Hospital mergers bring potential risks

Report notes increased patient volume, major changes in equipment, time for physicians to adjust

Ongoing consolidations, expansions and deal-making among hospitals aren’t just changing the culture of the health business — it may put patient safety at risk.

A report published this month in the Journal of the American Medical Association outlines potential safety pitfalls associated with the consolidation, purchase, merger and expansion of hospitals and health systems. These include increased patient volume, major changes in hospital equipment and infrastructure and the requirement of physicians to adjust to new settings.

These concerns seem valid to Lisa Freeman, executive director of the Connecticut Center for Patient Safety.

“As we know from past experiences, these expansions usually evolve from a financial motivation and patients are commonly told that they will lead to cost savings that will be passed on to the patient, without degradation of care,” Freeman said in an email. “They rarely are.”

The risks and benefits of hospital deal-making have been top-of-mind in Connecticut lately.

On March 27, Missouri-based nonprofit health system Ascension Health revealed plans to sell St. Vincent’s Medical Center in Bridgeport to Hartford HealthCare. The next day, Western Connecticut Health Network — which includes Danbury, Norwalk and New Milford hospitals

— announced it would join forces with Health Quest Systems, a four-hospital group in New York, to form a $2.4 billion medical system.

Experts have said this trend may be the new normal, which makes some of the concerns raised in the JAMA report worrisome. Even more concerning, the potential safety risks of hospital mergers and acquisitions hasn’t been rigorously analyzed in the state, said Patricia Baker, president and CEO of the Connecticut Health Foundation, which pushes for health care access for all state residents, particularly low-income people.

“I don’t think any of us know” whether the hospital deals that have created some of Connecticut’s health care change resulted in safety risks, Baker said. “We haven’t studied any of it, really.”

Safety concerns

The JAMA article analyzed patient safety risks at Harvard-affiliated hospitals, and the authors — who included prominent surgeon and writer Atul Gawande — identified three main issues linked to hospital mergers and acquisitions.

The first involves unfamiliar patients.

According to the article, “After a system expansion, health care institutions may experience significant changes in patient populations, including increases in general volume and inpatients with demographic characteristics or conditions that are new to a facility.”

For instance, expanding a hospital system could attract an influx of non-English-speaking patients who require interpreters, or those from a different income background than the system typically handles.

This particular issue could be a stumbling block with Hartford HealthCare’s planned acquisition of St. Vincent’s, Baker said. Though they are both urban areas, “Bridgeport’s population is going to be different than Hartford’s population,” she said. “How do you incorporate that cultural change?”

According to the JAMA report, another potential risk is system expansions often involve substantial changes to supplies, equipment, protocols and other aspects of hospital culture.

“Without planning, such changes can cause significant patient risk,” the article stated.

The last safety pitfall is these deals often mean

doctors have to travel to unfamiliar settings. According to the article, an industry survey of 82 health care institutions that had expanded their networks found 87 percent require physicians to travel to new practice sites.

These doctors often receive little orientation on their new surroundings, which can be problematic.

“In the absence of guidance, physicians indicated that they have adapted to these new circumstances through trial and error, which can put patients at risk,” the report reads.

Going forward

Freeman said the study is good is far as it goes, and she agrees with many of the possible risks identified. But, she said the analysis appears “to have been done without input from patients to find out what is important to them in identifying risks.”

For her work with patients — and her own experiences as a patient — Freeman said things like patient communication and work flow aren’t adequately taken into account when health systems expand.

“The engineers, architects and IT personnel design and re-design systems, in some cases without working with the employees and patients to understand those things that really impact patients,” Freeman said. “Without this input in redesign, systems are setting themselves up for problems.”

The JAMA article offers ideas for mitigating risks, including a patient safety toolkit, which provides guidance on topics officials at health systems should discuss prior to the launch of a merger or expansion.

Meanwhile, at least one local expert said, from her perspective as an academic, Connecticut hospitals and health systems have been conscientious in their transactions, but there is always room for improvement.

“I think people in Connecticut have been responsible toward quality of care issues in the mergers and acquisitions that have happened here,” said Angela Mattie, professor and chair of Quinnipiac University’s Department of Healthcare Management and Organizational Leadership.

However, she said, patient safety risks are associated with hospital dealmaking and, as with all aspects of this process, they need to be carefully considered.

“This isn’t even a conversation about mergers and acquisitions,” Mattie said. “It’s about ‘How do we add value for our patients?’ ”

Contributed photo New Milford Hospital is part of Western Connecticut Health Network.