Lovelace Medical Center and Heart Hospital of New Mexico in Albuquerque is navigating a complex healthcare landscape, with CFO George Wiley focused on payer relations, regulatory challenges and strategic growth to ensure financial stability and long-term success.
"I started working in healthcare around 1990 as a Medicare auditor, doing cost reports for various acute care hospitals and other facilities with Medicare reimbursement," Mr. Wiley said on an upcoming episode of the Becker's CFO and Revenue Cycle Podcast. "Over the past 25 to 30 years, I've worked at rural and urban facilities — from 400-bed hospitals to small 75-bed facilities. I've seen a broad spectrum of how hospitals operate."
This year, as CFO of Lovelace Medical Center, one of Mr. Wiley's top priorities is payer relations — specifically denials and pre-authorizations.
"When we take a look at denials and pre-authorizations, those are the ones that we're focusing on the most now because we're looking at reimbursement to ensure we are getting paid correctly," he said. "As I take a look back on my career 20, 30 years ago, denials were an issue, but it's nothing like it is today. So denials for us are a big thing. We're making sure we have everything documented as required and submitted correctly. That also ties back to pre-authorizations."
Lovelace's Heart Hospital frequently receives calls from rural facilities requesting transfers for cardiac procedures, and verifying insurance coverage and reimbursement is essential.
"We get called frequently from surrounding rural facilities who ask, 'Hey, we've got a patient who needs a certain procedure — can you do it?' So for us, it's about taking a look at whether we have the insurance coverage needed for that patient and whether the insurance will actually pay us for the procedure," Mr. Wiley said. "So, payer relationships are one of the top priorities — not just for me but for my peers within the hospital community."
Regulatory challenges at both the federal and state levels are also top of mind.
"Recently, with President Trump's second term, all eyes are on his next moves regarding healthcare policy. There's been discussion about Dr. Oz, who strongly supports managed Medicare — a system that has been linked to a significant rise in denials.
Beyond federal policy, state-level regulations are also driving uncertainty.
"We're monitoring various items, including average length of stay, malpractice costs and the possibility of mandatory staffing ratios," he said. "So my top three concerns are staffing ratios, federal and state legislation, and payer relations with denials."
While many challenges exist, Mr. Wiley is optimistic about technology's role in transforming healthcare delivery.
"For us, technology is big," he said. "Last year, we implemented the BioButton," a wearable device that constantly monitors vital signs while the patient is in the hospital. "It's a button that literally adheres to the patient's chest, so we can monitor them 100% of the time."
According to Mr. Wiley, the real-time monitoring capabilities of the BioButton have already demonstrated life-saving potential.
"We've had a couple of cases where the BioButton was almost a lifesaver — it allowed us to detect a problem on the monitors early, and we were able to respond appropriately and get the patient back to a stable condition," he said.
Despite these advancements, technology also presents challenges, particularly regarding cost and resource allocation.
"The question is always, 'How do we pay for it? Do we adjust nursing staff ratios for it?' There are a lot of unknowns, but it's one of the most exciting parts of healthcare," Mr. Wiley said. "I've been around for a while, and I remember when we had a two-slice CT scanner — now we're up to 256 slices. The pace of innovation is incredible, but the challenge is managing it strategically."
On the financial side, Lovelace Medical Center is focused on optimizing revenue cycle processes.
"The company is actively working on tracking contractuals and making sure we're being reimbursed correctly," Mr. Wiley said. "From a revenue generation perspective, I get approached at least once a month by physicians about new technologies that could improve billing and reimbursement opportunities.
"Just last week, I met with a vendor and six of our physicians to discuss a new procedure. They walked us through the new CPT codes and how it could enhance our revenue stream. So, we're looking at both sides of the equation — how can we generate revenue through new technology and procedures, and how can we ensure we're collecting what we're owed?"
The hospital is also investing in growth strategies, particularly in surgical services.
"Surgery is an area where we've seen a slight reduction, largely due to the malpractice environment in New Mexico, which has led to losing some surgeons," Mr. Wiley said. "We're looking at how to increase surgical cases, and our new urgent care centers will play a big role. They can serve as feeder sites, helping connect patients to our hospitals and specialists."
Looking ahead, Mr. Wiley emphasized the importance of physician recruitment in sustaining growth.
"Physician recruitment is one of our biggest challenges but also one of our biggest opportunities," he said. "We're competing against major cities like Chicago, Los Angeles and Phoenix, so attracting physicians to Albuquerque requires a thoughtful approach. But if we can bring in the right individuals and build strong programs around them, that will be key to our long-term success."
Despite the challenges, Mr. Wiley remains committed to finding solutions that balance financial stability with high-quality patient care.
"It's all about aligning payer relationships, managing technology investments wisely, and growing strategically while ensuring we continue to meet the needs of our community."