Heart Failure Care and Outcomes After Private Equity Acquisition of U.S. Hospitals

BACKGROUND Private equity firms have rapidly acquired U.S. hospitals and increasingly invested in cardiology over the past decade. However, little is known about how private equity acquisition of hospitals affects care and outcomes for patients with heart failure. OBJECTIVES The purpose of this study was to evaluate whether clinical care and outcomes changed for patients with heart failure after the acquisition of U.S. hospitals by private equity firms compared with matched control hospitals. METHODS This study identified U.S. hospitals acquired by private equity firms and matched control hospitals from 2012 through 2019. A quasiexperimental difference-in-differences analysis was used to evaluate changes in clinical outcomes, the case mix of admissions and transfers, as well as cardiac procedure utilization among Medicare fee-for-service beneficiaries aged 65 years or older with heart failure. RESULTS There were 41 private equity-acquired hospitals and 192 matched control hospitals. After private equity acquisition of hospitals, there was no change in 30-day mortality rates (difference-in-differences DiD +0.7 percentage points 95% CI: -0.4 to 1.8) or 30-day hospital revisit rates (DiD -0.2 percentage points 95% CI: -0.9 to 0.5), despite a significant decrease in the clinical risk of patients with heart failure when compared with those at matched control (nonacquired) hospitals. Overall hospital transfer rates did not change, but Black patients were significantly more likely to be transferred out to another site after private equity acquisition (DiD +7.1 percentage points 95% CI: 0.7-13.4), a change not observed across other racial groups. In addition, there was a significant increase in cardiac catheterization rates (DiD estimate, +0.7 percentage points 95% CI: 0.1-1.2) among heart failure patients at private equity-acquired vs control hospitals. CONCLUSIONS These findings suggest that private equity acquisitions of U.S. hospitals do not improve outcomes among older adults with heart failure, despite a decrease in the clinical risk of patients admitted to these sites.