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

While all of healthcare suffered during the Covid-19 pandemic, nursing homes were hit particularly hard.

At the start of the pandemic, nearly half of all Covid deaths were people living or working in long-term care facilities, according to data from KFF. By early 2022, more than 200,000 people had died from the virus, making up roughly 23% of all Covid-related deaths in the US, KFF found.

Part of this can be attributed to the fact that nursing home residents tend to be at higher risk for contracting viruses due to their age, and living close together means it’s easier for illness to spread.

 may lie in the fact that nursing homes are 

 and run on extremely thin margins—often 3% or less in 2020, according to a survey from the American Health Care Association and National Center for Assisted Living (AHCA/NCAL), a trade group that represents long-term care facilities.

And the fact that private equity (PE) firms are increasingly buying up nursing homes is 

 those troubles worse, some experts argue.

PE firms own somewhere between 5% to 13% of nursing homes in the US as of 2025, though a lack of transparency into ownership structures makes it virtually impossible to know the exact number, according to an April 2025 report from the nonprofit Private Equity Stakeholder Project (PESP).

An October 2020 study from Weill Cornell Medical College in New York estimated that about 4.7% of nursing homes—or 543 of 11,470 in the study—were PE-owned during part of that year.

“Private equity firms are able to engineer financial returns for themselves from the nursing homes that they own by using a playbook of legal but dubious tactics that can include high debt levels, the sale of real estate assets, and cost-cutting measures that can put workers and residents at risk,” Michael Fenne, a senior research and campaign coordinator at PESP who coauthored the firm’s report, told Healthcare Brew.

PE ownership can lead to worse care quality at nursing homes as well as other types of healthcare facilities like 

 distributed by the National Bureau of Economic Research states that after a PE firm buys a nursing home, the facility sees an average 1.4% reduction in staffing and 3% decrease in paid hours. Mortality rates also increase by 11%, the researchers said in the paper.

And a 2021 study from Weill Cornell found people living in a PE-owned nursing home were 11.1% more likely to have an emergency room trip and 8.7% more likely to be hospitalized for a “largely” preventable cause.

“Private equity ownership can leave nursing homes with less financial flexibility to respond to emerging care needs or changing conditions on the ground,” Fenne said. “It can also leave nursing homes with fewer resources to pay wages, acquire protective equipment, or spend on other supplies and resources.”

But PE ownership may also have some upsides, such as “operational improvements and capital infusion,” researchers wrote in a July 2025 

With such stark concerns over the quality of care received at PE-owned nursing homes, the connection between the numerous Covid deaths that occurred in these facilities and their ownership structure may seem obvious.

For example, at the height of the pandemic, a PE firm called the Portopiccolo Group came under 

 for buying more than 20 nursing homes, which employees said worsened patient care.

However, the available data on whether PE ownership directly worsened outcomes during the pandemic shows no direct correlation.

An October 2020 study from Weill Cornell that looked at nursing homes on a national scale found PE ownership had “no statistically significant” impact on staffing levels, number of Covid cases, or deaths.

The study, however, did find that PE-owned nursing homes tended to have less personal protective equipment (PPE) on hand than other facilities. Widespread PPE shortages 

 many medical facilities during the early days of the pandemic.

John Collins, a spokesperson for Portopiccolo, told the Washington Post in 2020 that the quality of care residents received at the firm’s nursing homes did not decline during the pandemic.

“Our company was founded by people who share a passion for caring for the sick, elderly, and forgotten. Any attempts to characterize our work or the work of our teams differently is flat out wrong,” he said.

Rachel Reeves, a spokesperson for AHCA/NCAL, told Healthcare Brew that “focusing on private equity in long-term care has become a distraction from the real issues that impact the majority of providers, like 

“The reality is that owners of long-term care facilities are extremely diverse and are often run by small, independent operators,” Reeves said.

