HFMA Chair Steven P. Rose, FHFMA, CPA, says healthcare finance professionals can best help their organizations meet the challenges ahead by doing whatever is needed to achieve positive outcomes and drive value.
Steve Rose once applied his background in finance and strategy to coaching his daughter’s travel softball team to a win.
There’s a term in baseball and softball called manufacturing a run—getting a runner on first base, then working together as a team to move that batter safely from base to base, whether through stolen bases, sacrifice hits, or bunts, until that batter scores a run. “If you can get a run every inning in fast-pitch softball, you’re going to win the vast majority of your games,” says Rose, CFO of Conway Regional Health System in Conway, Ark. “I’d tell the team, ‘We need to manufacture a run, however we can.’”
One summer, at the start of the team’s first tournament, Rose asked his leadoff batter, a player with a lot of speed, to bunt. When she made it safely to first base, Rose asked his next batter to bunt as well, a sacrifice play designed to move the first player to second base—and that player was able to get on base safely as well. So Rose tried the same approach with the third batter. Before he knew it, the bases were loaded.
“I thought, ‘Well, this has worked fairly well for us; let’s try this one more time.” Rose asked his cleanup batter to bunt as well—and his players ended up scoring a run, as the other team’s coach looked on in disbelief.
“Whatever it took to get that first run in, we would do it,” Rose says. “In that moment, bunting was the best path to success. After that, I let the girls hit away.”
Manufacturing a run isn’t quite as easy in healthcare finance, where the challenges that face finance professionals and their organizations are plentiful: the shift toward value-based business models; increased emphasis on primary care over hospital services; and changes in care delivery structures, payment, and more under healthcare reform. However, the mindset of doing “whatever it takes” to thrive in challenging times will empower healthcare finance professionals to make a profound difference—both for their organizations and for patients and their families, Rose says.
“We know our work matters. We know it has an impact on other people’s lives. And only by holding firm to a commitment to doing whatever it takes—for our organizations, our colleagues, and for those who rely on healthcare services—can we face the challenges ahead,” Rose says.
A Winning Mind-Set for Health Care
Rose, who became CFO of Conway Regional Health System when he was just 27 and has served in this top financial role for 22 years, has a reputation for doing whatever it takes to help the organization succeed. It’s not uncommon to see him pick up a stray piece of paper or litter as he walks through the hallways of the hospital, or to offer assistance to hospital guests who are navigating the facility. “I believe it’s important to do what needs to be done at any point in time to accomplish the goals of the organization, even if it’s not part of my specific job description,” Rose says.
“Something as simple as stopping to pick up a piece of paper to keep the interior of the hospital clean and inviting is one small thing that each of us can do to contribute to a greater cause: helping patients improve their physical well-being,” Rose says. “It’s also a way to inspire change in others by continually giving 100 percent, no matter how large or how small the task.”
Rose’s introduction to healthcare finance was as an auditor for a large accounting firm in Little Rock, Ark. Six months into the position, he was assigned to audit a couple of rural hospitals. One day, one of the partners asked Rose, “How do you like working with hospitals?” “I said, ‘Well, I kind of like it,’” Rose recalls. Before Rose knew it, he had been assigned to the firm’s healthcare team, working with hospitals across the state.
Part of what appealed to Rose about working in a hospital setting was the sense of being able to contribute to a greater cause. “There is a dedication that you find in people who work in hospitals, and a feeling of compassion at all levels,” Rose says. “The more I witnessed this spirit among the people who worked in the facilities I audited, the more it intrigued and excited me. I wanted to be part of an environment such as this.”
About five years after he began working for the accounting firm, Rose took a job as assistant administrator in fiscal affairs at a hospital in Texas. His wife had just given birth to their first child, and the position meant that he would no longer have to be on the road. He’d been in the position for a year when someone from the accounting firm called: One of the hospital clients he had worked with, Conway Regional Hospital (which would become Conway Regional Health System), had an opening for a CFO. Rose interviewed for the position—and soon found himself in the organization’s top finance role.
“Aside from my year at Decatur Community Hospital in Texas, I had never worked for a hospital before, so having such a large amount of responsibility for the financial performance at such a young age was intimidating,” Rose says. “I spent time with physicians, administrators, and other finance people and really got to see what made them tick. I admired their devotion, and I wanted to challenge myself to respond to my work with that same level of dedication and commitment.”
Over the years, as the city of Conway has grown from 25,000 people to 60,000 people, Conway Regional has undertaken a number of initiatives to encourage residents to continue to seek care locally, rather than in nearby Little Rock.
