November 19, 2025 • 50 mins
Join host Chad Mulvany as he shares the latest healthcare policy and legislative updates for the week of November 16, 2025. Later in the episode, Kevin Locke, managing principal of the Healthcare Consulting practice at Forvis Mazars, joins the podcast for a conversation with special guest Tom Strauss, senior partner at CEO Advisory Network and former health system CEO. Tom shares lessons on culture, innovation, resilience, and service from a 50-year career in healthcare leadership.
- Washington Watch (0:59)
- Kevin Locke & Tom Strauss Interview (24:09)
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Related Content:
- Government Shutdown Ends: Which Healthcare Programs Were Extended?
- Protecting Your Nonprofit Hospital’s Tax-Exempt Status
- Key Updates on the 2026 Medicare Physician Fee Schedule
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Transcript
Episode Transcript
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(00:00):
On today's episode of Achieving Health,I've got the latest policy and legislative
updates from Washington, D.C.,for the week of November 16th, 2025.
Then, my colleague Kevin Locke,managing principal for Healthcare
Consulting at Forvis Mazars,
will join the podcast for a conversationwith Tom Strauss,
co-founder and Senior Partnerat CEO Advisory Network.
(00:23):
Tom is also the former CEO of Summa
Healthcare System and Sisters of CharityHealth System.
Tom will share lessons on culture,innovation, resilience
and service from his distinguished careerin healthcare leadership.
It's a fascinating conversation.
Please stay tuned.
This is AchievingHealth, a podcast from Forvis Mazars,
where we delve into the topicsthat matter most to healthcare
(00:46):
organizationsacross the continuum of care.
Our goal is to help younavigate the dynamic healthcare landscape
and achieve health at your organization.
Here's your host, Chad Mulvany.
Welcome to Achieving Health.
I'm Chad Mulvany, directorin the Healthcare Practice at Mazars.
Thank you for joining me.
(01:06):
We'll begin the day with our WashingtonWatch segment, where I share
updates on the most recent actionsof federal policymakers
and their anticipated impacton healthcare providers and payers.
Today's WashingtonWatch reflects information as of 10 a.m.
Eastern Time on Friday,November 14th, 2025.
My comments on these discussions are basedon what's being reported by the D.C.
(01:28):
trade pressat the time of the conversation, mixed
with a lot of judgment about where thingsmay go, based on my experience in D.C.
So, today's remarks reflect informationas of this moment and will likely change.
As far as our agenda is concerned.
I'm happy to report
that Congress passed legislationthat has lifted the government shutdown,
extends key healthcare policiesuntil January 30th, 2026,
(01:53):
and mitigates the potential PayGo4% sequester that might have otherwise
been implemented due to the deficitincrease as a result of OB3.
Unfortunately, an extensionof the enhanced exchange subsidies
was not included in the bill,and the prospects for an extension
are still up in the air.
We'll also talkabout efforts to improve affordability,
(02:15):
which are related to, kind of,the shutdown drama.
And even though an extensionof the enhanced subsidies
wasn't included in the packagethat was passed in November 10th, senate
Democrats are expressing confidencethat they can reach
a bipartisan agreement to extend thembefore they expire at the end of the year.
However, Republicans are reportedlyworking on an alternative package
(02:36):
to address healthcare affordability.
On a bit of economic newsthat has implications
for out-of-pocket collections,
there are a record number of subprimeborrowers that are missing car payments
in October, and so delinquenciesamong some private auto borrowers
have reached a record high,with 6.65% of loans
(02:56):
at least 60 days past due in October,according to Fitch Ratings.
We also, on October 31stsince we last spoke, had the CMS
physician fee schedule final rulereleased for calendar year 2026,
and we'll cover a couple of the keychanges at a high level.
And then finally, we'll talk aboutemployer sponsored insurance sticker
(03:17):
shock.
The 165 million Americanswith employer sponsored insurance
are expected to face a 6.5% averageincrease in healthcare costs,
making thesethe steepest rise in 15 years.
And again, I anticipatethat this could potentially show up
both in future contract negotiationsas additional pressure on rates
and at the point of serviceas increased uncompensated care.
(03:40):
Finally, last thing before we dig in,
just want to note that as of this morning,as of Friday morning, 11/14,
we are still waiting on the OutpatientProspective Payment System final rule.
I would have thought that given
that PFS came out two weeks ago,we would have it by now.
But as soon as we get it,
we'll put out a FORsight on it, and we'llcertainly cover it in the next episode.
(04:00):
So with that agenda laid out,let's get into our program.
In terms of the shutdown,or the ending of the shutdown,
on November12th, 2025, President Trump signed
legislationending the partial government shutdown.
The package includes three full-yearspending bills and includes
a short-term continuing resolutionto fund the other government departments
(04:22):
not included in the full-yearspending bills through January 2026.
So this now gives Congressa little bit of time
(not much) to potentially negotiatethe rest of those spending titles.
The bill
also, as I mentioned, extended keyhealth policies through January 30th, 2026
and wipes the PAYGO scorecard clean,or the SPAYGO scorecard clean.
(04:45):
However, again, does not extendthe enhanced exchange subsidies.
Those tax credits are scheduledto expire on December 31st, 2025.
In exchange for voting to advancethe measure, Senate Majority Leader
John Thune has committed to holding a voteon extending the tax credits
in the coming weeks.
Speaker Johnson in the Househas not promised a similar vote,
(05:07):
and I am increasingly skepticalthat these will be extended.
The Urban Institute estimatesan expiration of the enhanced subsidies
would increase uncompensated carenationwide by $7.7 billion.
That's 12% relative to the $66.7billion baseline.
The burden of additional uncompensatedcare would fall
(05:28):
on the following providertypes: $2.2 billion on hospitals.
$1 billion on physician offices,$3.1 billion on other services,
and $1.5 billion on physician drugswith non-expansion
states more heavily impacted.
As the
likelihood of an extension of the enhancedACA subsidies
decreases, providers will want to focuson improving processes to connect patients
(05:53):
with other sources of coverage,improving upfront patient liability
collections for non-emergent services,and consider reevaluating
financial assistance policies.
We explored many of these revenuecycle improvement
strategies in the thirdinstallment of our OB3 Tuesdays series,
and the linkfor that is included in the show notes.
(06:14):
We also have a FORsight articlethat unpacks
how hospitals may want to reevaluatetheir financial assistance policies,
and we've also dropped that into the shownotes as well, in case you're interested.
In terms of the extenders,while the legislation doesn't
extend the credits,it does include language that addresses
a number of key issuesand extends them through Jan 30th, 2026.
(06:36):
These include, but are not limited to,a further delay of the ACA's Medicaid
Disproportionate Share Hospital cuts,extending the Medicare dependent
and low volume adjustment programs,continuing the telehealth, geographic
and originating site waivers, along withthe other COVID-era flexibilities
provided through the ConsolidatedAppropriations Act of 2023,
(07:00):
extending the Medicare Hospital at Homewaiver,
extending the Medicare Geographicindex floor, and also
providing $1.4 billion in CommunityHealth Center funding.
The cost of extendingthese policies is offset,
not surprisingly, by a one-monthextension to the 2% sequester
and an additional $400 million reductionin the Medicare Improvement Fund.
(07:23):
Last piece of this, that was included,and certainly a big win for providers
was the statutory SPAYGOMedicare sequester.
So in addition to providing short-term
extensions of the health policieswe just discussed, plus a few others,
the legislation wipesclean the SPAYGO scorecard.
So this eliminatesthe risk of a 4% sequester
(07:45):
that could have been appliedto all Medicare payments in 2026,
due to the $3.4 trillion increase
in the deficit projected by the CBOthat's attributed to OB3.
Given the results of the electionon Tuesday, November 4th, there's
certainly becoming a more focusedemphasis on affordability.
(08:06):
Obviously, Democrats have been focused on
addressing affordability through extendingthe enhanced exchange subsidies.
Republicans now are becoming awareof the exposure that they may have
through the midterm elections,if they don't do something about it.
And so, what you have now is SenateDemocrats continuing to express confidence
that they can reach
a bipartisan agreementto extend them before the end of the year.
(08:28):
However, there are some Democratsthat are starting to acknowledge
that the premium hikes in 2026may already be unavoidable.
The other piece, kind of fromthe Democrats side, is that even if Senate
Democrats can craft a bipartisan deal,
the House presents another obstacle.
Speaker Mike Johnson has not committedto advancing an ACA
(08:49):
subsidy extensionbill, and Republicans are pushing
for conservative modifications,such as lowering income
eligibility caps or restricting subsidiesfrom covering certain services.
And these are provisions that are unlikelyto gain Democratic support.
A handful of House Republicans,as I mentioned,
do see some political riskin letting those subsidies go
(09:12):
and are considering a discharge petitionthat could force a vote.
But it remains uncertainwhether they would do this
and sort of go against President Trump'swishes.
As the deadline approaches, both chambersface mounting pressure to balance
those ideological differencesto prevent steep premium increases
for millions of Americans.
(09:33):
You have a handful, also alternatively,of GOP
figures, including senatorsBill Cassidy and Rick Scott,
that are advocating for alternativesto an extension of the ACA subsidies.
These would include thingslike giving money to individuals through
tax-advantaged savings accountsthat would allow individuals
to manage their own healthspending directly.
President Trump has endorsedthis approach, arguing the funds should,
(09:55):
instead of being directed to insurancecompanies, should go to consumers.
However, Republicans still remain divided,and they're currently holding
listening sessions.
Certainly, you've got more moderates,those who are in swing districts,
favoring a temporary extension of thesubsidies to buy time for broader reform,
while others are pushingfor a more ambitious overhaul of the
(10:16):
healthcare system.
The challenge for Democratswill be keeping Republicans
focused on compromise around the ACAcredits, while Republicans weigh
whether to pursue collaboration or pursueindependent proposals.
It's unclear what, if any, legislativepackage will emerge at this point.
It's possible that an expansionof Medicare site-neutral payments
(10:39):
and the No UPCODE Actaffecting Medicare Advantage plans
might be included as offsets.
