By Joan Elizabeth Gee, Vice President and Financial Practice Leader at Tyler & Company with John N. Katsianis, CPA, Senior Vice President and CFO of DeKalb Medical Center in Atlanta

If the flip side of a challenge is an opportunity, then healthcare CFOs have a lot to be optimistic about. According to Becker’s Hospital Review, the top 10 challenges (or opportunities) facing hospitals1 this year relate to:

  1. Digesting health insurance exchanges  (decreased reimbursement, patient enlistment and high-deductible plan collections);
  2. Readying for ICD-10 going live (was Oct. 1, 2014; TBD as of April 2014);
  3. Leadership resource allocation given the organization’s scope of strategic projects;
  4. Keeping the organizational mission alive;
  5. Transparency with charges, prices and cost of care;
  6. Physician shortages;
  7. Patients’ access to care;
  8. Successful fundraising; 
  9. Workforce relations; and 
  10. C-suite retirement.

Peter Drucker, a management consultant and author, said, “The basic economic resource – the means of production – is no longer capital, nor natural resources, nor labor. It is and will be knowledge.”

After about a year at his new post at 628-bed DeKalb Medical Center in Atlanta, we asked  Tyler & Company alumnus, John N. Katsianis, CPA, Senior VP and CFO, to share his insight.

Gee: Please describe the landscape at DeKalb Medical Center when you joined.

Katsianis: When I joined DeKalb Medical Center in February 2013, the CEO (former COO who rejoined the organization in 2011) had recently rebuilt and restructured his team. Senior management (C-suite, senior VPs and VPs) totaled 11 members, most of whom had been with the organization fewer than two years.

Gee: What were some of your biggest challenges? 

Katsianis: Since the organization was struggling financially, my first challenge was to conduct a speedy evaluation of the accounts receivables system. Uncovering some of the system’s flaws led to a tough Q4 2013. But as we started making changes that better positioned the organization for financial success, we began to see improvement during Q1 of our 2014 fiscal year. 

Gee: What advice would you give to a CFO peer? 


  1. When it comes to your financial state, get to the bottom of what’s true. Focus on improving the revenue cycle, financial management and financial reporting.

  2. Devote yourself to relationship building. Build your credibility by making an effort in getting to know your team (especially your director- and administrator-level colleagues). Finance is a team sport, and it benefits others to know your intent is to improve the organization.

  3. Take time to work through any misunderstandings that exist in your organization. Bringing false perceptions to light can help everyone move forward, as well as help you lay a new foundation.

  4. Lead the charge within your organization so that it may gain confidence with its financial system.

  5. Empower your operations team so that it may make necessary changes. 

Gee: What is your response to changes in the healthcare market and its impact on hospital CFOs?

Katsianis: Medicare is underfunded. The government has limited options — either increase payroll tax to fund the actual cost of the program or cut costs. Encouraging patients and providers to reduce utilization and/or cut prices is the less political of those two options, in my opinion. CFOs need to embrace that driving toward more efficient operations will be a continual goal for the next decade. Learning to play by the rules and deciphering what will keep your organization alive are part of today’s CFO role. 

Gee: What has pleasantly surprised you about your position? 

Katsianis: When working through the process of interviewing for a new position, you always wonder — are these the people with and for whom I’ll actually work? (I’ve had experiences where this wasn’t true.) It brings me great pleasure to say and report — this time, it is. I work with an outstanding team of people.

Joan Elizabeth Gee, VP, chairs the firm’s Financial Leadership Practice. Her career spans more than 25 years, primarily in C-suite healthcare search. Her specialties include finance and accounting executive recruitment. Reach Gee at 770-396-3939 or

1 Gamble, Molly. “10 Challenges and Opportunities for Hospitals in 2014.” Becker’s Hospital Review. Dec. 16, 2013.