The rating on Rhode Island Health and Educational Facilities Building Corp.'s bonds, issued for Roger Williams General Hospital (RWGH), reflects weakening operating performance and an increasingly consolidating competitive service area, offset by improving utilization and a good liquidity position. The negative outlook reflects a decline in the revenue base and a continuing drop in operating performance. The bonds are secured by a gross revenue pledge of the hospital. Admissions and outpatient visits increased by 5.4% (7,600) and 1.2% (82,346), respectively, in fiscal 1998. However, in 1998 a 6% shift in the payor mix from Medicare to Medicare managed care plans and a decline in the case mix index to 1.25% from 1.35% in 1997 caused a 12.9% decline in net