I will note that what's been interestingto watch over the last, call it
week or so,is that there seems to be enough concern
about the prospects for the No UPCODE Actby Medicare Advantage plans
that just about every trade press articleI've read over the last week or so,
(11:03):
that's been related to the shutdownand also sort of healthcare packages
that may come out between nowand next year, have included
pop-up ads encouraging Congressto vote against the No UPCODE Act.
So it's just kind of an interestingtemperature check.
In terms
of kind of the impacts of the potential
consequencesof not extending the subsidies,
(11:26):
but then providing fundsthrough tax-advantaged accounts,
economists and policy expertswarn that funding directly
to consumers through HSAsor FSAs could significantly reduce
ACA enrollment as healthier individualsmight opt out.
Should this occur, it would increasepremiums for those who remain
(11:46):
in the market, potentially leadinginsurers to withdraw from the marketplace.
And this is probably more likelyif provisions in the legislation
are included, that would expand thingslike the availability of short-term,
limited-durationinsurance and association health plans.
While it's too soon to handicapthe likelihood of a legislative package
(12:06):
that includes these provisions,
it certainly is something that we'llcontinue to watch and bears watching.
On an economic note, as I mentionedat the top, there were a record
number of subprime borrowerswho missed car loan payments in October.
Delinquencies among subprimeauto borrowers have reached a record high,
with 6.65% of loansat least 60 days past due in October.
(12:29):
According to Fitch Ratings, this is arecord dating back to the early ‘90s.
Subprime borrowers are obviously thosewith weaker credit histories
who are particularly vulnerableas high borrowing costs,
rising living expenses and dwindlingsavings are straining budgets.
And we're starting to see a widening gapbetween subprime and prime borrowers,
which underscores
the uneven impact of economic conditions,with vulnerable households
(12:52):
bearing the brunt of rising costsand limited financial flexibility.
I think the implication for providersis that typically people
pay their auto loans first before anythingelse, even typically housing.
And that's a rational thing to doif you're in that situation
because if you don't have a car,it makes it much harder to either
(13:12):
drive to work or look for a jobif you happen to be unemployed.
So I guess my takeaway from this is that,if we're seeing defaults on subprime auto
loans, we’re likely going to be seeing,if not already seeing shortly,
an increase in uncompensated care,particularly at safety net hospitals.
Same strategies that I talked aboutwith the potential end of the enhanced
(13:34):
exchange subsidies, like upfrontcollections for non-emergent services,
improving efforts to connect patientswith other forms of coverage, or, failing
that,kind of looking at financial assistance
policies,making sure they meet the community,
and also thinking about how you'reconnecting people with that assistance
are all viable strategiesfor addressing these challenges.
(13:55):
Given what we know at this point,I'd even like to think of that
as starting to become no-fail strategies.
In terms of the physician fee schedulefinal rule, on October 31st, 2025,
so Halloween, CMS released the Medicare
Physician Fee ScheduleFinal Rule for calendar year 2026.
The rule is over2,300 pages and is detailed.
(14:17):
What I take fromthis is that CMS probably also hands out
pennies and floss at Halloweenwhen you go trick or treating.
I will say this summary is not meant to be
an exhaustive discussion, butI want to flag just a handful of items.
Key changes in the ruleinclude the conversion factor, the
calendar year 2026 qualifying alternativepayment model conversion factor.
(14:38):
So, for those professionalsthat QP is $33.57,
that's decreasedslightly from the proposed of $33.59, but
is still a 3.77% increasefrom the current conversion
factor of $32.35.
The calendar year 2026 non-qualifying
(14:59):
conversion factor is $33.40.
This is decreased slightly againfrom the proposed $33.42
and is a projected increase of 3.26%.
I think one of the more controversialthings that CMS finalized
was that, for 2026,it includes an efficiency adjustment
(15:20):
to work reviewsand the related inter-service portion
of physician timefor non-time-based services,
based on the assumptionthat efficiency in performing
these services should increasewith experience.
You see, CMS is using the priorfive year Medicare Economic Index
productivity adjustment, which will resultin an adjustment of -2.5%.
(15:44):
In the same veinof being somewhat controversial, CMS
also finalized updates to the methodologyused to calculate practice expense RVUs
given the decline in the numberof physicians working in private practices
and the increase of employmentby hospitals and health systems.
For calendar year 2026,the agency will recognize
(16:05):
greater indirect costs for practitionersin office-based settings.
In terms of telehealth,
CMS finalizes three significant changesto regulations related to telehealth.
First is the subsequent visitsand critical consultations.
CMS permanently removes frequencylimitations for subsequent inpatient
visits, subsequent telehealth visits,and critical care consultations provided
(16:27):
via telehealth.
In terms of direct supervision,CMS permanently
redefinesdirect supervision to allow the physician
or supervising practitionerto provide it through real-time audio
and visual interactive telecommunications,so it excludes audio-only,
and except for servicesthat had a global surgery indicator
(16:48):
of 10 or 90, virtual direct supervisionmay be provided for applicable incident
to services diagnostic tests,pulmonary rehab services,
cardiac rehab servicesand intensive cardiac rehab services.
This changealso applies to FQHCs and RHCs.
And then finally under telehealth, kind ofunder that same bucket of supervision,
(17:10):
related to residence, the COVID-era policyallowing teaching physicians
to provide virtual supervisionto residents in all teaching settings
was set to expire on December 31st, 2025.
CMS did not initially proposeextending this policy.
However, based on comments, CMS finalizes
a policy that permanentlyallows virtual supervision of residents,
(17:34):
but only for cases in whichthe service itself is virtually furnished.
And so, beyond kind of the policychange there, I think that underscores
not only the importance ofsubmitting comments when CMS issues regs,
but even if they don't addressa particular issue,
if it's something that's important to you,please
make sure you write a paragraphor 12 on it.
For FQHCs and RHCs,
(17:56):
the ruleallows them to use optional add-on codes
for APCM to billfor behavioral integration
and COCM services when RHCs and FQHCsprovide advanced primary care management.
In addition, effective July 1st, 2026,
RHCs and FQs are required to reportHCPCS codes
(18:18):
G0512 and G0071 that make up both the COCM
and communications-based technologyservices and remote evaluation services.
In terms of the alternative paymentmodels,
CMS finalized a mandatory payment model,the Ambulatory Specialty Model,
for physicians
treating Medicare fee-for-service patientswith heart failure and low back pain.
(18:42):
It runs for five years,so performance year 2027 to 2031,
and will impact paymentsoccurring from 2029 to 2033.
The model aims to incentivizechronic disease prevention
and managementthrough performance-based adjustments.
The adjustment range will start at +/-9%and increase to +/-12%.
(19:03):
The model is not budget neutral
and so similar to the HomeHealth Value-based purchasing model,
CMS will retain a portion of the savings,in this case 15%,
of the withholdto guarantee savings for the program.
The model will draft specialistsin 25% of core based statistical areas.
CMS will release additional guidanceabout participant
(19:26):
eligibility criteriafollowing publication of the final rule.
So I would anticipate that eitherany time now or sometime in December.
The final rule also notesthis calendar year 2027 performance year
participant list will be releasedin early 2026 through the CMS website.
(19:46):
A couple of thoughts on the PFSfinal rule.
The positive paymentupdate stems from provisions
in MACRA and the recently passed OB3.
It's important to remember that the changein OB3 was one year only for 2026.
So in 2027, physicians will have to againlobby Congress
to get a more generous payment update.
(20:09):
In terms of what MACRA required on this,obviously it requires different conversion
factors based on whether you're qualifyingor not qualifying in APMs
and so the portion of the updaterelated to QPing is 0.75%.
And for those that are nonqualifying,it's 0.25%.
So obviously there's some value therein beyond kind of the experience,
(20:31):
the savingsthat you could possibly generate.
There's value in participatingin alternative payment models.
Groups representing physiciansare going to continue,
given the issueswe just talked about, to advocate
for more durable reformsto the conversion factor,
if this point still haven't seenlegislation on what that might look like.
I know some of the associationsrepresenting the docs
(20:52):
have been working on this buthaven't seen anything yet that's hit paper
or hit The Hill yet as draft legislation.
While the payment update is positive,some specialties could see a decrease
in per-service Medicare revenuedue to the changes in practice
expense RVUs and the implementationof an efficiency adjustment.
The efficiency adjustment will negativelyimpact providers who mostly bill
(21:16):
non-time-based CPT codes, while benefitingthose who bill time-based codes.
And then the change in practice expenseRVUs will negatively impact hospital-based
providers while benefiting those remainingindependent office-based providers.
Regarding the ambulatory specialty model,
given it'smandatory and CMS will retain a portion
(21:37):
of the withhold, it's hard for me to seehow it's not going to generate savings.
Therefore,it's likely that CMS will not only expand
the current incarnationto other geographies.
So low back pain, heartfailure gets expanded to other CBSAs,
but I would imagine that as they lookat those high volume,
chronic conditions that aren't low backpain or, heart failure,
(22:00):
that we will see an expansionto other conditions.
We have a detailed FORsight comingthat will unpack the rule
and we’ll make that availableas soon as we have that finalized.
Last thing I want to cover: employer-sponsored insurance (22:12):
undefined
sticker shock.
While price hikes in the exchangeshave received a lot of the trade
press oxygen, the same phenomena, though
for different reasons, is occurringin the employer-sponsored market.
This fall as open enrollmentbegins, the 165 million Americans with ESI
(22:33):
are expected to face a 6.5% averageincrease
in healthcare costs per employee,making this the steepest rise in 15 years.
As a result,many employers plan to offset these costs
by raising premiums, deductibles,co-pays, and out-of-pocket maximums,
shifting
more of the financial burden onto workers.
(22:54):
Employers can expect paycheck deductionsfor health coverage to climb between
6% and 7%, and that's nearly double
the projected 3.1% average merit raise.
This widening gapbetween healthcare costs and wage growth
could lead to significant financial strainfor many insured workers.
