CEO Deborah Visconi outlines a behavioral health-centered ED redesign and strategies aimed at strengthening the safety net as financial and policy pressures intensify.
As behavioral health needs surge nationwide and financial pressures mount for publicly owned hospitals, Bergen New Bridge Medical Center president and CEO Deborah Visconi says the moment demands a new model that pairs expansion in behavioral health with a disciplined safety-net strategy for long-term stability.
Visconi, who has led the 1,070-bed New Jersey-based safety-net since 2017, said the organization’s first phase under her tenure focused on strengthening the foundation, with an emphasis on stability, access, and quality. But the environment has shifted, and with federal policies and Medicaid eligibility changes reshaping the economics of care, Visconi believes the hospital is entering a fundamentally different chapter.
"What we're seeing as the next phase is really about scale and sustainability," she told HealthLeaders.
At the center of that next phase is a behavioral health investment that includes a completely redesigned emergency department built around dignity, capacity, and stigma-free care.
"Behavioral health and addictions are at the core of who we are," Visconi said. "And they're not just service lines, but they are truly part of our identity and what the community needs and expects from us."
The redesign, set to be unveiled in the coming months, marks a significant expansion in which Bergen New Bridge’s bed capacity will increase by over 50% and the emergency room will extend from 19 bays to 49, with 30 going to behavioral health, according to Visconi.
However, the size of the project matters less to Visconi than how the space feels to patients in crisis.
She described the new unit as "a beautifully designed space that eliminates the stigma around those suffering from behavioral health and addictions." Rooms, she explained, are "amply sized with televisions and safe casings and furniture so the family can actually sit in the room with the patient."
The care model is rooted in the national EmPATH framework, an approach designed to bring humanity and emotional safety into emergency psychiatric care.
The ED is now also a certified autism center, another step meant to create an environment "truly innovating around the human spirit."
Visconi said: "That's really what is important to us for our communities, what they need, what they deserve, and what we can offer to them."
Pictured: Deborah Visconi, president and CEO, Bergen New Bridge Medical Center.
Balancing Mission and Margin as a Safety Net
Even as Bergen New Bridge leans further into behavioral health, Visconi acknowledged that the organization must support and fund that mission through a stronger financial footing.
"We don't have the luxury of choosing between mission and margin," she said. "We do live on that very thin line that can topple over to the negative side."
The path forward depends on expanding and diversifying the hospitals’ reach. Bergen New Bridge’s top priorities, according to Visconi, are growing the medical enterprise, developing new service lines, and expanding its ambulatory footprint.
It’s also vital that the hospital diversifies its payer mix so that it doesn’t have to rely on government funding streams, Visconi stated.
Simultaneously, Bergen New Bridge is leaning into value-based care arrangements that align financing with community needs. The strategy, Visconi said, includes "managing risk through value-based partnerships and at the same time never losing sight of why we exist."
These moves, she explained, are not for the sake of revenue, but about ensuring the hospital can keep delivering on its safety-net role. At the operational level, the organization evaluates every initiative through a simple test of whether it’s "grounded in access, equity, and long-term community impact," Visconi said.
That includes the implementation of Epic, a project she describes as essential to the sustainability of a modern safety net despite its big price tag. Epic will support "a truly integrated system of care that will connect every care setting so that patients have one place to look for all of their care needs, a seamless experience for patients and the providers." She added that Bergen New Bridge will leverage Epic’s AI components "to identify those gaps and coordinate those social supports interventions earlier."
Even with these strategies, Visconi is blunt about the need for stronger policy support to keep safety-net hospitals viable.
She pointed to three areas where she believes action is most urgent: "Advocating for sustainable Medicaid reimbursement, top of the list, expanding behavioral health funding, and investments in workforce pipelines and loan forgiveness programs."
If policymakers fail to act, she warned, the consequences extend far beyond any one hospital.
"If safety nets and hospitals like us remain underfunded, the entire system of care becomes vulnerable," Visconi said. "Strong safety nets make strong communities."
A report shows a steep drop in rural family physicians in recent years, raising concerns about the sustainability of primary care in underserved communities.
Rural healthcare is under duress, and a new study reveals that one of its most pressing challenges is a steady drain of family physicians.
The research, published in Annals of Family Medicine, found that the number of family physicians practicing in rural areas of the U.S. declined by 11% from 2017 to 2023. Using data from the American Medical Association Physician Masterfile to track actively practicing family physicians under age 65, researchers identified that there were 11,847 rural family physicians nationwide in 2017. By 2023, that number had dropped to 10,544 for a net loss of 1,303 physicians.
