As hospitals face continued financial pressure and uncertainty around federal policy and reimbursement, Tampa (Fla.) General Hospital is taking a long-term approach, strengthening operating performance now while continuing to invest in academic medicine and new care delivery models.
John Couris, president and CEO of Tampa General Hospital and Florida Sciences Center, said 2026 is unlikely to bring immediate disruption for most health systems, but he expects the cumulative impact of policy and funding changes to intensify in the years that follow. Tampa General is planning ahead rather than waiting for those pressures to materialize.
“I feel like 2026 is going to be about the barometric pressure dropping. I don’t think we’re going to see huge changes in healthcare in 2026,” Mr. Couris said during an interview with the “Becker’s Healthcare Podcast.” “I think in 2027 and 2028, we’ll start to really feel some significant effects from both policy and funding changes that are being put through the federal government.”
Academic alignment as a strategic investment
Over the past year, one of the system’s most significant initiatives has been further integrating Tampa General and Florida Health Sciences Center with the University of South Florida. Mr. Couris said the work has focused on aligning clinical operations, education, research and finances with USF Health and the Morsani College of Medicine.
“It’s taking a robust academic health system, connecting it with a university and a medical school, the Morsani College of Medicine, and integrating them clinically, integrating them educationally, integrating them from a research perspective, and financially integrating them,” he said.
That integration includes a substantial annual financial commitment. Tampa General invests roughly $162 million a year into the university’s academic enterprise to support faculty salaries, graduate medical education and research programs that are often underfunded.
He framed the spending as fundamental to the system’s long-term strategy, clinical differentiation and workforce pipeline rather than discretionary investment that could be easily reduced.
Margin improvement ahead of expected headwinds
At the same time, Tampa General is focused on strengthening its operating position in anticipation of future reimbursement and funding pressure. The system launched a multiyear operating performance initiative in late 2024 aimed at boosting margins through efficiency and process improvement.
“We have a pretty significant initiative that we call three and 30,” Mr. Couris said. “Three and 30 is we need to improve our operating margins by 3% over the next 30 months, our operating EBITDA margins, to be more specific.”
The effort began at the end of 2024 and spans the entire enterprise and emphasizes discipline, standardization and elimination of inefficiencies rather than workforce reductions. Mr. Couris was clear that layoffs and furloughs are not part of the plan.
“We have no plans to furlough people, lay people off, or freeze positions. That is not in our playbook,” he said. “Everything else is oriented around providing real value to the consumer but doing it by building really efficient and effective care models. That’s going to be some of the most difficult work in front of us and we’re probably not alone in that. Lots of health systems are doing really interesting, important and impactful work. We’re all confronted with the complexity and challenges of remaining focused and disciplined.”
Instead, teams across the organization are focused on improving efficiency and effectiveness in care delivery and operations. Mr. Couris described the work as sustained and demanding, requiring ongoing focus rather than one-time fixes.
“It’s a real grind, and it requires lots and lots of focus and teamwork,” he said.
Care coordination as an operating model
Beyond financial discipline, Tampa General continues to center its strategy on care coordination. Mr. Couris said the system views itself not primarily as a collection of hospitals, but as an organization responsible for guiding patients through complex care journeys.
“We believe we’re in the care coordination business,” he said. “Our job is to coordinate care for patients through the whole system that is seamless, that reduces fragmentation, that eliminates silos, and that applies a systems thinking approach to how we deliver care that’s patient centered and provider centric.”
That approach increasingly begins at the front door. Tampa General recently expanded the use of agentic AI to support patient access and scheduling through its call center, a move that has had an immediate operational impact.
“About a week ago, we turned on our agentic AI tool to schedule appointments,” Mr. Couris said. “When we turned agentic AI on, our call abandonment rate dropped to zero. Every call was answered.”
The health system continues to learn and refine the technology, but early results have reshaped how leaders think about access, throughput and coordination.
Growth through alternative care models
Looking ahead, Mr. Couris said Tampa General’s growth strategy is focused less on expanding inpatient capacity and more on maximizing its existing platform through new models of care.
“I think this may be a little controversial. You know, building more hospitals, that’s an old model. It’s an old paradigm,” he said.
One of the most prominent examples is the system’s hospital-at-home program, which has grown rapidly and now serves a steady population of high-acuity patients. Tampa General has a large program now and is one of the fastest growing in the country.
“We are very busy and this hospital at home program is a game-changer. We’re seeing better outcomes, better quality, better patient and staff satisfaction over time at a lower cost,” said Mr. Couris. “That’s a totally different model of care. What we’re planning for in the future is pivoting from a hospital-at-home program to what we’re calling a health system at home program where we can bring in vertical clinical service lines into the home beyond the traditional inpatient model. For example, infusions: instead of going to the hospital for your infusion, you can get that at home as part of our health system at home offering.”
The model has helped improve emergency department throughput, relieve inpatient capacity constraints and reduce overall cost of care while maintaining quality and satisfaction.
“Hospital at home has been a huge win for us,” Mr. Couris said. “It’s helped our ER throughput. It’s helped some of our busy clinical service lines and getting people out of the hospital, and getting their care delivered at home, which patients absolutely love.”
Tampa General is now planning to expand beyond inpatient substitution toward a broader health system-at-home strategy that brings additional clinical services into patients’ homes. As uncertainty continues to build across the healthcare industry, Mr. Couris said preparation is the most important leadership responsibility.
“Whatever challenges and obstacles get set in front of us, we will figure out as an industry,” he said. “Our industry is very resilient.”
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