Trends in Healthcare & Governance

HTNYS’ monthly Trends updates provide trustees with information about emerging developments in governance and healthcare. Published by HTNYS on the second Wednesday of each month, Trends’ timely statistics and insights help trustees fulfill their roles and responsibilities while adapting to the changing environment.

Quality improvement means better care and a stronger bottom line
February 2024

As hospitals and health systems continue to deal with significant economic challenges, it makes sense that many healthcare organizations look to conventional expense reduction methods. However, in today’s environment, clinical quality improvement is a great way for leaders to address pressing financial challenges while laying the groundwork for future success. An effective quality improvement program can increase revenue, reduce costs, decrease burdens on employees and enhance both the patient and provider experience.

Three critical elements for quality improvement initiatives:

  • Prioritization: Identify the most important quality areas to address, which may be based on a combination of factors, including the improvement of internal quality metrics, external consumer ratings like CMS’ Star Ratings or Leapfrog Hospital Safety Grades, financial criteria and strategic growth considerations.
  • Analytics: Provide actionable insights through data and reports to end users, and track key metrics to measure improvement.
  • An infrastructure based on systems and collaboration: In addition to the quality team, clinicians, frontline nurses, clinical documentation, coding and other staff must participate.

Other elements essential to quality improvement success include:

  • A top-down commitment to quality: Leaders must reinforce a culture where quality is a top priority.
  • Communication and change management: These are key for setting expectations about how the quality initiative fits into existing workflows and proactively engages employees.

With shifts in payment models, poor quality is now more costly than ever. For example, studies have found that surgical site infections are typically associated with an additional seven to 11 postoperative hospital days, preventing the hospital from filling medical-surgical beds with new patients.

As trustees provide oversight to their healthcare organizations, they should remember that quality initiatives result in better patient care and stronger finances.

Resources

  • For more information on the board’s role in quality oversight, refer to the HTNYS Board Responsibilities online resource library.
  • Stay tuned for HTNYS’ new series of educational videos on quality, coming soon. You’ll be able to watch them on your own, add them to your next board meeting agenda or include them in your new-member onboarding process.
  • You can also access a variety of resources from HANYS’ Quality Advocacy, Research and Innovation team, including information regarding clinical collaboratives, learning networks and issues impacting clinical and operational oversight.

Information for this article was obtained from: Quality transformation: How hospitals are striking a balance between the bottom line and better care, Becker’s Hospital Review.

2024 Healthcare trends for trustees
January 2024

As we enter this new year, many publications have identified trends expected to impact the healthcare industry in 2024 and beyond. Common themes include continued financial pressures, workforce shortages and issues associated with commercial health insurers.

Hospitals and health systems had to cope with a multitude of challenges in 2023, including rising costs, labor shortages and endemic COVID-19. Trustees and healthcare leaders should stay informed about emerging trends nationally and locally to help strategize and position your organization for success in a changing environment.

McKinsey & Company and Becker’s Hospital Review summarized the following trends in recent publications:

Financial pressures

  • Although hospitals’ margins improved in 2023, they still face significant long-term financial challenges. Greater labor and supply expenses and patient acuity will continue to challenge hospitals in the year ahead. Organizations will continue to focus on attracting and retaining patients to increase revenue and improve payer mix. Healthcare organizations will need to implement targeted approaches that focus on specific services with opportunities to increase volume and revenue.

Workforce shortages

  • Healthcare workforce supply, especially nurses and physicians, will continue to lag behind the growing demand to take care of a growing, older population.
  • Mental and behavioral health needs continue to grow, with the current workforce supply unable to keep pace.

Payers

  • The biggest payers are 10 times the size of the largest health systems. Hospitals face challenges with negotiated rates, claims denials and slow, costly and inconsistent reimbursement policies.
  • Medicare and Medicaid combined are larger than commercial payer sources. These government-funded programs present significant concerns for hospitals and health systems as they reimburse below cost and well below commercial rates.
  • Enrollment in Medicare Advantage will continue to grow. It now covers more than half of the Medicare population, giving big payers even more influence.
  • One of the world’s biggest insurers, UnitedHealthCare/Optum, has become the largest employer of physicians in the country. Optum added nearly 20,000 physicians in 2023, meaning it now has nearly 90,000 employed or affiliated physicians and another 40,000 advanced practice clinicians.

Technology solutions

  • Technology solutions such as artificial intelligence, automation, electronic health record optimization, virtual care programs and remote patient monitoring can close some care gaps by making administrative and clinician efforts less burdensome.
  • Healthcare has lagged behind other industries in AI adoption. Healthcare leaders are challenged to evaluate and ultimately unlock the value of transitioning to AI solutions unique to their organization.

Information for this article was obtained from:

2023 Trends

2022 Trends

2021 Trends

2020 Trends