--- title: Does Private Equity Own Your Doctor's Office? description: A new study shows private equity buyouts increase costs across all areas of health care—and makes a good case for ownership transparency. canonical: https://time.com/6299770/private-equity-health-care-impact/ author: Haley Weiss article:opinion: false article:content_tier: free article:published_time: 2023-07-31T20:13:15.000Z article:modified_time: 2026-08-04T08:03:34.657Z article:section: Health og:title: What Happens When Private Equity Buys Your Doctor's Office? og:description: A new study on the costs of private equity buyouts makes a case for ownership transparency across health care og:url: https://time.com/6299770/private-equity-health-care-impact/ og:site_name: TIME og:image: https://static.time.com/v3/assets/bltea6093859af6183b/blt136e44dff4ceea7f/698a3f2116d8844a08c3c14a/private-equity-health-care.jpg?branch=production&width=1200&quality=75&auto=webp&crop=16:9 og:image:width: 4000 og:image:height: 2250 og:image:alt: Private Equity Lands Billion-Dollar Backdoor Hospital Bailout og:type: article twitter:card: summary_large_image twitter:title: What Happens When Private Equity Buys Your Doctor's Office? twitter:description: A new study on the costs of private equity buyouts makes a case for ownership transparency across health care twitter:image: https://static.time.com/v3/assets/bltea6093859af6183b/blt136e44dff4ceea7f/698a3f2116d8844a08c3c14a/private-equity-health-care.jpg?branch=production&width=1200&quality=75&auto=webp&crop=16:9 ---  # What Happens When Private Equity Buys Your Doctor's Office? > Sponsored content. 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Revel plans to have installed at least 300 chargers in New York by the end of 2024._  by [Haley Weiss](https://time.com/author/haley-weiss/)  ## Haley Weiss Jul 31, 2023 8:13 PM UTC  The Willamette Valley Medical Center, is a subsidiary of LifePoint Health Inc., owned by private equity firm Apollo Capital Management. The Willamette Valley Medical Center, is a subsidiary of LifePoint Health Inc., owned by private equity firm Apollo Capital Management. Moriah Ratner/Bloomberg—Getty Images  by [Haley Weiss](https://time.com/author/haley-weiss/)  ## Haley Weiss Jul 31, 2023 8:13 PM UTC Private equity ownership of American health care facilities has grown massively in the last few decades. A [2021 study of U.S. hospice agencies](https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2779069) found private equity ownership more than doubled, to 7%, between 2011 and 2019 while in 2021, [63% of deals](https://www.mcknightshomecare.com/watchdog-sounds-alarm-over-private-equity-investment-in-home-health-hospice/) in hospice and home care were with private equity. Twice as many companies providing fertility care were bought between 2017 and 2019 than in the previous seven years combined, according to [a 2020 study](https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2769544). The trend of accelerating acquistion stretches overseas, as well, with international health care buyouts by private equity firms [totaling $240 billion](https://www.bain.com/insights/year-in-review-global-healthcare-private-equity-and-ma-report-2023/#:~:text=Indeed%2C%202022%20was%20the%20second,2020%20%28see%20Figure%201%29.) in 2021 and 2022, compared to $245 billion over the previous five years. This has all taken place without any clear answers about what such buyouts mean for the skyrocketing number of patients who rely on private equity-owned facilities for care. A new review of dozens of international studies, however, shows the first large-scale evidence that private equity takeovers are associated with rising costs and sinking quality of care. The findings, published [July 19](https://www.bmj.com/content/382/bmj-2023-075244) in the journal_The BMJ_, effectively synthesized the results of 55 existing studies in a so-called meta analysis, bridging difficult gaps between variations in study design, including a handful of studies from countries outside the U.S. with similar private equity activity. “Our most unequivocal evidence is that private equity is associated with increased costs,” says Alexander Borsa, a Ph.D. candidate in sociomedical sciences at Columbia University and a lead author on the study. Of the 12 studies included that looked at the cost of care, nine found that those costs increased after private equity takeover. ### More From TIME As private equity absorbs a larger and larger share of the U.S. medical system, ownership of facilities becomes more concentrated and less accountable to patients and regulators. The rate of these takeovers is far outpacing the creation and enforcement of laws that can reign in their potential downsides. ## Vulnerable patients and high costs The pursuit of profit by private equity firms is driving the sorts of facilities they acquire, says Borsa. “Places where there are a lot of particularly vulnerable patients with particularly high costs are particularly attractive,” to private equity firms, he says. Take, for example, nursing