Ascension gets green light from Illinois board to pursue Prime sale

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Ascension first proposed selling roughly half of its Illinois portfolio to Prime in July.

The deal comes amid two years of steep financial losses for Ascension — the hospital operator posted a $1.1 billion net loss in 2024 and a $2.7 billion net loss in 2023. 

Although the transaction is still subject to additional reviews, including by the Archdiocese of Chicago, Tuesday’s approval from Illinois’ Health Facilities and Services Review Board (HFSRB) represents a major step toward closing.

A spokesperson for Ascension said the system was grateful for the board’s “unanimous decision,” adding the sale will “preserve jobs and ensure needed healthcare access across Chicagoland.”

Under the deal, Prime will acquire Ascension Holy Family, Ascension Mercy, Ascension St. Francis, Ascension Resurrection, Ascension St. Elizabeth, Ascension St. Mary hospitals in Kankakee and Chicago and Ascension St. Joseph hospitals in Joliet and Elgin.

Seven of the hospitals are set to become for-profit, according to documents filed to the HFSRB. St. Francis and St. Mary will remain nonprofit facilities.

Prime has proposed closing St. Elizabeth, noting that during 2023 the hospital daily census showed an average of 16.9 patients — less than half the facility’s capacity. Prime also argues that with Ascension St. Mary-Chicago “approximately 1.5 blocks away” the closure would have minimal impact on patients’ access to care. 

Ascension told Healthcare Dive that it supports the closure and had been in the process of consolidating services between Ascension St. Elizabeth and St. Mary prior to Prime seeking to purchase the hospital. 

Prime currently operates 44 hospitals and hundreds of outpatient locations in 14 states. The system says it has a track record of quality and safety, as well as the “unique ability to transform financially struggling hospitals.”

Ascension executives lauded the health system as the “best steward” for Ascension hospitals during a public hearing in September, and noted they selected Prime after conducting extensive due diligence.

However, not everyone is excited about having Prime — which has never operated a hospital in Illinois — take over the facilities. It’s the third time ownership has reshuffled in ten years, with previous owners including Presence Health and Amita Health.

This fall, the Evanston Round Table reported some Illinois residents pressed Prime executives at town halls about whether they were dedicated to patient care or profits. A labor union representing Ascension’s nurses also wrote to the HFSRB to urge them against approving the deal.

Bradley Van Waus, Ascension division director for National Nurses United, asked the board to consider Prime’s history or lawsuits as well as alleged pattern of service cuts and closures in making their decision.

The union also cited Prime’s decision to close five maternity wards in California over the last decade as a potential bellwether for the Chicago area. Last year, Prime’s Los Angeles-based Centinela Medical Center closed its maternity ward despite having a 10% average five-year operating margin, according to the union.

“Prime’s focus on boosting profits lies behind drastic cuts, or the disappearance altogether, of critical but unprofitable healthcare, particularly impacting some of the most vulnerable communities,” Van Waus wrote.

Prime has been accused of engaging in Medicare fraud and conducting kickback schemes. Its most recent settlements occurred in 2018.

In a statement, John Kniery, an administrator for the HFSRB, stood by the board’s approval.

“The Board’s extensive questioning of the overall transaction between Prime and Ascension speaks for itself,” he said. “Prime provided a comprehensive presentation to the Board. Coupled with their response to the Board questioning — especially about past lessons learned and practices — they demonstrated they are fit, willing, and able to enter Illinois and participate in the proposed parts of our healthcare delivery system.”