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How a VA CFO Cut Through the Red Tape

Karen Minich-Pourshadi, for HealthLeaders Media, January 23, 2012

We have gotten better at longer-term and mission-focused planning. We focus on quality improvement, getting data in the hands of the provider and investing in safety—because nobody [in politics] is going to argue against those. We have a capital-rich organization, particularly in the last six to seven years, but that ebbs and flows. When budgets are tight and we hear political discussions, we know our margins will be tighter.

Right now we are focusing on increasing our outpatient presence and community clinics. We've also put a lot of money into telehealth and telehealth clinics recently because we can't be everywhere for every veteran, but we want to try to make contact.

HLM: How was your region able to improve payer collections by 15%?

Finegan: At the end of the day a lot of focus still goes into the fundamentals. You look for economies of scale and quality improvements; we find those investments make a return to the bottom line. But if you're not spending at least half your time on patient safety and quality, then you're leaving money on the table.

We also squeezed the lemon on our [vendor] contracts, but we're getting less savings juice from that now. Cost reduction is an opportunity to put in some Lean process improvement in place. We applied it to improve our flow management and also to our revenue cycle. We are rapidly moving through value stream mapping on other areas, so we're making more progress with Lean.

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