Mergers and acquisitions of US hospitals and health systems rarely improve the quality of care provided or result in lower health care costs and prices, according to a study published in Journal of the American College of Surgeons (JACS).
The study, a systematic review of hundreds of published studies, comes amid accelerating health care integration, which is sometimes called consolidation. About 70 percent of US hospitals now partner with the health system.
Proponents of health care integration say it controls costs and improves the quality of care. But we found that evidence is lacking that consolidation alone is an effective strategy for improving the quality of health care. “
Bhagwan Satiani, MD, MBA, FACS, lead author of the study, Professor of Surgery Emeritus at Ohio State University Wexner Medical Center, Columbus, Ohio
The results of the study send a clear message to health care leaders, Dr. Satiani said.
“These findings provide an opportunity to better define value by focusing on helping patients while balancing the financial sustainability of the health care industry,” he said. “Improving the quality of health care cannot be achieved through mergers and acquisitions alone.”
Effects of health care integration
A systematic review of authors included studies published from 2000-2024. Of these, 37 met the inclusion criteria. Among the 26 studies that measured the quality of care, almost 77 percent (20 studies) showed a reduced value or no change due to integration, the researchers reported. Only 23 percent (six studies) showed improved quality, mainly due to better care methods rather than outcomes. Only one study found fewer patients dying after fusion.
Hospital charges increased by combining 93 percent of the time, according to 13 of 14 studies that measured price changes. Of the 16 studies examining health care costs, 81 percent (13 studies) showed higher costs or no change.
The researchers also reported the overall effect of combining quality, price and spending:
- Only eight of the 37 studies (22 percent) showed that integrating health care has a positive (improved) effect.
- More than half (54 percent, 20 studies) indicated a negative (worse) impact.
Noticing the limitations of their analysis, Dr. Satiani said none of the studies reviewed used standardized measures of quality, price, or spending. Also, many studies did not examine the reasons for the lack of change in the quality of health care after mergers.
How does this study differ from previous studies?
Although other researchers have reached similar conclusions, Dr. Satiani said their education is different in two ways. First, most research on health care integration appears in health policy and economics publications and does not reach many surgeons, he noted. However, surgical services are a significant part of the health care system, accounting for one-third of health care costs in the United States.
“Surgical outcomes also have a direct impact on the quality of health care,” he said.
Second, Dr. Satiani said few of the published studies were systematic reviews, which are meant to reduce bias.
In this study, after reviewing 1,297 US articles published from 1990 to 2024, the researchers systematically reviewed 384 of them that addressed direct or indirect health care integration. straight. They defined horizontal integration as two or more hospitals that are integrated and vertical as hospitals that receive independent practices of doctors.
To be included in the analysis, articles must have reported at least three quality measures: value, price, and spending. Quality focused on patient outcomes, such as the number of 30-day readmissions or deaths, and on care management processes. Such practices include staffing levels and the use of nurse care managers. Price represented the amount the organization charged a customer for hospitalization, and expenditure was the organization’s cost per patient.
Focus on quality improvement
Dr. Satiani said health care leaders should define organizational tools and infrastructure to try to improve quality and measure quality metrics. As an example of quality improvement, he proposed the American College of Surgeons Quality Assurance Program as a model that improves the quality of surgery.
Study coauthors are David Way, MEd; David Hoyt, MD, FACS; and E. Christopher Ellison, MD, FACS.
Source:
American College of Physicians
Journal reference:
Satiani, B., and al. (2024). A Systematic Review of Cooperative Strategies Across the US Health Care System Shows No Consistent Improvement in Cost, Cost Reduction, or Quality of Care. Journal of the American College of Surgeons. doi.org/10.1097/XCS.0000000000001229.
#Hospital #mergers #acquisitions #rarely #improve #quality #health #care #costs
