Hospital Quality and Consolidation

By January 3, 2020 Commentary

More research that undermines the supposed quality of care justification for hospital consolidation is published in the New England Journal of Medicine.   (NEJM Article)   The researchers examined comparative trends in quality over the period 2007 to 2016 for hospitals that were acquired versus those that weren’t.  There were 246 acquired hospitals included in the study and 1986 control facilities that weren’t acquired.  The acquisitions occurred from 2009 to 2013, allowing time for measurement of quality trends before and after the acquisition.  Hospitals in the same market as acquired facilities and in-state acquiring hospitals were excluded from the control group to avoid confounding factors.  The quality measures included  seven process measures from CMS’ Hospital Compare program and five patient experience of care measures from the CMS’ consumer satisfaction program.  All-cause 30-day hospital readmissions and rate of death within 30 days of admission were also compared.  Patient characteristics tended to stay the same over the study period and before and after acquisition at the acquired hospitals.

In the pre-transaction period there were generally similar trends in patient experience and mortality rates.  Hospitals that ended up being acquired had slightly better pre-acquisition improvement in readmission rates and on clinical process measures.  After acquisition, there was a noticeable relative decline in patient experience among acquired hospitals compared to the control institutions.  There was not a significant differential trend in readmissions following acquisition, nor was there any improvement in clinical process measures that could be attributed to the post-acquisition period.  Hospital systems engaged in extensive consolidation have argued that it would lower costs by creating efficiencies of scale and improve quality by allowing more resources to be deployed and by better care coordination.  Both are lies; and I say lies because the evidence is clear that neither occurs and because the hospital systems know they intend to raise prices and that they won’t really feel the need to do anything to improve quality when they are the only game in town.

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