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What separates high- and low-performing hospitals in 2025
Hospital finances showed signs of improvement at the end of the second quarter, though notable performance gaps remain between higher- and lower-performing facilities, according to Kaufman Hall’s latest “National Hospital Flash Report,” published Aug. 11.
The median monthly operating margin index rose to 3.7% in June, up from 1.9% in May, though the pace of improvement remains uneven and somewhat unexpected amid recent market turbulence.
Hospitals in the Northeast and Mid-Atlantic reported the largest year-over-year increases in operating margins at 38%, followed by the South and Midwest at 29%. The West and Great Plains saw declines of 13% and 27%, respectively. Smaller and mid-size hospitals generally fared better than large facilities: hospitals with 26 to 299 beds saw margin gains between 17% and 30%, while those with more than 500 beds experienced a 29% decline.
“Higher performing hospitals are nimbler on both the revenue and expense sides,” Erik Swanson, managing director and data and analytics group leader at Kaufman Hall, said in a news release. “They may be expanding their outpatient footprint, diversifying services or managing expenses like purchased services by centralizing some functions. They are also more likely to have value-based care or bundled care arrangements in place.”
In 2025, top-performing hospitals are setting themselves apart from lower-performing facilities through a combination of strategic, operational and financial factors. According to Kaufman Hall and Fitch Ratings, the key differentiators include:
1. Strong market presence in growth regions: Hospitals located in expanding markets — especially in the South, Midwest and Northeast — are benefiting from rising demand, better payer mixes and stronger revenue potential. These organizations are leveraging local demographics and economic growth to drive performance.
2. Workforce recruitment and retention. Talent remains a key differentiator. High performers are more successful in hiring and retaining clinical and nonclinical staff amid national shortages, allowing them to maintain service capacity and quality care while controlling labor costs.
3. Aggressive payer strategy: Top-tier hospitals are skilled at negotiating favorable payer contracts, often using a “mind the gap” approach to keep reimbursement rates at the upper end of the scale. These hospitals maximize market leverage to drive revenue growth.
4. Operational agility: High-performing hospitals are nimble and can adjust quickly to changing conditions. They centralize purchased services, optimize supply chains and adapt care models to improve efficiency.
5. Investment in technology and infrastructure: Successful systems are proactively investing in AI, health IT and data analytics. These investments support care delivery and administrative efficiency and prepare hospitals for value-based care and alternative payment models.
6. Outpatient expansion and service diversification: Expanding outpatient footprints and diversifying service lines allow top hospitals to meet evolving patient demand and offset pressures on inpatient care, particularly in high-cost settings.
7. Proactive real estate and capital management. Strong performers are strategically managing real estate assets to bolster balance sheets and fund growth initiatives, such as facility modernization and digital transformation.
In contrast, lower-performing hospitals, often in rural or underserved regions, struggle with:
- Limited access to capital
- Declining patient volumes or poor payer mixes
- Severe staffing shortages
- High dependency on public reimbursement
- Little room for investment in innovation or infrastructure
Fitch warns that this divergence is becoming a “trifurcation” of hospital performance, with institutions separating into top-tier, middle-tier and lower-tier segments. Without strategic shifts, the financial gap may widen in the years ahead.
Top-performing hospitals will “have a predisposition to maximize that market essentially with annual payer negotiations, in a ‘mind the gap’ mentality that keeps them at the upper end of the payment scale,” Fitch said in a recent report.
Meanwhile, most hospitals are expected to remain in a middle band: operating sustainably but with limited margin growth and persistent staffing challenges. Those at the bottom of the scale face declining volume and payer mix issues and will likely need to rely heavily on outside cash to stabilize, according to Fitch.
The latest hospital financial reports indicate that 2025 performance gains are unevenly distributed, with the gap between top and bottom performers potentially widening as financial pressures persist.
How to Get a High Paying Contract Nursing Job
Contract nursing offers the chance to do meaningful work, gain diverse experience, and earn competitive pay. Whether you’re pursuing contract nursing jobs, per diem nursing positions, or rapid response assignments, the key to maximizing your income is preparation and strategy.
If you’re ready to secure a high-paying contract nursing job, use these proven tips to set yourself apart and negotiate pay that reflects your expertise.
Your resume is your first impression. A clear, polished resume highlights your skills, certifications, and professional accomplishments, and it determines whether you’ll be invited to interview.
Include:
- Your nursing specialties (such as ICU, emergency department, or medical imaging)
- Certifications (like ACLS, BLS, or specialty credentials)
- Details about your experience in different care settings, such as inpatient care, skilled nursing facilities, or acute care staffing
It’s normal to have employment gaps but be ready to confidently explain them during interviews. A well-organized resume positions you as a serious professional ready for high-paying nursing contracts.
Keeping your credentials updated makes you a more attractive candidate and can improve your earning potential.
Make sure to:
- Renew essential licenses and certifications promptly.
- Consider adding specialty certifications that are in demand for travel nursing jobs and contract assignments.
- Stay up to date with immunizations required by hospitals and clinics. Being ready with all documentation can speed up onboarding and help you access crisis response nursing jobs or urgent needs contracts that often pay premium rates.
The more prepared you are, the easier it is for a nurse staffing agency or recruiter to match you with higher-paying positions.
Professional references can be the deciding factor in landing a top-paying assignment.
Employers and recruiters rely on references to verify your:
- Clinical skills
- Professionalism
- Reliability
Choose references who can confidently speak to your work ethic and performance. Positive recommendations can open the door to flexible nursing shifts, per diem contracts, and specialized roles that pay more.
Flexibility is often rewarded in the world of contract nursing.
Consider these options to boost your pay:
- Accepting night shifts or weekends, which usually come with higher hourly rates.
- Taking assignments in locations experiencing shortages, such as rural facilities or emergency department nursing jobs.
- Being open to rapid response contracts or crisis response assignments, which often offer premium compensation.
When you demonstrate a willingness to adapt, you make yourself more valuable to medical staffing agencies and healthcare employers.
In contract nursing, your reputation follows you from one facility to the next. A strong track record makes it easier to secure higher-paying contracts and preferred assignments.
Tips for maintaining a great reputation:
- Be punctual and dependable.
- Communicate clearly with staffing agencies and supervisors.
- Go the extra mile to provide excellent patient care.
Facilities are willing to pay more to bring on nurses with proven reputations for excellence.
Being a contract nurse offers countless benefits, from career variety to premium pay. To make the most of your opportunities:
- Invest time in preparing a strong resume.
- Keep certifications and immunizations current.
- Maintain excellent references.
- Stay flexible with shifts and assignments.
- Build and protect your professional reputation.
When you combine preparation with dedication, you can consistently secure high-paying contract nursing jobs that match your skills and goals.
If you’re looking for your next opportunity, Staff Relief, Inc. is here to help. We partner with hospitals, clinics, and healthcare facilities to connect nurses with the best assignments in Georgia and beyond.
Contact us today to explore available contracts and start earning what you deserve.
Former nurse marks reaching 102 with advice to ‘stay active’
A former nurse, dubbed “inspirational” by care home staff, has celebrated her 102nd birthday with recommendations for a long, happy life.
Diana Creasey, who moved to Woodpeckers care home in the New Forest during 2023 when she was 100, shared her latest birthday with family, friends and staff.
“Stay active, keep going, follow a good diet and make sure to have lots and lots of fresh air”
Diana Creasey
Asked for the secret of her longevity, she said: “Stay active, keep going, follow a good diet and make sure to have lots and lots of fresh air. And a glass of sherry helps!”
Her advice follows a lifelong career in nursing and healthcare, both in paid roles and, following retirement, as a care volunteer for several years at Lymington’s Oakhaven hospice.
After growing up in North Devon in the 1920s and 30s, Ms Creasey trained as a nurse and worked in plastic surgery nursing during the Second World War.
Serving at London hospitals, she cared for many army personnel coming back from the horrors of the frontline.
One memory from of Blitz was nursing in an underground basement hospital with pregnant women on one side of the ward and casualties on the other. “It was a very stressful time,” she recalled.
Woodpeckers companionship team member Sian Harris said Ms Creasey remained very active, taking daily walks around the garden with the help of staff.
“She was an inspiration when she moved to Woodpeckers aged 100,” said Sian. “And she is still inspiring the staff and residents now aged 102.
“The very fact she is this remarkable age and still as active as she is makes her truly very special,” added Ms Harris.
Woodpeckers in Brockenhurst is run by care home provider Colten Care. It operates 21 care homes in Hampshire, Dorset, Wiltshire and West Sussex.
Hiring More Nurses Generates Revenue for Hospitals
Underfunding is driving an acute shortage of trained nurses in hospitals and care facilities in the United States. It is the worst such shortage in more than four decades. One estimate from the American Hospital Association puts the deficit north of one million. Meanwhile, a recent survey by recruitment specialist AMN Healthcare suggests that 900,000 more nurses will drop out of the workforce by 2027.
American nurses are quitting in droves, thanks to low pay and burnout as understaffing increases individual workload. This is bad news for patient outcomes. Nurses are estimated to have eight times more routine contact with patients than physicians. They shoulder the bulk of all responsibility in terms of diagnostic data collection, treatment plans, and clinical reporting. As a result, understaffing is linked to a slew of serious problems, among them increased wait times for patients in care, post-operative infections, readmission rates, and patient mortality—all of which are on the rise across the U.S.
Tackling this crisis is challenging because of how nursing services are reimbursed. Most hospitals operate a payment system where services are paid for separately. Physician services are billed as separate line items, making them a revenue generator for the hospitals that employ them. But under Medicare, nursing services are charged as part of a fixed room and board fee, meaning that hospitals charge the same fee regardless of how many nurses are employed in the patient’s care. In this model, nurses end up on the other side of hospitals’ balance sheets: a labor expense rather than a source of income.
For beleaguered administrators looking to sustain quality of care while minimizing costs (and maximizing profits), hiring and retaining nursing staff has arguably become something of a zero-sum game in the U.S.
But might the balance sheet in fact be skewed in some way? Could there be potential financial losses attached to nurse understaffing that administrators should factor into their hiring and remuneration decisions?
Research by Goizueta Professors Diwas KC and Donald Lee, as well as recent Goizueta PhD graduates Hao Ding 24PhD (Auburn University) and Sokol Tushe 23PhD (Muma College of Business), would suggest there are. Their new peer-reviewed publication* finds that increasing a single nurse’s workload by just one patient creates a 17% service slowdown for all other patients under that nurse’s care. Looking at the data another way, having one additional nurse on duty during the busiest shift (typically between 7am and 7pm) speeds up emergency department work and frees up capacity to treat more patients such that hospitals could be looking at a major increase in revenue. The researchers calculate that this productivity gain could equate to a net increase of $470,000 per 10,000 patient visits—and savings to the tune of $160,000 in lost earnings for the same number of patients as wait times are reduced.
“A lot of the debate around nursing in the U.S. has focused on the loss of quality in care, which is hugely important,” says Diwas KC.
But looking at the crisis through a productivity lens means we’re also able to understand the very real economic value that nurses bring too: the revenue increases that come with capacity gains.Diwas KC, Goizueta Foundation Term Professor of Information Systems & Operations Management
“Our findings challenge the predominant thinking around nursing as a cost,” adds Lee. “What we see is that investing in nursing staff more than pays for itself in downstream financial benefits for hospitals. It is effectively a win-win-win for patients, nurses, and healthcare providers.”
To get to these findings, the researchers analyzed a high-resolution dataset on patient flow through a large U.S. teaching hospital. They looked at the real-time workloads of physicians and nurses working in the emergency department between April 2018 and March 2019, factoring in variables such as patient demographics and severity of complaint or illness. Tracking patients from admission to triage and on to treatment, the researchers were able to tease out the impact that the number of nurses and physicians on duty had on patient throughput. Using a novel machine learning technique developed at Goizueta by Lee, they were able to identify the effect of increasing or reducing the workforce. The contrast between physicians and nursing staff is stark, says Tushe.
“When you have fewer nurses on duty, capacity and patient throughput drops by an order of magnitude—far, far more than when reducing the number of doctors. Our results show that for every additional patient the nurse is responsible for, service speed falls by 17%. That compares to just 1.4% if you add one patient to the workload of an attending physician. In other words, nurses’ impact on productivity in the emergency department is more than eight times greater.”
Adding an additional nurse to the workforce, on the other hand, increases capacity appreciably. And as more patients are treated faster, hospitals can expect a concomitant uptick in revenue, says KC.
“It’s well documented that cutting down wait time equates to more patients treated and more income. Previous research shows that reducing service time by 15 minutes per 30,000 patient visits translates to $1.4 million in extra revenue for a hospital.”
In our study, we calculate that staffing one additional nurse in the 7am to 7pm emergency department shift reduces wait time by 23 minutes, so hospitals could be looking at an increase of $2.33 million per year.Diwas KC
This far eclipses the costs associated with hiring one additional nurse, says Lee.
“According to 2022 U.S. Bureau of Labor Statistics, the average nursing salary in the U.S. is $83,000. Fringe benefits account for an additional 50% of the base salary. The total cost of adding one nurse during the 7am to 7pm shift is $310,000 (for 2.5 full-time employees). When you do the math, it is clear. The net hospital gain is $2 million for the hospital in our study. Or $470,000 per 10,000 patient visits.”
These findings should provide compelling food for thought both to healthcare administrators and U.S. policymakers. For too long, the latter have fixated on the upstream costs, without exploring the downstream benefits of nursing services, say the researchers. Their study, the first to quantify the economic value of nurses in the U.S., asks “better questions,” argues Tushe; exploiting newly available data and analytics to reveal incontrovertible financial benefits that attach to hiring—and compensating—more nurses in American hospitals.
We know that a lot of nurses are leaving the profession not just because of cuts and burnout, but also because of lower pay. We would say to administrators struggling to hire talented nurses to review current wage offers, because our analysis suggests that the economic surplus from hiring more nurses could be readily applied to retention pay rises also.Sokol Tushe 23PhD, Muma College of Business
For state-level decision makers, Lee has additional words of advice.
“In 2004, California mandated minimum nurse-to-patient ratios in hospitals. Since then, six more states have added some form of minimum ratio requirement. The evidence is that this has been beneficial to patient outcomes and nurse job satisfaction. Our research now adds an economic dimension to the list of benefits as well. Ipso facto, policymakers ought to consider wider adoption of minimum nurse-to-patient ratios.”
However, decision makers go about tackling the shortage of nurses in the U.S., they should go about it fast and soon, says KC.
“This is a healthcare crisis that is only set to become more acute in the near future. As our demographics shift and our population starts again out, demand for quality will increase. So too must the supply of care capacity. But what we are seeing is the nursing staffing situation in the U.S. moving in the opposite direction. All of this is manifesting in the emergency department. That’s where wait times are getting longer, mistakes are being made, and overworked nurses are quitting. It is creating a vicious cycle that needs to be broken.”
Goizueta faculty apply their expertise and knowledge to solving problems that society—and the world—face. Learn more about faculty research at Goizueta.
*Ding, Tushe, Kc, Lee: “Frontiers in Operations: Valuing nursing productivity in emergency departments.” Manufacturing & Service Operations Management 26:4:1323-1337 (2024)
Georgia could see the largest shortage of RNs by 2036
Staffing is one of the biggest issues facing ASCs. A 2023 survey from ORManager found that in the last 12 months, 56% of ASCs reported an increase in volume. Despite this success, 68% of facilities also reported having a more difficult time recruiting experienced operating room nurses.
“I think the biggest threat towards ASCs in 2023 is staffing, especially qualified, experienced staffing in all areas of an ASC, including business office, pre-op, OR (both nursing and surgical technicians), post-anesthesia care unit and recovery nurses. In addition, sterile processing technicians,” Michael Powers, administrator of Knoxville, Tenn.-based Children’s West Surgery Center, told Becker’s. “Each of these areas require a certain set of skills that are acquired and honed over time. There is increased competition, and in fact it is hard to compete with large health systems/hospitals. I am also finding that ASCs are competing in the same region against one another for the available staffing pool.”
The HRSA report highlights nurse workforce projections from 2021 to 2036 generated using the agency’s health workforce simulation.
Here are the five states with the largest projected shortages of registered nurses by 2036, per the report:
1. Georgia: 29% projected shortage
Projected vacancies: 34,800
2. California: 26% projected shortage
Projected vacancies: 106,310
3. Washington: 26% projected shortage
Projected vacancies: 22,700
4. New Jersey: 25% projected shortage
Projected vacancies: 24,450
5. North Carolina: 23% projected shortage
Projected vacancies: 31,350
https://www.beckersasc.com/leadership/5-states-facing-the-biggest-nurse-shortages-by-2036
Breaking News
Preparing for the storm: How 3 health systems are making capacity work harder
In the One Big Beautiful Bill era, capacity is more than a scheduling concern for hospitals and health systems — it’s a financial imperative. During a recent Becker’s Healthcare webinar hosted by LeanTaaS, executives from University Hospitals (Cleveland), Sutter Health (Sacramento, Calif.) and Scripps Health (San Diego) shared how their systems are leveraging predictive analytics, real-time data and cultural accountability to navigate tightening margins and rising demand.
Panelists shared their strategies in leveraging real-time data and visibility to boost operational agility, unlock capacity and ultimately safeguard access to care amid escalating financial headwinds. At University Hospitals, for example, smarter OR utilization efforts have raised productivity from 50% to 85%, translating into significant margin improvement.
Below are five key takeaways from the session.
1. Real-time data is essential to bridging capacity and access.
At Sutter Auburn (Calif.) Faith Hospital, data has become a strategic foundation for managing capacity and demand. “We are approaching [capacity and access] through a lens of data-driven agility,” said CEO Shanthi Margoschis, MSN, DHA, NEA-BC, FACHE. She emphasized the importance of real-time operational insights to anticipate bottlenecks, align staffing and maintain care quality.
The hospital has also prioritized data fluency among leaders. “Behind every story, there’s numbers, and every number needs to lead to a story,” Ms. Margoschis said. A recent initiative trained teams to interpret and act on data with confidence — a shift that has empowered better balancing of clinical and operational goals.
2. Systems are making ‘hidden’ capacity visible and profitable.
University Hospitals is managing complexity by making capacity optimization a core tenet of its clinical transformation strategy. Peter Pronovost, MD, PhD, FCCM
, the system’s chief clinical transformation officer, noted that value-based and fee-for-service models can coexist when capacity is leveraged effectively.
Using LeanTaaS’ playbooks, the system increased OR utilization from 50% to 85% and boosted physician productivity to around 80%. The key was making capacity visible and manageable. Additionally, the team used data to convert inpatient units into higher-margin service lines by shifting four patients per day to ambulatory care settings.
“Access problems, so often, are our own making,” Dr. Pronovost said. “There is capacity — it just isn’t leveraged.”
3. Systemwide coordination enables proactive resource planning.
Scripps Health has centralized operations through a corporate command center and transfer hub. “We’re using predictive analytics at a system level to look six to eight weeks ahead, and sometimes even six months ahead, to determine what our staffing needs are,” Chris Van Gorder, MPA, FACHE, president and CEO of Scripps, said. These forecasts guide decisions on hiring, training and ICU staffing, making the system more responsive and resilient.
The health system has also rolled out standardized models of care across facilities using lean principles. Front-line staff now welcome these efforts as tools for improvement rather than top-down mandates. “People are applauding the fact that it’s finally their turn to have a hand in systemwide change management,” Mr. Van Gorder said.
4. Accountability and culture change drive sustained improvements.
All three health system executives emphasized that data alone isn’t enough; culture and accountability are essential. Dr. Pronovost described a “handshake, not hammer” approach to shared accountability, reinforced by clear expectations and run charts that reflect performance over time. “If you can show me a run chart of a measure that matters, that has a slope other than zero, you have a management system,” he said.
By embedding these principles into daily workflows, systems are making capacity optimization a strategic lever, not a reactive fix.
5. Forward-looking organizations are preparing for financial pressures ahead.
Hospitals face growing financial challenges stemming from site-neutral payments, potential 340B cuts and reimbursement pressures. Leaders warned that organizations slow to adapt may face consolidation or service line closures.
“We message to the front-line staff that we need to get our cost structure down so we’re profitable on Medicare-level payments,” Dr. Pronovost said.
Mr. Van Gorder added: “We have a crisis that’s going to create opportunity for those who view it as an opportunity to become better.”
Building contingency plans and shifting from reactive to predictive operations are now table stakes for resilience. “We have to move from reactive problem-solving to becoming more proactive,” Ms. Margoschis said. “We need to invest in predictive and AI-driven insights — that’s the only way we’ll be able to anticipate demand and optimize resources.”
Through strategic use of technology and disciplined management practices, health systems are converting capacity challenges into opportunities for margin recovery and care continuity. AI-driven solutions such as LeanTaaS’ iQueue suite are helping hospitals meet the moment — not only to survive, but to evolve.
The post Preparing for the storm: How 3 health systems are making capacity work harder appeared first on Becker’s Hospital Review | Healthcare News & Analysis.
From -1.6% to 16.8%: 20 health systems ranked by operating margins
As policy uncertainties, reimbursement pressures and continued cuts and closures weigh on hospitals and health systems heading into 2026, third-quarter operating margins showed wide variation.
Several systems, such as UnityPoint, Montefiore Health System and Providence, saw operating losses or near-break-even results, while others like Allegheny Health Network, UPMC and Northwell Health saw only modest gains. On the stronger end, Tenet Healthcare led all systems with a 16.8% operating margin, followed by HCA Healthcare at 12.6% and Universal Health Services at 11.6%.
Below is a ranking of 20 health systems based on their operating margins for the third quarter of 2025.
Editor’s note: This is not an exhaustive list. The following financial results are for the three months ended Sept. 30, 2025, unless otherwise stated.
1. Tenet Healthcare (Dallas)
Revenue: $5.3 billion
Expenses: $4.5 billion
Operating income: $889 million
Operating margin: $16.8%
2. HCA Healthcare (Nashville)
Revenue: $19.2 billion
Expenses: $16.7 billion
Operating income: $2.4 billion
Operating margin: 12.6%
3. Universal Health Services (King of Prussia, Pa.)
Revenue: $4.5 billion
Expenses: $4 billion
Operating income: $521.7 million
Operating margin: 11.6%
4. BayCare (Clearwater, Fla.)
*For the nine months ending Sept. 30
Revenue: $5.2 billion
Expenses: $4.3 billion
Operating income: $543.5 million
Operating margin: 10.5%
5. Mayo Clinic (Rochester, Minn.)
Revenue: $5.2 billion
Expenses: $5 billion
Operating income: $442 million
Operating margin: 8.1%
6. Community Health Systems (Franklin, Tenn.)
Revenue: $3.087 billion
Expenses: $2.8 billion
Operating income: $243 million
Operating margin: 7.9%
7. Advocate Health (Charlotte, N.C.)
*For the nine months ending Sept. 30
Revenue: $28.8 billion
Expenses: $27.5 billion
Operating income: $1.3 billion
Operating margin: 4.5%
Revenue: $4.5 billion
Expenses: $4.1 billion
Operating income: $206.2 million
Operating margin: 4.5%
9. NewYork-Presbyterian (New York City)
Revenue: $2.9 billion
Expenses: $2.8 billion
Operating income: $115 million
Operating margin: 3.9%
10. BJC Health System (St. Louis)
*For the nine months ending Sept. 30 through the third quarter
Revenue: $8.9 billion
Expenses: $8.6 billion
Operating income: $335.5 million
Operating margin: 3.8%
11. Intermountain Health (Salt Lake City)
*For the nine months ending Sept. 30
Revenue: $13.8 billion
Expenses: $12.7 billion
Operating income: $442 million
Operating margin: 3.2%
12. Banner Health (Phoenix)
*For the nine months ending Sept. 30
Revenue: $11.9 billion
Expenses: $11.6 billion
Operating income: $338 million
Operating margin: 2.8%
13. Sanford Health (Sioux Falls, S.D.)
*For the nine months ending Sept. 30
Revenue: $8.5 billion
Expenses: $8.4 billion
Operating income: $93.3 million
Operating margin: 1.1%
14. Kaiser Permanente (Oakland, Calif.)
Revenue: $31.8 billion
Expenses: $31.6 billion
Operating income: $218 million
Operating margin: 0.7%
15. Allegheny Health Network (Pittsburgh)
Revenue: $1.4 billion
Expenses: $1.4 billion
Operating income: $7 million
Operating margin: 0.5%
16. Northwell Health (New Hyde Park, N.Y.)
Revenue: $5 billion
Expenses: $5 billion
Operating income: $26.9 million
Operating margin: 0.5%
17. UPMC (Pittsburgh)
Revenue: $8.5 billion
Expenses: $8.5 billion
Operating income: $45.6 million
Operating margin: 0.5%
18. Providence (Renton, Wash.)
Revenue: $8 billion
Expenses: $7.9 billion
Operating income: $21 million
Operating margin: 0.3%
19. UnityPoint Health (West Des Moines, Iowa)
*For the nine months ending Sept. 30
Revenue: $1.4 billion
Expenses: $1.5 billion
Operating loss: $17 million
Operating margin: -1.3%
20. Montefiore Health System (New York City)
*For the nine months ending Sept. 30
Revenue: $6.5 billion
Expenses: $6.6 billion
Operating loss: $103.7 million
Operating margin: -1.6%
The post From -1.6% to 16.8%: 20 health systems ranked by operating margins appeared first on Becker’s Hospital Review | Healthcare News & Analysis.
The financial impact of healthcare ransomware attacks: 4 notes
Healthcare continues to pay a significant financial toll for ransomware attacks, the U.S. Treasury Department found.
Here are four things to know from the December report, where the U.S. Treasury Financial Crimes Enforcement Network analyzed Bank Secrecy Act data involving cyberattacks:
1. From January 2022 through December 2024, U.S. companies paid $2.6 billion to ransomware hackers, of which healthcare accounted for 11.6%.
2. Financial services, manufacturing and healthcare were the industries most affected by ransomware, both by the number of incidents and aggregate payments.
3. Healthcare had 389 ransomware incidents in that time, trailing only financial services (456) and manufacturing (432) and ahead of legal services (334).
4. Healthcare organizations paid about $305.4 million to ransomware groups during that period, behind only financial services ($365.6 million) and ahead of manufacturing ($284.6 million), science and technology ($186.7 million), and retail ($181.3 million).
The post The financial impact of healthcare ransomware attacks: 4 notes appeared first on Becker’s Hospital Review | Healthcare News & Analysis.
Medical school enrollment surpasses 100,000 in 2025: AAMC
More than 100,000 students were enrolled in U.S. medical schools in 2025 — a record high, according to data released Dec. 9 by the Association of American Medical Colleges.
Total enrollment reached 100,723 students in 2025, with the largest-ever incoming class of 23,440 first-year students.
Here are three other key findings:
- 54,699 people applied to medical school in 2025, a 5.3% increase from 2024.
- First-time applicants accounted for 76.5% of the total; women made up 57.2%.
- Medical schools in California, Texas and Florida had the most applicants.
Learn more about the data here.
The post Medical school enrollment surpasses 100,000 in 2025: AAMC appeared first on Becker’s Hospital Review | Healthcare News & Analysis.
10 health systems named among America’s best companies: Forbes
Ten hospitals and health systems were included on Forbes’ “America’s Best Companies 2026″ list, published Nov. 19.
The list features 500 public and private companies, all evaluated on more than 100 metrics across 11 categories, including employee ratings, financial performance and sustainability. To be eligible, companies had to be headquartered in the U.S. and have more than 7,000 U.S.-based employees. Companies did not pay a fee to be considered or selected.
Here are the health systems that made the list, along with their overall ranking:
275. Northside Hospital (Atlanta)
309. Main Line Health (Radnor, Pa.)
374. Oklahoma Heart Hospital (Oklahoma City)
452. Sharp HealthCare (San Diego)
464. Carle Health (Urbana, Ill.)
468. Henry Ford Health (Detroit)
469. Sutter Health (Sacramento, Calif.)
475. Virtua (Marlton, N.J.)
484. Cincinnati Children’s
492. Harris Health (Houston)
The post 10 health systems named among America’s best companies: Forbes appeared first on Becker’s Hospital Review | Healthcare News & Analysis.
US News’ 147 maternity care access hospitals
U.S. News & World Report released its 2026 Best Hospitals for Maternity Care ratings Dec. 9, which also recognize hospitals providing services to underserved communities.
The media company used self-reported maternity care data to identify 147 hospitals as Maternity Care Access Hospitals for providing maternity services in areas that would otherwise lack adequate access to such care.
Hospitals were eligible if they met geographic and quality criteria. They met geographic criteria if they were the only hospital providing maternity care within their county and the county had fewer than 60 obstetric providers per 10,000 births. Alternatively, hospitals qualified if they were the only facility within a 15-mile radius and were located in a county with fewer than 128 obstetric providers per 10,000 births.
In terms of quality, these hospitals also demonstrated performance above the lowest normalized values for severe unexpected newborn complications, C-sections or episiotomy rates. Read more about the methodology here.
Here are the 147 Maternity Care Access Hospitals, listed alphabetically by state:
Alabama
North Baldwin Infirmary (Bay Minette)
California
Enloe Health (Chico)
Adventist Health and Rideout (Marysville)
Sutter Lakeside Hospital (Lakeport)
Colorado
Montrose Regional Health
UCHealth Parkview Medical Center (Pueblo)
Connecticut
Sharon Hospital
Florida
Ascension Sacred Heart Emerald Coast (Miramar Beach)
Orlando Health South Lake Hospital (Clermont)
NCH Baker Hospital (Naples)
Parrish Medical Center (Titusville)
Cleveland Clinic Indian River Hospital, (Vero Beach)
Georgia
Northeast Georgia Medical Center (Gainesville)
Northside Hospital Cherokee (Canton)
Tanner Medical Center-Carrollton
Piedmont Newton Hospital (Covington)
Northside Hospital Forsyth (Cumming)
Northeast Georgia Medical Center (Habersham)
WellStar Douglas Hospital (Douglasville)
Atrium Health Navicent Baldwin (Milledgeville)
Atrium Health Floyd Medical Center (Rome)
Idaho
Cassia Regional Hospital (Burley)
St. Joseph Regional Medical Center (Lewiston)
Illinois
Alton Memorial Hospital
Northwestern Medicine Kishwaukee Hospital (DeKalb)
Northwestern Medicine McHenry
Indiana
Memorial Hospital and Health Care Center (Jasper)
Indiana University Health Ball Memorial Hospital (Muncie)
Indiana University Health Paoli Hospital
Ascension St. Vincent Randolph (Winchester)
Iowa
Shenandoah Medical Center
Kansas
Ascension Via Christi Hospital (Manhattan)
Amberwell Health (Atchison)
Coffeyville Regional Medical Center
Susan B. Allen Memorial Hospital (El Dorado)
Amberwell Hiawatha
Labette Health (Parsons)
Mercy Hospital Pittsburg
Kentucky
Owensboro Health Regional Hospital
Ephraim McDowell Fort Logan Hospital (Stanford)
Louisiana
St. Tammany Health System (Covington)
North Oaks Medical Center (Hammond)
Maine
Central Maine Medical Center (Lewiston)
Maryland
UPMC Western Maryland (Cumberland)
University of Maryland Upper Chesapeake Medical Center (Bel Air)
Meritus Health (Hagerstown)
Garrett Regional Medical Center (Oakland)
Carroll Hospital (Westminster)
Massachusetts
Southcoast Hospitals Group (Fall River)
Michigan
Trinity Health Muskegon Hospital
MyMichigan Medical Center Alma
Corewell Health Lakeland Hospitals (St. Joseph)
Corewell Health Big Rapids Hospital
Corewell Health Gerber Hospital (Fremont)
Corewell Health Pennock Hospital (Hastings)
Henry Ford Jackson Hospital
Corewell Health Ludington Hospital
Memorial Healthcare (Owosso)
MyMichigan Medical Center Sault (Sault Sainte Marie)
Minnesota
M Health Fairview Lakes Medical Center (Wyoming)
Mayo Clinic Health System—Albert Lea and Austin (Albert Lea)
Mercy Hospital (Coon Rapids)
Grand Itasca Clinic and Hospital (Grand Rapids)
Missouri
St. Luke’s North Hospital—Barry Road (Kansas City)
Parkland Health Center—Farmington Community (Farmington)
Mercy Hospital Aurora
Mercy Hospital Jefferson (Festus)
Mercy Hospital Washington
Mississippi
Singing River Health System (Pascagoula)
Baptist Memorial Hospital-Union County (New Albany)
Montana
SCL Health MT—St. James Healthcare (Butte)
Nebraska
Columbus Community Hospital
Nevada
Renown Regional Medical Center (Reno)
New Hampshire
Cheshire Medical Center (Keene)
New Jersey
Hackensack Meridian Health Southern Ocean Medical Center (Manahawkin)
Newton Medical Center
New York
Putnam Hospital (Carmel)
Nicholas H. Noyes Memorial Hospital (Dansville)
Cayuga Medical Center at Ithaca
UPMC Chautauqua (Jamestown)
North Carolina
Cone Health Moses Cone Hospital (Greensboro)
Atrium Health Stanly (Albemarle)
Cone Health Alamance Regional Medical Center (Burlington)
Cape Fear Valley Medical Center (Fayetteville)
Watauga Medical Center (Boone)
Sentara Albemarle Medical Center (Elizabeth City)
UNC Health Southeastern (Lumberton)
Atrium Health Wake Forest Baptist Wilkes Medical Center (North Wilkesboro)
UNC Health Nash (Rocky Mount)
Novant Health Rowan Medical Center (Salisbury)
Novant Health Brunswick Medical Center (Bolivia)
Atrium Health Cleveland (Shelby)
Novant Health Thomasville Medical Center
Ohio
Trinity Health System (Steubenville)
Cleveland Clinic Union Hospital (Dover)
Licking Memorial Hospital (Newark)
Oklahoma
Mercy Hospital Ardmore
St. Francis Hospital Muskogee
Oregon
Asante Three Rivers Medical Center (Grants Pass)
Mercy Medical Center (Roseburg)
Pennsylvania
WellSpan Good Samaritan Hospital (Lebanon)
UPMC Northwest (Seneca)
UPMC Horizon (Farrell)
UPMC Altoona
UPMC Carlisle
WellSpan Chambersburg Hospital
Lehigh Valley Hospital—Pocono (East Stroudsburg)
Excela Health Westmoreland Hospital (Greensburg)
Lehigh Valley Hospital—Hazleton
Lehigh Valley Hospital—Schuylkill (Pottsville)
Guthrie Robert Packer Hospital (Sayre)
UPMC Williamsport
South Carolina
MUSC Health Lancaster Medical Center (Lancaster)
Roper St. Francis Berkeley Hospital (Summerville)
Prisma Health Oconee Memorial Hospital (Seneca)
Spartanburg Medical Center—Church Street Campus
Prisma Health Tuomey Hospital (Sumter)
Colleton Medical Center (Walterboro)
Tennessee
Vanderbilt Tullahoma Harton Hospital
Baptist Memorial Hospital-Union City
Texas
Texas Health Harris Methodist Hospital Stephenville
Baylor Scott & White Medical Center—Temple
Utah
Cedar City Hospital (Cedar City)
Delta Community Medical Center
Heber Valley Hospital (Heber City)
Sanpete Valley Hospital (Mount Pleasant)
Sevier Valley Hospital (Richfield)
St. George Regional Hospital
Ashley Regional Medical Center (Vernal)
Garfield Memorial Hospital (Panguitch)
Vermont
Rutland Regional Medical Center
Virginia
Centra Lynchburg General Hospital
UVA Health Culpeper Medical Center
Centra Southside Community Hospital (Farmville)
Sentara CarePlex Hospital (Hampton)
UVA Health Prince William Medical Center (Manassas)
Sentara Williamsburg Regional Medical Center
Sentara Northern Virginia Medical Center (Woodbridge)
Washington
St. Michael Medical Center (Silverdale)
Providence Centralia Hospital
Samaritan Healthcare (Moses Lake)
West Virginia
WVU Medicine Camden Clark Medical Center (Parkersburg)
Wisconsin
ThedaCare Medical Center-Berlin
Tamarack Health Hayward Medical Center (Hayward)
Aurora Medical Center—Bay Area (Marinette)
Marshfield Medical Center
ThedaCare Medical Center—Shawano
The post US News’ 147 maternity care access hospitals appeared first on Becker’s Hospital Review | Healthcare News & Analysis.
