The merger and acquisition trend is showing up in the annual CEO turnover rates recorded by the American College of Healthcare Executives (ACHE).

In 2013, ACHE tracked a CEO turnover rate of 20 percent, which was the highest rate the organization had ever recorded since it began tracking turnover rates in 1981. The annual rate has fluctuated between 14 and 18 percent in the decade prior to 2013.

In a statement, Deborah J. Bowen, FACHE, CAE, president and CEO of ACHE, pointed to consolidation in the hospital industry, complexity related to health care marketplace changes, and also the baby boomer generation of executives retiring as possible factors leading to the rate going up in 2013. However, of these, the most evident from the report was consolidation. Since 1981, the number of hospitals represented by the survey has shrunk by more than 1,000, and with each merger, there is a related re-organization of top leadership.

“The increase in the rate reinforces the need for healthcare leaders to work with their boards to ensure appropriate succession plans are in place,” Bowen noted.