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.

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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

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.

illustrated headshot of caroline catherman, healthcare brew reporter

Caroline Catherman

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!

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 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.

Health Care Without Harm trend report suggests sustainability is still important to hospital leaders

Despite changes in the federal government, some health systems are committing to sustainability initiatives and reaping cost-savings.

Trend report suggests sustainability is still important to hospital leaders

Maternal health has long been a challenge in rural areas, with 52.4% of 1,955 rural hospitals not offering obstetric care as of 2022, according to a 

, experts have previously told us access to birthing services is only expected to become more difficult.

New research from Carnegie Mellon University, Northwestern University, and the University of Georgia may provide more insight into why maternal care access is challenged in these areas—namely, due to mergers and acquisitions.

The study, which is a National Bureau of Economic Research 

, found that five years after rural hospitals are acquired, they are 30% less likely to provide obstetric services.

“It is very much a growing and troubling trend in rural communities,” Carrie Cochran-McClain, chief policy officer at the nonprofit National Rural Health Association, told Healthcare Brew.

 To conduct the study, researchers pulled M&A information from the American Hospital Association and data analysis firm Irving Levin Associates, and reviewed 467 M&As (317 involving at least one rural hospital) from 2006 to 2019.

There are three main reasons rural hospitals struggle to offer obstetrics care, Cochran-McClain said.

For one, Medicaid covers 47% of all births at rural hospitals, 

, and tends to reimburse providers much less than what commercial insurers do ($8,732 less on average for all deliveries, 

“They’re losing money on the obstetrics services they’re providing,” Cochran-McClain said.

 as a result, she added, noting that lower birth volumes (as fewer people live in rural areas) and low payments make it hard to pay workers and maintain the right equipment for labor and delivery services.

Last, malpractice insurance puts pressure on rural hospital providers, she said. In a 2022 report from independent watchdog the Government Accountability Office, stakeholders said the number of deliveries a provider needed to perform to offset the cost of malpractice insurance (around 100 a year) could be the total amount performed in a rural facility that year.

It’s more likely facilities that are struggling financially are “choosing to or having to” close because there are so many factors “stacked against being able to offer labor and delivery,” Cochran-McClain said.

These challenges can leave rural hospitals open to an M&A deal, too, as it’s sometimes their 

. And health systems can help the rural facility grow market share and access more patients.

There were 128 M&As of critical access centers (a federal designation for certain rural hospitals at least 35 miles from another hospital) between 2010 and 2022, according to 

 from University of Minnesota, University of North Carolina-Chapel Hill, and University of Southern Maine researchers.

Cochran-McClain said M&As can bring increased access to equipment, 

, referral networks, and specialty care. But it also means the facilities and communities lose “independent decision-making” about what services to offer or if the hospital will even stay open.

“Obstetrics is definitely a good example of [when] the community may not have the same influence on being able to provide that service as when it was an independent,” she said.

Study: Rural hospitals are 30% less likely to offer obstetric services after acquisitions 

Rural hospitals face low reimbursement and staffing challenges. 

AI is hailed by many in healthcare as the future. But some worry as the tech advances, rural areas may get left behind.

A 2025 survey of 972 rural healthcare staff and leaders by independent research firm Black Book Research found just 8% of rural community and critical access hospitals use AI-driven analytics for predictive healthcare. Compare this to an 

 of 2023 American Hospital Association survey data, which found 65% of 2,547 hospitals across the US used AI or other predictive models.

Carrie Cochran-McClain, chief policy officer for the National Rural Health Association, told Healthcare Brew many rural facilities don’t have the funds or infrastructure to adopt AI and other new tech. It’s already a “battle” to help more rural facilities implement telehealth amid interoperability issues and areas without broadband internet, she added.

“About half of our rural hospitals right now in the country have negative operating margins, which means there’s not a cushion to invest in new software,” she said. “We’ve talked to clinicians who are starting to integrate pieces of [AI] and seeing a lot of benefit, but it’s very much still new to that setting.”

 Though AI comes with potential drawbacks—like 

 concerns—studies also suggest predictive analytics can identify high-risk patients for earlier intervention, potentially 

Groups ranging from industry organization the 

 have pointed to AI as a way for rural hospitals to 

About 66% of primary care health professional shortage areas and 62% of mental health shortage areas were in rural regions as of March 31, 

 the Health Resources and Services Administration.

“Clinicians could use AI to help inform their decision-making where they may not have a deep bench of providers in their clinical practice,” Cochran-McClain said.

Rural systems’ low adoption of AI is something Cochran-McClain and other experts hope could soon change.

Though July’s reconciliation bill had provisions that were decried as potential 

 for rural health, it also allocated $50 billion of funds to a newly created Rural Health Transformation Program.

One of the approved uses for these funds is “providing training and technical assistance for the development and adoption of technology-enabled solutions that improve care delivery in rural hospitals,” including AI tools, according to Centers for Medicare and Medicaid Services (CMS).

Cost estimates vary, but California-based software development company Folio3 estimates adding AI can cost anywhere from $40,000 for a simple AI tool to $100,000+ for a fully customized system.

Without a pathway for long-term Medicare and Medicaid reimbursement, however, pouring money into these technologies doesn’t make sense, Cochran-McClain said.

“This funding could be a great way to infuse the startup or implementation of some of these technologies. But there needs to be a sustainable path to support them outside of the transformation fund,” she said.

CMS reimburses some AI devices through mechanisms like the new technology add-on payment 

, which allows payment for recently FDA-approved technology to be bundled with payments for other healthcare services.

But devices are only eligible for that pathway when they’re “new,” usually meaning the first few years after FDA approval. When that period ends, the path to reimbursement can become uncertain, and reimbursement amounts may decrease or go away.

There’s no predictable or permanent AI reimbursement pathway, Cybil Roehrenbeck, a partner at law firm Hogan Lovells who leads the firm’s healthcare lobbying practice and serves as executive director of the AI Healthcare Coalition, told us.

Roehrenbeck wants a pathway for software-as-a-service and AI medical services within the Medicare Physician Fee Schedule. She says they should be categorized as medical services under Medicare Part B and billed, like other services in that category.

CMS noted in its proposed 2026 Physician Fee Schedule that many in the industry have sought a similar pathway, and asked for public comment through Sept. 12.

“It’s easier for providers to onboard the technology with that type of certainty,” Roehrenbeck said.

United States technology modern innovation circuit board computer map shape.