The evolving CFO role, in quotes

https://www.beckershospitalreview.com/finance/the-evolving-cfo-role-in-quotes.html

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As healthcare evolves, so too are the roles of hospital and health system CFOs.

The CFO role is becoming more strategic as organizations face additional financial pressures and navigate the shift to value-based care. CFOs today generally play a greater role in operations and are seen as business partners by CEOs.

Four panelists provided thoughts on this evolving role during a session at the Becker’s Hospital Review 6th Annual CEO + CFO Roundtable in Chicago. Here are quotes from the panelists.

Jim McNey, senior vice president and CFO of North Kansas City (Mo.) Hospital, addressed the development of Centrus Health, a physician-led clinically integrated network including City, Mo.-area physicians across NKCH, the University of Kansas Health System, Merriam, Mo.-based Shawnee Mission Health and Kansas City Metropolitan Physician Association. In these types of scenarios, he said the CFO almost acts like a “salesman.”

“You have to sell these ideas to people who may not be receptive. … You’ve got to go out. You’ve got to get educated. You’ve got to stay current on what’s going on. …You can’t ever quit learning.”

Britt Tabor, executive vice president and CFO/treasurer of Chattanooga, Tenn.-based Erlanger Health System, noted the move away from the traditional CFO role.

“What I’ve seen … is there’s [now] dramatic input of the CFO from a strategic and operation standpoint. I’m meeting with two or three physicians a week talking about the business model of the health system.

“As pressures have come, we’ve hired a lot of doctors. I do think physicians are getting the idea that we’ve got to balance the quality, the patient care and the business scene,” he added.

Angela Lalas, senior vice president of finance for Loma Linda (Calif.) University Health, talked about the skills necessary for today’s CFO.

“We’ve [previously] looked at finance professionals as number crunchers and more focused on historical. Now it’s more communication and interpersonal skills [are the] top needs for finance professionals to become impactful and effective.”

Brad Fetters, COO of Prism Healthcare Partners, a healthcare consulting firm, described the finance discipline as “becoming more sophisticated.”

“What I mean by that is the leadership used to be kind of the scorecard — they were in the room to make sure the numbers jived up — then somebody else was working with physicians and influencing. What you’re seeing now … in other industries … [is] when CEOs abruptly leave … they promote the CFO because they’ve gotten more strategic, there [are]softer skills around influencing and changing behaviors. That’s what you’ve got to do with this information so those successful CFOs are in the room kind of influencing everybody.”

 

How do you ‘hire’ (and manage) an interim executive?

How do you ‘hire’ (and manage) an interim executive?

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Abstract:  This article is about the optimum relationship between an interim executive and their client.  It has been a while since I wrote on Interim Executive Services.  In this article,  I  return to the primary topic of this blog.

What is the difference between interviewing and hiring an interim vs. an employee?

First of all, it is not in your best interest to ‘hire’ an interim.

If the interim is furnished though a firm, they are more than likely paid on a W-2 and you are not technically ‘hiring’ the interim, you are engaging or entering a contact with their firm.  The interim is ’employed’ by the firm and not you.  Employed is loosely used in this case because while the interim may be on a W-2 program with their firm, the only time they are paid is if they’re producing billable revenue. Sadly for the interim, they get to bear all of the disadvantages of being paid by W-2 while consulting without having the ability to reap any of the benefits of being an independent expert.

Now assume that you are smart enough and lucky enough to source the perfect independent or free lance interim directly, what then?

Congratulations, you are probably well on your way to having a far superior resource that will  be highly motivated to address your situation without the interference of a third party that in my experience, adds little if any value beyond sourcing the interim.  If you have experience with this, you know what I’m talking about.  When was the last time you saw anyone from the interim firm you engaged other your interim?

With a free agent, you will be contracting with the Interim or a company (LLC or S-4 Corporation) they own.  Legally, you are dealing with a sole proprietor in most cases regardless of whether their corporate entity is involved or not.  For this reason and depending upon the circumstances, you might want to get their personal guarantee of their firm’s performance.

I have a S-4 Corporation that I can use for contracting.  The problem for me is that if I bill though my corporation, I am obliged to pay the federal government 9% of my earnings in the form of federal unemployment tax or FUTA that I can never claim because as an independent consultant, I cannot be ‘laid off’ so I am ineligible to receive FUTA.  Don’t get me started.  I have been fortunate that my clients have agreed to engage me directly and individually.  A corporate structure when dealing with a sole provider affords disproportionate list to the provider.

