Medicare quality-of-care data reveal that when a hospital is acquired by another hospital or hospital system, readmission and mortality rates are not affected but patient satisfaction deteriorates modestly.
These findings challenge arguments that hospital consolidation, which is known to increase prices, also improves quality, according to a research team led by Nancy Beaulieu of the Department of Health Care Policy at Harvard Medical School in Boston.
Writing in The New England Journal of Medicine, the researchers report on data from 246 hospitals acquired from 2007 through 2013, and extending from two or three years before the acquisition to three or four years after.
Compared to a control group of 1,986 hospitals that did not change hands, acquired hospitals saw their “patient experience” satisfaction score decline from the equivalent of 50th percentile to 41st. The researchers call that a “modest deterioration in performance.”
The satisfaction score was based on patient responses to questions about whether they would definitely recommend the hospital, whether the doctor or nurse communicated well, whether they received help when needed, and whether they would rate the hospital as a 9 or 10 on a 10-point scale.
Two standard measures of care quality saw virtually no change. Rates of patient readmission within 30 days of discharge declined by 0.1 percentage points and rates of death within 30 days of discharge dropped by 0.03 percentage points at the acquired hospitals.
Taken together, these findings provide no evidence of quality improvement attributable to changes in ownership, the Beaulieu team writes. Our findings corroborate and expand on previous research on hospital mergers and acquisitions in the 1990s and early 2000s and are consistent with a recent finding that increased concentration of the hospital market has been associated with worsening patient experiences.
All the hospitals had at least 25 beds and had admitted at least 100 fee-for-service Medicare patients per year. “We excluded local competitors and in-state acquirers from the control group to reduce potential bias from effects of diminished local competition for patients or diminished system-level competition for inclusion in insurers’ state hospital networks,” the researchers said.
The new analysis comes less than a month after a report in a special issue of the journal Health Affairs concluded that such mergers and acquisitions can reduce access to services for patients in rural areas while improving a hospital’s financial health.