Healthcare Brew covers pharmaceutical developments, health startups, the latest tech, and how it impacts hospitals and providers to keep administrators and providers informed.

Healthcare Brew

Amanda Eisenberg

Healthcare Brew delivers the latest news and trends in healthcare.

healthcare-brew.com

A female medical professional conducts a pelvic exam

HHS, CMS update informed consent guidance

The guidance comes as more than a dozen states have moved to ban non-consensual pelvic exams.

Maia Anderson

Positive arrows pointing upward above healthcare symbols

Health systems turn to internal VC arms to bring in additional revenue 

At least 23 health systems are operating venture capital arms. 

Will Peischel

Clinicians see increased understaffing and want protections, per survey

Almost half of respondents reported a higher patient ratio than the year prior.

A medical cross and circle denoting hospitals

Hospitals & Facilities

illustrated headshot of caroline catherman, healthcare brew reporter

Caroline Catherman

Each week, we schedule our rounds with Healthcare Brew readers. Want to be featured in an upcoming edition?

Many hospitals offer financial assistance programs or charity care, but still, 

 of US hospital bills go unpaid, Becker’s Hospital Review reported in February 2024.

These hospitals may write off those unpaid bills as “bad debt,” sell the debt to a collection agency for a fraction of its worth, 

 for payment, or refuse future nonemergency care to them.

But since 2014, there’s been another option: Undue Medical Debt.

The nonprofit uses donations from private organizations and local governments to buy years of bad debt from debt trading companies or healthcare providers—at a discount. The company says it has relieved nearly $23 billion in debt for 14.7+ million patients who make less than 4x the federal poverty level or have debt that’s over 5% of their income.

Undue’s leaders make it clear they are a bandage 

. But they have partnered with 300+ physician practices and health systems like Connecticut-based Trinity Health of New England as well as states like 

 to buy debt and help come up with strategies to help patients avoid it going forward.

Ruth Landé, VP of provider relations at Undue Medical Debt, talked to Healthcare Brew about the organization’s work.

This interview has been edited for length and clarity.

How do healthcare systems and providers benefit from partnering with you?

Not only can we acquire those accounts and do the debt relief, we also give analytics.

We’ll tell you what the [patients’] income levels were. They can then figure out, “Why don’t we capture those people in our financial assistance?” We can really walk them through: What are other hospitals doing in your area? What tools might be out there?

 for assistance]. And this is not some diabolical plot because it’s not what a hospital wants, but it is hard to find out what people’s income levels are. There’s technology you can buy. You have to pay for it every time you run a transaction, just like we do.

What’s the biggest obstacle in getting healthcare systems on board with a partnership?

We’ve been reaching a lot of places, growing very fast, but it’s still a relatively new concept for healthcare to have an option like us.

We spend a lot of time explaining…we’re not selling anything, and we’re nonprofit. And the other thing, I think, is that hospitals really feel beaten up. They feel so beaten up in the media, and they feel like they’re on the defensive. And when you’re on the defensive a lot, it’s hard for you to open up and trust.

Beyond forgiving debt, what can the average healthcare provider do to help patients afford care?

If you look at the financial assistance policy for any hospital out there, you will see a whole list of clinicians who don’t participate.

People can educate patients. They can poke around to see who’s not included in financial assistance to make sure that nobody falls through. If the anesthesiologists are not a part of that, that makes no sense, right?

A portrait of the Vice President of Provider Relations for Undue Medical Debt, Ruth Landé

Inside Undue Medical Debt, the nonprofit helping hospitals erase medical bills

Undue Medical Debt has taken an eraser to billions in patients’ unpaid bills.

Cassie McGrath

Welcome back to Signed and Scrubbed, a monthly roundup of hospital deals, developments, and bankruptcies.

We pulled together a list of provider transactions from October, including announcements of health systems from New York to San Diego.

