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Mergers and acquisitions of U.S. hospitals and well being programs hardly ever enhance the standard of care delivered or lead to decrease well being care prices and costs, in accordance with a examine printed within the Journal of the American School of Surgeons.
The examine, a scientific evaluation of tons of of printed research, comes amid accelerating well being care integration, typically known as consolidation. Practically 70% of U.S. hospitals at the moment are affiliated with a well being system.
“Proponents of health care integration have claimed it controls costs and enhances care quality,” mentioned lead examine creator Bhagwan Satiani, MD, MBA, FACS, professor of surgical procedure emeritus at The Ohio State College Wexner Medical Middle, Columbus, Ohio. “But we found that evidence is lacking that integration alone is an effective strategy for improving the value of health care delivery.”
The examine outcomes ship a transparent message to well being care leaders, Dr. Satiani mentioned.
“These findings provide an opportunity to better define value with a focus on benefiting patients while balancing the financial stability of the health care industry,” he mentioned. “Quality improvement in health care cannot be achieved by mergers and acquisitions alone.”
Results of well being care integration
The authors’ systematic evaluation 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 diminished 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 examine discovered fewer affected person deaths after integration.
Hospital expenses elevated with integration 93% of the time, in accordance with 13 of 14 research measuring value adjustments. 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 unfavourable (worse) internet influence.
In noting limitations of their evaluation, Dr. Satiani mentioned not one of the reviewed research used commonplace 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 examine differs from earlier analysis
Though different researchers have reached related 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 also have a direct impact on overall health care quality,” he mentioned.
Second, Dr. Satiani mentioned few of the printed research had been systematic opinions, 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 unbiased doctor practices.
To be included within the evaluation, articles should have reported not less than considered one 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 expenses the buyer per hospitalization, and spending was the group’s prices per affected person.
Dr. Satiani mentioned well being care leaders ought to delineate organizational sources and infrastructure for high quality enchancment efforts and standardize high quality metrics. As a mannequin for high quality enchancment, he steered the American School of Surgeons High quality Verification Program as a mannequin bettering surgical high quality.
Research co-authors are David Means, MEd; David Hoyt, MD, FACS; and E. Christopher Ellison, MD, FACS.
Extra info:
Bhagwan Satiani et al, Systematic Assessment of Integration Methods Throughout the US Healthcare System: Evaluation of Worth, Price, and High quality of Care, Journal of the American School of Surgeons (2024). DOI: 10.1097/XCS.0000000000001229
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American School of Surgeons
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Research signifies improved well being care worth can’t be achieved by hospital mergers and acquisitions alone (2024, December 30)
retrieved 30 December 2024
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