No Evidence Hospital Mergers Improve Quality of Care

New research published in the New England Journal of Medicine found that quality of care at hospitals that were part of a recent wave of mergers and acquisitions declined or stayed the same, calling into question executives’ claims that such transactions boost quality through new investments and shared resources.

Dealmaking among hospitals has soared in the last decade, from 50 transactions in 2009 to a high of 117 transactions in 2017. However, there was a dip in 2018, when 90 mergers and acquisitions were announced.

In this analysis, investigators searched for evidence of improved quality at nearly 250 hospitals involved in transactions between 2009 and 2013. The authors used 4 measures of performance: patient satisfaction, deaths within a month of entering the hospital, return trips to the hospital within a month of leaving, and how often some heart, pneumonia, and surgery patients received recommended care.

To avoid results skewed by economic changes, local patients, or health care policy, researchers examined the average results in these categories for acquired hospitals 3 years before and up to 4 years after each transaction, comparing them to hospitals not involved in transactions.

“Quality didn’t improve,” lead author and Harvard University research associate Nancy Beaulieu, PhD, told The Wall Street Journal. On average, patient satisfaction scores – which measure whether patients would give hospitals a good rating and recommendation – worsened at acquired hospitals, particularly those that already had lower patient satisfaction scores prior to the transaction.

Return trips to the hospital and rates of death remained the same before and after acquisitions, and results were inconclusive regarding how often heart, pneumonia, and surgery patients received recommended medical care.

Sources: The Wall Street Journal, January 1, 2020; Beaulieu ND, Dafny LS, Landon BE, et al. Changes in quality of care after hospital mergers and acquisitions. N Engl J Med. 2020;382:51-59.