☆ 4.5 Review

Evaluating trends in private equity ownership and impacts on health outcomes, costs, and quality: systematic review

BMJ-BRITISH MEDICAL JOURNAL (2023)

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Workforce Composition In Private Equity-Acquired Versus Non- Private Equity-Acquired Physician Practices

Joseph Dov Bruch et al.

Summary: Despite limited knowledge, this study examines how changes in ownership affect workforce composition in physician practices acquired by private equity (PE) in the US. The results show that there are differential changes in clinician workforce composition at PE-acquired practices, with a shift towards advanced practice providers for care delivery. The findings also reveal a higher clinician replacement ratio and significant yearly increases in the number of advanced practice providers at PE-acquired practices after acquisition compared to non-PE-acquired control practices.

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Private equity investment in Europe's primary care sector-a call for research and policy action

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Editorial Material Medicine, General & Internal

A Policy Framework for the Growing Influence of Private Equity in Health Care Delivery

Christopher Cai et al.

Summary: This Viewpoint emphasizes the necessity of enhanced supervision of private equity acquisition of physician practices and hospitals to minimize the impact on healthcare costs, clinicians' employment, and patients' access to care.

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION (2023)

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Article Dermatology

A Systematic Review: Landscape of Private Equity in Dermatology From Past to Present

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Journal of Drugs in Dermatology (2023)

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Trends in Private Equity Acquisitions of US Otolaryngology Practices

Hemali P. Shah et al.

Summary: With the rise of physician practice consolidation, private equity firms have started entering the otolaryngology-head and neck surgery field. From 2015 to 2021, there were 23 otolaryngology practices acquired by private equity. The number of acquisitions increased over time, with 8 practices being acquired in 2021. Almost half of the acquired practices were located in the South Atlantic region. Further research is needed to evaluate the impact of private equity investment on various aspects of healthcare.

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Provider Ownership and Indicators of Service Quality: Evidence from Swedish Residential Care Homes

Rasmus Broms et al.

Summary: This article investigates the variation in service quality between different types of non-public providers and its implications for government contracting and contract management. The study finds that non-public providers owned by private equity firms and publicly traded companies perform worse on most indicators compared to private limited liability companies and nonprofits.

JOURNAL OF PUBLIC ADMINISTRATION RESEARCH AND THEORY (2023)

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Surgical Dermatology and Private Equity: A Review of the Literature and Discussion

Alexander L. Fogel et al.

Summary: Private equity investment in medicine has shown significant growth in multiple specialties, with implications for dermatologic surgeons regarding team composition and supply management.

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Article Orthopedics

Recent Trends in Private Equity Acquisition of Orthopaedic Practices in the United States

Venkat Boddapati et al.

Summary: Private equity acquisition of orthopaedic surgery practices has significantly increased in recent years. The impact of private equity acquisition on physician independence, practice management, and procedure reimbursement is still unclear and deserves further exploration.

JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS (2022)

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Securitising Seniors Housing: The Financialisation of Real Estate and Social Reproduction in Retirement and Long-Term Care Homes

Martine August

Summary: The financialisation of seniors housing in Canada has fundamentally changed the landscape of long-term care homes and retirement communities, with investors rushing in to profit from the demographic wave. Financial firms profit from both the real estate aspect and the operating aspect of seniors housing, while also exploiting care workers, predominantly racialized women, who are employed precariously.

ANTIPODE (2022)

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Urology Practice Acquisitions by Private Equity Firms from 2011-2021

James Nie et al.

Summary: Private equity acquisitions have become the dominant form of urology practice consolidation in recent years, achieving significant market influence in certain regions. These acquisitions typically start with the purchase of large urology practices that own ancillary services and then consolidate local market share through the acquisition of smaller practices. Approximately 7.2% of private practice urologists in the U.S. are employed by private equity-backed platforms.

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Prevalence and performance of private equity-affiliated fertility practices in the United States

Alexander Borsa et al.

Summary: This study has found that a significant portion of fertility practices in the United States are affiliated with private equity, and these practices perform a greater proportion of ART cycles each year in the country. Patients at private equity-affiliated practices are more likely to use preimplantation genetic testing before embryo transfer, and the median household income in zip codes with these practices is slightly higher compared to nonaffiliated practices.

