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- [00:00]
A
This is Madeline with the Beckers CFO and Revenue Cycle Podcast. And I'm excited to be joined today by Sarah Bradley, CFO of UNC Health Southeastern. Sarah, thanks for joining me.
- [00:11]
B
Thank you. It's great to be here.
- [00:14]
A
So, Sarah, before we kick things off, I was hoping you might be able to share with our listeners just a little bit about yourself, your background in health care and and more about UNC Health Southeastern.
- [00:24]
B
Sure. So I've actually been in health care since 1995. I worked for a little while in physician consult and then actually worked for about five years in correctional health care, overseeing contracts that had health care and mental health in our jails and prisons around the country. And I got into acute health care, my First Hospital in 2003 in New York City in Brooklyn. And I've basically been doing this same thing ever since then. I started out as a controller and worked my way up. I had my first official CFO job in 2010 in Hot Springs, Arkansas, which actually happens to be my hometown. And so I've been doing this for about 22 years now. I have an accounting background. I got, got my accounting degree and then I got my cpa. And then about four years ago, five years ago, I finished my MBA with an emphasis in healthcare management just to kind of get a little bit of additional background knowledge and then also just to remain competitive in, in the employment market that we have today. So I, as I said, I've lived kind of all over. I'm from Arkansas. I've worked in hospitals in four different states now, which is interesting and it helps to make you more well rounded. So even though the federal programs are all the same, that every state has its own Medicaid program. So that's been interesting to learn all the different Medicaid programs and how that goes. I came here in 2022 initially just to do a temporary CF interim CFO position for a couple of months, six months, while they did a permanent search for one. And after I'd been here a couple months, I decided to throw my name in the hat. And so I came on permanently about four months into that six month contract. I work technically for UNC myself and our CEO are employees of UNC Health and we are part of a management agreement that Southeastern signed with UNC in 2021. So we're about, just about four and a half years into into this contract and they provide all of our IT services now. We're on their, we're on their instance of EPIC and have access to all of their customization and all of their. Their proprietary things that they've done with epic. And in that facility, we're on their finance systems. We're on. Well, pretty much we're on all of their systems except for payroll and some pharmacy systems that we use. So highly integrated from a technical perspective. But we do still have essentially, you know, a local leadership team and local management decision making here. Even though Chris and I are employees of unc, we function as though we're no different than the other executives here on this campus. So I've been here for three years, a little over three years now, and I love it. It's a great community hospital that offers a lot of great services and the largest employer in Robinson County. I don't know if you know anything about Robinson county in North Carolina, but we are the poorest and least healthy county in the state of North Carolina. So it's quite challenging. And we are what they consider a majority minority community made up of the Lumbee Indian tribe, as well as African American, Hispanic. And then we actually are kind of growing a Haitian Creole population. We've seen a lot more of that in the last couple of years. So quite a. Quite a challenging community and environment to be in for health care. But that makes it fun.
- [04:57]
A
Yeah. No. Wow. I truly appreciate you kind of diving deeper there and just sharing all of that background on UNC Health Southeastern. I'm not familiar with that area, but I. I don't even. I'm not sure if this is actually geographically close, but my parents used to live in the. The Outer Banks of North Carolina, so, like Hatteras and down on that little area. So.
- [05:18]
B
Yeah, and we're. We're south of there, and.
- [05:20]
A
Yeah.
- [05:21]
B
So we're about an hour and 15 minutes inland from. Okay. Wilmington and Myrtle Beach. So all very familiar Carolina line.
- [05:29]
A
Yes, I'm very familiar with those areas. Awesome. Well, no, I appreciate you sharing that background. I want to kick us off today by asking you, you know, and again, thank you so much for sharing your. Your background in health care and all the knowledge that you have there. And so I would be so curious to hear maybe two to three trends that you're closely following right now in the industry. You know, it is ever evolving. We're continuing to see lots of ebbs and flows and maybe why these trends are so important to you to keep your financial eye on right now.
- [05:56]
B
Sure. So really, I would say the first one is probably financial sustainability. To your point, Things are changing so rapidly. So we've seen. We actually just had a really good financial year the best one we've had in a couple of years. And so we're really enjoying that. But there's a lot of potential margin erosion and cost containment issues that come with just the healthcare environment in general. Because we're dealing with things both from a revenue perspective and trying to conserve revenue and retain it as well as, you know, trying to reduce cost and, and dealing with supply chain issues and, and all of that. So. So just financial sustainability is definitely something that stays front and center for me. It has been for a while, especially in what we would consider a safety net hospital that is so important to the community, definitely. And our population. And then the. Right now I would say that I have a lot of focus on the unpredictability in our government, you know, pay rates and pay structures and practices. So obviously with the passage of the one big beautiful bill.
- [07:15]
A
Yeah.
- [07:16]
B
Which some people are now calling OB3, took me a little while to catch on to what that was. But it's, it's going to pose a lot of challenges, especially for states like North Carolina. And then Robinson county is disproportionately hit because of our Medicaid population as well. And so we're highly focused on, you know, what we can do to address that when it comes to fruition. It'll be a couple of years before we start to really see financial impact from that. So we have a couple of years to get ready for it. But definitely top of mind right now as far as trends.
