Skip to main content

Cottage Hospital CFO Recaps HealthLeaders Spring CFO Exchange

Analysis  |  By Jack O'Brien  
   May 20, 2021

Ann Duffy, MHA, speaks from the HealthLeaders Spring CFO Exchange in Naples, Florida about the challenges facing rural healthcare organizations.

Editor's note: This conversation is a transcript from an episode of the HealthLeaders Finance Podcast. Audio of the interview can be found here.

The 2021 HealthLeaders Spring CFO Exchange held last month at the Naples Grande Beach Resort in Florida marked HealthLeaders' first in-person thought leadership event since the 2020 Winter CFO Exchange, which was held in New Orleans one month before the domestic spread of COVID-19 began.

We were thrilled to be able to interface with our community of hospital and health system finance executives in person and hear how they have dealt with the unprecedented obstacles related to a once-in-a-lifetime pandemic.

Related: What are the Financial Returns from a Vascular Surgery Line?


From the Exchange, Ann Duffy, MHA, CFO of Cottage Hospital, a 25-bed facility located in Woodsville, New Hampshire spoke about the challenges facing rural healthcare organizations.

This transcript has been edited for clarity and brevity.

HealthLeaders: Ann, this is your first time attending the CFO Exchange, so how has the experience been for you so far? What have been the top takeaways from your conversations with your fellow hospital and health system CFOs?

Duffy: Yeah, [with it] being my first time attending, I didn't know what to expect. The format, the thought leadership, and the different CFOs from various sized organizations have been interesting. Speaking with different people, you realize that big or small, we’re all facing the same challenges.

[I enjoyed] the morning sessions and open discussions around the challenges we’re all facing, and then coming back to present solutions. I found that very valuable. Again, seeing that there were a lot of similar challenges we're all facing and being able to hear some other leaders’ solutions and ideas they have had that I maybe hadn't thought about.

HL: How was the experience of leading a rural health organization through the pandemic? What is the current financial and operational status of Cottage more than a year after the spread of COVID-19 began?

Duffy: For Cottage, we're an independent standalone hospital and one of a few [organizations] left in New Hampshire that are not affiliated with a larger health system. That has its pros and cons; one of the biggest benefits is that we can be nimble and adapt quickly.

We stood up our incident command at the end of January 2020, early on [in the pandemic.] Our CNO was right on top of it, and we felt we were as prepared as we could be going into this. Our staff was phenomenal, and our community embraced the hospital. I think on the positive side of the pandemic, it gave the community a new appreciation for [Cottage] and everyone came together to help their neighbors.

From a financial standpoint, we saw a 55% decrease in volume when the elective surgeries came to a halt. But we were proactive in communicating with our community, educating them, and letting them know we were still here for them. Their hospital is here, we are still open, so don't be afraid to seek care. We let them know what our safety precautions were and what their experience would be when they came back. We tried to alleviate that fear to get people back into the system.

HL: When you look ahead to a post-pandemic landscape in healthcare, what are some of the biggest opportunities for growth?

Duffy: Telehealth is an area [of growth]. Pre-pandemic, we did very little; we had some virtual visits for psychiatric care and mental health, that's all we had. Then COVID came, and being nimble and adapting quickly, we stood up telehealth.

We had telehealth in our primary care, specialists, orthopedics, behavioral health, and it did well for a while, and the behavioral health [segment] has continued. That seems to be a population that has grasped the telehealth service and our providers providing the service have found it valuable as well. They're able to actually see the patient in their home and get a better sense of knowing their patient.

I see telehealth as an investment we'll continue to make; we have to work with our community and local town managers because we are so rural and we have broadband issues. There have been monies brought into the state because of COVID to invest in broadband and that's important for us.

As a hospital, as the largest employer in the community, we need to be part of that conversation, to help move that along, so that we can provide those services to our patients. We've also done some more home visits during COVID; we had a couple of primary care providers that would do some home visits previously, but we've seen an uptick in that [segment.] I see that as an area for us to continue to explore and perhaps build upon. We purchased a van, due to a lack of public transportation [in Woodsville,] and can assist in getting patients to their appointments, and we're also looking at using it to go out and provide some mobile services.

HL: What is Cottage’s current financial standing and what are some lingering challenges that your organization and other rural hospitals will have to overcome?

Duffy: We're doing pretty well; we've stabilized for the most part. Our primary care volume is still down, there's still a segment of the population that is waiting to get vaccinated and have some fear of coming out. So, those volumes haven't quite gotten back to pre-COVID numbers.

Our ED volumes are also down, and I heard a lot about that over the last couple of days from other CFOs. That seems to be a trend, not just with us, due to the lower utilization in the ED as we're seeing more inpatient acute stays. We're seeing higher acuity patients, they're staying longer, and that volume is up.

We also have an inpatient geriatric psychiatric unit, and during the pandemic, we weren't able to take admissions as easily, and then we were having difficulty discharging because there were nursing homes [and long-term care facilities]that weren't taking [patients] in. But we're starting to see that alleviate and we're able to take more admissions and discharge within our normal length of stay for that unit.

Something changes every day. We must be nimble; we had to be nimble pre-COVID because healthcare was always changing, but this just brought it to a whole other level. From day-to-day, guidance changes and we must go with the flow.

HL: Are you worried about the prospect of increased provider consolidation as the pandemic subsides? How can rural health organizations navigate difficult industry trends?

Duffy: We are independent; it's our strategic goal to remain independent and not affiliate with a larger health system, so it's always at the top of our mind on how we can stay relevant, profitable, and still perform the services that we need to for our community. We're just focusing on things we do well and investing in our outpatient, primary care, and specialty services. We've seen a decline in inpatient services over time, although we have been busy during this period.

But we must look at the long-term picture and always be evolving towards more of a population health, value-based care model. Even as a critical access hospital, we have a bit of a safety net but it’s all a balancing act.

It's a challenge, [rural hospitals] are closing all over the country. For Cottage, I would say collaboration is key as an independent hospital. We're not affiliated with any other health system, but we do collaborate with our peer hospitals. We don't so much look at them as competitors. We may not need a dermatologist five days per week, we need a dermatologist one day per week.

My best piece of advice would be to partner with the resources that you have in your area to provide the services that your community needs.

Related: How Rural Hospitals and Health Systems Should Approach Succession Planning

The HealthLeaders Exchange is an executive community for sharing ideas, solutions, and insights. Please join the community at our LinkedIn page.

To inquire about attending a HealthLeaders Exchange event, email us at or visit our website for more information.

Jack O'Brien is the Content Team Lead and Finance Editor at HealthLeaders, an HCPro brand.

Photo credit: Ann Duffy, MHA, CFO of Cottage Hospital, participates in a HealthLeaders CFO Exchange in Naples, Florida. (HealthLeaders/Spencer Selvidge)

Get the latest on healthcare leadership in your inbox.