Page 55 - BusinessWest December 8, 2025

munity Division, as well as interim vice president of
Patient Care Services and chief nursing officer for
CDH, when he was chosen to be its next president
and COO. “We always cite a chart showing costs ris-
ing at a much higher rate than what we’re receiving
for reimbursement, and reimbursement is flat if not
decreasing, especially with Medicaid within the Big
Beautiful Bill.”
Elaborating, he said that, for a variety of reasons,
including the aging of the population, hospitals of all
sizes are seeing the percentage of patients covered by
commercial payers decrease, with a corresponding
rise in those covered by Medicare and Medicaid.
“What we get reimbursed by public payers really
“The ripple effects will be felt by all
of us ... the health systems and the
communities we serve will feel the
effects in other ways. There could
be reductions in access and servic-
es, longer wait times, and potential
impacts in delivering care.”
professionals.
“We see a lot of people from other surrounding
facilities, knocking on our door and saying, ‘do you
have any openings? We heard it’s a great place to
work,’” he said, adding that, years ago, it was rare
to see professionals come to HMC from competing
hospitals.
“Not, it happens on a routine basis,” Hatiras said.
“And it’s because of our culture; we’ve built a great cul-
ture, and people are taking note.”
Overall, while 2025 was a year of coping with chal-
lenges at area hospitals, it was also a time to move
forward with several new initiatives in the broad
realms of patient care and patient experience, said
Whitney, listing, at CDH, every-
thing from new, state-of-the-art
MRI imaging services as its
Amherst location, which opened
last month, to expansion of the
Emergency Department, to the
resumption of no-cost shuttle ser-
vice, which takes patients from
CDH to Mass General Brigham
destination hospitals — Mass
General, Brigham & Women’s,
and Mass Eye and Ear.
The eight-passenger shuttle
departs promptly from the hospi-
tal’s Atwood location at 6:30 a.m.,
leaves the Boston hospitals at 3 p.m., and returns
to Northampton around 5 p.m., Whitney noted, add-
ing that this popular service is one of many efforts to
improve convenience and overall quality of care.
As for the emergency room expansion, it includes
a full imaging suite, which brings benefits for patients
and staff alike.
“There’s a new CT machine that’s immediately
available to our ED patients, and it’s a great support
for our team because it’s right there in the depart-
ment, as well as ultrasound and diagnostic imaging.
So it’s a full imaging suite right there in the depart-
ment, which makes it more accessible but also more
efficient for patients and the team,” he explained.
“Before, every patient who needed a CT scan, for
example, needed to be transported, with an ED staff-
er, to the imaging department, which is quite a dis-
tance away.”
DR. ROBERT ROOSE
doesn’t cover the cost of delivering care,” he went on.
“And traditionally, organizations have relied on com-
mercial payers to help offset those losses and enable
us to reinvest in our organization and our people.”
Quantifying the matter, he said the OBBA’s total
projected impact on Mass General Brigham, when
fully phased in, will be between $120 million to $300
million, with $100 million to $200 million from work
requirements, and another $20 million to $100 mil-
lion from Affordable Care Act cuts.
Those are big numbers, and they are expected to
generate a strong ripple effect that will impact hospi-
tals in many different ways, said those we spoke with.
For this issue, BusinessWest takes an in-depth
look at the many challenges facing hospitals today —
and the forecast for the year ahead.
Numbers Game
Hatiras told BusinessWest that, while many hospi-
tals struggled in 2025, HMC did not.
“It’s been a great year for us. We’ve grown our
business, revenue is strong, we’ve done well with our
workforce — it’s going to be a very strong year for us,”
he told BusinessWest, noting that HMC’s fiscal year
ended in September, and he didn’t have hard numbers
yet.
Breaking down the year and the hospital’s perfor-
mance, he said there were several factors that went
into it, including redesign of the state’s waiver sys-
tem — which he credited to the Executive Office of
Health and Human Services and MassHealth officials
— which directed more federal money to providers
across the Commonwealth.
“Everyone benefited from this, some hospitals
more than others,” he said, adding that HMC’s strong
fiscal 2025 was also attributable to growth in primary
care and outpatient services, with an expansion of the
hospital’s overall footprint with new locations, as well
as staff retention and the accompanying reduction in
the high costs of turnover.
