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Mark Ryberg is physician workforce practice leader at SullivanCotter.

Federal officials are giving more scrutiny to the financial arrangements between hospitals and health systems and their employed and contracted physicians.

Mitigating increased compliance risk through effective governance | 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

Since “The Pitt” debuted earlier this year, the series has emerged as a big hit with critics and audiences.

The series received 13 nominations for Emmy Awards earlier this week. The drama has also become one of the three most-watched HBO Max titles ever, the 

“The Pitt” depicts life in an emergency room at a fictional Pittsburgh hospital, and some scenes were filmed at Allegheny General Hospital in Pittsburgh. Doctors and nurses have advised the producers, and the show has succeeded in accurately depicting a busy emergency department in a big city, says Dan Laurent, senior vice president of corporate communications at Highmark Health.

“I think they're getting it absolutely right,” Laurent tells Chief Healthcare Executive®.

‘The Pitt’ scores 13 Emmy nominations, and a Pittsburgh hospital played a key role

Laurent says he’s especially encouraged that doctors and nurses have praised the realism of the series in media coverage of the show.

“Those urban trauma center ERs are very busy places, and can seem sort of chaotic at times. But there’s structure behind that chaos, and those teams are incredible in how they manage to triage the patients coming in and really perform heroic work, and saving lives in the midst of all of that chaos. It's really impressive,” Laurent says. 

(See more on making "The Pitt" in this video. The story continues below.)

The producers worked with Allegheny General Hospital to accurately depict a hospital

Making 'The Pitt' and getting it right

When the producers requested permission to shoot some scenes at Allegheny General, they said they wanted to present an honest and accurate look at a trauma center. Laurent says that was critical in Highmark, Allegheny General’s parent organization, agreeing to participate.

“I think they delivered on everything that they promised us in those initial conversations,” he says. “And so we were extremely gratified that it really did turn out how they had portrayed it in their minds and really delivered on the product.”

Doctors and nurses have heaped praise on the drama.

Dr. Nicholas Cozzi, director of emergency medical services at Rush University Medical Center in Chicago, wrote in 

 in April that watching the show is “cathartic,” in both its accuracy of the emergency department and the toll on clinicians.

“The show offers audiences a raw glimpse into a health care system on the brink,” Cozzi wrote. “It shines a light on complex, urgent issues—hospital boarding, limited resources, and the mounting toll of trauma and mass casualty events—that affect both patients and the people working tirelessly to save them.”

Several doctors and the nursing director in Allegheny General’s emergency department worked with the production team before shooting to ensure details in the scripts were accurate, Laurent says.

Most of the series is filmed in Los Angeles, but the producers came to Allegheny General for three long days to shoot a host of scenes.

During filming of a scene at Allegheny General involving the arrival of a patient who had an overdose, Laurent says one of the hospital’s emergency department physicians was on the set the whole time to advise on how such a patient would be treated “to make sure they got it right.”

“They've been incredibly meticulous in putting this program together,” Laurent says. “So I have to give a lot of credit to the production team and to Warner Brothers. They're getting it right because they're doing it right. They're engaging with the clinicians who provide care in a setting to make sure that that the language they're using is accurate and the care that they're providing is accurate.”

The series shines a spotlight on the doctors and nurses who work in emergency departments, their dedication, and the strain that comes with those jobs.

“There's no question, it's hard work,” Laurent says. “It's hard work in any clinical setting these days, let alone an emergency department where anything and everything comes through those doors. These caregivers not only have to have the expertise, but the stamina and the compassion to get through their day and do such great things for these patients.”

The HBO Max series received 13 nominations and enjoys a big audience. Healthcare leaders say the show's producers consulted clinicians to ensure authenticity.

Topic

How ‘The Pitt’ delivers a realistic view of a hospital: ‘They’re doing it right’

Fewer hospital mergers and acquisitions are taking place this year.

There were only eight reported hospital deals in the second quarter of the year, according to 

 by Kaufman Hall, the healthcare consulting firm. It represents a slight uptick over the first quarter, when only five transactions were announced.

So far this year, hospital merger activity trails the previous year. There have been only 13 deals in the first six months of the year, compared to 

 in the first half of 2024, according to data from Kaufman Hall. The eight transactions announced in the second quarter lags the 11 deals reported in the second quarter of 2024.

The number of hospital deals is well below the level seen a year ago.

Hospital merger activity slows in first half of 2025

The size of the deals taking place also falls short of transactions seen a year ago. In the second quarter, there were no “mega mergers,” or transactions where the smaller organization’s annual revenue surpassed $1 billion.

