Management's initiatives toward stable operating performance support a stable outlook for nonprofit hospitals and healthcare systems in 2013, according to a Fitch Ratings report.

"A continued focus on operating efficiency, stable reimbursement levels, modest managed care rate increases, and a higher than expected 2013 Medicare market basket increase all contribute to a stable landscape," said Jim Lebuhn, senior director. "However, Fitch believes there is increased uncertainty beyond 2013 as opportunities for further cost cutting wane and a wave of expected reimbursement reductions are realized under the full implementation of the Patient Protection and Affordable Care Act (PPACA) beginning in 2014."

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