Prior to joining TMC, Hipp served as chief financial officer for Banner University Medicine Tucson. He has also held finance leadership positions with Loyola Medicine and WellPoint.
Right off the bat, Hipp says he was excited to jump into his new position and knew he was stepping into a quality-driven organization.
"TMC is a leader in these areas, providing excellent quality, high patient experience," he says.
"You've got a dedicated community that is hugely supportive of Tucson Medical Center and what we mean to the community then drives the financials."
There's much that goes into ensuring quality from a health system, and Hipp says one thing he found and loved at TMC was that the organization has a good grip on how to pivot and adapt when needed.
"Just when you think you kind of figure something out, whether it's through legislation or a pandemic or anything else, it throws you a curveball and you're constantly trying to figure out what kind of curveballs are coming next," he says. "Having that basic block and tackling technique, I believe that TMC has that basic act of tackling down really well."
Quality comes first, and finances will follow, Hipp explains.
One piece of Hipp's financial strategy at TMC is looking at operations through a service line perspective. To do this, there must be service line alignment and a strategic arrangement. CFOs should examine what a community really needs and then think about those needs through a service line lens.
A second piece is staying on top of payer tactics. Hipp says health systems don't always have the luxury of margins to fall back on, so CFOs must work with payers to not only get them more engaged on denials, but also with peer reviews to be able to stick to their prior authorizations.
"It's a two-edged sword," he says. "You're losing on the revenue side and then your cost to collect goes way up because you have to invest resources in the revenue cycle side to track that down and to monitor that."
Partners, Not Employees
One consistent theme amongst finance leaders' goals and strategies this year has been collaboration; it's vital for health systems, particularly in finance. CFOs must make sure they are not making decisions in a vacuum and include other valuable perspectives from clinical teams that will affect patient care.
"I see finance's role as more of a consultative type approach, where we can present data to the chair or the physician leadership," Hipp says.
Hipp says healthcare finance must move on from the dictatorial type of reporting and strategizing that may have dominated in the past, and into an era of close-knit collaboration that brings invaluable insight to the discussion.
Physicians and nurses have the expertise and the scientific mindset to think through operational challenges. Hipp recalled a memory from his time working at Loyola that put physicians' work and dedication in perspective.
"Probably 10 years ago, when I was at Loyola, I was kind of stuck in traffic getting to an 8 a.m. meeting," he says. "It was a surgical clinical program meeting. It was one of those mornings where just everything was just kind of going wrong, and you're irritated when you walk in. Then we get to the meeting. We're in this room. The lead person on the physician side wasn't there. We're like, ‘Oh, god, what's going on?' He walks in 15 minutes later. He still has his scrubs on and he has blood on his scrubs. He said, ‘We had a tough night last night. We just had a double lung transplant.'"
Moments like this, Hipp says, put the value of physicians' work into perspective. To make the most informed clinical financial decisions, clinicians need to be at the table.
"And you think that you're so important with what you're trying to do?" he says. "But if you don't have that collaboration with those physicians then you're not going to be successful."
CNOs should gear up for the next wave of nursing challenges in 2025.
2024 was filled with many challenges for CNOs and other nursing leaders, and while many of the same ones will continue, there will be new trends and obstacles that leaders will face.
The health system plans to expand community sites and services, beef up its chronic care management and SDOH programs, add 1,000 new employees and build a new hospital to replace the aging Advocate Trinity Hospital.
Advocate Health Care has announced an ambitious expansion into Chicago’s South Side to the tune of $1 billion.
The Illinois-based arm of the national Advocate Health network, the third largest in the country, is planning to invest $300 million in a new lakefront hospital to replace the 115-year-old Advocate Trinity Hospital. In addition, it plans to spend more than $500 million on expanded outpatient care through community programs and services, $200 million on new hospital and outpatient services addressing chronic disease and social determinants of health, and $25 million on workforce development programs.
"We have built a model that gets at the heart of chronic disease and wellness through much greater access to extensive prevention, health management tools and education designed to help South Side residents live their healthiest lives," Michelle Blakely, PhD, President of Advocate Trinity Hospital, said in a press release. "We need to provide the community with the necessary resources to stay well – where we live, work, play and worship – and that takes a comprehensive plan."
