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Racial bias can be found in the description of patients in electronic health records, raising the potential for disparities in health outcomes, a new study indicates.

 on Jan. 19, found Black patients were more than twice as likely to have at least one negative description in the records.

Researchers from the University of Chicago examined 40,113 records from 18,459 patients between January 2019 and October 2020.

“​​Our findings raise concerns about stigmatizing language in the EHR and its potential to exacerbate racial and ethnic health care disparities,” the study said.

Additionally, patients with Medicaid and Medicare were more likely to have negative descriptors in their records compared to those with private insurance. Unmarried patients also had greater odds of negative descriptors compared to patients who were married.

More attention has been paid to inequity in health care among minority groups, particularly in the wake of the COVID-19 pandemic. National surveys have indicated Black patients said they have experienced discrimination in healthcare.

But the study notes that there hasn’t been much research on bias in clinical settings. The study noted stigmatizing terms such as “frequent flyer” or “sickler” are commonly used by healthcare professionals.

Researchers examined records from a large academic medical center in Chicago. The study included all patients with a history and at least one physical note in their electronic records. Roughly 60% of the patients were Black, while about 30% were white, 6% were Hispanic or Latino and the rest were categorized as “other.”

Black patients had 2.54 times the odds of having a negative descriptor, the researchers found. The most commonly used terms were “refused,” “agitated,” or descriptions indicating the patients were not compliant.

“Our findings are especially alarming because we limited our evaluation of negative descriptors to the history and physical notes of patient EHRs,” the study stated. The authors explain that the medical history and notes are frequently referenced by other care providers, so negative descriptors can be copied into notes from other providers. So it’s important for the initial patient evaluation to be done thoughtfully, the authors wrote.

“Subsequent providers may read, be affected by, and perpetuate the negative descriptors, reinforcing stigma to other health care teams,” the authors stated.

The study period includes the first several months of the COVID-19 pandemic. The researchers noted that records of patients who were treated after the pandemic began were less likely to have negative descriptors.

The authors suggested the rise of the pandemic and the increasing focus on social justice in the wake of the killing of George Floyd may have led to more empathy and sensitivity from providers for members of minority groups.

Medical institutions must work with their clinicians on understanding implicit bias and racial bias, the researchers said. For example, a clinician who describes a Black man as “aggressive” may be revealing his own inherent bias, but that descriptor can stay in the patient’s record and could influence the perceptions of other healthcare providers, even if they don’t have tendencies toward racial bias.

Healthcare providers need to train their staff on bias and the importance of using language with sensitivity in professional communications, including patient records.

Since healthcare organizations will share more electronic records in the future, it's crucial that patient descriptions don’t reflect racial bias, or other biases that could have an impact on their perception and even their treatment.

There’s another pressing reason to be more thoughtful about the language used by providers: patients can get access to their health records, including the notes. Providers should strive to ensure medical records are fully professional and without bias to avoid eroding the trust of patients and even potential lawsuits.

The study points to the need for greater emphasis on professional language standards in medical communications. Researchers suggested bodies such as the Accreditation Council for Graduate Medical Education should develop more specific recommendations on standards to be used in records.

The study also noted that expressions of bias are often symptoms of burnout, and many health professionals have struggled with burnout during the pandemic. Healthcare providers must address factors that contribute to burnout, the researchers said.

If healthcare providers tell their employees to change their behavior without addressing the stress they are experiencing, it could inadvertently compound burnout and expressions of bias, the authors stated.

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Black patients were more likely to have negative descriptions. The authors suggest bias in records could exacerbate inequities in healthcare.

Racial bias seen in electronic health records, study finds

Two years into the COVID-19 pandemic, healthcare leaders have repeatedly said they are concerned about burnout among doctors and nurses.

However, there are other members of the healthcare workforce, such as nurse assistants, therapists, and food and custodial staff, among others, who need more attention. Many of those workers are members of minority groups.

A new Rutgers University study of Black and Latinx healthcare workers underscores the stress, fear and confusion they have experienced in the pandemic.

Zorimar Rivera-Núñez, an assistant professor at Rutgers School of Public Health, said in an interview some members of the healthcare workforce have been marginalized for some time.

“Healthcare leaders should start paying attention and offer more resources,” Rivera-Núñez said.

Healthcare workers are making clear they need better pay and more support, she said.

“We want to retain them, moving forward,” she said. “We can see how many have left the workforce. We have to find ways to retain them and offer them the emotional and mental support that they need.”

