Health System Integration Is Not Associated With Improved Care Quality

Health systems’ increasing financial integration—in which multiple hospitals or physician practices are owned by a single entity—generally has not led to higher quality of care, according to an AHRQ-funded study published in Health Affairs. In surveys administered to 739 hospitals and 2,189 physician practices, researchers measured the adoption of nine quality-related care delivery reforms, such as use of evidence-based guidelines, screening for clinical conditions and participation in quality-focused payment programs. Little relationship between financial integration of hospitals and physician practices and better quality was found. In no case did physician practices in complex systems have higher scores. Bigger system size was not associated with better scores. Access the abstract.

Financial Integration's Impact On Care Delivery And Payment Reforms: A Survey Of Hospitals And Physician Practices

Affiliations

PMID: 32744948
DOI: 10.1377/hlthaff.2019.01813

Abstract

Health systems continue to grow in size. Financial integration-the ownership of hospitals or physician practices-often has anticompetitive effects that contribute to the higher prices for health care seen in the US. To determine whether the potential harms of financial integration are counterbalanced by improvements in quality, we surveyed nationally representative samples of hospitals (n = 739) and physician practices (n = 2,189), stratified according to whether they were independent or were owned by complex systems, simple systems, or medical groups. The surveys included nine scales measuring the level of adoption of diverse, quality-focused care delivery and payment reforms. Scores varied widely across hospitals and practices, but little of this variation was explained by ownership status. Quality scores favored financially integrated systems for four of nine hospital measures and one of nine practice measures, but in no case favored complex systems. Greater financial integration was generally not associated with better quality.

Keywords: Financial Integration; Government programs and policies; Hospital quality; Hospitals; Integrated Delivery Systems; Medical research; Organization of care; Payment; Physician practices; Primary care; Quality of care; Systems of care; consolidation; health policy; quality improvement.