Becker's Hospital Review

10 CFO / FINANCE model carries with it a hope and a promise. e hope is that we'll be here when the community needs care, and the promise is that when someone seeks access, they'll be able to get it." Dr. Seupaul is candid about what is at stake. Cuts to Medicaid, 340B and tax-exempt status are not abstract policy questions; they are decisions with direct consequences for the services Carilion Clinic and other nonprofit systems sustain. "I think of a few core principles that can help ensure those simple messages resonate with the people who need to hear them — whether that's the general public or those in legislative positions who need to understand the impact if funding evaporates for certain programs, particularly Medicaid," Dr. Seupaul said. "Most nonprofits have a very heavy government payer mix — about two-thirds government payers — compared to for-profits, which are closer to 50/50. Our business model is centered on caring for our community and investing accordingly in its long-term health." His message to policymakers and the public is deliberately simple, even if the execution is not. Nonprofit health systems are not businesses that happen to have a charitable wing. ey are organizations built around a different kind of responsibility, and answer to a fundamentally different bottom line. n Hospitals have 'tenuous' financial outlook By Laura Dyrda W hile average hospital margins ticked up from 1% in January to 1.9% in February, they are still well below 3%-plus margins hospitals reported in the second half of 2025, according to Kaufman Hall's National Hospital Flash Report, released April 9. "Cost pressures are driving a tenuous financial outlook," the report states. "Hospital expenses are elevated in early 2026 compared to 2025, while revenues are pressured by an eroding payer mix and remain below sustainable levels." Five things to know: 1. Operating margins dropped 10% on average year over year, although they are up 14% over the first two months of 2023. There was a "significant variation" in hospital performance by region, geography and market position, the report authors noted. Here is a regional breakdown of the average year-over-year margin change in February: • West: -21% • Midwest: -9% • South: -15% • Northeast / Mid-Atlantic: -2% • Great Plains: -12% 2. Net revenue per calendar day increased 5% month over month and 4% over February 2025, according to the report. Inpatient revenue was up 4% and outpatient revenue increased 7% year over year. 3. Expenses per calendar day grew faster than revenue, increasing 6% year over year. Supply and drug expenses per calendar day both increased 8% year over year while labor and purchased services expenses inched up by 4%. 4. Average patient volume dropped in February. Discharges per calendar day were down 2% year over year while ED visits dropped 5%. The average length of stay decreased 4% year over year and 6% compared with the first two months of 2023. "Patient days have softened in early 2026 while the average length of stay remains relatively steady, reflecting both demographic shifts and changes in where care is delivered," the report states. 5. Bad debt and charity care jumped 10% year over year in February, and is up 45% year to date compared with 2023. n CFOs as strategists: How finance leaders are rewriting their role By Madeline Scheetz Today's modern hospital and health system CFO has evolved from the behind-the-desk, numbers-cruncher role of even 10 to 20 years ago. Finance leaders must now don strategic hats to help balance competing pressures like thinning margins, rising labor costs and reimbursement headwinds to protect their organizations competitively while staying true to their mission. ey do this while holding a larger communication role as an educational, operational and visionary leader. Becker's connected with hospital and health system CFOs to discuss how they've evolved into strategic partners, the framework used to balance near-term financial pressures with long-term investment, and what it means to lead with both a mission and a balance sheet in mind. Editor's note: Responses have been lightly edited for clarity and length. Jason Hinkle. CFO of Deaconess Illinois (Marion, Ill.): We definitely have taken more of a role in the past several years at being at the table of those strategic decisions. What service lines do we want to delve into? What do our communities need? Ultimately, we have to make sure that our health system is around for years to come to continue to provide the excellent care that we do to our patients. Having a seat at that table on

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