Kelly Johnston, Interim CFO of St. Vincent Hospital

Summary

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Podcast Summary: Becker’s Healthcare Podcast

Guest: Kelly Johnston, Interim CFO, St. Vincent Hospital
Date: August 25, 2025
Host: Laura Dearda (Becker's Healthcare)

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Episode Overview

This episode features a conversation with Kelly Johnston, Interim CFO at St. Vincent General Hospital District, focusing on the hospital’s impressive financial turnaround, strategies for revenue cycle optimization, leadership in rural healthcare settings, and future growth opportunities. Kelly shares actionable insights relevant to rural hospitals nationwide, emphasizing operational excellence and community engagement as foundations for thriving in an evolving healthcare landscape.

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Key Discussion Points & Insights

1. St. Vincent’s Financial Turnaround (00:26)

• Kelly Johnston shares the journey from significant financial losses and minimal cash on hand to a strong, healthy bottom line.
• Key drivers included:
  • Hiring the right providers & senior leadership (notably Andy Driessen and Cypress Health Support)
  • Reassessing and refocusing service lines to align with community needs, especially on primary care, ER, and swing bed programs
  • Discontinuing offerings that weren’t beneficial to the local population
• Quote:

  "We've taken the organization from a pretty large loss with really little to no days cash on hand to having positive days cash on hand and a really strong, healthy bottom line."
  — Kelly Johnston (00:43)

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2. Critical Success Factors & Operational Practices (02:31)

• Revenue Cycle Optimization:
  • Greater emphasis on efficient processes from patient registration to payment.
  • Educational initiatives for providers to improve documentation and coding.
  • "We’ve really buttoned down on what that [revenue cycle] process looks like...and it's only going to be more important." — Kelly Johnston (03:28)
• Cost Efficiency and ROI:
  • Leveraging cost reporting to distinguish between essential and non-essential expenses.
  • Focused investment where it maximizes patient benefit and cost-effectiveness.
• Physician Recruitment & Retention:
  • Seen as critical for continued organizational growth.

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3. Revenue Cycle: Opportunities for Improvement (05:19)

• Revenue cycle viewed as a continuum, starting at the initial patient encounter and ending at final payment or write-off.
• Recommendations for other organizations:
  • Conduct a “gamma walk” through the revenue cycle to identify bottlenecks and inefficiencies.
  • Create and maintain detailed standard operating procedures (SOPs) for uniformity.
  • Enhance patient education to increase collections.
  • Stay ahead of regulatory changes and incorporate them into operational and financial planning.
• Quote:

  "It’s really important to tease [the revenue cycle] all apart because it starts the minute that patient presents in the emergency room… and doesn't end until you write off the claim or get paid."
  — Kelly Johnston (05:25)

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4. Forward-Looking Strategy and Forecasting (07:14)

• Predictive planning for the next 1–3 years is central to financial health and adaptability.
• Early identification of future financial trends enables proactive decision-making versus reactive approaches.

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5. Growth Opportunities and Community Needs (07:39)

• Community & Patient Education:
  • Maintaining communication so patients understand that access to care remains constant despite regulatory or financial changes.
• Service Line Expansion:
  • Considering the reintroduction or expansion of certain specialties and services post-financial hardship.
  • Caution against overextension; focus on high-need, high-competence areas,
  • Growth plans focus on what the community needs most and what the hospital does best.
• Quote:

  "Our goal is to serve the community to what its true needs are and what we're really good at and stay focused on that."
  — Kelly Johnston (08:34)

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6. Leadership for Rural Healthcare in the Next 5 Years (09:38)

• The ability to pivot quickly is a unique advantage for rural hospitals.
• Leaders must immerse themselves in frontline realities, continuously identifying services vital to the community.
• Ongoing search for alternative funding sources and ensuring payment for services delivered.
• Emphasis on partnerships and collaborations with other healthcare organizations to broaden patient options.
• Reiterates the importance of persistent patient education to assure access to care, regardless of insurance or economic shifts.
• Quote:

  "It is so important to stay informed, educated, as well as planning and preparing for all of those different things coming at us and being able to pivot."
  — Kelly Johnston (09:44)

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Memorable Quotes

• "We've taken the organization from a pretty large loss with really little to no days cash on hand to having positive days cash on hand and a really strong, healthy bottom line." (00:43, Kelly Johnston)
• "We’ve really buttoned down on what that [revenue cycle] process looks like...and it's only going to be more important." (03:28, Kelly Johnston)
• "It’s really important to tease [the revenue cycle] all apart because it starts the minute that patient presents in the emergency room… and doesn't end until you write off the claim or get paid." (05:25, Kelly Johnston)
• "Our goal is to serve the community to what its true needs are and what we're really good at and stay focused on that." (08:34, Kelly Johnston)
• "It is so important to stay informed, educated, as well as planning and preparing for all of those different things coming at us and being able to pivot." (09:44, Kelly Johnston)

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Timestamps of Important Segments

• 00:26 — Introduction & St. Vincent financial turnaround
• 02:31 — Key themes in operational success & revenue optimization
• 05:19 — Revenue cycle process and advice for peers
• 07:14 — The importance of forecasting and future planning
• 07:39 — Growth opportunities and maintaining community focus
• 09:38 — Strategies for leading rural healthcare for the next 5 years

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Tone and Language

The discussion was upbeat, candid, and pragmatic, with a strong focus on operational discipline, financial stewardship, and dedication to community-specific healthcare. Kelly Johnston spoke in a knowledgeable yet relatable manner, giving actionable advice while highlighting the unique strengths and nimbleness of rural healthcare leadership.

