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Merging the Clinical and Financial

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Like a lot of CFOs, Kimberly Boynton comes from a public accounting background. She was trained to read financial spreadsheets, craft budgets, and track ROI. When she began nearly seven years ago as CFO at Crouse Hospital, a 481-staffed-bed facility in Syracuse, NY, that was the skill set she needed.

Now, however, she also spends her days looking at quality control charts and monitoring clinical indicators. As quality improvement has grown as a priority at Crouse over the years, it has also become a bigger part of her daily job. And with healthcare moving forward into an era of value-based purchasing, CFOs can expect even more of their attention to be taken up by clinical quality issues in the future.

If payers increasingly tie financial results to quality improvement, it follows, then, that success under these new reimbursement systems will depend on similar ties between quality and finance leaders within the hospital. The CFO of tomorrow will need to understand clinical indicators and error prevention, because they will impact the bottom line. And the quality and clinical leaders of tomorrow will have to understand healthcare reimbursement, because incentives will drive quality improvement programs.

"In today's day, when so much of the revenue depends on quality measures, we have realized that you can't be separated," says Boynton. The CFO has to be on the same page as clinical leaders like the chief quality officer and chief medical officer, she says.

When one of Crouse's major payers approached the hospital about setting up a pay-for-performance contract in 2004, Boynton worked with Derrick Suehs, CQO at Crouse, to develop 10 measures for determining the reimbursement bonus. The two had already merged financial and clinical measurement in their dashboards for the board, and had begun increasing the finance presence at certain quality meetings and vice versa.

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