Rural Hospital Mergers Associated with Improved Patient Outcomes

Rural hospital mergers were associated with better patient outcomes compared to hospitals that remained independent, a study from JAMA Network Open found.

More than one in three community hospitals in the country are located in rural areas and are the main source of care for 60 million people. Many rural hospitals have experienced financial hardships and clinician shortages that increase their risk of closure but merging with another hospital may help them avoid that fate.

Mergers may increase access to financial resources, clinical expertise, and new technologies for small, rural hospitals. Hospital mergers may also increase market power through collective negotiation with payers and allow rural hospitals to join alternative payment models, such as accountable care organizations, the study stated.

Researchers looked at 172 merged hospitals and 266 hospitals that were independent to see if rural hospital mergers produced better patient outcomes for inpatient care. They used data from Irving Levin Associates and the American Hospital Association’s Annual Survey to identify hospital mergers between 2009 and 2016. They compared the mergers to independent rural hospitals in the same states.

Researchers used the Healthcare Cost and Utilization Project State Inpatient Databases to measure the quality of care in each hospital, looking at mortality rates for acute myocardial infarction, heart failure, acute stroke, gastrointestinal hemorrhage, hip fracture, and pneumonia. They also looked at inpatient stays for surgery and any complications that accompanied them.

Mortality rates for acute myocardial infarction stays were between 7.8 and 10.9 percent at hospitals premerger. After the hospitals merged, the rate declined to 6.3 percent after one year, and 4.3 percent after five years. The mortality rates for stroke, heart failure, and pneumonia also decreased post-merger.

Complications after elective surgeries decreased in both the merged hospitals and the independent hospitals, the study noted.

The mortality rates for all of the monitored conditions decreased in both merged hospitals and the independent hospitals, but the merged hospitals saw a greater decline.

Merged hospitals saw a 4.4 percent decrease in mortality rates for acute myocardial infarction stays, whereas the comparison hospitals only saw a 1.6 percent decrease. This trend remained consistent with the other conditions as well.

The merged hospitals may have produced better health outcomes due to increased resources and support as a result of the merger, the study indicated. Specifically, the merged hospitals may have had improved mortality rates for acute myocardial infarction due to the adoption of defined clinical pathways available through the transfer of technology from the larger health system in the merger.

The mortality rate improvements for stroke, heart failure, and pneumonia did not happen until three to five years after hospitals merged, indicating that adopting new approaches can be complex and it may take time for health systems to adapt.

Rural residents can struggle to access care compared to urban residents, which can increase their risk of death if they develop a serious condition. Mergers can help rural hospitals combine their resources and provide better care to patients. Mergers can also provide an opportunity for rural hospitals to partner with urban hospitals to improve care delivery and health outcomes.

“Furthermore, sharing staff and expertise as part of the merger can help alleviate workforce shortages and improve the hospital’s clinical services,” researchers concluded.