Hospitals should prepare for continuedcontentious rate negotiations
(23:17):
with employers and their TPAs.
They will need to use pricetransparency data
that's available through the transparencyand coverage requirements
to benchmark their existing rates to peers
to help make the case for why they needadditional rate increases.
Further, given that employers are shiftingmore of these cost increases on
to their employees, again,they're going to need to improve processes
(23:38):
for collections of costsharing at the point of service
for non-emergent services.
They're also going to needto revisit their processes
for qualifying individualsfor financial assistance, to ensure
those who are qualifyingor should qualify will not get billed.
I feel like there's kind of a themeto this episode.
This concludes today's Washington Watch.
Up next, we'll have a conversationbetween my colleague Kevin Locke and our
(24:00):
special guest, Tom Strauss.
I'd like to welcome
back to the podcast Kevin Locke,our managing principal for healthcare
consulting at Forvis Mazars,for a conversation with Tom Strauss.
Tom is a founder and senior partner at
SEO Advisory Network,and previously served
(24:24):
as CEO of Summa Health Systemand Sisters of Charity Health System.
Tom is also the 2025 recipientof our Charis Executive Impact Award,
which Forvis Mazars presentsannually to a healthcare leader
who has demonstratedthe qualities of grace, kindness and life
over the course of a distinguished career.
Kevin, I'll turn it over to youand look forward to the conversation.
(24:47):
Thanks, Chad.
It's always fun to joinyou on your podcast.
I think you do a great job with it,and it's always an honor to be a guest.
And it's even more of an honorto be joined by Tom Strauss.
Tom, you and I go back in our careersa long way, and you were honored this year
with the 2025 Charis Executive Impact
Award, which Chad just mentioned.
(25:09):
And, congratulations on that.
It's been really fun to kind of sharea bit of our professional journey together
so, congratulations.
Well, Kevin, first of all, thank youfor inviting me to come on and chat.
Kevin and I go back
many, many years, probably more yearsthan we want to comment.
Let me just spend a couple of secondson the Charis Healthcare Impact Award,
(25:30):
and then we certainly want to talk aboutyour career a bit on today's podcast.
And you know this well,but for the sake of the folks joining us,
our Charis Health Executive ImpactAward is is given annually to someone
who's had a long and distinguished careerin the healthcare field.
And we built the award around three key
themes (25:50):
grace, kindness, and life.
And grace, we talked about thingslike serving as a generous ambassador
for the organizationand for a healthcare industry.
Kindness.
We talk about things like living out,caring and compassionate spirit.
Which I know as part of, Tom, been
your healthcare journey and a lot of whyyou ended up in healthcare.
(26:13):
And then in life we talk aboutleading an organization forward, right?
Breathing life into the organization.
So as you think about those three things,
grace, kindness, life,I think, Tom, they've
described your careerpretty meaningfully, but
maybe spend a minute or twojust kind of sharing your career
(26:35):
highlights for the sake of the folksjoining us today.
Sounds great, I’d love to.
So I grew up in Pittsburgh.
I'm the son of a steelworker,so I really have
very much of a blue-collar background.
I worked five years while in collegefor pharmacy at Duquesne
University in the U.S.
Steel mills, and was a hookerand a mobile equipment operator.
(26:59):
So I saw firsthand one, the work of unionsand some of the activities there.
But secondly, the need and the interestfor me to stay in the professional area.
So I went to school to be a pharmacist.
I worked in many of the hospitalsin Cleveland, I mean, in Pittsburgh.
And then I was recruited
(27:19):
by American Hospital Supply Corporation
in 1983 to start one of the first home
infusion pharmacies in the country
in Pittsburgh called American ContinueCare.
And three mergersand four name changes later, in six years,
I was vicepresident of Caremark for central U.S,
(27:41):
but in 1989, I left Pittsburghto come to the Meridian Health System.
I really wantedto come back into hospitals.
That was my love.
And I decided to come to Cleveland
and it was tough as a Pittsburgh Steelersfan, I want you to know.
I enjoyed that involvement.
We had four hospitals in Cleveland,and I was president
(28:04):
of the Meridia Institute,which was actually a business incubator.
So innovation has always beena part of my, what I loved.
And we started 13 companiesduring that period,
everything from homeinfusion to home nursing to mobile MRI.
And in ‘92, I took over my first hospital,which was Meridia Suburban Hospital,
(28:24):
a hospital that had been struggling,losing money,
and we were able to do a turnaround
and finally grew to the pointwhere we needed more space.
And I ended up merging with the hospital
next door called Brentwood Hospital.
The merger was a DO and an MD merger,
which was somewhat unusual at the time.
(28:45):
And in seven months,we renovated one at Brentwood
and converted Suburbaninto an outpatient facility,
and the new hospital was calledMeridia South Point.
It was one of the most challenging thingsI ever did in the seven months.
I went on to run the service lines at allfour of the Meridia hospitals.
But in ‘95, somewhere around there,we merged with the Cleveland Clinic,
(29:07):
and I was then recruited to come downto Summa Health System in April of ’99,
became CEO in January of 2000,and had a 15-year career,
which was really one of the mostpleasurable times I ever had.
I had the opportunityto retire at the end of 2014,
came out and immediatelyflunked retirement.
(29:30):
Called a bunch of my friendsthat had run health
systems and said, look,you're a lousy golfer.
Let's go do something together.
And we put together what today is calledthe CEO Advisory Network.
Really, to give back to the industry.
Shortly after that, in 2017,I was approached by a headhunter
for the Sisters of Charity,
(29:50):
and I knew the congregational leader,Sister Judith Ann.
And I called her and said, sister,look, don't bring in a new CEO
that doesn't know this market,let me do this for you.
And you don't have to sign a contractor anything like that.
I thought I'd be there a year or two.
I was there five years,
and we were able to sell a hospitalto the Cleveland Clinic.
(30:12):
We were able to pay off all the debtand, really, created
three community foundations working onthe social determinants of care.
Now, today, I'm
back at the CEO Advisory Network,continuing to flunk my retirement,
but have enjoyed it thoroughly
and enjoy giving back to healthcare.
(30:32):
Well Tom, again,it's been fun to walk alongside
that journey with you for at least partsof that career you just described.
And you highlighted a couple of things
that I want to pull ona little bit here, Tom.
One is innovation.
One is service to the community.
I know that was a really big focalpoint for you at both Summa
and at Sisters of Charity and I'm sureprior to those stops in your career.
(30:57):
So, innovation, community service,
and then another one that I want to talka little bit about is culture,
because I know you spenta lot of your career in developing
really dedicated and committed cultureswithin the organizations that you led.
So maybe just talk about each of those
three themes a little bit,how you kind of approach innovation,
(31:19):
your commitment and passionregarding community service,
and then how you build a culturein a great organization.
Yeah.
Maybe I could start with culture,because that's really what, in my opinion,
the most important thingyou can do to live your,
you know, values, mission,vision and values
and instill those in the organizationis a critical piece of the future.
(31:42):
So if you think about healthcare is aright and it's a noble profession,
and we care for patientsin their most vulnerable time.
So those patients that we carefor deserve our best.
And I've always had the interestto create a vision around
providing the highest qualitybut compassionate care to our patients
(32:06):
and to contributeto a healthier community.
And one of those philosophies we've had,and I've had it for years, is called
servant leadership.
You remember Robert Greenleafstarted that way back in the ‘70s,
but it basically says that, and we had a motto at Summa Health System
where we flipped the organizational chartupside down,
(32:26):
and I was at the bottom,the patient was at the top,
and our job was to supportthose people at the bedside.
And and we had a motto that we said thatif you're not serving
the patient,you better be serving someone who is.
And we worked extremely hard,not only at the senior level,
but at the management levelto educate every employee around
(32:51):
the philosophies of Summaand how this servant leadership
is somethingthat was important for the future. So,
and then we took that one step forward,
and that is to improve the health statusof the communities we served.
And because at Summa,we had our own health plan,
we were able to go at risk to improve
(33:13):
the health statusof those people that we served.
And look at total cost of care,which I know,
Kevin,you believe is the future direction.
I do.
But that authentic value-basedleadership is so critical.
And in fact, I just this week was readingWarren Buffett's retirement letter.
I don't knowif you had a chance to see it?
I have not, no.
(33:34):
And he talks about thatgreatness does not come
through accumulationof great amounts of money,
great amounts of publicity,or a great amount of power in government.
When you help someone in any of thousandsof ways, you help the world.
And that kindness is costless,but also priceless.
(33:55):
Whether you are a religious personor not, it's hard to beat the Golden Rule.
And as a guide to behavior, don'tbeat yourself up over the past mistakes.
Learnat least a little from them and move on.
It's never too late to improve.
And I thought that philosophy was amazing.
So, spoken by the General.
That's really great and great timingto pull that in, right as he's
(34:19):
kind of going through his own processhere this week and
Tom, again,I'll just recognize and give you credit.
You have done many of those thingsat every step of your career:
building culture, kindness,leading with kindness, Golden Rule,
putting others first, flippingorganizational charts on their head.
All of those things have been coreto who you've been.
(34:41):
So I want to thank you for thatlevel of service that you've provided to,
really, the healthcare industryand the communities that you've served.
Let's maybe, pivot a little bit, Tom,
and a little lesslook back and a little more look forward.
As you sort of take some of those lessonslearned in the career that you've had
(35:02):
and the leadership principles that you'vebrought and shared with us even today,
what would you kind of take and say,
you know, the insight, or one or two keyinsights or lessons learned that
although you look back on your careerand say, that's
what I learned,can also serve us moving forward, right?
(35:24):
What are those one or two critical lessonslearned that today's leaders in today's
healthcareenvironment should be working on
and taking into the futurethat we're headed into?
I thinkwhat's critical is you can't rest on
what you've been successfulat in the past.
(35:44):
Honestly,if you think about where we're heading,
and I know we're going to talk about this,but the challenges we face today in
healthcare are beyond anything that I'veever seen in my 50 years in healthcare.