What about insurance?  Increasingly, client firms are requesting or requiring professional liability insurance.  Setting aside the fact that I have never seen a claim against a professional liability policy for interim services, I have been successful in convincing my clients to name me under their Directors and Officer’s Insurance (D&O) coverage if I as an interim am going to be authorized to execute documents and take actions on behalf of my client.  To me, this makes more sense for the client because if I am required to obtain insurance that will most likely be less robust than the organization’s D&O coverage, that cost is going to be passed along and in effect, the client will be paying twice for the same coverage.  Not only that, in the event of a problem, you are more than likely going to be drawn into a subrogation fight.  If I have no authority and I am not going to be executing documents, i.e., I am engaged to do project work, then liability insurance should be a non-issue.

In another article, I talk about how to find interim executives.

If you have found the ‘perfect’ interim for your transition or challenge, good for you.  If the interim is experienced and sophisticated, you should not have any reservation about engaging them directly and putting them to work in your organization immediately.

Once the interim is aboard, do not lose sight and do not allow your organization to lose site of the purpose of the interim engagement which is usually to help an organization work through a transition usually while beginning the process of addressing major challenges or problems.  The scope of the work to be performed should be mutually understood and memorialized in the contract with the Interim Executive.  Subsequent departures from the agreed scope represent sub-optimization of the engagement at best and a useless waste of resources at worst.

An interim is not an employee and the more you treat them like an employee, the less effective they will be and the higher risk you will bear with respect to their status as an independent contractor.

A number of requirements must be met before your interim reaches reach the threshold of independent contractor status.  To name a few:

  • You cannot set the interim’s hours
  • You cannot dictate when and how the interim does their work
  • You cannot require the interim to use your facilities and equipment to do their job
  • You cannot subject the interim to your personnel policies and procedures like travel policies, etc.
  • You should not require the interim to participate in employee related activities like employee health, computer system training, etc., unless their specific responsibilities require patient contact or hands-on operation of hospital systems which should be very rarely.
  • You should never require interims to record time on your organization’s timekeeping system

The more you require your interims to engage in the actives of employees; things like requiring them to attend out of scope meetings, the higher your risk that the IRS may subsequently find that they were not independent contractors and subject your organization to payroll tax liability and overtime claims that you did not anticipate.

Time and again, I have been required by hospital personnel departments to go through all of the clearances and sometimes orientation of employees.  Then I get invited to every meeting in the organization.  All of this increases the client’s risk while wasting my time.  I have asked the person that executed my contract to screen and approve meeting requests to insure that I am able to stay on task and that the rest of the organization understands my roles and its limitations from their perspective.

I tell clients that regardless of the number of hours they pay for, they receive 100% of my mental capacity virtually 100% of the time.  I find it difficult if not impossible to mentally divorce myself from the needs and issues of my client whether I am ‘on the clock’ or not.  Because of this, flexibility of hours should not be an issue because when I am engaged, I am always working for the benefit of my client.  That said, I assure my client that regardless of the ‘normal’ schedule we agree to, I endeavor to make myself available on-site as needed.  This means spending weekends in the client’s city and/or traveling on behalf of the client for matters not related to Interim services commuting.

Take another look at my article about how to find an interim.  The effort you expend to locate a ‘free agent’ Interim Executive is worth the trouble.  My prediction is that you will thank yourself for taking charge of what should be expected to be one of the most important decisions you may ever make because of the potential of a well conceived Interim Engagement to be favorably transformative in your organization.

If you are a Board member or a CEO and you do not know where to start or how to go about finding an Independent Interim, get in touch with me and I will give you some pointers.

Contact me to discuss any questions or observations you might have about these articles, leadership, transitions or interim  services.  I might have an idea or two that might be valuable to you.  An observation from my experience is that we need better leadership at every level in organizations.  Some of my feedback is coming from people that are demonstrating interest in advancing their careers and I am writing content to address those inquiries.
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Top 5 Concerns of Healthcare CFOs

http://www.healthleadersmedia.com/finance/top-5-concerns-healthcare-cfos#

Planning for a HealthLeaders Media gathering of hospital and health system chief financial officers reveals the weightiest issues on their minds.

Preoccupying the minds of healthcare financial executives are prevailing problems engulfing the industry’s business climate: uncertainty about healthcare reform, declining public and private reimbursement, accelerating operating expenses, and access to capital.

This August, 50 healthcare finance leaders will collaborate on fortifying their organizations’ fiscal health at the 2017 HealthLeaders CFO Exchange in La Jolla, CA.

In pre-event planning calls, CFO Exchange attendees, representing integrated health systems, academic medical centers, community hospitals, and safety net providers, have mentioned some of the struggles they’d like to know how others are tackling.

During the two-day event, a series of moderated, peer-to-peer roundtables will explore how organizations are addressing the top five issues.
1. Dismantling of the Affordable Care Act

CFOs foresee the negative financial impact a repeal will generate and are interested in knowing how others are preparing for anticipated changes in Medicaid for expansion and non-expansion states.

