7 AREAS CFOS MUST ADDRESS FOR ORGANIZATIONAL VIABILITY

https://www.healthleadersmedia.com/finance/7-areas-cfos-must-address-organizational-viability?utm_source=silverpop&utm_medium=email&utm_campaign=20180613_HLM_SPOTLIGHT_Cost-Containment%20(1)&spMailingID=13684315&spUserID=MTY3ODg4NTg1MzQ4S0&spJobID=1421195534&spReportId=MTQyMTE5NTUzNAS2

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An upcoming CFO roundtable provides a peer-sharing platform to learn best practices for advancing a healthcare organization’s financial health.

Today’s healthcare financial leaders face escalating costs, quality improvement issues, difficult reimbursement environments, an increasingly complex service portfolio, and risk management associated with performance contracting.

Pressure mounts on CFOs to ensure their organizations remain viable as they deal with these issues, which makes gleaning proven strategies from colleagues imperative.

Four dozen executives will convene at a private roundtable forum during the 2018 HealthLeaders Media CFO Exchange, August 8–10 in Santa Barbara, California, to
address top-of-mind concerns.

In pre-event planning calls, Exchange participants—representing integrated health systems, academic medical centers, community hospitals, and safety net providers from across the U.S.—want to know how others are taking on risk, improving costs, addressing consumerism, and capturing additional reimbursement.

During the two-day event, a series of moderated roundtables will explore areas of special interest expressed by CFOs, including the following:

1. Cost improvement

Since costs are increasing at rates higher than reimbursement, how does a CFO drive cost performance to maintain sufficient operating margins? How are systems successfully leveraging scale to rationalize administrative and support services?

2. Proliferation of mergers and acquisitions

How can an independent organization survive in this environment? Should it consider other affiliations? For those involved in new entities, how are leaders achieving value?

3. Taking on risk

How does an organization prepare to take on and reduce risk, and when does an organization know that it is ready? How can CFOs build reserves to offset unexpected outlays?

4. Enhancing revenue cycle performance

How can financial leaders improve payer terms, reduce denials, ensure payer compliance, and improve clinical documentation? What are effective ways to deploy new workflow technologies in patient accounts?

5. Performance-based contracts

How are organizations engaging medical staff to reduce the cost of care and improve outcomes?

6. Medical group employment

How does a health system minimize provider subsidies for employed physicians and improve practice performance?

7. Medical consumerism

How can healthcare organizations compete against disruptors in the growing environment of consumer choice? What are creative ideas for meeting consumer demand without adding cost?

Additional information will be shared during the two-day gathering. The CFO Exchange is one of six annual HealthLeaders Media events for healthcare thought leadership and networking.

Revenue cycle and patient financial experience

Recently, HealthLeaders Media hosted a Revenue Cycle Exchange, which brought together 50 executives to discuss improving the patient financial experience; maximizing reimbursement; managing claims denials; technology adoption and data analytics; revenue cycle optimization; and creating a leaner, more effective team.

Noting how consumerism is influencing bill payment and giving rise to the patient voice, leaders are seeking ways to make paying easier. Consumer feedback suggested easy-to-understand and consolidated statements.

“We have a single business office with Epic, so regardless of where a patient gets their services, they get one bill from our organization,” says Cassi Birnbaum, director of health information management and revenue integrity at UC San Diego Health.

“We’ve also created a position for a patient experience director, so any complaint goes through that unit and they’ll contact one of my supervisors to ensure the patient gets the answers they need. That’s helped a lot and provides a one-stop, concierge, patient-facing experience to help ensure the patient’s balance is paid,” Birnbaum says.

Providing estimates and leveraging technology are also helpful for fostering patient payments. More health systems are promoting MyChart, an online tool for patients to manage their health information, as well as kiosks in key locations.

“We have a patient portal in which you can see any outstanding balance at a hospital or clinic and decide what you want to pay today,” says Mary Wickersham, vice president of central business office services at Avera in Sioux Falls, South Dakota.

“Patients can also extend their payments since we have a hyperlink that goes to the extended loan program if needed. With kiosks at our clinics, patients pull out their credit card and complete their copay. Nobody asks; they just automatically do it,” she says.

Staffing

Front- and back-end staff play an integral role in calculating payment estimates, collecting dollars in advance of procedures and tests, and communicating the often-puzzling connection between hospital charges for physician practice and provider-based department patients.