The Rutgers researchers interviewed 17 Black and Latinx women who work in support positions in healthcare. They worked in hospitals, nursing homes and home care sites.

Some of the workers said they struggled with having to work additional hours and, particularly earlier in the pandemic, a lack of personal protective equipment.

The study found that COVID-19 testing of some workers was inconsistent. Some were regularly tested, while others said they were tested sporadically.

Workers also had another fear about testing positive for COVID-19: losing time at work and losing money.

‘They wanted to get tested,” Rivera-Núñez said. “If they tested positive, some feared they’d lose their job or their salary for that week.”

Some of the workers surveyed said they had some reluctance to discuss possible exposures to COVID-19 for fear of missing work and not getting paid. Some also were worried about being ostracized from fellow employees.

“It creates weird dynamics with co-workers,” Rivera-Núñez said.

Some Black and Latinx workers struggled with vaccine hesitancy and were concerned about side effects, researchers found. Some workers eventually became more comfortable with the vaccine as they saw their co-workers get the shots and did additional research.

Members of minority communities often have a mistrust of the medical establishment, which some healthcare leaders acknowledge is well-earned, Rivera-Núñez noted.

Some of that mistrust dates back decades to the notorious Tuskegee study of syphilis, where Black individuals weren't provided treatments and didn’t have the chance to give informed consent. Healthcare leaders said some mistrust continues today, with minority patients saying they weren’t given all treatment options or their concerns were dismissed.

Even for members of minority groups who work in the healthcare field, the skepticism of the medical community persists for some.

“It’s a real and fair struggle,” Rivera-Núñez said. “The history is there for us to see it and to learn from it.”

Some of the healthcare workers in the study said they struggled to cope with the changing nature of their jobs during the pandemic. Some would have to take on new responsibilities and said they received little training for their new duties.

For some home healthcare workers, the pandemic posed steep challenges. Some workers who typically visited patients in person on a regular basis were now seeing them remotely. They also had to instruct patients on the technology for virtual visits.

The study underscores the need to offer a better, more supportive work environment for healthcare workers in support roles.

Rivera-Núñez said it’s important to understand nursing assistants, therapists and others in support roles should be considered healthcare heroes.

“They have to be there every day for healthcare settings to work and function every day,” she said.

The study participants were interviewed between December 2020 and February 2021. The 

A new study highlighted the challenges for those working in supportive healthcare roles. Those workers need more support, the lead author says. 

How COVID-19 has affected Black and Latinx healthcare workers

With the U.S. Supreme Court upholding a vaccine mandate for healthcare workers, most hospitals and providers must ensure their workers get the COVID-19 shots.

The federal government has offered new guidance in the wake of 

 on Jan. 13. The court ruled the government can compel providers receiving federal funds to vaccinate their workers.

Under the Biden administration’s order, hospitals and healthcare providers that receive money from Medicare and Medicaid are required to have their workers vaccinated. There are limited medical and religious exemptions.

Here’s a breakdown on what’s happening.

What’s the latest guidance from the federal government?

The Centers for Medicare & Medicaid Services have now set out a COVID-19 vaccine schedule for 24 states affected by the ruling. 

A schedule has yet to be set for Texas, which was not a part of the Supreme Court case. A federal court dismissed a lawsuit over the order in Texas Wednesday, 

 reported. So the vaccine mandate will be enforced nationwide.

CMS has set a vaccination schedule for these 24 states: Alabama, Alaska, Arizona, Arkansas, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Utah, West Virginia and Wyoming.

Healthcare providers in these states must ensure workers have had at least one COVID-19 vaccine dose by Feb. 14. They must be fully vaccinated by March 15.

Does this change the deadline for any other states?

No. The federal government is sticking by its vaccination deadlines previously established 

. Healthcare employees in those states must get their first vaccine dose by Jan. 27 and must be fully vaccinated by Feb. 28.

Those deadlines apply in the following states: California, Colorado, Connecticut, Delaware, Florida, Hawaii, Illinois, Maine, Maryland, Massachusetts, Michigan, Nevada, New Jersey, New Mexico, New York, Minnesota, North Carolina, Oregon, Rhode Island, Tennessee, Pennsylvania, Vermont, Virginia, Washington state, and Wisconsin.

Washington, D.C. and other U.S. territories are also subject to these deadlines.

Healthcare providers will be determined to be compliant by the deadlines if they have all of their workers vaccinated, or have been granted a qualifying exemption.

