Monthly Archives: April 2024

Modern finance team makeovers: Controllers

Posted on by • Posted in Artificial Intelligence, Chief Accounting Officer (CAO), Controller, Controllership Function, Digital Transformation, Finance Department, Financial Close, Generally Accepted Accounting Principles (GAAP), Sarbanes Oxley Act (SOX), Talent Imperative, Talent Management, Talent Pipelines, Trusted Advisor • Leave a comment

https://www.cfodive.com/news/controllers-unsung-finance-heroes/704643

As finance departments undergo seismic tech-driven changes, controllers are poised to play a crucial role as the CFOs’ right hand.

Today’s finance chiefs are making strategic decisions and driving digital transformation, but to execute their changing roles successfully, they need to be supported by an equally resilient, adaptive team.

New technologies, ways of working and shifting business needs are impacting the day-to-day roles not just of the CFO, but of other crucial financial executives as “at the highest level, the entire finance organization is [undergoing] a seismic shift in ways that they haven’t seen ever,” said Sanjay Sehgal, advisory head of markets for Big Four accounting firm KPMG.

Taking a look at the evolving new responsibilities that controllers — as well as other staff in finance departments  — must embrace will be crucial for finance chiefs who must build modern finance teams capable of tackling the upcoming challenges of 2024.

Trusted advisor

The controller “is really becoming and has become the trusted advisor to the CFO,” Sehgal said in an interview.

As with many jobs, the role can vary depending on the company. But generally controllers oversee their company’s daily accounting operations, along with payroll and the accounts payable and receivable departments, according to human resource consulting firm Robert Half. It can also entail preparing internal and external records, handling the firm’s general ledger and taxes as well as reconciling accounts, coordinating audits and managing budgets. 

Already, the importance of the controller position is reflected in compensation trends: the role ranks among the most well-paid members of the finance team, with corporate controllers in the 75th percentile — meaning they take home salaries greater than three-quarter of financial professionals — in compensation earning annual average salaries around $210,750, according to data from human resource consulting firm Robert Half.

Controllers rank among top paid financial professionals

Starting salaries for corporate accounting executives in the 75th percentile

Central to the role too is the responsibility controllers take for their company’s close activities, ensuring the business is “producing information in a controlled fashion, to report to the street and to the Securities and Exchange Commission for a public company,” said Kevin McBride, corporate controller and chief accounting officer for software-as-a-service company ServiceNow.

In his capacity as controller for the Santa Clara, California-based SaaS company, McBride oversees global payroll, accounts payable, travel, collections, and credit, he said in an interview. The role of controller and chief accounting officer can also have some overlap, but don’t need to be combined; a CAO can be another name for a principal accounting officer as required under the Sarbanes-Oxley Act, for example, McBride said. A CAO typically focuses on more broad corporate governance, therefore, while a controller’s focus is more narrowly on processes such as the close and ensuring financial statements are compliant with GAAP.

Controllership is “really getting to the numbers and the descriptors and the story behind financial performance and ensuring that process is well-controlled,” McBride said. Joining ServiceNow in November 2021, he previously logged a 21-year tenure at tech giant Intel, where he served in a variety of key financial roles including as its vice president of finance and corporate controller as well as its global accounting and financial services controller. He also spent time at the Financial Accounting Standards Board as an industry fellow before joining Intel.

Opening a path to the touchless close

In recent years, however, controllers have also found themselves branching out from a pure numbers function as part of the ongoing “seismic shift” taking place in the whole of finance — driven partly by the advent of generative AI, machine learning, cloud technologies and other digital tools which have captivated the attention of finance leaders in recent months, Sehgal said.

New technologies such as GenAI could fundamentally change how controllers operate and the purpose of the role — for example, “I can see a future where we have a touchless close process,” Sehgal said.

This would mean the entire financial close process would no longer need routine manual intervention by such people as the controller, according to a 2022 report by Gartner which noted 55% of finance executives were targeting a touchless close by 2025.

Finance teams could inch closer to making such a process a reality in 2024 as companies continue to experiment with the applications of generative AI, something that could rapidly shift where today’s controllers are directing their time and focus.

The new technologies that have filtered into accounting over the past few decades have enabled their own improvements in quality, efficiency and cost, McBride said, allowing business leaders to get the information they need to run the business at a lower cost. When it comes to the controllership, “it also gives us capacity to invest in other ways to help drive business impact,” he said.

