What’s most concerning to C-suite level hospital and health system executives has changed over the past year, according to a survey conducted by the Advisory Board Company.

Out of the 183 respondents, the top five areas of “extreme interest” to hospitals and health systems were:

1. Improving ambulatory access (57%).
2. Innovative approaches to expense reduction (57%).
3. Boosting outpatient procedural market share (55%).
4. Minimizing unwarranted clinical variation (54%).
5. Controlling avoidable utilization (49%).

It’s quite a change from the results from last year’s survey. In 2016, improving patient access to ambulatory and outpatient care was ranked sixth, while this year’s No. 2, expense reduction, wasn’t even included as a choice a year ago.

Additionally, boosting outpatient procedural market share moved from No. 10 to No. 3, while last year’s top concern, minimizing unwanted variation, dropped to No. 4.

"This shift in topic rankings reflects a change in hospital and health system priorities in part driven by current discussions on health care policy reform," Chas Roades, chief research officer at Advisory Board Company, said in a statement. "Improving cost-effective access for consumers, who are likely to bear more direct financial responsibility for the cost of care, will be a growing concern for health care providers in the coming decade. Our survey shows executives are considering new strategies to remake their cost structures to respond to the changing environment."

Among the areas of concern which finished outside the top five were preparations from the Medicare Access and CHIP Reauthorization Act (MACRA). Past surveys of physicians have shown many in the healthcare field are unaware of the law and its changes to Medicare reimbursement and quality reporting. The top concern from the 2015 survey, “engaging physicians in cost and quality improvements,” was also outside the top five.

These results point to CEOs being more focused on the alignment of their systems and relationships with physicians than cost and quality changes.

"While demand for physician employment is at a near-record high, hospitals should use this moment to refocus their physician strategies on building a network centered on delivering accessible, lower cost and reliable health care. This will advantage systems regardless of the specifics of payment reform,” said Lisa Bielamowicz, MD, Advisory Board’s chief medical officer.