Voice of Experience: Richard Silveria says healthcare finance is rife with opportunities

August 29, 2023 3:25 pm

What conclusion might a finance leader reach after four decades of experience in healthcare financial management? For Richard Silveria, CFO of Cape Cod Healthcare in Hyannis, Massachusetts, his 40 years of such experience have only strengthened his belief that opportunities to improve final outcomes are always at hand for hospitals and health systems. That belief has been reinforced by his more than 30 years as a member of HFMA.

Richard Silveria

At Cape Cod Healthcare, Silveria has determined that, as CFO, he needs to be constantly working on performance improvement.

“On both the revenue and cost sides, we need to review all aspects of our operation if we are to be both clinically and financially successful,” Silveria said. “There are no easy solutions. We all must team together and do the work, and the CFO should take the lead in promoting that collaborative spirit.”

Silveria also believes it is imperative that provider organizations focus on growing their top line revenues.

“When we do, we will be able to support our operations,” he said. “The current industry cost structure post COVID is difficult, but we cannot cut our way to greatness. And while it is not easy, getting deep into the operational details will often give us the best opportunity to understand what’s needed and take appropriate actions.

As an example, Silveria referred to the need for an in-depth review of productivity and activity levels to ensure they are aligned with the ongoing shifts in volumes of inpatient and outpatient care occurring in today’s environment.

“As care continues to shift from the inpatient to outpatient setting, it is imperative to keep productivity benchmarks current so the organization can appropriately review its staffing levels and flex to the updated volumes,” he said.

Promoting care improvement

Silveria has long believed that clinical improvements can drive improved financial outcomes. Like most providers in 2023, Cape Cod Health is faced with an aging population, where people are moving from higher-paying commercial insurance to lower-paying Medicare. The relentless downward pressure on rates creates an opportunity to model different approaches to providing care. To meet this challenge, and improve clinical as well as financial outcomes, it’s necessary to reduce variability in approaches to care within healthcare organizations, he said.

“Therefore, we continue to refine service and product lines and to monitor results within the care given for patients within those same lines,” Silveria said. “We should be able to identify inliers and outliers to highlight areas for improvement. Where it is indicated, we should be able to modify procedures to improve the clinical outcomes.”

Silveria’s leadership journey

Silveria joined HFMA in June 1992, about nine years after beginning his career in healthcare as a financial systems manager with Choate-Symmes Health Services in Woburn, Massachusetts. In the years that followed, he has been a vice president of managed care, a corporate director of revenue finance and an executive vice president of finance, with only four years outside of Massachusetts. And through those years, he has seen almost every kind of leadership style.

“Strong leadership is always required wherever you work,” Silveria said. “Because I have seen success and failure across systems, time and distance, I have developed a hybrid leadership style that has been useful to my employers and has allowed me to practice and mentor a wide swath of up-and-coming leadership talent.”

His hybrid style emphasizes executive decision and garnering input from subordinates and colleagues.

“This allows for a deep understanding of the issues and has the benefit of engaging the team in the work and organizational goals,” he said. “It allows for a better relationship between management and leadership, moving towards better outcomes to goals.”

Silveria’s best HFMA memory

Silveria values the sense of networking and collegiality he has gained from involvement in HFMA. His best memory is helping to inaugurate the Massachusetts-Rhode Island Chapter-wide Revenue Cycle Conference. The experience matched his strong desire for teamwork with an abiding need for service. It occurred at the NFL’s Gillette Stadium, making it the largest healthcare conference in Massachusetts. 

5 guiding principles for healthcare finance leadership from Richard Silveria

Richard Silveria offered the following points of advice for all healthcare finance leaders.

1 Manage yourself. Always be firm and consistent in your actions toward all stakeholders. Your behavior becomes the culture. So as you set the tone, strive to be self-aware and present at all times. Always respect the people you are working with, and be a model of the change you want to see implemented.

2 Leverage the collective wisdom of your team(s.) Many have significant knowledge and expertise, beyond your own, that can be used to improve outcomes. As a corollary to that — whether as an up-and-comer or a seasoned professional — if you see that something needs to be done, step in and do it! Use the knowledge of others to help get it done, but the affirmative act of closing the gap is a behavior that can then be adopted by others.

3 Value the intangibles. The higher up you go in any organization’s leadership structure, relationships and intangibles become a foremost indicator of success. Collegial relationships become extremely important in shaping the success of your career. Therefore, it is vital to communicate across the organization and listen to what is needed from finance and for finance. Being involved with colleagues also is crucial. One way to do that is to invite them to participate in the hiring process of key positions (to ensure a prospect demonstrates the proper fit) and to stay engaged in onboarding and subsequent interactions with the new hires.

4 Be upfront with everyone you encounter. Be sure to stay curious and current. To lead successfully, you need to be able to “connect the dots” for a variety of stakeholders, but in doing so, be a bit provocative by challenging the status quo to drive improvement. Ask why things are done a certain way and whether there are other alternatives that can be tried to achieve better results.

5 Have passion and love what you do. It makes the days flow more smoothly and feel less hectic. Laugh with your colleagues, particularly in stressful situations. If you can’t laugh, you can get ground down.


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