The focus of the expansion is on community health and wellness, and represents one of the largest investment ever by a health system. Executives say the plan was forged over the past year through more than 20 listening sessions with South Side residents. It addresses "significant health inequities" in those neighborhoods, including four times as many deaths due to diabetes as the North Side.
Among the planned investments:
Adding capacity to accommodate 85,000 new appointments per year.
Establishing 10 new Advocate Health Care Neighborhood Care locations.
Redesigning the health system’s financial assistance program to ensure that no one goes without care.
Launching a mobile medicine unit to provide primary care services.
Expanding access to pharmacy services, including free prescription programs.
Expanding the Advocate Food Farmacy program.
Expanding access to pre- and post-natal care.
The new hospital, to be built on 23 acres of land that now houses a former U.S. Steel Works complex, will feature 52 beds, 36 medical surgery beds, four ICU beds, eight dedicated observation beds, and a four-bed dialysis unit. It will also house a cardiac catheterization lab, enhanced testing and imaging services and a 16-bed Emergency Department. Once the new hospital is open, the old hospital will be demolished and replaced by green space.
The health system’s workforce development plans include adding 1,000 new positions within the next three years, as well as job forums and a mobile recruitment van to connect with students and others in the community.
Students know they want to be in service of people, but they don't necessarily know they want to be doctors, says this CMO.
On this episode of HL Shorts, we hear from Dr. Lindsay Mazotti, chief medical officer of medical education and science at Sutter Health, about how CMOs can build pipelines for residents into the healthcare industry to attract new physicians. Tune in to hear her insights.
While many challenges are the same in rural healthcare, the available solutions can be vastly different, according to this CNO.
Health systems of all shapes and sizes are dealing with significant challenges, from staffing shortages to workplace violence, to implementing new technologies.
However, not all hospitals are starting on equal footing.
In rural communities, the challenges go deeper. According to a 2024 report from Chartis, 50% of rural hospitals in the United States are operating in the red, and since 2010, 167 rural hospitals have either closed or moved away from inpatient care.
Rural hospital closures have large impacts on their communities, and CNOs must work to prevent that and maintain patient access to care.
Keri Brookshire-Heavin, senior vice president, chief nursing officer, and chief operating officer at Phelps Health, has first-hand experience with the issues facing rural healthcare settings. Phelps Health is located in Rolla, Missouri, which is about two hours from all the major urban areas in Missouri, including St. Louis, Springfield, and Columbia. The health system serves six counties and about 250,000 patients.
Rural vs. urban: What’s the difference?
According to Brookshire-Heavin, the care needs of the rural community are very similar, and include chronic disease, heart disease, obesity, and lack of education and primary care prioritization.
The real difference lies in accessibility and the lack of resources to address those concerns.
"A lot of our residents…have no transportation to get to healthcare," Brookshire-Heavin said. "We don't have public transportation, we don't have a bus, we don't have the subway, we don't have things like that, so that's a challenge."
Even accessibility solutions that more urban health systems use, such as telemedicine, are not options for more rural areas, Brookshire-Heaven explained.
"Maybe if you were going to use telemedicine to serve some remote population, some of our community members don't have reliable Internet access," Brookshire-Heavin said, "so things like that are not even an option."
When it comes to nursing in the rural environment, the philosophy has had to change over the years. According to Brookshire-Heavin, the idea of hiring experienced or specialized nurses is no longer feasible. Phelps Health is focused on partnerships with local colleges, nursing schools, and nursing programs to find ways to get students to join the team.
"What we have found is our workforce is primarily unexperienced new graduate nurses that we have to provide experience to," Brookshire-Heavin said. "We changed our mindset from 'we're going to hire and look for all these experienced individuals,' because they're not there for us, to 'let's grow programs to grow experience and make new nurses.'"
At Phelps Health, the goal is to create support systems, new training programs, and extended training to start new graduates in specialty areas, along with programs that get students involved before they become nurses. Brookshire-Heavin detailed the internship program that pays students to come do their internships at the health system, which has been increasing the number of new graduate nurses entering the workforce.
"We're also seeing those nursing students [do] better on state boards," Brookshire-Heavin said. "They are more successful at one year for retention, [and] when we look at retention, we're seeing that rate increase as well."
