CALIFORNIA HOSPITAL MERGERS: Quality Of Care Not Impacted
"Patient care appears to be unchanged after hospitals merge or are bought by other institutions," according to the preliminary results of a new study by Washington University health care economists. The St. Louis Business Journal reports that the research shows that "mergers and acquisitions have little impact on two key measures of quality -- length of a patient's stay and inpatient mortality, or the number of patients who died before discharge from the hospital." The study "focused on transactions involving 370 hospitals in California between 1994 and 1996," including 19 independent hospitals which had merged; "56 acquisitions of independent hospitals by hospital systems"; "70 acquisitions of one hospital system by another"; and "20 acquisitions by Columbia/HCA Corp." The economists studied approximately 130,000 heart disease patients admitted to acute care facilities between January 1991 and June 1996.
The researchers found that the average length of a hospital stay "fell by a full day, from 5.74 days in 1991, to 4.74 days in 1995." The hospitals that showed bigger declines in average length of stay were those "not involved in mergers or acquisitions" and the independent hospitals that merged. Independent hospitals showed the greatest declines in inpatient mortality (down .018%), followed by hospitals not involved in mergers (down .012%), hospitals acquired by another system (down .007%) and hospital systems acquired by another system (down .005%). However, the hospitals acquired by Columbia displayed an increased inpatient mortality, "from 48 patients per 1,000 in 1991, to 53 patients per 1,000 in 1995." One of the researchers, Vivian Ho, said, "Columbia may have been taking in sicker patients to begin with. We can't determine that." The Business Journal notes that the study's time period "coincide[s] with the growth of managed health care insurance companies, which generally try to reduce costs by encouraging less expensive outpatient treatment over lengthy inpatient stays."
Ho noted that future investigations will focus on "whether merging hospitals actively try to screen for healthier patients and whether there is a difference between hospitals in rural and urban settings." Ho also wishes "to expand the analysis to look at readmissions" (Manning, 1/26).