Top Issues Confronting Hospitals: 2009
View the 2009 Top Issues press release.
Financial challenges ranked No. 1 on the list of hospital CEOs’ top concerns in 2009, making it their No. 1 issue for the last five years, according to the American College of Healthcare Executives’ (ACHE) annual survey of top issues confronting hospital CEOs.
The survey, which is sent each fall to hospital CEOs who are ACHE members, asked respondents to rank 13 issues affecting their hospitals in order of importance and to identify specific areas of concern within their top three issues. Following are the results of the survey, which was sent to 1,275 hospital CEOs in October and November 2009, of whom 525, or 41 percent, responded.
This year, 76 percent of respondents cited financial challenges as their top concern, which is similar to results obtained in 2008. Implementation of healthcare reform, an issue newly introduced in the 2009 survey, was cited by 53 percent of respondents, making it the No. 2 concern. Care for the uninsured ranked No. 3 as in 2008, cited by 37 percent of respondents.
| Issue |
2009 |
2008 |
2007 |
| Financial challenges |
76% |
77% |
70% |
| Healthcare reform implications |
53% |
NA |
NA |
| Care for the uninsured |
37% |
41% |
38% |
| Patient safety and quality 1 |
32% |
43% |
NA |
| Governmental mandates |
30% |
26% |
22% |
| Physician-hospital relations |
25% |
32% |
35% |
| Patient satisfaction |
15% |
22% |
17% |
| Personnel shortages |
13% |
30% |
30% |
| Capacity |
7% |
16% |
11% |
| Technology |
7% |
9% |
8% |
| Governance |
2% |
NA |
NA |
| Disaster preparedness2 |
1% |
1% |
1% |
| Issues about not-for-profit status |
1% |
2% |
4% |
| Patient safety |
NA |
NA |
29% |
| Quality |
NA |
NA |
33% |
1Starting in 2008, this issue comprises both patient safety and quality. In prior years, they were two unique issues.
2In 2008 this issue was broadened and changed from “biodisaster” to “disaster” preparedness.
Within each of their three top issues, respondents identified specific concerns facing their hospital. Following are those concerns in order of importance for the top three issues identified in the survey:
Financial Challenges (n=393)
| Medicaid reimbursement |
87% |
| Bad debt |
80% |
| Medicare reimbursement |
78% |
| Increasing costs for staff, supplies, etc. |
72% |
| Inadequate funding for capital improvements |
64% |
| Managed care payments |
47% |
| Other commercial insurance reimbursement |
46% |
| Revenue cycle management (converting charges to cash) |
45% |
| Emergency department |
43% |
| Competition from specialty hospitals |
25% |
| Other |
10% |
Healthcare Reform Implications (n=275)
| Reduced reimbursement as a result of: |
| Reduction in Medicare reimbursement |
91% |
| “Public option” |
83% |
| Bundling payments instead of fee for service |
80% |
| Tax on “Cadillac”-type plans |
25% |
| Other |
11% |
| Increased demand for services such as: |
| Queues for emergency services |
46% |
| Queues for preventive care (e.g., mammography) |
29% |
| Access to primary care* |
5% |
| Other |
2% |
| Reduced quality of care: |
| Less innovation in diagnosis and treatment |
40% |
| Standardized (“cookbook”) medical protocols |
35% |
| Other |
9% |
Care for the Uninsured (n=187)
| Medicaid |
91% |
| Advocacy for funding |
79% |
| Underwriting costs |
61% |
| Reaching out to all community members |
34% |
| Response to other hospital closings |
11% |
| Increasing numbers* |
6% |
| Emergency department overuse* |
5% |
| Other |
3% |
*This item was derived from written-in responses. Frequencies for this variable should be taken as an underestimate of perceived importance.