For the first dose deadlines, providers won’t face any penalties if they have ensured at least 80% of the staff have had a first dose and the facility has a plan to reach 100% within 60 days.

For the deadlines for full vaccination, 100% of workers must have completed both doses, unless the facility has some who have been granted exemptions or there has been some other delay, such as a lack of vaccine. 

Again, there is some latitude for those falling short but moving in the right direction. Providers won't face additional enforcement action if they have had 90% of their workers fully vaccinated and have a plan to reach full vaccination within 30 days.

For nursing homes, home health agencies and hospice providers, the penalties could include fines, denial of payment for new admissions and ultimately, ending participation in the Medicare and Medicaid agreement. The penalties will depend on the lack of compliance and the type of facility.

For hospitals and other acute care providers, the CMS said the sole enforcement remedy is ending participation in Medicare and Medicaid, a crucial lifeline for providers.

The agency has made clear it intends to work with providers to bring them into compliance, particularly those showing good faith efforts toward compliance.

“Termination would generally occur only after providing a facility with an opportunity to make corrections and come into compliance,” CMS said.

The American Hospital Association has been urging all healthcare workers to get vaccinated. Rick Pollack, the AHA's president, said the association “will work with the hospital field to find ways to comply that balances that requirement with the need to retain a sufficient workforce to meet the needs of their patients.”

He added he hoped the government will “continue to work closely with us to ensure that compliance is measured in a thoughtful and careful way that recognizes current circumstances.”

More than 2,500 hospitals - 40% of the nation's hospitals - have imposed a vaccine requirement, the White House has said. 

Some organizations held off on vaccine requirements until the Supreme Court ruling. The 

 said Friday it is now requiring its healthcare workers to be vaccinated. HCA Healthcare also said it will comply with the order and added 90% of the system's workers are vaccinated or have been approved for an exemption.

"Given the recent Supreme Court ruling, we will implement, in accordance with the CMS mandate rules, the requirement to vaccinate our healthcare workers who are covered by this policy, unless they qualify for an exemption," HCA said in a statement. "If we do not comply with the CMS mandate, we could compromise our ability to serve our communities and provide care to patients under the Medicare and Medicaid programs."

The American Health Care Association, which represents thousands of nursing homes and long-term care facilities, has expressed concerns that it will make it harder to retain workers, already a daunting problem in the pandemic. The association said 83% of nursing home staff are fully vaccinated and long-term care providers have been urging staff to get the shots, said Mark Parkinson, president and CEO of the ACHA.

“When we are in the midst of another COVID surge, caregivers in vaccine hesitant communities may walk off the job because of this policy, further threatening access to care for thousands of our nation's seniors,” he said in a statement. “We continue to ask that CMS and state surveyors show leniency during this critical time as well as consider a regular testing option for unvaccinated staff members to prevent worsening staff shortages.”

The U.S. Supreme Court’s ruling allows the government to require most healthcare workers to get vaccinated. Here’s a look at the deadlines and federal guidance in the wake of the ruling.

The vaccine mandate for healthcare workers: Questions and answers

Medical groups are looking to Washington for more support in dealing with COVID-19, but the group’s priorities for the next year go beyond the pandemic.

The Medical Group Management Association outlined its top issues for 2022.

Anders Gilberg, senior vice president of the MGMA, said medical groups are looking to see some of the regulatory flexibility allowed under the COVID-19 public health emergency to be made permanent.

The Biden administration just extended the public health emergency for another 90 days. The emergency allows greater flexibility for everything from telehealth to vaccines.

“As we move into the third calendar year of the pandemic, it is critical to integrate the regulatory flexibilities afforded by the PHE into permanent policies that provide better patient access and red tape relief,” Gilbert said in a statement. 

“Zooming out from the pandemic, the broader issue of physician payment reform looms over medical groups with cuts to Medicare reimbursement slated for as early as April.”

MGMA outlined some key issues in the year ahead.

What the healthcare industry can expect from Washington in 2022

The association is seeking reimbursement for expenses related to COVID-19, support for practices that are hurting financially, access to personal protective equipment and continued regulatory flexibility. The MGMA also would like to see streamlined reporting requirements.

The public health emergency allowed some temporary access to expand telehealth, but healthcare advocates would like 

. It’s a top priority for MGMA as well. 

“MGMA believes these flexibilities should extend past the expiration of the COVID-19 public health emergency to allow practices to continue providing safe, cost-effective, virtual care to vulnerable patient populations,” the group said.

The MGMA is looking for reimbursement rates that “cover the cost of delivering care to patients,” and said the rates should also be adjusted to keep pace with inflation. 

