Ascension sees progress in financial turnaround

After some trying years, Ascension is making headway in improving its financial performance.

The nonprofit Catholic health system said this week that it reported a strong fourth quarter of the 2026 fiscal year, with $1.5 billion in positive net income. Looking at a same-facility basis, net income improved by $826 million, or 141% year-over-year.

For the entire 2026 fiscal year, Ascension reported an operating loss of $120 million. The system reported a $491 million operating loss in 2025, so that represents an improvement of $371 million.

Eduardo Conrado, president and chief executive officer of Ascension, said the system is building a foundation to invest more in improving patient care.

“Three years ago, we set out to strengthen Ascension so we could better serve our patients and communities,” Conrado said in a statement. “Our results this year show the significant progress we have made. We have improved our financial performance, expanded access, advanced our clinical capabilities, and grown our ambulatory and community-based network.”

Shifting strategy

Ascension is reporting improved financial strength as the St. Louis-based system has made profound shifts in strategy in recent years.

Even though Ascension remains one of the largest nonprofit health systems in America, the organization has reduced its footprint and divested hospitals in some markets. The system has 118 hospitals, including 91 that are wholly owned and 27 joint venture hospitals.

But Ascension is also moving more into ambulatory care. This year, Ascension completed the $3.9 billion acquisition of AMSURG and its 300 ambulatory surgery centers. With the AMSURG acquisition, Ascension now has facilities in 36 states and Washington, D.C.

Saurabh Tripathi, the chief financial officer of Ascension, said during a panel discussion at the Healthcare Financial Management Association conference in June that the health system is pivoting to provide more care in the ambulatory setting.

“One thing we will never walk away from is our mission …. but we do want to take the care out of hospitals,” Tripathi said in the HFMA session.

Tripathi said more Americans are making it clear that they would prefer to get procedures done in an outpatient setting, so they can get home more quickly, rather than staying in the hospital. Ascension is moving in that direction to give them what they want, he said.

While Tripathi said at the HFMA conference that he was pleased to see the closure of the AMSURG acquisition, he said the hard work now begins.

“Making it successful is a whole other journey,” Tripathi said.

Acute care gains

Ascension’s hospitals reported improved revenues in the fourth quarter of 2026, the system said. Same facility revenue rose 9.8% compared to the final quarter of 2026. The system touted expanded service lines and community-based care as factors.

The system also reported a 6.8% reduction in the amount of time patients were staying in acute care hospitals. Ascension says the system is aiming to cut down the time patients are staying in patient beds unnecessarily, while still ensuring patients can be discharged safely.

Ascension says the results are a better patient experience, while freeing up beds for additional patients.

Work remains

Even with the gains Ascension is seeing, the system still saw an operating loss for the year.

In September 2025, Fitch Ratings downgraded Ascension’s bond ratings from “AA+” to “AA.” Fitch still retained a stable outlook for the health system, and noted that Ascension’s financial performance is improving, but said the gains were not sufficient to sustain the higher rating.

Still, Fitch notes that few health systems rival Ascension’s size and scale, and Ascension enjoys a strong presence in key markets such as Texas, Florida, Tennessee, and Indiana. Analysts also generally praised Ascension’s decision to divest facilities in certain markets.

And Fitch viewed the deal to acquire AMSURG as “a favorable opportunity to expand Ascension's ambulatory strategy and geographic reach.”