Healthcare mergers pose a patient safety risk, study finds

The healthcare industry's appetite for mergers has yet to be sated and they could pose safety risks to patients, according to Harvard researchers in a new study.   

That is because as mergers are primarily driven by the business considerations, the potential clinical consequences can fall by the wayside, researchers said.

"The complexities of how clinical care will change isn't really first on their mind or deep in their understanding," Susan Haas, M.D., one of the project leads and a visiting scientist at Harvard T.H. Chan School of Public Health, told FierceHealthcare in an interview.

The study was also led by renowned author and New Yorker staff writer Atul Gawande, M.D. who is also a professor at Harvard, and Mark Reynolds, CEO of CRICO Strategies.

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Among the risks to consider they identified are: 

  1. New patient populations: Merging entities don't just consolidate facilities, they also consolidate patients. New groups of patients may have new needs and may even require health systems to invest in new capabilities. For example, health systems that have expanded their patient populations may encounter fare more people who do not speak English, increasingly the likelihood that they are unable to understand providers.
  2. Varied infrastructures: Each party involved in a merger brings its own documentation protocols, supply chains or technology platforms, which must be unified.
  3. Physicians on the move: The researchers found that it's extremely common for doctors to be relocated to new sites of care during a merger.  

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Haas said that the researchers were surprised to discover how limited of a role physicians play in merger talks. Their perspective, she said, could bring some of these concerns to the fore sooner. 

James Merlino, M.D., chief transformation officer at Press Ganey, told FierceHealthcare that mergers offer providers a significant opportunity to rethink their approach to patient care, and that considering quality, safety and the patient experience in the integration talks can help mitigate the risks. 

"This is really an opportunity to really think about redesigning care and to deliver transformational solutions," Merlino said. 

Another potential hurdle, which is not noted in the Harvard study, is uniting two provider cultures in a merger, Merlino said. Mergers and acquisitions can cause significant disruptions, and it's crucial to have a plan in place to align those cultures to minimize the disruption to care quality. 

Engaging with frontline physicians throughout the integration process, as the Harvard team also suggests, can help avoid those problems, according to Merlino. 

"Cultural disruption leads to people losing their mindfulness around things like safety, quality and experience," he said. 

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This is only continuing to grow as an area of importance for providers. 

Ongoing "merger-mania" in healthcare has kept up its momentum in the first months of this year. There were 31 deals announced in the first quarter of 2018, compared with 30 in Q1 2017 and 25 in 2016's first quarter, according to Kaufmann Hall.

To help providers better prepare to talk about safety when navigating a merger, the Harvard team built a toolkit for providers navigating consolidation. 

The kit, which is available for free, includes guides healthcare organizations can use to navigate crucial conversations during a merger. In addition to addressing high-priority issues such as internal culture and infrastructure, the toolkit offers specialty-specific guides for obstetrics, emergency care and surgical care. It also offers guiding principles for more effective clinical integration.

That process highlighted some key steps that two providers might not consider when planning a merger, such as conducting first meetings between major players off-site. 

"It's really about getting to know each other," she said, "and the importance of understanding that everyone is bringing something to the table here."