ACC: Going for-profit doesn’t reduce hospital quality

SAN FRANCISCO—Quality of care does not diminish when hospitals convert from a non-profit to a for-profit structure, according to a poster presentation March 9 at the American College of Cardiology (ACC) scientific session. An analysis of acute MI measures found converting hospitals compared with controls maintained standards, including access to care for disadvantaged patients.

Studies in the 1980s suggested that when for-profit chains bought non-profits, acute MI mortality increased consistently, said Karen Joynt, MD, of Brigham and Women’s Hospital in Boston. Since that time, quality controls have been implemented and the non-profit model has evolved closer to for-profit institutions and for-profit corporations have challenged the perception that they sacrifice quality for financial gains.

“They are saying, ‘We are making these hospitals better; we’re bringing value,’” Joynt said.

Joynt et al used Medicare data from 2002 to 2010 to identify 216 hospitals that changed from a non-profit to a for-profit structure, a growing trend in the hospital industry. They matched those hospitals to similar non-profits and obtained their inpatient Medicare data on quality of care, outcomes and patient mix for acute MI.

They discerned no loss in these measures; on some measures the for-profits improved after their conversion. Mortality rates for converters was 21.3 percent pre-conversion and 18.1 percent post-conversion, while controls had a 20.3 percent rate that dropped slightly over the time period to 19.9 percent. Readmission rates held steady for both for converters and controls in the pre- to post-conversion periods.

The proportions of black, Hispanic and poor patients increased or stayed the same in hospitals that converted. The percentage of black patients increased, from 10.8 percent to 11.7 percent pre- and post-conversion and the proportion of Hispanic patients was 1.7 percent in each period. An analysis of the Disproportionate Share Index, a gauge of the proportion of hospital care for the poor, showed an increase for converted hospitals, from 28.8 percent to 30.3 percent.

Among control hospitals, the pre- and post-period proportions for black patients remained the same (9.7 percent) and increased slightly for Hispanic patients (1.2 percent and 1.8 percent) and for poor patients (26.2 percent and 26.8 percent).

“They [converters] certainly weren’t denying care to poor patients as a way to try to make money,” Joynt said. Mortality outcomes data showed quality was maintained. “If anything, the converters got better” with mortality decreasing while the controls stayed stable.