CHICAGO Jan. 25, 2019—Financial challenges again ranked No. 1 on the list of hospital CEOs’ top concerns in 2018, according to the American College of Healthcare Executives’ annual survey of top issues confronting hospitals. Governmental mandates and patient safety and quality both ranked second. Personnel shortages ranked third.
“The overriding concern of hospital executives is to assure safe and high quality care,” says Deborah J. Bowen, FACHE, CAE, president and CEO of ACHE. “The survey results indicate that leaders are working to overcome challenges of balancing limited reimbursements against the rising costs of attracting and retaining talented staff to provide that care, among other things. Also of particular note in this year’s survey is the high rank given to addressing behavioral health and addiction issues, as well as concerns about the availability of affordable medications.”
In the survey, ACHE asked respondents to rank 11 issues affecting their hospitals in order of how pressing they are and to identify specific areas of concern within each of those issues. Following are some key results from the survey, which was sent to 1,402 community hospital CEOs who are ACHE members, of whom 355, or 25 percent, responded. The issues cited by survey respondents are those of immediate concern and do not necessarily reflect ongoing hospital priorities.
|
Issue |
2018 |
2017 |
2016 |
|
Financial challenges |
2.8 |
2.0 |
2.7 |
|
Governmental mandates |
5.1 |
4.2 |
4.2 |
|
Patient safety and quality |
5.1 |
4.9 |
4.6 |
|
Personnel shortages |
5.2 |
4.5 |
4.8 |
|
Behavioral health/addiction issues |
5.3 |
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|
Patient satisfaction |
6.1 |
5.5 |
5.5 |
|
Access to care |
6.2 |
5.9 |
5.8 |
|
Physician-hospital relations |
6.6 |
5.9 |
5.9 |
|
Technology |
7.7 |
7.0 |
7.2 |
|
Population health management |
8.1 |
7.3 |
6.6 |
|
Reorganization (e.g., mergers, acquisitions, restructuring, partnerships) |
8.3 |
7.5 |
7.8 |
|
The average rank given to each issue was used to place the issue in order of how pressing they are 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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Within each of these 10 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 (n=355)1 |
All respondents |
|
Increasing costs for staff, supplies, etc. |
70% |
|
Medicaid reimbursement (including adequacy and timeliness of payment, etc.) |
68% |
|
Reducing operating costs |
59% |
|
Bad debt (including uncollectable emergency department and other charges) |
56% |
|
Competition from other providers (of any type—inpatient, outpatient, ambulatory care, diagnostic, retail, etc.) |
50% |
|
Managed care and other commercial insurance payments |
50% |
|
Medicare reimbursement (including adequacy and timeliness of payment, etc.) |
49% |
|
Government funding cuts (other than reduced reimbursement for Medicaid or Medicare) |
48% |
|
Transition from volume to value |
48% |
|
Revenue cycle management (converting charges to cash) |
43% |
|
Inadequate funding for capital improvements |
37% |
|
Emergency department overuse |
31% |
|
Moving away from fee-for-service |
30% |
|
Pricing and price transparency |
29% |
|
Other |
n = 17 |
|
1If number of respondents is fewer than 50, only numbers are provided. |
|
|
Governmental Mandates (n=355)1 |
All respondents |
|
CMS regulations |
70% |
|
Regulatory/legislative uncertainty affecting strategic planning |
61% |
|
Cost of demonstrating compliance |
59% |
|
State and local regulations/mandates |
50% |
|
CMS audits (RAC, MAC, CERT) |
46% |
|
Other |
n = 17 |
|
1If number of respondents is fewer than 50, only numbers are provided. |
|
|
Patient safety and quality (n=355)1 |
All respondents |
|
High price/insufficient reimbursement for medications |
57% |
|
Engaging physicians in improving the culture of quality/safety |
56% |
|
Engaging physicians in reducing clinically unnecessary tests and procedures |
51% |
|
Redesigning care processes |
50% |
|
Lack of availability of medications |
45% |
|
Redesigning work environment to reduce errors |
40% |
|
Public reporting of outcomes data (including being transparent, fairness of measures, reporting burden) |
39% |
|
Compliance with accrediting organizations (e.g., Joint Commission, NCQA) |
37% |
|
Pay for performance |
32% |
|
Leapfrog demands (i.e., computerized physician order entry, ICU staffing by trained intensivists and evidence-based hospital referral—moving patients to facilities that perform numerous surgeries or treat high-risk neonatal conditions) |
31% |
|
Medication errors |
14% |
|
Other |
n = 4 |
|
1If number of respondents is fewer than 50, only numbers are provided. |
|
echess@ache.org