2. Enhancing and Supporting Population Health

CFOs are concerned about building the right infrastructure to support population health, including integrating physicians, retooling their workforce, realigning the financial tracking of population health efforts, incorporating behavioral health in primary care, and determining how much payer risk to assume.

Executives expressed their concerns about knowing how and when to invest resources in a relatively uncharted path.

In addition, they are interested in how to bring disparate goals together to align with population health efforts.

3. Curtailing Clinician Costs

Optimizing access and productivity to ensure profitability among acquired physician practices, reducing clinical practice variation and cost-per-case, and lowering costs associated with filling in with agency labor due to the nursing shortage are challenges for senior executives.

Organizations will be requesting and sharing strategies for seizing the reigns on clinician expenses.

4. Increasing Revenue

Overcoming reimbursement struggles, uncovering innovative ways to cut costs, and ascertaining solutions to avoiding readmission penalties are common goals for CFOs.

5. Determining Gaps and Opportunities

Another goal shared by CFOs is the desire to share the most useful data analytics and business intelligence platforms for improving quality-of-care and outcomes.

In addition to their larger concerns, participants at the invitation-only event will talk about consumerism, direct contracting for healthcare with employers, charting a financial strategy on value-based care, and ideas about what competition will look like in the future.

Former healthcare CFO sentenced to more than 3 years in prison for fraud

http://www.beckershospitalreview.com/legal-regulatory-issues/former-healthcare-cfo-sentenced-to-more-than-3-years-in-prison-for-fraud.html

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U.S. District Judge Malcolm J. Howard sentenced William Canupp, former CFO of Beulaville, N.C.-based Eastpointe Human Services, to 3 1/2 years for wire fraud, tax fraud and conspiracy to commit federal program fraud, according to The Wilson Times.

Mr. Canupp served as Eastpointe’s CFO from March 2010 to April 2013. Eastpointe manages the public sector behavioral health system for several counties in eastern North Carolina.

On May 24, 2016, a federal grand jury returned a 47-count indictment against Mr. Canupp, charging him with conspiracy, bribery, organization fraud, wire fraud and money laundering. The indictment was issued nearly one year after a state audit found Mr. Canupp had facilitated kickbacks from two Eastpointe contractors. The audit revealed Eastpointe paid two contractors more than $1 million for renovations from 2010 to 2013. Each time a check was received from Eastpointe, the contractor wrote a personal check to Mr. Canupp. The contractors paid the former CFO a total of $547,595.

Mr. Canupp pleaded guilty in March to conspiracy to commit federal program fraud, wire fraud and tax fraud, according to The Wilson Times.

 

5 latest hospital, health system CFO moves

http://www.beckershospitalreview.com/hospital-executive-moves/5-latest-hospital-health-system-cfo-moves-080117.html

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The following hospital and health system CFO moves were reported by Becker’s Hospital Review since July 20.

1. Dallas-based Parkland Health and Hospital System named Richard Humphrey executive vice president and CFO.

2. Providence St. Joseph Health, the organization formed through the merger of Renton, Wash.-based Providence Health & Services and Irvine, Calif.-based St. Joseph Health, named Venkat Bhamidipati executive vice president and CFO.

3. Dennis Laraway, executive vice president and CFO of Houston-based Memorial Hermann, will join Phoenix-based Banner Health as CFO on Sept. 29.

4. Gainesville-based Northeast Georgia Health System named Brian D. Steines as its new CFO.

5. Albuquerque, N.M.-based Presbyterian Healthcare Services appointed Roger Larsen senior vice president and CFO.

More Memorial Hermann execs to depart

https://www.bizjournals.com/houston/news/2017/07/31/more-memorial-hermann-execs-to-depart.html?lipi=urn%3Ali%3Apage%3Ad_flagship3_feed%3B5bILEwnxSM%2BkK22A0oNGSA%3D%3D

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Three more executives plan to leave Memorial Hermann Health System, Houston’s largest nonprofit health care system, according to multiple reports.

Last week, Arizona-based Banner Health announced it hired Dennis Laraway as CFO, effective Sept. 29. Laraway has been CFO of Memorial Hermann since 2011.

Following the announcement, Modern HealthcareHealthcare Finance and others reported that two other executives plan to step down. Memorial Hermann spokeswoman Alex Loessin confirmed to the publications that Christopher Lloyd, CEO of Memorial Hermann’s physician network, and Jim Garman, chief human resources officer, also plan to leave. That’s in addition to Craig Cordola, president of Memorial Hermann Health System’s west region, whose departure was announced earlier this month.

