Few states are monitoring, much less acting to protect, patient-consumers from one of the hot trends in today’s health care: the mergers, acquisitions, consolidations─and yes, closings─that are creating super-sized hospital organizations, chain-institutions that for business reasons seek greater efficiencies but also may be lessening access to care, sometimes as a result of religious reasons.
That’s the contention of a group called mergerwatch.org, which arose from a group of New York state family planning advocates who reacted when two hospitals, one Catholic and the other secular, merged, and reproductive services became a contentious issue in the new institution.
The group since has scrutinized hospital mergers, consolidations, and closings nationally, issuing a new study from its “When Hospitals Merge” project─an initiative that has been foundation supported and has published in peer-reviewed, respected medical journals like the AMA Journal of Ethics.
As Pro Publica, the Pulitzer Prize-winning investigative news site, has reported about the group’s findings on hospital super-sizing, based on scrutiny of state’s requiring hospitals to file Certificates of Need when making business decisions that might affect community health:
Only 10 states require government review before hospital facilities and services can be shut down. Only eight states and the District of Columbia mandate regulatory review when hospitals enter into more informal partnerships rather than full-scale mergers, closing a loophole that exists in other states for deals to pass with minimal state oversight. Smaller, local hospitals often agree to merge with larger chains in order to survive. The goal is to cut overlapping services, negotiate better deals with insurance companies and share in the cost savings. But without state protections, local residents can see health services disappear, sometimes without a chance to weigh in.
Some 240 hospitals that once offered badly needed but costly short-term acute care no longer do so due to mergers or consolidations in the last 15 years, mergerwatch.org says. ProPublica cites an industry group’s reporting that in 2015, 112 hospital deals were announced, a 70 percent increase over 2010.
Mergerwatch.org offers model laws and ways that concerned parties can advocate for patient care access, including pressuring state regulators to act. The hospital merger project examined state oversight, giving letter grades: a B+ to the District of Columbia, a B to Virginia, and a B- to Maryland.
To be sure, the group’s cause may be upsetting to some because of its opposition to reductions in reproductive services that result when faith-based chains are involved in hospital chains. As Pro Publica, which published its report with Mother Jones, noted of reductions in health care services that occur as a result of hospital deals:
Sometimes the loss of services is ideological … the expansion of Catholic hospitals in Washington State has led to restrictions on women’s health services and end-of-life counseling. Other times it’s just the bottom line: Expensive services such as pediatrics, obstetrics, emergency room and neo-natal intensive care may be downsized when a non-profit hospital is taken over by a for-profit one.
I’ve noted before that some patients, physicians, and hospitals in California have gotten into a wrangle about religious freedoms and who decides what kind of care patients will receive. When it comes to deeply held beliefs and the delivery of health care, decisions aren’t easy, I know.
Still, there’s a big point that we can’t lose in valuable scrutiny of hospitals and their activity: much as these highly profitable institutions portray themselves as beneficent pillars of their communities, they’ve become big businesses that all too often act in self-interest. If they think becoming what’s best for them is becoming behemoth franchises ala McDonald’s or Wal Mart, patients and their “Lilliputian needs,” like compassionate, affordable, and accessible care, can get stomped on. Lawmakers, regulators, and advocates, including those acting in the civil justice system, need to be wary of corporatized giants and their potentially callous steps.
