Becker's Hospital Review

9 CFO / FINANCE Why transformation funds are 'critical' for rural healthcare By Madeline Ashley A ndy Zukowski, CFO of Greenville, N.C.-based ECU Health and the Brody School of Medicine at East Carolina University, is tackling healthcare industry uncertainties head on with his finance team as a new year dawns. North Carolina is facing a budget shortfall to fund a 10% provider- based payment rate reduction. Federal cuts from the One Big Beautiful Bill Act could also begin affecting reimbursements in October 2027. "ese two policy changes, combined, will make delivering rural healthcare more difficult and requires us to prepare now by rethinking these traditional models of care as it relates to rural health access and cost of care," Mr. Zukowski said during a Becker's CFO+Revenue Cycle Podcast episode. ECU Health is a rural academic safety net health system that serves more than 1 million people across 29 eastern North Carolina counties. It operates a 1,708-bed academic medical center with two campuses, eight community hospitals and multiple outpatient facilities, home health, hospice and wellness centers, according to its website. It comprises more than 1,100 academic and community providers. CMS also allocated $50 billion in late December to all 50 states through its Rural Health Transformation Program, a five-year federal initiative created under the OBBBA. Policy and rural healthcare leaders have questioned whether states will pass funds to local providers, since it's not required by the program that they do so. e legislation also includes long-term Medicaid cuts that are expected to cut rural funding by $155 billion over 10 years. "We're actively engaged and involved in understanding what that will look like," Mr. Zukowski said. "It's going to be really critical that the rural health funds get to the rural healthcare providers, and that's what we're most focused on at this point." Despite industry challenges, Mr. Zukowski said ECU Health has taken a proactive stance. "We're deeply committed to being the solution to this problem, with the focus on and not limited to collaboration with everybody, all of the decision makers, as we look at the rural health realities across eastern North Carolina." ECU Health is also working with state lawmakers to open the state's first rural emergency hospital. e health system and Martin County, N.C., signed a nonbinding letter of intent in July 2025 for the REH facility, and are working to secure state funding to ensure long-term regional care. "Growth mindset is critical, along with continued focus on fundamentals," he said. "is is all just to ensure that we can learn through change and not get distracted by the news of the day or the issue at hand. It's critical that we think long term and at the same time, focus on those fundamentals." n Why CFOs can't play the 'financial scorekeeper' in 2026 By Madeline Ashley J acksonville, Fla.-based Nemours Children's Health Executive Vice President and CFO Caswell Samms III is urging hospital and health system financial leaders to evolve beyond their traditional roles in 2026 as the industry navigates increasingly challenging circumstances. "I don't think we can continue to operate as financial scorekeepers," he said during a Becker's CFO+Revenue Cycle Podcast episode. "We're going to have to be more strategically engaged and fluent in clinical operations, technology, artificial intelligence, quality and workforce dynamics. As a financial leader, a little bit of rigor and empathy is going to create a lot of longevity for your organization." Nemours Children's Health is the sole multi-state pediatric health system in the country. It comprises two hospitals with more than 10,000 staff and 1,100 employed physicians operating in 80 different locations, Mr. Samms said. On the technology front, Mr. Samms said Nemours is heavily investing in its Center for Advanced Care at Home program, a telemedicine model that's shown early success in the system's Florida market and was recently launched in Delaware. The program helps keep patients out of the emergency room and allows for earlier discharges from pediatric ICUs. "Because of the reach we have and people seeking specialized services, we have families who may travel 70 to 90 miles," he said. "Imagine, as a mother or father, not having to travel and you can just log into a telemedicine system to have a discussion with a nurse and be able to alleviate any concerns, instead of having an unnecessary visit in the emergency room. We're significantly invested in seeing that continue to grow." Looking back on 2025, Mr. Samms said learning to move faster was a crucial lesson he's bringing into the new year, with Nemours doubling down on fundamentals to be as agile as possible amid industry changes. "We trust our leadership team to make informed decisions," he said. "We're going to have the appropriate financial durability that we need … I think that'll continue to help us make sure we serve our mission in a way that we want to serve." n

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