1. CFO Leadership
December 2016

2. If you drop an Oreo on the floor, can you still safely eat two thirds of it?
Random Thoughts

3. Three most difficult positions to fill in a CHC?
Random Thoughts

4. Chief Financial Officer Chief Information Officer Human Resources
Random Thoughts

5. Chief Financial Officer
Who needs a CFO? HRSA Program Requirement # 9 Key Management Staff
Chief Financial Officer

6. Chief Financial Officer
What is the difference between a CFO and a Controller?
Chief Financial Officer

7. Chief Financial Officer
A controller says NO, NO, and Heck NO!
A CFO says Yes, lets see if we can make it happen!
Chief Financial Officer

8. Chief Financial Officer
What knowledge, qualities & abilities do I want in a CFO?
Honesty – Everyone must be able to trust the CFO.
Good understanding of accounting & finance. (most important is experience)
Great understanding of reimbursement (Medicaid & Medicare).
Great understanding of CHC operations & providers (Revenue Cycle)
Creativity (think outside the box circle).
Ability to communicate both in writing and verbally.
Ability to manage staff (be a good teacher).
Good understanding of politics (internal & external).
Chief Financial Officer

9. Case Study – Federal 330 Grant less than $5 million
Go Big or Go Home
Case Study – Federal 330 Grant less than $5 million

11. Current Ratio

12. Days Cash on Hand

13. Perspective
Materiality
Words have meaning

14. Perspective Health Center Name State Total Cost Total Patients
Total Cost Per Patient
ALTA MED HEALTH SERVICES CORPORATION CA
$ ,773,300
188,122
$ ,226
SUNSET PARK HEALTH COUNCIL NY
$ ,310,800
123,769
$ ,602
YAKIMA VALLEY FARMWORKERS CLINIC WA
$ ,636,400
131,624
$ ,122
HUDSON RIVER HEALTH CARE
$ ,100,900
152,280 $
SEA-MAR COMMUNITY HEALTH CENTER
$ ,816,100
183,680 $
MULTNOMAH COUNTY OR
$ ,857,800
71,174
$ ,853
EAST BOSTON NEIGHBORHOOD HEALTH CENTER MA
$ ,700,000
66,960
$ ,907
FAMILY HEALTH CENTERS OF SAN DIEGO
$ ,706,300
134,788 $
DENVER HEALTH & HOSPITAL AUTHORITY CO
$ ,933,700
147,769 $
ACCESS COMMUNITY HEALTH NETWORK IL
$ ,339,600
180,981 $
Perspective

15. Perspective Health Center Name State Total Cost Total Patients
Total Cost Per Patient
BORREGO COMMUNITY HEALTH FOUNDATION CA
$ ,573,700
119,180 $
EL RIO SANTA CRUZ NEIGHBORHOOD HEALTH CENTER AZ
$ ,562,300
92,157
$ ,211
THE INSTITUTE FOR FAMILY HEALTH NY
$ ,420,300
98,478
$ ,101
SAN YSIDRO Health Centers
$ ,627,600
89,662
$ ,167
UNITY HEALTH CARE DC
$ ,504,200
106,469 $
LEGACY COMMUNITY HEALTH SERVICES TX
$ ,940,060
78,468
$ ,235
CLINICA SIERRA VISTA
$ ,191,850
149,826 $
FAMILY HEALTHCARE NETWORK
$ ,533,260
131,142 $
FAMILY HEALTH CENTER OF MARSHFIELD WI
$ ,659,490
83,258
$ ,137
LA CLINICA DE LA RAZA INC.
$ ,918,680
90,569
$ ,037
Perspective

