Hospital CFOs navigating today’s tight margins are being called to do more than manage spreadsheets — they’re being asked to rethink operations from the ground up.
From challenging the status quo to shifting care upstream and aligning financial discipline with patient-centered values, health system CFOs say long-term sustainability demands focus, creativity and an unwavering commitment to operational excellence.
St. Louis-based Ascension continues to work on its financial turnaround and recently introduced a strategic framework to help financial leaders focus on what matters most. The model, built around three acronyms — CTC, BTB and EMS — is designed to translate complex financial goals into practical operational action.
“CTC stands for control the controllables,” Ascension Executive Vice President and CFO Saurabh Tripathi said during an April 29 panel at the Becker’s Annual Meeting. “As CFOs and operators, there are so many things we can control, so focus on them. Don’t get distracted by all the noise.”
The second pillar, BTB — break the bracket — urges underperforming hospitals to challenge historical norms through data-driven improvements.
“Figure out, operationally, how you can break the bracket,” Mr. Tripathi said. Finally, EMS — every ministry should be sustainable — reinforces that each entity must be self-sustaining from a capital standpoint. “You can’t just borrow that from another entity and continue to sustain.”
Mr. Tripathi also stressed the importance of aligning financial sustainability with patient care strategies. In markets where patients with chronic conditions frequently rely on emergency departments for treatment, Ascension is working to shift care upstream.
“Is there an opportunity to take them to an urgent care setting or to primary care?” he asked. “It’s the right thing for the patients, because they don’t have to be edited in acute care. It’s the right thing for the providers, because the cost is lower. And frankly, the insurers like it, because the claims will be significantly lower.”
Luke Rockenbach, CFO of Sutter Health’s Silicon Valley market, echoed the importance of shifting care upstream, but added a deeply personal note: patient needs must come first — even in conversations about cost.
“When people come to me and ask questions, there’s an assumption that I’m bottom-line first. I’m not. I’m patients first, every single time,” Mr. Rockenbach said. “Our role as CFOs is to do the right thing for the patient, and then the hard work is figuring out how to make the economics work.”
Mr. Rockenbach challenges his team to stay laser-focused on three core principles. First: operational intensity.
“Be obsessed with operations,” he said. “Be obsessed with our customer, our patients, and figure out what great looks like.”
Second: never settle. “Keep asking. Never be satisfied with what we think good looks like,” he said. And third: anticipate the future. “What are the next five things that are going to happen if we put these interventions in place?”
If operational rigor and forward-thinking are key, so too is the ability to question assumptions, according to Jeff Daneff, CFO of CommonSpirit’s California Central Coast market.
Mr. Daneff has found success — and real cost savings — by asking questions others might overlook.
“Look at the status quo and go under the assumption that nobody has asked the question,” he said.
That mindset has led to tangible changes. He gave examples: eliminating unnecessary armored cash pickups at facilities and aligning high-tech imaging operations with actual patient volumes. He also stressed the importance of discipline in a field where priorities can shift multiple times in a single day.
“We work in an industry where the key priorities 48 hours from now are displaced by the ones 24 hours ago, and those were displaced by the emails we got at 8 a.m,” he said.
To manage that chaos, Mr. Daneff said CFOs must operate at the “top of their license” — just like the clinicians they support. That means knowing when to lead as a turnaround CFO in a cash crunch, when to serve as a strategic partner and when to dive into process and operational improvements.