 Pittsburgh, Pennsylvania-based Allegheny Health Network signed an affiliation agreement on Oct. 16 to acquire Beaver, Pennsylvania-based Heritage Valley Health System, bringing the combined total to 547 beds.

Evansville, Indiana-based Deaconess Health System acquired its 22nd hospital on Oct. 1: 194-bed Hopkinsville, Kentucky-based Jennie Stuart Health.

 Investment firm General Catalyst’s Health Assurance Transformation Company, aka HATCo, completed its acquisition of the more than 870-bed Summa Health, a nonprofit integrated delivery system based in Akron, Ohio, on Oct. 1. The $485 million deal helped Summa pay off debt and transitioned it from a 

Bronx, New York-based Montefiore Health System signed a letter of intent on Oct. 15 to merge its 10-hospital network with Middletown, New York-based Garnet Health, which has 552 beds across three hospitals.

On Oct. 14, the 1,101-bed UC San Diego Health and 372-bed Palomar Health, based in Poway, California, approved the creation of a joint powers authority, which combines two or more existing governmental entities into a separate public organization, marking the next step toward “mutually beneficial management, operation, and expansion of healthcare services for all Palomar Health facilities,” according to a release.

University of Pittsburgh Medical Center (UPMC). 

On Oct. 15, UPMC signed a letter of intent to acquire three hospitals in the Steubenville, Ohio-based Trinity Health System from Chicago-based CommonSpirit Health. Financial terms were not shared.

Hospital building split in half collaged with briefcase and $100 bill. 

Signed and Scrubbed: October 2025 hospital M&A

Investing firm General Catalyst’s HATCo bought a nonprofit health system this month and turned it into a for-profit. 

Nicole Ortiz

Recent years have highlighted how extreme weather events are becoming 

, which means patients are experiencing increased health risks like heat-related illnesses, mental health struggles, respiratory issues, and more.

 from the Commonwealth Fund ranked states to determine how prepared they were for extreme weather events and their role in contributing to greenhouse gas emissions. The healthcare research foundation analyzed publicly available federal and state data between 2020 and 2024 to show how states stacked up in categories including 

 11,755 people worldwide had died as a result of natural disaster in 2019, with 95 million additional people impacted, at a cost of almost $130 billion. And a 2023 study projected that if there were an electrical grid failure in Phoenix, Arizona, during a two-day heat wave, nearly 800,000 people would 

 for heat-related illness and nearly 13,000 people would die in the city.

In May, a group of health organizations including the American Public Health Association, Physicians for Social Responsibility, and 

 signed an open letter urging “leaders at every level take swift action to address the health impacts of climate change and reduce the pollution driving it.”

“What I hope the scorecard helps health systems understand is that they need to be leveraging their voice in these policy decisions on clean energy because it both affects their operations and it affects the health of their populations,” Lisa Patel, executive director of environmental and health group the Medical Society Consortium on Climate and Health, told us.

 To get to the good news first, Vermont, New York, Washington, New Jersey, and Maine all had top scores in the study, meaning these states are at a lower risk of environmental hazard, have cleaner and greener energy policies, and emit lower emissions across healthcare.

West Virginia, Kentucky, Louisiana, Florida, and Mississippi all scored among the lowest.

Arizona, Nevada, and New Mexico see higher temperatures and worse air quality, with Arizona topping the latter list, something that surprised Northeastern University Associate Professor of Environmental Engineering Matt Eckelman, who was also an author on the study.

“For a long time, we’ve known California has had the most serious air pollution issues in the nation,” he told Healthcare Brew. But when it came down to population density and air quality index numbers, he said, “Arizona came out even worse.”

As far as states that are at a higher risk for environmental hazards like floods, hurricanes, and severe winter weather, Florida and South Dakota scored the worst while West Virginia, Wyoming, and North Dakota had the highest greenhouse gas emissions per capita.