Best hospitals for maternity care: US News
U.S. News & World Report released its 2026 Best Hospitals for Maternity Care ratings Dec. 9.
To compile the list, U.S. News evaluated a record-breaking 901 hospitals providing labor and delivery services. Hospitals submitted detailed data, which were examined based on quality measures, such as C-section rates in lower-risk pregnancies; severe, unexpected newborn complication rates; routine vaginal birth after cesarean delivery rates; exclusive breast milk feeding rates; episiotomy rates; birthing-friendly practice; and reporting on outcomes disparities.
For its latest ratings, U.S. News asked hospitals to submit data from 2024 — the calendar year immediately before the survey. Previously, hospitals submitted data from two years prior.
The media company said hospitals could also submit electronic clinical quality measures instead of chart-abstracted perinatal care measures for cesarean birth, exclusive human milk feeding and severe unexpected newborn complications.
Overall, 495 hospitals made the final list, and 20 metropolitan areas had the greatest number of hospitals recognized for maternity care. These areas, listed in alphabetical order, are:
- Boston
- Charlotte, N.C
- Chicago
- Cincinnati
- Dallas-Fort Worth, Texas
- Denver
- Detroit
- Houston
- Indianapolis
- Kansas City, Mo., and Kan.
- Los Angeles
- Milwaukee
- New York
- Philadelphia
- Riverside-San Bernardino, Calif.
- San Diego
- San Francisco
- Seattle
- St. Louis
- Washington, D.C.
The following list is the number of hospitals in each state included in the ratings:
California — 80
Texas — 31
New Jersey — 27
New York — 25
Illinois — 23
North Carolina — 22
Pennsylvania — 21
Wisconsin — 21
Utah — 18
Indiana — 16
Colorado — 15
Ohio — 15
Virginia — 15
Missouri — 14
South Carolina — 14
Florida — 13
Michigan — 11
Kansas — 10
Massachusetts — 10
Georgia — Seven
Kentucky — Six
Maryland — Six
Minnesota — Six
Oklahoma — Six
Iowa — Five
Louisiana — Five
Nevada — Five
Connecticut — Four
Montana — Four
Oregon — Four
Alabama — Three
Arizona — Three
Tennessee — Three
Arkansas — Two
Hawaii — Two
Idaho — Two
New Hampshire — Two
West Virginia — Two
Wyoming — Two
Alaska — One
District of Columbia — One
Maine — One
Mississippi — One
Nebraska — One
New Mexico — One
North Dakota — One
Delaware — Zero
Rhode Island — Zero
South Dakota — Zero
Vermont — Zero
View the full ratings here. More information about the methodology is available here.
The post Best hospitals for maternity care: US News appeared first on Becker’s Hospital Review | Healthcare News & Analysis.
The employee gap fueling disengagement: Gallup
Workers with a strong sense of purpose in their roles are more likely to be engaged at work and less likely to feel burned out or search for a new job. Yet only 30% of hiring managers consider purpose to be a key predictor of success, according to Gallup survey results published Nov. 11.
Here are four findings from the Aug. 18-25 survey of 4,475 adults employed in the U.S.:
1. Employees with a strong sense of purpose at work are 5.6 times more likely to be engaged than those with a low sense of purpose.
2. Among workers with a strong sense of work purpose, 50% are engaged, 41% are looking for new roles and 13% report frequent burnout. Among those with a low sense of purpose, just 9% are engaged, 68% are job hunting and 38% feel burned out often.
3. Hiring managers ranked communication skills as the top factor in determining a new hire’s success (77%), followed by a desire to learn and grow (66%) and alignment with company culture (55%). They ranked a strong sense of personal purpose lower, at 30%, ahead of ambition to advance (26%) and experience, education or training level (25%).
4. Forty-five percent of respondents said they work primarily for pay and benefits. Only 18% said their work has a purpose they believe in, and 12% said their job allows them to pursue purpose in other areas outside of work.
While survey respondents’ ages were not available, hospital and health system leaders have recently highlighted Generation Z’s focus on purposeful work — a priority executives said is shaping workforce planning.
“The Gen Z workforce is our future, and we need to shift our value proposition and workforce planning approach to attract and engage this dynamic generation,” LeAnne Andersen, chief people officer of Green Bay and La Crosse, Wis.-based Emplify Health, said in August. “Gen Z has taught us that it is not only acceptable but important to openly discuss purpose, highlighting the difference between being mission-driven and purpose-driven, with a growing emphasis on emotional connection and a desire to make a positive impact in the world.”
The post The employee gap fueling disengagement: Gallup appeared first on Becker’s Hospital Review | Healthcare News & Analysis.
10 most caring US cities
Virginia Beach, Va., is the most caring U.S. city in 2025, based on its high shares of residents who volunteer or fundraise and its low violent crime rate, according to a Dec. 8 ranking from personal finance website WalletHub.
To develop the ranking, WalletHub compared the 100 largest U.S. cities across 38 key indicators in three categories: caring for the community, caring for the vulnerable and caring in the workforce. Metrics included nurses per capita, poverty rates, availability of paid family leave and share of income donated to charity.
10 most caring
1. Virginia Beach, Va.
2. Boston
3. Scottsdale, Ariz.
4. Gilbert, Ariz.
5. Fremont, Calif.
6. San Diego
7. Chesapeake, Va.
8. Colorado Springs, Colo.
9. St. Paul, Minn.
10. Madison, Wis.
The bottom 10
100. Birmingham, Ala.
99. Baton Rouge, La.
98. Memphis, Tenn.
97. Detroit
96. New Orleans
95. Cleveland
94. Tulsa, Okla.
93. San Bernardino, Calif.
92. Houston
91. Greensboro, N.C.
The post 10 most caring US cities appeared first on Becker’s Hospital Review | Healthcare News & Analysis.
Blood pressure medication recalled: What to know
The FDA has recalled multiple lots of a blood pressure medication sold under the brand name Ziac, according to a Dec. 6 report from USA Today.
The medication — bisoprolol fumarate and hydrochlorothiazide tablets — is manufactured by Glenmark Pharmaceuticals and may have been cross-contaminated with cholesterol drug ezetimibe, the report said.
The Class III recall affects 2.5-mg to 6.25-mg dosages from the following lots, according to USA Today:
- 30-tablet bottles, NDC-68462-878-30. Lot 17232401, exp. 11/2025.
- 100-tablet bottles, NDC-68462-878-01. Lot 17232401, exp. 11/2025.
- 500-tablet bottles, NDC-68462-878-05. Lot 17232401, exp. 11/2025
- 500-tablet bottles, NDC-68462-878-05. Lot 17240974, exp. 05/2026.
The post Blood pressure medication recalled: What to know appeared first on Becker’s Hospital Review | Healthcare News & Analysis.
More than 2 in 5 US primary care physicians report burnout: Survey
More than 2 in 5 primary care physicians in the U.S. are experiencing burnout, according to survey results published Nov. 20 by the Commonwealth Fund.
The 2025 Commonwealth Fund International Health Policy Survey of Primary Care Physicians drew responses from 10,985 physicians. The survey was conducted between March 12 and Sept. 22 across 10 countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland, the U.K. and the U.S.
Here are seven findings from the survey:
1. U.S. respondents were the most likely to report burnout, at 43%. Physicians in Canada and New Zealand followed, each at 38%.
2. Among U.S. physicians reporting burnout, 44% cited time-consuming administrative tasks as the primary driver.
3. Burned-out physicians in the U.S. also reported the following:
- 85% were somewhat or very dissatisfied with the amount of time spent on administrative tasks.
- 65% said time spent on insurance-related tasks is a major problem.
- 57% said time spent on patient care or visit documentation is a major problem.
- On average, physicians spent 23% of their time on administrative tasks.
4. Just 14% said burnout was primarily due to a patient panel that is too large or complex. Another 17% cited feeling their work is not valued.
5. More than half of physicians experiencing burnout said they were very or somewhat dissatisfied with the amount of time they can spend with each patient.
6. Nearly 70% of U.S. physicians with burnout said they were very or somewhat dissatisfied with their daily workload and work-life balance. Eighty-four percent said their job is extremely or very stressful.
7. To address burnout, the report recommends reducing administrative burdens, aligning patient panel size with available time for clinical and administrative tasks, and improving clinical leadership and ethical frameworks to enhance physicians’ sense of value and pride in their work.
The post More than 2 in 5 US primary care physicians report burnout: Survey appeared first on Becker’s Hospital Review | Healthcare News & Analysis.
Virtual nursing draws mixed reviews from bedside nurses: 5 study findings
Many bedside nurses say virtual nursing programs have not eased their workload, though a slight majority have seen benefits to patient care when working alongside virtual nurses, according to a new study from researchers at the University of Pennsylvania School of Nursing in Philadelphia.
Researchers at Penn Nursing’s Center for Health Outcomes and Policy Research surveyed nearly 900 in-hospital nurses across 10 states to understand how virtual nursing programs affect workloads and quality of patient care. The survey was conducted from December 2023 to March 2024.
Here are five key findings from the study, published Dec. 5 in JAMA Network Open:
- Fifty-seven percent of bedside nurses reported that working with virtual nurses did not reduce their workload. Among this group, 10% said virtual nurses increased their workload.
- Fifty-three percent of respondents said working alongside virtual nurses improved quality of care, though only 11% reported quality improved by “a lot.”
- Bedside nurses cited patient observation, admission and discharge activities, and patient education as the top uses of virtual nursing.
- In-person nurses identified virtual nursing’s strengths as monitoring and documentation, addressing staffing limitations, mitigating patient distrust and improving workflow inefficiencies.
- Taken together, the findings suggest hospital leaders should carefully evaluate virtual nursing models before broad implementation. While virtual nurses may ease administrative burdens in some cases, study authors say the programs are unlikely to meaningfully improve workload or care quality without sufficient bedside staffing and clearly defined roles.
“The data is mixed as to whether virtual nursing programs offer relief to in-hospital nurses and enhance the quality of patient care, which suggests hospitals should proceed cautiously in the absence of strong evidence about whether and under which conditions virtual nursing programs are safe and effective,” Karen Lasater, PhD, RN, study co-author and associate professor of nursing at Penn Nursing, said in a news release.
“While there is mixed evidence about the value of virtual nursing programs, there is strong evidence that staffing more nurses at the bedside is linked to better outcomes for patients and nurses alike,” Dr. Lasater added.
The post Virtual nursing draws mixed reviews from bedside nurses: 5 study findings appeared first on Becker’s Hospital Review | Healthcare News & Analysis.
747 hospitals patients would highly recommend
Becker’s has compiled a list of the hospitals patients would recommend in each state using Hospital Consumer Assessment of Healthcare Providers and Systems data from CMS.
CMS created 10 HCAHPS star ratings based on publicly reported HCAHPS measures. The patient recommendation star rating combines data from three HCAHPS survey questions and summarizes if patients would recommend the system to their friends and family.
The star rating is based on survey data collected from hospital patients between Jan. 1, 2024, and Dec. 31, 2024. The figures are from CMS’ Provider Data Catalog and were released Nov. 26.
Last year, 464 hospitals received a five-star rating for patient recommendation.
Here are the 747 hospitals patients would recommend:
Jump to state: Alabama | Alaska | Arizona | Arkansas | California | Colorado | Connecticut | Florida | Georgia | Hawaii | Idaho | Illinois | Indiana | Iowa | Kansas | Kentucky | Louisiana | Maine | Massachusetts | Maryland | Michigan | Minnesota | Mississippi | Missouri | Montana | Nebraska | Nevada | New Hampshire | New Jersey | New Mexico | New York | North Carolina | North Dakota | Ohio | Oklahoma | Oregon | Pennsylvania | Rhode Island | South Carolina | South Dakota | Tennessee | Texas | Utah | Vermont | Virginia | Washington | West Virginia | Wisconsin | Wyoming |
Alabama
Baptist Medical Center East (Montgomery)
Fayette Medical Center
Helen Keller Hospital (Sheffield)
Jack Hughston Memorial Hospital (Phenix City)
Lakeland Community Hospital (Haleyville)
Northwest Medical Center (Winfield)
Prattville Baptist Hospital
St. Vincent’s Chilton (Clanton)
St. Vincent’s St. Clair (Pell City)
Troy Regional Medical Center
University of Alabama Hospital (Birmingham)
Alaska
Central Peninsula General Hospital (Soldotna)
Providence Alaska Medical Center (Anchorage)
Arizona
Arizona Orthopedic and Surgical Specialty Hospital (Phoenix)
Arizona Spine and Joint Hospital (Mesa)
Banner Goldfield Medical Center (Apache Junction)
HonorHealth Scottsdale Shea Medical Center
HonorHealth Scottsdale Thompson Peak Medical Center
HonorHealth Sonoran Crossing Medical Center (Phoenix)
Mayo Clinic Hospital (Phoenix)
Oasis Hospital (Phoenix)
VA Northern Arizona Healthcare System (Prescott)
Western Regional Medical Center (Goodyear)
Arkansas
Arkansas Heart Hospital (Little Rock)
Arkansas Heart Hospital-Encore (Bryant)
Arkansas Surgical Hospital (North Little Rock)
Baptist Health Medical Center-Conway
Baptist Memorial Hospital Jonesboro
Conway Regional Medical Center
Fayetteville AR VA Medical Center
Mercy Hospital Northwest Arkansas (Rogers)
Piggott Community Hospital
California
60th Medical Group (Travis Air Force Base)
Adventist Health Howard Memorial (Willits)
Adventist Health St. Helena
Adventist Health Tehachapi Valley
Alta Bates Summit Medical Center (Oakland)
California Pacific Medical Center-Van Ness Campus (San Francisco)
Casa Colina Hospital (Pomona)
Community Hospital of the Monterey Peninsula
Community Memorial Hospital-Ventura
El Camino Hospital (Mountain View)
Fresno Surgical Hospital
Goleta Valley Cottage Hospital (Santa Barbara)
Hoag Memorial Hospital Presbyterian (Newport Beach)
Hoag Orthopedic Institute (Irvine)
John Muir Medical Center-Concord Campus
Kaiser Foundation Hospital-Orange County-Anaheim
Kaiser Foundation Hospital-Redwood City
Kaiser Foundation Hospital Fontana/Ontario
Keck Hospital of USC (Los Angeles)
Loma Linda University Medical Center
Loma Linda VA Medical Center
Mammoth Hospital (Mammoth Lakes)
Mercy General Hospital (Sacramento)
NMC San Diego
Novato Community Hospital
Palo Alto VA Medical Center
Peninsula Medical Center (Burlingame)
PIH Health Hospital-Whittier
Providence Redwood Memorial Hospital (Fortuna)
Providence St. Jude Medical Center (Fullerton)
Redlands Community Hospital
Santa Barbara Cottage Hospital
Santa Monica-UCLA Medical Center & Orthopaedic Hospital
Scripps Green Hospital (San Diego)
Scripps Memorial Hospital La Jolla (San Diego)
Sequoia Hospital (Redwood City)
Sharp Coronado Hospital and Healthcare Center
Sharp Memorial Hospital (San Diego)
Stanford Health Care
Stanford Health Care Tri-Valley (Pleasanton)
Sutter Amador Hospital (Jackson)
Sutter Maternity & Surgery Center of Santa Cruz
Sutter Roseville Medical Center
Sutter Santa Rosa Regional Hospital
Tahoe Forest Hospital (Truckee)
Torrance Memorial Medical Center
UCSF Medical Center (San Francisco)
Colorado
AdventHealth Castle Rock
Animas Surgical Hospital (Durango)
Aspen Valley Hospital
Boulder Community Health
Community Hospital (Grand Junction)
Good Samaritan Medical Center (Lafayette)
Grand Junction VA Medical Center
HCA HealthOne Presbyterian St. Luke’s (Denver)
HCA HealthOne Rose (Denver)
Longs Peak Hospital (Longmont)
Medical Center of the Rockies (Loveland)
Montrose Regional Health
OrthoColorado Hospital at St. Anthony Medical Campus (Lakewood)
Saint Joseph Hospital (Denver)
Southwest Memorial Hospital (Cortez)
St. Anthony Summit Medical Center (Frisco)
UCHealth Highlands Ranch Hospital
UCHealth Yampa Valley Medical Center (Steamboat Springs)
University of Colorado Hospital Authority (Aurora)
VA Eastern Colorado Healthcare System (Aurora)
Vail Health Hospital
Valley View Hospital Association (Glenwood Springs)
Connecticut
John Dempsey Hospital (Farmington)
Sharon Hospital
Florida
96th Medical Group (Eglin Air Force Base)
AdventHealth Wesley Chapel
Ascension St. Vincent’s St. Johns County (St. Johns)
Baptist Hospital (Pensacola)
Baptist Medical Center Beaches (Jacksonville Beach)
Baptist Medical Center-Nassau (Fernandina Beach)
Bartow Regional Medical Center
Bay Pines VA Medical Center
BayCare Hospital Wesley Chapel
Cleveland Clinic Hospital (Weston)
Gulf Breeze Hospital
HCA Florida Twin Cities Hospital (Niceville)
Jupiter Medical Center
Mayo Clinic (Jacksonville)
Mease Countryside Hospital (Safety Harbor)
Mease Dunedin Hospital
Morton Plant Hospital (Clearwater)
Morton Plant North Bay Hospital (New Port Richey)
Orlando VA Medical Center
Sacred Heart Hospital on the Emerald Coast (Miramar Beach)
Sarasota Memorial Hospital
Sarasota Memorial Hospital-Venice (North Venice)
St. Anthony’s Hospital (St. Petersburg)
St. Joseph’s Hospital (Tampa)
Tampa VA Medical Center
Viera Hospital (Melbourne)
Georgia
Bacon County Hospital (Alma)
Burke Medical Center (Waynesboro)
Dwight Eisenhower Army Medical Center (Fort Gordon)
Emory University Hospital (Atlanta)
Evans Memorial Hospital (Claxton)
Martin Army Community Hospital (Fort Benning)
Northeast Georgia Medical Center Lumpkin (Dahlonega)
Northside Hospital Cherokee (Canton)
Northside Hospital Forsyth (Cumming)
Optim Medical Center-Tattnall (Reidsville)
Piedmont Columbus Regional Northside
Southeastern Regional Medical Center (Newnan)
St. Joseph’s Hospital-Savannah
St. Mary’s Good Samaritan Hospital (Greensboro)
Union General Hospital (Blairsville)
Wellstar Paulding Medical Center (Hiram)
Hawaii
Kaiser Foundation Hospital (Honolulu)
North Hawaii Community Hospital (Kamuela)
Straub Clinic And Hospital (Honolulu)
Idaho
Boise VA Medical Center
Gritman Medical Center (Moscow)
Idaho Falls Community Hospital
Mountain View Hospital (Idaho Falls)
Northwest Specialty Hospital (Post Falls)
Saint Alphonsus Medical Center-Nampa
St. Luke’s McCall
St. Luke’s Nampa Medical Center
St. Luke’s Regional Medical Center (Boise)
St. Luke’s Wood River Medical Center (Ketchum)
Treasure Valley Hospital (Boise)
Illinois
Carle Hoopeston Regional Health Center
Deaconess Illinois Crossroads (Mount Vernon)
Gibson Community Hospital (Gibson City)
HSHS St. Elizabeth’s Hospital (O’Fallon)
Marion VA Medical Center
Memorial Hospital (Carthage)
Midwest Medical Center (Galena)
Midwestern Region Medical Center (Zion)
Morris Hospital & Healthcare Centers
Northwestern Medicine Central DuPage Hospital (Winfield)
Northwestern Medicine Delnor Community Hospital (Geneva)
Northwestern Memorial Hospital (Chicago)
OSF Holy Family Medical Center (Monmouth)
OSF Saint Anthony’s Health Center (Alton)
Paris Community Hospital
Red Bud Regional Hospital
St. Francis Hospital (Litchfield)
Wabash General Hospital (Mount Carmel)
Indiana
Ascension St. Vincent Fishers
Cameron Memorial Community Hospital (Angola)
Community Hospital East (Indianapolis)
Community Hospital of Anderson and Madison County
Community Hospital of Bremen
Franciscan Health Lafayette
Franciscan Health Orthopedic Hospital Carmel
Goshen Hospital
Greene County General Hospital (Linton)
Hendricks Regional Health (Danville)
Johnson Memorial Hospital (Franklin)
Memorial Hospital and Health Care Center (Jasper)
Monroe Hospital (Bloomington)
Orthoindy Hospital (Indianapolis)
Orthopaedic Hospital at Parkview North (Fort Wayne)
Parkview Regional Medical Center (Fort Wayne)
Parkview Whitley Hospital (Columbia City)
Pinnacle Hospital (Crown Point)
Riverview Health (Noblesville)
St. Vincent Heart Center (Carmel)
Unity Physicians Hospital (Mishawaka)
The Women’s Hospital (Newburgh)
Woodlawn Hospital (Rochester)
Iowa
Broadlawns Medical Center (Des Moines)
Buena Vista Regional Medical Center (Storm Lake)
Burgess Health Center (Onawa)
Compass Memorial Healthcare (Marengo)
Floyd Valley Healthcare (Le Mars)
Iowa City VA Medical Center
Iowa Specialty Hospital-Belmond
Iowa Specialty Hospital-Clarion
Kossuth Regional Health Center (Algona)
Lakes Regional Healthcare (Spirit Lake)
Mahaska Health Partnership (Oskaloosa)
Mary Greeley Medical Center (Ames)
Mercy Medical Center-Cedar Rapids
MercyOne Dubuque Medical Center
Orange City Area Health System
Pella Regional Health Center
Regional Medical Center (Manchester)
Sioux Center Health
Spencer Municipal Hospital
St. Anthony Regional Hospital & Nursing Home (Carroll)
St. Luke’s Hospital (Cedar Rapids)
VA Central Iowa Healthcare System (Des Moines)
Waverly Health Center
Winnmed (Decorah)
Kansas
Citizens Medical Center (Colby)
Clay County Medical Center
Hiawatha Community Hospital
Kansas City Orthopaedic Institute (Leawood)
Kansas Heart Hospital (Wichita)
Kansas Spine & Specialty Hospital (Wichita)
Kansas Surgery & Recovery Center (Wichita)
Manhattan Surgical Hospital
Mercy Specialty Hospital Southeast Kansas (Galena)
Mitchell County Hospital Health Systems (Beloit)
Neosho Memorial Regional Medical Center (Chanute)
Pratt Regional Medical Center
Republic County Hospital (Belleville)
Rock Regional Hospital (Derby)
Saint Luke’s South Hospital (Overland Park)
Salina Surgical Hospital
Stormont Vail Health Flint Hills (Junction City)
Summit Surgical (Hutchinson)
University of Kansas Hospital (Kansas City)
VA Eastern Kansas Healthcare System (Topeka)
Wichita VA Medical Center
Kentucky
ARH Our Lady of the Way (Martin)
Baptist Health LaGrange
Baptist Health Lexington
Baptist Health Louisville
Baptist Health Paducah
Baptist Health Richmond
Ephraim McDowell Fort Logan Hospital (Stanford)
Fleming County Hospital (Flemingsburg)
Harrison Memorial Hospital (Cynthiana)
Lexington VA Medical Center
Rockcastle County Hospital (Mount Vernon)
Three Rivers Medical Center (Louisa)
University of Kentucky Hospital (Lexington)
Louisiana
Avala (Covington)
Christus Central Louisiana Surgical Hospital (Alexandria)
Christus Ochsner Lake Area Hospital (Lake Charles)
Citizens Medical Center (Columbia)
Cypress Pointe Surgical Hospital (Hammond)
Lafayette Surgical Specialty Hospital
Ochsner St. Anne General Hospital (Raceland)
Ochsner St. Martin Hospital (Breaux Bridge)
Our Lady of Lourdes Regional Medical Center (Lafayette)
Our Lady of the Lake Surgical Hospital (Slidell)
Southeast Louisiana Veterans Health Care System (New Orleans)
Specialists Hospital Shreveport
St. Bernard Parish Hospital (Chalmette)
St. Charles Parish Hospital (Luling)
St. Tammany Parish Hospital (Covington)
The Spine Hospital of Louisiana (Baton Rouge)
Thibodaux Regional Medical Center
Woman’s Hospital (Baton Rouge)
Maine
LincolnHealth (Damariscotta)
Maine General Medical Center (Augusta)
Maine Medical Center (Portland)
MaineHealth Stephens Hospital (Norway)
Mount Desert Island Hospital (Bar Harbor)
Northern Light Health (Portland)
Northern Maine Medical Center (Fort Kent)
Redington Fairview General Hospital (Skowhegan)
St. Joseph Hospital (Bangor)
Togus VA Medical Center (Augusta)
York Hospital
Maryland
The Johns Hopkins Hospital (Baltimore)
Mercy Medical Center (Baltimore)
Suburban Hospital (Bethesda)
University of Maryland St. Joseph Medical Center (Towson)
Walter Reed National Military Medical Center (Bethesda)
Massachusetts
Beth Israel Deaconess Medical Center (Boston)
Brigham and Women’s Hospital (Boston)
Fairview Hospital (Great Barrington)
Martha’s Vineyard Hospital (Oak Bluffs)
Massachusetts Eye and Ear Infirmary (Boston)
Massachusetts General Hospital (Boston)
Milford Regional Medical Center
New England Baptist Hospital (Boston)
Newton-Wellesley Hospital
Tufts Medical Center (Boston)
VA Boston Healthcare System-Jamaica Plain
Michigan
Bronson Lakeview Hospital (Paw Paw)
Charlevoix Area Hospital
Chelsea Hospital
Corewell Health Zeeland Hospital
Hills & Dales General Hospital (Cass City)
Holland Community Hospital
Mercy Health Lakeshore Campus (Shelby)
Mercy Health Saint Mary’s (Grand Rapids)
MyMichigan Medical Center Gladwin
MyMichigan Medical Center Midland
MyMichigan Medical Center West Branch
Oaklawn Hospital (Marshall)
Sparrow Carson Hospital (Carson City)
Sparrow Clinton Hospital (Saint Johns)
University of Michigan Health-West (Wyoming)
University of Michigan Health System (Ann Arbor)
UP Health System Portage (Hancock)
VA Ann Arbor Healthcare System
Minnesota
Astera Health (Wadena)
Chippewa County Hospital (Montevideo)
Community Memorial Hospital (Cloquet)
Cuyuna Regional Medical Center (Crosby)
Glacial Ridge Hospital (Glenwood)
Glencoe Regional Health
Lakeview Memorial Hospital (Stillwater)
Maple Grove Hospital
Mayo Clinic Health System in Red Win
Mayo Clinic Health System New Prague
Mayo Clinic Hospital Rochester
Minneapolis VA Medical Center
New Ulm Medical Center
Northfield Hospital
Olmsted Medical Center (Rochester)
Park Nicollet Methodist Hospital (St. Louis Park)
Perham Health
Ridgeview Medical Center (Waconia)
River’s Edge Hospital & Clinic (St. Peter)
Riverview Hospital (Crookston)
Riverwood Healthcare Center (Aitkin)
Stevens Community Medical Center (Morris)
United Hospital District (Blue Earth)
Welia Health (Mora)
Mississippi
81st Medical Group (Biloxi)
Baptist Memorial Hospital North Mississippi (Oxford)
Baptist Memorial Hospital Union County (New Albany)
King’s Daughters Medical Center-Brookhaven
Merit Health Women’s Hospital (Flowood)
Methodist Healthcare-Olive Branch Hospital
North Mississippi Medical Center-Gilmore Amory
VA Gulf Coast Healthcare System (Biloxi)
Missouri
Barnes Jewish Hospital (St. Louis)
Barnes-Jewish West County Hospital (Creve Coeur)
Boone Hospital Center (Columbia)
Columbia VA Medical Center
Cox Monett Hospital
Freeman Neosho Hospital
Mercy Hospital Aurora
Mercy Hospital Carthage
Missouri Baptist Medical Center (St. Louis)
Missouri Baptist Sullivan Hospital
Mosaic Medical Center-Maryville
North Kansas City Hospital
Saint Luke’s East Hospital (Lee’s Summit)
St. Luke’s Hospital (Chesterfield)
St. Luke’s Hospital of Kansas City
Sainte Genevieve County Memorial Hospital)
Montana
Community Hospital of Anaconda
Great Falls Clinic Hospital
Holy Rosary Hospital (Miles City)
Logan Health-Whitefish
St. Vincent Healthcare (Billings)
St. Patrick Hospital (Missoula)
VA Montana Healthcare System (Fort Harrison)
Nebraska
Avera St. Anthony’s Hospital (O’Neill)
Beatrice Community Hospital & Health Center
Boone County Health Center (Albion)
Brodstone Healthcare (Superior)
Bryan Medical Center (Lincoln)
CHI Health Nebraska Heart (Lincoln)
Chadron Community Hospital and Health Services
Community Medical Center (Falls City)
Kearney Regional Medical Center
Midwest Surgical Hospital (Omaha)
Nebraska Orthopaedic Hospital (Omaha)
Nebraska Spine Hospital (Omaha)
Phelps Memorial Health Center (Holdrege)
St. Francis Memorial Hospital (West Point)
The Nebraska Methodist Hospital (Omaha)
York General Health Care Services
Nevada
Banner Churchill Community Hospital (Fallon)
Northern Nevada Sierra Medical Center (Reno)
Saint Rose Dominican Hospitals-San Martin Campus (Las Vegas)
VA Southern Nevada Healthcare System (North Las Vegas)
New Hampshire
Alice Peck Day Memorial Hospital (Lebanon)
Littleton Regional Healthcare
Mary Hitchcock Memorial Hospital (Lebanon)
New London Hospital
Wentworth-Douglass Hospital (Dover)
New Jersey
Deborah Heart and Lung Center (Browns Mills)
Morristown Medical Center
New Mexico
Lovelace Regional Hospital-Roswell
Nor-Lea Hospital District (Lovington)
Three Crosses Regional Hospital (Las Cruces)
New York
Adirondack Medical Center-Saranac Lake
Clifton Springs Hospital and Clinic
Community Memorial Hospital (Hamilton)
Elizabethtown Community Hospital
Hospital for Special Surgery (New York City)
John T. Mather Memorial Hospital of Port Jefferson
Northern Dutchess Hospital (Rhinebeck)
Northern Westchester Hospital (Mount Kisco)
St. Anthony Community Hospital (Warwick)
St. Francis Hospital-The Heart Center (Roslyn)
White Plains Hospital Center
North Carolina
AdventHealth Hendersonville
Arthur Dosher Memorial Hospital (Southport)
Asheville-Oteen VA Medical Center
Atrium Health Lincoln (Lincolnton)
Cape Fear Valley Hoke Hospital (Raeford)
Chatham Hospital (Siler City)
Duke University Hospital (Durham)
FirstHealth Moore Regional Hospital (Pinehurst)
North Carolina Specialty Hospital (Durham)
Novant Health Medical Park Hospital (Winston-Salem)
Novant Health Mint Hill Medical Center (Charlotte)
Pardee Hospital Henderson County (Hendersonville)
Rex Hospital (Raleigh)
St. Luke’s Hospital (Columbus)
UNC Hospitals (Chapel Hill)
Vidant Duplin Hospital (Kenansville)
W.G. Hefner Salisbury VA Medical Center (Salisbury)
Watauga Medical Center (Boone)
North Dakota
Fargo VA Medical Center
Jamestown Regional Medical Center
Ohio
88th Medical Group (Wright-Patterson Air Force Base)
Christ Hospital (Cincinnati)
Cleveland Clinic
Cleveland Clinic Avon Hospital
Crystal Clinic Orthopaedic Center (Akron)
Dublin Methodist Hospital
Institute for Orthopaedic Surgery (Lima)
Kettering Health Main Campus
Kettering Health Troy
Lodi Community Hospital
McCullough-Hyde Memorial Hospital (Oxford)
Memorial Hospital (Marysville)
Mercer County Joint Township Community Hospital (Coldwater)
Mercy Allen Hospital (Oberlin)
Mount Carmel New Albany Surgical Hospital
ProMedica Defiance Regional Hospital (Defiance)
Selby General Hospital (Marietta)
Soin Medical Center (Beaver Creek)
Summa Western Reserve Hospital (Cuyahoga Falls)
Surgical Hospital at Southwoods (Youngstown)
UHHS Memorial Hospital of Geneva
Wyandot Memorial Hospital (Upper Sandusky)
Oklahoma
Bailey Medical Center (Owasso)
Chickasaw Nation Medical Center (Ada)
Choctaw Nation Health Services Authority (Talihina)
Claremore Indian Hospital
Integris Health Edmond Hospital
McBride Orthopedic Hospital (Oklahoma City)
Muskogee VA Medical Center
Oklahoma Heart Hospital South (Oklahoma City)
Oklahoma Heart Hospital (Oklahoma City)
Oklahoma Spine Hospital (Oklahoma City)
Oklahoma Surgical Hospital (Tulsa)
Saint Francis Hospital South (Tulsa)
Saint Francis Hospital (Tulsa)
St. John Owasso
Tulsa Spine & Specialty Hospital
Oregon
Asante Ashland Community Hospital
Kaiser Foundation Hospital Westside (Hillsboro)
McKenzie-Willamette Medical Center (Springfield)
OHSU Hospital and Clinics (Portland)
Providence Hood River Memorial Hospital
Providence Newberg Medical Center
Providence Portland Medical Center
Providence St. Vincent Medical Center (Portland)
Samaritan North Lincoln Hospital (Lincoln City)
Samaritan Pacific Community Hospital (Newport)
Santiam Hospital & Clinics (Stayton)
Pennsylvania
Advanced Surgical Hospital (Washington)
AHN Wexford Hospital
Bryn Mawr Hospital
Canonsburg General Hospital
Chan Soon-Shiong Medical Center at Windber
Chester County Hospital (West Chester)
Conemaugh Miners Medical Center (Hastings)
Conemaugh Nason Medical Center (Roaring Spring)
Doylestown Hospital
Geisinger Jersey Shore Hospital
Geisinger Medical Center Muncy
Geisinger St. Luke’s Hospital (Orwigsburg)
Hospital of University of Pennsylvania (Philadelphia)
James E. Van Zandt VA Medical Center (Altoona)
Lebanon VA Medical Center
Lehigh Valley Hospital-Dickson City
Milton S. Hershey Medical Center
OSS Orthopaedic Hospital (York)
Paoli Hospital
Penn State Health Hampden Medical Center (Enola)
Penn State Health Lancaster Medical Center
Pennsylvania Hospital (Philadelphia)
Physicians Care Surgical Hospital (Royersford)
Rothman Orthopaedic Specialty Hospital (Bensalem)
St. Clair Hospital (Pittsburgh)
St. Luke’s Hospital-Carbon Campus (Lehighton)
St. Luke’s Hospital-Monroe Campus (Stroudsburg)
St. Luke’s Quakertown Hospital
Surgical Institute of Reading (Wyomissing)
Titusville Area Hospital
Troy Community Hospital
UPMC Muncy
UPMC Passavant (Pittsburgh)
UPMC St. Margaret (Pittsburgh)
Wellspan Evangelical Community Hospital (Lewisburg)
West Penn Hospital (Pittsburgh)
Wilkes-Barre VA Medical Center
Rhode Island
Newport Hospital
Providence VA Medical Center
South County Hospital (Wakefield)
South Carolina
Bon Secours-St. Francis Xavier Hospital (Charleston)
Charleston VA Medical Center
East Cooper Medical Center (Mount Pleasant)
Lexington Medical Center (West Columbia)
Mcleod Loris Hospital
Mount Pleasant Hospital
Pelham Medical Center (Greer)
Prisma Health Patewood Hospital (Greenville)
Prisma Health Greer Memorial Hospital (Spartanburg)
Roper Hospital (Charleston)
Roper St. Francis Hospital-Berkeley (Summerville)
St. Francis-Downtown (Greenville)
South Dakota
Avera Heart Hospital of South Dakota (Sioux Falls)
Black Hills Surgical Hospital (Rapid City)
Brookings Health System
Dunes Surgical Hospital (Dakota Dunes)
Sioux Falls Specialty Hospital
Sioux Falls VA Medical Center
VA Black Hills Healthcare System (Fort Meade)
Tennessee
Memorial Healthcare System (Chattanooga)
Mountain Home VA Medical Center
Saint Thomas Hospital For Spinal Surgery (Nashville)
Unity Medical Center (Manchester)
Vanderbilt University Medical Center (Nashville)
Williamson Medical Center (Franklin)
Texas
Baylor Medical Center at Trophy Club
Baylor Scott & White Heart & Vascular Hospital-Dallas
Baylor Scott & White Medical Center Grapevine
Baylor Scott & White Medical Center-Frisco
Baylor Scott & White Medical Center-Marble Falls
Baylor Scott & White Medical Center Hillcrest (Waco)
Baylor Scott & White Medical Center Pflugerville
Baylor Scott & White Medical Center Plano
Baylor Scott & White Medical Center-College Station
Baylor Scott & White Texas Spine & Joint Hospital (Tyler)
Baylor Scott & White The Heart Hospital-Plano
Baylor Scott and White Medical Center McKinney
Baylor Scott and White Orthopedic and Spine Hospital (Arlington)
Baylor Scott and White Surgical Hospital Fort Worth
Brooke Army Medical Center (Fort Sam Houston)
Childress Regional Medical Center
Christus Mother Frances Hospital-Jacksonville
Citizens Medical Center (Victoria)
Coryell Memorial Hospital (Gatesville)
Darnall Army Medical Center (Fort Cavazos)
Foundation Surgical Hospital of San Antonio
Guadalupe Regional Medical Center (Seguin)
Houston Methodist Baytown Hospital
Houston Methodist Clear Lake Hospital (Nassau Bay)
Houston Methodist Hospital
Houston Methodist Sugarland Hospital
Houston Methodist The Woodlands Hospital
Houston Methodist West Hospital
Houston Physicians’ Hospital (Webster)
Kell West Regional Hospital (Wichita Falls)
Legent Orthopedic + Spine (San Antonio)
Lubbock Heart Hospital
Methodist Hospital For Surgery (Addison)
Methodist Mansfield Medical Center
Methodist McKinney Hospital
Methodist Midlothian Medical Center
North Central Surgical Center (Dallas)
Permian Regional Medical Center Andrews County Hospital
Peterson Regional Medical Center (Kerrville)
The Physicians Centre (Bryan)
Quail Creek Surgical Hospital (Amarillo)
Rolling Plains Memorial Hospital (Sweetwater)
South Texas Spine and Surgical Hospital (San Antonio)
St. Luke’s Hospital at the Vintage (Houston)
Texas Health Harris Methodist Hospital Southlake
Texas Health Heart & Vascular Hospital Arlington
Texas Health Hospital Frisco
Texas Health Presbyterian Hospital Denton
Texas Orthopedic Hospital (Houston)
The Heart Hospital Baylor Denton
The University of Texas Health Science Center at Tyler
Tops Surgical Specialty Hospital (Houston)
University Medical Center (Lubbock)
UT Health East Texas Jacksonville Hospital
UT Health East Texas Pittsburg Hospital
UT Health East Texas Quitman Hospital
UT of Texas Southwestern University Hospital-William P. Clements Jr. (Dallas)
VA Amarillo Healthcare System
William Beaumont AMG (El Paso)
Utah
Cedar City Hospital
Central Valley Medical Center-CAH (Nephi)
Intermountain Health Alta View Hospital (Sandy)
Intermountain Health Heber Valley Hospital (Heber City)
Intermountain Health Layton Hospital
Intermountain Health Spanish Fork Hospital
Intermountain Health Utah Valley Hospital (Provo)
Intermountain Medical Center (Murray)
Lone Peak Hospital (Draper)
Park City Hospital
Riverton Hospital
St. George Regional Hospital
University of Utah Hospital and Clinics (Salt Lake City)
VA Salt Lake City Healthcare-George E. Wahlen VA Medical Center
Vermont
Copley Hospital (Morrisville)
Mount Ascutney Hospital (Windsor)
University of Vermont-Fletcher Allen Health Care (Burlington)
White River Junction VA Medical Center
Virginia
Carilion Franklin Memorial Hospital (Rocky Mount)
Centra Bedford Memorial Hospital
Fort Belvoir Community Hospital
Inova Fair Oaks Hospital (Fairfax)
Inova Fairfax Hospital (Falls Church)
Inova Loudoun Hospital (Leesburg)
Riverside Doctors’ Hospital of Williamsburg
Riverside Walter Reed Hospital (Gloucester)
Sentara Martha Jefferson Hospital (Charlottesville)
Sentara Princess Anne Hospital (Virginia Beach)
Sentara Williamsburg Regional Medical Center
University of Virginia Medical Center (Charlottesville)
UVA Health Haymarket Medical Center
Washington
Island Hospital (Anacortes)
Jefferson Healthcare (Port Townsend)
Legacy Salmon Creek Medical Center (Vancouver)
Madigan Army Medical Center (McChord)
Newport Community Hospital
Overlake Hospital Medical Center (Bellevue)
Prosser Memorial Hospital
Pullman Regional Hospital
Spokane VA Medical Center
Swedish Issaquah
Swedish Medical Center/Cherry Hill (Seattle)
Tri-State Memorial Hospital (Clarkston)
University of Washington Medical Center (Seattle)
West Virginia
Beckley VA Medical Center
Boone Memorial Hospital (Madison)
Clarksburg VA Medical Center
Huntington VA Medical Center
Martinsburg VA Medical Center
Potomac Valley Hospital (Keyser)
St Joseph’s Hospital of Buckhannon
Valley Health War Memorial Hospital (Berkeley Springs)
Wisconsin
Aurora BayCare Medical Center (Green Bay)
Aurora Medical Center (Grafton)
Aurora Medical Center-Summit
Aurora Medical Center Manitowoc County (Two Rivers)
Aurora Medical Center Oshkosh
Bellin Memorial Hospital (Green Bay)
Columbus Community Hospital
Door County Medical Center (Sturgeon Bay)
Froedtert Community Hospital (New Berlin)
Froedtert Memorial Lutheran Hospital (Milwaukee)
Grant Regional Health Center (Lancaster)
Gundersen Lutheran Medical Center (La Crosse)
Howard Young Medical Center (Woodruff)
Hudson Hospital
Madison VA Medical Center
Marshfield Medical Center-Minocqua
Mayo Clinic Health System Chippewa Valley (Bloomer)
Mayo Clinic Health System Eau Claire Hospital
Mayo Clinic Health System Oakridge (Osseo)
Mayo Clinic Health System-Franciscan Medical Center (La Crosse)
Mayo Clinic Health System-Northland (Barron)
Mercy Walworth Hospital & Medical Center (Lake Geneva)
Midwest Orthopedic Specialty Hospital (Franklin)
Milwaukee VA Medical Center
Oakleaf Surgical Hospital (Altoona)
Orthopaedic Hospital of Wisconsin (Glendale)
River Falls Area Hospital
Sauk Prairie Hospital (Prairie Du Sac)
SSM Health St. Clare Hospital-Baraboo
Southwest Health Center (Platteville)
Stoughton Hospital
Tamarack Health Ashland Medical Center
Tamarack Health Hayward Medical Center
Tomah Memorial Hospital
UnityPoint Health-Meriter (Madison)
University of Wisconsin Hospitals & Clinics Authority (Madison)
Upland Hills Health (Dodgeville)
Vernon Memorial Hospital (Viroqua)
Waupun Memorial Hospital
Westfields Hospital and Clinic (New Richmond)
Western Wisconsin Health (Baldwin)
Wyoming
Cheyenne VA Medical Center
Memorial Hospital of Converse County (Douglas)
St. John’s Medical Center (Jackson)
Star Valley Medical Center (Afton)
The post 747 hospitals patients would highly recommend appeared first on Becker’s Hospital Review | Healthcare News & Analysis.
