Rural Hospital Mergers Increased Between 2005 and 2016—What Did Those Hospitals Look Like?

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  • Williams, D., Jr.
    • Other Affiliation: Medical University of South Carolina
  • Reiter, K.L.
    • Affiliation: University of North Carolina at Chapel Hill
  • Pink, G.H.
    • Affiliation: University of North Carolina at Chapel Hill
  • Holmes, G.M.
    • Affiliation: University of North Carolina at Chapel Hill
  • Song, P.H.
    • Affiliation: University of North Carolina at Chapel Hill
Abstract
  • The objective of this study is to determine whether key hospital-level financial and market characteristics are associated with whether rural hospitals merge. Hospital merger status was derived from proprietary Irving Levin Associates data for 2005 through 2016 and hospital-level characteristics from HCRIS, CMS Impact File Hospital Inpatient Prospective Payment System, Hospital MSA file, AHRF, and U.S. Census data for 2004 through 2016. A discrete-time hazard analysis using generalized estimating equations was used to determine whether factors were associated with merging between 2005 and 2016. Factors included measures of profitability, operational efficiency, capital structure, utilization, and market competitiveness. Between 2005 and 2016, 11% (n = 326) of rural hospitals were involved in at least one merger. Rural hospital mergers have increased in recent years, with more than two-thirds (n = 261) occurring after 2011. The types of rural hospitals that merged during the sample period differed from nonmerged rural hospitals. Rural hospitals with higher odds of merging were less profitable, for-profit, larger, and were less likely to be able to cover current debt. Additional factors associated with higher odds of merging were reporting older plant age, not providing obstetrics, being closer to the nearest large hospital, and not being in the West region. By quantifying the hazard of characteristics associated with whether rural hospitals merged between 2005 and 2016, these findings suggest it is possible to determine leading indicators of rural mergers. This work may serve as a foundation for future research to determine the impact of mergers on rural hospitals.
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Resource type
  • Article
Rights statement
  • In Copyright
License
  • Attribution-NonCommercial 4.0 International
Journal title
  • Inquiry (United States)
Journal volume
  • 57
Language
  • English
Version
  • Publisher
Funder
  • National Institutes of Health, NIH: T32HS000032; U.S. Department of Health and Human Services, HHS: U1GRH07633, U66 RH31458; Health Resources and Services Administration, HRSA; Agency for Healthcare Research and Quality, AHRQ; Honeywell Hometown Solutions, HHS; Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill; University of North Carolina at Chapel Hill, UNC-CH: T32-HS000032; Federal Office of Rural Health Policy, FORHP
ISSN
  • 0046-9580
Publisher
  • SAGE Publications Inc.

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