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What Trinity announced
The Livonia, Mich.-based system, which runs 92 hospitals and employs about 133,000 people in 25 states, said in mid-January that it will transition certain revenue cycle functions that do not involve patient contact to an external partner. Revenue cycle is a shared service across Trinity, and the cuts span 15 states. Trinity did not say how many people are affected in total.
The system pointed to reimbursement that does not cover the cost of care, rising supply and drug expenses, staffing shortages and federal funding cuts. It expects recent and future government policy changes could reduce annual revenue by $1.5 billion. In its fiscal year ended June 30, 2025, Trinity reported a $12.2 million operating loss on $25.4 billion in operating revenue, close to breakeven but with little cushion against those changes.
Why this matters beyond Trinity
Revenue cycle teams, including coding, billing and follow-up roles, are among the largest non-clinical workforces in any system. They are also a natural target when leaders look for savings that do not touch the bedside. Trinity’s move follows workforce reductions at Providence and Memorial Sloan Kettering in 2025, and comes as hospitals plan for Medicaid cuts in last year’s federal budget law and the expiration of enhanced ACA marketplace subsidies.
Questions to settle before outsourcing
- What exactly is the savings case? Compare the vendor’s fee structure against fully loaded internal costs, including management overhead and technology, over the full contract term.
- How will performance be measured? Contracts should set targets for days in accounts receivable, denial rates, cash collections and patient billing complaints, with financial penalties for misses.
- What expertise stays in-house? Keep enough internal staff to oversee the vendor, manage payer disputes and bring the work back if needed.
- How is the patient experience protected? Billing errors and confusing statements damage trust. Set standards for patient-facing communication even when the work happens offsite.
- How are affected employees treated? Offer transfer opportunities with the vendor, severance and redeployment into open roles. How a system handles these cuts shapes morale among the staff who remain.
More systems are likely to review back-office work this year. Leaders who define the trade-offs clearly will make better decisions than those driven only by the size of the savings.
Archive entry for Jan 20, 2026, added Nov. 11, 2026.