However, it’s also important to remember that technology is “nothing new in accounting,” McBride — who started his career working on paper spreadsheets — said and that in “each one of these technology introductions, there’s the hype and then there’s the reality,” he said. Generative AI and the promise it brings remains in its early stages, he said.

As automation seeps into finance, technology opens up more time by removing routine tasks, in turn enabling the controller and the CFO to deepen their relationship. “With the CFO, we’re spending more time talking about strategic matters and how to best position not just the controllership but finance,” McBride said.

The evolution of the relationship comes as CFOs are likewise pivoting to a role more focused on driving strategy and controllers are finding themselves responsible for processes that may previously have been under the remit of the finance chief.

“As the CFO elevates himself or herself, I think the controller plays a bigger role in the organization,” Sehgal said.

Finance chiefs are serving more and more often as the “right hand” of the CEO and spending less time poring over day-to-day numbers, said Claire Bramley, CFO of San Diego, California-based AI cloud analytics and data platform Teradata. The controller and the CFO work closely together to drive an effective, innovative and forward-looking finance function, but that focus on day-to-day operations is what separates the two positions, Bramley said in an interview.

As a finance chief, “you need to make sure that you’ve got the processes in place, you understand what’s going on,” she said. However, the finance chief is now spending more time figuring out how to drive things forward at the company, she said.

Adding free cash flow forecasts 

Bramley pointed to something like free cash flow as an example: because she’s now spending more time conducting strategy transformation work on part of Teradata, she’s now relying on her controller to take on free cash flow management forecasting, she said.

Controllers, critically, still serve as “the owners of the financial data, from a protocols perspective, from a reporting perspective, and the CFO and the executive teams depend on that,” Sehgal said. Indeed, taking responsibility for the numbers is still the core of the controller’s role, McBride agreed.

However, controllers are not immune to the job creep plaguing the financial function amid a lack of qualified accounting talent, emerging technologies and new business needs. As the CFO’s role evolves into a more strategic position, the rest of finance could potentially be pulled along in their wake.  

“It’s very easy for a controller to be kind of put off to one side … and not be pulled into, I’ll say some of the business and strategic decisions,” Bramley said. “But if you decide as a controller that you want to be more involved in that, I think many companies give you the opportunity to build your business acumen, to build your business relationships and to be able to be an important part of managing the business.”

For example, the controller today has a huge opportunity to take point on digital transformation at a business — the controller organization tends to be the biggest team in the finance function, “so if they can drive [digital transformation], and they can be leading edge, then the rest of finance can adopt that moving forward,” Bramley said.

This can also provide a pathway to controllers to the CFO seat — Bramley spent two years serving as the global controller for HP, where she logged a 14-year tenure before making the jump to Teradata.

“The modern-day controller who is involved in strategic decision making, who is helping add business value, who is having an impact from a technology standpoint, I think, is an obvious candidate for a CFO,” she said.

Interim CFO requests skyrocket 46%: BTG

Posted on by • Posted in Certified Public Accountant (CPA), Interim CFO, Interim Controller, Interim Executives, Interim Financial Leadership, Interim Resources, Interim VP Finance, On Demand Talent, Recruiting, Talent Acquisition Strategy, Talent Competition, Talent Imperative, Talent Management, Talent Pipelines • Leave a comment
https://www.cfodive.com/news/interim-cfo-requests-skyrocket-46-percent-btg-accounting-accountants-hr/712730/?utm_source=Sailthru&utm_medium=email&utm_campaign=Issue:%202024-04-16%20CFO%20Dive%20%5Bissue:61108%5D&utm_term=CFO%20Dive

Companies are turning to interim financial leadership more frequently as they struggle to fill widening gaps in their accounting and finance functions.

Dive Brief:

  • Demand for interim financial leadership skyrocketed last year, with requests for interim CFOs jumping by 46%, according to a report by Business Talent Group, a Heidrick & Struggles company.  
  • As well as interim CFO leadership, requests for on-demand talent with skills in key areas of finance also jumped; requests for talent that’s skilled in audit, accounting and financial controls have increased 33%, while those for FP&A and modeling skills increased 28%, the report found.
  • The rise in demand for audit, accounting and similar skills is “a logical consequence of the declining pipeline of accounting majors and CPA candidates,” Jack Castonguay, an assistant professor of accounting at New York’s Hofstra University, said in an email.

