50 - Hospital Ownership Type and Region association with Change in Neonatal and Pediatric Serving Hospital Ownership

Publication Number: 3047.50

Dev Y. Gupta, Childrens Hospital of Philadelphia, Wynnewood, PA, United States; Nicolas P. Goldstein Novick, Children's Hospital of Philadelphia, Rose Valley, PA, United States; Matthew Coyle, Childrens Hospital of Philadelphia, Springfield, PA, United States; Insherah Qazi, Childrens Hospital of Philadelphia, Little Rock, AR, United States; Scott A. Lorch, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States; Elizabeth Salazar, Children's Hospital of Philadelphia, Philadelphia, PA, United States

Background: Hospital ownership change due to horizontal consolidation are associated with service elimination, including obstetrics. The pattern & characteristics of neonatal/pediatric serving hospitals with ownership change remain unknown.

Objective: To describe ownership change in neonatal/pediatric serving hospitals and analyze hospital characteristics are associated with ownership change.

Design/Methods: This is a retrospective cohort study of 2010-2019 neonatal/pediatric-serving acute care hospitals using merged data from the American Hospital Association (AHA) annual survey, Centers for Medicare and Medicaid Services (CMS) Healthcare Cost Reporting Information System (HCRIS), Pitchbook, and Brown Hospital Mergers and Acquisitions database (97% merge). Neonatal/pediatric service was defined annually by ≥1 of the following bed types: bassinet, neonatal intensive care unit (NICU), pediatric, pediatric intensive care unit (PICU). Examined hospital characteristics included ownership type (religious, academic, other non-profit, government, for-profit public, for-profit private, and private equity [PE]), region, bed number, rurality, teaching status, operating margin, & disproportionate share hospital (DSH) payments. The outcome was change in hospital ownership. Hospitals were censored prior to their second change in ownership. After descriptively comparing hospital-years by hospital change in ownership, longitudinal logistic regressions with fixed effect for years and clustering for hospital analyzed the associations between hospital characteristics, services, and ownership change.

Results: Among neonatal/pediatric serving hospitals, 649/3396 (19%) experienced ownership change. Hospitals with ownership change were located in metropolitan, Northeastern regions with lower operating margins and higher disproportionate hospital share payments (Table 1). In adjusted models, hospitals with government ownership (OR 0.5, 95% CI 0.3, 0.7) were less associated with ownership change. Hospital with religious, PE, and for-profit public ownership (respective OR 1.7 [1.2, 2.5]; 5.2 [2.5, 10.8]; 1.7 [1.1, 2.7]) and Northeast (OR 1.5, 95% CI 1.1, 2.0) were association with a change in ownership in adjusted models (Figures 1 & 2). Neither the presence of specific adult nor pediatric services were associated with ownership change.

Conclusion(s): Neonatal/pediatric serving hospitals with religious, PE, and for-profit public ownership were more frequently associated with change in ownership. While the impacts of PE on pediatric care access have been reported, future work needs to focus on the impact of other ownership types on care access.

Table 1. Characteristics of Acute Care Hospital-Years by Neonatal-Pediatric Service Status
*Indicates p < 0.01 in comparisons in this trait between acute care hospitals without neonatal/pediatric service and with neonatal/ pediatric-service
Abbreviations: DSH - Disproportionate Share Hospital; ICU - intensive care unit; NICU - neonatal intensive care unit; PICU - pediatric intensive care unit.
Operational Characteristics: Ownership type was determined by manual review of the AHA cntrl variable as well as supplemental pitchbook data. Rurality is defined using Urban Influence Codes (UICs). UICs 1 or 2 are metropolitan. UICs 3, 5, or 8 are micropolitan. UICs 4, 6, 7, 9, 10, 11 or 12 are noncore. Major teaching is defined as a member of the Council of Teaching Hospitals and American Medical Colleges. Minor teaching is defined as having a Graduate Medical Education Council residency program without other teaching association memberships.

Financial Characteristics: Operating margin is calculated by (net patient revenues less total operating expense) / net patient revenues *100. CMS HCRIS data obtained from Wharton Research Data Services.

Service Lines: Service lines were determined via AHA data. Pediatric service lines including additional manual review for missingness.


Figure 1. Longitudinal logistic regression of change in hospital ownership adjusting for hospital operational and financial characteristics and service line changes
Models were longitudinal logistic regression models with a fixed effect for year and clustering for hospital.
Unadjusted models were adjusted for hospital ownership type and year.
Operational characteristics included hospital beds, region, rurality, and teaching status.
Financial characteristics included operating margin and disproportionate hospital share payments.
Services included Bassinets, Neonatal Intensive Care Unit, Pediatric, Pediatric Intensive Care Unit,
Medical or Surgical ICU, Cardiac ICU, or Psychiatric Beds.


Figure 2. Hospitals with Ownership Change from 2010-2019 stratified by initial ownership type.
Legend: Ownership type was determined by manual review of the AHA cntrl variable as well as supplemental pitchbook data. Colors for ownership change are as follows: yellow - religious, red - academic, cyan - other non-profit, blue - government, orange - private equity, purple - for-profit private, and green - for-profit public.