How private equity influences care for heart failure patients
Heart failure patients treated at hospitals acquired by private equity (PE) groups do not experience a significant change in 30-day outcomes, according to new research published in the Journal of the American College of Cardiology.[1] However, the study’s authors did identify some notable trends that suggest there may be a drop in the quality of care.
“The growing presence of PE in healthcare has drawn widespread scrutiny from the public and policymakers, in part because these firms have a strong incentive to generate financial gains for investors over short time periods,” wrote first author Daniel Johnson, a researcher with Beth Israel Deaconess Medical Center, and colleagues. “In recent years, PE firms have intensified efforts to invest in cardiology, a shift that could have important implications for care and outcomes among higher-risk patients with cardiovascular disease. Heart failure is a leading cause of hospitalization among older adults in the United States, but little is known about the effects of PE acquisitions on patients with this condition.”
Johnson et al. explored Medicare data from 41 short-term acute care hospitals acquired by a PE firm from 2012 to 2019, using another 192 hospitals that were not acquired by a PE firm as matched controls. Hospitals acquired more than once, in addition to those that changes hands during or after the COVID-19 pandemic, were excluded from their analysis.
The group tracked more than 35,000 heart failure hospitalizations at PE-acquired hospitals as well as more than 178,000 heart failure hospitalizations at the matched control hospitals.
Overall, the group determined there was not a significant change in 30-day mortality or 30-day rehospitalization rates for heart failure patients treated at PE-acquired hospitals when compared to the control hospitals.
Right heart catheterization, however, did double at PE-acquired hospitals from a rate of 0.6% to 1.2%. The same trend was not seen when reviewing left heart catheterizations.
Another key takeaway involved van Walraven-Elixhauser comorbidity scores, which calculate a patient’s total disease burden. The mean Walraven-Elixhauser comorbidity score was lower among PE-acquired hospitals than the control hospitals, suggesting the patients face fewer clinical risks. If the patients face a lower overall risk at PE-acquired facilities, the researchers wrote, shouldn’t their outcomes be better?
“One might expect outcomes (eg, mortality, revisits) to improve at PE-acquired hospitals, given the decrease in the clinical risk scores of patients with heart failure at these sites when compared with control hospitals,” the authors wrote. “However, we observed no changes in 30-day mortality or hospital revisit rates after PE acquisition. In addition, our finding that cardiac catheterization rates increased among patients with heart failure at PE-acquired hospitals—despite a decrease in clinical risk—may reflect an incentive to shift toward greater use of highly reimbursed procedures to maximize profits. These findings build upon prior studies, which have shown an increase in hospital adverse events and decrease in patient care experience at PE-acquired hospitals.”
Finally, the group found that Black patients were much more likely to transfer to another facility at the PE-acquired hospitals than control hospitals.
“Although it is possible that this shift reflects an attempt to ensure that some patients receive appropriate care (eg, transferring higher-acuity patients to a tertiary care facility), we did not observe similar changes across other racial groups,” the authors wrote. “More concerning is the possibility that this shift in transfer patterns reflects implicit or explicit bias, potentially because Black adults tend to have lower incomes and are more likely to be insured by Medicaid, a pattern that has also been observed in one prior study that evaluated heart failure admissions to specialized cardiology services.”
Click here to read the full study.
For additional context about this subject, watch this video interview with senior author Rishi Wadhera, MD, MPP, MPhil, associate director of the Smith Center for Outcomes Research at Beth Israel Deaconess Medical Center and an associate professor at the Harvard School of Public Health.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.