Given the potential risk posed by PE ownership, Mark Unruh, associate professor of population health sciences at Weill Cornell who coauthored the university’s 2020 and 2021 studies, told Healthcare Brew there “absolutely” should be more oversight and regulation of nursing home deals.

Two prominent PE-owned nursing home companies in PESP’s report (LaVie Care Centers, which operated under names including Consulate Health Care, and Gulf Coast Health Care) as well as a PE firm that specialized in long-term care centers (Goldner Capital Management) have all filed for bankruptcy in recent years.

The Centers for Medicare and Medicaid Services (CMS) announced a 

 in 2023, Unruh noted, that would require more transparency in reporting the ownership structure for nursing homes.

“It’s a wonderful first step, but the problem with that rule is there’s no teeth to it,” Unruh said. “There’s no enforcement mechanism to ensure that the owners were actually reporting the information as they should.”

So, the logical next step would be for CMS to add an auditing process and implement consequences if nursing homes don’t report the required information, according to Unruh.

“I think that private equity has an incentive to keep acquiring nursing homes and keep making financial returns for themselves using the same set of tactics until something is changed in the policy landscape,” Fenne said.

Rear view of female caregiver assisting senior woman walking with mobility walker in corridor

As private equity firms buy up nursing homes, some studies suggest the ownership model worsens care quality 

Nursing homes were hit hard by the Covid-19 pandemic, and some data suggests private equity ownership made care quality worse. 

illustrated headshot of caroline catherman, healthcare brew reporter

Caroline Catherman

As some in the medical field know too well, it can be hard to leave a healthcare job.

Sure, patient relationships and coworker bonds are difficult to sever, but one of the top things keeping many from branching off on their own just might be their contracts.

Between 37% to 45% of US physicians are in employer agreements that limit where they can work after they leave or how long they must stay in their current position, according to professional group the American Medical Association (AMA), compared to about 18% of the overall workforce nationwide, per a 2021 

On Sept. 10, the Federal Trade Commission (FTC) announced it had sent warning letters to several healthcare and staffing companies with potentially “unreasonable noncompete agreements in employment contracts.” A few days earlier, it had 

 for public comment to inform “case-by-case” enforcement of noncompetes going forward.

This comes shortly after the commission announced Sept. 5 it’s officially abandoning attempts to defend a 

 on all noncompetes that it passed in April 2024.

It’s all left providers and hospitals alike asking: What’s next for noncompetes?

“Even though [the FTC ban] legally did not go through, that has caused a lot of professional societies, state governments, and regulators to take a look at the issue,” Joseph Marine, a professor of medicine at Johns Hopkins University School of Medicine, told us.

 Chances for a nationwide ban on noncompetes are “slim,” but restrictions are growing state by state, Daniel Gilman, a senior scholar of competition policy at nonprofit research organization International Center for Law & Economics, told us.

There have been more than 60 state bills introduced in 2025 to establish or expand restrictions on noncompete agreements, according to bipartisan public policy organization the Economic Innovation Group. As of June, the group counted four states (California, Oklahoma, Minnesota, and North Dakota) that have totally banned noncompetes and 34 plus Washington, DC, that have restricted their use.

Whether restricting noncompetes is a good thing depends on the market and who you ask.

Marine believes that while these agreements can be a tool for smaller practices to ensure they recoup their investment in new hires, it’s possible they could also be “abused” by big health systems and groups to dominate a local market, as has been previously 

“Noncompetes are being written in a way by these large health systems that physicians who wish to leave and do something differently are virtually always forced to move, sometimes out of the state, in order to practice,” he said.

In 2023, hospital lobbyist group the American Hospital Association opposed the FTC’s ban on noncompetes, arguing 

 to the commission it could disrupt the healthcare labor market and exacerbate healthcare worker shortages.

AMA, which lobbies for physicians, largely opposes noncompetes in its code of ethics. It argues they “restrict competition, can disrupt continuity of care, and may limit access to care,” though it 

 a complete ban, either, the organization said last year.