homes and fertility treatment centers, where out-of-pocket costs for patients are often much higher than in other forms of medicine. There, says Borsa, firms “can squeeze people for a lot of money.” Between 2017 and 2018, private equity firms [collectively acquired](https://pubmed.ncbi.nlm.nih.gov/34538462/) more than five times the number of fertility treatment centers as they had the previous year, with investments [continuing to increase ](https://www.bassberry.com/news/healthcare-transactions-q1-2022/)each year since then. And those facilities generate fees: Borsa and Bruch have found that despite [accounting for just 14.7%](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8714667/) of fertility treatment practices in 2018, private equity-backed facilities [provided 29.3%](https://pubmed.ncbi.nlm.nih.gov/34538462/) of the total assisted reproductive technology services U.S. patients received that year. Nursing homes in particular have been popular targets for firms in recent years. In 2021, [5% of nursing homes in the country](https://jamanetwork.com/journals/jama-health-forum/fullarticle/2786442) were owned by private equity firms and 90% of those were a part of multi-facility chains, which are associated with [higher profits and lower quality](https://journals.sagepub.com/doi/full/10.1177/1178632917710533). [In New Jersey](https://ourfinancialsecurity.org/wp-content/uploads/2020/08/AFREF-NJ-Private-Equity-Nursing-Homes-Covid.pdf), for example, the coronavirus infection rate in private equity-owned chain homes was 24.5% higher than the statewide average in the early months of the pandemic, during which time they also accrued 50% more violations than non-profit facilities. **_Read More:_**[_American Health Care is Broken. Major Hospitals Need to Be Part of the Solution._](https://time.com/6281957/american-health-care-is-broken-major-hospitals-solution/) Nursing homes are attractive to PE firms because they often contract with state and federal agencies, says Borsa, “which is a sort of guaranteed pool of money that PE firms can count on.” Borsa also believes the continued need for these types of facilities, even during the COVID-19 pandemic, played a role in making nursing homes appear more lucrative to investors. “They learned that if there's a major catastrophe or major funding issues, the government will step in,” says Borsa. But some players, [including many doctors](https://www.fiercehealthcare.com/finance/industry-voices-private-equity-investment-healthcare-making-positive-impact-especially) who sell their practices to big firms, see upsides in these deals that stretch beyond just the financial—including what they say is an increased focus on patient care. Buyouts can theoretically free up patient face time for doctors by allowing them to offload non-care tasks and gain access to better administrative systems. ## Declines in patient care In addition to costs, the researchers also looked at data on care quality in private equity-owned facilities from across the 55 studies. These results were a bit more varied. Some metrics, like patient satisfaction scores, indicated patient-care quality declined after takeover across all studies where it appeared. Others, like communication between providers and patients (which was evaluated in five studies), showed fairly mixed outcomes. Though the sample size for each metric was small, “the results skewed a little more toward mixed or harmful,” says Borsa. The exact factors that contribute to any quality changes are complex, but “one thing we see consistently is that private equity-owned clinics often have turnover or shifts in the amount of nursing that they staff or in the skill level of nurses that they employ,” says Borsa. Particularly in nursing homes, lower staffing levels often [directly correlate](https://journals.sagepub.com/doi/full/10.1177/1178632920934785) to worse patient outcomes. Despite the increasing role of private equity in health care, government policies haven’t kept pace. At the very least, “the primary thing that needs to happen before anything else is greater transparency of these deals,” says Joseph Dov Bruch, an assistant professor of public health sciences at the University of Chicago and an author on the study. While some such regulations do exist in certain states, “and their intentions are good,” Bruch says, “they frequently are underutilized.” At the federal level, where there aren’t really any private equity-specific policies, private equity purchases in health care are subject primarily to antitrust policies like the [Hart-Scott-Rodino ac](https://www.ftc.gov/enforcement/competition-matters/2023/02/hsr-threshold-adjustments-reportability-2023)t, which requires that acquisitions above a certain threshold ($111.4 million in 2023) be reported to the Federal Trade Commission. Most individual acquisitions in health care, however, just aren’t that large—even if, over time, a private equity firm can easily spend twice that amount on facilities in a given area. Mapping out who owns what is difficult even for