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. This survey, sent each fall to community hospital CEOs who are ACHE members, asked respondents to rank 11 issues affecting their hospitals in order of how pressing they are and to identify specific concerns within each of those issues. The survey was sent to 1,402 community hospital CEOs, of whom 355, or 25 percent, responded. This year, respondents cited financial challenges as their top concern, giving it an average rank of 2.8 on a 10-point scale. Governmental mandates and patient safety and quality both ranked second, with average ranks of 5.1. Personnel shortages ranked third, with an average rank of 5.2. The survey results are shown below.
ACHE wishes to thank the hospital CEOs who responded to this survey for their time, consideration, and service to their profession and to healthcare management research.
|
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 |
--- |
--- |
|
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, non specialty 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. |
|