 Already, hospitals in some states are taking measures to better prepare for extreme weather.

 showed the preparedness of Florida health systems, like Tampa Bay General Hospital and its new 

, which helped provide a barrier against flooding. On the other side of the country, California-based Kaiser Permanente is 

 with community awareness and support. And nonprofit Americares recently 

 it would award grants to clinics and community health centers across the country to combat extreme heat.

“For new facilities, this is the best opportunity there is to plan for the future, to make sure that not just the hospital, the physical building, but all the systems that support the hospital, including all the access and connected infrastructure, are also protected,” Eckelman said.

Without preparations in place, hospitals have to take measures like evacuating patients or closing entirely—in addition to “disruptions in the supply chain,” like what happened last year with 

—all of which “really does impact their bottom line,” Lovisa Gustafsson, VP of the Making Health Care Affordable program at the Commonwealth Fund, who also contributed to the study, said.

 across healthcare and federal agencies focusing on climate change, which can complicate tracking efforts and 

for states most impacted by climate change.

“We as healthcare providers are seeing the impacts of climate change today, right now,” Patel said. “We need to take climate change out of the realm of politics, understand that this is about the health and well-being of our communities, and empower our health leaders to act.”

global warming climate change abstract art spiritual mind watercolor painting illustration design hand drawing

Commonwealth Fund ranks which states are best, worst for health and climate change preparation

Regions prone to extreme weather events like heat waves, hurricanes, and severe winter weather scored the worst.

HCBR-Reprocessing-audio embed

We’ve all heard the phrase “Reduce, reuse, recycle.” Well, there’s also a fourth secret R: reprocess. 

Reprocessing is the act of cleaning and restoring used material for reuse. Hospitals have been reprocessing medical devices for decades. It’s a way for them to cut down on costs and 

 without sacrificing patient safety, the independent Government Accountability Office’s 

Not to mention, it cuts down on indirect supply chain (Scope 3) emissions, which account for an 

 71% of health system emissions worldwide, according to a 2019 report from sustainability organization Health Care Without Harm.

“Oftentimes, health systems have to choose between saving money and reducing Scope 3 emissions. Single-use device reprocessing presents the opportunity to realize both of those benefits at the same time,” Jake Lyonfields, sustainability strategy manager at nonprofit membership organization Practice Greenhealth, told us.

 based in Chicago—launched a formal reprocessing program in 2018 for devices across its patient care areas, operating rooms, and electrophysiology lab.

According to Northwestern’s tally, the program has diverted more than 400,000 pounds of waste since its launch—68,000 pounds in 2025 so far—and saves upwards of 25% per device, Amanda Schaumann, program director of supply chain management at Northwestern Medicine, told us.

“We see the value both from cost savings but also the environmental impact,” she said. “It’s definitely [a program] that we want to continue to grow.”

The process is fairly straightforward on the hospital side.

Medical staff puts used items in designated bins, from which they’re transported to an outside reprocessing vendor the system contracts with. The vendor disassembles and sterilizes them, then reassembles them back to FDA standards. The vendor then sells reprocessed devices back to Northwestern at a lower cost, Schaumann said.

One low-hanging fruit that Northwestern reprocesses a lot: air-assisted mattresses staff use to help move or transfer patients in and out of bed.

“[The mattresses are] big and bulky and can essentially create a lot of waste,” Schaumann said. “We’ve developed a lot of processes around how we’re able to reprocess those so that we can get as much useful life out of them as possible.”

Reprocessing can also be done for more complex devices, like those used in surgical procedures or electrophysiology. Reprocesser Innovative Health estimated in a 2021 

 that a brand-new diagnostic ultrasound catheter can cost $2,650 whereas a reprocessed one can be just $1,325.

For other systems looking to start or grow a reprocessing program, Schaumann advised taking a “hands-on” approach.

“Education is always a big piece of it. I think there can be a lot of misconceptions about reprocessing and concerns related to it,” she said.

For instance, the devices Northwestern reprocesses are labeled for “single uses” by their manufacturers. Some might think that means they can only be used once. But it can also just mean the original manufacturer didn’t test whether the device could be reused or chose not to market it that way, according to the FDA.

