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 "These findings challenge arguments that hospital consolidation,
which is known to increase prices, also improves quality," according
to a research team led by Nancy Beaulieu of the Department of Health
Care Policy at Harvard Medical School in Boston.
Writing in The New England Journal of Medicine, the researchers
report on data from 246 hospitals acquired from 2007 through 2013,
and extending from two or three years before the acquisition to
three or four years after.
Compared to a control group of 1,986 hospitals that did not change
hands, acquired hospitals saw their "patient experience"
satisfaction score decline from the equivalent of 50th percentile to
41st.
The researchers call that a "modest deterioration in performance."
The satisfaction score was based on patient responses to questions
about whether they would definitely recommend the hospital, whether
the doctor or nurse communicated well, whether they received help
when needed, and whether they would rate the hospital as a 9 or 10
on a 10-point scale.
Two standard measures of care quality saw virtually no change. Rates
of patient readmission within 30 days of discharge declined by 0.1
percentage points and rates of death within 30 days of discharge
dropped by 0.03 percentage points at the acquired hospitals.
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"Taken together, these findings provide no evidence of quality
improvement attributable to changes in ownership," the Beaulieu team
writes. "Our findings corroborate and expand on previous research on
hospital mergers and acquisitions in the 1990s and early 2000s and
are consistent with a recent finding that increased concentration of
the hospital market has been associated with worsening patient
experiences."
All the hospitals had at least 25 beds and had admitted at least 100
fee-for-service Medicare patients per year. "We excluded local
competitors and in-state acquirers from the control group to reduce
potential bias from effects of diminished local competition for
patients or diminished system-level competition for inclusion in
insurers' state hospital networks," the researchers said.
The new analysis comes less than a month after a report in a special
issue of the journal Health Affairs concluded that such mergers and
acquisitions can reduce access to services for patients in rural
areas while improving a hospital's financial health.
SOURCE: https://bit.ly/2F5DjFx The New England Journal of Medicine,
online January 1, 2020.
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