By James X. Stobinski, Ph.D., RN, CNOR, CSSM(E), CNAMB(E)
This month I am returning to a familiar and recurring issue for operating room leadership, financial issues, and reference an article by Jakob Emerson Becker’s Healthcare Review.1 For the detail behind Emerson’s summary readers must go to the website of Kodiak Solutions, to request the free download of the cogent and informative full report on the potential revenue losses for healthcare facilities with the One Big Beautiful Bill Act (OBBBA).2
Kodiak Solutions is a healthcare technology and consulting business that works with over 2,300 American hospitals and maintains an enormous database of financial information. In this report they lay out the overall financial landscape for American hospitals when they report that, “… the median operating profit margin for not-for-profit hospitals last year was just 1.1%.”2 and that, “Most of the hospitals in the Kodiak Platform database are not-for-profits.”2 This concise report summarizes an academic exercise in which they calculated the potential impact of the OBBBA on the finances of American hospitals. Although the full impact of the OBBBA is not yet known, we do know there will be less money devoted to Medicaid spending on the near horizon.
The OBBBA actualizes a smaller federal government with different spending priorities. The Kodiak Benchmarking Analysis reports that there could be up to a $911 billion reduction in Medicaid spending by 2034. The Affordable Care Act increased the overall number of Medicaid enrollees to provide health insurance coverage, but the OBBBA will markedly decrease that number. The net result is that up to 15 million Americans could lose Medicaid coverage. Some who lose coverage may find employer-based insurance, but many will become uninsured, and it is likely that unpaid medical bills will rise sharply as the payer mix shifts for many healthcare facilities.
An ageing American population coupled with longer lifespans yields more people living with chronic illnesses requiring more healthcare. With the OBBBA, some of these individuals will shift from Medicaid and become self-pay patients. The impact of that shift is what Kodiak Solutions forecasts in their report. While the Kodiak Report is an academic exercise the real-life implications for leaders working in surgery are clear. Financial resources will become scarcer and there will be additional pressure to maximize efficiencies in surgical care. The relentless pressure to do more with less will continue.
This report estimates that an average American hospital could lose “0.4 to 1.4% of their net revenue.”2 With profit margin of about 1.1 percent, a loss of net revenue of this size will spell trouble for many facilities. Likely, rural facilities will be heavily impacted as will urban facilities with a current high ratio of Medicaid patients. A shift in payer mix with higher numbers of uninsured patients will exacerbate current financial pressures. The stark reality of healthcare regulation is that financially challenged facilities must still provide some measure of care to all patients and a percentage of those patients will eventually require surgery.
If the Kodiak forecast comes to reality, operating room leaders will face continued pressure to squeeze greater efficiency from their workflows. For hospital-based operating rooms these pressures compound significant current issues. The continued shift of procedures to ambulatory care facilities have cut into the revenue streams of hospital operating rooms.3 Difficulty attracting surgical technologists, sterile processing staff and adequate numbers of new nurses increases labor costs. From a historical perspective, reimbursement is now less generous and surgical patient outcomes now draw more scrutiny. The OBBBA, in even the most optimistic forecasts, will add to the formidable challenges already faced by perioperative nurses. The information in the Kodiak Report gives us much to ponder.
References
- Emerson, J. (2025, September 8). OBBBA impact could cost hospitals $25B a year: Report. Becker’s Hospital Review | Healthcare News & Analysis. https://www.beckershospitalreview.com/finance/obbb-impact-could-cost-hospitals-25b-a-year-report/?origin=BHRE&utm_source=BHRE&utm_medium=email&utm_content=newsletter&oly_enc_id=0705J2387567B1E
- Advanced Healthcare Technology Solutions Provider | Kodiak. (2025, August). Kodiak RCA Benchmarking Analysis. How four different Medicaid disenrollment scenarios would impact hospitals’ net revenue and income. https://www.kodiaksolutions.io/
- Corzo, C. (2024). The move away from acute healthcare to ambulatory care. FIU Business Now Magazine Fall 2024. https://business.fiu.edu/magazine/fall-2024/the-move-away-from-acute-healthcare-to-ambulatory-care.html
