← Becker’s Healthcare Podcast
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- [00:02]
A
The most important healthcare decisions don't happen in isolation. They happen when leaders come together. Becker's 16th annual meeting brings together more than 3,500 hospital and health system executives this April in Chicago. With 800 speakers from Ascension, Cleveland Clinic, Common Spirit, and more, the conversations get real. Leaders will share how their scenario planning for policy shifts brief breaking through value based care barriers and building clinical teams that translate new ideas into real world care. Join top decision makers in the room April 13th through the 16th. For the agenda and event details, visit BeckersHospitalReview.com and click on the Events tab in the upper right.
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B
This is Madeline Ashley with the Becker CFO and Revenue Cycle Podcast, and I'm excited to be joined today by Wendy Fielding, CFO of Dartmouth Health. Wendy Wendy, thanks for joining me.
- [00:57]
C
Thanks for having me.
- [00:59]
B
So, before we kick things off, do you mind sharing just a little bit about yourself and your organization? And again, congrats on the new role of cfo.
- [01:07]
C
Great. Thank you. Yeah, I'm very excited to step into my new role as the system CFO for Dartmouth Health. I've been with the organization for more than 16 years and it has truly been a pleasure as the system grows, to also have my own role grow at the same time. For those of you who aren't familiar with Dartmouth health, we're a $4.3 billion system in rural New England. And so our system members span across New Hampshire and Vermont and include an academic medical center and associated Multispecialty physician practices, 2 community hospitals, 4 for critical access hospitals, and a visiting nurse and hospice organization. And so we really have some great ways of touching the members of the communities that we serve.
- [02:04]
B
Wonderful. Thank you so much for sharing. And as we both noted when we first got on Little Chilly where we both live right now. So hope everybody is staying warm. So Wendy, I wanted to kick things off with you. As you mentioned, you've been with the system for, I think you said, a little over 16 years, entering into 2026 now we're already in full swing into January. Could you share maybe some of the financial trends or shifts that you're keeping a close eye on as system CFO and why these trends are so important to you specifically?
- [02:34]
C
Yeah, that's a great question and thanks for asking. Madeline. One of the things that's top of mind for me right now has to do with the demographics associated with our aging rural population. And so if you think about that, our demographics affect our payer mix, which affects our revenue stream, which is shifting over time more and more to governmental payers like Medicare and Medicaid, which basically means we expect our future payment rates to keep on dropping while at the same time, you know, knowing that we're getting to a higher percentage of elderly folks, the demands for services are likely to increase. And so I'm very interested and trying to figure out how to make this work. We know that we can be efficient from an operating perspective. I feel like that's just the basics of what you have to do these days and will only get us so far. Efficiency only gets us so far. So we have probably thinking about ways to innovate within the way that we deliver care to our communities, Delivering health at home through teleservices. Our hospitals are chock a block full with patients who are driving sometimes several hours to get to a facility. And it seems like there should be a better way of delivering care to them that is more cost effective both for them and for us. So can we find that setting, that way of doing that? But I have to say it's kind of a big but that comes along with it. In order for it to work, we need an accompanying financial architecture that's going to actually support these new models of care delivery. So, you know, we still have a pretty strong fee for service environment in New Hampshire and Vermont. And those models got us where we are today, quite frankly. And they're not really the types of models that are going to pay for innovative care delivery and get us where we need to be in the future. And so it can be hard to invest in these different ways of delivering and care when you're not actually getting paid to do so. And so like one of our sayings in New Hampshire is if we're getting too far ahead of our skis, then it can really, we'll take it on the chin financially, meaning if we go too far into innovative care delivery without making sure that the payment mechanisms are there so that we're able to have a more holistic way of getting financially covered for our patients. It could be really challenging for us. So we, we need to advance both pieces of the puzzle together. And so that's probably what's top of mind for me right now.
- [05:37]
B
No, and I would be curious to hear too. You know, everyone's been talking about the rural transformation funding. Is that something that you're also looking towards just on, on this topic here? How are you kind of assessing that?
- [05:49]
C
Yeah. Meaning the Rural Health Transformation Fund dollars. Yes, we're actually very excited to see how those funds will play out for our states in New Hampshire and Vermont, because, like, it could enable just the right type of community investments that are going to allow us to make that step forward. So we don't have a lot of the specifics yet, as I know the state offices are really working hard to bring their plans to life, but I'm excited about it.
- [06:20]
B
And, you know, even amid some of the industry uncertainties right now, Dartmouth has in the last few years, seen some growth. You have acquired a few hospitals just, just for our listeners. For example, Littleton Regional Health care, that's a 25 bed critical access hospital. They signed a letter of intent with Dartmouth in September of 2025, I believe. And then in 2024, Dartmouth also added Valley Regional Hospital, which is a 25 bed facility. So this in mind, looking ahead just in terms of growth, do you see more academic health systems kind of following this path and maybe what differentiates those that succeed in these types of partnerships?
