Study Finds Private Equity Takeovers Increase Adverse Event, Infection Rates at Hospitals

Sneha Kannan, MD
Credit: Harvard Medical School

New research from Harvard Medical School is raising a red flag over declining quality of care associated with private equity takeovers of hospitals.

Results of the study, which included data from 4.8 million Medicare Part A hospitalizations, suggests private equity acquisition was associated with an increased rate of hospital-acquired adverse events, such as falls and infections. Investigators pointed out a decrease was observed for in-hospital mortality following acquisition, which was no longer evident 30 days after discharge, and could be explained by shifts in patient demographics following acquisition.

“Private equity firms have historically operated in the shadows in health care,” said study investigator Sneha Kannan, MD, a physician in the Division of Pulmonary and Critical Care at Massachusetts General Hospital and research fellow at Harvard Medical School. “Going forward, it’s important to lift the veil and increase transparency.”

In recent decades, the healthcare industry has seen an influx of private equity ownership. According to a 2023 report from the Commonwealth Fund, private acquity acquesitions of US physican practices rose 6-fold from 75 deals in 2012 to 484 in 2021.³ In July 2023, a systematic review and meta-analysis including 47 US-based studies concluded private equity ownership was associated with both increased costs to patients/payers as well as mixed to harmful impacts on quality of care.⁴

In the current study, Kannan and colleagues from Massachusetts General Hospital and Harvard Medical School sought to build upon the existing knowledge base as it relates to impacts of private equity in healthcare. With this in mind, investigators designed their study as an analysis of data from 100% Medicare Part A claims for hospitalizations at 51 private equity-acquired hospitals relative to those at 259 matched control hospitals from hospital stays b between 2009 and 2019.¹

From the 51 private equity-acquired hospitals, investigators obtained data from 662,095 hospitalizations. From the matched control hospitals, investigators obtained data from 4,160,720 hospitalizations. With a difference-in-differences design, investigators planned to assess hospitalizations from 3 year preceding and 3 years following private equity acquisition using a linear model adjusted for patient and hospital attributes.¹

The primary outcomes of interest for the study were the incidence of hospital acquired adverse events, patient mix, and hospitalization outcomes. Of note, hospital-acquired adverse events of interest included falls and trauma, central line–associated infection, and surgical site infections. The hospitalization outcome events of interest included mortality, discharge disposition, length of stay, and readmissions.¹

Upon analysis, results indicated Medicare beneficiaries admitted to a post-acquisition, private equity hospital experienced a 25.4% increase in rate of hospital-acquired conditions compared with those treated at control hospitals (4.6 [95% Confidence Interval [CI], 2.0-7.2] additional hospital-acquired conditions per 10,000 hospitalizations, P=.004). When assessing the drivers of this apparent increase in risk, results pointed to a 27.3% increase in falls (P=.02) and a 37.7% increase in central line–associated bloodstream infections (P=.04) at private equity hospitals. Investigator noted this increase in central-line associated infections occurred despite placing 16.2% fewer central lines.¹

Further analysis found the rate of Surgical site infections doubled from 10.8 to 21.6 per 10,000 hospitalizations at private equity hospitals despite an 8.1% reduction in surgical volume. In contrast, infections decreased at control hospitals, but investigators pointed out statistical precision of the between-group comparison was limited by the smaller sample size of surgical hospitalizations.¹

When assessing hospitalization outcomes, decreased from 3.5% to 3.3% at private equity hospitals, but there was no differential change in mortality by 30 days after hospital discharge. However, investigators noted patients treated at private equity hospitals were modestly younger, less likely to be dually eligible for Medicare and Medicaid, and more often transferred to other acute care hospitals after shorter lengths of stay, which could have contributed to the initial decrease observed in mortality.¹

Limitations for the study included potential lack of generalizability to all private equity-acquired hospitals, inability to generalize data to populations with Medicare Advantage, Medicaid, or commercial insurance, and use of ICD-19 and ICD-10 codes to capture hospital-acquired conditions.¹

“We had previously found that private equity acquisitions led to higher charges, prices, and societal spending,” said Zirui Song, MD, PhD, associate professor of health care policy and medicine in the Blavatnik Institute and director of research in the Center for Primary Care at Harvard Medical School.² “Now, we’re learning that there are also downstream concerns for the clinical quality of care delivered to hospital patients.”

References:

1. Kannan S, Dov Burch J, Song Z. Changes in Hospital Adverse Events and Patient Outcomes Associated With Private Equity Acquisition. JAMA. Published online December 26, 2023. doi: 10.1001/jama.2023.23147
2. Harvard Medical School. Quality of care declines after private equity takes over hospitals. EurekAlert!. December 26, 2023. Accessed December 21, 2023. https://www.eurekalert.org/news-releases/1029679.
3. Private equity’s role in Health Care. Commonwealth Fund. November 17, 2023. Accessed December 21, 2023. https://www.commonwealthfund.org/publications/explainer/2023/nov/private-equity-role-health-care.
4. Campbell P. Private equity ownership in health care linked to increased costs, potential for worsening outcomes. HCP Live. July 20, 2023. Accessed December 21, 2023. https://www.hcplive.com/view/private-equity-ownership-in-health-care-linked-to-increased-costs-potential-for-worsening-outcomes.