16. Minnesota CHC’s Health Center Name Total Cost Total Cost Per Patient
Total Patients 1
HENNEPIN COUNTY, DEPARTMENT OF PRIMARY CARE
32,152,240
1,270
25,323 2
WEST SIDE COMMUNITY HEALTH SERVICES
27,383,440
768
35,676 3
UNIVERSITY OF MINNESOTA
15,776,620
1,490
10,589 4
UNITED FAMILY PRACTICE HEALTH CENTER, INC.
13,993,810
960
14,579 5
COOK AREA HEALTH SERVICES, INC.
10,078,800
830
12,142 6
OPEN CITIES HEALTH CENTER
7,468,384
813
9,181 7
LAKE SUPERIOR COMMUNITY HEALTH CENTER
7,241,458
641
11,297 8
CEDAR RIVERSIDE PEOPLES CENTER
6,947,636
779
8,923 9
INDIAN HEALTH BOARD OF MINNEAPOLIS, INC.
6,889,315
1,453
4,743 10
OPEN DOOR HEALTH CENTER
6,097,922
793
7,685
Minnesota CHC’s

17. Minnesota CHC’s Health Center Name Total Cost Total Cost Per Patient
Total Patients 11
NEIGHBORHOOD HEALTHSOURCE
5,312,510
698
7,616 12
SAWTOOTH MOUNTAIN CLINIC
5,294,843
1,107
4,784 13
SOUTHSIDE COMMUNITY HEALTH SERVICES
5,145,119
566
9,090 14
COMMUNITY HEALTH SERVICES
4,273,591
1,351
3,164 15
NATIVE AMERICAN COMMUNITY CLINIC
4,261,956
945
4,511 16
HENNEPIN CO COMMUNITY HEALTH DEPARTMENT
3,056,222
716
4,268 17
UNIVERSAL MEDICAL SERVICES
2,139,939
524
4,085
Minnesota CHC’s

18. UDS 2015 Look-Alikes Program Grantees Community Health Centers 54
1,375
Total Patients
709,293
24,295,946
UDS 2015

19. UDS 2015 – National Data 2012 2013 2014 2015 Cost Data:
2012
2013
2014
2015
Cost Data:
Health Center Grant Expenditures
$2,331,290,193
$2,531,170,359
$3,209,598,399
$3,701,019,751
Total Cost
$14,490,666,198
$15,662,859,760
$17,443,687,411
$20,088,900,118
Total Cost Per Patient
$686.68
$720.89
$762.62
$826.84
Total Patients
21,102,391
21,726,965
22,873,243
24,295,946
UDS 2015 – National Data

20. UDS 2015 – Minnesota Data 2012 2013 2014 2015 Cost Data:
2012
2013
2014
2015
Cost Data:
Health Center Grant Expenditures
$20,658,825
$23,513,899
$26,214,765
$34,223,354
Total Cost
$136,381,896
$145,397,290
$152,751,940
$161,373,854
Total Cost Per Patient
$751.88
$832.78
$874.43
$929.73
Total Patients
181,389
174,593
174,688
173,571
UDS 2015 – Minnesota Data

21. National - Payor Mix % Payors 2012 2013 2014 2015 Uninsured 36.00%
34.80%
27.80%
24.50%
Medicaid/CHIP
40.80%
41.50%
47.30%
49.40%
Medicare
8.00%
8.40%
8.60%
8.90%
Other Third Party
15.20%
15.30%
16.30%
17.20%
National - Payor Mix %

22. Minnesota Payor Mix % Payors 2012 2013 2014 2015 Uninsured 37.10%
37.70%
29.90%
29.10%
Medicaid/CHIP
40.70%
38.90%
46.60%
47.20%
Medicare
7.80%
7.90%
8.60%
9.20%
Other Third Party
14.40%
15.50%
14.90%
14.50%
Minnesota Payor Mix %

23. Observations - % change 2012 - 2015
Cost Data MN
National
Health Center Grant Expenditures
166%
159%
Total Cost
118%
139%
Total Cost Per Patient
124%
120%
Total Patients
95.7%
115.1%
Observations - % change

24. Not Good! UDS Data 2012 2013 2014 2015 MN Total Patients 181,389
MN Total Patients
181,389
174,593
174,688
173,571
Not Good!

