Here are 21 health systems that recently had their outlooks upgraded by Fitch Ratings or Moody’s Investors Service in 2025.

Note: This is not an exhaustive list. Health systems were compiled from credit rating reports.

Boston Children’s Hospital’s outlook was revised to stable from negative by Moody’s. The revision reflects a modest improvement in operating performance and the likelihood that margins will continue to strengthen to roughly 4%-6% in fiscal 2025, Moody’s said. Boston Children’s has an “Aa2” rating with the agency.

Broward Health’s outlook was revised to positive from stable by Fitch. The revision highlights the Fort Lauderdale, Fla.-based system’s strategic initiatives to expand service lines and improve access via outpatient sites, Fitch said. Broward has an “A+” rating with the agency.

Butler (Pa.) Health System’s outlook was revised to stable from negative by Moody’s. The revision reflects Moody’s assessment that Butler’s parent company, Independence Health System, will continue on a path of improved operating performance and maintain sufficient days of cash on hand. It also reflects that Butler will meet its covenant requirements. The system has a “Baa3” rating with Moody’s.

Cooper University Health Care’s outlook was revised to positive from stable by Moody’s. The revision reflects the Camden, N.J.-based system’s maintenance of high single-digit operating cash flow margins and strong liquidity, despite significantly increased capital spending, Moody’s said. Cooper has an “A3” rating with the agency.

DCH Health Care’s outlook was revised to stable from negative by Moody’s. The revision reflects the likelihood that the Tuscaloosa, Ala.-based system’s recent operating improvements are sustainable, Moody’s said. DCH Health Care has a “Baa1” rating with the agency.

Essentia Health’s outlook was revised to positive from stable by Fitch. The revision reflects the Duluth, Minn.-based system’s operational improvement in fiscal 2024 and 2025 following periods of margin compression, Fitch said. Essentia has an “A-” rating with the agency.

EvergreenHealth’s outlook was revised to stable from negative by Moody’s. The revision reflects the Kirkland, Wash.-based system’s reduced enterprise risk as hospital operations continue to strengthen, Moody’s said. EvergreenHealth has an “Aa3” rating with Moody’s.

Hunterdon Medical Center’s outlook was revised to stable from negative by Fitch. The revision is based on the Flemington, N.J.-based system’s improved cash flow that reflects strategic growth initiatives and operating efficiencies that have been implemented in recent years, Fitch said. Hunterdon has an “A+” rating with Fitch.

Hutchinson (Kan.) Regional Medical Center’s outlook was revised to stable from negative by Moody’s. The revision reflects improving financial performance, with break-even to slightly positive cash flow expected in fiscal 2025, Moody’s said. Hutchinson has a “Baa2” rating with the agency.

Hurley Medical Center’s outlook was upgraded to positive from stable by Moody’s. The revision reflects Flint, Mich.-based medical center’s stronger volumes and favorable changes to Michigan’s Medicaid-directed payment program, Moody’s said. Hurley has a “Ba1” rating with the agency.

Kettering (Ohio) Health’s outlook was upgraded to positive from stable by Moody’s. The revision reflects the likelihood that the system will maintain strong liquidity as it increases capital spending, backed by high single-digit operating cash flow margins, Moody’s said. Kettering has an “A2” rating with the agency.

Mary Washington Healthcare’s outlook was revised to positive from stable by Fitch. The revision reflects Fitch’s view that the Fredericksburg, Va.-based system is well positioned to generate robust cash flow, absorb additional debt and build unrestricted cash and investments. Mary Washington has an “A” rating with the agency.

Miami Jewish Health Systems’ outlook was revised to stable from negative by Fitch. The revision reflects the system’s improved performance over the last two years, which has enabled MJHS to meet its debt service coverage and days cash on hand covenants in fiscal 2024, Fitch said. Miami Jewish has a “BB+” rating with the agency.

Nuvance Health’s outlook was revised to stable from negative by Moody’s. The revision reflects the Danbury, Conn.-based system’s improved financial performance, which Moody’s believes will be sustainable. Nuvance’s merger with New Hyde Park, N.Y.-based Northwell Health will provide additional financial resources to expand its market capture, Moody’s said. The system has a “Baa3” rating with the agency.

Phoenix Children’s Hospital’s rating was upgraded to positive from stable by Moody’s. The revision reflects the likelihood that the system’s expansion strategies will continue to drive good cashflow and liquidity growth, Moody’s said. Phoenix Children’s has an “A1” rating with Moody’s.

Rex Healthcare’s outlook was upgraded to positive from stable by Fitch. The revision reflects Fitch’s expectation that the Raleigh, N.C.-based system’s operating performance will continue to improve over the medium term. Rex has an “A+” rating with the agency.

San Antonio Regional Hospital’s outlook was revised to positive from stable by Moody’s. The revision reflects that the Upland, Calif.-based hospital has maintained strong operating cash flow of around 8%, Moody’s said. The hospital has a “Baa1” rating with Moody’s.

Tampa (Fla.) General Hospital’s outlook was upgraded to positive from stable by Moody’s. The revision reflects the health system’s integration of three new hospitals in 2024 while meeting budget, Moody’s said. Tampa General Hospital has a “Baa1” rating with the agency.

Texas Medical Center’s outlook was revised to positive from stable by Moody’s. The revision reflects the Houston-based system’s continued exceptional operating performance and liquidity relative to operations, Moody’s said. Texas Medical Center has an “A1” rating with the agency.

UC Health’s outlook was upgraded to positive from stable by Moody’s. The revision reflects the Cincinnati-based system’s growing cash flow and liquidity from improvement initiatives, bond proceeds and strong management execution, Moody’s said. UC Health has a “Baa3” rating with the agency.

Wayne Healthcare’s outlook was revised to positive from stable by Fitch. The revision reflects the Greenville, Ohio-based hospital’s June 2024 conversion to a critical access hospital, Fitch said. Wayne Healthcare has a “BB+” rating with the agency.

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