Changes in Oncology Care Provision Following Safety-Net Hospital Acquisition by Health Systems

Area of Science:

• Health Services Research
• Oncology Care Delivery
• Health Equity

Background:

• The impact of health system acquisitions on safety-net hospitals (SNHs) is not well understood.
• Specialty care access and equity implications are significant for vulnerable populations.

Purpose of the Study:

• To evaluate how SNH acquisitions by larger health systems affect oncology service availability, patient volumes, and demographics.
• To understand the implications for cancer care access and equity among Medicare beneficiaries.

Main Methods:

• Utilized Medicare fee-for-service claims data from 2008-2019.
• Identified 75 SNH acquisitions (2011-2015) and 151 independent SNHs as controls.
• Employed a weighted stacked event study design to estimate changes post-acquisition.

Main Results:

• Chemotherapy volumes significantly increased by 84% post-acquisition.
• No significant changes were observed in advanced imaging, radiation therapy, or cancer-directed surgery volumes.
• Service line availability and patient demographics (race, ethnicity, dual eligibility, age) remained unchanged.

Conclusions:

• Health system integration may lead to the selective expansion of scalable or financially favorable oncology services.
• Acquisitions did not markedly alter overall service offerings or the Medicare populations served by SNHs.
• Findings suggest potential shifts in service delivery without broad changes in patient populations or comprehensive oncology care.