Talking costs
Finances in general are a challenge in rural health systems and hospitals, and in the case of technology, Brookshire-Heavin explained that it boils down to a lack of resources to invest.
"You don't have extra to invest in those types of programs," Brookshire-Heavin said. "You are truly trying to keep up with operations and equipment purchases for capital budget, and things just to keep operations going and up to date."
Even for larger health systems, it’s difficult to find the funding for new cutting-edge technologies, and CFOs take convincing. In the rural setting, Brookshire-Heavin says the challenge depends on the financial status of the organization.
"We're very fortunate and we do have resources that we can dedicate to that," Brookshire-Heavin said. "Our organization has really embraced technology, and we do try to look at using technology to do things better."
Brookshire-Heavin recommends partnering with other members of the C-Suite to advocate for innovation.
"As a CNO, I think a big part of that is my relationship and partnership with our CFO to really be able to communicate the needs and the vision," Brookshire-Heavin said, "and the financial case for why this may have cost up front, but what value does it bring in the long run."
Advocating for the community
In terms of community needs, many patients in rural areas lack the resources and ability to invest in their health and wellness, such as public transportation to the hospital. According to Brookshire-Heavin, this issue requires CNOs to have an awareness of legislation and relationships with policy makers and lawmakers.
"We have a government affairs department," Brookshire-Heavin said, "and so I do talk with them and stay in the loop of legislation that's coming, discussions that are happening with legislators, [and I] answer questions and get involved."
Brookshire-Heavin emphasized staying up to date with local organizations and opportunities that can provide more funding.
"I try to stay active with MHA information about legislation, legislative issues," Brookshire-Heavin said, "but also [I look] at grant opportunities and ways to fund programs that we may otherwise not be able to do."
CNOs in rural areas should stick together as well, according to Brookshire-Heavin, and discuss the issues that are confronting their communities. Connections and relationships with other leaders in other organizations are just as important as connections within the CNO's own organization. Brookshire-Heavin also recommends staying current and challenging rigid ways of thinking.
"I think there's a uniqueness about rural healthcare, I find it very rewarding," Brookshire-Heavin said, "but I also think it's important to think outside the box, and try not to be limited by the ruralness of the area you're in."
Health systems need to attract learners to their organizations and give them sustainable career paths, says this CMO.
As healthcare executives everywhere work to overcome staffing shortages, it's important for CNOs, CMOs, and other clinical leaders to focus on providing career advancement opportunities to staff that fit career expectations.
According to Dr. Lindsay Mazotti, chief medical officer at Sutter Health, medical students are thinking differently about how they want their medical careers to unfold.
"The draw of academic medicine is still there," Mazotti said, "but there are people who are wanting to think differently about how they take care of patients and how their careers are sustainable through their lives."
These changing expectations are affecting recruitment and retention, and at Sutter Health, Mazotti sees graduate medical education (GME) as a helpful tool.
"For us, building graduate medical education programs means attracting learners to our system," Mazotti said, "[and] building a compelling reason why people want to come join us at Sutter Health."
HealthLeaders sat down with Mazotti, live from the Workforce Decision Makers Exchange in Washington D.C, to discuss how CMOs can use GME to improved their residency recruitment strategy. Tune in to hear her insights.
The HealthLeaders Exchange is an executive community for sharing ideas, solutions, and insights. Please join the community at our LinkedIn page.
Health systems and hospitals are ditching their competitive aspirations and joining forces to develop innovative new technologies and programs
Expensive technology, limited budgets and uncertain ROI are all combining to make healthcare innovation a challenging arena. So how are the nation’s forward-thinking health systems and hospitals responding?
They’re collaborating.
In what is often considered a competitive market, healthcare’s innovation leaders are finding value in sharing their ideas with their peers, in hopes of developing technologies and programs that can be scaled across much larger and more varied patient populations. And with the weight of multiple organizations supporting these ideas, they hope to create sustainability with more receptive payers, including the Centers for Medicare & Medicaid Services (CMS).
Just a few months back, Providence, Novant Health, Baylor Scott & White Health and the Memorial Hermann Health System announced the launch of Longitude Health, with the three-pronged goal of transforming business models, improving health system performance and empowering healthier futures.
