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Chief Healthcare Executive

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Mergers & Acquisitions

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Mark Williams is chief revenue officer of the Americas at Datasite.

Innovation, strategic thinking, and a favorable regulatory environment should drive more deals.



Healthcare M&A outlook: A promising landscape for 2025 | Viewpoint

Financial distress, value-based care, and digital healthcare services are some of the forces driving deals.

Healthcare M&A is poised to rise in the second half of 2024 | Viewpoint

By 2050, it's estimated that 139 million people worldwide will have dementia, but by today's standards, 60% will be undiagnosed. It's clear that there's a significant gap in dementia detection and care, but what can your organization do about it?

Get perspectives from clinical leaders and neuroscience experts about the underlying causes and consequences of these gaps, practical opportunities to address them, and a proven roadmap that shows how leading health systems have successfully transformed their dementia screening and care processes.

Closing the Dementia Care Gap: Expert Insights and Proven Strategies for Health Systems

By many measures, this year’s flu season is emerging as the worst in years.

Hospitals report packed emergency departments with patients with the flu, and federal data indicate the most severe flu season in 15 years.

The Centers for Disease Control & Prevention

 reported that 31% of flu tests were positive last week. Nearly 8% of patients visiting doctors offices and outpatient facilities were for respiratory illnesses, and flu-like symptoms, the highest level since 2009.

The CDC estimates that there have been at least 310,000 hospitalizations due to the flu, with 13,000 deaths. More than 48,000 Americans were admitted to hospitals over the past week. 

 for patients with influenza are “very high,” the CDC says.

At least 24 million Americans have become ill with the flu, the CDC reports. Nationwide, 

 have “high” or “very high” levels of flu activity, according to the CDC.

Ericka Hayes, MD, senior medical director of infection prevention at Children's Hospital of Philadelphia, says positive tests for the flu are the highest in the last 10 years of flu seasons. She says 57% of those tested last week were positive.

Some of those being admitted to the hospital include patients who were vaccinated.

“The influenza vaccine match was not the best,” Hayes tells Chief Healthcare Executive®. “I will also say the uptake of influenza vaccine in the first place this year was lower than in years past as well. So we are seeing patients who get sick enough to be hospitalized despite having an influenza vaccination, which is unusual.”

Still, Hayes says the vaccines offer some protection against developing more severe illness, and she says there’s value in getting vaccinated, even later in the flu season.

“I still think there is protection offered again, for having potentially less severe disease with vaccination. So I think that's important to remember,” Hayes says.

Ohio reported a 90% increase in flu cases over the last week, the Ohio Hospital Association reports.

Cincinnati Children’s says the number of positive flu cases more than doubled since last week, rising from 402 to 896. Doctors at Cincinnati Children’s warn of long waits in emergency departments for issues that aren’t life threatening, and are urging parents to take children to primary care doctors if their kids have the flu or flu-like symptoms.

Children’s Hospital Los Angeles reported the positive rate for children tested for influenza is 17.5%, compared to 2.6% the same time last year.

Flu cases are also higher than usual at Seattle Children’s.

“Seattle Children’s is currently seeing high levels of influenza and levels are higher than that seen last year,” a spokesperson for the pediatric system said in an email.

Also in Washington state, MultiCare’s hospitals in the Puget Sound are at or over capacity, 

In Michigan, Corewell Health is seeing high volume due to patients with the flu, COVID-19, and respiratory syncytial virus (RSV), the 

 reports. "That's wreaking a lot of havoc," Dr. Charles Gibson, chief medical officer of Corewell Health West, told the Free Press.

The flu season is peaking later than usual, but Hayes says it may be some time before there’s a drop in numbers.

“There are some years where the flu is really tapering down by February,” she says. “I've got to say, this year, we're not, we're not coming down. I can't say that we're headed downward yet. And again, I suspect, given how robustly it's come up, it's not like it's going to drop quickly. So I suspect we may still have, you know, several weeks of significant influenza activity.”

In addition to getting the vaccine for those who haven’t already, Hayes stresses the importance of thorough hand washing as a prevention step. She also suggests considering masks when in closed quarters, including public transportation, as another step.

Some areas are also seeing an uptick in patients with norovirus, which is highly contagious. Hayes issued a warning for those with norovirus to stay home, given how easily it spreads.

She also issued a special warning for healthcare workers who may have norovirus to be especially mindful to stay home and not bring it into their facilities.