3 states with high virus levels
Colorado, Louisiana and New York — particularly New York City — reported high levels of flu-like illness during the week ending Nov. 29, according to the latest CDC data on respiratory virus trends.
The CDC’s respiratory illness activity map reflects outpatient visits among patients who present with a fever plus a cough or sore throat, meaning it captures visits for flu, COVID-19 and respiratory syncytial virus. Overall, about 2.9% of outpatient visits were due to respiratory illness for the week ending Nov. 29, up from 2.2% a week prior, though still below the national baseline of 3.1%.
Two more respiratory virus updates:
1. Flu hospitalizations jumped nearly 52% for the week ending Nov. 29 compared to the previous week, according to the CDC’s FluView report. About 4,960 patients with laboratory-confirmed influenza were admitted to a hospital for the week ending Nov. 29, up from 3,264 a week prior. Overall, the CDC estimates at least 1.9 million flu cases, 19,000 hospitalizations and 730 deaths so far this season.
2. Flu-related emergency department visits have also been steadily rising in recent weeks. Flu accounted for about 1.4% of ED visits for the week ending Nov. 29, up from 0.6% two weeks earlier. ED visits for flu are highest among children, according to the data.
3. This year’s virus season is shaping up to be unusually complex, unfolding alongside ongoing measles outbreaks and a second consecutive year of elevated whooping cough cases. Public health officials have attributed the rise in pertussis and measles to declining childhood vaccination rates, with most measles cases this year involving individuals who were unvaccinated or whose vaccination status was unknown.
At the same time, federal officials are reviewing potential changes to the childhood immunization schedule. The FDA is also weighing sweeping changes to its vaccine approval process — including requiring larger, longer clinical trials — according to a recent internal memo obtained by The New York Times. The memo, authored by the FDA’s vaccine division head Vinay Prasad, MD, also called for revising the agency’s annual flu vaccine framework and included controversial claims about pediatric COVID-19 vaccine safety, prompting sharp pushback from public health experts.
The post 3 states with high virus levels appeared first on Becker’s Hospital Review | Healthcare News & Analysis.
10 states with biggest unemployment decreases
Unemployment claims nationwide have remained largely stable over the past year. However, state-level changes varied significantly, ranging from a 45% decrease to a 65% increase, according to a Dec. 4 analysis from personal finance website WalletHub.
Alabama saw the largest week-over-week decrease, while North Dakota had the steepest year-over-year drop in claims. In total, 13 states recorded more unemployment claims last week compared to the previous week, while 19 states and Washington, D.C., reported higher claims than the same week in 2024.
WalletHub analyzed the change in initial unemployment insurance claims for the week of Nov. 24 compared to both the week of Nov. 17 and the week of Nov. 25, 2024. Data was sourced from the Labor Department.
Healthcare organizations added 42,800 jobs in September, similar to the industry’s 12-month average of 42,000. At the same time, Becker’s has reported on at least 91 hospitals and health systems that have announced job cuts in 2025, including nine in September, 10 in October and four in November.
10 states with the largest year-over-year decreases in unemployment claims
1. North Dakota (45.68%)
2. Kentucky (33%)
3. Louisiana (30.64%)
4. Idaho (30.63%)
5. New Hampshire (29.55%)
6. Alabama (25.78%)
7. Georgia (25.54%)
8. Michigan (24.25%)
9. Arizona (22.69%)
10. Massachusetts (22.33%)
10 states with the largest year-over-year increases in unemployment claims:
1. Nebraska (65.06%)
2. Virginia (40.50%)
3. Oregon (20.02%)
4. Maine (19.56%)
5. Alaska (18.24%)
6. District of Columbia (18.16%)
7. Hawaii (17.54%)
8. Colorado (14.03%)
9. Connecticut (8.76%)
10. Kansas (7.57%)
The post 10 states with biggest unemployment decreases appeared first on Becker’s Hospital Review | Healthcare News & Analysis.
253 5-star hospitals: Forbes
Forbes launched an inaugural quality ranking of U.S. general acute care hospitals Dec. 4, which analyzes data on outcomes, best practices, value and patient experience.
The media company said its list, “Forbes Top Hospitals 2026,” differs from other hospital rankings and ratings in three key ways. First, the primary quality measures derive from CMS’ Provider Data Catalog; second, the methodology places the most weight on clinical outcomes, including mortality and readmission rates; and third, clinical outcomes are statistically adjusted for social drivers of health.
Forbes assigned a star rating, from one to five, across four categories to calculate a hospital’s overall score. The outcome category included 25 publicly reported measures, such as “surgical site infection after colon surgery” and “30-day readmission after discharge,” according to Forbes. Best practices had 10 measures, value had seven and patient experience had 14.
Outcomes carried a 55% weight in the overall calculation, followed by best practices (20%), value (15%) and patient experience (10%). Based on this criteria, Forbes recognized 253 hospitals with an overall five-star rating.
Forbes‘ five-star hospitals, by state:
Editor’s note: The list excludes children’s hospitals and psychiatric hospitals.
Alabama
Southeast Health Medical Center (Dothan)
Arizona
Banner Del E. Webb Medical Center (Sun City West)
Kingman Regional Medical Center
Mayo Clinic in Arizona (Phoenix)
California
Adventist Health Howard Memorial (Willits)
Adventist Health Ukiah Valley
Alta Bates Summit Medical Center Summit Campus (Oakland)
Eisenhower Medical Center (Rancho Mirage)
French Hospital Medical Center (San Luis Obispo)
MarinHealth Medical Center (Greenbrae)
Providence Little Company of Mary Medical Center Torrance
Providence St. Joseph Hospital Eureka
Sequoia Hospital (Redwood City)
Sharp Coronado Hospital
Stanford Health Care
Sutter Davis Hospital
Sutter Santa Rosa Regional Hospital
UC San Diego Health Hillcrest Medical Center
UCI Medical Center (Orange, Calif.)
Woodland Memorial Hospital
Colorado
CommonSpirit Health St. Elizabeth Hospital (Fort Morgan, Colo.)
CommonSpirit Health St. Thomas More Hospital (Canon City, Colo.)
CommonSpirit Mercy Hospital (Durango, Colo.)
CommonSpirit Penrose Hospital (Colorado Springs, Colo.)
UCHealth Highlands Ranch Hospital
UCHealth Poudre Valley Hospital (Fort Collins, Colo.)
UCHealth University of Colorado Hospital (Aurora)
Delaware
TidalHealth Nanticoke (Seaford)
Florida
AdventHealth Daytona Beach
AdventHealth Fish Memorial (Orange City)
AdventHealth Waterman (Tavares, Fla.)
AdventHealth Zephyrhills (Fla.)
Baptist Health West Kendall Baptist Hospital (Miami)
Lee Memorial Hospital (Fort Myers)
Mayo Clinic in Florida (Jacksonville)
North Okaloosa Medical Center (Crestview)
Santa Rosa Medical Center (Milton)
Sarasota Memorial Hospital-Sarasota Campus
Georgia
AdventHealth Murray (Chatsworth)
AdventHealth Redmond (Rome)
Memorial Health Meadows Hospital (Vidalia)
Idaho
Kootenai Health (Coeur d’Alene)
St. Luke’s Magic Valley Medical Center (Twin Falls)
St. Luke’s Wood River Medical Center (Ketchum)
West Valley Medical Center (Caldwell)
Illinois
Ascension St. Joseph-Chicago
Blessing Hospital (Quincy)
Northwestern Medicine Catherine Gratz Griffin Lake Forest Hospital
Northwestern Medicine Central DuPage Hospital (Winfield)
Northwestern Medicine Delnor Hospital (Geneva)
Northwestern Medicine McHenry Hospital
Rush University Medical Center (Chicago)
UChicago Medicine AdventHealth La Grange
Indiana
Ascension St. Vincent Fishers Hospital
Elkhart General Hospital
Franciscan Health Crawfordsville
Hendricks Regional Health (Danville)
MHP Major Hospital (Shelbyville)
Schneck Medical Center (Seymour)
Witham Health Services (Lebanon)
Iowa
Cass County Memorial Hospital (Atlantic)
MercyOne Waterloo Medical Center
Kansas
Ascension Via Christi St. Theresa (Wichita)
LMH Health (Lawrence)
Pratt Regional Medical Center
St. Luke’s South Hospital (Overland Park)
Stormont Vail Health Flint Hills Campus (Junction City)
University of Kansas Hospital (Kansas City)
Wesley Medical Center (Wichita)
Kentucky
Baptist Health Paducah
Meadowview Regional Medical Center (Maysville)
Owensboro Health Twin Lakes Medical Center (Leitchfield, Ky.)
St. Elizabeth Healthcare Edgewood Hospital
Louisiana
Lake Charles Memorial Hospital
Maine
Northern Light Eastern Maine Medical Center (Bangor)
Maryland
MedStar Union Memorial Hospital (Baltimore)
University of Maryland St. Joseph Medical Center (Towson)
UPMC Western Maryland (Cumberland)
Massachusetts
Beth Israel Deaconess Hospital-Plymouth
Brigham and Women’s Faulkner Hospital (Boston)
Brigham and Women’s Hospital (Boston)
Salem Hospital
Michigan
Beaumont Health (Southfield)
Bronson Battle Creek Hospital
Bronson Methodist Hospital (Kalamazoo)
Corewell Health Lakeland Hospitals-St. Joseph Hospital
Corewell Health Ludington Hospital
Holland Hospital
Trinity Health Ann Arbor Hospital
Minnesota
Buffalo Hospital
Essentia Health St. Joseph’s Medical Center (Brainerd)
Essentia Health St. Mary’s (Detroit Lakes)
M Health Fairview Southdale Hospital (Edina)
M Health Fairview St. John’s Hospital (Maplewood)
Mayo Clinic Health System in Albert Lea
Mayo Clinic Health System in Fairmont
Mayo Clinic Health System in Eau Claire
Mayo Clinic Health System in Mankato
Mayo Clinic in Rochester
Sanford Worthington Medical Center
Mississippi
Methodist Olive Branch Hospital
Missouri
Boone Hospital Center (Columbia)
Mercy Hospital Lebanon
Mosaic Life Care at St. Joseph
Parkland Health Center (Farmington)
St. Luke’s North Hospital-Barry Road (Kansas City)
Montana
Bozeman Health Deaconess Regional Medical Center
Logan Health Medical Center (Kalispell)
Providence St. Patrick Hospital (Missoula)
Nebraska
CHI Health St. Francis (Grand Island)
New Hampshire
Catholic Medical Center (Manchester)
Exeter Hospital
New Jersey
Morristown Medical Center
Overlook Medical Center (Summit)
St. Luke’s Hospital-Warren Campus (Phillipsburg)
New Mexico
Christus St. Vincent Regional Medical Center (Santa Fe)
New York
Adirondack Medical Center-Saranac Lake
Claxton-Hepburn Medical Center (Ogdensburg)
Jones Memorial Hospital (Wellsville)
NewYork-Presbyterian Hospital (New York City)
NYU Langone Health (New York City)
White Plains Hospital
North Carolina
CaroMont Regional Medical Center (Gastonia)
Mission Hospital (Asheville)
Novant Health Huntersville Medical Center
Novant Health Matthews Medical Center
Outer Banks Health Hospital (Nags Head)
Scotland Memorial Hospital (Laurinburg)
UNC Health Pardee (Hendersonville)
UNC Health Rex (Raleigh)
WakeMed Cary Hospital
North Dakota
Sanford Bismarck Medical Center
Sanford Medical Center Fargo
Ohio
Cleveland Clinic Akron General
Cleveland Clinic Avon Hospital at Richard E. Jacobs Health Campus
Cleveland Clinic Fairview Hospital
Cleveland Clinic Hillcrest Hospital (Mayfield Heights)
Cleveland Clinic Main Campus
Cleveland Clinic Medina Hospital
East Liverpool City Hospital
Memorial Hospital (Marysville)
Mercy Health-Springfield Regional Medical Center
OhioHealth Marion General Hospital
ProMedica Toledo Hospital
Oklahoma
Ascension St. John Broken Arrow
Hillcrest Hospital South (Tulsa)
Oklahoma Heart Hospital South (Oklahoma City)
Oklahoma Surgical Hospital (Tulsa)
St. Francis Hospital South (Tulsa)
St. Francis Hospital Vinita
Oregon
Asante Rogue Regional Medical Center (Medford)
Asante Three Rivers Medical Center (Grants Pass)
CHI Mercy Health Mercy Medical Center (Roseburg)
McKenzie-Willamette Medical Center (Springfield)
PeaceHealth Sacred Heart Medical Center RiverBend (Springfield)
St. Charles Bend
Pennsylvania
AHN Wexford Hospital
Geisinger Bloomsburg Hospital
Geisinger Jersey Shore Hospital
Geisinger Lewistown Hospital
Geisinger St. Luke’s Hospital (Orwigsburg)
Geisinger Wyoming Valley Medical Center (Wilkes-Barre)
Lancaster General Hospital
Mount Nittany Medical Center (State College)
Penn Presbyterian Medical Center (Philadelphia)
St. Luke’s Hospital-Anderson Campus (Easton)
St. Luke’s Hospital-Miners Campus (Coaldale)
UPMC Northwest (Seneca)
WellSpan Ephrata Community Hospital
WellSpan Evangelical Community Hospital (Lewisburg)
WellSpan Gettysburg Hospital
WellSpan Good Samaritan Hospital (Lebanon)
WellSpan Waynesboro Hospital
South Carolina
Beaufort Memorial Hospital
Prisma Health Baptist (Columbia)
South Dakota
Brookings Hospital
Prairie Lakes Healthcare System (Watertown)
Sanford Aberdeen Medical Center
Tennessee
CommonSpirit Memorial Hospital Chattanooga
Williamson Medical Center (Franklin)
Texas
Baylor Scott & White Medical Center-Irving
Baylor Scott & White Medical Center-Temple
Doctors Hospital of Laredo
Knapp Medical Center (Weslaco)
Harlingen Medical Center
Houston Methodist Baytown Hospital
Houston Methodist Clear Lake Hospital
Houston Methodist Hospital
Houston Methodist The Woodlands Hospital
Houston Methodist West Hospital
Houston Methodist Willowbrook Hospital
South Texas Health System Edinburg
Utah
Central Valley Medical Center (Nephi)
CommonSpirit Health Holy Cross Hospital-Davis (Layton)
Intermountain Health LDS Hospital (Salt Lake City)
Intermountain Health Logan Regional Hospital
Intermountain Health McKay-Dee Hospital (Ogden)
Intermountain Health Riverton Hospital
Intermountain Health Utah Valley Hospital (Provo)
Intermountain Medical Center (Murray)
Lone Peak Hospital (Draper)
University of Utah Hospital (Salt Lake City)
Vermont
Northwestern Medical Center (St. Albans)
Virginia
Augusta Health (Fishersville)
Carilion Franklin Memorial Hospital (Rocky Mount)
Carilion Roanoke Memorial Hospital
Inova Alexandria Hospital
Inova Fairfax Hospital (Falls Church)
Inova Loudoun Hospital (Leesburg)
Riverside Doctors’ Hospital Williamsburg
Sentara Obici Hospital (Suffolk)
Sentara Princess Anne Hospital (Virginia Beach)
Sentara RMH Medical Center (Harrisonburg)
Washington
Confluence Health Hospital (Wenatchee)
PeaceHealth St. John Medical Center (Longview)
St. Clare Hospital in Lakewood
Virginia Mason Medical Center (Seattle)
West Virginia
WVU Medicine (Morgantown)
Wisconsin
Ascension NE Wisconsin-St. Elizabeth Hospital (Appleton)
Ascension NE Wisconsin-St. Joseph (Milwaukee)
Aurora Lakeland Medical Center (Elkhorn)
Aurora Medical Center-Grafton
Aurora Medical Center-Sheboygan County
Aurora Medical Center-Summit
Bellin Memorial Hospital (Green Bay)
Beloit Health System
Froedtert ThedaCare Health (Menomonee Falls)
Mayo Clinic Health System in La Crosse
SSM Health St. Clare Hospital-Baraboo
SSM Health St. Mary’s Hospital-Madison
Sauk Prairie Hospital (Prairie du Sac)
ThedaCare Regional Medical Center-Appleton
ThedaCare Regional Medical Center-Neenah
Upland Hills Health Hospital (Dodgeville)
Wyoming
Memorial Hospital of Sweetwater County (Rock Springs)
St. John’s Health (Jackson)
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Top 12 reasons patients don’t trust their healthcare providers
One in 4 patients say they’ve switched healthcare providers because they lost trust in them, marketing agency Monigle found.
Here are the top 12 reasons consumers don’t trust their providers, according to the survey of 1,000 household healthcare decision-makers published in November:
1. Rushed or unpersonalized care: 23%
2. Financial or provider motives misaligned with patient’s: 18%
3 (tie). Distrust of medications/pharma: 8%
3 (tie). Provider makes mistakes: 8%
5 (tie). Past negative experiences: 7%
5 (tie). Gender preference for provider: 7%
7. Lack of communication/listening: 5%
8. Need for second opinions/skepticism of diagnosis: 4%
9 (tie). Preference for being able to make their own decisions: 3%
9 (tie). Preference for self-research: 3%
11. Emotional/mental health concerns: 2%
12. Concern about the competence of healthcare provider/diagnosis: 1%
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5 top workforce opportunities for health systems: AHA
The American Hospital Association outlined five key ways hospitals and health systems are reimagining their workforce strategies in a Dec. 3 report.
The association’s 2026 Health Care Workforce Scan report offers an annual snapshot of healthcare employment based on the latest industry reports and research. AHA said health systems will continue to rethink workforce strategies in 2026 amid persistent staffing shortages and rising demand for care.
“Hospitals and health systems should continually reevaluate their approaches to workforce management,” the AHA said. “Shifts in the workforce landscape demand that we act innovatively to embrace new opportunities and commit to supporting, engaging and empowering the team members who put patient needs front and center every day at every level of our organizations.”
The top five opportunities to reimagine the healthcare workforce, per AHA:
1. Integrate team-based care into staffing models and workflows.
2. Create a strong foundation for the responsible adoption of artificial intelligence tools that integrate into existing workflows.
3. Prioritize initiatives to improve staff engagement and retention, including flexible scheduling,
professional development and peer recognition programs.
4. Reassess workforce needs by building and upskilling for roles in digital health, virtual care and AI.
5. Tailor support and training to the multigenerational workforce, with targeted strategies to better retain Gen Z employees.
Learn more here.
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The looming challenge on revenue cycle leaders’ minds
Major shifts to Medicaid eligibility and financing set to take effect under the One Big Beautiful Bill Act in 2026 and beyond are emerging as a top concern for revenue cycle leaders, who say the changes could further intensify financial pressures.
“We used to talk about try[ing] to make a 3% operating margin on Medicare book of business, but post-COVID, with the inflation that we’ve seen in labor and supplies, that’s a really difficult thing to achieve,” said Stephen Rinaldi, senior vice president and chief revenue officer at Chapel Hill, N.C.-based UNC Health. “When you add on top of that the headwinds with the impact of Medicaid enrollment, the likely reduction of covered beneficiaries, it becomes even more challenging.”
Mr. Rinaldi told Becker’s that for most organizations to survive this type of disruption, “you really need to focus on both topline revenue integrity while working to control the cost footprint across your enterprise to the extent possible.”
“Most organizations cannot reduce the cost quickly enough to offset a loss of revenue,” he said. “This creates what is commonly known as a financial structural weakness. So you really have to be excellent at converting clinical services into that revenue. From a revenue cycle perspective that means strong front-end processes and financial clearance, really connecting the scheduling process to making sure that the scheduled service will be covered from a reimbursement perspective, and then also that the patient won’t have any surprises from a liability perspective.”
At Falls Church, Va.-based Inova Health, leaders are starting to think about roles differently, particularly around financial counseling and front-end capacity, Vice President, Revenue Cycle Erin Hodson, MSN, told Becker’s. They are also thinking about what kind of white-glove service they’re offering patients to help them better understand what’s ahead.
“That includes not just Medicaid changes, where we’ll need to hand-hold patients more than we have in the past, but also shifts in patient liability outside of Medicaid,” she said. “High-deductible plans, changing premiums — all of that is evolving.”
Staying aligned with the changes and understanding how they will affect health systems is a top priority for Sarah Ginnetti, chief revenue cycle officer and vice president of clinical revenue at Farmington, Conn.-based UConn Health, told Becker’s.
“We are collaborating with our regulators in the state, but also leaning on some of the professional associations that we’re closely aligned with,” Ms. Ginnetti said. “[The Healthcare Financial Management Association], for example, is one that we are very plugged into and [we’re] working with them on trying to model some of these impacts. And then also leaning on even Epic and some of our other vendor partners to help us with some of the modeling and understanding the implications.”
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Medical organizations form infection prevention group to fill CDC gap: 3 notes
Months after the CDC eliminated its infection control committee, two epidemiology organizations have created the Healthcare Infection Prevention Advisory Group.
The two organizations, the Association for Professionals in Infection Control and Epidemiology and the Society for Healthcare Epidemiology of America, said in a Dec. 2 news release that the advisory group will fill gaps formed by the May termination of the CDC’s Healthcare Infection Control Practices Advisory Committee.
The government established the CDC group, HICPAC, in 1991. The committee consisted of leaders in federal health, hospitals and medical associations. It crafted national standards on best strategies and practices for preventing and controlling antimicrobial resistance and infections in healthcare. During its run, HICPAC made 540 recommendations — 90% of which were fully implemented, NBC News reported May 6.
Here are three things to know about the new Healthcare Infection Prevention Advisory Group:
1. The Association for Professionals in Infection Control and Epidemiology and the Society for Healthcare Epidemiology of America said it is “intended to prevent fragmented or duplicative efforts, promote alignment and strengthen collaboration by connecting subject matter experts across disciplines and care settings.”
2. The group is inviting experts from medical societies, healthcare organizations, public health societies and patient advocacy groups to join the initiative.
3. The final structure and membership will happen in the coming weeks, “along with a coordinated communication and engagement plan,” according to the release.
Similarly, the Center for Infectious Disease Research and Policy at the University of Minnesota in Minneapolis and The New England Journal of Medicine created a CDC-esque publication in October. The publication reports on outbreaks and emerging diseases as an alternative to the CDC’s Morbidity & Mortality Weekly Report.
CIDRAP also launched the Vaccine Integrity Project to consult with national medical organizations to create vaccine recommendations — a role long performed by the CDC’s Advisory Committee on Immunization Practices. ACIP barred public health professionals and infectious disease experts from its working groups earlier in 2025.
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The Medicare Advantage question hospitals want answered
With Medicare Advantage enrollment approaching 55% of eligible beneficiaries, health systems across the country are grappling with a question that’s gone largely unaddressed in policy circles: What happens if the healthcare providers best equipped to care for seniors can no longer afford to participate?
Over the past couple of years, persistent operational and financial hurdles have driven a growing number of hospitals and health systems to end some or all of their commercial MA contracts. These range from rising denial rates and prior authorizations to delayed or insufficient reimbursements. And while payers and providers navigate these clashes behind the scenes, patients are left in limbo.
“Over the past 15 to 20 years, we’ve seen a dramatic shift with the rise of Medicare Advantage. It’s changed the dynamic,” Chip Kahn, president and CEO of the Federation of American Hospitals, told Becker’s. “In certain markets — take Southern Florida, for example — hospitals can have Medicare Advantage penetration rates as high as 70% to 80%, not just the national average of 54%. In those areas, it has essentially become the dominant way Medicare beneficiaries receive coverage.”
While MA plans are attractive to many enrollees for their simplicity and potential cost savings, the back-end friction they can generate has providers doubting whether the program is sustainable in its current form.
“The assumption seems to be that the more friction you introduce — whether through prior authorizations, delays or denials — the less care will ultimately be delivered, because patients, clinicians and hospitals will get worn down,” Mr. Kahn said.
‘I’ve long supported MA, but…’: A CEO’s shifting view
Barry Arbuckle, president and CEO of Fountain Valley, Calif.-based MemorialCare Health System, has been a longtime supporter of MA, citing the program’s emphasis on coordination, prevention and financial alignment with population health.
“MA — especially contracts where the providers are taking financial risk — is far more aligned with the health of the population,” Dr. Arbuckle said. “Having participated in dual-risk for over 25 years, I can confidently say that the MA program is better for our seniors, better for the providers (until recently), and better for the financial health of the U.S. healthcare system.”
But recent changes in regulation and reimbursement have weakened that optimism. Of particular frustration are inaccurate MedPAC reports, which Dr. Arbuckle says have led CMS and Congress to adopt increasingly restrictive policies.
“In the past few years, MA has been subjected to some serious blows,” Dr. Arbuckle said. “Some organizations — though I would argue a minority — have exploited loopholes or grey areas in MA regulations, and MedPAC has issued deeply flawed analyses of MA, which has led to CMS and members of Congress holding a very negative view of the program.”
In response, CMS and Congress have implemented changes — with more expected — that are pushing more providers and health plans to reconsider or exit MA altogether.
Dr. Arbuckle argues that many of these policy shifts stem from recent MedPAC reports that relied on simplistic comparisons between MA and traditional Medicare, failing to account for MA’s integrated care coordination, prescription drug coverage and affordability protections — features that are not part of traditional Medicare.
The March MedPAC report claims MA costs the federal government up to $84 billion more annually than traditional Medicare — figures Dr. Arbuckle believes are based on flawed assumptions about favorable selection and coding intensity.
“With worsening financial performance of MA, some providers took the tact that my organization took — appreciate the importance of MA to our community, but protect the financial stability of our hospitals — and move from taking hospital risk to fee-for-service, while keeping our physician division [in risk-based contracts],” he said. “Many more health systems have outright terminated MA contracts altogether, and an increasing number of MA health plans are abandoning multiple markets.”
Why Mayo Clinic is stepping back from Medicare Advantage
This friction is being felt at the highest levels of healthcare leadership. At Becker’s CEO+CFO Roundtable, Dennis Dahlen, CFO of Rochester, Minn.-based Mayo Clinic, discussed the health system’s decision to end contracts with most Humana and UnitedHealthcare MA plans in January 2026 — a move that reflects a broader trend.
Over the last three years, Becker’s has reported on about 90 hospitals and health systems that have dropped some or all of their MA contracts.
“There’s been a significant amount of peer and network disruption in the Medicare Advantage space, and Mayo Clinic is taking a fairly aggressive approach on that front,” Mr. Dahlen said. “We’re being very selective about which Medicare Advantage plans we contract with — but for those that we’re not in network with, patients likely won’t be able to get an appointment unless it’s clinically significant or we can make an exception.”
Mr. Dahlen emphasized that these decisions aren’t easy, but for every network or contract decision Mayo Clinic makes, there’s a clinical safety net in place.
“If a patient is currently under our care and needs to continue treatment, we will preserve access,” he said.
Some health systems are proactively advising patients aging into Medicare to consider traditional Medicare if they wish to maintain access, while others are advising seniors already enrolled in MA plans to switch to traditional Medicare.
