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For immediate release

American College of Healthcare Executives Announces Top Issues Confronting Hospitals: 2013

CHICAGO, January 13, 2014—Financial challenges again ranked No. 1 on the list of hospital CEOs' top concerns in 2013, making it their No. 1 concern for the last 10 years, according to the American College of Healthcare Executives' annual survey of top issues confronting hospitals. Healthcare reform implementation ranked second and governmental mandates and patient safety and quality both ranked third.

“It is not surprising that financial challenges and health reform implementation are on the minds of hospital CEOs,” says Deborah J. Bowen, FACHE, CAE, president and CEO of ACHE. “In addition, both government mandates and patient safety remain top priorities as CEOs and leadership teams work hard to improve patient care and redesign care delivery as they face a challenging reimbursement climate.”

In the survey, ACHE asked respondents to rank 11 issues affecting their hospitals in order of importance and to identify specific areas of concern within each of those issues. Following are some key results from the survey, which was sent to 1,091 community hospital CEOs who are ACHE members of whom 388, or 36 percent, responded. The issues in the following table are listed by the average rank given to each issue, with the lowest numbers indicating the highest concerns.





Financial challenges 2.4 2.5 2.5
Healthcare reform implementation 4.3 4.7 4.5
Governmental mandates 4.9 5.0 4.6
Patient safety and quality 4.9 4.4 4.6
Care for the uninsured 5.6 5.6 5.2
Patient satisfaction 5.9 5.6 5.6
Physician-hospital relations 6.0 5.8 5.3
Population health management 7.6 7.9
Technology 7.9 7.6 7.2
Personnel shortages 8.0 8.0 7.4
Creating an accountable care organization 8.6 8.6 8.4

Within each of these 11 issues, respondents identified specific concerns facing their hospitals. Following are those concerns in order of mention for the top issues identified in the survey. (Respondents could check as many as desired.)

Financial Challenges (n = 388)1

Government funding cuts 85%
Medicaid reimbursement (including adequacy and timeliness of payment, etc.) 81%
Medicare reimbursement (including adequacy and timeliness of payment, etc.) 71%
Bad debt 67%
Decreasing inpatient volume 64%
Increasing costs for staff, supplies, etc. 50%
Competition from other providers 40%
Inadequate funding for capital improvements 39%
Revenue cycle management (converting charges to cash) 37%
Other commercial insurance reimbursement 35%
Managed care payments 34%
Emergency department 31%
Other n=14

Healthcare Reform Implementation (n = 388) 1

Reduce operating costs 72%
Alignment of provider and payor incentives 66%
Shift to value-based purchasing 60%
Align with physicians more closely 53%
Regulatory/legislative uncertainty affecting strategic planning 50%
Develop information system integrated with primary care MDs 45%
Study avoidable readmissions to avoid penalties 40%
Hire one or more primary care physicians 35%
Obtain funding from the American Recovery and Reinvestment Act for electronic records 27%
Study avoidable infections to avoid penalties 17%
Other n = 17

Governmental Mandates (n = 388) 1

CMS audits (RAC, MAC, CERT) 83%
Implementation of ICD-10 79%
CMS regulations 65%
State regulations 33%
Increased government scrutiny (e.g., IRS, Sarbanes-Oxley Act) 32%
Other n = 35

Patient Safety and Quality (n = 388) 1

Engaging physicians in improving the culture of quality 71%
Redesigning care processes 66%
Pay for performance 54%
Redesigning work environment to reduce errors 45%
Compliance with accrediting organizations (e.g., Joint Commission, NCQA) 29%
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
and high-risk neonatal conditions)
Medication errors 28%
Public reporting of outcomes data 28%
Nonpayment for “never events” 26%
Nosocomial infections 15%
Other n = 13


About the American College of Healthcare Executives

The American College of Healthcare Executives is an international professional society of more than 40,000 healthcare executives who lead hospitals, healthcare systems and other healthcare organizations. ACHE offers its prestigious FACHE® credential, signifying board certification in healthcare management. ACHE's established network of more than 80 chapters provides access to networking, education and career development at the local level. In addition, ACHE is known for its magazine, Healthcare Executive, and its career development and public policy programs. Through such efforts, ACHE works toward its goal of being the premier professional society for healthcare executives dedicated to improving healthcare delivery. The Foundation of the American College of Healthcare Executives was established to further advance healthcare management excellence through education and research. The Foundation of ACHE is known for its educational programs—including the annual Congress on Healthcare Leadership, which draws more than 4,000 participants—and groundbreaking research. Its publishing division, Health Administration Press, is one of the largest publishers of books and journals on health services management including textbooks for college and university courses.

Lisa M. Freund, FACHE
Vice President
Communications and Marketing
American College of Healthcare Executives
One North Franklin, Suite 1700
Chicago, IL 60606
(312) 424-9420