January 3, 2020

A recent wave of hospital acquisitions and mergers did not change care quality at acquired hospitals and, in some cases, care quality got worse, according to a new study published in the New England Journal of Medicine.

Learn 4 ways to unlock cost reduction through effective integration

The trend

As the Wall Street Journal reports the number of hospital mergers and acquisitions "has surged in recent years." Data from Kaufman Hall show that hospitals announced 117 mergers and acquisitions in 2017 and 90 in 2018, compared with 50 in 2009.

According to the Journal, hospital executives typically make the case that "greater size will boost quality with new investments and yield other improvements as deal makers benefit from each others' strengths."

But as the number of hospital mergers and acquisitions have increased, health care experts have started questioning the impact of the deals, especially as studies began showing that mergers and acquisitions were linked with increasing health care prices.

The new study

For the study published Thursday, researchers analyzed the care quality of 246 hospitals that were acquired between 2007 and 2013. The researchers examined care quality at the facilities a few years before and a few years after the hospitals were acquired. To determine changes in quality, the researchers used four measures of performance outlined by CMS: patient satisfaction; deaths within a month of entering the hospital; return visits to the hospital within a month of being discharged; and how often heart, pneumonia, and surgery patients get recommended care.

The researchers compared the results of their analysis with almost 2,000 nearby hospitals that were not involved in acquisition deals between 2007 and 2013.

The researchers found that, among the acquired hospitals, "[q]uality didn't improve," according to Nancy Beaulieu, a Harvard University research associate and lead author of the study.

According to the study, patient-satisfaction scores, which were based on whether a patient would give the hospital a top rating or a recommendation, declined at acquired hospitals from the 50th percentile to the 41st. Patient satisfaction scores at acquired hospitals were more likely to drop among those acquired by facilities that also had comparatively lower satisfaction scores, the researchers found.

But the researchers found that acquired hospitals' performance on two of the examined quality measures were largely unchanged before and after the deals. According to the study, rates of patient deaths and 30-day return visits declined by an average of 0.1 percentage points and 0.03 percentage points, respectively, after the deals.

The researchers were unable to determine whether the number of patients receiving recommended medical care changed after the deals.

Discussion

According to the researchers, the "findings provide no evidence of quality improvement attributable to changes in ownership." Beaulieu said, overall, the "findings challenge arguments that hospital consolidation, which is known to increase prices, also improves quality."

Instead, the findings reinforce the results of a recent Health Affairs report that found such deals can reduce rural patients' access to services "and are consistent with a recent finding that increased concentration of the hospital market has been associated with worsening patient experiences," the researchers wrote.

Susan Haas—a visiting scientist at Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health's innovation center Ariadne Labs, who was not involved with the new research—said the study, will help regulators challenge hospital deal makers who claim acquisitions lead to better quality. "For the first time there is good science," she said. Now, regulators can say "[p]rove it to me," she added.

But Melinda Hatton, general counsel at the American Hospital Association, pushed back on the notion that hospital mergers and acquisitions don't improve quality of care. Hatton in a statement cited research by the group that found care quality improved at hospitals during the first year following such deals (Evans, Wall Street Journal, 1/1; Emery, Reuters, 1/1).

Learn 4 ways to unlock cost reduction through effective integration

The pace of hospital merger and acquisition (M&A) activity is increasing in both deal count and total value. However, cost reduction is rarely the primary strategic objective of these deals. As a result, operational integration and cost reduction post-merger is falling well short of potential.

We’ve identified four principles for cost-focused integration that can help ensure that newly acquired organizations become part of the solution, rather than part of a bigger cost problem. These principles are illustrated through in-depth, action-oriented profiles of Cleveland Clinic, UPMC, and Kaleida Health.

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