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CLEVELAND, Ohio — At a time when some credit rating firms are turning a thumb’s down on the not-for-profit hospital industry, two rating firms are giving University Hospitals a thumb’s up.

High unemployment, consumer pessimism, weakened employer insurance coverage and record government budget deficits — not to mention financial markets that have only partly recovered from a worldwide meltdown in late 2008 — caused Moody’s Investors Service to keep its “negative” outlook for non-profit hospitals in 2010, according to its annual sector report.

In 2008, the troubled economy hurt profitability and utilization/enrollment for both hospitals and health insurers in much of Ohio, according to the recently released Ohio Health Market Review 2009 report by Allan Baumgarten, an independent health care market analyst in Minnesota.

In the Cleveland area alone, hospitals recorded a $154.3 million loss in 2008, which represented 1.7 percent of patient revenues of nearly $9 billion, Baumgarten reported. That was down from 2007 net income of $809.9 million, or 10.4 percent of patient revenues.

At the same time, Moody’s gave its A2 rating — meaning upper-medium grade and subject to low credit risk — to $150 million in bonds issued by University Hospitals (UH) in mid-January.

And in a Tuesday RatingsDirect report, credit rating firm Standard & Poor’s assigned its A rating to $97.7 million in bonds the health system is selling to refinance past variable-rate debt at a fixed rate. Standard & Poor’s also affirmed its A rating on the health systems’ other bonds, giving the ratings a “stable” outlook.

The A rating means UH “has strong capacity to meet its financial commitments but is somewhat more susceptible to the adverse effects of changes in circumstances and economic conditions than obligors in higher-rated categories,” such as AA or AAA, according to the ratings firm.

Standard & Poor’s also gives some other health systems in Greater Cleveland high marks: Cleveland Clinic got an AA- in July. That’s a step higher than UH’s rating. And MetroHealth got a BBB+ — a step lower — in December.

“Overall, Standard & Poor’s is impressed with University Hospitals’ growth and has expressed confidence in our ability to continue achieving our operational goals,” Thomas F. Zenty III, UH’s chief executive, said in a statement.

“Of special note is that we achieved these results while growing our community benefit to $210 million in 2008, enhancing our investment in our physicians and clinical system-wide institutes, maintaining and improving our employee benefit packages, and expanding our operations in Northeast Ohio,” Zenty said.

In July, University Hospitals sold about $100 million in tax-exempt revenue bonds to complete external financing for construction projects that are part of its $1.2 billion strategic plan, called Vision 2010. The bond money will help complete the UH Ahuja Medical Center in Beachwood, and the UH Cancer Hospital and Center for Emergency Medicine at UH Case Medical Center in Cleveland, among other projects.

In its report, Standard & Poor’s said the emergency medicine center construction was delayed a year because of safety and work-flow issues at UH’s main campus, so it won’t open until 2011. Ahuja and a cancer hospital being built at the main campus are 35 percent complete and slated to open next year, according the report.

Last year, the health system completed a neonatal intensive care unit at UH Rainbow Babies & Children’s Hospital in Cleveland and UH Concord Health Center, among other projects, as part of its strategic plan. The short-term bonds will be used to repay existing debt, the health system said.

The growth springs from an operational turnaround under Zenty, who arrived in 2003. A year later, University Hospitals reported its first operating profit in 11 years, thanks in part to Zenty’s decisions to cut jobs, close a money-losing hospital, sell a psychiatric facility and exit the health insurance business.

In early December, UH streamlined its clinical and non-clinical operations and brought in some new faces to lead continued growth during a period that Chief Operating Officer Dr. Achilles Demetriou said would bring unprecedented challenges to his industry.

Standard & Poor’s was positive on University Hospitals because in the first nine months of 2009 it had:

• A “good” operating margin of 4.8 percent, as well as 3.8 times the cash it needed to cover debt
• Stable patient utilization, with discharges up 0.5 percent
• Managers who focused on delivering quality health care at the same time they worked through a major capital spending program in a troubled economy

S&P didn’t like UH’s:

• Higher-than-average debt level
• Continued spending on Vision 2010 building, which could weaken the balance sheet
• Only 134 days’ worth of cash on hand

“The stable outlook reflects our opinion that UH management will continue to operate at the existing level,” S&P said in its report. “Although 2010 will be a challenge as more costs come online with the opening of facilities associated with Vision 2010, we expect that management will be able to meet its operating goal. And though Vision 2010 was over budget, management has adjusted its current routine capital to cover the shortfall in the budget.”

The credit ratings firm also threw in this caveat: “However, if fiscal 2010 operations or the balance sheet ratios are worse than expected, then an outlook or rating change is possible.”