Previous Top Issues Reports
View convenient summaries of Top Issues Confronting Hospitals results from the last five years.
ACHE's Top Issues Survey identified the following challenges for hospitals
Financial challenges and workforce challenges both top the list of hospital CEOs’ concerns, according to the American College of Healthcare Executives’ annual survey of top issues confronting hospitals.
Sent in October 2024 to community hospital CEOs who are ACHE members, the survey asked respondents to rank 11 issues affecting their hospitals in order of how pressing they are and to identify specific concerns within each issue. The survey was sent to 1,297 community hospital CEOs, of whom 257, or 20%, responded.
For the first time in the survey’s history, financial challenges and workforce challenges tied as respondents’ top concern. Both received an average rank of 2.8 on an 11-point scale. Access to care ranked third with an average rank of 5.2. The survey results are shown below.
ACHE thanks the CEOs who responded to this survey for their time, consideration, and service to their profession and to healthcare leadership research.
| Issue | 2024 | 2023 | 2022 |
|---|---|---|---|
| Financial challenges | 2.8 | 2.6 | 2.8 |
| Workforce challenges (e.g., personnel shortages) | 2.8 | 2.3 | 1.8 |
| Access to care | 5.2 | 5.6 | 6.0 |
| Behavioral health/addiction issues | 5.6 | 5.3 | 5.2 |
| Governmental mandates | 5.7 | 5.7 | 5.9 |
| Patient safety and quality | 6.1 | 5.9 | 5.9 |
| Patient satisfaction | 6.8 | 6.4 | 6.6 |
| Technology | 7.0 | 7.3 | 7.7 |
| Physician-hospital relations | 7.5 | 7.6 | 7.6 |
| Population health management | 8.5 | 8.7 | 8.6 |
| Reorganization (e.g., mergers, acquisitions, restructuring, partnerships) | 9.3 | 9.3 | 8.7 |
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The average rank given to each issue was used to place the issue in order of how pressing it is to hospital CEOs, with the lowest numbers indicating the highest concerns. The survey was confined to CEOs of community hospitals (nonfederal, short-term, nonspecialty hospitals). |
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Specific Concerns Within the Top Issues
Within each of these 11 issues, respondents identified specific concerns facing their hospitals. Following are those concerns in order of mention for the top three issues identified in the survey. Respondents could check as many as desired.
| Financial Challenges | All respondents (n = 249) |
|---|---|
| Increasing costs for staff, supplies, etc. | 92% |
| Managed care and other commercial insurance payments | 71% |
| Reducing operating costs | 65% |
| Medicaid reimbursement (including adequacy and timeliness of payment, etc.) | 64% |
| Medicare reimbursement (including adequacy and timeliness of payment, etc.) | 62% |
| Inadequate funding for capital improvements | 59% |
| Revenue cycle management (converting charges to cash) | 52% |
| Bad debt (including uncollectable Emergency Department and other charges) | 48% |
| Government funding cuts (other than reduced reimbursement for Medicaid or Medicare) | 47% |
| Competition from other providers (of any type — inpatient, outpatient, ambulatory care, diagnostic, retail, etc.) | 42% |
| Emergency Department overuse | 33% |
| Transition from volume to value | 31% |
| Pricing and price transparency | 25% |
| Moving away from fee-for-service | 22% |
| Other (please specify) | (N = 45) |
| Workforce challenges (e.g., personnel shortages) | All respondents (n = 245) |
|---|---|
| Shortages of technicians (e.g., medical technicians, lab technicians) | 84% |
| Shortages of physician specialists | 73% |
| Shortages of registered nurses | 73% |
| Burnout among non-physician staff | 71% |
| Shortages of therapists (e.g., physical therapists, respiratory therapists) | 65% |
| Shortages of primary care physicians | 60% |
| Shortages of advanced practice professionals | 28% |
| Managing remote staff | 27% |
| Other (please specify) | (N = 40) |
| Access to care | All respondents (n = 253) |
|---|---|
| Access to behavioral/mental health counseling services | 75% |
| Rural health issues | 57% |
| Care for the uninsured | 55% |
| Access to primary care physicians | 54% |
| State Medicaid issues (expansion, waivers, etc.) | 54% |
| Underinsured/high deductibles, high co-pays | 54% |
| Insufficient clinical staff available to provide requested care in a timely way | 50% |
| Access to post-acute/home care/rehabilitation services | 49% |
| Advocacy for funding | 40% |
| Other (please specify) | (N = 10) |