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Private equity acquisition of physician practices in the specialties of dermatology, gastroenterology, and ophthalmology were associated with increases in healthcare spending, a difference-in-differences event study showed.

Among 578 private equity-acquired physician practices, an average increase of $71 (+20.2%) charged per claim (95% CI 13.1-27.3, P<0.001) was seen, as was an average increase of $23 (+11.0%) in the allowed amount per claim (95% CI 5.6-16.5, P<0.001), when compared with 2,874 control practices, reported Jane M. Zhu, MD, MPP, MSHP, of Oregon Health & Science University in Portland, and colleagues.

The private equity-acquired practices also increased their numbers of unique patients by 25.8% compared with the control practices, driven by a 37.9% increase in visits by new patients (P<0.001). In aggregate, their volume of encounters increased by 16.3% (P=0.04) versus the controls, with a 9.4% increase in the share of office visits for established patients that were billed as longer than 30 minutes (P=0.02), they noted in .

"Given that our study design held constant the physicians at each practice before and after acquisition, increased patient utilization per practice was unlikely to be the result of new physician hires," Zhu and team explained. "Instead, these findings may reflect changes in management and practice operations, such as expanding practice hours, branding and advertising, or broadening referral networks."

"Alternately, increased patient volume may also reflect overutilization of profitable services and/or unnecessary or low-value care, which could raise health care spending without commensurate patient benefits," they added.

Previous research by the same group examined where private equity investment in physician practices is most often taking place. Among the six specialties reviewed, they found that the proportion of physicians working in private equity-acquired practices was highest in dermatology and gastroenterology, and in the Northeast region.

"The reason this is of concern to patients and policymakers is that private equity is often driven by profit margins of 20% or more," Zhu said in a statement. "To do that, they have to generate higher revenues or reduce costs. Increasing private equity in these physician practices may be a symptom of the continuing corporatization of health care."

The researchers concluded that the results from their study "will be important for policy makers to monitor. Other consequences of private equity acquisitions, including quality of care, patient satisfaction, and the physician practice experience, remain key areas for future research."

For this study, Zhu and colleagues included U.S. physician practices in dermatology, gastroenterology, and ophthalmology that were acquired by private equity firms from 2016 to 2020. For each specialty, each private equity-acquired practice was matched with as many as five control practices based on the pre-acquisition number of unique patients, encounters, risk score, share of services billed out-of-network, and spending through year 2 after acquisition.

They found no statistically significant changes in patient risk scores between private equity-acquired practices and controls. Private equity-acquired practices did see a 5.4% reduction in share of total spending on out-of-network services (P=0.01).

Zhu and team acknowledged that some private equity acquisitions may have been missed, and that, given the study's focus on a commercially insured population, its findings may not be generalizable to other payers.

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