Other studies on the effects of mergers have been more focused on the cost aspects of such deals and have found resulting higher prices, while not focusing on such issues as quality of care. (Photo: Shutterstock)
They may have argued that mergers would improve such factors for patients as readmissions, mortality or experience, but hospitals that have been part of a merger arrangement have not found that to be the case.
According to a new study published in the New England Journal of Medicine, hospitals acquired by health systems actually experience poorer patient experience scores, while readimission rates remain unchanged.
Harvard University researchers' findings call into question the claims made in favor of mergers, while Leemore Dafny, a coauthor of the study and an economist at Harvard Business School, is quoted saying that the lack of improvement, considering those claims—and promises made by health systems that care will improve as a result of those deals—is a focus of concern.
"There is no evidence of systemic quality improvements," Dafny said. "It's less about the decline (in quality improvement), although that is concerning, but the absence of improvement."
Other studies on the effects of mergers have been more focused on the cost aspects of such deals and have found resulting higher prices, while not focusing on such issues as quality of care. The new study takes a broader approach in reviewing the effects of mergers on hospital systems from 2009 to 2013, exploring changes in select quality measures resulting from the deals.
Dafny adds, "It's clearly a piece of the drawing that was partly colored but wasn't fully colored in. This needed to be done."
Seven clinical process measures that are publicly reported were also included in the study, and although it found performance improved on those seven process measures for acquired facilities, the authors warn that those improvements can't be attributed to the acquisitions since the improvements were already occurring prior to the deals' inception.
The American Hospital Association, naturally enough, disputes the new study's results, after having released its own study finding mergers and acquisitions lead to lower costs and better quality of care. The patient experience survey from the Centers for Medicare and Medicaid was used in the new study, and AHA took issue with that.
Melinda Hatton, AHA's general counsel, told Modern Healthcare, "Using data collected from patients to make claims about quality fails to recognize that it is often incomplete, as patients are not required to and do not always respond comprehensively, and the survey does not capture information on the critical aspects of care as it is delivered today." CMS itself is planning to revise its survey, to which the patient response rate is low.
Still, Zack Cooper, an associate professor of public health and economics at Yale University who has researched the price impacts of hospital deals, says that the new study "throws cold water" on arguments from trade groups like the AHA that potential price increases as a result of acquisitions are justified because quality improves. "It's clear from (this) analysis that mergers also harm quality."
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Marlene Satter
Marlene Y. Satter has worked in and written about the financial industry for decades.