Dive Insight:

Competition to nab skilled accounting talent has only become fiercer in recent years amid a worsening shortage of accounting professionals, leaving companies with critical gaps in their financial leadership and function.

In addition to surging demand for interim CFOs, requests for senior vice president or vice president-level financial professionals — such as controllers and the heads of financial planning & analysis — rose by 114%, according to BTG.

When it comes to roles such as the head of FP&A or controllers, for example, “I think as you have shortages on one end, you’re going to have demand with organizations, whether it be full time or on-demand, for talent coming in,” Sunny Ackerman, global managing partner for on-demand talent at Heidrick & Struggles said in an interview. Ackerman does believe there is a link between the shortage in talent and the spike in requests for on-demand employees in these areas, she said. “So I think there is definitely a correlation for that.”

Historically, many companies have looked to fill roles in FP&A, audit, financial reporting and up to the CFO or controller chair with employees that have previously worked for an accounting firm, but dynamics have changed in recent years where many roles in accounting are now outsourced, Castonguay said.

“With accounting firm dynamics, largely insufficient salaries and work-life balance leaving firms struggling to attract people to the profession, the companies needing these people are now logically also struggling,” he said in an email. “You cannot disconnect the two.”

The narrower pipeline of new accounting graduates plus a high rate of retirement in the industry can leave the employees that are left overworked, increasing the likelihood of mistakes, according to a report by Fortune.

“Significant attrition” in the accounting department for retail brand Tupperware contributed to a delay in the company’s ability to file its annual 10-K form on time with the Securities and Exchange Commission, for example, the second consecutive year the brand will be filing late.  

“Fewer grads lead to fewer public accountants which leads to fewer qualified and experienced hires for companies to place in their internal accounting-focused roles,” Castonguay said. “The dynamic makes me wonder how the temporary or outsourced staffing firms are finding candidates at their staffing firms. It’s possible that will be the next shoe to drop.”

On the labor side, changing ways of working may also be impacting how employees want to work; while there may be shortages in certain areas, the company is not necessarily seeing a slowdown of new candidates joining their platform, Ackerman said. 

“So I think, even though there’s shortages in certain areas, I think talent is looking at this way of working differently than they did five years ago, and more companies are engaging with it,” she said. 

Companies may also be more motivated to try out on-demand talent as they look to plug critical skill gaps in their workforces. Ninety-five percent of executives said they anticipate difficulty finding the “ideal combination of skills, capacity and expertise” inside their teams, BTG’s report said.

Today’s companies “now are starting to really open up and look at how they can blend full time talent with more independent talent and tapping into those capabilities at the desired time,” Ackerman said.

That includes how they might be approaching interim leadership; many firms are looking for on-demand talent to help provide critical support for larger-scale projects or initiatives, according to BTG, a category that makes up 27% of all talent requests.

Interim leadership can provide benefits to companies who are in transition or who are undertaking major changes, according to a 2023 CFO Dive report citing BTG data from that year.

An interim controller, for example, could take point on business process optimization for the business to successfully execute such a project; “the CFO or that finance function is quite a bit of a right hand, I would say to the executive suite,” Ackerman said.

8 Reasons Hospitals must Re-think their Future

Posted on by • Posted in 2024 Election Issues, Affordability, Health Insurance Industry, Health Policy, Health System, Hospital, Hospital Industry, Inflation, Market Consolidation, Market Power, Media Backlash, Medical Debt, Medicare Funding, Medicare Payment, Operating Expenses, Operating Income, Operating Margin, Operating Margin Drivers, Operating Metrics, Operating Performance, Operating Revenue, Physician Compensation, Physician Discontent, Physician Shortage, Physician Workforce, Strategic Change, Strategy, Strategy and Transformation, Surprise Bills, Survival Mode, Sustainable, Value-Based Healthcare • Leave a comment
8 Reasons Hospitals must Re-think their Future

Today is the federal income Tax Day. In 43 states, it’s in addition to their own income tax requirements. Last year, the federal government took in $4.6 trillion and spent $6.2 trillion including $1.9 trillion for its health programs. Overall, 2023 federal revenue decreased 15.5% and spending was down 8.4% from 2022 and the deficit increased to $33.2 trillion. Healthcare spending exceeded social security ($1.351 trillion) and defense spending ($828 billion) and is the federal economy’s biggest expense.

