Why Month-End Is Too Late for Rural Healthcare Finance

Those improvements matter, especially for rural and community hospitals where every dollar carries weight. According to KFF, 44% of rural hospitals reported negative operating margins in 2023, compared to 35% of urban hospitals. When margins are that tight, any decision with a financial impact becomes much more important.  

But even when parts of the process get faster, many organizations are still waiting until the end of the month to fully understand what happened.  

The numbers that ultimately shape rural healthcare finance don’t appear out of thin air during the close process. After all, financial performance is shaped by countless moments throughout the month – patient volumes, staffing decisions, reimbursement activity, supply spending, and many more.  

Month-end is just when all of those moments that happen separately finally show up at the same time.  

The blurred vision caused by timing 

Now, if you ask any finance team, they’ll (hopefully) tell you they have enough information to work with. Where that information lives is another thing entirely.  

Reports, spreadsheets, dashboards, and systems all provide pieces of the story. For example, maybe overtime started to creep up in one or two departments. Maybe one of your suppliers raised prices unexpectedly. Or, maybe patient volume dropped in orthopedics.  

None of these things are unusual on their own. The problem is that they often take time to come into focus. And when they do, it might be difficult to make sense of what the numbers all mean, where they came from, what decision they’re tied to, and more importantly, how they shape your hospital’s future. 

Looking backwards is no way to drive 

For finance teams, there’s a familiar tension in all of this. The start of every month begins with questions about the previous month. That’s like keeping your eyes locked on the rear-view mirror.  

On the other hand, finance team members are trying to keep up with what’s already happening in the current month. That’s view from the windshield. 

In both cases, the challenge is pulling everything together quickly to provide enough information to do something with it while there’s still time. 

The organizations making progress aren’t necessarily dealing with fewer issues. They certainly haven’t figured out how to add more time in a day (trust us, we asked). 

These organizations have simply found ways to understand what’s happening long before it’s time to flip the calendar from one month to the next.  
 
Let’s look at two examples: Crawford Memorial Hospital in Robinson, Illinois and Montgomery County Memorial Hospital + Clinics (MCMHC) in Red Oak, Iowa. 

Two steps forward, one step back

Crawford Memorial Hospital experienced something many finance leaders know well. Its close process took roughly two weeks. Reporting for month-end didn’t begin until the close process was complete. As Michael Cheesman, Finance Director at Crawford Memorial Hospital, explained, “Before Multiview, we had to wait until after month-end was done to even start reporting.”  

You can immediately picture what that sequence looks like. Meanwhile, the activity around the hospital is already underway for the next month. That means everyone’s attention shifts to the next thing on the priority list. 

Creating a financial picture one number at a time  

Montgomery County Memorial Hospital + Clinics (MCMHC) faced a different obstacle. Financial, clinical, and operational information lived across multiple systems. Revenue data took time to flow into the general ledger, making it difficult to assemble a complete picture when it was needed. “We were closing the books with one hand tied behind our back,” noted Bryant Blay, CFO at MCMHC. 

For finance leaders, that phrase summarizes how much effort it takes to bring information together before you can work with it. After all, the ability to have a clear view of what’s happening across the organization is where things really start to pick up. 

What leading hospitals are doing instead  

The experiences at Crawford Memorial Hospital and MCMHC may look different on the surface, but they point to the same idea. 

One organization was waiting for reporting to begin after the close process was complete. The other was spending valuable time bringing information together before it could be used. In both cases, finance teams were working hard to understand performance after the fact. 

In both cases, the teams at Crawford Memorial Hospital and MCMHC found ways to understand what’s happening closer to when it actually happens. 

That’s no small feat. When you break it down, the difference shows up in the pace each organization can operate at. 

Finance can see the impact on the bottom line the minute something happens. Department leaders can see what direction their numbers are trending. Discussions happen when they need to while the details are still fresh.  

Month-end still matters. The timing of it, though, matters more. The more opportunities and time there is to understand performance, the more confident everyone will be when they’re about to make a decision. 

Which brings us back to our rear-view mirror and windshield. 

The organizations that are best positioned to navigate an uncertain financial environment aren’t ignoring the rear-view mirror. They still need it. 

They’ve simply learned that what’s in front of them, looking through the windshield, deserves more attention. 

And when margins are tight, resources are limited, and every decision matters, that’s often the difference between reacting to performance and helping shape it. 

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