A hidden risk for seniors
However, Dr. Arbuckle warns that advising patients to “just go back to traditional Medicare” may not be the easy fix it seems. This is especially true for seniors seeking Medigap coverage, extra insurance that can be bought to help pay for out-of-pocket costs in traditional Medicare.
“If someone buys Medigap at age 65, they get guaranteed-issue pricing,” he said. “But if they leave MA, go back to traditional Medicare, and attempt to purchase a Medigap plan, they must go through underwriting, they will have higher premiums (especially if they have any comorbidities) or they could be outright denied.”
Given that 93% of adults aged 65 or older have at least one chronic condition — and nearly a quarter have four or more — the affordability gap can be devastating. Dr. Arbuckle noted that $200 per month in added premiums is common, a steep price for many seniors on fixed incomes.
Reclaiming stability in Medicare Advantage
As MA plans evolve and providers reconsider participation, health system leaders are calling for greater education, transparency and reform.
“We must educate CMS, Congress and their healthcare staffers about the flaws in the MedPAC reports and the damage they’re causing,” he said. “It’s imperative that we get the MA program back on the right track — for our seniors, our provider systems, and the financial stability of the U.S. healthcare system.”
This level of dysfunction in something that serves 55% of America’s seniors — a demographic that votes in high numbers and holds influence with policymakers — is unsustainable, according to Mr. Dahlen.
“Seniorhood is when we need healthcare the most,” he said. “That should be the last point in life where you’re at risk of losing network access or care availability. So, while I don’t know exactly how this will play out, I don’t think the current path — where there’s massive annual disruption around network participation, plan exits and coverage drivers — is one that can continue.”
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Hospitals lose ‘room to maneuver’ as revenue gap widens
The revenue gap between large and small health systems grew starker this year, and will likely continue to widen as HR-1 takes effect in the coming years.
Operating revenue for health systems overall grew 3.1% for January through September of
2025 compared to 2024, according to Strata’s “Performance Trends Report: Market Insights from Q3 2025.” But systems with net operating revenue above $1 billion reported a 5.7% increase in operating revenue while systems with a net operating revenue of below $300 million reported a nearly 7% decline in operating revenue.
“These results underscore a widening financial gap in the sector, as larger systems leverage scale to sustain growth while smaller operations continue to struggle under persistent margin pressure,” according to the report.
Net patient revenue followed a similar trend. Systems with less than $300 million in revenue reported 0.3% decline in net patient year over year compared to 7.1% growth for systems with more than $1 billion net operating revenue.
“As expenses continue to climb and margins remain relatively stagnant, many organizations are running out of room to maneuver,” said Steve Wasson, chief data and intelligence officer at Strata. “The widening performance gap between large and small systems, the potential erosion of access to critical services like maternity care, and the structural imbalances in academic research programs all point to an urgent need for reliable data and predictive analytics as leaders work to navigate these pressures and prepare for what comes next.”
https://www.beckershospitalreview.com/finance/financial-pressures-mount-for-academic-medical-centers/
Hospitals reported a steep increase in non-labor expenses including a 21.6% third quarter jump in drug expenses at academic medical centers and 8.4% increase for hospitals overall. Supply expenses spiked 9.2% year over year in October, making it harder for hospitals to improve margins with the increasing patient demand, according to the report.
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Unemployment gap between high school, college graduates nears 40-year low
The unemployment gap between high school and college graduates ages 22-27 has reached its lowest level since the late 1970s, according to a Nov. 24 analysis from the Federal Reserve Bank of Cleveland.
Here are five things to know:
1. The unemployment gap has steadily declined since the 2008 financial crisis. After decades of higher job-finding rates for young college graduates, their rate is now roughly in line with that of high school-educated peers, according to Bureau of Labor Statistics data from the Current Population Survey spanning 1976 to 2025.
2. The gap held around 5 percentage points for decades before increasing after 2008, when high school graduates struggled with re-employment. The gap then narrowed, except for a brief pandemic spike. As of July 2025, the 12-month moving average of the gap is at 2.5 percentage points — near the all-time low of 2.4 percentage points in March 2024.
3. Despite similar job-finding rates, young college graduates continue to hold an advantage in compensation and job stability once employed.
4. The convergence is not attributed to recent economic conditions or artificial intelligence trends. Instead, it reflects a decades-long decline in job-finding rates for young college graduates that began around 2000, according to the analysis. Contributing factors include a shift from “college-biased” to “education-neutral” labor demand and a growing supply of college-educated job seekers.
5. Hospitals and health systems have developed programs to recruit both high school and college graduates. Georgetown, S.C.-based Tidelands Health, for example, offers pipeline programs beginning in high school. Students can dual-enroll in college courses and are guaranteed a role after college graduation. “Earn and learn” programs are another avenue hospitals use to employ students before graduation, aiming to retain them long term.
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Hospitals struggle as clinical-financial gap widens
Health systems nationwide are navigating a growing number of payer-driven rules that influence how care is delivered, documented and reimbursed. For clinical and financial leaders, these pressures have become central to both daily operations and long-term strategy.
At New York City-based Mount Sinai Health System, Stephen Teitelbaum, MD, senior vice president and chief medical finance officer, said the cumulative effect of policies such as DRGs, preauthorization and observation criteria has reshaped the relationship between physicians, hospitals and insurers.
Dr. Teitelbaum spent three decades as a practicing urologist before moving into health system leadership, and the intersection of clinical judgment and financial structures is more pronounced today than at any point in his career. He believes these pressures increasingly place physicians and hospitals in positions where medical care is shaped less by clinical expertise and more by administrative frameworks.
“My career has been about bridging the gap between clinical practice and the financial realities of healthcare, because when those worlds collide, patient care is often caught in the middle,” he said during an interview with the “Becker’s Healthcare Podcast.” “I’m passionate about how policy- and pay-driven decisions impact physicians, hospitals, and most importantly, our patients.”
One of the most significant trends in healthcare is the leadership shift away from clinical judgment and toward payer oversight. This shift happened slowly, built over decades as insurers expanded utilization management requirements and administrative expectations. The result is a system where physicians must navigate criteria that limit autonomy and constrain decision-making.
“One of my biggest concerns, and really something I find most concerning in health is how healthcare leadership is evolving,” he said. “Historically, physicians were the architects of care and policy. Clinical judgment drove decisions and leadership was rooted in patient centered values. But today, that leadership is seeded to payers through a series of policies and practices that prioritize cost containment over clinical autonomy.”
Those payer-defined requirements surface daily in physician workflows. Clinicians now encounter a framework of administrative checkpoints around medical necessity, imaging guidance, appropriateness and utilization rules. These frequently supersede clinical reasoning and delay care.
“We’re talking about insurance companies and managed care organizations,” he said. “So instead of physicians determining what’s best for our patients, payers use cost algorithms and administrative hurdles to dictate care pathways. And what’s the result? We’re drowning in documentation, hospitals are losing revenue, and patients are stuck in a system where cost containment trumps clinical judgment.”
But clinical judgement can be unchecked, either. Rising costs, an aging population, increased chronic disease burden, and growing demand for services contribute to the challenging economic situation hospitals are in. Together, these factors place pressure on the entire system and have forced hospitals to shed service lines, workforce reductions and closures. Clinicians need a financially stable organization to keep providing care.
“One reality we can’t ignore is that healthcare operates within a finite pool of dollars,” he said. “That limited pool is being stretched thinner every day as costs rise dramatically. We have an aging population that requires more complex and chronic care, skyrocketing drug prices, rapid adoption of expensive technologies, and an unchecked demand for services. These pressures create a perfect storm where every stakeholder is competing for a share of resources, and payers use cost containment strategies to manage this imbalance. Unfortunately, these strategies often come at the expense of clinical autonomy and patient centered care.”
The tone for today’s coverage model was set by CMS in the 1980s, when the agency released the prospective payment system. The model was designed to reward efficiency, but subsequent layers of policy have altered how hospitals are reimbursed and how care is judged. As the model evolved into MS-DRGs and became recalibrated annually by CMS, hospitals were expected to manage resource use within fixed payments while documenting increasingly complex clinical pictures. This structure, when combined with modern utilization management tools, shifted control away from clinicians and toward payer rules.
“Preauthorization was introduced as a utilization management tool intended to prevent unnecessary procedures and control costs,” he said. “But over time, it has become one of the most disruptive forces in healthcare delivery. Instead of streamlining care, it has created a choke point that delays treatment, increases administrative burden, and erodes physician autonomy.”
Payers now shape how diagnoses are validated, how long patients should remain in the hospital, and what constitutes “medical necessity.” Those determinations often conflict with clinical experience.
“Medical necessity was once clinical judgment,” he said. “Physicians determined what care was appropriate based on patient needs and evidence based practice. Today, that concept has been hijacked by payers, insurers define medical necessity using proprietary algorithms and rigid criteria that often ignore clinical nuance.”
Other big issues include:
1. Observation status rules, the ambulatory surgery 24-hour category and the two-midnight rule further eroded reimbursement integrity. Efficient care can inadvertently penalize hospitals under DRG structures.
2. Medicare Advantage plans often diverge from CMS rules despite requirements to follow the two-midnight standard, contributing to denials and forcing hospitals and physicians into additional rounds of documentation.
3. Clinical validation audits have eroded the integrity of clinical decisions by challenging medical necessity judgements as well as coding assignments. “Clinical validation audits take this erosion of integrity even further,” he said.
These dynamics have reshaped the physician-hospital relationship. Hospitals must implement documentation rules to avoid financial penalties, even though those rules contribute to physician burden.
“To protect revenues, hospitals have had to impose ever-increasing administrative and documentation demands on physician requirements for detailed medical necessity justification, compliance with the two midnight rule, and exhaustive clinical documentation requirements and queries,” he said. “These layers of bureaucracy strain relationships, erode trust, and shift the focus from collaborative patient care to defensive documentation and compliance.”
What can be done?
“Physician leaders need to acknowledge that we’ve ceded control of healthcare decision making to payers,” he said. “And that this shift has fundamentally changed how care is delivered. Ignoring the problem won’t make it go away.”
He added that changing the trajectory will require collective action.
“The next question is, is it worth the effort to reverse this trend?,” he said. “Because make no mistake, this will be an exhaustive uphill battle. It requires a unified physician voice, collaboration with hospitals, and engagement in policy advocacy at both state and federal levels.”
He encouraged physicians to deepen their understanding of payer policy and join coalitions that can influence rules and legislation.
“Physician leaders must understand the mechanics of payer policies, medical necessity criteria, observation status, the two midnight rule, clinical validation audits, and preauthorization requirements, and how these erode autonomy,” he said. “We need to build coalitions. We can’t fight this alone. Partner with hospitals, professional societies, and patient advocacy groups to push for reforms like prior authorization policy and governance, join committees, influence legislation, and participate in paying negotiations. Leadership means having a seat at the table where the rules are written.”
Despite the scale of the challenge, Dr. Teitelbaum remains committed to supporting emerging leaders and contributing to the broader movement to restore clinical leadership in healthcare. Incremental progress is possible with sustained effort.
“We have tools, we have to organize and it’s potentially exciting,” he said. “It’s gonna be a fight, but it’s not something we should shy away from.”
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Shaping culture: A practical framework for teams
Culture profoundly shapes organizational, team and individual performance. It can propel organizations toward excellence — or hold them back in risk and stagnation. Too often, however, employees view culture as something distant, external, or imposed from above.
They forget an essential truth: we are the culture. Each of us, through our daily words and actions, builds — or breaks — the culture we live in.
When I share this with teams, I see both hope and humility. Hope, because people realize they do have agency to improve the culture they long to see. Humility, because many feel uncertain about how to begin. Culture can seem abstract, intangible. To make it real and actionable, we developed a practical tool to help teams shape culture together.
We begin with appreciative inquiry. Teams are asked to imagine themselves two years in the future, on a truly extraordinary day — one where collaboration, safety, innovation, joy and excellence all flourish. We then ask them to describe what that day looks and feels like in vivid detail.
Next, we translate that vision into concrete behaviors. What would people be doing on this amazing day? How would they interact? What words would they use? What habits and practices would be visible?
Finally, we explore practical interventions that can bring those behaviors to life, guided by the Six R’s Framework for Shaping Culture:
1. Relationships
Strong cultures are built on strong relationships. They deepen when we listen more than we speak, ask humble questions and balance task talk with relational talk. A simple question about someone’s family, values or hobbies can strengthen connection and trust.
2. Role Modeling
Behaviors are contagious. If we want respect, collaboration or empathy, we must first
demonstrate those behaviors ourselves. Leaders and peers alike set the tone.
3. Rhetoric
Words matter. They can uplift or diminish. Language that conveys power with rather than power over fosters respect and hope. Choose words that affirm, inspire and connect.
4. Rituals
Rituals make values tangible. Think of how faith traditions, sports or operating room teams use rituals to create meaning and consistency. For example, our transformation team begins meetings with uplifting music, a well-being reflection and an inspiring story before reviewing performance.
5. Recognition
What we recognize, we repeat. Recognition must be intentional. We created an “Illuminator Award” for individuals who elevate, connect and uplift others. Anyone can nominate someone — no vetting, no gatekeeping. Over time, we hope everyone is recognized as an illuminator.
6. Rewards
Rewards, often formal through HR, should also align with the culture we want. They should be both monetary and non-monetary and signal clearly what behaviors matter most. In our team, we believe change moves at the speed of trust, and trust grows when we act with rather than to others.
We are testing and refining this framework in our organization, and early feedback has been overwhelmingly positive. Clinicians and staff tell us it gives them both agency and a clear set of actions to influence culture — not just lofty aspirations, but real tools.
Culture is not beyond our control. It lives in every interaction, every choice, every word. By applying the 6 R’s — Relationships, Role Modeling, Rhetoric, Rituals, Recognition and Rewards — we can all help build a culture that uplifts, connects and empowers.
Together, let’s shape a culture worthy of the people we serve and the people we work
alongside.
Peter Pronovost, MD, PhD, is Chief Quality & Clinical Transformation Officer and President, Veale Healthcare Transformation Institute at University Hospitals in Cleveland, Ohio.
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Flu activity low but rising: 5 virus updates
Flu activity remains low but is increasing nationwide, particularly among children and young adults, new CDC data shows.
Outpatient visits and hospitalizations for flu have risen in recent weeks, according to the CDC’s latest FluView update published Dec. 1. In the week ending Nov. 22, the U.S. reported 3,264 flu-related hospitalizations, marking a 39% increase from the week prior.
About 2.5% of outpatient visits involved flu-like illness during the week ending Nov. 22, , a slight increase from the week prior but still below the national baseline of 3.1%. Children ages 4 and younger reported the highest rate of flu-related outpatient visits among all age groups at 7.7%.
The CDC estimates at least 1.1 million flu cases, 11,000 hospitalizations and 450 deaths have occurred so far this season.
Four more virus updates:
1. The U.S. has recorded more than 25,000 whooping cough cases this year — the second consecutive year with elevated cases compared to historical trends, ABC News reported Nov. 25. At this time last year, the U.S. had reported 33,000 cases. The last time case totals were this high was in 2014, when 32,900 cases were confirmed, according to the report. The increase comes amid declining vaccinations rates, CDC data shows.
2. As of Nov. 25, the CDC had confirmed 1,798 measles cases in 42 states, 12% of which required hospitalization. The U.S. has seen 46 outbreaks this year, up from 16 in 2024. Most cases — 92% — involved individuals who were unvaccinated or whose vaccination status was unknown.
3. Global measles deaths declined 88% between 2000 and 2024, according to a Nov. 28 report from the World Health Organization. Health officials credited global vaccination campaigns for this reduction but noted 59 countries reported large or disruptive measles outbreaks in 2024 — nearly triple the number in 2021.
4. The FDA is proposing sweeping changes to its vaccine approval process, according to an internal memo obtained by The New York Times. Vinay Prasad, MD, the agency’s chief medical and scientific officer, authored the memo, which references an internal review linking COVID-19 vaccines to the deaths of 10 children. The analysis has not been published in a peer-reviewed journal, and public health experts have raised concerns about its findings. The memo surfaced ahead of a scheduled Dec. 4-5 meeting of the CDC’s Advisory Committee on Immunization Practices, which is set to review the childhood immunization schedule and timing of the hepatitis B vaccine.
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4 forces confronting health systems in 2025: McKinsey
Health systems across the U.S. are being confronted by four major forces during a “new era of unprecedented uncertainty,” according to a Nov. 18 McKinsey report.
The impact of the forces — which could cause margin pressures of 2 to 13 percentage points for health systems — lies largely on the implementation of certain government policies, according to the report.
Below are the four forces identified by McKinsey and what they could mean for health systems:
1. Healthcare regulatory and legislative pressure
The One Big Beautiful Bill Act, passed July 4, will lead to several changes in government-subsidized sources of health insurance coverage. Although there is uncertainty in how the changes will affect organizations across the U.S., the Congressional Budget Office has estimated the law could result in about 10 million individuals losing Medicaid coverage over a decade and as much as $1.1 trillion in federal healthcare spending reductions. A September report found the law could cost hospitals $25 billion annually.
Health system leaders recently shared with Becker’s how they believe the law will affect their organizations in 2026, highlighting a need to innovate and be prepared to pivot.
“Overall, the OBBBA is pushing our organization to innovate — optimizing technologies, leveraging provider and clinician resources, embracing integrated care models instead of siloed approaches, and eliminating all low-value cost areas,” said Joshua Michalski, COO of Kettering (Ohio) Health.
Other changes — including CMS’ expansion of site-neutral payments and potential changes to the 340B Drug Pricing Program — could also lead to negative margins, according to McKinsey.
McKinsey estimates the following approximate and nonexhaustive margin impact over the next five years for health systems:
- 340B program scope change: 0.0 to -2.0 percentage points
- Site-neutrality reimbursement changes for hospital outpatient departments: 0.0 to -4.0 percentage points
- Changes to eligibility, expiration of enhanced subsidies: -2.0 to -3.0 percentage points
- Federal and state income tax and state property tax: 0.0 to -2.0 percentage points
2. Tariffs
Depending on what tariffs and tariff levels remain in effect, McKinsey estimates that health system spending on medical supplies and pharmaceuticals could rise by 0.2% to 8.4%. CEOs are increasingly pessimistic about the global economy amid new tariffs, according to a survey of leaders at Fortune 500 companies.
3. Heightened clinical supply-and-demand shift
Heightened utilization from older Americans and workforce shortages are straining capacity, quality and access. The cohort of Americans 70 and older is projected to grow fastest of all age groups over the next five years, alongside increasing healthcare demand in this population, according to the report.
McKinsey noted that rising employer health coverage costs may translate into higher reimbursement rates — but could also reduce utilization for discretionary care. It estimated this dynamic could create up to 0.5 percentage points of margin pressure for health systems.
Health systems have begun addressing the twofold challenge of an aging population through expanded ambulatory networks, enhancing recruitment efforts and offering home health services. Specific initiatives include Houston-based Memorial Hermann’s launch of a healthcare high school to boost its workforce pipeline and Chicago-based Cook County Health’s investments in service lines expected to see increased demand as patients age.
4. Medical and technology innovation
McKinsey did not estimate the impact of innovation, given how uncertain developments in the area are. Several health systems have reported cost-saving and efficiency-boosting artificial intelligence initiatives. That includes Chicago-based CommonSpirit Health, which has deployed 230 AI applications throughout its facilities. Among them are AI and robotic process automation tools, generating more than $100 million in annual savings.
What organizations can do
Healthcare organizations should pursue a multifaceted change agenda for improved productivity, according to McKinsey. Technology such as AI could improve operational workflows to expand capacity and boost patient experience.
In addition to improving productivity by implementing automation and AI capabilities at scale, organizations should consider partnerships or outsourcing noncore administrative operations for low value-add functions.
“Navigating the uncertainty will require healthcare organizations to pursue one or more paths in parallel that emphasize transformation, business restructuring, and reimagining business models and innovation,” the report said. “Not-for-profit healthcare institutions should reflect on the trade-offs they can make and focus on the aspects of their mission that they can deliver most effectively.”
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Rural US loses 1 in 9 family physicians in 6 years, study finds
The rural family physician workforce shrank 11% from 2017 to 2023, marking an ongoing shortage in primary care access, according to a study published in November in the Annals of Family Medicine.
Lead author Colleen Fogarty, MD, professor and chair of the Department of Family Medicine at the University of Rochester (N.Y.), and co-authors Hoon Byun, DrPH, of the Robert Graham Center for Policy Studies in Family Medicine and Primary Care in Washington, D.C., and Alison Huffstetler, MD, of Richmond-based Virginia Commonwealth University’s Department of Family Medicine, used the American Medical Association Physician Masterfile to identify actively practicing U.S. family physicians and their practice locations during the study period.
The authors found an 11% nationwide drop in family physicians in rural areas, with year-over-year declines reported across all regions from 2017 to 2023. The Northeast saw the steepest percentage loss (15.3%), while the West saw the smallest (3.2%).
“The data reflect what we already experience and know about physician shortages, but the year-over-year numbers for rural areas were astonishing to me. The speed at which this has happened is remarkable and terrible,” Dr. Fogarty said in a Nov. 24 news release from the University of Rochester.
She noted that the decline is occurring even as more young adults move to rural areas, and she attributed the trend to factors including physician burnout and overwork.
One positive finding from the study: The percentage of practicing female family physicians in rural areas rose from 35.5% in 2017 to 41.8% in 2023. Still, Dr. Fogarty pointed to ongoing challenges, such as uncertainty around visa requirements for residents and international medical graduates.
“Ensuring an adequate rural family physician workforce likely requires a tailored regional approach, such as medical school pathway programs from rural communities,” the authors wrote.
Read the full study here.
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Health systems project big returns from EHR investments
Several health systems are making major bets on new Epic EHR platforms and expect to see substantial returns, with leaders pointing to application consolidation, efficiency gains and reduced administrative burden as key drivers.
Minot, N.D.-based Trinity Health expects its Epic implementation to generate nearly $1 billion in return on investment, CIO John McDaniel told Becker’s. The health system is slated to go live with the new EHR on Nov. 1, 2026.
A significant portion of the projected savings — $5 million to $6 million annually — will come from consolidating more than 400 applications down to fewer than 200. Additional gains are expected through expanded workflow automation, reduced redundancy and improved operational efficiency, according to the health system.
Paramus, N.J.-based Bergen New Bridge Medical Center launched its Epic implementation in August and plans to go live in early 2027, President and CEO Deborah Visconi told Becker’s.
Ms. Visconi said the organization expects to see a return on what she called its “largest strategic investment” within two to three years. She said the new EHR is expected to deliver benefits through increased efficiencies, reduced administrative burden and improved revenue capture.
Quincy, Ill.-based Blessing Health System is also undergoing an 18-month EHR project and plans to go live with Epic on March 21, 2026.
Christopher Solaro, MD, PhD, chief medical officer at Blessing Health System, told Becker’s that while implementing a new EHR system can be costly, he believes the transition to Epic will ultimately lead to cost savings.
“We can’t afford not to do this. With integration and efficiencies, we’re actually saving money by moving to Epic,” he said.
Taken together, the three projects show how some health systems are approaching Epic implementations as long-term financial moves as well as clinical ones, tying expected ROI to consolidation, operational efficiency and revenue performance.
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Hospital at home works in rural areas: 6 notes
Hospital-at-home treatment could be one way to “solve the rural healthcare crisis,” researchers from Somerville, Mass.-based Mass General Brigham say.
Here are six findings from their Dec. 1 JAMA Network Open study, which randomly assigned 161 adult patients from Quincy, Ill.-based Blessing Hospital (IL), Hazard (Ky.) Appalachian Regional Healthcare Regional Medical Center and Wetaskiwin (Alberta, Canada) Hospital to either home hospital or traditional brick-and-mortar care:
1. Patient experience was dramatically higher for hospital at home, with a net promoter score nearly double the brick-and-mortar group.
2. Hospital-at-home patients were far more active, walking 714 more steps per day.
3. Because most rural patients weren’t transferred home until late in their hospital stay, overall costs looked similar between groups. But when patients went home earlier — within the first two days — the cost of care dropped by 27%, driven by fewer hospital days, fewer tests, and fewer specialist consults.
4. For hospital-at-home patients, their home care days were substantially more efficient, costing 50% less per day than their hospital days.
5. Safety outcomes were equivalent, with no significant differences in adverse events and similar readmission rates.
6. Enrollment refusals were 31%, compared to 63% refusal in prior urban trials.
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Incarcerated patient escapes Georgia hospital
The Rockdale County (Ga.) Sheriff’s Office, along with other law enforcement agencies, is searching for an incarcerated patient who allegedly escaped custody after being transported to Grady Memorial Hospital in Atlanta for a medical examination following a reported suicide attempt, according to the sheriff’s office.
In a statement, sheriff’s deputies said emergency medical services provider National EMS, along with the sheriff’s office, transported Timothy Shane to Grady at approximately 8 p.m. Nov. 30. At approximately 1:20 a.m. Dec. 1, they said Mr. Shane escaped the hospital while in deputy custody.
After fleeing on foot, Mr. Shane allegedly stole an SUV in the area, then fled again on foot after crashing the vehicle, according to the sheriff’s office. The SUV’s owner later reported a Glock handgun was missing from the vehicle.
Authorities described Mr. Shane as a white male, 5 feet 9 inches tall, with a buzzed haircut. He was wearing a blue hospital gown and no shoes when he escaped, they said.
Deputies added that Mr. Shane “has a history of fleeing along with felony drug and weapon charges” and “should be considered armed and dangerous.”
In response to the incident, Grady administration shared the following statement with Becker’s: “The existing policy for inmates under treatment at the hospital is that the custodial law enforcement agency must have one-to-one oversight of them at all times.” The hospital referred further questions to the sheriff’s office.
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Why health systems send employees to Epic
While Epic sends staffers to health systems to educate healthcare workers about its EHR, the dynamic goes the other way as well.
Health systems around the country routinely dispatch employees to Epic’s massive headquarters in small-town Wisconsin to learn how to implement the company’s software.
“We have people now coming here on a relatively regular basis,” Sha Edathumparampil, chief digital and information officer of Coral Gables-based Baptist Health South Florida, told Becker’s at Epic’s Verona, Wis., campus in August. “We had people last week and in the coming weeks, leading all the way up to October, when we expect them to finish with the certification and everything.”
Baptist Health South Florida, a 12-hospital system, is switching to Epic, with a “big-bang” go-live set for mid-2027.
“I have a team up there right now in Verona that’s doing all the operational planning with them,” said Steven Holman, president and CEO of new Epic customer Terre Haute, Ind.-based Union Health, during a September interview. “We had 12 up there [in August]. And right now, I think there’s nine there.”
Health system employees often have to go back and forth to the EHR company’s home multiple times during implementations, when they are certified for roles such as Epic analyst. The stays last a handful of days each and add up to several weeks total.
“I don’t have to send all 20 people at one time, so we’re staging that,” said John McDaniel, CIO of Minot, N.D.-Trinity Health, which plans to turn on Epic in November 2026. “So if you’re going to work with Beacon, you’re going to go this time. If you’re going to work with Cupid, you’re going to go another time. You’re going to work with Dorothy … you’re going to go at different times. It’s not a huge impact or drain on the existing organization, since I’m not doing it all at once.”
About 100 employees of Mullica Hill, N.J.-based Inspira Health have traveled to Epic for certification ahead of the four-hospital system’s July 2026 EHR launch.
“Most of the work now, though, is done on-site here,” said Warren Moore, executive vice president and COO of Inspira Health. “And so the Epic team actually comes here once a month and spends an entire week with us. And then all the other work is done virtually between Wisconsin and here.”
It’s not just during implementations. Health systems regularly have staffers attend Epic’s annual Users Group Meeting and Expert Group Meetings, in part to get rebates on their EHR costs.
“We only sent about 15 people this year because we’re stretched a little financially now,” said David Kaelber, MD, PhD, chief health informatics officer of Cleveland-based MetroHealth, in August. “We do report-outs to other executives. I’m in the midst of putting together a PowerPoint where we’ll talk about all of the lessons learned and things that we want to do differently after going to the Users Group [Meeting].”
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Nearly 1 in 10 Americans have received a cancer diagnosis: Gallup
At 9.7%, Gallup polling has found the highest-ever percentage of U.S. adults who report receiving a cancer diagnosis, the analytics firm said Nov. 24.
The 2024-2025 figure is a significant increase from the 7% Gallup reported in 2008-2009. The percentage of adults reporting a cancer diagnosis in their lifetime has “increased at a greater pace over the past decade,” according to an article on the polling company’s website.
The cancer prevalence rate is measured in two-year averages, with the most recent results coming from 40,915 U.S. adults surveyed in 2024 and 2025. Gallup asked, “Has a doctor or nurse ever told you that you have cancer?”
New incidences for some cancer types are rising among younger adults and women, particularly breast cancer among adults younger than 50. National Institutes of Health researchers recently found increases in incidence of 14 cancer types and decreases in 19 types among adults younger than 50. Additionally, cancer mortality rates have fallen and people are living longer after diagnosis.
“Taken together, these results indicate that the slowly rising percentage of Americans who have had a cancer diagnosis in their lifetime is not a result of increasing rates of new cases,” Gallup wrote.
Lifetime cancer diagnoses are rising fastest among Black adults, men and Americans who are 65 or older.
“Overall, the cancer story in the U.S. is mixed with both good news and bad news,” Gallup wrote. “Mortality is falling and people are living longer post-diagnosis, but an aging population and an increasing percentage of those living post-removal or post-remission bring their own challenges to the U.S. healthcare system,” such as more medical surveillance and treatment for “millions of Americans [who] are no longer acutely ill.”
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Most expensive hospital therapy lines across 12 countries
On average, oncology accounts for about 70% of hospital drug expenditures, according to IQVIA data covering the U.S. and 11 other countries.
Countries approach drug spending in several different ways, clinical research firm IQVIA said in an Oct. 21 report. For example, voluntary insurance schemes account for a significant portion of the U.S. market, while the United Kingdom’s single-payer system, the National Health Service, makes up most medicine expenditure.
Countries also vary widely on the proportion of medicines and type of therapy dispensed in hospitals, according to the report. To account for this, IQVIA analyzed total drug expenditures across these 12 countries: the U.S., Japan, South Korea, Spain, Italy, Australia, Germany, Belgium, France, Ireland, Canada and the U.K.
In calculating the average hospital share of drug expenditures, oncology emerged as the largest contributor to hospital drug spend. Infectious disease medications accounted for between 50% and 60% of pharmaceutical expenditures in the average hospital, according to the report.
The following therapy areas averaged the most to least in expenditures: vaccines, immunology/allergy, eye/ear, hematologies, pain, neurology, vitamins/minerals, gastrointestinal, cardiovascular, endocrinology, genitourinary/women’s health, and dermatologics.
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We Cannot Recruit Our Way Out of Burnout: Lessons from Historical Staff Shortages
Two years ago news coverage warned of a national nursing shortage. Vacancies surged, burnout dominated conversations, and hospitals stretched themselves to staff essential units. Today the sense of alarm has faded. Inside hospitals, however, the crisis has not passed. Administrators still struggle to fill shifts, and the conditions that pushed nurses out of the profession remain largely unchanged.
It is understandable that many policymakers still view this as a shortage that should correct itself through supply and demand. That model held true for most of the past century. The first large-scale shortage appeared in the 1930s, and it deepened during World War II when Congress enacted the 1943 Bolton Act, which funded the U.S. Cadet Nurse Corps and expanded training through stipends and free education. Later shortages followed a familiar pattern. New hospital construction under the Hill-Burton Act and waves of retirement repeatedly outpaced supply. Expanding training programs or creating new roles helped close the gap. Once the cycle turned, the immediate crisis eased.
That history explains why many leaders believe the current workforce crisis will resolve the same way. However, this one is fundamentally different. It is no longer a cyclical shortage, it is a structural failure.
The 2022 National Nursing Workforce Survey found that the United States lost an estimated 200,000 registered nurses between 2020 and 2022. The Bureau of Labor Statistics projects that while the RN workforce will grow modestly from 3.1 million in 2022 to 3.3 million by 2032, nearly two hundred thousand openings will arise every year because of retirements and exits from the profession. Even maximum enrollment in training programs cannot offset this loss.
Burnout, moral injury, administrative overload and unsafe working conditions now drive nurses away. A 2023 study by the National Council of State Boards of Nursing estimated that one hundred thousand RNs left the workforce in just two years, with hundreds of thousands more planning to leave by 2027. Nearly one third of the nursing workforce is older than fifty. Large scale retirement is approaching at the same time younger nurses are leaving earlier than ever. These are not temporary pressures; they are persistent forces eroding the core of the workforce.
Education is another limiting factor. Enrollment in nursing programs declined in 2021 for the first time since 2000, not because of waning interest but because schools lacked faculty, clinical placements and adequate funding. Although enrollment has improved slightly, it is not growing fast enough to meet the projected demand for RN and APRN services. In the past, training capacity could be scaled quickly. Today it cannot.
National statistics hide the severity of regional disparities. Tennessee reported fewer than nine nurses per 1,000 residents, and wages remain low. According to the Health Resources and Services Administration’s 2024 projections, the adequacy of RN supply will vary dramatically by 2037, from a significant shortage in North Carolina to surpluses in other states. Rural and nonmetropolitan communities remain the most vulnerable. There is no single national crisis, there are fifty distinct labor markets, each moving in different directions.
This imbalance also extends beyond U.S. borders. Nursing shortages are a global challenge. The World Health Organization estimates a global shortage of nearly six million nurses, noting that migration may strengthen some health systems while straining others.
The persistence of today’s crisis reflects a powerful feedback loop: high turnover increases workloads for those who remain, fueling further exhaustion and exits. Recruitment incentives can even worsen conditions when retention is poor, because new hires inherit the same pressures that drove colleagues away.The result is a cycle that intensifies rather than resolves.
What Health System Leaders Must Do Now
1. Shift from recruitment to retention
Hiring bonuses attract candidates but do not keep them. Leaders should prioritize safe staffing ratios, flexible scheduling, manageable patient loads, and tangible reductions in administrative burden.
2. Stabilize and strengthen mid-career staff
These nurses anchor clinical units, precept new hires, and carry institutional knowledge. Focused career development pathways, compensation structures, and recognition programs should be tailored to this group.
3. Expand training capacity through incentives for nurse educators
States and health systems can create financial incentives for experienced nurses to transition into teaching roles, expanding capacity without losing clinical expertise to burnout.
4. Build rapid-response workforce planning for seasonal surges
Winter respiratory viruses routinely stretch EDs and pediatric hospitals. Leaders should prepare proactive staffing models that support nurses during peak demand rather than relying on costly short-term fixes.
Just as important is how we talk about nursing. For too long, nurses have been celebrated as the backbone of healthcare while being treated as a cost center. Their presence directly determines patient safety, length of stay, and mortality. Research consistently shows that hospitals with higher proportions of bachelor-prepared nurses achieve better outcomes, including lower surgical mortality. Workforce instability is therefore not only a staffing issue; it is a patient safety issue.
We have been here before, but the stakes are now higher. In the past, shortages eased as new nurses filled the gaps left by those who retired or left. Without structural reform, that recovery may no longer happen. The lesson from nearly a century of cycles is clear: we cannot recruit our way out of burnout. Valuing nurses means creating environments where they can stay, grow, and teach the next generation. Anything less risks repeating history with fewer nurses left to hold the system together.
As the country enters winter and respiratory season, one of the most demanding periods for emergency departments and pediatric hospitals, this becomes even more evident. The ability of hospitals to respond to surges in illness depends on the presence, skill, and judgment of nurses. Leaders who invest in the workforce today will determine whether their organizations remain resilient tomorrow.
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Nonprofit, for-profit health system financial divide grows
The financial performance of some of the country’s largest nonprofit and for-profit health systems in the third quarter of 2025 reflects a sector making cautious strides toward stability, but not all players are on equal footing.