“Innovation is a multi-faceted strategy and we are approaching it pluralistically,” Sara Vaezy, Providence’s chief strategy and digital officer, said in an e-mail to HealthLeaders.. “Thorny operational challenges that require networks, capital, and broad expertise to come together to solve these issues at scale can be tackled in partnership across health systems.”
“The defining components of the health system strategy of the future are transformation through innovation and collaboration,” she added. “We need to position ourselves as a trusted partner and navigator of services for our communities—rather than trying to do it all ourselves. As healthcare institutions, we must now think beyond our individual organizations and core delivery models to build solutions that serve the greater good across health systems, patients, and communities.”
“We will also pursue innovative individual partnerships with organizations that have built up scale and special capabilities in certain areas,” Vaezy noted. “In some cases, we’ll also engage in innovation on our own before seeking partners. There are many roads to innovation and this accelerates one of the paths.”
The latest to join the trend is the American Telemedicine Association (ATA), which unveiled the ATA Center of Digital Excellence (CODE) this week. The new center is billed as “an innovative alliance with leading health systems dedicated to advancing the integration of digital care pathways to support patients throughout their healthcare journeys.”
CODE’s founding members are Intermountain Health, the Mayo Clinic, MedStar Health, Ochsner Health, OSF HealthCare, Sanford Health, Stanford Health Care, UPMC and West Virginia University Medicine Children’s Hospital. The center will be overseen by Elissa Baker, BSN, RN, formerly of eVisit, the FemTech Lab, Phase2 Health and KeyCare, who was named the ATA’s SVP of digital strategy and clinical Innovation in October.
The ATA is uniquely positioned to usher in a new era of collaboration within healthcare,” ATA CEO Ann Mond Johnson said in a December 12 press release. “Through CODE, we are convening top health systems to establish models that seamlessly integrate digital care into broader care delivery approaches. Telehealth is not an either/or solution but a critical addition to in-person care, addressing gaps where traditional access is limited or unavailable. With these renowned health systems, we are setting the standard for how innovation and technology can enhance, extend, and equalize access to high-quality healthcare for all."
In a more unique partnership, Mass General Brigham and Tampa General Hospital have been collaborating for more than three years, beginning with the expansion of MGB’s innovative Home Base program for veteran healthcare and wellness to Home Base Florida in 2021.
“Our collaboration with Mass General Brigham is key to advancing innovation and expanding access to world-class care across Florida,” Tampa General CEO John Couris said in an e-mail to HealthLeaders. “We’re sharing expertise and best practices to capitalize on what both systems have to offer, leading to the best possible patient outcomes.”
The two health systems have been working together on cancer care and treatments, a bone marrow transplant program and cell therapies through the TGH Cancer Institute. They’re also planning to build a new radiation center in Palm Beach Gardens, where patients will be able to access either MGB or TGH clinicians for radiation oncology, medical imaging and clinical oncology services.
“The increased collaboration between our two health systems is a reflection of our mutual goals: To enhance, innovate and be at the forefront of medicine to offer Floridians the absolute best care options while simultaneously responding to the very complex needs each person has over the course of their lives,” he added.
The health system's new Virtual Care Center aims to use the latest in digital and telehealth technology and programs to address key pain points in rural healthcare.
Sanford Health is giving its virtual care strategy a very real base of operations.
The South Dakota-based health system, the largest rural network in the country, recently opened the Sanford Virtual Care Center at its Sioux Falls campus. Executives say the 60,000-square-foot building, divided into an Education Institute, Innovation Center and Clinical Service Delivery labs, will be critical in developing, scaling and sustaining innovative technologies and programs addressing rural health needs.
“We have lots of problems with access, quality and sustainability, and we firmly believe that virtual care is the single most important tool we have to address these shortages in our rural footprint,” David Newman, MD, Sanford Health’s CMO of virtual care, said during a recent HealthLeaders podcast.
David Newman, MD, CMO of virtual care for Sanford Health Care. Photo courtesy Sanford Health Care.
