Michael Breslin serves as CFO of NewYork-Presbyterian, a New York City-based academic health system, where he is responsible for areas including financial reporting, financial planning, revenue cycle, budget, reimbursement and cost accounting.
Before taking on the CFO role, he served as senior vice president of finance at NewYork-Presbyterian Brooklyn Methodist (then New York Methodist Hospital).
He also previously was CFO of New York City-based Lenox Hill Hospital, president and CEO of Richmond University Medical Center in New York City and worked as a partner with accounting firm Ernst & Young.
Here Mr. Breslin discusses the major unexpected changes in healthcare, describes several challenges health system CFOs face and discloses who has influenced his leadership style the most.
Note: The following responses were lightly edited for length and clarity.
Question: What skills are essential for a health system CFO in today's healthcare climate, beyond traditional financial and business acumen?
Michael Breslin: There's a certain level of subject matter expertise in terms of financial reporting and financings [required of CFOs]. [But] I think what we're seeing more today is the importance of valuable, strategic thinking, really being a partner to the C-suite and the executive team in terms of developing cutting edge strategies and communicating the same to the board leadership. We're kind of living in two worlds. For example, we're still a very fee-for-service-based industry, but there are movements afoot to value-based care. We still generate most of our margins on the inpatient side of the business, but we all see that for consumer-driven, cost, quality and patient experience reasons the need to expand into more outpatient settings. It's living in both worlds and really thinking through and understanding the strategy so when you buy in, you're all in. [This enables] the team to move together collectively and execute effectively on new strategies.
Q: Can you describe some unique challenges health system CFOs face?
MB: Thinking through the economics of care models that are not yet fully mature and developed. We [NewYork-Presbyterian] are a national leader and aspire to be the national leader in virtual care and telemedicine in the country, and some of those return on investment metrics are still evolving. So, you must buy into the strategy and appreciate that some of the benefits can't be calculated in the traditional ROI model.
I believe we are operating in very uncertain times in terms of the political environment. We're having local and national discussions about single payer and things like Medicare buy-in. We need to manage risk like never before. We all have long-term capital investments we need to consider, but the uncertainty is unprecedented. How much risk do you take regarding capital improvements in this uncertain world?
Q: What major changes in healthcare have you seen in recent years that you would have never expected when you started in the industry?
MB: The transformative nature of telemedicine is something I don't think too many people could have envisioned five-10 years ago. And today the opportunities and the value is limitless. We at NYP are integrating automation and digital into everything we do, end to end, whether it's patient care or back-office. I think that's something that was radically different than anyone would have thought of a few years ago. Again, I think the political and economic uncertainty is certainly at levels I don't think could have been predicted too accurately a few years ago.
I think the whole payer dynamic [is a major change]. We have payers now that are large employers of physicians and are in the provider space more so than we could have envisioned. Then you have the Aetna-CVS [integration], the vertical integration that I don't think could have been anticipated back in 2005 and 2010 when I was in a more traditional fee-for-service, provider-based environment.
Q: Since joining NewYork-Presbyterian, what has been one of your proudest moments as CFO?
MB: How collaboratively the organization came together in response to a commercial managed care plan that, after years of very intense but fair negotiations, employed a much more aggressive negotiation strategy that put our patients at risk. The entire NYP team came together from a governance, clinical, operational and leadership perspective and rallied around what was right for our patients, right for our organization, right for our medical school partners. The result was a win-win negotiation and letting the market know we will always do what is right for our patients. Seeing everyone rally together, seeing everyone appreciate the true importance of putting patients first and working together as a team, was very powerful.
Q: What philosophies, events or people influence your leadership style?
MB: I'm blessed in that I work for an organization that has one of the best boards in the country, so I get to watch and listen to some of the best and brightest in their respective field. In my days at Ernst & Young, I was blessed in that I got to see different hospitals and how their governance structures work and how their leadership teams and trustees operate, and NewYork-Presbyterian is by far a best practice. Watching and learning from our trustees is an incredible experience. We learn from them every day. Also, I have the benefit of my predecessor, Phyllis Lantos, working with the organization in an advisory capacity. Phyllis and I speak and meet regularly, and I welcome her advice and counsel. I work hard every day to further her legacy of fiscal competence coupled with transparency and collaboration.
Q: NewYork-Presbyterian Hospital recently signed a 10-year agreement with Philips to implement the health technology vendor's full suite of clinical informatics tools. What does this agreement mean in terms of the system's finances?
MB: Philips is a vendor partner of ours. Our 10-year agreement is related to an enterprise PACS [picture archiving and communication system] solution. We spend a lot of time with them on remote patient monitoring and telemedicine tools that can enhance the quality, experience and convenience for the patient. We have a number of those kinds of relationships and continue to look for more. We really want to change the way remote monitoring is administered.
Q: If you could pass along one nugget of advice to another hospital CFO, what would it be?
MB: In today's world, I think you must continue to be open-minded but stay grounded in the role of the CFO. Don't dismiss something that seemed outlandish a few years ago. But be the individual who continues to try to understand how it's going to change things. Understand how it's going to improve quality or reduce costs, but [also] understand the level of investment, the right level of investment and [whether] the returns are reasonable. So, it's kind of just balancing those two worlds.
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