The OBBBA, if you look at the resultsof that, it's going to be more than $911
billion in Medicaidspending reductions over 10 years.
(36:06):
We're going to see a 21% increase in theuninsured population of the country,
and over 24 million Americanscould see their insurance
premiums increaseby almost 93% on average.
So this oversight of our healthsystem has to change.
So we have to evolve innovation,speaking of that.
(36:30):
Artificial intelligence is going to bea critical piece of our future.
You know, the statistics
of the shortage of healthcare providers,you know,
a recent studyshowed that 340 million people in the U.S.
and about a million active physicians
as of 2023; however,they predict a shortfall of 328,000
(36:53):
nurses, registered nurses, 42,000 licensed
practical nurses and 33,000nurse practitioners through 2032.
So there's no way we can repeatwhat we've done in the past.
We must innovate,and a lot of those innovations
are going to work aroundartificial intelligence.
(37:15):
I would say that'sprobably the most important piece.
The other piece is, you know,there's a lot of burnout,
with our staff and our physicians,
and we have to employ the ideasof empathy and respect
and supporting those peopleat the frontlines,
giving them answersand creating a noble vision
(37:38):
that they can get excitedabout and move forward with.
So I would say those are sort of thetwo areas that I would go.
That's really well said.
And you mentioned your 50-year career,
it's been characterizedby lots of change over time.
And certainly we're in yetanother period of change, as you
(37:58):
mentioned, the OBBBA and all of the impactthat's going to have.
You mentioned artificial intelligence.
You mentioned innovation.
So it's yet another period of changethat hospital
administratorsand leaders in all industries are facing.
So, thank you for those insights.
Let me,let me take this idea of kind of OBBBA
(38:21):
and current change in our market, Tom,and pull it a little bit further.
What do you thinkis kind of an opportunity that maybe
some of your peers, some of the folksthat are leading hospitals today,
what do you think are one
or two of the opportunities out therethat they might be overlooking?
Opportunities to tap intofor better outcomes, for access,
(38:43):
for growth, for cost efficiency,those kinds of things?
So, yes, we're in a period of change.
Yes, we're in a period of challengerelated to the OBBBA,
but what are some of the opportunitiesthat exist in the marketplace as well?
I would sayprobably the biggest opportunity
is to improvethe way healthcare is delivered.
And I think some of thatmay be underappreciated,
(39:05):
among healthcare leaders today,I think you're aware the new CMS
administration is aggressively planningto reduce healthcare cost
and move Medicare to 100%
value-based payment system, and Medicaid,over the next few years.
And I believe that every health systemmust develop a strategy
(39:27):
and financial approachto building value-based payment,
including the development
of clinically integrated networksor accountable care organizations.
So we have embarked upon that, and I know,Kevin, you've been a champion of this
for yearsto help health systems really look at
what are the fundamental priorities
(39:47):
in that movement,from fee-for-service to value,
and what are the accomplishmentsin the categories
that they have to work on,because you can get in a lot of trouble
if you go a little too early,but you can't sit back.
And that's why so many people todayare trying to figure out
what they're going to do with MedicareAdvantage.
Medicare Advantageis not going to go away, but
(40:10):
you must find a way to workwith these payers in a new way.
And I've seen some wonderful examples.
I can tell you.
Mark Clement from Tri Health in Cincinnatiis one of the health systems
that historically has donevery well on fee-for-service
but has completely moved the organizationto value-based contracting
(40:32):
and is now doing extremely well in both.
And he's created a culture around that
that has really engagedthe workforce, engaged the medical staff,
which is another critical priorityto be successful for the future.
So that's just one example
of something that's worked really well.
(40:53):
And a great one.
And you're right,you and I and others have been very
passionateand dedicated and committed to this idea
of helping the industrymake the transition from volume to value.
Of course, we've been talking
for a long time about it and just tryingto create the momentum behind it.
(41:14):
And I totally agree with youthat anything we can do, any partnerships,
any ideas, the Tri Health example,that you learn from and drive
that forward is absolutely goingto be critical
in the coming years, and I think has beenover the last few as well.
You know, you in your role and any kind of
(41:35):
healthcare leader, there's
this dynamic of leading the organization,
but also kind of interactingwith other community leaders
that are critical to hospitalsand to communities.
And then there's also policymakersand regulators and others.
So there's this really intimate dynamicbetween
(41:56):
the organizations, the community leaders,the policymakers, etc.
What advicewould you give to health system leaders
to more effectively connect
the dots between themselves,community leaders, policymakers,
etc., to better understand and move
(42:16):
these initiativeswithin healthcare forward?
How would you kind of help folksconnect those dots a little bit better?
Well,first of all, that's a great question.
And it's a key priorityfor not only the CEOs
of health systems,but other people on that C team.
And, I think you understand thattoday, healthcare institutions
(42:36):
are not only responsible for advancingthe well-being of patients and employees
but also ensuring trust and transparencywith their care networks.
And unfortunately, today,that trust has been tested.
I think you know, astatistic only 25% of Americans
believe that hospitals’ prioritiesare patient care over profits.
(43:00):
And that's a drop of over 50 percentagepoints since 2021.
And I recently read an article about,I think it was in Becker's,
where Damon Boatright,who's the president and CEO of Hospital
Sisters Health System in Illinois,a great leader.
He outlined the message of what we can doto try to do that, we have to engage
(43:21):
not only with our own employeesand physicians, but also with the public.
And that, he gave a couple points.
One is model transparencyin every communication.
Two, champion integrityby ensuring that our teams
have the tools and support to communicatetruthfully and respectfully.
(43:42):
Three is to give intentionally,
especially by ensuring that our communitybenefit efforts are measurably addressing
the community needs and then promotingthat out into the community.
Fourth is to leadwith empathy and acknowledge that events
like cyber breaches are unsettling.
Five, bring clarity and offerconsistent opportunities for conversation.
(44:06):
Stay visible at the bedside, on the floor,in the boardroom and in the community.
And then finally six, reinforce financialaccountability through transparency
by continuously reviewing and sharingbilling and collection practices.
So as an example, at Summa,we actually created a white coat
session for the community.
(44:28):
We would invite community leaders infrom government, from business leaders,
and we would have themspend a day with us in our health system.
We would give them a white coat.
We would spend the day; they would tie upwith one of our physicians.
So, they saw the good, the bad,and the ugly of the challenges.
(44:49):
And at the end of the day,we would have a summation of that.
And it wasprobably the most impactful thing
that they experiencedand tied them to our organization
to create, to restore and strengthenthe trust that is foundational
to our country, at least, so we can leadwith clarity, courage, and conviction.
(45:09):
That's really what we need to do.
That's great stuff.
And I'm going to give youmaybe one more chance here
to summarize, Tom,just maybe with a final question.
As you kind of look back
and maybe think about the very beginningpart of your career, there are others,
right, entering the healthcare industryfor the first time.
(45:33):
There are others who are steppinginto hospital and health system
leadership roles right now, maybefor the first time in their careers.
There are folks
who are taking on the challengesthat you and I have been talking about
for the last 20 or 25 minutes, really,for the first time in their careers.
So maybe think about that group of folksearly in their career,
(45:53):
stepping into the environmentthat you've been describing
with the challenges, withthe opportunities that we've talked about.
What's maybe the one piece of adviceyou would give to someone
in that spot right nowstepping into a leadership role,
maybe for the first time in healthcare,in the environment that we're in today?
(46:14):
What piece of advice would you give?
I would sayprobably the most important thing is
you are taking on a blessing,an opportunity to serve
people in their most vulnerable time.
So the work you're going to dois noble work.
But also,nobody ever said it was going to be easy.
And so, you got to be preparedand develop resilience
(46:38):
to be able to move this thing forward.
And you have to modelthe values of your organization.
And that includes ethics and integrityand individual
responsibility and servant leadership.
And be prepared to adjust and correct,because there will be times
(46:59):
when you make mistakes, you will learnfrom those mistakes and move on.
And you need to knowthat you won't have all the answers.
You must surround yourselfwith a team of people
and give them the abilityand the authority to challenge you
if we get off track.
And the last piece is I,when I was at Duquesne,
(47:22):
I had a poster in my roomthat had a picture of the ocean
with the sun setting over the seaand it said, the important thing
is this to give upwhat you are for what you can become,
so that courage and resilience
is going to be critical in your futureand enjoy the ride.
(47:43):
Take time to support yourself.
You need to, you know, continueto have whatever your release is.
Running, your faith, your family, your friends.
But, if you love what you do,
and I hope you do,you will never work a day in your lives.
So that's would be the summary.
(48:05):
That's awesome, Tom.
And thank you so much for your thoughtstoday.
Thank you for your longand distinguished career.
Thank you that when you talk aboutthe kinds of things you just summarized,
they're real to youand they really have defined
your career over a long and distinguished time period.
So thank you for that career.
(48:26):
And, congratulations on the Forvis MazarsCharis Executive Impact Award for
2025.
And thanks for joining us today, Tom.
Thank you all.
I appreciate it.
And, Kevin, look forward to workingwith you in the future, my brother.
Tom, Kevin, I want to thank youboth for joining this episode.
Had a great timelistening to your conversation
(48:48):
and I know our listenerswill enjoy it as well.
I also want to thank our listenersfor tuning in
and following Achieving Healthwherever you listen to podcasts.
If you want to learn more about the topicswe discuss here,
be sure to check out the show notesfor related content and information
about how to get in touch with meand the team at Forvis Mazars.
I hope you'll join me in two weeksfor the next episode of Achieving Health.
(49:15):
You can follow
Achieving Healthon your favorite podcast platform or visit
forvismazars.us/AchievingHealthPodcastto learn more.
New episodes are released the firstand third Wednesday of each month.
Achieving Health is produced by ForvisMazars LLP, an independent member
of Forvis Mazars global, a leading globalprofessional services network.
(49:37):
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The information set forth in this podcastcontains the analysis and conclusions
(49:59):
of the panelists based upon his, her,or their research
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Such analysis and conclusionsshould not be deemed opinions
or conclusions by Forvis Mazarsor the panelists
as to any individual situationas situations are fact-specific.
