What’s New in the
Patient Safety World
September 2018
Mergers and Patient
Safety
In multiple presentations on healthcare policy (outside of
our patient safety activities) we have discussed the impact of mergers and
acquisitions in healthcare. Having participated directly or indirectly in
several mergers, we’ve focused primarily on the financial implications.
The American Hospital Association (AHA
2017) released a report in 2017 (Noether
2017) touting that:
- Mergers
decrease costs due to economies of scale, reduced costs of capital and
clinical standardization among other efficiencies
- Mergers
have the potential to drive quality improvements through standardization
of clinical protocols and investments to upgrade facilities and services
at acquired hospitals.
- Mergers
typically expand the scope of services available to patients,
and build upon existing institutional strengths to provide more
comprehensive and efficient care.
Call us skeptics. While every merger promises the community
incredible financial benefit, few deliver on those promises. Theoretically,
mergers should produce much savings by eliminating duplication. But, in reality, such mergers usually result in putting
negotiating clout in one system and eventually rising healthcare costs for the
community.
A number of years ago we participated in a panel discussion with Alan
Sager, Ph.D., from Boston University School of Public Health, who had done
extensive research on the community impact of hospital closures. His research
showed that hospital closings have repeatedly failed to cut costs,
and can even result in increased costs. Moreover, hospital closings have
harmed access to care—particularly in underserved areas and communities of
color (Sager
2006).
But until now there has been little attention to the patient
safety repercussions of hospital mergers. Haas and colleagues (Haas 2018)
recently published a Viewpoint in JAMA, highlighting several key challenges and
barriers that may interfere with clinical care following mergers.
The authors identified 3 key risks to patient care resulting
from mergers:
- New patient populations
- Unfamiliar infrastructure
- New settings for
physicians
Post-merger, patients may be cared for by clinicians and
staff who have little existing knowledge about them. Changes in supplies,
equipment, formularies, protocols, and information systems also lead to
unfamiliarity that may adversely impact patient care. And physicians,
especially specialists, may now be required to travel to new settings where
they may be unfamiliar with infrastructure, processes, teams, and clinical
cultures that may differ significantly from one organization to the other(s).
Importantly, in collaboration with their Ariadne Labs, they
make available for free a guide
and patient safety toolkit to help with clinical planning between
institutions prior to mergers. It also includes a checklist for developing a
joint clinical integration council.
Mergers are not easy on clinicians and healthcare staff and
ultimately may jeopardize patient safety. These resources are extremely
valuable for any organizations considering merger and need to be tapped very
early in any discussions about merger.
References:
AHA (American Hospital Association).
New Research Finds Hospital Mergers Drive High-Value, High-Performing Health
Care. AHA Press Release 2017; January 25, 2017
https://www.aha.org/press-releases/2017-01-25-new-research-finds-hospital-mergers-drive-high-value-high-performing
Noether M, May S. Hospital Merger Benefits: Views from Hospital
Leaders and Econometric Analysis. Charles River Associates 2017; January 2017
https://www.aha.org/system/files/2018-04/Hospital-Merger-Full-Report-FINAL-1.pdf
Sager A, Socolar D. Closing Hospitals in
New York State Won’t Save Money But Will Harm Access to Health Care. A Short
Report Prepared for The Committee of Interns and Residents New York City. 20
November 2006
https://www.bu.edu/sph/files/2015/05/Sager-Hospital-Closings-Short-Report-20Nov06.pdf
Haas S, Gawande A, Reynolds ME. The Risks
to Patient Safety From Health System Expansions. JAMA
2018; 319(17): 1765-1766
https://jamanetwork.com/journals/jama/article-abstract/2678285
Ariadne Labs. Patient safety toolkit for system expansion.
https://www.ariadnelabs.org/safe-expansion/
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