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Hospital mergers in N.J. unite sagging health-care quality with rising costs | Opinion

July 5, 2016

It's a small world in New Jersey health care and getting smaller every day. Eight proposed hospital mergers are currently awaiting approval. That brings the total to 18 completed and pending sales, mergers and partnerships in our state since 2010.
 

As a nurse, I'm very concerned about the impacts of this rampant consolidation of our local hospitals. It's like a large snowball rolling downhill, collecting all our community health resources along the way.
 

We should be careful about what we're sacrificing.
 

New Jersey's experience is part of an alarming nationwide trend in which competition in the health-care market is rapidly being eliminated. The pro-merger arguments are always the same: Only big hospital systems can survive in the Obamacare age. Bulk purchasing and administrative efficiencies will bring down costs. And coordination among providers will improve care.
 

The promises echo each other, too: The hospitals are doing this for patients, not profits. And they would never use monopolistic power to raise prices or strong-arm health-care workers in contract negotiations.
 

Unfortunately, the evidence belies all the claims and promises. Northwestern University researchers found that prices increase on average 14 percent after a hospital's acquisition. The impact on specialists is even greater. For example, cardiologist care soars by 34 percent after consolidation takes place.
 

But these are averages. The experiences in markets similar to New Jersey's show just how bad things can get. For example, Florida's Wuesthoff Medical Center charged patients admitted for irregular heartbeat $25,361 in 2011. A year after the facility was purchased, they charged $53,597—more than double the price for the same care. In Massachusetts, Partners HealthCare has been allowed to overtake 10 hospitals. Not surprisingly, their prices are now 60 percent higher than other providers.
 

Most of us are insulated from these effects because health insurance companies and programs like Medicare pick up the tab. The cost impacts may be unseen, but we are all nonetheless affected by higher health plan premiums and straining government budgets. Although cost is a key concern when it comes to our nation's limited health-care dollars, the issue transcends the financial. The lack of market competition leaves hospital system administrators free to do what they please in many areas.
 

In a hunt for so-called efficiencies, many hospital systems will vigorously reduce staffing costs. In some cases, this means fewer highly trained nurses and more techs.

Downward pressure on wages is also a side effect. At the extreme, cutbacks mean barely enough people on the floor, no matter what their training, to handle patients' basic needs.

Have you ever seen a patient in distress, anxiously pushing the call button to no avail? An elderly woman choke on her pills because the nurse was called away before he could monitor her swallowing?
 

As someone who entered this field to help people, I can barely work in such an environment with a clear conscience. Yet, when a hospital system becomes the only one for miles around, health-care workers like me are left with few options if we want to put food on the table for our families.

Some of the changes are more insidious but no less disturbing. As mammoth health-care systems grow larger, strategic planning meetings and bureaucratic discussions of process and protocol metastasize. Along the way, the voices of front-line employees and their insights into patients' individual needs are drowned out.
 

Today, New Jersey stands at a crossroads. We should take the time now to assess what we value most in our health-care system and task our policymakers with preserving it. If we instead say nothing and allow the market to be stripped of competition, we will all pay the price. Not only in dollars but in quality care.
 

 

Jean Bestafka, RN, is the former CEO of the New Jersey Home Health Services Association.

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