Advertisement

Variable surgical outcomes after hospital consolidation: Implications for local health care delivery

      Background

      With more hospital consolidations as an inevitable part of our future health care ecosystem, we investigated the relationship between hospital consolidations and operative outcomes.

      Methods

      Using the Health Care Cost and Utilization Project State Inpatient Database (Florida and California), the American Hospital Association Annual Survey Database, and Medicare's Case Mix Index data, we identified 19 hospitals that consolidated between 2007 and 2013 and propensity matched them with 19 independent hospitals, using patient and hospital characteristics. One year before consolidation and again 1 year after, we used difference-in-differences analysis to compare changes in the risk-adjusted complication rate of 7 elective operations performed in the consolidated hospitals and in the matched control group.

      Results

      Of the 7 procedures studied, 2 procedures saw a decrease in complication rate (lumbar and lumbosacral fusion of the posterior column posterior technique, difference-in-differences = −0.6%, P < .01; total hip replacement, difference-in-differences = −0.6%, P < .01); 3 procedures saw an increase in complication rate (transurethral prostatectomy, difference-in-differences = 4.1%, P < .01; cervical fusion of the anterior column anterior technique, difference-in-differences = 1.5%, P < .01; total knee replacement, difference-in-differences = 0.3%, P < .01); and 2 procedures saw no change in complication rate (laparoscopic cholecystectomy, lumbar and lumbosacral fusion of the anterior column posterior technique, both P > .05) after hospital consolidation.

      Conclusion

      Arguments have been made that consolidated health care systems can share high-performing clinical services and infrastructure resources, such as electronic medical records, to improve quality. Our results indicate that hospital consolidation does not uniformly improve postoperative complication rates.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. Daly R. Health care deals surge in 2015. 2015; Healthcare Business News; http://www.hfma.org/Content.aspx?id=42986).

        • Xu T.
        • Wu A.W.
        • Makary M.A.
        The potential hazards of hospital consolidation: Implications for quality, access, and price.
        JAMA. 2015; 314: 1337-1338
        • Frakt A.B.
        Hospital consolidation isn't the key to lowering costs and raising quality.
        JAMA. 2015; 313: 345
        • Gaynor M.
        • Town R.
        The impact of hospital consolidation—Update.
        (The Synthesis Project) Robert Wood Johnson Foundation, New Jerssey2012 (Available from:)
        • Abraham J.
        • Gaynor M.
        • Vogt W.B.
        Entry and competition in local hospital markets.
        J Ind Econ. 2007; 55: 265-288
        • Capps C.S.
        The quality effects of hospital mergers.
        US Dept. of Justice, Antitrust Division, Washington, D.C.2005
        • Encinosa W.E.
        • Bernard D.M.
        Hospital finances and patient safety outcomes.
        Inquiry. 2005; 42: 60-72
        • Escarce J.J.
        • Jain A.K.
        • Rogowski J.
        Hospital competition, managed care, and mortality after hospitalization for medical conditions: Evidence from three states.
        Med Care Res Rev. 2006; 63: 112S-140S
        • Rogowski J.
        • Jain A.K.
        • Escarce J.J.
        Hospital competition, managed care, and mortality after hospitalization for medical conditions in California.
        Health Serv Res. 2007; 42: 682-705
        • Romano P.S.
        • Balan D.J.
        A retrospective analysis of the clinical quality effects of the acquisition of Highland Park Hospital by Evanston Northwestern Health care.
        Int J Econ Business. 2011; 18: 45-64
        • Sohn M.
        • Rathouz P.J.
        Competition among hospitals and quality of care: Hospital-level analysis.
        (Unpublished paper) University of Chicago, 2003
        • Cutler D.M.
        • Huckman R.S.
        • Kolstad J.T.
        Input constraints and the efficiency of entry: Lessons from cardiac surgery.
        Amer Econ J: Econ Policy. 2010; 2: 51-76
        • Howard D.H.
        Quality and consumer choice in health care: Evidence from kidney transplantation.
        BE J Econ Analysis & Policy. 2005; 5: 1349
        • Luft H.S.
        • Bunker J.P.
        • Enthoven A.C.
        Should operations be regionalized? The empirical relation between surgical volume and mortality.
        N Engl J Med. 1979; 301: 1364-1369
        • Urbach D.R.
        Pledging to eliminate low-volume surgery.
        N Engl J Med. 2015; 373: 1388-1390
        • Dranove D.
        • Lindrooth R.
        Hospital consolidation and costs: Another look at the evidence.
        J Health Econ. 2003; 22: 983-997
        • Dimick J.B.
        • Ryan A.M.
        Methods for evaluating changes in health care policy: The difference-in-differences approach.
        JAMA. 2014; 312: 2401-2402
        • Southern D.A.
        • Quan H.
        • Ghali W.A.
        Comparison of the Elixhauser and Charlson/Deyo methods of comorbidity measurement in administrative data.
        Med Care. 2004; 42: 355-360
        • Burns L.R.
        • Bazzoli G.J.
        • Dynan L.
        • Wholey D.R.
        Impact of HMO market structure on physician-hospital strategic alliances.
        Health Serv Res. 2000; 35: 101-132
        • Blackwell R.H.
        • Barton G.J.
        • Kothari A.N.
        • Zapf M.A.
        • Flanigan R.C.
        • Kuo P.C.
        • et al.
        Early intervention during acute stone admissions: Revealing “the weekend effect” in urological practice.
        J Urol. 2016; 196: 124-130
        • Zapf M.A.
        • Kothari A.N.
        • Markossian T.
        • Gupta G.N.
        • Blackwell R.H.
        • Wai P.Y.
        • et al.
        The “weekend effect” in urgent general operative procedures.
        Surgery. 2015; 158: 508-514
        • Kothari A.N.
        • Zapf M.A.
        • Blackwell R.H.
        • Markossian T.
        • Chang V.
        • Mi Z.
        • et al.
        Components of hospital perioperative infrastructure can overcome the weekend effect in urgent general surgery procedures.
        Ann Surg. 2015; 262: 683-691