Fitch Ratings downgraded more than $370 million of debt issued for Eisenhower Medical Center to BBB from A-minus.

The bonds were removed from negative watch after the two-notch downgrade, but the outlook is negative, according to the rating report.

The downgrade applied to $110.6 million of revenue bonds issued through the California Municipal Finance Authority, as well as $262.4 million of revenue bonds and $27.5 million of certificates of participation issued through the Rancho Mirage Joint Powers Financing Authority.

“Since Fitch’s review in July 2010, Eisenhower’s financial profile has deteriorated significantly and was tremendously below expectations and projected figures,” the report said.

The decline in performance was mainly related to the lack of inpatient revenue growth and an adverse shift in payor mix, the report stated.

The medical center has 1.3 times debt coverage and a 6.7% operating Ebitda — earnings before interest, taxes, depreciation and amortization — margin compared to 2.8 times debt coverage and 13.5% Ebitda margin in the previous year, according to analysts.

On the upside, the medical center has completed a major expansion and renovation project and has been investing in its regional growth strategy by increasing outpatient clinic sites, which Fitch analysts said is expected to pay off over the long term.

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