In today’s healthcare landscape, “survival” isn’t just a dramatic turn of phrase — for many hospital and health system CFOs, it’s an honest reflection of the stakes.
Mounting reimbursement uncertainty, technology-driven disruption, and economic and regulatory volatility have converged to form what many finance leaders describe as the most turbulent financial environment of their careers.
From rural hospitals to academic medical centers, CFOs are being pushed to ask — and try to answer — the billion-dollar questions. How do they adapt, reinvest and remain solvent while continuing to provide quality care?
CFOs from across the country discuss four key issues keeping them up at night, and how they’re trying to future-proof their organizations.
Editor’s note: Most of the CFOs featured in this article are all speaking at the Becker’s 13th Annual CEO+CFO Roundtable, Nov. 3-6, 2025 at the Hilton Chicago. If you would like to join as a speaker or a reviewer, contact Mariah Muhammad at mmuhammad@beckershealthcare.com or agendateam@beckershealthcare.com.
1. Reimbursement
For John Mallia, interim CFO of Elmira, N.Y.-based Arnot Health, the greatest uncertainty revolves around reimbursement — particularly Medicaid. As a safety-net health system, Arnot Health serves a high volume of Medicaid patients, making it especially vulnerable to fluctuations in government funding.
“As the CFO of a safety net health system, my billion-dollar question is how much is governmental reimbursement going to decline — especially Medicaid — and how will commercial payers step up to fill the gap?
The concern is echoed across the country. Britt Tabor, executive vice president and CFO of Daytona Beach, Fla.-based Brooks Rehabilitation, points to the complexity and fragility of Medicaid policy as a key concern.
“With changing administrations at the state and federal levels, healthcare executives are uncertain about how Medicaid will be regulated or altered,” Mr. Tabor said. “Executives are primarily concerned with the financial stability of Medicaid, its impact on their organizations’ bottom lines, the changing regulatory environment and ensuring access to quality care for the growing Medicaid population. These challenges require ongoing attention and adaptability, especially as healthcare models continue to evolve.”
2. Financial viability
Jim Heilsberg, CFO of Clarkston, Wash.-based Tri-State Memorial Hospital and Medical Campus, distilled his concern into one haunting question: “How to survive and be in business in two years.” For smaller hospitals, particularly those in rural communities, narrow margins have grown even tighter, and the levers to pull for cost containment or revenue growth are few.
“Washington State is a particularly difficult market due to extreme labor cost inflation,” Dan Morissette, CFO of Chicago-based CommonSpirit, said during an episode of the Becker’s Healthcare Podcast. “Salaries and wages make up over 55% of our costs, and when wage inflation in a state is double the national average, it becomes nearly impossible to sustain operations.”
Similarly, Derek Goebel, CFO of Grand Forks, N.D.-based Altru Health System, cites external shocks such as trade tariffs and regulatory shifts as potential tipping points for financial sustainability. “In an industry with already narrow margins, programs like 340B and Medicaid expansion can be the difference between a positive year and a very negative one,” Mr. Goebel said.
3. Technology and transformation
While financial constraints loom large, hospital CFOs also recognize that innovation is not optional.
Rick Carrico, CFO of Louisville, Ky.-based Baptist Health, views technology as a strategic asset. “We’re addressing this by strategically investing in both people and technology — expanding our provider network, opening new facilities and enhancing digital tools that improve access to care,” Mr. Carrico said. “Our focus remains on creating a more seamless, personalized experience across every touchpoint.
However, digital adoption is not without its challenges. New tech platforms, hybrid care models and AI integration all demand upfront investment and come with uncertain ROI. “Capital investments to advance these new tools can be significant with little certainty to the long-term ROI — but simply sitting on the sidelines can prove costly as well,” Mr. Goebel said.
4. Policy volatility
Nowhere is the impact of policy uncertainty felt more acutely than in academic medical centers. Greg Damron, CFO of Columbia-based University of Missouri Health Care, highlights the complex intersection of clinical care, education and research.
“We are in a truly unprecedented era of uncertainty. Academic medical centers … are particularly exposed on a number of fronts to healthcare and fiscal policy changes, some of which are changing literally by the hour.” Mr. Damron said.
From potential cuts to Medicare and Medicaid, to fluctuations in research funding and new trade policies, Mr. Damron underscores the systemic risk that constant change introduces into long-term financial strategies.
“There are so many scenarios that have to be considered and planned against that it would not be hard to get paralyzed and be reactive to change versus being able to chart a steady course through the turbulence,” he said.