As Paula Tinch prepares for her retirement, she offers advice for other CFOs.
Paula Tinch joined Penn State Health as its executive vice president of finance and CFO in 2019. Now, she is preparing to pass the baton to her successor later this year.
Throughout her time at Penn State Health Tinch was a stabilizing force for the organization, especially during the pandemic where she led the finance team through COVID challenges and helped the system avoid layoffs that health systems across the country were experiencing.
Check out these three pieces of advice from Tinch as she closes out her long career in healthcare finance.
Check out the full interview with Paula Tinch here.
MultiCare's CMO breaks down how the system achieved cost savings through clinical and financial alignment.
From overtreatment like repetitive lab tests and duplicate imaging studies, to unnecessary medicine usage and care coordination failures, clinical waste can quickly devour a health system's budget. Research shows that clinical waste is a big driver of excess health spending, accounting for anywhere between 5.4–15.7% of national health spending.
Through a collaboration with Epic and IllumiCare, MultiCare Health System has achieved big savings by reducing clinical waste. In this episode of HL Shorts we hear from MultiCare's CMO Arun Mathews on how the new system helped reduce clinical waste and how much work went into physician alignment with the new program.
For CFOs, it’s important to not overlook the importance of collaboration with medical teams to uncover clinical and financial stewardship opportunities.
For more info, be sure to check out the accompanying aritcle with Mathews' full interview.
As Tinch prepares for her retirement, she looks back at the strategies, successes and challenges that have shaped her career.
Paula Tinch joined Penn State Health as its executive vice president of finance and CFO in 2019. Now, she is preparing to pass the baton to her successor.
Originally Tinch was set to retire at the end of January 2025, but when asked to stay with her team until June, she said the decision was an easy one.
“Pretty easy to say yes when you know when you have a great team and we've had a lot of really great momentum,” Tinch said.
Throughout her time at Penn State Health Tinch was a stabilizing force for the organization, especially during the pandemic where she led the finance team through COVID challenges and helped the system avoid layoffs that health systems across the country were experiencing.
The Steady Grind
In 2024, Tinch played a significant role in the system’s financial turnaround, setting it up for a much brighter year in 2025. In 2023, Penn State Health’s losses were mainly attributed to debt and expenses related to two recently opened hospitals, plus general increased costs from inflation, worker shortages, and supplies.
Tinch said a large component to finding this stabilization was the system’s specific internal call to action coming together in the form of a project launch titled Project F.I.T: financial improvement taskforce.
“It was really [about] engaging leaders and team members across the organization to kind of spark their change efforts and create some local ownership,” Tinch said. The process was also about expediting further integration, since Penn State Health has morphed as an organization over the last several years.
“Every year the system has changed in a way that it didn't exist the year before,” Tinch said.
For example, the system now has a centralized office that manages all of its contracted labor.
“It was creating some of those structures that are leveraging our size and scale, but making sure that it was broken down in a way that it was easier to leverage that size and scale,” Tinch said. “And we certainly have more to do, but that was laying the foundation and really getting everybody engaged.”
One thing Tinch is particularly excited for in her last few months at the system is the launch of its integrated Epic electronic health record (EHR), which will formally launch at the end of March. Epic is overwhelmingly the EHR of choice for academic medical centers.
“I'm sure it's going to be successful for the organization,” Tinch said.
The health system has also accomplished much in terms of partnerships and acquisitions. Tinch led the finance strategy here to acquire and integrate several private practice physician groups and build several new Penn State Health Medical Group locations.
“When I think about the past handful of years, we've really accelerated a lot of the acquisitions and practices, whether it's smaller practices, medium or large,” Tinch said. “It's really about facilitating that stabilizing clinical expertise in the community, as well as collaborating and strengthening that clinical backbone through different partnerships, bringing it in to grow the services that complement the services that we have.”
Behind The Numbers
As Tinch looked back on her career, she recalled some of the advice she had been given over the years.
“I had somebody always tell me, it's obviously more than numbers,” Tinch said.
CFOs know this but taking the moments to meditate on what the root concept of the job pursues can help to reframe the work when it gets challenging, which in healthcare, can be often.
“I can report on numbers. Everybody can be good at numbers,” Tinch said. “[But] I'm always looking at the history, right? You're always looking behind you to get those numbers, but I think it's trying to really understand the story behind the numbers and the patients that make up the story behind the numbers.”
CFOs don’t need to be experts at everything, Tinch explains.