In December, Congress and President Joe Biden agreed to delay cuts to Medicare, but a 1% reduction takes place in April. Medicare is slated to see a 2% reduction in July. Biden signed off on a one-year increase in the Medicare physician payment schedule of 3% for 2022. Healthcare advocates are pushing for more funding for Medicare and better payments for physicians.

Medical groups are pushing to move away from fee-for-service models and pushing more toward value-based care. The association says Washington should encourage more alternate payment models (also dubbed APMs). 

Alternative payment models “must be designed to offer participants appropriate support, incentives, reimbursement, and flexibility,” MGMA says. “We encourage Medicare and the industry as a whole to launch new voluntary APMs in order to expand participation opportunities for group practices of all specialties.”

Medical groups continue to call for relief in prior authorization, the process of determining if payers will cover certain drugs or treatments. Doctors and medical groups say the prior authorization process consumes too much time and delays patient care. 

 found 81% of respondents said prior authorization burdens have increased during the COVID-19 pandemic. The MGMA is also seeking more standardization in other administrative procedures.

Healthcare advocacy groups, including the MGMA, are calling on Congress and the Biden administration to take more steps to boost the physician workforce. Advocates say the nation was dealing with a physician shortage before the start of the pandemic.

The Medical Group Management Association outlines its priorities for the year ahead.

What medical groups want to see in 2022

Healthcare leaders may be wondering what they can expect from Washington in terms of funds or regulation, but analysts say it’s clear COVID-19 will remain at the top of the agenda throughout 2022.

The pandemic heads the list of issues to watch in terms of legislation and regulation. The Biden administration and lawmakers have their own goals and strategies for addressing the pandemic.

Here’s a roundup of what the healthcare industry should be watching for out of Washington.

The rapid spread of the Omicron variant has triggered pandemic peaks in new cases and hospitalizations nationwide. The pandemic is clearly going to remain the top priority and advocates for healthcare will be looking to Congress and President Joe Biden’s administration for more help, said Lisa Kidder Hrobsky, the American Hospital Association’s senior vice president for legislative and political affairs.

“Our top priority is advancing help to hospitals that need it right now,” she said.

Some hospitals are still waiting for money from relief packages that have been approved.

With hospitals overwhelmed with COVID-19 patients and many systems delaying non-urgent surgeries, analysts expect lawmakers are going to consider new legislation to provide more aid to healthcare providers.

If there is another COVID-19 relief package, Hrobsky said the bulk of the work would need to be done by the spring. By late summer, lawmakers will recess and then focus on the elections in November.

Hrobsky also said there will be a push to build up the healthcare workforce in the wake of the pandemic. She said lawmakers in both parties understand the need to attract more doctors and there is support for more aid for graduate medical education.

The Biden administration’s “Build Back Better” recovery plan offered big boosts for hospitals and the healthcare industry. But the prospects for Build Back Better are hazy at best.

In late December, U.S. Sen. Joe Manchin, a West Virginia Democrat, said he couldn’t support the package and has reiterated his problems with the package. The White House says it will continue talks with Manchin.

With the Senate divided 50-50, Biden can’t afford to lose any Democratic votes if he wants to see the package get to his desk.

The U.S. House of Representatives approved a $1.75 trillion package in November. The package included provisions to lower prescription drug prices, invest in public health infrastructure and would also offer more funding for graduate medical education. It’s unclear if it can get through the Senate.

For now, Congress has been focused heavily on the Voting Rights Act, noted Yvette Fontenot, a partner of Avenue Solutions, a lobbying firm.

“The hope is they will be able to turn to Build Back Better once they complete consideration of the Voting Rights Act,” Fontenot said in a Jan. 14 forum sponsored by the Alliance for Health Policy.

Analysts say the healthcare provisions in the Build Back Better package generally have strong bipartisan support, so they aren’t the elements holding up the bill.

If the bigger package can’t move, it’s possible lawmakers could focus on legislation focusing on the healthcare measures, since they are more popular with lawmakers. But the expectation is the administration will keep pushing for the Build Back Better plan.

Congress still hasn’t passed a budget for the 2022 fiscal year, and the federal government runs out of money next month.

In December, Biden signed a short-term spending plan to finance government programs through Feb. 18. At the time, some hoped that would be the last stop-gap measure and lawmakers and the White House could come together on a budget for the fiscal year.

