Challenges in Healthcare, Government Mandates and Financial issues


Question: What are the challenges seen by CEO/CMO's of hospitals/healthcare systems and how can they be addressed?
I have been talking to many CEO's and CMO's over the last few weeks of for-profit hospitals and there seems to be trend of challenges in the field of healthcare. As I cross-referenced the information I was given with surveys found online from 2017 and 2016, I saw similar responses. Seems like the top two challenges for top C-suite people are around government mandates and financial reimbursements.
Government mandates include things like ICD-10 coding and its transition/implementation and the second is around financial reimbursements. It seems as if the first challenge around ICD-10 Codes may have an impact on the financial reimbursements as well. Its always quite surprising to me that these challenges have been on the top of the list. I am wondering how these challenges can truly be addressed.

Artificial Intelligence
Stuti Desai
12 months ago

4 answers


Hi. Probably because this relates to my work- but I am going to say a key issue is how to deal with new accountable care payment modelts. CMS is transitioning away from fee-for service. Eventually- all payors will probably pay on some type of risk-based contract where they pay X amount for a specific population. However- right now, because of changes in the Medicare Quality Payment Program, all hospitals need to start adopting population health strategies and move into Alternative Payment Models so they are ready for Advanced APMs. I guess you could call this government mandates. However- Medicare is running out of money. We spend an increasing amount of the GNP on health care. Thus- we need to do something different. Whar I hear from CEOs and CFOs a lot is it's hard to get started. I work with smaller health systems and independent hosptials. They often feel they have fewer resources and that change is more difficult than for those in big systems. However- I would argue that it's easier for them. They don't need to convince corporate offices or leadership teams in multiple states that change is necessary.

Lisa Kilawee
12 months ago

Hi Lisa,
I can agree on some of the few points you made. The implementation and getting started seems to be a challenge regardless of the size of the organization based on the discussions i've had so far. Yes, it may be easier for smaller health systems over the larges ones but its still a challenge. And seems as if part of the reason is because the transition time could also result in money loss - which is where that "hard to get started" comes from.

Stuti Desai
12 months ago

CMS landed several changes that are small on their own but collectively will impact hospitals, health systems, and medical groups in a variety of significant ways. From base payment methods, tightening 340b drug use or billing, and providing extra funds are going to cause shifts in clinical and business practices.
Unfortunately, all of this doesn't significantly change the commercial market nor saves commercial employer plans. Rather, it shifts more cost onto commercial plans as an effort to protect Medicare.
Winning and losing continues verus real solutions that could benefit all concerned.

Randy Vogenberg, PhD
9 months ago

The military has used Agent Orange and other chemicals during the Vietnam War. These soldiers are getting more health problems the older they get due to their war time and non war time military service. Same for the Gulf War veterans with the "Gulf War Illnesses/syndrome". Many research studies have been done by the VA =Veterans Administration, Universities and other institutions to figure out what agents were used during their military war service and what is causing an increase in their health problems. These health problems often times occur many long years after the service member left the military. Civilian healthcare workers need to have additional training to be able to better diagnose, treat and hopefully cure these aging veterans. There conditions could/can also be affecting their family members (kids) when they try to reproduce. So many of the health conditions could/can have a multi-generational effect. Very few cures for their conditions.  

David Barckhoff-Sag-Aftra/Producer, Director
5 months ago

Have some input?