Recent hospital mergers and acquisitions haven't led to significant improvements in some patient outcomes, according to a new study in the New England Journal of Medicine.
The study, published this week by researchers at Harvard University, found that hospitals acquired by health systems experienced a modest decline in patient experience scores while performance on 30-day readmissions and mortality rates stayed largely flat.
Lack of improvement on the quality measures is concerning considering the proliferation of these deals and promises from health systems they will lead to better quality care, said Leemore Dafny, a co-author of the study and an economist at Harvard Business School.
"There is no evidence of systemic quality improvements," she said. "It's less about the decline (in quality improvement), although that is concerning, but the absence of improvement."
The findings add to the ongoing debate surrounding the merits of consolidation in the hospital sector. Studies thus far on the impact of mergers and acquisitions of hospitals have focused less on quality of care and more on costs, finding they lead to higher prices. This new study attempts to take a sweeping look at all hospital acquisitions from 2009 to 2013 and how performance on select quality measures changed afterward.
"It's clearly a piece of the drawing that was partly colored but wasn't fully colored in," Dafny said. "This needed to be done."
The analysis included 2,232 hospitals overall. Of those, 246 were acquired through transactions over the five-year period and the remaining 1,986 acted as the control group because they didn't change ownership.
In addition to examining how performance changed on patient experience, mortality and readmissions measures, the authors also looked at seven clinical process measures publicly reported. While the study found performance actually improved on the seven process measures for acquired facilities, the results can't be attributed to an acquisition because improvements were occurring before the deals took place, according to the authors.
The measures were selected because they were public and could be applied throughout the entire study period, Dafny said.
While some researchers are finding mergers and acquisitions raise prices and can hinder quality, hospitals have been steadfast in their defense of the deals. In fact, in early September, the American Hospital Association released a study finding mergers and acquisitions lead to lower costs and better quality of care.
In response to the new study, the AHA took issue with the use of the CMS' patient experience survey to examine quality of care.
"Using data collected from patients to make claims about quality fails to recognize that it is often incomplete, as patients are not required to and do not always respond comprehensively, and the survey does not capture information on the critical aspects of care as it is delivered today," Melinda Hatton, AHA's general counsel, said in an email.
Indeed, completion rates of the experience survey are low, and the CMS is considering revisions.
Acquisition activity in the hospital market is going strong, according to a recent analysis from Kaufman Hall. Nearly three-quarters of hospitals were part of a health system in 2017.
Zack Cooper, an associate professor of public health and economics at Yale University who has researched the price impacts of hospital deals, said in an email the new study "throws cold water" on arguments from trade groups like the AHA that potential price increases as a result of acquisitions are justified because quality improves.
"It's clear from (this) analysis that mergers also harm quality," he said.
The findings from this study should be a reminder to health systems that simply acquiring a facility isn't enough to see improvements in quality, said Greg Matthews, deputy director of the Center for Value in Healthcare at the consultancy Altarum.
"We need to not count on acquisitions to do any of the work for us," he said. Health systems "would do well to keep the patients in mind first and foremost in many of these transactions."
Indeed, critics argue health systems, particularly large ones, haven't done much to achieve standard clinical protocols across their network and instead see acquisitions as an opportunity to jack up prices.
Dafny said she hopes the study will get the attention of regulators and health system leaders. "I would like the boards to be asking these questions and trying to ascertain how they are doing to measure the effects of these transactions and what are the consequences for not meeting goals," she said.
