While primary and specialty physician supply was a big concern for many leaders (41% to 40%, respectively, thought it would negatively impact their organization), perhaps it’s still not as much of a concern as it needs to be, Laney says.
“CEOs underestimate that the shortage of primary care physicians could affect their ability to create the medical home.”
Finance: Cutting Costs Top Priority
As the economy makes a slow ascent out of recession, finance leaders are shuffling their hospital or health system’s top priorities, and nearly 60% feel the financial position of their organization is being weakened by healthcare reform, according to the 2011 HealthLeaders Media Industry Survey. Still, only 14% project negative fiscal performance in 2011.
Cost-cutting measures are the metric most cited as being among the top three priorities over the next three years, selected by 39% of respondents. Also making the 2011 top-priority list for top finance leaders, in order, are quality initiatives (34%), reimbursement (32%), patient experience (30%), and physician recruitment (21%).
As providers prepare for reductions in reimbursements from Medicare, Medicaid, and other payers, and as reimbursement becomes more tied to quality, it makes sense that finance leaders would rank their priorities in that order, says Robin LaBonte, CFO at the 79-staffed-bed York (ME) Hospital.
“As insurers reduce payments to hospitals, the only way to make it all work is with cost reductions. There has to be a refocus on cost because there is so much unknown with reimbursements. Everyone wants to be positioned well and right now no one knows what’s going to happen, so they are conservative with their costs.”
Over the past three years, as the recession progressed, the No. 1 priority for finance leaders also shifted somewhat. For instance, in 2010 they ranked their top three priorities for the next three years as:
1. Physician recruitment and retention (38%)
2. Cost reduction (36%)
3. Patient experience/patient satisfaction (34%)
Compare that to 2009 when top finance leaders as said their top priorities were:
1. Quality/patient safety (68%)
2. Physician recruitment and retention (38%)
3. Reimbursement (31%)
Physician recruitment, which hit the top of the priority list in 2010, slipped down the list to the fifth priority this year. One possible reason for the change, according to LaBonte, is that having spent this past year recruiting to help grow the bottom line, finance leaders are now preparing to elevate their quality initiatives, which also ties in to the need to strengthen the reimbursements.
“A lot of this has to do with health reform,” she says. “People are now more focused on the upcoming changes, and the quality and patient experience pieces are going to start factoring in. Physician recruitment is still important, but it makes sense that it is now ranking lower.”
LaBonte notes that last year her hospital, which generates a net revenue of $155 million annually and currently employs more than 100 healthcare providers, hired three primary care physicians in anticipation of the increase of newly insured patients attributable to the Patient Protection and Affordable Care Act.
In addition to the financial complexities brought on by the recession, now that portions of the PPACA
have taken effect, many finance leaders are concerned about how it will hurt their bottom line—59% of respondents said that healthcare reform is weakening their organization’s financial position, while 31% said they would be unaffected and 10% said their situation would improve.
“I can’t say it has had any impact on our financial position,” says LaBonte. “I don’t think that there will be financial improvements, but there’s still too much unknown.”
Technology: Making Meaningful Progress
Despite the healthcare industry’s reputation for being slow to embrace and adopt new technologies—from computerized physician order entry to patient portals that allow physicians and patients to communicate online—technology leaders report that, in fact, they’re making progress toward achieving meaningful use under the HITECH Act. They’re also increasing IT staff and budgets—and a fair number even consider themselves early adopters.
Organizations are closing in on the goal of becoming meaningful users of health IT. The number of respondents who already have achieved meaningful use or said they would achieve it in 2010 is relatively small (just 10%).
But add in the 33% who’ll hit the mark in 2011 and the 31% on track for in 2012, and three-quarters are looking at timely compliance with meaningful use.
And hospitals, health systems, and physician practices have implemented or are close to implementing most of the technologies we asked about in our annual industry survey of technology leaders. Most said they already have or will have within two years wireless networks (95%) and physician order entry (91%), for example. And 75% or more have or will have within two years clinical data repositories of current data, data mining of historic data, and electronic health records.
A few technologies are not as widespread or have a longer adoption timeline: Only 13% of respondents said they have an interactive patient portal in place, while 32% said they won’t have a patient portal for three to five years.
Organizations are dedicating more resources to IT. Most respondents (73%) said the number of IT employees will grow in the next five years, and most said they will see either a substantial increase (60%) or a slight increase (30%) in clinical IT spending in the next five years.
With 52 servers, 87 integrated software packages, three clinical and four nonclinical locations—as well as connectivity to three hospitals and 22 nursing homes, SouthEast Texas Medical Associates will absolutely be among those that plan to grow their IT programs, says CEO James L. Holly, MD.
The main focus is integration and communication with other organizations, he says. “We have a secure Web portal and HIE—our goal is to include all practices and institutions in our health information exchange over the next five years.”