As of 2000, the FDA requires reprocessing facilities to test and validate their devices to show they’re as safe and effective as the original devices up to however many reuses they’re approved for.

A trade organization, the Association of Medical Device Reprocessors (AMDR), was formed in 1999 for the biggest single-use device reprocessors: Cardinal Health’s Sustainable Technologies, Innovative Health, Medline ReNewal, Arjo’s ReNu Medical, 

, and Berlin-based Vanguard Medical Remanufacturing.

In 2024, AMDR estimated 36 million reprocessed devices were sold to more than 9,000 hospitals and surgical centers, saving the facilities $451 million, reducing medical waste by 12 million pounds, and reducing CO2 emissions by 115 million pounds.

Still, reprocessing companies sometimes face 

 from some of the original manufacturers of these medical devices, whose profits are maximized with “high-volume consumption” of single-use products, according to a 

In May, a California jury found Johnson & Johnson Medtech, for instance, had violated antitrust laws by not providing the same clinical support for another company’s reprocessed catheters as it had for its own versions.

A medical glove dropping into a reprocessing bin

What is reprocessing, and how can it save hospitals money?

Save money and save the environment!

We pulled together a list of provider transactions from September, including transactions from TriHealth in Cincinnati, Ohio and Hartford HealthCare in Hartford, Connecticut. Here’s the rundown.

Lebanon, New Hampshire-based Dartmouth Health signed a letter of intent on Sept. 12 to acquire 25-bed critical access center Littleton Regional Healthcare, also in New Hampshire.

Hartford HealthCare signed an agreement to acquire 249-bed Manchester Memorial Hospital and 102-bed Rockville General Hospital for $86 million from real estate investment trust Prospect Medical Properties, which is in bankruptcy proceedings, 

 On Sept. 2, Scottsdale, Arizona-based HonorHealth signed an agreement to acquire Evernorth Care Group, which has 20 care centers around the state. If the health system obtains the necessary regulatory and legal approvals, the deal is expected to close in early 2026.

Tallahassee locals Florida State University and Tallahassee Memorial HealthCare signed an agreement on Sept. 16 to turn the hospital into an academic medical center, a plan underway for a decade, according to a release.

 Cincinnati, Ohio-based TriHealth acquired its sixth acute hospital on Sept. 2: 140-bed Clinton Memorial Hospital based in Wilmington, Ohio.

Farmington, Connecticut-based UConn Health is in talks to acquire three other Connecticut hospitals: 154-bed Bristol Hospital, 104-bed Day Kimball Hospital, and 357-bed Waterbury Hospital for $400 million, according to the 

Hospital building split in half collaged with briefcase and $100 bill. Credit: Illustration: Anna Kim, Photos: Adobe Stock.

Signed and Scrubbed: September 2025 hospital M&A

TriHealth, Hartford HealthCare, and UConn Health announced M&A this month. 

 showed hospital executives are still holding strong to sustainability-related commitments regardless of 

. University of California, Irvine (UCI) Health is embodying that with its new all-electric hospital, set to open Dec. 10.

 is the first all-electric acute care hospital of its size in the country, featuring renewable solar park structures, electric instead of gas for utilities like heating and hot water systems (which also extends to water used in sterilization and humidification), and even all-electric appliances in its kitchen, Joe Brothman, UCI Health’s director of facilities and general services, who has overseen portions of this new project, told Healthcare Brew.

And electricity isn’t the only sustainable feature at the 350,000-square-foot, 144-bed hospital, Brothman said.

The hospital also has rainwater collection built into its landscaping that uses recycled water, bird-friendly glass, around 87% outdoor water reduction and about 38.5% indoor water reduction, and energy efficient equipment for lighting along with other building components.

“It’s a significant cost to make this all-electric [hospital], but we do anticipate, in the long run, that we will have a cost savings, especially with the rising costs of natural gas,” Brothman said.

