A lot of changes have been made to the healthcare system since the introduction of the Affordable Care Act, so it's no wonder that some hospitals are struggling to keep up. In 2014, the American College of Healthcare Executives (ACHE) conducted a survey to ask hospital CEOs about the top issues confronting hospitals. Number one on the list was financial challenges, followed by healthcare reform implementation and governmental mandates, which were tied for second place.
"The survey results show that these are challenging times for CEOs and leadership teams, and we are all expected to do more with less," Deborah J. Bowen, FACHE, CAE, president and CEO of ACHE said in a statement. "Taking care of patients and improving patient safety and quality in their organizations is job No. 1, but CEOs acknowledge they must do so in a climate of complex payment reform, dwindling reimbursement and government mandates."
According to survey respondents, here are the top four challenges faced by acute care hospitals, along with what you can expect to see this year.
1. Financial challenges.
Some of the biggest financial challenges, according to survey respondents, include Medicaid reimbursement, bad debt and decreasing inpatient volume. According to Healthcare Finance, some of the challenges hospitals can expect to face in 2015 include possible elimination of Medicaid subsidies, a continuing shift toward value-based payment models, reimbursement gaps due to a growth in high-deductible health plans and a continued decline in inpatient volume.
2. Healthcare reform implementation.
Reducing operating costs and a shift to value-based purchasing were among the respondents' top concerns related to healthcare reform implementation. According to Healthcare IT News, 2015 is going to be a landmark year for hospitals for everything related to costs. Karen Mihalik, executive director of revenue cycle management at the Cleveland Clinic told Healthcare IT News that risk-based contracting is going to be tough this year and that Accountable Care Organizations (ACOs) and handling bundled payments will also pose big challenges. "This year is different in that we really need to make sure that we align again with the clinical component, and that we're building the right business model and administrative model to manage that risk-based population," she said. The Centers for Medicare and Medicaid Services is continuing to advance efforts to strengthen incentives to reward higher value care rather than higher volume of care. Since passage of the ACA, more than 360 Medicare ACOs have been established in 47 states, serving more than 5.6 million Americans with Medicare. CMS also recently announced a Next Generation ACO model that will allow experienced ACOs to assume higher levels of financial risk and reward than are available under the current models. The Next Generation ACOs will be paid using a combination of capitation and fee-for-service.
3. Governmental mandates.
CMS audits and implementation of ICD-10 were among the ACHE survey respondents' top concerns. CMS has a new audit cycle, so even if your organization has been audited in the last few years, it could still be audited again this year. CMS is also adding two pilot areas in 2015: review of the Medication Therapy Management program and a Provider Network Adequacy pilot. As for ICD-10, the new codes, which were originally scheduled to be enacted in 2014, will go into effect on October 1.
4. Patient safety and quality.
Although the areas of greatest concern to hospital CEOs surveyed were unspecified, Becker's Healthcare has identified the following top patient safety concerns for hospitals in 2015:
- Healthcare-associated infections
- Antibiotic resistance
- Personal protective equipment protocols
- Hand hygiene
- Health IT issues
- Medication errors
- Workforce safety
- Transitions of care
- Diagnostic errors
- Patient engagement