These losses come at a time when many rural areas have experienced population growth, in part driven by young adults seeking affordable living under remote work arrangements. Family physicians in rural communities also often wear many hats by providing maternity care, pediatric care, and emergency coverage on top of standard adult care.
“The data reflect what we already experience and know about physician shortages, but the year-over-year numbers for rural areas were astonishing to me,” the study’s lead author, Dr. Colleen Fogarty, professor and chair of the department of family medicine at the University of Rochester, said in a news release. “The speed at which this has happened is remarkable and terrible,” said Fogarty.
One encouraging trend that emerged from the study is that more women are entering rural family medicine. The proportion of female family physicians in rural areas increased from 35.5% in 2017 to 41.8% in 2023, mirroring a nationwide shift toward gender parity among family physicians.
That shift, however, comes with its own challenges. “Does the rural community have what working mothers need? Healthy boundaries on work life are important; we need to get male and female family physicians the support they need so they are not working around the clock and diagnosing a medical issue while they’re at the cash register at the grocery store,” Fogarty said.
According to Fogarty, several factors contribute to the downward trend. Fewer medical students are choosing family medicine as a specialty, and rural-origin students remain underrepresented among those specializing in family medicine. Meanwhile, rural physicians often carry heavy workloads due to the many roles that serve, which contribute to burnout, relocation, or early retirement.
To begin turning the tide, Fogarty and her colleagues propose more targeted efforts, such as rural-specific training pathways, stronger support for advanced practice providers, and incentives including better compensation and work-life balance. The University of Rochester, for example, is launching a new rural residency track in which physicians will complete their first year of training in a city before spending the final two years in continuity practices in rural communities.
“It's an important initiative that we hope will make a difference,” Fogarty said.
Unless health leaders, policymakers, and medical educators strengthen efforts to recruit, train, and retain family physicians in rural communities, the access and quality gap between urban and rural settings will continue to widen.
Surging patient demand propelled the nonprofit health system to a sharp rebound in operating performance.
Mayo Clinic delivered a dramatic financial upswing in the third quarter, with its operating income soaring by more than 250% year-over-year on the strength of improved patient volumes.
For the three months ended September 30, the Rochester, Minnesota-based health system reported $193 million in operating income, blowing away the $55 million recorded over the same period last year. Beyond the operating earnings, Mayo’s income from current activities, including philanthropy and investment returns, reached $442 million for the quarter, nearly doubling the $232 million earned in 2024.
Total operating revenue for the quarter rose to $5.5 billion, up from $4.9 billion in the prior-year period, with net medical service revenue growing by 10.2%, reflecting strong demand across outpatient, surgical, and hospital services, Mayo highlighted.
Through the first nine months of 2025, Mayo’s outpatient visits rose 4.5%, surgical cases increased 4%, and admissions surged 7.2% compared to last year.
Operating expenses in the third quarter also increased by 8.5% to $5 billion, due to salaries and benefits rising 7.8% to $2.8 billion, and supply and service costs swelling 8.6%.
After more modest earnings in earlier quarters of 2025, Mayo’s third-quarter output emphasizes its service-line mix and ability to control costs even amid inflationary pressures.
The boost in both operating income and broader income from current activities gives the organization added financial flexibility to invest in technology, research, infrastructure, and other strategic priorities heading into 2026.
Looking ahead, sustaining this level of performance will likely depend on continued strong demand, particularly for complex procedures and specialty care.
Other major nonprofit health systems, like Providence, also enjoyed favorable earnings in the third quarter driven by rising patient volumes. The Renton, Washington-based organization reported operating income of $21 million, compared to a $208 million loss over the same period in 2024, as operating revenue climbed 6% to $8 billion.
"We're trying to create ecosystem solutions and not point solutions," says Longitude Health CEO Vishal Agrawal.
In this episode of HL Shorts, Longitude Health CEO Vishal Agrawal explains how emerging technologies can finally tackle the fragmentation problem in healthcare by offering solutions that connect payers, providers, pharmacists, and community resources.
These were the HealthLeaders stories on CEOs that readers were most interested in tracking this year.
Hospitals and health systems are closing out 2025 under mounting financial and workforce pressure, forcing leaders to make difficult decisions that will shape the year ahead.
These were the five most-read HealthLeaders stories on CEOs in 2025:
The health system opened fiscal 2025 with a $53.8 million operating loss, as rising labor, supply costs, and capacity constraints erased revenue gains, prompting its largest-ever round of layoffs.