- [07:56]
A
No. Yeah. I believe, you know, many financial leaders that I've spoken with, they're also keeping their eyes very closely on this. Just kind of watching, going through the bill, you know, watching as things kind of, you know, evolve over the next few years. So definitely worth keeping an eye on. Congratulations. I know you said at the very beginning of when we started discussing the trends that you had a strong financial year, so could you maybe share a little bit of more information there just into, you know, why you think you saw such a strong year?
- [08:27]
B
Sure. So North Carolina just passed two years ago. I think 2023 was our first year. Our version of the state directed program around Medicaid, we call it H.A.S.P, which is a hospital access and stability program. I always forget what that stands for and what it essentially does is approx. It takes our Medicaid managed population and approximates reimbursement at a commercial rate, like our average commercial rate. So for every Medicaid managed patient that I have, if I receive a dollar for the services that I provide, I will get essentially. It's not exactly this, but I would get another dollar from the state directed program. And it's mostly we put in, I don't know exactly what the federal share is, but we put in like 20% for the state portion and then it gets matched at the federal level and comes back. So it's like a 20, an 80, 20 federal match. But it has, it's been significant. And North Carolina is not the first state to do it or the only state doing it. But, but we just got ours in 2023. And so this year we had over 50 million in HASP funding on our books. And so that put us into the black significantly. And really, in addition to that, we've, we've worked hard over the last three years to, you know, decrease contract labor, get that out of, you know, out of our cost structure as much as possible and kind of try to stabilize our staffing as well as looking for other areas where we can cut some cost. We're building our revenue cycle teams up to deal with all of the challenges that come with the managed payers these days. And so we've really just seen a lot of positive trends this year in particular, which has been good because we did have a couple of bad years. And so we've, we've just come off this really good year. We don't have audited results yet, but come off of this really good year and hope to be able to have a good, positive, you know, couple more years in front of us before we have to start really dealing with the impact of, of what's in that bill. So we're excited about that.
- [11:04]
A
Oh no. And that's great to hear. And that kind of segues into my next question. Could you share with me maybe some of the things you're most excited about right now at UNC Health Southeastern and maybe how you're looking at growth over the few years?
- [11:16]
B
Sure. So as I said, we've seen just an incredible amount of positive change in our hospital and also in our community. We're, we're a small community, although we're the largest city in Robinson county, so we're the county seat, but we're a relatively small community, about 20,000 people, and we employ 10% of that population at the hospital and in our clinics. And so know when we're having, when things are going well for the hospital, it, it helps to economically lift up the community as well. We've seen significant improvement in quality, our quality scores, we've moved up in our star ratings, our leapfrog and just, you know, starting to really See the needle move on things like mortality and readmission rates and those sorts of things. So been a really good year for that. And then we've also seen a tremendous amount of improvement in our employee satisfaction. It's all just kind of, you know, coming together at the same time. So we're, we're excited about the momentum we have going into the new fiscal year to be able to leverage some of this stuff that we've learned over the last 12 to 24 months to be able to, to face what's coming. We are going to be able to focus a little bit more. We started this last year, but we're going to be able to focus a lot more on lowering readmissions and trying to get our length of stay under control. And both of those things are initiatives that are heavily driven by care management, which happens to report to me. So those initiatives are near and dear to my heart. And it's better for our patients when they're not coming back in the hospital and they're not staying for a long time. So. And then it also helps increase revenue and reduce costs. So it all kind of, you know, works together and then just kind of to, to continue down the path of culture. Our culture has just really evolved in the last couple of years. Our CEO put out a letter to our board yesterday, actually highlighting the number of providers that we've recruited to our community since 20. And we. We've recruited 77 providers. Wow, those are locums. Some of those are people who just come in and do shifts. Prn. Some of them are hospital only. Some of them are physicians through our clinics and through UNC clinics. But, but that's a lot of provider growth in a community our size. So very excited about that. As I said, we've seen our employment satisfaction, our employee satisfaction go up and we've also seen significant improvement in our patient satisfaction this year. So we're actually getting ready to celebrate that with our teams because of. We met our target both on the hospital HCAHPS side for the ED and the overall hospital rating, and then also for our medical practices. And we haven't met Target. Well, we definitely haven't met Target in the ED patient satisfaction in a really long time. So very proud of that.
- [14:35]
A
It sounds like definitely a testament to all of the strong work going on at UNC Health Southeastern. And you know, as you mentioned, with just all the unknowns coming, it's great to hear that you, you guys have put yourself in a strong position moving forward. Yeah. Well, Sarah, I want to thank you so much for taking the time to connect with me today. It was truly a pleasure getting to hear all the great things happening at UNC Health Southeastern. And I look forward to touching base with you again sometime soon.
- [15:03]
B
Sure. Well, I appreciate you having me on, and I look forward to talking to you again soon.
- [15:08]
A
Thank you so much.
- [15:10]
B
Thank you.