Latest / Becker’s Healthcare Podcast / Leading Through Change in Healthcare Finance with Edward Bleacher

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Leading Through Change in Healthcare Finance with Edward Bleacher · Becker’s Healthcare Podcast

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  This is Madeline Ashley with the Becker CFO
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  and Revenue Cycle podcast, and I'm excited to
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  be joined today by Edward Bleacher, CFO of
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  Saint Christopher's Hospital for Children's in Philadelphia.
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  Edward, thanks for joining me. Thanks, Patty. It's
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  my pleasure.
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  So before we begin, do you mind sharing
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  with our listeners just a little bit more
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  about yourself, and Saint Christopher's?
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  Sure. So I've been at, health care for
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  a little little more than thirty years, in
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  a number of different roles.
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  Really worked my way up from, early financial
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  analysts all the way through chief financial officer,
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  and and I've had the pleasure of experiencing
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  a lot of,
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  you know, twists and turns in, health care
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  industry along the way. And, happy to be
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  here at Saint Christopher's today. I've been here
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  a little more than five years
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  and, got here a little bit, after about
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  a year after bankruptcy. And so we spent
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  the better part of five years
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  really digging in, rolling up sleeves,
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  steering and saving Saint Christopher's,
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  and, most recently focused on long term strategy
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  and sustainability.
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  Wonderful. Thank you so much for sharing that.
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  So my first question for you, as you
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  said, you've been in the industry for a
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  few years.
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  So as we are now in 2026,
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  could you share with me maybe
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  a few financial trends or shifts that you're
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  keeping a close eye on, and why these
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  trends are so important to you in your
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  role?
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  Thanks, Patty. That's a really timely question, and
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  I think,
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  as many of us have experienced in in
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  recent,
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  time,
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  you know, more churn than usual in health
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  care health care finance,
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  particularly as it relates,
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  to both local pressures, regional pressures, as well
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  as regulatory
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  issues.
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  As all know,
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  the HR one or the big beautiful bill
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  is looming, in some cases starting to be
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  enacted.
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  So,
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  I'm sure most, if not all of us,
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  are keeping tabs on the best information we
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  have in order to be as nimble as
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  possible.
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  So as we're as we're gleaning, insight into
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  the general direction that might take, I think,
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  it's important to be,
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  you know, tracking that as as best possible.
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  Otherwise, you know, understanding as best we can
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  or quantifying downstream impacts
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  of non renewal of ACA subsidies, things of
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  that nature have been top of mind.
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  In addition,
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  hiring contractions and downsizing
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  of labor forces and health care as a
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  sector
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  in terms of what that's going to do
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  to overall economics,
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  within,
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  the rest of the cycles. So one hand
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  washes the other.
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  Again, regulatory
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  sort of relief of the Medicaid programs and
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  things of that nature,
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  lead to,
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  less coverage or more difficulty in gaining coverage
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  and then having higher levels of unemployment or
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  lower jobs in in the availability,
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  of hiring, if you will, or higher unemployment,
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  leads to higher levels of folks looking to
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  get into those programs. So, it adds pressure
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  in both directions.
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  Those are those are some of the higher
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  sort of trends that I'm looking at on
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  a regular basis.
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  Yeah. No. Definitely a lot to keep an
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  eye on right now. How would you say
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  that you and your finance team are working
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  to just keep up to date with everything
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  that that's coming at us left and right
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  here, just to stay nimble and ready to,
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  you know, tackle some solutions.
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  I tell you, it's Maddie, it's a real
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  challenge these days. Right? I I think, we're
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  all used to change in health care. That's
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  really the one constant.
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  And, with that said, you
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  know, the the sources of information are critical,
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  and constant,
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  up
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  upkeep and and, regular recurrence of communication is
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  is incredibly important. So,
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  again, gaining insight into as best, you know,
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  from diverse sources helps,
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  really to create a a general direction,
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  as those things crystallize over time,
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  where,
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  long term financial models were once
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  a nice to have. They've become a necessity.
