Top hospital CEO concerns: Outpatient care access, innovative ways to cut costs

Hospital executives are looking for innovative ways to control costs at the same time that they grow service lines to remain competitive in a consumer-driven world.

Indeed, a new survey from The Advisory Board indicates that the top concerns of hospital and health system C-suite executives are to improve patients’ access to care in ambulatory or outpatient settings and also find innovative ways to reduce expenses.

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Executives are focusing on ambulatory access because they know it is a competitive necessity and it’s a lower cost way to deliver care, Ben Umansky, managing director of research at the Advisory Board, told FierceHealthcare on Monday in an exclusive interview. They also continue to seek ways to take costs out of the healthcare system while improving the level of service to patients.

The survey, conducted between December 2016 and January 2017, asked 180 executives about their level of concern about 26 topics, ranging from preparing for the Medicare Access and CHIP Reauthorization Act (MACRA) to nonmerger partnership and affiliation models. Their top five concerns were:

  1. Improving ambulatory access (57%)
  2. Finding innovative approaches to expense reduction (57%)
  3. Boosting outpatient procedural market share (55%)
  4. Minimizing unwarranted clinical variation (54%)
  5. Controlling avoidable utilization (49%).

The findings illustrate a shift in hospital and health system priorities due in part to the uncertainty over healthcare reform, said Chas Roades, chief research officer, in an announcement about the survey. Last year, he noted, improving ambulatory access ranked in sixth place and the top concern among the C-suite was minimizing unwanted variation in care cost and quality.

“Improving cost-effective access for consumers, who are likely to bear more direct financial responsibility for the cost of care, will be a growing concern for healthcare providers in the coming decade,” he said. “Our survey shows executives are considering new strategies to remake their cost structures to respond to the changing environment.”

Umansky said he was struck by a common theme among the top 5 concerns: all require physician alignment. “You can’t do anything without the physician workforce being on board,” he said, noting that success depends on how hospital executives manage their physician networks.

Lisa Bielamowicz, M.D., chief medical officer and senior vice president of research at the Advisory Board, also noted in the announcement that uncertainty on timing and specifics of the repeal of the Affordable Care Act and MACRA have created more momentum from physicians to seek support and alignment with health systems.

“While demand for physician employment is at a near-record high, hospitals should use this moment to refocus their physician strategies on building a network centered on delivering accessible, lower cost, and reliable healthcare,” she said. “This will advantage systems regardless of the specifics of payment reform.”