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Envision Healthcare, the large chain of outpatient surgery centers and physician staffing services for hospitals, is on the cusp of bankruptcy and likely will run out of cash by the end of next year.

Moody’s Investors Service on Wednesday downgraded Envision’s debt to its lowest possible junk-level rating, one that indicates the debt is “typically in default, with little prospect for recovery of principal and interest.” Envision’s debt has been distressed since the pandemic started — concerning many lenders and investors — but now financial analysts are warning the health care firm is on borrowed time.

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