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 accordance with a research revealed within the Journal of the American School of Surgeons (JACS).
The research, a scientific evaluation of tons of of revealed research, comes amid accelerating well being care integration, typically referred to as consolidation. Practically 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 bettering the worth of well being care supply.”
Bhagwan Satiani, MD, MBA, FACS, lead research creator, professor of surgical procedure emeritus at The Ohio State College Wexner Medical Heart, Columbus, Ohio
The research outcomes ship a transparent message to well being care leaders, Dr. Satiani stated.
“These findings present a possibility to raised outline worth with a concentrate on benefiting sufferers whereas balancing the monetary stability of the well being care trade,” he stated. “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 evaluation included research revealed 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 attributable to integration, the investigators reported. Solely 23 % (six research) confirmed improved high quality, primarily attributable to higher care administration processes slightly than outcomes. Only one research discovered fewer affected person deaths after integration.
Hospital prices elevated with integration 93 % of the time, in accordance with 13 of 14 research measuring value modifications. Of 16 research assessing well being care spending, 81 % (13 research) confirmed increased prices or no change.
The researchers additionally reported the web influence of integration on high quality, value, and spending:
- Solely eight of 37 research (22 %) confirmed that well being care integration had a optimistic (improved) internet influence.
- Greater than half (54 %, 20 research) confirmed a unfavorable (worse) internet influence.
In noting limitations of their evaluation, Dr. Satiani stated not one of the reviewed research used customary measures of high quality, value, or spending. Additionally, most research didn’t discover causes for an absence 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 stated 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 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 influence on general well being care high quality,” he stated.
Second, Dr. Satiani stated few of the revealed research had been systematic evaluations, that are supposed to scale back bias.
On this research, after screening 1,297 U.S. articles revealed 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 evaluation, articles should have reported at the least one in every 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. Worth denoted the quantity the group prices the buyer per hospitalization, and spending was the group’s prices per affected person.
Give attention to high quality enchancment
Dr. Satiani stated 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 bettering surgical high quality.
Research 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 Assessment of Integration Methods Throughout the U.S. Healthcare System Reveals 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.