Under pressure from a projected $250 million budget gap over the next two years, MGB said the cuts and management restructuring are expected to yield more than $200 million in annualized savings.
A national wellbeing report showed that while burnout is easing slightly across much of the healthcare workforce, it remains deeply entrenched and uneven, with some professions experiencing far higher strain than others.
The findings highlight persistent pressures on clinicians and reinforce why workforce wellbeing continues to dominate CEO priorities heading into 2026.
Citing the aforementioned financial pressures and inefficiencies, MGB initiated what it called the largest staff reductions in its history, eliminating hundreds of nonclinical management and administrative roles across its network.
MGB was one of many hospitals and health systems to cut staff this year as organizations across the country resorted to layoffs to offset rising expenses.
John D'Angelo officially became CEO of Northwell Health in October, succeeding longtime leader Michael Dowling, and he spoke to HealthLeaders about ushering in a new chapter for the health system that seeks to balance transformation with continuity.
D’Angelo, a physician by training who rose through Northwell’s ranks, emphasized preserving a shared sense of purpose and a commitment to patients and caregivers, while accelerating innovation in care delivery and responding to growing demands around chronic disease.
A recent Kaufman Hall report found that many hospitals were heading into the final quarter of 2025 under significant financial strain as patient volumes decline and non-labor costs surge.
Supplies, drugs and, purchased services all saw cost increases, while uncompensated care also jumped, putting a squeeze on margins just when recovery seemed possible for many health systems.
A new survey reveals the factors that are driving clinicians toward the exit, pushing hospital leaders to rethink how they support and retain their workforce.
Clinicians are increasingly dissatisfied with their working conditions, with many questioning whether they can stay in the profession as staffing shortages and burnout persist, a new workforce report shows.
Vivian Health’s survey of 471 clinicians points to a widening gap between what workers expect and what they experience on the job, highlighting the need for hospital leaders to rethink their retention strategies.
Eighty-four percent of respondents said their units are facing staffing challenges, and more than half (53%) described their units as not adequately staffed. Forty-three percent reported being denied paid time off because of short staffing.
The disconnect is also affecting hiring and retention. One in five clinicians said they ended a contract early because the role didn’t match what was advertised, while 10% withdrew before their start date for the same reason. Safety concerns were the top driver as 31% ended contracts early due to unsafe or toxic work environments, while 42% backed out before starting after learning about safety issues.
Burnout remains widespread. Seventy-six percent of clinicians said burnout is unchanged or worse compared to last year. Nearly half (43%) rated their current job satisfaction at five or below on a 10-point scale, and two-thirds (66%) reported having considered leaving healthcare altogether.
The report reveals several contributing factors behind clinicians’ dissatisfaction, including misaligned job expectations, a lack of schedule flexibility, limited access to PTO, and unsafe working conditions. Respondents also reported increased concerns about patient care quality, medical errors, dissolving of public trust, and mental health impacts tied to current workloads.
How CEOs Can Respond
For hospital CEOs, the report calls attention to the need to realign workforce strategy with the realities clinicians face.
Greater transparency around job roles and working conditions can help reduce early contract terminations and prevent new hires from backing out before their start date.
The findings also point to the importance of strengthening staffing models so that units are adequately resourced, which in turn can ease burnout and reduce the frequency of denied PTO.
Leaders may need to rethink how they provide schedule flexibility, how quickly they respond to reports of unsafe conditions, and how they address burnout as a structural issue rather than relying on wellness initiatives alone.
Ensuring clinicians have clear channels to raise concerns, and acting on those concerns, can help rebuild trust.
By focusing on creating more transparency and alignment, hospital leaders can move closer to meeting clinician expectations and strengthen their ability to retain staff.
Standardization and shared governance are essential for hospitals adopting hybrid workforce models across their facilities, says this CNO.
In this episode of HL Shorts, Sentara Health senior vice president and CNO Amber Price breaks down the cultural and organizational shifts needed to successfully integrate hybrid workforce models, from unifying hospitals under consistent standards to partnering with frontline nurses through shared governance.
CEO Diana Richardson shares how the organization is integrating systems, infrastructure, and culture on the fly while stabilizing community hospitals long overdue for investment.
When the collapse of Steward Health Care threatened the future of two Massachusetts-based community hospitals in need of a lifeline, Merrimack Health didn’t have the luxury of years-long planning typical of health system integrations. Instead, the organization formed in crisis.
Now, president and CEO Diana Richardson is leading one of the most accelerated health system integrations imaginable, folding disparate electronic medical records, medical staffs, payroll systems, leadership structures, and even crumbling physical infrastructure into one cohesive organization.
