The list of things Nikki McLean was focused on five years ago as a CFO would fit most traditional job descriptions of crunching numbers, interpreting financial statements and verifying compliance. The job goes far beyond that now.
McLean, CFO of the Piedmont Augusta Clinical Hub in Augusta, Ga., part of Atlanta-based Piedmont Healthcare, described a job that has moved decisively beyond its original scope during a panel at the Becker’s 14th Annual CEO + CFO Roundtable in November.
“You think of the CFO role as being traditional finance, your financial statements, your investments, tax returns, cost reports,” she said. “Really today CFOs are expected to shape organizational strategy, drive transformation and serve as a key business partner across the system. We spend a lot less time on traditional finance roles and really looking at strategic growth, operational efficiency and how we can transform our organization for long-term success.”
The metric that has produced the most measurable improvement in her organization isn’t a financial one. She is instead obsessed with capacity metrics.
“If I could say there’s one thing I’ve spent a lot of time on the last couple years that has made the biggest improvement — it’s really looking at excess days,” she said.
Judy Peakley, CFO of University of Vermont Medical Center in Burlington, Vt., described the transition as a long-overdue recognition.
“I consider myself a strategic and operational CFO, and I am seeing organizations make that change,” she said. “I think the board’s finally recognizing the role of the CFO goes beyond crunching numbers.”
Building that credibility across a clinical organization requires operating differently than the finance function traditionally has. Eric Price, a former CFO and former Marine Corps sergeant with experience at critical access hospitals in Oregon, Michigan, Idaho and Alaska, described his approach through a framework he carried over from his military service.
“Give the troops tools to do the job and then get out of their way,” he said. “That’s kind of how I approach it as a CFO — try to give the clinical teams the tools, anything they need to help them be successful, and then create a partnership.”
David Hernandez, CFO of HHM Health, a federally qualified health center in Dallas that has grown from three to 10 locations over the past 18 months, said the biggest change in how he works has been in how he is perceived, and what that perception shift has enabled.
“There’s still that perception with a CFO — like we often are seen as a CF-No,” he said. “The more people talk to us and the more they get a chance to give us a chance to explain things, it has completely eliminated that barrier.”
Breaking down the siloes has extended his reach well beyond the organization’s walls. Mr. Hernandez described his role as an extension of the CEO, COO and CMO, including in the community, where he represents HHM Health with local partners. To illustrate the point, he mentioned a conversation with a school contact who mentioned that students were missing vaccines because of access barriers. He made a commitment on the spot.
“I jump in there and start working out, maybe we send our mobile unit to come get that taken care of for you,” he said. “Being more proactive — if you go in there and you don’t feel like you can actually deliver on something you’re saying, then it’s going to make it more difficult.”
The panel’s forward-looking conversation centered on what skills the next generation will need. Mr. Price, who is enrolled in a health administration doctoral program, said clinical knowledge can no longer be treated as optional.
“The skill set I believe that I need as a CFO is to have more clinical knowledge, not just from the ground, which is occurring, but the actual theory behind it,” he said.
He also pointed to advocacy. Mr. Price described drafting legislation in Oregon that preserved Medicaid benefits for behavioral health patients who were justice-involved, which is now a natural extension of the CFO function.
“Understanding the payment models, the CFOs probably have the most in-depth knowledge of all the little complex polynomials that go into how we get reimbursed,” he said. “Learning how to effectively articulate where these payment models are causing harm is where CFOs need to be more effective.”
That ability to communicate translates to boards as well. CFOs must be able to share their vision and seamlessly communicate how to get there. Mr. Hernandez said the CFO’s value is in creative problem-solving, not gatekeeping.
“It’s not a ‘well, let’s see if we can afford to do this.’ It’s more about, ‘Hey, help me do this, how can we make it happen?’” he said.
Ms. McLean said the board’s expectations for CFOs should change entirely.
“CEOs and boards should really think of their CFO as being a strategic business leader — more than just the finance guru,” she said. “We’re really uniquely positioned to connect data, operations and strategy.”
Ms. Peakley advised hospital CEOs and boards evolve along with the CFOs to take full advantage of their strategic outlook and skillsets.
“Bring the CFO to the table with you,” she said. “Not after decisions are made.”
Mr. Price concurred.
“The hospitals I’ve worked at and left from — the ones that had CEOs and boards that heeded counsel and trusted the numbers are doing well,” he said. “The ones that just couldn’t quite understand when I tried to explain payment models and why we couldn’t do something and did it anyways are in financial distress.”
His conclusion: “Trust your CFO.”
