Study: Hospital acquisitions hurt patient experience

Hospitals who have been acquired or merged show a modest decline in patient experience, according to a new study appearing in The New England Journal of Medicine.

The study used Medicare claims and Hospital Compare data from 2007 to 2016 on a hospital’s performance on four quality measures (clinical process, patient experience measures, mortality, and the readmission rate) as well as data on mergers and acquisitions from 2009 to 2013. The sample included 246 acquired hospitals and 1986 control hospitals which had no change in ownership during the study period.

While there was no significant change in the other mortality and readmission, clinical process saw a large increase in acquired hospitals, but the study’s authors were unable to conclusively attribute this to the change in ownership, the study says.

What this study means is hard to interpret because the patient experience metric is based on patient reporting, while the other measures can change due to alteration of physician reporting and documentation that can change after a change in management or reimbursement, the study says.

The study is significant as the hospital industry has undertaken a substantial consolidation in the United States over the past two decades with a surge beginning in 2010. The authors write that these acquisitions and mergers may lead to less competition leaving patients with fewer choices which could explain the decline in care.

“These findings challenge arguments that hospital consolidation, which is known to increase prices, also improves quality,” the study says.

The authors also found suggestions that management or staffing practices that may be responsible for lower patient satisfaction at the acquiring hospital may have spread to acquired hospitals. They did not find a symmetrical benefit when lower scoring hospitals were acquired by higher scoring hospitals, the study says.

Diverting hospital resources toward integrating the acquired hospital could also explain the decline in patient experience, but those conditions would eventually end as the time wore on and the researchers found steady declines in performance for four years following a transaction.

While the authors believe that pre-acquisition issues with these measures could lead to their merger with other hospitals, but the pre-transaction data did not present signs of such phenomena, the study says.

The authors admit the study was limited due to the averaging of scores, which could obscure effects on acquired hospitals, both positive and negative, as well as the affect a merger can have on the remaining control hospitals in the area.