25. OFH 2015 UDS Data Financial Cost/Viability 2010 2011 2012 2013 2014
Total Cost per Patient
California
676.65
705.49
757.29
804.16
841.51
949.96
National
629.67
653.88
686.68
720.89
762.62
862.54
OMNI
469.86
475.4
494.78
509.55
539.84
587.32
Medical Cost per Medical Visit
137.26
144.47
155.53
163.65
171.42
188.69
138.65
143.71
150.38
158.07
165.19
176.64
129.06
124.99
128.07
139.29
158.63
176.93
OFH 2015 UDS Data

26. Federal Grant $ per Patient
Health Center Name
Health Center Grant Expenditures
Grant $ per Patient
WEST SIDE COMMUNITY HEALTH SERVICES
$6,279,156
176
COMMUNITY HEALTH SERVICES
$3,028,870
957
COOK AREA HEALTH SERVICES
$2,942,797
242
OPEN CITIES HEALTH CENTER
$2,449,896
267
OPEN DOOR HEALTH CENTER
$2,240,176
291
HENNEPIN COUNTY, DEPARTMENT OF PRIMARY CARE
$1,689,353 67
SOUTHSIDE COMMUNITY HEALTH SERVICES
$1,578,135
174
UNIVERSITY OF MINNESOTA
$1,318,103
124
Average
$30,914,053
178
Federal Grant $ per Patient

27. Federal Grant $ per Patient
Health Center Name
Health Center Grant Expenditures
Grant $ per Patient
SAWTOOTH MOUNTAIN CLINIC
$1,306,809
273
CEDAR RIVERSIDE PEOPLES CENTER
$1,287,707
144
HENNEPIN CO COMMUNITY HEALTH DEPARTMENT
$1,248,263
292
LAKE SUPERIOR COMMUNITY HEALTH CENTER
$1,240,144
110
NEIGHBORHOOD HEALTHSOURCE
$1,151,185
151
UNITED FAMILY PRACTICE HEALTH CENTER
$1,135,217 78
NATIVE AMERICAN COMMUNITY CLINIC
$1,082,348
240
INDIAN HEALTH BOARD OF MINNEAPOLIS
$935,894
197
Average
$30,914,053
178
Federal Grant $ per Patient

28. Federal Grant $ per Patient - OFH
2011
2012
2013
2014
2015
2016
Federal 330 Grant
3,724,399
4,180,778
4,383,465
6,264,569
7,210,423
9,510,445
Users
64,619
63,336
63,076
71,675
81,752
95,722
Patient Visits
216,119
215,383
216,750
229,265
274,531
321,005
Grant $ per User
57.64
66.01
69.49
87.40
88.20
99.35
Grant $ per Visit
17.23
19.41
20.22
27.32
26.26
29.63
Federal Grant $ per Patient - OFH

29. OFH Grant $ Graph

30. Financial Dashboard Financial Information MUST BE: Easy to understand
Accurate
Timely
Financial Dashboard

31. Cash is King Follow the Money
Financial Dashboard

32. Best financial Indicators
Patient Visits
Net Patient Accounts Receivable
Cash
Best financial Indicators

33. OFH - Patient Visits

34. OFH – Net Days in A/R

35. OFH – Days Cash on Hand

36. Other Financial Indicators
Current Ratio
Operating Margin
Provider Productivity (visits per hour)
Debt Service Coverage Ratio
Debt to Equity
Other Financial Indicators

37. Omni Family Health 9/30/16 12 Months 7 Months Industry Average
12 Months
7 Months
Industry Average
Description
3/31/14
3/31/15
3/31/16
10/31/16
Current Ratio
4.21
3.44
2.94
3.88
Days Cash on Hand
127
142
166
172
Net Days in Patient A/R
60.3
25.2
24.2
23.6
Average Payment Period (Days)
44.1
44.7
39.4
34.9
Debt Service Coverage
4.68
7.87
17.7
14.1
1.5
Long-Term Debt to Net Assets Ratio
41.70%
34.80%
28.00%
23.70%
< 50%
Omni Family Health 9/30/16

38. Remember the Five Deadly Sins
Board & Management not on the same page.
Obsolete business model (centered on adult medicine).
Low provider productivity.
Unfunded grant obligations. (less availability to grants)
Poor patient revenue cycle management. (Cash is “King”)
Remember the Five Deadly Sins

39. Questions?