Gilman said whether noncompete agreements illegally restrict competition likely depends on the market and factors like how many competitors there are.

He said there’s not enough research to conclude how noncompetes impact physicians or healthcare costs.

“​​We have very few studies of the effects of noncompetes in the healthcare sector specifically, or even more specifically, with regard to particular healthcare occupations,” he said.

 in the Journal of Human Resources found noncompetes to be linked to lower physician job turnover. The study also noted, however, that this is a “relatively understudied topic” and more research is needed.

What is the future of healthcare noncompete agreements?

Breaking up is hard to do.

Fool one healthcare facility, shame on you. Fool 40 of them? There…might be a bigger problem at play.

Maryland resident Thomasina Amponsah pleaded guilty to working as a nurse at not one, not two, but 40+ facilities across Maryland despite never having a nursing license, according to an Aug. 14 release from the US Attorney’s Office for the District of Maryland.

Fraudulent nurses have been arrested in several states over the last year, from 

, involving everything from stolen identities to 

It’s a rare but avoidable mistake that puts patients’ lives and a healthcare facility’s reputation at risk, Jennifer Mensik Kennedy, president of trade organization the American Nurses Association, told us.

“When there are individuals who impersonate nurses, that breaks people’s trust. So it is very important to us to make sure the processes to ensure that these things don’t happen are strong,” Mensik Kennedy said.

The Maryland Board of Nursing “will continue to investigate and take appropriate action” against anyone caught misrepresenting themselves, Maryland Department of Health spokesperson David McCallister told us.

The National Council of State Boards of Nursing (NCSBN), a membership group for state boards, said in its 2024 fraud detection 

 that fraudsters “look for the easiest entry routes,” taking advantage of organizations with lax hiring policies and loopholes.

Most practices have a thorough screening process with multiple checks built in, but some fail to verify the license matches up with the applicant’s identity, Mensik Kennedy said.

, and people feel the pressure to get nurses approved into the system and hired as quick as possible,” she added.

But while less thorough screening might speed up a hire, the cost of firing and replacing that person might not be worth it. Turnover of one bedside registered nurse (RN) costs the average hospital $61,110, and each facility loses an average of $3.9 million to $5.7 million per year amid the current 16.4% RN turnover rate, according to 

 NSI National Health Care Retention and RN Staffing Report.

To ensure applicants are qualified, NCSBN advises employers to look up people on its nurse licensure and disciplinary database, 

The database allows employers to check for free if a person’s stated license number, birth year, and last four digits of their social security number match up. It also shows all their licenses and disciplinary history in other states and allows employers to get immediate alerts of any changes, Matt Sterzinger, NCSBN’s IT director, told Healthcare Brew.

Sometimes, though, imposters obtain a license linked to their real identity.

In 2023, a federal investigation known as Operation Nightingale uncovered a now-defunct diploma mill that sold 7,600+ fake nursing diplomas and transcripts in Florida, New York, New Jersey, Texas, and Delaware. People who bought these fraudulent transcripts qualified to sit for the nurse licensure exam. About 37% passed, allowing them to work as nurses, the New York Times 

Mensik Kennedy said this problem is potentially exacerbated in states like New York and California, where applicants can take the exam an unlimited number of times with just a 45-day waiting period between each attempt. Other states require additional training after several failed exams.

“When you get the opportunity to take unlimited tests and then keep getting your scores back…you learn what areas you need to study,” she said.

There’s discussion in the industry of whether some facilities should do even more to screen applicants, Mensik Kennedy added.

For instance, most states take fingerprints when new nurses get their licenses in order to perform a criminal background check, but most facilities don’t verify fingerprints before hiring someone, she said.

Mensik Kennedy argued another form of “fingerprint,” which the ANA has been advocating for, could be if nurses were reimbursed per service, like doctors—creating a paper trail—rather than the current norm of paying them a salary that’s bundled into the costs of patients’ rooms.

