Hospital mergers typically face little scrutiny from state regulators, putting women at risk for losing access to health care services that Catholic systems oppose on ideological grounds, according to a MergerWatch report released on Thursday, Mother Jones/ProPublica reports.
Background on hospital mergers
According to Mother Jones/ProPublica, the elimination of health care services has become an issue in recent years, as smaller hospitals move to merge with larger hospital chains to avoid closure.
In merging, hospitals often try to streamline services to avoid any overlap, improve insurer agreements and share any cost savings, MotherJones/ProPublica reports. Some organizations also curtail services based on ideological beliefs, such religious opposition to abortion rights (Lee, Mother Jones/ProPublica, 6/9). For example, Catholic hospitals operate under the Ethical and Religious Directives for Catholic Health Care Services, which ban Catholic facilities from performing abortion, sterilizations and certain other procedures. The American Civil Liberties Union (ACLU) has filed several lawsuits against Catholic hospitals that have applied the directives when treating pregnant patients (Women's Health Policy Report, 5/6).
MergerWatch reports that over the last 15 years, the number of short-term acute-care hospitals in the United States declined by about 240. Meanwhile, data from the consulting firm Kaufman, Hall & Associates found a 70 percent increase in the number of hospital deals between 2010 and 2015, with 112 such agreements in 2015 (Mother Jones/ProPublica, 6/9).
Moreover, MergerWatch and ACLU earlier this year reported that the number of hospitals in the United States that are Catholic-owned or affiliated increased by 22 percent over the past 15 years, posing problems for the provision of reproductive health care. According to the data, one out of every six hospital beds in the United States is located in a Catholic-owned or affiliated facility. The report noted that the federal government has identified 46 regions in the country where a Catholic-owned or affiliated hospital is the "sole community hospital" (Women's Health Policy Report, 5/6).
Report highlights regulatory shortcomings
In its latest report, MergerWatch examined health care regulations in all 50 states and Washington, D.C.
The report found that all but 10 states allow hospital facilities and services to be eliminated without government review. Further, according to the report, only eight states and Washington, D.C., require regulatory review for informal hospital partnerships. Mother Jones/ProPublica reports that hospitals in other states sometimes opt for such partnerships instead of formal mergers to evade state oversight.
In addition, MergerWatch found that only six states require a public hearing for merger applications. A lack of state oversight on hospital mergers can result in patients losing access to eliminated services without an opportunity to voice concerns, which in turn forces local residents to rely on grassroots campaigns to respond to the changes.
Moreover, states that do have regulatory oversight over such mergers often do not adequately protect patients from a reduction in health care services. Mother Jones/ProPublica reports that most state oversight rules were created in the 1960s and 1970s, at a point when hospitals were proliferating. As a result, the regulations primarily address concerns regarding duplication of services rather than the elimination of services.
According to Mother Jones/ProPublica, the attorneys general in many states have the authority to review transactions that involve not-for-profit hospitals to determine whether the facility could lose its charitable status designation. Moreover, state or federal officials can conduct antitrust reviews of certain mergers to ensure that a single health care organization is not monopolizing services in a particular region. The Federal Trade Commission since November 2015 has voiced opposition to such mergers in Illinois, Pennsylvania and West Virginia.
Report spotlights lack of regulatory oversight in Ariz. hospital merger
The MergerWatch report highlighted the experiences of residents seeking care at Sierra Vista Regional Health Center (SVRHC), an Arizona health care facility that in 2010 entered a partnership with a Catholic system, Carondelet Health Network. According to ProPublica, many residents learned of the partnership and new restrictions on services -- including tubal ligations, vasectomies and other contraceptive services -- only after it was approved.
Dotti Wellman, a Sierra Valley resident who led protests in opposition to the partnership, said, "It happened before anybody had any input from the community." She stated, "Quite honestly, if something happened to me, I didn't want to go there."
Bruce Silva, an OB-GYN who worked at SVRHC, said he witnessed the facility refuse certain care for patients. He recalled that the center would not provide an emergency abortion for a woman who experienced a miscarriage, adding that the center opposed what he "felt was the moral thing to do."
Further, Silva said that patients would have had to travel about 100 miles to reach the nearest non-Catholic hospital. Noting that some patients would be unable to afford travel costs, Silva said, "It was denying access to people who were [low income]."
Residents picketed at the health center, and some residents wrote the Arizona attorney general regarding the matter. Carondelet and Sierra Vista ended the partnership after one year. Two years later, SVRHC merged with a for-profit company and established a new facility called Canyon Vista Medical Center. Earlier this year, that for-profit company merged with RCCH Healthcare Partners, forming a health care organization that has facilities in 12 states. Spokespeople for RCCH and Tenet Healthcare Corporation, the majority owner of Carondelet, declined to comment on the latest mergers.
Comments
MergerWatch Director Lois Uttley, who helped author the report, said, "In a number of states, there is no oversight at all. So hospitals are just doing what makes business sense for them ... Someone needs to be looking out for the patients and the community."
Separately, Christine Khaikin, a co-author of the report, said the report is "a jumping off point" to "open the eyes of legislators and policymakers that the regulation of hospital transactions is not inherently bad." She stated, "It can be used to the consumers' advantage, and we're hoping to start really engaging healthcare advocates in the states" (Mother Jones/ProPublica, 6/9).
