Being Strong is Adapting: Q&A With Tahlequah City Hospital CFO Julie Ward

Julie Ward is committed to keep healthcare vibrant and sustainable in her rural Oklahoma community. In fact, it's been the central goal of her 18-year healthcare career.

Ms. Ward's career began at Tahlequah City Hospital, a 100-bed, city-owned facility in Tahlequah, in 1995. She joined as a staff accountant and quickly worked her way up to controller. In 1998, the hospital promoted Ms. Ward, who has also been a certified public accountant since 1995, to CFO, a position she still holds today.

Government-owned hospitals typically have weaker financial measures, compared with nonprofits and for-profits, but Ms. Ward and TCH have been on sound footing for the past several years. As of June 30, the hospital had 111 days cash on hand and a cash-to-debt ratio of 66.5 percent. In 2012, TCH posted a profit of more than $2.8 million on $85.8 million of net revenue, good for a 3.3 percent margin — a figure that is well above average compared with other government-owned facilities, according to data from Truven Health Analytics.

Here, Ms. Ward talks about her role as a hospital CFO amidst healthcare reform, how physicians and health insurers can help improve the system and how advice from her grandmother is motivating her today.

Question: What are the most important issues you face as a hospital CFO right now? What is most important for Tahlequah City Hospital, and what general trends are catching your eye?

JulieWardJulie Ward: Continuing to remain profitable is today's environment is the biggest challenge all hospitals face. We are being challenged to meet new requirements, almost daily, with less reimbursement.

TCH has worked diligently to build partnerships through joint ventures and other means to ensure positive outcomes. We have also worked to diversify so that all of our income is not dependent on patient care. I believe that we will weather the current storm and be stronger for it.

Q: How do you believe hospitals like Tahlequah City Hospital will fare under healthcare reform? Tahlequah, Okla., is a fairly rural area — how will rural hospitals fit into healthcare reform?

JW: The local hospital is a vital part of many communities, not only for healthcare needs but for economic reasons. It would be challenging in many rural areas if the healthcare services that are currently provided by the hospitals were no longer available.  

That being said, the model is changing. The kinds of services that will be offered in the future will be different. In a few years, the surviving hospitals will be the ones that remain aware of the evolving changes in treatment of health and adjust to provide them in an efficient, convenient and cost-effective way. Convenience is not our industry's strong suit, but I believe that is the ultimate expectation. Those that are able to meet that expectation in a safe and friendly manner should do well.

Q: What is your hospital doing right now to stay innovative with commercial payers like UnitedHealthcare, Aetna, Cigna, etc.?

JW: Our contracts with the payers you mentioned have remained virtually unchanged for several years.  

However, I see great opportunity in some of the things that the payers are doing. For example, Humana has a rewards program. They report recommended preventive and chronic condition screenings that our physicians did not order when they saw the patient. They reward physicians that meet their goals with an additional payment. This seems like a more positive approach than some of the others we are seeing.

Q: Currently, what projects or issues worry you most — specific to your hospital or broadly — and what gives you the most hope?

JW: Like most hospitals, the main issues we are dealing with right now include [recovery audit contractors] and medical necessity, ICD-10 and core measures. However, these all ultimately go back to the same goal, which is changing the behaviors of physicians.  

Physicians as a whole want to provide the best care possible and do not have the knowledge or strong desire to document in the very specific ways required. In my opinion, documentation is not given enough emphasis in their training. Compounding this problem is the fact that these documentation requirements are changing at a very rapid pace. Specifically, ICD-10 will significantly add to this problem.
Q: What's the best piece of advice you've received throughout your career?

JW: The best piece of advice that applies to the current environment came from my grandmother.  "A person is only as strong as their ability to adapt." It seems very appropriate in an industry that is changing at a rapid pace with no end in sight.

More Articles on Hospital CFOs:
Life as an Independent Rural Hospital: Q&A With Duncan Regional Hospital CFO Doug Volinski
In the Height of Transactions: Q&A With Franciscan Health System CFO Mike Fitzgerald
What Are the Biggest Issues Impacting Hospital CFOs Today? 10 Industry Experts Explain

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