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Financial challenges again ranked No. 1 on the list of hospital CEOs’ top concerns in 2019, according to the American College of Healthcare Executives’ annual survey of top issues confronting hospitals. This survey, sent each fall to community hospital CEOs who are ACHE members, asked respondents to rank 11 issues affecting their hospitals in order of how pressing they are and to identify specific concerns within each of those issues. The survey was sent to 1,481 community hospital CEOs, of whom 395, or 27 percent, responded. This year, respondents cited financial challenges as their top concern, giving it an average rank of 2.7 on an 11-point scale. Personnel shortages ranked second with an average rank of 4.6. Behavioral health/addiction issues ranked third, with an average rank of 5.0. The survey results are shown at right and below.
ACHE wishes to thank the hospital CEOs who responded to this survey for their time, consideration and service to their profession and to healthcare management research.
|
Issue |
2019 |
2018 |
2017 |
|
Financial challenges |
2.7 |
2.8 |
2.0 |
|
Personnel shortages |
4.6 |
5.2 |
4.5 |
|
Behavioral health/addiction issues |
5.0 |
5.3 |
--- |
|
Governmental mandates |
5.2 |
5.1 |
4.2 |
|
Patient safety and quality |
5.3 |
5.1 |
4.9 |
|
Access to care |
5.9 |
6.2 |
5.9 |
|
Patient satisfaction |
6.3 |
6.1 |
5.5 |
|
Physician-hospital relations |
7.1 |
6.6 |
5.9 |
|
Technology |
7.7 |
7.7 |
7.0 |
|
Population health management |
8.1 |
8.1 |
7.3 |
|
Reorganization (e.g., mergers, acquisitions, restructuring, partnerships) |
8.7 |
8.3 |
7.5 |
|
The average rank given to each issue was used to place the issue in order of how pressing they are to hospital CEOs, with the lowest numbers indicating the highest concerns. The survey was confined to CEOs of community hospitals (nonfederal, short-term, nonspecialty hospitals). |
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Within each of these 11 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=395)1 |
|
|
Increasing costs for staff, supplies, etc. |
76% |
|
Medicaid reimbursement (including adequacy and timeliness of payment, etc.) |
71% |
|
Bad debt (including uncollectable emergency department and other charges) |
60% |
|
Reducing operating costs |
56% |
|
Managed care and other commercial insurance payments |
54% |
|
Medicare reimbursement (including adequacy and timeliness of payment, etc.) |
54% |
|
Competition from other providers (of any type—inpatient, outpatient, ambulatory care, diagnostic, retail, etc.) |
51% |
|
Transition from volume to value |
48% |
|
Government funding cuts (other than reduced reimbursement for Medicaid or Medicare) |
47% |
|
Revenue cycle management (converting charges to cash) |
45% |
|
Inadequate funding for capital improvements |
42% |
|
Pricing and price transparency |
37% |
|
Moving away from fee-for-service |
32% |
|
Emergency department overuse |
24% |
|
Other |
N=27 |
|
1 If number of respondents is fewer than 50, only numbers are provided. |
|
|
Personnel shortages (n=395)1 |
|
|
Registered nurses |
73% |
|
Primary care physicians |
61% |
|
Technicians (e.g., medical technicians, lab technicians) |
61% |
|
Physician specialists |
55% |
|
Therapists (e.g., physical therapists, respiratory therapists) |
39% |
|
Physician extenders and specially certified nurses (physician assistants, nurse practitioners, certified nurse midwives, etc.) |
24% |
|
Other |
N=66 |
|
1 If number of respondents is fewer than 50, only numbers are provided. |
|
|
Behavioral health/addiction issues (n=395)1 |
|
|
Lack of appropriate facilities/programs in community |
81% |
|
Lack of funding for addressing behavioral health/addiction issues |
73% |
|
Insufficient reimbursement specifically for behavioral health/addiction services |
67% |
|
High volume of opioid addiction and related conditions |
56% |
|
Legal/regulatory framework limiting treatment options |
35% |
|
Other |
N=9 |
|
1 If number of respondents is fewer than 50, only numbers are provided. |
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