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Financial Impacts And Operational Implications Of Private Equity Acquisition Of US Hospitals

Marcelo Cerullo et al.

Summary: This study analyzes the impact of private equity acquisition on the financial performance of short-term acute care hospitals. The results show that acquisition leads to a decrease in cost per adjusted discharge and an increase in operating margin. Furthermore, private equity acquisition is associated with a reduction in total beds, a decrease in the ratio of outpatient to inpatient charges, and a decrease in staffing metrics.

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Access to Urological Care for Medicaid-Insured Patients at Urology Practices Acquired by Private Equity Firms

James Nie et al.

Summary: This study investigates the appointment access for Medicaid-insured patients seeking care at urology practices affiliated with private equity firms. The findings suggest that private equity-affiliated practices have lower Medicaid acceptance and more pronounced access disparities than non-private equity affiliated practices.

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Rohail Memon et al.

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JAMA DERMATOLOGY (2022)

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Association of Physician Management Companies and Private Equity Investment With Commercial Health Care Prices Paid to Anesthesia Practitioners

Ambar La Forgia et al.

Summary: This study found that prices paid to anesthesia practitioners increased after outpatient facilities contracted with physician management companies (PMCs), particularly if the PMC received private equity (PE) investment.

JAMA INTERNAL MEDICINE (2022)

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Article Medicine, General & Internal

Association Between Hospital Private Equity Acquisition and Outcomes of Acute Medical Conditions Among Medicare Beneficiaries

Marcelo Cerullo et al.

Summary: This study aimed to explore the impact of private equity acquisition of short-term acute care hospitals on healthcare access, patient outcomes, and spending. The results showed that PE acquisition had limited association with patient outcomes, but was moderately associated with improved mortality among Medicare beneficiaries hospitalized with acute myocardial infarction.

JAMA NETWORK OPEN (2022)

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Richard Buzek et al.

Summary: Private equity firms are taking over physician practices and integrating them into new corporations, creating a global wealth chain through offshore financial centers to avoid taxes. They are also opening up ambulatory health care as an asset for capital investment by overcoming market barriers. This paper analyzes private equity takeovers of Medical Care Centres in Bavaria, Germany to examine the spatial links of these finance-side and sector-specific corporate chains.

TIJDSCHRIFT VOOR ECONOMISCHE EN SOCIALE GEOGRAFIE (2022)

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To sell or not to sell: considerations when evaluating private equity acquisitions

Frini Makadia et al.

Summary: When considering a partnership with private equity, a thriving and mature private practice must conduct an in-depth analysis of four factors: how to transition the equity of a mature practice, how to continue growth, how to manage an increasingly complex organization, and the after-effects of a sale. These same issues must be addressed whether the group decides to pursue private equity or decides to remain independent.

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Implications of the presence of private equity in ophthalmology: an academic perspective

Shriji Patel et al.

Summary: Private equity acquisitions of ophthalmology private practices have been increasing over the past decade, impacting academic medical centers. Limited data in the ophthalmology literature hinders a clear understanding of the effect on patients and practices. Academic medical center leaders need to be aware of practice consolidation due to private equity, which could affect revenue streams and patient referral patterns, leading to accelerated expansion. Trainees may consider practicing in academic medical center ophthalmology departments due to the uncertain job market.

CURRENT OPINION IN OPHTHALMOLOGY (2022)

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Review Ophthalmology

Private equity in ophthalmology: differences between present versus past

Alan J. Ruby et al.

Summary: The current private equity model in ophthalmology is characterized by substantial capital, longer term business plans predicated on individual practice growth, increasing market share, physician-controlled clinical care, and integration of physicians into administration and governance. This model differs significantly from the failed physician practice management companies of the 1990s, making it a reasonable practice structure change model for ophthalmologists.

CURRENT OPINION IN OPHTHALMOLOGY (2022)

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Review Environmental Sciences

Physicians' Perspectives Regarding Private Equity Transactions in Outpatient Health Care-A Scoping Review and Qualitative Analysis

Tim N. Nolte et al.

