IMPACT OF PRIVATE EQUITY IN HEALTHCARE ON PATIENTS AND MARKETS: HUMAN MEDICINE

Human and veterinary medicine share common issues and challenges. Understanding private equity’s growing investments in human medicine will provide additional insight into its potential impact to the veterinary healthcare system including competition, quality of patient care, and medical costs for pets.

WHY THIS MATTERS: Many veterinary consolidators are owned and or controlled by private equity firms.

  • Based on current trends, up to 60 percent or more (represents 85% of total revenue; consolidators prefer to buy practices that employ many doctors) of the total number of veterinary practices in the United States may be owned by corporate consolidators within the next decade.

RECENT PRIVATE EQUITY NEWS IN HUMAN MEDICINE:

Doctor fired from ER warns about effect of for-profit firms on U.S. health care (3.28.22)
https://www.nbcnews.com/health/health-care/doctor-fired-er-warns-effect-profit-firms-us-health-care-rcna19975

  • A doctor fired after criticizing care at the ER he ran said execs are focused on the financial outcome, “and the outcome is ‘Hey, we’re making money.’”
  • Today, an estimated 40-plus percent of the country’s hospital emergency departments are overseen by for-profit health care staffing companies owned by private equity firms, academic research, regulatory filings and internal documents show.

‘Get that money!’ Dermatologist says patient care suffered after private equity-backed firm bought her practice (12.20.21)
https://www.nbcnews.com/health/health-care/get-money-dermatologist-says-patient-care-suffered-private-equity-back-rcna9152

  • A former doctor at a private equity-owned dermatology chain alleges lost biopsies, overbooking and questionable quality control in the company-owned lab.
  • The email to the health care workers was like something out of “The Wolf of Wall Street.” “We are in the last few days of the month and are only 217 appointments away from meeting our budget,” the August 2020 memo stated. “Don’t forget the August bonus incentive for all patients scheduled in August! That’s the easiest money you can make. Get that money!!”
  • Physicians have a duty to put their patients’ interests first. But when aggressive financiers take over medical operations, the push for profits can take precedence, doctors in an array of specialties have told NBC News. Paying bonuses for increased patient visits may result in unnecessary appointments and costs.

How Private Equity Is Ruining American Health Care (5.20.20)
https://www.bloomberg.com/news/features/2020-05-20/private-equity-is-ruining-health-care-covid-is-making-it-worse

  • Investors have been buying up doctor’s offices, cutting costs, and, critics say, putting pressure on physicians in ways that hurt patients.
  • The new management team introduced a scorecard that rewarded offices with cash if they met daily and monthly financial goals, according to a lawsuit filed in 2013 against the company by one of its dermatologists.
  • Dermatologists at most of the companies say they were pushed to see as many as twice the number of patients a day, which made them feel rushed and unable to provide the same quality of care. Others were forced to discuss their cases with managers or medical directors, who asked the doctors to explain why they weren’t sending more patients for surgery. Multiple practices also encouraged doctors to send home Mohs surgery patients with open wounds and have them come back the next day for stitches—or to have a different doctor do the closure the same day—because that would allow the practice to collect more from insurers.

Private equity firms now control many hospitals, ERs and nursing homes. Is it good for health care? (5.13.20)
https://www.nbcnews.com/health/health-care/private-equity-firms-now-control-many-hospitals-ers-nursing-homes-n1203161

  • The drive for profits can run counter to helping patients, critics say.
  • Mark Reiter is residency program director of emergency medicine for the University of Tennessee and past president of American Academy of Emergency Medicine, an advocacy group for practitioners. “Private equity-backed health care has been a disaster for patients and for doctors,” he told NBC News. “Many decisions are made for what is going to maximize profits for the private equity company, rather than what is best for the patient, what is best for the community.”
  • “We should not be running our health care system as a profit-making operation on steroids,” said Eileen Appelbaum, an authority on private equity and co-director of the Center for Economic and Policy Research, a left-leaning think tank in Washington, D.C. “Health care is not so much anymore about taking care of patients. It’s way more about making money.”

Dentists under pressure to drill ‘healthy teeth’ for profit, former insiders allege (3.19.20)
https://www.usatoday.com/in-depth/news/investigations/2020/03/19/dental-chain-private-equity-drills-healthy-teeth-profit/4536783002/

  • Dental Express was part of North American Dental Group, a chain backed by private-equity investors. At least a year earlier, the company had told dentists like Griesmer to meet aggressive revenue targets or risk being kicked out of the chain. Those targets ratcheted up pressure to find problems that might not even exist.

The Role of Private Equity in Driving Up Health Care Prices (10.29.19) – HARVARD BUSINESS REVIEW
https://hbr.org/2019/10/the-role-of-private-equity-in-driving-up-health-care-prices

  • Take the phenomenon of surprise bills: medical invoices that a patient unexpectedly receives because he or she was treated by an out-of-network provider at an in-network facility. These have been getting a lot of attention lately and are driven, at least in part, by investor-backed companies that remain out of network (without contracts with insurers) and can therefore charge high fees for services that are urgently or unexpectedly required by patients. Private equity firms have been buying and growing the specialties that generate a disproportionate share of surprise bills: emergency room physicians, hospitalists, anesthesiologists, and radiologists.

RELATED:

STUDY: Soaring Private Equity Investment in the Healthcare Sector: Consolidation Accelerated, Competition Undermined, and Patients at Risk (5.18.21)
https://publichealth.berkeley.edu/wp-content/uploads/2021/05/Private-Equity-I-Healthcare-Report-FINAL.pdf

SUMMARY OF MAJOR CONCLUSIONS:

  • The private equity business model is fundamentally incompatible with sound healthcare that serves patients. Private equity funds, by design, are focused on short-term revenue generation and consolidation and not on the care and long-term wellbeing of patients. This in turn leads to pressure to prioritize revenue over quality of care, to overburden health care companies with debt, strip their assets, and put them at risk of long-term failure, and to engage in anticompetitive and unethical billing practices.
  • Private equity’s focus on short-term revenue generation and consolidation undermines competition and destabilizes health care markets. Private equity companies seek to consolidate health care providers and companies not, primarily, to deliver higher quality healthcare more efficiently, but to engage in financial arbitrage and to gather leverage that can be used to bargain against suppliers, payors, and patients. The result impacts stability and leads to more concentrated and less competitive healthcare markets.
  • Private equity firms operate under the public and regulatory radar. Private equity is, in a word, private. Most private equity acquisitions in healthcare are not reportable to antitrust or financial regulatory authorities under current law.

STUDY: Changes in Hospital Income, Use, and Quality Associated With Private Equity Acquisition (8.24.20)
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2769549

  • Study found that hospitals have increased their prices after being acquired by private equity firms.
  • Conclusions and Relevance: Hospitals acquired by private equity were associated with larger increases in net income, charges, charge to cost ratios, and case mix index as well as with improvement in some quality measures after acquisition relative to nonacquired controls.

What is private equity, and why is it killing everything you love? (1.6.20)
https://www.vox.com/the-goods/2020/1/6/21024740/private-equity-taylor-swift-toys-r-us-elizabeth-warren

  • These organizations buy companies that have growth potential and then try to repackage them, speed up their growth, and theoretically make them work better. Then they sell them to another firm, take them public, or find some other way to offload them.
  • But a good deal for investors does not always translate to a good deal for other stakeholders, including employees and consumers.