Magnitude of unaudited operating losses in 2022 expected to continue in 2023 along with higher debt-related metrics

Halifax Hospital Medical Center Obligated Group

FL A- Stable Rating maintained Credit quality consistent with existing rating

Holy Redeemer Health System

PA BB+ Stable Rating lowered from BBB-; previous outlook negative Persistent operating losses that have accelerated and limited balance-sheet growth

Jackson Hospital and Clinic

AL BB Negative Rating lowered from BBB-; previous outlook negative Unexpected, significant, and persistent operating losses and diminished unrestricted reserves

Jennie Stuart Medical Center

KY BBB- Stable Rating maintained Credit quality consistent with existing rating

Lake Regional Health System

MO BBB+ Stable Rating maintained Credit quality consistent with existing rating

Lawrence Mem Hosp

KS A- Stable Rating lowered from A; previous outlook stable Expected continued decline in days’ cash on hand and weaker operating performance

MetroHealth System

OH BBB Stable Rating raised from BBB-; previous outlook positive Sustained positive financial profile metrics and near completion of its new hospital

Nicholas H. Noyes Memorial Hospital (Livingston Health System)

NY BB- Stable Rating maintained Credit quality consistent with existing rating

Oroville Hosp

CA B+ Negative Rating maintained Credit quality consistent with existing rating

Phoenix Children's Hospital

AZ A+ Stable Rating maintained Credit quality consistent with existing rating

Princeton Community Hospital

WV BBB Developing Rating maintained; outlook revised from negative Upside potential from PCH’s definitive agreement to be acquired by West Virginia University Health System

Scotland Memorial Hospital

NC A- Stable Rating maintained Credit quality consistent with existing rating

Sky Lakes Medical Center

OR A- Stable Rating maintained Credit quality consistent with existing rating

SouthEast Alaska Regional Health Consortium

AK A- Stable Rating maintained Credit quality consistent with existing rating

SoutheastHEALTH

MO BBB- Stable Rating maintained Credit quality consistent with existing rating

Trinity Health

ND BB+ Negative Rating lowered from BBB-; outlook revised from stable Expected near-term decline of unrestricted reserves leading to very thin days' cash on hand and cash to long-term debt

UAB Health System

AL AA- Stable Rating maintained Credit quality consistent with existing rating

University Health System, Inc.

TN BBB Stable Rating maintained Credit quality consistent with existing rating

Yuma Regional Medical Center

AZ A Stable Rating maintained Credit quality consistent with existing rating
Health Systems

Bon Secours Health System Inc.

MD A+ Positive New sale; rating maintained Credit quality consistent with existing rating

CHRISTUS Health

TX A+ Negative Rating maintained; outlook revised from stable Diminished unrestricted reserves and a weaker overall financial profile

Dartmouth-Hitchcock Obligated Group

NH A Stable Rating maintained Credit quality consistent with existing rating

Methodist Le Bonheur Healthcare and Affiliates

TN AA- Negative Rating maintained; outlook revised from stable Trend of weakening year to date operating performance and expectations of continued strain on unrestricted reserves

Northeast Georgia Health System

GA A Stable Rating maintained Credit quality consistent with existing rating

ProMedica Healthcare Obligated Group

OH BB Not meaningful Rating lowered from BBB-; Rating placed on CreditWatch negative Operating losses spurred by labor cost pressures, particularly in the skilled nursing side of the business.

Texas Health Resources

TX AA Stable Rating maintained Credit quality consistent with existing rating

Tufts Medicine

MA BBB+ Negative Rating maintained; outlook revised from stable Heightened and unexpected operating losses in 2022
Long term care and human service providers

Henry County Health Care Authority

AL BB+ Negative Rating maintained; outlook revised from stable Multiyear trend of weak operating performance

Noland Health Services

AL A Stable Rating maintained Credit quality consistent with existing rating

Westhills Village Retirement Community

SD A+ Stable Rating maintained Credit quality consistent with existing rating

This report does not constitute a rating action.

Primary Credit Analyst:John Magers, New York + 1 (212) 438 1151;
john.magers@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
Blake C Fundingsland, Centennial + 1 (303) 721 4703;
blake.fundingsland@spglobal.com

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