Tracking private equity: Cardiologist, CEO share perspective on acquisition trends
Dozens of cardiology practices have been acquired by private equity (PE) investors in recent years, according to recent research by a team of cardiologists and policy specialists.
In fact, the group reported, PE firms or PE-backed physician management groups acquired 41 outpatient cardiology practices in the last decade. Nearly all of those deals occurred from 2021 to 2023.
The report, published in full in the Journal of the American College of Cardiology (JACC), has been met with a variety of responses. These two reactions represent different sides of the story:
Cardiologist watching private equity trends closely—is it about more than the money?
Edward T.A. Fry, MD, a veteran cardiologist with Ascension St. Vincent Heart Center and president of the American College of Cardiology (ACC) in 2022-2023, shared his own perspective in a JACC editorial.[1]
According to Fry, the rise of PE investments arrived in cardiology at a time when independent cardiologists were already facing “difficult choices in how to continue practicing.” Reimbursement cuts, rising burnout rates and a lack of progress in the transition to value-based care were just some of the factors making things more difficult for independent practices—and that’s without even taking the COVID-19 pandemic into consideration.
Now, with PE firms gaining clear momentum, what will the long-term impact be on patient care? Fry wrote that there are no clear answers yet—but it’s something researchers need to learn more about as quickly as possible.
“Clearly more data and investigation are needed to understand the growing impact of PE in cardiovascular practice and especially to understand the impact on clinical quality, access to care, patient experience, long term physician satisfaction, total cost of care, coordination of comprehensive health services and overall value,” he said.
Fry added later that “we also need to understand the non-economic drivers enticing cardiologists to be acquired through such a vehicle.”
“Is it just about the money or is the move to PE a symptom of more foundational problems with the current practice of medicine and cardiology? Clinicians, health system administrators, policy makers, and the public need to define the elements of clinical practice that encourage a growing number of cardiologists to seek out alternative employment models. Addressing them will be necessary to truly transform care and promote equity and value,” he concluded.
Private equity’s point of view: Cardiovascular Associates of America CEO shares his perspective
Cardiovascular Business spoke to Tim Attebery, DSc, MBA, the CEO of Cardiovascular Associates of America (CVAUSA) and a former ACC CEO, about the JACC analysis. CVAUSA is one of the country’s most prominent PE-backed cardiology management groups, with 23 practices and approximately 400 cardiologists under its umbrella.
According to Attebery, the study’s authors made the number of PE acquisitions in cardiology seem larger than it is by counting each separate practice location as its own clinic.
“If we acquired a practice with seven offices, they would call that seven clinics,” he said. “Well, it’s not seven clinics, it’s one clinic with seven sites.”
Attebery also said, in his own experience with CVAUSA, cardiology practices aren’t sold and resold as often as the study’s authors wrote in their analysis. Firms do need to file certain paperwork that shows a change of control, and that paperwork has to be completed separately for each physical location, but he has not seen practices being sold multiple times in such a short period of time.
Outside of those concerns, Attebery said he is “generally pleased” so many cardiologists and cardiology leaders are paying attention to this growing trend.
He also said that the number of U.S. cardiologists currently backed by a PE firm remains quite low—“still minor in comparison” to the number who have “been gobbled up by hospitals.”
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.