Private equity acquisition can expand primary care use by expanding workforce, study finds

PROVIDENCE, R.I. [Brown University] - When health policy researchers at the Brown University School of Public Health tracked data from primary care practices that had been acquired by private equity firms, they found something that surprised them: Not all of the changes were detrimental.

Primary care practices acquired by private equity firms tended to see more patients, provide more services to patients, complete more annual wellness visits and expand their staff, according to the study published in Health Affairs.

"Our prior work found specific harms from private equity firms acquiring and consolidating physician practices, including higher prices for patients and insurers," said lead study author Yashaswini Singh, an assistant professor of health services, policy and practice at Brown. "This study is a reminder that the relationship between private equity and patient care is more complicated than it first appears, and financial incentives shaped by payment policy play an outsized role in how private equity operates."

Singh and the research team from Brown's Center for Advancing Health Policy through Research used national Medicare claims to track what happened at 225 primary care practices after they were acquired by private equity firms between 2016 and 2022. They compared that data with similar primary care practices that remained independently owned to understand how private equity buyouts can change the day-to-day practice of primary care medicine, including in regard to physician workload, how many patients doctors see and the services those patients receive.

The team found that while private equity ownership does seem to increase productivity pressures on practices - with physicians billing for about 30% more services - practices saw about 11% more patients overall. At a time when primary care is increasingly difficult to access nationwide, connecting more patients to primary care is generally a positive outcome, they said.

That context also applies to the roughly 13% more services received by individual patients in private equity owned practices. The increase was largely driven by more preventive care, including lab tests and screenings, that can identify problems such as diabetes or high cholesterol before they become serious.

One notable finding was that Medicare annual wellness visits drove much of the increase in services received. The researchers noted that the visit is a comprehensive preventive checkup, which Medicare has long recommended but which independent practices have historically struggled to complete because of documentation requirements. Acquisitions prompted an increase in annual wellness visits by more than 20%.

The study also found that in contrast to other private equity-owned healthcare settings where staffing cuts are common, primary care practices instead expanded their workforces under private firms.

Compared to independent practices, they hired about 17% more physicians and 40% more nurse practitioners and physician assistants, suggesting the extra work of providing additional services and seeing more patients is likely being spread across larger teams rather than falling on individual doctors.

"Research has documented real harm from staffing cuts following private equity involvement in other settings, as in the case of hospitals and nursing homes, but we must resist a one-size-fits all takeaway," Singh said. "What we see in primary care is more nuanced: Practices grew their teams and drew on both physicians and advanced practice providers in the short term."

The researchers noted a number of limitations to the study, including that it only looked at Medicare patients, followed practices for a relatively short period and cannot determine whether the changes actually improved patient health. There could also be unexamined harms to patients and doctors that the study does not capture, including the potential for reduced clinician autonomy and increased burnout.

According to the researchers, the biggest takeaway of this study and other recent work from the team is that private equity may not operate the same way in every sector of healthcare.

"In many other settings, my colleagues and I have documented clear harms from private equity," Singh said. "This study posits a different question: Under what market conditions and incentives can private equity actually deliver on the promises it makes around expanding access and improving care - and how do we create more of those conditions?"

The study was supported by grants from Arnold Ventures and the Commonwealth Fund.