“One of our big challenges now is we’re bringing a lot of that back-end work to the front,” says Terri Etnier, director of system patient access at Indiana University Health in Bloomington, Indiana.

Centralizing processes

As facilities move toward centralized scheduling systems to manage reimbursement, some facilities are centralizing coding and billing processes.

“We don’t have a full comprehensive preregistration function for our clinics mainly due to volume. We’re piloting a preregistration group for our clinic visits to work accounts ahead of time since we are continuing to work toward automation,” says Katherine Cardwell, assistant vice president at Ochsner Health System in New Orleans.

“We have kiosks in some of our clinics. Epic has an e-precheck function where we can now do forms. You can sign forms on your phone, and make your payment and your copayment ahead of time. And you can actually get a barcode that you can just scan when you get to the clinic,” Cardwell says.

CEO, CFO of Missouri hospital resign over inappropriate reimbursements

https://www.beckershospitalreview.com/hospital-executive-moves/ceo-cfo-of-missouri-hospital-resign-over-inappropriate-reimbursements.html

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The CEO and CFO of Ranken Jordan Pediatric Bridge Hospital in Maryland Heights, Mo., have resigned after the hospital board discovered the executives violated the hospital’s paid time off policy, according to the St. Louis Post-Dispatch.

The hospital board requested and accepted the resignations of president and CEO Lauri Tanner and vice president and CFO Jean Bardwell, effective May 2, according to the report.

In a statement to the St. Louis Post-Dispatch, the hospital said the two executives were allegedly paid for time off “to which they were not entitled.” The hospital said the board is demanding Ms. Tanner and Ms. Bardwell repay the hospital, but it did not disclose the amount of inappropriate reimbursement the executives allegedly received.

The board’s executive committee initially identified the potential irregularities, and the board subsequently launched an investigation, which allegedly revealed the two executives violated hospital policy, according to the report.

To help prevent a similar issue from occurring in the future, the hospital has put corrective measures in place.

Ranken Jordan Pediatric Bridge Hospital COO Brett Moorehouse has been named interim president and CEO, and a hospital board member will serve as interim CFO, according to the St. Louis Business Journal.

 

The CFO Confidence Crisis

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Few roles are as important as the chief financial officer at most companies, but the CFOs today who are thinking about tomorrow are growing nervous about a key talent issue. They just don’t think anyone else in the company can assume their role.

Indeed, according to a new Korn Ferry survey, 81% of CFOs surveyed say they want to groom the next CFO internally, but they don’t believe that there’s a viable candidate in-house. Currently, about half of new roles are filled internally. 

“The current CFO is the one charged with identifying and developing that talent, and since they know best the skills required to meet what’s coming, they are realizing the internal bench isn’t fully prepared,” says Bryan Proctor, senior client partner and Global Financial Officers practice lead at Korn Ferry.

The lack of confidence is owed in part to CFOs feeling that their firms’ leadership development programs haven’t kept up with the rapidly changing role of CFO. Core functions such as finance and accounting are increasingly being combined under one role, with CFOs citing a lack of resources or skills and career development opportunities as reasons for the merging. Korn Ferry surveyed more than 700 CFOs worldwide, asking them about their own internal talent pipelines. The top two abilities CFOs feel their direct reports need to develop are “leadership skills and executive presence” and “strategic thinking.” 

“The tapestry of skills and experiences CFOs of today and tomorrow need are vastly different than what was needed in the past,” says John Petzold, senior client partner and CXO Optimization lead at Korn Ferry. “The reason subfunctions are merging is because the focus is less on a role or person and more about the capabilities that need to be covered by a set of individuals.”

In essence, the CFO function is being deconstructed for optimization. Leaders are breaking down necessary functions based on their organization’s strategy and identifying people with a combination of those skills and piecing them together to get the right set of talent to execute against that plan. Core financial functions such as taxes, capital allocation, and M&A still need to be done accurately and in compliance with regulations, of course. But experts say the CFO role is becoming more about adapting and deploying talent in the most efficient manner possible. 

“The leadership profile of the future CFO is less about tactical, direct experience, and more about learning agility, adaptability, and big-picture global perspective,” says Proctor. “That kind of nimbleness and ability to pivot isn’t naturally ingrained in the typical CPA.” 

