Today, our world is a different place, and that certainly holds true for the long-term post-acute care LTPAC realm. Business-as-usual no longer generates the depth and breadth of revenues that LTPAC facilities need to help ensure optimal resident outcomes and organizational sustainability. The coronavirus (COVID-19) pandemic has proven just how fleeting once-predictable revenues can be as external pressures negatively impact clients, vendors, business partners and others on whom facilities rely. Moreover, rising business costs, shifting compliance requirements and new regulations make it tougher than ever to maintain financial health while providing quality care that residents deserve.

In this new environment, financial professionals in LTPAC organizations – and controllers in particular – must think and act differently. Not only are new skills needed, but a new mindset is essential.

This blog examines the traditional role of controllers in LTPAC settings as a means to understanding how a more expansive controller role can evolve.

The Traditional LTPAC Controller

The experience, insights and expertise of a qualified controller are essential to maintaining current quality levels, ensuring profitability and enabling future growth.

Consider some of the most significant benefits that controllers offer LTPAC organizations:

• Accurate cash management: With tight profit margins and delayed cash flow in today’s health care environment, effective cash management is critical to operating vitality.
• Confidence when the time comes for independent audits: Many lenders require independent audits. That, in turn, requires skilled accountants to prepare for and provide accurate information to auditors to achieve successful outcomes.
• Accurate information that enables good decision-making: Skilled accountants are a must to ensure successful and timely information on financial performance and position. This information enables organizational leaders to make informed decisions.
• Safeguarding valuable assets: Controllers play a key role in safeguarding the revenue assets of an organization.
• Compliance: Controllers also are vital in the drive to achieve and maintain regulatory compliance.

If you work within the administrative arm of a LTPAC setting, then you likely have a fairly basic and functional idea of a controller’s role within the enterprise. What may surprise you is the breadth of responsibilities that fall under this position.

Consider the widely accepted daily duties of today’s LTPAC controller:

• Manage purchasing and accounts payable processes
• Manage vendor contracts
• Oversee and / or collaborate with the payroll staff or third-party service provider on payroll functions
• Manage cash flow (and provide management with weekly cash position and forecast)
• Communicate with bankers and / or lenders
• Oversee revenue cycle outcomes (e.g., collections, forecasting, bad debt)
• Maintain general ledger and account reconciliations (and complete necessary audit work papers)
• Develop and implement “best practice” systems and procedures for all accounting functions
• Maintain the organization’s accounting software application
• Compile financial statements for management, the board, lenders and any other designated third parties
• Provide supplemental reports as requested by management (e.g., analysis of budget variances, board required documents)
• Assist management with annual operating budget development
• Assist management with review of contracts as requested
• Advise management on any matters that are financial in nature
• Provide tax and cost report accountant(s) with trial balance and supplemental information as required to complete tax returns and Medicare / Medicaid cost reports
• Serve in an advisory capacity to the organization’s board and / or leadership team

As you can see, many crucial duties reside on a controller’s plate each day. Yet, as we mentioned in the Introduction, next-gen controllers need to know more, see more, do more, understand the organization holistically and proactively chart a strategic course forward. While it’s tough enough to identify, attract and retain an individual who possesses all the current requisite skills necessary for this position, it will be even more challenging to equip controllers for future demands.