AHRQ: Nearly 70% of hospitals are in health systems

The 626 health systems in the U.S. accounted for the majority of hospitals, beds and discharges in 2016, according to data released by the Agency for Healthcare Research and Quality (AHRQ).

The report, which AHRQ called the first publicly available database of the nation’s health systems, found considerable variation in their size. More than 50 percent included just one or two hospitals and employed fewer than 250 physicians. The top 5 percent of systems, however, account for 42.8 percent of all hospitals in health systems and have 18 or more hospitals. The 10 largest systems account for nearly one-quarter of all beds in systems and 21.5 percent of all employed physicians in systems.

“Networks of private hospitals, clinics, and medical practices have consolidated in ways that are impacting the care patients receive on a day-to-day basis,” AHRQ deputy director Sharon Arnold, PhD, wrote in an accompanying blog post. “The proliferation of health systems is linked to several factors, including the advent of accountable care organizations, bundled payments, and quality-based payment incentives. Thus far, however, the health services research community has lacked a publicly available data resource that might shed light on the nation’s health systems and the role they play in areas such as health care quality and patient safety.”

Lower-income patient populations aren’t being excluded from hospitals in systems, according to the report. Systems include 63.4 percent of all hospitals with high uncompensated care burdens and 74.8 percent of those with high percentages of low-income patient populations. They also account for 88.4 percent of discharges from facilities with high uncompensated care burdens and 88.3 percent of discharges from hospitals with a high percentage of low-income patients.

Other characteristics of health system included:

• 25.9 percent (162) are high teaching intensity.
• 6.9 percent (43) include hospitals in three or more states.
• 5 percent (31) predominantly serve children.
• 2.9 percent (18) compromise predominantly investor-owned hospitals.

By state, more populous states had higher numbers of health systems led by California (53 systems) and New York (51 systems). However, smaller states had the highest percentage of hospitals in systems, with the top three being Hawaii (95.1 percent of hospitals in systems), Virginia (94.5 percent) and Connecticut (94.1 percent).

The percentage of discharges from health systems was above 90 percent in most states. Delaware had the highest percentage at 99.6 percent, with the lowest being found in Wyoming at 43.4 percent—35 percentage points below the next lowest state.