“But building a great team of those experts around you that you can rely on is key,” Tinch said. “You want to be able to hand it off and make sure that we can transition that information in a valuable way so that people can interpret it.”
According to Tinch, shifting data and information across different working groups in healthcare is a part of what makes the industry so complex, which is something that isn’t too often discussed amongst healthcare professionals.
“The complexity that we have all layered on to healthcare, I think we don't talk about enough,” Tinch said.
“I think there has to be some simplicity layered in behind it, which means peeling back some of the things that I think have been layered on over time that have all good intents and purposes, but have layered on costs.”
Research shows that clinical waste is a big driver of excess health spending.
Research shows that clinical waste is a big driver of excess health spending, accounting for anywhere between 5.4–15.7% of national health spending.
Instances of overtreatment like repetitive lab tests, duplicate imaging studies, unnecessary medicine usage and care coordination failures, can all lead to clinical waste which can quickly devour a health system's budget.
There are tools to curb these redundancies and mistakes, but they must be integrated in a comprehensive, evidence-backed, aligned way in order to truly improve patient care while locating cost savings.
Check out this infographic for tips on how CFOs can oversee the integration of digital tools to combat clinical waste.
Want to know more? Read this article on how MultiCare Health System made care improvements and saw millions in savings after integrated clinical decision support tools to combat clinical waste.
The cuts would likely disrupt coverage and care for millions of Americans.
Last week, House Republicans released their budget blueprint that’s calling for $880 billion in federal payment cuts. Caught in the crosshairs are Medicare and Medicaid programs, in which potential cuts would disrupt or eliminate care for millions of individuals.
The bill orders the Energy and Commerce Committee, which oversees Medicare and Medicaid, to find $880 billion in savings from fiscal years 2025 through 2034. Earlier this month, Elon Musk’s Department of Energy Efficiency (DOGE) gained access to CMS systems to allegedly examine spending data for potential fraud, waste, or abuse. The CMS payment system manages more than $1 trillion in annual payments for millions of patients and health systems. Soon after, a federal judge blocked DOGE’s access to the Treasury Department's central payment system.
Although the Trump administration has said that it will not cut Medicare, Medicaid and Affordable Care Act subsidies remain on the table. As of now, it does not seem feasible that Republicans will meet their spending target without making significant cuts to federal healthcare programs like Medicaid or the ACA.
Industry Pushback
Health spending is immense. In 2023, the federal government spent $1.6 trillion on health insurance and subsidies, according to the Congressional Budget Office (CBO). While reining in the massive expense is an important component to lowering overall healthcare spend, the federal government should examine other avenues to curb the budget, ones that don’t involve directly jeopardizing care for patients. By turning to other options such as provider incentives to address clinical waste (which accounts for between 5.4% to 15.7% of national health spending), or programs to address the underlying social determinants of health like extreme poverty, healthcare access, and food scarcity, which all have an impact on health.
Many industry experts have expressed rejection of the potential cuts, saying that it would immensely disrupt patient care.
“The proposed cuts could lead to 20 million people losing Medicaid coverage due to a $2.3 trillion reduction in spending over the next decade,” Nicole Keating, staff vice president of government business execution at Elevance Health, wrote on LinkedIn. “States may need to raise new revenues, cut coverage for certain populations or services, or reduce payments to healthcare providers.”
“We don’t need to know the mechanisms of how Medicaid would be cut to know the impact would be catastrophic,” Anthony Wright, executive director of patient advocacy group Families USA, wrote on LinkedIn. “The sheer size of the proposed cuts means millions of Americans losing coverage, hospitals and clinics plunged into budget shortfalls, and health care services we all depend on being eliminated."
“Patient access to care and practice sustainability are not partisan or geographical issues. It’s an urgent national issue that demands immediate attention from Congress,” AMA President Bruce A. Scott, M.D, said on the matter.
CFOs, grab a chair
CFOs must recognize their seat at the table in these discussions now more than ever. Now is the time for CFOs to step up and become involved in these policy making discussions that hold so much power over their health systems and the patients they serve.
As the new administration moves in with fast-acting tactics to reorganize government spending, CFOs must pay close attention to the discussions being had and how the outcomes will affect not only their organization, but the entire industry. CFOs should not hesitate to step up and advocate for policies that protect the future of healthcare for patients and their staff.
In this episode of the HL Shorts we hear from James Rohrbaugh, executive vice president and chief financial officer of Northern Light Health.
As healthcare bankruptcies continue to remain above average, especially for rural providers, executives are searching for strategies, including partnerships, to remain operational and profitable.