The average size of deals in the second quarter was $175 million, well below the year-end average of $984 million in 2024, which was the highest in years. The total transacted revenue in the second quarter was $1.4 billion, according to Kaufman Hall.

At the beginning of the year, hospital industry analysts said 

they expected to see a healthy number of mergers and acquisitions in 2025

. Some analysts expected to see more opportunities for mergers with some seeing strategic opportunities, and other systems in distress looking for a partner to ensure their long-term viability.

But with only 13 hospital mergers announced so far this year, it seems likely that the number of deals won’t match or surpass 

they see the potential for a reduction in hospital mergers this year

, coupled with changes in federal policy. Hospitals have also braced for higher supply costs due to tariffs put in place by the Trump administration, since many key supplies arrive from other countries.

denounced the tax package for cutting spending on Medicaid

, which they said could lead to more hospitals reducing services or shutting their doors.

Hospitals may be more cautious about mergers in the coming months, Mark Pascaris, senior director and analytic lead for nonprofit healthcare at Fitch Ratings, told Chief Healthcare Executive® in an interview in April.

“I think you're going to see plenty of health systems say, ‘There's a lot of uncertainty out there. We need to put the brakes on.’ That is absolutely a conversation,” Pascaris said.

Analysts say it’s possible that there could be a healthy amount of merger activity, due to some hospitals in especially dire circumstances needing to join with another health system to stay afloat.

Even with the slowdown of activity, some noteworthy hospital mergers and acquisitions have occurred in recent months.

Beacon Health System has completed its acquisition of four Ascension hospitals in Michigan

. Beacon and Ascension announced a definitive agreement in April and completed the deal this month.

Ascension has been divesting some of its hospitals in recent years, but the Catholic health system also recently announced an agreement to acquire AMSURG and its 250 ambulatory surgery centers. With the deal, Ascension is looking to offer more healthcare options for patients without a hospital stay.

The Tri-Health system in Cincinnati has reached an agreement to acquire Clinton Memorial Hospital

, a 140-bed hospital in Wilmington, Ohio. 

 has reached a letter of intent to acquire MercyOne Siouxland Medical Center, a 464-bed hospital based in Sioux City, Iowa.

Baptist Memorial Health Care, a non-profit system based in Memphis, and Arkansas Methodist Medical Center 

Deals picked up a bit in the second quarter, Kaufman Hall says. But the number of transactions in the first six months of the year trails the number of mergers seen in the first half of 2024.

Hospital mergers have dropped in the first half of the year

Hospital trade groups condemned the Senate tax bill, and now they made a desperate push for at least some changes before the legislation goes to President Trump.

Senate narrowly signed off on the tax package Tuesday

, and hospitals have said it was even more problematic than 

. The Senate was deadlocked 50-50, with three Republicans voting against it, and Vice President Vance casting the decisive vote. Hospitals hoped the Senate would offer some relief, but 

they contend the Senate took a bad proposal from the House and made it worse

They warn that millions of vulnerable Americans will lose Medicaid coverage, and some communities may lose hospital services. The House signed off on the package Thursday, sending it to President Trump.

Chip Kahn, president and CEO of the Federation of American Hospitals, tells Chief Healthcare Executive® that the legislation’s cuts to Medicaid and impact on hospitals isn’t being overstated.

“These reductions are totally unprecedented,” Kahn says.

“There's no question there'll be some closures,” he says. “And maybe even worse, because it could be much broader spread. There's going to be reassessment and services will have to be narrowed.”

Hospitals called it both a moral failure and a body blow to many struggling hospitals, and they warned that 

some hospitals would have to cut services and some may not survive

Hospitals cited the 11.8 million Americans that are projected to lose Medicaid coverage in the next decade, according to 

estimates from the Congressional Budget Office

. Another five million could lose coverage under the Affordable Care Act, as subsidies supporting coverage are slated to expire at the end of the year.

Critics warned that more people without insurance will end up in emergency rooms, and hospitals would face more cost pressures treating people with no ability to pay.

The American Hospital Association blasted the package for cutting Medicaid by nearly $1 trillion, calling it the biggest reduction to the program ever proposed by Congress.

Rick Pollack, president and CEO of the American Hospital Association, urged the House to make some changes in the final legislation. He said in a statement that the package “will result in irreparable harm to our health care system, reducing access to care for all Americans and severely undermining the ability of hospitals and health systems to care for our most vulnerable patients.”

“It will force hospitals to make service line reductions and staff reductions, resulting in longer waiting times in emergency departments and for other essential services, and could ultimately lead to facility closures, especially in rural and underserved areas,” Pollack said.

