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American College of Healthcare Executives Announces Top Issues Confronting Hospitals: 2010

CHICAGO, January 24, 2011—Financial challenges ranked No. 1 on the list of hospital CEOs’ top concerns in 2010, making it their No. 1 concern for the last six years, according to the American College of Healthcare Executives’ (ACHE’s) annual survey of top issues confronting hospital CEOs. Addressing concerns associated with healthcare reform ranked No. 2, similar to last year’s No. 2 issue “healthcare reform implications.” Concerns about governmental mandates moved to No. 3 on the list, up from No. 5 in 2009.

“Because health reform became a reality last year, it is not surprising that the importance of implementing reform has not only remained the No. 2 issue on CEOs’ minds but has also elevated the area of governmental mandates to CEOs’ No. 3 concern,” says Thomas C. Dolan, PhD, FACHE, CAE, president and CEO of ACHE.

In the survey, ACHE 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 some key results from the survey, which was sent to 1,399 hospital CEOs who are ACHE affiliates of whom 542, or 39 percent, responded. The issues in the following table are listed by the percentage of respondents who indicated it as one of the top three issues confronting their hospitals.

Issue 2010 2009 2008
Financial challenges 77% 76% 77%
Healthcare reform implementation1 53% 53%
Governmental mandates 32% 30% 26%
Patient safety and quality2 31% 32% 43%
Physician-hospital relations 30% 25% 32%
Care for the uninsured 28% 37% 41%
Patient satisfaction 16% 15% 22%
Personnel shortages 11% 13% 30%
Technology 10% 7% 9%
Capacity 6% 7% 16%
Governance 3% 2%
Issues about not-for-profit status 2% 1% 2%
Disaster preparedness3 < 1% 1% 1%
1 In 2009 this issue was referred to as “implications of healthcare reform.”
2 In 2008–2010 this issue was composed of both patient safety and quality. In prior years, they were two unique issues.
3 In 2008 this issue was broadened from “biodisaster” to “disaster preparedness.”

Within each of their three top 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.) Please note that because there were few responses to many of these issues, results are not generalizable to all ACHE affiliate hospital CEOs.

Financial Challenges (n = 414)
Medicaid reimbursement 88%
Medicare reimbursement 78%
Bad debts 70%
Increasing costs for staff, supplies, etc. 70%
Inadequate funding for capital improvements 63%
Managed care payments 51%
Other commercial insurance reimbursement 42%
Revenue cycle management (converting charges to cash) 37%
Emergency Department 30%
Competition from specialty hospitals 20%
Other n = 24
If number of respondents is fewer than 50, only numbers are provided.

Healthcare Reform Implementation (n = 284)
Reduce operating costs 86%
Align with physicians more closely 72%
Develop information system integrated with primary care doctors 65%
Obtain funding from the ARRA for EHRs 62%
Study avoidable readmissions to avoid penalties 61%
Hire one or more primary care physicians 46%
Study avoidable infections to avoid penalties 41%
Other n = 40
If number of respondents is fewer than 50, only numbers are provided.

Governmental Mandates (n = 132)
CMS audits (RAC, MAC) 92%
CMS regulations (including Patient Bill of Rights) 71%
Increased government scrutiny (e.g., IRS, Sarbanes-Oxley Act) 63%
Reporting of physician errors n = 42
HIPAA compliance n = 41
OSHA regulations n = 29
Other n = 29
If number of respondents is fewer than 50, only numbers are provided.

About the American College of Healthcare Executives
The American College of Healthcare Executives is an international professional society of more than 30,000 healthcare executives who lead hospitals, healthcare systems and other healthcare organizations. ACHE is known for its prestigious FACHE® credential, Congress on Healthcare Leadership conference, network of more than 80 chapters, educational offerings, publications, career development and public policy programs, and research. Based in Chicago, ACHE works toward its goal of being the premier professional society for healthcare executives dedicated to improving healthcare delivery.

For additional information, visit www.ache.org.


Kay A. Branz, CAE
Vice President
Communications and Marketing
American College of Healthcare Executives
One North Franklin, Suite 1700
Chicago, IL 60606
(312) 424-9420