The listener should performtheir own analysis and form
(50:19):
their own conclusionsregarding any specific situation.
Further, the panelists’ conclusionsmay be revised without notice,
with or without changes in industryinformation and legal authorities.
On today's episode of Achieving Health,I've got the latest policy and legislative
updates from Washington, D.C.,for the week of November 16th, 2025.
Then, my colleague Kevin Locke,managing principal for Healthcare
Consulting at Forvis Mazars,
will join the podcast for a conversationwith Tom Strauss,
co-founder and Senior Partnerat CEO Advisory Network.
(00:23):
Tom is also the former CEO of Summa
Healthcare System and Sisters of CharityHealth System.
Tom will share lessons on culture,innovation, resilience
and service from his distinguished careerin healthcare leadership.
It's a fascinating conversation.
Please stay tuned.
This is AchievingHealth, a podcast from Forvis Mazars,
where we delve into the topicsthat matter most to healthcare
(00:46):
organizationsacross the continuum of care.
Our goal is to help younavigate the dynamic healthcare landscape
and achieve health at your organization.
Here's your host, Chad Mulvany.
Welcome to Achieving Health.
I'm Chad Mulvany, directorin the Healthcare Practice at Mazars.
Thank you for joining me.
(01:06):
We'll begin the day with our WashingtonWatch segment, where I share
updates on the most recent actionsof federal policymakers
and their anticipated impacton healthcare providers and payers.
Today's WashingtonWatch reflects information as of 10 a.m.
Eastern Time on Friday,November 14th, 2025.
My comments on these discussions are basedon what's being reported by the D.C.
(01:28):
trade pressat the time of the conversation, mixed
with a lot of judgment about where thingsmay go, based on my experience in D.C.
So, today's remarks reflect informationas of this moment and will likely change.
As far as our agenda is concerned.
I'm happy to report
that Congress passed legislationthat has lifted the government shutdown,
extends key healthcare policiesuntil January 30th, 2026,
(01:53):
and mitigates the potential PayGo4% sequester that might have otherwise
been implemented due to the deficitincrease as a result of OB3.
Unfortunately, an extensionof the enhanced exchange subsidies
was not included in the bill,and the prospects for an extension
are still up in the air.
We'll also talkabout efforts to improve affordability,
(02:15):
which are related to, kind of,the shutdown drama.
And even though an extensionof the enhanced subsidies
wasn't included in the packagethat was passed in November 10th, senate
Democrats are expressing confidencethat they can reach
a bipartisan agreement to extend thembefore they expire at the end of the year.
However, Republicans are reportedlyworking on an alternative package
(02:36):
to address healthcare affordability.
On a bit of economic newsthat has implications
for out-of-pocket collections,
there are a record number of subprimeborrowers that are missing car payments
in October, and so delinquenciesamong some private auto borrowers
have reached a record high,with 6.65% of loans
(02:56):
at least 60 days past due in October,according to Fitch Ratings.
We also, on October 31stsince we last spoke, had the CMS
physician fee schedule final rulereleased for calendar year 2026,
and we'll cover a couple of the keychanges at a high level.
And then finally, we'll talk aboutemployer sponsored insurance sticker
(03:17):
shock.
The 165 million Americanswith employer sponsored insurance
are expected to face a 6.5% averageincrease in healthcare costs,
making thesethe steepest rise in 15 years.
And again, I anticipatethat this could potentially show up
both in future contract negotiationsas additional pressure on rates
and at the point of serviceas increased uncompensated care.
(03:40):
Finally, last thing before we dig in,
just want to note that as of this morning,as of Friday morning, 11/14,
we are still waiting on the OutpatientProspective Payment System final rule.
I would have thought that given
that PFS came out two weeks ago,we would have it by now.
But as soon as we get it,
we'll put out a FORsight on it, and we'llcertainly cover it in the next episode.
(04:00):
So with that agenda laid out,let's get into our program.
In terms of the shutdown,or the ending of the shutdown,
on November12th, 2025, President Trump signed
legislationending the partial government shutdown.
The package includes three full-yearspending bills and includes
a short-term continuing resolutionto fund the other government departments
(04:22):
not included in the full-yearspending bills through January 2026.
So this now gives Congressa little bit of time
(not much) to potentially negotiatethe rest of those spending titles.
The bill
also, as I mentioned, extended keyhealth policies through January 30th, 2026
and wipes the PAYGO scorecard clean,or the SPAYGO scorecard clean.
(04:45):
However, again, does not extendthe enhanced exchange subsidies.
Those tax credits are scheduledto expire on December 31st, 2025.
In exchange for voting to advancethe measure, Senate Majority Leader
John Thune has committed to holding a voteon extending the tax credits
in the coming weeks.
Speaker Johnson in the Househas not promised a similar vote,
(05:07):
and I am increasingly skepticalthat these will be extended.
The Urban Institute estimatesan expiration of the enhanced subsidies
would increase uncompensated carenationwide by $7.7 billion.
That's 12% relative to the $66.7billion baseline.
The burden of additional uncompensatedcare would fall
(05:28):
on the following providertypes: $2.2 billion on hospitals.
$1 billion on physician offices,$3.1 billion on other services,
and $1.5 billion on physician drugswith non-expansion
states more heavily impacted.
As the
likelihood of an extension of the enhancedACA subsidies
decreases, providers will want to focuson improving processes to connect patients
(05:53):
with other sources of coverage,improving upfront patient liability
collections for non-emergent services,and consider reevaluating
financial assistance policies.
We explored many of these revenuecycle improvement
strategies in the thirdinstallment of our OB3 Tuesdays series,
and the linkfor that is included in the show notes.
(06:14):
We also have a FORsight articlethat unpacks
how hospitals may want to reevaluatetheir financial assistance policies,
and we've also dropped that into the shownotes as well, in case you're interested.
In terms of the extenders,while the legislation doesn't
extend the credits,it does include language that addresses
a number of key issuesand extends them through Jan 30th, 2026.
(06:36):
These include, but are not limited to,a further delay of the ACA's Medicaid
Disproportionate Share Hospital cuts,extending the Medicare dependent
and low volume adjustment programs,continuing the telehealth, geographic
and originating site waivers, along withthe other COVID-era flexibilities
provided through the ConsolidatedAppropriations Act of 2023,
(07:00):
extending the Medicare Hospital at Homewaiver,
extending the Medicare Geographicindex floor, and also
providing $1.4 billion in CommunityHealth Center funding.
The cost of extendingthese policies is offset,
not surprisingly, by a one-monthextension to the 2% sequester
and an additional $400 million reductionin the Medicare Improvement Fund.
(07:23):
Last piece of this, that was included,and certainly a big win for providers
was the statutory SPAYGOMedicare sequester.
So in addition to providing short-term
extensions of the health policieswe just discussed, plus a few others,
the legislation wipesclean the SPAYGO scorecard.
So this eliminatesthe risk of a 4% sequester
(07:45):
that could have been appliedto all Medicare payments in 2026,
due to the $3.4 trillion increase
in the deficit projected by the CBOthat's attributed to OB3.
Given the results of the electionon Tuesday, November 4th, there's
certainly becoming a more focusedemphasis on affordability.
(08:06):
Obviously, Democrats have been focused on
addressing affordability through extendingthe enhanced exchange subsidies.
Republicans now are becoming awareof the exposure that they may have
through the midterm elections,if they don't do something about it.
And so, what you have now is SenateDemocrats continuing to express confidence
that they can reach
a bipartisan agreementto extend them before the end of the year.
(08:28):
However, there are some Democratsthat are starting to acknowledge
that the premium hikes in 2026may already be unavoidable.
The other piece, kind of fromthe Democrats side, is that even if Senate
Democrats can craft a bipartisan deal,
the House presents another obstacle.
Speaker Mike Johnson has not committedto advancing an ACA
(08:49):
subsidy extensionbill, and Republicans are pushing
for conservative modifications,such as lowering income
eligibility caps or restricting subsidiesfrom covering certain services.
And these are provisions that are unlikelyto gain Democratic support.
A handful of House Republicans,as I mentioned,
do see some political riskin letting those subsidies go
(09:12):
and are considering a discharge petitionthat could force a vote.
But it remains uncertainwhether they would do this
and sort of go against President Trump'swishes.
As the deadline approaches, both chambersface mounting pressure to balance
those ideological differencesto prevent steep premium increases
for millions of Americans.
(09:33):
You have a handful, also alternatively,of GOP
figures, including senatorsBill Cassidy and Rick Scott,
that are advocating for alternativesto an extension of the ACA subsidies.
These would include thingslike giving money to individuals through
tax-advantaged savings accountsthat would allow individuals
to manage their own healthspending directly.
President Trump has endorsedthis approach, arguing the funds should,
(09:55):
instead of being directed to insurancecompanies, should go to consumers.
However, Republicans still remain divided,and they're currently holding
listening sessions.
Certainly, you've got more moderates,those who are in swing districts,
favoring a temporary extension of thesubsidies to buy time for broader reform,
while others are pushingfor a more ambitious overhaul of the
(10:16):
healthcare system.
The challenge for Democratswill be keeping Republicans
focused on compromise around the ACAcredits, while Republicans weigh
whether to pursue collaboration or pursueindependent proposals.
It's unclear what, if any, legislativepackage will emerge at this point.
It's possible that an expansionof Medicare site-neutral payments
(10:39):
and the No UPCODE Actaffecting Medicare Advantage plans
might be included as offsets.
I will note that what's been interestingto watch over the last, call it
week or so,is that there seems to be enough concern
about the prospects for the No UPCODE Actby Medicare Advantage plans
that just about every trade press articleI've read over the last week or so,
(11:03):
that's been related to the shutdownand also sort of healthcare packages
that may come out between nowand next year, have included
pop-up ads encouraging Congressto vote against the No UPCODE Act.
So it's just kind of an interestingtemperature check.
