Moody’s Investors Service added to Envision Healthcare’s financial woes by downgrading the outpatient surgery and physician staffing company’s debt on Wednesday.

“The ratings downgrade reflects Moody’s view that Envision’s capital structure is unsustainable, that the probability of a bankruptcy or major restructuring is high and that recovery rates for much of the company’s debt will be low,” a Moody’s report says. Envision declined to comment.

The credit rating entity assigned a “C” rating, the lowest among non-investment-grade bonds that’s typically applied to debts in default with little prospect for recovery on interest and principal balances. In its report, Moody’s referenced declining profitability, weak liquidity and an expected poor operating performance due to labor costs and rising interest rates.

Nashville, Tenn.-based Envision Healthcare, which generates approximately $7 billion in annual revenue, provides emergency services and physician outsourcing and operates more than 250 ambulatory surgery centers in 34 states. Private equity firm KKR acquired Envision for nearly $10 billion in 2018.

Analysts project Envision could go into default within the next couple of years, said Jaime Johnson, senior healthcare analyst at Moody’s.

Envision has restructured some of its debt by issuing new agreements via subsidiary AmSurg and extending maturity dates, which has improved short-term liquidity, but the restructuring did not eliminate any debt, Johnson said. “It’s pretty clear to us that they’re going to run out of money at some point,” she said.

Envision has struggled throughout the pandemic including net losses during the first half of this year. The company continues to battle with UnitedHealth Group over claims following the insurer’s decision to remove Envision from its network last year. The No Surprises Act will also deal a blow to earnings, and Envision has recently come under fire for profiting off emergency department patients with unexpectedly high bills.