A survey from the American College of Healthcare Executives reaffirms the top issues affecting community hospital leaders. Among the top-of-mind issues: Government funding cuts, the shift to value-based purchasing, and CMS and state regulations.
For the tenth straight year "financial challenges" have been listed as the number one concern of healthcare executives, according to an annual survey from the American College of Healthcare Executives.
Coming in second was healthcare reform implementation, followed by government mandates, and patient safety and quality, both of which ranked third.
"You've heard the famous quote: No margin no mission. This just reflects the enormous stresses that hospitals are under right now," says Deborah J. Bowen, president/CEO of ACHE.
"Everybody is reducing operating costs and thinking differently about how they are going about moving from fee-for-service to these value-based payments where quality and finances are accounted for. It's not business as usual by any stretch of the imagination."
The 388 community hospital CEOs who responded to the survey were asked to rank 11 issues affecting their hospitals in order of importance and to identify specific areas of concern within each of those issues.
Among financial concerns, for example, government funding cuts ranked highest, led by inadequate reimbursements for Medicare and Medicaid, followed by an anticipated increase in bad debt due to high-deductible health plans, decreasing patient volumes, staffing costs, competition from other providers, and inadequate funding for capital improvements.
Within the healthcare reform rollout, the top issues were reduced operating costs, aligning incentives for payers and providers, the shift to value-based purchasing, physician alignment, and regulatory uncertainty.
Within the category of government mandates, the top concerns were CMS audits, implementation of ICD-10, CMS regulations, state regulations, and increase government scrutiny by the IRS, the Office of the Inspector General, and the Justice Department.
Patient safety and quality concerns included engaging physicians to improve the quality culture, redesigning care processes, pay for performance, and redesigning work environments to reduce errors.
Bowen concedes that the survey provided few surprises.
"What is a little interesting is this juxtaposition of government mandates and patient safety and quality and how the government mandates were high last year and patient safety and quality are even higher this year in terms of concerns and engaging physicians and redesigning care," she says.
"It speaks well to the fact that the industry is moving forward in their quest to redesign care, but they are painfully aware that the environment they are doing that in is fraught with other constraints that they have to be very realistic about."
Though void of surprises, Bowen says the survey provides a state-of-industry snapshot about the concerns of hospital leadership.
"It is pointing out some real concerns to grapple with," she says. "We've seen concerns around financial challenges. A lot of that has to do with Medicare funding and we all know the predicament that a lot of states were in with respect to funding Medicaid. In some respects that is not necessarily a new problem, but the magnitude is getting larger and larger as we seek to cover patients in growing numbers as Obamacare takes hold."
"We know that bad debt and everything else is going to get worse with high-deductible plans. In some respects it is more of the same, but the magnitude and the order of it might be changing somewhat," she says. "I also think there is promising news in the sense that patient safety and quality care are moving forward in a very challenging time."
Bowen says she doesn't expect the concerns of healthcare executives to shift much in next year's survey either.
"We won't see anything wildly different, but we will see some of the same themes, perhaps in a different order," she says. "Financial challenges have been on the top of the list for a long time because you have to have a certain amount of money to keep organizations afloat. It is interesting that patient safety and quality and redesigning care and engaging physicians are tops on the list. The order may shift a little bit but I don't think this is momentary transition. It's going to take a little while for accountable care to take hold and be the new paradigm for healthcare."
John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.