How hospital finance execs are preparing for 2026

While many hospitals have bounced back from the financial challenges of the Covid-19 pandemic—namely inflation and staffing costs—CFOs are still dealing with an evolving financial landscape filled with lots of ups and downs.

Whether it’s tariffs, uncertainty around Affordable Care Act (ACA) marketplace plans, or implementing new AI technologies…everywhere, making a hospital budget is, well, hard.

Notably, hospital leaders continue to raise concerns about reimbursement rates, which is what insurance companies or public plans pay for care. The American Hospital Association (AHA) reported in April 2025 that Medicare reimbursed 83 cents for every dollar hospitals spent in 2023.

But there’s one thing for sure, Reed Hurley, EVP and CFO at University Health System in Texas, told us: “If there’s any surprises—we don’t like those.”

Top of mind. In many ways, 2026 is a lot of the same ol’ financial challenges. CFOs are focused on keeping their health systems operational, despite macro industry challenges, Michele Cusack, SVP of finance at Northwell Health in New York, told Healthcare Brew.

Part of the CFO’s job is to get the health system in good shape to withstand anything out of its control, Niyum Gandhi, CFO at Mass General Brigham (MGB) in Massachusetts, told us, whether it be a cyberattack or a global pandemic.

“Revenues are growing slower than the expenses,” Gandhi added, so health systems are always looking for ways to hedge costs through new technology or long-term investments.

One of these long-term investments is the venture arm. MGB and Northwell both have investment groups—MGB Ventures and Northwell Holdings—where they put money into companies built by their own clinicians. Among others, these include drug developer Mediar Therapeutics, AI startup Optain, and pediatric telehealth company InStride Health.

Gandhi said MGB Ventures is an example of where the system “can generate some financial return that can then reduce the burden on the clinical enterprise.”

New tech. CFOs are also, of course, looking to new technologies for efficiency and cost-cutting. In 2025, AI investments accounted for nearly half of all healthcare spending at $18+ billion in US and European investments.

Some experts say AI scribes, the tools that support clinical documentation, haven’t quite returned profit back into the system, but Gandhi said “return can come in a lot of different currencies.”

The New England Journal of Medicine reported last June that scribes saved 15,700+ hours of work for 3,442 physicians over more than 300,000 patient encounters. And in staff surveys about AI scribes, for example, Gandhi said one clinician reported it “significantly reduced the likelihood” he would retire early from the practice. “‘For the first time since the [electronic health record] came out, I can actually look my patients in the eye,’” he recalled another saying.

Other tools, like using AI for revenue cycle management, have a clearer financial payoff, Gandhi added.

“We’re going to spend a million dollars on a new technology, and we better save that—either by eliminating other technologies, by being able to grow without adding staff, or by being able to terminate a contract with a vendor,” he said.

Regulatory landscape. Last year came with some significant policy changes, too, like tariffs. AHA reported last April that about 70% of medical devices in the US are manufactured abroad, meaning that healthcare is not immune from increasing prices.

Hurley said tariffs have been a “nonissue” for University Health System, even as the system builds new hospitals. Gandhi agreed, saying tariffs have “not had an enormous effect.” Cusack, however, said tariffs and inflationary price pressures on supplies, pharmaceuticals, and labor are “the predominant headwinds” for Northwell.

Otherwise, CFOs prepared for other potential financial pressures like changes to Medicaid coming from the One Big Beautiful Bill Act and reduced ACA subsidies, which help cover care costs for 24 million people, because they’re “going to increase the uninsured rate,” Gandhi said. In other words, if people lose public insurance and don’t find an alternative, it’s likely they will go to the hospital uninsured, which is more expensive.

“That’ll be a financial burden,” he said.