Our Take: Considering Quality in a Business Combination 

Of the umpteen elements hospital leaders evaluate when considering the viability of a potential partner, quality is generally at the top of the list.

A larger partner can bring the scale, resources and expertise many smaller hospitals and systems seek to improve care quality for their community. This can include enhanced clinical protocols and standards, facility and equipment investments, deployment or recruitment of highly-skilled medical staff, patient support programs and more. Integrated delivery systems are also better positioned to address population health and health inequities, offering new approaches to keeping communities well and synergies with readmissions reduction strategies.

A partnership can provide a host of opportunities to improve care quality and patient outcomes, but in the early stages of exploration there is limited ability to dive deep into tactics. Instead, hospital leaders look for succinct ways to ascertain a potential partner’s quality of care.

Countless measures can be equated to quality, from objective metrics like infection and readmission rates, to the more subjective, like noise levels at night. And there is no shortage of options for comparison: CMS Hospital Compare, Leapfrog, Consumer Reports, US News & World Report, the Commonwealth Fund. Many states also have their own scorecards. These comparison tools attempt to distill complex hospital data into a single,consumer-friendly quality rating or grade. While these efforts are admirable in theory, health care organizations and trade groups regularly question rating systems’ methodologies, weighting and the impact of incomplete or statistically insignificant data. Deloitte reported that “5-star rated hospitals tended to be missing data for more measures than their lower-rated peers”, and this summer Rush University Medical Center in Chicago released an analysis showing flaws in CMS’ Hospital Compare Star Rating calculations.

Using the same metrics to rate the quality of care at hospitals that have significantly disparate services, volumes, acuity and patient demographics does not result in highly-precise, comparable scores. Even comparing quality trends at a single hospital can be challenging, as the measures that go into a score can be modified year-to-year.

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