Improving the Delivery of Surgical Care Within Regional Hospital Networks

Andrew M. Ibrahim, MD, MSc; Kyle H. Sheetz, MD, MSc; Justin B. Dimick, MD, MPH


Annals of Surgery. 2019;269(6):1016-1017. 

In This Article

Abstract and Introduction


Hospitals continue to merge into larger networks in response to widespread calls for reducing costs and improving quality. Since passage of the Affordable Care Act, which introduced value-based payments and emphasized population health management, the rate of hospital mergers has nearly doubled.[1] Proponents for the mergers argue that larger hospital networks may be able to reorganize services lines to leverage the technical, infrastructure, and knowledge expertise now available to them. In doing so, they can improve care continuity and operate at higher efficiencies. Detractors of these mergers argue that they may make no significant changes to existing practice patterns and use the collective weight of the network to negotiate higher prices with payers. In this context, mergers decrease market competition and thereby reduce incentives to improve quality and costs. As debates continue about the benefits and drawbacks of ongoing hospital consolidation, there appear to be no signs that this trend will change course.

Recent efforts have been made to identify the "good merger"[2] and understand how hospital networks can leverage their combined assets to improve care delivery. While the formation of a large network has potential to positively impact a broad spectrum of service lines, changes to surgical services lines may be among the most actionable. More so than nonprocedural fields, surgical care has established volume–outcome relationships, variation in well-defined outcomes, and significant expenses over a short episode of care. We believe each of these can be leveraged by networks to improve their delivery of surgical care.

We describe 3 strategies that hospital networks can adopt to improve care for surgical patients undergoing high-risk, moderate-risk, and low-risk procedures. We underscore the impact these quality improvement strategies may also have in reducing costs.