'Cost' in healthcare means different things to many people: 3 questions with Marion General Hospital CFO Jeff Wakefield

Jeff Wakefield, a seasoned hospital finance leader, joined Marion (Ind.) General Hospital as CFO in June 2016. This is the sixth hospital Mr. Wakefield has worked at.

Prior to his role at Marion General, Mr. Wakefield served as director of finance for Goldsboro, N.C.-based Wayne Memorial Hospital for nearly four years, controller at Raleigh, N.C.-based Holy Hill Hospital for three years and also held a position as a public accountant prior to joining the healthcare arena.

Here, Mr. Wakefield discusses two of the most pressing challenges healthcare CFOs face, the essential skills CFOs need in today's healthcare landscape and his financial priorities in 2018.

Note: The following responses were lightly edited for length and clarity.

Question: What are the two biggest challenges healthcare CFOs are facing right now?

Jeff Wakefield: We face many challenges, especially as certain tenets of healthcare reimbursement are being changed, and not for the better. That said, one of our biggest challenges continues to be that of controlling costs. We hear much in the media about the rising costs of healthcare … and "cost" means different things to many people. My opinion is that true healthcare cost is determined by what providers have to pay in the everyday course of operating. We must negotiate smartly with vendors when purchasing things like major equipment and medical supplies. To do that, we've had to become smart about pooling resources together with other providers to gather some sort of leverage.  We also incur a lot of "cost" in the form of personnel that we have to deploy in the battle of denied or under-paid claims. As we continue seeing more reimbursement tied to quality and bundling of care for a set fee, it will be imperative that we get a really good fix on what it costs us to provide those services. This means we will need to really dissect both supply and labor cost to enable us to truly determine our position in regards to profitability on a particular bundle.

Another big challenge for healthcare CFOs is in the management of denials. We spend a significant amount of resources on appeals for claims that are denied, often times for reasons that make no sense. Often we have to contract with a third party to assist us in this process, both to add expertise that we may not have, as well as [to add the] tools to properly manage the flow of the denied claim. 

Q: Beyond financial knowledge, what skills are essential for hospital and health system CFOs in today's healthcare landscape?

JW: One essential skill I feel CFOs should have is being able to build meaningful relationships, not only with staff, but also members of our community… There are many initiatives in which we come together to create solutions and it's important that we can all come to the table and work together effectively. Building meaningful relationships that last is fundamental to accomplishing [solutions].

Another important skill is to be able to think and act strategically as the healthcare landscape changes … Changes will be thrust upon us, whether we are ready for them or not and we must understand the implications and be prepared to meet them head on and be prepared to position ourselves accordingly. An additional piece of being prepared is having the right resources available to help us gather and analyze our data in a timely, meaningful manner because we base important decisions [off this data]. This not only encompasses partnering with the right vendor, but also having talented staff that can both gather the data in a meaningful way as well as provide analysis.  

Q: What is one of your top priorities for 2018 as CFO?

JW: One of my top priorities for 2018 is to totally map out our revenue cycle process. I want to use this as a tool, which we can use to help educate our staff on the many different pieces and as a tool that helps us identify our strengths and weaknesses — our opportunities for improvement. It will also allow us to evaluate our vendor partnerships and determine which ones are working well, and which ones are not. We'll also use it to see which processes may need to change, by perhaps outsourcing parts of it, or bringing a certain function back in house. I'm considering partnering with a local university to have some interns work on mapping out our revenue cycle process with us. I realize they won't have revenue cycle experience, but I like the fact that they will be approaching this project with a fresh perspective. They will, of course, be guided along the way to keep them from getting too far off track. I really feel this will be an exercise that will teach all of us something and will greatly enhance our revenue cycle process.

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