Fiscal Management of Health Centers Fiscal Management of Health Centers Presenter: Ira J. Rothblut, CPA

The search for the ideal CFO Experience has shown that the quality and performance of a CFO can determine the success or failure of the entire FQHC operation. A good CFO MUST understand healthcare operations. No exceptions.

Challenges in recruiting the right CFO Lack of knowledge of FQHC specifics. Maybe set in ways from other industries or previous experience in the private sector. FQHC might be in financial emergency and unable to spare the time to find the right candidate. Candidates may not be “hands on” enough.

Staffing Models The home-grown CFO New hire Transitional CFO

The home-grown CFO Advantages Familiarity with health center staff and operations. Internal promotion builds morale among employees. Generally more inexpensive.

The home-grown CFO Potential Difficulties Promotions are often done before the candidate is ready. Existing department weaknesses may not give a time frame to adjust to the new position. If promotion does not work, a strong individual is lost.

New Hire Advantages “New blood” May provide best practices from another industry. At first, center gets objective assessment of fiscal management.

New Hire Potential difficulties New CFO may not understand FQHC Operations, especially reimbursement. Learning curve for new CFO At first, Fiscal Director may feel she or he is doing all the work. Potential friction between CFO and Fiscal Director.

Transitional CFO “Health Center maintains a fully staffed health center management team as appropriate for the size and needs of the center. Health center maintains accounting and internal control systems appropriate to the size and complexity of the organization reflecting Generally Accepted Accounting Principles (GAAP) and separates functions appropriate to organizational size to safeguard assets and maintain financial stability”. Extracted from HRSA’s Summary of Key Health Center Program Requirements.

Transitional CFO BPHC’s preference is to have a full time CFO employed directly by the FQHC. In accordance, the proof is undisputable that a quality and knowledgeable full time CFO is almost always the best route. However, if that individual is not recruited, the transitional CFO model may better serve as a semi permanent solution. Type of FQHC’s that could benefit most from this model FQHC with a Board that is results driven. Minimal State and City contracts. Limited number of sites. Fairly inexperienced CEO. FQHC’s looking to improve billing operations. Relatively new FQHC.

Transitional CFO A consultant to be on site part-time and available full-time remotely, taking charge of immediate needs. The transitional CFO is “hands on” from the beginning and works directly with CEO, COO, and Board.

Transitional CFO Advantages Can train FQHC’s existing Fiscal Director and empower Senior accountant toward greater functionality without any time pressure. An external partner offers consistent levels of objectivity. Organic infusion of best practices/industry trends Direct accountability to Senior Management and Board.

Transitional CFO Potential Difficulties Board may not feel as comfortable with a consultant versus a salaried employees. Transitional CFO not onsite every day. Fiscal Director may feel slighted that she or he did not get the CFO position right away. Initially, model may be more expensive.

Fiscal Department Deliverables -For any staffing model- Overarching Responsibilities - Growth analysis and strategic planning. - Preparation of Federal, state and city reporting. - ARRA reporting and compliance. - Cash projections and management. - Supervision of Billing and collections. - Supervision of payroll. - Accounts Payable management. - Creation and timely update of Accounting and Billing Policies and Procedures Manuals.

Fiscal Department Deliverables -For any staffing model- Tasks and Reports - Presentations to the Board, including monthly internal financial statements. - Budgeting for Federal grants and state contracts. - Monthly/quarterly vouchering of state and local contracts. - Contract Accruals management.

Fiscal Department Deliverables Tasks and Reports - Monthly patient revenue & receivable analysis by payor: -Collection rate/remediation of collection issues -Net revenue per visit -Days in accounts receivable -Reconciliation of general ledger to accounts receivable subsidiary ledger -Credentialing updates -Members and visits by managed care plan -Provider productivity -Exam room productivity

Fiscal Department Deliverables Interdepartmental Communications With Center administrators to discuss site budgets With Medical Director and COO to discuss productivity and exam room utilization. With Program Directors to discuss spending contracts. With IT Director to discuss budgeting/upcoming capital needs. With Billing department to discuss collection rates/procedures. With CEO to discuss everything.

Ira J Rothblut, CPA