“Healthcare workers with GI symptoms, it's absolutely critical that they stay home, because it can rip through units so quickly, affecting both staff and patients,” Hayes says.

Federal and state health officials report more positive tests and hospitalizations than in previous years, and some facilities are packed with patients.

Topic

Hospitals wrestling with worst flu season in years

President Donald Trump is returning to the White House, and that is likely to have a big impact on hospitals and health systems.

Hospitals are pressing Trump to preserve key funding for Medicare and other important priorities. But perhaps the biggest source of anxiety lies over the Medicaid program, which enables Americans with lower incomes to access healthcare.

Medicaid also provides important funds to hospitals, particularly those with a higher percentage of patients with lower incomes.

Moody's Ratings issued a report last week on trends to watch in 2025, and projected that hospitals should brace for cuts in Medicaid.

“The Trump administration offers the potential for material shifts in healthcare policy that would negatively affect not-for-profit and for-profit hospitals, particularly concerning Medicaid spending and subsidies for the insurance exchange marketplace,” the report stated.

“Hospitals could suffer from significant federal funding cuts and regulatory changes affecting Medicaid and state directed payments (SDP), which are administered by state Medicaid agencies but approved by the federal government,” Moody’s said. “A reduction in Medicaid or SDP funding would disproportionately impact hospitals in states that expanded Medicaid under the Affordable Care Act.”

What hospitals are seeking from Donald Trump and the new Congress

he doesn’t plan to try to abolish the Affordable Care Act

, as he did in his first term. He has said he’d look to improve it, although he hasn’t revealed specifics.

Noting that Trump is looking for places to reduce spending to finance tax cuts, it’s possible that Trump will look at cuts to Medicaid and the Affordable Care Act, Larry Levitt, executive vice president for health policy at KFF, wrote in a 

“Trump has said that Social Security and Medicare cuts are off the table, and defense reductions are unlikely as well,” Levitt wrote. “That means almost half of federal spending would be protected from cuts, leaving Medicaid, which is the next largest source of federal spending, and the ACA as prime targets for spending cuts. The math is inescapable.”

While Trump may not get rid of the Affordable Care Act, enhanced subsidies put in place by President Biden are slated to expire at the end of 2025. Republicans, who control both the House and Senate, could let that additional aid fade away.

Affordable Care Act enrollment rose to more than 21 million people in 2024, a record, and nearly double the 11 million people in 2020, 

But enrollment would almost certainly drop significantly without the additional aid from subsidies put in place by Biden in 2021, Levitt projected.

Nonprofit hospitals in particular could take a hit if the subsidies vanish, or are significantly diminished, Moody’s projected.

“Changes reducing or eliminating subsidies that help purchase insurance on the exchanges would likely lead to a rise in the uninsured or self-pay patients,” the Moody’s report said. “The increase would disproportionately impact not-for-profit hospitals that serve a large number of low-income and vulnerable populations.”

Lisa Kidder Hrobsky, senior vice president of federal relations, advocacy and political affairs for the American Hospital Association, says hospitals will push Congress to preserve the subsidies.

“We really are concerned and want to make certain that these subsidies to get insurance on the marketplaces continue,” Kidder Hrobsky says.

worried about the prospect of cuts for Medicaid

. Georges C. Benjamin, MD, executive director of the American Public Health Association, told Chief Healthcare Executive® in November that he’s concerned about Medicaid cuts.

“We know that there's been at least some verbalization on the campaign about reducing support for Medicaid, because their perspective of the Medicaid program is very different than my perspective of the Medicaid program, which is a comprehensive insurance program for people,” Benjamin said. “They see it as a program that needs to be limited in this cost. It actually saves taxpayers money.”

If hospitals see more patients without any healthcare coverage, then that’s going to affect their bottom line as they provide more uncompensated care.

“A higher uninsured rate stands to increase uncompensated care, curbing margins and straining resources, which could limit hospital investments in community health programs and facilities,” Moody’s said in its report.

Trump has also said he plans to expand the use of tariffs on some imported goods, which could affect hospitals and health systems. President Biden also imposed tariffs on certain medical supplies from China.

If the Trump administration imposes tariffs, it could add to cost pressures for hospitals, Moody’s Ratings said in its report.

“Increased tariffs on imported medical supplies, pharmaceuticals and equipment could lead to higher procurement costs. Hospitals, which operate on tight budgets, may struggle to absorb these additional expenses,” the Moody’s report stated.