 

Operator to bar New York hospital CEO, CFO and COO from expensing bi-yearly trips to Cayman Islands

https://www.beckershospitalreview.com/hospital-management-administration/board-to-bar-new-york-hospital-ceo-cfo-and-coo-from-expensing-bi-yearly-trips-to-cayman-islands.html

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East Meadow, N.Y.-based Nassau Health Care Corp. officials expect to pass a resolution March 8 barring East Meadow-based Nassau University Medical Center officials from traveling to the Cayman Islands twice a year and charging the hospital for expenses incurred on the trip, according to Newsday.

George Tsunis, chairman of the board of Nassau Health Care Corp., which operates NUMC, told the publication the proposal is part of a series of resolutions to cut costs at NUMC, prevent corruption and make the public more aware of executives’ actions.

Nassau Health Care Corp. created a limited liability company, called NHCC LTD, in the Cayman Islands for tax purposes to self-insure for malpractice and general liability claims, according to the report. Company officials must meet outside the U.S. at least once a year to maintain the Cayman Islands location. NUMC’s CEO, COO, and CFO were all named to NHCC LTD’s board, and previously traveled to the islands for two weeks out of the fiscal year to discuss the company’s financial and operational activities.

Under the proposal, two NUMC executives will meet once a year for one day at an offshore location, such as a Canadian airport, to discuss the company’s activities.

The series of resolutions also calls for a reduction in the use of outside legal firms to handle internal legal issues, and to enact anti-nepotism disclosure requirements for hospital trustees, among other initiatives.

Nassau Health Care Corp. officials did not disclose how much the organization would save as a result of the proposed changes, Newsday reports.

Mr. Tsunis said as a safety-net hospital, NUMC should adhere to federal expense guidelines and not use taxpayer money to fund executives’ trips.

“[The proposed resolutions are] essential for credibility. The taxpayers of Nassau County need to be assured that we are protecting their tax dollars and operating at the highest ethical levels,” Mr. Tsunis told Newsday.

 

Catholic Health Initiatives CFO Dean Swindle’s advice to other systems: ‘Don’t get too comfortable with your past success’

https://www.beckershospitalreview.com/finance/catholic-health-initiatives-cfo-dean-swindle-s-advice-to-other-systems-don-t-get-too-comfortable-with-your-past-success.html

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Englewood, Colo.-based Catholic Health Initiatives embarked on a turnaround plan several years ago with the goal of improving its financial picture while providing high-quality care at its hospitals and other facilities across the nation. The system has made great strides toward its goal, yet there is still a lot of work to be done.

CHI has been laser-focused on performance improvement over the past three years, but rolling out a comprehensive turnaround plan across an organization with 100 hospitals is challenging, and progress is slow. The health system’s efforts just began to take hold in the second half of fiscal year 2017. Although CHI has encountered obstacles on its path to financial stability, the system is pleased with the headway it has made and expects more improvement in the coming months.

CHI’s cost-cutting initiative

To improve its finances, CHI set out to cut costs across the system. It put a great deal of energy into lowering labor and supply costs, which combined can make up two-thirds or more of the system’s operating expenses. CHI developed plans and playbooks focused on reducing these costs several years ago, knowing it would not immediately see results.

In the labor area, CHI President of Enterprise Business Lines and CFO Dean Swindle says the system had to incur costs to cut costs. “In the second half of the year [fiscal 2017] we began to see the benefits of our labor activities in the markets, but we also had cost,” he says. For example, CHI incurred the one-time expense of hiring advisers to help the system develop new labor management techniques. The system also cut jobs, which resulted in severance costs.

“When we got to the second half of 2017, we were very confident and felt very pleased that we were seeing benefit … but it was difficult for others to see it because it was for half of the year, and we had the one-time costs that were burdening that,” Mr. Swindle says.

After factoring in expenses and one-time charges, CHI ended fiscal year 2017 with an operating loss of $585.2 million, compared to an operating loss of $371.4 million in fiscal year 2016.

However, CHI saw its financial situation improve in the first quarter of fiscal year 2018. The system’s operating loss narrowed to $77.9 million from $180.7 million in the same period of the year prior. “What you were able to see in the first quarter [of fiscal 2018] … was the one-time costs had gone away for the most part; those weren’t burdening our results,” says Mr. Swindle.

