The passage of the One Big Beautiful Bill Act on July 4 has prompted many hospital and health system CEOs and CFOs to rethink how their role relates to the other, primarily by accelerating strategic decision-making and deepening their partnership bond.
As systems calculate ways to address looming Medicaid and Medicare cuts, a stronger CEO and CFO bond can help build organizational trust, strengthen long-term planning and ensure a more unified, mission-driven response amid uncertainties.
Becker’s connected with hospital and health system CEOs and CFOs from Care New England, Loma Linda University Health and OSF HealthCare to discuss how the new law has reinforced the need for trust, flexibility and constant collaboration to remain financially sustainable and protect their long-term mission of providing care.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: How has your relationship with your CFO changed during this moment — in cadence, decision-making or the kinds of tradeoffs you’re facing together?
Bob Sehring. CEO of OSF HealthCare (Peoria, Ill.): OSF HealthCare, with our governing sisters’ guidance, has always valued the relationship between the CEO and CFO, and all other members of the leadership team, to help the organization through challenging times for 148 years. The uncertainty around the recently signed legislation has not changed the cadence or decision-making process. I would look more to the beginning of the pandemic as the catalyst for change due to the unknowns and uncertainty. The newly signed legislation just continues the challenges OSF and health care systems around the country have been grappling with, primarily because of a lack of clarity about some of what we’re facing.
Michael Wagner, MD. President and CEO of Care New England Health System (Providence, R.I.): The One Big Beautiful Bill Act has profoundly deepened my partnership with our CFO, elevating it to a new level of urgency, integration and strategic alignment. Together, we are not only reexamining the fundamentals of our financial forecasts but actively engaging our board — both at the committee level and with the full board — to ensure a clear understanding of the stakes involved. We are gathering intelligence from national organizations while leveraging internal expertise to assess the full scope of the bill’s impact. At the same time, we are leading conversations across our leadership teams to ensure we can protect access to care for the communities most at risk, particularly Medicaid beneficiaries and the growing number of uninsured individuals. Through it all, we remain grounded in our core mission: to serve as our community’s trusted source for healthcare, regardless of the challenges that arise.
Richard Hart, MD, DrPH. President and CEO of Loma Linda (Calif.) University Health: We’ve been on a yearslong journey now — on what we’re calling One Loma Linda, where we’ve been seeking to integrate a physician group, our medical center, six hospitals and the university all more closely together. So I’ve been depending upon the CFO a lot in that whole process and continue to do that. What it has meant, in my mind, is that when this latest crisis hits, from Trump et al., the mechanism was already there to collaborate and look at solutions together. That’s certainly been the case in the academic health science center. We have not just the healthcare side, but the academic side as well, which is getting hit pretty hard with the Grad PLUS loans being knocked out and a variety of things on the student side. So the structure, the routine committee meetings, the one-on-ones — have been there all the way along, but have been even more beneficial as we face the crisis of today.
For example, we’re in the process of finalizing — the last couple of months — our budgets for the next year, so trying to predict revenue streams. This time has been particularly stressful. So we walk through that, looking at service lines. We carry a lot of external contracts, so trying to determine those, looking at our contracting office and trying to adjust our payroll rates — those are all areas that we collaborate on significantly.
Question: What’s one decision you and your CEO have had to revisit or reframe entirely due to the ripple effects of the One Big Beautiful Bill Act?
Angela Lalas. CFO, Executive Vice President of Finance of Loma Linda University Health: Part of it is on our strategic and capital investments. Not that we’re changing course, but it’s more we’re taking a pause or re-evaluating, reprioritizing until we get a final certainty on the reimbursement — particularly with Medicaid reimbursement. So addressing the needs now, planning for the future, making sure that we’re not compromising the future of the organization.
Kirsten Largent. CFO of OSF HealthCare: The One Big Beautiful Bill hasn’t necessarily changed the cadence of decision-making for us, but it has reinforced the need for continual reassessment of priorities and trade-offs. Much like the pandemic, the recently signed legislation has highlighted the uncertainty surrounding reimbursement, requiring us to plan with even greater flexibility. Ultimately, the OBBB has not introduced a singular inflection point, but rather an ongoing need for disciplined collaboration between finance and strategy to ensure we remain nimble and aligned in the face of continued volatility.
Todd Conklin. Executive Vice President and CFO of Care New England Health System: The main decision that we have had to consider is related to the incredibly daunting estimated impact that a $1 trillion cut in Medicaid and Medicare spending could have on the U.S. healthcare industry and our specific health system. The estimated impact is broad and deep when considering the estimated $1 trillion of cuts impacting 11 million to 17 million Americans by 2034.
So, the question is, how can we operate a sustainable tax-exempt health system that is obligated to “serve all patients regardless of their ability to pay” amid a daunting reduction in our funding of these same patients that we are obligated to serve?
