You might be thinking – “Just five challenges?!” and it’s true that the healthcare industry is facing many challenges at the moment. Five of them, however, are most specific to hospitals. We often think of hospitals as the “front lines” of healthcare, and while it may be true that the majority of practicing physicians, nurses and allied health professionals find employment there, new data shows that one vital piece of the hospital picture might be missing: patients.

1. Even though more patients are insured now than last year, cost is still a barrier to treatment for many of them.

New data shows that even though coverage is up to 86% (from 82% this time last year) patients are still citing rising costs as a reason for forgoing treatment, either for acute or chronic conditions. This doesn’t bode well for hospitals fiscally or in terms of population health measures: if patients are putting off treatment indefinitely because of the cost, when they do find themselves in the hospital they’ll be sicker – and perhaps in for an even more complex course of treatment. Not only does this detract from the “good health” of the demographic, but it also costs hospitals more money to treat cases that have become more complex due to a lack of early intervention and treatment.

2. The rules keep changing as healthcare reform continues.

You’ve got Meaningful Use, Joint Commission, ICD-10, HITECH, HIPAA . . . the list goes on and on of guidelines, rulebooks and benchmarks that hospitals are supposed to meet on an annual basis. Compliance, perhaps now more than ever before, is an interlaced web of government and local standards that healthcare systems have to balance. Juggling the needs and wants of payers, providers and patients is hard enough when you haven’t thrown money into the mix – but, in the spirit of healthy competition, we now see more and more of these measures being tied to reimbursement. Money talks. Of course, while providers are monetarily incentivized to provide high quality care for lower costs, they’d be hard pressed to do so if their patient pool is dwindling.

3. RAC, CMS Audits continue to be costly, time consuming and emotionally draining.

Speaking from experience, several years ago I was employed to handle the RAC audit requests at a small, rural hospital and it was some of the most tedious and stressful administrative work I’ve ever done. Even on the microcosmic level of a small facility, the piles of paper that came in week after week were daunting. I can’t imagine what it must have looked like at larger facilities. The technology used for tracking the audits was subpar at best and the lack of communication and response from the CMS regarding audits (and lost requests) was emotionally wearing. Though these requests have slowed, hospitals still face them – and they’ll need to decide if the long-term solution is to hire staff to perform the tasks, upgrade their technology to support the auditing process, or both.

4. Physicians have to be motivated to provide better care and it must come from more than just a paycheck.

As previously mentioned, yes, money does serve to motivate people to perform tasks. More than that, especially in healthcare, there has to be an intrinsic motivation on the part of doctors to provide better quality care: we’d hope that everyone who enters the profession does so because they want to help people rather than harm them, but we’ve seen that overtime, the administrative demands placed on physicians -that keeps them away from patients – essentially drains them of their empathy, their energy and their enthusiasm for patient care. The bored and tired physician is not apt to be innovative or motivated to find ways to solve problems, either within the healthcare system or regarding their patients. As changes continue – and mount accordingly – keeping physicians engaged will be a top priority. If it’s proven hard to encourage people to get into medicine, it’s going to be even more difficult to keep them there.

5. With many CEOs and other executive leaders facing retirement, many healthcare organizations are apt to find themselves without a captain in the next few years.

The number of baby boomers who are currently in c-suite positions in healthcare is entirely disproportionate to the number of recent college-grads who are entering healthcare leadership. Even if retirement is a few years off, healthcare leaders need to engage their board members to define clear processes for succession of their organizational leaders, and have their interim plan in mind for when the day arrives; especially if, with all these changes and more on the horizon, that day comes far sooner than they planned. The rate of CEO turnover for 2013 was 20% – up from 16% the previous year. The upward trend of loss of leadership in healthcare has been climbing or at the very least holding steady around 15% since the mid-eighties. The question is, what can we do to get our physicians and healthcare leaders into the industry – and keep them there.