Ask Bryan Chalmers to name the top trends that he will be watching in 2015 and he has no shortage of ideas. As chief financial officer at Ivinson Memorial Hospital in Laramie, Wyoming, Chalmers said there are no less than eight critical topics that are vying for his attention.
"ICD-10; meaningful use; pricing; our staff; information technology as a whole; in-patient volumes; physician relationships; and physician recruitment. And they're not all separate, they're very intertwined."
There is a definite trend in Chalmers' picks – most are not typical finance issues. But that is not surprising, as the role of the chief financial officer is one in flux, and areas not traditionally under their authority are now taking center stage.
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Executive recruiter Paul Esselman of Cejka Search knows the trend first-hand. Specializing in healthcare finance executives, Esselman said today's healthcare CFO is much more focused on operations, patient care and quality control.
"That is what separates the more progressive finance leaders in this new environment – those that can be more strategically minded and have a greater understanding of the day-to-day operations, and how finance is tied to that, and also be a strong collaborator and strategic financial partner to the CEO," Esselman said.
According to Esselman, the healthcare CFO is expected to work closely with a growing executive team. Compensation models for healthcare executives are reflecting that change, and the size of a CFO's paycheck in 2015 will largely reflect how well they collaborate with the CEO, the COO and the CMO, among others. The relationship with the chief medical officer is especially important.
"I think that we're going to continue to see an increased emphasis and interest in finance leaders that understand the importance of integrating different medical groups into the healthcare system – not only from a focus on in-patient and hospital-based services, but also outpatient or ambulatory-based services," Esselman said.
"Hospitals want finance leaders that understand some of the post-acute care services like nursing homes, long-term care, and extended care beyond the patient's hospital visit. Hospitals and health systems are beginning to integrate all of those services into their continuum, and strong, dynamic finance leaders that understand and appreciate those nuances will be well-positioned in the future," Esselman said.
Lydia Ostermeier, an executive recruiter with B.E.Smith paints a similar picture.
"The healthcare industry is doing lots of things differently, including a shift from volume space to value space. We're no longer just looking at heads and beds," Ostermeier said.
All of this is creating intense competition for healthcare CFOs with the right stuff.
"Organizations need individuals that have a whole new knowledge base in the changing healthcare environment, as well as financial skills, and on top of that, the ability to communicate with stakeholders at all levels of the organization," said Terri Houchen, also an executive recruiter with B.E.Smith.
The good news is CFOs are stepping up the challenge.
"I don't think it's a surprise to any of the financial leaders right now that they need to understand clinical methods, patient satisfaction, and how they tie into whether an organization is successful or not. More and more they do have those skills out of necessity in this changing environment, and we're able to find people that have these skills," Houchen said.
Houchen, Ostermeier and Esselman may be finding the right CFO candidates for job openings. But the success of those executives also hinges on their ability to find desired talent in a host of other job areas. There are well-publicized shortages of any number of healthcare professionals.
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"The talent need is across the board," Chalmers said. "As we have to do more and we're not able to add staff for whatever reason, it requires a higher functioning staff member," Chalmers says. "So that position that may have been able to be held by someone with a high school education and maybe two years of experience now might require a bachelor's degree. Or, instead of that bachelor's degree you might really want to press for the master's degree. Or a bachelor's degree plus five years of experience."
Not surprising, the greatest recruiting challenge is probably for physicians, Chalmers said. The combination of physicians that are retiring, cutting back hours or patients, or moving in to specialty areas is causing a well-documented shortage for healthcare generalists.
"We're currently working on physician recruitment, and our challenge is where is the 'sweet spot'? Is it lifestyle? Is it pay?" Chalmers said. "The challenge is identifying what's really going to be that attraction to bring somebody in, to have them work hard for you, and still have a lifestyle that we're hearing the doctors want."