In terms
of kind of the impacts of the potential
consequencesof not extending the subsidies,
(11:26):
but then providing fundsthrough tax-advantaged accounts,
economists and policy expertswarn that funding directly
to consumers through HSAsor FSAs could significantly reduce
ACA enrollment as healthier individualsmight opt out.
Should this occur, it would increasepremiums for those who remain
(11:46):
in the market, potentially leadinginsurers to withdraw from the marketplace.
And this is probably more likelyif provisions in the legislation
are included, that would expand thingslike the availability of short-term,
limited-durationinsurance and association health plans.
While it's too soon to handicapthe likelihood of a legislative package
(12:06):
that includes these provisions,
it certainly is something that we'llcontinue to watch and bears watching.
On an economic note, as I mentionedat the top, there were a record
number of subprime borrowerswho missed car loan payments in October.
Delinquencies among subprimeauto borrowers have reached a record high,
with 6.65% of loansat least 60 days past due in October.
(12:29):
According to Fitch Ratings, this is arecord dating back to the early ‘90s.
Subprime borrowers are obviously thosewith weaker credit histories
who are particularly vulnerableas high borrowing costs,
rising living expenses and dwindlingsavings are straining budgets.
And we're starting to see a widening gapbetween subprime and prime borrowers,
which underscores
the uneven impact of economic conditions,with vulnerable households
(12:52):
bearing the brunt of rising costsand limited financial flexibility.
I think the implication for providersis that typically people
pay their auto loans first before anythingelse, even typically housing.
And that's a rational thing to doif you're in that situation
because if you don't have a car,it makes it much harder to either
(13:12):
drive to work or look for a jobif you happen to be unemployed.
So I guess my takeaway from this is that,if we're seeing defaults on subprime auto
loans, we’re likely going to be seeing,if not already seeing shortly,
an increase in uncompensated care,particularly at safety net hospitals.
Same strategies that I talked aboutwith the potential end of the enhanced
(13:34):
exchange subsidies, like upfrontcollections for non-emergent services,
improving efforts to connect patientswith other forms of coverage, or, failing
that,kind of looking at financial assistance
policies,making sure they meet the community,
and also thinking about how you'reconnecting people with that assistance
are all viable strategiesfor addressing these challenges.
(13:55):
Given what we know at this point,I'd even like to think of that
as starting to become no-fail strategies.
In terms of the physician fee schedulefinal rule, on October 31st, 2025,
so Halloween, CMS released the Medicare
Physician Fee ScheduleFinal Rule for calendar year 2026.
The rule is over2,300 pages and is detailed.
(14:17):
What I take fromthis is that CMS probably also hands out
pennies and floss at Halloweenwhen you go trick or treating.
I will say this summary is not meant to be
an exhaustive discussion, butI want to flag just a handful of items.
Key changes in the ruleinclude the conversion factor, the
calendar year 2026 qualifying alternativepayment model conversion factor.
(14:38):
So, for those professionalsthat QP is $33.57,
that's decreasedslightly from the proposed of $33.59, but
is still a 3.77% increasefrom the current conversion
factor of $32.35.
The calendar year 2026 non-qualifying
(14:59):
conversion factor is $33.40.
This is decreased slightly againfrom the proposed $33.42
and is a projected increase of 3.26%.
I think one of the more controversialthings that CMS finalized
was that, for 2026,it includes an efficiency adjustment
(15:20):
to work reviewsand the related inter-service portion
of physician timefor non-time-based services,
based on the assumptionthat efficiency in performing
these services should increasewith experience.
You see, CMS is using the priorfive year Medicare Economic Index
productivity adjustment, which will resultin an adjustment of -2.5%.
(15:44):
In the same veinof being somewhat controversial, CMS
also finalized updates to the methodologyused to calculate practice expense RVUs
given the decline in the numberof physicians working in private practices
and the increase of employmentby hospitals and health systems.
For calendar year 2026,the agency will recognize
(16:05):
greater indirect costs for practitionersin office-based settings.
In terms of telehealth,
CMS finalizes three significant changesto regulations related to telehealth.
First is the subsequent visitsand critical consultations.
CMS permanently removes frequencylimitations for subsequent inpatient
visits, subsequent telehealth visits,and critical care consultations provided
(16:27):
via telehealth.
In terms of direct supervision,CMS permanently
redefinesdirect supervision to allow the physician
or supervising practitionerto provide it through real-time audio
and visual interactive telecommunications,so it excludes audio-only,
and except for servicesthat had a global surgery indicator
(16:48):
of 10 or 90, virtual direct supervisionmay be provided for applicable incident
to services diagnostic tests,pulmonary rehab services,
cardiac rehab servicesand intensive cardiac rehab services.
This changealso applies to FQHCs and RHCs.
And then finally under telehealth, kind ofunder that same bucket of supervision,
(17:10):
related to residence, the COVID-era policyallowing teaching physicians
to provide virtual supervisionto residents in all teaching settings
was set to expire on December 31st, 2025.
CMS did not initially proposeextending this policy.
However, based on comments, CMS finalizes
a policy that permanentlyallows virtual supervision of residents,
(17:34):
but only for cases in whichthe service itself is virtually furnished.
And so, beyond kind of the policychange there, I think that underscores
not only the importance ofsubmitting comments when CMS issues regs,
but even if they don't addressa particular issue,
if it's something that's important to you,please
make sure you write a paragraphor 12 on it.
For FQHCs and RHCs,
(17:56):
the ruleallows them to use optional add-on codes
for APCM to billfor behavioral integration
and COCM services when RHCs and FQHCsprovide advanced primary care management.
In addition, effective July 1st, 2026,
RHCs and FQs are required to reportHCPCS codes
(18:18):
G0512 and G0071 that make up both the COCM
and communications-based technologyservices and remote evaluation services.
In terms of the alternative paymentmodels,
CMS finalized a mandatory payment model,the Ambulatory Specialty Model,
for physicians
treating Medicare fee-for-service patientswith heart failure and low back pain.
(18:42):
It runs for five years,so performance year 2027 to 2031,
and will impact paymentsoccurring from 2029 to 2033.
The model aims to incentivizechronic disease prevention
and managementthrough performance-based adjustments.
The adjustment range will start at +/-9%and increase to +/-12%.
(19:03):
The model is not budget neutral
and so similar to the HomeHealth Value-based purchasing model,
CMS will retain a portion of the savings,in this case 15%,
of the withholdto guarantee savings for the program.
The model will draft specialistsin 25% of core based statistical areas.
CMS will release additional guidanceabout participant
(19:26):
eligibility criteriafollowing publication of the final rule.
So I would anticipate that eitherany time now or sometime in December.
The final rule also notesthis calendar year 2027 performance year
participant list will be releasedin early 2026 through the CMS website.
(19:46):
A couple of thoughts on the PFSfinal rule.
The positive paymentupdate stems from provisions
in MACRA and the recently passed OB3.
It's important to remember that the changein OB3 was one year only for 2026.
So in 2027, physicians will have to againlobby Congress
to get a more generous payment update.
(20:09):
In terms of what MACRA required on this,obviously it requires different conversion
factors based on whether you're qualifyingor not qualifying in APMs
and so the portion of the updaterelated to QPing is 0.75%.
And for those that are nonqualifying,it's 0.25%.
So obviously there's some value therein beyond kind of the experience,
(20:31):
the savingsthat you could possibly generate.
There's value in participatingin alternative payment models.
Groups representing physiciansare going to continue,
given the issueswe just talked about, to advocate
for more durable reformsto the conversion factor,
if this point still haven't seenlegislation on what that might look like.
I know some of the associationsrepresenting the docs
(20:52):
have been working on this buthaven't seen anything yet that's hit paper
or hit The Hill yet as draft legislation.
While the payment update is positive,some specialties could see a decrease
in per-service Medicare revenuedue to the changes in practice
expense RVUs and the implementationof an efficiency adjustment.
The efficiency adjustment will negativelyimpact providers who mostly bill
(21:16):
non-time-based CPT codes, while benefitingthose who bill time-based codes.
And then the change in practice expenseRVUs will negatively impact hospital-based
providers while benefiting those remainingindependent office-based providers.
Regarding the ambulatory specialty model,
given it'smandatory and CMS will retain a portion
(21:37):
of the withhold, it's hard for me to seehow it's not going to generate savings.
Therefore,it's likely that CMS will not only expand
the current incarnationto other geographies.
So low back pain, heartfailure gets expanded to other CBSAs,
but I would imagine that as they lookat those high volume,
chronic conditions that aren't low backpain or, heart failure,
(22:00):
that we will see an expansionto other conditions.
We have a detailed FORsight comingthat will unpack the rule
and we’ll make that availableas soon as we have that finalized.
Last thing I want to cover: employer-sponsored insurance (22:12):
undefined
sticker shock.
While price hikes in the exchangeshave received a lot of the trade
press oxygen, the same phenomena, though
for different reasons, is occurringin the employer-sponsored market.
This fall as open enrollmentbegins, the 165 million Americans with ESI
(22:33):
are expected to face a 6.5% averageincrease
in healthcare costs per employee,making this the steepest rise in 15 years.
As a result,many employers plan to offset these costs
by raising premiums, deductibles,co-pays, and out-of-pocket maximums,
shifting
more of the financial burden onto workers.
(22:54):
Employers can expect paycheck deductionsfor health coverage to climb between
6% and 7%, and that's nearly double
the projected 3.1% average merit raise.
This widening gapbetween healthcare costs and wage growth
could lead to significant financial strainfor many insured workers.
Hospitals should prepare for continuedcontentious rate negotiations
(23:17):
with employers and their TPAs.
They will need to use pricetransparency data
that's available through the transparencyand coverage requirements
to benchmark their existing rates to peers
to help make the case for why they needadditional rate increases.
Further, given that employers are shiftingmore of these cost increases on
to their employees, again,they're going to need to improve processes
(23:38):
for collections of costsharing at the point of service
for non-emergent services.
They're also going to needto revisit their processes
for qualifying individualsfor financial assistance, to ensure
those who are qualifyingor should qualify will not get billed.