Mensik Kennedy also believes state boards, which investigate reports of potential posers, need more resources and funding in order to more efficiently track down these imposters.

“Nursing, without a doubt, is a very highly specialized and ethical profession, which requires rigorous and lifelong learning and training,” she said. “You can’t just show up. And there are no shortcuts.”

A close-up photo of a woman in scrubs holding a clipboard with a stethoscope around her neck, there's a large red question mark obscuring her face.

Think a fake nurse couldn’t be working in your hospital? Think again.

Just last month, a Maryland woman pleaded guilty to working as a nurse without a license.

Cassie McGrath

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

This month, UnitedHealth Group officially acquired home health company Amedisys, while Franklin, Tennessee-based health system Community Health Systems (CHS) sold off more hospitals after selling or looking to sell nearly 40 hospitals in the last five years.

We pulled together a list of provider transactions from August. Here’s the rundown.

On Aug. 20, Memphis, Tennessee-based Baptist Memorial Health Care signed a definitive agreement to purchase 96-bed OCH Regional Medical Center in Starkville, Mississippi, from the Oktibbeha County Board of Supervisors for $55 million. The sale would mark Baptist Memorial’s 25th hospital.

CHS signed a letter of intent on Aug. 6 to sell three of its for-profit Pennsylvania hospitals valued at $120 million to nonprofit Tenor Health Foundation, which helps distressed hospitals. CHS seems to be on a selling streak, announcing the sale, or shedding, of 39 hospitals since 2020, Becker’s 

Based in Flint, Michigan, Insight has walked away from a proposed deal with Hollister, California-based Hazel Hawkins Memorial Hospital on Aug. 13 due to “unprecedented uncertainty stemming from the recently signed One Big Beautiful Bill Act,” the system said in a statement.

The 143-bed St. Luke’s Des Peres Hospital in St. Louis, Missouri, closed on Aug. 1 due to “pressures, making continued operation as an acute care facility no longer sustainable,” 

. The facility had treated patients in the area for more than 50 years.

Health giant UnitedHealth Group officially completed its acquisition of home care provider Amedisys on Aug. 14. The $3.3 billion deal faced a Department of Justice probe, and the two companies had to sell assets (164 home health and hospice facilities in 19 states) for the deal to go through.

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

Signed and Scrubbed: August 2025 hospital M&A

UnitedHealth officially closed its acquisition of Amedisys this month after a federal probe, plus other updates.

Nicole Ortiz

When talking about climate change-related health issues, 

And for good reason: There’s been an increased risk of illness or death from extreme heat in recent years, and heat is the leading weather-related cause of death in the US, according to the National Weather Service.

That’s why nonprofit Americares, which brings health programs and supplies to communities impacted by disaster and inequity, announced plans to expand its protection efforts for patients dealing with extreme heat.

In an Aug. 21 press release, the organization shared it will award grants to 13 free clinics and 

 (CHCs) so they can purchase supplies to help patients confront extreme heat, including air conditioners, ice packs, reusable water bottles, and more. The grants are part of an extension of the Climate Health Equity for Community Clinics program, which provides extreme heat and 

These are the facilities receiving funding:

Albuquerque Health Care for the Homeless in New Mexico

The Broad Street Clinic in Morehead City, North Carolina

Coachella Valley Volunteers in Medicine in Indio, California

Community Health of South Florida in Miami

Miami Rescue Mission – Doral Clinic in Florida

Muncie Mission Ministries in Muncie, Indiana

Sonoma County Indian Health Project in Santa Rosa, California

St. Clair Community Health Clinic in Pell City, Alabama

Volunteers in Medicine in Wilkes-Barre, Pennsylvania

Further, in collaboration with CVS Health, Americares is planning to award an additional eight grants to healthcare facilities primarily in Arizona, Florida, Georgia, New Mexico, and Texas to secure supplies when there’s extreme heat in the forecast.

