Private Equity and Dermatology—First, Do No Harm

Sharfstein, Joshua M.; Slocum, Jamar

doi:10.1001/jamadermatol.2019.1322

Cited by 21 publications

(16 citation statements)

References 8 publications

(10 reference statements)

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“…Relevant to the dermatologic surgeon, these articles cite the strategic use of Mohs surgeons across multiple locations and states in order to maximize internal referrals, the increased use of NPPs in effort to increase procedural volume, blurring of lines between NPPs and dermatologists to minimize employee compensation, and upselling of cosmetic services and cosmetic product lines to expand revenue. [23][24][25][26] Perspectives from other surgical specialties, such as orthopedics, neurosurgery, and otolaryngology, discuss various issues of concern to the surgeon employed by PE.…”

Section: Perspective Articlesmentioning

confidence: 99%

Surgical Dermatology and Private Equity: A Review of the Literature and Discussion

Fogel

Hogan

Dover

2021

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BACKGROUND While there has been substantial investment in dermatology by private equity (PE), the relevance of this trend to the dermatologic surgeon has not been assessed. OBJECTIVE The literature on PE investment in medicine was reviewed to provide interdisciplinary data relevant to the dermatologic surgeon. MATERIALS AND METHODS The PubMed database was queried for all peer-reviewed articles containing the term "private equity" and identified 70 unique articles across 18 medical specialties, comprising 20 original research articles and 50 commentary articles. RESULTS Significant PE growth across multiple medical specialties occurred in the 2010s. Private equity ownership was associated with higher levels of nonphysician providers relative to physicians. Pooled data suggest that PE ownership is associated with lower staffing levels, particularly for non-revenue-generating staff, as well as potentially lower levels of medical supplies on hand. Data on financial performance suggests that PE-ownership results in higher profits, revenues, and costs. Surveys of physicians demonstrate concern about autonomy, ethics, and career prospects. CONCLUSION For the dermatologic surgeon, issues related to consolidation, provider scope of practice, support staff availability, and supply management are important due to the nature of procedural intervention and the increased risk of adverse events.

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Section: Perspective Articlesmentioning

confidence: 99%

Surgical Dermatology and Private Equity: A Review of the Literature and Discussion

Fogel

Hogan

Dover

2021

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“…Proponents of PE acquisition often assert that revenue generation from target hospitals via taxation is a societal boon, while the patients they serve may benefit from economies of scale, management expertise, and an incentive to implement cost-effective care. 5 , 7 , 29 , 30 , 31 Critics assert that PE firms, unlike other for-profit institutions, have an inherent incentive to favor short-term returns rather than long-term investments (eg, information technologies and care redesign) that would otherwise meaningfully improve population health. 29 , 32 In certain aspects of health care services, the latter view has been bolstered by important research 13 , 14 , 33 , 34 in nursing homes and outpatient clinical practices.…”

Section: Discussionmentioning

confidence: 99%

“… 5 , 7 , 29 , 30 , 31 Critics assert that PE firms, unlike other for-profit institutions, have an inherent incentive to favor short-term returns rather than long-term investments (eg, information technologies and care redesign) that would otherwise meaningfully improve population health. 29 , 32 In certain aspects of health care services, the latter view has been bolstered by important research 13 , 14 , 33 , 34 in nursing homes and outpatient clinical practices. Private equity–owned nursing facilities performed comparably, both in terms of equipment shortages and resident outbreaks, during the COVID-19 pandemic.…”

Section: Discussionmentioning

confidence: 99%

“…Regulators may determine that it is not sufficient that for-profit institutions do no harm; they may instead decide that for-profit owners produce improvements in value of care, either through better outcomes, lower costs, or both. Proponents of PE acquisition often assert that revenue generation from target hospitals via taxation is a societal boon, while the patients they serve may benefit from economies of scale, management expertise, and an incentive to implement cost-effective care . Critics assert that PE firms, unlike other for-profit institutions, have an inherent incentive to favor short-term returns rather than long-term investments (eg, information technologies and care redesign) that would otherwise meaningfully improve population health .…”

Section: Discussionmentioning

confidence: 99%

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Association Between Hospital Private Equity Acquisition and Outcomes of Acute Medical Conditions Among Medicare Beneficiaries

et al. 2022

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Key Points Question What is the association between private equity (PE) acquisition of short-term acute care hospitals and measures of comorbidity, mortality, readmission, length of stay, and spending among Medicare beneficiaries admitted to the hospital with 1 of 5 acute medical conditions? Findings In this cross-sectional study of more than 21 million Medicare beneficiaries with 5 different acute medical conditions who were hospitalized at short-term acute care hospitals, PE acquisition was associated with significantly lower inpatient mortality (−1.1 percentage points) and lower 30-day mortality (−1.4 percentage points) among patients admitted with acute myocardial infarction. However, PE acquisition was not associated with significant differences in other dimensions of quality and spending or with differences across other medical conditions. Meaning The study’s findings suggest that PE acquisition has mixed consequences for patient-level outcomes overall but is associated with moderate and consistent improvement in mortality among Medicare beneficiaries hospitalized with acute myocardial infarction.

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“…Some of our colleagues in dermatology have called for banning the sale of their practices to private equity firms until they have more meaningful data on how these transactions impact quality and affordability of care for patients. 13 Although this type of action may not be feasible, it does at least point to the fact that we must continue open and transparent conversations about PE's role in our field and staying engaged in these conversations to protect the field and our patients.…”

Section: Looking Aheadmentioning

confidence: 99%