This article is sponsored by BMO Bank. In this Voices interview, Behavioral Health Business speaks with Imran Javaid, Managing Director of the Healthcare Finance Group at BMO Commercial Bank, to discuss the current challenges facing the healthcare industry. With a particular focus on the new federal mandate requiring 24/7 registered nurse (RN) coverage, Javaid shares his thoughts on how this rule may impact healthcare providers in light of the ongoing labor shortages, inflationary pressures, and the industry’s recovery from the COVID-19 pandemic.
Javaid also weighs in on the likelihood of the industry rule on RN coverage being amended or postponed, particularly in light of the recent U.S. presidential election. Additionally, he provides his perspective on the broader changes that healthcare providers may face and how the rules around eligibility for care might shift in the coming years.
The Changing Healthcare Landscape: Navigating RN Coverage
Behavioral Health Business: What life and career experiences do you most draw from in your role today?
Imran Javaid: I began my career in public accounting, which laid the foundation for my understanding of finance and business operations. From there, I transitioned into private equity finance, and eventually, I found my way into a commercial finance company that was just beginning to establish its healthcare group. Since then, I’ve been working in the healthcare space, focusing on providing capital to healthcare providers. My career journey has given me a unique perspective on how to approach deals—especially in healthcare—where it’s not just about the metrics, but about understanding where the value lies. Over the past 15 years, I’ve transitioned to working at commercial banks, where we focus on very specific lending criteria. But my philosophy has remained the same: it’s about finding creative solutions to get deals done, especially when you believe in the product and its potential.
In the healthcare sector, there are often situations where providers face challenges—whether it’s regulatory changes, labor shortages, or inflation—and you need to be agile to navigate those challenges. It’s about understanding the operational realities of a provider’s business and aligning that with financial strategies that make sense. That’s the approach I’ve taken throughout my career, and it continues to serve me well in my role today.
Behavioral Health Business: There’s a lot of attention being placed on the federal rule requiring 24/7 RN coverage in healthcare settings. What’s your perspective on the likelihood of this rule being amended or delayed, especially in light of the recent U.S. presidential election?
Imran Javaid: The federal mandate for 24/7 RN coverage in healthcare facilities, particularly skilled nursing facilities (SNFs), has been a significant point of concern for many in the industry. The rule was expected to roll out over the next few years, and it’s clear that it would place immense strain on providers, especially given the current labor shortages, inflationary pressures, and the lingering effects of the pandemic. There’s been widespread concern that the healthcare industry wouldn’t be able to meet these staffing requirements without exacerbating existing challenges, including financial strain.
The general expectation within the industry is that some of these rules, including the RN coverage mandate, will either be delayed or possibly not implemented at all. Many believe that the political landscape—specifically the election results—will have an impact on the regulatory environment. Some of these staffing-related rules are now expected to be rolled back significantly or not move forward at all. For many healthcare providers, particularly those in rural or underserved areas, this could be a relief, as it would buy them more time to address the underlying issues contributing to staffing shortages without facing the additional pressure of stringent new regulations.
This change reinforces the importance of healthcare finance solutions that are flexible and adaptive to these ongoing industry shifts. Providers need partners who understand how policy changes and regulatory developments directly affect their financial health.
Behavioral Health Business: With the ongoing nursing shortage, do you expect any changes to the ability to bring overseas nurses to the U.S.?
Imran Javaid: The nursing shortage is a complex issue, and one that goes beyond politics. While immigration, border security, and labor issues were prominent topics during the election cycle, the need for skilled labor, particularly nurses, is a challenge that transcends political boundaries. There have been longstanding programs that have facilitated the entry of overseas nurses to the U.S., and while the political climate may shift, I don’t anticipate major changes in the ability to bring nurses from abroad in the near future.
That said, the shortage of nurses—especially in rural and underserved areas—continues to be a pressing issue. Various industry groups, including those in healthcare, have lobbied for more opportunities to bring skilled workers, such as registered nurses, into the U.S. to address the gap. While some reports, such as the Mercer Group report, suggest that the nursing shortage may ease by 2028, I remain skeptical. The demand for healthcare services continues to grow, driven in part by the aging population and increased need for care. Given these trends, I believe that the nursing shortage will remain a critical issue in the foreseeable future.
This ongoing challenge will continue to drive the need for healthcare finance solutions that help providers navigate recruitment challenges, streamline costs, and support workforce development.
Behavioral Health Business: Medicare Advantage enrollment has been rising steadily. Will we see changes to the rules around eligibility or care in the coming years?
Imran Javaid: Medicare Advantage has seen consistent growth in enrollment, and I expect that to continue, albeit at a slower pace compared to the dramatic increases we’ve seen in recent years. Medicare Advantage has enjoyed bipartisan support across multiple administrations, so I anticipate that support will continue. However, as enrollment grows, providers are facing increased pressure. The key dynamic in Medicare Advantage is that it forces providers to deliver high-quality care at the lowest possible cost. While that’s the goal of the system, it can sometimes create financial stress for providers, particularly those trying to balance quality care with the need to meet cost-cutting requirements.
Ultimately, the providers who succeed in the Medicare Advantage landscape will be those who are able to deliver strong, value-driven care. It’s about being strategic, focusing on operational efficiency, and maintaining high standards of care. I believe that, over time, this dynamic will balance out. Providers that can offer both high-quality care and cost-effective solutions will remain competitive and ensure the sustainability of their operations in a Medicare Advantage environment. This makes healthcare finance solutions critical for providers to manage the balance between care quality and cost control.
BMO’s Approach to Navigating Healthcare’s Evolving Financial Landscape
Behavioral Health Business: In light of these challenges, how does BMO’s partnership approach help providers navigate the changing financial landscape?
Imran Javaid: At BMO, we take a very personalized approach to working with our healthcare clients. Of course, financial metrics like EBITDA are important, but we don’t stop there. We go beyond the numbers to understand the operational realities of a facility or group’s performance. By digging deeper into the key drivers behind a provider’s success or challenges, we are able to create tailored financial strategies that align with their goals. It’s about understanding the whole picture, not just the bottom line.
We also focus on building long-term relationships with our clients. We take the time to get to know our potential borrowers—whether they are seeking financing or already in a relationship with us. Our team of experts in healthcare lending is dedicated to this space, which allows us to offer more nuanced insights and advice. By focusing on healthcare exclusively, we understand the specific challenges providers face—whether it’s dealing with staffing shortages, adapting to regulatory changes, or managing financial pressures. This deep understanding of the healthcare industry allows us to help our clients navigate these challenges more effectively and find the best possible solutions.
By partnering with organizations to provide tailored healthcare finance solutions, BMO helps ensure that providers can remain financially resilient, even as they face regulatory changes and industry challenges.
Conclusion
The healthcare industry is undergoing significant transformation, driven by new regulatory mandates, staffing challenges, and changing reimbursement models. As providers face these ongoing pressures, it is crucial to have financial partners who truly understand the intricacies of the healthcare sector. BMO’s commitment to deep, personalized partnerships, coupled with their expertise in healthcare finance, positions them as a valuable ally for providers navigating this rapidly changing landscape. By focusing on more than just the numbers and understanding the operational needs of healthcare organizations, BMO helps providers chart a course toward long-term success, even in the face of uncertainty. In today’s healthcare environment, healthcare finance solutions that adapt to both market and regulatory changes are key to ensuring sustainable, high-quality care.