Along with the fragile geopolitical landscape involving relationships with China, Russia and Middle East, federal spending and the economy frame the context for U.S. domestic policies which include its health system. That’s the big picture.

Today also marks the second day of the American Hospital Association annual meeting in DC. The backdrop for this year’s meeting is unusually harsh for its members:

Increased government oversight:

Five committees of Congress and three federal agencies (FTC, DOJ, HHS) are investigating competition and business practices in hospitals, with special attention to the roles of private equity ownership, debt collection policies, price transparency compliance, tax exemptions, workforce diversity, consumer prices and more.

Medicare payment shortfall: 

CMS just issued (last week) its IPPS rate adjustment for 2025: a 2.6% bump that falls short of medical inflation and is certain to exacerbate wage pressures in the hospital workforce. Per a Bank of American analysis last week, “it appears healthcare payrolls remain below pre-pandemic trend” with hospitals and nursing homes lagging ambulatory sectors in recovering.”

Persistent negative media coverage:

The financial challenges for Mission (Asheville), Steward (Massachusetts) and others have been attributed to mismanagement and greed by their corporate owners and reports from independent watchdogs (Lown, West Health, Arnold Ventures, Patient Rights Advocate) about hospital tax exemptions, patient safety, community benefits, executive compensation and charity care have amplified unflattering media attention to hospitals.

Physicians discontent: 

59% of physicians in the U.S. are employed by hospitals; 18% by private equity-backed investors and the rest are “independent”. All are worried about their income. All think hospitals are wasteful and inefficient. Most think hospital employment is the lesser of evils threatening the future of their profession. And those in private equity-backed settings hope regulators leave them alone so they can survive. As America’s Physician Group CEO Susan Dentzer observed: “we knew we’re always going to need hospitals; but they don’t have to look or operate the way they do now. And they don’t have to be predicated on a revenue model based on people getting more elective surgeries than they actually need. We don’t have to run the system that way; we do run the healthcare system that way currently.”

The Value Agenda in limbo:

Since the Affordable Care Act (2010), the CMS Center for Innovation has sponsored and ultimately disabled all but 6 of its 54+ alternative payment programs. As it turns out, those that have performed best were driven by physician organizations sans hospital control. Last week’s release of “Creating a Sustainable Future for Value-Based Care: A Playbook of Voluntary Best Practices for VBC Payment Arrangements.” By the American Medical Association, the National Association of ACOs (NAACOs) and AHIP, the trade group representing America’s health insurance payers is illustrative. Noticeably not included: the American Hospital Association because value-pursuers think for hospitals it’s all talk.

National insurers hostility:  

Large, corporate insurers have intensified reimbursement pressure on hospitals while successfully strengthening their collective grip on the U.S. health insurance sector. 5 insurers control 50% of the U.S. health insurance market: 4 are investor owned. By contrast, the 5 largest hospital systems control 17% of the hospital market: 1 is investor-owned. And bumpy insurer earnings post-pandemic has prompted robust price increases: in 2022 (the last year for complete data and first year post pandemic), medical inflation was 4.0%, hospital prices went up 2.2% but insurer prices increased 5.9%.

Costly capital: 

The U.S. economy is in a tricky place: inflation is stuck above 3%, consumer prices are stable and employment is strong. Thus, the Fed is not likely to drop interest rates making hospital debt more costly for hospitals—especially problematic for public, safety net and rural hospitals. The hospital business is capital intense: it needs $$ for technologies, facilities and clinical innovations that treat medical demand. For those dependent on federal funding (i.e. Medicare), it’s unrealistic to think its funding from taxpayers will be adequate.  Ditto state and local governments. For those that are credit worthy, capital is accessible from private investors and lenders. For at least half, it’s problematic and for all it’s certain to be more expensive.

Campaign 2024 spotlight:

In Campaign 2024, healthcare affordability is an issue to likely voters. It is noticeably missing among the priorities in the hospital-backed Coalition to Strengthen America’s Healthcare advocacy platform though 8 states have already created “affordability” boards to enact policies to protect consumers from medical debts, surprise hospital bills and more.

