Four of the 55 hospital systems with the most acute care beds are headquartered in North Texas and account for more than $100 billion in patient charges, according to an analysis by the New York-based Merger Watch.
With its 17,605 staffed beds, the Tenet Healthcare Corp., based in Dallas, is the third largest system in the country. East Dallas’ Baylor Scott & White Health came in at No. 20 with 3,727 beds. The Irving nonprofit global health system Christus Health ranked at No. 23 with 3,367 beds, and Arlington’s Texas Health Resources trailed at No. 24 with 3,258. The report highlights just how fast hospital systems are consolidating in the wake of the Affordable Care Act. The top 25, which include for-profit and nonprofit systems, combine for more than $890 billion in patient charges. The four that made it from North Texas accounted for about $110 billion of that—and that’s not even counting HCA North Texas, the 13-hospital (as well as the dozens of outpatient care sites under its umbrella) subsidiary of its Tennessee parent company.
Hospital Corporation of America is by far the nation’s largest system. It has 35,245 total staffed beds—more than 10,000 more than the runner up, Community Health Systems—and is responsible for $187.13 billion in patient charges.
The report points to Texas’ rapid growth in consolidation as a byproduct of the state’s lack of any sort of Certificate of Need program. Currently, 35 states and Washington, D.C. have some sort of CON system, which is explained by the report this way: “States recognized there should be a demonstration of need in the community before a new hospital was erected or established, in order to prevent overbuilding, duplication of services or unnecessary purchase of expensive medical equipment.”
Texas has none of that, which means that new hospitals can be built, partnerships can be established, and existing facilities can be bought up without the same amount of oversight as in other states. Mergers do get looked at before they go through, but non-public facilities can close a unit or expand without any sort of public approval. The market is the great definer.
Texas is one of 19 states that the report gives an “F” regarding its CON requirements. Head here to dig into the whole thing.