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Analysis

The Dangers of Unequal Access to Post-M&A Resources Among Providers

By Gregory A. Freeman  
   September 27, 2018

As health systems merge and expand, not everyone ends up with the same clinical decision support and other resources. The cost is usually the biggest obstacle. 

With mergers and acquisitions changing the healthcare landscape every day, the big-picture issues of cost savings, quality of care, and how to merge disparate cultures can overshadow a simpler but still vital concern: Does everyone have access to the same resources and tools?

The answer often is no after M&A, some in the industry say. That disparity can threaten quality of care issues and also the quality of the data that is increasingly important for any healthcare operation.

Health systems can find it difficult to ensure that all providers across a network have access to the same evidence-based medicine resources and decision support tools, says Diana Nole, CEO of Wolters Kluwer Health, which provides those resources to the industry. The difficulty of ensuring equal access to these tools has become more prominent with the steady rate of M&A activity lately—more than 70 deals per year, most in midsize systems, she says.

"This is very high on the priority list for the leaders who are expanding their reach into new facilities and building their networks, but it also is something that is difficult to do on the fly as you are continuing to care for people," Nole says.

She continues, "They may realize that they are not able to do everything in year one or year two, that they are on a journey, but most of them have a clear vision of where they're heading. It's a question of how fast they can do it along with all the other things they need to accomplish in a merger or acquisition."

Delay in Equal Access Brings Problems

The process of getting to full network access can expose the healthcare system to potential problems, Nole says.

When M&A results in uneven access to resources and tools, patient care can be affected in ways that threaten the reliability of data gathered systemwide, she notes. What might have been differences between separate healthcare systems can become internal differences between hospitals in the same system.

That can skew the interpretation of metrics both internally and externally for reimbursement levels and quality ratings, she says. The data will not be corrupted, she explains, but accurate analysis of the data will require factoring in the varying access to evidence-based decision-making.

"We can see the overuse of something in one geographic area versus another area. You might have more watchful waiting in a case with prostate cancer, for instance, whereas another area goes toward a more radical prostate surgery," Nole says. "You'll see disparities in services that end up resulting in higher costs and different outcomes from one of their sites than another. They will see that they're not meeting their mission of having a certain financial or patient outcome in one location versus another."

Data Sector Can Benefit

When systems can meet the challenge of ensuring equal access to evidence-based resources, which Nole says is largely a matter of cost, the expansions that come with M&A can benefit the data sector of the healthcare industry.

"We’re definitely seeing that there is impact from all of these acquisitions. People are trying to harmonize the suite of tools that they use across their institutions," Nole says. "At the very core they start with their EHRs, trying to synchronize that if they have multiple EHRs in use. But then there is consensus around wanting to have the same evidence-based tools for all of their sites, so they can evaluate all of their sites on a common set of data, outcomes, and results."

Gregory A. Freeman is a contributing writer for HealthLeaders.

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