The rating on Rhode Island Health and Educational Facilities Building Corp.'s revenue bonds, issued for Roger Williams General Hospital (RWGH), reflects: Weakened operating performance in the past two fiscal years, Managed care pressures, and An increasingly competitive and consolidating service area. Positive credit factors include improving utilization trends and a strong liquidity position. The negative outlook reflects a declining revenue base and continuing pressure on operating performance. The bonds are secured by the hospital's gross revenue pledge. Beginning 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% caused a 12.9% decline in net patient revenues to $84,971. As a result, RWGH ended
