Fiscal Management of
Health Centers
Presenter:
Ira J. Rothblut, CPA
The search for the ideal CFO

Experience has shown that the quality and
performance of a CFO can determine the
success or failure of the entire FQHC
operation.
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A good CFO MUST
healthcare operations.
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No exceptions.
understand
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Challenges in recruiting the right
CFO
Lack of knowledge of FQHC specifics.
 Maybe set in ways from other industries or
previous experience in the private sector.
 FQHC might be in financial emergency and
unable to spare the time to find the right
candidate.
 Candidates may not be “hands on” enough.
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Staffing Models
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The home-grown CFO
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New hire
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Transitional CFO
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The home-grown CFO
Advantages
• Familiarity with health center staff and
operations.
• Internal promotion builds morale among
employees.
• Generally more inexpensive.
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The home-grown CFO
Potential Difficulties
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Promotions are often done before the
candidate is ready.
Existing department weaknesses may not
give a time frame to adjust to the new
position.
If promotion does not work, a strong
individual is lost.
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New Hire
Advantages
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“New blood”
May provide best practices from another
industry.
At first, center gets objective assessment
of fiscal management.
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New Hire
Potential difficulties
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New CFO may not understand FQHC
Operations, especially reimbursement.
Learning curve for new CFO
At first, Fiscal Director may feel she or he
is doing all the work.
Potential friction between CFO and Fiscal
Director.
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Transitional CFO
“Health Center maintains a fully staffed health
center management team as appropriate for the
size and needs of the center. Health center
maintains accounting and internal control systems
appropriate to the size and complexity of the
organization
reflecting
Generally
Accepted
Accounting Principles (GAAP) and separates
functions appropriate to organizational size to
safeguard assets and maintain financial stability”.
Extracted from HRSA’s Summary of Key Health Center Program Requirements.
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Transitional CFO
BPHC’s preference is to have a full time CFO employed directly by the FQHC. In
accordance, the proof is undisputable that a quality and knowledgeable full time CFO
is almost always the best route. However, if that individual is not recruited, the
transitional CFO model may better serve as a semi permanent solution.
Type of FQHC’s that could benefit most from this model
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FQHC with a Board that is results driven.
Minimal State and City contracts.
Limited number of sites.
Fairly inexperienced CEO.
FQHC’s looking to improve billing operations.
Relatively new FQHC.
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Transitional CFO
A consultant to be on site part-time and
available full-time remotely, taking charge
of immediate needs.
The transitional CFO is “hands on” from
the beginning and works directly with
CEO, COO, and Board.
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Transitional CFO
Advantages
Can train FQHC’s existing Fiscal Director and
empower Senior accountant toward greater
functionality without any time pressure.
• An external partner offers consistent levels of
objectivity.
• Organic infusion of best practices/industry
trends
• Direct accountability to Senior Management
and Board.
•
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Transitional CFO
Potential Difficulties
Board may not feel as comfortable with a
consultant versus a salaried employees.
• Transitional CFO not onsite every day.
• Fiscal Director may feel slighted that she or he
did not get the CFO position right away.
• Initially, model may be more expensive.
•
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Fiscal Department Deliverables
-For any staffing modelOverarching Responsibilities
Growth analysis and strategic planning.
- Preparation of Federal, state and city reporting.
- ARRA reporting and compliance.
- Cash projections and management.
- Supervision of Billing and collections.
- Supervision of payroll.
- Accounts Payable management.
- Creation and timely update of Accounting and Billing
Policies and Procedures Manuals.
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Fiscal Department Deliverables
-For any staffing modelTasks and Reports
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Presentations to the Board, including
monthly internal financial statements.
Budgeting for Federal grants and state
contracts.
Monthly/quarterly vouchering of state and
local contracts.
Contract Accruals management.
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Fiscal Department Deliverables
Tasks and Reports
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Monthly patient revenue & receivable analysis by payor:
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Collection rate/remediation of collection issues
Net revenue per visit
Days in accounts receivable
Reconciliation of general ledger to accounts
receivable subsidiary ledger
Credentialing updates
Members and visits by managed care plan
Provider productivity
Exam room productivity
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Fiscal Department Deliverables
Interdepartmental Communications
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With Center administrators to discuss site budgets
With Medical Director and COO to discuss
productivity and exam room utilization.
With Program Directors to discuss spending
contracts.
With IT Director to discuss budgeting/upcoming
capital needs.
With Billing department to discuss collection
rates/procedures.
With CEO to discuss everything.
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Ira J Rothblut, CPA
irothblut@ijrconsulting.com
516. 496. 2051