Andy Zukowski, CFO of Greenville, N.C.-based ECU Health and the Brody School of Medicine at East Carolina University, is tackling healthcare industry uncertainties head on with his finance team as a new year dawns.
North Carolina is facing a budget shortfall to fund a 10% provider-based payment rate reduction. Federal cuts from the One Big Beautiful Bill Act could also begin affecting reimbursements in October 2027.
“These two policy changes, combined, will make delivering rural healthcare more difficult and requires us to prepare now by rethinking these traditional models of care as it relates to rural health access and cost of care,” Mr. Zukowski said during a Becker’s CFO+Revenue Cycle Podcast episode.
ECU Health is a rural academic safety net health system that serves more than 1 million people across 29 eastern North Carolina counties. It operates a 1,708-bed academic medical center with two campuses, eight community hospitals and multiple outpatient facilities, home health, hospice and wellness centers, according to its website. It comprises more than 1,100 academic and community providers.
CMS also allocated $50 billion in late December to all 50 states through its Rural Health Transformation Program, a five-year federal initiative created under the OBBBA.
Policy and rural healthcare leaders have questioned whether states will pass funds to local providers, since it’s not required by the program that they do so. The legislation also includes long-term Medicaid cuts that are expected to cut rural funding by $155 billion over 10 years.
“We’re actively engaged and involved in understanding what that will look like,” Mr. Zukowski said. “It’s going to be really critical that the rural health funds get to the rural healthcare providers, and that’s what we’re most focused on at this point.”
Despite industry challenges, Mr. Zukowski said ECU Health has taken a proactive stance.
“We’re deeply committed to being the solution to this problem, with the focus on and not limited to collaboration with everybody, all of the decision makers, as we look at the rural health realities across eastern North Carolina.”
ECU Health is also working with state lawmakers to open the state’s first rural emergency hospital. The health system and Martin County, N.C., signed a nonbinding letter of intent in July 2025 for the REH facility, and are working to secure state funding to ensure long-term regional care.
“Growth mindset is critical, along with continued focus on fundamentals,” he said. “This is all just to ensure that we can learn through change and not get distracted by the news of the day or the issue at hand. It’s critical that we think long term and at the same time, focus on those fundamentals.”
