Jim Gobell
Chief Financial Officer
St. Luke's Iowa Health System
Sioux City, Iowa
What do you anticipate spending most of your time managing over the next year?
Probably trying to adapt to the regulatory changes that are a result of healthcare reform. Coordination of care and cost management are two things that will draw a lot of attention. Physician alignment is also a big issue. But we don't think alignment requires physician employment. St. Luke's has multiple physician practice models - some employed and some not. Additionally, there are certain metrics we follow to help determine what needs close attention. Of course we follow the traditional operating metrics from a financial standpoint. And we also track a lot of market share information and population utilization of medical services.
What has been the biggest impact of the recession on St. Luke's?
The recession is still impacting us. There is very limited population growth in our market, with little infusion of new cash into the local economy. That affected our ability to reward our employees financially. It's also been a real challenge to maintain operating margins and make future capital investments to help the system grow.
Did you place capital projects on hold during the recession?
We didn't put projects on hold so much as hold them to a higher level of scrutiny. We want to make sure our capital projects are good long-term investments. We're trying to find the right balance between replacement capital and strategic future investment. You are always 'tugged' toward replacement capital investments, and you never have quite enough future investment capital. Day-to-day operations demand to be addressed, but you know that a longer-term strategy is crucial for organizational strength. It's a difficult balance.
What impact has the recession had on your patients?
We have seen an increase in patient responsibility with regard to co-pays, higher deductibles and more uninsured. We have initiatives underway to appropriately address the patient portion of the bill at the time of service, but it's actually a challenge to acquire information about a patient's expected deductible and co-pays. As we become better at acquiring that information and communicating it accurately to the patient at the time of service, we will put more emphasis on up-front collections.
Interviewed by Richard Pizzi, Editorial Director