Understandably, hospitals argue they’re victims. They depend on AHA, its state associations, and its alliances with FAH, CHA, AEH and other like-minded collaborators to fight against policies that erode their finances i.e. 340B program participation, site-neutral payments and others. They rightfully assert that their 7/24/365 availability is uniquely qualifying for the greater good, but it’s not enough. These battles are fought with energy and resolve, but they do not win the war facing hospitals.

AHA spent more than $30 million last year to influence federal legislation but it’s an uphill battle. 70% of the U.S. population think the health system is flawed and in need of transformative change. Hospitals are its biggest player (30% of total spending), among its most visible and vulnerable to market change.

Some think hospitals can hunker down and weather the storm of these 8 challenges; others think transformative change is needed and many aren’t sure. And all recognize that the future is not a repeat of the past.

For hospitals, including those in DC this week, playing victim is not a strategy. A vision about the future of the health system that’s accessible, affordable and effective and a comprehensive plan inclusive of structural changes and funding is needed. Hospitals should play a leading, but not exclusive, role in this urgently needed effort.

Lacking this, hospitals will be public utilities in a system of health designed and implemented by others.

America’s newest doctors fuel efforts to unionize

Posted on by • Posted in Health System, Hospital, Hospital Industry, Labor Shortages, Labor Union, Market Consolidation, Market Power, Physician Burnout, Physician Compensation, Physician Shortage, Physician Workforce, Physician's Labor Union • Leave a comment

https://www.axios.com/2024/04/15/doctors-union-gen-z-millennial

A new generation of doctors struggling with ever-increasing workloads and crushing student debt is helping drive unionization efforts in a profession that historically hasn’t organized.

Why it matters: 

Physicians in training, like their peers in other industries, increasingly see unions as a way to boost their pay and protect themselves against grueling working conditions as they launch their careers.

What they’re saying: 

“We deserve an increased salary to be able to afford to live in one of the most expensive areas in the United States,” said Ali Duffens, a third-year internal medicine resident at Kaiser Permanente’s San Francisco Medical Center.

  • She’s among the 400 residents at Kaiser’s Northern California system filing to unionize earlier this month.
  • Duffens earns about $82,000 per year, while paying $3,000 a month for rent and facing $350,000 in medical school loans.

The big picture: 

The Kaiser residents are part of a growing number of younger peers in medicine who have been unionizing in recent years.

  • The number of medical residents in unions has about doubled to more than 32,000 in three years, per CalMatters.
  • In the last year, residents at Montefiore Medical Center, Stanford Health Care, George Washington University and the University of Pennsylvania voted to unionize, per WBUR.
  • “The cost of day care … in a month is about half of my salary in total, and the cost of a nanny is essentially the entirety of my salary,” Leah Rethy, an internal medicine resident with Penn Medicine, told NPR last year.
  • Residents can work as much as 80 hours per week while earning far less than their older colleagues.

Yes, but: Just about 6%-7% of physicians are estimated to be in unions.

  • Historically, doctors have thought they could just suck up the long hours and relatively low pay in training as part of the tradition of medicine, said Robert Wachter, chair of the department of medicine at the University of California, San Francisco.
  • “For a new generation, they look at it and say, ‘That’s crazy. I can’t believe you did that. I want to work hard, but I also want a life and I want a family, and I want a reasonable income,'” he said.

And it’s not just younger doctors. 

Those more established in their careers are also unionizing as they see the industry changing in ways that they think undermine their profession.

  • In recent months, attending physicians at Salem Hospital, owned by Mass General Brigham, and a Cedars Sinai-owned anesthesiology practice filed to unionize.
  • About 600 doctors at Allina Health in Minnesota and Wisconsin last fall agreed to form what appears to be the largest union of private sector physicians.

Zoom in: 

The corporatization of American medicine is seen as a key driver. More than half of all U.S. doctors now work for a health system or large medical group rather than running an independent practice.

  • This shift has brought heavier workloads and less control over how they care for patients, said John August, director of health care labor relations in the Scheinman Institute on Conflict Resolution at the ILR School at Cornell.
  • That could mean demands to see more patients, limiting the time that doctors can spend with them.
  • “What you will hear from them 100% of the time in every conversation they have is they feel that they have lost control over the patient-physician relationship. I mean, every single physician says that now,” August said.

