Rural CEOs Concerned about Doc Recruitment, Controlling Costs Not So Much

The HealthLeaders Media Industry Survey is always a highlight on our editorial calendar. The survey asks questions to healthcare stakeholders from seven areas: CEOs, CFOs, CIOs, physicians, marketing, health plans, and quality. We also take the results from the CEO survey and drill down deeper so we see how community and rural CEOs' answers correspond with non-rural CEOs.

For the 2010 survey, we found that there was surprisingly little disagreement between CEOs at non-rural hospitals compared with CEOs at rural and community hospitals about most issues. For instance, both ranked quality/patient safety, patient experience/patient satisfaction, and reimbursement as the two through fourth priorities for their organizations over the next three years. [See Question 5 of the Community and Rural survey.]

However, there were some disconnects. For instance, community and rural CEOs ranked physician recruitment and retention as their top priority. For non-rural CEOs, recruitment and retention was a distant fifth—with reducing costs seen as the No. 1 goal. Community and rural CEOs ranked cost reduction as their No. 6 goal.

The likely reason, non-rural hospitals usually don't have problems recruiting doctors to their facilities, but a hospital 200 miles from the nearest major city struggles to attract and keep doctors.

"Workforce issues are always going to be the No. 1 concern for rural hospital CEOs, and that's what makes rural hospitals unique," Alan Morgan, CEO of the National Rural Health Association, recently told my colleague Cheryl Clark about the findings.

Interestingly, cost is one area that community and rural hospitals are usually adept at keeping under control, as they are generally working as lean as possible. Additionally, Morgan said most rural hospitals are "dealing with low-volume patient care" and are more concerned about improving health access rather than controlling costs.

Our survey showed that most health leaders are disappointed with leadership in Washington, but community and rural hospital CEOs also see help on the way from the capital. Thirty-five percent of respondents said the federal stimulus package will have a positive impact, which is more than the 24% of non-rural CEOs. [Question 9.]

Moreover, nearly 63% of community and rural CEOs believe stimulus and the HITECH Act will have a positive influence on future business. That's compared to the 51% of non-rural CEOs who view the stimulus and HITECH Act positively. [Question 15.] Funding sources for rural hospitals are usually limited and, as these findings show, CEOs are viewing this possible infusion of funds as a rare shot in the arm.

These are just a few of the dozens of insightful findings gathered from this year's survey. Here are a handful more:

• Most community and rural CEOs disapprove of the job President Barack Obama, Congressional Democrats and Republicans, and Health and Human Services Secretary Kathleen Sebelius are doing with respect to healthcare reform. [See Question 7.]
• While community and rural CEOs largely disapprove of the job health plan leadership, drug makers, and device makers are doing regarding healthcare reform, they approve of the hospital industry leadership, industry lobbyists/associations, and the public.
• Only 30% of community and rural CEOs believe layoffs and staff reductions are effective in dealing with the economic crisis, which is lower than 43% of non-rural CEOs. Twenty-nine percent said that strategy has actually been ineffective, compared to slightly more than the 21% of non-rural CEOs. [See Question 13.]
• Instead, community and rural CEOs have had greater success with supply chain management improvements (82% effective), revenue cycle enhancements (76% effective), physician alignment (65% effective), emphasize high-margin services (61% effective), and cut capital spending (59% effective).

For a glimpse at other findings such as the top healthcare cost drivers [Question 17], the service lines with the most potential [Question 22], the personnel issues facing community and rural organizations [Question 27], and the total annual salary and bonus compensation packages for CEOs [Question 28] check out the full survey.

Explore these results and more in this year's survey, but I must warn you, once you start reading, analyzing, and comparing stakeholder responses, you won't be able to stop.