Department of Healthcare Leadership and Management, College of Health Professions, Medical University of South Carolina, South Carolina.
Department of Health Policy and Management, Gillings School of Global Public Health and the Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
J Rural Health. 2021 Mar;37(2):308-317. doi: 10.1111/jrh.12461. Epub 2020 Jun 25.
To determine whether inpatient and outpatient charges changed at rural hospitals after a merger.
Hospital mergers were derived from proprietary Irving Levin Associates data through manual review and validation. Hospital-level characteristics were derived from HCRIS, CMS Impact File Hospital Inpatient Prospective Payment System, Hospital MSA file, AHRF, and US Census data. A difference-in-differences approach was used to determine whether inpatient and outpatient charges changed at rural hospitals after a merger. The comparison group, rural hospitals that did not merge at any point during the sample period, was weighted using inverse probability of treatment weights. Key outcome measures were total inpatient and total outpatient charges (logged).
Hospitals that merged billed 17.73% more inpatient charges and 12.66% more outpatient charges at baseline compared to hospitals that did not merge. Our results indicate that merging was associated with a 3.04% decrease in inpatient charges (P < .001) and a 1.07% increase in outpatient charges (P = .082). Merging was also associated with a 4.38% decrease in total revenue, a 3.58% decrease in net patient revenue, and no change in total inpatient discharges or average daily census.
CONCLUSIONS & IMPLICATIONS: Merging was strongly associated with a decrease in inpatient charges and somewhat associated with an increase in outpatient charges for rural hospitals. Future work could build upon this work to determine whether acquirers reduce or eliminate certain services at rural hospitals after a merger, and ultimately how changes in service delivery could impact patients in those rural communities.
确定农村医院合并后住院和门诊费用是否发生变化。
通过手动审查和验证，从 Irving Levin Associates 专有数据中得出医院合并。医院水平特征来自 HCRIS、CMS Impact File Hospital Inpatient Prospective Payment System、Hospital MSA 文件、AHRF 和美国人口普查数据。采用差异中的差异方法来确定农村医院合并后住院和门诊费用是否发生变化。比较组是指在样本期间任何时候都没有合并的农村医院，使用逆概率治疗权重进行加权。主要结果指标是总住院和总门诊费用（对数）。
与未合并的医院相比，合并的医院在基线时的住院费用高出 17.73%，门诊费用高出 12.66%。我们的结果表明，合并与住院费用减少 3.04%（P<0.001）和门诊费用增加 1.07%（P=0.082）有关。合并还与总收入减少 4.38%、净患者收入减少 3.58%、住院总出院人数和平均每日住院人数不变有关。
合并与农村医院住院费用的降低密切相关，与门诊费用的增加略有相关。未来的工作可以在此基础上进一步确定，农村医院合并后收购方是否会减少或取消某些服务，以及服务提供方式的变化最终如何影响这些农村社区的患者。
