Reimbursement tops the list of concerns of healthcare chief executive officers, far surpassing quality and patient safety, according to a new survey by the American College of Healthcare Executives.
Even after Congress passed sweeping legislation that promises hospitals more Medicare dollars, the issue of adequate Medicare and Medicaid payments is likely to remain a top priority for CEOs, according to the second annual ACHE survey, released exclusively to Modern Healthcare last week.
The survey also found that CEOs continue to be concerned about personnel shortages, capacity issues and the uninsured. CEOs were less concerned about malpractice insurance and governmental mandates than they were last year.
The Chicago-based ACHE faxed the survey in October to 730 hospital CEOs nationwide, with 230 responding for a 32% response rate.
Of the respondents, 73% identified reimbursement as one of their top three concerns and 58% named personnel shortages, while 28% placed capacity at the top of the list.
"I have traveled all over and these are the issues I am hearing everywhere I go," said Larry Sanders, chairman and CEO of Columbus (Ga.) Regional Healthcare System and ACHE chairman. "These are pretty universal issues."
ACHE President Thomas Dolan and fellow healthcare executives said they believe the Medicare reform bill, which includes increases in general payments, rural hospital payments and indirect medical education, among other hospital-friendly provisions, will ease CEO concerns in the short run.
Dolan said he would not be surprised if reimbursement remained the top issue next year. "It underscores the importance for healthcare executives to become more active in public policy debates, telling our story to the communities and legislators," he said. "Are we getting enough reimbursement to provide care?"
Within each of the top issues respondents selected, they also identified specific concerns.
Under reimbursement, 80% identified Medicare as their top concern, while 78% named Medicaid and 62% said bad debt was their biggest worry.
"Whatever gains we see in Medicare may be offset by Medicaid in many, many places," Sanders said. The slumping economy is leading to increased unemployment and charity care, as states struggle to provide funding for the program, he said.
Samuel Odle, senior vice president of five-hospital Clarian Health Partners and chief administrative officer at Methodist Hospital, Indianapolis, said reimbursement and personnel shortages are "clearly the things you get up every day thinking about." Odle said healthcare systems would continue to feel reimbursement pressure.
"The Medicare reform bill may give some breathing room for 2004, but it will not solve the fundamental problem of the uninsured and underinsured," said Odle, who was nominated chairman-elect of the ACHE in October.
Executives also continue to worry about personnel shortages, but those concerns have subsided from last year, when the category ranked first with 71% of CEOs picking that as the top issue. In 2003, CEOs were most concerned about filling positions for registered nurses, imaging technicians and pharmacists.
Finding workers for vacant positions was not the only challenge for respondents who were focused on personnel shortages. In that group, 29% of the respondents said they were concerned about complying with staffing ratio requirements.
In California, hospital executives are busy preparing for the nation's first nurse-staffing law, set to go into effect Jan. 1, 2004 (See related story, p. 10). The legislation calls for hospitals to staff one nurse for every six patients in medical-surgical units, dropping to 1-to-5 the following year. Intensive-care units would operate with a 1-to-2 nurse-to-patient ratio.