The work is fast, high-stakes, and unusually backward, but Richardson says the urgency is the point.
“We stepped into the situation in the midst of a crisis to really make sure that [the hospitals] didn’t collapse,” she told HealthLeaders.
After Steward filed for Chapter 11 bankruptcy in May 2024, the futures of Holy Family Hospital-Methuen and Holy Family Hospital-Haverhill were thrown in flux. Lawrence General Hospital stepped forward and, with the state’s help, took control of the two hospitals in October 2024.
Richardson, who had previously helped lead the state’s incident response to the Steward fallout as a senior transition liaison with the Massachusetts Department of Public Health, already understood the fragility of the situation when she was appointed interim CEO of Lawrence General this past April. But familiarity didn’t make the task any less daunting. The health system was born before the components were aligned, resulting in what Richardson calls an integration process done in reverse.
The transition also came with a new identity. In September, the organization rebranded as Merrimack Health to reflect its roots in the Merrimack Valley, and in October, Richardson shifted from interim to permanent CEO to continue guiding the health system in its next phase.
Integrating After Go-Live
What makes Merrimack Health’s story uncommon is not just the scale of the integration, but the order in which it had to happen.
“Approaching integration for the last year has been thinking quickly and efficiently, and then implementing that work after the integration or after the system had actually formed,” Richardson said. “A little bit unusual to what most [organizations] go through.”
When the system launched, every major operational and clinical platform still existed independently.
“All the systems were still separate, ranging from a payroll system to an electronic medical record, to names on the buildings, to our medical staff,” Richardson said.
What followed was an expedited push to knit those functions together in real time.
One of the biggest milestones came just months into the system’s existence: “We integrated our electronic medical record, which was aggressive and scary,” Richardson said. “But now we actually have a consolidated record for patients.”
Unifying the medical staff was equally critical to ensuring consistent care across the system.
The next major step is modernizing and consolidating on the administrative front, with payroll and HR systems set to go live in January, Richardson noted.
Pictured: Diana Richardson, president and CEO, Merrimack Health.
To integrate this quickly, across multiple hospitals and legacy systems, required what Richardson describes as both discipline and improvisation. The goal, she stated, was always to serve the community by stabilizing the hospitals and building reliable long-term structures.
“We have taken a very systematic approach to thinking through integration, always starting with, 'What do the patients in the community need? What does our team need to do that work? And how do we do that in a fiscally responsible way to make sure that this source to the community is here for a long time,'” Richardson said.
While integration alone is a massive undertaking, Richardson said the organization has simultaneously faced a second challenge of repairing the physical state of the former Steward facilities.
“We’ve had to do a lot of work like placing roofs and placing HVAC systems and fixing old piping and wiring, making sure that we have an electrical backbone for equipment,” she said.
Ordinarily, a newly formed health system would spend years unifying strategy before tackling capital projects. Merrimack did everything at once.
A Fast Path Toward Unity
Despite the complexity, Richardson said the organization has moved faster than anyone expected. Much of that momentum stems from the shared culture she found across the hospitals, which helped integration at the human level.
“Whether you are from the former Lawrence General Hospital or from the legacy Holy Family hospitals, the culture is completely focused on providing care for the community,” Richardson said. “People are neighbors. People often worked together before.”
Many staff who left Holy Family during Steward’s instability later took jobs at Lawrence General, creating bridges across the new system. “There’s just much more awareness, knowledge of each other, and comfort with the teams than you might think,” Richardson said.
That social cohesion made it easier to implement rapid operational changes.
Though internal alignment has progressed quickly, Richardson admitted that a major part of integration has been external as Merrimack Health works to restore trust in the quality and stability of the former Steward hospitals.
“The trust that we have to work on is the trust in the community, that in fact the care that they're receiving at Holy Family now is the highest quality, the safest care, the facilities are up to par, that there aren't equipment shortages and supply shortages and some of the things people heard about in the news,” Richardson said.
The rebrand has been integral to recapturing that trust, with Richardson highlighting that the health system is conveying to its community that it has one medical record, one medical staff, one set of bylaws, necessary equipment, and fixed infrastructure.
Richardon’s work is far from finished, but with the foundational pieces now in place, Merrimack Health can begin to shift its focus from standing up a system to shaping one that will support its community for years to come.
The 51-hospital system posted a $21 million operating gain on rising volumes and tighter labor controls, though pressures continue to weigh on its recovery.
