JOHNSON CITY, Tenn. (WJHL) — Despite one of them describing the national nonprofit hospital system outlook as “deteriorating” last August, all three credit rating agencies have affirmed Ballad Health’s “A” rating.

The ratings are one indicator of financial stability, and better ratings make for more favorable lending terms. Ballad recently refinanced some of its debt and got permission to add $53 million of new debt for capital improvements at its hospitals.

A Ballad news release Wednesday said Fitch, Standard & Poor’s and Moody’s all affirmed the ratings. It cited a Standard & Poor’s report from January that twice as many health systems are being downgraded as are receiving upgrades.

Fitch and S&P both referenced the management team’s experience and Fitch noted the 2018 merger of Wellmont Health System and Mountain States Health Alliance to create Ballad “continues to mature and has resulted in a more streamlined approach to health care delivery in the service area, various cost efficiencies and improvements in quality.”

S&P pointed to management “making some difficult decisions around the need to consolidate services across the system, and to improve quality and performance, while maintaining access across the region.”

All three reports mentioned ongoing challenges for not-for-profit hospitals that have been hit nationwide with staffing shortages, supply cost inflation and quick wage growth.

“Ballad Health has remained focused on delivering high-quality care, reducing the cost of healthcare and being good stewards of our resources,” CEO Alan Levine said in the release.

“We are pleased all three agencies have cited our improved quality and lower cost of care, because it demonstrates our strategy of reducing unnecessary duplication, investing in needed services and using our scale and resources to expand access can work.”