Hospital Impact: Here's what keeps this CEO up at night

Executive looking out window
As the healthcare industry grapples with the prospect of more disruptive change, CEOs have even more to worry about than usual. (Getty/Tom Merton)

Being a leader at a healthcare organization has never been an easy task, but as the industry grapples with the prospect of more disruptive change, we have even more on our plates.

First and foremost, one of the biggest issues is the presidential election results and the impact on healthcare. There had been quite a bit of rhetoric over the last several years, especially during the recent presidential campaign, on repealing the Affordable Care Act. 

For a health system CEO in Maryland like myself, the threat of repeal has an additional set of concerns, as we are engaged in a significant demonstration project through the Center for Medicare and Medicaid Innovation (CMMI), which was created as part of the ACA. CMMI is also funded through the Budget Reconciliation Act, so it could be defunded, putting our statewide project in serious jeopardy. 

As it relates to the ACA on healthcare in general, Congress has used repeal of the act in the past more for theater than reality. Now with Congress and the president-elect on board, come January that reality could be around the corner. It is anticipated that repealing the law and replacing it with a viable plan for healthcare coverage, especially with more than 20 million Americans being covered under the ACA, would take close to two years. In this crazy era of politics, the next steps would be anyone's guess.

Many other issues keep CEOs up at night. The issues affecting my health system and community include:

  • MACRA and its impact on primary care physician availability over the next several years
  • Workforce shortages at every level of healthcare
  • The behavioral health crisis facing providers, with special emphasis on the growing heroin/opioid epidemic
  • The ever-increasing responsibility on hospitals related to social determinants of health and healthy lifestyles
  • The overregulation of the healthcare industry
  • Regulators' lack of patience with providers related to initiatives surrounding the cost and delivery of care 
  • Nonaffordability of cutting-edge technologies and pharmaceuticals
  • Addressing potentially avoidable utilization
  • Reducing the total cost of care

A handful of the above issues may relate more to Maryland at this point in time. However, as has been the case with earlier Maryland-initiated mandates such as reducing readmissions, population health requirements and performance-based rewards and penalties, these have been CMS demonstration projects that have eventually transcended to healthcare across the country.

There will always be those issues that keep me up at night. Over the last several years, however, I have learned that health systems across the U.S. are doing some amazing things as everyone tries to keep up with this ever-changing industry. Since so many have paved these roads ahead of me, I have found my colleagues to be extremely accommodating whenever I reach out to them, as I have been to them since we began the value-based care delivery journey six years ago.  

Barry Ronan is the president and CEO of Western Maryland Health System in Cumberland, Maryland.