Hospital mergers and acquisitions not linked to better care, study finds

When a merger or acquisition occurs in healthcare, the conjoining providers often say that patient experience will benefit as a result. But new findings published in the New England Journal of Medicine suggests that may not be the case.

In fact, the study found just the opposite: Acquired hospitals actually actually saw a patient experience that was moderately worse, on average. What's more, 30-day mortality and readmission rates stayed largely the same at such facilities.

The only real improvement that was found among the majority of acquired entities was in the realm of clinical process, which improved modestly. But the improvement was so incremental that it couldn't be linked to the actual acquisition, and prices for commercially insured patients tended to be higher.

WHAT'S THE IMPACT
 
The research looked at 250 hospitals acquired in deals between 2009 and 2013. In addition to patient satisfaction and 30-day mortality and readmission rates, the data also looked at the frequency with which heart, pneumonia and surgery patients received the recommended care. The study looked at results three years before and after the acquisition, and compared those results to nearby hospitals not involved in M&A transactions.

Patient satisfaction scores at acquired hospitals tended to be worse, on average. Such scores take into account what rating a patient would give a hospital, and how likely they would be to recommend it to someone else.
Acquiring entities that had lower patient satisfaction scores to begin with tended to see the steepest drops post-transaction, suggesting that organizations with already-low scores could inspire a similar drop at their acquired facilities.

THE LARGER TREND
 
The findings mirror research published in February 2019 finding mergers and acquisitions may negatively impact patient satisfaction and the perception of their care.

The Rice University Baker Institute of Public Policy research team expected that integrated hospital and physician groups would deliver better care coordination, but after looking at factors such as process care measures and readmissions rates, the group determined that simply wasn't the case. It was in looking at 10 patient satisfaction measures that researchers found some differences.

Of the 10 patient satisfaction measures, six of them declined following a merger or acquisition of a hospital or physician group. The current working hypothesis is that such acquisition activity consolidates the market, resulting in decreased market competition between providers.

With a relative lack of competition, there's less pressure to keep patients satisfied, and providers are more likely to slacken their efforts in explaining medications to patients, for example, which was one of the 10 satisfaction measures considered.

In time that could translate to decreased clinical quality, especially if patients don't understand their care recommendations, or lack the knowledge to satisfactorily adhere to their business health insurance plans.

For now, though, it's patient perceptions that are hurting, largely driven by non-clinical, external factors. Vertical integration improves quality for only a limited set of care processes, and that's more than offset by increased market concentration, the research found.