Fontenot said she was skeptical lawmakers would be able to get a comprehensive 2022 spending plan done in a month. She expected Congress to do another short-term spending bill, a measure that could fund the government for another couple of months, and then try and focus on a budget for the fiscal year.

Lawmakers have proposed spending increases for health programs in 2022. Some have speculated if a bigger budget proves to be too elusive, lawmakers could opt for measures funding government programs at current levels through the rest of the fiscal year, which ends in September.

However, some analysts said lawmakers on the appropriations committees will be anxious to set some spending priorities while they can.

The Biden administration has proposed funding increases for the National Institutes of Health, the federal government’s primary source of funds for medical research.

Biden has also proposed the creation of a new agency called the Advanced Research Projects Agency for Health, or ARPA-H. This agency would be focused on cutting edge research with potential for major breakthroughs.

Funding for NIH remains a bipartisan priority, said Jennifer B. Alton, president of the Pathway Policy Group, a lobbying firm focused on biotechnology and public health. Alton said there’s also strong support for ARPA-H. A bipartisan bill that would pump billions into research - the 

 - would authorize the creation of the new agency.

The federal government eased restrictions on telehealth in the pandemic, allowing more people to access care via video or phone than ever before. Healthcare advocates have urged Congress and the Biden administration to 

“There is a really good possibility that some of these telehealth provisions will be permanent,” said Hrobsky of the AMA.

Lawmakers have shown interest in improving the nation’s protections against future pandemics, Alton said. She said some lawmakers are anxious to pass measures to boost domestic production of vaccines and other healthcare supplies.

“There’s concerns about our overseas reliance on products that we need,” Alton said.

In September, the Biden administration released its pandemic preparedness plan. The plan would spend $65 billion over 10 years to strengthen public health systems.

“Pandemic preparedness is one area where there can be bipartisanship,” Alton said.

With the federal government declaring COVID-19 a public health emergency, healthcare providers have received waivers for some services, such as telehealth and home healthcare. On Friday, the White House announced it was extending the public health emergency for another 90 days. The latest extension took effect Sunday, 

Some analysts expect the Biden administration to extend the COVID-19 public health emergency through 2022.

On Jan. 1, the “No Surprises Act” took effect. It’s a new federal law designed to protect customers from getting bills for medical services they didn’t expect if they are treated in an emergency department. The bill has been hailed as a win for consumers, but 

 over certain provisions. They contend the resolution process for billing disputes is unfairly tilted toward insurers.

Katie Keith, director of Georgetown University’s Health Policy and the Law Initiative, said the law will merit attention.

“We need to keep a close eye on how the actual implementation goes,” she said. “There are still going to be questions of enforcement.”

The Biden administration has focused on improving health outcomes among minority and underserved communities. Analysts said the administration is examining all healthcare efforts with an eye on health equity. The White House has directed more funding toward 

diversifying the nation’s pool of doctors and nurses

. The administration has also focused on maternal mortality.

That focus on health equity will continue, said Cindy Mann, a partner of the Manatt Health consulting firm.

“Expect activity around social drivers of health and equity,” Mann said.

Look for a push for more COVID-19 relief for hospitals, more aid for medical research and pandemic preparedness.

What healthcare leaders should expect from Washington in 2022

Looking to practice medicine in the northeast? You’ll have lots of company.

But in some states, physicians in some minority groups may feel a bit lonely.

Every two years, the Association of American Medical Colleges compiles a report looking at the doctors practicing in every state. The AAMC’s 2021 State Physician Workforce Data Report breaks down the states in a number of categories, including age, gender, and race, among others. 

With much attention focused on adding more diversity to the nation’s pool of doctors, the report shows interesting data about minority representation among physicians in the states. In three states, fewer than 1% of doctors identify as Black.

Women account for 36.7% of the nation's doctors. But in a few states, only about a quarter of the doctors are women.

Nationally, about one in four of the nation’s practicing doctors (24.7%) graduated from an international medical school.

The report looks at which states are faring best in keeping doctors after they finish their medical training. And the report shows the five states with the most active doctors per capita are all in the northeast. 

Here’s a look at the top states in a host of different categories. The figures will offer the top five and bottom five in each category, along with the state median. The figures reflect 2020 data. (For more data on each state, check out the 

The Association of American Medical Colleges’ latest study on the physician workforce sheds light on the doctors practicing in each state.

These states have the most women doctors, the most international graduates and more

The healthcare industry witnessed a sharp drop in mergers and acquisitions in 2021, and the COVID-19 pandemic played a big factor.

 identified 49 announced healthcare transactions in 2021, down from 79 the previous year. There were fewer mergers and acquisitions in healthcare than at any point in the past decade, according to the report.

