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Healthcare Mergers, Integration Detract from Patient Satisfaction

Healthcare mergers and care integration reduced patient satisfaction scores in six different HCAHPS domains.

patient satisfaction

Source: Thinkstock

By Sara Heath

- Healthcare mergers and acquisitions may not take away from clinical care quality, but they do have a negative impact on overall patient satisfaction and patient perception of care, according to a study from the Rice University Baker Institute of Public Policy.

The study, which looked at 2008 to 2015 CMS Hospital Compare website data, concluded that hospital mergers and acquisitions neither harmed nor helped clinical care quality.

The analysis of 29 key data points – including readmission rates, process care measures, and 10 patient satisfaction measures – ran contrary to the researchers’ hypothesis, which stated that an integrated hospital and physician group would deliver better care coordination.

Further, the analysis of 10 different patient satisfaction measures showed that hospital mergers may in fact detract from the overall patient experience of care. Specifically, six patient satisfaction measures decreased following a hospital or physician group merger or acquisition, the researchers reported.

This is likely because hospital mergers and acquisitions result in a more consolidated market, meaning there is less market competition between healthcare organizations.

“With fewer competitors it seems that there is less incentive to keep patients content,” the researchers wrote. “Given the nature of some satisfaction measures, such as explaining medications and communicating well with patients, overall clinical quality could suffer if patients do not properly understand care recommendations during their hospital stay or post-discharge.”

The researchers did acknowledge that there is a difference between clinical quality and patient experience. A healthcare team could deliver high-quality, coordinated care, but external factors may still result in a poor patient satisfaction rating.

But understanding the care experience from the point of view of the patient is nonetheless important, said researcher Marah Short, who is associate director of the Institute’s Center for Health and Biosciences.

“Although better patient experience may not always correlate with higher clinical quality, measuring quality based on patient perception is increasingly important as more consumers use online physician ratings and reviews of patient experience to select providers,” Short said in a statement.

“Therefore, we need further research on the ability of patient satisfaction to reflect clinical quality, and if it does not, we need to develop and provide to patients better measures in terms that patients can understand and use.”

These results do call into question the rationale behind healthcare mergers and acquisitions, said Vivian Ho, the James A. Baker II Institute Chair in Health Economics and director of the center.

“The government requires that hospitals report on a wide variety of quality measures, such as practice of preventive care for surgical patients, whether their doctor or nurse communicated well, or whether the patient would recommend the hospital to others,” Ho said.

“Physician-hospital integration did not improve the quality of care for the overwhelming majority of these measures. If patient welfare doesn’t improve after integration, there may be other reasons why physicians and hospitals are forming closer relationships — perhaps to raise profits.”

Hospital and physician group mergers have been increasing in recent years, according to recent data from Kaufman Hall. In 2017, there were 13 percent more healthcare mergers than in the year previous, Kaufman Hall reported.

A separate analysis from PricewaterhouseCoopers revealed that there were 255 healthcare merger and acquisition deals in Q2 of 2018.

But with evidence stacking up indicating that these mergers may not be benefitting patients, industry regulators may want to rethink them, Ho and Short said.

“Our overall recommendation is one shared with previous researchers: Regulators should continue to focus scrutiny on proposed hospital mergers, take steps to maintain competition and reduce counterproductive barriers to entry,” the authors wrote in a summary of their paper.

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