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Armchair Finance

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How worried should you be?

Ever wonder what your boss is thinking? What he’s worried about? It’s a healthy exercise, especially when statistics outlining his concerns are usually covering your desk as the chief financial officer. News flash: For at least the third year running, hospital bosses are most worried about money.

According to a recent survey by the American College of Healthcare Executives, financial concerns are keeping the CEO up at night. Sixty-seven percent of hospital CEOs marked finances as a top challenge, far exceeding any other concern.

Well, that’s no surprise, you may say. Mr. CEO is always asking me about length-of-stay this and days-cash-on-hand that to get a handle on the financial picture before the next board meeting. In fact, if you ask the average husband and wife, financial concerns probably top their worry list, too (I’ll let you know—I just got married myself). So where’s the news?

As a journalist, I’m supposed to dig deeper for you, and I’m determined not to disappoint in this, my first personal column in HealthLeaders. So on page two of the ACHE report, we discover that within financial concerns, hospital CEOs worry most about Medicaid (81 percent), Medicare (71 percent) and bad debt (68 percent), far exceeding worries about revenue cycle management (44 percent), managed care payments (42 percent) or the emergency department (40 percent).

So the villain in the hospital finance game is not managed care, not consumer-directed care, but the government’s payment system, on which so many hospitals claim to lose money? Yes. But the financial picture for hospitals in 2006 has been improving slightly; the survey shows financial worries are down from 73 percent of CEOs in 2003 and 70 percent in 2004. But as hospital CEOs continue to have tough financial conversations with their CFOs about Medicare and Medicaid spending, as well as the bad debt that results when those funding sources are inadequate, lobbyists can surely feel their ears burning.

—Philip Betbeze