“You could attribute a pretty significant portion to the pandemic,” said Anu Singh, managing director at Kaufman Hall.

While there were fewer mergers, there was a higher percentage of large transactions, according to the Kaufman Hall report. Eight transactions were “mega mergers” where the smaller partner had more than $1 billion in annual revenue.

Some analysts project that healthcare systems will engage in more mergers and acquisitions in 2022. At the very least, analysts said there should be more discussions, even if deals don’t get finalized until 2023. Healthcare systems are still dealing with an overwhelming number of COVID-19 patients along with serious staffing shortages.

In a changing landscape, providers have to deliver healthcare in ways that are more convenient for the consumer. Some hospitals and providers may need to find partners to meet those needs, analysts said.

Richard Bayman, senior vice president and managing director of H2C Securities Inc., an investment banking firm that offers strategy on mergers and acquisitions, said he projects more mergers will take place in 2022.

“We do believe it’s going to pick up,” he said.

With healthcare organizations grappling with the worst pandemic in more than a century, executives have been in crisis management for two years. That leaves much less time for long-term strategy, analysts said.

“You have the switch from strategic thinking to tactical thinking,” Bayman said.

In addition to dealing with COVID-19 patients, hospitals have been scrambling to address a shortage of healthcare workers, particularly nurses. “Labor is a giant issue,” Bayman said.

For some leaders, it wasn’t just a lack of time.

“It’s not just resources and people's attention that were redeployed,” Singh said. “It’s that we couldn’t even launch a lot of strategic initiatives to say, ‘What do we want to look like at the other end of this?’”

Hospitals received billions in federal relief aid during the pandemic, helping systems stay afloat and removing some financial pressure that often drives mergers. In addition, healthcare systems have been able to take advantage of extremely low borrowing rates. With more money available, at least temporarily, hospitals felt less urgency to find new partners, analysts said.

Beyond the pandemic, some larger systems are being more selective in choosing partnerships. In the past, healthcare systems aggressively moved to expand their geographic footprint by acquiring more hospitals, Bayman said.

Today, healthcare organizations, particularly for-profit systems, are looking at markets where they can be significant players and aren’t simply looking to add as many sites as possible to their corporate maps.

“The dots on the map strategy didn’t work,” Bayman said. “You have to be relevant in your market.

“It's a much more strategic viewpoint from the buyer’s side of things.”

Analysts also note that given the amount of consolidations in the industry that have taken place, there aren’t as many suitors.

“There’s just fewer buyers,” Bayman said.

Analysts do expect more mergers and acquisitions in the year ahead.

“We’ll see more activity than we did,” Singh said.

H2C Securities is having more conversations about transactions now than six months ago, Bayman said.

“People are going to have to figure out how to do more with less,” Bayman said. “Some will say they can’t generate enough cash from operations to support all the investments I need.”

At the very least, analysts expect more conversations that could lead to new partnerships, even if the deals aren’t finalized before the end of 2022.

Some of the activity will go beyond healthcare organizations acquiring more hospitals. Singh projected there will be different types of mergers. 

More hospitals and healthcare systems will be merging with specialty providers, such as those focused on outpatient services, telehealth services and home healthcare, he projected.

“All alternative sites of care are going to be of interest,” Singh said.

More consumers are demonstrating they want options such as outpatient care or services that will allow them to see doctors at home, either virtually or with in-person home visits. Healthcare organizations are going to have to offer more robust options outside of hospital settings, Singh said.

Bayman also projected there would be more mergers between hospital systems and outpatient services.

“It’s becoming more important, those non-acute, non-in-patient services,” he said. “A lot of times, hospitals don't manage those businesses well because they are different than running a hospital.”

While the coronavirus has suppressed merger activity, Bayman said the pandemic is eventually going to drive more transactions.

Hospitals have already received billions in aid from the government. The CARES Act funds buoyed providers but some systems aren’t going to be able to ignore their precarious financial position much longer.

Hospitals and healthcare systems have also received billions in loans from the Medicare program as part of the federal relief effort, and many providers must repay the loans this year, Bayman noted.

“Our overarching belief is that activity is going to accelerate and the pandemic is the underlying accelerant,” Bayman said. “You’re not going to have the artificial support that kept everyone up over the last two years.”

Mergers and acquisitions fell to the lowest point in a decade. There should be more discussions in the months ahead.