researchers, which means it’s nearly impossible for patients, who could theoretically live in a town where [every dermatology clinic](https://jddonline.com/articles/a-systematic-review-landscape-of-private-equity-in-dermatology-from-past-to-present-S1545961623P0404X) nearby is owned by the same company and never know it. When ownership of a practice changes hands it often bringing new priorities into play, and patients deserve to be informed, says Bruch. ## Regulations are not enforced While the study’s authors advocate for amending the Hart-Scott-Rodino act with either a lower reporting threshold or other redefined requirements, states also have the opportunity to extend or enforce their own regulations. These include laws covering the corporate practice of medicine, which restrict the influence companies like private equity firms can have on how physicians and clinics operate. [More than 30 states](https://www.derm.theclinics.com/article/S0733-8635%2823%2900041-4/fulltext) have these laws, but even in states like [California](https://www.mbc.ca.gov/Licensing/Physicians-and-Surgeons/Practice-Information/) and Texas, where they’re strictest, “they have tons of exemptions, and are [often not enforced](https://www.law.com/thelegalintelligencer/2023/05/09/overlooked-law-states-can-use-to-get-private-equity-out-of-health-care-decisions/,),” says Bruch. As private equity’s buyout of health care continues, possible new federal regulations are in the works at a few different levels. In [February](https://www.law360.com/articles/1593310/how-cms-proposal-would-change-pe-deal-transparency), the Centers for Medicare and Medicaid Services proposed a new rule, currently being worked on, that would require qualifying skilled nursing facilities to disclose any private equity ownership. And in March, U.S. Representative Pramila Jayapal, a Democrat from Washington state, proposed a Healthcare Ownership Transparency Act that would require similarly broad disclosures, as well as create a task force within the U.S. Department of Health and Human Services dedicated to advising Congress on future related legislation. The Biden Administration has also played a role in increasing ownership transparency in national health systems, and last year [published a spreadsheet](https://www.statnews.com/2022/12/20/hospital-ownership-data-private-equity/) sharing ownership information for Medicare-certified hospitals. Transparency makes it possible for states to identify negative trends as private equity ownership grows and try to eliminate loopholes that firms regularly use to build monolithic portfolios. ## Transcript [00:00] Baby transition in cities in the u.s. [00:02] is actually stuck in neutral. [00:03] Is there a charging infrastructure in cities? [00:05] Because nobody really hasn't even yet? [00:07] And who would want an Eevee in a big city in the US without [00:10] fast charging infrastructure. [00:11] That's reliable accessible and everywhere. [00:23] We physically cannot do what Rideshare the past it. [00:28] There's 100,000 For Hire vehicles in York City. [00:31] As an example of between Uber Lyft, [00:33] taxi Rebel, the city, just recently announced the mayor's [00:36] office at all of them need to be electric by 2030 means. [00:40] You're going to need 7 to 10,000 fast charger that a publicly-available [00:44] reliable and accessible. [00:47] You currently have maybe less than a hundred across the city. [00:58] We are going out for anybody else and building that dense network [01:02] of fast-charging for structure. [01:04] That is reliable. [01:05] That is acceptable. [01:07] They were supporting a network of fashion Roddy. [01:09] Ricch structure with for revenue streams that is are all electrical [01:12] employee rights your service. [01:13] That start with 50 cars in New York as a protein, [01:16] 750 couples by the end of this year. [01:17] According to public, EV adoption of Eevee's as a charger [01:21] or stations or you have to third-party fleets post. [01:25] Like car, rental companies like government leaves as a transition [01:28] still sleeping any places to charge and enough for streaming [01:31] through Zachry Services. [01:32] Think of that, as feeding energy back into the group, [01:37] princess for a profit. [01:38] So, that is our business. [01:40] We are scaling that in your city right now and we're bringing [01:43] that model to the Bay Area in the second half of this year. [01:54] Getting access to large amounts of Excess power in the grid. [01:58] That's hard enough as it is already tapped out but then you later [02:01] in the other problems, like zoning, can you even put fast charge [02:05] in certain areas Insurance in manufacturing? [02:08] Things like easier, just physical space and real estate available [02:11] for 20 30, 50, fast Chargers in the right location of the city. [02:14] The locations were all this lines up very few and far between [02:19] in the city that were targeting. [02:20] So are first-mover like us building it before, [02:23] anybody else, clear Advantage. [02:25] We've