Insights
Notes for finance leadership
Short pieces on operations, capital, Medicaid policy, quality, and the reports behind them, written for CFOs, controllers, and boards.
Capital
August 2026 · 6 min
Model the capital before you approve the drawing
Campus projects fail in the sources-and-uses, not in the renderings. Tie debt, covenants, and operations together before the board votes.
Medicaid
August 2026 · 6 min
Medicaid policy only works if operations can run it
Waivers, capitation, and supplemental payments fail when the budget office, CMS, and the provider are looking at three different pictures of the same dollar.
Skilled nursing
August 2026 · 6 min
Staffing hours on the cost report and the Five-Star rating
Nursing hours that cannot be rebuilt from payroll will fail both the star rating and the wage-index worksheet. Keep them in one file.
Hospitals
July 2026 · 7 min
CAH election and what it does to the plant
Cost-based payment looks simple until swing beds, method II, and the 96-hour rule meet the hospital you actually run.
FQHC
June 2026 · 5 min
Using UDS with the FQHC cost report
Patient mix, visit productivity, and enabling services show up in UDS first. The cost report and the 330 budget should match that picture.
Senior living
May 2026 · 6 min
CCRC debt covenants and related entities
Entrance fees, management agreements, and the SNF under the independent-living tower are where debt compliance usually breaks.