For smaller hospitals, not all mergers created equal

In a healthcare environment where small hospitals increasingly have no choice but to affiliate with larger facilities and chains, the new primary consideration is often which network to join.

"As a small hospital you have to pick. You have to choose which network you'll be a part of or you'll be shut out," Jim Albert, president of the Bristol Chamber of Commerce and Central Connecticut Chambers of Commerce, told the Record-Journal. "Anyone under $4 billion in annual revenue is discussing and thinking, 'How do we partner with someone to survive?'"

For example, Bristol Hospital in Connecticut may join both Yale-New Haven Health System and the Texas-based Tenet, according to the Record-Journal. Networks often have different integration strategies for new hospitals, and give those new members varying levels of local control.

Hartford HealthCare, for example, takes a more heavy-handed approach, Albert said, requiring new members to adopt culture and computer systems. MidState Medical Center CEO Lucille Janatka defended such changes--and others, such as bed reduction--as a necessary part of the transition, according to the article.

Large-scale proposed mergers, such as that of Chicago's Advocate Health Care and NorthShore University Health System, increase pressure on not only stand-alone hospitals, but smaller systems as well, according to Crain's Chicago Business.

"I suspect all the boards of these stand-alones and small systems are putting heat on management, asking, 'What are we doing, and if we're not doing anything, why not?'" Don Hamilton, a Wisconsin-based healthcare consultant, told Crain's.

However, hospital network growth can potentially drive up prices, according to, and some experts fear they run afoul of antitrust laws.

Congress could clarify these concerns and laws on provider coordination and antitrust, writes Robert I. Field, Ph.D., of the Drexel School of Public Health, but legislators' healthcare focus has been almost exclusively on attempting to repeal the Affordable Care Act (ACA). If Congress transcends the debate over the ACA, he writes, "it might instead be able to address more pressing healthcare concerns, such as the balance between provider collaboration and competition, to everyone's benefit."

To learn more:
- read the Record-Journal article
- here's the article
- check out the Crain's article