The Internal Revenue Service has been facing staffing and budget cutbacks that threaten its ability to carry out its responsibilities, which include overseeing the troubled nonprofit hospital sector.

The report, released earlier this month by the Treasury Inspector General for Tax Administration in response to a request in 2023 from four senators, found that “vague and outdated guidance” is creating challenges for oversight of tax-exempt hospitals. TIGTA noted that the Affordable Care Act requires the IRS to evaluate the community benefit activities of tax-exempt hospitals at least once every three years. In response, the IRS created a group to conduct compliance reviews, known as Community Benefit Activity Reviews, to make sure hospitals adhere to the federal requirements to maintain their tax-exempt status.

Revenue Ruling 69-545 outlines the community benefit standard applicable to tax-exempt hospitals and includes examples of six factors that can demonstrate a tax-exempt hospital’s community benefit. But the vague definition of community benefit makes it hard for both hospitals and the IRS to determine if hospitals are offering enough community benefits to justify their tax exemption. 

Other factors, including whether a hospital provides financial assistance to those unable to pay, are relevant in determining whether a hospital is providing a benefit to the community, the report noted. However, the Internal Revenue Code doesn’t specify what eligibility criteria or level of assistance provided is considered to be adequate for a financial assistance policy to meet the statutory requirements. “Vague or unclear eligibility criteria could potentially cause confusion for patients and inconsistent application of the requirements across hospitals,” said the report.

In April 2022, the IRS revised the scope of its CBARs to focus only on the Affordable Care Act’s statutorily required community benefit standard. As a result, examination referrals dropped 98% from fiscal years 2022 through 2024. 

To address the reduced amount of oversight due to the streamlined CBAR process, the IRS implemented a compliance strategy that aimed to identify potential noncompliance by tax-exempt hospitals. Using the IRS’s data, TIGTA did an analysis of the available filing information to identify tax-exempt hospitals potentially subject to the CBARs and compared it to the IRS’s population of tax-exempt hospitals. TIGTA identified 142 missing tax-exempt hospitals that the IRS should have included in its population but weren’t identified or reviewed. In addition, the IRS excluded 14 governmental unit and 13 church-affiliated hospitals from the population for other reasons. 

TIGTA made four recommendations in the report, suggesting the Treasury Department’s Office of Tax Policy consider a legislative proposal to amend Section 501 of the Internal Revenue Code and any other required provisions of law to define the community benefit standard and establish baseline criteria for tax-exempt hospital financial assistance policy eligibility. TIGTA also recommended the IRS should update its guidance to include reasons for excluding dual status governmental unit and certain church-affiliated hospitals from the CBARs because they are statutorily mandated. The IRS agreed with all four of TIGTA’s recommendations and plans to implement corrective actions.

“The IRS appreciates TIGTA’s analysis and the opportunity to consider improvements in the tax administration of tax-exempt hospitals,” wrote Robert Choi, acting commissioner of the IRS’s Tax-Exempt and Government Entities Division. He pointed out that the Government Accountability Office agreed with TIGTA that Congress should consider specifying in the Internal Revenue Code what services and activities it considers sufficient community benefit to improve the IRS’s ability to oversee tax-exempt hospitals.That would enable the IRS to issue updated regulations that provide more specific guidance. 

However, the IRS will likely face difficulties given the cuts in its staffing and budget in carrying out such oversight. The Trump administration has also emphasized deregulation rather than increased regulation, and the Supreme Court’s decision last year in the Loper Bright case may also constrain its regulatory abilities. Nevertheless, complaints have mounted about tax-exempt hospitals not providing adequate services to their communities. The TIGTA report notes that in 2022, 2,987 (49%) of 6,120 hospitals nationwide were nongovernment, nonprofit hospitals. According to an analysis of Medicare cost reports, 2,927 nonprofit hospitals received $37.4 billion in tax benefits in 2021. However, in 2023, according to the Lown Institute, out of 1,773 nonprofit hospitals it evaluated, 77% spent less on charity care and community investment than the estimated value of their tax breaks.

Cloud ERP provider Acumatica has been acquired by private equity firm Vista Equity Partners, which specializes in enterprise software, data and technology-enabled businesses. 

“Our partnership with Vista not only marks a significant milestone in Acumatica’s history but also is a strong endorsement of the real-world value we deliver to the market and our customers,” said Acumatica CEO John Case. “Vista’s investment can help power our AI-first product strategy and further strengthen our thriving Community of partners, developers and customers, working together to find better ways to work and redefine business management software for everyone. With Vista’s support and track record of growing software companies, we believe we’re positioned to accelerate product development, deepen partner engagement and extend our impact.”

Vista will acquire Acumatica from EQT, which will no longer be an investor in the company. 