Summary: This paper aims to unravel the argumentative structure of the vivid discussion among medical professions regarding the drastic increase in private equity investments in health care. Through a scoping review and semi-structured interviews, the study explores physicians' perceptions and concerns regarding this trend, highlighting key issues such as autonomy, quality of care, work-life balance, investment strategies, and expertise.

INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH (2022)

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Association Between Private Equity Acquisition of Urology Practices and Physician Medicare Payments br

James Nie et al.

Summary: The study found that private equity acquisitions of urology practices were associated with increases in Medicare payments and patient volume both before and after the acquisition, while non-private-equity urologists showed declines in these aspects.

UROLOGY (2022)

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Review Ophthalmology

Private equity in ophthalmology: lessons from other specialties

Daniel Brill et al.

Summary: This article reviews the role of private equity in other medical specialties and suggests that ophthalmology may experience similar trends, including increased volume of services, increased profits, improved payer mix, increased payment per patient visit, increased use of midlevel practitioners, decreased physician autonomy, and decreased physician salaries.

CURRENT OPINION IN OPHTHALMOLOGY (2022)

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Article Health Care Sciences & Services

Private Equity Acquisitions Of Ambulatory Surgical Centers Were Not Associated With Quality, Cost, Or Volume Changes

Joseph Dov Bruch et al.

Summary: This study finds that the acquisition of ambulatory surgical centers (ASCs) by private equity firms does not have significant effects on outcomes such as unplanned hospital visits, total costs, and total encounters. The study also suggests that there is no significant relative change in outcomes when comparing private equity-acquired ASCs with those that were never acquired.

HEALTH AFFAIRS (2022)

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Effects of chain ownership and private equity financing on quality in the English care home sector: retrospective observational study

Sharvari Patwardhan et al.

Summary: This study aimed to examine the association between financing and organization of care homes and regulator assessments of quality. The results showed that private equity financing and independent for-profit ownership were associated with lower quality.

AGE AND AGEING (2022)

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Article Health Care Sciences & Services

Association of Private Equity Acquisition of Physician Practices With Changes in Health Care Spending and Utilization

Yashaswini Singh et al.

Summary: The study investigates the impact of private equity acquisition of physician practices on healthcare spending and utilization, finding that acquisitions are associated with increased spending, patient volume, and total encounters. The findings suggest that these acquisitions have significant economic implications for healthcare delivery.

JAMA HEALTH FORUM (2022)

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Trends in Real Estate Investment Trust Ownership of US Health Care Properties

Joseph Dov Bruch et al.

Summary: This study investigates the prevalence and characteristics of real estate investment trust-owned health care properties in the US health care sector.

JAMA HEALTH FORUM (2022)

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Letter Health Care Sciences & Services

Geographic Variation in Private Equity Penetration Across Select Office-Based Physician Specialties in the US

Yashaswini Singh et al.

JAMA HEALTH FORUM (2022)

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Letter Medicine, General & Internal

Characteristics of Private Equity-Owned Hospitals in 2018

Joseph Bruch et al.

ANNALS OF INTERNAL MEDICINE (2021)

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Trends in Private Equity Deals in Oral and Maxillofacial Surgery and Dentistry

Sumun Khetpal et al.

JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY (2021)

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Growth of private equity in dermatology through acquisitions and new clinic formation, 2018 to 2019

Kira Seiger et al.

JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY (2021)

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Private Equity Acquisition And Responsiveness To Service-Line Profitability At Short-Term Acute Care Hospitals

Marcelo Cerullo et al.

Summary: Private equity acquisitions in hospitals are associated with increased likelihood of adding profitable services, technologies, and emergency departments, while decreasing services with unreliable revenue streams or facing nonprofit hospital competition. This reflects a trend of acute care hospitals shifting towards outpatient settings and synergizing with existing holdings by private equity firms.

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Matthew B. Flynn

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SOCIAL SCIENCE & MEDICINE (2021)

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Insurance Acceptance, Appointment Wait Time, and Dermatologist Access Across Practice Types in the US

Andrew Creadore et al.

