Rural hospitals that merged with or were acquired into larger health systems are associated with greater reductions in mortality for conditions like heart failure, stroke and pneumonia compared to facilities that remained independent, according to a new study.
The annual inpatient mortality rate for acute myocardial infarction decreased from 9.4% to 5% among acquired hospitals, researchers at the Agency for Healthcare Research and Quality and IBM Watson Health found. Meanwhile, independent facilities saw inpatient AMI mortality fall from 7.9% to 6.3% during the period studied.
"Mergers may enable rural hospitals to improve quality of care through access to needed financial, clinical, and technological resources, which is important to enhancing rural health and reducing urban-rural disparities in quality," the study that was published Monday in JAMA Network Open concluded.
The researchers compared the mortality rates from 2009 through 2016 for six health conditions at 172 hospitals before and after they were acquired and compared them to more than 260 facilities that were not involved in a merger during the same period.
Improvements in the mortality rate for heart failure, stroke and pneumonia were also significant among hospitals that were acquired, but those results were not seen until after three to five years post-merger.
Mortality rates for other conditions, including gastrointestinal bleeding, hip fractures, and complications from elective surgeries, remained relatively stable for both merged and non-merged hospitals during the years studied.
The findings seem to indicate differences in the association between mergers and care quality between urban and rural hospitals. Previous studies have found hospital mergers in urban markets having either no effect or a negligible impact on some quality measures.
"Future research should examine whether there are differential outcomes for rural hospitals that are acquired by large hospital systems than for rural hospitals that merge locally with another hospital, or for those that were already merged or affiliated before a second merger," researchers wrote.
The findings add a new dimension to the debate over the benefits and potential harms of hospital consolidation.
More than one-third of community hospitals in the U.S. are located in rural areas and serve 60 million people. Yet economic challenges exacerbated by years of declines in patient volume and clinician shortages have closed more than 100 rural hospitals between January 2013 and February 2020. One in four rural facilities is at risk of closing.
Those financial concerns have increased merger and acquisition activity over the past decade as more rural hospitals view joining with larger health systems as an alternative to reducing services or closing entirely. More than 380 rural hospital mergers occurred from 2005 through 2016, according to 2018 research brief conducted by the University of North Carolina's Cecil G. Sheps Center for Health Services Research.
Other benefits that attract rural hospitals to merge with larger health systems include having better clinical coordination, standardizing processes like billing that can lead to making them more efficient, as well as assistance in recruiting clinicians to address staff shortages.
Proponents of consolidation, like the American Hospital Association, have argued for years hospital mergers and acquisitions lead to lower healthcare costs and improve care quality. An AHA analysis released last month that examined more than 750 hospital acquisitions from 2009 through 2019 found such transactions were associated with a 3.3% reduction in annual operating expenses per admission at the acquired facilities, and a 1.1% decline in the 30-day readmission rate for heart attacks.
Critics however contend such deals lead to less competition, reduced healthcare access, and higher medical costs, while not producing significant care quality improvements.
Results of a previous study funded by AHRQ and published last year in the New England Journal of Medicine found hospital was associated with, "…modestly worse patient experiences and no significant changes in readmission or mortality rates."