'You can't cut or shrink your way to greatness': University of Chicago Medical Center CFO on managing finances amid the pandemic

Rich Silveria has spent the last three years as executive vice president and CFO of the University of Chicago Medical Center and more than 30 years in healthcare, but his road to the C-suite has been anything but traditional. 

"I actually started out in IT because that is where I had most of my experience," he said. "I did an internship as a programmer, and I quickly realized that it wasn't relational enough for me, but I liked the logistical challenge. This led me to pursuing finance."

Mr. Silveria's resume includes close to a seven-year stint as senior vice president of finance and CFO of Boston Medical Center, a safety-net facility where he led a financial turnaround, and 12 years as director of revenue cycle finance at Mass General Brigham, formerly Partners HealthCare in Boston.

Here, Mr. Silveria shares how the resurgence of COVID-19 cases could affect finances at the University of Chicago Medical Center (which is part of the UChicago Medicine health system), describes his priorities heading into the new year and offers advice to other hospital CFOs.

Editor's Note: Responses have been lightly edited for length and clarity. 

Question: Illinois is currently seeing a resurgence in COVID-19 cases and hospitalizations. Do you expect the rise in cases to affect finances at University of Chicago Medical Center?

Rich Silvia: It depends on the degree of the new surge, which remains to be determined. It depends if the surge is large enough to compel Gov. J.B. Pritzker or other elected officials to shut down procedures to ensure hospitals across the city and state can care for COVID patients who need to be admitted — similar to what occurred in the spring. The degree of the financial impact will depend on if we have to shut down entirely to focus on COVID and ensure capacity is ready for COVID, but still have empty beds. That is an expensive proposition for healthcare providers. 

For context, in the first wave we shut down entirely. As a result we saw an 85 percent to 90 percent reduction in outpatient elective volumes. Inpatient elective surgical volumes were cut in half. We have recovered those volumes, but are still not where we were pre-COVID. Right now, to prepare for the resurgence, we have increased our inventory of personal protective equipment and testing supplies and are adjusting staffing as needed. We are also doing everything we can to make sure staff and patients are safe. We have to make sure our employees isolate or quarantine if they are exposed to COVID. As a result, we may have to rely heavily on overtime pay, temporary nurses or agency nurses, which adds expenses as well. 

Q: Based on University of Chicago Medical Center's response to the first wave, is there anything you would do differently or encourage colleagues to be mindful of, based on your experience?

RS: We did really well. I'd give our response an A- or B+. We had a hospital incident command center set up by January where we started to plan for the novel coronavirus outbreak, which allowed us to quickly ramp up our efforts once the pandemic was declared in March. We had hospital epidemiologist Emily Landon, MD, and the infectious diseases team help UChicago determine how to best manage patients and the pandemic. We have a lot of talented people here at the university. As CFO, I believe it is imperative to leverage that talent and read up on the latest news and frameworks. 

In terms of the supply issues that emerged across the U.S., I wish we had more of a regional or federal response to the supply chain. Everyone needed N95 masks, personal protective equipment, and what happened was that the supply chain got oversubscribed. Facilities competed with facilities, states competed with states for the same products, and the prices skyrocketed. Some of the terms on supply contracts were a bit scary. Something that cost 65 cents to 75 cents started to become $9 each, and suppliers wanted you to prepay before they shipped it. I think shoring up our supply chain and having a more orchestrated regional or federal response so that we don't have to compete with one another is something that needs to be considered in the future.

From a finance perspective, I would encourage colleagues to educate themselves on the epidemiology of the virus and make plans accordingly. My boss asked me to start thinking about a budget scenario for the upcoming fiscal year. So, I began to read the frameworks and history of the 1918 pandemic and learned from colleagues. I also participate in a number of national CFO forums, and the information we share is invaluable; we learn from each other and implement best practices. 

Q: What are two of your top priorities as CFO heading into 2021?

RS: My top priority is to guide the organization through the pandemic from a financial perspective, making sure that our teams have what they need to care for patients and to be safe. It also involves managing expenses and cash flow and maintaining liquidity so that any financial harm is mitigated during this pandemic.

The second priority is coming up with a point of view on our capital capacity. You can't cut or shrink your way to greatness. As CFO you have to preserve the mission, but manage through this crisis so you have the financial strength to reinvest into your strategic plan. So, what I am looking at is: What can I do to help guide the organization to preserve cash and manage expenses? Can we flex our budget with the volume as it goes up and down so we can perform well and form the capital needed to invest into the organization?

Q: What has been one of your proudest moments as CFO of University of Chicago Medical Center?

RS: Generally, UChicago Medicine has good number of talented and eminent people. It's an honor to work here and be part of something great. Since I've been here, we expanded our emergency department and added adult trauma service for the South Side, which went without a hitch. 

However, I'd say my proudest moment came this year. It was the convergence of thoughts we had in terms of thinking about the pandemic, its implications on patients, safety and how we would render care. It was working with clinicians and other leaders to come up with a plan. The proudest moment is being part of the team that prepared to rise to the occasion of the pandemic. Helping in my small way from where I sit, was probably in my three years, my best moment. 

Q: If you could pass along one piece of advice to another hospital CFO, what would it be and why?

RS: The CFO is no longer just someone who completes the audit, does the Medicare cost report, pays checks and collects bills. It's more than that now, you need to help shape strategies and organizational management approaches. I'd recommend actively seeking dialogue with others and really participating in it. You learn a lot from others. As a leader, you need to actively communicate with colleagues, intake information, get the best ideas and leverage the collective wisdom of those around you to help make decisions. Sometimes those decisions are unilaterally yours, but sometimes you will be in a war room-type situation, and you can help shape the best decision. That is what I learned from this unprecedented event  — how to approach it from a finance perspective, but be informed by a number of helpful perspectives gained from my clinical and operating colleagues. My budget and approach would not have been informed if I just approached it from a cash flow perspective and didn't understand the crisis from various vantage points. 


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