“Fly as close to the flame as you can”: Hospital CEOs on social responsibility in challenging times

The recording below is from a panel at LOWN26: Confronting Healthcare Affordability. All panel recordings are available on Youtube.

What do hospital CEOs think it takes to maintain affordability and sustainability under pressure? We heard from the following hospital leaders at LOWN26. Watch the video and read the summary of the panel!

Medicaid cuts and the path forward

Panelists discussed keeping a balance between financial stability and serving as many uninsured and underserved patients as possible. Dr. Carr recalled when he became CEO at Mount Sinai, he was told that the goal was to “fly as close to the flame as you can.” “Do not let us go bankrupt, but do as much good as possible. That is the tension,” said Carr.

“Do not let us go bankrupt, but do as much good as possible. That is the tension.”

Dr. Brendan Carr, CEO of Mount Sinai Health System

For Zuckerberg San Francisco General Hospital, which serves a substantial number of patients with Medicaid coverage, HR1 (legislation passed in 2025 that includes billions in Medicaid cuts) will have an outsized impact. They stand to lose $300 million per year in revenue from these cuts. At the same time, 60% of their expenses are from salaries and benefits for employees that the hospital does not negotiate. “What we have to do is work on the things that we can control and that’s kind of my mantra,” said Ehrlich. For example, they saved hundreds of hospital days by giving patients a long-lasting antibiotic for skin infections in the emergency department rather than admitting all of them. Ideas from the front line like this one can help save time and money.

Carr noted that Medicaid cuts could lead to even more of a bifurcation of patients between the private and public hospitals, and potentially push patients without access to use AI instead. “I think we’re dangerously close—if we’re not there already—to just accepting this quietly existing two-tiered system,” said Carr.  

“Times like these should not change mission. In fact what it should tell us is if our missions are true.”

Jason Carter, President of Duke Regional Medical Center

Jason Carter from Duke Regional Hospital pushed back against the “duality of margin versus mission” and maintained that the challenges of HR1 should not deter socially responsible hospitals from their mission in fear of financial challenges. “The unfortunate reality in many circumstances in times where things are getting harder, when we should be innovating and investing or prioritizing mission, we all come back into our shells in this cost-minded methodology. Times like these should not change mission. In fact what it should tell us is if our missions are true,” said Carter.

Embracing AI and other creative cost and quality solutions

CEOs explained how they were using AI tools to help improve cost and quality of care. For example, AI tools through their PROSPECT lab allowed San Francisco General to identify racial disparities in readmission rates, and led to the creation of a new clinic for heart failure to address the issue.

Mount Sinai Health System is taking steps to be leaders in AI, not followers. “We want to be the assurance lab. We want to help to make the rules. We want to partner with the tech industry. We don’t think if we just stick our head in the sand, they’re going to stop,” said Carr.

At Duke Regional Hospital, they found that long hospital stays were leading to higher costs and longer wait times. Carter heard from front-line providers that these patients would probably do better if they got time outside. They implemented a program called “Project Sunshine” to give these patients regular time outdoors along with mobility activities, and found reductions in delirium days, workplace violence, and behavioral emergency response calls. As a result, they were well enough to be placed in long-term care when needed, which reduced hospital length of stay.

“In these periods of time when it’s challenging, instead of running to our shell I think we should be running and looking for ways to continue to invest in the system of care,” said Carter. Hospitals should “stop living in this duality of margin and mission and instead looking at it as a singular focus.”