The other side: 

Health systems and large practices generally say they value their doctors and the relationships they hold with patients.

  • Hospitals have also struggled with pandemic-era financial shortfalls, including increasing labor costs.

The bottom line: 

While this is a labor issue, it ultimately trickles down to quality and safety for patients, said Rachel Flores, organizing director of the Union of American Physicians and Dentists.

  • “Patients should care because that’s less time to address their issues,” she said. “Patients should care because there’s not enough staff to support the physician.”

23 health systems with strong finances

Posted on by • Posted in Financial Performance, Financial Ratios, Financial Reserves, Financial Stewardship, Financial Strength, Financial Viability, Health System, Hospital, Hospital Industry, Net Income, Nonoperating Income, Operating Expenses, Operating Income, Operating Margin, Operating Metrics, Operating Performance • Leave a comment
https://www.beckershospitalreview.com/finance/20-health-systems-with-strong-finances.html?origin=CFOE&utm_source=CFOE&utm_medium=email&utm_content=newsletter&oly_enc_id=2893H2397267F7G

Here are 23 health systems with strong operational metrics and solid financial positions, according to reports from credit rating agencies Fitch Ratings and Moody’s Investors Service released in 2024.

Avera Health has an “AA-” rating and a stable outlook with Fitch. The rating reflects the Sioux Falls, S.D.-based system’s strong operating risk and financial profile assessments, and significant size and scale, Fitch said.  

Cedars-Sinai Health System has an “AA-” rating and a stable outlook with Fitch. The rating reflects the Los Angeles-based system’s consistent historical profitability and its strong liquidity metrics, historically supported by significant philanthropy, Fitch said. 

Children’s Health has an “Aa3” rating and stable outlook with Moody’s. The rating reflects the Dallas-based system’s continued strong performance from a focus on high margin and tertiary services, as well as a distinctly leading market share, Moody’s said.    

Children’s Hospital Medical Center of Akron (Ohio) has an “Aa3” rating and stable outlook with Moody’s. The rating reflects the system’s large primary care physician network, long-term collaborations with regional hospitals and leading market position as its market’s only dedicated pediatric provider, Moody’s said. 

Children’s Hospital of Orange County has an “AA-” rating and a stable outlook with Fitch. The rating reflects the Orange, Calif.-based system’s position as the leading provider for pediatric acute care services in Orange County, a position solidified through its adult hospital and regional partnerships, ambulatory presence and pediatric trauma status, Fitch said. 

Cook Children’s Medical Center has an “Aa2” rating and stable outlook with Moody’s. The ratings agency said the Fort Worth Texas-based system will benefit from revenue diversification through its sizable health plan, large physician group, and an expanding North Texas footprint.   

El Camino Health has an “AA” rating and a stable outlook with Fitch. The rating reflects the Mountain View, Calif.-based system’s strong operating profile assessment with a history of generating double-digit operating EBITDA margins anchored by a service area that features strong demographics as well as a healthy payer mix, Fitch said. 

JPS Health Network has an “AA” rating and stable outlook with Fitch. The rating reflects the Fort Worth, Texas-based system’s sound historical and forecast operating margins, the ratings agency said. 

Mass General Brigham has an “Aa3” rating and stable outlook with Moody’s. The rating reflects the Somerville, Mass.-based system’s strong reputation for clinical services and research at its namesake academic medical center flagships that drive excellent patient demand and help it maintain a strong market position, Moody’s said. 

McLaren Health Care has an “AA-” rating and stable outlook with Fitch. The rating reflects the Grand Blanc, Mich.-based system’s leading market position over a broad service area covering much of Michigan, the ratings agency said. 

Med Center Health has an “AA-” rating and stable outlook with Fitch. The rating reflects the Bowling Green, Ky.-based system’s strong operating risk assessment and leading market position in a primary service area with favorable population growth, Fitch said.  

Novant Health has an “AA-” rating and stable outlook with Fitch. The ratings agency said the Winston-Salem, N.C.-based system’s recent acquisition of three South Carolina hospitals from Dallas-based Tenet Healthcare will be accretive to its operating performance as the hospitals are highly profited and located in areas with growing populations and good income levels. 