He says although the system employed more physicians, its absolute labor costs were lower year over year. CHI’s supply costs, including drug costs, were also lower in the first quarter of fiscal year 2018 than in the first quarter of last year.

Mr. Swindle says CHI saw its finances improve in a difficult operating environment. Patient volume was lower in the first quarter of fiscal year 2018 than a year prior, and the system also experienced a nearly $26 million loss from business operations as a result of Hurricane Harvey.

“[This has] given us a level of confidence that we can move forward and address the difficulty that our industry is going to be facing over the next several years,” he says.

In early January, Fitch Ratings affirmed CHI’s “BBB+” rating and upgraded its credit outlook to stable from negative. The credit rating agency cited the health system’s strong start to the 2018 fiscal year and financial improvements in several markets as key reasons for the upgrade.

Preparing for new challenges

Although healthcare organizations are currently facing many challenges, including regulatory uncertainty and dwindling reimbursement rates, Mr. Swindle anticipates hospitals and health systems will face new obstacles over the next few years.

For example, hospitals will be challenged by changes to the 340B Drug Pricing Program. CMS’ 2018 Medicare Outpatient Prospective Payment System rule finalized a proposal to pay hospitals 22.5 percent less than the average sales price for drugs purchased through the 340B program. Medicare previously paid the average sales price plus 6 percent.

“I don’t think 340B was by chance and in isolation,” says Mr. Swindle. “I think we’re entering one of those cycles that the whole economic environment of our industry is going to be working against us.”

The pressures in the industry are driving hospitals and health systems to join forces. After more than a year of talks, CHI and San Francisco-based Dignity Health signed a definitive merger agreement in December 2017. The proposed transaction will create a massive nonprofit Catholic health system, comprising 139 hospitals across 28 states.

In the short term, the combination of the two systems is expected to drive synergies in the $500 million range, according to Mr. Swindle. In the coming months, the two systems will dive deeper into the synergies they expect to achieve over a multiyear period. “We do believe beyond the synergies there are some strategic initiatives we can put into place as a combined organization that we couldn’t do individually,” Mr. Swindle says. “You won’t see the benefit of those as much in the short term.”

“Take a deep breath”

Mr. Swindle knows firsthand that developing and executing an operational turnaround plan is no easy task. However, today’s healthcare landscape requires health systems to re-engineer their business models.

“Regardless of how good your results … have been over the last five to 10 years, we’re all going to have to transform ourselves in our own way to meet the characteristics of our organizations,” says Mr. Swindle.

When embarking on a performance improvement plan, the first thing health system CFOs should do is “take a deep breath,” he says. Then, they should focus on the things they have more control over. Mr. Swindle says it is critical for health systems to continue to drive improvement in patient experience and quality. They also need to be strategic cost managers.

“It’s not going to be as easy as just saying we’re going to take these [full-time employees] out or reduce this service. You’re really going to have to be very smart and very thoughtful about how you become a good cost manager that adds value to your communities,” says Mr. Swindle. “Don’t get too comfortable with your past success and your past models.”

 

Cost reduction tops list of 5 top CFO priorities for 2018

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CFOs rank cost reduction opportunities as most important for year ahead, though most expressed limited confidence in their ability to do it.

CFOs rated cost reduction as the most important performance management activity for 2018, according to a new Kaufman Hall survey of senior finance professionals.

Nearly 30 percent chose “identifying and managing cost-reduction initiatives” as the most important performance management function for their organizations, from a list of five choices, according to the 2018 CFO Outlook: Performance Management Trends and Priorities in Healthcare.

The other four priorities, in order, are improving performance reporting to operational leaders (25.8 percent); predicting and managing the impact of changing payment models (18.1 percent); developing more integrated and planning processes across financial planning and strategic capital allocation (16.3 percent); and leveraging rolling forecasting as part of a more continuous planning and financial performance monitoring process (10.7 percent).

Most CFOs, however, also said they have limited confidence in their organization’s ability to manage the financial impact of evolving business conditions. Only 15 percent said their organizations are “very prepared” to manage evolving payment and delivery models with current financial planning processes and tools.

Seventy-percent said they have cost measurement tools that are too simplistic or provide inaccurate data that can’t be trusted or have no tools in place at all, according to the survey of senior finance executives at 350-plus hospitals and health systems.

