'Understand Market Demand First,' Says This CFO

See how this CFO balances inpatient and outpatient capacities at a Level II Trauma Center.

At Medical City Denton, a 228-bed, acute care hospital with more than 900 employees and 1,100 physicians, balancing several different types of patient care, — from strokes to open heart surgery — is a big task.

Whitney Bendel took over as CFO of the organization in August 2024; she shared what goes into the financial management of an organization like this, from insurance challenges to growth opportunities.

The Pulse of the Organization

With over 10,000 annual admissions, Bendel's organization takes on a variety of specialty services including cardiology, imaging, neurological care, orthopedic care, spine care and surgery.

A big component to ensuring these services and reimbursement run smoothly is coverage, which can become tricky, Bendel says. The organization sees many critically ill patients coming from all over the state, requiring subspecialty coverage, which comes with the weight of policy complexities.

Two big factors come into maintaining a Level II trauma center, according to Bendel. One is ensuring there is comprehensive subspecialty coverage in place, and the other is having physicians to cover those services.

"We see patients coming from all over, and many are unfunded or underfunded populations, which can make it challenging from a reimbursement standpoint," Bendel says. "Of course, we want to serve our community and will always provide care for anyone who walks through our doors, but that dynamic can cause some financial challenges."

But Denton is prepared for these challenges and works to help these patients obtain coverage.

"We have financial counselors and public benefit coordinators to help support patients in obtaining insurance coverage while they are in the hospital," Bendel adds.

Labor costs for these specialty physician groups also come into play, but at an organization like Medical City Denton, a part of HCA Healthcare, Bendel says the organization is stable in its market.

"We offer our teams relocation and referral benefits to help bring in experienced staff. We also partner with technical schools and college programs to allow students to do their clinical rounds at the facility. HCA also started the Galen College of Nursing and there is a local DFW campus," Bendel says. "[Also,] we have a robust nurse resident program to onboard new graduates and give them the opportunity to grow within the organization."

Aiding in this stability are the organization's sister hospitals like Medical City Heart and Spine, and Medical City Argyle, which recently joined the Medical City group; through both locations Denton can serve the community in cardiac services.

At Medical City Heart and Spine specifically, the organization helps to "offer higher levels of care for ECMO and heart transplant patients," allowing Denton to focus on its various acute cardiac patients.

Bendel highlighted a key focus of the organization: exploring the opportunities for growth through these service line expansions.

"For the Argyle Campus we are excited about our current and growing orthopedic and robotic GYN volume as well as identifying new opportunities for spine and robotic general surgery," Bendel says. "We also continue to drive awareness around the free-standing ER located on the front corner of campus. Patients can get in and out quickly."

Innovative tools also come into play here. To ensure Denton's patients get the highest level of care with the least complications, the organization has invested in the Inari Thrombectomy device to treat pulmonary embolism.

"It's fairly new to Medical City Denton, it's a device that allows the proceduralist to grab the pulmonary embolism in a single case as opposed to the patient going to the operating room multiple times," Bendel says. "There are less complications, shorter length of stay, less ICU time; this device has played a key role in innovation in our cardiac service line."

Growth and Understanding the Market

For Denton, one of the largest and most comprehensive providers in North Texas, understanding the market from both a broad perspective and a community one is crucial to understanding and creating opportunities for growth.

Staying vigilant on circumstances such as shifting population growth, shifting age demographics, new providers, and new service line offerings all help in understanding the market and where opportunities may lie, Bendel says.

"Understanding the market demand is vital, then you can help align your facility and your team to what the market needs. We also have to make sure we are balancing inpatient capacity," Bendel says. "You have to understand the service area and market needs to be able to provide services in demand. As the population grows, ages, shifts there are different service lines that become more in demand while others decline. Understanding the population and competitors in the market drives your strategy for growth."

With many services being pushed to outpatient settings, Bendel says Denton must find a balance to ensure it is aligning its "inpatient needs with services that are being pushed to outpatient."

"We have to ensure we are leveraging our operating room capacity appropriately to maintain our current book of business and continue to grow," says Bendel. It's a multifaceted approach, she explains, ensuring that the organization has the equipment, the services, and the staff it needs to continue to grow in specific service lines.

Understand that the market comes first, says Bendel. Then make adjustments to make sure "that your current team is aligned and supported to meet the demand."