Oregon Health & Science University has an “Aa3” rating and stable outlook with Moody’s. The rating reflects the Portland-based system’s top-class academic, research and clinical capabilities, Moody’s said.  

Orlando (Fla.) Health has an “AA-” rating and stable outlook with Fitch. The rating reflects the health system’s strong and consistent operating performance and a growing presence in a demographically favorable market, Fitch said.  

Presbyterian Healthcare Services has an “AA” rating and stable outlook with Fitch. The Albuquerque, N.M.-based system’s rating is driven by a strong financial profile combined with a leading market position with broad coverage in both acute care services and health plan operations, Fitch said. 

Rush University System for Health has an “AA-” rating and stable outlook with Fitch. The rating reflects the Chicago-based system’s strong financial profile and an expectation that operating margins will rebound despite ongoing macro labor pressures, the rating agency said. 

Saint Francis Healthcare System has an “AA” rating and stable outlook with Fitch. The rating reflects the Cape Girardeau, Mo.-based system’s strong financial profile, characterized by robust liquidity metrics, Fitch said. 

Saint Luke’s Health System has an “Aa2” rating and stable outlook with Moody’s. The Kansas City, Mo.-based system’s rating was upgraded from “A1” after its merger with St. Louis-based BJC HealthCare was completed in January. 

Salem (Ore.) Health has an”AA-” rating and stable outlook with Fitch. The rating reflects the system’s dominant marketing positive in a stable service area with good population growth and demand for acute care services, Fitch said. 

Seattle Children’s Hospital has an “AA” rating and a stable outlook with Fitch. The rating reflects the system’s strong market position as the only children’s hospital in Seattle and provider of pediatric care to an area that covers four states, Fitch said.  

SSM Health has an “AA-” rating and stable outlook with Fitch. The St. Louis-based system’s rating is supported by a strong financial profile, multistate presence and scale with good revenue diversity, Fitch said. 

University of Colorado Health has an “AA” rating and stable outlook with Fitch. The Aurora-based system’s rating reflects a strong financial profile benefiting from a track record of robust operating margins and the system’s growing share of a growth market anchored by its position as the only academic medical center in the state, Fitch said. 

Willis-Knighton Medical Center has an “AA-” rating and positive outlook with Fitch. The outlook reflects the Shreveport, La.-based system’s improving operating performance relative to the past two fiscal years combined with Fitch’s expectation for continued improvement in 2024 and beyond. 

No appointments available: America’s escalating primary care shortage

Posted on by • Posted in Physician Compensation, Physician Shortage, Physician Workforce, Primary Care, Primary Care Workforce, Workforce Shortages, Workforce Strategy • Leave a comment
https://www.healthcaredive.com/news/no-appointments-available-americas-escalating-primary-care-shortage/712049/?utm_source=Sailthru&utm_medium=email&utm_campaign=Issue:%202024-04-15%20Healthcare%20Dive%20%5Bissue:61075%5D&utm_term=Healthcare%20Dive

Chronic disinvestment and inadequate training have created a shortage of primary care workers.

As the presidential election nears, issues from the economy to climate change are vying for airtime, yet markedly absent from the headlines is a deepening crisis that threatens the future health and wellbeing of communities nationwide: a primary care sector on the brink of collapse.  

Primary care is the cornerstone of community health. It helps us live longer lives, prevents disease and reduces health disparities. It is indispensable to strengthening our nation’s ability to withstand another deadly pandemic or climate disaster. And yet, over 100 million Americans report they lack access to a regular doctor or source of care.

Physicians and patients acutely feel the primary care workforce shortage. In recent interviews we heard an alarming refrain from clinicians and health executives: “I could spend all my time helping friends find doctors accepting new patients.” Another said, “I have 100 open staff positions and am in a bidding war for primary care physicians.”

Just in the past decade, there has been a 36% jump in the share of U.S. children without a usual source of care. Among adults it’s a 21% increase, according to a Milbank report. And with America’s rapidly aging population, access to critical primary care services is only expected to get worse. 

Understanding what’s driving America’s primary care workforce shortage is key to finding effective, long-term solutions. 

A workforce exodus amid chronic disinvestment

America is not producing enough primary care physicians to meet growing population needs. New primary care physicians are leaving for other fields at alarming rates. In 2021, only 15% of all physicians were practicing outpatient primary care three to five years after residency, according to a Milbank report. 