A big impetus behind this project has been reducing healthcare’s impact on the community, Brothman said.

“Hospitals, typically, are significant burdens on the local community with their output, both with carbon emissions and with waste,” Brothman said. “This hospital is going to be different.”

 analyzing how health systems impact the environment concluded their global greenhouse gas emissions are equivalent to that of 514 coal power plants.

On top of that, Brothman noted, California is particularly keen on environmental initiatives, especially as the state often bears the brunt of climate change-driven 

“We wanted every aspect of sustainability. Our priorities here at UCI Health is to model environmental stewardship, and we wanted this [hospital] to be an example of that in all aspects,” Tony Dover, energy management and sustainability officer at UCI Health, told us.

A rendering of a single-occupancy hospital room with sliding glass doors.

According to Madhura Dhayagude—assistant VP with engineering consultancy WSP and an energy and sustainability consultant on the UCI project—the project beat expectations and stretched goals.

Engineers aim to meet the American Society of Heating, Refrigerating, and Air-Conditioning Engineers’s 90.1 standards, which is an industry guideline for measuring energy use, and the new hospital saw a 43.7% reduction over that number, she said. Further, the builders set out to achieve a minimum 160 energy use intensity (EUI), which measures how energy efficient a building is (a lower number means it’s more energy efficient), and achieved 110 EUI when including the solar panels atop its parking garage.

The hospital is also on its way to a platinum 

, a tiered sustainability certification, which would make it the sixth hospital in the country to receive this designation (the highest possible), she added.

Ultimately, having an all-electric hospital is a solid step in sustainability goals, but if execs aren’t looking to Scope 3 supply chain emissions, then it’s not making as significant of a difference, Tinglong Dai, Bernard T. Ferrari business professor at Johns Hopkins University, told us.

“[Hospitals] may be switching to all-electric operations, but if their suppliers, if their vendors are still creating a lot of emissions, it probably will not matter as much as is advertised,” he said.

 published in Health Affairs, about 82% of emissions were Scope 3, which are those that come from indirect sources like manufacturers and suppliers. Comparatively, only around 7% make up the Scope 1 emissions that come directly from hospital operations.

To take things to the next level, Dai added, hospitals should look at emissions created by utility suppliers, transportation deliveries, where drugs are made, where medical devices come from, software and hardware vendors, and whether they’re using data centers for AI.

Dover said UCI tracks and reports Scope 3 emissions for employees’ commutes, business travel, and waste. Some vendors and suppliers the health system contracts with “prioritize sustainability,” he added, and UCI Health is “collaborating with [suppliers] to identify opportunities to reduce emissions,” such as by reducing packaging waste and cutting transportation-related carbon emissions.

Though, Dai said, moving things around with manufacturers could ultimately hurt a hospital’s bottom line and shift too much of the focus away from its main priority—which is, of course, serving patients.

“A lot of things are really completely outside [a hospital’s] control. Most hospitals have no clue about the sources of supplies,” he said. “If we do not have that kind of transparency, it’s very difficult for us to make any informed decision. But that’s precisely what most hospitals, most health systems, are facing.”

A 3D rendering of a gray modular 6-floor building.

UCI Health’s new all-electric hospital reinforces system’s commitment to sustainability

The facility focuses on reducing its direct carbon emissions by cutting reliance on fossil fuels.

While the federal government has made clear that issues like 

 have been deprioritized, that hasn’t stopped some hospital leaders from continuing to pursue those goals.

In fact, according to the latest sustainability benchmark report from Health Care Without Harm and Practice Greenhealth, the opposite may be true. The health sustainability nonprofit’s annual report found that among almost 493 hospital partners, there’s been a reduction of roughly 185,000 metric tons of greenhouse gases and more than $203 million in annual savings due to sustainability initiatives.