For-profit systems — including HCA Healthcare, Tenet Healthcare, Community Health Systems and Universal Health Services — reported solid operating gains, bolstered by improved volumes, payer mix and cost control. By contrast, large nonprofit systems including Trinity Health, Providence, Ascension and CommonSpirit posted more modest improvements, with two still reporting operating losses.
Here’s how the two groups compare:
For-profit health systems: Gains across the board
- Nashville, Tenn.-based HCA Healthcare reported $1.6 billion in net income on $19.2 billion in revenue, with an 8.6% net margin. The system raised its full-year outlook after seeing growth in admissions, acuity and revenue per admission.
- Dallas-based Tenet Healthcare posted the highest operating margin at 16.8%, with operating income of $889 million. Despite a year-over-year decline in net income to $342 million, its ambulatory segment — United Surgical Partners International — showed continued strength.
- Franklin, Tenn.-based Community Health Systems swung to a $130 million net profit (4.2% margin) after a $391 million loss (-12.7% margin) in the third quarter of 2024. Its operating margin hit 7.9%, with improved EBITDA and a strategic shift through divestitures and debt reduction.
- King of Prussia, Pa.-based Universal Health Services reported $373 million in net income (8.3% margin) and a $522 million operating gain (11.6% margin) in the third quarter. Growth in both its acute care and behavioral health divisions supported strong revenue performance.
Nonprofit health systems: Signs of progress, persistent pressure
- Livonia, Mich.-based Trinity Health led among the nonprofit group, reporting $77.4 million in operating income 1.2% margin. Better payment rates, volumes and payer mix were key drivers.
- Renton, Wash.-based Providence turned a corner with a $21 million operating gain (0.3% margin) after posting a $208 million loss (-2.7% margin) in the third quarter of 2024. A 33% reduction in contract labor and increased case mix-adjusted admissions contributed to the turnaround.
- St. Louis-based Ascension narrowed its operating loss to $88 million (-1.4% margin) — down from a $221 million loss (-3.1% margin) in the same quarter in 2024 — with improved patient volumes and reduced length of stay. Investment gains helped the system post $338 million in net income.
- Chicago-based CommonSpirit posted the steepest loss of the group at $165 million (-1.6% margin), though that marked a significant improvement from the prior year when it posted a $331 million operating loss (-3.5% margin). The system is pursuing a comprehensive transformation initiative aimed at long-term sustainability.
A diverging landscape
While both for-profit and nonprofit systems reported gains in volumes and operational efficiency, the margin gap is stark. For-profit largely reported margins above 7%, while nonprofits — though improving — are still working toward sustainable levels. Nonprofits continue to face a challenging reimbursement environment and persistent inflationary pressure, particularly in labor and supply costs.
As 2025 winds down, the quarter underscores both progress and disparity, with some systems on the brink of sustainable growth and others still working through the long tail of pandemic-era disruptions.
Looking ahead, 2026 may bring even greater financial pressure, with Medicaid cuts slated for late 2026 and early 2027, and uncertainty surrounding the extension of ACA subsidies, which hinges on a December vote by lawmakers.
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Hospital stuck in ‘data rich, information poor’ reality
Artificial intelligence is only as strong as the data behind it. Healthcare leaders are working with their teams to build the infrastructure, governance, and culture necessary to support AI at scale.
Healthcare leaders gathered at the AI Summit during the Becker’s CEO+CFO Roundtable in early November to discuss the need for high-quality data, alignment between technical and clinical teams, and a cautious approach to security and interoperability.
Five emerging trends:
- Clean, well-structured data is the foundation for enterprise AI
Rajiv Kolagani, chief data and AI officer at Ann & Robert H. Lurie Children’s Hospital of Chicago, said hospitals can’t expect meaningful results from AI without first addressing the basics of data readiness. “We can’t really get any utility or value out of AI without data,” he said. “When you think about AI, you have to really think about preparing data for AI differently.”
Lurie has spent three years on a data modernization initiative, shifting to a modern cloud-based data platform that includes Snowflake and Fabric. “That became the foundation for us to do any kind of AI on top of it,” he said.
Lurie now uses a medallion architecture with bronze, silver, and gold layers to ensure trustworthy data sources. From there, the team builds knowledge graphs to “teach AI what the data means,” enabling semantic understanding of concepts like infections and diagnoses.
“You have to teach AI all of the context,” he said.
- Data quality isn’t an accident — it requires structure and accountability
Quality must be intentional and tracked through every stage of a health system’s data ecosystem. “It’s not an afterthought,” Mr. Kolagani said. “In order to make that happen, you have to have different tooling in your infrastructure.”
Lurie implemented data catalogs and lineage tools to trace where data originates, how it’s processed, and what errors occur along the way.
“There’s a ton of work that actually goes into making sure that you have high-quality data output,” he said. “Quality doesn’t happen by accident. You have to be super intentional about it, and you also have to have the right guy or gal running the data shop.”
- Healthcare’s data challenge is usability
Margaret Lozovatsky, MD, CMIO and vice president of digital health innovation at the American Medical Association, said that while healthcare is data rich, it remains information poor.
“Anybody that has ever used an EHR to deliver care to their patients knows that there’s a lot of stuff in there that is not accurate and shouldn’t be in there,” she said.
She described the problem as one of structure and interoperability.
“So much of our information that exists in the EHR today exists in a format that is a narrative,” she said. “We have struggled for years with interoperability, because every organization has this data in their own format.”
Large language models could help overcome those barriers, processing and translating disparate data into usable insights. “These tools can unlock the data and translate it into useful information that clinicians can use to make decisions,” Dr. Lozovatsky said.
The AMA focuses on AI with the conceptualization of augmented intelligence, emphasizing that while computers excel at processing, humans understand the context of that data.
- Governance and security must move as fast as innovation
Protecting patient data while encouraging innovation requires strong governance frameworks.
“We need to go slow to go fast,” Dr. Lozovatsky said. “Setting up these processes today to understand how your organizational data is being used in testing these tools and implementing these tools to ensure that at the end of the day, the patient information is not identifiable is really important.”
The AMA’s new AI Governance Toolkit, which offers an eight-step process for balancing privacy and progress. “It’s an eight-step process that is some of the best practices for organizations to think about as you’re setting up your governance within your institution,” she said.
- AI’s next leap will come from administrative efficiency and connected care
Early AI gains will likely come from automating administrative functions rather than direct clinical care. Dr. Lozovatsky predicted that “we’re going to start to tackle all of the administrative burdens first,” including patient access and scheduling. “That’s the next iteration of these tools.”
Anil Saldanha, chief innovation officer at Rush University System for Health in Chicago, added that AI represents the reset the industry needed. He envisions a future of connected, data-driven care across the continuum.
“We can’t just look at health systems in isolation. We live in a connected world,” he said. “I’m really bullish on diagnostics, machine learning, AI, cancer detection, stroke triage […] we’re building the plane as we fly, but I’m really bullish on the future of medicine.”
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How hospitals are ‘raising the bar’ in retention
Hospitals and health systems have consistently focused on recruiting top talent. While this remains a key priority, retention is gaining prominence amid ongoing workforce challenges.
In 2025, 2 in 5 healthcare workers reported feeling their role is unsustainable, and 1 in 4 said they are considering leaving the industry entirely, according to Indeed’s “Pulse of Healthcare 2025” report.
Erie County Medical Center, a level 1 trauma center in Buffalo, N.Y., is taking a holistic approach to culture and retention.
“We have high expectations as an important healthcare provider in a community that serves thousands of people every year — to have high standards of our employees and, in turn, what we want to deliver to patients, will retain the top talent” Chief Human Resources Officer Julie Kline said during a “Becker’s Healthcare Podcast” episode. “What we’ve found is, when you have high standards, people live up to those high standards, feel greater pride in their work, and become more engaged.”
“It’s when an employer has low standards for their employees, people will become complacent and stop caring,” she added. “The top talent won’t put up with low standards and will eventually leave.”
Ms. Kline cited several efforts to raise expectations, including resetting preferred qualifications on job descriptions, revising attendance policies, adopting a “walk the talk” approach for leaders that reinforce the organization’s values, and fostering an environment where employees can openly share their strengths and learn from one another.
“Many organizations across the U.S. have lowered their standards, accepting behavior or actions not conducive to an organization’s mission. At ECMC, we constantly raise the bar. We want the best of the best.”
As a result of these and other efforts, ECMC’s voluntary turnover rate is one of the lowest among hospitals at 8%. Ms. Kline said she expects that figure to continue declining as they continue to focus on culture and people.
Other systems have launched rare benefits as retention drivers, such as Midland-based MyMichigan Health’s program allowing employees to access a portion of their earned pay before payday.
“We see this supporting engagement and retention,” Chief Human Resources Officer Julie Ward, EdD, told Becker’s in October. “It may also help with new hires, depending on where they fall in the pay cycle. Sometimes, it could be three weeks before they get their first paycheck, and this gives them the opportunity to access their earnings earlier.”
Career advancement initiatives
Children’s National Hospital in Washington, D.C., recently aligned its recruitment efforts with its broader retention strategy. The organization launched its first apprenticeship cohort in September, aiming to foster long-term employee engagement and career pathways.
The seven-month patient care technician apprenticeship includes 10 apprentices who are paid for 40 hours per week — 20 spent shadowing and 20 in the classroom with academic partners — while earning their credentials. After completing the program, apprentices move into patient care technician roles and begin a pathway to become registered nurses.
A workforce that feels energized by its work and supported in career mobility and growth is a strong factor in retention, Chief People Officer Gina Cronin said.
“What we’ve learned from our colleagues about apprenticeships is that there’s incredible loyalty,” she told Becker’s. “Once we invest in this workforce, there’s a really high retention rate into the organization.”
Children’s National is located near wards 7 and 8 in Washington, D.C., which as of 2020 had poverty rates of 26.6% and 35.7%, respectively, according to data from the Health Resources and Services Administration. The purpose of the apprenticeship is to attract local residents into healthcare roles that offer family-sustaining careers, while also promoting internal mobility and long-term retention among current staff.
“This is a unique opportunity where it is the ultimate win-win,” Ms. Cronin said. “How do we attract new caregivers into our workforce for these roles that have critical shortages but are also well-paying careers? How do we support entry into those roles from either our own workforce or the communities that we serve that require no skills, no degrees — and support them along the way?”
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Percentage of primary care physicians, by subspecialty
Internal medicine represents the largest primary care specialty, with 41.4% of all primary care physicians practicing in the field, according to new data from KFF.
In contrast, geriatrics represents just 0.3% of the primary care workforce, underscoring a significant disparity in physician distribution as the U.S. population continues to age, driving demand for specialized care.
For its analysis, KFF obtained information on the number of active, licensed primary care physicians in the U.S., as of this September from Redi-Data. Figures include both allopathic and osteopathic physicians.
Nationwide, 544,097 professionally active primary care physicians were practicing in the U.S., as of September.
Here’s a breakdown by field:
| Primary care subspecialty | Internal | Family medicine/ general practice |
Pediatrics | Obstetrics & gynecology | Geriatrics |
| Number of professionally active physicians | 225,469 | 159,614 | 98,377 | 58,739 | 1,898 |
| Percentage | 41.5% | 29.3% | 18.1% | 10.8% | 0.3% |
To view the full analysis, which includes state-specific data, click here.
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US drug expenditure far outpaces other countries: Report
As the U.S. works several levers to lower drug pricing, such as Medicare negotiating costs with drugmakers and President Donald Trump launching TrumpRx, a report from the IQVIA Institute quantified how much more the U.S. pays for medications.
IQVIA, a clinical research company, published a report Oct. 21 detailing global drug expenditure trends from 2000 through 2022.
In 2022, the U.S. led in absolute and per capita spending compared to 11 other markets, the report found. The other markets were Japan, South Korea, Spain, Italy, Australia, Germany, Belgium, France, Ireland, Canada and the United Kingdom. The average market spent 15% of healthcare expenditure on pharmaceuticals, according to IQVIA.
The U.S.’ per capita drug spending was approximately $2,000 in 2022, which the report said was driven by higher payments to hospitals and physicians, as well as administrative costs. Other countries range from $656 to $1,337 in per capita drug spending.
The World Health Organization and the Organisation for Economic Co-operation and Development’s reports often omit non-retail pharmacy drug spending, such as hospital spend, according to IQVIA, whose report estimates total spending across healthcare settings.
Here are three other findings:
1. Twenty percent of Japan’s healthcare expenditure in 2022 was attributable to drug spending, compared to 15% in the U.S. and 9% in the U.K., which had the lowest drug share and lowest per capita drug spending.
2. In 2000, the range in drug expenditure across these markets was wider, at 9% to 28%, whereas it was 9% to 20% in 2022.
3. Markets with higher percentages in drug spending, such as Japan, typically have lower absolute healthcare spending.
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The healthcare workforce in 12 numbers
The workforce is top of mind for hospitals and health systems across the U.S., particularly as they focus on recruitment and retention amid today’s industry pressures.
Here are 12 numbers to know about the workforce today, per reports recently covered by Becker’s:
1. The Bureau of Labor Statistics released its September jobs report Nov. 20 — the agency’s first since the 43-day government shutdown from Oct. 1 to Nov. 12. Healthcare added 42,800 jobs for the month, roughly in line with the 12-month average of 42,000, according to the report. Ambulatory healthcare services contributed the most to September’s healthcare job gains, adding 23,300 positions, followed by hospitals, which added 16,400.
2. A recent Mercer study based on responses from 2,010 employers predicts a 6.7% increase in total health benefit costs for employers in 2026 — the steepest in 15 years.
3. Healthcare job postings have declined 8.5% year over year as of Oct. 10, according to a third-quarter report from Indeed’s Hiring Lab. The report examined job postings and wage data for U.S. healthcare roles on the employment site. Overall healthcare job postings were 2.4% above their February 2020 baseline, seasonally adjusted, as of Oct. 10.
4. U.S. healthcare wage disparities modestly narrowed during the COVID-19 pandemic, according to an analysis of wage data. Researchers from Minneapolis-based University of Minnesota and Seattle-based University of Washington found that workers in the lowest-earning healthcare occupations experienced wage increases of approximately 13% between 2015 and 2024 — significantly more than higher-earning groups.
5. In 2025, 2 in 5 healthcare workers report feeling working conditions in their role is unsustainable, and 1 in 4 said they were considering leaving the industry altogether, according to an Indeed survey of 924 U.S. healthcare workers ages 18-65 conducted July 23 and Aug. 6. Participants included 197 prescribing providers — physicians, nurse practitioners and physician assistants — 75 registered nurses and 74 dental hygienists. Other roles included therapists, dentists, imaging technologists and mental health practitioners.
6. Employment in the nation’s private sector climbed by 42,000 jobs in October, with 26,000 added in the education and health services sector, according to an ADP Research report released Nov. 5. The October national employment report, produced in collaboration with the Stanford Digital Economy Lab, examined anonymized weekly payroll data from more than 26 million private-sector employees in the U.S.
7. Healthcare recorded 4,339 cuts in October, up from 3,022 year over year, according to a Nov. 6 report from executive coaching firm Challenger, Gray & Christmas. The firm overall found that from January through October, U.S. employers cut 1,099,500 jobs — up from 664,839 during the same period in 2024.
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Healthcare employment trends up: 5 notes
The Bureau of Labor Statistics released its September jobs report Nov. 20 — the agency’s first since the 43-day government shutdown from Oct. 1 to Nov. 12. Healthcare added 42,800 jobs for the month, roughly in line with the 12-month average of 42,000, according to the report.
Here are four more notes from the report:
1. Ambulatory healthcare services contributed the most to September’s healthcare job gains, adding 23,300 positions, followed by hospitals with 16,400.
2. Healthcare was among the few sectors to post job gains in September. Food services and drinking places, and social assistance, also added jobs.
3. September’s healthcare job gains mark a slowdown from August, when the industry added 26,800 jobs.
4. The U.S. economy added 119,000 jobs overall in September, including gains in healthcare.
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The state of rural primary care: 4 notes
Nearly 40% of adults living in rural areas have turned to emergency departments for care that could have been handled in a primary care setting, pointing to persistent issues rural residents face when trying to access routine healthcare services, according to a Commonwealth Fund report published Nov. 17.
The report, “The State of Rural Primary Care in the United States,” draws from federal health workforce projections and data from the Commonwealth Fund’s 2023 International Health Policy Survey. It offers a comprehensive look at rural primary care gaps across the country, examining projected workforce shortages, geographic disparities in provider availability and highlights community-based care delivery models to address access issues.
Four takeaways from the report:
1. Supply‑and-demand mismatch: Nationally, primary care physician supply is expected to meet 73% of demand by 2037; in rural areas, that figure drops to 68%. As physician capacity lags, rural areas are increasingly relying on advanced practice providers. The supply of nurse practitioners in rural communities is expected to exceed demand by 2037 as they take on an expanded role in primary care. Nurse practitioner is the fastest-growing clinical role and the third-fastest growing occupation in the country overall. These providers are increasingly relied on to offset physician shortages and improve access in underserved areas.
2. The majority of rural counties face primary care workforce shortages: Around 92% of rural counties are federally designated as primary care Health Professional Shortage Areas, meaning they lack a sufficient number of providers relative to community needs. Overall, nearly 43 million people live in rural areas where there is an insufficient supply of primary care providers.
3. Access gaps drive rural patients toward higher-cost care: Limited provider availability continues to push rural residents toward higher-cost settings. Nearly 40% of rural adults reported using the emergency department for care that could have been handled in a primary care setting. Fewer than 30% said they can easily access after-hours primary care. Beyond provider shortages, additional barriers — such as transportation challenges and limited access to broadband internet — continue to limit rural residents’ ability to get timely care, according to the report.
4. Efforts to strengthen primary care delivery: The report outlines several efforts to strengthen rural primary care delivery, including broader use of community-based models such as rural health clinics and mobile health units that bring services directly to underserved areas.
It also highlights strategies to recruit and retain clinicians, such as expanding federal loan repayment programs such as the National Health Service Corps and rural training tracks during medical school to encourage long-term practice in rural communities. On the financial side, the report calls for rural-specific payment models to help stabilize primary care practices, which often face higher operating costs and lower patient volumes. Investments in broadband and digital infrastructure are also cited as critical to expanding access through telehealth.
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3 trends complicating flu season for hospitals this year
As signs point to a more-severe-than-normal flu season this year, hospitals might see more congestion among patients and in physical capacity.
Several variables are intensifying this outlook as a new variant emerges, inoculation rates fall and measles outbreaks grow.
1. A new variant
Overall flu activity is low, with influenza-related cases accounting for less than 1% of emergency department visits. A whisper of a more severe season is growing into a roar, though. Clinical laboratories have detected a majority of influenza A specimens, which usually cause more severe illness, particularly in young children and older adults.
A version of the H3N2 subtype, which is a type of influenza A, is spurring earlier and more intense flu outbreaks in Canada, the United Kingdom and Japan. Half of H3N2 cases are coming from a new variant called subclade K.
UK Health Security Agency scientists told CNN subclade K is expected to dominate this season, and approved flu vaccines cover an adjacent group of viruses, meaning vaccine efficacy might be lessened from past years.
In the U.S., flu-related ED visits are rising among children, according to the CDC’s FluView report, which reflects national data as of Nov. 8. The latest week also saw increases in percent positivity for influenza across pediatric age groups, the CDC said.
2. Declining vaccination rates
As people travel and gather for winter holidays, fewer of them are receiving vaccinations against flu and numerous other viral infections.
Last year, less than half of U.S. adults and children received a flu vaccine, according to the CDC. For the 2025-26 influenza season, flu shot producer CSL predicts vaccination rates to fall 12% overall, including a 14% decline among adults 65 and older.
So far, flu vaccination rates are down 8% compared to last year. Between August and the end of October, retail pharmacies administered about 26.5 million flu shots — roughly 2 million fewer than the 28.7 million administered during those months in 2024, according to prescription data IQVIA provided to CNN.
3. Ongoing measles outbreaks
In 2000, the U.S. achieved measles elimination status. Twenty-five years later, the nation risks losing it.
During a Nov. 17 call with state health departments, CDC officials tied a measles outbreak originating in West Texas to another in Utah and Arizona, according to The New York Times. Countries with sustained transmission of measles for over a year lose their “elimination status” as determined by the World Health Organization. Last week, Canada lost its 27-year streak as a country that had eliminated measles.
The West Texas measles outbreak began in January 2025 and ended in August. Its association with the outbreak in Utah and Arizona, however, means the U.S. has only a few weeks to quash the largest measles outbreak currently in the country, according to the Times.
As of Nov. 12, the CDC has confirmed 1,723 measles cases across 43 states. The outbreak has worsened throughout 2025, and with early pressures appearing in the 2024-25 flu season, hospital capacity might further strain.
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Best, worst US states for healthcare cost, quality, access: Gallup
The overall U.S. healthcare system received a “C” grade from a broad survey of U.S. adults, according to the West Health-Gallup Center for Healthcare in America, which released its inaugural report, “State of the States 2025: Insights on Healthcare in America.”
Nationwide, the healthcare system received a “D+” for cost, a “C+” for quality and a “C+” for access.
The rankings are based on an online survey of 19,535 U.S. adults conducted June 9 to Aug. 25 across all 50 states and the District of Columbia. Respondents graded the healthcare system in their state, with letter grades converted to a 4.0 GPA scale for analysis.
Across all states, 47% of survey respondents said they are concerned they will not be able to afford healthcare in the next year.
One in 5 Americans said they or someone in their household could not afford prescription medications in the past three months. That figure rose to 29% in the 10 lowest-ranked states and dropped to 15% in the 10 highest-ranked states.
Nationally, 30% said they skipped a recommended medical test or procedure in the past year due to cost. This percentage rose to 40% in the bottom 10 states and was 25% in the top 10 states.
Quality ratings also varied by state. While 70% of Americans said their provider ensures they receive all recommended screenings and evaluations, that number rose to 78% in Massachusetts and Rhode Island and dropped to 59% in Oregon and Wyoming.
Additionally, 25% of Americans said not knowing how to find a provider prevented them from receiving care. That percentage dropped to 14% in Iowa — the top-ranked state overall — and rose to 36% in New Mexico, which ranked 49th.
Access remains a top priority for hospital and health system leaders amid growing demand and capacity constraints. Many are expanding ambulatory networks and launching telehealth programs in response.
Here are the rankings of all 50 states and the district, by grade, in descending order:
1. Iowa — Overall: C+ | Cost: D+ | Quality: C+ | Access: C+
2. Massachusetts — Overall: C+ | Cost: D+ | Quality: B- | Access: C+
3. District of Columbia — Overall: C | Cost: D+ | Quality: C+ | Access: C
4. Rhode Island — Overall: C | Cost: D+ | Quality: C+ | Access: C
5. Virginia — Overall: C+ | Cost: D+ | Quality: C+ | Access: C+
6. Pennsylvania — Overall: C+ | Cost: D+ | Quality: C+ | Access: C+
7. North Carolina — Overall: C+ | Cost: D+ | Quality: C+ | Access: C+
8. North Dakota — Overall: C+ | Cost: D+ | Quality: C+ | Access: C+
9. Michigan — Overall: C+ | Cost: D+ | Quality: C+ | Access: C+
10. Nebraska — Overall: C+ | Cost: D | Quality: C+ | Access: C+
11. Ohio — Overall: C+ | Cost: D+ | Quality: C+ | Access: C+
12. Minnesota — Overall: C+ | Cost: D+ | Quality: C+ | Access: C+
13. Wisconsin — Overall: C+ | Cost: D+ | Quality: C+ | Access: C+
14. Maryland — Overall: C+ | Cost: D+ | Quality: C+ | Access: C+
15. New York — Overall: C | Cost: D+ | Quality: C | Access: C
16. New Jersey — Overall: C+ | Cost: D+ | Quality: C+ | Access: C+
17. Connecticut — Overall: C+ | Cost: D+ | Quality: C+ | Access: C+
18. Missouri — Overall: C | Cost: D+ | Quality: C+ | Access: C+
19. New Hampshire — Overall: C+ | Cost: D+ | Quality: C+ | Access: C+
20. South Carolina — Overall: C+ | Cost: D+ | Quality: C+ | Access: C+
21. South Dakota — Overall: C+ | Cost: D+ | Quality: C+ | Access: C+
22. California — Overall: C | Cost: D+ | Quality: C+ | Access: C
23. Georgia — Overall: C | Cost: D+ | Quality: C | Access: C
24. Hawaii — Overall: C+ | Cost: C- | Quality: C+ | Access: C
25. Tennessee — Overall: C | Cost: D | Quality: C | Access: C
26. Colorado — Overall: C | Cost: D | Quality: C+ | Access: C+
27. Illinois — Overall: C+ | Cost: D+ | Quality: C+ | Access: C+
28. Maine — Overall: C | Cost: D | Quality: C | Access: C
29. Utah — Overall: C+ | Cost: D+ | Quality: C+ | Access: C+
30. Indiana — Overall: C | Cost: D+ | Quality: C+ | Access: C+
31. Idaho — Overall: C | Cost: D | Quality: C+ | Access: C
32. Alabama — Overall: C+ | Cost: D+ | Quality: C+ | Access: C+
33. West Virginia — Overall: C | Cost: D | Quality: C | Access: C
34. Washington — Overall: C | Cost: D+ | Quality: C+ | Access: C
35. Kentucky — Overall: C | Cost: D+ | Quality: C | Access: C
36. Louisiana — Overall: C | Cost: D+ | Quality: C | Access: C+
37. Kansas — Overall: C | Cost: D+ | Quality: C+ | Access: C+
38. Florida — Overall: C | Cost: D+ | Quality: C+ | Access: C+
39. Wyoming — Overall: C | Cost: D+ | Quality: C | Access: C
40. Oklahoma — Overall: C- | Cost: D+ | Quality: C | Access: C
41. Oregon — Overall: C | Cost: D | Quality: C | Access: C-
42. Montana — Overall: C | Cost: D | Quality: C+ | Access: C
43. Arkansas — Overall: C | Cost: D+ | Quality: C | Access: C
44. Mississippi — Overall: C | Cost: D+ | Quality: C | Access: C+
45. Arizona — Overall: C | Cost: D+ | Quality: C | Access: C
46. Delaware — Overall: C | Cost: D+ | Quality: C | Access: C-
47. Vermont — Overall: C- | Cost: D | Quality: C | Access: C-
48. Texas — Overall: C | Cost: D+ | Quality: C+ | Access: C+
49. New Mexico — Overall: C- | Cost: D+ | Quality: C | Access: D+
50. Nevada — Overall: C- | Cost: D+ | Quality: C- | Access: C-
51. Alaska — Overall: C- | Cost: D | Quality: C | Access: C-
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Healthcare job postings hover just above COVID-era baseline: 7 notes
Healthcare job postings have declined 8.5% year over year as of Oct. 10, according to a third-quarter report from Indeed’s Hiring Lab.
The report analyzed job postings and wage data for U.S. healthcare roles on the employment site. Here are seven things to know:
1. Overall healthcare job postings were 2.4% above their February 2020 baseline, seasonally adjusted, as of Oct. 10.
2. Physician and surgeon job postings declined 1.3% year over year but remained 84.9% above their pre-pandemic baseline. Nursing job postings fell 8.4% in the past year but were still 13% higher than February 2020.
3. Pharmacy roles saw the largest annual decline in postings at 10.1%, followed by medical technician roles at 9.1%. Both categories, however, remained above 2020 levels — up 25.1% and 27.1%, respectively.
4. Three healthcare job categories exceeded the labor market’s average wage growth of 2.6% in September: personal care and home care (3.2%), medical technician (3%) and childcare (2.8%).
5. Nursing wages rose 1.6% in September, trailing behind dental (2.2%) and therapy (2.1%) roles.
6. All healthcare job categories in the report — except for childcare — saw declining wage growth over the past six months.
7. While financial challenges at hospitals and health systems have affected hiring at some organizations, many leaders are also seeing workforce growth through the addition of new facilities and expansions. Widespread shortages and baby boomer retirements are also shaping healthcare hiring, leaders told Becker’s in August.
“Being able to attract those early in their career is really important, and then recognize that there is a lot of experience that’s being lost as well,” Mike Wukitsch, PhD, chief people officer of Fort Myers, Fla.-based Lee Health, said in August. “Demographically, there’s tremendous competition for healthcare talent, pretty much across the board — nursing, technologists and those in diagnostic areas.”
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High-performing nursing homes, by state: US News
California has the greatest number of high-performing nursing homes in the U.S., followed by Florida, according to U.S. News & World Report’s “2026 Best Nursing Homes” ratings, published Nov. 13.
Hawaii has the highest rate of high-performing nursing homes, followed by the District of Columbia.
Compared to the national average, U.S. News found that the top-rated nursing homes have a 15% lower rate of hospitalizations for long-term residents and provide 20% more total staffing per resident per day, according to a Nov. 13 news release from the news outlet.
U.S. News used CMS quality measures data to evaluate nearly 15,000 nursing homes, factoring in resident care, safety, outcomes, staffing levels, use of antipsychotic medications and ER visit prevention. Read the full methodology here.
Here are the number and rate of high-performing nursing homes, by state, for both short and long-term care, per U.S. News:
| State | High-performing nursing homes | Total nursing homes rated | Percentage of high-performing nursing homes |
| Alabama | 1 | 211 | 0.47% |
| Alaska | 2 | 11 | 18.18% |
| Arizona | 6 | 131 | 4.58% |
| Arkansas | 0 | 219 | 0% |
| California | 122 | 1094 | 11.15% |
| Colorado | 22 | 196 | 11.22% |
| Connecticut | 18 | 188 | 9.57% |
| Delaware | 8 | 42 | 19.05% |
| District ofColumbia | 4 | 16 | 25% |
| Florida | 89 | 685 | 12.99% |
| Georgia | 9 | 325 | 2.77% |
| Hawaii | 12 | 36 | 33.33% |
| Idaho | 6 | 72 | 8.33% |
| Illinois | 36 | 641 | 5.62% |
| Indiana | 33 | 490 | 6.73% |
| Iowa | 22 | 366 | 6.01% |
| Kansas | 25 | 278 | 8.99% |
| Kentucky | 14 | 262 | 5.34% |
| Louisiana | 0 | 257 | 0% |
| Maine | 8 | 72 | 11.11% |
| Maryland | 31 | 215 | 14.42% |
| Massachusetts | 38 | 340 | 11.18% |
| Michigan | 33 | 400 | 8.25% |
| Minnesota | 34 | 259 | 13.13% |
| Mississippi | 0 | 198 | 0% |
| Missouri | 8 | 443 | 1.81% |
| Montana | 3 | 54 | 5.56% |
| Nebraska | 17 | 171 | 9.94% |
| Nevada | 3 | 60 | 5% |
| New Hampshire | 4 | 74 | 5.41% |
| New Jersey | 51 | 337 | 15.13% |
| New Mexico | 3 | 65 | 4.62% |
| New York | 71 | 580 | 12.24% |
| North Carolina | 24 | 405 | 5.93% |
| North Dakota | 5 | 70 | 7.14% |
| Ohio | 28 | 773 | 3.62% |
| Oklahoma | 3 | 265 | 1.13% |
| Oregon | 7 | 107 | 6.54% |
| Pennsylvania | 83 | 644 | 12.89% |
| Rhode Island | 4 | 65 | 6.15% |
| South Carolina | 10 | 181 | 5.52% |
| South Dakota | 9 | 86 | 10.47% |
| Tennessee | 22 | 294 | 7.48% |
| Texas | 21 | 1098 | 1.91% |
| Utah | 17 | 87 | 19.54% |
| Vermont | 1 | 34 | 2.94% |
| Virginia | 35 | 285 | 12.28% |
| Washington | 23 | 183 | 12.57% |
| West Virginia | 3 | 113 | 2.65% |
| Wisconsin | 35 | 305 | 11.48% |
| Wyoming | 1 | 32 | 3.13% |
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From crisis mode to control: Building a resilient workforce strategy
The persistent healthcare talent crisis has evolved from cyclical labor shortages to a structural workforce problem that’s reshaping how hospitals and health systems operate.
To deliver quality care, meet safe staffing standards and rein in the cost of agency staff and travelers, a strategic approach to workforce planning is more important than ever.
In a session sponsored by CareRev at Becker’s 13th Annual CEO + CFO Roundtable, Larry Adams, chief nursing executive and SVP, strategy, at CareRev, and Tim Johnsen, founder and CEO of Keynote Enterprises, moderated a roundtable discussion about how healthcare organizations are addressing today’s workforce challenges.
Three key takeaways were:
- Talent shortages extend beyond nursing. Many hospitals and health systems are struggling to recruit and retain support staff in departments like EVS and dietary. Others are experiencing tech shortages in the lab, mammography and radiology, which creates bottlenecks in the care continuum and negatively affects the patient experience.
A participant from an academic medical center in the South elaborated. “When CT turnaround times are high and people have to wait really long periods, the patient experience goes into the tank,” he said. “We’re doubling down on recruitment in those areas.”
In anesthesia services, the cost for locums have become unsustainably high. At a health system in the Midwest, locum tenens nurse anesthetists are paid the same as the hospital’s cardiac surgeon.
- It’s time to compete differently for talent. In an environment where large companies like Chick-fil-A, Target and Amazon offer highly competitive employee benefits, healthcare leaders must think more creatively about workforce strategies. Some have crafted compensation packages with multi-year, tiered sign-on bonuses. Once staff are on board, organizations offer career ladders to boost retention.
The importance of culture as a competitive differentiator can’t be underestimated. “Culture is what drives people to come to our organization and it’s why they stay,” the president of a children’s hospital in the Southwest explained. “Turnover usually occurs between years one and three. Once we get past year three, turnover drops 50% so we’re homed in on how to recruit and retain to that three-year mark.”
- Modern workforce models minimize costs, while supporting quality care. Permanent staff are at the core of effective healthcare workforce models. These employees can be augmented with a strong internal float pool that flexes based on census and acuity levels. If positions still need to be filled, organizations may turn to more costly external float pools and travelers.
CareRev’s on-demand workforce platform prioritizes internal staff and then looks externally as necessary. “We build local talent pools in your community, pulling from individuals looking for work on an on-demand basis. This gives you an opportunity to sell people on your culture and then hire them,” Mr. Adams said.
Internal float pools meet today’s talent where they are, putting workers in control of the shifts they pick and how much they will be paid. “Internal resource pools must be sophisticated and match units with the competencies of nurses,” Mr. Johnsen noted.
In today’s world, workforce planning is just as critical as anything in a hospital or health system’s strategic plan. Internal float pool programs can play a central role, minimizing labor costs and enabling healthcare leaders to serve as financial stewards of their organizations.
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10 big themes for AI in healthcare heading into 2026
Artificial intelligence has evolved from experimental pilots to a foundational part of healthcare strategy.
Across eight sessions at the Becker’s CEO + CFO Roundtable AI Summit, hospital and health system leaders described how they are moving beyond hype to build governance, data discipline, and measurable impact. Ten key themes emerged that define where AI in healthcare stands today — and where it’s headed next.
Join us at the next AI Summit during the 16th Annual Meeting on April 14! Learn more and register here.
1. ROI encompasses people as much as profit. Health system leaders are redefining return on investment to include time savings, workforce satisfaction, and patient experience, not just financial returns. Many organizations are measuring success by reduced clinician burnout, improved documentation accuracy, and better care coordination alongside cost savings.
2. Data quality is the cornerstone of AI success. Every discussion reinforced that reliable data is the true infrastructure for AI. Without standardized, interoperable, and well-governed data, predictive tools fail to deliver consistent results. Health systems are investing heavily in cleansing data pipelines, strengthening interoperability, and building enterprise-level analytics teams to support trustworthy insights.