I feel like there's kind of a themeto this episode.
This concludes today's Washington Watch.
Up next, we'll have a conversationbetween my colleague Kevin Locke and our
(24:00):
special guest, Tom Strauss.
I'd like to welcome
back to the podcast Kevin Locke,our managing principal for healthcare
consulting at Forvis Mazars,for a conversation with Tom Strauss.
Tom is a founder and senior partner at
SEO Advisory Network,and previously served
(24:24):
as CEO of Summa Health Systemand Sisters of Charity Health System.
Tom is also the 2025 recipientof our Charis Executive Impact Award,
which Forvis Mazars presentsannually to a healthcare leader
who has demonstratedthe qualities of grace, kindness and life
over the course of a distinguished career.
Kevin, I'll turn it over to youand look forward to the conversation.
(24:47):
Thanks, Chad.
It's always fun to joinyou on your podcast.
I think you do a great job with it,and it's always an honor to be a guest.
And it's even more of an honorto be joined by Tom Strauss.
Tom, you and I go back in our careersa long way, and you were honored this year
with the 2025 Charis Executive Impact
Award, which Chad just mentioned.
(25:09):
And, congratulations on that.
It's been really fun to kind of sharea bit of our professional journey together
so, congratulations.
Well, Kevin, first of all, thank youfor inviting me to come on and chat.
Kevin and I go back
many, many years, probably more yearsthan we want to comment.
Let me just spend a couple of secondson the Charis Healthcare Impact Award,
(25:30):
and then we certainly want to talk aboutyour career a bit on today's podcast.
And you know this well,but for the sake of the folks joining us,
our Charis Health Executive ImpactAward is is given annually to someone
who's had a long and distinguished careerin the healthcare field.
And we built the award around three key
themes (25:50):
grace, kindness, and life.
And grace, we talked about thingslike serving as a generous ambassador
for the organizationand for a healthcare industry.
Kindness.
We talk about things like living out,caring and compassionate spirit.
Which I know as part of, Tom, been
your healthcare journey and a lot of whyyou ended up in healthcare.
(26:13):
And then in life we talk aboutleading an organization forward, right?
Breathing life into the organization.
So as you think about those three things,
grace, kindness, life,I think, Tom, they've
described your careerpretty meaningfully, but
maybe spend a minute or twojust kind of sharing your career
(26:35):
highlights for the sake of the folksjoining us today.
Sounds great, I’d love to.
So I grew up in Pittsburgh.
I'm the son of a steelworker,so I really have
very much of a blue-collar background.
I worked five years while in collegefor pharmacy at Duquesne
University in the U.S.
Steel mills, and was a hookerand a mobile equipment operator.
(26:59):
So I saw firsthand one, the work of unionsand some of the activities there.
But secondly, the need and the interestfor me to stay in the professional area.
So I went to school to be a pharmacist.
I worked in many of the hospitalsin Cleveland, I mean, in Pittsburgh.
And then I was recruited
(27:19):
by American Hospital Supply Corporation
in 1983 to start one of the first home
infusion pharmacies in the country
in Pittsburgh called American ContinueCare.
And three mergersand four name changes later, in six years,
I was vicepresident of Caremark for central U.S,
(27:41):
but in 1989, I left Pittsburghto come to the Meridian Health System.
I really wantedto come back into hospitals.
That was my love.
And I decided to come to Cleveland
and it was tough as a Pittsburgh Steelersfan, I want you to know.
I enjoyed that involvement.
We had four hospitals in Cleveland,and I was president
(28:04):
of the Meridia Institute,which was actually a business incubator.
So innovation has always beena part of my, what I loved.
And we started 13 companiesduring that period,
everything from homeinfusion to home nursing to mobile MRI.
And in ‘92, I took over my first hospital,which was Meridia Suburban Hospital,
(28:24):
a hospital that had been struggling,losing money,
and we were able to do a turnaround
and finally grew to the pointwhere we needed more space.
And I ended up merging with the hospital
next door called Brentwood Hospital.
The merger was a DO and an MD merger,
which was somewhat unusual at the time.
(28:45):
And in seven months,we renovated one at Brentwood
and converted Suburbaninto an outpatient facility,
and the new hospital was calledMeridia South Point.
It was one of the most challenging thingsI ever did in the seven months.
I went on to run the service lines at allfour of the Meridia hospitals.
But in ‘95, somewhere around there,we merged with the Cleveland Clinic,
(29:07):
and I was then recruited to come downto Summa Health System in April of ’99,
became CEO in January of 2000,and had a 15-year career,
which was really one of the mostpleasurable times I ever had.
I had the opportunityto retire at the end of 2014,
came out and immediatelyflunked retirement.
(29:30):
Called a bunch of my friendsthat had run health
systems and said, look,you're a lousy golfer.
Let's go do something together.
And we put together what today is calledthe CEO Advisory Network.
Really, to give back to the industry.
Shortly after that, in 2017,I was approached by a headhunter
for the Sisters of Charity,
(29:50):
and I knew the congregational leader,Sister Judith Ann.
And I called her and said, sister,look, don't bring in a new CEO
that doesn't know this market,let me do this for you.
And you don't have to sign a contractor anything like that.
I thought I'd be there a year or two.
I was there five years,
and we were able to sell a hospitalto the Cleveland Clinic.
(30:12):
We were able to pay off all the debtand, really, created
three community foundations working onthe social determinants of care.
Now, today, I'm
back at the CEO Advisory Network,continuing to flunk my retirement,
but have enjoyed it thoroughly
and enjoy giving back to healthcare.
(30:32):
Well Tom, again,it's been fun to walk alongside
that journey with you for at least partsof that career you just described.
And you highlighted a couple of things
that I want to pull ona little bit here, Tom.
One is innovation.
One is service to the community.
I know that was a really big focalpoint for you at both Summa
and at Sisters of Charity and I'm sureprior to those stops in your career.
(30:57):
So, innovation, community service,
and then another one that I want to talka little bit about is culture,
because I know you spenta lot of your career in developing
really dedicated and committed cultureswithin the organizations that you led.
So maybe just talk about each of those
three themes a little bit,how you kind of approach innovation,
(31:19):
your commitment and passionregarding community service,
and then how you build a culturein a great organization.
Yeah.
Maybe I could start with culture,because that's really what, in my opinion,
the most important thingyou can do to live your,
you know, values, mission,vision and values
and instill those in the organizationis a critical piece of the future.
(31:42):
So if you think about healthcare is aright and it's a noble profession,
and we care for patientsin their most vulnerable time.
So those patients that we carefor deserve our best.
And I've always had the interestto create a vision around
providing the highest qualitybut compassionate care to our patients
(32:06):
and to contributeto a healthier community.
And one of those philosophies we've had,and I've had it for years, is called
servant leadership.
You remember Robert Greenleafstarted that way back in the ‘70s,
but it basically says that, and we had a motto at Summa Health System
where we flipped the organizational chartupside down,
(32:26):
and I was at the bottom,the patient was at the top,
and our job was to supportthose people at the bedside.
And and we had a motto that we said thatif you're not serving
the patient,you better be serving someone who is.
And we worked extremely hard,not only at the senior level,
but at the management levelto educate every employee around
(32:51):
the philosophies of Summaand how this servant leadership
is somethingthat was important for the future. So,
and then we took that one step forward,
and that is to improve the health statusof the communities we served.
And because at Summa,we had our own health plan,
we were able to go at risk to improve
(33:13):
the health statusof those people that we served.
And look at total cost of care,which I know,
Kevin,you believe is the future direction.
I do.
But that authentic value-basedleadership is so critical.
And in fact, I just this week was readingWarren Buffett's retirement letter.
I don't knowif you had a chance to see it?
I have not, no.
(33:34):
And he talks about thatgreatness does not come
through accumulationof great amounts of money,
great amounts of publicity,or a great amount of power in government.
When you help someone in any of thousandsof ways, you help the world.
And that kindness is costless,but also priceless.
(33:55):
Whether you are a religious personor not, it's hard to beat the Golden Rule.
And as a guide to behavior, don'tbeat yourself up over the past mistakes.
Learnat least a little from them and move on.
It's never too late to improve.
And I thought that philosophy was amazing.
So, spoken by the General.
That's really great and great timingto pull that in, right as he's
(34:19):
kind of going through his own processhere this week and
Tom, again,I'll just recognize and give you credit.
You have done many of those thingsat every step of your career:
building culture, kindness,leading with kindness, Golden Rule,
putting others first, flippingorganizational charts on their head.
All of those things have been coreto who you've been.
(34:41):
So I want to thank you for thatlevel of service that you've provided to,
really, the healthcare industryand the communities that you've served.
Let's maybe, pivot a little bit, Tom,
and a little lesslook back and a little more look forward.
As you sort of take some of those lessonslearned in the career that you've had
(35:02):
and the leadership principles that you'vebrought and shared with us even today,
what would you kind of take and say,
you know, the insight, or one or two keyinsights or lessons learned that
although you look back on your careerand say, that's
what I learned,can also serve us moving forward, right?
(35:24):
What are those one or two critical lessonslearned that today's leaders in today's
healthcareenvironment should be working on
and taking into the futurethat we're headed into?
I thinkwhat's critical is you can't rest on
what you've been successfulat in the past.
(35:44):
Honestly,if you think about where we're heading,
and I know we're going to talk about this,but the challenges we face today in
healthcare are beyond anything that I'veever seen in my 50 years in healthcare.
The OBBBA, if you look at the resultsof that, it's going to be more than $911
billion in Medicaidspending reductions over 10 years.
(36:06):
We're going to see a 21% increase in theuninsured population of the country,
and over 24 million Americanscould see their insurance
premiums increaseby almost 93% on average.
So this oversight of our healthsystem has to change.
So we have to evolve innovation,speaking of that.
(36:30):
Artificial intelligence is going to bea critical piece of our future.
You know, the statistics
of the shortage of healthcare providers,you know,
a recent studyshowed that 340 million people in the U.S.
and about a million active physicians
as of 2023; however,they predict a shortfall of 328,000
(36:53):
nurses, registered nurses, 42,000 licensed
practical nurses and 33,000nurse practitioners through 2032.