“Conway Regional is the sole community hospital in Conway, Ark., and as our city has experienced dramatic growth, our hospital has experienced significant growth in volumes as well,” Rose says. “We’ve worked to continue to meet the healthcare needs of our community by increasing our bed size from 100 beds to 150 beds, establishing joint ventures with physicians for rehabilitative and surgical care. We’ve just completed an initiative to expand Conway Regional by 50,000 square feet to allow for more surgical suites and OB rooms. It’s the most financially ambitious project our hospital has undertaken, with a price tag of about $32 million.”
The financial challenges associated with a project of this size, combined with the implementation of an electronic health record system at a cost of more than $7 million, have been numerous. “Those two initiatives have driven up our cost structure in a relatively short period of time, without a corresponding revenue increase,” Rose says. “We’re experiencing some of the most financially challenging months in our organization’s history, at a time when the complexities and demands of providing care are increasing.”
Keeping pace with not only changing demographics, but also changes in the industry related to healthcare reform, the move toward value-based business models of care, payment structures, and the regulatory environment hasn’t been easy for Conway Regional. “Like many organizations our size, one of the key questions we need to consider is: What will our role be in the future?” Rose says. “Traditionally, our philosophy has been to remain independent. We’re beginning to explore whether that’s an appropriate strategy, going forward. We’re challenged with knowing exactly where and when to partner with other organizations or physician groups in support of our mission.”
One thing that has not changed: Rose’s commitment to finding creative ways to deal with the challenges at hand in collaboration with Conway Regional’s healthcare team. “With an organization composed of such aligned, passionate people, I have never felt we’ve taken on more than we could deal with,” Rose says.
Rose has grown as a leader since taking an executive role with the organization in his late twenties. “I’ve become a more effective delegator over time,” he says. “I’ve realized that I can’t do it all. When you’re put into a leadership role at a young age, you may attempt to do more than you actually should be doing, just to prove yourself. I’ve found that delegating responsibilities to others allows them the opportunity to grow as well—and that is critical to their ability to do whatever it takes to help their organization succeed.”
Exemplifying a ‘Whatever It Takes’ Spirit
Much of Rose’s inspiration to do whatever it takes to meet a challenge or achieve a common goal can be traced back to his family.
Rose’s mother was an educator who taught math in their hometown of Walnut Ridge—a town of about 3,500 people—before becoming a counselor at the high school Rose later attended. “I couldn’t get into too much trouble in high school—otherwise, word would get back to her pretty quickly,” Rose jokes. His father was a jack of all trades, a business major who for years ran the family’s farm equipment dealership, Rose Implement Company, a company that Rose’s great-grandfather founded in the 1930s.
“Growing up, I thought, ‘I’m going to work there someday, too,’” Rose says. “I had my mind set on that.” But economic declines in the farming industry forced many equipment dealerships to go out of business in the late 1970s and the 1980s. Rose’s father had a painful choice to make. “I remember him telling us, ‘I’m not going to go bankrupt. I’m going to close the store and sell off the assets,’” Rose says. “I remember the process of closing the dealership down, selling off the inventory, and then auctioning off the remaining assets. It was a painful process, but my dad did what needed to be done to protect the financial security of his family.”
From that point on, Rose’s father used his talents in a number of ways: becoming a loan officer for a bank; working for a local manufacturing company; concentrating on woodworking projects at home. Rose chose to develop another plan for life after high school and college. He chose to major in accounting, influenced by his parents’ interests in business and math.
Rose was actively involved in sports as a child—football, basketball, and baseball—as well as Cub Scouts and, later, marching band, where he played the trombone (except on Friday nights, when he played football). Rose remembers his parents volunteering to help in whatever ways they could: dyeing t-shirts for his little league teams, because uniforms weren’t provided; serving as a den leader for his Cub Scout group; volunteering with the Jaycees summer baseball program; assisting with church activities, including those geared toward youth. “They set the example of being involved and giving back to your community,” Rose says. “They did whatever it took to address the needs of the situation at hand.”
Today, Rose’s mother and sister, Dina, live just a block from each other in their hometown of Walnut Ridge. His father and grandfather passed away within months of each other in 2009. During holidays, he and his wife, Tracy, and their daughters, Heather, 24, and Lauren, 20, travel two-and-a-half hours to Walnut Ridge for celebrations with his family and with Tracy’s, who grew up in the neighboring town of Hoxie. “For me, it’s all about family,” he says. “My wife, my mother, my girls—they are the most important people in my life.”
