Like many healthcare leaders across the U.S., one of the trends that Brewer, Maine- based Northern Light Health executive vice president and CFO James Rohrbaugh has his eye on right now is policy changes from Washington, specifically related to potential Medicaid cuts.
“When we look at Northern Light Health and many rural providers, one of the challenges we face is the percent of our revenue that comes from government payers,” Mr. Rohrbaugh said during a Becker’s CFO+Revenue Cycle Podcast episode. “At Northern Light Health, 66% of our revenue comes from either the Medicare or Medicaid program, and we’re providing healthcare in a rural setting.”
Mr. Rohrbaugh said regulatory partnerships and commitments are among the most important factors in ensuring these programs remain intact. System CFOs and government affairs teams need to work with elected officials to have a strong understanding of all regulatory changes, how they affect reimbursement and how they could strengthen — or threaten — rural healthcare sustainability.
Another trend Mr. Rohrbaugh is following is the continued pressure that revenue cycle teams are under in healthcare.
“I like to simply say that one of the most important tasks that we have in finance and operations is to make sure we get paid for the services we deliver,” he said. “That task has become increasingly more difficult over the last several years, it almost monthly gets more difficult. The level of abrasion to get paid has never been higher, and unfortunately, that’s not just affecting the ability to drive sustainability, but it’s also affecting the patient experience that our patients have in the process, because they’re stuck between the payer and the provider in these processes.”
In January 2023, Northern Light Health outsourced around 1,400 employees to UnitedHealth Group’s Optum. It’s a partnership that Mr. Rohrbaugh said can be key for systems to help deliver services and a set of expertise that might not be in house.
“We’re constantly evaluating potential partnerships,” he said. “It doesn’t change the work we need to do around revenue cycle, but [Optum] does give us access to a different set of resources than maybe we have had on our own as we tackle some of the challenges around revenue cycle and it provides the opportunity to get benefits of scale and provide those services when we’re able to use a provider that offers similar services to other providers as well.”
As health systems across the U.S. continue to feel the brunt of industry challenges, many have been forced to pause or close services and hospitals. So far in 2025, Becker’s has reported on 10 hospital closures, including Northern Light Health’s Northern Light Inland Hospital in Waterville, Maine.
The system shared plans to close the 105-bed facility in May due to “immense pressure of higher operational costs, unsustainably low reimbursement rates and a tight labor market.”
“There’s certainly tremendous pressure on rural health systems,” Mr. Rohrbaugh said. “One of the things that’s challenging is we know healthcare has high fixed costs, and many times it requires a certain amount of volume in order for it to be sustainable. In Inland and many other situations, what we’re finding, especially in markets where you have a high degree of government payer mix, it’s very difficult to be sustainable without sufficient volumes.”
Luckily, Mr. Rohrbaugh said amid the closure of Inland Hospital, there is another provider serving that market to ensure healthcare services will continue to be provided.
Looking toward the future, Mr. Rohrbaugh said even in challenging times for the healthcare industry, it’s important to take these moments to find ways to drive improvement, partnering with and building relationships between government and providers to drive rural healthcare sustainability.
“My focus in my time here has been and will continue to be on, ‘how do we bring other partners together to tackle these challenging issues in rural settings to make sure that our community has the access that it needs,'” he said.
