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The Exec: Critical Access CFO on Shifting Your Focus to Outpatient Services

Analysis  |  By Amanda Norris  
   August 23, 2023

To ensure financial success, hospital leaders need to expand their outpatient footprint.

As the financial boost during the pandemic from federal relief funds has officially dried up, rural health and critical access hospitals are fighting to keep their doors open.

Losses on patient services, low financial reserves, rising labor costs, and increasing inflation are all contributing factors to the financial challenges facing these providers.

These challenges are leaving the CFOs of these smaller organizations to dig deep to find ways to ensure financial stability. One way to address this new normal? Leaders need to develop and implement a strategy to expand their outpatient footprint. Stacy Taylor, CFO at Nemaha County Hospital, a top 100 a critical access hospital located in Nebraska, has done just that.

The hospital, which sits in the south-east corner of Nebraska, is a small critical access hospital that sees about 2,000 ER patients a year. On top of this, roughly 25,000 outpatients come through the facility in a year.

If you’re a smaller, critical access hospital, you need to capitalize on those outpatient services, Taylor said.

“As a critical access hospital, one thing that we have done to maintain financial stability is to make ourselves true to the critical access model of reimbursement. We've stayed true to that outpatient business,” Taylor said.

This is why roughly 80% if Nemaha’s business is through outpatient services, Taylor says.

“We try to stay in the market by bringing in as many outpatient doctors that we can from the bigger cities so that they can see patients here. This way, patients are not driving an hour to get to the city, and we can see them here at the hospital in a rural setting,” Taylor said.

While shifting its focus to outpatient services has helped maintain Nemaha’s financial stability, it’s not without its challenges.

“As for other challenges, labor shortage has been the biggest challenge we've had. In the last couple of years, we've tried really hard to stay true to that core and work with hiring staff locally, but we did make the decision to start working with some contract agencies as far as getting some nursing staff coverage,” she says.

Keeping pace with the changing healthcare financial landscape is also key, Taylor says.

“We need to be able to adapt to changes that are coming to us,” Taylor said.

In order to save more money and streamline efficiency, Taylor made the decision to merge its medical records and business office into one space.

“When it comes to working with one another, we've got coders sitting right next to the billers so that way we can get our claims out the door a little more quickly,” she said.

“We've cross trained a lot of people within the business office. With having them cross trained, everyone knows how to answer the phone. Everyone knows how to cover our front desk. Everyone knows how to set up a patient and complete an admission for them. That way, we can help each other out when we were short staffed,” Taylor said.

Amanda Norris is the Director of Content for HealthLeaders.


Funding has dried up. Margins are low. Inflation is high.

How can smaller hospitals survive?

By eyeing outpatient services, one CFO says.

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