Standard & Poor's downgraded Temple University Health System's debt to speculative grade BB-plus from investment grade BBB-minus on Thursday.
The Philadelphia Hospital and Higher Education Facilities Authority is the conduit issuer of the system's bonds.
Fitch Ratings made the same downgrade in late May, saying it affected $524 million in debt.
"The downgrade reflects a weak overall financial profile, which offers little cushion to weather disruptions in volume, revenue, or progress related to the recent Fox Chase Cancer Center acquisition," said S&P credit analyst Charlene Butterfield.
S&P has a stable outlook on the rating. The outlook is due to the system's progress in physician recruitment, lowering length of stay, and increasing patient acuity.