The study found that consolidation increased the mortality rate in rural hospitals

Rural hospitals that have merged or been merged into larger health systems are associated with larger reductions in deaths from conditions such as heart failure, stroke and pneumonia, compared to institutions that have remained independent, according to a new study.

The annual inpatient mortality rate from acute myocardial infarction has dropped from 9.4% to 5% among acquired hospitals, researchers from the Agency for Health Research and Quality and IBM Watson Health found. Meanwhile, in independent medical institutions during the study period, inpatient mortality from AMI decreased from 7.9% to 6.3%.

“Mergers can enable rural hospitals to improve the quality of care by accessing the necessary financial, clinical and technological resources, which is important for improving health in rural areas and reducing quality disparities between urban and rural areas,” says a study published Monday in JAMA Open Network concluded.

The researchers compared mortality rates from 2009 to 2016 from six health conditions in 172 hospitals before and after they were acquired, and compared them to more than 260 institutions that did not participate in the merger over the same period.

Improvements in mortality rates from heart failure, stroke, and pneumonia were also significant among acquired hospitals, but these results were not noticeable until three to five years after the merger.

Mortality rates from other conditions, including gastrointestinal bleeding, hip fractures, and complications after elective surgery, remained relatively stable for both pooled and non-pooled hospitals over the years studied.

The findings appear to point to differences in the relationship between mergers and the quality of service in urban and rural hospitals. Previous studies found that hospital mergers in urban markets had little or no impact on some quality metrics.

“Future research should investigate whether there are excellent results for rural hospitals acquired by large hospital systems, compared to rural hospitals that merge locally with another hospital, or for those that have already been merged or merged before the second merger,” they write researchers.

The findings add a new dimension to the debate about the benefits and potential harms of hospital consolidation.

More than one third of public hospitals in the United States are located in rural areas and serve 60 million people. However, the economic troubles, compounded by years of declining patient numbers and a shortage of doctors, have stopped. more than 100 rural hospitals between January 2013 and February 2020. Every fourth rural institution is under threat of closure.

These financial problems have increased the activity of mergers and acquisitions over the past decade, as more rural hospitals see joining larger health systems as an alternative to cutting services or completely closing them. More than 380 rural hospital mergers took place between 2005 and 2016, according to a 2018 study by the University of North Carolina. Cecil G. Sheps Health Services Research Center

Other advantages that rural hospitals are attracted to merge with larger health systems include better clinical coordination, standardization of processes such as billing that can make them more efficient, and assistance in recruiting doctors to address staff shortages.

Consolidation advocates such as the American Hospital Association have argued for years that hospital mergers and acquisitions lead to lower health care costs and better quality of care. AHA analysis published last month, which reviewed over 750 hospital acquisitions from 2009 to 2019, it was found that such transactions were associated with a 3.3% reduction in annual hospital operating costs in acquired facilities and a 1.1% decline 30 – the daily rate of readmission for heart attacks. …

Critics, however, argue that such deals result in less competition, reduced access to health care and higher medical costs, but do not significantly improve the quality of care.

Results from previous research funded by AHRQ and published last year in New England Journal of Medicine Hospitalization was found to be associated with “… a moderately worse patient experience and no significant change in readmission or mortality rates.”

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