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  Yeah. And the degree of detail within those
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  long term models,
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  has become much more,
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  specific,
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  with specific assumptions along the way. And those
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  assumptions need to be,
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  iterative in nature because, again,
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  information changes across time. And so Yeah.
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  I think the the the real,
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  you know, the real message here is to
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  be,
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  active, much more active, than you than we
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  were in the past.
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  And and that really is a challenge in
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  terms of how much time we take for
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  tactics as opposed to strategy work. So, again,
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  it becomes more and more difficult to to
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  focus on the down the road when you're
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  you're, knee deep in today issues.
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  No. Definitely some some good, insights there for
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  sure. I wanna shift gears a tiny bit
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  now. You mentioned, at the very beginning of
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  the podcast,
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  that you joined kind of amid, you know,
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  just after the whole bankruptcy thing. So just
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  for our listeners,
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  Saint Christopher's
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  Hospital for Children,
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  and keep me honest here. Filed for bankruptcy
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  in 2019. Correct?
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  Filed in 2018. Came out in 2019.
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  I joined around December 2020.
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  Okay. So 2018 is when it was filed,
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  came out 2019, just to reiterate.
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  Could you share with me maybe some of
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  the lessons that have been learned? What financial
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  changes were most critical to stabilizing the hospital?
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  Any anything secret sauce that you might have?
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  Yeah.
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  I mean, a lot of it's a lot
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  of it's not so much secret sauce as
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  it is execution.
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  Sure.
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  You know,
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  cash becomes
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  critical more so critical than,
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  atypically. Typically, you've got a a good nest
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  egg put aside. You've got substantial days cash
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  on hand,
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  and, you're you've got some time to work
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  with that. You know, coming out of bankruptcy,
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  it's much more,
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  detail oriented in terms of
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  where the uses of cash are. And,
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  it's not much different today in terms of
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  decision making around for strategies,
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  going forward.
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  You've gotta be far more critical,
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  than you would expect, in terms of how
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  you're using your cash.
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  You've got to hold,
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  the line in terms of return on investments,
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  anticipated,
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  value,
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  upstream in terms of of the few bets
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  that you have when you're coming out. And
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  again,
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  you've gotta reestablish
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  continuity in the market, from that perspective. You
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  come out with a bit of a bad
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  aura from bankruptcy because,
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  the the neighborhoods and the region are not
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  exactly sure your stability
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  and whether to trust you with, in our
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  case, their children or or trust you as
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  a patient.
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  In terms of longevity of care,
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  reestablishing
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  that is core,
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  in terms of, embracing your your neighborhoods and
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  communities and and getting families to trust you
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  again, to come and and get care.
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  Yeah. And could you share with, myself and
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  the listeners, how things are looking now at
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  the at the hospital? Anything in terms of,
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  you know, big opportunities, smart growth you're looking
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  at? What's the future look like?
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  Yeah. No. I think those are great questions.
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  And I think, again, as we've we've come
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  down the road quite a bit from the
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  early days of of,
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  day to day work to really looking at
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  strategic growth and and, a longer term strategy
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  plan of sustainability.
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  The early conversation,
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  again, sort of off to the side in
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  terms of,
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  some of the headwinds.
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  When we look at, you know, really smart
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  growth, what we're looking at is what our
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  market affords us in terms of,
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  penetration. Right? So where's our where our service
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  lines are, how much market,
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  we we sort of own today,
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  what our leakages, where our keepages
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  from, internal referral sources,
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  diagnostic sort of connections, as well as our
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  ability to motivate and influence,
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  in terms
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  of our brand or affiliations,
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  again, primary relationships with families and and, where
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  they're making choice at the end of the
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  day. So,
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  again, continuity and consistency has a lot to
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  do with that. Outreach
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  connection with neighborhoods and grassroots
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  has a lot to do with it.
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  Soft connections with independent referring sources,
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  obviously, in a
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  legal way is important to us.
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  Again, building long longstanding
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  relationships going forward. And as well,
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  building on,
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  a brand with Saint Christopher's is helpful.