Kevin Holloran, senior director of Fitch Ratings and head of the U.S. healthcare sector, said the imposition of more tariffs will add to financial pressures to hospitals. The tariffs by themselves aren’t damaging but they add to the other headwinds hospitals are facing.

“This will, at least over the near term, most likely result in higher prices for equipment and supplies for healthcare providers,” Holloran told Chief Healthcare Executive®.

Hospitals poised for better year in 2025, but system remains fragile

The second Trump administration promises to bring changes that will affect America’s hospitals, with concerns about Medicaid funding, ACA subsidies, and potential higher costs with tariffs. 

How Donald Trump’s return affects hospitals: Medicaid, the Affordable Care Act and tariffs

With the resurgence of powerful labor unions, 2024 saw two significant strikes: the Amazon workers' and the dockworkers' strikes. Both worried retailers that supply chains could experience delays, and prices could rise in 2025.

For retailers, this meant stocking up on the latest electronics so the shelves wouldn't be depleted during the vital holiday shopping season. That's preparation in the same way that if your restaurant specialized in Kobe beef, you would have a backup generator for refrigeration when the power went out. Or if you and your family were taking a long car trip, you'd want to ensure your AAA membership is still valid.

Organizations know supply chains can’t run without IT security software protecting mission-critical data. Hence, a priority is ensuring that procedures to mitigate risks are in place to protect critical operations and resources from attacks that could cause significant interruptions and the loss of vital information. That's also preparation.

Now, apply all this preparation thinking to the healthcare system. The words "critical" and "vital" truly live up to their meaning during a strike, when healthcare operations are strained and patient care is impacted.

All this wise preparedness—retailers stocking up on goods, restaurant generators, car service for road breakdowns, security software—is the same foresighted wisdom that healthcare providers must apply to their strategic thinking for a work stoppage.

The staffing agency becomes the operational safety net if a healthcare organization faces imminent threats to its function due to strikes or increased demand. In these cases, the staffing agency is not just a backup but more of a critical player whose purpose is to maintain operational readiness. 

For an agency to properly service healthcare needs, it must be adaptable, quick to respond, and excel at problem-solving. Having a reliable staffing agency on the team helps healthcare organizations realize that operations can continue without interruption—with expertise and professionalism. To provide this peace of mind, healthcare staffing agencies must ensure that:

Temporary workers are appropriately certified.

They can meet the need for specialized services.

In addition to the list above, a staffing agency must conduct constant collaboration and communication as standard operational procedures.

In healthcare, compliance means that staff must comply with certifications outlined by accredited organizations such as the

 Joint Commission for Healthcare Staffing Services

. An agency that provides staffing for healthcare organizations must ensure that all personnel meet clinical standards, are qualified, and behave professionally. It must also ensure its personnel files are current, including licensing, health documents, background checks, and drug screenings.

Inventiveness in healthcare means the staffing agency is ready to meet specific needs and excels at problem-solving. For example, in the healthcare sector, inventiveness could mean that the staffing agency is prepared to provide additional nursing personnel (RN, LPN, CNA, etc.) during a flu outbreak or provide security (strike line and video documentation, property protection, secured transportation of personnel, etc.) to ensure the safety of healthcare employees and the temporary staff during a strike.

In healthcare, respiratory therapists, surgical technicians, lab technicians, physical therapists, occupational therapists, radiology technicians, speech-language pathologists, phlebotomists, clinical supervisors, social workers, and registered dieticians require licensing to comply with standards. Therefore, a good staffing agency will only use licensed professionals.

If a strike occurs in the healthcare world, security becomes an issue. A good staffing agency will be ready to protect striking workers and temporary staff using video documentation, de-escalation techniques, and the latest robotic surveillance. The purpose is to ensure healthcare services continue and both sides have a calm environment for thoughtful negotiation.

A good staffing agency will not just be on call; it will be a vital member of the team. Collaboration means the agency will be involved with pre- and post-event planning and tabletop exercises. Mock drills to test the effectiveness of emergency response are crucial, and staffing strategies become necessary during peak demand for healthcare needs. Both kinds of preparedness require the agency to be on board for the lead-up and the follow-up.

Providing temporary staffing is not just about filling vacancies. Agencies are respected and vital for keeping healthcare services available to the communities they serve. When critical healthcare services are stressed, such as when disasters arise or epidemics break out, healthcare providers know that services can withstand the stress without compromising patient care.

