Moody's Investors Service last week downgraded one Indiana health care bond rating and confirmed twelve others in a review of health care ratings in Indiana.

Moody's lowered to Ba from A the rating on $5.86 million of debt sold by Bedford Medical Center, citing the institution's "weak cash position, marginal financial performance, above-average debt position and possible additional borrowing," according to a press release.

The rating agency said that "inherent vulnerabilities" associated with the hospital's small size are also a concern.

Officials from Bedford Medical Center did not return phone calls.

Moody's confirmed the ratings on a total of about $603 million of debt belonging to Elkhart General Hospital, La Porte Hospital, Lafayette Home Hospital, Lutheran Hospital of Indiana, Marion County Health and Hospitals Corp., Memorial Hospital and Health Center, The Methodist Hospitals, Methodist Hospital of Indiana, Parkview Memorial Hospital, Riverview Hospital, St. Anthony's Medical Center, and St. Joseph Hospital and Health Center.

Moody's said that the rating confirmations reflect general operating stability due to "modest managed care pressures, favorable market positions for most providers, and historically favorable Medicaid reimbursement levels."

But the rating agency said that it expects competition to heat up in many areas of the state in anticipation of an increase in managed care systems, which accumulate pools of consumers and negotiate health care rates with doctors and other health care providers.

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