Mergers and acquisitions of U.S. hospitals and well being methods not often enhance the standard of care delivered or end in decrease well being care prices and costs, in line with a examine printed within the Journal of the American School of Surgeons (JACS).
The examine, a scientific evaluate of lots of 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. However we discovered that proof is missing that integration alone is an efficient technique for enhancing the worth of well being care supply.”
Bhagwan Satiani, MD, MBA, FACS, lead examine creator, professor of surgical procedure emeritus at The Ohio State College Wexner Medical Heart, Columbus, Ohio
The examine outcomes ship a transparent message to well being care leaders, Dr. Satiani mentioned.
“These findings present a chance to higher outline worth with a deal with 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 evaluate included research printed from 2000-2024. Of those, 37 met inclusion standards. Among the many 26 research that measured high quality of care, practically 77 % (20 research) confirmed decreased high quality or no change as a consequence of integration, the investigators reported. Solely 23 % (six research) confirmed improved high quality, primarily as a consequence of higher care administration processes somewhat than outcomes. Only one examine discovered fewer affected person deaths after integration.
Hospital fees elevated with integration 93 % of the time, in line with 13 of 14 research measuring worth modifications. Of 16 research assessing well being care spending, 81 % (13 research) confirmed larger prices or no change.
The researchers additionally reported the online impression of integration on high quality, worth, and spending:
- Solely eight of 37 research (22 %) confirmed that well being care integration had a constructive (improved) internet impression.
- Greater than half (54 %, 20 research) confirmed a destructive (worse) internet impression.
In noting limitations of their evaluate, Dr. Satiani mentioned not one of the reviewed research used normal measures of high quality, worth, or spending. Additionally, most research didn’t discover causes for a scarcity of change in well being care worth after integration.
How this examine differs from earlier analysis
Though different researchers have reached comparable conclusions, Dr. Satiani mentioned their examine 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 providers 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 general well being care high quality,” he mentioned.
Second, Dr. Satiani mentioned few of the printed research have been systematic critiques, that are meant to cut back bias.
On this examine, 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 impartial doctor practices.
To be included within the evaluate, articles will need to have reported at the least considered one of three measures of worth: high quality, worth, 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. Worth denoted the quantity the group fees the patron per hospitalization, and spending was the group’s prices per affected person.
Concentrate on high quality enchancment
Dr. Satiani mentioned well being care leaders ought to delineate organizational sources and infrastructure to high quality enchancment efforts and standardize high quality metrics. As a mannequin for high quality enchancment, he prompt the American School of Surgeons High quality Verification Program as a mannequin enhancing surgical high quality.
Examine coauthors are David Approach, MEd; David Hoyt, MD, FACS; and E. Christopher Ellison, MD, FACS.
Supply:
Journal reference:
Satiani, B., et al. (2024). A Systematic Evaluation of Integration Methods Throughout the U.S. Healthcare System Exhibits No Constant Enchancment in Worth, Value Discount, or High quality of Care. Journal of the American School of Surgeons. doi.org/10.1097/XCS.0000000000001229.
