Financial Leadership
A farewell, with reflections on a 50-year career in healthcare finance
Published
July 31, 2025
2:55 pm
This month marks the 50th anniversary of my start in the healthcare industry. In August 1975, I began a job with Blue Cross and Blue Shield of Greater New York (now known as Empire Healthcare Services) as a Medicare cost report auditor, a position that impacted the final Medicare reimbursements for every hospital across the country.
Little did I know where this first job out of college would lead me.
At the time, Gerald Ford was the President of the United States, and the first Arab oil embargo happened only two years earlier, sending the country into a tailspin. Bill Gates and Paul Allen founded Micro-Soft (original name), the world population was a smidgen over 4 billion and, significantly, the Medicare and Medicaid programs were only nine-years old and growing more complicated by the day.
I had no idea at the time that over the next 50 years, I would be a hospital controller, a director of budget and reimbursement, a vice president of finance and CFO. And that would lead to my becoming an educator, teacher, trainer, lecturer, consultant and entrepreneur who would write four peer-reviewed books about the industry and several articles for hfm, all culminating in the inspiration to develop this Voice of Experience column over the past three years.
But my intent is not to tout my accomplishments: I only want to share my experience as a testament to what’s possible for those just beginning their careers in healthcare finance.
Leading with passion
The most important thing I learned over the years is that if you want to succeed — with integrity, with honesty and with honor — you need true passion.
Think back to the healthcare finance leaders who have been featured in this column. Each one exudes a deep passion for their jobs, their positions and their purpose.
But if you think you can’t achieve what they have, think again. You don’t need to get to where they are. You should only get to where you want to be, in response to the question, “Who do I want to be?”
Maybe it’s not the CFO job. Whatever it is, it should be the job that excites you, fulfills you and makes you happy every day.
In my career, after 20 years on the provider side of the healthcare finance table, I decided that I wanted to teach what I knew to a wider audience.
Although I had a full-time job as a hospital vice president of finance, I started teaching two-day classes for the HFMA, which led to more classes and eventually to my leaving the provider side and starting a training and consulting business. That led to teaching more classes and then, with a business partner, to the development of an industry-leading hospital budgeting, monitoring and reporting software system.
Along the way, I wrote my first book, Fundamentals of Healthcare Financial Management, First Edition 1999, which, to this day, is one of my proudest achievements. It’s a 350-page peer-reviewed account of a year in the life of a hospital vice president of finance written in a diary form, with graphs, charts and commentary.
Why did I do it? That’s not the question. The real question is: “Why couldn’t you do it, whatever it is. You just need to decide what it is for you, and you’ll find yourself on your way.
A farewell
I conceived of this Voice of Experience column more than three years ago to highlight the achievements and thoughts of highly placed and long-tenured hospital and healthcare CFOs. The hfm leadership team, to my delight, agreed with the premise.
On this, my 50th anniversary month, I am calling this column quits. But I don’t consider this to be the end of the road for me. Who knows what the future may bring? After all, I still have the passion to do more. Which brings me to my last piece of advice: Always keep your passion alive within you.
Favorite HFMA memory
In this column, I have always asked the long-standing members to share their favorite HFMA memories. But after 48 years of membership, with 38 of those years active in the HFMA, I can’t begin to choose one. There are so many.
So that led me to conclude I wouldn’t change a thing.
You may well feel the same way after so many years of active membership. But first, you have to get involved. I think you will find it’s one of the best decisions you ever made.
5 leadership tips from Steven Berger
1 Challenge yourself. Do not fall for the easy way out. Sure, it will be hard sometimes, but it is your job, your career, your passion and yours to decide. And if you do not give it your all, you won’t be making a true decision. Even if it’s beyond what you think you can do, decide what you want to accomplish and then develop plans to achieve the goal. You can do it!
2 Be unafraid to challenge others, especially your superiors. When you get into the room where decisions are made, speak up. Break through the group thinking. Be a truth-teller. Do not believe that your bosses always have the correct answers. Do your own research on the points to be discussed so you know the details. Never bluff or dissemble. If the facts tell you your boss is in error, don’t be afraid to speak up and present the facts respectfully and with confidence.
Your boss may overrule you, and that’s OK. But it’s also OK for you to speak up and make sure your boss is not missing something important. You actually have a responsibility to do so.
3 Always put the customer first. As financial leaders, you hold the purse strings. So, in budget meetings, where financial resources are finite, opt for customer-facing solutions first. Sure, every 20 years, the building will need a new boiler or roof, so plan for it. But prioritize the customers — your patients — above all else.
4 Actively volunteer for HFMA. Start at the chapter level with whatever committee you like. I have gained many fabulous friends across the nation from my HFMA involvement. And you can, too!
5 Plan your career … when you are ready. I recall the words of recently retired HCA CFO Bill Rutherford in a previous Voices of Experience column. Rutherford said that early in his career he had a boss/mentor who advised him to set short-, intermediate- and long-term professional goals — and to write them down. Why? Because that extra step lays a road map that is accessible over time.a To this day, Rutherford keeps that small notebook-sized paper in his wallet. One goal from 1991 was “Become the HCA CFO” — which shows the value of writing down your goals.”
In 1998, while still a hospital finance executive, I wrote down four little words “I want to teach.” And so it was — just as it can be for you.