The measure also includes work requirements for some healthy Americans to receive Medicaid benefits, and some would have co-pays. The legislation would also put limits on state provider taxes, which states have used to bring in more federal Medicaid dollars.

Sister Mary Haddad, president and CEO of the 

Catholic Health Association of the United States

, denounced lawmakers for approving a package that she said would have “devastating impact” to those most in need.

“It is shameful that Congress has once again prioritized the interests of the wealthy over the needs of millions of vulnerable Americans,” Haddad said in a statement.

“This bill inflicts deep harm on essential community health and social safety-net programs, threatening the survival of rural hospitals and long-term care facilities,” Haddad said. “It places additional financial strain on already overburdened health care providers and state budgets.”

Hospitals have repeatedly voiced concerns about the impact of the package on rural hospitals, since 

about half of all hospitals in rural areas are losing money

The Senate inserted a $50 billion fund to support rural hospitals in the final package. The funds would be distributed over a five-year period. Hospital leaders said that they appreciated some recognition of the needs of rural hospitals, but they said that fund likely wouldn’t have much impact.

“I think it's a band-aid,” Kahn says. “It's limited in scope, and it's limited in time, and the damage done by this legislation to rural hospitals will be something that extends over the entire life of the law.”

“Frankly, I know of hospitals in rural areas that will be losing millions of dollars of revenue due to these cuts, and their share of any kind of program is going to be a few hundred thousand dollars,” he added.

Healthcare leaders have said they are alarmed at the prospect of millions of Medicaid recipients losing coverage, and expect many of those patients are going to show up in emergency rooms.

But hospitals have also sought to convince lawmakers that the impact of cuts would affect many Americans who don’t rely on Medicaid. If local hospitals shut down or cut services like labor and delivery, then the impact is far wider than those who need Medicaid.

“I think there's a domino effect that will take place here,” Kahn says. “It goes way beyond Medicaid. And it's not simply a question of the services or obviously, whether a hospital keeps their doors open or not. It’s going to affect the ability of hospitals to treat other patients.”

Hospitals are going to lose more money, and costs for other patients could rise, he said.

“That's going to have to be made up by the payments from other patients, because hospitals have to make up the slack to provide the care that's expected,” Kahn says.

Cuts threaten ‘survival of hospitals’

Statewide hospital groups said the tax reform package would reduce access to care and place more pressure on hospitals.

The Virginia Hospital & Healthcare Association said the state’s hospitals would lose more than $2 billion annually and said Medicaid cuts “jeopardize the stability and survival of hospitals.”

“It is likely that several hospitals, including those serving rural parts of Virginia, could end up closing in that scenario. Others may have to cut services or reduce employment, which would limit patient access to care,” the association said in a statement.

, president and CEO of the Hospital + Healthsystem Association of Pennsylvania, said the bill will “destabilize Pennsylvania hospitals and communities. This legislation puts health care access, jobs, and economic competitiveness in jeopardy, especially in our rural communities.”

“More than half of the commonwealth’s acute care hospitals are operating in the red because payments already do not reflect the actual cost of providing care,” Stallings said in a statement. “They cannot absorb a cut of this magnitude, and some will have no choice but to reduce services or close.”

Some House Republicans have expressed some unease with the scope of the Medicaid cuts in the Senate bill. The House passed its version of the tax bill by only one vote last month.

President Trump said he wanted the legislation finished by July 4. Kahn hoped for the chance to reduce some of the pain in the final package.

“We’re obviously trying to turn that around because of the impact this is going to have on coverage and care,” Kahn says.

(Note: This story was updated to reflect the House of Representatives passing the tax bill on July 3.)

The Senate signed off on a tax package that hospitals adamantly opposed, saying it would leave millions without Medicaid coverage. Hospitals say it would do significant damage.


Hospitals say Medicaid cuts are 'totally unprecedented'

The Changing Landscape of ASC's

Ransomware groups have consistently tried to break into hospitals’ networks, and they aren’t just eyeing big health systems.

Increasingly, cyberattackers are going after smaller hospitals, industry leaders say. Ransomware groups are going after rural hospitals, federally qualified health centers, clinics, and other facilities with modest resources. The Health Sector Coordinating Council’s Cybersecurity Working Group outlined some of those threats in 

 sent to the White House and the U.S. Department of Health & Human Services.

Jennifer Stoll, the chief external affairs officer of OCHIN, a collaborative of hundreds of safety net organizations, said more rural hospitals and federally qualified health centers are suffering breaches.

“We're the least funded section of the delivery system, and we are the most vulnerable when it comes to cybersecurity,” Stoll tells Chief Healthcare Executive®.

