Private equity's influence continues to rise in cardiology—what does that mean for patient care?
The growing footprint of private equity (PE) in healthcare has sparked a vigorous debate among clinicians, economists and policymakers. Over the past decade, more than 600 U.S. hospitals and 5,000 private practices have been acquired by PE firms, with cardiology increasingly being swept into the trend. But what does this mean for patient care?
"If you look at cardiology practices, we've seen a surge in acquisitions of outpatient cardiology practices over the last three years. It's exploded since 2020," explained 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. "I think it begs this question of, what are the implications of these changing dynamics and organizational structures? And what does that mean for patient care and patient outcomes?"
Private equity is a double-edged investment
PE's investment in cardiology practices, particularly in outpatient settings, continues to rise. Wadhera notes that such firms can bring needed capital and organizational know-how. However, they may also introduce business imperatives that conflict with optimal patient care.
“PE has the resources to modernize struggling practices—upgrading equipment, renovating facilities, and potentially improving care delivery efficiency,” he explains. “But their goal is to deliver financial returns over a short time horizon, typically three to five years. There's concern that that might incentivize cost cutting strategies that aren't good for patient care, and might ultimately have adverse effects on patient care."
Mounting evidence private equity may pose a risk to patient care
The evidence on how PE ownership affects patient outcomes is sobering—particularly on the hospital side. Wadhera referenced a study from his team showing that patient experience scores decline after PE acquisitions. Other studies have tracked this trend, including a notable Journal of the American Medical Association (JAMA) paper that reported a 20% increase in adverse events such as hospital-acquired infections and falls in PE-owned hospitals compared to their non-PE counterparts.[1]
"We know there's a lot of concern about what acquisitions, at least on the inpatient and hospital side of things, mean for patient care and outcomes. I would say the evidence to date suggests that acquisitions of hospitals result in worsening quality of care and potentially worse outcomes. On the outpatient side of things, there's a great body of work, not in cardiology, but in specialties that have really been subjected to PE acquisitions for many years now, ophthalmology, gastroenterology, dermatology. It's very clear that after an acquisition happens, spending goes up, charges go up, prices go up and utilization goes up," Wadhera explained.
He said there is a strong case to be made that PE firms intentionally consolidate in specific geographic markets to boost their negotiating leverage with insurers. He added that they may raise prices and costs system-wide, but the higher costs may not lead to better care.
“We don't know much about outcomes yet, and we definitely don't know much about cardiology because the majority of acquisitions have happened over the last few years," he emphasized during the interview.
The quality of care at PE-managed hospitals may also be declining from the perspective of patients. He authored a JAMA article in January 2025 that presented patient-reported care experience, an important dimension of care quality, showing worsened reviews after PE acquisitions of U.S. hospitals.[2]
"These findings raise concern about the implications of PE acquisitions on patient care experience at U.S. hospitals," Wadhera and his co-authors wrote.
A shifting landscape driven by policy made healthcare appealing to private equity
Wadhera stresses that the PE boom in cardiology is not occurring in a vacuum. Federal and state policy decisions have created fertile ground for such investment by undermining the viability of independent practice.
“We don’t have site-neutral payments. That means hospitals get paid more than independent practices for providing the same service,” he said. “Add declining physician reimbursement and rising hospital payments, and it makes sense that health systems are coming in and aggressively trying to buy up practices. It's a favorable market for them."
Indeed, the American College of Cardiology (ACC) has reported a dramatic shift in cardiology practice ownership. In just a decade, private practices in cardiology dropped from 90% of the cardiologist employment model, to just 10% today, with the majority now employed by hospitals or private equity.
Data is needed to better assess how private equity is impacting cardiology and other areas of medicine and whether more regulatory oversight is needed. But a major challenge is the lack of transparency by these firms.
Not all private equity is the same
Wadhera is quick to caution against the overgeneralization of PE. These firms are all different from one another, he said.
"There are many types of firms that use many different types of strategies, and I think it would be wrong for us to ... say PE is bad or good. There's likely a lot of heterogeneity across different PE firms in terms of improving things, versus just cost cutting, generating profits and then selling so that you can satisfy investors. So I think it's just important to remember that there's a lot of variability in the types of firms that are out there, and it's very hard to study single-platform practices," Wadhera said.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]