How One CFO Led a Rural Texas Hospital Through COVID-19

John Everett, CFO and COO of Cogdell Memorial Hospital, explains how the hospital is faring, what the pandemic experience was like in rural west Texas, and why provider CFOs need to be involved in all aspects of the organization.

The COVID-19 pandemic battered nearly all provider organizations across the country, but some of the most vulnerable entities during the crisis were rural hospitals.

These provider organizations were dealing with razor-thin margins even prior to the outbreak in March 2020 and hundreds closed because of mounting costs and slashed revenues due to the temporary halt in elective procedures.

Cogdell Memorial Hospital is a 34-bed rural healthcare organization based in Snyder, Texas. According to the American Hospital Directory, Cogdell had total patient revenues of more than $55 million.

John Everett, CFO and COO of Cogdell, recently spoke with HealthLeaders to explain how the hospital is faring, what the pandemic experience was like in rural west Texas, and why provider CFOs need to be involved in all aspects of the organization.

This transcript has been edited for clarity and brevity.

HealthLeaders: Where does Cogdell Memorial stand at this point in the pandemic?

Everett: As a baseline, our organization is doing well from the clinical side. With the pandemic, we were able to use an old unit and convert that into a COVID unit. We also built some negative pressure rooms on the med-surge floor.

As a rural health organization, as challenging as COVID was, our nurses’ skillsets improved by dealing with higher-level care patients that we weren't able to transfer. Moving forward, we feel like we have a great opportunity to capitalize on it and keep some patients here that we might have had to transfer in the past. [The pandemic] forced our hand and gave us a lot of great training; our providers have always been capable.

Financially, I think that we made it through as well as anybody could have. We’re a rural hospital, so to some extent we're always going to worry and struggle, but at the same time, financially, we're doing well.

We had everybody out of the hospital and taken care of virtually, but now we’re looking at getting them back in the hospital and moving in the right direction [toward] utilizing services [again].

My biggest concern from the COO/CFO role is how do we get people back in the hospital and feel comfortable doing that. I think the vaccines are helping and our community cases [are down these past few months.] In life after COVID, the next challenges are around the state reimbursable programs, including DSH [payments], uncompensated care, and the potential cuts that are coming with that.

HL: What have you done to maintain patient trust in visiting the physical office and making sure your population isn’t siphoned off to larger systems for treatment?

Everett: With our primary care clinic, it's picking up the phone, calling patients, and getting routine appointments scheduled, especially for those with chronic care issues. I think that through the pandemic and with us put in charge of vaccinations in the community, patients saw all that we were doing and that no one came out of there positive for COVID.

Over the past year, [the community] has seen that maybe it was frustrating going through screenings, but we were probably one of the safest places in town to go and not have to worry about contracting COVID.

I think that keeping patients here and not having to transfer them makes [the experience] a lot easier for the families. We can do things with certain drips and [treatments] that we may have sent out for before, but now we can keep the patient here. We conduct orthopedic surgeries here, we do general surgeries, and we do several [treatments] already here. [But] it's not just seeing the doctor, it’s coming back for the lab tests, X-rays, CTs, MRIs, etc. A lot of patients put off health issues because of COVID.

As Texas opens more and people see that we're releasing our standard on having more visitors, that goes a long way with the community and their effort to buy in, come back here, and get their tests.

HL: What was the telehealth experience like at Cogdell and what do you see in terms of the longevity and sustainability of those virtual care programs?

Everett: As a rural health organization, the problem is getting legislation changed for telehealth being an originating site.

I think that our telehealth [program] was kind of an abbreviated version: it's either a phone call, Zoom, or FaceTime; whatever was HIPAA-compliant. We're in the process of implementing a telehealth system with AmWell that'll be a lot more robust.

I think that the frustration with our patients wasn't telehealth itself, but that everything was put to telehealth in an effort to keep them out of the hospital facilities. As time went along, they were comfortable with it, but you can find a lot of communities where it became frustrating when people want to see an in-person doctor.

If we use it the right way, I think telehealth has a lot of [positives] to it. We have a lot of opportunities to expand [telehealth] to treat kids in schools, either through Texas Health Steps or some of the Well Child Checkups; that's where our growth is with telehealth. It’ll make it a lot easier so physicians can see a lot of kids fairly quickly as opposed to having to do a face-to-face visit.

Telehealth is a great thing; we've just got to be able to use it the right way. When you just kick everybody to telehealth, it can wear on people and I think that happened in a lot of communities. Telehealth was much needed last year, now it’s about getting it in the right workload and setting with patient care. There are a lot of roles that we can expand and use telehealth, but it just can’t be what it was last year where you're putting [patients] through telehealth all the time.

HL: How has the role of being a CFO changed during the pandemic and what advice would you pass along to your peers, especially those who are also leading rural health organizations?

Everett: For me as a CFO, it's always been about getting into [hospital] operations. It’s not just about dynamic budgeting; our budget this year was a crapshoot. No one knew what the volumes were going to be and we’re on a [December 31] budget.

We had no idea when our volumes were going to come back, and because we’re a hospital district, we had to have everything done by July. There were some [difficult] months in there from the end of March, April, and May of 2020. I don’t expect this next year to be similar to what it was last year, or January 2022 to be what it was like in January 2021 with all the in-house COVID patients.

With your role as a CFO, you can’t only be worried about the numbers. In rural healthcare, you wear so many different hats, but I think that you must want to expand your knowledge and truly learn the operations because all those things come back to impact you.

The typical CFO has probably five departments… but you must expand outside those [areas] and think outside of the box. There’s not always going to be flexibility, but I think COVID has shown everybody that change and technology are inevitable; it’s about how we embrace, work, and utilize it to make us work smarter, not harder, and continue to improve and use resources.

[Through] technology, we can be more automated, efficient, and effective in getting things done, [and] how do we get the dollars in a timelier [fashion]? If you're not flexible and don't believe in technology, it's going to leave a mark.

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

Photo credit: A big billboard in Dallas to promote wearing masks. Dallas,Texas,2021. / Editorial credit: Marouanesitti / Shutterstock.com