The specific terms of the transaction were not disclosed. Monti Saroya, senior managing director and co-head of Vista’s Flagship Fund, said Acumatica is well positioned to take advantage of recent shifts in modern ERP solutions. 

“Acumatica is an ascendant, cloud-native ERP platform that has become a leading provider of mission-critical tools that enable small and mid-sized businesses to run more efficiently and effectively,” said Saroya. “With its industry-leading, strong partner ecosystem and growing presence in markets embracing cloud-based business technology, we believe Acumatica is well-positioned to lead the shift toward modern, integrated ERP solutions.”

Acumatica has been focusing heavily on AI over the past few years and especially so this year. The company recently rolled out its spring update, which offered enhanced AI features as well as more industry-specific solutions, part of the company’s move away from strictly back-office functions to become a comprehensive business platform. In January, the company announced its AI Studio, as well as new features for its AI Lab, updates that align with Acumatica’s AI-first product strategy, which involves looking at business problems from the ground up and then determining how applied AI can address problem scenarios.

Moelis & Company served as financial advisor to Acumatica on the deal. Simpson Thacher & Bartlett LLP acted as legal counsel to Acumatica, and Greenberg Traurig LLP served as legal counsel to Vista.

Markets are as unpredictable as ever. One week brings optimism, and the next, uncertainty takes over. Between inflation concerns, shifting trade policies and inconsistent buying behavior, one thing is clear: volatility is the new normal.

As a CFO, I know firsthand how accounting and finance teams are asked to do more with less when the market wobbles. Expectations rise, visibility shrinks and decisions carry more weight. But this isn’t a time to retreat; this is a time to lead. Accountants in particular are being asked to step outside their traditional roles, going beyond compliance to bring more insight, agility and strategic value.

Is your accounting team still seen as a traditional back-office function, or are they driving real impact at the center of business decision-making? Here are three ways accountants can shift from support role to strategic force, helping organizations stay profitable, predictable and well-positioned, no matter what the market brings.

1. Start at the source: sales

Revenue starts long before it hits the ledger. But that doesn’t mean accountants should wait on the sidelines. Especially in services businesses where margins are tight and people are the product, accounting can, and should, get involved earlier in the sales process.

Helping shape pricing models, validate margins and confirm delivery costs ensures your company is closing profitable deals. Left unchecked, discounting habits and poorly scoped projects can erode margin before the work even begins.

AI is making this type of involvement more accessible. Tools that analyze historical bid data can suggest optimal pricing and help avoid unnecessary concessions. For instance, if sales instinctively offers a 20% discount, data may show a 5% reduction would’ve closed the deal. When that insight is applied at scale, the impact on profitability is significant. Accountants are the experts best equipped to drive that discipline.

2. Fix the handoff from sales to delivery

In theory, the transition from sales to delivery should be seamless. In practice, it’s a common source of margin loss. Missing scope items, mismatched rate cards and vague assumptions can trigger change orders, billing disputes or even client dissatisfaction.

This is where today’s accountants can be instrumental, not just in reconciling revenue after the fact, but in helping prevent leakage before it happens. By advocating for accurate project setup, enforcing controls over rate use, and identifying gaps in scope or delivery assumptions, you can bring structure to a phase that’s historically been a bit chaotic.

Invoicing is another area where accountants make or break cash flow. Manual processes, delays in approvals and spreadsheet-driven billing often lead to late invoices and slower collections. Automation shortens the billing cycle, reduces disputes and improves cash predictability. Speed matters, but what really drives value is confidence in your numbers.

3. Build more accurate forecasts with an accountant’s lens

Cash flow forecasting is part art, part science. In volatile markets, the margin for error is small. Most forecasts assume customers pay on time and expenses follow plan, but the real world rarely works that way.

Modern accounting teams are being asked to deliver sharper forecasts based on behavior, not just assumptions. AI can now analyze payment histories and customer patterns to predict actual payment timing, flagging risks before they affect liquidity. It can also suggest tactical changes, such as offering split invoicing or switching to electronic payments to accelerate cash.

This kind of insight allows you to advise your business leaders with greater confidence. When to invest. When to hold back. How to plan for best- and worst-case scenarios. Especially in unpredictable markets, that level of precision becomes a huge competitive advantage.

Embrace your role as a strategic partner

We’ve entered an era where profitable growth matters more than growth at all costs. That shift puts finance front and center. Accountants have moved well beyond compliance to become central to how organizations stay agile, make smarter decisions and protect profitability.

In uncertain economic environments, businesses look for solid ground. And time and again, it’s accountants who provide it. From reconciling revenue to advising leadership on where and when to invest, the accounting function has evolved from a back-office operation into a front-line driver of performance — offering both operational clarity and strategic stability when it’s needed most. Now is the time to keep leaning in on that.