The 18-month-long pilot program will tap into weather data in an effort to cut down on patients needing hospital-level care for heat-related illness. According to CDC data, almost 120,000 emergency department visits were associated with health-related illness in 2023, double the record between 2018 and 2022.

“As heat waves become more frequent and intense, we’re taking action to protect those most at risk,” Americares SVP of Programs and Chief Medical Officer Julie Varughese said in a statement. “Healthcare providers at safety net clinics see firsthand how the environments where their patients live and work exacerbate existing health disparities.”

Graphic of a thermometer showing a very high temperature

Americares provides grants to help 13 clinics, community health centers combat extreme heat

As temperatures climb due to climate change, patients are at an increased risk for heat-related illness or death.

Mental health workers at Kaiser Permanente are protesting a policy that pauses gender-affirming surgeries for patients under 19.

Kaiser announced the pause, which will go into effect Aug. 29, following 

 to stop trans youth from accessing gender-affirming care. Other gender-affirming treatments, like puberty blockers, hormone therapy, and mental health care will still be available, 

The workers are represented by the National Union of Healthcare Workers (NUHW), which has 19,000 members in total. Of that, 4,700 are psychologists, social workers, and marriage and family therapists at Kaiser Permanente’s California and Hawaii locations. The union also has trans members, parents of trans children, and staff who provide gender-affirming care regularly, Sal Rosselli, president emeritus at NUHW, told Healthcare Brew.

Rosselli said the union “has a long track record of standing up for the rights of patients to get the care they need and countering misinformation that could lead to patients not getting appropriate care.”

During the HIV/AIDs crisis, for example, he said NUHW helped educate members who were afraid of treating patients. In April, the 

 Kaiser was illegally using unlicensed clerks to direct mental health care.

“The federal government is trampling on the rights of patients to get care that could save lives,” he said. “We’ll always defend the principle that medical choices should be made by patients in consultation with their doctors and loved ones, not by the federal government.”

The union and staff said they have not heard back from Kaiser, Rosselli said.

Kathleen Chambers, a spokesperson for Kaiser, told us in an emailed statement that “we appreciate the union raising their concern for patients seeking gender-affirming care. This is an extremely challenging and stressful time for our patients, as well as for our clinicians whose mission is to care for them.”

 have also recently stopped providing some gender-affirming services for trans youth. At Stanford, “gender-related surgical procedures” have stopped as of early June, while the Children’s Hospital closed its pediatric gender clinic on July 22.

Rosselli said the union opposes those decisions as well, but is focused on Kaiser due to the nearly 5,000 mental health workers it represents there.

“They’re on the front lines, and they understand how the care is provided and how important it is, both for the child and their family, that they have control over medical conditions in consultation with their doctors,” he said.

 are trying to manage “significant risks” for patients and caregivers as they respond to President Trump’s 

 that instructs the federal government to block funding for gender-affirming care and subpoena providers who provide it, Chambers said.

“In response to these federal actions, many health systems and clinicians across the country have paused or discontinued providing gender-affirming care for adolescents,” Chambers said. “Only after significant deliberation and consultation with internal and external experts, including our physicians, did we make the difficult decision to pause gender-affirming surgical treatment for patients under the age of 19.”

These policies can have life and death consequences, as LGBTQ+ organization the Trevor Project reported in 2024 that suicide attempt rates among minors reached 

 in states with laws limiting gender-affirming care for youth.

A building that shows the Kaiser Permanente logo

Union pressures Kaiser Permanente to restart surgeries for trans youth 

California providers Stanford Medicine and Children’s Hospital Los Angeles also recently stopped providing some gender-affirming services to trans children. 

 since the beginning of President Donald Trump’s second term, and some health center leaders say fewer patients are coming in for routine care.

The day after Trump took office, the Department of Homeland Security (DHS) 

 preventing Immigration and Customs Enforcement (ICE) from arresting people in “sensitive” areas, including hospitals and health centers.