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  It's been around for a hundred and fifty
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  years, and so a lot of a lot
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  of, the area knows it well.
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  And it's it's really reestablishing
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  that trust.
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  And,
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  and, again, I think,
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  in a broader in a broader spectrum, acquisition
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  as a as a as a possibility of
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  growth
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  is important.
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  But, again, I think in today's environment,
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  that acquisition
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  as as, scale
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  has to come with an immediate ROI to
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  it. It can't just be for the sake
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  of of gaining scale. I think there was
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  a lot of that, in the past,
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  where, folks made bets on scale as a
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  way to to enhance growth,
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  and found that,
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  some of those so some of that growth
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  didn't garner the type of margin enhancement that
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  it was looking for,
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  simply by,
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  adding size.
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  Yeah. But it's fair to say that the
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  the hospital is on the the up and
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  up, essentially.
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  Yes. It is. Yes. It is. Wonderful.
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  And you touched on service lines a little
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  bit there. So I guess top of mind
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  for me, what service lines do you feel
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  are going to be, you know, primary drivers
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  for financial sustainability in the next few years?
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  Yeah. I mean, for sure, you're looking at
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  things that, generate positive,
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  contribution margins. So, again,
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  when you're talking about adding volume, you're adding,
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  margin with that volume. Yeah. Again,
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  these are things of that, already contribute positively
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  to indirect cost. So, again, financially,
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  we're targeting those sorts of things.
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  And typically, those are surgical services,
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  of, varied,
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  components. And so, again,
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  within children depending on the level of complexity.
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  Sure. You know, those surgical services vary pretty
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  widely.
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  I think and and,
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  in this,
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  segment of the industry,
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  we look at things like,
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  cardiac, orthopedics,
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  GI,
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  those sorts of things. There's Yeah. There's a
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  fair amount of dollars to be made in
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  otolaryngology,
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  your ENT,
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  and and those sorts of things while
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  more voluminous,
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  but there is money to be made there.
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  Yeah. And then, again, higher end surgeries,
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  like cardiothoracic
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  or neurosurgical,
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  things like that. Also,
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  good moneymakers,
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  but, require
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  significant investment.
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  And so Sure. The return on investment,
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  it will be there,
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  but it's maybe longer term than some of
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  the other things. Right. Those are a little
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  more niche, essentially. Yeah. From your perspective, you
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  know, as a CFO in in a children's
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  health care setting,
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  what leadership mindset for for fellow,
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  financial leaders
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  is important
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  this year, maybe even into next year, again,
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  as we just navigate these ongoing headwinds?
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  Yeah, buddy. That's that's great. I I think,
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  some of this is tried and true. Leaders
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  need to be flexible.
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  They need to be nimble. They need to
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  create partnerships,
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  from that perspective. I think
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  in as I mentioned earlier, there's a lot
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  of
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  bigarity, if you will, to
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  the information we get until it really, you
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  know, becomes crystallized.
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  So you've gotta you've gotta make the best
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  decisions with the information you have at the
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  time and continue to to move with that
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  over the course of,
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  crystallization.
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  Right? Yeah. So, I think the other components
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  of that is mentioned is that we're in
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  an era, if you will, of efficiency
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  and productivity,
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  at its highest peak. And in order to
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  achieve that, partnerships are important.
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  Yeah. CFOs are not, driving efficiency,
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  let's say, in operating areas. We're not choosing,
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  staffing shift by shift for nursing. Right? So
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  so having the the partnerships with other leaders
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  within your organization
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  that can help proliferate,
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  financial acumen and finance,
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  financial stewardship as a culture
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  in your organization is critically important.
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  I think it's been important. I think it's
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  ever more so,
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  nowadays when there is so much pressure on
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  on margins into the future.
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  Some incredible advice there. Well, Ed, it was
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  such a pleasure getting to chat with you.
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  I, really appreciate you taking the time and
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  excited to connect again sometime soon.
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  It was it was my pleasure. Thank you
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  so much. Thank you.