Quality of care harmed after hospital acquisitions
Hospital acquisitions may have a negative impact on the quality of patient care, according to findings published in the New England Journal of Medicine. The study results may help answer the question of how the flourishing mergers and acquisitions market in healthcare impacts patients and quality of care.
The Federal Trade Commission (FTC) and Congress have taken interest of the effect of M&A on healthcare since the industry has seen a whirlwind of transactions over the past several years. The FTC ordered a handful of health insurance companies and health systems to hand over information about the competitive regulatory regimes known as certificates of public advantage (COPAs).
Several studies have already shown that M&A across hospitals and health systems can increase prices, but the impact on quality of care has been debated with limited data. M&A can have several outcomes, including better administration or clinical operations. However, reduced competition could disincentivize hospitals from providing higher quality of care to attract new patients, according to Harvard researchers who published the study.
Researchers analyzed Medicare claims and Hospital Compare data from 2007 through 2016 and M&A data from 2009 to 2013 to compare performance of acquired hospitals from the time of acquisition to the time after acquisition, controlling for hospitals that did not have a change in ownership. The study included 246 acquired hospitals and 1,986 control hospitals.
They found that being acquired came with a decline in performance in the patient-experience measure.
“By the third post-transaction year, the adjusted differential change in the composite score was −0.17 SD (95% confidence interval [CI], −0.26 to −0.07; P=0.002),” wrote first author Nancy D. Beaulieu, PhD, research associate in healthcare policy at Harvard Medical School, et al. “This decline is analogous to a fall from the 50th percentile to the 41st percentile in the distribution of performance among control hospitals and was consistent across the component measures of the patient-experience composite.”
There was no significant difference in 30-day readmission or mortality rates by the third post-transaction year, and researchers said the difference of performance on clinical-process measures was inconclusive.
“Taken together, these findings provide no evidence of quality improvement attributable to changes in ownership,” Beaulieu et al. wrote.
The patient experience measure may be most impacted by acquisitions because patients can actually see a difference, the researchers surmised.
“Because patient experiences, by definition, constitute aspects of quality that are observable to patients, they may be particularly affected by weakened competitive pressures for hospitals to attract patients,” they wrote.
Amy joined TriMed Media as a Senior Writer for HealthExec after covering home care for three years. When not writing about all things healthcare, she fulfills her lifelong dream of becoming a pirate by sailing in regattas and enjoying rum. Fun fact: she sailed 333 miles across Lake Michigan in the Chicago Yacht Club "Race to Mackinac."