The AcademyHealth Annual Research Meeting (ARM) serves as a crucial platform for groundbreaking research in health services and policy, while also recognizing and awarding outstanding contributions to the fields.
At this year's meeting in Baltimore, Associate Professor of Health Care Policy and Medicine, Zirui Song, and HCP Fellow and incoming Assistant Professor at the University of Pittsburgh, Sneha Kannan, the study’s first author, were honored with the Publication of the Year Award for their December 2023 JAMA study, "Changes in Hospital Adverse Events and Patient Outcomes Associated with Private Equity Acquisition." Joseph Bruch, former fellow at HCP and Assistant Professor at the University of Chicago, is a co-author.
Kannan, Bruch, and Song’s research tackles a critical question in health care today: how does quality of care change after health care providers are acquired by investors through such entities as private equity firms? The study's relevance is amplified by the current rise of private equity ownership across the delivery system—including hospitals, nursing homes, hospices, physician practices, and other parts of the care trajectory.
By analyzing Medicare claims data, the research team compared hospitals acquired by private equity firms to similar hospitals that were not acquired. This approach, involving a matched control group and over 4.8 million hospitalizations across 11 years of data, revealed concerning findings. Hospitals after private equity acquisition experienced a substantial increase (25%) in hospital-acquired adverse events like infections and falls. This rise was particularly alarming in central line-associated bloodstream infections (38% increase) and falls (27% increase). Among the subset of hospitalizations involving surgery, the study also found a doubling of surgical site infections, while such infections at the matched control hospitals declined, although the difference was statistically less precise.
Additionally, patients were more likely to be transferred to other acute care hospitals after private equity acquisition (12% increase), most pronounced among patients with sepsis (36% increase). Private equity hospitals exhibited a slight decrease in in-hospital mortality after acquisition, which coincided with these hospitals admitting younger and lower-risk patients. This mortality difference dissipated by 30 days after discharge.
Concerns over the impact of private equity ownership on patients, communities, and clinicians have led to recent policy activity by federal and state policymakers, including the Federal Trade Commission and legislative committees. This includes investigations by the U.S. Senate Committee on the Budget, Committee on Homeland Security & Governmental Affairs, and Committee on Health, Education, Labor, and Pensions. Other Congressional lawmakers (Energy and Commerce, Ways and Means), as well as state legislators from California, Massachusetts, Oregon, and elsewhere have also made efforts to safeguard quality of care in response to private equity ownership. The ongoing public discourse has given this study and others a meaningful opportunity to contribute to policy efforts.
About the Researchers:
Dr. Kannan M.D.. M.S. is a Research Fellow at Harvard Medical School’s Department of Health Care Policy and a physician in the Division of Pulmonary/Critical Care at Massachusetts General Hospital. She is an incoming Assistant Professor at the University of Pittsburgh. Her research focuses on the complexities of healthcare costs and how financial incentives shape patient care delivery.
Zirui Song, M.D., Ph.D. is an Associate Professor of Health Care Policy and Medicine at Harvard Medical School and a general internist at Massachusetts General Hospital. His research focuses on health care spending and the effects of policies and financial incentives in the delivery system. This has included studies of payment reform, health care prices, Medicare Advantage, employer programs, and changes in provider ownership.