Providence St. Joseph Health and Ascension Health are discussing a merger that would create the largest hospital system in the U.S., news reports said.

Ascension is based in St. Louis; Providence is based in Renton, Wash., and includes by a previous merger the former St. Joseph Health, which was based in Irvine.

At the time of the mid-2016 link-up, the combined Providence St. Joe had 43 hospitals.

A merger now with Ascension would create a company with 191 hospitals and about $45 billion in revenue, topping Nashville-based HCA Healthcare Inc., which owns 177 hospitals and had $41.5 billion in 2016 revenue.

News reports said the two companies’ discussion is ongoing and includes the possibility of different ways to work together short of a merger.

A merged company would be the latest in a series of deals in a consolidating healthcare industry; most recently Woonsocket, R.I.-based drugstore chain CVS Corp. has offered to buy Hartford, Conn.-based Aetna Inc. for $77 billion, including debt.