already locked up. [02:26] All the bedsides government didn't build every gas station, [02:30] so we can't build, every electric charging station. [02:34] We need a partnership and you are providing that partnership. [02:37] We are working day in and day out with Sol. [02:40] S, mayor's office for folks, like Con Edison. [02:42] The folks, like PG in it, [02:45] If you're not working with them, it's going to be very hard [02:47] to do overdo it. [02:48] Roll? Seen the vision of a hundred percent electrification. [02:52] We're going to work together together. [03:06] Too many vehicles in New York City. [03:09] Hundred thousand of them. [03:10] If they're in Eevee, they have enough power in their batteries [03:14] to provide electricity in your city grid for 24 hours is Vigo [03:19] from hundreds of a Sharpie installed in the sea. [03:20] Like you are. [03:21] As we go from, hundreds of vehicles. [03:23] 2000 are business starts to look a lot more like a distributed [03:28] power. Plant moving electrons, or a power around on Wheels [03:32] because Chargers aren't always going to stay you need directions [03:36] for not only going to pump electricity into cars, [03:39] or slowly, and is starting to accelerate that transition [03:42] of everything will be. [03:43] Bi-directional power will be able to feed back into the grid. [03:47] That's really exciting. [03:48] Future is with a chill down, my spine to type anything. [03:52] Why is it matter to transition? [03:55] All transportation and city like New York to Electric. [03:57] I took a revel moped to the office here, [03:59] in a pickup truck passed by me with some sort of carburetor [04:04] problem or something. [04:05] And it was literally just spewing black smoke down, [04:07] Bedford Avenue in Brooklyn, the whole later, [04:09] I literally had to close my mouth and not breathe. [04:11] That's why we always a reason cities to live in cities. [04:15] We all want to be to be cleaner. ```json [{"@context":"https://schema.org","@type":"NewsArticle","@id":"https://time.com/6299770/private-equity-health-care-impact/","mainEntityOfPage":{"@type":"WebPage","@id":"https://time.com/6299770/private-equity-health-care-impact/"},"headline":"What Happens When Private Equity Buys Your Doctor's Office?","datePublished":"2023-07-31T20:13:15.000Z","dateModified":"2026-08-04T08:03:34.657Z","description":"A new study shows private equity buyouts increase costs across all areas of health care—and makes a good case for ownership transparency.","url":"https://time.com/6299770/private-equity-health-care-impact/","keywords":["Health Care","healthscienceclimate"],"thumbnailUrl":"https://static.time.com/v3/assets/bltea6093859af6183b/blt136e44dff4ceea7f/698a3f2116d8844a08c3c14a/private-equity-health-care.jpg?branch=production&width=1200&quality=75&auto=webp&crop=1200:675&height=675","author":[{"@type":"Person","name":"Haley Weiss","jobTitle":null,"url":"https://time.com/author/haley-weiss/"}],"articleSection":"Health","image":[{"@type":"ImageObject","url":"https://static.time.com/v3/assets/bltea6093859af6183b/blt136e44dff4ceea7f/698a3f2116d8844a08c3c14a/private-equity-health-care.jpg?branch=production&width=1200&quality=75&auto=webp&crop=1200:675&height=675","width":1200,"height":675,"headline":"Private Equity Lands Billion-Dollar Backdoor Hospital Bailout","caption":"A sign of Willamette Valley Medical Center, a subsidiary of LifePoint Health Inc., in McMinnville, Oregon","creditText":"Moriah Ratner/Bloomberg—Getty Images","representativeOfPage":true}],"publisher":{"@type":"Organization","name":"Time","url":"https://time.com/","logo":{"@type":"ImageObject","url":"https://time.com/images/logo.png","width":528,"height":156},"foundingDate":"March 3, 1923","sameAs":["https://www.facebook.com/time","https://www.instagram.com/time/?hl=en","https://twitter.com/time","https://www.pinterest.com/timemagazine"]}},{"@context":"https://schema.org","@type":"BreadcrumbList","itemListElement":[{"@type":"ListItem","position":1,"item":{"@id":"https://time.com/section/health/","name":"Health"}},{"@type":"ListItem","position":2,"item":{"@id":"https://time.com/tag/health-care/","name":"Health Care"}},{"@type":"ListItem","position":3,"item":{"@id":"https://time.com/6299770/private-equity-health-care-impact/","name":"What Happens When Private Equity Buys Your Doctor's Office?"}}]},{"@context":"https://schema.org","@type":"VideoObject","name":"This Ride-share Company Wants to Make EV Charging More Accessible","description":"Revel plans to have installed at least 300 chargers in New York by the end of 2024.","thumbnailUrl":"https://cdn.jwplayer.com/v2/media/eJ7M1ErI/poster.jpg?width=720","uploadDate":"2023-07-25T20:02:50.000Z","contentUrl":"https://cdn.jwplayer.com/manifests/eJ7M1ErI.m3u8","embedUrl":"https://time.com/6299770/private-equity-health-care-impact/","duration":"PT4M29S","potentialAction":{"@type":"SeekToAction","target":"https://time.com/6299770/private-equity-health-care-impact/?jw_start={seek_to_second_number}","startOffset-input":"required name=seek_to_second_number"}}] ```