Bob Karl is a veteran healthcare leader with about 20 years of accounting and physician practice management experience.
As CFO of Christus Clinic Management Services at Irving, Texas-based Christus Health, he oversees support services for more than 1,100 clinicians. These services include revenue cycle, finance, clinician compensation and accounts payable.
Before joining Christus Health in 2012, Mr. Karl was CFO of the physician division at Austin, Texas-based Seton Healthcare Family.
Here, Mr. Karl shares one of his proudest achievements at Christus Health, discusses the physician ministry’s financial strategy and offers advice for other healthcare finance chiefs.
Note: The following responses were edited for length and clarity.
Question: Since joining Christus Health, what has been one of your proudest moments as physician group CFO?
Bob Karl: When I started with Christus, the organization was beginning to consolidate operations into the Irving corporate headquarters. They had just moved the physician services offices from Houston to Irving. Only a handful of individuals were willing to relocate to Irving from Houston. It was particularly bad in the revenue cycle department, where no one relocated from Houston. There was no permanent revenue cycle staff. So, when I got here, we were in a situation where we needed to rebuild everything. For me, it was putting the revenue cycle back together. A year and a half later, the department was staffed, and we were at 32 days in accounts receivable. It was a huge transition for us to move everything to Irving.
Q: What are the greatest challenges you face in 2019?
BK: One is the changing regulatory environment and two is the challenge of timing. Let me explain. We are currently on the volume road, and we know that the road is going to curve at some point, and change to the value road. As CMS is changing its perspective on reimbursement and trying to move us from volume to value, it's [about determining] how [to] move along that continuum at the right pace. If you get too far out in front of it, it's going to be problematic because we won’t be aligning our clinician compensation models with our payment model. Right now most of our compensation models try and align compensation with volume. If we get too far out on the value front before our payer contracts reward us for value, we risk negatively impacting revenue and, potentially, clinician compensation, which then ultimately negatively impacts care, if we don't have the clinicians we need to provide that care. So I look at it as timing, trying to watch CMS change the rules on reimbursement, and then making sure we're adjusting our compensation models as they're making those changes. We are attempting to anticipate those changes so we're in a good position to accommodate them.
Q: How is Christus working to overcome this challenge?
BK: We need to be flexible in multiple ways. As the physician group CFO, I worry about patients and their access to us and how that might change as we move from volume- to value-based reimbursement. On one side, we have to be flexible to meet patients where they want and need to be seen, in the setting that is most appropriate for the care they need to receive. That might be in an urgent care, in the clinic setting [or] at the hospital. We need to have those access points where we can meet our patients.
On the other side, we need flexibility in our compensation models. We need to be able to align our compensation models with those goals that CMS has been encouraging us to address with their changing payment models.
Q: What philosophies, events or people influence your leadership style?
BK: My personal philosophies align very closely with the Christus core values: dignity, excellence, integrity, compassion and stewardship. I keep these values in mind when dealing with our patients, our staff, our clinicians and other administrators. I am always trying to think about how I would want to be treated if I were in one of these groups. My grandfather, C.T. Grabowski, was one of the most compassionate, giving, caring individuals I know. If I think he would approve of my decisions and actions, then I know I am on the right path.
Q: Christus has more than 600 healthcare centers in multiple states. How does the system's size affect your financial strategy?
BK: We have to centralize where appropriate and allow local variation where it makes sense. There are things that can be done centrally, like in all big organizations, where you see centralized accounting or centralized revenue cycle. I would say human resource management, recruiting [are some areas] where it makes sense to centralize those particular parts of the organization, yet you're still going to need local flexibility because each market is going to be a little bit different.
Q: If you could pass along one nugget of advice to another hospital CFO, what would it be?
BK: You have to surround yourself with great people. Right now, your CFO is expected to be a jack-of-all- trades. You need to know finance. You need to know accounting. You need to know compensation, tax, IT, operations, legal. So you have to have a little bit of knowledge about everything, but you really need to surround yourself with experts in those fields that you can trust and you can tap to provide you with advice to make the best decisions possible for the organization.
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