“Everybody needs a lot of money to be able to support the cybersecurity infrastructure, because we are really facing a national crisis, which is a war against our healthcare providers every day, with bad actors domestically, but mostly abroad. And we just don't have the resources,” she says.

What it’s like to negotiate with ransomware gangs

Hundreds of healthcare organizations have suffered breaches in recent years. 

In 2024, there were 592 breaches of health data

, and 259 million Americans were affected, according to John Riggi, national advisor for cybersecurity and risk with the American Hospital Association. Three out of four Americans were impacted by a breach of private health information last year.

Rural hospitals recognize that they are vulnerable to cyberattacks, but most don’t have the money or manpower to invest in strong defenses, says Jim Roeder, the vice president of information technology of Lakewood Health System, which operates a critical access hospital and several primary care clinics in Minnesota. He served as co-leader of the task force that produced the report on cyberattacks and smaller systems.

For smaller providers, Roeder says, “We could have a couple million dollars for cybersecurity, or we can get that CT machine that we need to bring in more revenue and keep the doors open. And so that's the constant battle that we face from our budget, when we have to go to the board.”

Cybersecurity panel: How hospitals can protect their patients and their systems

At first blush, a small, 25-bed hospital in a rural community wouldn’t seem like it would be worth the time for a cyberattacker. But analysts say there are reasons why ransomware gangs would go after a rural hospital or a federally qualified health center.

First, even a small organization still has a great deal of private health information, which is very valuable to bad actors. And that’s also true of clinics and health centers serving neighborhoods where many have low incomes.

“Just because they're low resource communities doesn't mean that it's not great data to be able to hijack or steal,” Ochin says.

“Even if you're dealing with low income and underserved or rural communities, you know, it still creates havoc, and it still allows them to have a very powerful weapon, with lots of things that they can do for nefarious purposes,” she adds.

Federally qualified health centers aren’t being spared, she says.

“They have just as many breaches. They really do,” Ochin says.

Retired Army General Paul Nakasone, the former leader of the U.S. Cyber Command, warned of 

the growing risk of cyberattacks aimed at rural providers

 at the HIMSS Global Health Conference & Exhibition in March.

“These rural hospitals have limited funds, have limited capabilities, and they are often the target of ransomware actors,” Nakasone said.

Plus, ransomware groups know smaller hospitals are more likely to have less imposing defenses, so they reason they could get a payday with relatively low effort, experts say.

are exposed to breaches involving many of the vendors they utilize

 for all sorts of business functions. Leaders of smaller hospitals are increasingly frustrated by the risks of attacks tied to vendors, and they are left wondering whether those vendors are staying up to date with software patches to address vulnerabilities. And smaller systems don’t have the staff to do some of the leg work to be sure vendors are doing what they should be doing.

In the cybersecurity report, Roeder says some hospital leaders expressed frustration that they have to take on all the risk involving vendors properly updating their systems. They want vendors to take more responsibility.

“If they want these devices to be put into healthcare systems, they have to be willing to patch them, support them, make sure they stay secure,” Roeder says.

Rural hospitals and health centers typically may have one person focused on cybersecurity, and sometimes even that individual is juggling other responsibilities.

many hospitals struggle to find talented cybersecurity pros

, it’s especially difficult for rural hospitals.

Roeder says it’s difficult to “find people that have the knowledge that want to work in healthcare in a rural area.”

Some hospitals and health systems have allowed cybersecurity staff to work remotely, which helps to a degree, he says. But that’s a bit of a double-edged sword, because cybersecurity pros living in rural areas don’t necessarily have to work at the local hospital.

“It kind of hurt us, because these people with that knowledge all of a sudden can work for bigger companies elsewhere, too,” he says.

Hospital cybersecurity leaders have stressed that breaches have costs beyond the bottom line and even reputational damage. 

Cyberattacks threaten the safety of patients

, particularly when attacks succeed in knocking electronic health records offline and disrupting vital systems.

“Cybersecurity for one is cyber security for all, and it's also patient safety,” Stoll says.

Cybersecurity leaders are also talking more about 

, because an attack at one hospital can force patients to be transferred to other facilities.

But the risks to patient safety may be magnified at smaller hospitals, particularly those in rural areas. In plenty of rural areas across the country, a small, community access hospital may be the only hospital within an hour or more.

If an attack happened at Lakewood Health in Minnesota, Roeder says patients may have to go to another facility that may be an hour or two away.

“We got to try and hope they have room for these patients,” Roeder says. “And you know, we have two ambulances. How do you get them there? How do you transport them there in a timely manner?”

Providers with modest resources are being attacked. Healthcare leaders say breaches at smaller hospitals and clinics can have a serious impact.

Mark Ryberg

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