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Larger healthcare systems generally not associated with better healthcare quality

The COVID-19 pandemic has led to severe financial stress for both hospitals and physician practices, raising serious concerns that many may either close or be purchased by larger organizations. Such consolidation is well-recognized to lead to higher consumer prices. However, a new study finds that there are apparently no offsetting advantages in terms of higher quality healthcare.

The study—published in the August 2020 issue of Health Affairs and co-authored by experts from UC Berkeley’s School of Public Health—is based on the first comprehensive national survey of physician practices, hospitals and health systems, and  found that larger, more complex healthcare systems do not generally deliver better quality.

In addition, the study showed a remarkable degree of variation in quality scores across hospitals and physician practices, regardless of whether they were independent or owned by larger systems.

“This degree of variation points to tremendous opportunities to improve the quality of care in both hospitals and practices,” said co-author Stephen Shortell, PhD, distinguished professor emeritus at Berkeley Public Health. “We must continue to put in place the incentives and programs needed to drive improvement.”

The research team assessed the degree to which hospitals and physician practices under several different ownership structures—including financial independence and financial integration with larger health systems—adopted care delivery and payment reforms intended to improve quality. They analyzed data from the National Survey of Healthcare Organizations and Systems, which included responses from 2,190 physician practices and 739 hospitals that were collected between June 2017 and August 2018. The surveys included questions about care for complex, high-need patients; participation in quality-focused payment programs; screening for clinical conditions and social needs; and use of registries and evidence-based guidelines.

The results are consistent with recent research from the patient’s perspective finding that larger medical practices and hospital-owned groups do not provide more coordinated care.

“Our nation’s hospitals and physician practices have not widely adopted strategies to better engage patients in their own health care, such as motivational interviewing and shared decision-making, and largely do not screen for social risks that are known to exacerbate chronic conditions,” says study co-author Hector P. Rodriguez, PhD, MPH, Henry J. Kaiser Professor of Organized Health Systems at Berkeley Public Health.

“In spite of extensive national discourse about the importance of engaging patients and addressing social risks that impact health, our study results highlight that much work needs to be done across all types of organizations to better address patient needs and preferences, and the underlying social determinants of health,” Rodriguez says.

This research is a collaboration between Dartmouth College; the University of California, Berkeley; UCSF; the University of North Carolina at Chapel Hill; Harvard University; and the Mayo Clinic.