Providence’s third quarter marked another breakthrough in its mission to achieve a financial turnaround, with the nonprofit returning to the black to show signs of progress.
For the three months ended Sept. 30, the Renton, Washington-based health system recorded an operating income of $21 million for a 0.3% margin, with revenue growth largely driven by improved patient volumes.
Comparatively, Providence suffered an operating loss of $208 million (-2.7% margin) during the same period last year and a loss of $21 million in the previous quarter, when the organization said it was dealing with a “polycrisis.”
“When we started the year, we intentionally set out to reach a breakeven financial sustainability goal,” Providence president said CEO Erik Wexler said in a news release. “It has taken a tremendous amount of hard work and decisive action from everyone across Providence St. Joseph Health, and that effort is starting to make a real difference. We must remain steadfast. While there’s more work ahead to secure our Mission for the long term, it’s important to pause and take stock of how far we’ve come.”
In the third quarter, Providence’s operating revenues surged 6% to $8 billion, boosted by higher volumes as inpatient admissions jumped 5% and case-mix-adjusted admissions rose 4%.
At the same time, the health system saw operating expenses climb just 3% as the organization gained productivity through a 33% reduction in contract labor spend and other long-term sustainability initiatives. However, Providence’s supply costs increased by 8% year-over-year, including a 12% swelling of pharmaceutical expenses.
The health system has taken several steps to cut back on costs this year, such as eliminating 600 full-time equivalent positions in June, freezing nonclinical hiring in April, and restructuring its leadership team in January.
Despite the improvements on the balance sheet, Providence remains short of its 2024 pace. Through the first nine months, the organization’s operating losses sit at $244 million, compared to $155 million over the same period last year.
Moreover, the organization cautioned that external headwinds remain heavy, with regulatory pressures stemming from the One Big Beautiful Bill Act potentially threatening to slow progress.
“These headwinds reinforce the urgency of our transformation and our commitment to adapt, so we can sustain our Mission and ensure continued access to high-quality care in the communities we serve,” Providence CFO Greg Hoffman said in a statement.
After Providence showed in the third quarter that it can leverage increased volume and tightened operations to deliver a profit, the key now is translating that success into consistent performance across the full year and beyond.
Rising volumes aren't resulting in stronger margins as many organizations are finding little to no relief, Kaufman Hall's latest report shows.
Hospitals are seeing higher patient volumes but little margin improvement, and the divide between the strongest and weakest performers continues to grow, according to Kaufman Hall’s latest National Hospital Flash Report.
The analysis, compiled from data on 1,300 hospitals nationwide, shows that patient volumes increased across emergency departments and inpatient care in September. However, despite volume trending positively, median operating margins remained essentially unchanged as hospitals continued to face elevated costs for labor, drugs, supplies, and purchased services.
The median hospital operating margin for the month including all allocations for the cost of shared services that they receive from their health system, was 2.3% in September. That figure was closer to the level of previous months after August’s drop-off.
For the first nine months of the year, the median calendar year-to-date operating margin, including allocations, ticked up to 2.9%, compared to 2.5% in August.
Still, Kaufman Hall found that the average margins for hospitals in the 75th percentile and those in the 25th percentile ranged from 14.7% to -1.8%, respectively.
“The gap between strong performers versus struggling hospitals continues to widen,” Erik Swanson, managing director and data and analytics group leader with Kaufman Hall, said in a statement.
In terms of volume, discharges per calendar day were up 1% month-over-month and 4% year-over-year, while emergency department visits per calendar increased 3% month-over-month and 2% year-over-year.
Improved volumes led to a 4% jump month-over-month in net operating revenue per calendar day and an 8% rise year-over-year.
Kaufman Hall indicated that the ability to manage patient flow, especially as emergency and inpatient demand grows, is playing an increasingly important role in determining performance.
“Hospitals need to think about how to manage increased volumes despite flat margins,” Swanson said. “There will be more demand for emergency departments and inpatient care, and the ability of hospitals to manage patient throughput will be increasingly important.”
Even with revenue growth from increased volumes, swelling drug and supply costs kept margins from improving meaningfully in September.
Total expense per calendar day was up 3% month-over-month and 8% year-over-year, with supply expense per adjusted discharge surging 5% and 7%, respectively, and drugs expense per adjusted discharge climbing 2% and 6%, respectively. Increases in pricing and expanded use of more advanced pharmaceuticals are contributing to ballooning drug costs, the report highlighted.
The performance gap between higher- and lower-performing hospitals is expected to remain through the remainder of the year, testing the resiliency of organizations and their cost structures.
