Your hospital makes enterprise-sized decisions without an enterprise Decision Support team. We provide one.
Rural, critical access and community hospitals face the same questions as large systems: what a service line truly costs, which payer contract is underpaying and whether next year's budget will hold. We deliver the cost accounting, modeling and reporting to answer them, as a service.
WHERE WE HELP
Hospitals that need Decision Support but cannot staff it full time.
No one owns Decision Support
The hospital has an EHR, a general ledger and payroll, but no analyst or platform turning that data into cost and margin by service line.
A payer contract is up for renewal
Leadership suspects a contract is underpaying but cannot model the net revenue impact of the proposed terms before the negotiation.
Supplemental payments drive the margin
Medicaid, DSH and other supplemental programs make the difference between a loss and a break-even year, and the timing and filings are hard to manage with a small team.
New funding, new reporting
Rural Health Transformation funding created under the One Big Beautiful Bill Act brings applications, budgets and reporting obligations that a two-person finance office was not built to carry.
The board wants better answers
Board and finance committee members ask what a service costs, how the hospital compares with peers and what the forecast shows, and the monthly packet does not answer them.
Behavioral health cost reporting
Community behavioral health providers spend weeks each year assembling detailed state cost reports by hand.
WHAT WE DELIVER
Decision Support as a service
We host and operate a Decision Support platform for you, load your data each month and deliver the reports and dashboards leadership uses.
Cost accounting
True cost at the department, service line, procedure and patient level, built from direct and indirect costs.
Net revenue modeling
Commercial and governmental reimbursement terms translated into models that predict collections and the effect of payer mix and volume.
Payer contract analysis
Contract-by-contract performance and modeled scenarios that support your team in negotiation. Your leadership makes the decisions and leads the negotiation.
Benchmarking
Comparison with peer hospitals and with your own history to find efficiencies and areas for improvement.
Medicaid, DSH and supplemental payments
Review of cost reports and supplemental program filings, and forecasting of program timing so cash planning reflects reality.
Rural Health Transformation support
Application writing, budgets and the reporting structure behind Rural Health Transformation funding.
Budgeting and flex budgeting
Operating, capital and per-unit flexible budgets with variance analysis leadership can act on.
Board reporting
A monthly executive and board packet that explains performance in plain language, delivered on schedule.
DECISION SUPPORT PILOT
Up to five rural hospitals. Six to nine months.
Our pilot with Oi Health brings true cost accounting and a monthly executive packet to rural hospitals, with Ledger & Oak handling the implementation so the burden on hospital staff stays minimal.
HOW AN ENGAGEMENT WORKS
Prove the value first, then build a lasting partnership.
Assessment
We start with a focused review of your numbers, systems and the decision in front of you, and we tell you plainly what we would do and what it would take.
Project-based retainer
Work begins as a defined project or a modest retainer with monthly deliverables, so you see the value in your own numbers before any long-term commitment.
Ongoing partnership
Hospitals that continue move to an ongoing agreement sized to the scope of work, with clear terms, defined deliverables and regular review, so the commitment always reflects the value delivered.
THE DECISION SUPPORT DISCIPLINE
Our healthcare work is where the Decision Support discipline was formed: cost accounting, net revenue modeling, benchmarking and budgeting built inside hospital finance. Every other sector we serve uses the same methods.
Bring enterprise Decision Support to your hospital.
Tell us about your hospital, your systems and the decision in front of you. We will respond with how we would approach it.
FROM THE DESK OF OUR FOUNDER
Read the thinking behind the work.
Rural hospital data is worse than you think
What we learned building a Decision Support model for facilities the industry has overlooked.
Read on LinkedIn →The CHC CFO playbook
Turning the $50 billion Rural Health Transformation Program into real-time financial intelligence.
Read on Blackbaud →Solving the quiet problem
Turning your new financial infrastructure into true cost intelligence.
Read on Blackbaud →