The new center comes at a time when Newman and his colleagues across the country are facing acute workforce shortages. Roughly one-third of doctors will be retiring in the next 10 years, Newman says, and there will be 25% fewer rural docs by 2030. There aren’t enough new doctors, nurses and other healthcare workers coming into the pipeline, and many of those that are will be heading to urban and suburban areas, where the patient base is bigger and the pay is better.
Enter telehealth and digital health, and the idea that a patient can access any care needed at home or in a local doctor’s office or clinic, while a rural health system can reach out and either provide those services or act as the conduit between the patient and a specialist or a larger health system with those resources.
“With a click of a button on your phone, just like ordering a pizza or talking to your grandkids on FaceTime, you can see a behavioral health provider,” says Newman, noting that roughly one-quarter of all behavioral health services are now handled via virtual care.
The center serves three specific functions. The Education Institute allows Sanford Health to have a hand in training the provider of the future, offer guidance on virtual nursing, robotics, AR and VR technology, remote patient monitoring (RPM) and so-called webside manner. Through this, the health system is bringing its current workforce up to date on new strategies and creating an environment to attract new providers.
“A lot of the younger doctors coming out, a lot of the younger nurses, this is an expectation,” Newman says, “And we see it as a huge recruitment and retention tool to offer these things.”
“Some younger providers want fully virtual careers,” he adds. “They want to be able to work from home. There's a work life balance that is a much bigger thing for younger providers than it has been for older providers, and we want to be able to offer them work life balance.”
The Innovation Center gives Sanford Health an area to work with small companies and start-ups, as well as providing workshops for their own doctors and nurses to test out new ideas.
“One of the biggest problems in healthcare right now is operationalizing really great ideas,” Newman says.
The Clinical Service Delivery labs, meanwhile, gives Sanford Health an area to test out new programs that pull family and caregivers into care management, as well as testing out Hospital at Home and other home-based care concepts. One lab might be designed like an exam room in a doctor’s office, while another represents a skilled nursing facility room and a third looks like a patient’s bedroom or living room.
“A big part of healthcare is not just examining what it's like through the provider lens, but also seeing what it's like from the patient,” Newman says.” We want to know how that patient is receiving healthcare” in different environments.
“We honestly want to be very, very nimble,” he says. “We designed the center to be changed. The rooms can be flexed, [because] we really don't know where digital healthcare is going to be going in the next 10 years, and we're OK with that, that we hope it's very, very different and we hope that we're ready to be different.”
Staffing, workplace violence, and potential legislative changes will challenge CNOs in the new year, according to this CNE.
2024 was a rollercoaster ride for healthcare, and 2025 will likely be no different.
This year, CNOs and other nurse leaders faced a wide array of challenges, from expanding the nursing workforce through recruitment and retention, to tackling new technologies like AI and virtual nursing, and to addressing nurse burnout and wellbeing. Many of these issues are expected to continue, while more will appear on the horizon in the new year.
"We continue to have a large number of early career nurses leaving their organization and maybe even leaving the profession soon after they join us," Norton-Rosko said, "and we continue to see an increasing number of nurses retiring, because at the same time the population in general is aging, so is the nursing population."
Nurses nowadays have more opportunities to be employed in non-traditional roles, Norton-Rosko explained, which creates more competition to keep nurses working clinically at the bedside. Nurses are also experiencing record levels of burnout.
"While they're working to address urgent patient needs, they’re still dealing with the staffing crisis," Norton-Rosko said, "and we need to continue to pull on their expertise to help support the innovation related to new models of care and integrating technology."
Looking ahead to 2025, Norton-Rosko believes that the staffing challenges will continue, along with workplace violence incidents. Change management will be essential for CNOs moving forward.
"We also need to work on striking the right balance between providing care and supporting technology solutions," Norton-Rosko said, "[and] really balance how much change our teams can take at one time."
As for new challenges, Norton-Rosko emphasized the importance of focusing on diversity, equity, and inclusion (DEI), and addressing social determinants of health. Potential policy changes under a new administration will also be a point of concern for CNOs in 2025.
“While nurses play a large role in identifying disparities," Norton-Rosko said, "we need to work really hard with other disciplines to make sure we can then address the disparities once they’re identified."
Listen to this week’s episode of the HealthLeaders Podcast to hear more about nursing trends and challenges going into the new year, and how CNOs should plan to address them.
