Becker's Hospital Review

7 CFO / FINANCE The No. 1 financial lever systems are leaning on in 2026 By Madeline Scheetz H ospitals and health systems in 2026 are staring down a financial reckoning. With margin pressure mounting from every direction in the form of rising labor costs, reimbursement uncertainty and growing patient complexity, finance leaders are no longer questioning when to act, but which lever to pull first. From restructuring revenue cycle operations to leveraging AI tools to support workforce shortages, leaders are working to move beyond ongoing challenges to secure real-time solutions that stretch each dollar further. Becker's connected with Joe Caristi, CFO of Plymouth, N.H.-based Speare Memorial Hospital; Noel Sousa, senior vice president and CFO of Baltimore-based University of Maryland Medical System; Sham Firdausi, deputy CFO of County of Santa Clara (Calif.) Health System; and Jack O'Hara, founder and CEO of Translucent AI, to discuss their top financial priorities for the year during Becker's 16th Annual Meeting panel, "CFOs' Plans to Future-Proof Health Systems." Editor's note: Responses have been lightly edited for clarity and length. Question: Health systems are facing persistent margin pressure in 2026 and beyond. What's the single biggest financial lever your organization is focused on pulling right now? Sham Firdausi: e county of Santa Clara, the health system alone, is on track to almost lose about a billion dollars by 2028. at's almost, give or take, about 25% of the revenue that we bring in the door. ey brought me on to start helping them think through that portion of it. I'm doing a complete overhaul of our revenue cycle. ere are so many levers and tools just in the revenue cycle area alone. Finance is one thing, you can look at reports and do things, but looking at operations is where things have been happening. e areas that I'm focusing on is strengthening our denial management team and revenue integrity team, really looking at every single dollar on the door. I say this very openly, our healthcare system, public health, is just under attack right now from every angle you can look at. e goal has really been to maximize every dollar. e focus has been on the revenue cycle. One other area that I'm strengthening is how finance is perceived across the system. For a very long time finance had such a back-office function. I'm embedding a finance person in every single area of the operationals and clinical teams. If you can learn and understand what clinical teams do and what operations do, it makes it easier when it's your time to make those financial decisions, tough or not. Noel Sousa: e pressure really is on expense management. As you look at your organizations, not just even within the finance area, how do you do those efficiently? How do you look at the new technologies? [With] operations, you get into, what is your length of stay? What's your throughput through the emergency department? What's your wait time? I think a lot of people think there's a lot of waste in the system. ere is. Our job is to try and get that out. At the same time, it's also the job of everyone else to recognize that it's not just all on the systems to manage. We take care of the patients coming through the door, and if they show up at the ED, you need to take care of them. We can be as efficient as we can, but we have to address as a society some of the bigger issues, which is why are people showing up in your ED if there's no other alternative care? … We need to work with partners and payers to figure out what are some of the solutions? Not just tell everyone to work harder, be more efficient and be productive. at only goes so far until the system implodes on itself. Joe Caristi: Part of it is focusing on the blocking and tackling of utilization and maximizing productivity. Investment in tech is really going to unlock a lot of levers. In rural healthcare, we have a lot of recruitment challenges, and it's not just from a clinical perspective. We have a hard time hiring qualified accountants. We have a hard time hiring revenue cycle staff with any level of experience. I think we're actually looking to some of these new technology solutions, these AI solutions, as ways to try to buffer some of the bumps and the hurdles that come up with turnover. One of our ED coders had an extended leave last September, and half of our emergency room volume didn't get coded for a month. It highlighted to us, well, maybe one of these AI coding tools would have been immensely beneficial had we had it at that point. … [Y]ou still have to do the blocking and tackling that we've always done in healthcare to find improvement and efficiency, but then using technology to further enable your ability to solve those complex problems. Ultimately, my hope with this kind of AI, an almost revolution, is it's going to allow us to enable problem solving at a higher purpose. We won't spend our days chasing, "Why did we get a medical necessity denial? What do I have to do to fix it?" Hopefully, AI solutions can help us with that and we can focus more of our efforts on higher end problems. Jack O'Hara: What's the technology that you remember, like nostalgia that you miss? … One specifically that really came to mind was MapQuest … [T]here was MapQuest where you'd go print out all these reports and you'd go on a long drive and then the second the one road was closed, you're like … this is messed up. en I remember pulling off the road … asking a gas station attendant where to go and then I even remember one time I actually printed out another MapQuest. at was pretty painful. at's essentially how we're managing the business of healthcare. We have all these MapQuest-type reports and analysis that are built and they're all done retrospectively at the end of the month, at the end of the quarter. And then the people, when you embed them in operations, they're saying, "Looking at this MapQuest, I need to make this right turn right now." Whether it's on all the aspects of your business like physician productivity, payers, revenue cycle or labor management. Unfortunately, we're not equipping them with the tools. n

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