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Hospitals are getting squeezed from all sides, so winning will come down to nailing the basics—tight operations and finances, great quality, a workable payer mix, steadily better clinical talent, and a patient experience that’s easy and welcoming—with strong board and leadership teamwork to pull it all off.

Hospital rating downgrades declined in 2025 while the number of upgrades increased, resulting in a lower ratio of downgrades to upgrades and tempering higher downgrade activity in recent years.

In 2025, many health system leaders renewed an enterprise-wide strategy while navigating major uncertainties. They evaluated growth, advanced ambulatory and service line efforts, and balanced performance, growth, and transformation. In 2026, health systems will need to clearly define how they’ll transform to fulfill their missions and better serve patients.

The healthcare payment landscape continues to face uncertainty as support grows for additional “site neutrality” in reimbursement, with the policy goal of reducing or eliminating payment differentials between hospital-based outpatient departments (HOPDs) and freestanding physician offices or ambulatory care sites for the same services.