The U.S. Department of Health & Human Services commissioned a report by the RAND Corporation to keep track of changes to health care delivery brought by the federal No Surprises Act passed last year. This first analysis measures the effects of hospital consolidations across the country and is meant to set a baseline for future reports to Congress. Among the key findings is strong evidence that hospital mergers and acquisitions increase healthcare services and spending prices; there is less conclusive evidence on how consolidation affects quality and patient access. Studies on the impact on rural hospitals were inconsistent, raising concern and a call for more careful examination.