Effective staffing agencies offer qualified personnel, provide strategic insights, and deliver best practices. A key to their effectiveness is their ability to help an organization identify problems before they happen with contingency planning. This proactive, unified stance ensures that healthcare problems will be identified before they escalate, making society feel secure, safe, and ready to handle any dangers to its functioning.

Trevor Fandale is the president of Huffmaster

In a crisis, when healthcare organizations face shortages or even stoppages, staffing agencies play an important role. 

Healthcare staffing’s vital and critical features | Viewpoint

For the first time, Robert F. Kennedy is going to face lawmakers as he looks to make the case to be the next U.S. Secretary of Health & Human Services.

The Senate Finance Committee has scheduled a hearing for Wed., Jan. 29 to consider Kennedy’s nomination. President Trump nominated Kennedy to lead the federal health agency and said Kennedy is the right choice to Make America Healthy Again.

Kennedy has been meeting with senators as he attempts to lock up the nomination.

Many healthcare leaders have denounced the choice of Kennedy

 to lead the nation’s health department, which includes the Centers for Medicare & Medicaid Services, the Centers for Disease Control & Prevention, the Food and Drug Administration, the National Institutes of Health, and other agencies.

Donald Trump’s first steps on healthcare

his many public criticisms of vaccines and his lack of experience

Dr. Georges C. Benjamin, executive director of the American Public Health Association, told Chief Healthcare Executive® in November that he opposes the nomination of Kennedy to lead the health department.

“We do not believe that Mr. Kennedy is qualified to be HHS secretary, and do not believe that he should have that job under any circumstances,” Benjamin said.

The Committee to Protect Health Care, an advocacy group for physicians, 

 opposing Kennedy’s confirmation. More than 22,000 have signed it.

U.S. Rep. Kim Schrier, a Democrat from Washington state and a pediatrician, appeared at a 

 with other elected officials opposing Kennedy’s nomination. Schrier said she has fielded more questions from parents asking about the safety of vaccines and has had to correct misinformation about vaccines.

“Sowing needless doubt in the minds of parents and the citizens of this country should disqualify Robert Kennedy Jr. from this job,” Schrier said at the press conference earlier this month. “Make no mistake: stoking vaccine hesitancy will lead to deaths.”

Hawaii Gov. Josh Green, MD, an emergency physician, appeared at the press conference to speak out against the confirmation of Kennedy.

Green accused Kennedy of sowing doubt about measles vaccines in Samoa in 2019. Two deaths due to vaccines were attributed to human error, when clinicians put the wrong re-agent in the vaccines, Green said. Kennedy visited Samoa and criticized the use of vaccines, which Green said contributed to a “crash” in immunizations and a measles outbreak. Green went to Samoa with other doctors to help with vaccinations, which he said helped curb the outbreak.

But Green said he worries that Kennedy could do lasting damage leading the health department.

The health department’s secretary “has to believe in science, has to take these absurd biases away,” Green said. “Otherwise, you will be condemning America's children to disease and fatalities, and we healthcare providers will have to do all we can to clean up after that disaster.”

Republicans hold the Senate majority, and Kennedy has received support from GOP lawmakers. Kennedy's backers cite his focus on chronic diseases and raising awareness of the dangers of processed foods. 

Sen. Lindsey Graham, R-South Carolina, said he was impressed when he met with Kennedy last month.

“Bobby was thoughtful in his answers and sincere in his desire to work with President @realDonaldTrump and all members of Congress to make America a healthier place to live,” Graham 

 on X. “He has clearly done his homework when it comes to the state of American health.”

Kennedy has engendered opposition from some conservatives who say he isn’t fully committed to opposing abortion. Former Vice President Mike Pence, who served under Trump, has publicly come out against Kennedy’s nomination.

“I believe the nomination of RFK Jr. to serve as Secretary of HHS is an abrupt departure from the pro-life record of our administration and should be deeply concerning to millions of Pro-Life Americans who have supported the Republican Party and our nominees for decades,” Pence 

It’s worth noting that only the Senate will vote on Kennedy’s confirmation. The full Congress doesn’t vote on Cabinet nominations.

Four physicians, all Republicans, serve in the U.S. Senate: U.S. Sens. Roger Marshall (R-Kan.); Bill Cassidy (R-La.); Rand Paul (R-Ky.); and John Barrasso (R-Wyoming).

