Adding Up the Romantic and Philosophical Benefits of Provider Affiliations

In Bargain, Pete Townshend of The Who sings, “One and one don’t make two. One and one make one.”

It’s the romantic notion that when two people who are right for each other get together they essentially become one person. A new being. They are better together than they are apart.

Or, if you prefer Aristotle to Townshend, “The whole is greater than the sum of its parts.”

Two studies published in JAMA Network Open tested whether that same notion applies in healthcare regarding provider affiliations. The results were mixed, proving once again that healthcare, although a business like any other business in any other industry, is more complicated than love or philosophy.

In the first study, which you can download here, researchers from the Medical College of Wisconsin and Eastern Michigan University wanted to know whether there was a connection between how many hospitals doctors were affiliated with and how doctors practiced. One would think physician practice patterns would improve as the number of affiliations increased as doctors picked up best practices at each hospital and applied them at their other hospitals. 

Alas, the answer is no. Compared with doctors affiliated with a single hospital, doctors affiliated with multiple hospitals: 

• Used more medical and drug services  
• Performed a wider range of medical and drug interventions 
• Incurred higher medical and drug costs

“These findings suggest that clinicians may shift their treatment patterns—both treatment mix and quantity—when they start working across more hospitals,” the researchers said.  Further, “Greater use of costlier hospital resources, whether as a result of defensive medicine or other hospital incentives, is potentially responsible for an increase in per-patient care use and costs of affiliated clinicians.”

One and one don’t make two. One and one make at least three when it comes to hospital-physician affiliations.  

If you want to learn more about this topic, please read, “Beware the Vertically Integrated Employed Physician” on 4sighthealth.com.

In the second study, which you can download here, eight researchers from NYU Langone Health in New York wanted to know if the system’s 2016 acquisition and merger with Lutheran Medical Center, also in New York, improved quality and safety at Lutheran, now known as NYU Langone Hospital-Brooklyn.

You know it did or else there wouldn’t be a published study with eight names on it. But I’ll give you the details anyway.

Comparing six years before the merger with three years after the merger at the old Lutheran facility:

• Patient mortality rates went down
• Central-line infections went down
• Urinary-tract infections went down
• More patients said they would recommend the hospital
• But readmission rates stayed about the same 

“Despite evidence that mergers usually reduce quality, we found that strategic consolidations can be associated with substantially improved quality when performed effectively,” the researchers said.

One and one don’t make two. One and one make a better one in this case, which interestingly includes the candid acknowledgment that most hospital mergers do just the opposite.

When you put the two studies together, what do you get? You get a lot of room and opportunity for cost and quality improvement, but provider affiliations aren’t magic bullets to achieve either It’s completely up to the parties involved whether they want to use their affiliation to create more value for patients.

So much for love and philosophy. 

Thanks for reading.