C16-01 Clinical Outcomes for Pulmonary Conditions Worsened After Private Equity Acquisition of Us Hospitals: A Difference-In-Differences Analysis

Abstract Rationale Private equity firms are acquiring US hospitals at a rapid pace. The incentive for private equity firms to generate short-term profits, however, may adversely affect care quality, particularly for patients with chronic conditions including many pulmonary diseases. The impact of private equity acquisition on outcomes for patients with pulmonary conditions is poorly understood. Methods In this difference-in-differences analysis, we used 100% Medicare fee-for-service claims data from 41 private equity hospitals and 192 matched control hospitals between 2010-2019 to evaluate the impact of private equity acquisition on outcomes among patients with asthma, chronic obstructive pulmonary disease (COPD), and pneumonia. Our study population was Medicare beneficiaries age ≥65 years who had at least one hospital encounter (observation stay or inpatient admission) for asthma, COPD or pneumonia. Outcomes included patient characteristics (age, sex, clinical risk score, dual eligibility) and clinical outcomes (in-hospital mortality, 30-day mortality, 30-day hospital revisit rates). We performed difference-in-differences analyses to assess changes in outcomes across the 3 years before and after acquisition. We fit multivariable linear regression models that included year fixed effects and hospital random effects. For clinical outcomes, models also adjusted for patient age, sex, race and ethnicity, clinical risk score, and dual eligibility status. Parallel trends were assessed for each outcome. Results Our study included 14,463 asthma, 146,904 COPD, and 194,993 pneumonia hospital encounters at private equity hospitals and matched controls. Following private equity acquisition, there were no changes in patient age, sex, clinical risk scores or dual-eligibility status across all conditions at private equity hospitals compared with control hospitals. Among patients with a hospital encounter for asthma, 30-day hospital revisits increased at private equity hospitals compared to control hospitals (difference-in-differences, +8.3 percentage points 95% CI, 4.0-12.7), while there were no changes in in-hospital or 30-day mortality. Similarly, patients with an encounter for COPD at private equity hospitals experienced an increase in 30-day hospital revisits relative to those at control hospitals (+0.9 percentage points 95% CI, 0.1-1.6). Among patients with pneumonia, there was an increase in-hospital mortality at private equity hospitals compared with control hospitals (+0.7 percentage points 95% CI, 0.2-1.2), while there were no changes in 30-day mortality or revisits. Conclusions Following private equity acquisition of US hospitals, 30-day revisits increased for patients with asthma and COPD and in-hospital mortality increased among those with pneumonia, suggesting acquisitions negatively impacted care quality. Given the increasing privatization of healthcare, policymakers should consider stronger regulation of acquisitions. This abstract is funded by: None