par John R. Fischer
, Staff Reporter | February 26, 2019
Providers and physician groups merge for a variety of reasons, from conserving costs to combining specialties, all undertaken with the assumption that it will improve patient care.
But do mergers actually benefit patients? A new study has found no improvement or decline in the quality of care – and actual decreases in patient satisfaction – provided by entities that combine with one another.
“Increased quality is used as an argument for integration with the expectation that it will decrease fragmentation and improve coordination of care. Unfortunately, we do not see evidence of this in our results,” co-author Marah Short, associate director of the Center for Health and Biosciences at Rice University's Baker Institute for Public Policy, told HCB News. “Across the 29 measures in our study, this type of integration is neither improving nor harming quality, overall.”
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Evaluating data from the Centers for Medicare and Medicaid Services’ Hospital Compare database, Short and another co-author, Vivian Ho, the James A. Baker III Institute chair in health economics and director of the center, used 29 data points and assessed 16 processes of care to determine if increases in hospital market concentration or vertical integration between hospitals and physicians influence patient outcomes. Among these points were readmission rates; process of care measurements for how well a hospital provides care; and patient satisfaction scores.
Initially hypothesizing that better coordination among primary care doctors, specialists and admitting and attending hospital physicians led to greater patient care, the two were surprised to find that the onset of vertical integration neither improved nor harmed quality of care.
“For the 16 processes of care examined, this could be, in part, due to the fact that these treatment standards are so widely accepted,” said Short. “Therefore, regardless of integration level, physicians want the best outcomes for patients and may adhere to common processes with or without hospital oversight.”
They also linked increased market concentration to lower levels of quality for patient satisfaction, chalking the matter up to less incentive among clinicians to keep patients happy, due to reductions in fear of or pressure from less competition.
Such a fact, they assert, may eventually negatively impact the quality of care provided to patients, but that further examination of patient experience is necessary.
“Further research is needed to determine how well better patient experience correlates with higher clinical quality. We have found that increased market concentration, which lowers competition, results in lower patient satisfaction," said Short. "And given the nature of these measures, there are those which may arguably directly affect quality of care, such as explaining medications or communicating well with patients. And if patient satisfaction does not correlate with higher clinical quality, better measures need to be developed and made available in terms that the average consumer can understand and utilize.”
The study was limited by the exclusion of certain outcomes, such as mortality and morbidity, as measures of quality. Patient satisfaction was assessed from surveys filled out by patients at the end of their hospital stay.
The findings were published in the journal, Medical Care Research and Review.