Originally published by Becker’s Healthcare.
TeamHealth brought together health system leaders for a panel discussion with Becker’s Hospital Review focused on how the One Big Beautiful Bill Act (OBBBA) is already reshaping the strategic and financial calculus for health systems across the country.
Leaders from rural, urban, and academic settings gathered to discuss how their organizations are preparing for the sweeping changes ahead — from payer mix shifts and rising uncompensated care to workforce strain and competitive repositioning.
Below are four key takeaways from the conversation.
1. Leaders are moving fast
For many organizations, the first step was quantifying the impact. A CEO of an independent rural hospital in the Midwest described sitting with his board months before HR1 passed and making clear the moment required urgent action.
“This is real. This is happening,” he said. “We need to pivot very quickly.” For his hospital alone, state modeling projected a $6 million annual revenue loss, a staggering figure with 72% governmental payer mix. A CFO of a community health system in the Midwest estimated $350 million in impact over ten years.
In response, leaders described organizing planning around operational pillars that include people, service, quality, growth, and finance. Organizations should also start focusing on holding recurring committee meetings to keep strategy current.
“You’re going to have to deliver the same kind of care at a higher cost and figure out how to lose less doing it,” said the CFO of a community health system in the Midwest.
2. EDs under pressure
As patients lose coverage and outpatient access erodes, panelists expect ED volumes to climb, acuity to rise, and discharge planning to grow more complex. A COO of a rural system in the south described tracking ED boarding rates as a key stress indicator, drilling into triage levels and throughput to connect patients to the right care at the right time.
A CMO of a large public health system in the Northeast noted that nine of the system’s EDs already exceed one million visits annually and expects those numbers to grow significantly as disenrollment accelerates.
A CMO of an academic medical center in the Midwest even drew a parallel to the pandemic.
“Patients delayed care for chronic conditions and came in with their conditions out of control. I think we’re going to see more of that.”
For all panelists, patients arriving further along in disease progression, with fewer resources and limited post-acute options could be the new reality.
3. Why workforce wellbeing matters
Several panelists pushed back on treating clinician wellbeing as a soft issue, framing it instead as a direct driver of financial exposure. Burnout drives turnover, turnover drives up agency and locum costs, and stretched staffing erodes patient experience scores and raises malpractice risk.
A physician group leader in the Northeast described investing in predictive staffing technology and AI documentation tools to get ahead of volume spikes before they degrade care. “The challenge is not really a lack of tools or insight,” he said. “It’s the consistency and discipline required to operationalize those insights while protecting clinician wellbeing.”
4. The path to long-term success
With margins compressing and capital scarcer, leaders described making faster, more deliberate decisions about where to invest and where to pull back. A COO of a health system in the West described pivoting toward high-margin service lines — orthopedics, cardiovascular, and oncology — while exploring hub-and-spoke models for essential but less profitable services like OB.
The organizations best positioned to navigate OBBBA, panelists agreed, will be those that make deliberate, data-driven choices while never losing sight of their communities.
“OBBBA is not the only thing that’s potentially financially harmful,” said the CFO of a Midwest community system. “We have 340B cuts, provider-based cuts. There is so much on the table. Take action early and often, and keep those relationships with your legislators and associations strong.”