In this episode of the HL Shorts we hear from James Rohrbaugh, executive vice president and chief financial officer of Northern Light Health. After facing financial chaos in 2024, Northern Light took big steps to get back on track, including selling off clinics and laying off some executive administrative staff. Rohrbaugh discusses the strategic partnerships at his health system, from local collaborations to joint ventures, and the importance they play in the organization’s operations.
MultiCare's CMO breaks down how the system achieved cost savings through clinical and financial alignment.
From overtreatment like repetitive lab tests and duplicate imaging studies, to unnecessary medicine usage and care coordination failures, clinical waste can quickly devour a health system's budget.
Research shows that clinical waste is a big driver of excess health spending, accounting for anywhere between 5.4–15.7% of national health spending.
MultiCare Health System, a 2,413-bed network in Tacoma, WA, has taken an incremental approach to tackling clinical waste, and has seen significant results.
By using a report by IllumiCare to analyze opportunities for areas of clinical stewardship within the organization, MultiCare took the first step towards understanding where the system needed help. Now it's made measurable progress with lllumiCare's Epic integration via CDS Hooks. This integration allows for real-time recommendations within the provider's workflow when ordering medications, lab tests, or imaging studies.
How It Works
The program works by nudging clinicians when they are about to place a potentially redundant or less cost-efficient order and then offers appropriate alternatives. These recommendations aren't created by just a new, flashy AI model, but by evidence-based research focused on clinical best evidence through a database called the Choosing Wisely database, which is built out of a relationship with the American Board of Internal Medicine, designed specifically to reduce unnecessary tests.
The interventions have helped MultiCare achieve a 26% acceptance rate for recommendations, with 23% for medications and 36% for lab orders. These numbers may sound low, but they far exceed national averages.
Working with Physicians
The potential of this integration was clear. The next step, according to MultiCare CMO Arun Mathews, was getting physicians to love it.
Once there was an understanding by physicians that the recommendations they were being given were sound, then it became time to perfect the process.
"One thing that has become apparent in the [informatics] literature is best practice. These alerts, being too prodigious, actually occur too many times and it's causing something called alert fatigue."
MultiCare then worked with IllumiCare, as well as its own internal governance, to develop an understanding as to what are the most significant and clinically relevant alerts needed so physicians didn't become overwhelmed. Physician engagement caught on a bit, but not entirely.
"The work of this involved allowing our physicians a little bit of time to become comfortable just turning it on and seeing the level of engagement," said Mathews.
The next step, Mathews said, was partnering with MultiCare's contracted hospitalist physician group, and developing a quality performance metric that helped physicians find an understanding that the work that they were doing in responding to these alerts was actually helping to reduce clinical waste.
"[Then], we could share some of that savings of some of that clinical waste reduction with our physicians by having them follow through with some of these best practice recommendations," said Mathews. "That was a bit of a breakthrough for us."
Lastly, what Mathews calls phase three of this integration, came in the form of Epic's CDS (clinical decision support) Hooks, which operates within Epic. This function took the extra work off of physicians when a new recommendation was made and functions so the program completes the task for the physician.
"The doctors have been really grateful for the fact that they don't have to do these extra sort of thought cycles to jump into the orders pane and order and do the extra work when they've already cognitively agreed with the decision to follow the alert."
The Results
Mathews says MultiCare was conservative with its predictions for the new integration, but the end results were staggering. Where the system was expecting around a 5% waste reduction, the results translated into more than a 13% reduction.
"[That] reduction in waste translated in our pilot program of five hospitals to about $2.5 million worth of savings within one calendar year," Mathews said. "And again, all tied to best practice, best evidence and aligned with our physicians so that they can get credit for making those decisions by the bedside."
The financial results were great, but what about the patients? MultiCare wanted to ensure patients were safe, satisfied and still encountering a great care experience. Every initiative at MultiCare, Mathews says, gets reframed as a patient safety and or quality initiative.
"If we uncovered a concern around patient experience or uncovered a concern around increased risk of readmission as a result of these changes that were recommended, we would certainly consider placing the program on pause," he said. "I'm pleased to report that we saw no statistically significant changes in either of those two countermeasures as a result of rolling this out."
Overall, the integration of the new program revived an understanding amongst clinicians and executives about the importance of meshing clinical and financial stewardship based on better clinical practices.
"I think the unintended consequences have been better awareness about where the hidden costs within healthcare actually exist," he said.
MultiCare plans to integrate this into its radiology department next.
