During the first quarter of 2013 Moody's Investors Service downgraded six ratings in the not-for-profit healthcare sector and upgraded three ratings, detailed in the report "U.S. Not-For-Profit Healthcare Quarterly Ratings: Small Hospitals Dominate Downgrades in First Quarter 2013." Five of the six downgraded ratings were on smaller hospitals with less than $500 million in revenues.

"Almost all rating downgrades were small-sized providers, continuing a trend we have seen for several years. Small hospitals are unable to absorb the reimbursement pressures facing the industry," says Lisa Goldstein, Associate Managing Director. "Two of the three upgraded providers have over $500 million in revenues and all demonstrated multiple years of improved financial performance reflecting growing volume trends and dominant local market positions."

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