Fifty-six percent of CFOs and executives said their organizations lack

access to clean, consistent, and trusted data, while ninety-percent think their hospitals should be doing more to leverage financial and operational data to inform strategic decisions.

CFOs said long budgeting cycles are preventing value-added analysis by finance teams. Sixty-nine percent have a budget process that takes more than three months from initial rollout to board presentation. For 9 percent of these organizations, the process takes more than six months.

The survey addresses the rapidly changing healthcare business environment, and the growing role and importance of the CFO function to inform strategic business decisions that will impact long-term success, according to consulting firm Kaufman Hall.

Hospital CFOs: 3 things demanding your attention in 2018

https://www.beckershospitalreview.com/finance/hospital-cfos-3-things-demanding-your-attention-in-2018.html

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From managing new risk-based payment models to navigating an uncertain regulatory environment, healthcare industry finance leaders face many challenges this year, making it difficult to determine which initiatives to prioritize.

To simplify and focus, below are three areas hospital and health system CFOs should prioritize in 2018, according to a new study from Kaufman Hall. For the study, Kaufman Hall surveyed CFOs and other senior finance executives from more than 350 hospitals, health systems and other healthcare organizations across the nation from Oct. 2 to Oct. 27, 2017. Of the respondents, 69 percent were from multihospital health systems, 19 percent were from standalone hospitals, 4 percent were from medical groups and 8 percent were from health plans or other organization types.

1. Cost reduction initiatives. Nearly 30 percent of the respondents said identifying and managing cost reduction initiatives is the most important performance management activity for their organizations. “CFOs recognize the urgency of generating cost improvements, but are struggling with data, processes, and tools due to their lack of structure, transparency, accuracy, and hence, creditability,” according to Kaufman Hall. Seventy percent of survey respondents said their organizations do not use cost measurement tools, or use tools that are too simplistic or provide inaccurate data.

A reliable cost accounting solution can help healthcare organizations manage cost-reduction initiatives. “It must provide flexibility and transparency of costing model elements and a fluid ability to support strategic and financial planning,” according to Kaufman Hall. “A trusted cost accounting tool enables modeling and forecasting of utilization, labor and other costs, and insights into current costs at a patient or service line level.”

2. Financial planning. More than 50 percent of respondents said operational budgeting and forecasting, cost management and efficiency, and reporting and analysis to support decision-making as top initiatives. To improve in these areas, hospital leaders need to have clear goals that are communicated across the organization, according to Kaufman Hall. However, further improvement is needed to ensure transparency and accountability, as nearly half of respondents said their organizations do not closely track targets across the organization to help achieve financial goals.

“Progress is being made in improving financial planning processes, analytics, and tools in order to ensure best-possible organizational performance,” according to Kaufman Hall. “But CFOs and other finance leaders must focus on the areas that will generate the most significant returns.” Kaufman Hall recommends hospitals and health systems examine whether they have the financial resources and talent to successfully implement and operate clinical and administrative tools; support ongoing data collection and management; drive data analytics; and integrate the results with broader organizational plans.

3. Budget processes. The budget process at most healthcare organizations is time consuming, and budget assumptions are often outdated by the time they are published. Although the majority of respondents (69 percent) said their organization’s budget process takes more than three months from initial rollout to board presentation, CFOs recognize there is room for improvement in this area. Forty-seven percent of respondents said their budget cycles do not leave ample time for value-added analysis that can inform strategic decisions.

“Finance leaders are and should be considering different approaches to budgeting, not just simple tweaks to the existing process,” according to Kaufman Hall, and many healthcare organizations are doing just that. Thirty-one percent of respondents said their organizations plan to start using rolling forecasting in the near future to give them the ability to adjust projections and strategies to remain in sync with long-term financial plans.

Access the full Kaufman Hall report here.

CapEx vs. OpEx

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Quick strategy question: If you could start from scratch and implement Microsoft Outlook by cutting a fat check to acquire the software and hardware to run it on-site, and then foot the bill to maintain both, would you really sign-off on that rather than simply subscribing to a cloud-based email service and letting someone else take care of the maintenance and upgrades?

That answer is a resounding ‘unlikely.’

