Study indicates improved health care value cannot be achieved by hospital mergers and acquisitions alone

Mergers and acquisitions of U.S. hospitals and well being programs hardly ever enhance the standard of care delivered or end in decrease well being care prices and costs, in keeping with a research printed within the Journal of the American Faculty of Surgeons.

The research, a scientific assessment of a whole lot of printed research, comes amid accelerating well being care integration, typically referred to as consolidation. Almost 70% of U.S. hospitals at the moment are affiliated with a well being system.

“Proponents of well being care integration have claimed it controls prices and enhances care high quality,” mentioned lead research creator Bhagwan Satiani, MD, MBA, FACS, professor of surgical procedure emeritus at The Ohio State College Wexner Medical Heart, Columbus, Ohio. “However we discovered that proof is missing that integration alone is an efficient technique for enhancing the worth of well being care supply.”

The research outcomes ship a transparent message to well being care leaders, Dr. Satiani mentioned.

“These findings present a chance to higher outline worth with a concentrate on benefiting sufferers whereas balancing the monetary stability of the well being care trade,” he mentioned. “High quality enchancment in well being care can’t be achieved by mergers and acquisitions alone.”

Results of well being care integration

The authors’ systematic assessment included research printed from 2000-2024. Of those, 37 met inclusion standards. Among the many 26 research that measured high quality of care, almost 77% (20 research) confirmed decreased high quality or no change because of integration, the investigators reported. Solely 23% (six research) confirmed improved high quality, primarily because of higher care administration processes reasonably than outcomes. Only one research discovered fewer affected person deaths after integration.

Hospital costs elevated with integration 93% of the time, in keeping with 13 of 14 research measuring value adjustments. Of 16 research assessing well being care spending, 81% (13 research) confirmed increased prices or no change.

The researchers additionally reported the online impression of integration on high quality, value, and spending:

Solely eight of 37 research (22%) confirmed that well being care integration had a constructive (improved) web impression.
Greater than half (54%, 20 research) confirmed a unfavourable (worse) web impression.

In noting limitations of their assessment, Dr. Satiani mentioned not one of the reviewed research used commonplace measures of high quality, value, or spending. Additionally, most research didn’t discover causes for a scarcity of change in well being care worth after integration.

How this research differs from earlier analysis

Though different researchers have reached comparable conclusions, Dr. Satiani mentioned their research differed in two methods. First, most research of well being care integration seem in well being coverage and economics publications and don’t attain many surgeons, he famous. But, surgical companies have an effect on well being organizations’ backside line, accounting for about one third of U.S. well being care expenditures.

“Surgical outcomes even have a direct impression on total well being care high quality,” he mentioned.

Second, Dr. Satiani mentioned few of the printed research had been systematic opinions, that are meant to scale back bias.

On this research, after screening 1,297 U.S. articles printed from 1990 to 2024, the investigators systematically reviewed 384 of them that mentioned both horizontal or vertical well being care integration. They outlined horizontal integration as two or extra hospitals merging and vertical integration as hospitals buying unbiased doctor practices.

To be included within the assessment, articles should have reported at the least certainly one of three measures of worth: high quality, value, and spending. High quality referred each to affected person outcomes, such because the variety of 30-day readmissions or deaths, and to care administration processes. Such processes included staffing ranges and use of nurse care managers. Value denoted the quantity the group costs the buyer per hospitalization, and spending was the group’s prices per affected person.

Dr. Satiani mentioned well being care leaders ought to delineate organizational assets and infrastructure for high quality enchancment efforts and standardize high quality metrics. As a mannequin for high quality enchancment, he prompt the American Faculty of Surgeons High quality Verification Program as a mannequin enhancing surgical high quality.

Research co-authors are David Manner, MEd; David Hoyt, MD, FACS; and E. Christopher Ellison, MD, FACS.