Future considerations for clinical dermatology in the setting of 21st century American policy reform: Corporatization and the rise of private equity in dermatology

Konda, Sailesh; Francis, Joseph; Motaparthi, Kiran; Grant‐Kels, Jane M.

doi:10.1016/j.jaad.2018.09.052

Cited by 62 publications

(68 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…‘The New York Times’, for example, recently reported that the rapid ‘industrialization’ of dermatology practices in the USA, apparently, also has resulted in significant ‘commoditization’ in that respective practice arena (Hafner, 2018). As previously noted, the dermatology literature has also taken notice of this fact (Konda et al ., 2018). As especially Australia’s experience suggests, such developments may lead to higher prices, poorer clinical outcomes and decreasing patient satisfaction.…”

Section: Discussionmentioning

confidence: 65%

See 1 more Smart Citation

Worldwide decline of IVF birth rates and its probable causes

Gleicher

Kushnir

Barad

2019

Human Reproduction Open

100

View full text Add to dashboard Cite

With steadily improving pregnancy and live birth rates, IVF over approximately the first two and a half decades evolved into a highly successful treatment for female and male infertility, reaching peak live birth rates by 2001–2002. Plateauing rates, thereafter, actually started declining in most regions of the world. We here report worldwide IVF live birth rates between 2004 and 2016, defined as live births per fresh IVF/ICSI cycle started, and how the introduction of certain practice add-ons in timing was associated with changes in these live birth rates. We also attempted to define how rapid worldwide ‘industrialization’ (transition from a private practice model to an investor-driven industry) and ‘commoditization’ in IVF practice (primary competitive emphasis on revenue rather than IVF outcomes) affected IVF outcomes. The data presented here are based on published regional registry data from governments and/or specialty societies, covering the USA, Canada, the UK, Australia/New Zealand (combined), Latin America (as a block) and Japan. Changes in live birth rates were associated with introduction of new IVF practices, including mild stimulation, elective single embryo transfer (eSET), PGS (now renamed preimplantation genetic testing for aneuploidy), all-freeze cycles and embryo banking. Profound negative associations were observed with mild stimulation, extended embryo culture to blastocyst and eSET in Japan, Australia/New Zealand and Canada but to milder degrees also elsewhere. Effects of ‘industrialization’ suggested rising utilization of add-ons (‘commoditization’), increased IVF costs, reduced live birth rates and poorer patient satisfaction. Over the past decade and a half, IVF, therefore, has increasingly disappointed outcome expectations. Remarkably, neither the profession nor the public have paid attention to this development which, therefore, also has gone unexplained. It now urgently calls for evidence-based explanations.

show abstract

Section: Discussionmentioning

confidence: 65%

“…Concerns like this do not only exist in the IVF arena. Similar expressions of concern have, indeed, recently also come up with entry of private equity investments into dermatology (Konda et al ., 2018) and for US clinical medicine in general (Gondi and Song, 2019).…”

Section: Resultsmentioning

confidence: 73%

Worldwide decline of IVF birth rates and its probable causes

Gleicher

Kushnir

Barad

2019

Human Reproduction Open

100

View full text Add to dashboard Cite

show abstract

“…High-net-worth investors that think the stock market is overvalued or that are looking for alternative investments are investing their capital with PE firms. 3 With interest rates being at alltime lows, these firms are also able to tap into the debt markets. This allows PE firms to be in an ideal position with significant amounts of equity to invest and debt markets offering them the ability to access low-cost leverage.…”

Section: The Last Ten Yearsmentioning

confidence: 99%

“…The PE firm's goal is to increase value by adding revenue, cutting costs, adding debt, and doing so in the shortest timeline possible. 3 The average PE holding period for an investment like this is 5.6 years before they sell the practice and exit their investment. 11 Although the younger physician may have had input on the initial sale and the PE firm that they would be working with, there is very little likelihood that they will have any input on who their next owner will be, which can have a negative impact on the practice culture and day-to-day experience for the physicians and their patients.…”

Section: Timelines Mattermentioning

confidence: 99%

Private Equity's Game Plan and Why it Should Matter to Us

Sheth¹,

Dhoot²

2020

Ophthalmic Surg Lasers Imaging Retina

View full text Add to dashboard Cite

“…1 The roll-up model, which is characterized by platform investments into physician practice management companies, with subsequent add-on acquisitions and de novo growth, has also been reported in medical specialties beyond dermatology. 6,9 Other researchers, including Konda et al, 10 have sought to describe PE investment in dermatology practices. The purpose of our study was to use a systematic and reproducible method to describe the recent trends and geographic reach of PE-backed acquisitions of dermatology practices through May 31, 2018, and to identify the major stakeholders completing these deals.…”

mentioning

confidence: 99%

Trends in Private Equity Acquisition of Dermatology Practices in the United States

et al. 2019

View full text Add to dashboard Cite

IMPORTANCE Private equity (PE) firms invest in dermatology management groups (DMGs), which are physician practice management firms that operate multiple clinics and often acquire smaller, physician-owned practices. Consolidation of dermatology practices as a result of PE investment may be associated with changes in practice management in the United States. OBJECTIVE To describe the scope of PE-backed dermatology practice acquisitions geographically over time. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study examined acquisitions of dermatology practices by PE-backed DMGs in the United States. Acquisition and investment data through May 31, 2018, were compiled using information from 5 financial databases. Transaction data were supplemented with publicly available information from 2 additional financial databases, 2 financial news outlets, and press releases from DMGs. All dermatology practices acquired by PE-backed DMGs were included. Acquisitions were verified to be dermatology practices that provided medical, surgical, and/or cosmetic clinical care. Private equity financing data were included when available. The addresses of clinics associated with acquired practices were mapped using spatial analytics software. MAIN OUTCOMES AND MEASURES The number and location of PE practice acquisitions over time were measured based on the date of deal closure, the geographic footprint of each DMG's acquisition, and the financing of each DMG. RESULTS Seventeen PE-backed DMGs acquired 184 practices between May 1, 2012, and May 22, 2018. These acquired practices accounted for an estimated 381 dermatology clinics as of mid-2018 (assessment period from May 1 to August 31). The total number of PE-owned dermatology clinics in the United States was substantially larger because these data did not reflect DMGs that opened new clinics (organic growth); acquisitions data represented only the ownership transfer of existing practices from physician to PE-backed DMG. Practice acquisitions increased each year, from 5 in 2012 to 59 in 2017. An additional 34 acquisitions took place from January 1 to May 31, 2018. The number of financing rounds to sustain transactions mirrored the aforementioned trends in practice acquisitions. Clinics associated with acquired practices spanned at least 30 states, with 138 of 381 clinics (36%) located in Texas and Florida. CONCLUSION AND RELEVANCE The study findings suggest that PE firms have a financial stake in an increasing number of dermatology practices throughout the United States. Further research is needed to assess whether and how PE-backed ownership influences clinical decision-making, health care expenditures, and patient outcomes.

show abstract

Future considerations for clinical dermatology in the setting of 21st century American policy reform: Corporatization and the rise of private equity in dermatology

Cited by 62 publications

References 9 publications

Worldwide decline of IVF birth rates and its probable causes

Worldwide decline of IVF birth rates and its probable causes

Private Equity's Game Plan and Why it Should Matter to Us

Trends in Private Equity Acquisition of Dermatology Practices in the United States

Contact Info

Product

Resources

About