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This summary captures the major themes and actionable insights from the episode, offering value for healthcare executives, especially those facing challenges in rural hospital management and financial turnaround.

Transcript

[A]

This is Laura Dearda with the Beckers Healthcare podcast. I'm thrilled today to be joined by Kelly Johnston, interim CFO for St. Vincent Hospital. Kelly, it's a pleasure to have you on the podcast today.

[B]

Thank you so much.

[A]

Now, I'm excited for our conversation because I know it's just such a unique time to be in healthcare and certainly excited to learn more about what you're doing at St. Vincent. But before we begin, can you please introduce yourself and tell us a little bit about the hospital? What's been your biggest winner success story from the last year?

[B]

Yes, definitely. Well, my name is Kelly Johnston and I'm currently serving as the interim CFO here at St. Vincent General Hospital District. I've been with the organization since 2022, so it's quite a long interim stint for those that are not used to that. But we've had some amazing stories and journey happen over the last two, three years here at the organization, and a lot of it stems just from my background and the history of the organization and kind of what we've navigated. But one of the big wins things that have happened here at St. Vincent is we've overcome a huge financial turnaround. As you guys are mostly aware. If you guys have read any of the Becker's articles in the past, we've taken the organization from a pretty large loss with really little to no days cash on hand to having positive days cash on hand and a really strong, healthy bottom line. And this is attributed to so many different things, everything from making sure we have the right providers in place to really great senior leadership and hiring of Andy Driessen and Cypress Health Support, and then also really evaluating our service lines and making sure that we're serving our community to the best of its needs and capability. I know the organization for a while was offering services that weren't maybe in alignment with the community needs or they weren't even in the local area. And so by really focusing on really strong primary care, our emergency room, our swing bed program, and all of the ancillary services that support those, the organization has made a huge turnaround and we're excited for what the future has to bring.

[A]

That's awesome to hear and, you know, certainly just important to have those turnaround stories because I know so many hospitals, especially in rural settings, are struggling in one way, shape or form today and, you know, looking to find ways that they can rebuild, have that turnaround, and then, you know, grow for the future. So from your perspective, what do you say has been really key and critical to Your success in the last year. What are some of the big things and themes that you've been working on with your teams?

[B]

Great question. There's so many things that we're attacking on all different levels. I know in critical access hospitals or rural healthcare for that matter, the role of the senior leadership team is truly block and tackling and making sure we're staying on top of current issues. For us here at St. Vincent, there's some really big things that we've been working on. First is really optimizing our revenue cycle. With all of the changes in the regulatory environment and payers and how they're contracting and whatnot, it is really, really imperative for us to make sure we're getting paid for the work that we're doing and correctly. And so we've been spending a lot of time on revenue cycle optimization. This includes everything from analyzing our payers and how they're paying to making sure that the front end of that revenue cycle is happening properly with patient registration, to even doing some provider education and making sure we're all working as a cohesive team to capture what's truly happening related to patient care. Oftentimes, just in my past of working with other facilities and organizations, one of the common areas of issue is always that revenue cycle. And so I know here at St. Vincent, over the last two and a half years, really, we've really buttoned down on what that process looks like and making sure that we're staying on top of it and it's only going to be more important as things continue to happen for us. The other thing that we're really focused on is optimizing the return on investment for expenses. As a cost based reimbursed hospital, it's super important to understand what costs are important versus what, which costs are ones that you want to lean out and really have high efficiency in departments. And so we've been using our cost report as part of the strategy to make sure that we are staying effective and efficient for our patients. Because we all know the cost of health care is high. And so anything we can do to reduce the expense related to the services we're providing, but also maximize them in the right areas, meaning getting a good return on investment for our patients has been a huge part of our plan. And as we look towards the future, these two things in partnership along with really great physician recruitment and retention, are going to lend itself to the goals and future of St. Vincent, which we're pretty excited about. So when I look at these two things and the strategic work we're doing at the senior leadership team level with our department leaders. Pretty excited about what we're seeing from a reimbursement perspective.

[A]

That's fantastic to hear and you know, I'd love to just hear a little bit further. Kind of what you're seeing, hearing some of the top things and issues that on your mind. Obviously as you were talking about revenue cycles, some of the things you've been working with on payers and reimbursement is amazing. So anything else that you wanted to mention or talk through that would be helpful for our listeners who are certainly trying to figure out how they can optimize their revenue cycle in the same ways as well?

