Moody’s Investors Service has revised the outlook to negative from stable on Deborah Heart and Lung Center’s outstanding bonds issued by the New Jersey Health Care Facilities Financing Authority.

Moody’s affirmed the B1 rating on the $20.1 million of outstanding debt.

“The revision of the outlook to negative reflects the growing financial pressures that we believe may impair future financial performance, given DHLC’s high exposure to Medicare and concentration in cardiology services,” analysts said in a report.

If the medical center’s current financial levels are not maintained or there is a decline in liquidity, the rating could be downgraded in the next 12 to 18 months, Moody’s said.

The rating reflects the overall stability in financial performance over the past three years, following a longer-term history of larger losses and greater subsidies.

Moody’s said the credit profile of the center still remains a high-risk investment, given its small size, concentrated service array and reliance on fundraising.

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