CEOS’ most press­ing prob­lems

But fi­nan­cial chal­lenges re­main top con­cern in ACHE’S an­nual sur­vey

Modern Healthcare - - FRONT PAGE - Ashok Selvam

Last sum­mer’s U.S. Supreme Court rul­ing up­hold­ing the Pa­tient Pro­tec­tion and Af­ford­able Care Act ap­pears to have quelled some un­ease about the law for hospi­tal CEOs. Even though the im­ple­men­ta­tion of the re­form law is ac­cel­er­at­ing, “health­care re­form im­ple­men­ta­tion” dropped a spot to No. 3 among the most press­ing con­cerns for hospi­tal CEOs ranked in an an­nual sur­vey by the Amer­i­can Col­lege of Health­care Ex­ec­u­tives. Re­form switched places with “pa­tient safety and qual­ity,” which climbed to No. 2 this year.

The Chicago-based ACHE asked ex­ec­u­tives to rank a list of 11 chal­lenges and com­piled the list based on sur­vey re­sults from 472 ex­ec­u­tives from com­mu­nity hos­pi­tals across the coun­try. The re­spon­dents sent their an­swers in Oc­to­ber, which means the re­sults didn’t take into ac­count Pres­i­dent Barack Obama’s Novem­ber re-elec­tion.

“Fi­nan­cial chal­lenges” re­mained the king of the moun­tain, rank­ing at the top of the list for the eighth-con­sec­u­tive year. One rea­son for that is de­clin­ing Medi­care and Med­i­caid re­im­burse­ments loom as a ma­jor worry for ex­ec­u­tives, said Joseph Wil­czek, CEO of Ta­coma, Wash.-based Fran­cis­can Health Sys­tem. Wil­czek is also a se­nior vice pres­i­dent of di­vi­sional op­er­a­tions for Fran­cis­can’s par­ent, En­gle­wood, Colo.-based Catholic Health Ini­tia­tives. Re­spon­dents called “Med­i­caid re­im­burse­ment” the top fi­nan­cial chal­lenge.

“I think we’ve seen a steady de­cline in prof­itabil­ity in health­care for about the last five years,” he said. “We’re still not see­ing our costs meet in­fla­tion, and again we’re not get­ting re­im­burse­ment in the way we have been while see­ing a de­cline in the pa­tient cen­sus.”

“Pa­tient sat­is­fac­tion” ranked sixth in this year’s tally, switch­ing spots with “physi­cian­hos­pi­tal re­la­tions,” which ranked No. 7. The only other change in this year’s sur­vey was the ad­di­tion of “pop­u­la­tion health man­age­ment,” which ranked No. 9. Last year, ACHE added “cre­at­ing an ac­count­able care or­ga­ni­za­tion,” which ranked No. 11 both years.

The or­ga­ni­za­tion asks a cross sec­tion of its mem­ber­ship for in­put on adding sur­vey cat­e­gories, and ACHE tries to keep them gen­eral, Pres­i­dent and CEO Thomas Dolan said. He said he was not sur­prised that nei­ther of the two new cat­e­gories have risen very high. “Both pop­u­la­tion health and ac­count­able care or­ga­ni­za­tions are fu­ture chal­lenges that peo­ple are start­ing to rec­og­nize,” he said.

The in­di­vid­ual sur­vey re­sponses re­flect the nu­ances of each CEO’s own or­ga­ni­za­tion and mar­ket. For ex­am­ple, car­ing for the unin­sured—fifth on the ACHE sur­vey—is a top con­cern at Cook County Health & Hos­pi­tals Sys­tem. It de­liv­ered about $500 mil-

lion in unin­sured care last year—which, CEO Dr. Ram Raju said, rep­re­sents more than half of his bud­get—and suf­fered a $169 mil­lion short­fall. Unin­sured care ranked fifth in the ACHE sur­vey. “Pa­tient safety and qual­ity is def­i­nitely on the front burner, but the unin­sured and fi­nan­cial chal­lenges take on a much big­ger scale for us,” Raju said.

Many of the top is­sues in the sur­vey blur the lines sug­gested by the cat­e­gories, which is ev­i­dent in spe­cific con­cerns ex­ec­u­tives said un­der­lie the 11 broad is­sues.

Pa­tient safety and qual­ity ranked No. 2, while physi­cian-hospi­tal re­la­tions ranked No. 7. How­ever, in ex­plain­ing con­cerns re­gard­ing “pa­tient qual­ity and safety,” 69% of ex­ec­u­tives an­swered “en­gag­ing physi­cians in im­prov­ing the cul­ture of qual­ity.” The top con­cern iden­ti­fied in health­care re­form im­ple­men­ta­tion— ap­pear­ing in 76% of ex­ec­u­tives’ sur­veys—was “re­duc­ing op­er­at­ing costs.”

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