10 most concerning issues for hospital CEOs

For the 11th year in a row, hospital CEOs ranked financial challenges as the No. 1 issue facing their organizations in 2014.

Each year, the American College of Healthcare Executives surveys community hospital CEOs to identify the top issues confronting their organizations. Findings reflect 338 CEOs' responses.

1. Financial challenges
2. Healthcare reform implementation
3. Governmental mandates
4. Patient safety and quality
5. Care for the uninsured/underinsured
6. Patient satisfaction
7. Physician-hospital relations
8. Population health management
9. Technology
10. Personnel shortages

The rankings are identical to what CEOs found most challenging in 2013, although the level of concern for individual items fluctuated. For instance, CEOs expressed less concern about population health management, even though the issue held onto its No. 8 spot. On the other hand, CEOs expressed more concern about healthcare reform implementation.

"Creating an accountable care organization" was the 11th survey item in previous years, but it was not included in the 2014 survey.

CEOs also ranked specific aspects of the top three categories they found most pressing. CEOs could choose as many as desired. Here are the top five for each.

Within financial challenges
1. Medicaid reimbursement (69 percent)
2. Bad debt (67 percent)
3. Decreasing inpatient volume (63 percent)
4. Medicare reimbursement (57 percent)
5. Competition from other providers (of any type) — 55 percent

Within healthcare reform implementation
1. Reduce operating costs — 78 percent
2. Shift to value-based purchasing — 66 percent
3. Alignment of provider and payer incentives — 65 percent
4. Align with physicians more closely — 54 percent
5. Develop information systems integrated with primary care physicians — 48 percent

Within governmental mandates
1. CMS audits — 80 percent
2. ICD-10 implementation — 68 percent
3. CMS regulations — 64 percent
4. State regulations — 34 percent
5. Increased government scrutiny — 32 percent

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