, our partners are still deeply committed to their sustainability strategies,” Sarah Irwin, associate director of sustainability solutions at Practice Greenhealth, told us. “Some of our partners might be doing that in slightly different ways than they did before…but the work is still happening—and in fact, they’re doubling down.”

For Washington-based nonprofit Providence Health, Beth Schenk, chief environmental stewardship officer, told us the health system is approaching sustainability through mitigation, procurement, resilience, and advocacy.

“[We’re] working to address the problems that we can to help move healthcare to a way of operating that’s more compatible with a healthy planet,” she said.

Providence’s 51 hospitals and 1,014 clinics adhere to its WE ACT framework, which focuses on creating sustainable initiatives around waste, energy and water, agriculture and food, chemicals, and transportation. Each facility has been rated on a scorecard annually since 2019 based on data collected from 150+ categories tied to the five themes in the framework.

In 2020, the environmental stewardship team set a goal of becoming more carbon negative by 2030 and cutting between 3%–5% of emissions per facility each year, reaching a 23% cut in its hospitals so far. Schenk confirmed the health system is on track to achieve both goals. This has resulted in $32 million in savings associated with the stewardship programs for 2024 and $40 million for 2023, she added.

Having “accurate, transparent, verifiable data in order to justify and defend different requests for expensive finances, how are we going to measure our progress, etc.” was an important part of committing to these goals, she said.

, Providence has reduced Scopes 1, 2, and 3 carbon emissions—which include emissions an organization directly and indirectly emits—by 18% since 2019 and has saved $15 million annually in conservation efforts. For reference, a 

 of multiple databases found healthcare made up between 15% and 50% of Scopes 1 and 2 emissions and 50% to 75% of Scope 3 emissions—that accounts for between 4% and 5% of all greenhouse gas emissions worldwide.

This also aligns with what Practice Greenhealth found: Among its partners that reported 2024 Scope 1 and 2 emissions, there was an 8.7% decrease overall.

Providence’s post goes on to state that 100 of its facilities run fully on renewable energy and 85% of its hospitals have deactivated “wasteful” nitrous oxide piping. Further, business travel has operated at a 50% reduction since 2019, according to the post.

Reducing plastic use features heavily in the Greenhealth study, too, with almost 50% of its partners saying they’ve made efforts to reduce plastic use in their facilities.

The Ohio State University Wexner Medical Center, for example, has a partnership with medical reprocessing manufacturer Stryker’s Sustainability Solutions, which reprocesses devices like cables, catheters, and pulse oximeters, saving $1.4 million between July 2023 to July 2024.

According to Ohio State’s Environmental Sustainability Consultant Cecil Okotah, since the program was implemented in 2021, the university has saved close to $4 million and been able to divert almost 60 tons of waste from landfills between 2018 and 2024.

Practice Greenhealth estimated 20%–25% of hospital waste is plastics in 2024, but less than 5% is actually recycled, according to a 

The university also has sustainability initiatives to decrease energy use in its facilities, increase composting and recycling efforts, and implement 

For Practice Greenhealth, the more data it can get from hospital partners the better, as that can serve as a roadmap for other institutions. Especially since partners can be at any stage, from “extremely new” to “fairly mature,” Irwin said.

Hospitals that are newer to sustainability initiatives then get the opportunity to learn from veteran teams and see how they can implement what’s already proven to be effective, she said.

As for one of the areas that needs the most continued attention? Irwin said transportation is where she thinks there’s “more that we can be doing and supporting” since it’s so far-reaching—encompassing everything from daily commutes to the Scope 3 emissions from materials being flown or driven to a facility—and the data tends to come from third-party resources.

For Schenk, moving into a place where more institutions take sustainability “seriously” is an integral next step in implementing industrywide change.

“We’re here for health,” she said. “I think in healthcare we have even more of an obligation to not to cause harm and also to be ready and planning and responding to the harm that is underway.”

Green Heartbeat symbol. Symbolic green heart pulse isolated on white background. World Environment Day and Earth Day Concept. Green ecology Concept.