The reports did not specify when Lloyd and Garman will step down or what their next positions will be. Cordola, however, will become senior vice president of St. Louis-based Ascension Healthcare and ministry market executive of Ascension Texas, effective Sept. 1. Memorial Hermann is evaluating a successor for Cordola internally, Loessin previously told the Houston Business Journal.

“Career moves by top leaders to other signature health systems speak volumes about the caliber of talent we have at Memorial Hermann,” CEO Chuck Stokessaid in a statement to the publications last week. “While we will miss the contributions of these individuals to the organization, I’m incredibly proud of all they accomplished, and I wish each of them the very best. We have a strong management team at Memorial Hermann and excellent support from our board.”

Stokes was named CEO for Memorial Hermann in early July. He had served in an interim capacity for a few weeks after Dr. Benjamin Chu abruptly stepped down from the position June 19.

Molina to cut 1,400 positions to improve financial performance

http://www.healthcarefinancenews.com/news/molina-cut-1400-positions-improve-financial-performance?mkt_tok=eyJpIjoiTXpVelkyRXhZMkpqTmpKaSIsInQiOiJFVjFscVRVVDdXZmZqek02STNMSVNjelwvREEwMmZmckZrWmNyZjNrQnVcL0szTGZuNXA4ZGdrOGRhT1V5bnREanBwWitPbTNkQllLZW5BTmd4VDk5TDg0ak1NNStnTllqdEllQlNpQmRZbDUwcm5JdVNaZ1lJcmpVVXJNYWxcL0JcL28ifQ%3D%3D

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The cuts follow removal of CEO and CFO due to financial losses blamed on Affordable Care Act market.

Molina Healthcare, which fired its CEO and CFO in May due to the poor financial performance of the company, will eliminate about 1,400 jobs over the next few months, according to an internal memo obtained by Reuters.

The cuts are due to financial losses blamed on Molina’s individual business in the Affordable Care Act market, in which it has been a major player.

Molina will reduce its workforce by the elimination of 10 percent of its 6,400 corporate positions and about 10 percent of 7,700 health plan jobs, according to Reuters. It will not affect Molina’s Pathways behavioral health business, which employs about 5,500 people.

Interim CEO and CFO Joe White sent the memo to employees saying the cuts aim to contribute to savings by 2018 in what he called “Project Nickel,” to do more with less.

In March, Molina was touted as an ACA success story.

Former CEO J. Mario Molina, MD, was an outspoken opponent of the Republican plan to repeal and replace the ACA. His brother, John C. Molina, who served as CFO. was also let go in a decision by the board to turn around the company’s financial position.

Last week Molina said it was concerned about Republicans repealing the ACA without having a replacement plan in place, the roll back of Medicaid expansion and the lack of a guarantee of federal cost-sharing reduction payments, which allows insurers to offer lower-income consumers lower deductibles and out-of-pocket expenses.

Molina also argued for the continuation of the individual mandate to get insurance.

“The bedrock of any coverage system is a requirement that people must obtain health insurance,” Molina said. “The lack of such a requirement will be detrimental to the individual market risk pool and will result in adverse selection, which would significantly increase costs.”

In June, Molina said it would file rates for 2018 to remain in the exchange market in Florida.

The California Department of Insurance is releasing on August 1 the insurers which have filed rates for the ACA market in 2018.

A week after CEO’s ouster, St. Luke’s CFO stepping down

http://www.chron.com/local/prognosis/article/A-week-after-CEO-s-ouster-St-Luke-s-CFO-11268360.php?utm_source=Sailthru&utm_medium=email&utm_campaign=Newsletter%20Weekly%20Roundup:%20Healthcare%20Dive%2007-08-2017&utm_term=Healthcare%20Dive%20Weekender

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St. Luke’s Health System’s top financial executive is following the CEO out the door, another casualty of the Catholic network’s ongoing struggles in the Houston market.

Jenny Barnett-Sarpalius, senior vice president and chief financial officer, will step down Friday, the St. Luke’s system announced in an internal email Wednesday. The resignation came a week after the system announced the resignation of St. Luke’s CEO Michael Covert.

Since August, St. Luke’s has laid off 810 employees and cut its payroll by 1,295 jobs. In March, the nation’s two largest credit-rating services downgraded the debt ratings of Catholic Health Initiatives, St. Luke’s Colorado-headquartered owner.

Barnett-Sarpalius, who has 30 years of experience in finance and accounting, joined St. Luke’s in 2015. She previously worked for the Memorial Hermann Health System, CHRISTUS Health, Catholic Health East and Trinity Health.

CHI, the third-largest hospital system in the nation with 104 hospitals in 19 states, acquired the then-St. Luke’s Episcopal Health System in 2013 in a $2 billion deal.