From shifting federal policies to rising inflation and uncertainty around reimbursement, health system CFOs across the country say 2025 is shaping up to be one of the most turbulent and complex years in recent memory.
The financial playbook that sustained many systems in the past is no longer enough — leaders are being forced to make tough decisions in real time, balancing immediate cost pressures with long-term strategic investments.
In recent conversations on the “Becker’s CFO and Revenue Cycle Podcast,” health system CFOs describe a financial landscape where adaptability, creative capital planning and data-driven forecasting are no longer nice-to-haves, but mission-critical.
Editor’s note: Responses are lightly edited for length and clarity. Hospital and health system CFOs interested in being featured on the podcast can reach out to Alan Condon at acondon@beckershealthcare.com.
Michele Cusack, Executive Vice President and CFO, Northwell Health (New Hyde Park, N.Y.): The changes happening in Washington and local government are a major concern. Executive orders that reduce NIH overhead, potential Medicaid and safety net funding cuts and reductions in the federal workforce could all significantly impact our financial performance and our communities.
We’re also watching inflationary trends and potential tariffs. We typically spend around $1 billion a year on capital investments, and these pressures threaten our ability to modernize and expand. Operating on a 1% margin, any economic shift carries real consequences.
Brett Tande, Corporate Executive Vice President and CFO, Scripps Health (San Diego): The bill that came out of the House proposed $880 billion in Medicaid cost reductions over several years — a massive number that some argue aims to return Medicaid to its original intent. There’s significant debate about that. Many of my peers and organizations have had to pivot quickly, working to understand how potential Medicaid funding reductions — along with other changes, such as site-neutral payments — could affect their operations. The challenge is not just assessing the impact on our organizations but also on how care is delivered to communities across the country. That has been, by far, the biggest focus over the past few months.
Matthew Arsenault, Executive Vice President and CFO, Baptist Health South Florida (Coral Gables): We’re closely watching reimbursement policy and legislative changes. Medicare and Medicaid make up such a large part of our revenue — the stakes are high. Right now, we’re in a wait-and-see mode, but we know decisions in Washington could fundamentally alter how we operate.
George Wiley, CFO, Lovelace Medical Center and Heart Hospital of New Mexico (Albuquerque): There’s a lot of uncertainty around policy changes. For example, there’s increasing denial activity related to managed Medicare — something being influenced by national voices like Dr. Mehmet Oz. At the state level, we’re tracking regulatory developments including malpractice reform, mandatory staffing ratios, and policies that affect average length of stay.
Michael Gleason, Executive Vice President and CFO, Franciscan Missionaries of Our Lady Health System (Baton Rouge, La.): CMS recently encouraged states to move toward supplemental funding that approaches average commercial rates, which has been incredibly important for supporting health systems — especially in states like Louisiana, Mississippi and Florida. While this is a positive development, as with all government programs, policy changes can happen quickly and unexpectedly.
We’re closely monitoring the ongoing pressure from big pharma on the 340B program. This program is a significant revenue stream for us, helping offset the costs of providing care to underinsured patients in our markets. We’re also concerned about site neutrality threats, which remain a major issue.
Additionally, with the change in administrations, there’s renewed focus on the subsidies for exchange products, set to expire in 2026 unless renewed. The potential impact is significant — recent projections show that in Louisiana, up to 32% of those insured through the exchange could lose coverage, while in Mississippi, it could be as high as 43%. If those individuals move into the uninsured population, the financial impact on health systems would be substantial.
Lisa Goodlett, Senior Vice President, CFO and Treasurer, Duke University Health System (Durham, N.C.): We’re really trying to figure out what steps the administration is going to take next, and how do we anticipate that and have our various enterprises ready for change. Coming out of COVID, margins are starting to improve, but we see a lot of threats on the horizon or risk to our federal reimbursement, and also what could trickle down to the state levels.
Susan Green, Executive Vice President and CFO, Sharp HealthCare (San Diego): We’re in uncharted territory, and funding cuts are top of mind for everyone. On top of that, inflation continues to outpace reimbursement. At Sharp, we operate under a capitated model, which aligns well with population health goals — but even then, we need to rethink cost structures. Alternative payment models are key to that transformation.
Ivan Samstein, Enterprise CFO, University of Chicago and UChicago Medicine: The million-dollar question is about policy: How will changes affect government insurance programs, 340B, or outpatient departments?
Government policy plays a huge role in healthcare finance, and uncertainty about where things are headed — especially over the next 12 months — makes strategic planning extraordinarily difficult.
Paula Tinch, Executive Vice President, Finance, CFO, Penn State Health (Hershey, Pa.): We’re trying to strike a balance between investing in what our patients need — like new pharmaceuticals and technologies — while also driving down systemic costs.
Labor and infrastructure remain our biggest expenses. The key is empowering our teams to work at the top of their license, using automation and process improvements to reduce friction. We’re not reinventing the wheel, but we are laser-focused on refining and scaling what works.
