B. E. Smith’s annual survey of more than 300 healthcare executives reveals top-of-mind trends that will affect the industry in the coming year. The trends noted in the October 2011 survey have been discussed in the board room for some time, but the pressure they’re putting on providers will intensify in 2012 — making the need for skilled executive leaders more urgent than ever. The following are the top 10 trends cited by healthcare leaders as the industry prepares for 2012.
1. Decreasing reimbursement
Survey respondents repeatedly cited the new pay-for-performance environment as a major challenge for 2012. With HCAHPS scores and value-based purchasing being used to calculate reimbursement, compliance risks and costs are shifting to healthcare organizations — creating a renewed focus on meaningful ways to improve patient satisfaction. In 2012, expect to see providers redefining organizational objectives and processes to meet regulatory demands and quality initiatives for reimbursement.
2. Growth in skilled nursing; long-term care facilities
With hospitals working to maximize reimbursement opportunities while cutting expenses, use of skilled nursing and long-term care facilities for higher acuity patients continues to grow. The 2012 introduction of Medicare’s 30-day return stay rule will drive health systems to acquire or partner with these facilities to improve readmission rates and better manage patient care. The result will be improved financial performance by providing the right care to the right patients at the right time.
3. A changing landscape for physicians
In 2012, physician reimbursement is scheduled to be reduced by nearly 30 percent. While the policy is not yet finalized, physician payments will decrease in the near future. In response, many physicians will retire. Others will stop accepting Medicare and Medicaid patients, limiting care access for these people — right at a time when the healthcare system will be inundated with aging baby boomers. Physician practices will continue aligning with organizations that manage billing and reimbursement for them. One respondent noted that physician alignment into systems will impact doctors’ ability to provide necessary patient care while limiting their influence on how that care is delivered.
4. Meaningful Use
For organizations that have been slow to implement electronic health records (EHR), 2012 will bring a rush to meet requirements before the penalty phase begins. The result will be information technology leaders working overtime to implement EHR on top of regular responsibilities. With resources already stretched trying to meet incentive deadlines, one respondent noted many facilities are struggling to implementcomputerized physician order entry (CPOE) and discharge continuation plans in systems that aren’t ready for these challenges.
5. Technology integration and mobility
Approaching deadlines for EHR and ICD-10 implementation will drive a focus on technology integration in 2012. In addition, patients are increasingly choosing providers who use internet tools in care delivery.(1) Whether it’s introducing new programs to improve quality or tapping into social media to raise awareness of programs and fundraising, providers will benefit from testing technologies to determine those that drive results. More and more organizations — and their patients — are going mobile. Programs enabling extensive data-sharing with physicians, executives and patients while on-the-go will be crucial.
6. Organizational consolidation
Access to capital continues to be limited. In 2012, expect to see smaller organizations increasingly affiliating with larger systems or in some cases, partnering to form new systems. These systems also will align closely with physicians, employing doctors directly and acquiring practices. One respondent observed that integration of physicians, payers and other ancillary entities — for example, accountable care organizations (ACOs) — will become common as providers work toward end-to-end health management of a defined population. The 2012 American Hospital Association (AHA) Environmental Scan reported a trend of for-profit entities purchasing sizable nonprofit systems, signaling a shift toward consolidation in numerous U.S. markets.
7. Shifting socio-economics
Longer lifespans — along with increased incidence of chronic conditions, obesity and poverty — are driving a boost in patient volume while reimbursement is shrinking. Skilled leaders who control costs and deliver effective patient care management will be in demand in 2012. According to one respondent, many organizations will be focusing on comprehensive patient care management and aligning processes and documented evidencebased outcomes with the revenue cycle — a key element in achieving outstanding care and maximum reimbursement.
8. Evolving leadership roles
Now more than ever, healthcare leaders — particularly within the C-suite — must acquire cross-functional skills that help them understand other major functions of the organization and how these play into decision-making. For example, today’s successful hospital CFO is an expert communicator and business strategist who understands physician relations and alignment, technology and the effective integration of quality and finance. Additionally, workforce retention will be dependent upon each leader’s ability to inspire and engage.
9. The talent gap
The gap in healthcare talent continues to widen as baby boomers retire. In just one example, the 2012 AHA Environmental Scan predicted a nationwide shortage of nearly 63,000 physicians in five years — 50 percent higher than in previous estimates. Experienced senior executives, CNOs and other key leaders also will be in short supply. Many organizations will address talent management challenges with seasoned interim leaders who bring the instant stability, experience and cross-functional skills to help them thrive in a complex environment.
10. Increasing focus on engagement and culture
In a pay-for-performance environment where HCAHPS scores are a key determining factor in reimbursement, a high level of employee engagement — which leads to improved quality and safety, thus increasing patient satisfaction — is more critical than ever before. In 2012, many organizations will be focusing on creating a positive, collaborative culture that both retains employees and increases their engagement.
The key is a seasoned leadership team. Organizations with executives who consistently deliver positive financial performance and outstanding quality of care will continue to prosper in these challenging times. As pressures intensify in 2012, the success of each individual healthcare organization will depend on having experienced leaders with the right skills in roles that enable them to make the greatest impact.
1 Survey of Healthcare Consumers: Key Findings, Strategic Implications, Deloitte, 2009.
2 For-Profit Investment in Not-for-Profit Hospitals Signals More Consolidation Ahead, Moody’s Investors Service, April 2010.