Top Issues Confronting Hospitals: 2011
View the 2011 Top Issues press release.
Financial challenges again ranked No. 1 on the list of hospital CEOs' top concerns in 2011, making it their No. 1 concern for the last eight years, according to the American College of Healthcare Executives' (ACHE's) annual survey of top issues confronting hospitals. Healthcare reform implementation was again the No. 2 concern, as it has been since it was introduced to the survey in 2009. Patient safety and quality ranked third, edging out governmental mandates by a small margin.
“With healthcare reform still unfolding, it's not surprising that financial challenges, healthcare reform implementation and patient safety and quality are top of mind for CEOs,” says Thomas C. Dolan, PhD, FACHE, CAE, president and CEO of ACHE.
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 1,294 community hospital CEOs who are ACHE affiliates of whom 514, or 40 percent, responded. For 2011 the issues in the following table are listed by the average rank given to each issue, with the lowest numbers indicating the highest concerns.
| Issue | 20111,2 |
20103 | 20093 |
| Financial challenges | 2.5 | 77% | 76% |
| Healthcare reform implementation4 |
4.5 | 53% | 53% |
| Patient safety and quality |
4.6 | 31% | 32% |
| Governmental mandates | 4.6 | 32% | 30% |
| Care for the uninsured | 5.2 | 28% | 37% |
| Physician-hospital relations | 5.3 | 30% | 25% |
| Patient satisfaction | 5.6 | 16% | 15% |
| Technology | 7.2 | 10% | 7% |
| Personnel shortages | 7.4 | 11% | 13% |
| Creating an accountable care organization |
8.4 | - | - |
| 1In 2011 the average rank given to each issue was used to place issues in order of concern to hospital CEOs, with the lowest numbers indicating the highest concerns. |
| 2In 2011 the survey was confined to CEOs of community hospitals (nonfederal, short-term, nonspecialty hospitals). |
| 3In 2010 and 2009, the percent of CEOs who named an issue among their top three concerns was used to place issues in order of concern to hospital CEOs. |
| 4In 2009 this issue was referred to as “implications of healthcare reform.” |
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 = 514)† |
| Medicaid reimbursement |
88% |
| Government funding cuts |
88% |
| Medicare reimbursement |
78% |
| Bad debt |
71% |
| Decreasing inpatient volume |
54% |
| Increasing costs for staff, supplies, etc. |
51% |
| Inadequate funding for capital improvements |
43% |
| Managed care payments |
38% |
| Other commercial insurance reimbursement |
35% |
| Emergency Department |
31% |
| Revenue cycle management (converting charges to cash) |
28% |
| Competition from specialty hospitals |
13% |
| Other | n = 34 |
| † If number of respondents is fewer than 50, only numbers are provided. |
| Healthcare Reform Implementation (n = 514)† |
| Reduce operating costs |
67% |
| Alignment of provider and payor incentives |
60% |
| Regulatory/legislative uncertainty affecting strategic planning |
55% |
| Align with physicians more closely |
54% |
| Develop information system integrated with primary care doctors |
51% |
| Study avoidable readmissions to avoid penalties |
45% |
| Obtain funding from the American Recovery and Reinvestment Act for electronic records |
40% |
| Hire one or more primary care physicians |
34% |
| Study avoidable infections to avoid penalties |
25% |
| Other | n = 7 |
| † If number of respondents is fewer than 50, only numbers are provided. |
| Patient Safety and Quality (n = 514)† |
| Engaging physicians in improving the culture of quality |
72% |
| Redesigning care processes |
58% |
| Pay for performance |
50% |
| Redesigning work environment to reduce errors | 43% |
| Non-payment for “never” events | 35% |
| Public reporting of outcomes data | 31% |
| Medication errors | 31% |
| Compliance with accrediting organizations e.g., JCAHO, NCQA | 30% |
| 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) | 29% |
| Nosocomial infections |
21% |
| Other | n = 5 |
| † If number of respondents is fewer than 50, only numbers are provided. |
