What's up for hospitals in 2014? On top of every hospital administrator's mind is the need to shoulder a new round of changes this year, from electronic health records and ICD-10 implementation to new penalty programs and payment models, to a host of new regulations, some with ambitious timelines. Hospitals are also concerned with meeting the needs of the growing number of baby boomers reaching an age when they can be expected to put greater demands on the health care system and with responding rapidly to other demographic shifts in their communities.

Fortunately, with these changes come new opportunities.

Even in states that are not expanding Medicaid, hospitals can expect considerable gains in coverage — with millions of newly insured Americans. This constitutes a significant and welcome step forward on the road to building healthier communities. But hospitals will have plans to achieve their own improvements this year.

Hospitals will be working hard to make further gains in quality and patient safety. Nothing succeeds like success, and we now have examples of highly effective, evidence-based improvement efforts across the board — from eliminating health care-acquired infections to reducing patient readmissions. Hospitals will evaluate carefully the many opportunities for improvement and make a strategic plan to implement those that will have the greatest impact. AHA's Health Research & Educational Trust has a new guide, "Leading Improvement Across the Continuum: Skills, Tools and Teams for Success," (www.hpoe.org/Reports-HPOE/Improvement_Continuum_October2013.pdf) that lays out a framework and tools hospitals can use to get started.

Gains in outreach — to individuals, to families and to entire communities — will become more and more critical to every hospital, too. Reimbursement is increasingly reliant on keeping patients happier, healthier and more involved, so hospitals will devote considerable energy to becoming adept at engaging patients in their own care. Outreach at the community level will encourage people to get the preventive care they need and help hospitals partner with organizations that can help patients who need assistance after discharge to stay healthy. Engagement is a sensible strategy to improve both quality and outcomes while reducing overall health care costs. Greater diversity and cultural competency among hospital leaders and caregivers, paired with better collection and use of race, ethnicity and language data, will support hospitals in their quest for better engagement.

As we move toward a more coordinated system of care, hospitals will position themselves to keep people healthy and out of emergency departments. They will find ways to reconfigure to better meet the needs of their communities. They will work to identify and eliminate costly treatments that don't improve patient outcomes. They will move care into their communities in nontraditional ways. Some will merge with others to benefit from economies of scale to provide the latest treatments and access to new technologies.

All of this adds up to an extraordinarily challenging year for hospitals in 2014. But there is one more priority. Much of the hard work hospitals will do this year will take place out of the view of people who matter greatly: local leaders, state and federal legislators and policymakers. So hospitals will add another priority to an already long list — creating opportunities for those leaders to visit their hospitals, learn about the pace of change and understand how hospitals are addressing it.

It's a tall order, but America's hospitals have proven time and again that they are up to the task.

Rich Umbdenstock is president and CEO of the American Hospital Association.

News from the AHA

Rural Health Care Leadership Conference coming right up

Hundreds of rural hospital executives, board members and staff will descend on Phoenix Feb. 9–12 for the annual Health Forum Rural Healthcare Leadership Conference. Along with experts in care delivery, finance and policy, they'll assess the changing health care environment, explore various partnerships and strategic affiliations and clarify the roles of trustees. They'll also discuss how rural hospitals can improve recruitment and retention of physicians, nurses and other skilled personnel. Visit www.healthforum-edu.com/rural.

Results of a national survey on population health infrastructure

Many factors, most notably the Affordable Care Act, are driving hospitals and care systems to expand their scope to focus on population health management. The AHA and the Association for Community Health Improvement conducted a national survey of hospitals' organizational infrastructure and staffing as they pertain to population health. Results reveal wide variation in how hospitals structure and implement their approaches and reinforce the need for more education and professional training in population health management. Visit www.hpoe.org/Reports-HPOE/ACHI_Survey_Report_December2013.pdf.

'Transparency for all' is the key to lower costs

Hospitals believe that transparency is key to achieving lower health care costs and better care, AHA President and CEO Rich Umbdenstock said at a panel discussion concluding a health care transparency summit sponsored by the Robert Wood Johnson Foundation in December. "But it's transparency for all," he said. "Let's move away from blame and work on getting the data out to see what we can do to start working on solutions." A key challenge is the complexity of health care billing. "We need to streamline and simplify the system," he said. "You can't keep adding requirements to the system without recognizing the financial impact."