Paul has publicly backed Kennedy. After Trump announced the nomination of Kennedy, Paul wrote on X: “Get ready for health care freedom and MAHA!” (MAHA is an acronym touted by Kennedy: “Make America Healthy Again.”)

Cassidy, who is chairman of the Senate Health, Education, Labor and Pensions Committee, said he met with Kennedy earlier this month. His committee will also hold a hearing on Kennedy’s nomination.

 on X Jan. 8, Cassidy wrote, “Had a frank conversation with HHS nominee @RobertKennedyJr. We spoke about vaccines at length. Looking forward to the hearings in HELP and Finance.”

Two former health secretaries have lambasted the choice of Kennedy.

Donna Shalala, who led HHS under President Clinton’s administration, 

 on X that Trump’s nomination of Kennedy was “shocking.”

“Kennedy is an unqualified, know nothing,” Shalala wrote. “He is dangerous to the health and well being of every American.”

Kathleen Sebelius, who led the U.S. Health Department under President Obama, 

 that the prospect of Kennedy leading the agency “is absolutely terrifying and people should understand how serious it is.”

In an interview with MSNBC, Kennedy said he wasn’t going to get rid of vaccines.

“I’m not going to take away anybody’s vaccines,” Kennedy said. “If vaccines are working for someone, I’m not going to take them away.”

Green said he worries that Kennedy, if confirmed, will discourage millions of Americans who are skeptical from being vaccinated.

“Millions of millions of people who are on the bubble … they will not get vaccinated, or they will delay,” Green said.

President Trump has chosen Kennedy to lead the U.S. Department of Health & Human Services. Many healthcare leaders oppose the pick and are urging the Senate to reject the nomination.

Robert F. Kennedy Jr., HHS nominee, faces first Senate hearing this week

More hospitals and health systems engaged in mergers and acquisitions in 2024, and many of those deals involved an organization in financial distress, according to a new 

There were 72 announced hospital mergers in 2024, up from 

 in 2023. For more perspective, there were 

53 hospital mergers and acquisitions in 2022

Nearly one in three hospital mergers (30.6%) involved a party in distress, which represents a record, according to Kaufman Hall, the healthcare consulting firm. In 2023, 27.7% of hospital deals involved a provider in financial distress, and that was a record, albeit a short-lived one.

Many of those distress-driven deals involved Steward Health Care, the for-profit firm that filed for bankruptcy and 

In addition, 2024 also witnessed a peak percentage of deals involving a health system divesting some of its hospitals, with some systems leaving certain markets. Many of those deals involved Steward facilities, but other systems shifted strategies. In 2024, Tenet Healthcare Corp. 

More than half (62.5%) of the hospital deals in 2024 involved divestitures, Kaufman Hall said.

Many hospitals continue to struggle financially in the wake of the COVID-19 pandemic, and the hospital mergers offered more evidence of the difficulties of some providers.

The percentage of deals involving the smaller party with a credit rating of “A-” or higher fell to an all-time low, Kaufman Hall said. Only 2.8% of the deals in 2024 involved a smaller party with a rating of at least “A-”, down from 12.3% in 2023.

In previous years, many deals involving hospitals in financial trouble have been smaller hospitals, but there are larger hospitals in distress seeking partners, Kaufman Hall notes. In 2024, the average size of a distressed hospital in a merger rose to $401 million, nearly double the figure just two years earlier ($219 million in 2022).

The past year has seen some large mergers, including mega-mergers where even the smaller party in the deal has more than $1 billion in revenue. 

Sanford Health and Marshfield Clinic Health System

 announced plans to come together last summer, and they completed their merger last week, creating a $10 billion system.

But Kaufman Hall says another trend is emerging, judging from the deals seen in 2024. More hospitals and systems are striking deals with much larger partners. Even some that aren’t exactly distressed are looking for larger systems to maintain their viability, Kaufman Hall notes.

Such deals include Northwell Health’s planned acquisition of Nuvance Health, 

. Northwell, New York’s largest health system, operates 21 hospitals. Nuvance owns seven hospitals, with four in Connecticut and three in New York. Nuvance has struggled with financial losses.

Risant Health, a subsidiary of Kaiser Permanente, 

, a North Carolina hospital system. The deal follows Risant’s purchase of the Geisinger health system in Pennsylvania.

Greg Adams, CEO of Kaiser Permanente, has said 

Many of the year’s transactions involved systems or hospitals on shaky ground. There were other noteworthy trends in mergers over the past year.

Mark Williams

Articles

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