3. Governance defines responsible innovation. Formal AI governance frameworks are now essential. Hospitals are establishing multidisciplinary committees that include clinical, operational, cybersecurity, and ethics leaders to review algorithms before deployment. This structure helps balance innovation with safety, transparency, and compliance.
4. Transparency and trust drive adoption. Executives emphasized that successful AI depends on transparency — how models are trained, monitored, and updated. Hospitals expect vendors to provide explainability, audit trails, and ongoing validation. Building trust requires consistent communication about model performance and safety, not just accuracy claims.
5. Predictive AI Is delivering measurable impact. AI is beginning to fulfill its promise in clinical settings. Predictive models for patient deterioration, chronic disease management, and readmission prevention are producing tangible results, improving outcomes while reducing mortality and length of stay. Hospitals that pair these tools with strong workflows and human oversight are seeing the biggest gains.
6. Ambient and agentic AI are transforming clinical workflows. AI-driven documentation tools are freeing clinicians from administrative burden and improving engagement. Many systems have reported substantial reductions in after-hours charting and significant increases in physician satisfaction. A new wave of agentic AI tools — automated voice and text agents — are extending this value to scheduling, patient outreach, and care coordination.
7. Ethical data sharing and consent are emerging priorities. Health systems are embracing privacy-preserving methods that allow data collaboration without compromising patient privacy. At the same time, leaders are calling for clear standards on patient-level consent and data provenance. Ethics, fairness, and accountability are becoming central to AI strategy discussions.
8. Long-term partnerships matter more than point solutions. Hospitals are increasingly cautious about one-off pilots and unproven startups. They are prioritizing vendors with financial stability, proven integration capabilities, and long-term support plans. Sustainable partnerships — those built around shared outcomes and governance — are replacing transactional contracts.
9. Regulation and standards are on the horizon. The industry expects stronger oversight and standardization in the near future. Health systems and coalitions are already developing frameworks for testing, validation, and assurance modeled after regulated industries. Early adopters view this as an opportunity to establish credibility and consistency across AI deployments.
10. AI’s true value lies in empowering people. Across all sessions, leaders agreed that AI’s greatest potential lies in amplifying — not replacing — human expertise. Whether reducing burnout, improving accuracy, or giving clinicians more time for patient care, the technology’s success will ultimately be measured by how well it enhances human performance and connection.
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How accurate are smartwatches for detecting Afib?
Several smartwatches claim to be able to detect atrial fibrillation in wearers. But how accurate are they?
That was the focus of an October meta-analysis in JACC: Advances that reviewed 28 studies spanning 17,349 patients. Here is where the devices ranked for accuracy:
Sensitivity
1. Amazfit: 99%
2. Seiko Epson PWM: 98%
3 (tie). Garmin Forerunner: 97%
3 (tie). Samsung: 97%
5. Apple Watch: 94%
6. Withings ScanWatch: 89%
7. Fitbit: 66%
Specificity
1. Amazfit: 99%
2. Garmin Forerunner: 98%
3. Apple Watch: 97%
4. Samsung: 96%
5. Withings ScanWatch: 95%
6. Seiko Epson PWM: 91%
7. Fitbit: 79%
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Margins, missions and medicine: Driving transformation without compromising care
Healthcare operates in a highly disrupted market with multiple headwinds, including ongoing staff shortages, financial pressures, policy and regulatory changes and cyber threats.
Disruption in the industry is most pronounced among clinical providers, according to the latest AlixPartners’ survey of more than 3,000 global executives across 10 sectors. Tailoring solutions provided the foundation for a roundtable discussion we hosted at Becker’s 2025 CEO + CFO event in Chicago.
The diverse group of health systems operators reflected a broader industry that’s deep into transformation mode. Operators are seeking to integrate technological developments with the realities of a shifting payment and revenue landscape, as well as ongoing workforce challenges.
The wide-ranging discussion provided a framework for providers to assess their own progress in transformations that deliver uninterrupted patient care and avoid unintended consequences.
Key takeaways included:
- Flexibility is central to transformation. Some require wholesale organizational change, focused on operations, processes and the workforce, while others can benefit most from digital transformation that decreases the burden on clinicians. Some operators may be best served by a streamlined revenue cycle transformation that simplifies the patient experience.
- Internal buy-in and collaboration are essential. Regardless of the type of transformation a health system undertakes, there must be organizational alignment and the changes must be supported across departments. “Transformations need to be well coordinated for them to stick,” Greg Magrisi, Partner & Managing Director in AlixPartners’ healthcare practice, said at the event. “All of your leaders need to be in lockstep to make sure these transformations are the right fit.”
- ROI may be indirect. For some processes, the return on investment cannot be fully captured in simple financial terms, although the transformation can still have tremendous value for the organization.
For example, AI scribes using ambient listening are gaining widespread adoption, promising increased efficiency and reduced errors. The returns on investment may not be immediate or directly related to cost savings – although providers directly replacing human scribes with AI have seen more bottom-line impact.
The primary benefit can be in workload management, which improves physician satisfaction and reduces the sometimes-chronic staff turnover. Outcomes are highly dependent on the physician compensation model, specialty, and adoption rate.
“It’s more about improving retention and work-life balance, as well as reducing burnout. That may not be directly impacting the bottom line, but you need to trace that well,” said Jerry Wang, Partner in AlixPartners’ healthcare practice, during the roundtable.
The primary door
Technology is just one tool in the transformation of providers’ operating models, which includes a targeted focus on expanding primary care options and diversifying revenue streams beyond a reliance on public payers.
Restructuring primary care and closing gaps in transitional support after patients leave a facility provides opportunities to build revenue and trust. This can include same-day appointment guarantees to improve access and establish patient loyalty. Health systems are also exploring strategies such as leasing beds in skilled nursing facilities to ensure a safe transition, provide continuity of care and prevent costly readmissions.
The landscape is shifting from pure competition to strategic collaboration. Health systems are increasingly open to joint ventures and partnerships to provide comprehensive care. Projects such as expanding clinical trial programs provide another path to diversifying revenue.
Leaders are intensely focused on optimizing and, in some cases, rationalizing their service lines, asking not only what services they should provide, but more importantly, where they should be provided to be most cost-effective and margin accretive.
A prominent strategy involves consolidating highly specialized services into regional centers of excellence that can improve quality and patient safety by concentrating volume and expertise while avoiding duplicative capital investments.
The post Margins, missions and medicine: Driving transformation without compromising care appeared first on Becker’s Hospital Review | Healthcare News & Analysis.
Piedmont hospital names chief medical officer
Jeff Metts, MD, has been named chief medical officer of Piedmont Newton Hospital in Covington, Ga.
Dr. Metts joins Atlanta-based Piedmont Healthcare from City of Hope Cancer Center Atlanta, where he most recently served as medical director of outpatient medicine, perioperative medicine and occupational health, according to a Nov. 17 news release. From 2013 to 2020, he served as chief of medicine at City of Hope. When the COVID-19 pandemic hit, Dr. Metts took on the role of incident commander, leading the emergency response across five cancer centers.
Piedmont Newton is a 107-bed community hospital.
The post Piedmont hospital names chief medical officer appeared first on Becker’s Hospital Review | Healthcare News & Analysis.
Hospital mortality improvements resume after COVID-19: Study
Risk-adjusted in-hospital mortality is once again improving at U.S. hospitals, even as they care for more complex, high-acuity patients after the COVID-19 pandemic, according to a study published Nov. 12 in JAMA Network Open.
The study, conducted by the American Hospital Association and Vizient, analyzed more than 7.8 million inpatient encounters at 715 hospitals from late 2019 through early 2024. Researchers sought to determine whether two key patient safety indicators — risk-adjusted mortality and case mix index — had returned to their prepandemic trajectories.
Risk-adjusted mortality decreased from 1.00 in the fourth quarter of 2019 to 0.80 in the first quarter of 2024, marking a significant and steady improvement. Meanwhile, the mean case mix index jumped from 1.70 to 1.79 over the same time period.
“Risk-adjusted in-hospital mortality declined significantly following the COVID-19 pandemic, resuming its prepandemic trajectory of improvement, while patient acuity as measured by CMI remained elevated,” study authors wrote. “These findings suggest a new postpandemic baseline for patient acuity, whereas hospital mortality outcomes have returned to prior improvement trends.”
See the full study here.
The post Hospital mortality improvements resume after COVID-19: Study appeared first on Becker’s Hospital Review | Healthcare News & Analysis.
Healthcare wage gaps narrowed after COVID-19: Study
U.S. healthcare wage disparities modestly narrowed during the COVID-19 pandemic, according to a new analysis of wage data.
The study, published Nov. 3 in Health Affairs, examined data from the Current Population Survey to identify trends in median earnings among healthcare workers between 2015 and 2024.
Researchers from Minneapolis-based University of Minnesota and Seattle-based University of Washington found that workers in the lowest-earning healthcare occupations experienced wage increases of approximately 13% during this period — significantly more than higher-earning groups.
Among nonphysician healthcare workers, aides and assistants saw the largest wage gains, with earnings rising 13.6%, according to a news release from Seattle-based UW Medicine. Registered nurses and technicians saw smaller increases of 3.8% and 1.1%, respectively, while advanced practice providers saw 8.3% wage growth over the same period.
“In a way, the silver lining for the pandemic was that it created more job opportunities within the system for low-wage workers,” senior author Bianca Frogner, director of the Center for Health Workforce Studies at the University of Washington School of Medicine, said in the release. “I hope we can take advantage of the moment we see here and not let it fade.”
Researchers also found that less-educated workers saw faster wage growth than more-educated employees. Additionally, Black and Hispanic healthcare workers saw faster wage increases than their white and Asian counterparts, although racial and ethnic pay gaps persisted, according to the release.
Women’s wages grew 8.8% over the study period, compared with 2.1% wage growth for men.
Read more about the study here.
The post Healthcare wage gaps narrowed after COVID-19: Study appeared first on Becker’s Hospital Review | Healthcare News & Analysis.
What to Expect When Working for a Nurse Staffing Agency
Starting a new nursing job in metro Atlanta—or anywhere in Georgia, South Carolina, Alabama, Florida or beyond —can feel overwhelming, even when you know it’s the right move. Working for a nurse staffing agency opens the door to exciting opportunities like travel nursing jobs, per diem nursing positions, and flexible contract nursing assignments, but for many nurses, the process can seem mysterious.
Here’s what to expect and how to prepare so you can start your journey with confidence.
Whether you’re interested in contract nursing jobs, per diem, or full-time placements, the process of joining a nursing agency is straightforward.
- Explore Open Positions
Start by browsing our current healthcare staffing opportunities, including travel nurse contracts and per diem RN jobs across Georgia. You can view all available positions [here]. - Apply and Submit Your Resume
Once you find a role that matches your skills and interests—like emergency department nursing jobs, radiology technologist positions, or ICU contract assignments—submit your application. Our recruitment team reviews your resume to ensure a great fit. - Complete Skills Assessments
After initial screening, you’ll complete online assessments to evaluate your clinical expertise. - Interview and Client Screening
Next, you’ll interview with a recruiter from Staff Relief. Some positions require additional interviews with the hiring facility, especially for rapid response nursing or specialized roles.
The good news? This process typically moves fast—most candidates receive an offer within 9 days of applying.
More Earning Potential
One of the biggest reasons nurses choose agencies like Staff Relief is the pay. Per diem and contract nursing jobs can pay up to 50% more than traditional staff positions. You’ll also have access to the same premium assignments available with leading partners such as Aya Healthcare, AMN Healthcare, and Medical Solutions.
More Flexibility and Freedom
When you work with a nurse staffing agency, you decide when and where you want to work. Whether you prefer travel nurse assignments across the Southeast or local shifts around Georgia, you have control over your schedule.
More Responsibility and Professional Growth
As a contract or per diem nurse, you’ll take on additional responsibilities like tracking time and attendance. While this requires organization, it also builds valuable skills in accountability and independence.
More Variety and Travel
You won’t be tied to one facility. With travel nursing jobs, you can explore new cities, gain diverse experience, and enjoy housing assistance coordinated through agency partnerships.
More Security and Benefits
Even though you’re working flexible assignments, you still receive comprehensive benefits. Staff Relief provides health insurance and other perks so you can feel secure in your role.
If you’re a nurse who thrives in a fast-paced, dynamic environment and values more freedom, higher pay, and a variety of assignments, agency work could be your ideal career path.
Staff Relief partners with major healthcare staffing leaders to offer you access to top contracts and exclusive opportunities. Ready to get started?Contact Staff Relief today to learn more about our per diem nursing jobs, travel nurse assignments, and allied health contracts in Georgia. Let the best nurse staffing agency in Geogia find the perfect fit for your skills and goals.
Travel Nurse Pay in Georgia – Updated
Working as a contract nurse or per diem nurse in Georgia opens doors to flexibility, premium pay rates, and the chance to grow your experience across different healthcare settings. Whether you’re comparing travel nursing jobs, exploring remote RN jobs, or looking into per diem nursing positions, it’s essential to understand the factors that impact your earnings so you can make informed decisions and advocate for fair compensation.
Below, you’ll find everything you need to know about travel nurse pay in Georgia, average hourly rates, and how variables like specialty and location shape your paycheck.
When you partner with a nursing staffing agency or medical staffing agency, you’ll likely choose between contract assignments and per diem shifts:
- Contract Nursing Jobs: You’ll sign an agreement to work a set number of hours over a defined period, such as 8–13 weeks. Many contract nursing jobs offer guaranteed hours, premium rates for urgent needs, and stipends for housing and travel.
- Per Diem Nursing Jobs: “Per diem” means “per day.” These shifts are typically scheduled a week at a time, providing maximum flexibility for nurses who prefer short-term or occasional work. Per diem nurses often receive higher hourly rates to compensate for the lack of long-term commitment and benefits.
Whether you’re drawn to the stability of a contract or the freedom of per diem nursing shifts, you’ll be paid hourly, with rates that can fluctuate based on demand and specialty.
No two assignments are exactly the same. Here are the main factors that determine what you’ll earn as a travel nurse or per diem nurse in Georgia:
1. Location
Urban areas like Metro Atlanta and Savannah typically offer higher compensation compared to rural hospitals and clinics. Travel nurse jobs in Atlanta often pay a premium to attract experienced RNs to high-volume facilities.
2. Specialty
Your area of expertise makes a significant difference. Roles in the emergency department, ICU, operating room, and critical care nursing often command the highest hourly rates. Specialized skills like medical imaging, radiology technologist jobs, or dialysis RN contracts can further boost your earning potential.
3. Experience and Credentials
More years in the field—and specialty certifications—qualify you for higher-paying assignments. Rapid response nursing jobs and crisis response contracts also tend to pay more due to urgency and complexity.
4. Facility Type
Pay can vary depending on whether you’re working in an acute care hospital, skilled nursing facility, outpatient clinic, or rehab center. Some settings offer incentives like retention bonuses or completion bonuses.
5. Travel Requirements
Assignments requiring you to commute 50+ miles often include additional stipends or elevated pay rates to offset costs and time away from home.
While rates fluctuate weekly based on demand and season, here’s what you can generally expect in Georgia:
- General RN: $40–$46 per hour
- General RN (Metro Atlanta): $48–$55 per hour
- Specialty RN (ICU, OR, ED): $55–$75+ per hour, depending on urgency and shortage areas
- Licensed Practical Nurse (LPN): $25–$40 per hour
- LPN (Metro Atlanta): $30–$45 per hour
These figures often include travel stipends and housing allowances. For high-paying travel nursing companies or crisis response contracts, rates can exceed $80 per hour in peak demand.
Some agencies bundle housing and travel reimbursements, while others pay a higher hourly rate without stipends.
Before accepting a contract, review details carefully:
- Hourly base pay
- Housing allowance or provided housing
- Meal and incidentals stipends
- Travel reimbursements
- Completion and referral bonuses
If you’re unsure whether a pay package is competitive, compare it with similar contract nursing jobs.
- Get certified in high-demand specialties like emergency room nurse staffing, ICU nursing, or radiology technologist work.
- Consider rapid response nursing or ICU contract nurse positions for premium rates.
- Pick up flexible options like weekend nursing contracts or extra per diem shifts to maximize income.
- Keep your licenses and certifications current to qualify for the broadest range of assignments.
If you’re ready to explore per diem nursing jobs in Georgia or secure a travel nurse contract with competitive pay and benefits, Staff Relief, Inc. is here to help.
Contact us today to learn more about available contracts and start earning what you deserve.
The Ultimate Guide to Per Diem and Travel Nursing Jobs in the Southeast
If you’re an RN exploring your next career move, you’re not alone. Demand for per diem nursing jobs, travel nursing assignments, and contract nursing positions continues to rise across the Southeast—including Georgia, Florida, Alabama, and North Carolina.
At Staff Relief, we specialize in connecting nurses with flexible, rewarding opportunities at top healthcare facilities. Whether you’re searching for remote RN jobs, weekend nursing contracts, or emergency department nursing careers, this guide will help you understand your options and how to get started.
Per diem nursing offers unmatched flexibility. You can pick up shifts on your schedule—ideal for maintaining work-life balance or supplementing your income. Contract nursing jobs, meanwhile, provide stability for a set duration, often with higher pay rates and benefits.
- Flexible nursing shifts that fit your lifestyle
- The ability to work in acute care, skilled nursing facilities, or inpatient care units
- Opportunities to gain experience in critical care, emergency departments, or medical imaging
- Access to rapid response nursing jobs and crisis response travel nurse contracts that offer premium compensation
- The chance to build your resume with respected employers like Aya Healthcare, AMN Healthcare, and Medical Solutions
Many nurses are drawn to the Southeast for its competitive pay and growing healthcare networks. Here are some popular areas to consider:
- Georgia: From Atlanta to Savannah, per diem nursing jobs in Georgia are in high demand. If you’re wondering how to become a travel nurse in Georgia, Staff Relief can guide you through licensing and onboarding.
- Florida: Coastal communities and urban hospitals alike need RNs for contract nursing jobs in Florida, especially in ICU, OR, and emergency room nurse staffing.
- North Carolina: Explore travel nurse assignments in North Carolina, including rapid response nursing and critical care contracts.
- Alabama: More facilities are offering remote RN jobs in Alabama and local contracts to address staffing shortages.
You have more options than ever to search for your next role. While many nurses and allied health professionals look on popular platforms like Indeed and Vivian, applying through multiple agencies can be time-consuming and repetitive.
Staff Relief makes it simpler. Our job board and mobile app put thousands of opportunities in one place. You can browse, compare, and apply to positions without juggling multiple applications or credentialing processes.
Here are a few resources to explore:
- Staff Relief Job Board & Mobile App – Your all-in-one hub for per diem, travel, and contract jobs, with a streamlined application process and dedicated support.
- Indeed – Search a wide range of listings for nursing and allied health jobs.
- Vivian Healthcare Jobs – Compare pay packages and contract details across agencies.
Ready to save time and find your next assignment faster? Start with Staff Relief’s platform for the most efficient experience
Aya Healthcare, AMN Healthcare, and Medical Solutions are some of the most respected companies in the industry offering extensive travel nursing, per diem, and rapid response assignments nationwide. As a partner, Staff Relief has access to some of the same contracts and exclusive opportunities available through Aya, AMN, and Medical Solutions. You can explore top-paying positions without having to apply separately to multiple agencies. Whether you’re interested in Aya Healthcare contracts, AMN Healthcare rapid response nursing jobs, or Medical Solutions travel nurse assignments, our team can help you compare options and secure the role that fits you best.
Choosing the right nursing agency is essential. Whether you’re evaluating Aya Healthcare reviews, AMN Healthcare pay packages, or Medical Solutions job openings, here are factors to consider:
- Transparent pay packages and benefits
- Support with licensing and credentialing
- Access to crisis response contracts and rapid response nursing jobs
- A reputation for placing nurses in top paying travel nursing companies
- Ongoing support and career development resources
Staff Relief partners with major systems and local facilities to deliver healthcare staffing solutions that prioritize both the nurse and the patient.
If you’re searching for flexible RN shifts, contract nursing jobs, or remote nursing positions, we’re here to help. From emergency department nurse jobs to radiology technologist staffing, our team can match you with assignments that fit your goals.
Connect with Staff Relief today to get personalized recommendations, compare contracts, and start your next chapter with confidence.
Pros and Cons for Working for a Nurse Staffing Agency
In today’s fast-changing healthcare landscape, more nurses are exploring flexible career paths, including per diem nursing jobs, travel nursing contracts, and remote RN positions. Whether you’re a seasoned nurse searching for higher pay or a new grad eager to explore diverse settings, working with a nursing staffing agency can be a rewarding option. But like any career move, it’s important to weigh the benefits and challenges before deciding.
Below, we break down the main pros and cons of working with a medical staffing agency in Georgia and across the Southeast, so you can make the best choice for your lifestyle and goals.
One of the top reasons nurses choose per diem nursing positions or local contract nursing is the freedom to control their schedule. Unlike full-time hospital roles, contract assignments and per diem shifts let you decide when and where you work. This flexibility is ideal if you have family commitments, are pursuing further education, or simply want more autonomy in your day-to-day life.
Agencies like Aya Healthcare, AMN Healthcare, and Medical Solutions often post weekend nursing contracts, PRN RN positions, and rapid response nursing jobs you can pick up on your terms.
If maximizing your earnings is a priority, you’ll be glad to know that contract nursing jobs and per diem shifts typically pay higher hourly rates compared to permanent staff roles. These assignments often include stipends for meals, lodging, and travel—especially for travel nurse jobs in Atlanta, Savannah, and the Florida Panhandle. Many nurses find that with smart budgeting; they can work fewer shifts while maintaining or even increasing their income.
Plus, expenses related to travel nursing—like transportation and temporary housing—are often tax-deductible, creating additional financial benefits.
For nurses who thrive on change, working with a healthcare staffing agency provides a steady stream of new experiences. You’ll build your skills across different units, such as emergency departments, inpatient care, and even specialized areas like radiology technologist jobs or diagnostic imaging. This variety not only helps you stay engaged but also makes your resume stand out to future employers.
While flexible shifts are a major perk, it’s important to recognize that per diem nursing jobs don’t always guarantee steady hours. You may have weeks packed with back-to-back assignments, followed by slower periods. In some cases, last-minute schedule changes can impact your plans. If you prefer consistency, consider long-term contract nursing jobs, which often range from 6 to 17 weeks and offer more predictable schedules.
Contract and travel nurses frequently rotate among facilities, from skilled nursing facilities to acute care hospitals. Each location has its own protocols, electronic health records, and workplace culture. While you’ll eventually become comfortable in new settings, the learning curve can feel steep, especially when starting out. Nurses who value long-term relationships with coworkers and patients may find this aspect challenging.
If you’re adaptable, resourceful, and excited by the idea of working in diverse environments, you’re well-positioned to succeed. Many RNs say contract work rekindled their passion for patient care, exposed them to innovative treatments, and expanded their professional networks.
Whether you’re interested in remote nursing jobs in Alabama, ICU travel nurse assignments in Georgia, or emergency room contracts throughout the Southeast, there’s no shortage of options through reputable agencies like Aya Healthcare, AMN Healthcare, and Medical Solutions.
Ready to explore per diem nursing positions or contract opportunities? Here are a few steps to begin:
- Research Top Agencies: Read reviews and compare pay packages, benefits, and housing support.
- Set Your Priorities: Decide what matters most—schedule flexibility, pay rate, location, or specialty.
- Prepare Documentation: Update your licenses, certifications, and resume.
- Search Nursing Jobs Online: Use platforms like Indeed, Vivian Health, and agency job boards to find assignments that match your goals.
- Ask Questions: Speak with recruiters to understand expectations, cancellation policies, and support resources.
Working with a nursing staffing agency can be an empowering way to build a flexible, well-paid, and fulfilling career. If you’re considering making a change, take time to explore your options and connect with agencies committed to supporting nurses at every step.
Explore current per diem and contract openings with Staff Relief today and discover how flexible nursing can work for you.
How to Get a High Paying Contract Nursing Job
Contract nursing offers the chance to do meaningful work, gain diverse experience, and earn competitive pay. Whether you’re pursuing contract nursing jobs, per diem nursing positions, or rapid response assignments, the key to maximizing your income is preparation and strategy.
If you’re ready to secure a high-paying contract nursing job, use these proven tips to set yourself apart and negotiate pay that reflects your expertise.
Your resume is your first impression. A clear, polished resume highlights your skills, certifications, and professional accomplishments, and it determines whether you’ll be invited to interview.
Include:
- Your nursing specialties (such as ICU, emergency department, or medical imaging)
- Certifications (like ACLS, BLS, or specialty credentials)
- Details about your experience in different care settings, such as inpatient care, skilled nursing facilities, or acute care staffing
It’s normal to have employment gaps but be ready to confidently explain them during interviews. A well-organized resume positions you as a serious professional ready for high-paying nursing contracts.
Keeping your credentials updated makes you a more attractive candidate and can improve your earning potential.
Make sure to:
- Renew essential licenses and certifications promptly.
- Consider adding specialty certifications that are in demand for travel nursing jobs and contract assignments.
- Stay up to date with immunizations required by hospitals and clinics. Being ready with all documentation can speed up onboarding and help you access crisis response nursing jobs or urgent needs contracts that often pay premium rates.
The more prepared you are, the easier it is for a nurse staffing agency or recruiter to match you with higher-paying positions.
Professional references can be the deciding factor in landing a top-paying assignment.
Employers and recruiters rely on references to verify your:
- Clinical skills
- Professionalism
- Reliability
Choose references who can confidently speak to your work ethic and performance. Positive recommendations can open the door to flexible nursing shifts, per diem contracts, and specialized roles that pay more.
Flexibility is often rewarded in the world of contract nursing.
Consider these options to boost your pay:
- Accepting night shifts or weekends, which usually come with higher hourly rates.
- Taking assignments in locations experiencing shortages, such as rural facilities or emergency department nursing jobs.
- Being open to rapid response contracts or crisis response assignments, which often offer premium compensation.
When you demonstrate a willingness to adapt, you make yourself more valuable to medical staffing agencies and healthcare employers.
In contract nursing, your reputation follows you from one facility to the next. A strong track record makes it easier to secure higher-paying contracts and preferred assignments.
Tips for maintaining a great reputation:
- Be punctual and dependable.
- Communicate clearly with staffing agencies and supervisors.
- Go the extra mile to provide excellent patient care.
Facilities are willing to pay more to bring on nurses with proven reputations for excellence.
Being a contract nurse offers countless benefits, from career variety to premium pay. To make the most of your opportunities:
- Invest time in preparing a strong resume.
- Keep certifications and immunizations current.
- Maintain excellent references.
- Stay flexible with shifts and assignments.
- Build and protect your professional reputation.
When you combine preparation with dedication, you can consistently secure high-paying contract nursing jobs that match your skills and goals.
If you’re looking for your next opportunity, Staff Relief, Inc. is here to help. We partner with hospitals, clinics, and healthcare facilities to connect nurses with the best assignments in Georgia and beyond.
Contact us today to explore available contracts and start earning what you deserve.
How to Find the Best Nursing and Allied Health Jobs in 2025
If you’re thinking about a career change this year, you’re not alone. Thousands of nurses and allied health professionals are exploring contract nursing, per diem shifts, and even remote RN jobs to gain more flexibility, better pay, and fresh experiences.
But with so many options and so many staffing agencies—how do you know where to start?
This guide will walk you through:
✅ Why more professionals are choosing contract and per diem work
✅ How to evaluate agencies and read nursing agency reviews
✅ Where to find the best nursing jobs in 2025
✅ Tips for comparing assignments and getting hired faster
The days of sticking to one hospital job for your entire career are long gone. Today’s nurses are building more dynamic, customized careers—often combining contract assignments with per diem shifts.
The benefits of contract nursing are clear:
- Higher pay compared to permanent staff roles
- Housing and travel stipends
- Bonuses for completing assignments
- The chance to build experience in specialized areas like ICU, ER, and diagnostic imaging
- Flexibility to take time off between contracts
Meanwhile, per diem nursing jobs offer even more control over your schedule. You can pick up shifts when you want—whether that means extra weekends or just a few days a month.
If you’re drawn to this flexibility, you’re in good company. Contract and per diem work have become the fastest-growing segments of healthcare employment.
Once you decide to make a change, your next step is choosing a partner to help you find assignments. But not all agencies are the same.
Before you commit, take time to read nursing agency reviews. Here’s what to look for:
- Transparency in pay packages and benefits
- Support with licensing, credentialing, and onboarding
- Access to rapid response nursing jobs and high-demand contracts
- A track record of placing candidates in the highest paying travel nursing companies
- Clear communication and responsive recruiters
At Staff Relief, we know that trust matters. As a partner of Aya Healthcare, AMN Healthcare, and Medical Solutions, we can give you access to exclusive contracts without the hassle of applying to multiple platforms.
There are dozens of websites that list healthcare jobs, but it’s easy to get overwhelmed. To save time, start with the best nursing job sites for 2025:
- Staff Relief Job Board & Mobile App – Your one-stop platform to see per diem, contract, and travel nursing jobs nationwide, including remote RN jobs and medical imaging positions.
While many agencies focus on nursing alone, allied health roles are booming, too. If you’re a technologist or imaging specialist, consider exploring:
- Radiology technologist jobs in hospitals and outpatient centers
- Diagnostic imaging careers in high-demand specialties
- Medical imaging staffing agencies that can connect you to flexible contracts
- Radiographer employment for mobile imaging services or large health systems
Staff Relief supports professionals across disciplines and can help you find medical imaging jobs near you with excellent pay and benefits.
Ready to pick up extra shifts or transition into per diem work full-time? Here are tips to get per diem nursing jobs faster:
- Keep your credentials and health records updated.
- Sign up with an agency that has real-time job listings.
- Use the Staff Relief app to get instant alerts when new shifts are posted.
- Be proactive—per diem openings often fill quickly.
Whether you want the best remote nursing jobs for RNs, the stability of contract work, or the variety of per diem assignments, 2025 is the perfect year to take control of your career.
At Staff Relief, we make it easy to:
- Access the highest paying travel nursing companies
- Compare contracts side by side
- Read verified nursing agency reviews
- Secure opportunities in radiology, imaging, and allied health
- Apply once and explore thousands of jobs nationwide
Connect with Staff Relief today, and let’s build your path forward together.
Everything You Need to Know About Travel Nurse Credentialing
Every hospital, clinic, and long-term care facility has its own standards for verifying a clinician’s qualifications and readiness to practice. Even if you’ve worked at a similar facility before, you can’t automatically carry over your credentials. Each assignment requires you to complete a credentialing and onboarding process to ensure patient safety and compliance with regulations.
Credentialing typically includes:
- Drug screening
- Health assessments
- Proof of licensure and certifications
- Background checks and reference verifications
- Competency exams
- Facility-specific training and onboarding
Many nurse managers or department leaders will schedule a phone or video call to review workflows, discuss expectations, and confirm you’ve completed all requirements before your start date.
Preparation is key. Keeping all your essential documents organized will save you time and stress whenever you accept a new assignment. Here’s what you’ll need to have ready:
- Copies of your professional license(s) and any specialty certifications (such as BLS, ACLS, PALS)
- Two valid forms of identification (e.g., driver’s license and passport)
- A record of your annual physical exam (valid for one year)
- TB test results (valid for one year)
- Drug screen results
- Immunization and titer records (MMR, Varicella, Hepatitis B, and others)
- Proof of flu vaccination (especially if starting in the fall or winter)
- COVID vaccination records if required by the facility
- Payroll forms and direct deposit information
- References and verified work history
- Competency test results (if applicable)
If you want to avoid delays, consider getting your TB test, physical, and immunizations updated while you’re applying for contracts. Staying current helps you move quickly when the right opportunity arises.
Most healthcare facilities require online assessments to verify your competency in your specialty. These assessments might include:
- Skills checklists
- Clinical scenario testing
- Electronic medical record (EMR) training modules
Once you pass these evaluations, you’ll typically complete one to two days of orientation to get familiar with the facility’s policies, documentation standards, and workflows. This process helps ensure you can provide safe, effective care from day one.
If you work in in-demand roles such as ER RN, PCU RN, CT Technologist, RRT, Surgical Tech, Mammo Tech, Home Health RN, or M/S RN, expect additional verifications and specialty-specific assessments. Facilities often have strict guidelines for these positions due to the complexity of care and the need for current certifications.
Staff Relief’s credentialing team can walk you through these specialty requirements step by step so you feel confident and prepared.
Large national agencies often have more rigid, self-directed credentialing processes. Working with a regional partner like Staff Relief provides you with hands-on support. Our team will:
- Help you track deadlines for documents and assessments
- Coordinate background checks and health screenings
- Connect you with local resources for TB testing and physicals
- Answer your questions about compliance and onboarding
This personal guidance ensures nothing falls through the cracks—and you’re always ready to step into your next assignment.
Credentialing isn’t a one-time process. Here are a few habits that can help you stay organized:
- Keep a digital folder with scanned copies of your documents
- Mark your calendar with expiration dates for your TB test, physical, and certifications
- Get your annual flu shot early if you expect to start an assignment in the fall
- Check whether your next facility requires a COVID vaccine or booster
- Keep your immunizations up to date to avoid delays
Being proactive makes you more competitive for premium travel contracts and quick-start assignments.
Navigating credentialing can feel like a lot to manage, especially if you’re juggling multiple offers. That’s why choosing the right staffing partner is so important.
Staff Relief has years of experience supporting clinicians across Georgia, Alabama, Florida, and the Carolinas. Whether you’re a first-time traveler or a seasoned professional, you’ll have a dedicated team behind you to make credentialing smooth, transparent, and stress-free.
If you’re exploring travel nursing jobs or allied health contracts in the Southeast, our team is here to help you navigate credentialing and start your next adventure with confidence. Contact Staff Relief today to learn about current opportunities and get expert support every step of the way.
Addressing Georgia’s Critical Nursing Shortage
The nursing shortage in Georgia has reached critical levels in 2025, with nearly every county—urban and rural—struggling to recruit and retain qualified healthcare professionals. This crisis isn’t just about open positions; it’s about ensuring patients receive safe, timely, and compassionate care when they need it most.
From major hospitals to long-term care facilities, healthcare organizations are urgently seeking skilled nurses, surgical techs, and allied health professionals who can step into high-demand roles and make an impact.
Several factors continue to drive Georgia’s nursing shortage:
- Rising demand for healthcare services: The state’s aging population and expanded access to care have increased the need for RNs, LPNs, and allied health professionals.
- Burnout and workforce attrition: The lingering effects of the pandemic, combined with long hours and emotional stress, are pushing many clinicians to reduce hours, retire early, or leave the field altogether.
- Education and training bottlenecks: Limited capacity in nursing schools and faculty shortages continue to constrain the pipeline of new graduates.
- Rural disparities: Non-metro counties face even steeper challenges recruiting clinicians, leaving communities with limited access to primary and specialty care.
As a result, many hospitals and clinics are leaning heavily on travel contracts, per diem staff, and flexible assignments to keep up with patient needs.
The staffing shortage has ripple effects throughout Georgia’s healthcare infrastructure:
- Hospitals are relying on travel clinicians—especially in specialties like ER RNs, PCU RNs, and Surgical Techs—to fill critical gaps.
- Skilled professionals such as CT Technologists, RRTs, Mammo Techs, and Home Health RNs remain in high demand, driving up competition and pay rates.
- Burnout among the remaining workforce leads to higher turnover, further deepening shortages.
- Patients experience longer wait times, delayed procedures, and uneven access to care, particularly in rural and underserved areas.
The result is a cycle of strain that requires strategic intervention.
While the challenges are significant, Georgia’s healthcare leaders are adopting innovative strategies to rebuild the workforce and improve retention:
1. Expanding Educational Pathways
- New state investments in nursing schools and allied health programs are increasing enrollment capacity.
