Ascension Health Alliance caught some attention last month when the nation’s largest Catholic hospital system formed a partnership with Google to find and use patient data in a more efficient way.  But for those who are watching Ascension’s business practices, this seems more of a practical move to cut the company’s losses. 

According to current president and CEO Joseph Impicciche, Ascension paid out more than $2 billion in charity care and community services last year, but the hospital system was looking toward other methods of profiting from other patients and absorbing as much costs as possible. 

Back in 2018, the system cut $465 million in costs from its administrative offices. Ascension also stopped pursuing a merger that would have made it the nation’s largest hospital operator (it’s just the biggest Catholic hospital now), choosing to focus on more ambulatory services that work more efficiently and avoid the high costs of in-patient care. Around the same time, Ascension formed partnerships with Ramsay Health Care to improve its supply chains, and also Centene to create a joint venture that would sell Medicare Advantage plans, or supplementary private insurance to Medicare users. Ascension’s investment arm also led a $32.8 million Series D round of AI startup Olive, which aims to automate a lot of the repetitive tasks in hospitals to create more 

Enter Impicciche this July, mandated with balancing his promises to provide care for those who can’t pay while continuing the system’s revenue increase, which jumped to $12.6 billion in the second half of 2018. The C-suite shift also elevated Eduardo Conrado, an executive vice president and chief of innovation strategy who once held the same role for telecom company Motorola Solutions. 

By the latest available nonprofit tax forms, Impicciche earned more than $3.4 million as EVP in 2017, while their CEO at the time, Anthony Tersigni, earned a whopping $13.6 million. 

When he speaks to the media, Impicciche is quick to call comprehensive health care a right for all citizens and voice his support for universal coverage. 

But Ascension’s lobbying appeared to ramp up in line with their cost-saving approach. The nonprofit’s lobbying so far this year is nearly $1.8 million, already in the third quarter this year outpacing the amount Ascension spent lobbying through the full 2018 cycle. Most of their pet issues this year involved preserving drug pricing secrecy, which Impicciche has argued would confuse patients rather than offer more competitive prices. 

In 2018, Ascension lobbyists also participated in widening patient record access, working against a privacy statute that allows only substance use disorder patients to have authority over their medical records, instead lumping it into the looser regulations under HIPAA. 

As for the partnership with Google, Project Nightingale will reportedly build an easier and more efficient data platform through cloud services, which would allow clinicians better access. Both Ascension and Google said the latter would not be able to use patient data for commercial purposes. 

But there’s already a multi-billion dollar industry around cleaning, organizing, packaging and using patient data, which is more of a cost burden to hospitals that have to store and manage it until someone pitches a way to monetize it. And though health care providers are the clear owners of health care data under HIPAA provisions, the use of data becomes murky in granting use for “research” or “health care operations” purposes. 

As health care legal advisor Jodi Daniel told NPR last year: “If [someone’s] trying to use your information in order to develop a product that he can then sell and make millions of dollars off of, that might not be a ‘health care operation,’ ” she says. “But there isn’t a clear interpretation at this point.”