Association of Hospital Network Participation With Surgical Outcomes and Medicare Expenditures

Objective: The aim of this study was to evaluate whether hospital network participation is associated with improvement in surgical outcomes and spending compared to control hospitals not participating in a network. Summary Background Date: Hospitals face significant financial and organizational pressures to integrate into networks. It remains unclear whether these business arrangements impact clinical quality or healthcare expenditures. Methods: We conducted a longitudinal, quasi-experimental study of 1,981,095 national Medicare beneficiaries (2007-2014) undergoing general, vascular, cardiac, or orthopedic surgery at a network (n = 1868) or non-network (n = 2734) hospital. We tested whether joining a network was associated with improvement in the study outcomes after accounting for overall trends toward better outcomes. We used hierarchical multivariable logistical and linear regression to adjust for patient factors, procedural characteristics, type of admission, and hospital factors. Results: After accounting for patient factors and existing trends toward better outcomes, there was no association between network participation and surgical outcomes. For example, the rates of serious complications were similar between network [11.4%, 95% confidence interval (CI) 11.1%-11.5%] and non-network hospitals (11.2%; 95% CI 11.0%-11.3%; odds ratio 1.00, 95% CI 0.97-1.03, P = 0.92). There was no association between time-in-network and improvement in rates of serious complications during the 8-year study period. For example, after 7 years of network participation, the rate of serious complications in 2014 was 9.6% (95% CI 8.8%-10.4%) in network hospitals versus 9.2% (95% CI 8.5%-9.9%, P = 0.11) in non-network hospitals. Conclusions: Hospital network participation was not associated with improvements in patient outcomes or lower episode payments among Medicare beneficiaries undergoing inpatient surgery.