The Wall Street Journal reports that Ascension and Providence St. Joseph Health have halted merger talks and that Ascension has embarked on a new strategic direction.

The WSJ reported in December that the two were discussing a merger, which, if approved, would create the largest U.S.  hospital operator in the U.S., with  191 hospitals across 21 states and total annual revenue of $44.8 billion.

The newspaper reported that Ascension’s new direction was in response to new competition from nontraditional sites of care, such as outpatient clinics, and payers’ pressure to cut reimbursements. The system’s operating margins have declined over the past year.

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