For several large health systems, the selling phase is ending. In May, Becker’s reported that Dallas-based Tenet Healthcare, St. Louis-based Ascension and Franklin, Tenn.-based Community Health Systems were shedding hospitals and putting the proceeds into surgery centers.
Five months later, the next phase is clearer. These systems are reporting improved margins and are treating that recovery as permission to grow again, carefully and close to home.
Here are four patterns emerging as systems move from defense to offense.
They fixed operations before buying
Ascension lost $3 billion from operations in fiscal 2023. For the fiscal year ended June 30, 2026, the system narrowed its operating loss by $371 million, to $120 million. Excluding interest on bonds issued ahead of its acquisition of Nashville, Tenn.-based Amsurg, an ambulatory surgery center operator with more than 250 centers in 34 states, and related transaction costs, Ascension’s core operations generated $109 million in operating income. It ended fiscal 2026 with 233 days cash on hand.
Executive Vice President and CFO Saurabh Tripathi credited what he calls “relentless incrementalism.” “Every day you come in, focus on a small, tiny improvement on a consistent basis, whether it’s volume, cost, efficiency, length of stay — all the key metrics,” he told Becker’s.
Renton, Wash.-based Providence followed a similar order. Over the course of its turnaround, it cut leadership layers, scaled back underused programs and reduced agency staffing. It also delayed a planned acute skilled nursing program with Select Medical. In the first half of 2026, Providence reported $175 million in operating income, a $400 million improvement over the first half of 2025.
“We are now moving into a growth mode,” CEO Erik Wexler told Becker’s in July.
They’re buying in markets they already know
The new deals mostly deepen existing footprints rather than opening new regions. On Oct. 1, Austin, Texas-based Ascension Seton signed a definitive agreement to acquire a hospital and two urgent care sites in the north Austin area from Cedar Park, Texas-based Family Hospital Systems. Ascension Seton already operates 12 hospitals and more than 200 care sites in Central Texas, and the deal is expected to close later this year. Ascension is pursuing a similar move in Tennessee. In July, Franklin, Tenn.-based Williamson Health’s board voted to pursue a sale to Nashville-based Ascension St. Thomas valued at about $700 million, a process expected to extend into 2027 or 2028.
“Austin and its surrounding suburbs are among the fastest-growing communities in the nation, and our healthcare services need to expand to match that growth,” Jamie Youssef, ministry market CEO of Ascension Texas, said in October.
Ascension’s largest move, the roughly $3.9 billion Amsurg deal, closed in June and expanded its ambulatory platform to more than 300 surgery centers. Executives have framed the deal as an extension of the existing hospital network rather than a standalone bet.
“We see [Amsurg] as a major accelerant to build more hub-and-spoke around our existing hospital system network in our nine markets,” Executive Vice President and Chief Clinical Officer Thomas Aloia, MD, said.
CHS has divested about 35% of its portfolio since 2019. Over the past three to four years, it has also added 500 to 600 beds to its core portfolio, along with freestanding emergency departments, surgery centers and clinics. Its net revenue was $12.5 billion in 2025, compared with about $13 billion in 2019.
“The EBITDA is also relatively close, even though we have 35% fewer facilities,” CEO Kevin Hammons said in February. CFO Jason Johnson added that interest in selling the remaining assets “is certainly dwindling.”
They’re exiting businesses outside care delivery
The pruning now goes beyond hospitals. In October, Ascension agreed to sell its stake in Arizona Medicaid managed care plan Mercy Care to Aetna. San Francisco-based Dignity Health, part of Chicago-based CommonSpirit, is selling its stake as well. Ascension expects the sale, which is set to close in fiscal 2027 pending regulatory approval, to free up at least $1 billion for the two systems combined to put back into provider operations.
The deal continues an earlier retreat from insurance. In November 2023, Ascension sold its 50% stake in Network Health to Milwaukee-based Froedtert Health, and in 2025 it exited ACA marketplace coverage in Texas, Indiana, Kansas and Tennessee.
“The insurance part is probably not our core strength,” Mr. Tripathi told Becker’s.
CommonSpirit has also exited Conifer Health Solutions and is bringing revenue cycle operations in-house. In December 2025, CHS sold its ambulatory outreach lab assets to LabCorp for $194 million.
Growth, with guardrails
The return to growth comes with tighter controls on spending. Any Providence commitment above $250 million goes to the board, Mr. Wexler previously said. The system’s ambulatory priorities are diagnostics, surgery centers — where it is seeking a partner — and virtual care.
Tenet sold 14 hospitals for more than $4.8 billion in 2024 and has since committed to a steady annual pace of surgery center deals. After putting about $339 million into surgery center acquisitions in 2025, it plans to invest at least $250 million a year in such deals.
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