“If you’re struggling with staffing and temporary
staffing, that’s a big hit,” Hatiras noted. “We had less
of an issue with that than perhaps others did, and
that’s just one of the many factors that contributed to
a solid 2025.”
Maybe the biggest factor is that lost status as a
best-kept secret, he went on, adding that, while area
residents are finding the facility, so too are healthcare
Business W est
the expenses of turnover, for example.”
“We have to be as
proactive as we can
to prepare for and
manage the impacts
of the Big Beautiful
Bill, in particular.”
KEVIN WHITNEY
Such initiatives will help position CDH to better
handle what could be additional headwinds in the ED,
said Whitney, who, like others we spoke with, said
hospitals must do what they can to prepare for what
is to come and become more resilient in the wake of
those forces.
“We have to be as proactive as we can to prepare
for and manage the impacts of the Big Beautiful Bill,
in particular. It’s about continuing to be the best of the
best in quality, safety, and experience,” he said, citing
the overriding goal at CDH, “and also making sure
that we’re creating the best environment in which to
practice, deliver care, and work and staff appropriate-
ly. The more we can retain folks, it will create more of
a sense of community, but it will also help us reduce
Looking Ahead
Roose agreed, returning to the subject of poten-
tial — even probable — ripple effects from the federal
cuts, and their widespread impact.
“The emergency room is one example,” he said.
“When people don’t have coverage, like Medicaid or
a similar insurance product, they often can’t go to
their primary care provider, so they turn to the emer-
gency room for routine care, which can result in more
crowding in emergency departments, delays, and staff-
ing challenges that impact others.
“So that can have a ripple effect in other areas,
including even cost, including the cost for those with
private insurance because the system isn’t as efficient
and now needs to provide care for many people who
don’t have coverage,” he went on. “And that can have a
ripple effect that can influence operations and staffing
and finances.”
It might be several months into 2026 before the
full impact of the federal legislation — many pieces
of which won’t take effect in April — and those ripple
effects are known, but they could be substantial, he
continued, adding that it is incumbent upon health
systems to prepare as best they can for what is to
come.
“The impact is not insignificant, and it’s something
we’re actively planning around,” Roose said. “And we
won’t know the true impact until it fully plays itself out
— it will be well into 2026 until we fully understand
the impact.”
Meanwhile, there are many different kinds of
headwinds facing hospitals and health systems, some
obvious to the public and some less so, said Hatiras,
citing, as one example, the state’s Paid Family and
Medical Leave (PFML) program, which is certainly
impacting his hospital — and, from what’s he’s heard
anecdotally, others as well.
“We’re pretty good at spotting icebergs. We’re not
like the Titanic; we have people out front looking at
icebergs, and we’ve spotted a few in the time that I’ve
been here, and this is the next big iceberg coming
down — for hospitals and other large employers as
well,” he warned, adding that the system has, in his
view, become abused.
In the case of hospitals, it leaves them forced to fill
staffing voids, often with little notice, and, in the case
of nurses and other professionals, with usually expen-
sive options.
“Prior to the PFML being enacted, on average,
we had about 20,000 to 25,000 hours of leave that
people would take in a year, and that was a little less
than 1% of our total work hours,” he said. “Last year,
we approached 500,000 hours, a 20-fold increase,
amounting to 13% of our total work hours, or the
equivalent of more than 230 FTEs.
“Try to wrap your brain around that number ... this
is out of control,” Hatiras went on, adding that this
is not an HMC problem, but an industry problem,
one that now has the attention of the Massachusetts
Health & Hospital Assoc., which is surveying hospi-
tals to gather information.
Elaborating, he said that, in addition to the leave
being used for long-term health matters, it is being
used intermittently, maybe a few days a week, for
problems such as stress.
“That leaves us in the lurch,” he explained, adding
that, with some positions, such as nursing, it leaves
the hospital few options other than overtime or agen-
cy personnel, which increases costs significantly.
Whether it’s the many expected ripple effects
from the OBBBA or growing detrimental repercus-
sions from PFML, 2026 seems certain to be a year
of intrigue and challenge for area hospitals — and the
full impact of these forces and other headwinds may
not be known for several months. BW
MONTHLY FEATURE 55
DECEMBER 8, 2025