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- [00:00]
A
This is Madeline Ashley with the Becker CFO and Revenue Cycle Podcast. And I'm thrilled to be joined again today by Andy Zukowski, CFO of ECU Health in Greenville, North Carolina. Andy, thanks for joining me again. I'm excited to chat with you today.
- [00:15]
B
Oh, thanks so much, Madeline. I'm excited to share what we're working on here in Greenville, North Carolina as well.
- [00:21]
A
Wonderful. So, Andy, for people who haven't heard our previous episode together, do you mind just sharing a little bit about yourself and ECU Health?
- [00:30]
B
Hi, Andy Zukowski here and I'm the Chief Financial Officer for ECU Health. We focus on rural healthcare, rural academic healthcare system across eastern North Carolina. So we serve about 1.2 million patients. We've got 10 hospitals, $3 billion in size of organization wide, and a couple hundred ambulatory sites, as well as the School of Medicine focused on about 500 students there. And so happy to share more about what we're focused on as we look to improve the health and well being of all the patients here in eastern North Carolina.
- [01:07]
A
Wonderful. Thanks so much for sharing that, Andy. I'd love to dive in here. You know, like we've discussed before, it's crazy that we're already halfway through 2025, more than halfway through. With that in mind, could you maybe share what have been your top financial priorities this year and how they're shaping your strategic planning for 2026?
- [01:28]
B
Absolutely. You know, there are four key things we're focused on. The first is we're continuing to reinforce the structure and processes we've developed over the last couple of years to really drive and sustain financial improvements. We're focusing on culture and people development, creating a psychologically safe environment in support of maintaining our culture of continuous improvement, a lot of innovation and technology, and then timely execution. And this is all critical for us to stay keep up with and try to stay ahead of many of the steady headwinds and risk that we're all being confronted with. The second is we're really focused on building a strong balance sheet. And with that, we're improving the way we make strategic investment decisions. So we have, we've improved and maintained focus on cash and creating a cash culture. We've looked at how we look at reinvestments in support of sustainability. And really through that, we've coined the phrase no positive cash flow, no mission. And so that's been our mantra there as it relates to access to care, redesign of care in a rural environment. That's something we take great pride in. And so with that, it's always a three pronged approach. How do we do that to maintain or improve quality, the experience of the patients and providers and team members? And then how does that then drive and improve our financial performance? And then the fourth is really been focused on how do we establish a balanced near term strategic agenda and focus. It's critical. We can't cut our way to sustainability. However, some of the elements of our balanced approach include growth, continued focus on people and a lot of focus on transformation in terms of care and access, the way we deliver care. And that really is really creating a sustainable financial profile for us and a positive portfolio of investment decisions and returns.
- [03:26]
A
Yeah. And Andy, you kind of touched on it a little bit just now, just in terms of changes in what we're seeing in the industry, some of the headwinds. So could you share how you're adapting your financial leadership approach to guide ECU Health through some of the things that we're seeing right now? Well, kind of positioning it in a long term resilience stance.
- [03:48]
B
Yeah, I think it's critical as we lead through all this that we maintain our focus on people first. It's important to be very transparent, engaging and actionable. All this really then allows us to then focus leadership. In my leadership, I focus a lot on where are we going, what's the future, Maintaining a sense of balanced optimism, making sure that you have to maintain visibility, which is critical because at ECU Health, part of that is important because we're trying to improve our culture and ensure that we care for everybody. We're focused on continuous improvement and always striving towards excellence, even in the midst of all the headwinds that we're being confronted with.
- [04:35]
A
And I want to touch on something else too that I've previously covered here at Becker. So ECU Health recently unveiled proposal to reopen Martin General Hospital, and that's in Williamston, North Carolina. And it would be reopened as a rural emergency hospital. So if this is approved. Well, first, can you share some updates here? And if approved, how does ECU Health plan to ensure long term financial sustainability? Excuse me for this.
- [05:03]
B
Yeah, absolutely. This rural emergency hospital would be the first of its kind in the state and the first hospital in the nation to reopen after being closed as a rural emergency hospital. To build this sustainable model, several elements are required. One includes, we're advocating for investment from the state in terms of capital and changes to how the rural emergency hospital is reimbursed for Medicaid. There's some changes there specific within the state of North Carolina. Importantly, this rural emergency hospital will be part of a broader system of care that includes a proposed expansion of a hospital in close proximity that would allow us then to have inpatient capacity to transfer patients from the rural emergency hospital when needed. So ultimately, we know that support from the state and federal lawmakers is critical and essential to making our rural health mission a reality. And more importantly, this critical transformation of creating access to care in a community where that hospital has been closed. So, in total, we're advocating for a total of $220 million from the state to really help establish the rural care center, which will house this rural emergency hospital, as well as expand that hospital and renovate that hospital to really support Martin county and the four other counties in the region. And this will then allow us to transform a regional system of care within a rural, underserved market.
- [06:40]
A
Yeah. And so just in terms of next steps, I mean, when do you expect to hear something else?
- [06:47]
B
You know, right now we're working with the county. We're also working with the state. And as things are in flux, it's just a matter of time. You know, I don't think there's a definitive date here in mind. It's just a continuous discussion, and with a lot of changes that are going on, we want to make sure that we keep this front and center and really follow through on our commitment to provide access to care in Martin County.
- [07:13]
A
Yeah. And just in terms of rural health care, you know, it's facing its own industry challenges at the moment. Do you think that a model like a rural emergency hospital could kind of guide future rural revitalization efforts?
- [07:27]
B
Yeah, absolutely. Just the premise of the rural emergency hospital, the point, the type of services provided, the access to care, and the point of connection. So that way there's a. In this example, we have this other hospital that will then complete that system of care so that there's access from an ambulatory perspective, as well as there would be phenomenal care provided on inpatient as needed. So this is the future as we see it in rural North Carolina.
- [07:57]
A
Then I want to wrap here. This is kind of a big question, but over your time in health care, could you share maybe the most valuable lesson that you learned, maybe even just early in your career in healthcare finance, and maybe how it's influenced your current leadership approach?
- [08:15]
B
I've had the privilege of working with so many mentors throughout my career, and there are a couple consistent themes that I've always kept true to heart. And one is it's important to be transparent and engaging, and that means always being visible, rounding, seeking to understand and creating a colorful picture with all these black and white numbers. I think that is one. I think the other is there are a couple others. One is always listen first, focus on relationships. It's through those relationships that we can then develop others as well as then create an open environment that fosters leaders and other members across the organization that we all serve within to be successful. And then the final piece of advice that I learned many years ago when I was at Michigan Medicine was go slow to go fast. And it's critical to really understand the current state, the problem that we're trying to solve in order to be successful.
- [09:24]
A
Right. Slow and steady wins the race. Well, Andy, as always, it has been such a pleasure getting to chat with you and hear about all the exciting things happening at ECU Health, and I'm excited to chat with you again down the line.
- [09:38]
B
Madeline, I can't thank you enough as well, so thank you for everything you're doing as well.
- [09:43]
A
Thank you.