The Evolving Role of the CFO: Q&A With HFMA CEO Joe Fifer

Joe Fifer, president and CEO of the Healthcare Financial Management Association has had a busy 12 months. After being named as the head of the organization that represents more than 40,000 healthcare financial professionals following the retirement of Richard Clarke in June, he has led the organization's involvement in several initiatives, including its newly released guidelines for patient financial interactions, created by a steering committee comprised of leaders from the American Hospital Association, America's Health Insurance Plans and others.

At HFMA's Annual National Institute in Orlando on June 18, Mr. Fifer sat down with me to discuss challenges and opportunities for healthcare financial leaders as well as the evolving role of the organization he leads.


Joe FiferQuestion: CFOs and other financial leaders certainly have a lot of challenges on their plates right now when we consider the current pressure on hospital reimbursements as well as movement toward new payment models. The latter, of course, could dramatically change how healthcare is delivered and paid for. As these changes are unfolding, how has the role of financial leaders changed?

Mr. Fifer: It really has expanded; that's how it changed. By that expansion, it ranges from health systems where the CFO is really the chief strategy officer, maybe not by title, but by function. There's a number of CFOs that are much more intimately involved in operations, and I'm a big advocate of that. I think the days of the CFO doing his or her job just by sitting in his or her office really need to be over. CFOs need to be engaged with things outside their historically direct purview of finance.

In terms of the career trajectory, we are seeing more and more CFOs going unto other roles. I know of CFOs in larger systems going into COO roles. I know of CFOs going into the CEO role, and I think that speaks to the broadening nature of CFO responsibility.

Q: There has been a great deal of scrutiny recently on hospital charges and pricing, especially in the last few months. Just this morning you announced HFMA’s participating a new steering committee to explore transparency in healthcare pricing. Today though, healthcare pricing is confusing for consumers. How did we get where we are today?

JF: How we got here is we've had a health system that by and large, really for two generations of patients, weren't that engaged in the financial aspects of healthcare. They weren’t engaged because they didn't need to be. They had low- or zero-deductible plans, low or zero co-pay plans, so we had all this massive infrastructure and environment where there really wasn't a marketplace because consumers — the ultimate consumer meaning the patient — wasn't expected to be engaged. And you know, seemingly overnight we have this environment where now they are engaged, and they do have a lot of out-of-pocket cost and it is within that environment that the spotlight is being shown where it hadn't been shown before.

Q: CMS recently released hospital chargemaster data which the consumer media has been quick to publish and draw conclusions from. However, we within the industry know that very few patients actually pay these chargemaster rates. Rather, they’re set as a starting point for negotiations with payers. It’s been done that way for many years, but of course, doesn’t make sense to consumers. Do you see this process for rate setting changing?

JF: It has to change. Hospitals can't fix this on their own. They can’t fix the price structure on their own. It does take cooperation by the payer community.

Q: What are some other things healthcare providers should do to respond to this consumer desire for better increased transparency and understanding?

JF: I think they need to embrace it. Embracing it results in taking a variety of actions, but really embracing it -- that’s an attitudinal thing that needs to take place. That’s not just the CFOs, that’s throughout the organization. We need to recognize that patients want and need this information. I think embracing it would suggest we would need to open up as organization and have these conversations. And that’s exactly where these patient financial interaction conversations are taking us. It’s encouraging.

Q: Tell me more about the patient financial guidelines that were released. How long has the steering committee been developing them?

JF: It's been about a year in the works. It started last summer with the formation of the steering committee and we met at least monthly, sometimes more. I never counted the hours, but there were a lot of hours by a lot of people that went into these guidelines.

Q: The principles released make a lot of sense to most people who read them I think. They really seem like ideas hospitals should rally around. That said, how will hospitals take them from being simply nice principles to actions that are actually carried out in hospitals?

JF: First, I'm glad to hear you think they make sense because that's important. We think that they do make sense. But, just because they satisfy the common sense test doesn't mean they're easily adoptable or that they're naturally adopted, because if it was so easy it would have been done a long time ago. We've all played a role in getting to this spot, so we all need to play a role in the solution side of this.

To drive adoption, it starts with the education, and that's really one of the reasons HFMA was selected to be the organization to promote these. As you know, there were a myriad of other organizations that were part of this. HFMA was selected as an organization by this group to promote these because, one, it's right in our wheelhouse, and two, we have an educational platform. That's what we do. We provide education. So that's the first way we'll start promoting this is to publish and publicize these best practices through a variety of mechanisms. And then we'll start pushing the adoption of these. A lot of the specifics about how and when and what tools and what recognition and those kinds of things are all being talked about as we speak and will be finalized in the next few months. While we receive comments about the subject of the best practice guidelines, we'll also be developing the roll out plan.

Q: You’ve been leading HFMA for a year now. What excites you about your role leading this organization and its future?

JF: I am incredibly excited. It's been terrifically interesting and exciting for me, and the reason why is it's a combination of things. I've had a longstanding and long developed passion for HFMA, and it started when I joined in 1983 up through a variety of leadership positions including sitting in the chair spot in the mid-2000s. That history reflects a lot of passion I have for HFMA. The ability to work for them is kind of a dream come true. And when you couple that history and that passion with what's going on in our industry and changes that are taking place and need to take place, it's really a great opportunity. I don't want to leave a mess of healthcare for my kids. I mean that. I don't want to leave a mess for our kids. It's messy right now, and I'm very excited about playing a role, a small role, and not a political role, but a contributory role in bringing some light, some data and some analysis from a financial standpoint to the things that we need to do differently. The whole thing is just indescribably exciting to me to lead the organization in this environment.

Q: If you had to pick one message for healthcare leaders to take away from this ANI, what would it be?

JF: I would say it would be an enhanced view and appreciation for a broader view of our industry, and that can play out in payer environments. I hope they can walk away from here and realize [our role] goes beyond just creating value. You can have a value agenda, and say 'here's my limited role in that value agenda'. I want people to be able to understand that their input is into something broader than that. It needs to encompass all of the aspects of the healthcare industry from a financial standpoint. I think the education they're getting here should lead them in that direction.

More Articles on HFMA's ANI 2013:

To Merge or Not to Merge: Benefits, Challenges and the Future for Stand-Alone Hospitals
HFMA Issues Advisory on Financial Communication With Patients
HFMA Chair Steven Rose: Doing Whatever It Takes to Support Healthcare Financial Leaders

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