Outgoing Columbus Regional Health CFO Marlene Weatherwax opined on how healthcare finance has changed over the past few decades and what advice she'd give a young hospital CFO just starting out.
Marlene Weatherwax, CFO of Columbus Regional Health and a longtime member of the HealthLeaders Exchange, announced in January that she would be retiring this year.
Weatherwax's impending departure from the independent health system based in Columbus, Indiana brings an end to a more than 25-year healthcare finance career in the southeastern portion of the state.
Ahead of her upcoming retirement, Weatherwax shared her thoughts with HealthLeaders on how healthcare finance has changed over the past few decades and what advice she'd give a young hospital CFO just starting out.
This transcript has been edited for clarity and brevity.
HealthLeaders: After a 25-year career in healthcare finance leadership, what are the changes that most stand out to you?
Weatherwax: I came [to CRH] after DRGs were put into place. The biggest [factors] were owning physician practices, trying to align the physicians with the hospital, and implementing our Epic EHR system to try to get everybody on the same IT platform.
We completed our Epic implementation in July 2019, and we had all our employed physicians and the hospital on the same system. That was probably one of the biggest [factors,] and then trying to stay independent while continuously making improvements to the bottom line was the next biggest challenge.
HL: Independent hospitals like CRH were already dealing with tight financial margins prior to the pandemic, so what are your thoughts on what those provider organizations need to do to survive going forward?
Weatherwax: You have to always be rethinking [strategies,] be a little bit more innovative, always be improving your efficiency, and figure out new services that you and only you can provide.
[CRH] is a little bit lucky because we're in a pretty affluent town, although we do have our share of Medicaid and self-pay populations, so we take care of everybody from the poor to the rich in our city. [It's important] to make sure you've got that continued focus on expense improvements, while also figuring out how you can expand your services.
[Independent hospitals] must be creative. There are a couple of other hospitals in southeastern Indiana that also want to maintain their independence, and so we just have to figure out how we can collaborate and work better with them.
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The other thing that I would say is that we have been fortunate to be part-owners of a health plan with a large health system in Indianapolis and one in Evansville.
We created a joint venture to start a Medicare Advantage program and there are smaller hospitals south of us that have ownership in managed care organizations which could bring the infrastructure to a Medicare Advantage program. I think that's probably the next venture: trying to figure out how you can supplement the hospital revenues with premium dollars, and how you can work to do some good population health. Entering that Medicare Advantage space, you have to get kind of creative with how you become both the insurer and the health provider.
HL: Looking back on your career, what are some of the highlights or moments you're most proud of?
Weatherwax: One of the things I'm most proud of is that I've been able to help our health system remain independent; I've been in this position for [more than] 20 years. In addition to COVID, we had another natural disaster that hit our hospital back in 2008.
We had a flood in Columbus, and the water came up through the basement into the first floor of the hospital which took out all the electrical and mechanical infrastructure. We were closed for five months while [the building] was being repaired. We were able to get FEMA assistance, so I worked hard because the flood insurance limits of our property and casualty insurance were only $25 million and the damages were over $100 million. We had to put a plan in place to scrape together the funds to cover that total loss. We were able to keep our employees on the payroll that whole time, we reopened, then we recovered from it.
Within five years, our cash position was back up to where it was before the flood. We were ready to look at providing some new services. We had expanded our cardiovascular program before the flood, but after the flood, we brought in some excellent medical and radiation oncologists to build our cancer program up again.
Then COVID-19 hit.
Within that short time frame, we were able to get about $9 million from the Provider Relief Fund. We did avail ourselves of the accelerated Medicare payments, but of course, those are just loans. Those helped stabilize our cash position, so we were able to make it through the first six to eight weeks of the shutdown period back in March and April [of 2020.]
We were able to maintain our cash position and we finished the end of the year with a positive EBITDA. We kept ourselves out of any trouble with our debt covenants and didn't have to borrow on any lines of credit or anything like that, so that was another thing I'm pretty proud of.
HL: Is there any advice that you've given or received during your time as a leader that you've been able to rely upon over the years?
Weatherwax: It's funny because, when I first started to attend the HealthLeaders CFO Exchange, I know it happened with me and it happened with other CFOs, we struck up pretty close friendships.
If you can make a connection with at least one other CFO that's in an area outside of your market, one that you can call on and you know they'll tell you how they're doing things in their market, it's good to network. Having their name, number, and having developed a relationship with them that you can call them, ask questions, and pick their brain is just a good thing to do.
HL: Do you have any advice for young CFOs who might be starting out at their first hospital or health system?
Weatherwax: Keep an open mind and try new things to push yourself out of your comfort zone. Attend some of these networking opportunities and develop some relationships with other CFOs across the country. Always be on the lookout for good educational opportunities because [dynamics] evolve so quickly that you've got to be up to speed and willing to learn new things.
You kind of have to reinvent what you're doing every four or five years because [dynamics] change so quickly.
HL: Do you have any parting advice for our audience of healthcare executives?
Weatherwax: I don't know that I have anything earth-shattering other than you just have to be prepared for anything. You also have to keep a positive attitude and have fun at work.
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Jack O'Brien is the Content Team Lead and Finance Editor at HealthLeaders, an HCPro brand.