The investment rating firm Moody's isn't optimistic about Piedmont Healthcare's future after it acquired the hospital formerly known as Athens Regional Medical Center.

Ratings firms said last week that $406 million in bonds Piedmont recently sold are a safe investment (giving them an Aa3 or AA- rating), but Moody’s downgraded the Atlanta-based hospital chain’s future outlook to “negative,” raising more questions about ARMC’s decision to become a Piedmont subsidiary. While hospitals across the country are consolidating to become more efficient and gain leverage in reimbursement negotiations with health insurance companies—and Piedmont has been gobbling up hospitals successfully for years—Moody’s thinks Piedmont may have gone too far.

“Management has demonstrated a core competency in integrating smaller, distressed hospitals into the system as it expands its footprint through mergers,” analysts wrote. “The revision of the outlook to negative reflects a material increase in debt associated with this issuance that will weaken debt service coverage and leverage metrics. Furthermore, the newly merged entity, Athens Regional Medical Center, only shows a recent history of stable operations and represents a sizable addition to Piedmont. Athens is not located in the Atlanta metro area, presenting additional challenges to successfully integrate operations and gain synergies.”

Noting that another ratings agency, Standard & Poor’s, continues to view Piedmont’s outlook as stable, company spokesman Matt Gove dismissed Moody’s concerns as simply a difference of opinion. “Every ratings agency is going to have its take on where we are whenever we do these issuances, but it won’t have any effect on our ability to issue these bonds or operate successfully,” he said.

Last week’s bond sale included $176 million in bonds issued through the Clarke County Hospital Authority to finance the acquisition of ARMC, now called Piedmont Athens Regional. As part of the deal—which was finalized Oct. 1—Piedmont agreed to take on ARMC’s $195 million in debt and spend $375 million on capital improvements over the next seven years. Piedmont is also selling bonds to expand its hospitals in Atlanta and Fayetteville.

“I don’t know exactly what the funds will be used for, but it is part of our overall commitment to Athens Regional,” Gove said. 

Rest Easy, UnitedHealthcare Customers: The Piedmont deal also fueled speculation that Piedmont Athens Regional (that’s gonna take some getting used to) would no longer accept UnitedHealthcare. ARMC accepted its plans, but Piedmont stopped taking them earlier this year because of a dispute over reimbursement rates, and hospital officials declined to comment until the merger closed.

Anyway, it’s a moot point now. Gove also reported that Piedmont has reached an agreement with UHC.