Mass General Brigham executives tout a plunge in observed-to-expected mortality ratios, crediting corporate integration for saving 1,400 lives and lifting Vizient rankings from the 70s-90s to the mid-30s. Yet internal skepticism from physicians reveals a classic disconnect: administrative tweaks to risk-adjustment models can inflate O/E scores without corresponding drops in raw deaths or improvements in care access. This pattern echoes broader accountability shortfalls in merged academic systems, where PR dashboards prioritize rankings over frontline metrics like specialist wait times and primary-care shortages. Observational data from Vizient (sample sizes in thousands across member hospitals) lacks the rigor of RCTs, and conflicts arise when analytics firms like Vizient are paid by the same systems they rank. A 2023 JAMA Internal Medicine study (observational, n=2.8 million admissions) found O/E mortality highly sensitive to coding changes rather than true outcome shifts, with no correlation to patient-reported outcomes. Similarly, a 2024 Health Affairs analysis (observational, n=1,200 hospitals) documented how corporatized mergers often widen gaps between reported quality and actual access, particularly in high-volume systems like MGB. Doctors note unchanged death counts amid integration, suggesting the celebrated 0.62 ratio at MGH may reflect sicker-patient reclassification more than clinical gains. Accountability erodes when physician input is sidelined for executive strategy, turning mortality stats into motivational tools rather than transparent benchmarks.