The Bedrock of Efficiency: Collaboration and Alignment
Yes, this is a lot of clinical talk for a finance article, but CFOs need to recognize the importance of their involvement here. It's critical for finance leaders to collaborate with not only CMOs, but lead physicians and physician groups to develop a thorough understanding of where medical inefficiencies and clinical waste lie, and how much that can cost a health system each year.
The underlying opportunities for a health system's financial prosperity can be uncovered with the right collaborations. CFOs should note that informed decisions take time, organization, and alignment with care practitioners to truly understand the nuanced pitfalls in modern healthcare.
"The key here is a single word, and to me it's alignment," Mathews said.
"While I strongly believe that financial stewardship is how we keep the lights on and the doors open so that we can render care for our communities, it has to be done on the bedrock of making sure that that care is the same care that I would want."
Employee retention and strategic partnerships helped shape this system's success.
Northern Light Health, Maine's second largest healthcare system, found itself in financially tumultuous times in 2024. Through the first three questers of the year, the health system saw $100 million in operational losses and a debt of $620 million, leading to a credit downgrade.
Many of the challenges for Northern Light hung around post-pandemic, and over the last few years the system has made big steps to get back on track, including closing clinics, changing programs, selling off laboratory services and outsourcing non-medical positions.
One of the biggest steps the system took was a major administrative staff layoff in October 2024. The system eliminated three executive administration positions in order to preserve frontline medical staff.
Overseeing this from a financial standpoint was James Rohrbaugh, who was hired as Northern Light Health's executive vice president and CFO in July 2024. Rohrbaugh says the system has made a significant turnaround since then.
"We've seen significant increases in volume, specifically in the first quarter, this year compared to the first quarter of last year," he said. "That certainly is very encouraging."
Much of the challenges last year stemmed from low reimbursement, labor shortages and increased costs. Rohrbaugh says the health system has shifted its focus since then to highlight patient access, efficiency, retention and partnerships.
Keeping Local Healthcare Accessible
The 10-hospital system, headquartered in Brewer, Maine, includes several critical access hospitals within its network, serving much of Maine's rural population. With 37 care locations, a physician-led medical group, and close to 1,000 licensed beds, Northern Light Health plays a vital role in Maine's healthcare landscape. It's also one of Maine's largest private employers, employing more than 10,000 people.
When asked if there were ever any thoughts of selling the system during its financial chaos, Rohrbaugh emphasized that it was never a part of the plan.
"Our board and our hospitals consist of community members that are devoted and focused on making sure that we're delivering services to our communities, and so we've been much more focused on what we need to do as a system to drive sustainability," he said. "To us, it's critically important to keep healthcare local."
Strategic Partnerships
Rohrbaugh says a key strategy in Northern Light Health's turnaround has been strategic partnerships. One is with local organizations such as the Maine Hospital Association. Through this partnership Northern Light Health is able to interact with "other providers together that are challenged with the same kinds of issues," he says, helping the health system to tackle challenges through a policy lens.
Joint ventures create the second category.
"For example, we have a joint venture with First Atlantic Health Care [which manages 18 nursing, rehabilitation, long-term care and assisted living centers across Maine] to manage our long- term care centers," he said. "One of the things we recognize is that it's helpful to have expertise that's focused."
Lastly, smaller partnerships play a significant role. Rohrbaugh says these types of partnerships are important for the system to leverage economies of scale, and improve efficiency and the care experience for patients.
"Over the last couple years we've put in place a number of partnerships with organizations such as Quest [Diagnostics], Optum and then most recently Compass One [Healthcare]," he said. "Partnerships show up in many ways, but they clearly are a critical part of success for us in the future."
Retention with Intention
As Northern Light Health gets back on track after last year's challenges, the spotlight on its medical staff has never dimmed.
"Maybe the most important part from our perspective is engaging the leadership and the workforce together, attacking, tackling the challenges, changing the work," Rohrbaugh said.
A couple factors the system found to be very important are the structure of job descriptions and flexible scheduling.
"[We are] being innovative around people, scheduling and making sure that we can think outside the box around how we schedule them," he said.
Engaged employees and a good organizational culture are a couple components to the health system's retention strategy. But with a labor shortage, those employees can be difficult to find. Rohrbaugh says building a robust talent pipeline, intertwined with another partnership, was vital for the system.
"Talent strategies are a critical part of the work that we do," he said. "We've been fortunate that we built strong relationships between the Maine Community College system and nursing schools across the state. So schools of nursing, for example, have clinical rotations at Northern Light Health. We also have family practice and physiatry residency programs."