Summary: The study found that patients with Medicaid had lower appointment success rates and longer wait times regardless of clinic ownership. Although the use of dermatologists and nonphysician clinicians was similar regardless of clinic ownership, PE-owned clinics were more likely to offer new patient appointments with nonphysician clinicians.

JAMA DERMATOLOGY (2021)

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Private Equity in Plastic Surgery: A Nine-Year Analysis

Sumun Khetpal et al.

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Private Equity Investments In Health Care: An Overview Of Hospital And Health System Leveraged Buyouts, 2003-17

Anaeze C. Offodile et al.

Summary: The study provides an overview of private equity-backed hospital acquisitions from 2003 to 2017, highlighting significant differences in financial and operational aspects between acquired and non-acquired hospitals. These findings should prompt policy makers and researchers to evaluate the impact, if any, of private equity acquisition on healthcare access, spending, and risk-adjusted outcomes.

HEALTH AFFAIRS (2021)

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Private Equity In Dermatology: Effect On Price, Utilization, And Spending

Robert Tyler Braun et al.

Summary: Private equity firms are increasingly acquiring dermatology practices, with one in eleven dermatologists practicing in a private equity-owned practice by 2017. Private equity firms target larger practices with more commercially insured patients, and their acquisitions result in higher patient volume per dermatologist and slightly higher prices for routine medical visits.

HEALTH AFFAIRS (2021)

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Review Medicine, General & Internal

The PRISMA 2020 statement: an updated guideline for reporting systematic reviews

Matthew J. Page et al.

Summary: The PRISMA statement was designed to help systematic reviewers transparently report the purpose, methods, and findings of their reviews. The updated PRISMA 2020 statement includes new reporting guidance, a 27-item checklist, an abstract checklist, and revised flow diagrams for reviews.

BMJ-BRITISH MEDICAL JOURNAL (2021)

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Acquisitions of Hospice Agencies by Private Equity Firms and Publicly Traded Corporations

Robert Tyler Braun et al.

JAMA INTERNAL MEDICINE (2021)

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Trends in Private Equity Acquisition of Orthopaedic Surgery Practices in the United States

Christopher Mikhail et al.

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JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS (2021)

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Financial Profit in Medicine: A Position Paper From the American College of Physicians

Ryan Crowley et al.

Summary: The increasing corporate interest and influence have made the US healthcare system more business-oriented, promoting for-profit and private equity investment. Proponents believe this leads to greater efficiency, innovation, and financial stability, while critics argue that it prioritizes profit over care and weakens the patient-physician relationship.

ANNALS OF INTERNAL MEDICINE (2021)

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Trends in Funding and Acquisition of Surgical Practices by Private Equity Firms in the US From 2000 to 2020

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Alesha Ignatius Brereton

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Comparative Performance of Private Equity-Owned US Nursing Homes During the COVID-19 Pandemic

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Trends in Private Equity Acquisition of Dermatology Practices in the United States

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JAMA DERMATOLOGY (2019)

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Joshua M. Sharfstein et al.

JAMA DERMATOLOGY (2019)

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Craig Frances

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Future considerations for clinical dermatology in the setting of 21st century American policy reform: Corporatization and the rise of private equity in dermatology

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Private equity ownership and nursing home quality: an instrumental variables approach

Sean Shenghsiu Huang et al.

INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT (2019)

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Editorial Material Dermatology

Dermatology Practice Consolidation Fueled by Private Equity Investment Potential Consequences for the Specialty and Patients

Jack S. Resneck

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Financialisation in health care: An analysis of private equity fund investments in Turkey

Ipek Eren Vural

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Ulrika Winblad et al.

BMC HEALTH SERVICES RESEARCH (2017)

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Marketization in Long-Term Care: A Cross-Country Comparison of Large For-Profit Nursing Home Chains

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HEALTH SERVICES INSIGHTS (2017)

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ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions

Jonathan A. C. Sterne et al.

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ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions

Jonathan A. C. Sterne et al.

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Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation

Larissa Shamseer et al.

BMJ-BRITISH MEDICAL JOURNAL (2015)

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Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation

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