When we look at the disparities in compensation rates and the nation’s chronic disinvestment in primary care, this workforce exodus shouldn’t come as a surprise. Specialists in the U.S. now routinely make two to three times what their primary care colleagues do, creating powerful incentives for physicians in training to “go for the gold.” 

Primary care accounts for 35% of healthcare visits but receives only about 5% to 7% of total healthcare expenditures. For context, hospitals account for 30% of healthcare expenditures. Additionally, since 2019, the share of total spending by Medicare, Medicaid and commercial insurers in primary care has steadily declined; Medicare’s share has dropped by 15%, according to Milbank.

Inadequate training, disparities in access

Today, the vast majority of primary care residents train within hospitals and academic health centers, which do not expose them to the needs of underserved communities, nor provide them with the skills needed to successfully practice in challenging, real-world clinical environments. In 2021, only 15% of primary care residents spent a majority of their time training in community settings, outside of hospitals. 

Moving forward, the solutions are clear. Congress and both the public and private sectors must work together to enact stronger federal and state policies in three critical primary care areas. First, Medicare and Medicaid physician reimbursement — which has led to our specialty-dominated healthcare system — must become more effective and efficient. We know that inadequate compensation is one reason why many medical students choose not to go into primary care.  

Second, the billions in public dollars going to clinician training must be focused on creating a highly skilled primary care workforce with practical experience in community settings. This is essential to meet the complex health needs of our nation’s ever-changing and growing population. 

And finally, we need to expand the footprint of community health centers, the linchpin to improving health outcomes in underserved communities. Currently, these centers provide care to 1 in 11 patients around the country, but that number needs to be vastly expanded.

It’s time to strengthen our fragile primary care system to ensure it delivers the comprehensive, affordable care Americans so desperately need. Access to high-quality primary care for everyone should not be an aspiration, but an expectation that we – as a nation – have an urgent duty to fulfill.

Medical Properties Trust selling spree continues, Utah deal closes

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The deal is expected to generate approximately $1.1 billion in in cash for the liquidity-strapped hospital landlord.

Dive Brief:

  • Medical Properties Trust has sold the majority of its interests in five Utah hospitals for $886 million, the hospital landlord said Friday. The hospitals included in the deal are currently leased to a subsidiary of CommonSpirit Health.
  • The buyer is an unspecified investment firm’s newly formed joint venture. The JV also granted MPT a $190 million non-recourse secured loan — meaning if MPT defaults, the lender cannot collect MPT’s other assets or income. In total, MPT expects the two transactions to generate $1.1 billion in immediate cash, according to the announcement.
  • The sale comes just three days after the landlord sold five hospitals to Prime Healthcare for $350 million.

Dive Insight:

MPT is on a selling spree in order to free up liquidity.

The Birmingham, Alabama-based real estate investment trust has said it’s been heavily exposed during the Dallas-based Steward Health Care’s financial meltdown.

Steward accounted for 19.2% of MPT’s assets as of Dec. 31 and was the largest tenant in its portfolio, according to MPT’s 2023 annual report. The for-profit physician owned network began delaying rent payments to MPT in September, and only paid $16 million of its required $70 million of rent during the fourth quarter. At the same time, MPT was funding multiple rounds of asset-backed loans to Steward, according to the filing.

MPT reported a net loss of $556 million for fiscal year 2023, citing the Steward shortfall as a significant contributor to the results.

The loss of Steward’s rent cushion — coupled with increasing interest rates and $1.3 billion of debt coming due within the next year — motivated the company to pursue several sales early this year, MPT said.

During its fourth quarter earnings call, investors asked whether Steward’s financial instability could play out in the their dividend checks moving forward. 

“The dividend is not dependent on Steward’s rent. It’s more dependent on our ability to close some of these liquidity transactions,” MPT CEO Edward K. Aldag Jr. said. MPT announced its quarterly dividend of $0.15 per share alongside the Utah deal. 

Aldag said the company hoped to sell enough property to shore up at least $2 billion in liquidity. With the Utah deal closed, the CEO said in a release that he is now “confident” MPT will exceed that threshold.

MPT’s stock price was up 20.8% when the markets opened Monday morning, trading at $4.80 per share.