Black Book, in fact, found that 92 percent of hospital C-suite executives believe that cloud shifts the IT cost burden from capital expenditure to operational expenditure with positive results. Doug Brown, Black Book Managing Partner, pulled that from research the firm conducted for its upcoming 2018 Health IT Trends report.

“Moving software purchases to a cloud model and the resulting flexibility in how a healthcare organization can account for these tools as an OpEx versus a CapEx is one of the many advantages that the cloud has brought to organizations,” Brown said.

Cloud: Here today and to stay

Cloud computing is not the next big thing, it’s already here and at this point moving to the cloud model is largely being driven by end users and tech shops. And that is creating something of a mess. Symantec researchers found that at the end of 2016, enterprises in various industries had 926 cloud apps in use, up from 841 the year before, but top executives estimated that number to be between 30 and 40 apps.

“The ultimate decision often comes down to the CIO,” said IDC Health Insights Research Director Mutaz Shegewi.

That poses its own set of problems, notably that some CIOs want to keep their data on-premise for fear of losing hold over it or are concerned about the larger value IT provides as a department when pieces of its role can be outsourced to the cloud, Shegewi said.

“Increasingly and with time, I have seen resistive CIOs give in and even advocate for the switch once they understand the value and benefits that could be brought about by the cloud, especially around security and vulnerability,” Shegewi said.

Therein lies the opportunity for forward-thinking finance executives to help lead their IT counterparts toward the cloud and its OpEx cost advantages. Who better to spearhead that migration?

Former hospital CFO Kim Lee, who is now COO at Faith Community Hospital in Wichita Falls, Texas, ranked the cloud model’s positive points as lower upfront costs and shorter implementation time as well as upgrades managed for customers, and less of a support burden on the IT team. She added to that list with easier remote access and connecting to apps, as well as improved security management.

Lee said that Faith Community Hospital as an organization, in fact, recommends certain cloud-based apps to its user base.

“We find cloud apps are less likely to experience security issues compared to utilizing a third-party vendor who may have to go through an interface process to talk to the software,” Kim said. “It takes out the middleman approach and the mobility support is provided by your software vendor.”

And with Black Book predicting that 57 percent of hospitals with 200 or more beds will pair back, if not freeze altogether, CapEx investments in IT during 2018 and the same goes for 85 percent of hospitals with fewer than 200 beds, now is the time for finance teams to get more involved in cloud decisions by working closely with the CIO and other technology leaders.

That’s not to suggest everything should be moved into the cloud strictly for the sake of OpEx, of course.

CapEx vs. OpEx considerations

Northwell Health CFO Michele Cusack works with the IT department to help make choices about what to put in the cloud and what should really stay on-site.

Cusack said it’s important to evaluate which systems can better fuel the overall mission on-premise or do so in the cloud. Certain applications, like email, commodity and productivity apps, are a good OpEx fit.

Software that houses sensitive patient data, on the other hand, requires more careful consideration before transitioning that out to the cloud, if at all.

Northwell is now in amidst a shift to the cloud for its human capital management system, for instance, and it subscribes to other key applications running in private clouds.

“We look at the overall savings by comparing the monthly fees to the upfront capital costs, the potential reduction or elimination of certain on premise IT infrastructure, the cost benefit of seamless future upgrades to systems, and the cost benefit of being able to scale resources quickly in response to demand,” Cusack explained.

Lee added to that list of aspects to account for when tapping into the cloud for apps or bigger software services.

“A few of the top considerations when choosing a cloud-based software is reviewing your contract to ensure there are procedures in place for internet downtimes, procedures for access to facility records long-term, certification of compliance with HIPAA, Security Risk Assessments and PHI, processes in place to accommodate your back up requirements and adequate planning prior to implementation and timely notification for new software releases,” Lee said.

CFO as the new cloud champions

Cusack and Lee are not the only CFOs reaping the cloud’s OpEx advantages.

Seventy-two percent of the finance chiefs Black Book polled reported that IT spend as a percentage of operating expenses in their organizations increased at least 50 percent since 2015’s study.

“In current economic times with most organizations in the pursuit of maintaining a lean balance sheet to preserve cash flow, the cloud migration decision is appropriately led by the Chief Financial Officer,” said Doug Brown, managing partner of research firm Black Book. “It shouldn’t be a CIO’s job to determine CapEx or OpEx or the benefits of accounting for technology investments as an operational expense versus a capital expense.”