Moody's Investors Service said it downgraded a record $20 billion in not-for-profit healthcare debt in 2012, an increase of 213% from the $6.4 billion downgraded in 2011, and the highest amount of downgraded debt in one year in the sector since the rating agency began tracking the metric in 1995.

The $20 billion in downgraded debt was more than double the year's $9.7 billion of upgraded debt, according to the rating agency report, "US Not-For-Profit Healthcare Rating Activity in 2012 Sets Record for Downgraded Debt."

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