Creating a ‘Can Do’ Culture
Over the years, Rose has observed the ways in which healthcare organizations and HFMA itself has adapted to meet challenges facing the industry, from the advent of Medicare DRGs to the impact of the Balanced Budget Act in the late 1990s to the changes that are just beginning to be felt from healthcare reform. “I think we will need to evolve again, as an association and as an industry, as we prepare to face new challenges unlike any we’ve seen before,” Rose says.
What he’s learned is the importance of looking beyond the numbers in healthcare finance and taking the time to focus on the issues that are affecting the hospital as a whole.
“Each of us in health care—no matter what our role may be—is having an impact on people’s lives in ways that we may never know,” Rose says. “In healthcare finance, it’s important to put yourself in the shoes of physicians, clinicians, and patients—to try to see things from their perspective, and to align together in making a difference in a person’s physical and mental well-being.”
There will be hard decisions ahead for healthcare organizations of all types and all sizes—and these decisions will require leadership from those in every level of healthcare finance. Now more than ever, a commitment to doing whatever it takes is needed from everyone in the industry—and healthcare finance professionals can drive a “whatever it takes” mindset in the culture of their organizations and in their work with other organizations, patients, physicians, payers, and government agencies.
“We know our work matters,” Rose says. “We know it has an impact on people’s lives. And only by holding firm to a commitment to doing whatever it takes—for our organizations, our colleagues, and for those who use healthcare services—can we face the challenges that the coming years will surely bring.”
It’s not enough to apply a “whatever it takes” attitude to your own work, Rose says. To drive a culture of “whatever it takes,” HFMA members should take the lead in demonstrating this attitude to all those they work with—in actions big and small—
so that others may be inspired by their example.
“The people I see who truly exemplify the ‘whatever it takes’ spirit don’t distinguish between the size of the action; they only ask, ‘Is it in my power to do?’” Rose says. “When we align on a goal, we all need to do whatever we can to make it happen—and that can be as simple as stopping to pick up a piece of trash in a hallway to make our facilities more inviting for patients and their families or as big as an initiative to improve quality of care in a particular service line.”
During Rose’s year as HFMA Chair, he will explore the ways in which HFMA also will expand its realms of influence to drive a spirit of “whatever it takes” and make a greater difference for the industry as a whole.
“There are always better ways to do things,” Rose says. “There are always more creative ways to do things. I think that’s the beauty of HFMA: being able to network with your peers and learn from them and from thought leaders in health care so that you can apply what you’ve learned to your own organization.”
More About HFMA Chair Steve Rose
Family matters. Rose met his wife, Tracy, when they were children—he lived in Walnut Ridge, Ark., and she lived in the neighboring town of Hoxie—but they did not begin dating until college. “She was dating a friend of mine. They broke up, I moved in, and the rest is history,” he says. They have two daughters, Heather, 24, and Lauren, 20.
First experience with HFMA: bartender for a chapter event. “It was an event at a state park in a dry county, and my assignment was to pick up the liquor and serve drinks with another member, and I had to haul it all there in the trunk of my car,” Rose says. “I don’t have much experience in bartending, so I stuck with pulling beers out of a container filled with ice. By the end of it, my fingers were numb and my fingernails felt used up. People would come up to me and ask for a mixed drink, and I’d tell them, ‘You’re going to need to see the other guy.’”
Sports centered. Rose has had a passion for sports since he was young. He enjoys playing basketball and coaching competitive softball, and loves watching sports of professional teams such as the St. Louis Cardinals and the Dallas Cowboys. Rose is also a NASCAR fan (Batesville, Ark., native Mark Martin is his favorite driver).
Down-home television. Rose enjoys reality television programs such as “Duck Dynasty,” about the family of a Louisiana man who became rich by selling duck calls, and “Swamp People,” which follows alligator hunters in Louisiana. He also watches fictional shows such as “Big Bang Theory.”
Keep on rocking. Rose’s musical tastes vary widely: His favorite songs include “Celebration” by Kool and the Gang and “Low” by Flo Rida.
Personal heroes. Rose’s daughter Heather, who was born with several congenital heart defects, continually inspires him with her resilience. Like Rose, she enjoys music, and stays as active as possible. Steve is also inspired by his youngest daughter Lauren, who scored the winning run in the state championship softball game.
Fitness oriented. Rose’s goal before turning 50 this past month was to lose 30 pounds. He reached that goal with the support of his family and fellow HFMA members, lowering his cholesterol by 50 points. “All of us need to be taking greater responsibility for our personal health,” Rose says. “I knew this was a goal that needed to be accomplished in cooperation with others. I needed the support of my family, which included my HFMA family, so that they could encourage me not to eat that extra cookie at our meetings. It was a matter of doing whatever it took within the parameters I set for myself to achieve that goal.”