Research & Resources

Survey: Healthcare Finance, Reform
Top Issues Confronting Hospitals in 2014

View the 2014 Top Issues press release.

Financial challenges again ranked No. 1 on the list of hospital CEOs' top concerns in 2014, according to the American College of Healthcare Executives' annual survey of top issues confronting hospitals. Healthcare reform implementation and governmental mandates ranked next in a tie for second, closely followed by patient safety and quality.

“The survey results show that these are challenging times for CEOs and leadership teams, and we are all expected to do more with less,” says Deborah J. Bowen, FACHE, CAE, president and CEO of ACHE. “Taking care of patients and improving patient safety and quality in their organizations is job No. 1, but CEOs acknowledge they must do so in a climate of complex payment reform, dwindling reimbursement and government mandates.”

In the survey, ACHE asked respondents to rank 10 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 1,118 community hospital CEOs who are ACHE members, of whom 338, or 30.2 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 2.5 2.4 2.5
Healthcare reform implementation 4.6 4.3 4.7
Governmental mandates 4.6 4.9 5.0
Patient safety and quality 4.7 4.9 4.4
Care for the uninsured/underinsured 5.5 5.6 5.6
Patient satisfaction 5.9 5.9 5.6
Physician-hospital relations 5.9 6.0 5.8
Population health management 6.8 7.6 7.9
Technology 7.3 7.9 7.6
Personnel shortages 7.4 8.0 8.0

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 = 338)1

Medicaid reimbursement (including adequacy and timeliness of payment) 69%
Bad debt (including uncollectable emergency department and other charges) 67%
Decreasing inpatient volume 63%
Medicare reimbursement (including adequacy and timeliness of payment) 57%
Competition from other providers (of any type—inpatient, outpatient, ambulatory care, diagnostic, retail, etc.) 55%
Government funding cuts (other than reduced reimbursement for Medicaid or Medicare) 55%
Increasing costs for staff, supplies, etc. 55%
Revenue cycle management (converting charges to cash) 39%
Managed care payments 37%
Other commercial insurance reimbursement 37%
Inadequate funding for capital improvements 32%
Emergency department overuse 26%
Other n=22

Healthcare Reform Implementation (n = 338)1

Reduce operating costs 78%
Shift to value-based purchasing 66%
Alignment of provider and payor incentives 65%
Align with physicians more closely 54%
Develop information system integrated with primary care MDs 48%
Regulatory/legislative uncertainty affecting strategic planning 47%
Study avoidable readmissions to avoid penalties 46%
Hire one or more primary care physicians 35%
Obtain funding from the American Recovery and Reinvestment Act for electronic records (meaningful use) 32%
Study avoidable infections to avoid penalties 26%
Other n = 17

Governmental Mandates (n = 338)1

CMS audits (RAC, MAC, CERT) 80%
Implementation of ICD-10 68%
CMS regulations 64%
State regulations 34%
Increased government scrutiny (e.g., IRS, Sarbanes-Oxley Act) 32%
Other n = 35