So there's no way we can repeatwhat we've done in the past.
We must innovate,and a lot of those innovations
are going to work aroundartificial intelligence.
(37:15):
I would say that'sprobably the most important piece.
The other piece is, you know,there's a lot of burnout,
with our staff and our physicians,
and we have to employ the ideasof empathy and respect
and supporting those peopleat the frontlines,
giving them answersand creating a noble vision
(37:38):
that they can get excitedabout and move forward with.
So I would say those are sort of thetwo areas that I would go.
That's really well said.
And you mentioned your 50-year career,
it's been characterizedby lots of change over time.
And certainly we're in yetanother period of change, as you
(37:58):
mentioned, the OBBBA and all of the impactthat's going to have.
You mentioned artificial intelligence.
You mentioned innovation.
So it's yet another period of changethat hospital
administratorsand leaders in all industries are facing.
So, thank you for those insights.
Let me,let me take this idea of kind of OBBBA
(38:21):
and current change in our market, Tom,and pull it a little bit further.
What do you thinkis kind of an opportunity that maybe
some of your peers, some of the folksthat are leading hospitals today,
what do you think are one
or two of the opportunities out therethat they might be overlooking?
Opportunities to tap intofor better outcomes, for access,
(38:43):
for growth, for cost efficiency,those kinds of things?
So, yes, we're in a period of change.
Yes, we're in a period of challengerelated to the OBBBA,
but what are some of the opportunitiesthat exist in the marketplace as well?
I would sayprobably the biggest opportunity
is to improvethe way healthcare is delivered.
And I think some of thatmay be underappreciated,
(39:05):
among healthcare leaders today,I think you're aware the new CMS
administration is aggressively planningto reduce healthcare cost
and move Medicare to 100%
value-based payment system, and Medicaid,over the next few years.
And I believe that every health systemmust develop a strategy
(39:27):
and financial approachto building value-based payment,
including the development
of clinically integrated networksor accountable care organizations.
So we have embarked upon that, and I know,Kevin, you've been a champion of this
for yearsto help health systems really look at
what are the fundamental priorities
(39:47):
in that movement,from fee-for-service to value,
and what are the accomplishmentsin the categories
that they have to work on,because you can get in a lot of trouble
if you go a little too early,but you can't sit back.
And that's why so many people todayare trying to figure out
what they're going to do with MedicareAdvantage.
Medicare Advantageis not going to go away, but
(40:10):
you must find a way to workwith these payers in a new way.
And I've seen some wonderful examples.
I can tell you.
Mark Clement from Tri Health in Cincinnatiis one of the health systems
that historically has donevery well on fee-for-service
but has completely moved the organizationto value-based contracting
(40:32):
and is now doing extremely well in both.
And he's created a culture around that
that has really engagedthe workforce, engaged the medical staff,
which is another critical priorityto be successful for the future.
So that's just one example
of something that's worked really well.
(40:53):
And a great one.
And you're right,you and I and others have been very
passionateand dedicated and committed to this idea
of helping the industrymake the transition from volume to value.
Of course, we've been talking
for a long time about it and just tryingto create the momentum behind it.
(41:14):
And I totally agree with youthat anything we can do, any partnerships,
any ideas, the Tri Health example,that you learn from and drive
that forward is absolutely goingto be critical
in the coming years, and I think has beenover the last few as well.
You know, you in your role and any kind of
(41:35):
healthcare leader, there's
this dynamic of leading the organization,
but also kind of interactingwith other community leaders
that are critical to hospitalsand to communities.
And then there's also policymakersand regulators and others.
So there's this really intimate dynamicbetween
(41:56):
the organizations, the community leaders,the policymakers, etc.
What advicewould you give to health system leaders
to more effectively connect
the dots between themselves,community leaders, policymakers,
etc., to better understand and move
(42:16):
these initiativeswithin healthcare forward?
How would you kind of help folksconnect those dots a little bit better?
Well,first of all, that's a great question.
And it's a key priorityfor not only the CEOs
of health systems,but other people on that C team.
And, I think you understand thattoday, healthcare institutions
(42:36):
are not only responsible for advancingthe well-being of patients and employees
but also ensuring trust and transparencywith their care networks.
And unfortunately, today,that trust has been tested.
I think you know, astatistic only 25% of Americans
believe that hospitals’ prioritiesare patient care over profits.
(43:00):
And that's a drop of over 50 percentagepoints since 2021.
And I recently read an article about,I think it was in Becker's,
where Damon Boatright,who's the president and CEO of Hospital
Sisters Health System in Illinois,a great leader.
He outlined the message of what we can doto try to do that, we have to engage
(43:21):
not only with our own employeesand physicians, but also with the public.
And that, he gave a couple points.
One is model transparencyin every communication.
Two, champion integrityby ensuring that our teams
have the tools and support to communicatetruthfully and respectfully.
(43:42):
Three is to give intentionally,
especially by ensuring that our communitybenefit efforts are measurably addressing
the community needs and then promotingthat out into the community.
Fourth is to leadwith empathy and acknowledge that events
like cyber breaches are unsettling.
Five, bring clarity and offerconsistent opportunities for conversation.
(44:06):
Stay visible at the bedside, on the floor,in the boardroom and in the community.
And then finally six, reinforce financialaccountability through transparency
by continuously reviewing and sharingbilling and collection practices.
So as an example, at Summa,we actually created a white coat
session for the community.
(44:28):
We would invite community leaders infrom government, from business leaders,
and we would have themspend a day with us in our health system.
We would give them a white coat.
We would spend the day; they would tie upwith one of our physicians.
So, they saw the good, the bad,and the ugly of the challenges.
(44:49):
And at the end of the day,we would have a summation of that.
And it wasprobably the most impactful thing
that they experiencedand tied them to our organization
to create, to restore and strengthenthe trust that is foundational
to our country, at least, so we can leadwith clarity, courage, and conviction.
(45:09):
That's really what we need to do.
That's great stuff.
And I'm going to give youmaybe one more chance here
to summarize, Tom,just maybe with a final question.
As you kind of look back
and maybe think about the very beginningpart of your career, there are others,
right, entering the healthcare industryfor the first time.
(45:33):
There are others who are steppinginto hospital and health system
leadership roles right now, maybefor the first time in their careers.
There are folks
who are taking on the challengesthat you and I have been talking about
for the last 20 or 25 minutes, really,for the first time in their careers.
So maybe think about that group of folksearly in their career,
(45:53):
stepping into the environmentthat you've been describing
with the challenges, withthe opportunities that we've talked about.
What's maybe the one piece of adviceyou would give to someone
in that spot right nowstepping into a leadership role,
maybe for the first time in healthcare,in the environment that we're in today?
(46:14):
What piece of advice would you give?
I would sayprobably the most important thing is
you are taking on a blessing,an opportunity to serve
people in their most vulnerable time.
So the work you're going to dois noble work.
But also,nobody ever said it was going to be easy.
And so, you got to be preparedand develop resilience
(46:38):
to be able to move this thing forward.
And you have to modelthe values of your organization.
And that includes ethics and integrityand individual
responsibility and servant leadership.
And be prepared to adjust and correct,because there will be times
(46:59):
when you make mistakes, you will learnfrom those mistakes and move on.
And you need to knowthat you won't have all the answers.
You must surround yourselfwith a team of people
and give them the abilityand the authority to challenge you
if we get off track.
And the last piece is I,when I was at Duquesne,
(47:22):
I had a poster in my roomthat had a picture of the ocean
with the sun setting over the seaand it said, the important thing
is this to give upwhat you are for what you can become,
so that courage and resilience
is going to be critical in your futureand enjoy the ride.
(47:43):
Take time to support yourself.
You need to, you know, continueto have whatever your release is.
Running, your faith, your family, your friends.
But, if you love what you do,
and I hope you do,you will never work a day in your lives.
So that's would be the summary.
(48:05):
That's awesome, Tom.
And thank you so much for your thoughtstoday.
Thank you for your longand distinguished career.
Thank you that when you talk aboutthe kinds of things you just summarized,
they're real to youand they really have defined
your career over a long and distinguished time period.
So thank you for that career.
(48:26):
And, congratulations on the Forvis MazarsCharis Executive Impact Award for
2025.
And thanks for joining us today, Tom.
Thank you all.
I appreciate it.
And, Kevin, look forward to workingwith you in the future, my brother.
Tom, Kevin, I want to thank youboth for joining this episode.
Had a great timelistening to your conversation
(48:48):
and I know our listenerswill enjoy it as well.
I also want to thank our listenersfor tuning in
and following Achieving Healthwherever you listen to podcasts.
If you want to learn more about the topicswe discuss here,
be sure to check out the show notesfor related content and information
about how to get in touch with meand the team at Forvis Mazars.
I hope you'll join me in two weeksfor the next episode of Achieving Health.
(49:15):
You can follow
Achieving Healthon your favorite podcast platform or visit
forvismazars.us/AchievingHealthPodcastto learn more.
New episodes are released the firstand third Wednesday of each month.
Achieving Health is produced by ForvisMazars LLP, an independent member
of Forvis Mazars global, a leading globalprofessional services network.
(49:37):
Ranked among the largest publicaccounting firms in the United States,
the firm's 7,000 dedicated team membersprovide an Unmatched Client Experience
through the delivery of assurance, taxand consulting services for clients
in all 50 states and internationallythrough the Global Network.
The information set forth in this podcastcontains the analysis and conclusions
(49:59):
of the panelists based upon his, her,or their research
and analysis of industryinformation and legal authorities.
Such analysis and conclusionsshould not be deemed opinions
or conclusions by Forvis Mazarsor the panelists
as to any individual situationas situations are fact-specific.
The listener should performtheir own analysis and form
(50:19):
their own conclusionsregarding any specific situation.
Further, the panelists’ conclusionsmay be revised without notice,
with or without changes in industryinformation and legal authorities.
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