Partnerships like these have shaped the system's recruitment and retention strategies. This particular collaboration includes the state's largest health system, Maine Health.
"That's a really good example where you have two health systems that are in the same state and in [the same] markets, and we compete against each, [but are] both part of a partnership together helping fund a program through The Maine Community College [system] to grow our workforce," he said.
Rohrbaugh says partnerships highlight the opportunities in healthcare that can't be seen in isolated decision- making. Health systems work best when decisions emerge from informed groups, meshing executive leadership with outside organizations and clinical staff.
"I think it's an exciting opportunity for all of us, continuing to reinvent how we deliver healthcare, and the best way that happens is by going as close to the care as you can," he said. "I think the most important part of making those tough decisions is making sure that the workforce and the staff is part of that decision making process."
Trump's tariffs are set to dramatically increase healthcare supply costs. Here's how CFOs can prepare.
The Trump administration is rapidly introducing a slew of new policies, and CFOs are about to come face-to-face with the effects of trade tariffs. The challenge of budgeting amidst shifting tariffs will call for keen analysis and proactive planning from every finance leader.
Check out these three tips for CFOs to prepare their organization's budget for expensive tariffs.
82% of finance executives predict that costs for health systems will jump by at least 15% over the next six month due to new tariffs.
The Trump administration is rapidly introducing a slew of new policies, and CFOs are about to come face-to-face with the effects of trade tariffs. The challenge of budgeting amidst shifting tariffs will call for keen analysis and proactive planning from every finance leader.
The President has signed executive orders imposing stiff tariffs on the country’s three largest trading partners, consisting of a 25% tariff on imports from Canada and Mexico and a 10% tariff on Chinese imports. Although Mexico and Canada were able to put a pause on tariffs for 30 days, the tariff on Chinese imports is in effect.
The Industry Impact
With its heavy reliance on imported goods, from pharmaceuticals and medical devices to essential equipment, healthcare stands to face significant financial implications.
Industry professionals, from supply chain leaders to pharmaceutical executives, to distributors and medical equipment manufacturers, have all expressed deep apprehension over the potentially surging costs.
A large area of concern is the pharmaceutical industry, where the U.S. relies heavily on China for imports. Tariffs on imported drugs or raw materials used in drug production could result in higher prices for both generic and brand-name medications. CFOs will likely see an increase in medication costs, potentially affecting both provider profits and the financial burden on patients.
According to a Black Book Research survey, the majority of healthcare leaders predict that costs will jump by at least 15% in the next six months from increased import expenses. For pharmaceuticals, it’s estimated that costs will rise by at least 10% as a direct effect of Trump’s tariffs on China.
Roughly 90% of finance executives in this survey said they will need to shift increased costs onto insurers and patients in the form of higher service charges.
The Economic Impact
Tariffs can disrupt the flow of global trade, leading to inflationary pressures and reduced consumer confidence. If the costs of healthcare services rise because of these tariffs, there could be broader consequences for patients, particularly those without comprehensive insurance. Rising healthcare costs may lead to a higher uninsured rate or an increased burden on government-funded programs like Medicare and Medicaid.
Economic instability and inflation, stemming from the ripple effects of trade tariffs, could also impact consumer behavior. With higher costs of living and wages potentially stagnating, patients may delay or simply forego medical care.
This could lead to revenue instability for healthcare systems, making it difficult for CFOs to predict revenue streams accurately. Plus, financial markets' volatility could affect the pricing of some healthcare investments, as well as the cost of borrowing for hospital expansions or infrastructure upgrades.
The CFO Gameplan
Task #1: With tariffs potentially fluctuating, CFOs should develop flexible budgeting models that can accommodate sudden price increases or disruptions in the supply chain. This will help providers maintain liquidity and adjust to unexpected costs without sacrificing quality or access to care for patients.
Task #2: CFOs should consider broadening their supplier base to mitigate risks due to tariffs on specific countries or industries. By sourcing materials and goods from various global markets, CFOs can help reduce dependency on a single region or vendor that could be vulnerable to tariff hikes.
“They might have to use a domestic supplier or U.S .-based supplier, as well as an international one, and kind of use both,” says HFMA Senior Vice President for Content and Professional Practice Guidance Rick Gundling. “I think it'll always be hard.”
Task #3: CFOs are surely sick of hearing this by now, but they need to work with clinical leaders and procurement teams to implement strategies for reducing waste, improving efficiency, and optimizing purchasing practices. Negotiating better pricing with suppliers will also be crucial, especially when purchasing in bulk or committing to long-term contracts.