Of 511 lawfully present immigrants in the US 

 surveyed this spring, about 9% said they had avoided seeking healthcare since the start of the new administration.

Healthcare Brew spoke with health centers in 

 about the effects they’re seeing from increasing immigration arrests as well as steps they’re taking to ensure patients continue receiving care.

The Southern California city has been a prime target of the administration’s immigration enforcement actions, with the 

 “hundreds” of National Guard soldiers there in June following protests over immigration raids.

Despite being a sanctuary city—meaning it has policies to limit its cooperation with immigration officials—ICE has made 4,163 arrests in LA since June, according to DHS data reported by 

Louise McCarthy, president and CEO of the Community Clinic Association of Los Angeles County, which represents more than 450 clinics that treat a combined 2 million patients per year, told us the 

 (CHCs) have seen an “uneven impact” as far as no-show rates and cancellations.

“It’s notable that people of all immigration statuses, including people who are citizens, are living in fear because of the sense that the streets are not safe for people to go out, to go to school, to go to their jobs, to get healthcare,” McCarthy said.

The clinics are spreading the word that they offer telehealth services for things like prescription refills and other care that doesn’t require an in-person visit, according to McCarthy.

“We just want to make sure that people get care,” she said.

From January through July, ICE issued 6,025 arrest requests in New York City, according to a July 23 statement from DHS.

At Community Healthcare Network, which comprises 14 CHCs in the city, President and CEO Robert Hayes told Healthcare Brew the centers are focused on spreading the message that they don’t turn anyone away based on immigration status. In fact, the health centers, which see about 65,000 patients annually, “do not and have never asked people what their immigration status is,” he said.

, the network has deployed mobile health programs and been “very proactive” in offering patients the option for telehealth when appropriate, Hayes added.

“We’re trying to do everything possible to get the message to people that it is reasonably safe to come in, that it is completely unsafe to ignore your healthcare needs, and to really push things like vaccines for kids and other fundamental principles of primary healthcare,” he said.

Though Chicago is also a sanctuary city, Cook County, Illinois, had 113,959 pending deportation cases as of March, the second highest number in the country behind Miami-Dade County, Florida, 

Laura Starr, director of external affairs at CommunityHealth, which runs four CHCs in the city and sees about 4,200 patients per year, told Healthcare Brew the organization saw fewer patients coming to appointments “almost immediately after the inauguration in January.”

“Those first couple of weeks, almost 40% of our primary care appointments were no-shows,” Starr said. “A lot of people were not picking up their prescriptions from our pharmacy. We just, in general, had a pretty empty health center.”

By mid-February, the health centers were nearly back to “normal appointment adherence rates,” she said, except at the location in the Little Village neighborhood, which has a high concentration of Mexican immigrants.

All CommunityHealth staff has been trained in the Know Your Rights 

, which informs people of their legal rights when met with law or immigration enforcement, and they regularly conduct drills, Starr added.

ICE arrested more than 10,818 people in Florida from the start of Trump’s second term through July, according to data from the Deportation Data Project, 

Amy Halstead, CEO of Rural Health Network of Monroe County, Florida, located in Key West, told us fewer patients are coming in for care. The clinic sees about 7,500 visits per year for both medical and dental care.

“Where we’ve seen the biggest decrease in this area has been with pregnant women,” Halstead said, noting there’s only one hospital the clinic’s patients can access for labor and delivery in Key West. “The fact that the hospital numbers are down—and all the surrounding practices aren’t seeing as many pregnant women—is telling us that it’s probably an indication of people leaving the area.”

In addition to offering telehealth, the health center has a mobile unit it takes directly into communities to make sure patients can access care.

She said it has also trained staff on what to do if immigration officials enter a clinic.

“We haven’t actually had anybody come on-site yet. We’ve seen [immigration officials] around our clinic but not actually physically walking into our clinic,” Halstead said.

Medical humanitarian aid concept. Cross made by crowd of people on white background, vector illustration in flat style