- Fast-track bridge programs are helping LPNs and paramedics advance to RN licensure more efficiently.
2. Financial Incentives and Career Support
- Loan repayment and tuition reimbursement programs are helping attract graduates to high-need areas.
- Retention bonuses and flexible scheduling are becoming standard in many contracts.
3. Investing in Burnout Prevention
- More facilities are offering mental health resources and dedicated time off to protect clinician well-being.
- AI-supported scheduling tools are helping balance workloads and reduce last-minute staffing gaps.
4. Expanding Telehealth and Remote Care
- Telehealth adoption continues to grow in 2025, allowing clinicians to manage certain care remotely.
- Hybrid care models are easing staffing pressures in rural counties.
5. Embracing Flexible Staffing Models
- Short-term contracts, rapid response assignments, and per diem shifts give clinicians more options to work on their terms.
- Many clinicians are finding that a mix of travel and local assignments offers better work-life balance.
Healthcare facilities across Georgia and the Southeast increasingly rely on experienced staffing agencies to fill urgent and specialized positions. When you partner with a staffing agency that understands the local landscape, you gain access to:
- Skilled clinicians ready to step into critical roles—whether it’s an ER RN, PCU RN, CT Tech, RRT, or Mammo Tech.
- Flexible workforce solutions to manage seasonal demand and unexpected absences.
- Streamlined credentialing and onboarding to get staff in place faster.
- Insights into regional pay trends and incentives.
Staff Relief, for example, has built long-standing partnerships with hospitals, outpatient centers, and home health agencies across Georgia, Florida, Alabama, and the Carolinas, making it easier to adapt to changing needs.
If you’re considering your next step in nursing or allied health, there has never been a better time to explore opportunities in Georgia. Clinicians with experience in specialties like emergency nursing, progressive care, surgical services, medical-surgical units, and diagnostic imaging are in especially high demand.
With flexible contracts, competitive compensation, and support from experienced recruiters, you can build a career that aligns with your goals and helps meet a pressing need.
Georgia’s nursing shortage is a complex, urgent issue—but progress is happening. By investing in education, supporting the workforce, embracing innovation, and building strong partnerships, the state is working to rebuild its healthcare capacity.
If you’re a healthcare professional ready to make an impact—or a facility seeking experienced clinicians—this is the moment to take action.
Ready to explore the latest opportunities or learn how strategic staffing can help? Contact Staff Relief today and join the effort to strengthen Georgia’s healthcare system for everyone.
10 Tips for Travel Nurses
Travel healthcare is more than just an assignment, it’s an opportunity to expand your skills, explore new places, and make an impact where it matters most. Whether you’re a seasoned travel nurse, a respiratory therapist, or a surgical technologist, knowing how to navigate contracts and maximize your experience is key to success.
Here are ten essential tips every travel healthcare professional should keep in mind.
1. The Demand for Your Skills is Higher Than Ever
In 2025, healthcare facilities across the Southeast in Georgia, Alabama, Florida, and the Carolinas are experiencing critical staffing shortages. High-demand specialties like CT Tech, ER RN, Surgical Tech, RRT, PCU RN, Mammo Tech, Home Health RN, and M/S RN are seeing unprecedented opportunities.
Travel nursing jobs and allied health contracts are plentiful, but competition can be fierce for the best assignments. Staying flexible and proactive will help you secure roles that match your expertise and goals.
2. Understand Tax Implications of Travel Assignments
Many clinicians overlook how travel pay affects their taxes. Housing stipends, travel reimbursements, and per diem allowances can all impact your taxable income. It’s wise to consult a tax professional who understands healthcare contracts to ensure you’re planning ahead and taking advantage of eligible deductions.
3. Credentialing and Compliance Take Preparation
Every state has different licensure and credentialing requirements. Georgia, Florida, and the Carolinas all have their own rules around background checks and health records.
Be prepared to provide:
- A TB test (valid for 1 year)
- A current physical exam (valid for 1 year)
- Titers and immunization records
- A background check
- A drug screen
It’s smart to get your TB test, physical, and immunizations done while you’re applying so you’re ready as soon as you receive an offer. Keep your immunizations updated, including your flu shot in the fall and COVID vaccinations where required. This will prevent delays when it’s time to start your contract.
Working with a healthcare staffing agency like Staff Relief ensures you’ll have help coordinating these documents and understanding what’s required for each facility.
4. Housing Options Vary by Assignment
Some contracts include housing stipends, while others offer pre-arranged accommodations. It’s critical to understand:
- What your stipend covers
- Whether you’ll be responsible for utilities, deposits, or furniture
- How your housing affects your taxable income
If you prefer to find your own place, Staff Relief can help source local housing options and connect you to reputable providers in your assignment area.
5. Your Reputation Will Follow You
Healthcare facilities often work with the same staffing partners across regions. Showing up on time, being adaptable, and maintaining professionalism will build your reputation and make it easier to secure future assignments.
Positive references can help you access competitive roles in specialties like ER, PCU, and surgical services.
6. Flexibility is Your Superpower
The most successful travel clinicians are those who can pivot quickly. Being open to night shifts, rural contracts, or high-demand specialties often results in higher pay and priority placement.
If you’re willing to work in critical areas, you’ll find more opportunities and stronger negotiating power.
7. Pay Packages Can Be Complex
Your compensation may include:
- Base hourly pay
- Travel stipends
- Housing allowances
- Completion bonuses
Make sure you understand the full picture, not just the hourly rate. This is essential so that you can budget effectively. A reputable healthcare staffing agency will always be transparent about how your pay is structured.
8. Burnout is Real so Take Care of Yourself
Long shifts and adapting to new teams can be stressful. Protect your mental health by:
- Scheduling regular downtime between contracts
- Accessing telehealth services offered through Staff Relief for confidential support
- Staying connected to your support network
Prioritizing self-care helps you bring your best to every assignment.
9. Smaller Agencies Can Get You Into Hidden-Gem Facilities
Smaller agencies can often place clinicians into smaller community hospitals and rural facilities where patient loads are more manageable, but pay rates remain competitive. These positions are available through Staff Relief in Georgia, Alabama, and South Carolina. Only Staff Relief and one or two other boutique firms serve these facilities, so you won’t find these assignments through large national agencies like Aya, Medical Solutions, or AMN Healthcare.
10. Choosing the Right Staffing Partner Matters
Your agency isn’t just your employer, it’s your advocate. The best healthcare staffing partners:
- Have deep relationships with respected hospitals and clinics
- Offer personal support before, during, and after your assignment
Staff Relief has decades of experience supporting clinicians across the Southeast, combining local expertise with a commitment to transparency and respect.
If you’re exploring travel nursing jobs or allied health contracts in Georgia and beyond, now is the time to take the next step. With the right support and preparation, your travel career can be rewarding, sustainable, and full of growth. Contact Staff Relief today to learn about current opportunities and find the right fit for your skills and goals.
How to Choosing the Right Medical Staffing Agency
Choosing the right medical staffing agency isn’t just about finding a job—it’s about building a career with the support, transparency, and opportunities you deserve. Whether you’re looking for contract nursing jobs, travel assignments, or allied health positions, partnering with the right agency helps you feel confident every step of the way.
As a regional leader in the Southeast serving Georgia, the Carolinas, Alabama, and Florida, Staff Relief specializes in high-demand roles and offers deep local expertise to help you succeed.
Here are six essential tips to guide your search for a medical staffing agency you can trust.
1. Work with a Partner Who Knows the Region
When you’re working in states across the Southeast, you want an agency that understands the unique dynamics of each market. Regional experience matters because:
- Different states have varying credentialing and compliance requirements
- Compensation rates shift between urban and rural facilities
- Each area has its own demand for specialties, including CT Tech, ER RN, Surgical Tech, RRT, PCU RN, Mammo Tech, Home Health RN, and M/S RN assignments
Staff Relief’s recruiters have years of experience placing clinicians throughout Georgia, Alabama, Florida, and the Carolinas. This local knowledge ensures you’re matched with facilities that fit your skills, preferences, and professional goals.
2. Evaluate the Agency’s Reputation and Track Record
A medical staffing agency’s history is a strong indicator of what you can expect. Take time to:
- Explore the agency’s website to see testimonials from nurses, surgical techs, respiratory therapists, and imaging professionals
- Review social media and online platforms for authentic feedback
- Look for examples of long-term partnerships with respected hospitals, outpatient centers, and home health organizations across the Southeast
When you choose an agency that has established relationships and a reputation for consistency, you gain peace of mind that your career is in capable hands.
3. Expect Clear Communication About Pay
Transparency around compensation is crucial. Medical staffing pay packages can include:
- Base hourly rates
- Travel and housing stipends
- Bonuses
Without clarity, it’s easy to feel uncertain about what you’ll actually earn. A trustworthy agency will explain exactly how your pay is structured, whether you’re taking on a rapid response ER RN contract, a CT Tech travel assignment, or a Mammo Tech position.
At Staff Relief, we prioritize transparent communication so you can make informed decisions and feel confident in your earnings.
4. Assess Benefits and Support
The right staffing agency offers more than just placements. Look for a partner that provides:
- Credentialing and compliance support
- Guidance navigating state requirements if you’re crossing from Georgia into Florida, Alabama, or the Carolinas
- Professional development resources and scheduling assistance
Staff Relief is committed to offering comprehensive support, so you can focus on providing excellent patient care, whether you’re working in PCU, ER, surgical services, or home health.
5. Look for Joint Commission Certification
When an agency is Health Care Staffing certified by The Joint Commission, it demonstrates a commitment to quality and safety. Certification means the agency has:
- Passed rigorous evaluations of processes, compliance, and clinical standards
- Demonstrated consistent excellence in recruiting and supporting healthcare professionals
This recognition shows you’re working with an organization that meets the highest standards. This is something you can expect when partnering with Staff Relief.
6. Find the Right Fit for Your Working Style
Every agency operates differently. Some rely on automated platforms and self-service tools, while others offer more personal, one-on-one support.
Ask yourself:
- Do you want direct access to a recruiter who knows you by name?
- Would you rather work with an agency that manages credentialing and logistics for you?
- Do you prefer a more high-touch approach over an impersonal online process?
Choosing an agency that fits your communication style and values makes every assignment more rewarding. Staff Relief’s approach is personal, responsive, and focused on helping you thrive in the role that’s right for you.
When you work in specialized, high-demand fields like CT Tech, ER RN, Surgical Tech, RRT, Mammo Tech, PCU RN, Home Health RN, and M/S RN. You deserve a staffing partner who understands your expertise and advocates for your success.
The right agency combines:
- Regional knowledge of healthcare employers throughout Georgia, Alabama, Florida, and the Carolinas
- Transparent, competitive pay structures
- Robust support and credentialing assistance
- A proven reputation with hospitals and clinics across the Southeast
- Certification that demonstrates credibility
- A commitment to personal service and professional respect
With the right support you’re not just taking a job, you’re building a sustainable career.
If you’re exploring your next contract or travel assignment in the Southeast, Staff Relief is here to help. Our partnerships with respected healthcare facilities and our experience placing clinicians in high-demand specialties mean you can feel confident you’re making the best move for your future.
Contact us today to learn more about available positions and start your search with a staffing agency that puts you first.
The Cost of Nurse Turnover: A Breakdown
Poor nurse retention is a major issue for healthcare facilities, with the national registered nurse (RN) turnover rate standing at nearly 20%. According to the 2024 NSI National Healthcare Retention and RN Staffing Report, the average cost of nurse turnover is estimated to be $56,300 per every RN who leaves their job. For the average hospital, this can equate to roughly $3.9 to $5.8 million in losses per year.
Beyond the financial impacts, high turnover can also have rippling effects on company culture and patient care. In this article, we’ll break down all the costs of nurse turnover and outline strategies that can help you mitigate this issue at your facility.
Nurse turnover occurs when nursing professionals leave their jobs or the profession altogether. This can include instances in which staff are involuntarily terminated from their positions, enter retirement, or choose to leave their roles for other reasons. Some of the most common reasons why nursing professionals willingly leave their jobs include burnout, feeling underappreciated, and a lack of peer support.
Before we break down the cost of nursing turnover, it’s important to note that national nurse turnover and cost estimates often only account for RNs. While it’s difficult to estimate a turnover rate that is representative of all levels of nursing, let’s take a look at how turnover rates and costs have been reported for other types of roles:
- The cost of nurse practitioner turnover is estimated to be $85,832 to $114,919 per episode, with the average turnover rate standing at roughly 10%.
- The cost of nurse managerturnover is estimated to be between $132,00 to $228,000 per episode, with some hospitals reporting that 50% of their nurse leaders intend to leave their jobs within 5 years.
- The indirect costs of replacing one certified nursing assistant (CNA) can range from $3,000 to $6,000, with turnover rates averaging as high as 50% in nursing homes alone.
From these statistics, it’s clear that turnover costs can add up quickly if nursing professionals keep leaving their positions. But how exactly does turnover amount to millions of dollars per year? Here’s a rundown of what can contribute to both the economic and non-economic costs.
There are several ways in which frequent turnover can lead to increased operational costs for facilities. We’ll review and summarize these costs below.
Costs of Vacancies
When a nurse leaves their position, facilities must spend excess money to compensate for vacancies and understaffing. This includes the costs of advertising the opening, hiring temporary staff, and paying existing staff for overtime. Facilities may even need to close beds and defer patients, which leads to diminishing returns.
Several studies have found that these factors combined can contribute to significant losses, accounting for anywhere between 44% to 83% of turnover costs. These costs also continue to rise the longer a position stays open.
Costs of Training
Each time a facility hires a new nurse, additional resources must be spent for onboarding and training. Research has suggested that training can account for roughly 7% to 9% of turnover costs, as preceptors are often given temporary salary raises to orient new nurses.
Facilities that invest in new nurse residency programs are also estimated to incur an additional training cost of roughly $2,041 per resident. Residency programs are often used as a strategy to improve new nurse retention. But if turnover remains high for other reasons, these programs can have a lower return on investment.
Costs of Productivity Loss
Studies have also shown that initial reductions in productivity can contribute to a large proportion of losses, accounting for roughly 45% to 88% of turnover costs. This is because facilities are essentially paying two nurses to do the work of one during training periods — with some preceptorships lasting months at a time.
Additionally, there can be variations in skill level when facilities use a mix of temporary staff. This means that managers may need to spend more time overseeing care, which also contributes to reduced productivity at the leadership level.
High turnover can also impact the overall workflow and culture at a facility. These non-economic costs are important to consider since they can, conversely, lead to more turnover and create a cyclical issue over time.
Poor Teamwork
High turnover means that the entire nursing team must frequently adapt to new personalities and workstyles. Studies have shown that this can worsen communication and collaboration, impacting the overall cohesiveness of the unit. This can also make it more difficult to retain new hires, since teams may come across as unsupportive.
Lower Quality of Care
When existing staff take on increased workloads to compensate for gaps in staffing, quality of care can go down. Some studies have even shown that high turnover can significantly increase the rate of medical errors, mortality, pressure ulcers, and length of stay.
Reduced Employee Morale
The fragmented communication and increased stress resulting from high turnover can also lower staff morale. This may contribute to burnout, which can cause even more nurses to leave their jobs if staff retention and job satisfaction aren’t made a priority.
While there are many different causes of nurse turnover, studies have shown that nurses are four times more likely to voluntarily leave their positions than to get involuntarily terminated. This means that comprehensive measures at the institutional level are needed to retain staff and keep them satisfied in their roles.
Fundamentally, it’s important to engage your staff in conversations and identify the root causes of turnover at your facility. From there, you can apply more meaningful solutions that help your staff feel supported. This may include:
- Using sustainable staffing alternatives that allow for manageable workloads.
- Empowering nurses by giving them more control over their schedules and work.
- Creating a healthy work environment to prevent staff burnout.
- Providing transparent, consistent, and objective leadership.
The cost of nurse turnover can impact the operations, care quality, and culture at your facility. Need solutions that will stabilize your workforce in the long run? Get dozens of free, expert-written facility management tips and insights delivered straight to your inbox.
https://www.intelycare.com/facilities/resources/the-cost-of-nurse-turnover-a-breakdown/
KPMG’s 2017 U.S. Hospital Nursing: Labor Costs Study
This study identifies several trends and benchmarks in relation to hospital nursing labor costs in the United States. Some of the key findings are summarized below. When all costs are considered, traveling nurses appear to cost less than permanent nurses on an hourly basis. Cost data provided by hospitals indicates that the hourly, all-in cost for a full-time, permanent nurse is approximately $89. This hourly cost is higher than traveling nurses that cost approximately $83 per hour. Key costs that are after captured in this all-in measure are overtime pay, paid time off, retirement, insurance, recruiting, and payroll taxes – and these costs vary by nurse type. Additionally, the survey finds a quantifiable “hidden” cost associated with permanent nurses that is the result of non-productive labor hours, and an unquantified “hidden” cost associated with attrition and time required to fill a permanent direct care registered nurse position. Respondents to the survey indicated that traveling nurses are widely used today, representing approximately 11 % of respondent’s nursing staffs. Also, these hospitals indicated their use of traveling nurses will likely continue to grow in the future. Primary factors for this upward trend are local nursing shortages and facility growth. In all, traveling nurses appear to be a cost effective source of labor tor hospitals, and hospitals are forecasting higher usage of these nurses in the future.
2025 NSI National Health Care Retention & RN Staffing Report
With people living longer, the subsequent rise in chronic conditions and the fact that all Baby Boomers will reach retirement age by 2030, recruiting and retaining quality staff will continue to be a top healthcare issue for years to come. Last year, hospitals increased staff by adding ~304,000 employees, a 5.4% add rate. Of this, ~98,000 RNs were hired which represents a 5.6% RN add rate.
Hospital and RN turnover continue to fall but both remain slightly elevated. Nationally, the hospital turnover rate stands at 18.3%, a 2.4% decrease from CY23, and RN turnover is recorded at 16.4%, a 2.0% decrease. Registered Nurses working in pediatrics, women’s health, and surgical services reported the lowest turnover rate, while nurses working in behavior health, step down and emergency services experienced the highest.
The cost of turnover can have a profound impact on diminishing hospital margins and needs to be managed. According to the survey, the average cost of turnover for a bedside RN is $61,110, an 8.6% increase, resulting in the average hospital losing between $3.9m – $5.7m. Each percent change in RN turnover will cost/save the average hospital an additional $289,000/yr.
The RN vacancy rate also remains elevated at 9.6% nationally. While 0.3% lower than last year, over forty percent (41.8%) reported a vacancy rate of ten percent or more. The RN Recruitment Difficulty Index decreased three (3) days to an average of 83 days. In essence, it takes approximately 3 months to recruit an experienced RN, with step down and med/surg presenting the greatest challenges. Feeling financial stress, hospitals will continue to focus on controlling the high cost of labor with contract labor being a top strategy to navigate a staffing shortage. The greatest potential to offset margin compression is in the top budget line item (labor expense). Every RN hired saves $79,100. An NSI contract to replace 20 travel nurses could save your institution $1,582,000.
2024 Employer Health Benefits Survey
Employer-sponsored insurance covers 154 million nonelderly people. To provide a current snapshot of employer sponsored health benefits, KFF conducts an annual survey of private and non-federal public employers with three or more workers. This is the 26th Employer Health Benefits Survey (EHBS) and reflects employer-sponsored health benefits in 2024.
Hiring More Nurses Generates Revenue for Hospitals
Underfunding is driving an acute shortage of trained nurses in hospitals and care facilities in the United States. It is the worst such shortage in more than four decades. One estimate from the American Hospital Association puts the deficit north of one million. Meanwhile, a recent survey by recruitment specialist AMN Healthcare suggests that 900,000 more nurses will drop out of the workforce by 2027.
American nurses are quitting in droves, thanks to low pay and burnout as understaffing increases individual workload. This is bad news for patient outcomes. Nurses are estimated to have eight times more routine contact with patients than physicians. They shoulder the bulk of all responsibility in terms of diagnostic data collection, treatment plans, and clinical reporting. As a result, understaffing is linked to a slew of serious problems, among them increased wait times for patients in care, post-operative infections, readmission rates, and patient mortality—all of which are on the rise across the U.S.
Tackling this crisis is challenging because of how nursing services are reimbursed. Most hospitals operate a payment system where services are paid for separately. Physician services are billed as separate line items, making them a revenue generator for the hospitals that employ them. But under Medicare, nursing services are charged as part of a fixed room and board fee, meaning that hospitals charge the same fee regardless of how many nurses are employed in the patient’s care. In this model, nurses end up on the other side of hospitals’ balance sheets: a labor expense rather than a source of income.
For beleaguered administrators looking to sustain quality of care while minimizing costs (and maximizing profits), hiring and retaining nursing staff has arguably become something of a zero-sum game in the U.S.
But might the balance sheet in fact be skewed in some way? Could there be potential financial losses attached to nurse understaffing that administrators should factor into their hiring and remuneration decisions?
Research by Goizueta Professors Diwas KC and Donald Lee, as well as recent Goizueta PhD graduates Hao Ding 24PhD (Auburn University) and Sokol Tushe 23PhD (Muma College of Business), would suggest there are. Their new peer-reviewed publication* finds that increasing a single nurse’s workload by just one patient creates a 17% service slowdown for all other patients under that nurse’s care. Looking at the data another way, having one additional nurse on duty during the busiest shift (typically between 7am and 7pm) speeds up emergency department work and frees up capacity to treat more patients such that hospitals could be looking at a major increase in revenue. The researchers calculate that this productivity gain could equate to a net increase of $470,000 per 10,000 patient visits—and savings to the tune of $160,000 in lost earnings for the same number of patients as wait times are reduced.
“A lot of the debate around nursing in the U.S. has focused on the loss of quality in care, which is hugely important,” says Diwas KC.
But looking at the crisis through a productivity lens means we’re also able to understand the very real economic value that nurses bring too: the revenue increases that come with capacity gains.Diwas KC, Goizueta Foundation Term Professor of Information Systems & Operations Management
“Our findings challenge the predominant thinking around nursing as a cost,” adds Lee. “What we see is that investing in nursing staff more than pays for itself in downstream financial benefits for hospitals. It is effectively a win-win-win for patients, nurses, and healthcare providers.”
To get to these findings, the researchers analyzed a high-resolution dataset on patient flow through a large U.S. teaching hospital. They looked at the real-time workloads of physicians and nurses working in the emergency department between April 2018 and March 2019, factoring in variables such as patient demographics and severity of complaint or illness. Tracking patients from admission to triage and on to treatment, the researchers were able to tease out the impact that the number of nurses and physicians on duty had on patient throughput. Using a novel machine learning technique developed at Goizueta by Lee, they were able to identify the effect of increasing or reducing the workforce. The contrast between physicians and nursing staff is stark, says Tushe.
“When you have fewer nurses on duty, capacity and patient throughput drops by an order of magnitude—far, far more than when reducing the number of doctors. Our results show that for every additional patient the nurse is responsible for, service speed falls by 17%. That compares to just 1.4% if you add one patient to the workload of an attending physician. In other words, nurses’ impact on productivity in the emergency department is more than eight times greater.”
Adding an additional nurse to the workforce, on the other hand, increases capacity appreciably. And as more patients are treated faster, hospitals can expect a concomitant uptick in revenue, says KC.
“It’s well documented that cutting down wait time equates to more patients treated and more income. Previous research shows that reducing service time by 15 minutes per 30,000 patient visits translates to $1.4 million in extra revenue for a hospital.”
In our study, we calculate that staffing one additional nurse in the 7am to 7pm emergency department shift reduces wait time by 23 minutes, so hospitals could be looking at an increase of $2.33 million per year.Diwas KC
This far eclipses the costs associated with hiring one additional nurse, says Lee.
“According to 2022 U.S. Bureau of Labor Statistics, the average nursing salary in the U.S. is $83,000. Fringe benefits account for an additional 50% of the base salary. The total cost of adding one nurse during the 7am to 7pm shift is $310,000 (for 2.5 full-time employees). When you do the math, it is clear. The net hospital gain is $2 million for the hospital in our study. Or $470,000 per 10,000 patient visits.”
These findings should provide compelling food for thought both to healthcare administrators and U.S. policymakers. For too long, the latter have fixated on the upstream costs, without exploring the downstream benefits of nursing services, say the researchers. Their study, the first to quantify the economic value of nurses in the U.S., asks “better questions,” argues Tushe; exploiting newly available data and analytics to reveal incontrovertible financial benefits that attach to hiring—and compensating—more nurses in American hospitals.
We know that a lot of nurses are leaving the profession not just because of cuts and burnout, but also because of lower pay. We would say to administrators struggling to hire talented nurses to review current wage offers, because our analysis suggests that the economic surplus from hiring more nurses could be readily applied to retention pay rises also.Sokol Tushe 23PhD, Muma College of Business
For state-level decision makers, Lee has additional words of advice.
“In 2004, California mandated minimum nurse-to-patient ratios in hospitals. Since then, six more states have added some form of minimum ratio requirement. The evidence is that this has been beneficial to patient outcomes and nurse job satisfaction. Our research now adds an economic dimension to the list of benefits as well. Ipso facto, policymakers ought to consider wider adoption of minimum nurse-to-patient ratios.”
However, decision makers go about tackling the shortage of nurses in the U.S., they should go about it fast and soon, says KC.
“This is a healthcare crisis that is only set to become more acute in the near future. As our demographics shift and our population starts again out, demand for quality will increase. So too must the supply of care capacity. But what we are seeing is the nursing staffing situation in the U.S. moving in the opposite direction. All of this is manifesting in the emergency department. That’s where wait times are getting longer, mistakes are being made, and overworked nurses are quitting. It is creating a vicious cycle that needs to be broken.”
Goizueta faculty apply their expertise and knowledge to solving problems that society—and the world—face. Learn more about faculty research at Goizueta.
*Ding, Tushe, Kc, Lee: “Frontiers in Operations: Valuing nursing productivity in emergency departments.” Manufacturing & Service Operations Management 26:4:1323-1337 (2024)
Georgia could see the largest shortage of RNs by 2036
Staffing is one of the biggest issues facing ASCs. A 2023 survey from ORManager found that in the last 12 months, 56% of ASCs reported an increase in volume. Despite this success, 68% of facilities also reported having a more difficult time recruiting experienced operating room nurses.
“I think the biggest threat towards ASCs in 2023 is staffing, especially qualified, experienced staffing in all areas of an ASC, including business office, pre-op, OR (both nursing and surgical technicians), post-anesthesia care unit and recovery nurses. In addition, sterile processing technicians,” Michael Powers, administrator of Knoxville, Tenn.-based Children’s West Surgery Center, told Becker’s. “Each of these areas require a certain set of skills that are acquired and honed over time. There is increased competition, and in fact it is hard to compete with large health systems/hospitals. I am also finding that ASCs are competing in the same region against one another for the available staffing pool.”
The HRSA report highlights nurse workforce projections from 2021 to 2036 generated using the agency’s health workforce simulation.
Here are the five states with the largest projected shortages of registered nurses by 2036, per the report:
1. Georgia: 29% projected shortage
Projected vacancies: 34,800
2. California: 26% projected shortage
Projected vacancies: 106,310
3. Washington: 26% projected shortage
Projected vacancies: 22,700
4. New Jersey: 25% projected shortage
Projected vacancies: 24,450
5. North Carolina: 23% projected shortage
Projected vacancies: 31,350
https://www.beckersasc.com/leadership/5-states-facing-the-biggest-nurse-shortages-by-2036
Nursing Shortage Fact Sheet
The U.S. is projected to experience a shortage of Registered Nurses (RNs) that is expected to intensify as Baby Boomers age and the need for health care grows. Compounding the problem is the fact that nursing schools across the country are struggling to expand capacity to meet the rising demand for care. The American Association of Colleges of Nursing (AACN) is working with schools, policy makers, nursing organizations, and the media to bring attention to this healthcare concern. AACN is leveraging its resources to shape legislation, identify strategies, and form collaborations to address the shortage.
For more information including below, see attached PDF:
- Current and Projected Shortage Indicators
- Contributing Factors Impacting the Nursing Shortage
- Impact of Nurse Staffing on Patient Care
- Efforts to Address the Nursing Shortage
The cost of nurse turnover in 24 numbers
The 2024 NSI National Health Care Retention & RN Staffing Report features input from 400 hospitals in 36 states on registered nurse turnover, retention, vacancy rates, recruitment metrics and staffing strategies.
It found the average cost of turnover for one staff RN grew from January through December 2023 to $56,300, among other dollar figures and statistics that are helpful to understand the financial implications of one of healthcare’s most challenging labor disruptions.
Here are 24 numbers that illustrate the cost of nurse turnover, according to the most recent edition of the report, which is available in full here.
1. The turnover rate for staff RNs decreased by 4.6% in 2023, resulting in a national average of 18.4%. Given varying bed size, RN turnover can range from 5.6% to 38.8%.
2. The average cost of turnover for a staff RN increased by 7.5% in the past year to $56,300, with a range of $45,100 to $67,500. This is up from the average cost of turnover for an RN in 2022, which was $52,350.
3. Each percent change in RN turnover stands to cost or save the average hospital $262,500 per year.
4. The RN vacancy rate sits at 9.9% nationally. This marks an improvement, as hospitals hired an additional 153,000 RNs in 2023 and lowered the vacancy rate by 5.8%.
5. The average time to recruit an experienced RN ranges from 59 to 109 days, with the average for 2023 sitting at 86 days — nine days quicker than the year prior.
7. Every region represented in the 2024 report recorded a decrease to RN turnover, ranging from -1% to -5.1%. The South Central region saw the high end of this range while the North Central region saw the low end.
8. Over the past five years, RNs in step down, emergency services, and telemetry were most mobile with a cumulative turnover rate between 112% and 119%. “Essentially, these departments will turn over their entire RN staff in less than four and a half years,” the report states.
9. RNs in pediatrics, surgical services, and women’s health were less mobile, with 2023 turnover rates of 13.3%, 15.4% and 16.3%, respectively.
https://www.beckershospitalreview.com/finance/the-cost-of-nurse-turnover-in-24-numbers-2024
Costs and cost-effectiveness of improved nurse staffing levels and skill mix in acute hospitals
Extensive research shows associations between increased nurse staffing levels, skill mix and patient outcomes. However, showing that improved staffing levels are linked to improved outcomes is not sufficient to provide a case for increasing them. This review of economic studies in acute hospitals aims to identify costs and consequences associated with different nurse staffing configurations in hospitals.
Although more evidence on cost-effectiveness is still needed, increases in absolute or relative numbers of registered nurses in general medical and surgical wards have the potential to be highly cost-effective. The preponderance of the evidence suggests that increasing the proportion of registered nurses is associated with improved outcomes and, potentially, reduced net cost. Conversely, policies that lead to a reduction in the proportion of registered nurses in nursing teams could give worse outcomes at increased costs and there is no evidence that such approaches are cost-effective. In an era of registered nurse scarcity, these results favour investment in registered nurse supply as opposed to using lesser qualified staff as substitutes, especially where baseline nurse staffing and skill mix are low.
https://www.sciencedirect.com/science/article/pii/S0020748923001669
American Hospital Association Health Care Workforce Scan
The pandemic exacerbated existing shortages of health care workers in all roles, from clinicians to environmental and food services to admissions and scheduling. These shortages will persist well beyond the pandemic given today’s highly competitive labor market.
Record numbers of people are leaving their current jobs for new ones, new fields or new pursuits outside the job market altogether.
Despite all the difficulties, trauma and challenges they have faced, millions continue to show up and believe in their ability to make a difference in patients’ lives. Their mental and physical well-being requires tangible help and support from their leaders, and respect from the communities they serve.
The incredible challenges have also created unique opportunities to accelerate change and improve the way care is delivered, whether through technology, new care delivery approaches or multidisciplinary team models.
Ensuring the health and safety of the health care workforce – and the health and safety of the patients they care for – requires commitment at the individual, organizational and community level.
The Real Costs of Healthcare Staff Turnover
Staffing tops the list of healthcare industry challenges heading into 2023, according to polling data from healthcare advocacy group MGMA. It’s no wonder: Hospital staff turnover rates climbed as high as 26% in 2021 as workers retired due to burnout or went to work for organizations offering higher pay or better work-life balance.
For healthcare organizations, high employee turnover rates are a burden on finances and resources. Turnover costs include the expense of recruiting, hiring, and training new employees, as well as the cost of temporarily filling staffing gaps with expensive contract workers. There’s also the cost of reduced productivity as managers shift much of their attention to hiring and as new hires get up to speed. A less tangible—but still significant—turnover cost is lower employee morale as those who remain work harder to fill gaps for less pay than contract workers hired to provide temporary coverage.
Employee turnover refers to the total number of workers who leave a company over a specific period of time. Companies measure involuntary departures (layoffs and firings) and voluntary turnover (resignations) as well as the cost of replacing a given type of employee. Considering turnover can provide opportunities to replace underperformers, many employers also calculate the ideal turnover rate for their organization so managers can set specific employee retention goals. Every company has employee turnover—farsighted companies take the time to understand their turnover rate, the factors driving turnover, and what they can do to build and retain a workforce that will help achieve their organizational goals.
Key Takeaways
- Even before COVID-19, more than half of doctors and nurses reported symptoms of burnout, defined by physical and/or emotional exhaustion due to the rigors of the profession. But the pandemic shifted burnout into overdrive. During the pandemic, 93% of health workers reported experiencing stress.
- The average cost of turnover for a regular position is between six and nine months of an employee’s salary. Replacing a highly specialized healthcare professional can cost as much as 200% of the employee’s yearly salary.
- Patients notice high turnover rates when they see the impact of poor patient-to-staff ratios. They lose confidence in their healthcare provider when they don’t believe they’re receiving the best care, which can cause reputational damage.
In 2022, turnover rates for segments of the healthcare industry ranged from 19.5% at hospitals to 65% for at-home care providers to 94% at nursing homes.
This level of turnover puts a huge financial and logistical burden on healthcare providers. While COVID-19 put additional stress on the healthcare labor force, and the industry will likely feel the effects of COVID for years to come, the healthcare staffing crisis existed long before the pandemic. The following factors are also contributing to today’s healthcare worker exodus:
Inflexible, demanding schedules
Healthcare jobs are notorious for long hours and erratic schedules, and many are considered “deskless” jobs, meaning workers spend much of their time on the move. In fact, it’s estimated that nurses in hospitals walk about five miles a day.
Excessive administrative work
Fictional doctors and nurses are often depicted standing by a patient’s bedside, developing personal relationships and providing hands-on care. In reality, providers no longer have sufficient time to spend one-on-one with patients and other caregivers. Instead, they’re burdened by documentation, charting, and other administrative tasks. In 2021 doctors reported spending, on average, 15.6 hours per week on paperwork and other administrative tasks. First-year medical residents spend only about 10% of their work time face-to-face with patients, according to a study from Penn Medicine and Johns Hopkins University.
Heavy workloads
Even before COVID-19, more than half of nurses and physicians reported symptoms of burnout, according to the U.S. Department of Health and Human Services, and burnout rates have worsened over the past several years due to heavy workloads and related job stress. (A person experiencing burnout suffers from emotional exhaustion, depersonalization—a sense of detachment from oneself—and a reduced sense of personal accomplishment.) During the pandemic, researchers found that 93% of health workers were experiencing stress, 86% had anxiety, and 76% reported exhaustion.
Disconnection from managers
Healthcare workers who don’t work in a single location, such as nurses, medical assistants, and respiratory therapists, may miss out on opportunities to interact with their managers in person. Cut off from these critical personal connections, they can feel underappreciated and unseen, which makes it more likely they’ll look for a job elsewhere.
