Transforming Health Care Through Evidence and Collaboration
Transforming Health Care Through Evidence and Collaboration
The NIHCM Foundation is a nonprofit, nonpartisan organization dedicated to improving the effectiveness, efficiency and quality of America's health care system.
  • Data Insights

    Mental illness is increasingly common among young people but many are not receiving the treatment that they need. This Data Insights explores current trends in youth mental health and opportunities to improve outcomes.

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  • Grants

    NIHCM Foundation has awarded 14 grants for health care journalism including investigative reporting and educational opportunities for reporters.

    Press Release All Journalism Grantees
  • Awards

    NIHCM Foundation is pleased to welcome Dr. Karen DeSalvo, Dr. Aaron E. Carroll and Eliza Barclay to the independent judges panel of the NIHCM Awards. All three bring considerable expertise to the prestigious panel.

    Press Release Judges Panels The NIHCM Awards
  • Grants

    NIHCM Foundation has awarded over $500,000 in grants to support nine investigator-initiated research studies.

    Press Release All Research Grantees
  • Briefing

    NIHCM Foundation led a briefing on Capitol Hill to discuss social determinants of health and the opioid crisis with Founding President and CEO Nancy Chockley, former CMS Administrator Don Berwick, Curtis Barnett of Arkansas Blue Cross Blue Shield, Craig Samitt of Blue Cross and Blue Shield of Minnesota, and Grant Baldwin from the CDC.

    Press Release Watch the Video
  • Advisory Board

    NIHCM Foundation is pleased to welcome Dr. Scott Gottlieb, Sherry Glied, PhD, and Katherine Baicker, PhD, to its distinguished Advisory Board. Their ideas and insights will advance NIHCM's mission to improve health care for millions of Americans.

    Press Release Advisory Board
  • News

    NIHCM welcomed Secretary Azar to a meeting in March to discuss efforts by the Department of Health and Human Services to transform health care by lowering costs and improving value for patients.

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Events

February 24, 2020
Teen-Mental-Health-webinar-graphic

This webinar explored cross-sector strategies to prevent teen substance and suicide, as well as the role of school-based health services in providing behavioral health care.

January 27, 2020
SDOH-webinar-graphic-012720

This webinar explored public and private sector efforts to improve health outcomes by addressing social determinants of health.

In the News

February 2020
Population Health Spotlight
newsletter-alcohol-deaths-v2

Hospital Mergers and the Unrealized Promise of Better Quality

Why This Study Is Important

Across the country, mergers and acquisitions in the hospital industry are reducing competition between local rival hospitals and conferring additional clout to regional and national hospital systems as these systems grow in size and dominance. Strong empirical evidence shows this increased market power enables hospitals to negotiate higher prices. While proponents of hospital mergers often assert that consolidation can also improve quality of care, the limited evidence on this point is mixed and derived primarily from studies examining a narrow set of quality measures for specific acquisitions and for merger activity occurring two decades ago. This study is the first systematic assessment of a broader range of quality impacts on hospitals acquired in a comprehensive set of recent mergers. Its findings belie the claims that hospital consolidation improves quality of care.

What This Study Found

  • Compared to similar hospitals that were not acquired, acquired hospitals experienced a progressive decline in patient experience measures after the ownership change. By the third post-acquisition year, the decline in the composite patient experience measure for acquired hospitals was equivalent to a drop from the 50th to the 41st percentile of the performance distribution.
  • These declines occurred mainly when acquiring hospitals had lower baseline performance on the patient experience measure, suggesting that their own low performance may have subsequently spread to their acquired hospitals. There was no evidence of a corresponding boost in quality when the acquiring hospital had higher baseline patient experience ratings.
  • Acquisitions did not have a significant impact on 30-day readmission or mortality rates. Acquired hospitals had marginally better performance on both measures prior to acquisition, but did not widen their performance advantage in the three years following acquisition.
  • Although acquired hospitals improved their performance on clinical process measures relative to control hospitals over the study period, nearly all of the differential improvement took place before the ownership change, suggesting the acquisition was not the causal factor.

What These Findings Mean

It is well established that hospital mergers bring higher prices for patient care, but many hospital systems argue that mergers can also improve quality. Findings from this study run contrary to that claim for the four dimensions of quality examined. On average, across all acquired hospitals, there was no evidence that clinical processes or patient outcomes improved after an ownership change, but results point to modestly worsening quality from the patient experience perspective. The deterioration in the patient experience measures may be of particular concern because these measures reflect aspects of quality that matter to patients when receiving care. In the face of ongoing hospital market consolidation and accompanying price increases, consumers deserve to experience measurable and meaningful quality improvements, extending even beyond the dimensions studied here. Merging hospitals must be held more accountable for achieving, not just promising, such benefits.

More About This Study

This study used difference-in-differences modeling to compare changes in the quality performance of 246 short-term acute care hospitals that were acquired between 2009 and 2013 with concurrent changes for 1,986 control hospitals not experiencing an ownership change. Performance for four different quality indicators was assessed for each hospital for several years before and after the acquisition period. Two composite measures of quality were derived from the Medicare Hospital Compare data system: the first was based on five measures of patient-reported experiences during hospital stays and the second reflected hospital performance on seven indicators of clinical processes of care such as timely use of appropriate medications for specific types of patients. Medicare claims were used to compute risk-adjusted all-cause 30-day readmission and mortality rates.

Full Citation

Beaulieu ND, Dafny LS, Landon BE, Dalton JB, Kuye I, and McWilliams JM. “Changes in Quality of Care after Hospital Mergers and Acquisitions.” The New England Journal of Medicine, 328(1):51-9. January 2, 2020.

This Research Insights highlights a new study on hospital consolidation that did not find improvements in the quality of care following hospital acquisition.

Events

February 24, 2020
Teen-Mental-Health-webinar-graphic

This webinar explored cross-sector strategies to prevent teen substance and suicide, as well as the role of school-based health services in providing behavioral health care.

January 27, 2020
SDOH-webinar-graphic-012720

This webinar explored public and private sector efforts to improve health outcomes by addressing social determinants of health.

In the News

February 2020
Population Health Spotlight
newsletter-alcohol-deaths-v2

Grants

Journalism GrantsJournalism Grant Program

NIHCM has announced its 2019 journalism grantees. We will begin accepting Letters of Inquiry for the 2020-2021 funding cycle in late spring 2020.

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Investigator-Initiated Research Grant Program

NIHCM has announced its 2019 research grantees. We will begin accepting Letters of Inquiry for the 2020-2021 funding cycle in late spring 2020.

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Awards

The 26th Annual Research and Journalism Awards

Winners Announcment 2018 1

We are no longer accepting entries for this year's awards cycle. Winners and finalists will be recognized at a dinner in Washington, D.C., in May 2020.

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