[B]

Yeah, definitely. To me, revenue cycle has so many different pieces and components. It's really important to tease it all apart because revenue cycle starts the minute that patient presents in the emergency room or books an appointment and doesn't end until you write off the claim or get paid. And so there's so many pieces in between there. Everything from proper documentation, making sure you're hitting medical necessity, having proper coding, billing, all of those aspects. And then you have to pair that also with, you know, having those third party relationships with our payers as well as making sure that we're staying on top of the cash flow that comes from those payers. And so if I was any other listener tuning in and really wanting to maximize things, I would go through my revenue cycle from start to finish, kind of do what we call a gamma walk and really analyze where there's great areas of opportunity to create efficiency, streamline the process, or even come up with SOPs or statement of operating procedures to really uniform and button down that process. This will lend itself to increased patient education which then results in better collections and things like that for your organization. I would then pair this with really staying on top of the regulatory environment. We have so many things being thrown at us right now and it's really important from a CFO or a finance lens to make sure you're marrying the best you can from an operations perspective to making sure you're getting credit and pay for the things that matter now. And then we get to take that information and forecast out what is coming. I know in the St. Vincent world, I'm really heavy right now looking at what the next 1, 2, 3 years looks like for our organization and mapping out the cash flow potential as well as impact so that way we can start making decisions today and not waiting and having a reactionary thought process to things that might be coming down the pike.

[A]

Got it? That's really helpful to know, and I love that eye towards the future because you do have to have some of that forecasting happening or, you know, keep a close eye on what you want over the next couple of years. So you can, as you said, make those decisions today. To get there. From your perspective, what are the big growth opportunities for you, especially when you're looking into the future? Where do you see places where you want to double down or see potential growth opportunities?

[B]

I think there's so many here as well. I love the questions that you're asking today inside of St. Vincent. I think that one of the first opportunities is community and patient education. With all of the regulations that are changing, it's really important to make sure patients in our community are very aware that access to care is not changing, regardless of what. What's happening in the economic environment. And so really engaging our stakeholders in the community and making sure they understand that we're here. We're working through everything. We're working together to make sure that our community gets served. We're going to pair that, obviously, with making sure that the right departments and the right services are being provided to our community. There's some opportunities inside of St. Vincent to add some certain specialties or really evaluate certain services or procedures that we're offering our patients that we maybe had to scale back during the last couple of years due to the financial hardship that we are facing. And so right now, with our senior leadership and the department leaders, we're coming up with plans for the organization to make sure that those services do get offered to the community, but also in a fiscally responsible way. It's so easy for rural hospitals to want to offer everything, but in all reality, our goal is to serve the community to what its true needs are and what we're really good at and stay focused on that. And so in our growth plans, yes, we want to be able to continue to add more services, but we need to be very diligent about what those are and that they truly do serve the community at its highest need. Absolutely.

[A]

That's a great way to think about it. And understanding that community and knowing the pillar and the spot that you have, you know, I think is just so critical, and it's helpful to kind of keep that in mind. Before we wrap up here, I'm curious, what do you think it will take to lead a thriving organization in the next five years or so, especially given some of these shifts we've been talking about and really the focus in being able to expand and provide great Rural healthcare.

[B]

Oh man. Leading a thriving organization is going to be imperative. With everything that is constantly being thrown at us as healthcare providers, it is so important to stay informed, educated, as well as planning and preparing for all of those different things coming at us and being able to pivot. One beautiful thing about rural hospitals and rural healthcare specifically in the critical access space, is we do have the ability to pivot a lot quicker than some of the larger organizations. And so from my lens, I think the first thing is a lot of the leadership team members throughout the organization are going to have to roll up our sleeves and really understand frontline what is the most imperative services and things to offer our community and continue to make sure that those stay in existence. The other is continuing to look at alternative funding sources, making sure that our again, we're getting paid in credit for the services that we are providing, and then also continuing to build relationships throughout other healthcare organizations to make sure our patients are well taken care of. So over the next five years, it's going to be a lot of continued black and block and tackling, more so than maybe we've seen in the past, but also really making sure that we have strategic partnerships to be able to offer those services that maybe we wouldn't offer internally, but our patients could get elsewhere. If we have that type of partnership and agreement, pairing that again with the patient education aspect and making sure patients know that despite changes happening in their insurance coverage or even economic environment or workplace, we are still here to provide excellent patient care. We have such an amazing clinical team here at St. Vincent that it is going to become so, so important that that message continues to reach our community. So that way if they feel like their coverage changes or drops, that they know they can still come and get the care that they need to serve this organization community respectively. I love that.

[A]

Kelly, thank you so much for joining us on the podcast today. This has been such a fun conversation, very informative and I look forward to connecting with you again soon.

[B]

Awesome. Thank you so much for your time.