Relatively low pay
Many nurses feel they aren’t getting the pay they deserve. Even with a median annual salary of US$77,600, 66% of nurses describe pay as their No. 1 consideration when planning their next career move, according to a survey by Vivian, a healthcare hiring platform.
The direct costs of high employee turnover—the costs of recruiting, onboarding, and training new people and the costs of hiring contract staff to fill empty positions—are relatively easy to measure. The indirect costs are less quantifiable but just as burdensome; they include reduced patient satisfaction and lower employee morale. Consider these costs as you assess the impact of employee turnover on your organization.
1. Separation costs
These include severance pay, costs associated with unemployment insurance claims, payments for any ongoing benefits, and the costs associated with exit interviews and removing employees from all internal systems and directories.
2. Hiring costs
Turnover costs an organization much more than money. There’s the cost of reduced productivity when an employee leaves, and the hiring process itself can be expensive and resource intensive. It costs an employer an average of between six and nine months of an employee’s annual salary to replace them, according to the Society for Human Resource Management, and it can cost as much as 200% of the employee’s annual pay to replace a specialized healthcare professional.
3. Training costs
Even highly skilled and experienced employees need time to adapt to a new job. The healthcare industry has mandatory training and certification requirements that don’t exist in other industries. Unfortunately, many healthcare employees don’t feel they’re getting the right skills training for their rapidly changing roles, and managers and healthcare HR teams struggle to track and enforce training requirements.
4. Contingent labor costs
Understaffed healthcare organizations often resort to hiring travel or contract staff to fill workforce gaps. Unfamiliar with a facility’s policies, staff, and even its geography, contract workers can reduce overall productivity and burden full-time employees.
5. Substandard patient care
High employee turnover can lead to unsafe staff-to-patient ratios that make it hard to provide the best care. With too many patients to monitor, nurses and aides can overlook issues that slow recovery times and endanger patients. A study by the US National Institutes of Health showed that patients can lose confidence in their healthcare provider when they don’t believe they’re receiving the best care, which can tarnish the provider’s reputation.
6. Lower morale
The US healthcare industry lost more than 500,000 employees each month in 2022, according to the U.S. Bureau of Labor Statistics, and those left behind are dispirited about the future. In 2021, nearly three quarters of healthcare employees surveyed by Vivian, a healthcare hiring platform, said that workplace morale had gotten worse over the previous 12 months, and only 20% said they’re optimistic about the future of healthcare in the US. This lack of employee engagement is likely to increase employee turnover rates and reduce patient care levels, negatively impacting a healthcare organization’s reputation and financial health.
To reduce healthcare staff turnover (PDF), organizations must first improve employee well-being. People want to be compensated fairly, but beyond that, they want to be surrounded by coworkers and managers they respect. They want to feel ownership of their work lives and find work-life balance. They want systems and processes that are easy to navigate so they can focus on what matters—patient care. Here are some steps healthcare organizations can take to reduce turnover.
Managers who practice intentional hiring take the time to develop a clear job description for an open role and a clear plan for finding the right set of candidates. It may feel like this preparation lengthens the hiring process, but in the long run, it will pay off for the organization and for the candidates’ coworkers.
There are complications inherent in managing any 24/7 workforce, but these complications are compounded in healthcare by the need to have people with specific education, training, and certifications present at all times. The latest cloud-based human capital management (HCM) systems give managers visibility into staffing needs and availability and allow them to anticipate and cover surges.
Giving new employees the right tools at the start allows them to get a clear sense of the organization’s training goals and how they can fit training requirements into their workday. Dashboards that show employees what training they need, and when they need it, can improve compliance numbers while showing HR staff who’s falling behind. Cloud-based HCM systems let employees set their own training pace and measure their progress, which is especially valuable in busy workplaces where staff may have limited time to devote to training.
Healthcare professionals look for organizations that offer professional development programs beyond what’s required by law, including courses in management, communications, and ethics.
The stress of logging long hours in challenging situations is compounded by having to use inflexible, out-of-date, unconnected systems. Prospect Medical Holdings, which operates 17 hospitals and 165 medical care clinics across five states, at one time had 37 different HCM systems before successfully centralizing operations on a single cloud platform. A cloud HCM system enables employees to choose flexible schedules, sends workers notifications when it’s time to take a break, and allows management to send out regular communications that make workers feel more connected to the organization.
Healthcare-specific recruiting features in Oracle Fusion Cloud HCM help hospitals and other providers attract the best doctors, nurses, physician assistants, therapists, technicians, and support staff while giving them the tools they need to retain their accreditations and grow their expertise.
Oracle Cloud HCM’s workforce management capability enables staff to manage their schedules, sign up for shifts on their mobile devices, and block off time when they’re not available—giving them the ability to manage when and where they work. Healthcare providers can also use the cloud application’s dashboards to stay informed about patient counts and resource requirements so they can make shift changes as needed. Additionally, Oracle Cloud HCM’s employee experience platform makes it easy for hospital leaders to keep employees informed about significant organizational news and initiatives and, through pulse surveys, learn about employee concerns and needs.
Technology alone will never solve the healthcare industry’s employee turnover problem. That will take concerted efforts by healthcare organizations to focus on staff well-being, open up lines of communication, and improve the workday experience. But the right technology—easy to use, mobile friendly, and able to take on the most monotonous administrative tasks—can make a huge difference, allowing staff to focus on more complex and rewarding work: caring for patients.
Learn how the Oracle ME platform can help your organization improve the employee experience.
What is the cost of employee turnover generally?
Employee turnover costs US companies an average of $50,000 per worker, not factoring in the heavy burden on the employees who stay.
How is the cost of employee turnover calculated?
To calculate turnover costs, dig into the numbers. Calculate the cost to hire contract fill-ins for the vacant position and the cost to recruit and hire the new employee (including job postings, managerial and HR time, and background screenings). Also factor in onboarding and training costs, as well as productivity costs as the new hire ramps up. The latter is usually calculated as the cost of a new hire’s salary and benefits during their first 30 to 90 days, when they’re doing more training than work.
What is the cost of nurse turnover?
The average cost of turnover for a staff registered nurse in the US is $46,100, with an average range of $33,900 to $58,300, according to the 2022 NSI National Health Care Retention and RN Staffing Report from Nursing Solutions Inc., a national nurse recruitment agency. The average time needed to replace a nurse is about 87 days. Nurses in some fields, including emergency services and behavioral health, are leaving at accelerating rates, with cumulative turnover rates that exceed 100%. (This happens when jobs need to be filled over and over—for example, an organization with 100 employees may have 50 positions that are filled by employees who stay long term and 50 positions where lots of turnover is the norm. Each terminated employee is part of the organization’s overall turnover rate.)
https://www.oracle.com/human-capital-management/cost-employee-turnover-healthcare
The Relationship Between Nurse Staffing, Quality, And Financial Performance In Hospitals
Little evidence exists on the relationship of nurse staffing and quality with financial performance in hospitals. This study aimed to measure the relationship between nurse staffing, quality of care, and
profitability in hospitals. This study used longitudinal panel datasets from 2006 to 2010, drawn from various datasets including the American Hospital Association Annual Survey Database, Medicare Cost Report, and Hospital Compare Data. This study used the random-effects linear regression model to measure the relationship between nurse staffing, quality, and profitability. In addition, we tested a mediating effect of quality on the relationship between nurse staffing and profitability. This study found nurse staffing’s significant association with quality and profitability in hospitals. First, compared to hospitals in the lowest quintile of RNs per 1,000 inpatient days, hospitals in the higher quintiles had lower pneumonia readmission rates, and higher total profit margins, operating margins, and cash flow margins. In addition, hospitals with lower pneumonia readmission rates were found to have higher total profit margins and cash flow margins. Lastly, the current study found that the positive relationship between RNs per 1,000 inpatient days and total profit margin and cash flow margin was partially mediated by pneumonia readmission rates. In conclusion, our finding that nurse staffing is positively associated with both quality of care and profitability in hospitals suggests that the idea of hospitals responding to financial pressures by cutting RN resources with a goal of greater profitability should be called into question. The influence of lower RN staffing levels on higher profitability for hospitals is uncertain, while it is possible that RN staff reductions may compromise the quality of patient care. Keywords: nurse staffing, registered nurse, quality of care, readmission rate, profitability, total profit margin, operating margin, cash flow margin, hospital.
On a practical level, the findings on the relationship between nurse staffing, and the quality and financial outcomes in hospitals can assist nurse managers and chief executive officers in identifying the optimal RN staffing level. These findings suggest that RN staffing level may be a strong predictor of quality and profitability and that the quality may mediate the relationship between RN staffing level and profitability in hospitals. This could be of particular interest to current hospital managers because of the payment reductions for excessive readmissions embedded in the ACA, which might have significantly affected the average profitability of some service lines in their hospitals. A lesson that can be learned from the past is that hospitals may attempt staff reductions in response to increased financial pressures as a result of payment reforms. However, as the findings in this research and the literature suggest, the reduction of nursing staffs may be related to an increase in adverse effect on the quality of patient care. The analysis results of this study demonstrated that a higher RN staffing level was associated with a lower pneumonia readmission rate, while the medium level of RN staffing level (≈ 7.7 RNs per inpatient day) had the highest profitability among general and acute care, non-federal government hospitals. Staffing decisions involve balancing between labor costs and the level of care required to fulfill healthcare needs of patients (Blegen, Vaughn, & Vojir, 2008). It is a matter of choice to hospital managers to decide what would be the most effective nurse staffing strategy for their hospitals in response to the HRRP.
https://journals.scholarpublishing.org/index.php/ABR/article/view/8745
The Effects of Nurse Staffing on Hospital Financial Performance: Competitive Versus Less Competitive Markets
Hospitals facing financial uncertainty have sought to reduce nurse staffing as a way to increase profitability. However, nurse staffing has been found to be important in terms of quality of patient care and nursing related outcomes. Nurse staffing can provide a competitive advantage to hospitals and as a result better financial performance, particularly in more competitive markets
In this study we build on the Resource-Based View of the Firm to determine the effect of nurse staffing on total profit margin in more competitive and less competitive hospital markets in Florida.
By combining a Florida statewide nursing survey with the American Hospital Association Annual Survey and the Area Resource File, three separate multivariate linear regression models were conducted to determine the effect of nurse staffing on financial performance while accounting for market competitiveness. The analysis was limited to acute care hospitals.
Nurse staffing levels had a positive association with financial performance (β=3.3; p=0.02) in competitive hospital markets, but no significant association was found in less competitive hospital markets.
Optimizing the Role of Nursing Staff to Enhance Physician Productivity: One Physician’s Journey
After completing my family medicine residency a few years ago, I immediately joined a private group practice with eight family physicians and two nurse practitioners and inherited a nearly full patient panel from a retiring family physician. I naively assumed that transitioning from residency to private practice would decrease my workload and increase my quality of life, but after a hectic first year, I knew that something had to change for my professional life to be sustainable. I was spending way too much time working and could see that the complexity of practicing medicine would continue to increase in the years ahead.
I began to look for ways to cope and came across an article in Family Practice Management by Peter Anderson, MD, and Marc D. Halley, MBA.1 The article described a new model in which a physician works simultaneously with two clinical assistants – a registered nurse (RN), a licensed practical nurse (LPN), or even a capable medical assistant (MA) – allowing them to assume more responsibility for each patient encounter so the physician can focus on the patient and medical decision-making. The additional nurse responsibilities include gathering an initial history (including the history of present illness, HPI; review of systems; past medical, social, and family history, PSFH; and health habits) and then staying in the exam room to document the physician encounter, order needed tests, print handouts, send prescriptions to the pharmacy, and complete the note including the assessment and plan. By shifting many of the ancillary physician tasks to well-trained clinical assistants, the physician can focus on what he or she is uniquely trained to do – provide high-quality acute, chronic, and preventive care in the context of a therapeutic relationship. After discussing this idea with my nurse (an LPN) and practice manager, we decided to try this new model.
My nurse and I started slowly, selecting several days where we would see fewer patients, thereby allowing additional time to learn our new process. It was a significant adjustment for both of us. She was now in charge of the documentation (and thus the computer), and it became necessary for me to clearly verbalize every aspect of the visit, including the physical exam, the assessment, and the plan for treatment or additional workup (labs, imaging, medications, referrals, etc.). We used Anderson and Halley’s model as our starting point, but soon our process evolved based on our own skills and strengths, the needs of our patients, and the limitations of our office space, schedule, and electronic health record (EHR). After experimenting for a month, we were both convinced that we were ready to fully commit to this new model and decided to hire a second nurse. Because we had spent significant time fine-tuning our system, the training process for our second nurse (also an LPN) was relatively smooth, and my original nurse was able to do the bulk of the teaching.
Every new process requires some experimentation and modification in the early stages, and for our practice key adjustments occurred in the following areas:
Communication with nurses. When we first began, I would handwrite my assessment and plan for each patient encounter to ensure accuracy. Quickly, my nurses let me know that this was a waste of time. Instead, they suggested that I clearly explain each diagnosis and associated plan to the patient, and they would capture the information as I spoke. The nurses have also demonstrated that they can capture patient instructions as we discuss them, and they now typically print those instructions at the conclusion of each visit. Today it is unusual for me to type or handwrite anything during an office visit.
Access to patient data. Each of our exam rooms has a desktop computer that we use to navigate the EHR. Lab and imaging results import electronically into the EHR, as do many of our consult notes. With my nurse in the room using the computer during the office visit, I lost the ability to peruse the chart during the visit, so I began to use an iPad with our wireless Internet connection to view a read-only version of the chart. The iPad also allows me to review the history related to each problem, the problem list, and current medications without pulling my nurse away from her documentation responsibilities.
Chart review. As we progressed with our new model, I continued to gradually shift more responsibility onto my nurses’ capable shoulders. They assumed responsibility for immunization status (checking status for adults and children, administering needed vaccines, creating catchup schedules, etc.), preventive care, and even some basic chronic disease management (confirming annual diabetic eye exams and referring as needed, ordering annual lipid panels when appropriate, etc.). The nurses found that in opening a visit note, they were essentially doing a thorough chart review including reviewing, updating, and sorting the problem list; reviewing preventive care needs; sorting the medication list; reviewing and reorganizing the PFSH and health habits; starting the HPI by searching the chart for any prior tests or visits related to the chief complaint (as recorded by the front desk staff when scheduling the visit); and even starting the assessment and plan portion of the note by listing the relevant diagnoses. It was not possible to accurately complete such a chart review between patients, so my nurses agreed to arrive about an hour before our first patient each day to allow additional time for this work.
Patient check-in form. We have continually worked to implement processes that improve patient flow and efficiency during office visits. One of our more successful processes involves using a patient check-in form. Early on, it became apparent that the rooming process was a bottleneck in our patient flow because of the need to confirm problems, medications, allergies, social history, family history, habits, etc. I had asked my nurses to attempt to quickly update these at each office visit, and it turned into a time-consuming process, particularly for complex patients on multiple medications. To expedite the process, we worked with our EHR support staff to create a one-page document that lists a patient’s medications, allergies, family history, social history, health habits/risk factors, pharmacy of choice, and advance directives. These forms are printed directly from the EHR during the morning chart review and are given to the front desk staff to pass out to patients when they arrive. This allows patients to review much of their history while sitting in the waiting room and allows the nurses to address only changes that need to be made. As an added benefit, patients appreciate that we put time into prepping for their arrival rather than handing them a blank form to complete.
Patient privacy. I was concerned that having a nurse present in the exam room might be a distraction for patients or make them uncomfortable sharing sensitive information. While we did receive several questions initially about the nurse being in the room, I have been pleasantly surprised by how many patients don’t even seem to notice. There are occasional instances when it is evident that a patient would be more comfortable without a nurse present during the visit, and the nurses can usually ascertain this while rooming the patient. Overall, feedback has been amazingly positive. Rather than viewing the nurses as an intrusion, patients appreciate the additional resources that my nurses have become. They also seem to recognize that the nurses’ presence allows me to be fully focused on them, rather than trying to manage charting, test orders, referrals, and refills while providing their care.
Space, workflow, and scheduling issues. Because my colleagues were not implementing the same practice model that I was, I was careful to limit the impact on them. To create a new workspace for my second nurse, I cleared some supplies from an unused desk, purchased a new computer, purchased a new office chair, and moved an unused phone. I typically have access to only two or three exam rooms while seeing patients (the Anderson and Halley model suggests three to five exam rooms), but I have not asked for more. I have found that even with two exam rooms I am considerably more efficient under this model.
While both of my nurses participate in patient visits throughout the day, they typically have short breaks between patients and can use this time to manage phone calls, medication refills, and other peripheral nursing issues. Because of this, we have not needed to schedule additional time for the nurses to manage these tasks, although we have utilized our group’s two full-time triage nurses for support on our most hectic days.
The transition to our new model has probably been most difficult for our office manager and our group’s lead nurse. A new process was required to schedule my nurses, and it can be tedious to manage schedules when I am out or one of my nurses is out. I have just recently started training some of our other office nurses in the new model, but previously I would have to resort to my old single-nurse system if one of my two nurses was out of the office.
Ongoing improvement. To fully implement this system requires nurses who are motivated and willing to assume more ownership over each patient encounter. The nurses’ knowledge of each patient and their overall medical knowledge has grown as a result of their active participation in each visit, and they have learned by watching how I make decisions and conduct the medical workup. I also continue to teach them in a more formal manner by using interesting cases that we see, and I have learned this model requires an ongoing commitment to training. I started out meeting with my nurses for one hour each week, and even though I have been using this system for almost two years, I continue to meet with them at least twice per month. During these meetings I elicit feedback about problems or inefficiencies, provide feedback on recent chart notes, and provide teaching about changing medical standards of care. My nurses are now often the ones to identify problems and suggest appropriate changes to improve our model and the care we provide. These routine meetings have created a culture of teamwork and a continual focus on innovation – traits that will likely serve us well in the ever-changing world of medicine.
Two years into the model, we can report positive results.
Patient care statistics. The organization I work for monitors patient care data, generating physician report cards for preventive care and chronic disease management. Since implementing this new practice model, I have seen an improvement in most of my report card measures, particularly those that rely more on my nurses to complete. For example, the table below shows improvements in virtually every category of diabetes care, with a particularly large jump in the percentage of diabetes patients who have received foot exams, a task I have completely turned over to my nurses.
Since implementing my new practice model, in which nurses take greater responsibility for certain aspects of the patient visit, I have seen improvements in most of my report card measures, including those for diabetes care, shown here.
| Percentage of diabetes patients | |||
|---|---|---|---|
| Diabetes measures | Goal | Old system | New system |
| A1C > 9% | < 15% | 5% | 0% |
| A1C < 7% | > 40% | 53% | 64% |
| Blood pressure > 140/90 mm Hg | < 35% | 22% | 7% |
| Blood pressure < 130/80 mm Hg | > 25% | 53% | 64% |
| Eye examination completed | > 60% | 47% | 48% |
| Smoking status and cessation advice or treatment provided | > 80% | 98% | 98% |
| LDL > than 130 mg/dl | < 37% | 15% | 9% |
| LDL < 100 mg/dl | > 36% | 58% | 62% |
| Nephropathy assessment completed | > 80% | 95% | 95% |
| Foot examination completed | > 80% | 60% | 79% |
Finances and productivity. The costs incurred with this new model can be divided into two categories: initial startup costs and ongoing costs. I estimate that my initial startup costs were in the range of $15,000. This includes the fairly nominal cost of additional office equipment (computer, office chair, etc.) and the more significant cost of slowing down my days as I brought both nurses up to speed on the new system. The only significant ongoing cost is paying the salary and benefits of my second LPN, approximately $8,000 per quarter. This is less than you might expect because four months after transitioning to this new model, I made a personal decision to decrease my full-time equivalent (FTE) status from 1.0 to 0.75. Thus, I am not responsible for the full salary of my second nurse. The remainder of her time is allocated to other parts of the practice.
My FTE change makes it nearly impossible to calculate how my practice change has affected revenue, but I can say that my office productivity has increased. We measure productivity in terms of patient visits per half-day and average charge per patient visit, which we track based on work relative value units (RVUs). Since moving to this new system, I have seen my patient visits per half-day increase by 15 percent and my average charge (work RVU) per office visit increase by 10 percent (see the graph below). Because some of our practice costs are divided based on productivity, this increase in my productivity has led to a relatively minor, but ongoing, increase in those costs.
Under my new practice model, patient visits per half-day have increased 15 percent and work relative value units (RVUs) have increased 10 percent. These numbers reflect an eight-month average before and after changing to the new model.
Although this new model has certainly brought an increase in expenses, I have seen a much greater increase in productivity and revenue, which has allowed me to maintain an annual income above the national median of $160,000 for a full-time family physician, despite having decreased my FTE status to 0.75.
Nurse and patient satisfaction. During this transition I have regularly asked my nurses for feedback regarding their satisfaction with our change, and when there have been frustrations or difficulties, I have done my best to work creatively with them to correct those. At this point, I am happy to report that my nurses are both very pleased with our current system. My original nurse reports that “Overall, I am very happy with the two nurse system. My favorite thing about it would be that I get to see from start to finish the entire diagnostic and treatment process. It allows me to become educated on each patient’s history and treatment plan, which in turn allows me to provide appropriate care and to be a better advocate for that patient. While working so closely together, I’ve been able to gain an understanding of how Dr. Anderson practices, and I have become more confident in myself and my own skills. Our care as a team has become significantly more thorough, and we are able to focus now on providing comprehensive care to each individual.”
Although we have not conducted a formal patient survey, the feedback we have received from patients has been almost universally positive. Patients are happy to have my undivided attention while in the exam room, they appreciate getting so much done with each office visit, and they are grateful that my increased efficiency has allowed me to be more available for same-day appointments.
This journey in restructuring my practice model has led me to a place where I am able to focus more on my patients, provide higher quality care, be more productive, and have happier employees. As physicians, we should not view ourselves as beholden to old models of care. Instead, we ought to view ourselves as empowered to institute fundamental changes to our work. The practice of family medicine is likely to get more demanding in the years ahead, and it is our opportunity and responsibility to build innovative practices that meet these demands while enabling excellent patient care, employee satisfaction, and a sustainable and meaningful personal life.
10 Best Practices for Increasing Hospital Profitability
Industry experts say that hospitals wishing to increase their profitability can focus on two key areas — reducing costs and increasing reimbursement. Here are 10 best practices for increasing hospital profitability by reducing costs and increasing revenue and reimbursement.
Because labor is the largest single expense for hospitals, it is critical that hospitals are not over- or under- staffing their facilities.
Hospitals leaders can cosider the use of flexible staffing, such as part-time or hourly employees, and adjust staffing based on patient census data. Leaders should also monitor the efficiency of this staffing by continuously reviewing benchmarking data such as hours worked per case.
Amy Floria, CFO of Goshen (Ind.) Health System, says that her facility monitors patient volume on a daily basis and adjusts staffing accordingly. “We adjust our nursing staffing every eight hours after looking at our inpatient volume and expected discharges and admits,” she says.
Kevin Burchill, a director at Beacon Partners, a healthcare management consulting firm, agrees that staffing must be adjusted daily. “The easiest thing that a hospital can do to improve profitability is for the senior management team to assume responsibility for the day-to-day performance of an organization and look at the organization’s performance in real time,” he says. “You must shift to an emphasis on the day-to-day, not pay-period to pay-period or month-to-month.”
It is important that concerns regarding efficient staffing are communicated throughout the organization and that hospital leaders work in collaboration with physicians. Donna Worsham, COO of National Surgical Hospitals, suggests that hospital leaders share staffing efficiency benchmarking data with unit managers and provide feedback regarding the productivity of the unit.
Flexible staffing is especially useful for OR nursing staff. OR managers should review clock-in times versus surgery-start times and determine if their staff is consistently arriving before a surgery actually begins. If this is the case, mangers can utilize flexible staffing to allow nursing staff to arrive later so that when surgeries run over, no overtime expenses are incurred, says Ms. Worsham.
Other facilities are saving in staffing costs by reducing benefits for full-time staff. Goshen Health System, for example, deferred merit increases, reduced paid vacation time and suspended its retirement matching program in response to the current economy, according to Goshen’s CEO, Jim Dague. Goshen reduced employee dissatisfaction in response to these cuts by soliciting employee feedback on which benefits to reduce, thereby building organizational support for the changes. In addition, Goshen’s executives took a voluntary 20 percent cut in order to help sustain the system through the recession.
Joe Freudenberger, CEO of OakBend Regional Medical Center in Richmond, Texas, agrees that staff must buy in to any reductions in hours and shifts worked that will personally affect them in order for the hospital to remain successful. He says that hospital leaders must communicate the reasoning for these changes to the staff before making them. “If we call off staff, they see it as personally hurting their income when we need to help them understand that it is actually preserving their income by maintaining the financial viability of the hospital,” he says. “It may be obvious to us that we’re calling them off because we have a significant reduction in patient volume, but we need to communicate that to them for them to understand the financial realties we face.”
Although some staffing cuts may be necessary, hospitals should be careful not to take a blanket approach to layoffs or cuts in services. Hospital leaders must take a close look at their business before making cuts.
“Don’t make the same mistake everyone else does — don’t look at bottom line, determine that you need to cut $1 million, for example, and then cut 10 percent across the board. Doing so will trim some fat but will cut meat and bone in other areas,” says Mr. Burchill.
He suggests that hospitals assess each program individually and determine which ones are what are winners and losers. “You do not want to cut areas that you should be doing more of or that are already profitable,” says Mr. Burchill.
Hospital leaders can reduce supply costs by working with vendors to improve contracts and encouraging physicians to make fiscally responsible supply decisions.
“When it comes to supply costs, you must drive this expense or the vendor will drive it for you,” says Ms. Worsham.
Hospital leaders should not shy away from approaching vendors for discounts. Goshen’s IT director recently requested a discount on the health system’s contract for IT maintenance due to current economic conditions and successfully received a discount that saved the hospital 15 percent on this contract, according to Ms. Floria.
Hospitals can also reduce supply costs be reducing the number of vendors. Goshen, for example, is in the process of reducing the number of vendors in its surgical suite and aims to eventually scale the vendors down to 4-6 companies. “This action is expected to save us at least a million dollars in supply costs,” says Mr. Dague.
Another way in which hospitals may reduce supply costs is by requiring vendors to submit purchase orders for any equipment or implants that are not included in a negotiated, written agreement with the facility. “All of our vendors sign agreements that any purchase orders must be submitted at least 24 hours before a procedure and must be approved by the materials manager or the CEO, or it’s free,” says Ms. Worsham. “If you don’t require this, vendors will drop off the invoice for a pricey piece of equipment or implant after the procedure has already taken place and walk out the back door, which can greatly hurt your profitability.”
All hospitals can benefit from tightening up the efficiency of their operating rooms, but it is especially critical that less busy facilities ensure that their ORs are used as efficiently as possible.
“Hospitals need to review block time utilization,” says Ms. Worsham. “Physicians who are assigned more time than they are using are hurting your profitability.”
Ms. Worsham suggests that hospital OR managers work directly with physicians to make OR utilization more efficient.
“When physicians’ schedules create gaps in the OR schedule, it effects a hospital’s ability to staff effectively, which can create significant labor costs for the hospital,” says Ms. Worsham.
Hospitals should work to encourage physicians to become more concerned about the costs of supplies and other activities, such as unnecessary tests and inefficient coding processes that may drive up hospital costs.
“Hospitals today have a unique opportunity to leverage physicians’ interest in having hospitals help to stabilize their incomes with the hospitals’ needs to involve physicians in cutting costs and improving quality,” says Nathan Kaufman, managing director of Kaufman Strategic Advisors, a hospital consulting firm.
Hospitals can encourage the use of products from vendors that are cost-effective, but still high quality, especially in areas such as orthopedic implants, which can be considerably costly for hospitals. In addition, experts say the use of protocol-based care can reduce costs associated with unnecessary tests or treatments.
Mr. Freudenberger says that one of the biggest mistakes hospitals make is not engaging medical staff in profitability. “Physicians have a huge role in maintaining hospital profitability, but unless you give them a reason to be concerned with a hospital’s profitability, they will make choices in what and to whom they refer services that will not consider the implications to the hospital,” says Mr. Freudenberger. “Hospital leaders should work to help medical staff understand the connection of their referrals to the hospital’s viability so that their referral decisions reflect the value they place on the hospital.”
During tough economic times, some hospitals may benefit from outsourcing or partnering with other organizations for certain services, such as food and laundry services, and even, in some cases, clinical services.
“Some hospitals see these economic times as an opportunity to outsource unprofitable services,” says Mr. Burchill.
By outsourcing certain services to more efficient providers, hospitals can share the savings with the service provider. However, hospitals must be sure to select truly efficient providers.
“Outsourcing is clearly a smart thing to do if an organization can gain greater efficiency through finding a larger-scale operation; however the provider must be more efficient than the hospital,” says Kevin Haeberle, executive vice president, HR capital, for Integrated Healthcare Strategies.
Oftentimes, hospitals outsource services such as laundry, food and nutrition, information technology or human resources because they do not have the capital to invest in the equipment upgrades or training that is needed to increase the efficiency of their internal service. In these cases, the decision to outsource may not directly be related to profitability but instead the “lacking of funds for the investment required to make current services viable,” says Mr. Haeberle. However, this decision can improve profitability in the long-run by allowing hospitals to use funds for more profitable services.
Some hospitals have also begun to outsource clinical services such as emergency room staffing and anesthesiology in an attempt to become more efficient. Because these staffing groups employ a large number of specialty physicians, they may be able to provide more efficient services, especially in clinical areas that require around-the-clock coverage where the demand for services is high.
Mike Mikhail, MD, vice president of client services for Emergency Physicians Medical Group, says that hiring an emergency department management company can help to improve the profitability of hospitals whose demand for emergency services exceeds its emergency treatment capabilities. “An emergency management group can help make the emergency department more efficient by introducing management oversight and best practices, allowing more patients to be seen and keeping others from leaving to find another hospital,” he says. “Because a majority of hospital admits come from emergency walk-ins, driving more patients through an ER will create more admits, and therefore more profit for the hospital.”
An increasing number of hospitals are joint venturing with local physicians and surgery center management companies to offer outpatient services through the development of a surgery center.
According to Clete Walker, vice president of development for Surgical Care Affiliates, hospitals are beginning to focus on the need for a comprehensive outpatient strategy and recognizing the need to partner with doctors to effectively execute on this strategy. Mr. Walker reports that he has seen an increased interest from hospitals in joint venture arrangements for outpatient services.
“More and more hospitals are realizing that their core competency is providing inpatient care; their outpatient cases are more costly per case and take up more of the physician’s and patient’s time than they do at an ASC,” he says. “As a result, hospitals are competing with physicians for outpatient cases. Hospitals with joint-venture agreements, however, do not have to compete with the physicians.”
Hospitals can leverage their standing in the community to partner with local physicians to share the revenue generated by efficient outpatient cases.
“We are in lean times, and lean times call for us to rethink our strategies,” says Mr. Walker. “It’s better for physicians, hospitals and other groups to work together to provide an efficient delivery system for patient care than for the groups to compete.”
Identifying and attracting additional physicians to bring cases to your hospital is another way that hospital leaders can increase profits. Physician-owned hospitals can bring in additional physicians as partners, while other types of facilities can recruit new physicians who are willing to perform cases at their hospitals.
“New physicians will bring in more cases and grow your profits,” says Ms. Worsham.
Ms. Worsham suggests polling your medical staff for names of local physicians to target and inviting them into the facility. During the visit, Ms. Worsham recommends that hospitals work to “wow” the target physician. “We work tirelessly to promote the services we can offer them,” she says.
When a new physician begins performing cases at one of Ms. Worsham’s facilities, that physician is assigned a concierge. “We have strong internal programs in place for this first day. A concierge is assigned to each new physician who provides them with a tour facility and walks them through every aspect of their day,” says Ms. Worsham.
Hospitals may also be able to grow case volume and profits by adding new service lines. However, hospitals need to be careful to do their homework on the expected profitability and ROI for any new lines added, especially in a market where access to the funds required to invest in new service lines may be tight.
“You have to look at what the market needs are and where you’re going to get the referrals from,” says Ms. Worsham. “Meet with local physicians and interview them about their needs and the number of cases they see that could utilize a new service.”
Hospitals should also be sure to examine the competitive landscape for any new service line.
Ms. Worsham reports that her facilities have had great success from adding a hyperbaric service line because few competitor hospitals were offering this service.
Hospitals that use hospitalists to care for patients can benefit from the more efficient care and better documentation that specialized hospitalists can potentially provide.
“A protocol-based hospitalist program can increase efficiency and help to reduce the length of stay for patients, which can increase case volume without the need for additional beds,” says Mr. Kaufman.
Hospitals should consider employing these specialists as a means to improving care and enhancing their bottom lines, according to Mr. Kaufman.
Stephen Houff, MD, president and CEO of Hospitalists Management Group, says that hospitalist groups can provide effective care to patients and possibly increase reimbursement. “Hospitalists may be the most reliable and cost-effective means available for hospital leaders to transform medical delivery in their health system,” he says. “Through shared vision, an effective hospitalist team partners with hospital leadership to improve patient safety and access, streamline care, improve patient and family satisfaction, enhance reimbursement via improved clinical documentation and provide seamless transition to post-discharge care.”
One of the most important ways that hospitals can improve their profitability is by continually evaluating and renegotiating their managed care contracts.
“Hospitals must demand their fair share of premiums from third-party payors in order to subsidize the underpayment of Medicare and Medicaid,” says Mr. Kaufman. “Hospitals need to focus on reducing their cost structure as much as possible to approach breaking even with Medicare reimbursement rates, but that only goes so far.”
Mr. Kaufman recommends that hospitals only agree to contracts that reimburse at 130-140 percent of cost. “If a facility is not big enough or strong enough to get these rates, then they should look at merging with a larger facility,” says Mr. Kaufman.
Ms. Worsham suggests that hospitals perform a profitability analysis by payor and by procedure in order to determine where a facility is losing money and identify any trends. She also suggests that hospitals evaluate older contracts due to changes in severity-based DRGs and carve out the reimbursement of implants in order to ensure they are reimbursed appropriately for the costs associated with these.
Ms. Worsham also suggests that hospitals evaluate contracts on a quarterly basis, even if the contract is not near expiring. She suggests that hospital leaders examine the contracts with the following questions in mind:
• Is revenue where we thought it would be given reimbursement rates and volume of policy holders?
• Are we being paid as agreed upon in the contract?
• Are we being paid in a timely manner?
Contracts that are determined to be “high risk” should be renegotiated. Make sure your contracts contains a material harm clause, which will allow you to readdress terms of contracts that have become financially harmful to the facility, according to Ms. Worsham. Renegotiating contracts can be very valuable — one hospital Ms. Worsham advises will gain $500,000 this year due to renegotiations.
Hospitals that focus on enacting these best practices are likely to see improvements in their profitability; however, hospitals can also benefit by using today’s economic conditions as an opportunity to improve their overarching approach to business, creating a more sustainable organization in the future.
“When profits were high, hospitals had the luxury of being sloppy in some areas; now we must run a tighter ship,” says Ms. Floria. “This will benefit the industry in the long-run.”
Hospitals can also use this opportunity to find creative solutions to problems that plague their facilities.
Goshen Health System, for example, recently enacted a program in which the hospital pays the premium required to sustain Cobra benefits for recently laid-off patients seeking care. “We are willing to be creative with our patients,” says Ms. Floria. “We pay for benefits when certain patients cannot. The revenue we receive from caring for these patients recoups this cost and provides us with additional cash flows that likely would have been uncollected or written off to charity care or bad debt.”
This idea, which was enacted during lean times to improve profitability, will continue to benefit the hospital’s bottom line, even when profitable times return.
Contact Lindsey Dunn at lindsey@beckersasc.com.