- [07:00]
C
Yeah, so I just wanted to clarify. Our relationship with Littleton is in the works. It hasn't made it through the due diligence process yet. So just wanted to highlight that basically, we've seen it as a really important part of our strategy given our rural environment. So when you look at how the geography of the state is laid out, it's been pretty important for us to make sure that people can have local access to care and again, are not driving crazy distances or choosing not to get care at all. And so by honestly, I have to say, many of our small organizations, I think nationally are pretty financially challenged to be an. I don't. To be a vibrant, ongoing concern in their communities. And so by virtue of bringing them into the Dartmouth Health family, we're able to provide additional security. The wherewithal of the system is certainly more so than, like, each individual part by itself. And we're able to make sure that care remains at the best place, which is really locally. And so I can't really comment too much nationally on does this work for everyone. But certainly in our environment, it's been an important element of making sure that those resources continue to exist in the communities that we serve. Yeah.
- [08:34]
B
And again, as we touched on, you know, there's, there's growth going on at your system. There's, you know, everything going on in the industry right now. So I know you've been in your role just for a few weeks at this point, but again, with the system for a good amount of time. So how have you found it to be successful in keeping finance teams resilient amid so much change? Maybe engage. There is do you have a secret sauce?
- [08:56]
C
Oh, geez, I wish I had a secret sauce. I think one of the things we found is really important is to make sure that folks see how their work is connected to the patient and to the community. You know, when you're a finance person and you're working on, I don't know, spreadsheets all day, you know, you name it, it is really hard to appreciate that your work actually has an impact on your community, on neighbors that you run into at the grocery store, you know, that we're also taking care of in our organization. And so whenever we have a chance to remind our teams about that, like, for example, we're recently in the middle of completing a couple of floors that were previously shelled in our inpatient hospital at our main academic campus. And one of the reasons why we're able to do that is because of the financial analysis work that was done to prove that the importance of the project, and then, of course, the financial benefits of the project for the overall health of the system. And so just reminding folks like, hey, that wouldn't have happened if you weren't a part of the team. And even though you're not touching patients directly, so to speak, you know, your stewardship is really making a difference for the organization. And just to say, I really don't think there's a special sauce. I mean, I was kind of a little bit flipped when I responded, but I actually, I feel like as a leader, you have to be a really good listener and consider what matters the most to each of your team members. And so it's not like the same sauce bottle is going to fit for each person. You know, you want to be. You want to be supporting them. You got to make. I think you have to make them feel a little bit uncomfortable so that they are growing, you know, professionally, and let them know that you always have their backs if. Should that ever arise. So I don't know. It's, you know, recognizing the individual person for what they are. They are.
- [11:17]
B
That's some incredible advice there from a leadership perspective. And in that same vein, how would you say finance leader roles, particularly now CFO roles, are evolving in the industry? I mean, it's not just all numbers crunching and spreadsheets anymore. It's communication that is such a huge piece. So how do you feel it's evolving?
- [11:39]
C
Yeah, I absolutely agree with your thoughts about communication. I mean, I feel like over the years, my role really changed from providing the financial data and kind of making sure all the transactions were accurate and that was pretty much a very major part of the role to now you are being one of the decision makers and more of a, I guess a strategic thought partner to the other executives on the team. And so aside from communicating the context for a particular decision or financial situation or what have you, I think that I often find myself also talking with them about the risks associated with it. So geez, you know, you can think as, you know again as a finance person, what are the things I might have gotten wrong about the assumptions for this particular case? Are there things that would make it go better or worse? But then you also have to be prompting your team like you know, what are the odds? What could we do that would make this more successful? How are we feeling about the team that's ways to execute on this strategy? Do they need more support? Are my confident that they're going to get us there? I guess. And then are we actually responding fast enough? You know, creating a sense of urgency sometimes I feel like is a really important element when you're trying to get folks to do hard stuff. Just reminding them of how necessary it is and keeping their eye on the long, on the long view. Oftentimes, especially today's environment, we're really, it's easy to get bogged down in kind of feeling like geez, you're dealing with problems every day. How are you putting out the fires? And so part of the role of a finance leader I think is really to help raise folks gaze to the horizon and be like we're taking the long view. This organization is going to be in place, this health system for our community for a very long time and we're going to figure it out, you know, give folks that sense of optimism and remind them, you know, we've been through challenging times before and we're able to, to get there again.
- [14:08]
B
So anyway, no, no, it is, I mean to your point, it is an ever shifting industry. This is so true. So keeps us all on our toes. But it's good to have a forward thinking mindset. So my final question for you here, I just would love to hear a little bit more about what you're most excited about right now at the system. Just looking forward in your new role. Any future growth plans, any partnership plans, anything that you're just like yay, I can't wait for.
- [14:37]
C
Yeah, well, I think actually I'm really excited about getting to know each of the leadership teams at our member organizations more because I do believe that by tackling some issues together, we're going to be so much more successful than by kind of applying our individual manpower to them. As I mentioned, we have a lot of patient demand that we're trying to settle out throughout our system and so being able to really understand each member organization's perspective on how are they dealing with these challenges and what we can learn from them and also bring to them in order to do the best thing for our communities. I mean I'm excited about what we could unleash. I don't mean to say we haven't done some of that already but I'm like this is it just feels like a great opportunity to for like one plus one to equal three instead of two.
- [15:42]
B
Well you can definitely hear the excitement and passion in your voice so that's great to hear. Wendy, again, congratulations on the new role. It was such a pleasure having you on the podcast and I'm excited to chat with you again down the line.
- [15:54]
C
Sounds great. Thank you so much for having me.
- [15:56]
B
Thank you.