Jack O’Hara is the founder and CEO of Translucent.
It’s no surprise that health systems are under financial pressure. A recent analysis found that hundreds of hospitals could see their deficits grow 50% to 75% under the combined weight of Medicare sequestration, Medicaid cuts and expiring ACA subsidies, and federal actuaries project national health spending will climb to $9 trillion by 2034, nearly 21% of the economy. Every CFO I talk to is living inside that math, and most of the public coverage stops there, at the balance sheet.
What gets less attention, however, is what that pressure does to the people inside the finance department itself.
I recently spoke with a finance leader at a large West Coast health system who described her team in a way that’s stuck with me since. People stay, she said, mainly because they’re too busy to look for another job. And nearly everyone she’s hired over the past few years has eventually left because of the work itself; hours spent pulling numbers out of systems that don’t talk to each other, reconciling reports that disagree, chasing down the “real” version of a number by month-end is not sustainable. It’s not that the people can’t handle hard work. It’s that the work isn’t the kind that builds toward anything. It just resets every 30 days.
That’s the part of the healthcare cost story that doesn’t make the headlines: A finance function under constant strain produces worse numbers and loses the people who understand the business well enough to do anything about them. In an environment where every dollar of margin matters more than it did two years ago, that determines whether a health system can actually respond to the pressure it’s under or just keep documenting it.
Here’s what it actually takes to break the cycle.
Stop routing judgment and data assembly through the same person.
Most finance teams still expect their most capable analysts to spend the bulk of their time reconciling and assembling numbers before they ever get to the part of the job that requires judgment. That’s backward. The skill it takes to catch that a number looks wrong is not the same skill it takes to manually chase down why across five systems. Separating those two kinds of work, even informally, changes what a day actually feels like for the people doing it.
For example, a large academic health system in the Midwest was facing the same kind of month-end scramble: pulling payer performance data from a mix of systems, then trying to reconcile the differences before anyone could act on what the numbers actually meant. The finance team stood up a workspace that handles the assembly work automatically, pulling and reconciling the underlying data on its own, and put a layer on top that flags where a payer contract is underperforming and surfaces where to look next. The team now runs more than 40 report sets that used to require manual pulling and cross-checking. Freed from that reconciliation work, the team has been able to focus on interpreting what the numbers mean and has identified millions in open revenue opportunities so far.
Get off the month-end sprint.
A huge amount of finance burnout is really a cadence problem. Teams that only look closely at the numbers once a month are guaranteed to hit crunch weeks, because a month’s worth of drift gets discovered and explained all at once, under deadline.
One thing I hear often from finance teams is that the same number gets explained three different ways depending on who you ask: the version in the general ledger, the version in a department’s own spreadsheet and the version someone remembers from a conversation two months ago. Untangling that, done once a month, can eat the first week of every cycle before anyone gets to what to do about it. Done continuously, as the numbers happen instead of after the fact, there’s only ever one version to reconcile, because nothing’s had a month to drift and fracture into three stories. The time that frees up goes toward deciding what to do next versus agreeing on what already happened.
Measure the team on decisions instead of documents.
Ask most finance leaders what their team produced this quarter, and they’ll point to reports: the forecast, the variance analysis, the board deck. Ask what decisions those reports actually changed, and the answer gets a lot fuzzier. Teams that are evaluated on output volume will keep producing output, even when it’s not moving anything. Redefining what “good” looks like (e.g., fewer reports, more decisions unblocked) is as much a retention lever as a performance one because it tells your best people that their time is being spent on something that matters.
For example, a health system CFO told me his team was producing dozens of recurring reports a month. When I asked him which of those had actually changed a decision in the last quarter, he paused and couldn’t name any. He guessed that at least half were legacy asks nobody remembered requesting in the first place, just inherited from someone who’d left the team years ago. Nobody wanted to be the one to cut them, so they kept getting produced and kept eating hours that could have gone toward analysis that would actually shape what the system did next.
None of this is free, and none of it happens by accident. It takes a CFO deciding that the current cycle is both inefficient and unsustainable and treating that as seriously as any other line item under pressure right now. Given what health systems are already up against, they can’t afford to keep losing the people who understand their business best.
The information provided here is not investment, tax or financial advice. You should consult with a licensed professional for advice concerning your specific situation.
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